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Open AccessArticle

Lumbar and Thoracolumbar Curves Are Associated with Coronal Lower Limb Malalignment in Adolescent Idiopathic Scoliosis

by Ahmet Serhat Aydin, Emre Kocazeybek, Ahmet Mücteba Yildirim, Onur Kutlu, Serkan Bayram and Turgut Akgul

Medicina 2026, 62(5), 978; https://doi.org/10.3390/medicina62050978 (registering DOI) - 17 May 2026

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Abstract

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and [...] Read more.

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and to determine whether these parameters differ according to main curve location. Materials and Methods: In this retrospective study, 70 AIS patients treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped according to main curve location as thoracic (n = 28), lumbar (n = 21), or thoracolumbar (n = 21). Pre-treatment standing full-spine radiographs were used to assess Cobb angle, coronal balance, and pelvic coronal obliquity angle (PCOA). After completion of spinal treatment, full-length weight-bearing lower-limb radiographs were evaluated for femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA). Additional treatment-stratified, treatment-adjusted, and threshold-based analyses were performed. Results: PCOA, coronal balance, bilateral MAD, right aLDFA, and right mLDFA differed significantly among the three curve-location groups. The lumbar group demonstrated more negative MAD values than the thoracic group, indicating a tendency toward valgus alignment (right MAD: −5.88 ± 8.8 mm vs. 3.65 ± 7.9 mm, p = 0.004; left MAD: −3.5 ± 7.5 mm vs. 3.75 ± 7.0 mm, p = 0.005). After adjustment for treatment modality, age, and main Cobb angle, curve location remained significantly associated with right MAD, left MAD, right aLDFA, and right mLDFA. However, the proportion of patients with clinically relevant malalignment, defined as MAD exceeding ±10 mm in at least one limb, did not differ significantly among the groups. Conclusions: AIS patients show subtle but measurable differences in coronal lower-limb alignment after completion of spinal treatment. Lumbar and thoracolumbar curves are associated with greater pelvic obliquity and a tendency toward more valgus mechanical-axis alignment, whereas limb lengths and NSA remain comparable among curve-location groups. These findings appear to represent mainly radiographic or biomechanical variations rather than overt clinically relevant deformity in most patients. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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35 pages, 1732 KB

Open AccessArticle

Replacement and Revision Hip and Knee Surgery Projections up to the Year 2060: An Analysis Based on Data from the Romanian Arthroplasty Register

by Flaviu Moldovan and Liviu Moldovan

Medicina 2026, 62(3), 588; https://doi.org/10.3390/medicina62030588 - 20 Mar 2026

Cited by 1 | Viewed by 629

Abstract

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is [...] Read more.

Background and Objectives: Hip and knee replacement joint surgeries are experiencing constant growth, and anticipating future needs allows decision-makers and stakeholders involved in the healthcare system to allocate the necessary resources for safe and effective services. The objective of this study is to estimate the volumes of primary and revision hip and knee surgeries expected to be performed in Romania by 2060. Materials and Methods: We used data from the Romanian Arthroplasty Register regarding the total volume of primary hip replacement surgery (cumulative n = 51,252 across five years), hip revision surgery (cumulative n = 3579), primary knee replacement surgery (cumulative n = 32,283), and knee revision surgery (cumulative n = 943) performed in 2017–2019, 2023 and 2024—the last five years of complete registrations, excluding the pandemic period. We projected future numbers of hip and knee primary and revision surgeries using the arithmetic mean of annual procedure rates observed during the study period, combined with the average annual trend in these rates. Projections were stratified by age group (0–39, 40–49, 50–59, 60–69, 70–79, and ≥80 years) and sex and were applied to population forecasts from the National Institute of Statistics of Romania up to 2060. Results: By 2060, primary hip replacement surgery volumes will increase by 40.14% relative to 2024 levels (from 13,526 in 2024 to 18,965 in 2060), and primary knee replacement surgery volumes will increase by 79.78% (from 9003 in 2024 to 16,186 in 2060). Revision hip surgery volumes will increase by 42.02% (from 759 in 2024 to 1078 in 2060), and revision knee surgery volumes will increase by 109.25% (from 227 in 2024 to 475 in 2060). The largest relative increases are concentrated in patients aged ≥80 years, with projected growth substantially exceeding those in younger age groups across all procedure types and both sexes. These percentages represent the projected growth in procedure volumes for this age group compared with 2024 baseline volumes. Conclusions: By 2060, we project substantial increases in all arthroplasty procedure types in Romania, with the most pronounced growth among patients aged ≥80 years. Given that resource utilization and morbidity are higher in this population, the increased demand for medical interventions requires advance planning, which will have significant implications for the healthcare system. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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14 pages, 2718 KB

Open AccessArticle

Knee Osteoarthritis (KOA) Severity Influences Proximal Femoral Biomechanics and Predicts Pertrochanteric Fracture Instability: A Retrospective Radiographic Study

by Seyed Ali Hashemi, Bahram Abedini, Hossein Hosseini, Shayan Yousufzai, Christos Koutserimpas, Georgi P. Georgiev, George Tiantafyllou, Eva Diomidous, George Tsakotos, Ioannis Paschopoulos, Fotios Kantas and Maria Piagkou

Medicina 2026, 62(3), 469; https://doi.org/10.3390/medicina62030469 - 1 Mar 2026

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Abstract

Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence [...] Read more.

Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence suggests that degenerative knee changes may alter lower-limb load distribution and increase susceptibility to unstable fracture patterns. This study evaluated whether KOA severity, graded using the Kellgren–Lawrence (KL) system, is associated with ITF stability according to the 2018 AO/OTA classification. Materials and Methods: A retrospective observational study was conducted on 138 patients with IHFs treated between 2018 and 2023. KOA severity was assessed using KL grades I–IV on non-weight-bearing anteroposterior knee radiographs. Lateral wall thickness (LWT) was measured using the Hsu method, with <20.5 mm indicating fracture instability. Statistical analyses included correlation, linear regression, logistic regression, and receiver operating characteristic (ROC) curve analysis to examine the association between KL grade and fracture stability. Results: Among 138 patients, 98 (71.0%) had unstable ITFs. Advanced KOA was significantly more common in the unstable group (KL III 45.9%, KL IV 48.0%; p < 0.001). KL grade showed a significant inverse correlation with LWT (Pearson’s r = −0.394, p < 0.001). Each one-grade increase in KL severity was associated with a 3.8 mm reduction in LWT (p < 0.001). In multivariable logistic regression, KL grade remained an independent predictor of fracture instability (adjusted OR = 4.9, 95% CI: 2.8–8.8, p < 0.001), whereas age and comorbidities were not significant. ROC analysis demonstrated good discriminatory power (AUC = 0.79). A KL ≥ III threshold achieved 95% sensitivity and 56% specificity for predicting instability. Conclusions: Higher KOA severity is strongly associated with unstable ITF patterns. KL grade independently predicts instability and may serve as a simple, accessible radiographic indicator of biomechanical vulnerability and fracture risk in older adults. Incorporating KOA severity into the preoperative evaluation may enhance risk stratification, guide selection of fixation strategy, and support individualized rehabilitation planning. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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11 pages, 263 KB

Open AccessArticle

Assessing the Quality and Accuracy of ChatGPT-3.5 Responses to Patient Questions About Hip Arthroscopy

by Maximilian Heinz, Hassan Tarek Hakam, Mikhail Salzmann, Robert Prill and Nikolai Ramadanov

Medicina 2025, 61(12), 2080; https://doi.org/10.3390/medicina61122080 - 22 Nov 2025

Cited by 3 | Viewed by 997

Abstract

Background and Objectives: Artificial intelligence-driven large language models such as ChatGPT increasingly influence patient education in surgical fields. This study evaluates the quality and accuracy of ChatGPT-3.5-generated responses to patient questions regarding femoroacetabular impingement syndrome (FAIS) and hip arthroscopy (HAS). Materials and [...] Read more.

Background and Objectives: Artificial intelligence-driven large language models such as ChatGPT increasingly influence patient education in surgical fields. This study evaluates the quality and accuracy of ChatGPT-3.5-generated responses to patient questions regarding femoroacetabular impingement syndrome (FAIS) and hip arthroscopy (HAS). Materials and Methods: In this descriptive observational study, ChatGPT-3.5 generated and answered 20 representative patient questions about FAIS and HAS (n = 20 question–answer pairs). No patient-derived questions or data were used. Each response was independently evaluated by two fellowship-trained orthopedic surgeons across four domains: relevance, accuracy, clarity, and completeness, using a five-point Likert scale. Inter-rater reliability was calculated using the intraclass correlation coefficient (ICC), and descriptive inter-rater agreement percentages were reported. Additional qualitative impressions from the reviewers were recorded to contextualize areas in which responses were rated slightly lower, particularly regarding explanatory depth and postoperative variability. Results: Mean ratings across all domains ranged from 4.85 ± 0.24 (95% CI: 4.74–4.96) to 5.00 ± 0.00. Relevance achieved a perfect mean score of 5.00, while accuracy and clarity each obtained 4.98 ± 0.11 (95% CI: 4.91–5.00). Completeness demonstrated the lowest scores (4.85 ± 0.24). Due to pronounced ceiling effects, ICC values were non-informative; however, descriptive agreement between raters was high, with 100% concordance for relevance and 90% agreement for accuracy and clarity. No factually incorrect or unsafe information was identified. Overall, responses were concise, structured, and clinically appropriate, though occasionally lacking in granularity concerning individual recovery trajectories and procedure-specific nuances. Conclusions: ChatGPT-3.5 demonstrates significant potential as a supplementary patient education tool in hip preservation surgery. While its responses were consistently accurate and easy to understand, their occasional lack of detail, particularly concerning postoperative expectations and variability in outcomes, indicates that the findings apply primarily to synthetic, standardized questions in a controlled setting. Further validation is required before generalizing these results to real-world patient interactions. Future studies should incorporate authentic patient questions, diverse evaluator groups, and longitudinal assessment across different LLM versions to better define clinical applicability and safety. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

12 pages, 1452 KB

Open AccessArticle

High Satisfaction and Strength Recovery After Mini-Open Double-Row Repair of Partial Gluteal Tears Without Advanced Osteoarthritis: A Unicentric Retrospective Cohort Study

by Ingo J. Banke, Amr Seyam, Kilian Blobner, Rüdiger von Eisenhart-Rothe and Vanessa Twardy

Medicina 2025, 61(10), 1863; https://doi.org/10.3390/medicina61101863 - 16 Oct 2025

Viewed by 1097

Abstract

Background and Objectives: Partial gluteal tendon tears in native hips are often misdiagnosed as greater trochanteric pain syndrome, resulting in ineffective conservative treatment and persistent symptoms. Although surgical repair techniques exist, data on objective strength outcomes in non-arthritic hips remain limited. The [...] Read more.

Background and Objectives: Partial gluteal tendon tears in native hips are often misdiagnosed as greater trochanteric pain syndrome, resulting in ineffective conservative treatment and persistent symptoms. Although surgical repair techniques exist, data on objective strength outcomes in non-arthritic hips remain limited. The objective of this study was to evaluate pain reduction, patient-reported outcomes (PROMs), and isometric hip abductor strength following mini-open, knotless double-row repair using the Hip Bridge technique. Material and Methods: This retrospective, single-center cohort study (Level III) with prospective outcome evaluation included 27 patients (mean age 53 years, BMI 27 kg/m²) with partial gluteal tendon tears and no advanced osteoarthritis (Tönnis grade ≤ 1), treated between 2015 and 2022 using the mini-open, knotless double-row Hip Bridge technique. The mean follow-up was 29.3 ± 24.3 months (minimum 6 months). Diagnosis was confirmed by 3-Tesla MRI, and other sources of lateral hip pain were excluded. Clinical outcomes included the Visual Analog Scale (VAS), modified Harris Hip Score (mHHS), Hip Outcome Score (HOS), normalized Western Ontario and McMaster Universities Osteoarthritis Index (nWOMAC), and Copenhagen Hip and Groin Outcome Score (HAGOS). Isometric hip abductor strength was assessed in 22 patients using a dynamometer, comparing the operated and contralateral limbs. Results: Postoperative satisfaction was high: 93% would undergo surgery again, 88% reported improved Trendelenburg gait, and 85% noted subjective strength gains. Pain improved significantly from VAS 8 (range, 3 to 10) preoperatively to VAS 2 (range, 0 to 7) postoperatively (p < 0.001); 100% reported pain relief. Patient-reported outcome scores were mHHS, 84.2; nWOMAC, 86.5; HOS, 80.7; and HAGOS, 70.7. Isometric strength testing showed significant improvement on the operated side (Fmax: p = 0.006; Fmean: p = 0.009). The mean limb symmetry index was 118% for Fmax and 122% for Fmean. Conclusions: Mini-open, knotless double-row repair of partial gluteal tears in non-arthritic hips yields adequate pain relief, high satisfaction, and objective strength recovery. The Hip Bridge technique could be an effective option after failed conservative treatment. Future prospective comparative studies are warranted to validate mid-term outcomes and establish long-term efficacy. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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14 pages, 3549 KB

Open AccessArticle

The Use of Fibrin Clot During Meniscus Repair in Young Patients Reduces Clinical Symptom Rates at 12-Month Follow-Up: A Pilot Randomized Controlled Trial

by Viktorija Brogaitė Martinkėnienė, Donatas Austys, Andrius Brazaitis, Aleksas Makulavičius, Tomas Aukštikalnis, Ilona Dockienė and Gilvydas Verkauskas

Medicina 2025, 61(9), 1616; https://doi.org/10.3390/medicina61091616 - 7 Sep 2025

Viewed by 3865

Abstract

Background and Objectives: The menisci are crucial fibrocartilaginous structures of the knee joint and have to be repaired in case of a tear. However, not all meniscal tears heal, even in young patients. Fibrin clot (FC) started to be used to reduce the [...] Read more.

Background and Objectives: The menisci are crucial fibrocartilaginous structures of the knee joint and have to be repaired in case of a tear. However, not all meniscal tears heal, even in young patients. Fibrin clot (FC) started to be used to reduce the failure rates following meniscus repair. The purpose of this study is to evaluate and compare outcomes after isolated arthroscopic meniscal repair augmented with FC versus without FC. Materials and Methods: Fifty-nine patients aged under 19 with isolated meniscal tears were randomized into two groups: one group underwent the meniscal repair with FC (FC-augmented), and the other group did not receive FC (control). The evaluation and comparison between the groups based on FC augmentation included secondary arthroscopy rates, patient-reported outcome measures (Pedi-IKDC, Lysholm, and Tegner), and clinical and radiological (MRI) assessments at a median follow-up of 12 months. Results: No statistically significant difference was observed between FC-augmented and control groups in Pedi-IKDC, Lysholm, and TAG scores, or following clinical and radiological (MRI) evaluation. Patients in the FC-augmented group reported fewer clinical symptoms at the final follow-up across unstable and demanding (bucket-handle and complex) tear type subgroups (p = 0.012 and 0.041, respectively). Overall, nine revision arthroscopies occurred in both groups (2 and 7, respectively), all across bucket-handle and complex tears with no significant difference between the FC-augmented and control groups (p = 0.072). Conclusions: This pilot study found that FC usage during meniscal repair reduces clinical symptoms for patients with unstable, bucket-handle, or complex meniscal tears at the final follow-up of 12 months postoperatively. Nonetheless, no statistically significant differences were observed within the other outcome measures between the FC-augmented and control groups and subgroups based on meniscal tear types. Level of evidence: Level II. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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12 pages, 1626 KB

Open AccessArticle

Operative Treatment of Adolescent Diaphyseal Clavicle Fracture: Elastic Stable Intramedullary Nail Versus Plate Fixation

by Kunhyung Bae, Soorack Ryu, Sung Hoon Choi, Hyunjae Kwon and Yoon Hae Kwak

Medicina 2025, 61(8), 1494; https://doi.org/10.3390/medicina61081494 - 21 Aug 2025

Viewed by 1966

Abstract

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate [...] Read more.

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate fixation for treating diaphyseal clavicle fractures in adolescent patients. Materials and Methods: We conducted a retrospective review of 35 adolescents who underwent surgery for diaphyseal clavicle fractures between 2010 and 2024. Patients were assigned to either the ESIN group (n = 18) or the plate fixation group (n = 17). Postoperative outcomes assessed included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, intraoperative time, time to complete fracture union, and clavicle shortening at 1 year postoperatively. Postoperative complications were also evaluated. Results: Fracture union occurred significantly faster with ESIN than with plate fixation, specifically 3 weeks earlier (11.0 weeks vs. 14.0 weeks; p < 0.001). No significant differences were observed between the groups in QuickDASH scores, intraoperative time, or clavicle shortening at 1 year. The overall postoperative complication rate was 25.7% (9/35), with no statistically significant difference between the ESIN (27.8%) and plate fixation groups (23.5%) (p = 0.774). Refractures occurred exclusively in the plate fixation group (n = 2), while one patient in the ESIN group required early nail removal due to insertion site irritation. Conclusions: ESIN provided functional and radiographic outcomes comparable to plate fixation in adolescents with diaphyseal clavicle fractures, with a 3-week shorter time to union and a less-invasive surgical approach. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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11 pages, 1461 KB

Open AccessArticle

Volumetric Bone Mineral Density Assessed by Dual-Energy CT Predicts Bone Strength Suitability for Cementless Total Knee Arthroplasty

by Dong Hwan Lee, Dai-Soon Kwak, Sheen-Woo Lee, Yong Deok Kim, Nicole Cho and In Jun Koh

Medicina 2025, 61(7), 1305; https://doi.org/10.3390/medicina61071305 - 20 Jul 2025

Cited by 2 | Viewed by 1286

Abstract

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone [...] Read more.

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone mineral density (vBMD) is an emerging tool for assessing bone quality. This study aimed to determine whether DECT-derived vBMD can accurately predict suitable bone strength for cementless TKA. Materials and Methods: A total of 190 patients undergoing primary TKA with a standardized posterior-stabilized implant were prospectively enrolled. Prior to TKA, DECT-derived vBMD was measured in the femoral box region. Actual bone strength was evaluated using an indentation test on resected femoral box specimens. Correlation and linear regression analyses were performed to assess the relationship between DECT vBMD and actual bone strength. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) calculations were used to determine the optimal cut-off value and diagnostic accuracy of DECT vBMD in identifying candidates suitable for cementless TKA. Results: DECT-derived vBMD exhibited a strong correlation with actual bone strength (correlation coefficient = 0.719, p < 0.01), while linear regression analysis revealed a moderate association (R² = 0.51, p < 0.01). In addition, it demonstrated excellent diagnostic performance in predicting adequate bone quality for cementless TKA, yielding an AUC of 0.984, with a sensitivity of 91.9% and a specificity of 92.0%. Conclusions: DECT-derived vBMD is a reliable and accurate tool for assessing bone strength around the knee and predicting the suitable bone quality for cementless TKA. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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12 pages, 1945 KB

Open AccessArticle

Accuracy Verification of a Computed Tomography-Based Navigation System for Total Hip Arthroplasty in Severe Hip Dysplasia: A Simulation Study Using 3D-Printed Bone Models of Crowe Types II, III, and IV

by Ryuichiro Okuda, Tomonori Tetsunaga, Kazuki Yamada, Tomoko Tetsunaga, Takashi Koura, Tomohiro Inoue, Yasutaka Masada, Yuki Okazaki and Toshifumi Ozaki

Medicina 2025, 61(6), 973; https://doi.org/10.3390/medicina61060973 - 24 May 2025

Cited by 2 | Viewed by 1583

Abstract

Background and Objective: The use of computed tomography (CT)-based navigation systems has been shown to improve surgical accuracy in total hip arthroplasty. However, there is limited literature available about the application of CT-based navigation systems in severe hip dysplasia. This study aimed [...] Read more.

Background and Objective: The use of computed tomography (CT)-based navigation systems has been shown to improve surgical accuracy in total hip arthroplasty. However, there is limited literature available about the application of CT-based navigation systems in severe hip dysplasia. This study aimed to evaluate the accuracy of a CT-based navigation system in patients with severe hip dysplasia using three-dimensional (3D)-printed bone models. Methods: 3D-printed bone models were generated from CT data of patients with severe hip dysplasia (Crowe type II, 10 hips; type III, 10 hips; and type IV, 10 hips). The accuracy of automatic segmentation, success rate, point-matching accuracy across different registration methods, and deviation values at reference points after registration were assessed. Results: For the combined cohort of Crowe II, III, and IV cases (n = 30), the Dice Similarity Coefficient and Jaccard Index were 0.99 ± 0.01 and 0.98 ± 0.02, respectively. These values indicate a high level of segmentation accuracy. The “Matching with true and false acetabulum + iliac crest” method achieved a 100% success rate across all groups, with mean deviations of 0.08 ± 0.28 mm in the Crowe II group, 0.12 ± 0.33 mm in the Crowe III group, and 0.14 ± 0.50 mm in the Crowe IV group (p = 0.572). In the Crowe IV group, the anterior superior iliac spine deviation was significantly lower using the “Matching with true and false acetabulum + iliac crest” method compared to the “Matching with true and false acetabulum” method (0.28 ± 0.49 mm vs. 3.29 ± 2.56 mm, p < 0.05). Conclusions: This study demonstrated the high accuracy of automatic AI-based segmentation, with a Dice Similarity Coefficient of 0.99 ± 0.01 and a Jaccard Index of 0.98 ± 0.02 in the combined cohort of Crowe type II, III, and IV cases (n = 30). The matching success rate was 100%, with additional points on the iliac crest, which improved matching accuracy and reduced deviations, depending on the case. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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10 pages, 4149 KB

Open AccessArticle

A Novel Interfragmentary Technique vs. A Conventional Posterolateral Approach for Unstable Femoral Intertrochanteric Fractures in the Elderly: A Retrospective Cohort Study

by Hakan Zora, Gökhan Bayrak and Ömer Faruk Bilgen

Medicina 2025, 61(4), 605; https://doi.org/10.3390/medicina61040605 - 27 Mar 2025

Cited by 2 | Viewed by 1016

Abstract

Background and Objectives: Intertrochanteric fractures of the femur are common in the elderly due to the increase in longer life expectancy. However, unstable intertrochanteric fractures in the elderly population were still a significant concern for the postsurgical period after total hip arthroplasty [...] Read more.

Background and Objectives: Intertrochanteric fractures of the femur are common in the elderly due to the increase in longer life expectancy. However, unstable intertrochanteric fractures in the elderly population were still a significant concern for the postsurgical period after total hip arthroplasty (THA). This study aimed to compare the demographics, operative time, dislocation rate, and length of stay of the novel interfragmentary technique (IFT) and the conventional posterolateral approach (CPA) for unstable intertrochanteric femoral fractures treated with THA in the elderly. Materials and Methods: This retrospective study investigated community-dwelling elderly patients with type III, IV, and V unstable femoral intertrochanteric fractures according to the Evans–Jensen classification, treated with THA by a well-experienced single surgeon. The patients were separated into IFT (n = 74) and CPA (n = 67) groups. Patient demographics (age, gender, and body mass index), total surgical duration, dislocation rates, length of stay and follow-up, and complication rates were recorded. Results: The mean age was 80.37 years in the IFT and 80.14 in the CPA groups (p = 0.838). Body mass index, gender, complication, and revision rates did not differ between groups (p > 0.05). The mean follow-up of the IFT group was 4.15 years, and 10.25 years in the CPA group (p = 0.001). Total surgical duration was comparable, with 69.98 min in the IFT group and 69.55 min in the CPA group (p = 0.697). The dislocation rate was 2.7% (n = 2) in the IFT group and 9% (n = 6) in the CPA group (p = 0.109). The mean length of stay was 66.97 h in the IFT group and 67.83 h in the CPA group (p = 0.729). Conclusions: The interfragmentary surgical technique, a novel technique for unstable intertrochanteric fracture surgery, shows promising clinical outcomes. Preserving the short rotator muscles and posterior capsule utilizing the novel IFT can be advantageous for the risk of dislocation without increasing surgical duration. It can be concluded that performing THA using IFT emerges as a practical and viable procedure for treating unstable intertrochanteric fractures in elderly patients. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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15 pages, 5365 KB

Open AccessArticle

Computed Tomography Angiography-Guided Study of the Superficial Femoral Artery Course in the Thigh and the Identification of Dangerous Zones for Lateral Femoral Surgical Approaches

by Yılmaz Mertsoy, Şeyhmus Kavak and Ayhan Şenol

Medicina 2025, 61(3), 441; https://doi.org/10.3390/medicina61030441 - 28 Feb 2025

Viewed by 1597

Abstract

Background and Objectives: The superficial femoral artery (SFA) can be injured during an intramedullary femoral nailing procedure with proximal and distal cross fixation, performed for proximal femoral fractures and intertrochanteric fractures. The aim of this study was to determine the safe and [...] Read more.

Background and Objectives: The superficial femoral artery (SFA) can be injured during an intramedullary femoral nailing procedure with proximal and distal cross fixation, performed for proximal femoral fractures and intertrochanteric fractures. The aim of this study was to determine the safe and dangerous zones for the SFA during operative interventions on the femoral body in Turkish society and to define the relationship of these zones with femur length and sex. Materials and Methods: Using a computed tomography angiography, the relationship between the SFA and the medial shaft of the femur was examined in 160 limbs of 80 patients. The upper and lower cut points of the medial part of the SFA in the sagittal plane were defined. The distance of these points to the adductor tubercle was measured and the ratio of this value to the femur length was calculated. Results: The average distance of the SFA to the adductor tubercle in women was 214.2 ± 25.9 mm at the anterior border of the femur, while in men it was 229.8 ± 26.2 mm (p = 0.000). The danger zone length was 85 mm in women and 102 mm in men, and the difference was statistically significant (p = 0.000). The average distance of the SFA to the adductor tubercle at the anterior border of the femur was 223.1 ± 27.3 mm, the average femur length was 374.9 ± 30.2 mm, and a moderate correlation was found between them (r = 0.568). Conclusions: When determining the intraoperative danger zone using anatomical reference points in surgical approaches to the femur, variables such as sex and femur length should not be ignored. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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12 pages, 694 KB

Open AccessArticle

Risk Factor Analysis of Ski and Snowboard Injuries During the 2023/2024 Winter Season: A Single, High-Volume Trauma Center Database Analysis

by Michele Paolo Festini Capello, Pieralberto Valpiana, Giuseppe Aloisi, Giovanni Cristofolini, Svea Caren Misselwitz, Giuseppe Petralia, Mario Muselli, Salvatore Gioitta Iachino, Christian Schaller and Pier Francesco Indelli

Medicina 2025, 61(1), 117; https://doi.org/10.3390/medicina61010117 - 14 Jan 2025

Cited by 4 | Viewed by 7345

Abstract

Background and Objectives: The objective of the study was to evaluate the epidemiology of slope-related accidents in a high-volume trauma center during the winter season. In addition, this study aims to analyze patient-related, equipment-related, and environment-related characteristics. Materials and Methods: A questionnaire containing [...] Read more.

Background and Objectives: The objective of the study was to evaluate the epidemiology of slope-related accidents in a high-volume trauma center during the winter season. In addition, this study aims to analyze patient-related, equipment-related, and environment-related characteristics. Materials and Methods: A questionnaire containing 22 items was distributed to all adult patients admitted to the emergency department of the Brixen Hospital (Italy) during the 2023/24 winter season because of a ski/snowboard-related injury. Results: The final database included 579 questionnaires from 579 patients who ultimately entered the study: 285 were females and 294 were males. The analysis of risk factors for fractures revealed that patients with fractures were generally older (50.7 ± 16.0 years) compared to those without fractures (45.4 ± 17.2 years, p = 0.0021). Thirty-six percent of injuries were considered as joint sprain/ligament strain: patients in this group were younger (45.5 ± 16.2 years) compared to all patients (48.3 ± 17.3 years, p = 0.0151). Conclusions: In conclusion, this study identified significant risk factors associated with skiing and snowboarding injuries. Fractures were more common among older and more experienced skiers, particularly those who described themselves as experts. Ligamentous distortions were more common among younger and less experienced skiers. Fatigue is generally underestimated, and the general physical preparation is often lacking for sports like skiing and snowboarding. Additionally, the absence of significant correlations between weather conditions, snow quality, equipment type, and the difficulty of the slope with injury risk suggests that individual factors such as age and skill level are more critical determinants of injury risk than environmental or equipment-related factors. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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Bone–Ti-Alloy Interaction in Hip Arthroplasty of Patients with Diabetes, Dyslipidaemia, and Kidney Dysfunction: Three Case Reports and Brief Review

by Cosmin Constantin Baciu, Ana Maria Iordache, Teodoru Soare, Nicolae Catalin Zoita, Cristiana Eugenia Ana Grigorescu and Mircea Bogdan Maciuceanu Zarnescu

Medicina 2025, 61(12), 2228; https://doi.org/10.3390/medicina61122228 - 17 Dec 2025

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Abstract

Background and Objectives: Organ dysfunctions affect the quality of bone and body fluids. This case report seeks links between the underlying conditions of three patients undergoing hip arthroplasty (HA) with uncemented implants, the quality of their bones, and their Ti-6Al-4V orthopaedic implants, [...] Read more.

Background and Objectives: Organ dysfunctions affect the quality of bone and body fluids. This case report seeks links between the underlying conditions of three patients undergoing hip arthroplasty (HA) with uncemented implants, the quality of their bones, and their Ti-6Al-4V orthopaedic implants, on different time spans. Femoral stems are investigated. A brief review supports our findings. Materials and Methods: Cases: two women (F1 35+, F2 80+), and one man (M 65+), all having diabetes, dyslipidaemia, and kidney dysfunction. Samples: a segment of a broken 7-year-old stem, bone with a metallic layer, soft tissue, segments of one spare stem, and synthetic plasma enriched with glucose and urea according to the biochemistry tests of the respective patients. Vast studies show that cholesterol influences bone quality only. The stem pieces were ultrasonicated for 7 h at 37 °C in synthetic plasma. Scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and profilometry investigated the Ti-alloy samples, electrochemistry analysed the post-sonication plasma, and histopathology examination was performed on the soft tissue remnants on the broken stem. Results: EDX show that all stem samples are Ti-6Al-4V with minute additions of other elements and hydroxyapatite (HAp) coating. SEM and profilometry analysis are consistent for the roughness in the outer layers of the stems. Electrochemistry on the bone fragment shows migration of vanadium during the 6 months since fracture to revision for M. Conclusions: Stems in altered synthetic plasma are affected by glucose and urea. Metal migration from the prostheses can occur through the chemical interactions between body fluids with abnormal biochemistry and the orthopaedic prostheses, favoured by cracks and concurring with wear following friction during usual movements. Cholesterol influences on the bone quality. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

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