Int Orthop. 2025 Dec 6. doi: 10.1007/s00264-025-06705-y. Online ahead of print.

ABSTRACT

PURPOSE: Periprosthetic joint infection (PJI) after shoulder arthroplasty remains a devastating complication, and the optimal surgical approach is still debated. This study aimed to compare the outcomes of single-stage versus two-stage revision and to identify clinical or demographic factors associated with treatment failure.

METHODS: A retrospective observational study was conducted at a single tertiary hospital including 29 patients treated for shoulder PJI between 2010 and 2023. Patients underwent either one-stage (n = 15) or two-stage (n = 14) revision according to clinical and microbiological criteria, and the final choice of surgical strategy (one-stage vs. two-stage revision) was made at the discretion of the attending surgeon. The primary outcome was treatment success, defined as infection eradication without further surgery or suppressive antibiotics. Secondary outcomes were pain and functional results measured with the Constant-Murley Score (CMS), the Simple Shoulder Test (SST), and the Visual Analog Scale (VAS). A standard statistical analysis was performed comparing baseline data of both groups and finding factors related to the primary outcome.

RESULTS: Baseline characteristics of both groups were comparable. Overall infection control was achieved in 83% of patients, nonetheless, the one-stage group showed a higher success rate compared with the two-stage group (93% vs. 71%), although this difference did not reach statistical significance (p = 0.169; OR:0.19(0.003,2.29)). Functional outcomes assessed by CMS and VAS did not differ significantly between groups, whereas SST scores were significantly better following one-stage revision (p = 0.006). Increased BMI and a higher number of previous surgeries tended to be associated with treatment failure.

CONCLUSION: Single-stage revision achieved comparable infection control and better functional outcomes than two-stage revision, supporting its role as a reliable surgical option for shoulder PJI in appropriately selected patients, although it could be influenced by bias selection.

PMID:41351768 | DOI:10.1007/s00264-025-06705-y

Int Orthop. 2025 Dec 6. doi: 10.1007/s00264-025-06706-x. Online ahead of print.

ABSTRACT

BACKGROUND: The quest for optimal treatment of acute distal tibiofibular syndesmotic disruptions is still in full progress. Using suture-button repair devices is one of the dynamic stabilization options, however, they may not be always appropriate for stabilization, for example in length-unstable syndesmotic injuries. The aim of this biomechanical study was to investigate whether a novel screw-suture implant addresses such issues compared to suture-button implants while preserving dynamic capabilities.

METHODS: Eight pairs of human cadaveric lower legs were injured by complete syndesmosis and deltoid ligaments cuts, and reconstructed using a screw-suture (FIBULINK, Group 1) or a suture-button (TightRope, Group 2) implant for syndesmotic stabilization, placed 20 mm proximal to the tibia plafond. Following, all specimens were biomechanically tested over 5000 cycles under combined 1400 N axial and ± 15° torsional loading. Anteroposterior, axial/vertical, mediolateral and torsional movements at the distal tibiofibular joint level were evaluated biomechanically via optical motion tracking.

RESULTS: Anteroposterior and axial/vertical movements were significantly smaller and maintained over the cycles in Group 1 compared with Group 2 (p < 0.001). No further significant differences were identified between the groups (p ≥ 0.318).

CONCLUSION: Although both implant systems demonstrate ability for stabilization of unstable syndesmotic injuries, the screw-suture reconstruction provides better anteroposterior and axial/vertical stability of the distal tibiofibular joint, and maintains it over time under dynamic loading in a cadaveric study design. Therefore, it could be considered as a valid option for treatment of syndesmotic disruptions with length-unstable fibula.

LEVEL OF EVIDENCE/ STUDY DESIGN: Level V, Controlled Laboratory Study.

PMID:41351767 | DOI:10.1007/s00264-025-06706-x

SICOT J. 2025;11:58. doi: 10.1051/sicotj/2025060. Epub 2025 Dec 5.

ABSTRACT

BACKGROUND: Subtrochanteric femur fractures present complex biomechanical and biological challenges with considerable variability in management approaches. Despite a structured approach to operative fixation using the intramedullary nail being accepted as the gold standard for most subtrochanteric fractures, a number of high-impact clinical dilemmas lack clarity and consensus on management approaches due to limited high-level clinical and published evidence.

METHODOLOGY: We identified 11 key controversies through a comprehensive literature review of the PubMed, Scopus, and Cochrane databases from 2011 to 2024. Expert input through direct conversations with high-volume trauma surgeons further reinforced the selection of these problem statements. A modified Delphi consensus process was used to engage with 64 experienced Indian orthopedic surgeons. A four-phase methodology was employed, beginning with the pre-definition of 11 key controversies through literature review. PubMed/Scopus/Cochrane: 2000-2024 and expert input. Phase I description: Before initiating the consensus process, a steering committee systematically reviewed existing literature to predefine and shortlist 11 high-impact, unresolved clinical dilemmas. This ensured all subsequent phases of evidence synthesis and voting were focused on these predefined domains.

RESULTS: Eleven evidence-supported consensus statements were ratified, addressing implant selection, reduction techniques, technical nuances, and complex scenarios. All statements included clinical rationale, consensus strength (10 Strong, 1 Moderate), and evidence level (I-III). Key outputs of the meeting were the formulation of a standardized treatment algorithm and a decision-making framework for ambiguous clinical situations.

CONCLUSION: This consensus provides practical, expert-endorsed guidance to resolve recurring controversies in subtrochanteric fracture management. By bridging evidence gaps with collective surgical experience, it aims to standardize care, reduce unwarranted variation, and improve patient outcomes.

PMID:41348957 | PMC:PMC12680372 | DOI:10.1051/sicotj/2025060

EFORT Open Rev. 2025 Dec 5;10(12):894-902. doi: 10.1530/EOR-2025-0020.

ABSTRACT

PURPOSE: Telemedicine has emerged as a valuable tool in spinal surgery, enabling remote consultations, preoperative assessments, and postoperative care. This systematic review evaluates its impact on clinical outcomes, patient satisfaction, and healthcare resource use from 2020 to 2024, highlighting key benefits, challenges, and future research directions.

METHODS: A systematic search of PubMed/MedLine, Scopus, Web of Science, and Embase identified studies assessing telemedicine in patients undergoing spinal surgery. Covidence (Covidence, Melbourne, Australia) was used for screening and selection. Risk of bias was evaluated, and a qualitative synthesis was conducted following SWiM guidelines due to study heterogeneity. Data were standardised to one decimal place, except for reported P-values.

RESULTS: In total, 37 studies comprising 91,139 patients met inclusion criteria. Telemedicine demonstrated high diagnostic accuracy, with concordance rates exceeding 90% in most studies. Patient satisfaction remained consistently high (86.9-96.4%). It improved treatment adherence, pain management, and functional outcomes. Key advantages included cost-effectiveness and increased accessibility, though challenges such as bias and technological limitations persist.

CONCLUSION: Telemedicine plays a significant role in spinal surgery, offering high diagnostic accuracy, patient satisfaction, and improved clinical outcomes, including reduced pain and disability. It enhances compliance, reduces costs, and improves access to care. However, technological barriers, regulatory concerns, and study heterogeneity underscore the need for further research. Telemedicine holds promise for transforming spinal surgery care.

PMID:41347774 | DOI:10.1530/EOR-2025-0020

EFORT Open Rev. 2025 Dec 5;10(12):882-893. doi: 10.1530/EOR-2025-0021.

ABSTRACT

Malignant bone tumors, including primary bone tumors, such as osteosarcoma (OS), Ewing's sarcoma (ES), and multiple myeloma, and secondary bone tumors from prostate and breast cancers, pose significant mortality risks. Osteoblasts (OBs) and their derivatives play critical roles in the development, recurrence, and metastasis of these tumors. OBs promote metastasis-related events, including osteoclast differentiation and proliferation. Their derivatives, including extracellular vesicles and cytokines, modulate bone remodeling and tumor development through various signaling pathways. Recent in vivo and in vitro studies highlight the involvement of OBs in tumor progression, recurrence, and metastasis. Emerging therapies targeting OBs and their derivatives show promise in improving patient outcomes. The review emphasizes the importance of understanding the specific roles of OBs and their derivatives in malignant bone tumors. This knowledge can lead to the development of new therapeutic strategies aimed at improving patient survival rates and quality of life. Key findings include the regulatory effects of OBs on tumor dormancy, the vicious cycle of bone metastasis, and the potential for targeted therapies to disrupt these processes. Future research should focus on developing experimental models that more closely mimic the human tumor microenvironment and integrating multiple signaling pathways to create comprehensive treatment strategies.

PMID:41347773 | DOI:10.1530/EOR-2025-0021

EFORT Open Rev. 2025 Dec 5;10(12):865-881. doi: 10.1530/EOR-2024-0204.

ABSTRACT

PURPOSE: The purpose of this systematic review and meta-analysis was to synthesise available evidence on functional outcomes, knee stability, and complications between quadriceps tendon with patellar bone block (B-QT) and quadriceps soft-tissue (S-QT) autografts for primary anterior cruciate ligament reconstructions (ACLR).

METHODS: A systematic search (PROSPERO ID: CRD42023472220) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was performed on PubMed/MEDLINE, EMBASE, and WoS. The data concerning functional outcomes, knee stability, and complications were analysed.

RESULTS: There were 5,898 B-QT patients (67.5% male) and 1,849 S-QT patients (51.5% male) included, with a mean age of 27.4 ± 9.3 and 24.7 ± 9.2 years and mean follow-up of 28.9 months (5.3-123.6 months) and 25.3 months (6.0-69.9 months), respectively. In a meta-analysis, the B-QT had higher KOOS subscales scores: activity-of-daily-living 95.98 (95% CI: 94.09-97.88) vs 93.88 (95% CI: 93.66-94.11), P = 0.028; pain 91.99 (95% CI: 89.48-94.49) vs 88.51 (95% CI: 88.21-88.81), P = 0.005; sports & recreation 84.26 (95% CI: 79.20-89.31) vs 79.21 (95% CI: 78.69-79.73), P = 0.041; symptoms 87.82 (95% CI: 84.75-90.90) vs 81.26 (95% CI: 80.71-81.82), P < 0.001; quality-of-life 78.28 (95% CI: 73.68-82.89) vs 65.37 (95% CI: 60.59-70.15), P < 0.001; and a higher Marx score: 11.90 (95% CI: 10.92-12.87) vs 9.65 (95% CI: 8.21-11.09), P = 0.006. B-QT had higher side-to-side difference in anteroposterior tibial translation: 1.55 mm (95% CI: 1.33-1.77) vs 1.15 mm (95% CI: 0.85-1.33 mm), P = 0.026.

CONCLUSION: A QT autograft, with or without a bone block, provides satisfactory functional outcomes, knee stability, and few complications in primary ACLR. B-QT may result in higher patient-reported outcomes, while S-QT may potentially result in slightly improved knee stability.

PMID:41347769 | DOI:10.1530/EOR-2024-0204

Injury. 2025 Nov 21:112894. doi: 10.1016/j.injury.2025.112894. Online ahead of print.

ABSTRACT

Individuals experiencing homelessness are known to be at an increased risk of poor health outcomes compared to those of relatively higher socioeconomic statuses. Specifically, a major cause of morbidity for people experiencing homelessness is traumatic injury. While poor outcomes after a traumatic injury for people experiencing homelessness is well documented in the American context, such literature for the Canadian context remains sparse. In this retrospective cohort study of 4551 trauma patients admitted at a Level 1 trauma center in Montreal, Canada, from 2016-2019 (inclusive), we determined the trauma outcomes of patients experiencing homelessness. We found that the outcomes between homeless and non-homeless trauma patients to be similar, but experiencing homelessness was associated with a 71 % increase in the odds of intubation. Healthcare coverage may have the potential to mitigate some of the adverse effects of a low socioeconomic status.

PMID:41350142 | DOI:10.1016/j.injury.2025.112894

Injury. 2025 Dec 4;57(2):112915. doi: 10.1016/j.injury.2025.112915. Online ahead of print.

NO ABSTRACT

PMID:41349238 | DOI:10.1016/j.injury.2025.112915

Int Orthop. 2025 Dec 5. doi: 10.1007/s00264-025-06715-w. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the incidence and risk factors for dressing-induced allergic contact dermatitis (DIACD) following total hip and knee arthroplasty (THA and TKA, respectively) across different dressings and sealants.

METHODS: A retrospective review was conducted of patients who underwent primary, elective THA or TKA between 2019 and 2024 with ≥ 90 days of follow-up. Incidences of DIACD were identified by reviewing medical records for "allergy" diagnoses and use of antihistamines or corticosteroids within 30 days postoperatively. Patient characteristics, prior exposure, treatment, dressing type, and allergy history were analyzed.

RESULTS: A total of 61 (0.3%) of the 23,396 investigated patients developed a DIACD on average 12.2 ± 7.3 days postoperatively. Overall, 41% had a preoperative allergy (excluding seasonal), and 55.7% were treated with topical or low-dose oral antihistamines and corticosteroids. The majority (41%) of the DIACD involved mesh-adhesive dressings, and a liquid skin adhesive (2-octyl cyanoacrylate) was also used in 41% of cases, often in combination with the primary dressing. Of the 61 DIACD patients, 24 (39.3%) had previously undergone THA or TKA, and nearly half of these (n = 11, 45.8%) had been exposed to the same dressing without prior occurrence of DIACD. DIACD patients were significantly more likely to have undergone TKA (73.8 vs. 58.3%, p = 0.015) and to have never smoked (75.4 vs. 58.4%, p = 0.014). The effect sizes of these findings were negligible (Cramer's V = 0.016 and 0.019, respectively).

CONCLUSIONS: The incidence of DIACD following joint arthroplasty is low (0.3%) but remains a frustrating complication, primarily occurring two weeks postoperatively, with mesh-adhesive dressings most frequently implicated. Patients with prior exposure to dressings, those undergoing TKA, and non-smokers are at higher risk. Identifying at-risk patients can guide dressing selection and application.

PMID:41348336 | DOI:10.1007/s00264-025-06715-w

Int Orthop. 2025 Dec 5. doi: 10.1007/s00264-025-06711-0. Online ahead of print.

ABSTRACT

BACKGROUND: Unicompartmental Knee Arthroplasty (UKA) is effective for knee anteromedial osteoarthritis (AMOA), but aseptic prosthetic loosening causes failures. While periprosthetic bone loss links to loosening in Total Knee Arthroplasty (TKA), this association and post-UKA periprosthetic Bone Mineral Density (BMD) changes are understudied. Systematically exploring dynamic post-UKA BMD changes is vital for optimizing management and reducing loosening risk.​.

PATIENTS AND METHODS: This prospective study included 40 patients (40 knees) with knee AMOA who underwent UKA (January 2020-January 2024). All received cemented Oxford unicompartmental prostheses implanted by the same surgeon (standard technique). Dual-Energy X-ray Absorptiometry (DEXA) measured periprosthetic BMD preoperatively, and at one, three, six and 12 months postoperatively to analyze change patterns.​.

RESULTS: Periprosthetic BMD decreased rapidly at one and three months postoperatively, then increased at six and 12 months (p < 0.05). No significant differences were noted in tibial prosthesis BMD changes (ROI 1, ROI 2) or femoral prosthesis stem posterior BMD values (ROI 4) between six and 12 months (p > 0.05).​.

CONCLUSION: Early postoperative (≤ 3 months) rapid periprosthetic BMD decline in UKA suggests potential clinical value of early anti-osteoporotic treatment.

LEVEL OF EVIDENCE: Level 2b - Prospective case-control study.

PMID:41348335 | DOI:10.1007/s00264-025-06711-0

Injury. 2025 Nov 26;57(2):112912. doi: 10.1016/j.injury.2025.112912. Online ahead of print.

ABSTRACT

INTRODUCTION: Open fractures are associated with soft tissue injury and may require reconstruction via delayed flap coverage. The timing of coverage is critical as prolonged time to coverage is associated with increased risk for wound complications. Few studies have included all lower extremity fractures when analyzing time from definitive fixation to coverage. We analyzed the effect of time to flap coverage from both admission and definitive fixation, on fracture-related infections (FRI) in patients admitted with open fractures of the lower extremity.

METHODS: The National Inpatient Sample was queried from 2015-2019 for open fractures of the tibia, fibula, and femur that required flap coverage. Patients who underwent simple skin grafts only or fixation prior to admission were excluded. The number of days to coverage and days from fixation to coverage was determined using the inpatient stay day on which the flap coverage procedure was conducted. The primary endpoint was FRI acquired during the inpatient stay. Multivariable regression was used to quantify the odds of FRI for every day of delayed coverage.

RESULTS: Between 2015-2019, 1970 patients underwent flap coverage for open fractures of the lower extremity. Isolated tibia fractures constituted the majority (33.7 %), followed by tibia and fibula (27.7 %), and isolated femur (26.1 %). The rate of FRI during the initial hospital stay was 9.9 %. The median times from admission to flap coverage (6 days, IQR 4-18, vs 3 days, IQR 1-8) and definitive fixation to flap coverage (2 days, IQR 1-10, vs 0 days, IQR 0-4) were significantly greater in the FRI group compared to the non-fracture related infection (nFRI) group (p < 0.001 and p < 0.001, respectively). After controlling for confounding variables, each day of delay from admission and from fixation was associated with 10.7 % and 9.1 % increased odds of acquiring inpatient FRI (OR: 1.107, 95 % C.I. 1.062-1.154, p < 0.001, and OR: 1.091, 95 % C.I. 1.047-1.138, p < 0.001, respectively).

CONCLUSION: Our study analyzed all open fractures and did not employ arbitrary endpoints for coverage such as "late" and "early" coverage. Instead, we provide more general evidence in support of early flap coverage. We found that every additional day definitive flap coverage was delayed, the risk of FRI developed during the initial inpatient stay was increased by approximately 10 %. Despite our findings, it is critical to note that we only evaluated FRIs acquired during the inpatient stay, and many of these infections occur following discharge. However, the temporal relationship described in our study suggests that definitive wound closure should be achieved in the shortest time possible. Additionally, fixation should be performed as close to the definitive coverage procedure as possible.

LEVEL OF EVIDENCE: Level III.

PMID:41344103 | DOI:10.1016/j.injury.2025.112912

Injury. 2025 Nov 26;57(2):112914. doi: 10.1016/j.injury.2025.112914. Online ahead of print.

ABSTRACT

INTRODUCTION: Musculoskeletal soft tissue injuries (MSKIs) impose a significant burden on the United States (US) healthcare system, constituting a large proportion of emergency department (ED) visits. Understanding the epidemiology of these injuries is critical for identifying at-risk populations, improving preventive measures, and optimizing resource allocation. This study aims to identify and describe trends in MSKIs presenting to US EDs from 2003 to 2023, using the National Electronic Injury Surveillance System (NEISS).

PATIENTS AND METHODS: A retrospective cross-sectional analysis of NEISS data from 2003 to 2023 was performed, focusing on low-energy mechanism injuries categorized as "Strain, Sprain" or "Avulsion." Avulsions were manually evaluated to exclude non-MSKI avulsion injuries. Demographic and injury data, including age, gender, race, injury severity (defined according to disposition), and affected body part, were analyzed using descriptive and inferential statistics as well as survey analysis techniques. Piecewise regression was employed to assess trends in injury incidence rates (IR100k), with significance set at α = 0.05.

RESULTS: The final dataset included n = 941,996 observed injuries, which was extrapolated to an estimated national total of 36,605,488 injuries over 21 years. Annual IR100k declined significantly, with breakpoints in 2010, 2019, and 2020 (for each, P < 0.001), coinciding with important national public health events such as initiation of the Affordable Care Act (ACA) and the COVID-19 pandemic. The IR100k of soft tissue injuries presenting to US EDs did not rebound in the three years following the pandemic (P = 0.388). Severe injuries accounted for 0.68 % of all injuries, with minimal change over time in terms of proportion of injuries. The most common injuries presented in the lower extremities (56.8 %) and occurred in males aged <18-44 years. While demographic distributions showed marginal, yet statistically significant, variation, effect sizes were weak.

CONCLUSION: This 21-year analysis revealed declining trends in soft tissue MSKIs presenting to EDs, potentially influenced by societal events such as the ACA and COVID-19 pandemic. These findings highlight the potential impact of healthcare policy and public health crises on ED utilization patterns. and can potentially inform the aims of preventive and rehabilitative measures.

PMID:41344102 | DOI:10.1016/j.injury.2025.112914

Injury. 2025 Nov 27;57(2):112909. doi: 10.1016/j.injury.2025.112909. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to investigate the association between frailty and osteoporosis in middle-aged and older adults, and to evaluate the discriminative value of different frailty assessment tools, including the Groningen Frailty Indicator (GFI), SARC-F questionnaire, and a combined GFI + SARC-F score, in identifying patients at risk for osteoporosis.

METHODS: A total of 36 patients aged 50 years or older with distal radius fractures were included. Sociodemographic and clinical data were recorded. Osteoporosis was defined as a T-score < -2.5. Participants were assessed for frailty using GFI (cutoff ≥4), and sarcopenia risk was defined via SARC-F. Comparisons were made between patients with and without osteoporosis. Logistic regression and ROC analyses were conducted to determine associations and predictive performance.

RESULTS: Frailty, as measured by GFI, was significantly more common among osteoporotic patients (83.3 % vs. 33.3 %, p = 0.007). Logistic regression analysis showed that both GFI (OR: 1.563, 95 % CI: 1.039-2.350, p = 0.032) and the GFI + SARC-F (OR: 4.000, 95 % CI: 1.128-14.184, p = 0.032) were independently associated with osteoporosis. ROC analysis revealed AUC values of 0.717 for GFI and 0.743 for GFI + SARC-F, indicating good discriminative performance, with the combined assessment showing improved accuracy.

CONCLUSION: Frailty is a significant predictor of osteoporosis in older adults. Combining frailty with the sarcopenia risk, such as GFI and SARC-F, enhances the identification of patients at risk of osteoporosis.

LEVEL OF EVIDENCE: II.

PMID:41344101 | DOI:10.1016/j.injury.2025.112909

Injury. 2025 Nov 26;57(2):112911. doi: 10.1016/j.injury.2025.112911. Online ahead of print.

ABSTRACT

OBJECTIVE: Distal femur shaft fractures are typically associated with high-energy trauma. Stress fractures involving the distal femur shaft are extremely limited. Therefore, epidemiological characteristics, diagnostic protocol, optimal management strategies, and prognosis of distal femoral shaft stress fractures (DFSSF) remain poorly understood. This study aims to report clinical experience with 10 cases of DFSSF in South Korean military.

METHODS: This retrospective case series included patients diagnosed with DFSSF at the single South Korean military hospital between January 2022 and December 2023. Demographic and epidemiologic data, including military rank and training context, were collected. Radiographic evaluation including AO classification and femoral bowing angles were assessed. Clinical outcomes assessed included time to union, treatment modality, return to military duty, and complications.

RESULTS: Nine patients were male, one female noncommissioned officer candidate with a mean age of 21.2 ± 1.8 years (range, 19-24). As military rank, six patients were recruits, two were privates, and one patient was a private first class. The mean anterior and lateral femoral bowing angle measured by the Sasaki method was 3.7 ± 1.8° and 12.7 ± 2.3° respectively. All fractures achieved successful union within an average of 16.3 ± 2.4 weeks. All patients successfully returned to full military duty at an average of 16.7 ± 2.8 weeks post-injury. No complications were observed.

CONCLUSION: This study provides valuable insight into the rare entity of DFSSF, emphasizing clinical awareness, and optimal management strategies.

LEVEL OF EVIDENCE: Case Series, IV.

PMID:41344100 | DOI:10.1016/j.injury.2025.112911

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06718-7. Online ahead of print.

NO ABSTRACT

PMID:41343083 | DOI:10.1007/s00264-025-06718-7

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06707-w. Online ahead of print.

ABSTRACT

BACKGROUND: Malunions of tibial pilon fractures pose significant challenges for corrective reconstruction due to the solidly healed displaced fracture fragments and frequently defective articular cartilage. This study aims to introduce a joint-preserving reconstruction strategy for managing tibial pilon fracture malunions in young patients and to evaluate the clinical outcomes.

METHODS: We retrospectively analyzed 39 patients (mean age: 32.7 ± 10.4 years) with malunions of tibial pilon fractures who were treated with corrective reconstruction surgeries from 2013 to 2021. This cohort included 11 patients who underwent corrective intra-articular osteotomy, 17 who received combined osteoperiosteal iliac autograft transplantation, and 11 who underwent combined osteochondral autograft transplantation. The median duration from the initial injury to joint-preserving treatment was 7.4 months (interquartile range [IQR], 4.4-11.1). Radiographic assessments included plain radiographs and computed tomography (CT) scans. Clinical outcomes were evaluated using the visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and ankle range of motion (ROM).

RESULTS: After a median follow-up of 41.5 months, patients showed significant improvements in pain and function. The median VAS score improved from 5 (IQR, 6-7) to 2 (IQR, 1-3), and the median AOFAS score increased from 42 (IQR, 33-58) to 79 (IQR, 73-87) (P < 0.001). The mean SF-36 scores increased from 37.2 ± 12.2 to 71.2 ± 9.6 (P < 0.001), and the median ankle ROM improved from 20 degrees (IQR, 16-30) to 25 degrees (IQR, 20-34) (P = 0.004). Major complications included two patients requiring reoperation, and two patients progressing to radiographic end-stage arthritis; however, the pain remained tolerable, and no secondary arthrodesis or arthroplasty was performed by the final follow-up.

CONCLUSION: Joint-preserving corrective reconstruction surgeries can offer reasonable improvement over a four-year follow-up period, making them a viable alternative for the reconstruction of tibial pilon fractures malunions in young patients.

PMID:41343082 | DOI:10.1007/s00264-025-06707-w

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06714-x. Online ahead of print.

ABSTRACT

PURPOSE: Rotational instability is a key factor in fixation failure of extracapsular hip fractures. The U-Blade (RC) lag screw was designed to improve rotational stability. This study aimed to compare mechanical complication rates between Gamma3 and Gamma3 RC nails in elderly patients with rotationally unstable extracapsular fractures.

METHODS: We conducted a prospective, single-center randomized controlled trial including 316 patients aged ≥ 65 years with rotationally unstable extracapsular fractures. Patients were randomized to treatment with a Gamma3 nail (n = 169) or a Gamma3 RC nail (n = 147). Mechanical complications were classified as major (rotation and migration of the implant, cut-out, non-union) or minor (back-out, cervicodiaphyseal angle change, excessive sliding).

RESULTS: The overall rate of major complications was 2.9 per 10,000 person-days, being the most frequent the cut out (2.2%), with no significant difference between Gamma3 and Gamma3 RC groups (RR = 1.0; 95% CI: 0.4-2.7). TAD > 25 mm increased the risk of major complications (RT = 3.7; 95% CI: 1.2-11.2), as did superior screw placement (Cleveland zones 1-3: RT = 7.5; 95% CI: 2.7-20.8) and postoperative diastasis (RT = 4.7; 95% CI: 1.4-16.2). Similarly, implant type was not significantly associated with minor complications that were observed in 85 patients (26.9%), most frequently back-out (14.6%).

CONCLUSION: The U-Blade (RC) lag screw did not reduce mechanical complication rates compared with the standard Gamma3. Radiographic parameters, particularly TAD, reduction quality, screw position, and postoperative diastasis, were the main predictors of fixation failure.

PMID:41343081 | DOI:10.1007/s00264-025-06714-x

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06716-9. Online ahead of print.

ABSTRACT

PURPOSE: Supracondylar humerus fractures are the most common elbow injuries in children, with non-operative management frequently preferred in Gartland type I and selected type II cases. While biomechanical factors affecting outcomes have been well documented, the influence of socioeconomic status (SES) on functional and radiological results remains insufficiently explored.

METHODS: This retrospective cohort study analyzed 237 children (aged 3-13 years) treated non-operatively for supracondylar humerus fractures between February 2019 and February 2024. Socioeconomic status was determined using the Hollingshead Index and categorized as low, middle, or high. Functional outcomes were assessed using Flynn's criteria, while radiological evaluation included Baumann and carrying angle measurements. Subgroup analyses were performed according to fracture type.

RESULTS: There were no significant differences in age, gender, or fracture type between SES groups (p > 0.05). However, Flynn functional scores were significantly lower in the low-SES group compared with middle- and high-SES groups (p = 0.014). Radiological parameters, including Baumann and lateral humerocapitellar angles, did not differ significantly among groups (p = 0.41 and p = 0.37, respectively). Complications were rare (2.3%) and similar between groups.

CONCLUSION: Socioeconomic disadvantage was associated with poorer functional recovery after non-operative management of paediatric supracondylar humerus fractures, despite comparable fracture characteristics and radiological results. Early follow-up and caregiver support may help mitigate these disparities.

LEVEL OF EVIDENCE: Level III (retrospective cohort study).

PMID:41343080 | DOI:10.1007/s00264-025-06716-9

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06710-1. Online ahead of print.

ABSTRACT

PURPOSE: This study assessed early complications and postoperative blood transfusion rates after simultaneous bilateral prosthetic hip or knee replacement.

MATERIALS AND METHODS: Between 2020 and 2024, 285 patients underwent single-session bilateral total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) at a single referral centre. The cohort consisted of 102 patients in the TKA group, 83 in the THA group, and 100 in the UKA group. Patients were 57.2% male, with a mean age of 65.2 years ± 10.9 and a mean BMI of 27.9 ± 4.5. Based on the American Society of Anesthesiologists (ASA) classification, preoperative risk assessment showed a mean score of 1.8 ± 0.5. Early complications occurring within the first two postoperative months and anaemia requiring blood transfusion were recorded.

RESULTS: The early complication rate was 2.5% (7/285), with no complications in the UKA group, 5% (4/83) in the THA group, and 2% (2/100) in the TKA group. No deaths, deep venous thrombosis, pulmonary embolisms, or surgical site infections were reported. Complications included three periprosthetic fractures, one hip dislocation, one early unipolar revision for acetabular migration, and one extensor mechanism rupture. The transfusion rate was 4.6% (13/285), with no transfusions required in the UKA group, which was lower compared to THA (6%; 5/83) and TKA (8%; 8/100) (p = 0.02).

CONCLUSION: Single-stage bilateral hip and knee replacement prove to be a safe procedure with a low complication rate. UKA showed no early complications or transfusion needs, confirming its reliability as a safe option for single-stage bilateral procedures.

PMID:41343079 | DOI:10.1007/s00264-025-06710-1

Int Orthop. 2025 Dec 4. doi: 10.1007/s00264-025-06701-2. Online ahead of print.

ABSTRACT

PURPOSE: Children with chronic diseases are at a significant risk of radiation exposure. This cohort study evaluates the effectiveness and reliability of ultrasonography (US) for detecting femoral head decentration in children with cerebral palsy (CP) and developmental dysplasia of the hip (DDH), comparing it with traditional radiographic techniques to reduce radiation exposure.

METHODS: A total of 169 patients were enrolled in the study. Both hips were evaluated in 158 patients, resulting in a total of 327 hips. Patients underwent clinical and radiological assessments, including standardized US. Parameters measured included the ventral and lateral bony and cartilaginous ultrasonographic migration indices (bUMI and cUMI), which were compared with standardized radiographic indices (Reimers index (RI) and extrusion index (EI)).

RESULTS: The lateral bUMI (17.4%) was significantly lower than the lateral cUMI (25.9%). RI values were lower than EI values (16.8% vs. 27.7%). No significant differences were observed between the bUMI and RI, or between the cUMI and EI, indicating the reliability of US. All lateral parameters correlated well with the lateral centre-edge angle (LCE). Positive correlations were found between the lateral cUMI and the radiological indices, with high inter- and intra-rater reliability (ICC). Significant differences in lateral and ventral UMIs were noted when comparing DDH and CP patients.

CONCLUSION: US is a reliable alternative to radiography for hip surveillance in detecting hip decentration in children with CP and DDH. It reduces radiation exposure while maintaining diagnostic accuracy. The findings support the adoption of US in clinical practice to improve early diagnosis and intervention.

PMID:41343078 | DOI:10.1007/s00264-025-06701-2