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Abstract Purpose To observe the clinical efficacy and safety of arthroscopic single-row modified Mason-Allen(mMA) suture technique in repairing delaminated rotator cuff tears (RCTs). Methods According to the inclusion and exclusion criteria, a total of 65 selected cases were treated with mMA by a senior physician. Outpatient follow-up visits were conducted at 1.5 months, 3 months, 6 months, and longer after treatment. The postoperative shoulder range of motion (ROM), Constant Murely score (CS), and UCLA shoulder joint score were evaluated by the same examiner. After the follow-up, the data will be summarized and finally subjected to statistical analysis (Fig. 1). Results Collected 65 patients with delaminated RCTs repaired using arthroscopic modified Mason-Allen suture technique from May 2022 to June 2023. Three were lost to follow-up, leaving 62 patients who were included in the study analysis, including 21 males and 41 females; age ranged from 50 to 81 years old, with a median age of 65 years old; 34 cases in the left shoulder and 28 cases in the right shoulder; 30 cases with a history of trauma and 32 cases with no obvious history of trauma; According to the Cofield classification of RCTs, all were delaminated tears of the rotator cuff. We recorded changes in shoulder range of motion (ROM) and functional ratings for at least 6 months (6 months to 18 months, average 10 months) postoperatively. Shoulder anteflexion improved from 98.06 ± 11.28° to 172.26 ± 6.63° (P = 0.028), abduction improved from 69.68°±18.55° to 160.97 ± 9.53° (P = 0.006), internal rotation improved from 14.52°±10.35° to 45.81 ± 4.97° (P = 0.007), and external rotation improved from 22.42°±8.62°to 51.29 ± 6.14° (P = 0.027); CS preoperative 49.08 ± 4.91and at the last follow-up 97.89 ± 1.62 (P = 0.043); and UCLA shoulder score, preoperative 15.73 ± 2.60 and at the last follow-up 33.85 ± 0.15 (P = 0.044). 3 cases developed adhesive capsulitis symptoms due to inactive rehabilitation activities after the operation, and the symptoms disappeared after standard rehabilitation training (no secondary operation). All patients had no problems such as rotator cuff tearing and anchor removal. Conclusion The use of mMA suture technique to repair rotator cuff delamination tears can effectively relieve shoulder pain, improve shoulder function, and have fewer complications.

Abstract Background Dual fluoroscopic imaging system (DFIS) was employed to identify the Center of Rotation(COR) in the lower lumbar spine and determine its relationship with weight bearing. Methods In this study, twenty participants were recruited. A 3D model of each participant’s lumbar spine was created using CT images, and their relative positions were determined through DFIS. By integrating CT imaging with DFIS, the kinematic data of the participants’ spines during movement were captured. The lower lumbar spine’s COR was calculated using the method of perpendicular bisectors. Results While flexing and extending, the Center of Rotation (COR) initially moved downward with increasing load, followed by upward movement as the load further increased. During flexion and extension, the COR coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.3549 ± 0.2176,0.0177 ± 0.1317),(0.0598 ± 0.2095,-0.1806 ± 0.1719),(0.1427 ± 0.1440,-0.0911 ± 0.2722); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(0.0566 ± 0.2693,-0.0727 ± 0.2132),(0.0964 ± 0.2671,-0.2037 ± 0.2299),(0.1648 ± 0.1520,-0.0049 ± 0.1641). The anterior-posterior position of the COR shifted posteriorly with increasing weight-bearing. During lateral bending, the center of rotation coordinates of L3-4 at 0 kg, 5 kg and 10 kg are(0.0745 ± 0.1229,0.0966 ± 0.3403) (-0.0438 ± 0.1281,0.1161 ± 0.1584), (-0.0464 ± 0.1517,0.1320 ± 0.2730); The center of rotation coordinates of L4-5 at 0 kg, 5 kg and 10 kg are(-0.0314 ± 0.1411,-0.0355 ± 0.2088), (-0.0764 ± 0.3135,0.0105 ± 0.3230),(-0.0376 ± 0.1701,0.0285 ± 0.2395). Throughout the lateral bending exercises, the upper and lower COR positions increased as the load increased, while the left and right COR positions remained unaffected by the load increment. The COR height differed between flexion and lateral bending. We observed variations in the COR position of the lumbar spine during lateral bending and flexion-extension movements. This enhanced our comprehension of coupled motion patterns within the lumbar spine. Conclusions Position of the lumbar spine COR changes with variations in the load. During different movements, the COR location of the lower lumbar spine varied. This finding suggests the presence of distinct motion patterns in the lower lumbar spine. As the load increases, the lumbar COR position changes significantly. Abnormal movement patterns of the lower lumbar spine under different loads may be one of the factors that accelerate lumbar disc degeneration.

Abstract Background Medial opening wedge high tibial osteotomy aims to correct coronal plane deformities and redistribute the load in varus-aligned knees. However, changes in the sagittal plane during medial opening wedge high tibial osteotomy can influence the posterior tibial slope, potentially affecting knee biomechanics. The sagittal inclination angle of the osteotomy, which is the angle between the medial joint line and the osteotomy line on lateral view, is a relatively new parameter that has been discussed in the literature, as a factor influencing the posterior tibial slope. The aim of this study is to investigate success rates in achieving the targeted postoperative slope, which is to avoid increasing the slope, with posteriorly inclined sagittal osteotomy. Methods This research was designed as a retrospective single-center case-series study. In order to avoid increasing the posterior tibial slope, our modified surgical technique involves adjusting the sagittal inclination angle to be 10o posteriorly inclined. This angle was considered to be posteriorly inclined if the anterior portion of the osteotomy was inclined proximally. Pre- and postoperative posterior tibial slope measurements were recorded. Changes in postoperative tibial slope compared to preoperative tibial slope were statistically evaluated using the paired t-test. Changes were categorized as decreases, no change, or increases, and these three groups were compared using the one-sample binomial test. Results Ninety-five patients (77 women and 18 men) with a mean age of 52.8 ± 7.0 were included in this study. The preoperative mean posterior tibial slope was measured as 12.5 ± 3.9° and the postoperative mean PTS was 10.6 ± 4.3°. A paired t-test revealed a statistically significant difference of 1.9 ± 3.8° (95% confidence interval: 1.13–2.71; p

Abstract Objective This study aimed to evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) performed with a two-step fluoroscopy technique for treating thoracic osteoporotic vertebral compression fractures (OVCFs) in older patients. Methods A retrospective analysis was conducted on clinical and imaging data from 48 patients diagnosed with thoracic OVCFs, who underwent treatment with percutaneous vertebroplasty(PVP) utilizing a two-step fluoroscopy technique at Yangquan First People’s Hospital between January 2019 and January 2022. The study assessed the clinical efficacy of this procedure by analyzing Visual Analog Scale(VAS) scores, Cobb angle values, and vertebral height measurements before surgery and at 2 days, 3 months, 6 months, and 12 months postoperatively. Results Before treatment, the mean VAS score of patients was 7.5 ± 0.6. Subsequently, at 2 days, 3 months, 6 months, and 12 months after the procedure, these mean scores decreased to 2.3 ± 0.6, 2.2 ± 0.5, 2.2 ± 0.4, and 2.0 ± 0.3, respectively. This decline was statistically significant (P 0.05). Conclusion Percutaneous vertebroplasty using a two-step fluoroscopy method not only has the therapeutic effect of traditional surgical methods, reducing pain from thoracic vertebral compression fractures in the elderly and enhancing their quality of life and mobility, but also streamlines the intraoperative fluoroscopy procedure. This method stand as an effective approach for managing osteoporotic compression fractures of the thoracic vertebrae in elderly.

Abstract Background The site-specific tissue properties of knee cartilage may play an essential role in knee joint mechanical function, and mitigate joint injury and cartilage degeneration. The present study aimed to determine the significance of tissue inhomogeneity in knee joint contact mechanics using a porcine model. Methods Finite element models were developed for a porcine knee with intact and total meniscectomy conditions to simulate whole-joint compression-relaxation tests under a 1.2-mm ramp-compression at 0.01, 0.1, or 1 mm/s. Two reference benchmarks were introduced for the implementation of poromechanical material properties of fibril-reinforced cartilage: Benchmark II consisted of 17 sets of cartilage properties, each for a region in the knee, representing site-specific inhomogeneity averaged from cartilage indentation maps of 14 porcine knees. Benchmark I was comprised of a single set of properties by taking the average properties of 17 regions in Benchmark II, assuming tissue homogeneity. To validate the modeling method, the reference benchmarks were used to produce results against whole-joint compression test data. Results Both benchmarks were able to approximate experimental force-compression data obtained from the same knee with intact menisci and total meniscectomy, provided that the average properties from 14 knees were appropriately scaled to account for individual joint differences. Noticeable differences in stress and pressure distributions were observed between the benchmarks. For instance, benchmark I generated higher peak contact and fluid pressures in the medial tibial cartilage, but benchmark II produced the higher ones in the lateral tibial cartilage. The load sharing asymmetry between the lateral and medial compartments was reduced in benchmark II which was more pronounced for higher compression rates. On the other hand, benchmark II produced a more uniform stress distribution or lower maxima. Meniscectomy caused a slight shift of the contact centers in the tibial plateaus as compared to the intact joint. Conclusion The modeling results demonstrated substantial differences in loading distributions in the joint between the homogeneous and nonhomogeneous models represented by the two benchmarks, indicating the role of tissue inhomogeneity in the joint contact mechanics. Region-dependent tissue properties may need to be implemented in joint mechanical modeling to evaluate the site of cartilage prone to injury or degeneration.

Abstract Background Total hip arthroplasty (THA) is associated with considerable blood loss during the perioperative period, which commonly requires a blood transfusion, especially in patients who continue aspirin treatment preoperatively. Blood transfusion can significantly increase both the length of hospital stay and total treatment costs and is potentially associated with adverse reactions. However, a visual predictive model for assessing the risk of blood transfusion in THA patients is lacking. The aim of this study was to develop and validate a nomogram to predict the risk of blood transfusion during THA in patients who continue aspirin treatment preoperatively. Methods From June 2016 to December 2022, 228 consecutive patients who continued preoperative aspirin treatment and underwent primary unilateral THA were enrolled in this retrospective study. Potential risk factors were screened using least absolute shrinkage and selection operator (LASSO) regression, and univariate and multifactorial logistic regressions were performed on the factors screened using LASSO regression to further control for confounding effects. Finally, a nomogram was constructed on the basis of the variables identified through multiple regression analysis. Internal validation was carried out using the Bootstrap method to assess the performance of the model using the C-index, area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Results Among the 228 patients, 43 (18.9%) received a blood transfusion. Patients who received a blood transfusion had a longer hospital stay (p = 0.01). The independent risk factors for blood transfusion included the concomitant use of clopidogrel (OR = 4.415), preoperative hemoglobin level (OR = 0.062), total estimated blood loss volume (OR = 3.411), American Society of Anesthesiologists (ASA) class (OR = 1.274), and the use of tranexamic acid (OR = 0.348). The prediction model had a C-index of 0.862, an internally validated C-index of 0.833, and an AUC of 0.833, indicating excellent discriminatory power. The calibration curve showed a good calibration effect, and DCA indicated that the nomogram has strong clinical applicability. Conclusions Based on these five independent risk factors, our nomogram can accurately predict the risk of blood transfusion in THA patients who continue aspirin treatment preoperatively, thereby assisting surgeons in clinical decision-making.

Abstract Background Attention to the collection of patient-reported outcomes measures (PROMs) associated with total hip arthroplasty (THA) is growing. The aim of this study was to preoperatively predict failure to achieve the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) between pre- and postoperative PROMs. In addition, we sought to identify factors predictive of failure to achieve MCID and SCB in patients undergoing a THA. Methods A retrospective query of the electronic health record data was performed at a single institution. Outcomes of interest were the anchor-based MCID, the distribution-based MCID, and the SCB for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement. Several machine learning models were built for each outcome and were evaluated by areas under the receiver operating characteristic curve and the precision-recall curve. Furthermore, logistic regression models were used to identify significant risk factors. Results Of the 857 patients who underwent THA, 350 patients completed both pre- and postoperative surveys. Of the final sample (i.e., 350 patients), 56 (16.0%), 29 (8.3%), and 71 (20.3%) failed to reach the anchor-based (i.e., 17.7 points) and distribution-based (10.6 points) MCIDs and the SCB (i.e., 22.0 points). The machine learning model performances were far beyond the baseline and comparable to the ones in existing studies, suggesting reliability in the prediction. Two shared factors associated with the failure in both the MCIDs and the SCB were highlighted: a patient’s race and pre-existing mental illness. Conclusion Understanding the risk factors of failing to meet MCID and SCB may provide a more objective opportunity to quantify patient and surgeon expectations associated with THA. Our findings call stakeholders' particular attention to patients with preoperative mental disorders, and raise further questions regarding the impact of race, in the care of patients with degenerative hip disease.

Abstract Background To analyze the risk factors of neck re-shortening after reduction and fixation in patients with valgus-impacted femoral neck fractures. Material and methods Analysis of the clinical data of 46 cases with valgus-impacted femoral neck fractures treated by one surgeon in our hospital from January 2020 and December 2023. The collected clinical data includes: patient's gender, age, body mass index (BMI) and American Society of Anesthesiologists (ASA) classification, fracture side, Cause of injury, time from injury to surgery, Pauwels angle, valgus angle, posterior tilt, Hounsfield units of femoral neck from CT scan, surgical time, internal fixation method, blood loss in operation. SPSS 26.0 software (univariate analysis and Logistic regression analysis) was used to simulate a decision analysis and find risk factors. Results 17 of 46 patients who were included in the study developed neck re-shortening after surgery, with an incidence rate of 37.0%. Univariate analysis showed that there were significant differences in age(P = 0.004), valgus angle(P 53.5 years (OR 4.821, 95% CI: 1.248–18.624), initial valgus angle was > 17.6° (OR 2.417, 95% CI: 1.567–3.727), and femoral neck CT HU ≤ 92.5(OR 15.500, 95% CI: 4.057–59.222) were risk factors of postoperative neck re-shortening(P

Abstract Background The National Institutes of Health (NIH) Research Task Force (RTF) on Research Standards for Chronic Low Back Pain impact score is a composite measure of Patient Reported Outcomes Measurement Information System (PROMIS) pain intensity, pain interference and physical function. PROMIS surveys are available in short-form and computer adaptive testing (CAT) formats. Minimal important change (MIC) can be estimated to determine if between-group differences are large enough to be important. To date, three anchor-based estimates of impact score MIC ranging from 3 to 7.5 have been published, and all were based on data collected using PROMIS short-form surveys. None used CAT versions of PROMIS surveys. Methods Secondary analysis of data collected during the conduct of two randomized clinical trials of 6-week courses of nonpharmacological pain therapies. Research subjects were US active-duty service members referred to an interdisciplinary pain management center. Impact score was assessed at the beginning and end of treatment. The Patient Global Impression of Change (PGIC) questionnaire was administered at the end of treatment and asked respondents to report their status compared to the start of treatment using a 7-item categorical scale ranging from very much improved to very much worse. A PGIC response of “much” or “very much” improved defined important improvement. Receiver operating characteristic (ROC) curve analysis and predictive logistic regression models were used to estimate MIC for the full combined sample and stratified by study sample and baseline impact score. Measures of individual statistical change were also computed. Results Overall, a decrease of 3 points in impact score was the estimated MIC (2.5 for ROC analysis and 3.4 for predictive modeling approach). Larger decreases in impact score were needed for participants with moderate and severe baseline pain impact to report important improvement. Thresholds for individual statistically significant change ranged from 6 to 14. Conclusions Using data collected with CAT surveys, we calculated an MIC of 3 points for the NIH RTF impact score, and estimates ranged from 1.3 to 7.2 depending on the baseline impact score and statistical approach used. These findings are consistent with previous MIC estimates that were based on non-adaptive short form surveys and have implications for improving the accuracy of pain treatment response assessment. Registry information Trial registration. ClinicalTrials.gov. Registry numbers: NCT03297905 (registered 9/29/17) and NCT04656340 (registered 11/30/20). Link to full applications: https://classic.clinicaltrials.gov/ct2/show/NCT03297905?titles=Determinants+of+Optimal+Dosage%26cntry=US%26draw=2%26rank=1 ; https://classic.clinicaltrials.gov/ct2/show/results/NCT04656340?titles=Complementary+and+Integrative+pain+therapies+and+functional+restoration+%28IMPPPORT%29%26draw=2%26rank=1 . Patient enrollment dates: SMART: 17 March 2021, prospectively registered; IMPPPORT: 9 December 2015, retrospectively registered.

Abstract Background This study aimed to assess the relationships between knee OA (KOA) and the genes encoding collagen type XI-alpha1 (COL11A1), vascular endothelial growth factor (VEGF), and growth differentiation factor-5 (GDF-5), which have recently been investigated for their role in the pathophysiology of KOA in a Turkish Population. Methods This study included 100 patients who underwent surgery for KOA at Pamukkale University Medical Faculty’s Orthopedics and Traumatology clinics and 100 volunteers with knee pain but without radiological evidence of KOA as a control group. Knee radiographs were assessed, and blood samples were collected from both groups for gene polymorphism analysis, with a focus on COL11A1 rs4907986, COL11A1 rs1241164, VEGF rs833058, and GDF5 rs143383. Results Our findings revealed no statistically significant difference between the KOA and control groups for COL11A1 rs4907986 and rs1241164. However, COL11A1 rs4907986 was found to be more common in women. The VEGF rs833058 polymorphism did not significantly differ between the KOA and control groups, although the equal distribution of homozygous polymorphisms in both groups suggests its potential utility in diagnostic considerations. Similarly, no significant difference was observed for the GDF-5 rs143383 polymorphism. However, this polymorphism was more frequent than the wild type in both groups, suggesting its potential association with KOA and its possible utility as an early diagnostic marker. Conclusion While no significant associations were found between COLL11A1, VEGF, or GDF-5 polymorphisms and KOA, the findings highlight the prevalence of GDF5 rs143383 in both groups, suggesting its potential role in the pathogenesis of KOA and its utility as a diagnostic marker. Further research is needed to better understand the genetic factors involved in KOA. Clinical trial number Not applicable.

Abstract Background Individuals with arthrogryposis multiplex congenita (AMC) exhibit a range of modes of ambulation, from walking independently to requiring a wheelchair. Presence of joint contractures and muscle strength plays a crucial role, and, in some patients, orthoses are necessary to facilitate or enable walking. Methods Gait was assessed with a three-dimensional (3D) gait analysis, calculated as a gait deviation index (GDI) of nine kinematic variables, and compared between childhood and adulthood. Results A total of 12 persons, 8 with community and 4 with household ambulation, who had undergone a 3D gait analysis in childhood (CH) and as an adult (follow-up, FU) at the same gait laboratory were enrolled in the study. At the FU, three, five, and four participants respectively were categorized based on need of joint stabilization while walking as AMC1 using knee-ankle-orthoses (KAFOs) with locked knee joints, AMC2 using KAFOs with free-articulating knee joint or ankle–foot-orthoses (AFOs) and AMC3 using insoles or shoes. Two participants in AMC2 had changed from AFOs to insoles or shoes between CH and FU. There were no differences in joint contractures between the AMC groups at CH or FU. Two participants had orthopaedic surgery between CH and FU. The GDI of the leg with the lowest GDI score at CH vs FU was median [min, max] 55.67 [41.79, 65.14] vs 48.4 [42.67, 56.30] (p = 1.000) in AMC1, 81.25 [59.42, 84.12] vs 68.96 [47.68, 70.33] (p = 0.043) in AMC2, and 73.15 [43.94, 91.72] vs 73.46 [50.82, 75.24] (p = 1.000) in AMC3. Time and distance parameters of cadence, walking speed, step length, and step width did not differ between the CH and FU, nor were there differences in satisfaction with the device or the service at the FU. Conclusion A difference in the GDI was found in one of the AMC groups between childhood and adulthood that could not be explained by factors such as contractures or muscle strength. This study reflects that gait is maintained in ambulating persons with AMC who were offered an orthosis program that has been available from childhood into adulthood.

Abstract Background Knee osteoarthritis (OA) is the most common joint disorder of the knee, and its progression, influenced by multifactorial predisposing factors such as age, BMI, and physical activity, often results in significant limitations in day-to-day activities and deterioration of quality of life. Although the prevalence and predisposing factors of OA are well-documented globally, this study is distinct in its focus on the semi-urban population of Al Madam City, Sharjah. The unique socio-cultural and occupational characteristics of this community provide an opportunity to identify localized risk factors and their impact on OA prevalence, offering insights that can inform tailored healthcare strategies. Objective The present study was conducted to estimate the prevalence of OA and its associated predisposing factors among the population of Al Madam, Sharjah. Methods A community-based cross-sectional study was conducted to estimate the prevalence of knee OA in the population of Al Madam City, Sharjah. This study was conducted in twelve villages. 1300 participants were recruited through convenience sampling using a screening questionnaire survey to identify individuals with knee OA. The Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used, with an additional questionnaire consisting of questions related to its predisposing factors. Results The prevalence of knee OA was 12.9% in Al-Madam City, Sharjah. Predisposing factors, such as age (χ2:314.900), sex (χ2:13.581), nationality (χ2:76.657), BMI (χ2:86.174), physical activity levels (χ2:11.099), previous knee injury (χ2:657.715), level of education (χ2:259.906), and occupation with the sedentary job (χ2:193.911), were found to be associated with the prevalence of knee OA. Conclusions This study highlights that the prevalence of knee OA in Al Madam City is 12.9%, with significant associations observed between knee OA and factors such as age, sex, BMI, physical activity levels, education, and previous knee trauma. The findings underline the impact of the city’s unique socio-cultural and occupational characteristics, such as high representation of labor-intensive jobs and limited leisure activity options, on the development of knee OA.

Abstract Background Distal radius fractures are among the most common fractures, traditionally evaluated using two-dimensional (2D) parameters. These methods are unreliable in significantly displaced fractures, with discrepancies among evaluators. Recent advancements in imaging have introduced three-dimensional (3D) models, but standard parameters for 3D reduction morphology are not well established. This study aimed to develop a novel method for evaluating 3D reduction morphology based on the normal vector of a plane defined by anatomical reference points, comparing the reduction shape to the mirror image of the unaffected contralateral side. Methods This retrospective case-control study included 27 patients (mean age 67.6 years) who underwent osteosynthesis with a volar locking plate for distal radius fractures. Preoperative and postoperative computed tomography (CT) scans of the affected and unaffected wrists were analyzed using 3D image analysis software. The 3D coordinates of three reference points; (1) radial styloid process, (2) sigmoid notch volar edge, and (3) sigmoid notch dorsal edge, were used to evaluate the reduction shape and compare it to the unaffected side mirror image. Correlations between vector angles in the coronal, sagittal, and axial planes and clinical outcomes, such as % total active motion (%TAM) and Mayo wrist scores, were analyzed. Results The distances between the unaffected mirror image and postoperative image for the three reference points were 2.1 mm, 2.1 mm, and 2.7 mm, with barycenter differences of 1.7 mm. The postoperative plane areas consisted from three reference points were significantly larger in the postoperative image compared to the unaffected mirror image (203.4 mm² vs. 192.4 mm², P

Abstract Purpose The two most commonly used techniques for gap balancing in robot-assisted total knee arthroplasty (RA-TKA) are measured resection (MR) and ligament balancing (LB). There are limited studies have reported differences in intraoperative and postoperative outcomes between MR-TKA and LB-TKA in RA-TKA. This study aims to compare the intraoperative and postoperative outcomes of primary RA-TKA between LB and MR techniques. Methods This cohort study utilized prospectively collected data from a single center, spanning from January 2021 to December 2022. We compared the intraoperative procedures and postoperative clinical and imaging results between two groups. Results The LB group had a thinner distal femur cut and a lower usage of thicker polyethylene. Additionally, the LB group exhibited a higher mean femoral component external rotation and greater tibial posterior slope. The rate of soft tissue release and bone recut was lower in the LB group, as was the mean C-reactive protein level. Conclusion In RA-TKA, LB offers advantages in soft tissue protection and bone mass preservation. However, no differences were observed in clinical and radiographic outcomes after a 2-year follow-up.

Abstract Background High-grade acromioclavicular (AC) joint injuries often require coracoclavicular (CC) stabilization, which increases the risk of neurovascular injury due to coracoid process proximity to vital structures. Previous intact AC joint measurements may have underestimated the surgical risks of high-grade injuries with altered anatomy. Therefore, this study investigated the distance from the coracoid base and tip to the adjacent neurovascular structures in simulated acute high-grade AC joint injuries. Methods Eight freshly frozen cadaveric specimens, consisting of four male and four female specimens, were subjected to simulated high-grade AC joint injuries via AC capsule and CC ligament transection and deltotrapezial fascia detachment. Closest distances from the coracoid base and tip to the lateral border of adjacent neurovascular structures were measured in the supine, beach chair, and lateral decubitus positions. Results The distance from the coracoid base to the neurovascular structures varied significantly depending on the body position. The supine position provided the greatest distance, reducing the risk of neurovascular injury compared to the beach chair and lateral decubitus positions (p = 0.030 and p

Abstract Background There is no conclusive evidence from evidence-based medicine that clarifies whether the efficacy and safety of lateral lumbar interbody fusion (LLIF) differ significantly with or without auxiliary posterior fixation. This study embarks on a comprehensive comparative meta-analysis, delving into both domestic and international research landscapes, to scrutinize the efficacy of stand-alone LLIF versus LLIF coupled with auxiliary posterior fixation in the treatment of degenerative lumbar diseases. Methods In this meta-analysis, we searched Pubmed, Embase, and Cochrane databases from inception to December 2023. This study includes research comparing LLIF combined with auxiliary posterior fixation versus stand-alone LLIF in the treatment of lumbar degenerative disease. and we excluded studies without full-text or for which data extraction was not possible; studies using animal studies; reviews and systematic reviews. Review manager 5.3 software was used to analyze the data. Results Twelve literatures are included in this study, all of which are cohort studies. The sample sizes varied between 30 and 132, totaling 781 patients, of which 440 belonged to the group with posterior fixation, and 224 to the stand-alone group. Findings revealed a significantly higher fusion rate when LLIF was combined with auxiliary posterior fixation compared to stand-alone LLIF. Additionally, postoperative disc height and restoration in segmental lordosis of LLIF combined with auxiliary posterior fixation were all significantly higher than that of stand-alone LLIF. However, postoperative VAS score for LLIF combined with auxiliary posterior fixation is significantly higher than that for stand-alone LLIF. There were no significant differences in the restoration of lumbar lordosis, the ODI and incidence of adverse events. Conclusions In summary, compared to standalone LLIF, the combination of LLIF with auxiliary posterior fixation exhibits a higher postoperative fusion rate. Additionally, both postoperative disc height and restoration of segmental lordosis are significantly greater. Although the occurrence of adverse reactions is consistent between the two surgical approaches, the LLIF combined with auxiliary posterior fixation approach demonstrates a lower reoperation rate.

Abstract Background Fracture healing is commonly evaluated through physical examination and radiographic results. However, these methods rely on the surgeons’ subjective experience, without including the objective biomechanical properties of the bony callus. This paper presents an innovative method for measuring the callus stiffness in vivo to evaluate fracture healing, further instructing surgeons to remove external fixator safely. Methods A novel dynamic axial load-share ratio (D-LS) index and its associated measuring system was introduced, including the system’s composition (hexapod and insole modules), theoretical model, and method for D-LS measurement. From Jan 2022 to May 2024, 36 patients with tibial shaft fracture treated by Taylor Spatial Frame were evaluated in this prospective study. Once the patient had reached clinical bone healing conditions, the in vivo D-LS measurement was conducted. The patients’ demographic data, clinical outcomes, particularly D-LS value and refracture rate were recorded. Results At a mean follow-up of 16.50 ± 5.79 months, a total of 36 patients completed the final follow-up. Fixators were removed with an average of 24.81 ± 4.51 weeks. The result of hexapod module’s precision examination were maximum errors of 3.72 N, 3.31 N and 2.68 N in x-, y- and z-axis, respectively. The measuring process took an average system installation time of 15.42 ± 4.88 min. Two patients (5.56%) reported fracture site pain. Each patient’s D-LS was determined after three rounds of measurement. The average D-LS value was 15.58 ± 2.77% (range, 9.60–20.52%). None of the 36 patients reported refracture at the last follow-up. Conclusions The novel D-LS measurement system can measure the dynamic forces of lower limb for patients with external fixator in vivo. An objective biomechanical indicator of the regenerate callus was provided by the D-LS. The D-LS measurement is a complement to standard radiological assessment only after radiologically confirmed bone union. Measuring the D-LS in vivo could indicate whether the callus healing is sufficient in external fixation, and 15.6% (average) was recommended as a reference D-LS value for safe fixator removal.

Abstract Background Avascular necrosis (AVN) of the femoral head lacks a standardized classification system, with multiple systems used in clinical practice by orthopedic surgeons, radiologists, and clinicians treating this condition. Differences in the reliability and diagnostic criteria across existing classification systems can give rise to conflicts in the treatment decisions made. Therefore, identifying the most reliable and uniform classification system is crucial for optimal patient care and treatment planning. This research aimed to identify the most reliable and uniform classification system across all therapeutic results. It also considered precision and dependability as diagnostic standards among these systems. Methods This retrospective observational study was conducted between January 2021 and January 2023, involving 20 patients who had avascular necrosis of the femoral head confirmed by magnetic resonance imaging. The reliability of diagnosis was evaluated using five main classifications (Ficat and Arlet, Steinberg, Mitchell, ARCO, Marcus Enneking) at two different time points: initially and after one month, assessed by two orthopedic surgeons and one radiologist. Key measures included the intraclass correlation coefficient (ICC) for interobserver agreement/intraobserver consistency, Spearman’s rho for MRI progression correlation, and staging outcome analysis of variance. Results The findings showed that classification systems have different diagnostic precision. Furthermore, the Marcus Enneking scoring system recorded the best diagnostic performance (AUC = 0.65, p

Abstract Background The current study investigated Whiplash Associated Disorders (WAD) and health related quality of life (HRQOL) from the perspective of Swedish patients. Another aim was to assess medicine consumption and income loss due to WAD. Method The present study was a planned secondary analysis using baseline data from a prospective, multicentre randomized controlled trial. The study participants were WAD patients, victims of four-wheel motor vehicle collisions at least six months but not more than five years ago. Neck Disability Index and HRQOL were measured. HRQOL was measured by the EQ-5D instrument. Cross tabulations, Box Plots, and regression analyses were performed. Trial registration section The study was registered before data collection started (ClinicalTrials.gov Protocol ID: NCT03022812, initial release 12/20/2016). Results There were 137 WAD participants (78.8% women), and almost three-fourths (74.5%) were married. The majority (54.7%) of the WAD patients were in white-collar jobs, followed by blue-collar jobs (35%) and students /unemployed (10.2%). Both consumption of medicine for neck pain and income loss due to WAD have a negative relation with the Neck Disability Index (NDI). On average, EQ-VAS for WAD women is 58.21 (± 17.625), and for men, it is 61.11 (± 16.444). WAD patients with a university education have the highest EQ-VAS average of 60.42 (± 17.738). Conclusions The low HRQOL seen in WAD patients in this study should warrant the attention of the medical fraternity, researchers and policymakers.

Abstract Background Musculoskeletal disorders, including back pain, pose a significant challenge to workforce health, particularly in professions characterized by prolonged periods of sedentary activities. This challenge is notably relevant in commercial airline piloting due to unique ergonomic issues. Despite extensive research on back pain in various occupational settings, an understanding of the specific factors contributing to back pain among commercial airline pilots in Saudi Arabia is still lacking. Methods This cross-sectional survey aimed to investigate the prevalence of back pain among Saudi Arabian commercial airline pilots. A structured questionnaire, developed through literature review and expert consultation, covered demographic information, occupational details, and back pain history. The survey was administered online to active pilots recruited through the Saudi Airlines Medical Services, with data collection spanning six weeks. Results Among 310 predominantly male participants (99.0%), a significant prevalence of back pain was identified, with 71.3% reporting lower back pain in the last 12 months. Factors associated with a decreased likelihood of low back pain included comfortable seat conditions (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.2–0.7), a senior officer position (OR: 0.5, 95% CI: 0.3–0.8), and regular exercise (OR: 0.6, 95% CI: 0.3–1.0). Higher flying hours in the past year were associated with an increased prevalence of back pain (OR: 2.2, 95% CI: 1.2–4.1). The multivariable analysis revealed that a comfortable seat was the single independent factor most significantly associated with back pain (OR: 0.3; 95% CI: 0.1–0.7). Conclusions This study highlights a notable prevalence of back pain among Saudi Arabian commercial airline pilots, underscoring the need for targeted interventions. The critical role of seat comfort emphasizes the importance of ergonomic considerations. Findings contribute to the global discourse on pilot health, emphasizing the necessity for ongoing evaluation and potential revisions to existing guidelines. Clinical trial number Not applicable.

Abstract Background Current guidelines for osteoporosis diagnosis do not recommend forearm dual-energy X-ray absorptiometry (DXA) as a standard tool, except in specific cases. This systematic review and meta-analysis investigates the potential correlation between forearm BMD and BMD at the lumbar and/or hip sites. Methods The protocol was registered in PROSPERO (CRD42024568756), and the study adhered to the PRISMA guidelines. Major databases were systematically searched from their inception until August 2024 to identify studies evaluating the ability of forearm DXA scans to detect osteoporosis, particularly in comparison to central sites like the femoral neck and lumbar spine. A meta-analysis was conducted on studies that reported correlation coefficients between these measurements. Quality assessment was conducted independently by 3 reviewers following Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Additionally, a narrative synthesis of the main findings across different patient groups was performed. Results Thirteen studies were included. Published between 1992 and 2023, these studies involved 5941 participants. Forearm scans exhibited strong correlations with lumbar and femoral sites (pooled effect size 0.603, 95%CI 0.579–0.627 and 0.641, 95%IC 0.600–0.680, respectively) demonstrating good predictive value for central osteoporosis. Despite some result variations, forearm DXA scanning emerged as a valid method, especially when lumbar and femoral measures are challenging. Conclusions A DXA scan of the distal forearm proves to be a valuable supplementary tool for identifying osteoporotic conditions. This could be particularly relevant in older patients, where conducting lumbar or hip scans is often challenging or not feasible.

Abstract Background Thoracic hyperkyphosis (HK), common in older adults, has been linked to impairments in physical function, mobility, balance, gait, and falls. Our pilot study used a novel 4-week manual therapy and exercise intervention for HK and showed improved posture and function. This secondary analysis aims to explore 1) the changes in gait parameters after a novel intervention for HK, 2) the correlations between posture and gait variables at baseline, and 3) pre- to post intervention. Methods This secondary analysis uses data from a quasi-experimental, single group pilot study. Participants with HK underwent pre- and post intervention measurements in posture, function, and unique to this secondary analysis, gait parametrics of velocity (V), step length (SL), double limb support (DLS), and step width (SW) using the GAITRite® electronic walkway. Paired t-tests compared pre- and post intervention gait parameters. Pearson correlation coefficients were utilized to investigate correlations between all variables at baseline and in pre- and post intervention change values. Results Fourteen women and 8 men (aged 65.9 years ±9.2; range 52 - 90) completed 12 treatments (3 times/week for 4-weeks). Statistically significant improvement (p≤.001) occurred pre- to post for postural measures: height (M=0.73cm ±0.54), Kyphotic index (-2.41 ±2.96), Block (-1.17cm ±1.22), Acromion to table (ATT) (-1.85cm ±1.42), and 3 gait measures: V (M=0.087m/s ±0.09), SL (2.34cm ±2.55), and DLS (- 0.031sec ±0.04). SW improvement was not statistically significant. Block and ATT measures were moderately correlated with V, SL, SW (Block only), and DLS (ATT only) at baseline. Strong correlations were found among V, SL, and DLS at baseline and in pre- to post change scores, but no correlation between change scores of posture and gait. Conclusions This study shows that a clinically practical 4-week PT intervention may benefit older adults with HK by demonstrating improved posture and gait parameters. Further research is warranted. Trial registration This study was retrospectively registered on 16/09/2019 under ClinicalTrials.gov Identifier: NCT04114331.

Abstract Background Work-related musculoskeletal disorders (WRMSDs) are significant concern in intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU nurses, providing valuable insights for targeted interventions. Methods In this six-month convergent mixed methods study, 200 consenting nurses with over one year of experience from seven ICUs across three public tertiary hospitals of Ahmedabad participated. Structured questionnaires were used to collect data on socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain (through modified Nordic Musculoskeletal Questionnaire) and ergonomic issues using REBA (Rapid Entire Body Assessment) scale. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analysis involved chi-square, t-test and logistic regression, with a significance level set at p

Abstract Background Increasing life expectancy has led to a rise in hip fractures and an associated increase in hemiarthroplasty procedures aimed at restoring mobility and preventing muscle loss. Despite the extensive literature on failed hemiarthroplasty, limited data address the influence of pre-operative fracture types—intracapsular versus extracapsular—on outcomes, including inpatient mortality. This study investigates the revisions of uncemented bipolar hemiarthroplasties concerning fracture type and identifies risk factors for inpatient mortality. Methods This retrospective cohort study included 68 patients (16 males and 52 females) who underwent revision of uncemented bipolar hemiarthroplasties at a single institution between 2017 and 2024. Data on demographics, comorbidities, fracture type, surgical details and outcomes were analysed. Statistical analyses included t tests, chi-square tests and logistic regression, with significance set at p

Abstract Background This study aimed to compare the effectiveness of exercise therapy delivered via a smartphone mobile app, using asynchronous video-based tools, with synchronous telerehabilitation models using videoconferencing for individuals with fibromyalgia syndrome (FMS). Methods The research, utilizing a randomized clinical study design, involves sixty-six FMS patients in an 8-week exercise program. Participants are divided into synchronous (n: 33) and asynchronous (n: 33) groups. Assessments, pain intensity (VAS), functional limitations (FIQr), health-related quality of life (SF 12), catastrophizing (PCS), anxiety and depression (HADS), functional capacity (6MWT), muscle strength (Arm curl test), and joint position sense (LI-RATT), are conducted at baseline, mid-treatment (week 4), end of treatment (week 8). Results No significant group-time interaction was found for total VAS, FIQ, SF 12, PCS, HADS, 6MWT, Arm curl tests, LI-RATT extension, LI-RATT flexion, LI-RATT right rotation scores (p > 0.05). Significant effects of time and interactions between groups and time were observed in the neck (p = 0.010, ES = 0.19) and back region (p = 0.039, ES = 0.19) of the Visual Analog Scale, left rotation score of the LI-RATT (p = 0.008, ES = 0.36), and HADS Anxiety Score (p = 0.029, ES = 0.31). Group differences were significant at all-time points for the outcomes (p

Abstract Background Alpha-melanocyte-stimulating-hormone (α-MSH) has been identified as a new anti-inflammatory treatment compound in rheumatoid arthritis (RA) and other inflammatory diseases. However, its direct effect on bone cell differentiation or on bone regeneration, which is an inflammatory process, too, has not been investigated, yet. Bone tissue is significantly affected in inflammatory joint diseases. Additionally, inflammatory signaling is essential -in bone regeneration during fracture healing. Therefore, we evaluated the impact of α-MSH-treatment on bone forming cells in an inflammatory setting in vitro and as a treatment approach in a murine fracture healing model in vivo. Methods The influence of α-MSH treatment and melanocortin-receptor expression patterns was investigated in vitro in the presence of either IL-1β or/and TNF-α as an inflammatory stimulus. Osteoblast cell function was evaluated by analyzing proliferation and mineralisation capacities. Using quantitative real time PCR, we analyzed mRNA expression of receptors. To explore the impact of α-MSH on bone regeneration in vivo, treatment with α-MSH or NaCl (control) was performed in a murine fracture-healing model using a closed femur fracture stabilized with an intramedullary implant (female, n = 6–8 mice per group). Results α-MSH-treatment did not impair either proliferation nor mineralisation of osteoblastic cells under native or inflammatory conditions (no significant differences found). All four melanocortin receptor-molecules were expressed in murine osteoblastic cells but in very limited amounts and this did not change upon treatment with inflammatory cytokines or α-MSH or both at the same time. Callus formation in fractured femurs of α-MSH-treated mice was slightly delayed at day 14 post fracture with regard to less cartilage formation (NaCl: 19.9%; α-MSH: 13.5%) and soft tissue remodeling (NaCl: 15.2%; α-MSH: 19.5%) but these results were not significantly different and fracture healing overall occurred in a regular way. Conclusion α-MSH has no negative impact on bone or bone-forming cells in native, inflammatory, or regenerative contexts. We can conclude from our results, that treatment of inflammatory diseases using α-MSH does not interfere significantly with bone regeneration in a murine fracture model and therefore treatment with α-MSH could be continued without negative effects on bone formation and bone regeneration in patients. Clinical trial number Not applicable.

Abstract Objective This study aims to investigate the associated factors of intercostal neuralgia in patients with osteoporotic vertebral compression fractures (OVCF) of the thoracic spine and to develop a predictive model to assess the likelihood of patients developing intercostal neuralgia following thoracic vertebral fractures. Methods The retrospective study involved 518 patients with thoracic OVCF treated at our hospital, among whom those with and without intercostal neuralgia were matched at a 1:1 ratio.Relevant basic clinical data and imaging parameters of the patients were recorded, t-test was used for continuous variables and chi-square test for categorical variables to determine the factors associated with intercostal neuralgia. Subsequently, the above associated variables were screened using univariate and multivariate logistic regression models to obtain associated factors. Finally, a prediction model for osteoporotic thoracic spine fracture was developed and validated. Results This study included a total of 104 patients based on the presence or absence of intercostal neuralgia.The results of multifactorial logistic regression analysis showed that injured vertebral intervertebral foraminal area (P = 0.0008, regression coefficient estimate 0.0490, 95% confidence interval 0.0219–0.0798, OR = 1.0503), injured vertebral intervertebral foraminal volume (P = 0.0001, regression coefficient value − 0.0028, 95% confidence interval − 0.0044 to -0.0015, OR = 0.9972), and nerve root area (P = 0.0038, regression coefficient estimate=-0.0876, 95% confidence interval − 0.1506 to -0.0309, OR = 0.9161) were independent associated factors.The fatty degeneration ratio have a positive promotional effect on the probability of developing intercostal pain.The area under the ROC curve (AUC) of the prediction model was 0.851, which indicated that the line graph model had a certain degree of predictive validity. Conclusion Thoracic osteoporotic fractures are a common geriatric disease, and changes in the morphological parameters of the intervertebral foramina, such as a reduction in the area and volume of the injured vertebral intervertebral foramina, as well as fatty degeneration of the thoracic back muscles, suggest an increased probability of developing intercostal neuralgia.

Abstract Background People with knee osteoarthritis (OA) may have more thigh intermuscular and intramuscular adipose tissue (interMAT and intraMAT, respectively) compared to those without knee OA. Literature has not considered differences in body mass index (BMI) in the context of comparing intraMAT and interMAT between individuals with and without knee OA, matched for BMI (± 1 kg/m²). This study aims to compare interMAT and intraMAT, along with physical function (including knee extension strength), between individuals with and without knee osteoarthritis, matched by BMI. Methods Participants aged ≥ 40 years with symptomatic and radiological knee OA group (grade 2 and 3 on the Kellgren and Lawrence (KL) scale) were included in the affected group, while those with no knee pain and no radiological knee OA changes were included in the unaffected group. No participants were lost to assessment, ensuring complete data analysis for all participants. We used independent t-test and mean difference (95% CI) to compare thigh intraMAT and interMAT volume, self-reported measures (WOMAC questionnaire), physical function measures, and knee extension strength between groups. Results Forty-six participants were analyzed (23 in each group). The affected group had significantly higher intraMAT compared to the unaffected group (p

Abstract Background Fragility fractures lead to considerable societal costs and individual suffering. Despite the availability of cost-effective treatments for high-risk patients, a significant treatment gap exists, with many high-risk individuals remaining unidentified and untreated. The aim of this study was to explore the potential cost-effectiveness and societal impact of opportunistic screening for fracture risk with IBEX Bone Health (BH), a software solution that provides bone mineral density from wrist radiographs, in a UK general radiography setting. Methods The study used a health economic model that compared the health outcomes and costs of screening with IBEX BH versus usual care for men and women aged 50 and older who had a forearm radiograph for any reason. The model incorporated data on fracture incidence, fracture risk reduction, mortality, quality of life, and fracture and treatment costs from published sources and Royal Cornwall Hospitals NHS Trust. Costs and health outcomes in terms of quality-adjusted life years (QALYs) were simulated over the remaining lifetime of patients. The analysis took the perspective of the National Health Service (NHS) and Personal Social Services in the UK. Results The results showed that screening with IBEX BH was associated with a gain of 0.013 QALYs and a cost saving of £109 per patient compared with usual care, making it a dominant (cost-saving) strategy. Sensitivity analyses confirmed the robustness of the results under various assumptions. Widespread adoption of IBEX BH in the NHS was estimated to save 8,066 QALYs and £65,930,555 in healthcare costs over the lifetime of patients visiting hospitals for wrist radiographs each year. Conclusions IBEX BH could be a cost-effective tool for early identification and prevention of fragility fractures in the UK, addressing the current challenges of low provision and access to fracture risk assessment and treatment.

Abstract Objective Recent studies highlight the role of H-type vasculature in bone regeneration. This study, based on single-cell RNA sequencing (scRNA-seq), aims to explore the changes in H-type vasculature endothelial cells (H_ECs) in osteonecrosis of the femoral head (ONFH) and hip osteoarthritis (HOA), focusing on the death modes such as ferroptosis, pyroptosis, and parthanatos. Methods We re-analyzed the scRNA-seq data of femoral head samples publicly available in 2022. This study selected nine femoral head samples (3 each from HOA, ONFH stage 3 A, and ONFH stage 4). CD31 + EMCN + endothelial cells were classified as H_ECs. Molecular differences were assessed using Gene Ontology and KEGG analysis. Hypoxia, ferroptosis, pyroptosis, and parthanatos indices were calculated, and transcription factors were predicted using SENIC. Cell communication was analyzed with CellChat. Results After integrating the 9 samples, 14 cell types were identified: B cells, Mesenchymal stem cells, Osteoblasts, Endothelial cells, Monocytes, T cells, NK cells, Fibroblasts, Macrophages, Common myeloid progenitors, Chondrocytes, Myelocytes, Osteoclasts, and Pericytes. The number of endothelial cells and H_ECs decreased with necrosis severity. H_ECs showed higher angiogenic capacity but lower stress resistance compared to other endothelial cells. Angiogenic capacity decreased in necrotic samples, accompanied by an elevation in inflammation levels. The hypoxia index was higher, with ferroptosis increased in stage 3 A and parthanatos in stages 3 A and 4. No change was observed in pyroptosis. Cell communication analysis revealed downregulation of SLIT3-ROBO4 signaling during necrosis. Conclusion H_ECs show molecular differences compared to other endothelial cells. Ferroptosis and parthanatos contribute to the demise of H_ECs in ONFH, with pericytes and fibroblasts supporting H_EC angiogenesis.

Abstract Purpose This study aimed to assess the efficiency of a minimally invasive technique for correcting malunions of extra-articular metacarpal fractures, followed by percutaneous fixation using a cemented K-wire frame. Methods From January 2018 to January 2022, 31 patients (31 malunions of extra-articular metacarpal fractures) were treated. The mean age of the patients was 32 years (range, 21–52 years). There were 25 fifth, 4 fourth, 1 third, and 1 second metacarpal malunion. Range of motion of the fingers was assessed based on the total active motion scoring system of American Society for Surgery of the Hand. Range of motion of the joint was graded as excellent (85–100%), good (70–84%), fair (50–69%), and poor (

Abstract Background Spinal deformity associated with Neurofibromatosis type1(NF-1) is known to be intractable, and it’s surgical outcome is known to be poor. However, it is not clear whether or not patients are able to lead a healthy social life as adults, and we investigated the surgical outcomes of patients who had reached adulthood after surgery. Methods Thirty-eight patients (16 males, 22 females) who had undergone spinal deformity surgery and had reached the age of 18 years at last follow up were included. X-rays, surgery, complications, survival rate, employment status, and married rate were evaluated. HR-QOL was compared with those of adolescent idiopathic scoliosis(AIS) operated in our hospital. The idiopathic scoliosis group includes 110 patients who had undergone surgery from 2015 to 2018 at our hospital and 38 patients(2 males, 36 females) were selected by excluding patients who could not be followed up until the age of 18 years and those who did not describe their HR-QOL, and adjusting the mean preoperative cobb angle values to match those of the NF-1 group. Results The mean age at the initial surgery was 14.6 [4〜49] years, and the mean age at the last observation was 29.4 [18〜56] years. Anterior and posterior fusion were performed in 18 patients, posterior fixation was performed in 20 patients. Five patients died (3: malignant schwannoma, 1:brain tumor, 1:unknown), with a mean age of 27.0 [18〜35] years at the time of death and 12.2 [3〜21] years after the last surgery. Two patients over 40 years of age were treated for vascular system disorders, and 1 patient for a brain tumor. All survivors were ambulators except 1 case of non-ambulator due to neoplastic destruction of the hip joint. The working status was light work in 13 patients, desk work in 7, unemployed in 4, students in 8. Four patients were married. SRS-22 and ODI at the last follow-up in the NF-1 group and AIS group were compared. There were no significant differences in SRS-22 Pain, Mental Health, Satisfaction, and ODI, but SRS-22 Function and Self-image were significantly lower in the NF-1 group. Conclusions At an average follow-up of 14.8 years after surgery, 5 of 38 patients had died, 29 patients (76.3%) were able to lead a social life. However, HR-QOL was lower than that of AIS. Patients undergoing NF-1 scoliosis surgery require careful long-term follow-up, taking into account the possibility of reoperation due to osteolysis, malignant changes in the tumor, and vascular problems due to vascular fragility

Abstract Background This meta-analysis aimed to determine whether resistance exercise training (RET) can attenuate the loss of muscle volume and function in anti-gravitational muscles, especially quadriceps and calf muscles, during immobilization/disuse conditions. Methods A comprehensive literature search was conducted to identify randomized controlled trials comparing RET vs. no exercise during immobilization/disuse. Searches were conducted in databases including Web of Science, PubMed, EBOSCO, and Cochrane Library, without imposing a time limit until 20 March, 2023. Studies reporting outcomes related to muscle volume, MVC, peak power, concentric peak force, eccentric peak force, isometric MVC torque of knee extension, isometric MVC torque of knee flexion were included. Data were pooled using random-effects models. Results Eleven randomized controlled trials were finally included. RET elicited substantial benefits for preserving quadriceps muscle volume (n = 5, MD = 252.56, 95% CI = 151.92, 353.21, p

Abstract Background Cubitus varus, a common complication of pediatric supracondylar humerus fractures, presents with internal rotation, extension, and varus angulation. While primarily considered a cosmetic concern, it can lead to significant complications, including chronic pain, ulnar nerve palsy, and posterolateral elbow instability. This study evaluates the effectiveness of supracondylar dome osteotomy in decreasing lateral condylar prominence and improving functional outcomes in patients with cubitus varus. Methods This retrospective cohort study analyzed 65 patients under 18 who underwent dome-shaped corrective osteotomy between 2017 and 2022 at the Hospital and Rehabilitation Center for Disabled Children, Nepal. Inclusion criteria comprised patients with cubitus varus deformity greater than 10 degrees and at least six months post-trauma. Outcomes were assessed using the Mayo Elbow Performance Score (MEPS), Lateral Condylar Prominence Index (LPI), and radiological measurements of carrying angle (CA). Results The mean age at surgery was 11.77 years (± 3.76), with an average time since injury of 54.15 months (± 31.76). Post-operatively, the radiological carrying angle improved from 23.90° (± 8.84) varus to 5.14° (± 7.64) valgus. The LPI changed from 0.58 (± 16.68) preoperatively to -3.18 (± 16.39) post-operatively. MEPS improved from 89.54 (± 6.66) to 95.23 (± 5.26). Significant improvements in LPI were observed in patients older than 12 years (p = 0.00) and patients with radiological CA less than 20° (p = 0.02) and with a clinical CA less than 20°(p = 0.04). Conclusions Supracondylar dome osteotomy effectively reduces lateral condylar prominence in cubitus varus, particularly in post-pubertal patients and cases with radiological carrying angles less than 20 degrees. The procedure demonstrates good functional outcomes with acceptable complication rates, making it a viable surgical option for treating cubitus varus deformity.

Abstract Background Previous research suggests that restoring pre-arthritic alignment in fixed-bearing unicompartmental knee arthroplasty (UKA) can improve postoperative knee function. However, its applicability to mobile-bearing UKA remains unclear. This study evaluated whether patients who achieve pre-arthritic alignment following mobile-bearing UKA with the kinematic alignment technique experience superior postoperative knee function compared with those who do not. Methods A retrospective analysis was conducted on 236 knee joints that underwent UKA using kinematic alignment techniques between May 2015 and November 2017. Of these, 222 knee joints met the inclusion criteria for the study. Postoperative outcomes were assessed, with pre-arthritic alignment determined using the arithmetic hip-knee-ankle angle (aHKAA). Postoperative alignment within ± 3° of the aHKAA was classified as pre-arthritic alignment. Patients were categorized into two groups: pre-aligned and non-pre-aligned. Final follow-up occurred in September 2024, and outcome measures included the visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for daily living, sports, and survivorship. Additionally, the percentage of patients meeting the patient-acceptable symptom state (PASS) criteria for KOOS-related subscales was recorded. Failure was defined as conversion to total knee arthroplasty. Results Among the 222 knee joints analyzed, the average follow-up time was 8.65 years (range: 7–9 years), with an average implant survival time of 8.48 years and a total knee arthroplasty conversion rate of 2.7%. The 5-year survival rate was significantly higher in the pre-arthritically aligned group (99.4%) than in the non-pre-arthritically aligned group (92.5%) (p = 0.012). In total, 169 knees (76.13%) were classified as pre-arthritically aligned, while 53 knees (23.87%) were non-pre-arthritically aligned. postoperative VAS scores significantly improved from 6.90 ± 0.82 to 0.58 ± 0.56 (p

Abstract Background The quadriceps during activities mainly affect patellar movement in the sagittal plane. This study was to analyze the pattern of sagittal patellar tilt in patellofemoral pain (PFP) patients by four-dimensional computed tomography (4DCT). Methods Thirty-four knees of PFP patients and 34 control knees were scanned with 4DCT. Patella-patellar tendon angle (P-PTA), patella-lateral tibial plateau angle (P-LTPA), patella-screen horizontal line angle (P-SHLA), articular facet of the patella-lateral tibial plateau angle (PA-LTPA), articular facet of the patella-screen horizontal line angle (PA-SHLA), and upper margin of the patella-quadriceps tendon angle (PU-QTA) were used to evaluate the sagittal patellar tilt. Two-factor repeated-measures ANOVA was used to compare all parameters between the two groups. Results At 30°−40° of flexion, P-PTA was significantly lower in PFP group than in control group (p = 0.004). At 0°–10°, PU-QTA was significantly higher in PFP group than in control group (p = 0.027). During flexion and extension, P-SHLA and PA-SHLA were significantly higher in PFP group than in control group, but there were no significant differences in P-LTPA and PA-LTPA. From − 10° to 30°, P-PTA decreased as the knee flexion angle increased. PU-QTA, P-LTPA, and PA-LTPA also decreased as the knee flexion angle increased, but P-SHLA and PA-SHLA increased. Conclusions In PFP group, sagittal patellar tilt was abnormal, and patella showed anterior tilt relative to the screen horizontal line during active knee flexion and extension. The pattern of patellar sagittal motion during dynamic process was consistent between PFP and control groups. The characteristics of patellofemoral sagittal alignment should not be ignored when analyzing patellofemoral stability.

Abstract Background This study reports the mid-term outcomes of primary total hip arthroplasty (THA) and investigates the effect of bony ankylosis on postoperative hip function in patients with ankylosing spondylitis (AS). Methods We identified 544 primary THAs performed in 319 consecutive patients with AS (median age, 33 years) from 2012 to 2017. Survivorship of the implants, complications, and patient satisfaction were investigated. Functional outcomes were assessed by the measurement of hip flexion–extension range of motion (ROM), the Harris hip score (HHS), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The hips undergoing THA were divided into a bony ankylosis group and a hip stiffness group based on the severity of hip involvement. The postoperative functional results of the two groups at the most recent follow-up were compared. Results Survivorship was 99.8% with a mean follow-up of 7 years (range, 5–9 years). The main complications included dislocation (5 hips, 0.9%), periprosthetic femoral fracture (15 hips, 2.7%), and infection (primary infection in 2 hips and periprosthetic joint infection in 1 hip, 0.6%). The flexion–extension ROM improved significantly with a median of 0° (0 ~ 120°) pre-operatively to 100° (30 ~ 130°) after THA (P

Abstract Background Subchondral bone cysts (SBCs) can significantly impact the outcomes of cartilage repair procedures such as autologous chondrocyte implantation (ACI). However, the etiology and progression of SBCs following ACI remain poorly understood. This case report highlights a progressively enlarging SBC following ACI using all-suture anchors, treated with autologous osteochondral transplantation (AOT). Case presentation A 58-year-old female with progressive right knee pain, varus alignment, and Kellgren-Lawrence grade 3 osteoarthritis underwent atelocollagen-associated ACI combined with medial opening wedge high tibial osteotomy. Longitudinal radiological assessment revealed bone hole enlargement corresponding to all-suture anchor sites, with one hole continuing to expand up to 15 months postoperatively, reaching a size of 11 × 13 × 13 mm. This expanding SBC exhibited a connection to the joint cavity via a tiny fissure, scant osteosclerotic rim on CT, and fluid intensity on MRI. Histological analysis of tissue obtained during subsequent AOT revealed several findings. The SBC was located at the anterior portion of the medial femoral condyle, just beneath the all-suture anchor. Osteochondral necrosis was observed surrounding the anchor site, with no evidence of foreign body reaction. The cyst was filled with a mucoid substance and featured an aggregation of foamy macrophages. A sclerotic wall indicative of a strain response was observed. Notably, the presence of osteoclasts along the adjacent bone surface indicated ongoing bone resorption. The patient underwent AOT, which resulted in confirmed bone union. Postoperative follow-up demonstrated successful integration of the osteochondral graft and improved knee function scores over three years. Conclusion This case report documents SBC formation following knee surgery with all-suture anchors and provides histological evaluation of such a cyst. The observed histological findings may contribute to our understanding of SBC pathophysiology in the context of cartilage repair procedures. This case underscores the importance of secure suturing techniques in high-stress areas and suggests the potential benefit of extended post-operative monitoring of SBC progression beyond one year. These observations may inform future strategies for the early detection of SBC formation and its progression, as well as timely intervention to prevent further joint damage in similar cases, though further research is needed to establish broader clinical implications.

Abstract Background Low back pain is the leading cause of disability worldwide with a significant socioeconomic burden; artificial intelligence (AI) has proved to have a great potential in supporting clinical decisions at each stage of the healthcare process. In this article, we have systematically reviewed the available literature on the applications of AI-based Decision Support Systems (DSS) in the clinical prevention and management of Low Back Pain (LBP) due to lumbar degenerative spine disorders. Methods A systematic review of Pubmed and Scopus databases was performed according to the PRISMA statement. Studies reporting the application of DSS to support the prevention and/or management of LBP due to lumbar degenerative diseases were included. The QUADAS-2 tool was utilized to assess the risk of bias in the included studies. The area under the curve (AUC) and accuracy were assessed for each study. Results Twenty five articles met the inclusion criteria. Several different machine learning and deep learning algorithms were employed, and their predictive ability on clinical, demographic, psychosocial, and imaging data was assessed. The included studies mainly encompassed three tasks: clinical score definition, clinical assessment, and eligibility prediction and reached AUC scores of 0.93, 0.99 and 0.95, respectively. Conclusions AI-based DSS applications showed a high degree of accuracy in performing a wide set of different tasks. These findings lay the foundation for further research to improve the current understanding and encourage wider adoption of AI in clinical decision-making.

Abstract Background Femoral head fractures result from high-energy trauma and may be associated with posterior dislocation of the hip joint. An appropriate surgical approach is essential for improving clinical outcomes and preventing complications. This study aims to compare the clinical efficacy of the modified Smith-Peterson (mS-P) approach and Ganz surgical dislocation (GSD) approach in the treatment of Pipkin I fractures. Methods We conducted a retrospective analysis of patients diagnosed with Pipkin I fractures at Pidu District People’s Hospital from June 2010 to May 2020. Of these, 11 cases were treated with the mS-P approach and 12 cases were treated with the GSD approach. All patients were followed for 12–55 months, with a mean duration of 37.7 months. Basic demographic information, perioperative-related records, postoperative complications, and outcomes at the final follow-up were compared. Functional evaluations included the Thompson-Epstein Score, the Modified Harris Hip Score (MHHS), and the Vail Hip Score (VHS). Results Overall, 21 patients were included in the study. We found that the mS-P approach was associated with a smaller incision, shorter operative time, and reduced intraoperative blood loss compared to the GSD approach (P

Abstract Background As the most prevalent fragility fracture caused by osteoporosis, increasing attention was paid to vertebral compression fractures (VCF) day by day. Percutaneous vertebroplasty (PVP) had unique advantages in treatment of VCF and was used widely. However, there were still part patients suffering from residual or unrelieved pain after the surgery. The purpose of our study was to identified the associated factors for good clinical outcomes and provide evidence for surgical strategy. Material and methods 186 patients who underwent PVP from January 2021 to January 2023 were reviewed retrospectively in the study. The patients were divided into two groups according to clinical outcomes. Preoperative general data and surgical data were collected for statistical analysis. Multivariate logistic regression analysis and the receiver operating characteristic curve were used to identify the associated factors with good clinical outcomes. Results There were statistically significant differences between two groups in volume of bone cement (p = 0.012), standardized treatment for osteoporosis (p = 0.004) and bone cement continuity (p = 0.006). The associated factors with good clinical outcomes after PVP were continuous bone cement (OR = 2.237, 95% CI = 1.191–4.201, p = 0.012), standardized treatment for osteoporosis (OR = 2.105, 95% CI = 1.089–4.068, p = 0.027) and volume of bone cement > 5.5 ml (OR = 1.271, 95% CI = 1.023–1.579, p = 0.030). Conclusion PVP effectively released the back pain of patients and was worthy of promotion. However, postoperative residual pain was an important factor that reduced the clinical outcomes. Continuous bone cement and standardized treatment for osteoporosis were guarantee of good clinical outcomes for PVP and injected bone cement > 5.5 ml might be a guarantee.

Abstract Background Legg-Calve-Perthes Disease (LCPD) is described as idiopathic avascular osteonecrosis of the capital femoral epiphysis in pediatrics. LCPD is usually present in children between 2 and 15 years and happens more frequently in boys more than girls; this study aims to compare the outcome of two surgical methods in treating LCPD. Methods We included sixty patients with unilateral LCPD who underwent Salter or femoral varus osteotomy from 2007 to 2017. Patients were followed up for at least five years. Patients’ claudication, pain, leg circumference, range of motion, lever arm ratio (LAR), neck shaft angle (NSA), migration index, vertical distance, and the presence of teardrop sign, sagging rope sign, and Trendelenburg sign were evaluated five years after surgery. Results The mean neck shaft angle, the lever arm ratio, migration index and, sagging rope sign incidence in patients undergoing femoral varus osteotomy were significantly lower than those undergoing Salter surgery; the thigh circumference was higher in patients undergoing femoral varus osteotomy than those undergoing Salter osteotomy. Conclusion There were significant differences in biomechanical indices of hip and acetabulofemoral in salter and femoral varus osteotomy; the results of the current study are highly suggestive of prioritizing femoral varus osteotomy to Salter surgery.

Abstract Background The pathogenesis of male osteoporosis (MOP) remains unclear, with the role of genetic factors attracting the attention of researchers. In the present study, we aimed to investigate critical circRNA biomarkers associated with male osteoporosis. Methods RNA-sequencing was performed to investigate the circRNA expression profiles between 3 men with osteoporosis and 3 with normal mass density. Then, shared mRNAs between host genes acquired in this present study and mRNAs acquired in previous study were identified to screen vital circRNAs associated with male osteoporosis. PPI networks of shared mRNAs were constructed and the hub genes in the PPI networks were identified with CytoHubba, a plugin in Cytoscape software (3.10.1). Finally, a ceRNA network of four circRNAs derived from three hub genes was constructed. Validation experiments were performed on selected circRNAs and related miRNAs in this ceRNA network using peripheral blood clinical samples. Results In total, 657 circRNAs were detected in male osteoporosis. The shared mRNAs were significantly enriched in the metabolic pathways, RNA transport, Ubiquitin mediated proteolysis and Amyotrophic lateral sclerosis. Then, three genes, including SETD2, ATM and XPO1, were identified as hub genes with four algorithms. Ultimately, the ceRNA network, involving 4 circRNAs, 40 miRNAs, and 592 mRNAs, was obtained. Using 35 clinical samples, three potential circRNAs and three miRNAs associated with male osteoporosis were selected for validation. It was ultimately found that three miRNAs were upregulated in MOP, while hsa-circ-9130, novel_circ_0014940 and hsa-circ-0054894 were upregulated, hsa-circ-2484 and novel_circ_0033084 were downregulated in patients with MOP. Conclusion We emphasized the roles of several significantly up- and down-regulated circRNAs and four circRNAs derived from three hub genes in male osteoporosis. Differences in expression were confirmed for three miRNAs and five circRNAs in the ceRNA network among patients with male osteoporosis.

Abstract Background The aim of the study is to compare the mechanical stability of posterior malleolar fractures fixed with different screw types and locking plates in the management of trimalleolar ankle fractures using the finite element (FE) method. Methods An FE model containing the distal tibia, fibula, talus, and calcaneus was created based on the computed tomographic images of a healthy man without any musculoskeletal disorders. The medial, lateral, and posterior malleoli were segmented using three virtual planes to create a trimalleolar fracture model, with the posterior malleolar fracture fragment comprising approximately 30% of the articular surface. Four different fixation approaches, including two partial thread cannulated screws (PTS), two full thread cannulated screws (FTS), and L-shaped (LLP) and T-shaped (TLP) locking plates with screws, were used to fix the posterior malleolar fracture. Two partial thread screws and a locking plate along with screws were used to fix the medial and lateral malleolar fractures, respectively. Two different loading conditions, namely static axial load and Achilles tendon force, were considered in the simulation. Results Under axial load, the maximum gap opening distance of the posterior malleolar fracture with screws only was obviously larger than that with locking plates. The maximum gap distance was 0.12 mm, 0.08 mm, 0.04 mm, and 0.05 mm in the PTS, FTS, LLP, and TLP, respectively. Under Achilles tendon force, the maximum gap opening distance were 0.12, 0.1, 0.03, and 0.1 mm, in the PTS, FTS, LLP, and TLP, respectively, under Achilles tendon force. Conclusion The results suggest that locking plates offer greater stability and reduce the fracture gap opening for posterior malleolar fractures involving 30% of the distal tibial articular surface in the fixation of trimalleolar ankle fractures.

Abstract Background The best stem type and location for femoral shortening in high-riding developmental dysplasia of the hip (DDH) in not clear. We evaluated the morphology of the proximal femur on EOS™ images, focusing on the anatomical landmarks and measurements relevant to the stem selection in high-riding DDH. Our goal is to identify and define the differences in the anatomy of the proximal femur between patients with Crowe type IV DDH and normal individuals, in order to determine the appropriate neck cut location in these patients to increase the chances of successfully using a wedge femoral stem. Methods EOS™ images of 40 hips with Crowe type-IV DDH and 40 normal hips were included. The distances between the tip of the greater trochanter and vastus ridge (GT-VR), vastus ridge and proximal border of lesser trochanter (VR-LT), greater- and lesser trochanters (GT-LT), base width of the LT, and the proportion of these distances to the femoral length were evaluated. Canal Flare Index (CFI) was also measured, at two different levels. Results The mean GT-LT index was not different between the two groups (p = 0.46). The GT-VR index was smaller in the case group (p

Abstract Background The Caprini risk assessment model (RAM) is a classical score that evaluates the risk of developing venous thromboembolism (VTE) aimed at patients with lower extremity fractures (LEF). However, the influencing factors of RAM pay more attention to clinical characteristic variables and recognized thrombophilia markers such as prothrombin, while ignoring the influence of other laboratory indicators on thrombosis. This is the first paper to screen predictive risk factors associated with VTE to modify the Caprini model and determine its diagnostic value. Results and methods We included 953 LEF patients from January 2019 to December 2021 and randomized them in a 7:3 ratio into a training set (n = 667) and a validation set (n = 286). Logistic regression and LASSO regression were used to screen for independent predictors of patients in the training set. Logistic regression screened for: age (OR 1.04, 95% CI 1.02—1.06), D-dimer (OR 1.06, 95% CI 1.03—1.08), Caprini (OR 1.17, 95% CI 1.08—1.27) and fasting blood glucose (FBG) (OR 1.18, 95% CI 1.03—1.35), which also appeared in the LASSO seven-factor model. In addition to Caprini and age, FBG and D-dimer may be important predictors of deep vein thrombosis in patients with LEF. Therefore, we constructed three models. caprini + D-dimer, caprini + FBG, and caprini + D-dimer + FBG. We compared them with caprini alone. Caprini + FBG + D-dimer showed the greatest ROC (0.784, 95% CI 0.730–0.837, Delong test P = 0.002 vs. Caprini’s ROC). D-dimer and FBG have a significant increase in the predictive effect for predicting DVT in terms of NRI (59.98% improvement, P

Abstract Background Earthquakes frequently cause injuries to the musculoskeletal system. Studies conducted after earthquakes often report on injured limbs, fractures, and surgeries. This study aimed to enhance preparedness for future earthquakes by acquiring knowledge about the prevalence of fractures and the relationship between fracture types and injury mechanisms. Methods A retrospective analysis was conducted on medical records of patients with fractures admitted to our hospital following the 2023 Kahramanmaraş Earthquake. Patients with fractures resulting from traffic accidents or other causes unrelated to earthquakes were excluded. The recorded data included age, gender, fracture site, fracture type, mechanism of injury, date, duration of surgery, and peak creatine kinase (CK) level. The injury mechanisms were classified into four main categories: injured by falling objects, falling while running, falling from height, and being trapped under rubble. The study investigated the relationship between fractures and other factors. Results The study included 185 patients with a mean age of 39.62 ± 20.83 years. The most frequent mechanism of injury was being trapped under rubble. In total, there were 214 fractures, with pelvic fractures being the most common (21.50% of all fractures). Tibia fractures were the most common fractures in the lower extremities (15.89%). Women had a significantly higher occurrence of pelvic fractures (33.3%) compared to men (14.5%) (p = 0.003). The frequency of pelvic fractures significantly increased as age decreased (p = 0.007). Patients with pelvic fractures had a significantly greater peak CK concentration (p = 0.006). Open fractures were more common in the first few days, and Kirschner wires were the first treatment applied at a mean of 74 h and external fixators at a mean of 94.3 h. Conclusion Injuries from falling objects from roofs and jumping from heights are important in earthquakes. In addition to lower extremity fractures, pelvic fractures are common in earthquake disasters. Most pelvic fractures are simple lateral compression fractures and it is important to follow the patients for crush syndrome in the first days instead of focusing on definitive fracture treatment. Open fractures should be prioritized for fracture surgery within the first few days. External fixators and Kirschner wires are recommended. Closed fractures should be treated conservatively and definitive surgical procedures should be postponed to the following weeks.

Abstract Background Benefits of partial weight bearing (PWB) in operated extracapsular hip fractures (ECF) have not been proved. We have assessed influence of PWB on long-term survival and the final mobility achieved, dependence and mortality-related factors. Methods Retrospective cohort study of osteoporotic ECF in ≥ 65-year-old patients who underwent surgery with trochanteric Gamma3 nails in 2014 (n = 218), followed in the long-term (consolidation or stabilisation). According to Baumgaertner-Fogagnolo classification (138 good, 71 acceptable and 9 poor) a postoperative protocol was applied. 116 cases bore weight before discharge (Immediate Partial Weight Bearing, IPWB = 116; Not-IPWB = 102), and 118 did it after a month (Early PWB, EPWB = 118; Not-EPWB = 100). Variables were collected from medical records and complementary studies. We used FMS (Fracture Mobility Score) and the National Mortality Database from the Spanish Ministry of Health at > 5 years. EPWB and Not-EPWB were comparable, except for hospital stay and dependence. We used the Cox method for mortality.

Abstract Introduction The tensor fasciae suralis is an aberrant muscle frequently identified in cadaveric studies and MRI studies; however, it has been rarely reported in clinical studies. We present a case of recurrent popliteal pain in a young adult male and our experience with its diagnosis and treatment. Case presentation A 20-year-old active-duty soldier presented with recurrent right popliteal pain, initially triggered by intense physical activity during military training. Pain subsided with rest but recurred after strenuous exercises, such as soccer. Examination revealed a palpable soft mass with mild tenderness and swelling in the popliteal region. Ultrasonography identified an aberrant tensor fasciae suralis muscle with perifascial edema, originating from the semimembranosus muscle and attaching to the fascia of the medial gastrocnemius. MRI confirmed the findings with edema at its boundary. Conservative management led to symptom improvement. A follow-up ultrasound six months later showed resolution of swelling. Conclusion This case highlights the importance of recognizing the TFS muscle to avoid misdiagnosis and unnecessary interventions.

Abstract Background Low back pain (LBP) is a widespread condition that increasingly affects the older adults, highlighting the need for a detailed examination of its global impact. Our research aimed to evaluate the LBP’s burden and trends in individuals over 55 years of age across 204 countries and territories from 1990 to 2021. Methods We analyzed the data from the Global Burden of Disease 2021, focusing on LBP prevalence, incidence, and years lived with disability (YLDs), along with associated risk factors. Results In 2021, a total of 271,680,057 individuals aged 55 and older globally suffered from LBP. The age-standardized prevalence rate was 18,282.8 per 100,000 population, marking a 10.4% decrease since 1990. The age-standardized incidence and YLD rates had decreased by 9.4% and 11.0%, respectively. Central and Eastern Europe and Australasia had the highest burden, while Andean Latin America, Caribbean, and East Asia had the lowest. Notably, there were significant gender differences, with males experiencing lower rates than females. Occupational ergonomic factors, smoking, and high body mass index were identified as major contributors to the LBP burden. Conclusion This study analyzed the global burden of LBP in adults aged 55 and older, noting a decrease in age-standardized rates but an increase in total cases and regional disparities. It stressed the need to tackle modifiable risk factors like occupational ergonomics, smoking, and obesity to lessen LBP’s impact. The study also called for region-specific, gender-sensitive healthcare policies to ensure fair health outcomes for all adults aged 55 and older.