Injury. 2025 Jul 8:112598. doi: 10.1016/j.injury.2025.112598. Online ahead of print.

NO ABSTRACT

PMID:40651873 | DOI:10.1016/j.injury.2025.112598

Injury. 2025 Jul 3:112583. doi: 10.1016/j.injury.2025.112583. Online ahead of print.

NO ABSTRACT

PMID:40651872 | DOI:10.1016/j.injury.2025.112583

Injury. 2025 Jul 4:112581. doi: 10.1016/j.injury.2025.112581. Online ahead of print.

NO ABSTRACT

PMID:40651871 | DOI:10.1016/j.injury.2025.112581

Injury. 2025 Jul 1:112571. doi: 10.1016/j.injury.2025.112571. Online ahead of print.

NO ABSTRACT

PMID:40651870 | DOI:10.1016/j.injury.2025.112571

Injury. 2025 Jul 4:112587. doi: 10.1016/j.injury.2025.112587. Online ahead of print.

NO ABSTRACT

PMID:40645870 | DOI:10.1016/j.injury.2025.112587

Injury. 2025 Jul 3:112575. doi: 10.1016/j.injury.2025.112575. Online ahead of print.

ABSTRACT

BACKGROUND: For acetabular fractures of both columns, the antegrade posterior column screw (APCS) is often inserted via the anterior intrapelvic approach to stabilize both columns. Insertion of the APCS can be technically demanding due to the complex anatomy of the posterior column. Misdirection or mispositioning of the screw during surgery can result in penetrate the hip joint or damage the neurovascular structures. The purpose of this study was to detect the ideal insertion point and angles of the APCS based on anatomical landmarks that can be directly identified intraoperatively.

METHODS: We retrospectively reviewed the pelvic CT of 50 adults who underwent serial slice CT imaging. Three reference plane was determined using image analysis software; (1) iliac plane (IP), which contains the anterior superior iliac spine (ASIS), the anterior margin of sacroiliac joint (AMS), and the posterior margin of pubic symphysis (PMS), (2) pelvic inlet plane (PIP), which contains the AMS of both sides, and the PMS, (3) sagittal midline plane of the pelvis (SMP). The ideal insertion point and angles of the APCS, and its maximum length were measured. The ideal insertion point was measured on the line connecting ASIS and AMS (AA line) at a distance from AMS (APCS horizontal distance) and vertical distance from AA line (APCS vertical distance). The ideal angles were measured between the screw and the PIP and between the screw and the SMP.

RESULTS: The APCS horizontal distance was 27.4 ± 6.4 mm. The APCS vertical distance was 1.6 ± 6.6 mm. The angle between the ideal APCS and yz-plane on the outlet view (α-angle) was 5.8 ± 5.8° The angle between the ideal APCS and y-axis on the xy-plane (β-angle) was 51.6 ± 5.0° The length of the APCS was 125.8 ± 9.5 mm.

CONCLUSION: The ideal insertion point detected as the distance from the AMS on the AA line and the ideal insertion angles relative to the PIP and the SMP may aid in proper insertion of the APCS during surgery.

PMID:40645869 | DOI:10.1016/j.injury.2025.112575

Injury. 2025 Jun 28;56(8):112540. doi: 10.1016/j.injury.2025.112540. Online ahead of print.

ABSTRACT

INTRODUCTION: Periprosthetic proximal femoral fractures (PPFFs) present significant challenges in orthopaedic and trauma care, particularly in older patients with comorbidities. Although guidelines recommend early surgery for native proximal femoral fractures, the optimal time to surgery (TTS) for PPFFs remains uncertain. This study aimed to assess the impact of TTS on survival in patients with PPFFs and investigate the role of patient-specific factors in survival outcomes.

MATERIALS AND METHODS: This retrospective study included 262 patients who underwent surgical treatment for PPFFs at a German trauma centre between 1995 and 2023. Survival outcomes were assessed using Kaplan-Meier analysis with log-rank tests and multivariate Cox regression analysis.

RESULTS: The mean (standard deviation) age was 82.8 (8.1) years, and 68.7% of patients were female, with a mean TTS of 62.8 (27.7) h. Log-rank tests revealed no significant survival difference between the optimal cut-off TTS ≤ 68 h and > 68 h (p = 0.51). Multivariate Cox regression analysis identified age (hazard ratio [HR] = 1.06, 95% CI [1.04, 1.08]), male sex (HR = 1.43, [1.01, 2.02]), dementia (HR = 2.12, [1.50, 3.00]), heart disease (HR = 1.43, [1.02, 2.00]), diabetes (HR = 1.49, [1.03, 2.16]), and tumour disease (HR = 1.62, [1.05, 2.51]) as risk factors for mortality. Protective factors included higher preoperative haemoglobin levels (HR = 0.83, [0.76, 0.90]), and erythrocyte transfusion was associated with improved survival in patients undergoing revision arthroplasty but not in those treated with open reduction and internal fixation. Chronic obstructive pulmonary disease was associated with a reduced mortality risk (HR = 0.68, [0.50, 0.93]).

CONCLUSIONS: Despite limitations related to the retrospective, single-centre design, the long study period, and incomplete documentation of transfusion timing and volume, our findings suggest that TTS did not significantly affect survival. Patient-specific factors, including age, comorbidities, perioperative complications, preoperative haemoglobin levels, and transfusions, were the primary drivers of survival outcomes.

PMID:40644865 | DOI:10.1016/j.injury.2025.112540

Injury. 2025 Jul 1;56(8):112573. doi: 10.1016/j.injury.2025.112573. Online ahead of print.

ABSTRACT

PURPOSE: Combat-related peripheral nerve injuries (CRPNIs) are frequently associated with significant long-term disability. While conventional practice often favors delayed exploration to avoid unnecessary interventions, emerging evidence supports early intervention.

METHODS: We retrospectively reviewed 184 patients (265 CRPNIs) treated during the first ten months of the 2023-2024 Israel-Hamas war. Collected data included demographics, injury details, surgical timing, intraoperative findings, procedures performed, and postoperative complications. Surgical Explorations were considered positive if partial/complete nerve transection or nerve compression (e.g., by shrapnel or bone fragment) were found.

RESULTS: Of 184 patients, 136 (74%) underwent nerve exploration at a median of 8 days post-injury, with positive findings in 72% of these cases. Definitive nerve procedures (DNP), such as direct repair or graft reconstruction, were performed in 48% of explored cases, yielding a 5% perioperative complication rate. Early DNP recipients had significantly fewer secondary nerve procedures than those managed nonoperatively (19% vs. 38%, p=0.01).

CONCLUSIONS: Early surgical exploration in CRPNIs demonstrated a high rate of actionable findings and reduced the subsequent need for surgical interventions, supporting a more aggressive initial approach. Further studies are warranted to determine long-term functional outcomes.

PMID:40644864 | DOI:10.1016/j.injury.2025.112573

J Bone Joint Surg Am. 2025 Jul 11. doi: 10.2106/JBJS.24.01461. Online ahead of print.

ABSTRACT

BACKGROUND: We conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures.

METHODS: We recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months.

RESULTS: More patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery.

CONCLUSIONS: When treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:40644505 | DOI:10.2106/JBJS.24.01461

Int Orthop. 2025 Jul 12. doi: 10.1007/s00264-025-06608-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive disease associated with significant morbidity and mortality. Few studies have reported the risk factors for adverse outcomes in NF. Our study aims to investigate the risk factors associated with various clinical outcomes of NF - to better guide decision making and patient counselling regarding outcomes during the crucial initial phase of this time sensitive disease process.

METHODS: A retrospective review of patients diagnosed with NF of the upper and lower extremities over a ten-year period from January 2008 to December 2017 in our tertiary institution was performed. Patient demographics, clinical parameters, microbiological data, and clinical outcomes were collected and analyzed using multivariate regression analysis. The primary clinical outcomes analyzed were mortality, major amputation (proximal to the wrist or ankle), prolonged intensive care unit(ICU) stay (> 7 days), and prolonged hospital stay (> 30 days).

RESULTS: 191 patients were included in the study with a mortality rate of 17%, with predictors for mortality being age > 65 years (OR: 3.04, p = 0.024), female gender (OR: 3.04, p = 0.017), peripheral vascular disease (OR: 8.94, p = 0.003), renal impairment (OR: 5.10, p = 0.002), mean arterial pressure (MAP) < 60mmHg (OR: 3.06, p = 0.040), and bacteraemia (OR: 3.11, p = 0.032). 61 patients underwent major amputation, and the risk factors were peripheral vascular disease (OR: 4.45, p = 0.042), lower limb involvement (OR: 5.67, p < 0.001), soft tissue gas on x-ray (OR: 5.78, p = 0.013), and bacteraemia (OR: 5.20, p < 0.001). The predictors for prolonged ICU admission were female gender (OR: 2.55, p = 0.016) and creatinine > 140µmol/L (OR: 3.44, p = 0.002).

CONCLUSION: This study has helped to identify significant risk factors associated with necrotizing fasciitis for mortality and major amputations. Predictors of mortality included elderly age > 65, female gender, peripheral vascular disease, renal impairment, decreased mean arterial pressure and bacteraemia. Predictors of major amputation were peripheral vascular disease, lower limb involvement, presence of soft tissue gas seen on X-ray and bacteraemia. Factors such as these will assist us in identifying patients with higher probabilities of specific outcomes when they present at an early stage of the disease process, to allow for more accurate patient counselling and management of expectations regarding outcomes of patients with NF.

LEVEL OF EVIDENCE: IV.

PMID:40646259 | DOI:10.1007/s00264-025-06608-y

Injury. 2025 Jul 3:112554. doi: 10.1016/j.injury.2025.112554. Online ahead of print.

NO ABSTRACT

PMID:40640012 | DOI:10.1016/j.injury.2025.112554

Injury. 2025 Jun 30;56(8):112558. doi: 10.1016/j.injury.2025.112558. Online ahead of print.

ABSTRACT

INTRODUCTION: Quality registers are used for quality assessment, cost analyses, and research regarding outcomes of surgical and non-operative treatments. As the Swedish Fracture Register (SFR) expands, and is used as a platform for randomized trials, assuring reliability and accuracy of the data is essential.

AIM: This study aimed to investigate the accuracy of the radiographic classification data for proximal humerus fractures recorded in the SFR.

METHOD: All radiographic images of 171 patients with a proximal humerus fracture registered in the SFR between 2019 and 03-01 and 2019-08-31 at 3 hospitals were included. The radiographs were independently assessed at 2 occasions >3 weeks apart by 1 surgeon at each center and IRR was calculated to validate the modification of the AO/OTA classification used in the register. A "gold standard" classification for each patients' images was then established with a consensus discussion involving 4 shoulder surgeons. The gold standard classification was compared with the classification registered in the SFR.

RESULTS: Intra-rater reliability was moderate (kappa 0.549-0.596) with percent agreement (PA) 61-66 %. Inter-rater reliability was also moderate (kappa 0.508-0.557) with PA 58-62 %. Accuracy of the SFR recordings compared with gold standard was fair with kappa 0.36 (95 % CI 0.297-0.425) and PA 44 %.

CONCLUSION: For registers to be of use the accuracy of data is essential as well as coverage, completeness, validity and reliability. The modified AO/OTA classification for proximal humerus fractures used in the SFR had moderate reliability but registered data only fair accuracy compared with a gold standard. This questions its value as a base for scientific research and clinical decisions.

PMID:40639131 | DOI:10.1016/j.injury.2025.112558

Injury. 2025 Jun 27;56(8):112566. doi: 10.1016/j.injury.2025.112566. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture-related infection (FRI) is a devastating complication of musculoskeletal trauma. Pain and poor functional outcomes are common, however there is limited insight to the long-term opiate use in this cohort. This study aims to 1) compare the rate of chronic opiate use between trauma patients with and without FRI, and 2) identify risk factors for chronic opiate use among patients with FRI.

METHODS: A cohort of adult injured patients hospitalized in Queensland, Australia between 2014 and 2015 undergoing operative fracture management was extracted from the Community Opioid Dispensing after Injury (CODI) study. This included person-linked hospitalization clinical data, community opioid dispensing and mortality. Data were extracted from 3-months prior to the index-hospitalization to 2-years after discharge. Community opioid dispensing was compared for patients with and without FRI. Increased risk of chronic opiate therapy (COT) (≥90 days cumulatively) was examined using multivariable logistic regression, odds ratios (OR) and 95 % Confidence Intervals (95 % CI).

RESULTS: There were 19,218 operatively managed orthopaedic trauma patients, of which 394 (2.1 %) were complicated with FRI. Opioids were dispensed post injury for 9399 patients. Patients with FRI were more likely to be prescribed opioids (68 %) than patients without FRI (48.5 %, p < 0.001). COT was associated with FRI, with 29.0 % of infected patients being dispensed opiates >90 days (23.8 % no FRI group, p < 0.001). The median duration of opiate therapy among patients with FRI who were dispensed opiates was 60 days [IQR 15-237] (versus 23 days [IQR 15-84] for no FRI, p < 0.001) and the median end dose was 14 mg oral morphine equivalent for both groups [FRI IQR 10-30; No FRI IQR 10-28]. Among patients with FRI, pre-injury opiates, high injury severity, length of stay >21 days and >2 revision surgeries were associated with COT.

CONCLUSION: Infection following trauma surgery is associated with long term opiate use. Risk factors identified for with COT include pre-injury opiate use, high injury severity, increased length of stay and multiple revision surgeries. These insights should be utilised to guide opiate stewardship programs, advocate for improved prevention and treatment strategies for FRI and optimise physical and mental rehabilitation.

PMID:40639130 | DOI:10.1016/j.injury.2025.112566

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01106. Online ahead of print.

ABSTRACT

BACKGROUND: Hypermobile Ehlers-Danlos syndrome (hEDS) is a collagen disorder affecting multiple organ systems, including the musculoskeletal system. We sought to determine the type and severity of orthopaedic manifestations experienced by these patients. The purpose of this study was to identify the most common orthopaedic manifestations in patients with hEDS and to examine the patient-reported helpfulness of treatments. Of note, collagen disorders such as hEDS may affect the success rates of orthopaedic interventions. The success or failure of treatment is not currently fully understood for this patient population.

METHODS: A total of 1,999 patients who were enrolled in an international EDS registry were contacted to complete a 260-question survey regarding their experience with nonoperative and operative treatments for musculoskeletal instability and/or pain. Participants reported their demographic characteristics, hEDS diagnosis characteristics, symptomatic joints, nonoperative and operative treatments, and satisfaction with each treatment.

RESULTS: Over a 30-day period, 1,075 responses were received. Participants were predominately female (95.3%) and had a median age of 40.0 years (interquartile range width, 17.0 years). The majority (60.8%) of respondents reported a mental health burden every day, with the remainder reporting a mental health burden weekly (24.4%), monthly (11.0%), or never (3.80%). Compared with those who underwent standard physical therapy (n = 378), individuals who underwent physical therapy tailored to EDS (n = 602) more frequently reported improved posture (78.6% versus 43.1%; p < 0.001), greater helpfulness (p < 0.001), and a longer duration of attending therapy (p < 0.001). A total of 1,120 primary and 261 revision operations for joint or spine instability and/or pain were reported. The reported complication rates were 35.7% and 42.9% for joint and spine surgeries, respectively. Physical therapy was the only nonoperative treatment for which the median reported helpfulness sometimes equaled or exceeded that of a joint or spine surgery.

CONCLUSIONS: This study offers insights into the demographics and management of hEDS. The high rate of surgical complications reported by patients indicates the need for a better understanding of surgical indications and treatment options. These findings should guide physicians in managing hEDS and highlight the importance of incorporating this knowledge into clinical practice to improve the management of orthopaedic manifestations in patients with hEDS.

LEVEL OF EVIDENCE: Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638721 | DOI:10.2106/JBJS.24.01106

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01304. Online ahead of print.

ABSTRACT

BACKGROUND: Researchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.

METHODS: Radiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).

RESULTS: The values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).

CONCLUSIONS: Using mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.

CLINICAL RELEVANCE: These data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.

PMID:40638717 | DOI:10.2106/JBJS.24.01304

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01293. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic surgeons routinely delay surgical management of femoral neck fractures in patients taking direct oral anticoagulants (DOACs) to decrease perioperative bleeding and associated complications. However, this practice contradicts the principles of hip fracture management, as early surgery is associated with morbidity and mortality benefits. The purpose of this study was to quantify the association of DOAC use and perioperative outcomes in patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures. We hypothesized that early surgical intervention on a patient taking a DOAC medication would not lead to worse perioperative outcomes.

METHODS: A retrospective cohort study was conducted on 2,833 patients who underwent primary THA or HA for femoral neck fractures between December 31, 2017, and January 29, 2024, across our hospital system. The patients taking a DOAC were divided into 3 groups based on the time since the last DOAC intake: 1 day, 2 days, and ≥3 days. Propensity matching was performed 1:1, accounting for age, sex, Elixhauser Comorbidity Index, preoperative chronic kidney disease stage, preoperative hemoglobin, body mass index, and hospital type. Subanalyses utilizing linear and conditional logistic regression models were performed to assess differences in outcomes between the groups that had a DOAC withheld and the control groups.

RESULTS: The mean age of all patients was 81 ± 10 years, 1,805 patients (64%) were women, and 207 patients (7%) were taking a DOAC prior to surgery. Despite comparable preoperative and postoperative hemoglobin levels between the groups that had a DOAC withheld and the control groups (all p > 0.05), the patients who had a DOAC withheld for 1 day were more likely to receive a postoperative blood transfusion (23.1% compared with 0%; p = 0.002). This difference in transfusion rate was not observed in other cohorts. There were no differences in medical complications, reoperation, discharge disposition, or mortality between the groups that had a DOAC withheld and the matched controls at any time point.

CONCLUSIONS: Delaying surgical management due to DOAC medications may be unnecessary in patients undergoing arthroplasty for femoral neck fractures. Consideration should be given to adjusting transfusion triggers to reduce unwarranted blood transfusions in patients taking a DOAC.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638713 | DOI:10.2106/JBJS.24.01293

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01287. Online ahead of print.

ABSTRACT

➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.

PMID:40638702 | DOI:10.2106/JBJS.24.01287

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.00098. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnostic accuracy of neurological examination findings for identifying degenerative cervical myelopathy (DCM) is not apparent, given the paucity of studies with appropriate control groups. In order to address this knowledge gap, we conducted a community cervical spine screening project and examined subjects without DCM or evidence of myelopathy on cervical magnetic resonance imaging (MRI).

METHODS: This study included a total of 229 patients diagnosed with DCM, based on MRI evidence of spinal cord compression and improvement after surgery, and 807 controls without DCM (40 to 79 years of age) enrolled in the screening project. Neurological examination was performed on each subject, including the assessment of deep tendon reflexes at the biceps, triceps, patella, and Achilles tendon and the Hoffmann reflex, Babinski sign, sensory disturbance, and 10-second grip-and-release test. Multiple logistic regression analysis was performed to build a diagnostic model for DCM based on the neurological examination findings.

RESULTS: Using a stepwise multiple logistic regression analysis method, an almost perfect diagnostic model was designed that comprised sex, age, 10-second grip-and-release test, patellar tendon reflex, Hoffmann reflex, Babinski sign, and sensory disturbance (area under the curve [AUC] in the receiver operating characteristic curve analysis, 0.994). However, given that the last 2 parameters are less commonly evaluated in routine practice, an alternative reduced model was developed for practical use and consisted of sex, age, Hoffmann reflex, patellar tendon reflex, and 10-second grip-and-release test. The reduced model yielded a nearly equivalent AUC of 0.956.

CONCLUSIONS: Both diagnostic prediction models demonstrated excellent accuracy in distinguishing patients with DCM from subjects without DCM, highlighting the importance of combining specific neurological signs and performance measures when evaluating patients with suspected DCM.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638695 | DOI:10.2106/JBJS.24.00098

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01219. Online ahead of print.

ABSTRACT

BACKGROUND: Psychological distress is increasing in adolescents and young adults, but comprehensive screening programs are not commonly incorporated into orthopaedic clinical practice. We implemented a screening program for depression symptoms and psychological distress in adolescents and young adults with hip pain. The aims of this study were to report the prevalence and risk factors and determine the relationship with patient-reported pain and dysfunction.

METHODS: Patients 10 to 24 years of age presenting for hip pain at an initial clinic visit completed the Patient Health Questionnaire-9 (PHQ-9), the 17-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) tool, and the International Hip Outcome Tool-12 (iHOT). Two outcome levels for depression symptoms using the PHQ-9 were compared (mild or less versus moderate or greater), and 3 outcome levels for psychological distress using the OSPRO-YF were compared (none or mild versus moderate versus severe). Age, sex, body mass index, previous surgery, and the hip diagnosis were entered into logistic regression models to predict outcomes for the levels of depression symptoms and psychological distress. iHOT scores were compared between groups using the Wilcoxon rank-sum test and the Kruskal-Wallis test followed by pairwise Wilcoxon rank-sum tests.

RESULTS: Among 500 patients who completed screening, 10.6% had moderate or greater depression symptoms and 26.9% had severe psychological distress. Multivariable logistic regression revealed that young adults (age, 20 to 24 years) had higher odds of moderate or greater depression symptoms compared with adolescents (age, 10 to 19 years) (odds ratio, 2.09; p = 0.016). Female patients (risk ratio [RR], 1.86; p = 0.026), patients who had undergone a prior surgery (RR, 2.29; p = 0.025), and overweight patients (RR, 2.10; p = 0.008) had a higher risk of severe psychological distress. Both moderate or greater depression symptoms and increasing levels of psychological distress were significantly associated with lower iHOT scores (all p < 0.001).

CONCLUSIONS: Psychological distress was common in adolescents and young adults with hip pain and was associated with greater patient-reported hip pain and dysfunction. Young adults had a greater risk of depression symptoms. Severe psychological distress was more common in female patients, overweight patients, and those who had undergone failed prior hip surgery.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40638688 | DOI:10.2106/JBJS.24.01219

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01420. Online ahead of print.

ABSTRACT

➢ Strategic action following the measurement of outcomes in the context of cost allows for the reallocation of resources to value-adding interventions, while eliminating non-value-adding services.➢ Providers and administrators should leverage institutional alignment to advance best-practice principles through integration and utilization of patient-reported outcomes and cost-containment initiatives and engagement in institution-wide value-based care dialogue.➢ Health-care policy and reimbursement structures in the United States are shifting from a fee-for-service model to a value-based care model with policy changes such as the Hospital Price Transparency Regulation by the U.S. Centers for Medicare & Medicaid Services, Comprehensive Care for Joint Replacement, the risk-standardized performance measure for elective total hip arthroplasty and total knee arthroplasty based on patient-reported outcomes, and the Transforming Episode Accountability Model.➢ The incorporation of machine learning technologies presents major potential for refining our understanding of high-value events and identifying exemplary surgeons within the orthopaedic field. The successful incorporation of artificial intelligence models into practice requires investment from and alignment of several partners: health-care administrators, information technology, legal teams, providers, and patients.

PMID:40638684 | DOI:10.2106/JBJS.24.01420