Category: Statistics

Perspect Biol Med. 2026;69(1):106-125. doi: 10.1353/pbm.2026.a985817.

ABSTRACT

Death certificates act as verified records concluding the administrative aspects of a person’s life. In the US, the death certificate includes essential biographical information about the decedent, including the manner and cause of death. To some, the cause of death may be a procedural step necessary to obtain a death certificate, and where there is not an ensuing forensic investigation, the cause of death may even seem immaterial. But specificity in determining the cause of death is crucial to epidemiological and public health initiatives and for the maintenance of accurate mortality records. This article argues that inaccuracies in cause of death determinations are harmful: they are detrimental to the professional commitments physicians owe their patients and distort the lived experiences of the deceased. Inaccuracy in vital statistics affects individuals and families by misrepresenting the physiological and biological processes leading to death and potentially altering the deceased person’s life story. While there is extensive literature exploring the challenges faced by clinicians in determining the cause of death, this article focuses on modifications made to the cause of death-whether consciously through deliberate intent to conceal, or unconsciously through error or omission-where the death may be socially stigmatizing.

PMID:41906895 | DOI:10.1353/pbm.2026.a985817

Jt Dis Relat Surg. 2026 May 1;37(2):552-562. doi: 10.52312/jdrs.2026.2769. Epub 2026 Mar 23.

ABSTRACT

OBJECTIVES: This study aims to evaluate the effects of topical creams containing mucopolysaccharide polysulfate (MPS) on wound healing using an experimental wound model.

MATERIALS AND METHODS: Standard full-thickness skin defects were created in 32 Wistar rats and monitored for 14 days under four different topical treatment protocols: Control (Group 1, n = 8), Hirudoid (Group 2, n = 8), Silverdin (Group 3, n = 8), and Hirudoid + Silverdin (Group 4, n = 8). Wound closure rates were quantified through photographic analysis, while histological and immunohistochemical healing characteristics were assessed using the Structure, Presence of Cells, Organization, and Tissue Integration (SPOT) score, additional histological indices, and the transforming growth factor-beta 1 (TGF-β1) H-score. Intergroup differences were analyzed using appropriate non-parametric statistical tests.

RESULTS: On Day 3, wound closure rates were higher in the Hirudoid, Silverdin, and Hirudoid + Silverdin groups compared to the control group (p < 0.01). By Day 14, this difference sustained only in the Silverdin and Hirudoid + Silverdin groups, indicating that the early advantage observed with Hirudoid alone was not maintained over time (p < 0.01). No significant differences in the general histological parameters were observed among the groups (p > 0.05). However, the TGF-β1 H-score was lower in the Silverdin group than in the control and Hirudoid groups (p < 0.01).

CONCLUSION: Our study results suggest that MPS may accelerate early wound closure, but does not significantly improve wound closure in later stages, and its combination with silver sulfadiazine offers no additional benefit compared to silver sulfadiazine alone.

PMID:41906850 | DOI:10.52312/jdrs.2026.2769

Jt Dis Relat Surg. 2026 May 1;37(2):519-530. doi: 10.52312/jdrs.2026.2655. Epub 2026 Mar 16.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the healing effects of vericiguat at various concentrations on rat femur fractures through clinical and radiological and biomechanical and histopathological assessments.

MATERIALS AND METHODS: In this study, a total of 60 female Wistar-Albino rats were used. The study comprised of six rat groups with 10 rats in each group: Group 1 (normal controls), Group 2 (positive controls – only fracture), Group 3 (low-dose vericiguat – 3 mg/kg), Group 4 (high-dose vericiguat – 6 mg/kg), Group 5 (fracture + low-dose vericiguat), Group 6 (fracture + high-dose vericiguat). Under general anesthesia, standard closed fractures were created in the right femurs of rats in the fracture groups. Radiological examinations were performed on Days 7, 14, and 28. The Lane-Sandhu scoring system was used for radiological assessment. At the end of Day 28, the rats were sacrificed, and the fracture healing tissues were examined biomechanically and histologically using the Huo scale.

RESULTS: The 28^th day biomechanical assessment showed significant differences in maximum load values between the fractured groups (Group 2: 88.75 ± 23.25 N, Group 5: 83.54 ± 23.15 N, Group 6: 39.07 ± 10.38 N; p = 0.003). The stiffness values showed similar patterns (Group 2: 64.71 ± 45.52 N/mm, Group 5: 99.20 ± 43.82 N/mm, Group 6: 40.47 ± 19.27 N/mm; p = 0.088). In the histological evaluation according to the Huo scale, Group 5 showed the highest quality of healing (8.6 ± 1.14) and a significant difference was found between Group 2 and Group 5 (p = 0.009). Group 6 demonstrated necrosis in four out of 10 animals and severe inflammation in eight out of 10 animals. In the radiological evaluation on Days 7, 14, and 28, no statistically significant differences were observed between the groups according to the Lane-Sandhu scoring system (p = 0.811 on Day 14; p = 0.299 on Day 28).

CONCLUSION: Our study results suggest that soluble guanylate cyclase (sGC) activators show promise for fracture healing treatment when used at specific concentrations, but their therapeutic range remains limited and their toxic effects at high doses need careful consideration.

PMID:41906847 | DOI:10.52312/jdrs.2026.2655

Jt Dis Relat Surg. 2026 May 1;37(2):510-518. doi: 10.52312/jdrs.2026.2600. Epub 2026 Mar 17.

ABSTRACT

OBJECTIVES: This study aims to evaluate the outcomes of the flexor tenolysis cases with wide-awake local anesthesia no tourniquet (WALANT) and to compare them with cases with other anesthesia types.

PATIENTS AND METHODS: Between March 2004 and March 2024, a total of 104 patients with 150 fingers with flexor tenolysis (71 males, 33 females; mean age: 32.67 ± 11.64 years; range, 16 to 62 years) were included in the study. The WALANT group consisted of 41 patients with 53 fingers, while the conventional anesthesia group consisted of 63 patients with 97 fingers. Pre- and postoperative total active motion (TAM) gains were compared between the two groups and relevant factors were investigated.

RESULTS: Overall TAM gain was 47% in our study cohort. The TAM gain was 55% and 43% in the WALANT group and in the conventional anesthesia group, indicating a statistically significant difference (p = 0.005). The best TAM gains were observed in the clean-cut injury type. The TAM gains were better in the cases without fractures. Age was a significant factor in the tenolysis outcomes, and younger patients had improved outcomes.

CONCLUSION: Our study results indicate a significant difference in the TAM gain between the WALANT and conventional methods. Taken together, we believe that the application of WALANT in tenolysis of flexor tendon adhesions represents a significant advancement in hand surgery. The ability to perform the procedure under local anesthesia while allowing for immediate assessment of tendon function enhances the surgical precision and results.

PMID:41906846 | DOI:10.52312/jdrs.2026.2600

Jt Dis Relat Surg. 2026 May 1;37(2):461-469. doi: 10.52312/jdrs.2026.2537. Epub 2026 Mar 11.

ABSTRACT

OBJECTIVES: This study aims to evaluate the foot as a whole, to compare the foot bones in terms of volume, and investigate the role of the foot bones in the formation of hallux valgus (HV).

PATIENTS AND METHODS: Between February 2024 and September 2024, a total of 21 patients (6 males, 15 females; mean age: 29.04 ± 5.21 years; range, 19 to 38 years) with an HVA of ≥ 30° and intermetatarsal angle (IMA) of ≥ 13° were included in this prospective study. The control group consisted of 18 patients (5 males, 13 females; mean age: 28.94 ± 5.56 years; range, 20 to 39 years) with an HVA of < 15°. Computed tomography (CT) images were uploaded to the 3D Slicer program, and the volumes of the foot bones were measured and calculated as percentages.

RESULTS: In terms of volume percentage, the mean talus (22.68 ± 1.62 vs. 21.37 ± 1.81; d = 0.78; 95% CI 0.10-1.44) and the fifth metatarsal (4.63 ± 0.85 vs. 4.15 ± 0.52; d = 0.65; 95% CI -0.01-1.29) were higher, while the mean cuboid volume (5.31 ± 0.71 vs. 5.89 ± 0.55; d = 0.90; 95% CI 0.23-1.57) was lower in the HV group, indicating a statistically significant difference (p<0.05). No significant difference was observed in the volume ratios between the bones of the medial and lateral rays (p ≥ 0.05). When medial ray bones were combined, the ratios of talus/medial cuneiform (d = 0.92) and (talus + 1^st metatarsal)/medial cuneiform (d = 0.82; 95% CI 0.20-1.52) were found to be significantly higher in the HV group (p < 0.05).

CONCLUSION: Although genetic factors are widely considered to play a key role in HV development, we propose that the process originates more proximally, most likely at the level of the talus. Based on our study results, we conclude that an increase in talar volume may lead to a compensatory reduction in the volumes of the cuboid and medial cuneiform bones, initiating a sequence in which soft-tissue forces contribute to progressive pronation of the first metatarsal, ultimately resulting in HV.

PMID:41906841 | DOI:10.52312/jdrs.2026.2537

Jt Dis Relat Surg. 2026 May 1;37(2):442-453. doi: 10.52312/jdrs.2026.2680. Epub 2025 Nov 26.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the clinical outcomes of a novel, single-stage arthroscopic ankle arthrodesis employing complete arthroscopic fibular osteotomy in patients exhibiting significant varus malalignment (≥ 10°) and severe osteoarthritis (OA) and to compare these results with those of patients undergoing arthroscopic ankle arthrodesis with mild deformity.

PATIENTS AND METHODS: Between August 2018 and May 2023, a total of 49 patients (23 males, 26 females; mean age: 50.00 ± 14.72 years; range, 21 to 71 years) who underwent arthroscopic ankle arthrodesis for tibiotalar arthrosis with a minimum postoperative follow-up of two years were retrospectively analyzed. The patients were divided into two groups: Group A (n = 20) consisted of end-stage tibiotalar OA patients with ≥ 10° varus alignment and Group B (n = 29) consisted of those with < 10° varus alignment. An arthroscopic fibular osteotomy at the level of ankle joint was performed using an osteotome introduced through the anteromedial portal in Group A, resulting in fibula shortening equivalent to the thickness of the osteotome. Fixation in both groups was achieved using two or three 6.5-mm cannulated screws. Outcomes were evaluated utilizing the Visual Analog Scale (VAS) for pain, the 36-item Short Form Survey (SF-36), and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS) at baseline and at three, six, 12, and 24 months postoperatively.

RESULTS: There was no statistically significant difference between the groups in terms of age, sex, or the affected sides between the groups (p = 0.210, p = 0.348, and p = 0.906, respectively). All the patients had Takakura Stage IIIB and IV ankle OA with a trauma-related etiology. The mean duration of the operation was 85.50±9.72 min in Group A which included arthroscopic fibular osteotomy and 57.59 ± 5.61 min in Group B, indicating a statistically significant difference (p < 0.001). The mean fusion times and complication rates were comparable between the groups (p = 0.064 and p = 1.000, respectively). All patients demonstrated significant and consistent improvements in VAS, AOFAS, and SF-36 scores, compared to baseline (p < 0.001). At three months, the VAS scores in Group A were significantly higher (p=0.020); however, later evaluations showed comparable scores between the groups. Group B exhibited significantly higher AOFAS scores at three, six, and 24 months. The SF-36 scores indicated no significant differences between the groups in any time points in the postoperative period.

CONCLUSION: This study provides the novel, initial clinical evidence for a single-stage arthroscopic procedure which incorporates complete arthroscopic ankle arthrodesis and arthroscopic fibular osteotomy in severe varus deformities. It can be effectively used with similar fusion and recovery times, by eliminating mechanical obstruction caused by the fibula in varus OA without necessitating additional surgical incisions.

PMID:41906839 | DOI:10.52312/jdrs.2026.2680

Jt Dis Relat Surg. 2026 May 1;37(2):431-441. doi: 10.52312/jdrs.2026.2603. Epub 2025 Dec 29.

ABSTRACT

OBJECTIVES: This study aims to evaluate the clinical characteristics, surgical management, and outcomes of irreducible metacarpophalangeal (MCP) dislocations.

PATIENTS AND METHODS: Between August 2020 and August 2024, a total of 13 patients (7 males, 6 females; mean age: 29.2 ± 23.7 years; range, 7 to 78 years) with MCP dislocations who were surgically treated were retrospectively analyzed. Demographics, dislocation patterns, obstructing elements, operative approach, and postoperative complications were documented. Functional outcomes included MCP range of motion (ROM), extension lag, grip strength recovery compared to the contralateral hand, and patient-reported disability using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) questionnaire.

RESULTS: The index finger was most frequently involved (53.8%), with dorsal dislocations predominating (76.9%). A dorsal approach was performed in 76.9%. Dorsal reconstruction resulted in greater MCP ROM (flexion 85.8° ± 7.5° vs. 78.4° ± 6.7°), smaller extension lag (-1.8° ± 3.7° vs. -4.2° ± 5.3°), and lower disability scores (QuickDASH 4.0 ± 4.7 vs. 8.8 ± 5.5). Volar reconstruction provided superior grip strength (107.5 ± 8.7% vs. 90.9 ± 12.3%), exceeding baseline. Return-to-sport was earlier after the dorsal approach (11.5 ± 2.9 vs. 14.4 ± 3.0 weeks). Although differences did not reach statistical significance, large effect sizes (d ≥ 0.8) highlighted clinical relevance. Transient postoperative hypoesthesia occurred in two volar cases.

CONCLUSION: Timely operative management, tailored to dislocation type and obstructing anatomy, is essential. The dorsal approach optimizes MCP mobility, disability reduction, and athletic recovery, whereas the volar approach enhances grip strength. These complementary outcomes underscore the importance of individualized surgical selection and structured rehabilitation.

PMID:41906838 | DOI:10.52312/jdrs.2026.2603

Jt Dis Relat Surg. 2026 May 1;37(2):390-401. doi: 10.52312/jdrs.2026.2500. Epub 2026 Mar 20.

ABSTRACT

OBJECTIVES: In this meta-analysis, we systematically compared the efficacy of the Allgöwer-Donati suture technique versus the interrupted vertical mattress suture technique in preventing postoperative incision complications following calcaneal fracture surgery.

MATERIALS AND METHODS: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inceptions up to May 2025. This study included randomized-controlled trials (RCTs) involving adults (18-80 years) with closed calcaneal fractures who underwent open reduction and internal fixation (ORIF) via a lateral incision. The primary outcomes were surgical suture time, wound suture time, drainage tube removal time, and the incidence of postoperative complications. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effect or random-effects models based on heterogeneity (I² statistic).

RESULTS: Eight RCTs comprising 640 patients were included. The Allgöwer-Donati technique significantly reduced surgical suture time (SMD = 0.81, 95% CI 0.22 to 1.39, p = 0.007; I² = 47%), drainage tube removal time (SMD = 4.94, 95% CI 4.42-5.47, p < 0.00001; I² = 65%), and wound suture time (SMD = -3.36, 95% CI -3.90 to -2.81, p < 0.00001; I² = 34%) compared to the interrupted vertical mattress technique. However, there was no significant difference in the overall rate of postoperative complications between the two techniques (OR = 1.32, 95% CI 0.95-1.82, p = 0.10; I² = 0%).

CONCLUSION: The Allgöwer-Donati suture technique offers significant advantages in operative efficiency by reducing suture times and drainage duration without increasing the risk of postoperative complications compared to the interrupted vertical mattress technique. It represents a promising suturing option for calcaneal fracture surgery, particularly in settings valuing procedural efficiency.

PMID:41906834 | DOI:10.52312/jdrs.2026.2500

Jt Dis Relat Surg. 2026 May 1;37(2):372-380. doi: 10.52312/jdrs.2026.2654. Epub 2026 Mar 16.

ABSTRACT

OBJECTIVES: This study aims to evaluate the osteogenic effect of platelet-rich fibrin (PRF) graft with periosteal repair on a bone defect of long bone in rabbits, compared to control group that underwent periosteal repair alone.

MATERIALS AND METHODS: A total of 12 female New Zealand white rabbits were used in this study. Two rabbits were designated for PRP preparation, mixed with a human thrombin agent to produce PRF. A bone defect (5 mm in diameter and 7 mm in depth) was created in both proximal tibiae of 10 rabbits. The defect site of the right proximal tibia was filled with PRF, followed by periosteal repair (PRF group). In contrast, only periosteal repair was performed on the left proximal tibia (control group). For histological evaluation, hematoxylin and eosin (HE) and Masson’s trichrome (MT) staining were performed at Weeks 4 and 8 after surgery. The bone healing ratio, defined as the proportion of newly formed bone area to surgically created defect area, was calculated to assess bone regeneration. For radiological examination, micro-computed tomography (micro-CT) was conducted at Week 8 after surgery.

RESULTS: A total of nine rabbits survived until the planned euthanasia time points (four rabbits at Week 4 and five at Week 8). At Week 4 postoperatively, HE staining revealed a higher bone healing ratio in the PRF group compared to the control group; however, the difference was not statistically significant (PRF group: 71.0 ± 15.6, control group: 59.5 ± 18.1, p = 0.34). At Week 8 postoperatively, histological analysis showed no difference in the bone healing ratio between the two groups (PRF group: 79.3 ± 8.7, control group: 75.9 ± 13.2, p = 0.55). Micro-CT analysis demonstrated a superior LaneSandhu score in the PRF group compared to the control group, although this difference was not statistically significant (p = 0.15).

CONCLUSION: The PRF graft with periosteal repair appears to promote improved early-stage new bone formation in bone defects of long bone in an animal model compared to periosteal repair alone, although it does not reach statistical significance.

PMID:41906832 | DOI:10.52312/jdrs.2026.2654

Jt Dis Relat Surg. 2026 May 1;37(2):360-371. doi: 10.52312/jdrs.2026.2558. Epub 2026 Mar 11.

ABSTRACT

OBJECTIVES: This meta-analysis aimed to systematically compare the clinical outcomes of cannulated screw tension band (CSTB) and Kirschner wire tension band (KWTB) fixation for patellar fractures.

MATERIALS AND METHODS: Comprehensive searches were conducted in the Cochrane Library, Web of Science, PubMed, Embase, and SpringerLink databases for studies published through July 2025. Search terms included “cannulated screw,” “Kirschner wire,” “tension band,” and “patellar fracture.” Mean differences (MDs) and odds ratios (ORs) were utilized as pooled effect measures, with 95% confidence intervals (CIs).

RESULTS: Eleven studies involving 1,358 patients with patellar fractures met the inclusion criteria. Meta-analysis revealed no statistically significant differences between the groups in terms of operative time (MD = 4.00; 95% CI -1.82~9.82; p = 0.18), fracture healing time (MD = 0.08; 95% CI -0.07~0.22; p = 0.28), or postoperative Visual Analog Scale scores (MD = 0.21; 95% CI -0.74~1.15; p = 0.67). However, CSTB fixation demonstrated significantly superior postoperative knee range of motion (ROM) (MD = -7.16; 95% CI -9.34~-4.98; p < 0.00001), higher Lysholm scores (MD = -4.80; 95% CI -6.62~-2.99; p < 0.00001), and significantly lower rates of reoperation (OR = 5.14; 95% CI 2.66~9.93; p < 0.00001) and overall complications (OR = 14.19; 95% CI 4.85~41.56; p < 0.00001) compared to KWTB.

CONCLUSION: For patellar fracture fixation, CSTB offers significant advantages over KWTB in terms of postoperative knee ROM, functional outcomes, reoperation rates, and overall complication rates.

PMID:41906831 | DOI:10.52312/jdrs.2026.2558