Nevin Manimala

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

Jt Dis Relat Surg. 2026 May 1;37(2):344-350. doi: 10.52312/jdrs.2026.2642. Epub 2026 Mar 18.

ABSTRACT

OBJECTIVES: This study aims to compare the volume and impact of hidden blood loss (HBL) following total hip arthroplasty (THA) performed via the direct anterior approach (DAA) versus the posterolateral approach (PLA).

PATIENTS AND METHODS: Between January 2016 and January 2024, a total of 134 patients (63 males, 71 females; mean age: 69.7 ± 7.7 years; range, 48 to 79 years) who underwent primary THA were retrospectively analyzed. The patients were stratified into two cohorts according to surgical approach: DAA group (n = 63) and PLA group (n = 71). Preoperative blood volume and visible blood loss (VBL) were quantified for both cohorts. Total blood loss (TBL) was derived from hematocrit (Hct) levels measured preoperatively and on postoperative Day 3, which subsequently allowed calculation of HBL and its proportion relative to TBL. Intergroup comparisons were performed for these parameters.

RESULTS: The most common etiology for THA was hip osteoarthritis. The mean operative time was 120.4 ± 10.2 min in the DAA group and 117.7 ± 8.2 min in the PLA group, indicating no statistically significant difference between the two groups (p = 0.093). The mean TBL was 366.3 ± 54.3 mL in the DAA group and 477.0 ± 71.6 mL in the PLA group (p < 0.001), while the mean HBL was 206.3 ± 40.4 mL and 318.9 ± 44.9 mL, respectively (p < 0.001). The reductions in Hb and Hct were significantly lower in the DAA group compared to the PLA group (p < 0.001 for both).

CONCLUSION: During the perioperative period of THA, HBL represents a considerable clinical concern regardless of the surgical approach employed. Compared to the PLA, the DAA is associated with a significant reduction in both HBL and TBL.

PMID:41906829 | DOI:10.52312/jdrs.2026.2642

Jt Dis Relat Surg. 2026 May 1;37(2):325-343. doi: 10.52312/jdrs.2026.2523. Epub 2025 Dec 29.

ABSTRACT

OBJECTIVES: This study aims to systematically evaluate the efficacy and safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) in promoting bone regeneration.

MATERIALS AND METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to May 2024. Fifteen randomized-controlled trials involving 2,137 cases were included. Traditional and network meta-analyses were performed, machine learning techniques were applied to explore heterogeneity, and subgroup analyses were carried out to assess efficacy across anatomical sites including alveolar sockets, palatal clefts, and spinal fusion.

RESULTS: No significant difference was found in the overall bone healing rate between the rhBMP-2 and control groups (relative risk [RR] = 1.02, 95% confidence interval [CI] 0.87-1.20). However, rhBMP-2 demonstrated a significant advantage in spinal fusion (RR = 1.09, 95% CI 1.01-1.17) and a positive, although not statistically significant, trend in small oral and jaw bone defects. The incidence of serious adverse events was comparable (RR = 0.97, 95% CI 0.66-1.42). Network meta-analysis indicated that the overall success rate of bone regeneration with rhBMP-2 (odds ratio [OR] = 1.53, 95% CI 0.54-4.33) and other bone substitutes (OR = 1.42, 95% CI 0.39-5.21) did not significantly exceed autograft treatment, although both showed a trend toward superiority. Direct pairwise comparison revealed that rhBMP-2 was significantly more effective than autograft (OR = 1.54, 95% CI 1.02-2.33, p < 0.05), with low heterogeneity (I² = 0%).

CONCLUSION: While the overall healing rate was comparable to controls, rhBMP-2 showed significant efficacy in spinal fusion and a favorable safety profile. Its effectiveness was context-specific, influenced by anatomical site and patient factors. These findings support the selective use of rhBMP-2 in specific clinical contexts such as spinal surgery, while further research is needed to optimize its application in other indications.

PMID:41906828 | DOI:10.52312/jdrs.2026.2523

Jt Dis Relat Surg. 2026 May 1;37(2):291-298. doi: 10.52312/jdrs.2026.2556. Epub 2025 Dec 15.

ABSTRACT

OBJECTIVES: This study aims to quantify hidden blood loss (HBL) associated with minimally invasive pedicle screw placement and to compare HBL between the Wiltse approach and percutaneous pedicle screw techniques.

PATIENTS AND METHODS: Between January 2020 and December 2022, a total of 126 neurologically intact patients (63 males, 63 females; mean age: 43.0 ± 11.5 years; range, 18 to 65 years) with single-segment traumatic thoracolumbar fractures who underwent surgery were retrospectively analyzed. The patients were categorized into two groups based on surgical technique: the study group (Wiltse approach) and control group (percutaneous pedicle screw). Demographic and clinical data were collected. Perioperative laboratory values were recorded, and HBL was calculated using a combination of the Nadler, Gross, and Sehat formulas.

RESULTS: The Wiltse approach group demonstrated a significantly shorter surgical time and fewer intraoperative fluoroscopy uses compared to the percutaneous group (p < 0.001 for both). Although intraoperative visible blood loss (VBL) was higher in the Wiltse group (p < 0.001), this group showed a smaller postoperative hemoglobin loss (p = 0.025) and significantly less HBL in absolute volume (p=0.031).

CONCLUSION: In minimally invasive surgery for single-segment thoracolumbar fractures, perioperative HBL considerably exceeds VBL. Compared to the Wiltse approach, percutaneous pedicle screw fixation is associated with longer operation time, greater radiation exposure, and higher HBL. Therefore, spine surgeons should emphasize close monitoring of postoperative hemoglobin and appropriate management of anemia in patients undergoing percutaneous instrumentation.

PMID:41906824 | DOI:10.52312/jdrs.2026.2556

Pacing Clin Electrophysiol. 2026 Mar 30. doi: 10.1111/pace.70217. Online ahead of print.

ABSTRACT

BACKGROUND: Current guidelines recommend the use of combined oral anticoagulants and antiplatelet agents in patients with acute myocardial infarction (AMI) and atrial fibrillation (AF), especially for those at high risk. In real-world clinical practice, adherence to anticoagulant therapy is often suboptimal, and some patients do not routinely receive it.

METHODS: Patients diagnosed with AMI and AF who were prescribed dual antiplatelet drugs in Tianjin, China, from August 2016 to June 2023 were enrolled. The primary outcomes were stroke, ischemic stroke, and hemorrhagic stroke.

RESULTS: A total of 1,026 patients were identified (mean age: 73.7, standard deviation: 9.12; 39% female), which included 132 rivaroxaban users and 894 non-users. Over a median follow-up of 922 days, 298 patients died and 367 patients suffered from stroke. After adjusting for multiple variables, rivaroxaban users had a lower risk of any stroke (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.43-0.90) and ischemic stroke (HR, 0.63; 95% CI, 0.43-0.92), compared to non-users. In the propensity matched cohort, rivaroxaban users had a lower risk of stroke and ischemic stroke with no significant difference in bleeding or major bleeding. Multivariable competing risk models were consistent with the above results. No statistically significant association was found for rivaroxaban use and bleeding, major bleeding, all-cause mortality, or cardiovascular mortality.

CONCLUSIONS: Concomitant rivaroxaban use is associated with lower risks of stroke, especially ischemic stroke, but with no significant increase in the risks of bleeding and major bleeding in patients with AMI and preexisting AF taking dual antiplatelet drugs.

TRIAL REGISTRATION: Registration number: ChiCTR2400094021.

PMID:41906822 | DOI:10.1111/pace.70217