Category: Statistics

J Psychoactive Drugs. 2026 Aug 2:1-9. doi: 10.1080/02791072.2026.2712399. Online ahead of print.

ABSTRACT

This paper aims to evaluate the perceived value of the drug prevention activities in Malaysia’s high-risk areas. The drug prevention activities involved are counseling, outreach, workshop, and program. A quantitative method is employed in this study to investigate the participants’ perception on the programs. A cross-sectional survey of 332 participants across seven selected high-risk regions in Peninsular Malaysia were selected for their proximity to international borders and high drug-related crime statistics. The results revealed compelling insights, showing that emotional and social values were strongly correlated with program effectiveness, while functional value showed only marginal influence. These findings challenge conventional policy approaches by demonstrating that community-based interventions fostering emotional support networks and social cohesion yield substantially greater impact than traditional information-driven or enforcement-focused strategies. The study also has theoretical contributions by validating the applicability of perceived value theory in substance abuse prevention contexts, while offering practical recommendations for policymakers to redesign interventions with greater emphasis on psychosocial support mechanisms. Limitations include the cross-sectional design and regional focus, suggesting opportunities for future longitudinal studies across broader geographical areas to assess program sustainability and cultural adaptability.

PMID:42542935 | DOI:10.1080/02791072.2026.2712399

Jt Dis Relat Surg. 2026 Jul 24;37(3):873-881. doi: 10.52312/jdrs.2026.2959. Epub 2026 Jul 24.

ABSTRACT

OBJECTIVES: This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time.

PATIENTS AND METHODS: Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified.

RESULTS: Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78 ± 1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant.

CONCLUSION: The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.

PMID:42542930 | DOI:10.52312/jdrs.2026.2959

Jt Dis Relat Surg. 2026 Jul 23;37(3):822-837. doi: 10.52312/jdrs.2026.2951. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of BPC-157, synthetic thymosin beta-4 (TB-500), and their combination on Achilles tendon healing using biomechanical, histopathological, histochemical, and immunohistochemical analyses in a rat model.

MATERIALS AND METHODS: Thirty-two male Sprague-Dawley rats, each aged 12 weeks and weighing approximately 330 g, underwent standardized Achilles tendon transection and repair and were randomly assigned to four groups, with eight rats in each group: control, BPC-157 (10 µg/kg/day), TB-500 (60 µg/kg/day), and combined BPC-157 + TB-500 (BPC + TB). Treatments were administered intraperitoneally for four weeks postoperatively. At four weeks, tendons were harvested for biomechanical testing or histological evaluation. Maximum load to failure was assessed biomechanically. Histological and histochemical analyses included hematoxylin-eosin, Masson trichrome, Alcian blue, and Sirius red staining and were evaluated using Bonar and Movin scoring systems. Expression of collagen types I and III was assessed immunohistochemically and semiquantified using H-score analysis.

RESULTS: Biomechanical testing revealed higher maximum load to failure values in the BPC-157 and TB-500 groups compared to controls, reaching statistical significance in the TB-500 group (p < 0.05). Histopathological evaluation demonstrated significantly lower total Bonar scores in the TB-500 group (p = 0.016) and significantly lower total Movin scores in the TB-500 and BPC + TB groups (p = 0.017 and p = 0.040, respectively) relative to controls, indicating improved tendon architecture, collagen alignment, and reduced degenerative changes. The BPC-157 group showed numerically lower scores without reaching statistical significance for total scores. Sirius red birefringence analysis showed increased type I collagen organization and altered type III collagen distribution in treatment groups, particularly in the TB-500 group, suggesting progression toward matrix maturation. Immunohistochemical analysis revealed no significant differences in collagen type I expression among groups, whereas collagen type III expression differed significantly, consistent with histochemical findings. Combined BPC-157 and TB-500 treatment did not confer additional benefits compared to either agent alone.

CONCLUSION: In this exploratory rat model study, both BPC-157 and TB-500 were associated with improved histopathological parameters and extracellular matrix organization during early Achilles tendon repair, with TB-500 additionally demonstrating a significant biomechanical advantage at four weeks. The absence of additive effects with combination therapy may reflect convergence on shared downstream pathways; however, this hypothesis requires further experimental confirmation. These preliminary findings indicate that both peptides warrant further investigation as candidate adjuncts to tendon repair, pending dose-optimization and longer-term studies.

PMID:42542926 | DOI:10.52312/jdrs.2026.2951

Jt Dis Relat Surg. 2026 Jun 12;37(3):785-799. doi: 10.52312/jdrs.2026.2795. Epub 2026 Jun 12.

ABSTRACT

OBJECTIVES: This study aims to evaluate the dose-dependent protective effects of punicalagin (PUN) in a rat model of Steroid-induced osteonecrosis of the femoral head (SONFH).

MATERIALS AND METHODS: Twenty-four male Wistar albino rats were randomly assigned to four groups (n = 6 per group): control, osteonecrosis (ON), ON treated with 10 mg/kg PUN, and ON treated with 40 mg/kg PUN. Osteonecrosis was induced using lipopolysaccharide and methylprednisolone. Femoral heads were evaluated using micro-computed tomography (CT), histopathological examination, and immunohistochemical analysis of cleaved caspase-3. Serum oxidative stress and antioxidant parameters including malondialdehyde (MDA), reduced glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were measured.

RESULTS: The primary outcome measure, the percentage of empty lacunae, was significantly higher in the ON group compared to controls (p = 0.01), showing a numerical reduction in the 40 mg/kg PUN group. Histopathological evaluation demonstrated a significant reduction in pyknotic cells in the high-dose PUN group compared to the ON group (p < 0.05). Furthermore, PUN treatment reduced the incidence of osteonecrosis (2/6 vs. 6/6; p < 0.01) and improved trabecular architecture. Immunohistochemical analysis showed decreased caspase-3 expression specifically in trabecular bone and adipocytes in the high-dose PUN group (p < 0.01), while downward trends were observed in bone marrow and endothelial cells. Micro-CT analysis confirmed a significant reduction in bone mineral density in the ON group compared to controls (p = 0.02). Regarding oxidative stress, although no statistically significant differences were observed, numerical trends toward reduced lipid peroxidation (p = 0.61) and a strong trend toward enhanced antioxidant capacity (GSH; p = 0.07) with a moderate-to-large effect size were noted.

CONCLUSION: Punicalagin may exert dose-dependent protective effects against SONFH in rats, primarily associated with reduced apoptotic activity and partial preservation of bone microarchitecture. While systemic oxidative stress markers show numerical improvements, the marked reduction in osteocyte apoptosis and necrotic incidence suggests that PUN represents a promising adjunctive strategy for mitigating steroid-related bone injury.

PMID:42542923 | DOI:10.52312/jdrs.2026.2795

Jt Dis Relat Surg. 2026 May 4;37(3):777-784. doi: 10.52312/jdrs.2026.2927. Epub 2026 May 4.

ABSTRACT

OBJECTIVES: In this study, we aimed to compare the clinical and radiological outcomes of patients undergoing arthrodesis and trapeziectomy with ligament reconstruction and tendon interposition (T + LRTI) for thumb carpometacarpal (CMC) osteoarthritis and to investigate whether patient-specific decision-making could offer advantages over LRTI or arthrodesis as a surgical approach.

PATIENTS AND METHODS: Between August 2014 and January 2025, a total of 40 patients who underwent surgical treatment for thumb CMC osteoarthritis were retrospectively analyzed. The patients were divided into two groups as the T + LRTI group (n = 22) and arthrodesis group (n = 18). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), grip strength (kg), and pinch strength (kg) measurements.

RESULTS: Of the patients, 7 were male and 33 were female with a mean age of 62.9 ± 6.5 years in T + LRTI group, 60.1 ± 7.4 years in arthrodesis group (range, 40 to 75 years). Both groups demonstrated significant improvement in VAS and QuickDASH scores postoperatively (p < 0.001). The mean postoperative VAS scores were 2.7 ± 2.0 in the T + LRTI group and 1.9 ± 0.9 in the arthrodesis group (p = 0.267), while QuickDASH scores were 26.4 ± 17.3 and 19.1 ± 3.2, respectively (p = 0.085). No significant differences were observed in grip strength (p = 0.358), palmar pinch (p = 0.104) and key pinch strength (p = 0.097) between the groups. The overall complication rate was 12.5% in both groups, indicating no statistically significant difference (p = 0.642).

CONCLUSION: Our study results suggest that both T + LRTI and arthrodesis provide effective and comparable pain relief and functional outcomes in the surgical management of thumb CMC osteoarthritis and can be considered reliable surgical options.

PMID:42542922 | DOI:10.52312/jdrs.2026.2927

Jt Dis Relat Surg. 2026 Jul 23;37(3):768-776. doi: 10.52312/jdrs.2026.2776. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of medial openwedge high tibial osteotomy (OWHTO) on gait analysis outcomes in patients with medial compartment osteoarthritis and varus alignment of the knee.

PATIENTS AND METHODS: This prospective, observational study included a total of 22 patients who underwent biplanar medial OWHTO between February 2023 and March 2024 were included. Gait analysis was performed preoperatively and at the sixth postoperative month using the DIERS formetric 4D system. Early postoperative (6 months) gait parameters, angular parameters (tibial slope and correction angle), and joint kinematics were evaluated. Patient-reported outcomes were obtained using the Oxford Knee Score (OKS) to assess pain and physical function before and after the procedure.

RESULTS: Of a total of 22 patients included in the study, 4 were male and 18 were female with a mean age of 55.41 ± 5.86 (range, 47 to 63) years. Postoperatively, patients’ walking speed (0.83 ± 1.12 m/s), step length (0.58 ± 0.73 m), and cadence (82.72 ± 92.05 steps/min) increased significantly (p < 0.001). The tibial slope angle showed a mean increase of 1.93° (p < 0.001). The mean correction angle was 7.53°. The mean knee flexion increased significantly from 35.05° ± 8.74° preoperatively to 52.96° ± 13.21° postoperatively (p < 0.001). Knee extension improved minimally but significantly from -7.55° ± 1.18° to -6.03° ± 0.05° (p = 0.046). Ankle dorsiflexion increased significantly (p < 0.001), whereas changes in plantar flexion were not statistically significant. The OKS score increased significantly from 18.30 preoperatively to 41.50 at the sixth postoperative month (p < 0.001).

CONCLUSION: Medial OWHTO results in early improvements in walking speed, step length, and cadence, as well as enhanced knee flexion kinematics and patient-reported outcomes. These findings indicate that OWHTO is an effective surgical option contributing to the improvement of gait patterns in the early postoperative period.

PMID:42542921 | DOI:10.52312/jdrs.2026.2776

Jt Dis Relat Surg. 2026 Jul 13;37(3):756-767. doi: 10.52312/jdrs.2026.2866. Epub 2026 Jul 13.

ABSTRACT

OBJECTIVES: This study aims to evaluate the clinical and objective biomechanical outcomes at a minimum 10-year follow-up following open double-Tajima repair combined with a structured functional loading protocol.

PATIENTS AND METHODS: Between January 2011 and December 2014, a total of 47 consecutive non-competitive adults (Tegner Activity Scale ≤ 4) with acute unilateral Achilles tendon rupture treated with open double-Tajima repair and an eight-week functional loading protocol were included in this retrospective cohort study. The primary outcome was the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Secondary outcomes included isokinetic dynamometry (peak torque at 30°/s and total work at 120°/s for plantar flexion and dorsiflexion), joint position sense, and ankle/calf circumference. Between-limb comparisons were performed.

RESULTS: Of the patients, 35 were male and 12 were female with a mean age at the time of surgery of 36.7 ± 6.6 (range, 22 to 55) years. The mean follow-up was 132.4 ± 13.5 (range, 120 to 168) months. The rupture involved the dominant limb in 29 patients (61.7%) and the non-dominant limb in 18 patients (38.3%). The primary outcome (AOFAS score) showed no statistically significant between-limb difference: the median score was 91.0 (IQR, 91.0 to 93.0) on the operated limb versus 93.0 (IQR, 91.0 to 93.0) on the contralateral limb (median difference: 0.00 points; 95% confidence interval [CI]: -1.00 to 1.00; p = 0.92). No statistically significant between-limb differences were detected across the secondary outcomes, including peak torque at 30°/s, total work at 120°/s, joint position sense, and ankle/calf circumference (p ≥ 0.09 for all). The complication rate was 4.3% (2/47): one partial rerupture managed conservatively and one superficial wound infection treated with oral antibiotics. No complete reruptures were observed.

CONCLUSION: Open double-Tajima repair combined with a structured functional loading protocol seems to be associated with clinically acceptable long-term outcomes in this cohort of non-competitive adults. However, given the retrospective, single-cohort design without an independent comparison group or formal equivalence framework, these findings should be interpreted as descriptive long-term observations.

PMID:42542920 | DOI:10.52312/jdrs.2026.2866

Jt Dis Relat Surg. 2026 Jul 24;37(3):714-722. doi: 10.52312/jdrs.2026.2784. Epub 2026 Jul 24.

ABSTRACT

OBJECTIVES: This study aims to evaluate the reliability of cervical vertebral maturation (CVM) staging in determining skeletal maturity in patients with adolescent idiopathic scoliosis (AIS), focusing on the effect of professional experience among orthopedic surgeons.

PATIENTS AND METHODS: Between January 2023 and January 2025, this reliability and agreement study included a total of 72 patients aged between nine and 16 years who were diagnosed with AIS. Intra- and inter-rater reliability were analyzed using weighted kappa (κ) statistics with standard errors (SEs) and 95% confidence intervals (CIs). A total of 72 full-spine lateral radiographs were independently assessed by 10 raters with varying levels of orthopedic expertise, including medical students, residents, consultants, and spinal surgeons. None of the raters had prior experience with the CVM classification. Each rater performed CVM staging twice with a four-week interval between assessments.

RESULTS: Of the patients, 33 were male and 39 were female with a mean age of 13.07 ± 1.97 (range, 9 to 16) years. Overall intra-rater reliability was substantial (κ = 0.64, SE = 0.032, 95% CI: 0.569-0.714), and overall inter-rater reliability was moderate (κ = 0.52). Although spinal surgeons showed slightly higher intra-rater reliability overall, inter-rater reliability declined between assessments (first assessment κ = 0.61 vs. second assessment κ = 0.34). Consultants exhibited the highest inter-rater agreement (κ = 0.62), whereas residents showed improvement between assessments (κ = 0.40 vs. 0.52); however, no significant difference observed between groups.

CONCLUSION: The reliability of CVM staging for assessing skeletal maturity in AIS patients does not significantly differ across levels of orthopedic expertise. While CVM staging has potential as a radiation-sparing method, the overall moderate agreement, particularly among physicians without prior experience, indicates that reliability is not significantly influenced by professional experience.

PMID:42542916 | DOI:10.52312/jdrs.2026.2784

Jt Dis Relat Surg. 2026 Jul 13;37(3):705-713. doi: 10.52312/jdrs.2026.2698. Epub 2026 Jul 13.

ABSTRACT

OBJECTIVES: This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients.

PATIENTS AND METHODS: Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell’s lines.

RESULTS: Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 ± 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury.

CONCLUSION: Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.

PMID:42542915 | DOI:10.52312/jdrs.2026.2698

Jt Dis Relat Surg. 2026 Jun 17;37(3):688-696. doi: 10.52312/jdrs.2026.2570. Epub 2026 Jun 17.

ABSTRACT

OBJECTIVES: This study aims to compare the biomechanical performance of three different surgical fixation techniques in the treatment of proximal humerus fractures with medial metaphyseal defects.

MATERIALS AND METHODS: A total of 24 synthetic humerus bone models were used and equally divided into three groups (n = 8 per group). A standardized unstable proximal humerus fracture model with a medial metaphyseal cortical defect extending to the surgical neck was created using a three-dimensional (3D)-printed osteotomy guide. Group 1 received fixation with a lateral anatomical locking plate. Group 2 was treated with a combination of a lateral anatomical plate and a medial buttress plate (dual plating). Group 3 underwent fixation with an intramedullary nail (IMN); in this group, four specimens had distal locking with an endopin (Group 3a), and the other four with static screws (Group 3b). All specimens were subjected to axial loading until failure. Forces at the onset of failure and complete failure were recorded, and fracture patterns were documented.

RESULTS: In Groups 1 and 2, transverse fractures consistently occurred at the level of the most distal screw of the lateral plate. In Group 3, failure was observed either proximally or distally at the nail tip, including butterfly fragment formation and metaphyseal collapse. Group 2 exhibited the highest resistance to axial loading, followed by Group 1 and Group 3, with statistically significant differences between all groups (p = 0.043, p = 0.0003, p < 0.00001). No significant difference was found between subgroups 3a and 3b (p > 0.05).

CONCLUSION: Our study results indicate that double plating provides the greatest axial stability in proximal humerus fractures with medial metaphyseal defects, supporting its use in fracture patterns with medial column deficiency. However, as fixation choice should be guided by patient-specific factors and surgical feasibility, these findings should be interpreted in the context of experimental conditions and loading limitations.

PMID:42542913 | DOI:10.52312/jdrs.2026.2570