Effects of restoration of hip-related parameters following primary total hip arthroplasty on patient-reported outcome measures.

Femoral diaphysis malunion: An overview.

Intra-Articular Influence of PETS Technique Treating Limb Length Discrepancy for Both Femur and Tibia: Comment on Study By Lee et al.

To evaluate the short-term effectiveness of a visual treatment solution (VTS)-assisted total hip arthroplasty (THA) in patients with Crowe type Ⅲ-Ⅳ developmental dysplasia of the hip (DDH). A retrospective analysis was conducted on the clinical data of 43 patients with Crowe type Ⅲ-Ⅳ DDH who were treated between June 2023 and December 2024 and met the eligibility criteria. Of these, 22 patients underwent conventional THA (traditional group), and 21 underwent VTS-assisted THA (VTS group). There was no significant difference ( P>0.05) between the two groups in baseline data, including gender, age, side, Crowe classification, preoperative visual analogue scale (VAS) score, or Harris score. The operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and postoperative complications were recorded and compared between the two groups. Functional recovery and pain relief were assessed using the Harris score preoperatively and at 1 week, 3 months, and 6 months postoperatively, as well as the VAS score preoperatively and at 1 week and 1 month postoperatively. The acetabular cup anteversion and abduction angles were measured, and cup position was assessed with reference to the Lewinnek safe zone. Limb length discrepancy was measured, and acetabular coverage as well as the matching rates between the preoperatively planned and actually implanted prosthesis sizes were calculated. The operation time, intraoperative blood loss, and postoperative drainage volume were all significantly lower in the VTS group than in the traditional group ( P<0.05), whereas no significant difference was found in length of hospital stay ( P>0.05). All patients were followed up 6-9 months, with a mean time of 7.4 months. Primary wound healing was achieved in both groups, and no poor wound healing or neurovascular injury occurred. Deep venous thrombosis developed in 2 patients in the VTS group and 4 patients in the traditional group; 1 patient in the traditional group experienced prosthetic dislocation. No other complication, including dislocation or thrombosis, was observed during follow-up. There was no significant difference in the overall complication incidence between the two groups ( P>0.05). In both groups, acetabular anteversion and abduction angles were within the Lewinnek safe zone, but their distributions were more concentrated in the VTS group than in the traditional group. Compared with the traditional group, the VTS group showed significantly smaller postoperative limb length discrepancy and significantly greater anteversion angle and acetabular coverage ( P<0.05). No significant difference was found between the two groups in abduction angle, acetabular prosthesis matching rate, or femoral stem prosthesis matching rate ( P>0.05). Harris scores at 3 and 6 months postoperatively and VAS scores at 1 week and 1 month postoperatively were significantly better in the VTS group than in the traditional group ( P<0.05), whereas no significant difference was observed at the other time points ( P>0.05). VTS-assisted THA for Crowe type Ⅲ-Ⅳ DDH yields favorable short-term effectiveness by improving implant positioning accuracy, reducing surgical trauma, and promoting early pain relief and functional recovery.

Introduction: Rotationplasty is a valid surgical technique in the management of bone sarcomas about the knee in children. This technique is often useful in patients with large extraosseous tumor extension and in the very young patients with anticipated significant limb length discrepancy. The aim of this study is to assess the long-term functional outcome and quality of life in our cohort of patients who have survived into adulthood. Methods: We have prospectively analyzed the functional outcome and quality of life in ten rotationplasty survivors. There were five male and five female patients with a mean age at the time of the index procedure of 11.6 ± 2.7 years. The functional outcome was evaluated using the Musculoskeletal Tumor Society Score (MSTS) and the Quality of Life (QoL) was assessed using the core quality of life questionnaire (QLQ-C30) of the EORTC. Results: Patients were followed up for a mean duration of 13.8 ± 4.4 years. The mean overall MSTS functional score was 82.7%. Nine patients reported either no or only minor functional restrictions. Only one patient used a crutch on walking for long distances, while other patients had unlimited or mild limitation of the distance that they could walk. The mean score of the global health status (QoL) was 85.8% with a mean score for social functioning of 90% and a mean score for role functioning of 88.3%. Conclusions: Rotationplasty affords the patients with an active lifestyle with no psychological or psychosocial disadvantages. The long-term assessment confirms that these patients maintain excellent functional results and quality of life through adulthood.

Congenital sensorineural hearing loss (CSNHL) is a very common subtype of pediatric hearing loss disorders. Less severe deformities in CSNHL might not be recognized during a simple visual inspection in computed tomography (CT) of the temporal bone. Therefore, the present study aimed to compare the inner ear measurements between CSNHL patients with grossly normal CT appearance and the healthy population. Children with confirmed CSNHL were enrolled along with a control group of healthy children. Their CT scans of the temporal bone were retrospectively reviewed. Ten inner ear radiologic measurements, including cochlea height (CH) and width (CW), width of cochlear nerve bony canal (WCN), superior and lateral semicircular canals (SSCC and LSCC) bony island widths, posterior semicircular canal (PSCC) inferior limb length, vestibule height (VH) and width (VW), and vestibular aqueduct (VA) width at the midpoint and operculum were compared between the two groups. 62 children (30 CSNHL, 37 females, mean age: 7.1 ± 3.4 years) were included. The intra-observer repeatability was very good to excellent across all parameters (Intraclass correlation coefficient: 0.83-0.96). CH (P ≤ 0.001) and VA midpoint width (P ≤ 0.001) were significantly higher in CSNHL patients than healthy individuals, and WCN (P ≤ 0.001), SSCC bony island width (P ≤ 0.001) and LSCC bony island width (P = 0.01) were significantly lower. There was no statistically significant difference in terms of CW (P = 0.83), PSCC inferior limb length (P = 0.54), VH (P = 0.67), VW (P = 0.83), and VA operculum width (P = 0.15). WCN (ROC-AUC: 0.80, cut-off point = 1.9mm, sensitivity = 60%, specificity = 84%) and VA midpoint width (ROC-AUC: 0.80, cut-off point = 1mm, sensitivity = 77%, specificity = 75%) demonstrated the highest diagnostic utility in identifying CSNHL, followed by CH, SSCC and LSCC bony island widths. Inner ear radiologic measurements, particularly WCN and VA midpoint width, demonstrate relatively high diagnostic value in identifying CSNHL with subtle malformations on temporal bone CT.

Revision total hip arthroplasty (rTHA) in the setting of substantial proximal femoral bone loss is technically challenging. Modular tapered fluted stems provide predictable diaphyseal fixation while allowing independent adjustment of version, offset, and limb length. Among these, two commonly used systems-modular tapered fluted stem Type A (Revitan™) and Type B (LIMA Modulus™)-have limited direct comparative evidence. This study aimed to prospectively compare radiographic stem subsidence (primary outcome), as well as functional outcomes, complications, survivorship, and secondary outcomes, between Type A and Type B modular long stems in femoral rTHA. In this single-center randomized prospective study, 110 patients undergoing femoral revision rTHA were randomly assigned to receive either Type A (n = 55) or Type B (n = 55) stems. All procedures were performed by experienced revision surgeons under standardized perioperative and rehabilitation protocols. Radiographs were analyzed for stem subsidence, osseointegration, and limb-length restoration. Functional outcomes were assessed using the Harris Hip Score (HHS), Oxford Hip Score (OHS), and European Quality of Life Visual Analogue Scale (EQ-VAS) at baseline and final follow-up (mean 61.4months). Complications and stem survivorship were recorded prospectively. Statistical analysis included paired and unpaired comparisons, correlation, regression, and Kaplan-Meier survival estimates. Baseline demographics and femoral defect severity were comparable. Both groups achieved high radiological stability, with mean distal subsidence of 1.3 ± 0.7mm (Type A) and 1.5 ± 0.9mm (Type B; p = 0.24), and osseointegration in > 92% of cases. Limb-length and offset restoration were similar. HHS improved significantly in both groups (Type A: 44.7 → 88.1; Type B: 45.1 → 87.3; p < 0.001), with > 80% achieving good-to-excellent outcomes. Complication rates were low and comparable. Five-year stem survivorship was 98.2% (Type A) and 97.6% (Type B). Early full weight-bearing and lower Paprosky defect grades independently predicted superior functional outcomes, whereas stem type did not. Both Type A and Type B modular tapered fluted stems demonstrated durable fixation, minimal subsidence, low complication rates, and excellent mid-term functional recovery. Radiographic stem subsidence did not differ between groups, indicating that design variations do not significantly affect clinical outcomes. These findings support the use of modular tapered fluted stems as reliable solutions in complex femoral rTHA.

The optimal surgical strategy for length-unstable pediatric femoral shaft fractures remains debated. This study compared clinical and radiologic outcomes between submuscular biological plating (SBP) and flexible intramedullary nailing augmented with external fixation (FIMN/EF). In this prospective, randomized trial, 32 children (5 to 14 years) with unstable femoral fractures (AO/OTA 32-D/5.1 or 32-D/5.2) were allocated to SBP (n=16) or FIMN/EF (n=16). Primary outcomes included operative time, fluoroscopy time, time to union, complications, and knee range of motion (ROM). Secondary outcomes included alignment, limb length discrepancy, functional scores (Flynn criteria), and implant removal characteristics. The SBP group demonstrated shorter operative time than the FIMN/EF group (mean: 73.1 vs. 88.8min, P =0.002) and reduced fluoroscopy time (mean: 51.9 vs. 74.1s, P <0.001). Time to radiologic union was comparable between groups ( P >0.05). Knee flexion at final follow-up was greater in the SBP group (mean: 108.1 vs. 100.6 degrees, P =0.015). Complication rates and limb length discrepancies (≤10mm) were similar in both groups, with no statistically significant difference. Functional outcomes were excellent or good in most patients in both groups. Both SBP and FIMN/EF appear to be effective treatment options for selected length-unstable pediatric femoral shaft fractures. SBP offers shorter surgery, reduced radiation exposure, and better early knee ROM, whereas FIMN/EF provides easier implant removal. Technique selection should be based on patient factors, fracture pattern, surgeon experience, and family preference.

Assessing the precision of 3D human model for forensic biomechanics application.

n-Butanol is extensively used in industrial, food, pharmaceutical, and petrochemical sectors, raising concerns about environmental and developmental exposure. However, evidence regarding its developmental toxicity remains limited. This study investigated the teratogenic and toxicological effects of n-butanol using a chick embryo (Gallus gallus domesticus) model, with emphasis on dose-dependent morphological alterations, feeding, and locomotory behavioral outcomes, oxidative stress responses, and histopathological damage. Fifty fertilized eggs were randomly assigned to five groups (n = 10 per group): a control group (received an equivalent sterile saline) and four treatment groups receiving n-butanol at doses of 10, 12, 14, and 20 μL per egg, via in ovo injection. Embryonic development was evaluated through morphometric measurements, including body length, limb length, head and beak dimensions, crown-rump length, and body weight. Oxidative stress was assessed in cardiac and hepatic tissues by determining DPPH radical scavenging activity and the activities of superoxide dismutase (SOD) and catalase (CAT), complemented by histopathological examination. Exposure to n-butanol resulted in a significant, dose-dependent reduction in most morphometric parameters (p < 0.0001), whereas head circumference remained unaffected. Antioxidant enzyme activities were markedly altered, indicating enhanced oxidative stress at higher exposure levels. Histopathological analysis revealed pronounced structural damage in liver and heart tissues, accompanied by behavioral abnormalities and limb deformities at elevated doses. Overall, these findings demonstrate that n-butanol induces developmental toxicity in chick embryos in a dose-dependent manner, likely mediated through oxidative stress and tissue injury. The chick embryo model proved to be a sensitive and effective system for evaluating developmental and environmental toxicants, highlighting potential risks associated with n-butanol exposure.

Effect of RYGB Limb Lengths on HbA1c in Patients with Obesity and Type 2 Diabetes.

OBJECTIVETotal hip arthroplasty (THA) is one of the orthopaedic surgeries performed today that yields satisfactory results. The surgeon volume has an important effect on the success of THA and we predict that surgeon-related variables can be brought to the most optimal level with experience.METHODSPatients who underwent primary THA surgery between 2015 and 2024 and had at least 1 year of follow-up were included in the study. High volume (HV) in surgeons who performed at least 20 primary THA operations in at least 3 consecutive years. Surgeons with 5 years or more of experience in orthopedics and traumatology were defined as low volume (LV). Acetabular inclination angle, limb length discrepancy, femoral stem malalignment, and hip rotation center conformity according to the Ranawat triangle method were determined from postoperative radiographs.RESULTSIn the study investigating the relationship between primary THA and surgeon volume, a significant relationship was found between surgical time, hospital stay, dislocation, blood loss, leg length discrepancy and hip rotation center according to Ranawat triangle as surgeon experience increased. No significant relationship was found between the groups in terms of revision surgery, acetabular inclination angle, femoral stem malalignment and periprosthetic infection.CONCLUSIONAs in every field, there is a linear relationship between increasing experience in a surgery or disease group and successful results in orthopedics and traumatology. Complication rates may decrease with the increase in HV surgeons in every field. For this reason; increasing the experience of surgeons in a certain field in orthopedics and traumatology will help them follow new developments in this field.

Following C5 and C6 brachial plexus injury there is loss of active elbow flexion. Nerve transfers from ulnar and median nerves have been reported for restoration of innervation to biceps and brachialis. However, fatigue of reinnervated elbow flexors remains a challenge. Double versus single fascicle transfer results are superior (MRC Grade 4 score 83% vs. 63.3%; p = 0.013), considering this we evaluate the feasibility of reinnervating a third muscle to support elbow flexion in terms of minimum reinnervation distance and surgical technique. This study explores the feasibility of nerve transfer to biceps, brachialis, as well as brachioradialis (BR) via a lateral cutaneous nerve of forearm (LCNF) in-situ interposition graft. Eight fresh frozen body donors, of mixed age range and gender, were dissected to measure baseline limb lengths, irrespective of bone circumference to determine: branching motor points for key muscles (biceps, brachialis, and BR) and measure donor nerve fascicle dissection lengths and calculate theoretical reinnervation distances from median nerve to biceps, ulnar nerve to brachialis via MSCN and to BR via the LCNF. The novel transfer from the ulnar nerve to BR using LCNF interposition graft was feasible in all eight limbs. The average fascicle dissection length of the median nerve was 14.63 mm (95% CI: 12.4-16.9) and for the ulnar nerve was 17.5 mm (95% CI: 13.9-21.0). Average theoretical reinnervation distance for BR was 94.13 mm (±23.21, R: 70-145, 95% CI: 77.35-110.90) equivalent to 3 months for reinnervation. With the biceps, reinnervation was 23.0 mm (±3.46, R: 15-35, 95% CI: 17.38-26.82) approximately 4 weeks and was 35.0 mm (±16.23, R: 9-55, 95% CI: 25.5-47.39) or approximately 5 weeks for brachialis, not accounting for latency or intramuscular axon regeneration distances from the motor point. Nerve transfer reinnervation of the BR through a LCNF in-situ graft is feasible with acceptable reinnervation distances. Clinical adoption of this modification to the traditional Oberlin nerve transfer could provide a way of improving elbow flexion strength and endurance through providing more reinnervated muscle mass, with the inclusion of BR.

Dislocation remains a common reason for revision after total hip arthroplasty (THA), and adverse spinopelvic mobility is increasingly recognized as a major contributor to instability. Whether its prevalence differs between surgical approaches is unclear. This study compared adverse spinopelvic mobility and associated risk factors in patients who sustained a dislocation after a posterior approach (PA) or a direct anterior approach (DAA), and evaluated whether implant positioning differed between groups. A retrospective analysis was performed on 133 patients with post-operative dislocation and available functional lateral radiographs and low-dose CT scans, including 85 PA and 48 DAA dislocations. Spinopelvic parameters, dynamic pelvic motion between standing, sitting, and supine postures, and established spinopelvic risk factors were assessed. Cup orientation, femoral version, combined anteversion, limb length, and global offset were compared. Spinopelvic morphology was similar, with no significant differences in standing spinopelvic tilt, pelvic incidence, PI-LL mismatch, lumbar lordosis, or lumbar flexion. However, dynamic motion differed markedly. A change in spinopelvic tilt (SPT) of ≥ 20° from standing to seated occurred in 41.3% of DAA dislocations versus 21.1% after PA (p = 0.029). A change in SPT ≤ - 13° from supine to standing occurred in 17.8% after DAA compared with 4.7% after PA (p = 0.048). Other spinopelvic risk factors showed no significant differences. Implant positioning was largely comparable; femoral and combined anteversion, cup inclination, and limb length were similar. Although femoral head size and global offset differed between groups, the association between surgical approach and adverse spinopelvic mobility persisted after accounting for these implant-related factors. Patients dislocating after DAA demonstrated a substantially higher prevalence of adverse spinopelvic mobility despite similar implant orientation and hip restoration. These findings suggest that dynamic pelvic behavior may contribute to anterior instability patterns and highlight the potential relevance of hip-spine assessment in patients undergoing anterior-approach THA. Retrospectively registered, CNIL MR004 2,225,508.

Distraction osteogenesis using the Ilizarov technique is a cornerstone in managing bone defects and limb length discrepancies. The choice of corticotomy method - multiple drill-hole or percutaneous Gigli saw osteotomy - affects regenerate quality, though no clear consensus exists on the superior technique. This prospective observational study compared Gigli saw (n = 14) and multiple drill-hole (n = 20) corticotomy techniques in 34 skeletally mature patients undergoing Ilizarov-based tibial lengthening or bone transport. All surgeries were performed by a single surgeon, with a minimum 1-year follow-up. The Modified Healing Index (MHI) was the primary outcome, while consolidation time and postoperative pain (VAS score) were secondary measures. The mean patient age was 36.97 ± 8.6 years, with road traffic accidents as the most common indication. Radiographs confirmed cortical formation in all cases. The mean consolidation time was 8.85 ± 2.9 months, and the overall MHI averaged 1.32 ± 0.17 months/cm. The drill-hole group showed a significantly lower MHI than the Gigli saw group (t = -2.733, P = 0.010), indicating superior bone regeneration. Both techniques are effective, but the multiple drill-hole method demonstrated better healing and consolidation. Further multicentric randomized studies are needed to confirm these findings.

Rigid intramedullary nailing with suprapatellar approach for tibial shaft fractures in adolescents with open physes.

The use of artificial intelligence (AI) in pediatric musculoskeletal imaging has undergone significant expansion over the past few years. Until recently, the use of AI was limited to evaluating bone age and opportunistically assessing the bone health index. Currently, validated AI software for commercial use includes the detection of appendicular fractures, automated measurement of scoliosis, assessment of lower limb length discrepancy, and assessment of developing hip dysplasia. For other applications, further work is needed. Diagnostic accuracy for detecting rib and vertebral fractures in children using AI is currently not satisfactory; however, future research using enhanced deep learning is projected to address these limitations. The implementation of other applications of diagnostic AI in pediatric musculoskeletal imaging for non-accidental trauma, bone dysplasia, and tumor assessment is hindered by the lack of large pediatric datasets, which would require multicenter collaborations. This paper aims to succinctly outline the present clinical applications of AI in the pediatric musculoskeletal field, while elucidating existing possibilities, limitations, and future needs and prospects.

Functional reconstruction to restore limb length of the upper limbs after sarcoma resection is always challenging for reconstructive surgeons, particularly in pediatric patients, keeping in mind the necessity of matching the growth of limbs. We present our cases of using vascularized proximal fibula free flap, along with physis based on anterior tibial vessels, for upper limb reconstruction. In this study, we conducted a retrospective analysis of 14 consecutive patients who underwent vascularized proximal fibula flap transfer for autologous functional reconstruction following oncologic resection of the humerus between April 2022 and April 2024. We evaluated all patients preoperatively and postoperatively, documenting outcomes like an increase in bone length, bony union, and donor site morbidity. A total of 14 patients with an average age of 9.0 ± 2.4 years were included in this study. The average length of the humerus defect after surgical resection was 14.4 ± 2.3 cm. All patients had a smooth postoperative period with no wound healing issues and 100% flap survival rate. There was a measurable increase in bone flap length with complete bone union in all cases. One patient experienced brief common peroneal nerve palsy postoperatively. In none of the cases was knee instability noted. The mean follow-up period was 17.4 ± 2.6 months. The mean Musculoskeletal Tumor Society (MSTS) score was 29. Vascularized proximal fibula free flap based on anterior tibial vessels not only restores immediate limb length, but the growth allows long-term increase in limb length with minimal donor site morbidity.

Congenital hyperextension of the knee joint is a rare malformation with a variety of names, principally genu recurvatum of knee, backward bending of the knee, and dislocation of knee. Abnormal anterior hyperextension position and limitation of flexion of tibiofemoral joint are the classical clinical presentation in an infant at birth. The accurate etiology of the malformation is undetermined. Congenital genu recurvatum (CGR) can occur as an isolated entity or can present in association with other congenital abnormalities like talipes equinovarus, developmental dysplasia of the hip, hindfoot, and forefoot abnormalities. Two baby girls were born in our institution with abnormal position of the knees that one of them was isolated and the other associated with developmental dysplasia of hip. Based on clinical presentation and X-ray findings, diagnosis of CGR was proved for them. They were treated with early gentle manipulation, serial casting, and splinting at the first days of birth. Postnatal management of the CGR is conservative. Surgical treatment is the last option. Newborns with CGR should be evaluated to determine the cause and plan treatment. Symptoms include pain, joint instability, limb length difference, and cosmetic concerns. A full physical examination with bilateral comparison is essential. Radiology helps measure recurvatum in terms of bone and ligament involvement. Knowing the cause guides proper treatment.

Abstract Background Midshaft femoral fractures are among the most common long-bone injuries in paediatric populations. Treatment strategies have since evolved with Elastic Stable Intramedullary Nailing (ESIN) and Submuscular Plating (SMP) emerging as the predominant options. Despite this, the comparative long-term outcomes of these modalities remain inadequately defined. Methods A literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library. Eligible studies included randomised controlled trials and cohort studies involving children aged 5–16 years treated with ESIN or SMP published from 2010 to 2025. Data extraction focused on fracture union, complications, growth disturbances, and functional outcomes. Results Eight studies comprising 461 patients (266 ESIN, 195 SMP) were included. The systematic review revealed that SMP was associated with slightly faster radiographic union (mean 9.7–11.5 weeks) compared to ESIN (11.2–13.05 weeks). SMP also demonstrated superior outcomes in alignment, limb length discrepancy, and functional recovery, with Flynn’s criteria rating a higher proportion of SMP patients as ‘excellent’ (88–94%) versus ESIN (54.5–76%). While ESIN offered shorter operative times and earlier mobilisation, it was associated with higher rates of implant prominence, refracture, and reoperations. Conclusions Although initial literature favoured ESIN for its healing efficiency and minimal invasiveness, this systematic review found SMP to offer improved union times, alignment, and functional outcomes, particularly in older children or those with length-unstable fractures. Nonetheless, both techniques exhibit safe profiles with low rates of severe complications. The findings highlight the importance of individualising treatment decisions based on fracture pattern, patient weight, and age.