Osteonecrosis Research Articles

The effect of the Japanese Investigation Committee classification on hip joint survival after core decompression therapy in pre-collapsed avascular necrosis of the femoral head

Aim: This study aimed to determine the failure rate of pre-collapse avascular necrosis (AVN) of the femoral head treated with core decompression (CD) and risk factors affecting the progression of the disease in patients by using an easily applicable staging system. . Material and Methods: A total of 174 hips from 134 patients diagnosed with precollapse AVN and treated with CD were retrospectively examined. Each hip was classified using the Japanese Investigation Committee (JIC) classification. The endpoint for joint survival following treatment was defined as the occurrence of total hip arthroplasty (THA). The risk analysis on joint survival of various independent variables (treatment type, age, gender, etiology) and the frequency of THA 2 and 5 years after treatment was calculated. Results: The mean age of the patients was 44.0 ± 15.0 years, with the majority being male (71.8%). THA was performed in 28.7% of treated hips within two years and 40.2% within five years. The frequency of THA application within two years was 2% for type A, 8% for type B, 40% for type C1 and 50% for type C2. Age (p=0.033), type C1 (p=0.028) and type C2 (p

Long-term outcomes of avascular necrosis in sickle cell disease using joint-specific patient-reported outcome measures: Results from a multicentre study.

Avascular necrosis (AVN) is a prevalent and progressive complication in young patients with sickle cell disease (SCD), but no study evaluated the long-term subjective and objective outcome measures. Oxford hip score (OHS) and Oxford shoulder scores (OSS) are validated joint-specific patient-reported outcome measures (PROMs). In this prospective multicentre study, 47 SCD patients with pre-existing diagnosis of AVN occurred at a median age of 35.9 (24.2-47.6) filled out the OHS and OSS at median follow-up of 9.4 years (4.5-12.9). No patient died after diagnosis of AVN. Hip AVN was present in 34 (72%) patients, with bilateral involvement in 25 (74%); 26 (59%) underwent total hip arthroplasty (THA) at a median age of 34.6 (22.6-49.5); and 4 (15%) required re-surgery. OHS revealed moderate to severe impairment both in patients underwent THA and no hip surgery. Shoulder AVN was present in 13 (6%) patients and OSS revealed mild to moderate impairment. A high rate of compromised joint function and pain was observed 10 years after diagnosis of AVN regardless of the type of treatment, outlying the need to improve the management of this sickle-related complication. OHS and OSS are validated joint-specific PROMs easy to use in all SCD centres.

Post-operative short-term clinical evaluation of direct lateral (Harding) approach in primary total hip replacement.

To evaluate patients' functional outcomes after total hip arthroplasty through a direct lateral approach. The prospective, observational, descriptive study was conducted at Al-Yarmouk Teaching Hospital, Baghdad, Iraq, from May 2019 to June 2020, and comprised patients aged 28-81 years having advanced osteoarthritis and avascular necrosis who underwent cementless total hip arthroplasty. The patients were followed up for 6 months. Outcome was assessed using the Harris hip score, Trendelenburg sign, post-operative hip dislocation, post-operative infection, and heterotopic ossifications. Data was analysed using Excel version 2019. Of the 30 patients, 14(47%) were males and 16(53%) were females. The overall mean age was 49.8±15.28 years. The mean pre-operative Harris hip score was 43.166±8.27, while it was 83.566±3.83 post-operatively (p<0.001). There was 1(3.33%) case of heterotopic ossification, 3(10%) had Trendelenburg sign. There was no case of postoperative hip dislocation or infection. The lateral hip approach was found to be associated with good post-operative hip stability and good post-operative functional outcome with low post-operative risk of infection.

Patient-reported outcomes and comprehensive assessment of wrist function after scaphoid reconstruction: A single-center retrospective study on 162 patients

A vast body of literature emphasizes radiological data for assessing outcomes in scaphoid reconstruction. The goal of this single-center study was to examine patients' reported outcomes and wrist function after scaphoid reconstruction.162 of 370 patients who underwent scaphoid reconstruction between January 2007 and December 2020 were included. Analyses used R version 4.0.2 with a significance level at p=0.05.The clinical follow-up averaged 7.44 years (range 1.03-14.65), with 87% of patients achieving union. The average DASH score was 7.54 (±10.08). The range of motion (ROM) for extension/flexion (E/F) averaged 115.97° (±21.77°) and the grip strength 42.49kg (±10.78). No statistically significant differences in the parameters studied were observed regarding the occurrence of union. Subgroups of patients without avascular necrosis (AVN) and those with preoperative carpal misalignment and without carpal instability achieved better functional outcomes with non-vascularized bone grafts compared to vascularized grafts. K-wire fixation resulted in poorer functional outcomes in case of carpal instability, including ROM in E/F (p=0.02) and complete ROM (p=0.03), compared to stabilization with compression screw. In patients with AVN (N=27), neither the type of bone graft nor the osteosynthesis method had any significant effect on functional or patient-reported outcomes. Female patients reached a higher DASH score (p=0.03), ROM in E/F (p=0.04), ROM in ulnar/radial deviation (p=0.04), ROM in pronation/supination (p=0.02), and cROM (p= 0.01) than the male patients.More complex reconstruction methods may lead to inferior outcomes and should be reserved for specific indications. Better functional but worse patient-reported outcomes in female patients warrant further analysis.

Ferroptosis: Regulatory mechanisms and potential targets for bone metabolism: A review.

Bone homeostasis is a homeostasis process constructed by osteoblast bone formation and osteoclast bone resorption. Bone homeostasis imbalance and dysfunction are the basis for the development of various orthopedic diseases such as osteoporosis, osteoarthritis, and steroid-induced avascular necrosis of femoral head. Previous studies have demonstrated that ferroptosis can induce lipid peroxidation through the generation of reactive oxygen species, activate a number of signaling pathways, and participate in the regulation of osteoblast bone formation and osteoclast bone resorption, resulting in bone homeostasis imbalance, which is an important factor in the pathogenesis of many orthopedic diseases, but the mechanism of ferroptosis is still unknown. In recent years, it has been found that, in addition to iron metabolism and intracellular antioxidant system imbalance, organelle dysfunction is also a key factor affecting ferroptosis. This paper takes this as the starting point, reviews the latest literature reports at home and abroad, elaborates the pathogenesis and regulatory pathways of ferroptosis and the relationship between ferroptosis and various organelles, and summarizes the mechanism by which ferroptosis mediates bone homeostasis imbalance, with the aim of providing new directions for the research related to ferroptosis and new ideas for the prevention and treatment of bone and joint diseases.

Clinical Value of ABCB1 and PAI-1 Gene Polymorphisms in Predicting Glucocorticoid-induced Adverse Reactions in Nephrotic Syndrome Patients.

Glucocorticoid (GC)-induced adverse reactions (ARs) have been extensively studied due to their potential impact on patients' health. This study aimed to examine the potential correlation between two polymorphisms [adenosine triphosphate-binding cassette B1 (ABCB1) C3435T and plasminogen activator inhibitor-1 (PAI-1) 4G/5G] and various GC-induced ARs in nephrotic syndrome (NS) patients. In this study, 513 NS patients who underwent GC treatment were enrolled. Then, the patients were divided into two groups based on ABCB1 C3435T and PAI-1 4G/5G genotyping, and intergroup comparisons of clinicopathological data and GC-induced ARs were performed. Univariate and multivariate logistic analyses were subsequently conducted to identify potential risk factors for GC-induced ARs, and a nomogram was subsequently established and validated via the area under the ROC curve (AUC), calibration curve and decision curve analysis (DCA). We identified ABCB1 C3435T as an independent risk factor for the development of steroid-associated avascular necrosis of the femoral head (SANFH) (OR: 2.191, 95% CI: 1.258-3.813, P=0.006) but not as a risk factor for the occurrence of steroid diabetes mellitus (S-DM). On the other hand, PAI-1 4G/5G was identified as an independent risk factor for the development of both SANFH (OR: 2.198, 95% CI: 1.267-3.812, P=0.005) and S-DM (OR: 2.080, 95% CI: 1.166-3.711, P=0.013). Notably, no significant correlation was found between the two gene polymorphisms and other GC-induced ARs. In addition, two nomograms were established and validated to demonstrate strong calibration capability and clinical utility. Assessing ABCB1 C3435T and PAI-1 4G/5G before steroid treatment in NS patients could be useful for identifying patients at a high risk of developing SANFH and S-DM.

Revision rate of displaced femoral neck fractures in non-elderly adults: a retrospective comparative study of the femoral neck system and cannulated screws

BackgroundDisplaced femoral neck fractures are associated with a high revision rate. The new femoral neck system(FNS) offers advantages in fixation stability, potentially reducing the need for revision. The purpose of this study was to compare the revision rate of patients with different reduction quality treated with the FNS and cannulated screws (CS).MethodsThis retrospective study included patients with Garden III or IV femoral neck fractures who underwent osteosynthesis in a level 1 trauma center between July 2019 and June 2023. A total of 141 cases met the inclusion criteria and received treatment with either the FNS (N = 65) or CS (N = 76). The quality of fracture reduction, surgical complications (such as femoral neck shortening, avascular necrosis of femoral head, nonunion of fracture, implant failure and withdrawal), revision surgery and the reasons for revision were analyzed.ResultsThe mean age of the 141 cases was 52.0 years (range 18–65); with sixty-five cases being male (46.1%). Eighty-four fractures (59.6%) were classified as Garden type III. Reduction quality was good in 71 cases (50.4%) and fair in 70 cases. The mean follow-up period was 25.9 months (range 12–46). A total of 26 cases(18.4%) underwent revision surgery. The revision rate in cases with good reduction was 11.3% (8/71 cases), with seven cases (four hardware removal and three arthroplasty) in the CS group and one case (arthroplasty for fracture nonunion and implant failure) in the FNS group, a significant difference was found between the two groups(P = 0.041). Among the 18 cases (25.7%, 18/70) with fair reduction who underwent revision surgery, nine cases (six hardware removal and three arthroplasty) in the CS group, and nine cases (arthroplasty for implant failure and cut-out) in the FNS group, and there was no significant difference between the two groups (P = 0.672). The total revision rate between the FNS group (15.4%, 10/65) and the CS group (21.1%, 16/76) was not significantly different (P = 0.387).ConclusionsThe total revision rate between the FNS and CS group showed no difference. However, in cases with good reduction, the revision rate was lower in the FNS group compared to the CS group.

Radial neck fracture in children-"Abenign fracture?"

Radial neck fractures in children are rare but clinically relevant injuries that are often accompanied by concomitant injuries. Girls between the ages of8 and 12 years old are more frequently affected, whereby acubitus valgus variant can be apredisposing factor. The main trauma mechanism is afall onto the outstretched, supinated arm with additional valgus stress. Radial neck fractures can be associated with concomitant injuries of the elbow joint, including an olecranon fracture and elbow dislocation. The diagnosis is typically made by conventional X‑radiographs, although ultrasonography can be indicated in younger children.The treatment depends on the fracture dislocation. Conservative treatment is certainly possible at any age if the proximal fragment is angulated less than 20°, while asurgical intervention can be indicated for larger dislocations depending on age. Closed reduction with internal fixation using aelastic stable intramedullary nail (ESIN) according to Métaizeau has become established as the standard procedure. Complications such as premature epiphyseal joint closure, synostosis, avascular necrosis, pseudarthrosis and deformation of the radial head can occur and affect the functional outcome. The treatment of such complications often requires acomprehensive multidisciplinary approach and can include both conservative and surgical measures. Long-term studies show that most patients with radial neck fractures achieve good to very good outcomes, although certain predictive factors are associated with poorer outcomes.Knowledge of the potential complications and their treatment is crucial for the successful management of children with radial neck fractures and should be considered when making clinical decisions.

Association between ossific nucleus volume changes and postoperative avascular necrosis risk in children with developmental dysplasia of the hip

This study aimed to investigate the correlation between ossific nucleus volume and avascular necrosis (AVN) in pediatric patients diagnosed with developmental dysplasia of the hip (DDH). Analyzing 211 cases, including 119 open reduction (OR) and 92 closed reduction (CR) procedures, we quantified ossific nucleus volume using magnetic resonance imaging (MRI). Categorizing the OR group based on ossific nucleus volume revealed no statistically significant difference in AVN incidence. Similarly, in the CR cohort, there was no significant discrepancy in AVN occurrence between subgroups with or without the ossific nucleus. Logistic regression in CR identified the international hip dysplasia institute (IHDI) grade as a significant AVN risk factor (p = 0.007). IHDI grades 3 and 4 exhibited a 6.94 times higher likelihood of AVN compared to grades 1 and 2. Across CR and OR, neither initial age nor ossific nucleus volume emerged as AVN risk factors. In conclusion, ossific nucleus volume does not pose a risk for AVN in DDH children undergoing CR or OR, emphasizing the clinical significance of IHDI grading in predicting AVN risk during CR and the importance of early intervention to prevent treatment delays.

Can Any Proximal Pole Scaphoid Fracture Nonunion be Treated with Arthroscopic Bone Grafting? A Series of Case Reports of Successes in Challenging and Unique Cases

AbstractDue to the unique morphology and tenuous vascularity, proximal pole fractures of the scaphoid are prone to nonunion if neglected. The vascular anatomy and the understanding that the blood flow to the proximal pole is retrograde in nature, has supported the concept of disruption of blood flow to the proximal pole with the possibility of avascular necrosis in a nonunited proximal pole. Historically, surgical management at this stage has favored the use of a vascularized bone graft over a nonvascularized bone graft to achieve union and good outcomes. However, the current literature seems to deviate from the long-standing understanding of proximal pole nonunion and its relationship to avascular necrosis. Not only does it state that avascular necrosis is extremely rare, but it also advocates arthroscopic bone grafting of proximal pole nonunions using morselized nonvascularized bone graft which has been proven to be a highly successful operation. Here, in our paper, we present a short series of some unique but surgically challenging cases of proximal pole nonunion and our successful management by bone grafting and fixing them arthroscopically. Our experience and invariably the experience of many may indicate that arthroscopic bone grafting and fixation may be the correct choice of surgery for proximal pole nonunion of the scaphoid bone.

THERMOGRAPHIC AND SONOGRAPHIC FINDINGS IN PATIENTS WITH KNEE PAIN: A RETROSPECTIVE STUDY FOR THE PERIOD JANUARY 2010 TO JULY 2023.

Our study is a retrospective study in which, from the total number of patients who were admitted to our institution for knee pain between January 2010 and July 2023, we selected only those who had a positive sonographic finding and were also examined thermographically. The total number of selected patients was 727. Of these, 321 were females and 406 were males aged 11 to 91 years. The mean age was 45 years. The number of positive sonographic findings was 2040. According to the nature of sonographic findings we divided them into: findings with liquid content (gangliomas, cysts, bursae, hydrops, haemarthrosis...) - total 36%. Findings of solid structure (calcifications, ossifications, osteophytes, mucoids, tophi, corpora libera) - 25% in total. Arthrosis femorotibial, femoropatellar - a total of 20%. Lesions (meniscopathies, tendinopathies, ruptures of tendons, muscles, ligaments, fractures, abruptions, usurations) - a total of 17%. Complications after TEP - 1%. Other (growing pains, plicae, chondrocalcinosis, aseptic osteonecrosis, tumors, nerve lesions) - 2% total. Of the 727 patients with sonographic abnormalities, 72% had a temperature distribution disorder. Of these, 67% of patients had hyperthermia of the painful knee, 5% had hypothermia. 28% of patients had a normal temperature pattern of the symptomatic knee compared to the contralateral knee.

The Application of Magnetic Resonance Imaging in the Early and Accurate Diagnosis of Hip Joint Avascular Necrosis.

Introduction Avascular necrosis (AVN) is characterized by the death (necrosis) of cellular bone components in the subchondral bone or epiphysis due to a lack of or an interruption of the blood supply. In routine practice, AVN is most frequently encountered in the femoral head. In this study, we aim to evaluate the application of magnetic resonance imaging (MRI) in the early and accurate diagnosis of hip joint AVN. Materials and methods This was a retrospective, cross-sectional study conducted in the Department of Radiodiagnosis of Dr. D. Y. Patil tertiary care hospital, Pimpri, Pune, India. We studied 30 patients with complaints of pain and associated limping who underwent primary radiograph analysis of the hip joint, followed by MRI. Results We assessed 30 patients (45 hip joints) using plain radiography and MRI. Of the 45 hips, we could diagnose AVN in 28 hips (62.2%) using plain radiography, but we could not diagnose it in 17 hips (37.8%), whereas we were able to diagnose AVN in all hips (100%) using MRI. Forty percent of the patients (n = 12) were on steroids, 26.7%(n = 8) were chronic alcoholics, and 16.7% (n = 5) were idiopathic. The other less common causes were a history of trauma or fracture of the neck of the femur (n = 3) and sickle cell disease (n = 2).Of the 45 hips of the 30 patients studied, 15 patients had bilateral disease affecting a total of 30 hips (66.7%), and 15 patients had unilateral disease affecting a total of 15 hips (33.4%). Of the 30 hips (bilateral disease), five (13.3%) contralateral hips were clinically occult and were incidentally diagnosed with AVN. Conclusion The assessment of AVN based solely on plain radiography can miss vital information in stages II and III (Ficat and Arlet classification). Due to its multiplanar capability, superior spatial resolution, and better tissue characterization, MRI is very sensitive and able to detect femoral head AVN early and promptly in cases that are radiograph-negative or otherwise clinically unsuspected.

Comparison of outcomes after total hip arthroplasty in hip fracture versus elective cases in patients over 60 years of age

BackgroundTotal hip arthroplasty (THA) allows for the replacement of impaired parts of the hip joint with artificial ones. This study aimed to compare the differences in preoperative patient profiles, postoperative complications, and clinical outcomes of two patient groups: those who underwent THA for fractures and those who underwent THA electively for diseases such as osteoarthritis (OA) and avascular necrosis (AVN). MethodsWe retrospectively analyzed the data of patients who underwent THA between March 2012 and December 2021. Of 232 patients, 173 patients who met the exclusion and inclusion criteria were included. Patients were divided into two groups (Group 1: 113 patients diagnosed with OA or AVN; Group 2: 60 patients diagnosed with hip fracture). Pre- and postoperative Visual Analogue Scale (VAS), Koval scores, and postoperative modified Harris Hip Score (mHHS) were used to assess clinical outcomes. Demographic data and postoperative complications of the two groups were compared. After surgery, a rehabilitation protocol was initiated. ResultsPatients in Group 2 (fracture) had more preoperative comorbidities than those in Group 1 (elective). Follow-up months are 26.22 ± 19.78 (Group 1), and 27.42 ± 17.02 (Group 2) respectively (P > 0.05). There were no statistical differences in the prevalence of postoperative complications between two groups (P > 0.05). Compared with Group 1(elective), Group 2(fracture) showed lower VAS (P < 0.01) at last follow-up, and no difference in Koval score (P = 0.77) and mHHS (P = 0.96) at last follow-up. ConclusionConsidering the characteristics of the two groups and their perioperative multidisciplinary care, THA for hip fractures can provide good clinical results compared to those with elective THA.

The Conservative and Operative Treatment of Carpal Fractures.

Carpal fractures (incidence: 30-60 per 100 000 persons per year) are one of the more commonly overlooked fracture types. They can have serious consequences, as the use of the hand is indispensable in everyday life. In the following article, we present the elements of the diagnosis and treatment of fractures of the carpal bones. This review is based on meta-analyses and randomized controlled trials (RCTs) published from 2013 to 2023 that were retrieved by a structured literature search, supplemented by guideline recommendations and expert consensus statements. In addition, data on the administrative prevalence of carpal fractures were obtained from the German Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung, KV) and from the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV). The administrative prevalence of carpal fractures in 2022 was 44 496 outpatient cases (KV, DGUV) in one year. After clinical history-taking, physical examination and x-ray have been performed, thin-slice computed tomography is recommended as part of the diagnostic evaluation. Treatment recommendations are based on evidence of levels II to IV. Multiple RCTs have been carried out on the treatment of scaphoid fractures, and a clinical guideline exists. Proximal, dislocated and unstable scaphoid fractures should be treated surgically. Non-displaced or minimally displaced fractures of the middle third of the scaphoid bone require a shorter period of immobilization with surgical treatment (2-4 weeks) than with conservative treatment (6-8 weeks). The use of plaster casts that do not hinder elbow and thumb mobility yields healing rates similar to those obtained with the immobilization of both of these joints. Failure to treat an unrecognized scaphoid fracture can lead to pseudarthrosis, avascular bony necrosis, and misalignment. Other, rarer types of carpal fractures must be managed on an individual basis, as the available evidence is limited to expert consensus. Early recognition and appropriate treatment of carpal fractures lead to healing in more than 90% of cases. Although the available evidence on their proper treatment is growing, many questions are subject to expert consensus, and decisions about treatment must be made individually.

Talar head fractures: An observational study of 33 talar head fractures derived from the Swedish Fracture Register

BackgroundReports in the literature on talar head fractures are rare and limited to case reports and small case series. Questions/PurposesThis study aimed to describe a national cohort of talar head fractures for fracture characteristics, associated injuries, treatment, and reoperations. MethodsWe reviewed all radiographs of patients enrolled in the SFR between 2011 and 2021 showing talar head fractures (AO/OTA 81-A3). We excluded those with talar head avulsion fractures, misclassified, multiple registrations, or with a privacy notice in their medical records. The cohort was reviewed using medical records and radiographs at a minimum 2-year follow-up. ResultsThe study included 32 patients (33 fractures) ≥18 years of age. The median age was 32 (range 18–65) years, 84 % were men, and the main trauma mechanisms were motor vehicle accidents (28 %) and falls from heights (28 %) and graded as high-energy injuries in 50 % of the cases. 18 (55 %) were displaced and 15 (45 %) had comminuted fractures. 14 talar head fractures (42 %) had multiple injuries to the same foot. 21 patients (66 %) underwent surgical treatment, most commonly with screw fixation. Surgery was performed in 15 of 18 patients with displaced fractures. Four patients were reoperated, one with arthrodesis of the talonavicular joint and three for implant removal. No cases of avascular necrosis were identified. ConclusionsTalar head fractures are rare and occur mainly in men. They are associated with other foot injuries. Most talar head fractures are treated operatively. In this case series, we did not identify any case of avascular necrosis. Levels of EvidenceIV, retrospective observational cohort study

Avascular necrosis of hematopoietic stem cell transplantation (HSCT): state of the art

Avascular necrosis (AVN) is a complex, multifactorial disease that may affect one bone, several bones together, or different bones at different times and it can impair the patient’s quality of life. It predominantly occurs in the femoral head, but also commonly affects other sites, especially the femur and knees, causing severe pain, bone necrosis, and, in extreme cases, even bone collapse. It can be diagnosed by magnetic resonance imaging analysis, and is usually staged using the Association of Research Circulation Osseus (ARCO) system or the Ficat system. Currently, literature on the prevention and treatment of AVN is very scanty, and studies are based on retrospective analyses. The aim of this review is to analyze the state of the art with regard to risk factors and treatments for AVN in patients who have received a hematopoietic stem cell transplant. KEY WORDS: Avascular necrosis, AVN, osteonecrosis, HSCT.

An Overview of Avascular Necrosis of the Hip in Patients with Sickle Cell Disease

Abstract Background: Avascular necrosis (AVN) of the femoral head is a devastating complication of sickle cell disease characterised by hip pain and dysfunction. The prevalence of this condition in patients with sickle cell disease in Ghana is unknown. Objectives: This study aims to look at the demographics of sickle cell disease patients presenting with AVN, the pattern of the disease on presentation, and the severity of the disease. Materials and Methods: Data were collected from patients referred to the Orthopaedic clinic over three years. Data collection forms were created and filled out for all patients. Analysis was done with Microsoft Excel (Windows 10 version), and the ensuing data were represented with descriptive statistics such as proportions, ratios, percentages, tables, and histograms. Results: A total of 134 patients were seen over a 3-year study period. The vast majority, 109 (85.3%), were below 40 years of age. The sex distribution of the patients was predominantly female (78%). Genotype SS was in the majority (89), representing (66.4%). The majority of the patients, 104 (77.6%), were regular attendees of the Ghana Institute of Clinical Genetics or other specialised sickle cell disease clinics. The main reason for referral was on account of X-ray changes seen by the referring doctor (90, 67.1%). Unilateral disease was seen in 94 (70%) patients. Seventy (52.2%) presented with stage III disease, and 42 (31%) had symptoms for more than 2 years. Conclusions: Most of our patients were young, predominantly with genotype SS. They presented late with advanced disease stages and were referred to the orthopaedic clinic only after X-ray changes were seen.

Artificial intelligence as an adjunctive tool in hand and wrist surgery: a review

Artificial intelligence (AI) is currently utilized across numerous medical disciplines. Nevertheless, despite its promising advancements, AI’s integration in hand surgery remains in its early stages and has not yet been widely implemented, necessitating continued research to validate its efficacy and ensure its safety. Therefore, this review aims to provide an overview of the utilization of AI in hand surgery, emphasizing its current application in clinical practice, along with its potential benefits and associated challenges. A comprehensive literature search was conducted across PubMed, Embase, Medline, and Cochrane libraries, adhering to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The search focused on identifying articles related to the application of AI in hand surgery, utilizing multiple relevant keywords. Each identified article was assessed based on its title, abstract, and full text. The primary search identified 1,228 articles; after the application of inclusion/exclusion criteria and manual bibliography search of included articles, a total of 98 articles were covered in this review. AI’s primary application in hand and wrist surgery is diagnostic, which includes hand and wrist fracture detection, carpal tunnel syndrome (CTS), avascular necrosis (AVN), and osteoporosis screening. Other applications include residents’ training, patient-doctor communication, surgical assistance, and outcome prediction. Consequently, AI is a very promising tool that has numerous applications in hand and wrist surgery, though further research is necessary to fully integrate it into clinical practice.

Anti-Shortening Screw for the Prevention of Postoperative Shortening in Displaced Femoral Neck Fractures: A Retrospective Cohort Study.

Early femoral neck shortening after femoral neck system (FNS) fixation for displaced femoral neck fractures can occur in 22.3%-39.1% of cases, leading to decreased hip joint function. This study aimed to investigate the effectiveness of using an anti-shortening screw (ASS) in FNS fixation to prevent postoperative femoral neck shortening in displaced femoral neck fractures. We retrospectively analyzed 106 cases of displaced femoral neck fractures treated with FNS at the Hospital from April 2020 to April 2023. Patients were divided into two groups based on the use of an ASS: the traditional group and the ASS group, each consisting of 53 cases. The ASS group was age-matched with the traditional group treated during the same period without an ASS. The study variables included age, sex, body mass index (BMI), smoking and drinking history, injury mechanism, side of injury, fracture type, surgical time, intraoperative blood loss, Harris Hip Score (HHS) at the final follow-up, radiographic assessment (femoral neck shortening), and complications (infection, femoral head necrosis, nonunion, and secondary surgery). Statistical analysis was performed using SPSS software, with continuous and categorical variables analyzed using appropriate parametric (t-test) and nonparametric (Mann-Whitney U test) tests, and chi-square or Fisher's exact tests, respectively. A p-value <0.05 was considered significant. There were no significant differences in background characteristics between the traditional and ASS groups. The shortening distance at postoperative day 1 did not differ significantly between the two groups (0 vs. 0 mm, p = 0.120). However, at 1, 3 months, and 1 year postoperatively, the femoral neck shortening in the ASS group was significantly less than that in the traditional group (1 month: 2.3 vs. 3.1 mm, p = 0.007; 3 months: 2.6 vs. 3.5 mm, p = 0.005; 1 year: 2.6 vs. 3.5 mm, p = 0.002). The ASS group also had a significantly lower shortening distance during the fracture healing process (0.9 vs. 2.7 mm, p = 0.005). The incidence of moderate to severe shortening (≥5 mm) at 1 year postoperatively was lower in the ASS group compared with the traditional group (15.1% vs. 37.7%, p = 0.001). The ASS group had a longer surgical time (63.0 ± 13.4 vs. 73.0 ± 23.2 min, p = 0.008) and a higher HHS (90.7 vs. 94.8, p = 0.008). There was no significant difference in fracture healing time or postoperative complications between the two groups. The traditional group had 3.8% cutouts, 7.5% nonunions, 5.7% avascular necrosis, and 7.5% secondary hip replacements. The ASS group saw 0% cutouts, 1.9% nonunions, 3.8% avascular necrosis, and 3.8% hip replacements. No significant differences in complication rates (p > 0.05). The use of an ASS in FNS fixation for displaced femoral neck fractures can reduce the degree of postoperative shortening and improve hip joint function.

Letter to the Editor: Commentary on Acute Paraparesis Caused by Spinal Epidural Fluid After Balloon Kyphoplasty for Traumatic Avascular Necrosis: A Case Report (Korean J Neurotrauma 2023;19:398-402).

Letter to the Editor: Commentary on Acute Paraparesis Caused by Spinal Epidural Fluid After Balloon Kyphoplasty for Traumatic Avascular Necrosis: A Case Report (Korean J Neurotrauma 2023;19:398-402).