J Bone Joint Surg Am. 2025 Oct 15;107(20):e98. doi: 10.2106/JBJS.25.00901. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091100 | DOI:10.2106/JBJS.25.00901

J Bone Joint Surg Am. 2025 Oct 15;107(20):e97. doi: 10.2106/JBJS.25.00977. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091099 | DOI:10.2106/JBJS.25.00977

J Bone Joint Surg Am. 2025 Oct 15;107(20):2227. doi: 10.2106/JBJS.25.00999. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091098 | DOI:10.2106/JBJS.25.00999

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06672-4. Online ahead of print.

ABSTRACT

PURPOSE: Registry data suggests that robotic-assisted unicompartmental knee arthroplasty (rUKA) significantly reduces all-cause revisions compared to conventional implantation (cUKA). This study aims to compare joint line-related parameters and their reconstruction accuracy between rUKA and cUKA.

METHODS: Five databases were searched using a pre-defined strategy and inclusion criteria: (1) comparative studies reporting radiological outcomes, (2) human studies, (3) English language, and (4) meta-analyses for cross-referencing. Cadaveric or saw-bone studies were excluded. Data extracted included demographics data, pre- and postoperative radiological parameters (HKA, MPTA, LDFA, posterior tibial slope, femoral sagittal angle, joint line height, implant congruency), and outliers. A random-effects meta-analysis was conducted using mean difference (MD) and odds ratio (OR) as main effect estimators. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated with funnel plots.

RESULTS: A total of 18 studies assessing 2470 patients (1112 rUKA, 1358 cUKA) were included in the analysis. No significant baseline differences were found in age, sex, BMI, follow-up period, MPTA, LDFA, or tibial slope. Postoperative radiological parameters showed no significant differences between groups for HKA, LDFA, MPTA, or tibial slope (p > 0.05). Joint line height was significantly lower in cUKA compared to rUKA (MD = -1.37 mm, 95% CI: -2.06 to -0.69, p < 0.001). Outlier analysis revealed that rUKA had significantly fewer outliers across relevant radiological parameters, including HKA, joint line height, tibial slope, femoral flexion, femoral implant congruency, and medial, anterior, and posterior tibial congruency.

CONCLUSION: Reporting pre- and postoperative mean alignment parameters undermines patient-specific anatomy reconstruction with advanced technologies. Outlier reporting showed significant variability, with limited evidence supporting its clinical relevance. Future studies should focus on patient-specific reconstruction and define clinical thresholds for outliers.

PMID:41091159 | DOI:10.1007/s00264-025-06672-4

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06670-6. Online ahead of print.

NO ABSTRACT

PMID:41087774 | DOI:10.1007/s00264-025-06670-6

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06666-2. Online ahead of print.

NO ABSTRACT

PMID:41087773 | DOI:10.1007/s00264-025-06666-2

Injury. 2025 Oct 8:112788. doi: 10.1016/j.injury.2025.112788. Online ahead of print.

ABSTRACT

BACKGROUND: Mild traumatic brain injury (mTBI) is commonly associated with alcohol use. We investigated how inpatient admission patterns after mTBI vary for patients with alcohol use disorder (AUD).

METHODS: This was a retrospective cohort study of patients with mTBI from the American College of Surgeons Trauma Quality Program dataset. Mixed regression models measured associations with inpatient admission, including among a subgroup of patients with AUD. Effect modification was tested for age, race, and acute intoxication.

RESULTS: 78,937 patients with mTBI were included, and 7.0 % had AUD. AUD was associated with increased admission odds (OR, 1.83; 95 % CI, 1.67-2.01). Black patients and those presenting intoxicated had this effect reduced. Among a subgroup of patients with AUD, acute intoxication reduced admission odds (OR, 0.73; 95 % CI, 0.59-0.91).

CONCLUSIONS: AUD increased inpatient admission odds after mTBI, while acute intoxication reduced these odds among patients with AUD. These findings help contextualize care for the common diagnostic constellation of mTBI and AUD.

PMID:41077492 | DOI:10.1016/j.injury.2025.112788

Injury. 2025 Oct 4;56(12):112785. doi: 10.1016/j.injury.2025.112785. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment options of orthopedic surgeons for older adults with proximal humeral fractures (PHF) may vary according to chronological age. This study aimed to present the treatment modalities, complications, and mortality rates after PHF in octogenarians, nonagenarians, and centenarians from the Turkish national database.

METHODS: This retrospective study was conducted using health records from the National Health Record System of Ministry of Health Turkey for individuals aged 80 and over who presented to public, private, and university hospitals from January 2016, to October 2024. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S42.2 (code for closed PHFs) was used to identify patients. A total of 9799 patients were included and categorized into three age groups: octogenarians (80-89 years), nonagenarians (90-99 years), and centenarians (≥100 years) and 4 groups according to treatment modalities (conservative, osteosynthesis, reverse shoulder arthroplasty (RSA), and hemiarthroplasty). Early systemic complications, revision surgery and mortality rates regarding 30-day and 90-day were recorded.

RESULTS: The mean age of the study population was 85.1 ± 4.2, ranging between 80-106 years. The female ratio was 76.1 %. Octogenarians comprised 84.3 % of the entire study population, whereas 15.5 % were nonagenarians and 0.3 % were centenarians. Conservative treatment was the most preferred across all age groups (62.3 %). Among patients initially managed conservatively, 7.0 % (n = 425) subsequently required surgical intervention, with no statistically significant difference in surgical conversion rates across the three age groups. Only 77 patients (0.8 %) underwent RSA. No differences were observed in the ratio of early systemic complications between octogenarians, nonagenarians, and centenarians. 30-day and 90-day mortality rates were 4.9 % and 10.2 %, respectively. RSA was associated with the highest risk of 90-day mortality (HR: 2.222, 95 % CI: 1.328-3.718; p = 0.002), with centenarians exhibiting an even greater risk (HR: 2.879, 95 % CI: 1.193-6.949; p = 0.019).

CONCLUSION: Conservative treatment remains the most preferred approach for PHFs in the patient population over the age of 80. Given the significantly higher mortality rates in centenarians and in patients undergoing RSA, individualized treatment decisions should prioritize functional outcomes, patient comorbidities, and life expectancy.

PMID:41075714 | DOI:10.1016/j.injury.2025.112785

Injury. 2025 Oct 4;56(12):112783. doi: 10.1016/j.injury.2025.112783. Online ahead of print.

ABSTRACT

BACKGROUND: Upper extremity fractures (UEFs) are a growing public health concern in China, yet comprehensive epidemiological data remain limited. This study examines the burden, trends, and risk factors of UEFs in China from 1990 to 2021.

METHODS: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, years lived with disability (YLDs), and causes of UEFs in China. Age-standardized rates (ASRs) were calculated, and trends were assessed using regression models. Sociodemographic index (SDI) associations and global comparisons were evaluated.

RESULTS: In 2021, China recorded 11.1 million new UEF cases, a 31.92% increase since 1990. The age-standardized incidence rate (ASIR) rose by 7.97%, contrasting with a 20.92% global decline. Fractures of the radius and/or ulna had the highest ASIR (404.52 per 100,000), while shoulder fractures saw the steepest YLD increase (42.69%). UEFs were more prevalent in males, except among children (<1, 10-14 years) and older adults (≥65 years), where females predominated. Falls accounted for 72.98% of UEFs, followed by road injuries (13.38%). Rehabilitation needs (YLDs) grew by 32.28%, with SDI-linked trends showing a plateau at SDI 0.59-0.72.

CONCLUSIONS: China's increasing burden of UEF, influenced by factors such as falls, an aging population, and urbanization, contrasts with the global downward trends. Immediate targeted actions (implementing fall prevention strategies for the elderly, enhancing road safety for young people, and broadening access to rehabilitation services) are essential to address this escalating public health issue.

PMID:41075713 | DOI:10.1016/j.injury.2025.112783

Injury. 2025 Sep 30;56(12):112779. doi: 10.1016/j.injury.2025.112779. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to investigate on the influence of physical workload and workers' compensation status on fulfillment of patients' expectations, return to initial work, and functional outcome after surgical treatment of complex proximal tibial fractures.

METHODS: This prospective study included 114 patients with complex tibial fractures (AO/OTA type B and C). At final follow-up, an individualized questionnaire based on the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES) was used to assess whether preoperative expectations had been met. In addition, the condition of the knee joint, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Physical workload was assessed using the REFA classification. Physical workload and workers' compensation status was corelated to duration of incapacity to work (weeks), fulfillment of expectations, and functional outcome.

RESULTS: Patients with higher physical workloads showed longer incapacity to work (20.1 weeks on average) and were significantly less likely to report a complete return to their initial professional activity (r=-0.21). Their preoperative expectations were significantly less frequently fulfilled (r=-0.29). Workers' compensation status was associated with lower satisfaction and higher workload demands. Reintegration programs proved effective, enabling a high percentage of patients to return to work without restrictions (p = 0.04). Significant negative correlations were found between workload and functional outcomes (KOOS dimensions, residual pain, quality of life).

CONCLUSION: Individualized, job-oriented rehabilitation with realistic expectations is crucial for improving return to work, especially for high-workload patients. Future research should integrate physical and psychosocial factors in rehabilitation strategies.

PMID:41072123 | DOI:10.1016/j.injury.2025.112779

Injury. 2025 Sep 30:112778. doi: 10.1016/j.injury.2025.112778. Online ahead of print.

ABSTRACT

OBJECTIVE: Prehospital performed Extended Focused Assessment with Sonography in Trauma (EFAST) has poor sensitivity for pneumothorax (PTX) when compared to scans performed in hospital. This study describes the computed tomography (CT) location of PTX detected after an initial negative prehospital EFAST.

METHODS: Trauma patients treated by New South Wales Ambulance (Aeromedical Operations) who underwent prehospital EFAST between 1st August 2022 and 31st December 2023 were included if they were found to have PTX on CT imaging following a negative or indeterminate prehospital EFAST ultrasound. Patients were excluded if prehospital pleural decompression was undertaken. Corresponding CT imaging was manually analysed for the location of each PTX and mapped to two-dimensional coordinates on an unfurled thoracic cage.

RESULTS: Of 58 patients median (IQR) age was 29 (20, 58) years. The majority (76 %) were male who had sustained blunt trauma. The median (IQR) estimated PTX volume was 8 % (4-10) with 43 % of patients having a pneumothorax located to either the second intercostal space or most anterior portion of the chest on CT-mapping. The midpoints of each locule were anatomically distributed with a median (IQR) of 4th (3rd-5th) intercostal space and distance from the sternal edge (cm) of 4.1 (2.5-5.1) on the right, and 4.4 (3.5-5.2) on the left. Most PTX were sonographically occult due to apical, retrosternal, or posterior position.

CONCLUSION: Most traumatic PTX missed by prehospital EFAST were truly sonographically occult, but a significant number corresponded with the traditional scanning landmarks, particularly the parasternal 4th intercostal space. This reinforces current literature advocating this scanning region. The balance between optimal detection and sono-paralysis should be considered for ongoing education and governance.

PMID:41067963 | DOI:10.1016/j.injury.2025.112778

Int Orthop. 2025 Oct 9. doi: 10.1007/s00264-025-06665-3. Online ahead of print.

ABSTRACT

PURPOSE: Conserving the subscapularis tendon during reverse shoulder arthroplasty (RSA) has proven its impact on postoperative outcomes, particularly regarding stability and range of motion. A subscapularis preserving approach has been developed: the Anterior Muscle Sparing (AMS) approach that enables not to violate the subscapularis tendon. Our aim was to compare this approach with the conventional approach, which consists of reinserting the subscapularis at the end of the procedure, with a specific focus on intraoperative complications and postoperative position of the implants.

METHODS: A retrospective consecutive study was performed of patients undergoing a primary RSA between January 2021 and December 2024 performed by the same surgeon. We included 32 patients receiving the standard approach (SA) and 24 patients receiving the AMS approach. Implant positioning was assessed through three different variables: the glenoid implant inclination relative to the floor of the supraspinatus fossa; the glenoid implant height described as the distance between the inferior border of the glenoid bone surface and the inferior part of the glenoid baseplate; and the humeral stem alignment relative to the intramedullary humeral shaft axis.

RESULTS: There were no significant differences in terms of glenoid implant inclination (-4.71 ± 6.3° Vs -3.8 ± 7.17°; p = 0.68), glenoid implant height (0.608 ± 1.94 mm Vs 0.315 ± 0.896 mm ; p = 0.655), and PERFORM® humeral stem alignment ( 1.34 ± 4.11° Vs 1.89° ± 4.63°; p = 0.715) between the two groups. The intraoperative complication rate was not significant different between the groups, with only two cases within the AMS approach group (p = 0.181). The mean operative times were not significantly different between the groups (94.06 min ± 18,71 Vs 81,73 min. ±16,58; p = 0,06). Since September 2023, when the senior author started performing RSAs with the described technique only one patient was converted from an AMS to a traditional approach during surgery due to an intraoperative complication.

CONCLUSION: When compared to the standard approach, the AMS showed no significant difference in terms of implant positioning, surgical operative times and intraoperative complication rate. An attempt to preserve the subscapularis tendon seems to be always justified, as this method is a safe and reliable alternative to the traditional approach.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Comparison Treatment study.

PMID:41065821 | DOI:10.1007/s00264-025-06665-3

Injury. 2025 Sep 30;56(12):112780. doi: 10.1016/j.injury.2025.112780. Online ahead of print.

ABSTRACT

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

METHODS: This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and infected hardware at 30 days, 90 days, 1 year, and 2 years postoperatively.

RESULTS: 5,264 patients were in each cohort after matching. Nonunion diagnosis was similar between the ketorolac and no-ketorolac groups at 30 days (16 vs. 18, P=0.731), 90 days (31 vs. 40, P=0.284), 1 year (93 vs. 88, P=0.708), and 2 years (104 vs. 100, P=0.777). Similarly, revision surgery for nonunion was comparable between the two groups at all time points, 30 days (<10 vs <10, P=1), 90 days (<10 vs <10, P=1), 1 year (24 vs. 20, P=0.546), and 2 years (27 vs 26, P=0.890). Opioid prescription rates were comparable across all time points but trended lower in the ketorolac group: 30 days (1,827 vs. 1,906, P=0.108), 90 days (1,967 vs. 2,051, P=0.092), 1 year (2,340 vs. 2,428, P=0.085), and 2 year (2,574 vs 2,642, P=0.185).

CONCLUSION: Ketorolac use following clavicle surgery was not associated with increased nonunion or revision surgery rates. Although opioid prescription rates trended lower in the ketorolac group, the difference was not statistically significant.

PMID:41061370 | DOI:10.1016/j.injury.2025.112780

Int Orthop. 2025 Oct 8. doi: 10.1007/s00264-025-06668-0. Online ahead of print.

NO ABSTRACT

PMID:41060390 | DOI:10.1007/s00264-025-06668-0

Int Orthop. 2025 Oct 7. doi: 10.1007/s00264-025-06667-1. Online ahead of print.

NO ABSTRACT

PMID:41055733 | DOI:10.1007/s00264-025-06667-1

Injury. 2025 Sep 20;56(11):112770. doi: 10.1016/j.injury.2025.112770. Online ahead of print.

ABSTRACT

INTRODUCTION: A dedicated Major Trauma Ward (MTW) is core to the function of a Major Trauma Centre (MTC). MTCs are central to the hub-and-spoke model of an inclusive Major Trauma System (MTS). The implementation of the London Major Trauma System is heralded to have increased the in-hospital odds ratio of survival of traumatically injured patients by 19 %. There is no one universal definition of Major Trauma, but the National Institute for Health and Clinical Excellence (NICE) provides the definition, "Major trauma is defined as an injury or combination of injuries that are life-threatening and could be life changing because it may result in long-term disability". Major Trauma is a disease requiring multidisciplinary and multi-specialty input at every stage of the continuum of care. However, there is no formal education for staff on a MTW on the care of these complex, severely injured patients. The Trauma ORchestration of Continuing Healthcare (TORCH) course was established in 2018 to help to address this educational void. The aims of this paper are to describe the rationale for the course, report the feedback, and identify key strengths and areas for improvement.

METHODS: A mixed methods study was undertaken with simultaneous quantitative and qualitative analysis. Descriptive statistics of quantitative data was undertaken to describe delegate demographics. Thematic analysis of the 136 attendee responses to course feedback was performed. Course feedback was assimilated contemporaneously at the end of each course via online survey.

RESULTS AND DISCUSSION: There was an 88 % (136/154) response rate to feedback. Attendees included 96 doctors, and 16 nurses and allied health professionals. The 2019 course of 24 delegates did not stratify participant demographics. The largest group of doctors (39 %) were Senior House Officer grade, with 41 % of all doctors coming from a surgical background. Feedback themes identified as course strengths include the multidisciplinary curriculum approach. Speakers include Consultants from 12 different specialties and multiple therapists across the continuum of trauma care. Lectures based on real life case discussion was found to be an engaging and thought provoking medium of education with the focus on MTW based decision making commonly required of MTW junior staff. Areas for future development include the continued delivery of the TORCH course outside of London and consideration of course validation for quality assurance, and a "train the trainer" model to allow for course expansion and sustainability in other MTSs of the UK and Ireland to implement formal, high quality education for staff on MTWs.

PMID:41045758 | DOI:10.1016/j.injury.2025.112770

Injury. 2025 Sep 30;56(11):112777. doi: 10.1016/j.injury.2025.112777. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior shoulder dislocations are common in emergency settings, requiring effective procedural sedation and analgesia (PSA). Ketofol (ketamine-propofol) and etofen (etomidate-fentanyl) are widely used, but their comparative efficacy remains debated.

OBJECTIVES: The aim of this study was to compare the efficacy and safety of ketofol versus etofen for PSA in shoulder dislocation reduction.

METHODS: This randomized clinical trial enrolled 92 patients (46 per group). Ketofol (0.75 mg/kg) or etofen (0.15 mg/kg etomidate + 1.5 µg/kg fentanyl) was administered. Outcomes included sedation depth, hemodynamics, adverse events, and recovery times.

RESULTS: Ketofol provided deeper sedation (RSS 4.5 vs. 4.1, p < 0.001), better analgesia (VAS 1.64 vs. 2.64, p < 0.001), and easier reduction but had more emergence reactions. Etofen showed faster onset and fewer respiratory events but caused myoclonus.

CONCLUSION: Ketofol offers superior analgesia and sedation, while etofen ensures rapid recovery and hemodynamic stability. The choice depends on clinical priorities.

CLINICAL TRIAL REGISTRATION: IRCT20220824055790N1.

PMID:41045757 | DOI:10.1016/j.injury.2025.112777

Injury. 2025 Sep 24;56(11):112775. doi: 10.1016/j.injury.2025.112775. Online ahead of print.

ABSTRACT

OBJECTIVE: Although rare, shark bites can cause complex injuries requiring specialized management. This study aims to describe the surgical and medical management of shark bite injuries in New Caledonia.

METHODS: A retrospective, descriptive, single-center study including 22 patients hospitalized between 2011 and 2023. Demographic data, attack context, injury types, surgical treatments, infectious complications, and length of hospital stay were analyzed.

RESULTS: The median age was 33.5 years (IQR 15); 82 % were male. Spearfishing was the most common context (32 %). Injuries predominantly affected limbs, with musculoskeletal damage (82 %), nerve injuries (32 %), vascular injuries (27 %), and fractures (18 %). Infectious complications were rare (9 %), but identified pathogens were polymicrobial and marine-derived. The median hospital stay was 5 days (IQR 6, range 1-50 days).

CONCLUSION: Shark bites require rapid, specialized surgical care. Local organization enabled effective management. Empirical antibiotic therapy should cover marine pathogens.

LEVEL OF EVIDENCE: IV.

PMID:41037958 | DOI:10.1016/j.injury.2025.112775

EFORT Open Rev. 2025 Oct 1;10(10):733-744. doi: 10.1530/EOR-2023-0179.

ABSTRACT

Hip pain can be caused by extra-articular conditions such as subspine impingement, iliopsoas impingement, and ischiofemoral impingement. These syndromes are frequently secondary to underlying pathologies involving the hip joint or lumbar spine. While most cases are managed conservatively through activity modification and physiotherapy, surgical intervention is considered for refractory cases. Imaging, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) is crucial for diagnosing these conditions, as clinical symptoms can be nonspecific. CT scans help identify predisposing factors such as acetabular morphology, femoral version, and acetabular version, while MRI is useful for ruling out other conditions and detecting soft tissue pathology. Although positive treatment outcomes are generally observed, there are variations in results and procedures, and long-term follow-up studies are lacking. Complications of the treatments are a concern, but most reported complications are minor in nature.

PMID:41031635 | PMC:PMC12494060 | DOI:10.1530/EOR-2023-0179

EFORT Open Rev. 2025 Oct 1;10(10):771-781. doi: 10.1530/EOR-2025-0027.

ABSTRACT

PURPOSE: This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values.

RESULTS: Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95-2 g given 1-2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates.

CONCLUSIONS: Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.

PMID:41031630 | PMC:PMC12495541 | DOI:10.1530/EOR-2025-0027