Category: Statistics

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

Jt Dis Relat Surg. 2026 May 15;37(3):649-657. doi: 10.52312/jdrs.2026.2794. Epub 2026 May 15.

ABSTRACT

OBJECTIVES: This study aims to evaluate the efficacy and safety of a comprehensive, multidisciplinary perioperative blood management (PBM) protocol in patients with Hemophilia A undergoing total joint arthroplasty (TJA).

PATIENTS AND METHODS: Between December 2014 and November 2024, a total of 29 male patients (mean age: 33.38 ± 8.62 years; range, 20 to 55 years) with hemophilic arthropathy (HA), all diagnosed with Hemophilia A, who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) were retrospectively analyzed. All patients received a standardized PBM protocol, including preoperative factor Ⅷ sensitivity testing, individualized factor replacement, restrictive fluid management, ultrasound-guided regional anesthesia, and tranexamic acid administration. Primary outcomes included total blood loss (TBL) and hemoglobin (Hb) drop. Secondary outcomes included operation time, length of hospital stay (LOS), and perioperative complications.

RESULTS: All 29 procedures were successfully completed under our PBM protocol. For the entire cohort, the median TBL was 630.52 (range, 470.95 to 939.64) mL, and the mean Hb decrease on postoperative Day 5 was -41.83 ± 22.81 g/L. The median operative time was 122.0 (range, 91.0 to 182.5) min, and the median LOS was 23.0 (range, 19.0 to 31.0) days. Simultaneous double TJA showed higher TBL and transfusion rates than single TJA, but the outcomes remained within safe clinical limits. Furthermore, THA was associated with significantly shorter operation time (p = 0.008) and lower total FⅧ consumption (p = 0.036) compared to TKA, despite similar TBL (p = 0.860). No major complications, such as inhibitor development, hemorrhage or venous thromboembolism were observed.

CONCLUSION: A standardized, multidisciplinary PBM protocol ensures surgical safety in patients with end-stage HA. Despite the underlying hemorrhagic diathesis, optimized factor replacement and comprehensive anesthetic strategies can achieve surgical outcomes comparable to the general population. These findings support the broader clinical application of comprehensive PBM for high-risk hemophilic surgical cases.

PMID:42542909 | DOI:10.52312/jdrs.2026.2794

Jt Dis Relat Surg. 2026 Jul 10;37(3):637-648. doi: 10.52312/jdrs.2026.2311. Epub 2026 Jul 10.

ABSTRACT

OBJECTIVES: This study aims to compare the efficacy of conventional rehabilitation alone, conventional rehabilitation combined with balance acupuncture (BA) and conventional rehabilitation plus BA and unconscious proprioception training in chronic ankle instability (CAI) patients.

PATIENTS AND METHODS: This single-center, parallel-group, assessor-blinded randomized-controlled trial included a total of 120 CAI patients between October 2022 and October 2024. The patients were randomly assigned to control (n = 40), BA (n = 40), and combination therapy (CT, (n = 40) groups. All groups received six weeks of intervention (6 days/week): the control group received conventional rehabilitation, the BA group received conventional rehabilitation + BA and the CT group received conventional rehabilitation + BA + unconscious proprioception training. Unconscious proprioception training was defined as dual-task training using the MOTOmed system with cognitive distraction to shift focus away from conscious movement control. Assessments were conducted before and after treatment using a three-dimensional gait analysis system, a balance function testing and training system, and the Star Excursion Balance Test (SEBT).

RESULTS: There was no statistically significant difference in age and sex among the groups (p > 0.05). In addition, disease duration and number of previous sprains were comparable among the groups (p > 0.05). Following the six-week intervention, all three groups showed significant improvements in gait parameters, balance function and SEBT scores compared to baseline (p < 0.05). The CT group exhibited significantly greater improvements in gait speed, cadence, movement length, movement ellipse area and SEBT scores than the BA group (p < 0.05), whereas the BA group outperformed the control group in all outcome measures (p < 0.05). No adverse reactions were reported in any group.

CONCLUSION: The integration of BA and unconscious proprioception training may offer additional benefits for improving gait and balance in CAI patients compared to conventional rehabilitation plus BA or conventional rehabilitation alone. Based on these preliminary findings, the combined approach shows potential clinical value for targeted populations with CAI.

PMID:42542908 | DOI:10.52312/jdrs.2026.2311

Jt Dis Relat Surg. 2026 Jul 16;37(3):626-636. doi: 10.52312/jdrs.2026.2619. Epub 2026 Jul 16.

ABSTRACT

OBJECTIVES: This study aims to compare the rates of medical complication and mortality following initial bipolar hemiarthroplasty (bHA) and reoperation procedures, as well as between different causes of reoperation (nonseptic vs. septic).

PATIENTS AND METHODS: The retrospective study included 118 patients undergoing reoperation after bHA for femoral neck fractures between January 2002 and December 2022. The primary outcomes included in-hospital complications, readmission, and mortality events, while secondary outcomes included length of hospital stay, transfusion rates, and estimated blood loss. These outcomes were compared between each patient’s initial bHA and their subsequent reoperation procedure. The two cohorts were matched using propensity scores based on age, sex, and Charlson Comorbidity Index to compare outcomes between nonseptic and septic causes of reoperation.

RESULTS: Of the 118 patients, 64 were male and 54 were female. The mean age was 77.8 ± 7.9 years, with a range of 61 to 98 years. The in-hospital complication rate was higher after reoperation than after initial bHA (15.3% vs. 1.7%, p < 0.001). Conversely, the readmission rate was higher after the initial procedure (60.2% vs. 23.7%, p < 0.001), mainly due to surgical complications. Patients undergoing reoperation had longer hospital stays, higher transfusion requirements, and more frequently received general anesthesia compared to the initial procedure (p < 0.05). In the matched cohort, septic group had higher in-hospital complication rates than the nonseptic group (23.5% vs. 3.9%, p = 0.004), while readmission and mortality rates were comparable.

CONCLUSION: Reoperations after bHA carry a higher risk of medical complications. This risk is particularly pronounced in cases related to septic conditions, underscoring the greater impact of reoperation and careful clinical attention.

PMID:42542907 | DOI:10.52312/jdrs.2026.2619

Jt Dis Relat Surg. 2026 Jul 23;37(3):581-891. doi: 10.52312/jdrs.2026.2733. Epub 2026 Jul 23.

ABSTRACT

OBJECTIVES: In this meta-analysis, we discuss the clinical efficacy of closed reduction with in situ fixation for valgus-impacted femoral neck fractures (VIFNFs) by contrasting postoperative functional recovery and complication profiles.

MATERIALS AND METHODS: We performed a systematic literature search in PubMed, Embase, Web of Science, the Cochrane Library, and ScienceDirect for publications up to October 2025. The search targeted original studies which directly compared the surgical outcomes of closed reduction and in situ internal fixation for valgus-impacted femoral neck fractures. Search terms included combinations of: valgus-impacted (or valgus impaction), femoral neck fracture, in situ, reduction, and internal fixation. Pooled data were analyzed using mean differences (MD) with 95% confidence intervals (CIs) for continuous outcomes and risk differences (RD) with 95% CIs for dichotomous outcomes.

RESULTS: The final analysis included a total of 447 patients extracted from five studies that met the predetermined inclusion criteria. The meta-analysis demonstrated that the closed reduction group exhibited a statistically significant reduction in postoperative femoral neck shortening (FNS) compared with the in situ fixation group (MD: 4.05; 95% CI: 2.68 ~ 5.42; p < 0.00001). For the caput-collum-diaphysis (CCD) angle, the closed reduction group showed a borderline significant improvement relative to the in situ fixation group (MD: 9.79; 95% CI: 0.19 ~ 19.39; p = 0.05). The in situ fixation group was associated with a substantially lower reoperation rate (RD: -0.08; 95% CI: -0.16 ~ -0.01; p = 0.04). No statistically significant intergroup differences were detected for the Harris Hip Score (HHS) (MD: -4.13; 95% CI: -9.37 ~ 1.11; p = 0.12), incidence of femoral head necrosis (RD: -0.05; 95% CI: -0.14 ~ 0.05; p = 0.36), or fixation failure rate (RD: -0.05; 95% CI: -0.17 ~ 0.06; p = 0.37).

CONCLUSION: Closed reduction yields a statistically significant advantage in reducing postoperative FNS and a borderline significant benefit in maintaining the CCD. In contrast, in situ fixation is associated with a lower reoperation rate. The two strategies show comparable outcomes for the HHS, femoral head necrosis incidence, and fixation failure rate. Thus, surgical approach should be individualized based on patient-specific profiles.

PMID:42542903 | DOI:10.52312/jdrs.2026.2733

Cureus. 2026 Jul 2;18(7):e111959. doi: 10.7759/cureus.111959. eCollection 2026 Jul.

ABSTRACT

Background MRI radiomics has recently gained attention for evaluating intratumoral heterogeneity in thoracic malignancies. Thymic epithelial tumors (TETs) include a wide spectrum from the low-risk thymoma group (LRG) to thymic carcinoma (TC), but imaging-based differentiation remains challenging. This study aimed to assess the utility of MRI texture analysis for differentiating TET subtypes according to the 2021 WHO classification. Methods Forty-seven patients with histologically proven TETs (19 LRG, 18 high-risk thymoma group (HRG), and 10 TC) underwent preoperative MRI including T1-, T2-, diffusion-weighted (DWI), and apparent diffusion coefficient (ADC) sequences. Texture analysis was performed using LIFEx software (version 7.6.0; French Alternative Energies and Atomic Energy Commission, Paris, France). A total of 41 texture features were extracted from manually delineated three-dimensional tumor volumes. Statistical comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests with Benjamini-Hochberg false discovery rate correction. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. Results Among the 47 lesions, 24, 28, and 37 texture parameters differed significantly between LRG-HRG, LRG-TC, and HRG-TC, respectively. The highest area under the curve (AUC) values were 0.785 for DWI coefficient of variation in differentiating LRG from HRG, 0.933 for T1WI morphological radius in differentiating LRG from TC, and 0.867 for ADC intensity variance in differentiating HRG from TC. Conclusions MRI-based texture analysis provides a promising noninvasive approach for differentiating thymic epithelial tumor subtypes according to the WHO classification. Sequence-specific texture parameters demonstrated moderate to high diagnostic performance, particularly for differentiating low-risk thymoma from thymic carcinoma. These findings suggest that MRI radiomics may contribute to preoperative risk stratification and treatment planning in patients with thymic epithelial tumors.

PMID:42542899 | PMC:PMC13428655 | DOI:10.7759/cureus.111959

Cureus. 2026 Jul 29;18(7):e113599. doi: 10.7759/cureus.113599. eCollection 2026 Jul.

ABSTRACT

Introduction In recent years, artificial intelligence (AI)-generated prostate whole-gland segmentation has shown promise for clinical use. This study compares AI- and human-derived prostate segmentation on magnetic resonance imaging (MRI) and evaluates its practical application. Methods A retrospective study from December 2020 to December 2022 evaluated 31 randomly selected patients who had previously undergone MRI-ultrasound (US)-guided fusion biopsies. AI-generated auto-contours of the whole-gland prostate, seminal vesicle, and urethra were produced using the ProtégéAI feature of the MIM Software from MRIs obtained on GE Signa HDxt 3.0T and Siemens Altea Magnetom 1.5T scanners. The same MRIs were independently contoured manually by a board-certified urologist (U) and a board-certified radiologist (R) using MIM Software contouring tools. Volumetric conformity among the three contour sets was assessed using the Dice similarity coefficient, Hausdorff distance (HD), and mean distance to agreement (MDA). Contouring time was recorded for each method, with AI timed from command execution to file generation and physicians timed from file opening to save. Pairwise Wilcoxon signed-rank tests (JMP Pro 15) compared contouring times and similarities across AI to urologist (AI-U), AI to radiologist (AI-R), and urologist to radiologist (U-R) contours. Results The average volumetric Dice similarity, HD, and MDA for the AI-U contours were 0.875±0.039, 9.186±4.004 mm, and 1.410±0.511 mm for the whole-gland prostate, 0.283±0.185, 18.117±13.265 mm, and 4.907±4.992 mm for the urethra, and 0.377±0.244, 14.708±9.489 mm, and 4.260±4.092 mm for the seminal vesicle. For the AI-R contours, the values were 0.757±0.072, 17.562±7.240 mm, and 3.050±1.339 mm for the prostate, 0.162±0.105, 19.956±11.962 mm, and 4.798±3.879 mm for the urethra, and 0.451±0.219, 16.069±9.245 mm, and 4.075±3.734 mm for the seminal vesicle. For the U-R contours, the values were 0.769±0.070, 15.109±6.177 mm, and 2.733±1.265 mm for the prostate, 0.144±0.091, 13.560±7.087 mm, and 3.406±1.985 mm for the urethra, and 0.471±0.216, 12.981±6.756 mm, and 3.264±2.308 mm for the seminal vesicle. Using the Wilcoxon signed-rank test with statistical significance defined as p<0.01, the AI-U Dice similarity for the prostate differed significantly from both the AI-R and U-R comparisons. Similarly, AI-U demonstrated significantly different HD values than both AI-R and U-R, whereas the AI-R and U-R HD comparison was statistically insignificant. All pairwise MDA comparisons for the prostate were statistically significant. For the urethra, the AI-U Dice similarity differed from the other two comparisons, while for HD, the AI-R and U-R comparisons differed significantly from each other. No significant differences were observed among the three comparisons for the seminal vesicle across any metric. The average times to produce contours for the AI, urologist, and radiologist were 96.5 seconds, 285.8 seconds, and 217.9 seconds, respectively (p<0.01 for each time comparison). Conclusion This study suggests that AI may be a useful tool for prostate segmentation workflows in streamlining MRI-US prostate cancer diagnostics by producing similar contouring results in less time. Additional investigation should be conducted regarding the differences between the pathological outcomes of AI and non-AI contours, and the accuracy, cost analysis, and efficiency of AI technology should be elucidated.

PMID:42542897 | PMC:PMC13428640 | DOI:10.7759/cureus.113599

Cureus. 2026 Aug 1;18(8):e113791. doi: 10.7759/cureus.113791. eCollection 2026 Aug.

ABSTRACT

Introduction The use of health services expanded during the pandemic and became a regular part of healthcare. There is not a lot of information about how these services are used over the long term and how patients engage with them. This study examined how patients used telemental health services at King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia, from 2019 to 2025. Objectives To evaluate how telemental health services were used and how patients engaged with them during the time before the pandemic, during the pandemic, and after the pandemic. The study also compared how many appointments were completed and the characteristics of patients who had virtual appointments versus in-person appointments. Methods This was a retrospective, repeated cross-sectional census study of electronic health record data on all scheduled mental health appointments, virtual and in-person, at KAMC from January 1, 2019, to December 31, 2025. All eligible encounters and unique patients across 12 facilities were included using total enumeration rather than sampling. Data were cleaned and analyzed in Python using Google Colab. Descriptive statistics were used to summarize appointment and patient characteristics. Chi-square tests were used to compare categorical variables, including appointment completion by encounter type, and the Mann-Whitney U test was used to compare patient age between virtual and in-person appointments. A binary logistic regression model was used to identify factors associated with appointment completion, including encounter type, pandemic period, and patient demographics. Results The study included 479,643 appointments with 51,323 patients at 12 facilities. Overall, 9% of the appointments were virtual. In 2019, there were no appointments, but their use increased during the pandemic and then stayed steady at around 11% to 12% per year after 2021. Overall, 55% of appointments were completed. Virtual appointments had a higher completion rate than in-person appointments, with 60% of virtual appointments being completed compared to 54% of in-person appointments. We also found that patients who had virtual appointments were substantially older and that virtual appointments were mostly used for follow-up visits rather than new patient appointments. Conclusion Telemental health services went from being an emergency solution during the pandemic to a part of mental health services at the facility. The study found that virtual appointments were associated with patient engagement, which means that patients were more likely to complete their appointments. These findings support the continued use of a hybrid of in-person and virtual mental health services. The findings provide information to support the planning and development of telemental health services. Telemental health services are a part of the healthcare system, and they can be an effective way to deliver the services.

PMID:42542890 | PMC:PMC13428641 | DOI:10.7759/cureus.113791