Latest Research in Orthopedic Surgery

Spinal cord injury induces progressive bone loss and increases fracture susceptibility. While the neurological consequences of skeletal trauma remain poorly characterized, underlying molecular mechanisms require systematic investigation. To systematically characterize the temporal dynamics of spinal cord responses, L4-L5 spinal segments were harvested from Sprague-Dawley rats at 0, 3, 7, 14, and 28 days post-fracture for RNA sequencing (Illumina platform). Integrated bioinformatics analyses revealed temporally stratified differentially expressed genes (DEGs). Quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was used to validate the expression of key genes. Transcriptomic changes peaked at 3 days and 7 days post-fracture. By day 14, transcriptomic signatures shifted toward synaptic plasticity-related pathways. DEGs were substantially reduced by day 28. Key genes (PCP4 and RICTOR) identified by bioinformatics were validated via qRT-PCR, confirming their temporal expression patterns. This study elucidates temporal dynamics of spinal cord transcriptomic remodeling post-fracture, establishing a foundation for understanding neuro-osseous cross-talk during bone healing.

Efforts to determine the relationship between patient reported outcome measures (PROM) and patient reported improvement has been largely focused on determining threshold values to classify patients as having experienced a certain amount of improvement or satisfaction. While these metrics aid in understanding the extent to which specific PROM scores associated with improvement vary across studies, they are imperfect thresholds sensitive to the practice and setting in which they were estimated. Even when applied to the patients that contributed to their estimate, thresholds misclassify patients. The misclassification is often exacerbated when threshold values are used outside the setting where they were derived due to differences in patient expectations, setting, and practice patterns among others. The growing amount of research reporting thresholds for various measures and patient populations in the orthopedic and sports medicine literature provides the opportunity to evaluate the consistency between PROM scores and patient reported improvement and satisfaction across different settings. While this is valuable, overreliance on thresholds to determine substantial improvement or satisfaction will obscure the complexity and nuance of patient perceived improvement.

» Posterior shoulder instability (PSI) constitutes approximately 10% of all shoulder instability cases and is prevalent among contact sport athletes because of recurrent blunt trauma to the shoulder.» PSI presents as persistent pain and can be diagnosed using clinical tests such as the Kim test and the Jerk test.» Surgical intervention is recommended for athletes who have exhausted nonoperative treatment. Shoulder arthroscopy with posterior labral repair is the primary surgical treatment for PSI, with the goal of mitigating risk for recurrent instability and persistent pain.» The primary objective of this review was to discuss the relevant literature regarding the etiology, diagnosis, treatment, and rehabilitation for PSI.

» Kim's lesion of the shoulder is characterized by incomplete tearing of the junction between the posteroinferior labrum and the glenoid, with the superficial labral tissue remaining intact, and generally requires arthroscopic evaluation for accurate confirmation.» Kim's lesion represents an under-reported subtype of posterior labral injury and a source of activity-related posterior shoulder discomfort and instability.» Kim's lesions are frequently observed in young, active individuals involved in overhead and contact sports, often resulting from traumatic mechanisms with the shoulder in flexion and adduction, as well as from repetitive microtrauma and overuse.» Patients often present with posterior or posteroinferior instability and discomfort with provocative physical examination maneuvers stressing the posterior labrum, accompanied by pain during activities of daily living and/or sports.» For patients with persistent discomfort and/or instability despite nonoperative management, arthroscopic fixation is generally recommended to restore pain-free mobility and posterior labral stability.

Sports-related musculoskeletal injuries are common and represent a significant public health concern, especially among physically active individuals. These injuries are typically managed through pharmacological methods such as pain medication or through rehabilitative approaches like physical therapy (PT). While both modalities are widely used, their comparative effectiveness in promoting long-term recovery, particularly from the perspective of those injured, remains a critical area for research. # Objectives The objective of this study is to evaluate the relative effectiveness of PT and pain medication in managing sports-related injuries. Specifically, it explores pain relief outcomes, long-term recovery perceptions, and treatment preferences among individuals with prior sports injuries, using a patient-reported survey approach. # Methods This cross-sectional survey-based study involved 200 participants who had experienced a sports-related injury. Inclusion criteria for the study included being at least 18 years of age, having sustained an injury related to physical activity, and having undergone treatment involving either pain medication, physical therapy (PT), or a combination of both. Participants provided information on injury types, pain intensity immediately following the injury (measured on a 5-point Likert scale), treatment approaches, treatment duration, and their perceptions of long-term effectiveness. Data analysis was performed using JMP Pro 15. # Results The participant population, totaling 200 individuals, consisted of 99 males (49.5%) and 101 females (50.5%), with a median age of 36.5 years (range 18-88). The most frequently reported injuries were sprains (33%) and muscle strains (20%). Regarding treatment, 50% of participants used a combination of pain medication and PT, 38% relied solely on pain medication, and 12% underwent only PT. A majority (59%) rated their initial pain as severe (≥4/5). Among those treated with pain medication, 65% experienced pain recurrence once the medication's effects subsided. In contrast, 73% of PT users agreed or strongly agreed that PT provided long-term injury resolution. Additionally, 68.2% of participants who utilized both treatments indicated that PT was more effective for sustained recovery.

The sports medicine community and society at large have recognized traumatic brain injury (TBI) as a major public health concern. It is estimated that more than 150 million youths have played football in the United States. As an alternative to blood, sweat is a potential source for protein biomarkers, providing a non-invasive method for objective measurements for head safety guidelines. This pilot study explores sweat as a means of detecting protein biomarkers of brain injury before and after a football season. Participants were football players from an NCAA Division III college (

» Early-onset scoliosis (EOS) causes restrictive lung disease, secondary to deformation of the thoracic cavity, stiffening of the chest wall, and weakening of the respiratory muscles.» Early spinal fusion has been shown to limit thoracic growth and be associated with poor pulmonary outcomes. This has led to the rise of growth-friendly surgical techniques to maximize thoracic growth.» Radiographic improvements occur, but lung functions do not predictably improve in proportion to normal growth after growth-friendly spine surgery for EOS.» Outcome measures in combination with lung function tests should be explored to better define the impact of EOS and its treatments.

To design a minimally invasive transverse cross-link for use in percutaneous pedicle screw fixation surgery and to explore and observe its clinical application value. A retrospective analysis of the clinical data of 50 patients with thoracolumbar burst fractures treated with percutaneous pedicle screws was conducted. A self-made, minimally invasive transverse cross-link was implanted during surgery. Preoperative, postoperative, and final follow-up imaging examinations were performed to compare the imaging parameters and document the occurrence of complications related to internal fixation. Clinical efficacy was evaluated via the visual analog scale for pain and the Oswestry disability index. All patients successfully underwent surgery and achieved bony fusion 1 year after surgery. Compared with the preoperative values, the local Cobb angle and anterior vertebral height ratio at 3 days, 3 months, and final follow-up significantly improved (P < .05). The visual analog scale and Oswestry disability index scores at 3 months and at the final follow-up were significantly better than the preoperative scores (P < .05). No complications related to internal fixation, including screw loosening, withdrawal, or rod fracture, were observed during the follow-up period. The application of the self-made minimally invasive transverse cross-link provides additional stability to percutaneous pedicle screw fixation surgery while maintaining the integrity of the posterior midline structures. This technique is safe and feasible.

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease characterized by a specific pattern of bone and joint destruction. Instability of C1-C2 can be seen in up to 65% of RA patients. Occipito-cervical fixation (OCF) protects spine from trauma damage and neurological deficit progression though it causes limitation of cervical movement. The aim of the study was to evaluate the change in the cervical lordosis angle after OCF in the course of C1-C2 instability in patients with RA. The patients studied all underwent OCF in the period of 1999-2018 in the Department of Neuroortopedia MCR STOCER. Thirty three patients with RA were considered. The data was analyzed retrospectively. Clinical data and radiological data such as X-rays were analyzed. The radiological evaluation of cervical lordosis angle C2-C7 (C2-C7 CL) before and after occipito-cervical fixation was performed. Cervical lordosis angles before and after OCF did not differ: 17 (IQR 10-30) vs. 20 (IQR 7-25); p = 0.158. The analysis showed no significant changes of cervical lordosis after OCF in rheumatoid patients. It can be result of surgical procedure careful performing. However, further research is necessary in this area.

In this narrative review, we explore the role of artificial intelligence (AI) in managing lumbar degenerative conditions, a topic that has recently garnered significant interest. The use of AI-based solutions in spine surgery is particularly appealing due to its potential applications in preoperative planning and outcome prediction. This study aims to clarify the impact of artificial intelligence models on the diagnosis and prognosis of common types of degenerative conditions: lumbar disc herniation, spinal stenosis, and eventually spinal fusion. Additionally, the study seeks to identify predictive factors for lumbar fusion surgery based on a review of the literature from the past 10 years. From the literature search, 96 articles were examined. The literature on this topic appears to be consistent, describing various models that show promising results, particularly in predicting outcomes. However, most studies adopt a retrospective approach and often lack detailed information about imaging features, intraoperative findings, and postoperative functional metrics. Additionally, the predictive performance of these models varies significantly, and few studies include external validation. The application of artificial intelligence in treating degenerative spine conditions, while valid and promising, is still in a developmental phase. However, over the last decade, there has been an exponential growth in studies related to this subject, which is beginning to pave the way for its systematic use in clinical practice.

Expandable cage is designed to facilitate cage insertion from small posterior inlet and minimize neural structure over-traction, at the same time, to expand the disk space as large as possible while prevent posterior endplate breakage during cage insertion in transforaminal lumbar interbody fusion surgery. The purpose of this study is to compare radiologic and clinical outcomes between expandable and static cage, and complications of the 2 groups. Between January 2021 and January 2023, patients with lumbar spine degeneration or herniation of intervertebral disk accepting transforaminal lumbar interbody fusion surgery were included in the study. Anterior segmental height, posterior segmental height, and Cobb angle of fusion segment were recorded. These patients were divided to expandable and static group. Both group of patients were recorded of Oswestry Disability Index, back pain visual analogue score, and leg pain visual analogue score. Expandable cage group was 101 patients and static cage group was 103 patients. After operation, both groups had improvement of anterior and posterior disk height (P < .001). Fusion segmental lordosis increased after surgery in both group (P < .001). The improvement of lordosis was better in expandable group. Cages posterior migration (P < .01), cage subsidence (P = .03), and screws loosening (P = .03) were higher in static group. Expandable group had more cage breakage (P = .04),. Both groups had decreased Oswestry Disability Index and leg pain after operation (P < .001). Expandable group had better leg pain relief. Both groups had more back pain at postoperative stage. The back pain decreased at postoperative 6-month, 1-year, and 2-year gradually. Expandable group had less back pain after surgery. Expandable cage had less cage migration and cage subsidence than static cage. At the same time, expandable cage had better functional outcome than static cage. However, cage breakage rate was higher in expandable cage.

Ischemic complications in the supramesocolic anatomical region with the development of acute pancreatitis due to compression of the celiac artery or superior mesenteric artery are rare but potentially serious complications after major spine surgery. A case report of two patients with idiopathic scoliosis who underwent posterior instrumented correction and fusion with subsequent development of acute pancreatitis due to vascular compression of the retroperitoneum is presented. The manifestation of an acute abdomen within 24 hours after the surgery with elevation of pancreatic obstruction enzymes and confirmation of acute pancreatitis on CT angiography with abdominal pain, gastrectasia, and ileus clinical findings. In both cases, due to the clinical progression, acute revision spinal surgery was performed with release of the original deformity correction. Subsequently, in combination with conservative treatment of the acute abdomen, both patients achieved full clinical recovery.

Pediatric orthopedic care in Vietnam has experienced transformative growth over the past three decades, overcoming challenges unique to low-resource settings through innovation, collaboration, and dedication. This review explores Vietnam's progress in managing congenital deformities, trauma care, and rehabilitation, with a focus on decentralized care delivery, cost-effective surgical techniques, and capacity-building initiatives. Highlighting the critical roles played by the Vietnam Pediatric Orthopaedic Association and international collaborations, this analysis underscores the impact of tailored interventions and multidisciplinary approaches. By integrating technology, fostering education, and addressing systemic disparities, Vietnam exemplifies the potential for sustainable advancements in pediatric orthopedic care globally, even amidst resource constraints.

Reconstructing multi-tissue defects in the finger remains a significant challenge in hand surgery. We present the case of a 37-year-old man with segmental loss of bone, skin and extensor apparatus on the dorsal aspect of the index finger. A single stage reconstruction was successfully performed using a pedicled chimeric flap based on the second dorsal metacarpal artery combining skin paddle, second metacarpal base bone and the extensor indicis proprius. At 12 weeks, proximal interphalangeal joint fusion was achieved and the skin flap healed uneventfully. The patient regained full extension and 20° of active flexion at the distal interphalangeal joint. To our knowledge, this specific chimeric flap has not been previously described in the literature. This technique provides a versatile, single-stage solution for complex dorsal finger reconstruction, minimizing morbidity and optimizing functional outcomes.

High-pressure injection injuries to the hand are infrequent but potentially catastrophic injuries that have the potential for amputation or severe functional deficits. This is a case report on the management of a 28-year-old machinery operator who sustained a high-pressure grease gun injury to his dominant hand and underwent surgical debridement with a novel hydrosurgery technique. He had no complications and achieved a good functional outcome with a Disabilities of the Arm, Shoulder and Hand score of 1.67 at the 1-year follow-up. We also present a review of the literature and propose the use of hydrosurgery to address the challenges associated with the surgical treatment of these injuries.

Syndactyly is a common congenital malformation of the hand, characterized by fusion of adjacent digits. Early surgical correction is recommended to prevent functional limitations and esthetic concerns. We report the case of a three-year-old girl with congenital simple complete cutaneous syndactyly between the third and fourth fingers of the left hand. The fusion was limited to soft tissues, with fully formed and separate fingernails. Surgical separation was performed using interdigital dorsal and palmar Z-plasty incisions, followed by full-thickness skin grafting harvested from the groin donor site. Postoperative recovery was uneventful. At follow-up, the patient demonstrated a normal range of motion, satisfactory esthetic results, and no evidence of web creep or joint stiffness. This case supports the effectiveness and safety of Z-plasty combined with full-thickness skin grafting for the correction of simple syndactyly in early childhood.

Hand and wrist fractures are among the most common orthopaedic injuries, with a growing trend toward surgical treatment. However, large-scale data on regional variations and treatment trends remain limited. This population-based study analyses the incidence, trends, and regional variations in hand and wrist fracture fixation with plates and screws in Sweden from 2008 to 2023, with predictive modelling for future trends. A total of 56,163 patients aged ≥15 years underwent fixation (code NDJ69). Southern regions, including Skåne and Halland, had the highest fixation rates (>100/100,000), while northern areas like Norrbotten had significantly lower rates (<20/100,000). Women ≥65 years had the highest incidence. Predictive models indicate a continued increase in procedures, particularly among women aged ≥65, through 2035. These findings highlight regional disparities and the ongoing shift towards surgical treatment in older populations, emphasizing the need for optimized treatment strategies to ensure equitable access to care.

This systematic review summarizes the state of historically underrepresented minority and gender diversity in foot and ankle surgery (FA) at multiple levels, particularly leadership and research productivity. A literature search was performed following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Included studies presented demographics regarding diversity within FA and provided trends in rank, leadership, or research. Ten cross-sectional studies were included and assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) cross-sectional study checklist. Demographics on hundreds of FA applicants, attendings, fellowship directors, and researchers/research articles were collected. Results show disparity at each level, particularly in leadership with females accounting for one (5.5%) chair, three (15.8%) program directors, five (9.8%) division chiefs, three (4.4%) fellowship directors, and one (0.9%) professor. Although there has been an increase from 12% to 14% females in FA from 2010 to 2019, parity is not met. Recognition of the lack of diversity within FA will allow for targeted approaches to an equitable workforce. (Journal of Surgical Orthopaedic Advances 34(2):062-068, 2025).

The 2025 AANA Annual Meeting delivered a robust program featuring cutting-edge instructional course lectures, case-based debates, innovation spotlights, and original research presentations. The multidisciplinary scope-from shoulder and knee to hip, elbow, foot, and ankle-ensured relevance for arthroscopists at every stage of practice. We look forward to seeing you in the Valley of the Sun, Phoenix, Arizona, May 14-16, 2026, for AANA26.

Outpatient surgery is gaining in importance, not least due to the politically driven structural transformation in the German healthcare system. As a result, more and more trauma surgery and orthopedic procedures as well as corresponding inpatient services are being carried out on an outpatient basis. Assuming a correct selection of suitable patients and a comprehensive outpatient care structure, outpatient surgery is not only less expensive but is also associated with increased patient satisfaction and safety. While other countries already have established outpatient care systems in place, these still need to be developed and expanded in Germany. The outpatient trend in hospital medicine aims to relieve hospitals, create resources and counteract the rising costs in the healthcare system. This requires a financially sustainable, cost-effective and patient-centered approach that does not harm either the patient or the healthcare provider.

» Posterior shoulder instability (PSI) constitutes approximately 10% of all shoulder instability cases and is prevalent among contact sport athletes because of recurrent blunt trauma to the shoulder.» PSI presents as persistent pain and can be diagnosed using clinical tests such as the Kim test and the Jerk test.» Surgical intervention is recommended for athletes who have exhausted nonoperative treatment. Shoulder arthroscopy with posterior labral repair is the primary surgical treatment for PSI, with the goal of mitigating risk for recurrent instability and persistent pain.» The primary objective of this review was to discuss the relevant literature regarding the etiology, diagnosis, treatment, and rehabilitation for PSI.

» Kim's lesion of the shoulder is characterized by incomplete tearing of the junction between the posteroinferior labrum and the glenoid, with the superficial labral tissue remaining intact, and generally requires arthroscopic evaluation for accurate confirmation.» Kim's lesion represents an under-reported subtype of posterior labral injury and a source of activity-related posterior shoulder discomfort and instability.» Kim's lesions are frequently observed in young, active individuals involved in overhead and contact sports, often resulting from traumatic mechanisms with the shoulder in flexion and adduction, as well as from repetitive microtrauma and overuse.» Patients often present with posterior or posteroinferior instability and discomfort with provocative physical examination maneuvers stressing the posterior labrum, accompanied by pain during activities of daily living and/or sports.» For patients with persistent discomfort and/or instability despite nonoperative management, arthroscopic fixation is generally recommended to restore pain-free mobility and posterior labral stability.

The clinical presentation of rotator cuff ruptures varies greatly and ranges from no symptoms to severe shoulder impairment. Clinical shoulder tests are an effective screening tool to identify patients who require early specialist assessment or further radiological investigation, but they are not sufficient to rule out smaller ruptures. Small ruptures can often be managed non-surgically, while larger traumatic ruptures may necessitate early surgical intervention. Treatment is multimodal, requires a thorough clinical evaluation, and should be individualized through shared decision-making as discussed in this review.

Reverse Hill-Sachs lesions pose a complex challenge in the acute management of posterior shoulder dislocations, often resulting in joint incongruity and compromised function. This article describes a surgical technique for the anatomical reduction and fixation of humeral head impaction injuries, aiming to restore the native sphericity of the articular surface and optimize joint stability. The proposed technique enables the precise realignment of the humeral cartilage and subchondral bone, thereby minimizing residual deformity and preserving the biomechanical integrity of the glenohumeral joint. When indicated, this approach offers a valuable alternative to traditional reconstructive procedures, potentially improving functional outcomes by preventing chronic instability and degenerative changes. The rationale, surgical steps, and key technical considerations are outlined, highlighting the advantages of early intervention in mitigating long-term sequelae.

PurposeTo compare the clinical and radiological results of two double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) techniques. DB ACLR and anterolateral ligament reconstruction (ALLR) with internal brace (IB), and outside-in (OI) DB ACLR.HypothesisWe hypothesized that DB ACLR and ALLR with IB wound yield less femoral tunnel, especially femoral posterolateral bundle tunnel complications, than OI DB ACLR without ALLR because of better rotational control. Both techniques could provide good postoperative clinical outcomes.MethodsPatients who received DB ACLR and ALLR (ALLR group) and who received outside-in DB ACLR (non-ALLR group) were enrolled. Age, BMI, follow-up duration, meniscus repair, laterality, and knee range of motion (ROM) were collected. Lysholm, Tegner scale, and radiological results were compared.ResultsThirty-four and 33 patients were enrolled in the ALLR and non-ALLR groups. Patient demographics were similar between groups. Both groups showed postoperative improvements in Lysholm (ALLR group, 62.5 ± 6.8 preoperatively and 85.1 ± 5.7 postoperatively (

Anterior Cruciate Ligament (ACL) injuries are a major concern in sports, especially among athletes with limited ankle dorsiflexion, impacting performance and career longevity. Targeting kinetic and kinematic risk factors of high-risk sports actions through effective strategies is crucial for injury mitigation. This study aimed to assess the impact of internal focus (IF), and external focus (EF) within linear (LP) and differential learning (DL) methods on movement quality of a single leg drop jump (SL-DJ) task training in male handball players with restricted ankle dorsiflexion. Sixty-five professional handball players (aged 20-25 years) with ankle dorsiflexion <10 degrees were randomly assigned to five groups: (1) Control group (n=13), (2) EF-LP (n=13), (3) IF with LP (IF-LP) (n=13), (4) EF-DL (n=13), and (5) IF-DL (n=13). A single 30-minute training session comprised four tasks (double-leg squats, single-leg squats, single-leg step-downs, and lateral step-downs). Pre-test, post-test, retention (24 h), and transfer (48 h, elevated task height) assessments measured joint angles (hip, knee, ankle), ground reaction forces (GRF), and moments (hip and knee) of a SL-DJ task using a 3D motion analysis system. The EF-DL demonstrated significant improvements, with increased ankle dorsiflexion angle, decreased knee valgus angle, and lower vertical GRF during SL-DJ (p < 0.001). The IF-DL showed moderate gains, while LP were less effective during retention and transfer phases. The control group did not exhibit significant improvements in any SL-DJ performed. DL combined with an EF led to significant improvements in biomechanical variables associated with ACL injury risk during SL-DJ tasks, suggesting enhanced neuromuscular efficiency and adaptability. This approach is particularly beneficial for short-term interventions and dynamic sports conditions. Future studies should expand to other sports, genders, and long-term training protocols to validate and broaden these findings.

Re-rupture following anterior cruciate ligament (ACL) reconstruction remains a challenging complication, necessitating effective revision strategies. To evaluate the clinical and technical outcomes of synthetic ligament-based revision ACL reconstruction for postoperative re-rupture, a retrospective analysis was conducted on patients undergoing synthetic ligament revision ACL reconstruction between January 2023 and January 2024. Preoperative assessments included laboratory tests (ESR, CRP, tuberculosis antibodies), radiographic imaging (X-ray, CT, MRI), and functional scoring (VAS, IKDC, Lysholm). Surgical protocols emphasized meticulous tunnel planning, arthroscopic debridement, synthetic ligament placement, and dual fixation with metallic interference screws. Postoperative care involved early mobilization, systematic rehabilitation, and regular follow-ups. Results showed that the procedure demonstrated technical feasibility, with successful ligament fixation and no intraoperative complications. Postoperative evaluations revealed improved functional scores (IKDC, Lysholm) and reduced pain (VAS). Imaging confirmed proper ligament positioning and graft integrity. No instances of infection, graft failure, or significant joint instability were reported during follow-up. Those results indicate that synthetic ligament revision ACL reconstruction offers a reliable solution for re-rupture cases, combining precise surgical techniques with rigorous postoperative rehabilitation. This approach addresses anatomical challenges, restores knee stability, and enhances patient outcomes, supporting its adoption in complex revision scenarios.

Quadricep weakness is frequently observed in patients following anterior cruciate ligament (ACL) injury or in those with knee osteoarthritis, often contributing to functional impairments and persistent symptoms. While high-intensity resistance training has been shown to effectively improve muscle strength, its application may be limited in certain populations due to pain or the risk of surgical complications. In recent years, blood flow restriction (BFR) training has emerged as a promising alternative. Growing evidence indicates that low-load BFR exercise can significantly improve muscle strength, induce hypertrophy, and enhance knee function, with outcomes comparable to those of high-intensity resistance training. When implemented using appropriate protocols, BFR training appears to be a safe and efficacious rehabilitation strategy for individuals with knee pathology.

Hip fractures in the elderly are frequently associated with complications and unfavorable outcomes. Managing postoperative delirium, pain, sleep disturbances, and overall quality of life presents significant challenges in clinical care. This study aimed to explore the effectiveness of refined nursing interventions in improving postoperative recovery and patient satisfaction among elderly patients undergoing hip fracture surgery. A retrospective analysis was conducted on 252 elderly patients with surgically treated hip fractures admitted to Zhejiang Provincial People's Hospital and Tongxiang First People's Hospital between January 2021 and June 2024. To minimize selection bias, participants were allocated into 2 groups using propensity score matching, ensuring comparable baseline characteristics between the groups. The observation group (n = 126) received refined nursing care tailored to individual needs, while the control group (n = 126) received standard nursing care. Key outcomes assessed included the incidence and duration of postoperative delirium, hospital length of stay, pain intensity (visual analog scale), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), recovery quality (the quality of recovery-40), and satisfaction with nursing care. Compared to the control group, patients in the observation group showed a marked reduction in both the incidence and duration of postoperative delirium. They also experienced shorter hospital stays and reported lower pain scores by the third postoperative day. Sleep quality was notably better on the first and third days following surgery. Moreover, assessments at 1 and 2 months postoperatively revealed significantly higher scores in both quality of life and recovery. Nursing satisfaction was also significantly enhanced in the refined care group (P < .05 for all comparisons). Refined nursing interventions, with a focus on personalized, comprehensive care strategies, significantly improve postoperative outcomes in elderly patients with hip fractures. These measures not only mitigate delirium and pain but also promote better sleep, faster recovery, improved life quality, and greater patient satisfaction, demonstrating meaningful clinical application.

Ultrasound imaging of the elbow is an invaluable tool that enhances diagnostic precision and facilitates therapeutic procedures with high accuracy. Compared to palpation-guided techniques, ultrasound-guided interventions significantly improve precision. This article reviews ultrasound-guided techniques for elbow joint interventions, including intra-articular injections, tennis elbow, golfer's elbow, triceps and distal biceps tendinopathy, and ulnar nerve neuropathy. Practical guidance is provided on probe selection, patient positioning, and step-by-step procedural details. Special emphasis is placed on optimizing needle placement and minimizing risks such as nerve injury or other inadvertent damage. Ultrasound-guided procedures represent a pivotal advancement in conservative orthopedics and rehabilitation, enabling precise treatment delivery and improving patient outcomes. Text is supplemented with anatomical notes.

ObjectiveTo evaluate the efficacy of intermittent pneumatic compression therapy after arthroscopic release for post-traumatic elbow stiffness.DesignRandomised controlled trial.SettingSingle-centre trial conducted in Shanghai Sixth People's Hospital, Shanghai, China.ParticipantsA total of 197 patients undergoing arthroscopic elbow release were randomised into intervention (

This study aims to investigate the correlation between axial and sagittal malrotation of distal humerus fractures and elbow mobility. A transverse distal humerus fracture was generated in 5 cadaveric specimens. Rotation of the distal humeral fragment was performed on the medial column with a stable lateral column, as well as rotation of the lateral column with a stable medial column. Elbow flexion and extension range of motion were measured and repeated with an additional 5° and 10° of sagittal flexion and extension fracture deformity. All 4 fracture types suffered extension loss with increasing rotation. A peak extension loss was found within the range of 10-14° rotational deformity. A significant decrease in flexion of up to 50° was found in type MS2 fractures due to the interference of the radial head and the humeral metaphysis. Conversely, increased flexion motion was found in MS1 types. Fracture types and rotational malalignment should be considered when analyzing distal humeral fractures to predict future mobility with conservative treatment. The radial head seems to be the dominant factor in type MS fractures to predict flexion increase or limitation, while the extension limitation will gradually increase in both LS and MS type fractures. Future in vivo radiological and clinical studies are needed to validate these results. Level of Evidence: 3b.

Introduction: Giant cell tumor of bone is accountable for 5–9% of primary bone tumors and is usually characterized by intermediate dignity and high recurrence rate. Numerous adjuvant procedures have been presented in the literature, however, their efficiency remains controversial, often due to low case numbers and the consequential inappropriate statistical interpretation. Objective: Our aim was to survey the demographical and epidemiological data of patients treated at the Department of Orthopedics of Semmelweis University between 2008 and 2023, compare these data to the international literature, and analyze the impact of different adjuvant therapies on recurrence-free survival. Method: 135 patients’ data have been analyzed. Depending on the type of surgery and adjuvant therapy, the patients were clustered into homogenous groups, and their recurrence-free survival probabilities were compared. Results: Among the different adjuvant therapies, the lowest recurrence rates were observed when using phenol with bone resin (21%) or phenol only (30%). Wide resection resulted in a significantly reduced recurrence rate (5%) but in most cases also in sacrificing the joint. 67% of patients became tumor-free after the curettage of the primary tumor. Conclusion: When treating giant cell tumor of bone, joint-sparing techniques must be prioritized. This makes intralesional curettage combined with local adjuvant therapy the most practiced surgery. Utilizing phenol alone or with bone resin seems to reduce the recurrence rates nearly equally, which were curative in 67% of the cases at the first time. Filling the deficiency with homologous bone and acrylic bone resin is less efficient and is only advised in defined indications. The most effective treatment is wide resection but, in most cases, it results in sacrificing the joint. Recurrence did not indicate the more aggressive behavior of the tumor, probably it was due to the limitations of the prior surgery. The primary tumor underwent malignant transformation in 4%. Orv Hetil. 2025; 166(33): 1294–1301.

Generative artificial intelligence (AI), particularly large language models (LLMs), has emerged as a transformative technology across all medical specialties, including musculoskeletal (MSK) oncology. These models, such as ChatGPT and others, can process natural language, synthesize vast amounts of information, and generate contextually relevant outputs that resemble human communication. In orthopedic oncology, LLMs show promise in facilitating literature reviews, enhancing patient education, and supporting clinical decision-making by analyzing multidimensional data while providing improved logic-based reasoning. Additionally, they can assist in radiological and pathological workflows by interpreting imaging reports and drafting diagnostic summaries, thereby increasing efficiency and accuracy. In the near future, they are expected to aid in real-time patient follow-up and counseling, information transfer, efficient diagnostics, and even continuous surgical education and assistance. Despite their potential, challenges such as the risk of inaccuracies and biases, as well as the necessity for continuous supervision, warrant a cautious and responsible integration into clinical practice. This narrative review examines the current applications of LLMs in MSK oncology, their limitations, and their future potential in shaping precision medicine and equitable healthcare delivery.

An enchondroma is a benign neoplasm of mature hyaline cartilage that proliferates from the medullary cavity toward the cortical bone. This results in the formation of a significant endogenous mass within the medullary cavity. Although enchondromas are predominantly asymptomatic, they may exhibit various clinical manifestations contingent on the size of the lesion, its localization, and the characteristics observed on radiological imaging. This study aimed to identify and present cases of bone tissue enchondromas to field specialists as preliminary data. In this study, authentic X-ray radiographs of patients were obtained following ethical approval and subjected to preprocessing. The images were then annotated by orthopedic oncology specialists using advanced, state-of-the-art object detection algorithms trained with diverse architectural frameworks. All processes, from preprocessing to identifying pathological regions using object detection systems, underwent rigorous cross-validation and oversight by the research team. After performing various operations and procedural steps, including modifying deep learning architectures and optimizing hyperparameters, enchondroma formation in bone tissue was successfully identified. This achieved an average precision of 0.97 and an accuracy rate of 0.98, corroborated by medical professionals. A comprehensive study incorporating 1055 authentic patient data from multiple healthcare centers will be a pioneering investigation that introduces innovative approaches for delivering preliminary insights to specialists concerning bone radiography.