<?xml version="1.0" encoding="utf-8"?>
    <rss version="2.0">
      <channel xmlns:content="http://purl.org/rss/1.0/modules/content/">
        <title>Frontiers in Surgery | Orthopedic Surgery section | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/surgery/sections/orthopedic-surgery</link>
        <description>RSS Feed for Orthopedic Surgery section in the Frontiers in Surgery journal | New and Recent Articles</description>
        <language>en-us</language>
        <generator>Frontiers Feed Generator,version:1</generator>
        <pubDate>2026-05-14T17:52:07.571+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1808791</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1808791</link>
        <title><![CDATA[Guiding acute repair decisions of MCL injuries with a novel MRI classification system: a retrospective study of 226 cases with MRI and intraoperative findings]]></title>
        <pubdate>2026-05-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yu Mei</author><author>Shuangshuang Li</author><author>Zegang Wang</author><author>Xing Xie</author><author>Yu Yin</author><author>Dai Li</author><author>Shaofeng Yang</author>
        <description><![CDATA[ObjectiveThis study aimed to investigate the relationship between magnetic resonance imaging (MRI) findings and intraoperative findings of Grade III medial collateral ligament (MCL) injuries to validating the diagnostic accuracy of MRI in localizing the tear and exploring the distribution of tear locations in these injuries.MethodsWe reviewed 226 patients with MCL repair surgery and introduced a novel MRI-based classification system. MCL tears were classified into types 1a, 1b, 2a, 2b, 3, 4a, and 4b based on their location relative to the seven attachments. We then recorded tear locations and calculated the incidence of each type. The Kappa statistic was used to assess both the agreement between MRI and intraoperative classifications and inter-observer reliability. The sensitivity, specificity and accuracy (95% CIs) of MRI for localizing tears were calculated against intraoperative findings.ResultsThere was good inter-observer (k = 0.63, P < 0.001) and substantial intraoperative (k = 0.92, P < 0.001) agreement for the MRI classifications. MRI demonstrated high diagnostic performance across all locations. Sensitivity ranged from 81.8% (95% CI: 47.8%–96.8%) for location S2 to 100% for locations P1 (95% CI: 97.0%–100.0%) and P2 (95% CI: 75.9%–100.0%). Specificity was consistently high, ranging from 90.8% (95% CI: 80.3%–96.2%) for D1 to 100.0% (95% CI: 97.8%–100%) for S2. Accuracy ranged from 95.6% (95% CI: 92.1%–97.6%) for D1 to 99.6% (95% CI: 97.5%–99.9%) for P1 and P2. Type 1b tears were the most common (63.3%), followed by types 4b and 3. The posterior oblique ligament (POL) tears were present in 77.0% of the cohort.ConclusionThe MRI classification system provides high diagnostic accuracy in locating MCL tears, particularly POL tears, for which the adductor tubercle serves as a reliable reference. Thus, this system confirms that the presence of a POL tear is a key factor guiding acute MCL repair.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1781748</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1781748</link>
        <title><![CDATA[Comparative study of femoral neck shortening following two types of internal fixation in young and middle-aged patients with displaced femoral neck fractures]]></title>
        <pubdate>2026-05-11T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Yun He</author><author>Yiliyaer Abudusimu</author><author>Guosheng Wang</author><author>Bin Xu</author><author>Tayierjiang Yasheng</author>
        <description><![CDATA[ObjectiveTo compare the outcomes of femoral neck shortening between the Femoral Neck System (FNS) and FNS combined with Cannulated Compression Screws (CCS) in the treatment of displaced femoral neck fractures in young and middle-aged patients.MethodsA retrospective analysis was conducted on 163 young and middle-aged patients with displaced femoral neck fractures who underwent either FNS or FNS combined with CCS internal fixation surgery in the Department of Trauma Orthopedics at the Sixth Affiliated Hospital of Xinjiang Medical University between September 2019 and January 2023. According to the internal fixation method, patients were divided into the FNS group (n = 94) and the combined group (n = 69). There were 76 males and 87 females, aged 39 to 61 years, with a mean age of 52.5 years. The causes of injury included 94 cases of road traffic injuries, 31 cases of high falls, and 38 cases of falls. According to the Garden classification, there were 44 cases of type III and 119 cases of type IV. Differences in perioperative indicators, femoral neck shortening, hip joint function, and complications were compared between the two groups.ResultsThere were no statistically significant differences between the two groups in terms of age, gender, injury mechanism, injury location, Garden classification, time from fracture to surgery, or the presence of cardiovascular diseases, diabetes, smoking history, or alcohol history (P > 0.05). The operative time and intraoperative blood loss in the combined group were significantly greater than those in the FNS group [142 (112, 152) min vs. 81 (76, 92) min; 86 (77, 92) mL vs. 56 (51, 66) mL], with statistical significance (P < 0.05). The degree of femoral neck shortening in the combined group was significantly lower than that in the FNS group at 3 months (1.58 ± 0.32 mm vs. 3.04 ± 0.68 mm), 9 months (2.65 ± 0.52 mm vs. 3.98 ± 0.30 mm), and 15 months (2.88 ± 0.79 mm vs. 4.62 ± 1.09 mm) postoperatively, with statistical significance (P < 0.05). There were no statistically significant differences between the two groups in reduction quality, postoperative hospital stay, hip Harris score, or complication rates (P > 0.05).ConclusionAlthough FNS combined with CCS can reduce the degree of femoral neck shortening in patients with femoral neck fractures, it requires higher surgical expertise, longer operative time, and greater intraoperative blood loss. Surgeons should select the appropriate surgical approach based on the patient's specific circumstances.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1867369</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1867369</link>
        <title><![CDATA[Retraction: Predictive modeling of surgical outcomes in lumbar stenosis and degenerative scoliosis using 3D gait-based spine-pelvic compensation analysis]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Retraction</category>
        
        <description></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1798468</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1798468</link>
        <title><![CDATA[Combined flap with Masquelet technique and 3D-printed titanium cage for reconstruction of traumatic composite heel defects: a case report and literature review]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Junhong Chen</author><author>Xiaojun Yu</author><author>Xulin Zhang</author><author>Qingshan Li</author><author>Zhiqiang Wang</author>
        <description><![CDATA[BackgroundOpen calcaneal fractures accompanied by substantial segmental bone loss and severe soft-tissue damage represent a rare clinical presentation. The intricate anatomy of the heel region poses a significant challenge to limb-salvage efforts in such cases, for which a standardized treatment protocol remains to be established.Case summaryHere we report a case of extensive soft tissue defects around the ankle and heel, combined with a large segmental defect of the calcaneus, managed through a staged surgical approach. The first stage involved emergency debridement and coverage with antibiotic-loaded cement, while the residual heel skin was banked in the anterolateral thigh region. In the second stage, to address the composite soft tissue defects across multiple planes, a pedicled flap was combined with a free flap for reconstruction: a propeller flap based on a perforator of the peroneal artery was used to cover the posterior heel and lateral malleolus, followed by a free anterolateral thigh flap, which incorporated the banked skin, to resurface the heel and remaining critical areas. Split-thickness skin grafts were applied to non-critical zones. Antibiotic cement was implanted in the bone defect to prepare the site for later reconstruction. In the third stage, after confirming satisfactory soft tissue healing without signs of infection, a custom 3D-printed titanium cage prosthesis was implanted. To our knowledge, no similar case has been reported in the literature. This study represents the first application of a combined flap technique, the Masquelet induced membrane technique, and a 3D-printed patient-specific calcaneal prosthesis for this type of injury. One-year follow-up revealed well-positioned prosthesis on radiographic imaging, with acceptable foot contour and range of motion meeting the patient's basic functional needs. The American Orthopedic Foot & Ankle Society (AOFAS) score was 90 and the Maryland Foot Score was 89. The patient reported mild heel pain during weight-bearing, with minimal impact on daily activities.ConclusionThis case demonstrates that integrating the anti-infection benefits of the Masquelet technique, the precise structural support of 3D-printed titanium cages, and the revascularization advantages of microsurgery provides a promising combined strategy for achieving both aesthetic and functional reconstruction in complex composite heel defects.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1752070</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1752070</link>
        <title><![CDATA[A retrospective analysis of the surgical efficacy for tophi wounds in Hainan province]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Weihao Xiao</author><author>Xingchen Ming</author><author>Yuxi Huang</author><author>Jiaxuan Li</author><author>Qiqi Jiao</author><author>Jian Yang</author><author>Linyang Zheng</author><author>Yunfu Zeng</author><author>Rong Wang</author><author>Shaowen Cheng</author><author>Yangyang Bian</author><author>Jiangling Yao</author>
        <description><![CDATA[IntroductionGouty tophi are chronic inflammatory nodules resulting from monosodium urate (MSU) crystal deposition, often leading to joint deformity, skin ulceration, and functional impairment. Surgical management remains controversial due to a lack of standardized indications. This study aimed to evaluate the efficacy of surgical treatment for gouty tophi wounds and to explore surgical indications.MethodsThis retrospective study consecutively enrolled patients with gouty tophi wounds who underwent surgical treatment at the First Affiliated Hospital of Hainan Medical University, a tertiary hospital in Haikou, Hainan Province, China, between April 2018 and April 2024. Clinical data, including demographic characteristics, infection markers, nutritional parameters, and surgical outcomes, were collected from electronic medical records and paper-based patient charts. Perioperative changes in these indicators were analyzed. The study was reported in accordance with the STROBE guidelines.ResultsA total of 130 patients were included, comprising 129 males (99.2%) and 1 female (0.8%), with a mean age of 58.15 ± 14.04 years. The primary comorbidities included hypertension (43.85%), diabetes mellitus (13.85%), renal insufficiency (11.54%), and hyperlipidemia (8.46%). The primary surgical modalities were lesion excision (41.54%), debridement (34.62%), and vacuum sealing drainage (VSD) (23.08%). Wound healing was achieved in 124 cases (95.38%), with a mean healing time of 31.43 ± 16.18 days; 5 cases (3.85%) failed to heal, and 1 patient (0.77%) died from multiorgan failure. The positive microbiological culture rate decreased from 21 cases (16.15%) preoperatively to 1 case (0.77%) postoperatively, with Staphylococcus aureus (28.57%) being the predominant preoperative pathogen. Postoperative laboratory parameters showed significant reductions in white blood cell count (WBC, P < 0.05), neutrophil count (NE, P < 0.001), blood urea nitrogen (BUN, P < 0.001), uric acid (P < 0.001), and creatinine (P < 0.001) compared with preoperative values. Albumin levels increased slightly (P > 0.05), while prealbumin levels rose significantly (P < 0.001). Pain scores assessed by the Faces Pain Scale-Revised (FPS-R, P < 0.001) and the Changhai Pain Scale (P < 0.001) also demonstrated marked postoperative declines.DiscussionSurgical management of gouty tophi wounds is associated with favorable wound healing, significant systemic anti-inflammatory and metabolic benefits, and effective pain relief. The low infection rate in ulcerated tophi supports the bacteriostatic role of MSU crystals. Based on these findings, surgical indications include functional impairment, chronic non-healing wounds, refractory pain, and large tophi (>1.5 cm) impeding daily activities. Surgery should be avoided during acute gout flares and in high-risk patients with uncontrolled comorbidities.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1771682</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1771682</link>
        <title><![CDATA[Regenerative peripheral nerve interface following forequarter amputation: a case report]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jinxian Zhao</author><author>Weichun Liang</author><author>Mingshuang Wang</author><author>Haiwen Pan</author><author>Jianfeng Chen</author><author>Qingbin Li</author><author>Jianhui Lin</author><author>Guokai Feng</author><author>Zongquan Mo</author><author>Yongqiang Lao</author>
        <description><![CDATA[BackgroundForequarter amputation is a radical surgical procedure for malignant bone and soft tissue tumors involving the shoulder girdle, typically indicated for cases where limb salvage is not feasible due to extensive local invasion. However, post-amputation neuroma and phantom limb pain are major complications, occurring in 80%–90% of cases and severely impairing patients' quality of life. Traditional nerve management techniques often fail to prevent recurrent neuroma formation. The Regenerative Peripheral Nerve Interface (RPNI) is an emerging technique designed to guide axonal regeneration and mitigate pain. However, its application in oncologic high-level amputations has not been widely reported.MethodsWe report the case of a 68-year-old female who underwent forequarter amputation for a malignant tumor of the left upper arm with simultaneous prophylactic RPNI reconstruction. The main trunks of the brachial plexus were sharply transected, and their stumps were implanted into small segments of denervated free muscle graftsharvested from the brachioradialis muscle of the amputated limb to promote organized axonal regeneration.ResultsThe patient's postoperative course was uneventful, without infection or other complications. Follow-ups at 1, 3, 6, and 12 months demonstrated significant and sustained relief of residual limb pain. The Visual Analog Scale (VAS) score decreased from a preoperative level of 9 to 0 Crucially, the patient reported no phantom limb pain or symptomatic neuroma-related discomfort during follow-up. Final pathology confirmed osteosarcoma.ConclusionConcurrent RPNI reconstruction during forequarter amputation for malignancy is a safe and effective strategy to prevent postoperative neuropathic pain. This innovative application in high-level amputation patients offers a promising approach to improving quality of life.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1812315</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1812315</link>
        <title><![CDATA[Case Report: Revision surgery for a missed posterior dislocation of the humeral head in a shoulder fracture-dislocation and literature review]]></title>
        <pubdate>2026-04-30T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xin Hu</author><author>Gang Zheng</author><author>Wei Zhao</author><author>Hao Dong</author><author>Jinhao Li</author><author>Zhe Hu</author><author>Haoming Lu</author><author>Dewei Shen</author><author>Nan Wang</author>
        <description><![CDATA[BackgroundPosterior shoulder dislocation is uncommon and therefore prone to being missed. When accompanied by a proximal humeral fracture, complex fracture lines may obscure the radiographic signs of dislocation. Inadequate standardization of the imaging workup may consequently result in inappropriate management and treatment failure.Case presentationWe report a young patient in whom posterior shoulder dislocation was missed at the initial assessment because axillary and scapular Y-view radiographs were not obtained and the available imaging was insufficiently interpreted. The dislocation persisted after the index operation. Revision surgery was performed on postoperative day 9 and resulted in a favorable 5-year outcome, with no radiographic evidence of humeral head avascular necrosis or post-traumatic osteoarthritis and near-complete recovery of shoulder function.ConclusionOccult posterior shoulder dislocation should be strongly suspected in patients with complex proximal humeral fractures after high-energy trauma. Obtaining axillary or scapular Y-view radiographs, together with a systematic CT-based assessment, is essential. Even after early treatment failure, targeted revision surgery combined with structured rehabilitation may still achieve a satisfactory long-term outcome in young patients.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1816291</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1816291</link>
        <title><![CDATA[Is submuscular drainage mandatory for posterior spinal fusion in adolescent idiopathic scoliosis? A retrospective clinical study]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Duan Wenbo</author><author>Fang Guofang</author><author>Wu Jiachang</author><author>Sang Hongxun</author><author>Cao Lei</author>
        <description><![CDATA[ObjectiveThis single-center retrospective analysis was designed to evaluate the outcome of closed-suction wound drainage following posterior spinal fusion with internal instrumentation for mild to moderate adolescent idiopathic scoliosis (AIS).MethodsEighty-six AIS patients undergoing posterior spinal fusion were divided into two cohorts: submuscular closed-suction wound drainage (n = 35) and simple compressed dressing clothes without wound drainage (n = 51). These two cohorts were thoroughly compared in terms of demographic distribution and perioperative blood loss, including hemoglobin and hematocrit levels and blood transfusion volumes. Additionally, the incidence of wound-related problems (pyrexia and wound complications), duration of hospital stay, and lumbar function evaluation (lumbar mobility and SRS-22 questionnaire scores) were annually assessed during at least 5-year follow-up.ResultsThe drainage group had significantly lower hemoglobin (93.73 g/L vs. 99.95 g/L, P = 0.01) and hematocrit levels (27.75% vs. 29.94%, P < 0.01) on the third postoperative day, as well as a significantly higher postoperative blood transfusion volume (40.0 mL vs. 23.5 mL, P = 0.011) compared to the non-drainage group. Furthermore, the duration of hospital stay was significantly longer in the drainage group than in the non-drainage group (10.9 d vs. 8.0 d, P < 0.01). In contrast, the two groups were statistically similar regarding duration of fever (0.9 d vs. 1.2 d, P = 0.268), incidence of wound problems, latest lumbar mobility (42.79° vs. 44.97°, P = 0.586), and scores of function/activity domain (16.74 vs. 16.08, P = 0.285) and pain domain (22.18 vs. 21.48, P = 0.374) in the SRS-22 questionnaire.ConclusionsRoutine closed-suction drainage significantly increased blood loss and hospital stay without obviously improving wound healing or functional outcomes. Utilizing simple compressed dressings without drainage was a clinically superior and resource-efficient alternative for posterior AIS fusion, particularly in uncomplicated primary surgeries for mild to moderate deformities.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1750755</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1750755</link>
        <title><![CDATA[Anterior vertebrectomy and O-arm navigation for old L5 traumatic fractures with kyphotic deformity: a retrospective case series of clinical and radiological outcomes]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Zhi-da Chen</author><author>Yuan-jie Jiang</author><author>Bin Lin</author><author>Xiao-yang Hu</author><author>Yu-zhe Zeng</author><author>Hui Liu</author><author>Tao-yi Cai</author>
        <description><![CDATA[BackgroundOld L5 traumatic fractures with kyphotic deformity are quite rare and surgical management constitutes a significant challenge. Anterior vertebrectomy and reconstruction with O-arm navigation for old L5 traumatic fractures with kyphotic deformity aim to restore spinal stability, correct deformity, and improve functionality. This study evaluates the efficacy and safety of this approach.MethodsA retrospective case series was conducted on 43 patients with old L5 traumatic fractures and kyphotic deformity who underwent anterior vertebrectomy and reconstruction using O-arm navigation. Data were collected on operation duration, blood loss, radiological and clinical outcomes (VAS, ODI, ASIA, local Cobb angle, and vertebral anterior margin height ratio), Bridwell classification, and complications.ResultsThe mean operation duration was 182.5 ± 32.8 min, with an average blood loss of 570.5 ± 71.4 mL. All patients had regular follow up with an average duration of 27.1 ± 6.8 months. The VAS scores and ODI at 3 months postoperatively and at the final follow-up showed significant improvement compared to preoperative scores (P < 0.05). VAMHR improved significantly from 35.9 ± 5.6% preoperatively to 92.1 ± 2.1% at the final follow-up (P < 0.001). The LCA at the final follow-up 14.4 ± 3.7° showed statistically significant difference compared to preoperative measurements 37.8 ± 2.4°. Preoperative ASIA grades were C in 1 patient, D in 18 patients, and E in 24 patients. And ASIA grades were D in 9 patients and E in 34 patients at the final follow-up. Wilcoxon signed-rank test showed a significant improvement in ASIA grade at the final follow-up compared with preoperative status (P < 0.001). 11 of 43 patients (25.6%) improved by one grade, 32 of 43 patients (74.4%) remained unchanged. 34 patients achieving Bridwell grade I bone fusion. Complications were minimal, with 1 case of intraoperative venous bleeding successfully managed.ConclusionAnterior vertebrectomy and reconstruction using O-arm navigation is an effective and safe approach for treating old L5 traumatic fractures with kyphotic deformity in the medium term follow-up. It offers significant pain relief, functional recovery, and sustained correction of spinal alignment, with low complication rates and high fusion success.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1800944</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1800944</link>
        <title><![CDATA[The number of fusion levels as a potential factor influencing long-term complications of anterior controllable antedisplacement fusion: a biomechanical analysis]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Gaole He</author><author>Haopeng Li</author><author>Liang Yan</author><author>Zhongkai Liu</author><author>Teng Lu</author>
        <description><![CDATA[BackgroundAnterior controllable antedisplacement fusion (ACAF) is widely used for cervical ossification of the posterior longitudinal ligament, but long-term complications, such as adjacent segment degeneration (ASD), pseudarthrosis, cage subsidence, and implant failure, remain nonnegligible. This study aimed to explore the influence of the number of fusion levels (NFL) on these complications through finite element (FE) analysis, providing a biomechanical basis for optimizing surgical strategies for ACAF.MethodsThree FE ACAF models (two-level, three-level, and four-level) were established on the basis of a validated C2–T1 cervical spine model. A hybrid loading protocol with a 75 N follower load and physiological moments was applied to simulate physiological motions. Key parameters, including the range of motion (ROM) of the surgical and adjacent segments, disc stress, facet joint force (FJF), endplate stress, and the plate, screw, and screw–bone interface stresses, were compared among the three models.ResultsAn increase in the NFL led to significant increases in the ROM, disc stress, and FJF of adjacent segments, with the upper adjacent segment showing more prominent changes than the lower segment. The ROM of the surgical segment gradually increased with increasing NFL, and the fusion space micromotion correspondingly increased. Endplate stress and implant-related stresses (plate, screw, and screw–bone interface stresses) all tended to increase steadily with increasing NFL, reflecting a continuous increase in the mechanical load at the surgical site and in the adjacent segments.ConclusionsThe NFL is a potential risk factor for long-term complications of ACAF. An increase in the NFL raises the mechanical load in the surgical and adjacent segments, thereby potentially increasing the risks of ASD, pseudarthrosis, cage subsidence, and implant failure.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1738809</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1738809</link>
        <title><![CDATA[Case Report: Patient-specific 3D-printed preoperative simulation for tailored resection and reconstruction in complex vertebral tumors: a case of giant recurrent chondrosarcoma at the cervicothoracic junction]]></title>
        <pubdate>2026-04-24T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>M. De Robertis</author><author>P. P. Cotrufo</author><author>N. Khaled Mansour</author><author>P. Oliva</author><author>C. Cappelli</author><author>E. Stucchi</author><author>A. Baram</author><author>G. Capo</author><author>U. Cariboni</author><author>G. Mercante</author><author>M. Fornari</author><author>F. Pessina</author><author>C. Brembilla</author>
        <description><![CDATA[IntroductionThree-dimensional (3D) printing is a rapidly evolving technology that is transforming various fields and its application in surgery, particularly in spinal procedures, has seen substantial growth in the last 10 years. It enables the production of highly accurate, patient-specific custom implants and anatomical models, enhancing preoperative surgical planning and intraoperative decision-making. This article describes the workflow adopted to produce a 3D-printed model of the cervical column of a patient affected by a recurrent giant cervical chondrosarcoma, focusing on its application in the presurgical resection and reconstruction planning.Methods and resultsWe present the case of a 67-year-old female patient with recurrent clear cell chondrosarcoma of the cervical spine. After multidisciplinary discussion, a two-stage (posterior and anterior stage) intentional Enneking inappropriate subtotal resection, followed by adjuvant proton beam therapy (PBT), was planned. One week before the second surgical stage, a surgical simulation was performed on a 3D-printed model. For the 3D virtual modeling, contrast-enhanced CT images of the cervicothoracic spine were obtained for the segmentation of the different anatomical structures. A PolyJet J850 Digital Anatomy® (Stratasys, USA) printer was used due to its ability to assign different materials to each structure, closely mimicking real tissue properties. Surgery was completed without complications, with neurological improvement from American Spinal Injury Association (ASIA) C to D. Adequate decompression and stable reconstruction were achieved. Adjuvant PBT was delivered postoperatively. At the 6-month follow-up, imaging demonstrated good local control and early fusion, and the patient was pain-free and functionally independent.Discussion and conclusionThe creation of patient-specific, 1:1 scale 3D-printed anatomical models is a crucial tool in the improvement of preoperative planning, providing crucial tactile and visual insights for complex spinal tumor resection and reconstruction, thereby improving surgical precision and safety.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794712</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1794712</link>
        <title><![CDATA[Lateral rectus abdominis approach fixation of a high-energy both-column acetabular fracture after total hip arthroplasty with retention of a stable acetabular cup: a case report]]></title>
        <pubdate>2026-04-23T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Xiangyu Zong</author><author>Qicai Li</author><author>Chunpu Li</author><author>Hongtao Ge</author><author>Xuemei Yang</author><author>Yingze Zhang</author><author>Tianrui Wang</author>
        <description><![CDATA[BackgroundAcetabular fractures are intra-articular injuries with complex anatomy and demanding reduction requirements. Traumatic periprosthetic acetabular fractures after total hip arthroplasty (THA) are rare and particularly challenging because treatment must simultaneously address fracture stability and acetabular component stability.Case presentationA 72-year-old woman sustained a high-energy road-traffic injury from an outside vehicle 10 years after left THA. Computed tomography (CT) demonstrated a comminuted both-column acetabular fracture with medial displacement of the quadrilateral surface and compromised periacetabular bone continuity, raising concern for cup instability. Open reduction and internal fixation (ORIF) was performed in the supine position through a lateral rectus abdominis approach (LRAA). Intraoperative direct visualization and fluoroscopy confirmed a well-fixed, osseointegrated acetabular cup, which was therefore retained. The anterior and posterior columns and quadrilateral surface were reconstructed using two contoured reconstruction plates, with careful screw trajectory planning to avoid the cup.ConclusionFor traumatic periprosthetic both-column acetabular fractures after THA, intraoperative assessment of acetabular component stability is pivotal. When the cup is stable, LRAA can provide direct intrapelvic exposure enabling anatomic reduction and robust buttress fixation of the quadrilateral surface while avoiding revision arthroplasty.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1806067</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1806067</link>
        <title><![CDATA[Efficacy of visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy: a retrospective controlled study]]></title>
        <pubdate>2026-04-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Honglin Liu</author><author>Yuxiang Hu</author><author>Yang Zhan</author><author>Zhixin Kang</author><author>Zhuoxuan Zhang</author><author>Chengyu Huang</author><author>Ningjing Zeng</author><author>Yang Xiao</author><author>Juntao Ma</author><author>Zibo Gao</author><author>Hao Liu</author><author>Guoyi Su</author><author>Yongpeng Lin</author><author>Zhirong Fan</author><author>Dingkun Lin</author><author>Yihao Liang</author><author>Yongjin Li</author>
        <description><![CDATA[ObjectivesThe purpose of this study was to retrospectively compare the efficacy and safety of visualized reamer foraminoplasty vs. the traditional TESSYS technique in transforaminal endoscopic lumbar discectomy (TELD) for lumbar disc herniation (LDH).MethodsIn this retrospective study, 140 LDH patients were assigned to the visualized reamer group (n = 70) or the TESSYS group (n = 70). Perioperative parameters (operative time, fluoroscopy frequency), clinical outcomes [Visual Analog Score (VAS) for back/leg pain, Oswestry Disability Index (ODI)] were assessed preoperatively and at 1 day, 1, 3, 6, and 12 months postoperatively. Peri-operative complications were recorded. Subgroup analyses were performed.ResultsThe visualized reamer group demonstrated significant advantages in operative time (66.34 ± 7.65 vs. 76.06 ± 15.89 min, P < 0.05) and intraoperative fluoroscopy frequency (6.10 ± 0.90 vs. 12.06 ± 0.92, P < 0.05). Both groups showed significant clinical improvement at all timepoints (P < 0.05). The visualized reamer group demonstrated superior early postoperative leg pain relief, evidenced by significantly lower VAS leg scores at 1 day (mean difference: −0.64 points) and 1 month (mean difference: −0.43 points) compared to the TESSYS group (both P < 0.05). Mid-term clinical outcomes were comparable between the two groups. Complication analysis revealed a significantly lower incidence of postoperative lower limb dysesthesia in the visualized reamer group (0% vs. 5.71%, P < 0.05), while recurrence rates showed no significant difference (1.43% vs. 2.86%, P > 0.05). Subgroup analyses confirmed consistent treatment benefits across age, BMI, and sex (P > 0.05).ConclusionThe visualized reamer technique significantly enhances perioperative efficiency and early pain control in TELD, with comparable mid-term efficacy to the TESSYS technique. Its benefits are consistent across diverse patient populations, supporting its broad applicability.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1790170</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1790170</link>
        <title><![CDATA[Percutaneous transforaminal endoscopic discectomy vs. unilateral biportal endoscopy for far lateral lumbar disc herniation: a retrospective comparative study]]></title>
        <pubdate>2026-04-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Lu Yongjiang</author><author>Li Chunbo</author><author>Wang Jianyuan</author>
        <description><![CDATA[ObjectiveTo compare the early clinical efficacy, perioperative parameters, and safety profiles of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic (UBE) discectomy in treating single-level far lateral lumbar disc herniation (FLLDH).MethodsThis retrospective cohort study analyzed 81 patients with FLLDH treated between January 2021 and June 2024. Patients were allocated to the PTED group (n = 38) or the UBE group (n = 43) based on the surgical technique received. Perioperative indicators (operative time, incision length, blood loss, hospital stay) and clinical outcomes—assessed by Visual Analogue Scale (VAS) for back/leg pain and the Oswestry Disability Index (ODI) preoperatively and at 1, 3, 6, and 12 months postoperatively—were compared. Statistical analyses included independent samples t-tests, chi-square tests, and repeated-measures ANOVA.ResultsAll patients completed 12-month follow-up. The two groups were comparable at baseline (P > 0.05). The PTED group demonstrated significantly shorter operative time (62.4 ± 8.7 vs. 105.3 ± 14.1 min, P < 0.001), smaller incision length (7.8 ± 0.9 vs. 24.6 ± 4.2 mm, P < 0.001), less intraoperative blood loss (18.5 ± 4.3 vs. 68.2 ± 10.5 mL, P < 0.001), and shorter hospital stay (4.8 ± 1.1 vs. 5.9 ± 1.7 days, P = 0.002). Both groups showed significant and sustained improvement in VAS and ODI scores postoperatively (P < 0.05). At 1 month, PTED was associated with lower back pain VAS but slightly higher leg pain VAS and ODI compared to UBE (P < 0.05). From 3 months onward, no significant inter-group differences were observed in any clinical scores (P > 0.05). Repeated-measures ANOVA indicated a different improvement trajectory for back pain between the groups (interaction P = 0.024).ConclusionBoth PTED and UBE are effective minimally invasive techniques for FLLDH, offering comparable and excellent mid-term clinical outcomes. PTED offers advantages in reduced surgical trauma and faster early recovery, whereas UBE provides superior endoscopic visualization. The choice of technique can be individualized based on patient characteristics and surgical expertise.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1787824</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1787824</link>
        <title><![CDATA[Clinical efficacy of minimally invasive transforaminal lumbar interbody fusion via bilateral channel for lumbar degenerative disease]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Ji-hui Zhang</author><author>Liang Yu</author><author>Jing-fei Xu</author><author>Jin-ming Han</author><author>Xu-yu Liao</author><author>Bo Chai</author><author>Liu-jun Zhao</author>
        <description><![CDATA[ObjectiveTo evaluate the clinical efficacy of bilateral channel minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the management of lumbar degenerative diseases.MethodsA retrospective analysis was conducted of 68 patients diagnosed with lumbar degenerative diseases who underwent surgical intervention at Ningbo No.6 Hospital between April 2021 and February 2022. The patients were categorized into a traditional TLIF group (38 cases) and a bilateral channel MIS-TLIF group (30 cases). Comparative assessments were performed between the two groups in terms of surgical outcomes.ResultsAll surgical procedures were successfully performed and postoperative follow-up was maintained for (12.7 ± 1.7 months). Statistically significant differences were observed in operation time, intraoperative fluoroscopy frequency, intraoperative blood loss, postoperative drainage volume, and length of hospital stay between two groups. The VAS scores and ODI of the two groups measured at 7 days postoperatively and at the final follow-up were significantly lower than the preoperative values, with statistically significant differences. The fusion rates were 89.5% in the traditional group and 93.3% in the bilateral channel MIS-TLIF group, with no statistically significant differences.ConclusionBilateral channel MIS-TLIF is a feasible surgical procedure and it can reduce the surgical duration and radiation exposure associated with intraoperative fluoroscopy.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1807236</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1807236</link>
        <title><![CDATA[Arthroscopic-assisted uni-portal spine surgery via modified interlaminar approach combined with annular suturing for L5/S1 disc herniation: a case report and technical note]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Zhijun Chen</author><author>Wenrong Yang</author><author>Jincai Liu</author><author>Zhigang Zhao</author><author>Nan Zhou</author><author>Guangmin Pu</author><author>En Song</author>
        <description><![CDATA[BackgroundLumbar disc herniation (LDH) is a common clinical spinal disorder, with the L5/S1 segment being a frequently affected site due to its unique anatomical and biomechanical characteristics. Conventional minimally invasive spinal endoscopic techniques, such as percutaneous transforaminal endoscopic discectomy (PTED), percutaneous endoscopic interlaminar discectomy (PEID), and unilateral biportal endoscopy (UBE), have inherent limitations in treating L5/S1 LDH. These include difficulty bypassing the high iliac crest (for PTED), a steep learning curve (for PEID), and potential impairment of spinal stability (for UBE). To address these challenges, this study applied Arthroscopic-assisted uni-portal spine surgery (AUSS) via a modified interlaminar approach combined with 4-0 absorbable suture annular repair for L5/S1 LDH, reporting its short-term clinical outcomes and detailing key technical points.Case presentationA 45-year-old male patient presented with a 1-year history of low back pain, which worsened over 1 month with persistent right lower limb radicular pain, unresponsive to conservative treatment. Preoperative lumbar MRI and CT confirmed L5/S1 disc herniation, with T2-weighted MRI showing low signal intensity of the herniated disc and axial CT demonstrating direct compression of the right S1 nerve root by the herniated nucleus pulposus. The patient underwent the modified procedure: during surgery, a portion of the ligamentum flavum was excised to expose the herniated nucleus pulposus, while the remainder was retracted and preserved. After complete removal of the herniated nucleus pulposus, full-thickness annular suturing was performed using 4-0 absorbable sutures, with knot tying performed extracanalicularly and pushed into place using a dedicated knot pusher. At 1, 3, and 12 months postoperatively, the incision healed well without complications such as infection, nerve injury, or cerebrospinal fluid leakage. Imaging re-evaluation showed no recurrence of L5/S1 disc herniation and a smooth posterior annular margin. The patient experienced significant relief of low back and leg pain, resuming normal daily activities within 1 month postoperatively. The visual analogue scale (VAS) score decreased from 7 preoperatively to 1, the Japanese Orthopaedic Association (JOA) score reached 25, and the Oswestry Disability Index (ODI) decreased from 68% preoperatively to 12%.ConclusionArthroscopic-assisted uni-portal spine surgery via the modified interlaminar approach combined with annular suturing is a safe, feasible, and effective treatment for L5/S1 LDH. Its core advantages include bypassing anatomical barriers such as the high iliac crest, maximizing the preservation of spinal osseous and ligamentous structures, ease of operation, high surgical efficiency, and a low short-term recurrence rate. This procedure is a targeted optimization of the traditional interlaminar approach, providing a valuable treatment option for L5/S1 LDH, especially in cases where conventional endoscopic techniques are limited. However, the results of this single-case study cannot be generalized to long-term efficacy, and large-sample, multi-center follow-up studies are needed for further validation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1805531</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1805531</link>
        <title><![CDATA[Unilateral biportal endoscopic decompression compared with tubular or uniportal endoscopic decompression for lumbar spinal stenosis: a systematic review and meta-analysis]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Systematic Review</category>
        <author>Jie Song</author><author>Jun Li</author><author>Xiu-Lei Xu</author><author>Quan Sun</author>
        <description><![CDATA[BackgroundComparative evidence regarding unilateral biportal endoscopic decompression vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis remains limited and inconsistent.MethodsWe conducted a systematic review and meta-analysis of comparative clinical studies that evaluated UBE vs. tubular decompression or uniportal endoscopic decompression for lumbar spinal stenosis. Pooled analyses were performed for predefined outcomes, and comparator-specific analyses were additionally performed to improve interpretability.ResultsA total of 1,395 patients from 10 studies were included in this meta-analysis. Overall complications and dural tear or cerebrospinal fluid leak events were lower in the unilateral biportal endoscopic decompression group than in the pooled control group. The unilateral biportal endoscopic decompression group also showed modestly lower ODI and pain scores at the final follow-up, although the magnitude of benefit varied across outcomes. In addition, the changes in the dural sac cross-sectional area after surgery also favored unilateral biportal endoscopic decompression, with low to moderate heterogeneity.ConclusionsFor lumbar spinal stenosis, UBE may provide comparable overall safety and modest advantages in selected perioperative, clinical, and radiological outcomes compared with tubular or uniportal endoscopic decompression. However, the clinical relevance of some statistically significant differences remains uncertain, and further high-quality comparative studies are required.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1833919</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1833919</link>
        <title><![CDATA[Ewing sarcoma of the first metacarpal: a rare case report with thumb-sparing resection and fibular graft reconstruction]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Aouinti Mohamed Nizar</author><author>Sahar Ben Ammar</author><author>Walid Saied</author><author>Hajer Ben Mansour</author><author>Ahmed Hamdi</author><author>Henda Rais</author><author>Sami Bouchoucha</author><author>Rim Boussetta</author>
        <description><![CDATA[BackgroundEwing sarcoma is a malignant primary bone tumor that predominantly affects the long bones and pelvis of children and adolescents. Involvement of the hand is exceptionally rare, particularly at the level of the first metacarpal. When the dominant thumb is affected, treatment becomes especially challenging due to the critical functional role of this structure.Case presentationWe report the case of an 11-year-old right-handed boy who presented with a painful swelling of the right thumb. Imaging revealed an aggressive osteolytic lesion of the first metacarpal with soft tissue extension. Histology confirmed Ewing sarcoma. After neoadjuvant chemotherapy according to the EuroEWing 2012 protocol, Thumb-sparing resection was performed, including the trapeziometacarpal and metacarpophalangeal joints. Reconstruction was achieved using a non-vascularized fibular autograft. Despite a poor histological response, surgical margins were tumor-free. Adjuvant chemotherapy and radiotherapy were administered. At one-year follow-up, there was no local recurrence, with satisfactory functional outcome of the dominant hand.ConclusionEwing sarcoma of the first metacarpal is exceedingly rare. Limb-sparing surgery with fibular graft reconstruction may represent a valid alternative to amputation in carefully selected pediatric patients, even in cases of limited histological response, provided that oncological principles are respected.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1786576</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1786576</link>
        <title><![CDATA[Posterior uniportal endoscopic laminotomy for cervical ossification of posterior longitudinal ligament: a case report and technical summary]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Baoliang Li</author><author>Zhigang Shi</author><author>Jianxin Zhang</author><author>Nianhu Li</author><author>Changjiao Ji</author>
        <description><![CDATA[BackgroundThe management of cervical ossification of posterior longitudinal ligament (OPLL) with unilateral radiculopathy poses significant challenges. Posterior uniportal endoscopic laminotomy offers a minimally invasive alternative, yet its application in OPLL-related stenosis remains technically demanding and underreported.Case summaryA 49-year-old female presented with progressive left upper limb radiculopathy, numbness, weakness, and cervicobrachial pain due to OPLL-induced severe neuroforaminal and lateral recess stenosis at C6-C7 and C7-T1. Through a single 1-cm incision, posterior endoscopic decompression was performed via unilateral laminotomy at both target levels. The procedure was completed in 1.5 h with minimal blood loss. Postoperatively, the patient showed rapid symptomatic improvement, with significant reduction in pain and recovery of grip strength by 6-month follow-up. Integrating contemporary evidence with technical experience, we outline key procedural insights to support the adoption of this technique in selected OPLL cases.ConclusionPosterior uniportal endoscopic laminotomy is a feasible and effective minimally invasive option for selected OPLL patients with unilateral radiculopathy. It achieves clinical improvement while preserving spinal motion and avoiding fusion-related complications, provided patient selection and surgical technique are optimized.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761489</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fsurg.2026.1761489</link>
        <title><![CDATA[Transforming spinal surgery: five years of navigation, workflow optimization and clinical impact]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Johannes Groh</author><author>Simon Schramm</author><author>Lilli Holzmann</author><author>Simon Wagner</author><author>Mario Perl</author><author>Johannes Krause</author>
        <description><![CDATA[BackgroundNavigation-assisted spinal instrumentation is increasingly used in modern spine surgery, offering improvements in accuracy, workflow efficiency, and radiation safety. However, real-world implementation and the transition from fluoroscopy to navigation in high-volume trauma centers remain insufficiently described.MethodsThis retrospective single-center study reviewed all dorsal spinal instrumentation procedures performed between 2015 and 2025 at a Level I trauma center. A total of 557 patients were analyzed: 119 navigated and 438 fluoroscopic procedures. Demographics, ASA classification, operative time, screw count, radiation parameters, anatomical distribution, and revision rates were compared, with specific focus on changes after the introduction of navigation in 2020.ResultsNavigation use increased steadily and expanded from lumbar to more anatomically demanding regions. Navigated cases involved older patients with higher ASA scores. Although operative times were longer in navigated procedures, this was explained by higher screw counts, and time per screw did not differ significantly. A clear learning curve was observed, with time per screw improving from 27 (±22) to 19 (±7) minutes (p = 0.03). Radiation time was significantly lower in the navigated group, while total dose was comparable. Screw misplacement–related revisions were less frequent with navigation (1% vs. 5%), whereas wound-related revisions were more common, reflecting higher comorbidity and a greater proportion of open procedures.ConclusionNavigation substantially altered clinical practice, leading to its predominant use in complex anatomies and higher-risk patients. It improved screw accuracy and reduced radiation exposure while maintaining procedural efficiency after the learning curve. With ongoing advances such as robotics, augmented reality, and markerless registration, the role of navigation in spinal trauma surgery is expected to expand further.]]></description>
      </item>
      </channel>
    </rss>