Journal of Southeast Asian Orthopaedics

Pediatric Tuberculous Osteomyelitis of the Hip Managed with an Antibiotic-Loaded Cement Spacer Fabricated Using a 3D-Printed Mold: A Case Report

2026-05-22T09:34:27+07:00

Purpose: To describe a pediatric case of advanced tuberculous osteomyelitis of the hip managed with an antibiotic-loaded cement spacer fabricated using a three-dimensional (3D)-printed mold.

Methods: An 11-year-old child patient with a 2-year history of progressive hip pain, draining sinus formation, and inability to bear weight underwent staged surgical management, including debridement, sequestrectomy, and Girdlestone procedure. Radiographs demonstrated extensive proximal femoral osteolysis with superolateral displacement of the femoral head. Initial microbiologic studies were negative for Mycobacterium tuberculosis, while blood cultures grew Burkholderia cepacia. Histopathology later demonstrated caseating granulomatous inflammation consistent with tuberculosis. A patient-specific antibiotic-loaded cement spacer was fabricated using a 3D-printed mold based on contralateral hip measurements and implanted during the second-stage procedure.

Results: The patient initially showed clinical improvement, with reduced pain and decreased inflammatory markers. At 2 months, spacer displacement was noted, which was associated with poor functional outcomes (Harris Hip Score, 15.19). Long-term follow-up of the patient was not completed.

Conclusions: Customized spacer fabrication using 3D printing is feasible for pediatric patients with hip infections. However, outcomes may be limited in patients with advanced disease. Careful patient selection and follow-up are essential.

Surgical Management and Clinical Outcomes of Spinal Tuberculosis: A Systematic Review and Meta-analysis on Current Concepts and Strategies

2026-05-30T17:30:09+07:00

Background: Spinal tuberculosis, also known as Pott’s disease, accounts for nearly half of all musculoskeletal tuberculosis cases and is the most common form in children and young adults. Its incidence is increasing in developed countries. This study aimed to evaluate surgical outcomes, from percutaneous biopsy to anterior and posterior spinal decompression, in patients with spinal tuberculosis and kyphosis through different surgical procedures and the expectation of clinical outcomes.

Methods: A comprehensive search was conducted across ScienceDirect, PubMed/MEDLINE, and Google Scholar in accordance with the PRISMA guidelines. Statistical analysis was performed using R statistical software and Excel (PROSPERO REGISTRATION NUMBER: CRD420261327294). The search terms included “spinal tuberculosis” and its management, surgical techniques, and associated outcomes related to morbidity and mortality, as well as related pathologies. Inclusion criteria were limited to English-language studies published between January 2012 and September 2025.

Results: In this review, a total of 2,710 patients with spinal tuberculosis were identified. Of these, 1,010 patients (37%) were analyzed for surgical approach; 439 (16%) underwent a posterior approach, and 554 (20%) underwent an anterior approach. Regarding diagnostic methods, among 1,700 patients (63%), 867 (32%) underwent histopathological examination, 1,211 (44%) had smear testing, and 858 (31%) were tested using GeneXpert.

Conclusions: Spinal tuberculosis remains complex in both diagnosis and surgical management. Well-executed anterior or posterior approaches are effective for kyphosis correction and spinal cord decompression. However, biopsy performed post-laminectomy through paravertebral or multifidus muscle incisions carries a higher risk of sample contamination compared with alternative techniques.

De Quervain Tenosynovitis: Anatomical Variants of the First Dorsal Compartment and Their Role in Ultrasound-Guided Injection and Surgical Management — A Narrative Review

2026-06-14T18:49:39+07:00

Purpose: De Quervain tenosynovitis is a common cause of radial wrist pain and is characterized by stenosing tendinopathy of the abductor pollicis longus and extensor pollicis brevis in the first dorsal compartment. Increasing evidence suggests that the anatomical variants within this compartment contribute to disease development and treatment failure. To summarize the current evidence on anatomical variations in the first dorsal wrist compartment, their detection using ultrasound, and their implications for injection-based and surgical management of de Quervain tenosynovitis.

Methods: Studies published between 2015 and 2025 on de Quervain stenosynovitis, first dorsal compartment anatomy, ultrasonography, injection therapy, and surgical outcomes were included.

Results: Inter-tendinous septation and subcompartmentalization of the abductor pollicis longus and extensor pollicis brevis tendons were more prevalent in patients with de Quervain tenosynovitis than in controls and were associated with persistent symptoms after conventional corticosteroid injection or surgical release. Ultrasound demonstrates high sensitivity and specificity for detecting septa, multiple tendon slips, and subcompartments and reliably maps adjacent neurovascular structures. Ultrasound-guided corticosteroid injections, hydrodissection, platelet-rich plasma injection, and percutaneous release techniques have shown improved targeting of pathological compartments and favorable clinical outcomes. In surgical management, failure to recognize and decompress the separate subcompartments is a key cause of residual pain and recurrence.

Conclusions: Anatomical variants of the first dorsal compartment are common and clinically significant in de Quervain stenosynovitis. The routine use of ultrasound to identify anatomical variants can optimize the selection and execution of both nonsurgical and surgical treatments, potentially improving outcomes and reducing recurrence.

The Effectiveness of a Machine Learning Model in Predicting Blood Transfusion Probability in Bipolar Hemiarthroplasty Hip Replacement Surgery

2026-02-02T19:14:08+07:00

Purpose: To verify a machine learning-based prediction model for blood transfusion risk in patients undergoing bipolar hemiarthroplasty and to determine whether there are significant differences between the accuracy results of this verification and the original model.

Methods: A retrospective study using purposive sampling was designed to gather 136 samples with the inclusion criterion of undergoing bipolar hemiarthroplasty for femoral neck fractures at the author’s institution between January 1, 2021, and June 30, 2024. The research instruments included (1) a machine learning-based prediction model for blood transfusion probability (smskbl.streamlit.app), which was constructed using 232 femoral neck fracture samples undergoing bipolar hemiarthroplasty at the author’s institution from 2015 to 2020, and (2) a research questionnaire created by the researcher, including six items: one on demographic data, four on medical health conditions, and one on actual blood transfusion during surgery.

Results: The prediction model accuracy was 89%, compared with that of the original model (80%). The comparison of the accuracy results was not statistically significant (Z = 0.424, p > 0.05). In the blood transfusion group, the precision was 0.70, recall was 0.73, and F1-score was 0.72, whereas the group that did not receive blood transfusion had a precision of 0.94, recall of 0.93, and an F1-score of 0.93. The area under the curve was 0.83.

Conclusions: The blood transfusion prediction model demonstrated good performance in predicting transfusion risk. The model provides confidence in its risk prediction outcome and can be used to perform optimal risk management in preparation for bipolar hemiarthroplasty.

Alternative Technique to Reduce Radiation Exposure during Locked Plate Fixation of Distal Radius Fracture; the Plummet as a Targeting Device

2026-02-26T19:58:18+07:00

Purpose: Radiation exposure from intraoperative fluoroscopy is routinely encountered in orthopedic procedures, especially during distal radius fracture fixation. Prolonged exposure to high-dose radiation is a known risk factor for genetic mutations. This study presents a simple, alternative mechanical targeting device using a plummet that functions as a laser aimer.

Methods: A prospective randomized controlled trial was conducted at a single institution involving 42 consecutive patients who underwent locked plate fixation for distal radius fractures and were randomized into two groups. One group underwent fluoroscopic imaging using a plummet as the aiming device, whereas the other group underwent imaging without an aimer. The radiation exposure time, dose, and fluoroscopy accuracy were recorded and analyzed.

Results: A total of 42 patients were enrolled, with 21 assigned to the Plummet group and 21 to the Control group. Demographic data and fracture patterns were comparable between the groups. Compared to the Control group, the Plummet group required significantly fewer fluoroscopic images (8.38 vs. 21.86) and demonstrated a higher accuracy of fluoroscopy (99.21% vs. 67.53%). Radiation exposure was also lower in the Plummet group (3.78 vs. 9.98 µSv), with a shorter ionizing radiation exposure time (0.05 vs. 0.13 min). Operative time was also reduced in the Plummet group (51.52 vs. 60.81 min).

Conclusions: Compared to the conventional method, the use of a plummet as an aiming device significantly reduced the number of fluoroscopic images, radiation exposure, and operative time, while improving the accuracy of fluoroscopy.

Risk Factors for Postoperative Delirium in Older Adults Undergoing Major Orthopedic Surgery: A Systematic Review and Meta-Analysis

2026-03-02T20:08:59+07:00

Purpose: We aimed to identify the risk factors for postoperative delirium (POD) in adults undergoing orthopedic surgery and review evidence-based prevention strategies.

Methods: We conducted a systematic review and meta-analysis of studies published between 2014 and 2024, searching multiple databases. Fifty studies involving 1,247,832 patients met the inclusion criteria. We calculated the pooled odds ratio (OR) values of various risk factors for POD.

Results: The pooled incidence of POD was 23.4%. The significant non-modifiable risk factors included dementia (OR 24.85), a history of stroke (OR 14.61), and age ≥80 years (OR 4.73). The key modifiable risk factors were use of sedative-hypnotics (OR 6.42), depression (OR 4.98), and polypharmacy (OR 2.34). Undergoing general anesthesia and longer surgical duration also increased the risk of POD.

Conclusions: POD is a common complication in orthopedic surgery and is associated with modifiable and non-modifiable risk factors. The use of risk assessment models and multicomponent prevention strategies focusing on medication optimization, perioperative care, and environmental support is recommended to mitigate the risk of POD.

Efficacy of Modified Periarticular Infiltration Compared with Conventional Periarticular Infiltration in Controlling Pain After Total Knee Arthroplasty: A Randomized Controlled Non-Inferiority Trial

2026-03-03T20:21:54+07:00

Purpose: Patients with end-stage knee osteoarthritis typically undergo total knee arthroplasty (TKA), a surgical procedure that has long been considered a cost-effective treatment. However, moderate to severe postoperative pain is a common problem following TKA. Therefore, in this study, we aimed to compare the effects of postoperative pain management using conventional periarticular infiltration (conventional periarticular infiltration [PA]) versus modified periarticular infiltration (modified PA).

Methods: This study was designed as a randomized controlled non-inferiority clinical trial conducted from April 2024 to April 2025. A total of 58 patients undergoing primary unilateral TKA were enrolled and randomly assigned to receive either modified PA or conventional PA. The primary outcome was postoperative pain within the first 24 h after surgery, measured using the visual analog scale. Secondary outcomes included time to first morphine hydrochloride rescue, total morphine consumption during the first 24 postoperative hours, and length of hospital stay (LOS).

Results: Modified PA was non-inferior to conventional PA for postoperative pain control at rest and during movement within 24 h after TKA. Time to first morphine rescue, 24 h morphine consumption, and LOS did not differ significantly between the groups. All mean differences and corresponding 95% confidence intervals remained within the predefined non-inferiority margin of 0.5.

Conclusions: Modified PA and conventional PA provided comparable pain relief during the first 24 h after TKA and showed similar times to first morphine rescue. Morphine consumption and LOS were similar between the groups. These findings may inform the selection of intraoperative analgesic infiltration techniques.

Biomechanical Comparison of Different Angles of K-wire Fixation Configuration for Management of Proximal Phalanx Fracture by Syringe External Fixators

2026-03-10T21:23:34+07:00

Purpose: To optimize the K-wire fixation configuration for managing proximal phalanx fractures using Syringe External Fixators.

Methods: In this biomechanical comparison study, 48 sawbone models of proximal phalanx fractures stabilized with syringe external fixators were tested across eight different K-wire configurations (Groups A–H). Configuration included parallel, nonparallel, or combined patterns at angles of 0°, 30°, or 45°. The models were underwent longitudinal compression and pull-out tensile tests. Data were analyzed using one-way analysis of variance (ANOVA) to overall group comparison and independent t-test for pairwise comparisons.

Results: Compression testing revealed that Group B (two parallel and two crossed K-wires) exhibited the highest mean ultimate strength (11.82 N). In contrast, Group D (two parallel and two crossed K-wires at varying angles) and G (four crossed K-wires) demonstrated the lowest strengths (5.49 N and 5.91 N, respectively). Although pairwise comparison between the highest- and lowest-strength groups showed a significant difference (p = 0.004), no statistically significant difference was observed across the eight groups in compression testing (p = 0.062). In pull-out testing, Group A (four parallel K-wires) displayed the highest mean ultimate strength (72.14 N), while group F (four cross-K-wires) showed the lowest (32.76 N). Pairwise comparison between these groups showed no statistically significant differences (p = 0.083). Similarly, no statistically significant difference in the pull-out tensile strength was observed among groups (p = 0.235).

Conclusions: In proximal phalanx fractures stabilized syringe external fixators, nonparallel and parallel K-wire fixation showed not significantly biomechanical different in compression and pull-out tensile testing.

Artificial Intelligence-Based Assessment of Hip Fracture Detection from Radiographic Images: Diagnostic Accuracy Compared with that of Orthopedic Surgeons and Radiologists

2026-03-22T21:03:25+07:00

Purpose: Hip fracture is a major global public health concern and one of the leading causes of morbidity and mortality among older adults. Diagnostic inaccuracies often result in delayed treatment and poor outcomes. Artificial intelligence (AI) has shown promise in fracture detection, but studies did not fully reflect real-world clinical practice. We aimed to evaluate the feasibility and capacity of a YOLOv8-based AI model to detect hip fractures from anteroposterior pelvic radiographs as accurately as orthopedic surgeons and radiologists.

Methods: A total of 345 anonymized radiographs were used, comprising 45 images for physician comparison and 300 for extended testing. Various clinicians reviewed 45 images, evenly distributed among normal, femoral neck, and intertrochanteric fractures. Diagnostic accuracy, sensitivity, specificity, and error types were analyzed. The AI model was trained by simulating real-world hospital conditions.

Results: AI achieved an overall accuracy of 0.94, with 0.92 sensitivity and 0.91 specificity, comparable to radiologists and orthopedic surgeons and superior to physicians. Model performance remained stable when tested on the larger dataset (p > 0.05). Most errors occurred in minimally displaced femoral neck fractures, though accuracy for this group improved with larger test data. Mean processing time was 1.9–2.3 seconds per image.

Conclusions: The YOLOv8-based AI system demonstrated expert-level diagnostic performance and high processing efficiency without requiring advanced hardware. Our findings highlight its applicability in hospitals. Although occasional misclassifications and mislocalizations occurred, the model shows promise as a clinical decision-support tool for improving diagnostic confidence, reducing delays, and enhancing patient safety.

A Biomechanical Analysis of Transverse Patella Fracture Fixation Constructs

2026-04-08T18:12:21+07:00

Purpose: Tension-band wiring is a frequently employed surgical technique for patella fractures fixation technique. However, this technique can be disadvantaged by failure of fixation, implant prominence, implant migration, and skin irritation. While alternative fixation techniques have been proposed, few biomechanical studies have been conducted to compare these constructs in a controlled setting. Hence, we designed a biomechanical study to directly compare the strength of constructs that are commonly used in clinical practice.

Methods: A transverse fracture pattern was created on 24 saw-bone patellae. Four different fixation techniques were applied:

Tension-band wiring (TBW)
Cannulated lag screws (CLS)
CLS with PermaTape suture
CLS with TBW

A distraction force was then progressively applied to the construct until failure occurred. Failure was defined as a sudden plunge in the force-displacement curve or a fracture gap exceeding 2mm.

Results: TBW(A) withstood the smallest load of 535±115 N. CLS(B) fixation was objectively stronger, tolerating a load of 700 ± 62N. This was further augmented with the addition of the PermaTape(C) or TBW(D). CLS with TBW(D) had the highest failure load of 1018±165 N whereas CLS with PermaTape(C) withstood a smaller load of 886±155 N, although the differences between these two groups during post-op analyses were not significant.

Conclusions: CLS(B) alone is a biomechanically stronger construct compared to TBW(A) for transverse patella fractures. Additionally, CLS can be supplemented with synthetic sutures or wires to increase the fixation strength by 20-50% when required.

Patellar Resurfacing and Crepitation After Total Knee Arthroplasty, Propensity Score Matching

2026-04-08T19:08:25+07:00

Purpose: Patellar crepitation (PC) is a complication of posterior-stabilized total knee arthroplasty (PS-TKA). However, the role of patellar resurfacing (PR) in the reduction of PC remains controversial. This study aimed to evaluate the effectiveness of PR in reducing PC after PS-TKA.

Methods: This retrospective comparative study included patients aged 55–80 years with Kellgren–Lawrence grades 3–4 knee osteoarthritis who underwent PS-TKA. The patients were divided into resurfaced and non-resurfaced groups. Propensity score matching using sex, body mass index, age, preoperative Knee Society Score, and preoperative Feller score produced 89 matched patients per group. The primary outcome was the presence of patellar crepitus. Secondary outcomes included blood loss, radiographic patellar alignment, functional scores, and complications.

Results: The incidence of PC was significantly lower in the resurfaced group than that in the non-resurfaced group (15.7% vs. 77.5%, p<0.001). The estimated blood loss was higher in the resurfaced group, but the difference was not clinically significant. Functional outcomes were comparable between groups, whereas the Feller knee score and patellar shift favored the resurfaced group.

Conclusions: PR significantly reduces PC and improves patellofemoral function after PS-TKA without increasing the complication rates.

Accuracy of Supra-acetabular Schanz Pin Insertion Using a Finger-Assisted Technique: A Cadaveric Study

2026-04-10T21:03:59+07:00

Purpose: External pelvic fixation is an essential procedure for stabilizing unstable pelvic fractures. Supra-acetabular pin placement provides greater biomechanical stability than the supra-iliac crest technique, but it is technically more demanding and typically requires fluoroscopic guidance, which may be unavailable in urgent or resource-limited settings. In this study, we aimed to evaluated the accuracy of a finger-assisted technique for guiding supra-acetabular Schanz pin insertion without fluoroscopy.

Methods: This experimental cadaveric study included 18 fresh-frozen cadavers (36 hemipelves). Six orthopedic residents experienced in external pelvic fixation using sawbone models underwent training to perform the finger-assisted technique. Each resident performed the procedure on three cadaveric pelves (six hemipelves). After pin insertion, all the specimens were dissected using an iliofemoral approach. Pin position and complications, including hip joint penetration, lateral femoral cutaneous nerve injury, and intra-abdominal organ injury, were recorded.

Results: Of the 36 supra-acetabular Schanz pins inserted, 33 were completely intraosseous, yielding an accuracy rate of 91.7%. Three pins (8.3%) were malpositioned: two breached the medial cortex of the iliac wing, and one penetrated the hip joint. No visceral or lateral femoral cutaneous nerve injuries were observed.

Conclusions: Supra-acetabular external fixation using a finger-assisted technique is a useful alternative for guiding Schanz pin insertion, particularly in resource-limited settings.

Effect of End Cap Type on Outcomes in Elderly Intertrochanteric Fractures Treated With PFNA

2026-04-10T21:31:34+07:00

Purpose: Intertrochanteric hip fractures in the elderly are most commonly managed using a proximal femoral nail anti-rotation (PFNA) system, which employs a helical blade secured by either a locked or non-locked end cap. While locked end caps prevent blade migration, they may concentrate stress and increase cut-out risk; non-locked end caps allow controlled dynamization but can permit lateral sliding. This study evaluated the influence of end cap choice on radiographic union and mechanical complications in elderly patients.

Methods: We performed a retrospective cohort analysis of 107 patients aged ≥ 60 years with low-energy intertrochanteric fractures treated with PFNA at Sansai Hospital between January and December 2024. Surgeons selected locked (n = 54) or non-locked (n = 53) end caps based on fracture stability and bone quality. The primary outcome was radiographic union at final follow-up (mean 267.5 ± 50.0 days). Secondary outcomes included screw cut-out, screw cut-through, and lateral blade migration. Fisher’s exact test was used, with p < 0.05 considered significant.

Results: Overall union was achieved in 95.3% of patients, with no significant difference between groups (92.6% vs. 98.1%, p = 0.363). In the locked group, three patients (5.6%) had screw cut-out requiring arthroplasty. In the non-locked group, two patients (3.8%) developed lateral migration requiring implant removal. No central cut-through occurred.

Conclusions: Both end caps types yielded high union rates. Locked end caps carry a higher risk of screw cut-out, whereas non-locked end caps are associated with lateral blade migration. Locked end caps may have more catastrophic failure requiring major revision.

Patient Factors Associated with the Good Outcome after a Single Injection of Plasma-Rich Growth Factors in Patients with Osteoarthritic Knee

2026-05-01T13:37:37+07:00

Purpose: This study aimed to evaluate patient factors for a good outcome of a single intra-articular (IA) plasma-rich growth factor (PRGF) 12 months after injection in patients with varying severities of knee osteoarthritis (KOA) using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score.

Methods: Patients with mild-to-severe KOA who received a single IA PRGF injection at an outpatient clinic were eligible to participate in this study. An observational analytical cohort study and clinical evaluation using WOMAC scores for the baseline and five follow-up periods were performed. A good outcome was defined as ≥50% improvement in pain or in function of WOMAC score at 12 months after injection compared to baseline. Logistic regression was performed to determine the factors associated with good outcomes of a single IA PRGF injection.

Results: A total of 215 knees with osteoarthritis (OA) were recruited in this study; 30.7% of them had severe KOA. The mean age of the participants was 65.26 ±7.96 years (range; 41-87 years), and the mean body mass index (BMI) was 25.74 ±3.56 kg/m2 (range; 17-38 kg/m2) The mean difference in WOMAC scores between baseline and at 12 months after injection were 82.71±36.53 in good response group and 23.20±30.15 in short response group. Overall, 72.56% of the participants had good outcomes. Multivariate analysis revealed that demographic patient factors, including age, sex, and BMI, did not affect good outcomes. Hypertension (HT) and KOA severity were significant negative factors associated with good outcomes.

Conclusions: 72.56% of the patients had good outcome in terms of WOMAC score improvement in pain or function, 72.56% of the patients had good outcomes 12 months after a single injection of IA PRGF. The patient factors that negatively affected good outcomes were not only underlying diseases, including HT, but also KOA severity. Further clinical studies should be conducted to obtain more details on HT, including severity, disease control, and treatment, which may have affected our results.

Optimal Hematocrit Level Associated with Blood Reservation for Surgery for Hip Fracture

2026-05-11T20:05:38+07:00

Purpose: To study the optimal hematocrit level associated with blood reservation for high hip fracture surgery.

Methods: We retrospectively studied the medical records of 56 patients with hip fractures who underwent surgery at our hospital between January and December 2022. Data were collected including hematocrit levels before and after surgery at 6, 48, and 72 h. Risk factors and hematocrit levels for blood transfusion were assessed using univariate, bivariate, and multivariate analyses and receiver operating characteristic (ROC) curves to determine the associated factors and optimal hematocrit level in patients with hip fractures.

Results: Fifty-six inpatient medical records showed a statistically significant difference in age, sex, and use of antiplatelet and/or anticoagulant drugs between the blood transfusion and non- transfusion groups. The group that received antiplatelet and/or anticoagulant drugs lost significantly more blood, 191.67 ± 172.67 ml, compared with 122.86 ± 75.49 ml in those who did not receive them. In the fractures at the intertrochanter of femur, the least intraoperative blood loss was statistically significant, at 110.00 ± 60.74 ml. Comparison with fractures at the neck and subtrochanteric of femur, the blood loss was 210.74 ± 126.06 ml and 1 liter, respectively. When divided into subgroups according to femoral neck fractures, the Garden 1 group had the least intraoperative blood loss, with statistical significance at 88.00 ± 52.63 ml. There was a linear relationship between estimated blood loss and body mass index (kg/m²), time to operation (days), and operative time (minutes), with R = 0.724 and R² = 0.524. When analyzing the ROC, the optimal hematocrit level for blood reservation for hip fracture surgery was ≤34%. The sensitivity, specificity, and accuracy were 85.7 %, 60%, and 84.2 %, respectively.

Conclusions: The optimal hematocrit level in blood reservation planning is ≤34%, with accuracy of 84.2%.

Functional and Symptomatic Effects of Vitamin D Supplementation Following Carpal Tunnel Release: A Randomized Controlled Trial

2026-05-16T16:43:47+07:00

Purpose: Carpal tunnel release (CTR) is the standard surgery for patients with carpal tunnel syndrome (CTS) who do not respond to conservative management. Vitamin D is implicated in musculoskeletal and neurological health; evidence suggests it has neuroprotective effects, influencin pain and functional outcomes. This randomized controlled trial aimed to evaluate the impact of postoperative vitamin D supplementation on functional and symptomatic outcomes after CTR.

Methods: Seventy patients with CTS who underwent CTR were randomly assigned to receive postoperative vitamin D supplementation (40,000 IU/week for 4 weeks) or none. Patients were assessed at baseline and 12 weeks postoperatively. The primary outcomes included pain intensity measured using the Visual Analog Scale (VAS), grip strength, and the Thai version of the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale [SSS] and Functional Status Scale [FSS]). Baseline characteristics were compared between groups.

Results: Of the 70 patients, 54 (79.4%) were female, with a mean age of 53.02±8.52 years and mean body mass index of 24.24±3.62 kg/m². Most (93.8%) were right-handed, with right-sided disease in 38 (55.1%) and severe CTS in 39 (57.4%) patients. Baseline characteristics were similar between groups. At 12 weeks, there were no statistically significant differences between the vitamin D and control groups in the VAS scores, grip strength, SSS, or FSS. No vitamin D toxicity or hypervitaminosis-related complications were observed.

Conclusions: Postoperative vitamin D supplementation at 40,000 IU/week for 4 weeks did not significantly improve pain, functional status, or symptom severity after CTR. Supplementation was well tolerated with no adverse effects.

Femoral Neck Growth and Remodeling After Screw Removal Following Slipped Capital Femoral Epiphysis

2026-05-20T14:37:44+07:00

Purpose: The primary objective of this study was to investigate the remodeling process of the femoral neck after screw removal in patients with slipped capital femoral epiphysis (SCFE).

Background: In situ screw fixation is widely used to stabilize SCFE and prevent its progression, often with the expectation that physeal closure will occur over time. However, concerns remain regarding the alteration of proximal femoral growth and morphology, and the potential for remodeling after elective screw removal is not well defined.

Methods: We retrospectively reviewed 40 patients (47 hips) diagnosed with SCFE, who underwent in situ screw fixation using two cancellous screws, followed by scheduled screw removal approximately one year later. The immediate postoperative radiographs were compared with those obtained at the time of physeal closure. Radiographic parameters, including articulotrochanteric distance (ATD) and lesser trochanter–articular distance (LTA), were analyzed to assess femoral neck morphology in terms of width, length, and angular changes.

Results: Radiographic comparisons between immediate postoperative and post-physeal closure evaluations revealed a statistically significant improvements in femoral neck length, width, and anglular remodeling.

Conclusions: SCFE treated with in situ screw fixation followed by screw removal facilitates femoral neck remodeling and contributes to hip restoration at skeletal maturity.

Landmark Loss-of-Resistance Versus Fluoroscopy-Guided Caudal Epidural Steroid Injection for Sciatica: A Prospective Comparative Study

2026-05-24T14:05:23+07:00

Purpose: To compare clinical outcomes, procedure time, and adverse events between landmark loss-of-resistance (LOR) and fluoroscopy-guided (FL) caudal epidural steroid injection (CESI) for sciatica due to magnetic resonance imaging (MRI)-confirmed lumbar disc protrusion or extrusion.

Methods: In a prospective, randomized, 1:1-allocation trial, patients received LOR or FL CESI using an identical injectate. Pain (Visual Analog Scale [VAS]), disability (Oswestry Disability Index [ODI]), and patient satisfaction (Patient Satisfaction Score [PSS]) were assessed at baseline and at 1, 3, 6, and 12 months. Procedure time and adverse events were recorded. The primary between-group inference at 12 months used baseline-adjusted analysis of covariance (ANCOVA), reported as adjusted mean differences (AMD; LOR−FL) with 95% confidence intervals (CIs).

Results: Seventy patients were randomized equally (LOR n = 35; FL n = 35). Both groups showed improvement in VAS, ODI, and PSS over 12 months. At 12 months, adjusted between-group differences were small and not statistically significant: VAS 0.41 (95% CI -0.54 to 1.36), ODI 1.96 (95% CI -2.96 to 6.87), and PSS 0.37 (95% CI -0.45 to 1.20). Procedure time was significantly shorter with LOR (6.37 ± 1.99 vs 14.09 ± 2.20 minutes; p < 0.001). Adverse events were rare, with no dural puncture or bleeding in either group.

Conclusions: In this single-center randomized study, LOR and FL CESI showed comparable 12-month outcomes for pain, disability, and satisfaction. LOR required much less procedure time and may be a practical alternative when fluoroscopy is unavailable or resources are limited.

Epidemiology and Factors Associated with Clinical Outcomes of Fragility Hip Fractures in Kamphaeng Phet Province, Thailand

2026-06-03T12:26:07+07:00

Purpose: This study investigated the epidemiological characteristics, incidence, and outcome-related factors of fragility hip fractures in Kamphaeng Phet Province, examined care pathway time intervals, comparing office-hour and off-hour arrivals, and identified independent predictors of in-hospital mortality.

Methods: This retrospective cohort study analyzed data from the provincial health database between 2020 and 2023. Eligible participants were adults aged ≥50 years with low-energy hip fractures (ICD-10: S72.0, S72.1, S72.2). Beyond Multivariate logistic regression and survival analysis (Kaplan–Meier and Cox proportional hazards model) were employed to identify independent predictors of clinical outcomes.

Results: This study included 901 patients (mean age; 77.3 years, 66.0% women). The average incidence rate was 89.2 per 100,000 population annually. The mean time from injury to hospital arrival was 101.4 h. Multivariate logistic regression revealed that delayed surgery (>48 h) was a significant independent predictor of in-hospital mortality (adjusted odds ratio = 2.45, 95% confidence interval; 1.20–4.98, p = 0.012). Survival analysis confirmed that age ≥ 70 years (hazard ratio [HR] = 3.10, p = 0.004) and delayed surgery (HR = 2.25, p = 0.018) significantly increased the hazard of mortality.

Conclusions: Although in-hospital admission processes were efficient, delayed surgery significantly increases the risk of in-hospital mortality. These findings emphasize the critical importance of the 48-h surgical window. Healthcare policies should focus on reducing pre-hospital delays and surgical waiting times to improve survival outcomes in patients with fragility hip fracture.

Incidence of Postoperative Urinary Tract Infection in Fragility Hip Fracture after Preoperative Urinary Catheter: A Randomized Controlled Trial

2026-06-03T21:58:53+07:00

Purpose: Urinary tract infection (UTI) is a prevalent complication following fragility hip fractures in the elderly, significantly impacting morbidity and mortality. Whether preoperative urinary catheterization mitigates or exacerbates this risk remains a subject of clinical debate. This study evaluates the impact of preoperative urinary catheterization on the incidence of postoperative UTI in patients aged 60 years and older undergoing surgery for fragility hip fractures.

Methods: In this prospective randomized controlled trial, 114 elderly patients were randomized (1:1) into either a preoperative urinary catheter (PUC) group or non-urinary catheter (NUC) group at a single tertiary center. The primary outcome was the incidence of symptomatic UTI (SUTI). Secondary outcomes included asymptomatic bacteremic UTI (ABUTI), acute urinary retention (AUR), postoperative pneumonia, and length of hospital stay (LOS).

Results: Among the 114 patients analyzed, the incidence of SUTI was higher in the PUC group than in the NUC group; however, this did not reach statistical significance. Similarly, the rate of ABUTI was identical in both groups. The NUC group exhibited a higher incidence of AUR (19.30% vs. 8.77%); however, the difference was not statistically significant. Notably, the PUC group experienced a significantly higher rate of postoperative pneumonia and prolonged mean LOS.

Conclusions: Routine preoperative urinary catheterization in elderly patients with fragility hip fractures was associated with a higher clinical trend of symptomatic UTIs, significantly increased rates of postoperative pneumonia, and prolonged hospital stays. The findings show that avoiding routine catheterization may help mitigate systemic complications and facilitate recovery.

Surgical Treatment of Insertional Achilles Tendinopathy With or Without Endoscopic Gastrocnemius Recession: A Retrospective Comparative Study

2026-06-06T09:28:12+07:00

Purpose: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain, often associated with Haglund deformity, degenerative changes at the tendon insertion, and gastrocnemius tightness. Standard surgical management includes open debridement, retrocalcaneal bursectomy, calcaneal exostectomy, and Achilles tendon reattachment. The role of adjunct endoscopic gastrocnemius recession (EGR) remains controversial because comparative data on functional outcomes, ankle motion, and complications are limited.

Methods: This single-center retrospective comparative study included patients with chronic IAT who failed ≥3 months of nonoperative management and underwent surgery between January 2019 and December 2023. All patients received open debridement, Haglund resection, retrocalcaneal bursectomy, and double-row reattachment with or without adjunct EGR. Patients were allocated to gastrocnemius (GR, n = 18) or no gastrocnemius (no GR, n = 15) recession groups. Outcomes included VAS pain, FAAM, SF‑36 physical and mental subscales, heel-rise height difference, ankle dorsiflexion, and complications, assessed preoperatively and at three, six, and 12 months postoperatively.

Results: Thirty-three patients were analyzed. At three months postoperatively, the GR group had lower pain, higher FAAM and SF‑36 physical scores, and greater dorsiflexion gains. By 12 months, pain, function, heel-rise symmetry, and complication rates were similar; wound complications and transient nerve symptoms occurred only in the no GR and GR groups, respectively.

Conclusions: Adjunct EGR in IAT surgery provides earlier pain relief, better short-term functional recovery, and sustained dorsiflexion improvement without increasing overall complications and may reduce wound-related problems.

Risk Factors for Postoperative Sciatic Nerve Injury Following Open Reduction and Internal Fixation of Acetabular Fractures: A Systematic Review and Meta-Analysis

2026-06-17T20:14:49+07:00

Purpose: Postoperative sciatic nerve injury is a debilitating complication after open reduction and internal fixation (ORIF) of acetabular fractures. The reported incidence and risk factors are highly variable. This systematic review and meta-analysis aimed to synthesize the current evidence on the incidence and risk factors of this complication.

Methods: A systematic search was conducted in the PubMed/MEDLINE and Scopus databases for studies published January 2000–December 2025. We included cohort and case-control studies that reported new-onset postoperative sciatic nerve injuries after acetabular ORIF. Studies not distinguishing between pre-(traumatic) and postoperative injuries were excluded. A random-effects meta-analysis using the Restricted Maximum-Likelihood estimator and Hartung-Knapp-Sidik-Jonkman adjustment was performed to pool incidence. Risk factors were analyzed by pooling unadjusted odds ratios (ORs) and narratively synthesizing adjusted ORs.

Results: Five retrospective cohort studies involving 3,104 patients were included. The pooled incidence of postoperative sciatic nerve injury was 5.9% (95% confidence interval [CI]: 1.8%–12.2%) with substantial heterogeneity (I²=88.8%). Analysis of potential risk factors, including patient positioning (prone vs. lateral), was inconclusive because of the limited number of studies and extreme statistical uncertainty. These findings should be considered exploratory and hypothesis-generating rather than definitive. Several risk factors were identified from single studies, including transverse fracture patterns (unadjusted OR 3.00, 95%CI: 1.10–7.90) and obesity (unadjusted OR 3.35, 95%CI: 1.61–6.96), but these require further validation. Leave-one-out sensitivity analysis identified one study as a major source of heterogeneity.

Conclusions: The incidence of sciatic nerve injury after acetabular ORIF was approximately 6%; however, this was based on highly heterogeneous retrospective evidence. The current literature is insufficient to support definitive conclusions regarding specific risk factors. There is an urgent need for high-quality, prospective, multicenter studies with standardized definitions to better delineate risks and guide preventative strategies.

Level of evidence: Level III (Oxford Centre for Evidence-Based Medicine 2011).