EFORT Open Rev. 2026 May 1;11(5):366-371. doi: 10.1530/EOR-2026-0055.

ABSTRACT

The European Union Medical Device Regulation (MDR 2017/745) has introduced stricter requirements for clinical evidence, limited reliance on equivalence and expanded post-market surveillance for orthopaedic implants. While designed to improve patient safety following high-profile device failures, MDR implementation has been associated with longer certification timelines, increased costs and withdrawal of established implants, particularly in lower-volume indications. The central regulatory challenge is proportionality: novel devices require robust prospective evidence, whereas long-established implants with extensive clinical track records may warrant risk-based recertification pathways. Uniform regulatory application risks unintended consequences for intermediate- and lower-volume indications that fall between orphan-device provisions and standard MDR requirements. Orthopaedic societies may play a key role in developing speciality-specific evidence guidance to support regulators and notified bodies, improving clarity while maintaining patient safety and sustainable innovation.

PMID:42065230 | DOI:10.1530/EOR-2026-0055

EFORT Open Rev. 2026 May 1;11(5):415-425. doi: 10.1530/EOR-2026-0076.

ABSTRACT

Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction. Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology. The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies. Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.

PMID:42065229 | DOI:10.1530/EOR-2026-0076

EFORT Open Rev. 2026 May 1;11(5):381-389. doi: 10.1530/EOR-2026-0051.

ABSTRACT

Carpal instability is fundamentally a dynamic disorder that may not be detected using conventional static imaging modalities such as radiography, CT, and MRI. This diagnostic limitation may delay diagnosis and treatment, potentially leading to progressive instability and degenerative changes. Four-dimensional CT enables dynamic, in vivo visualisation and quantitative analysis of wrist kinematics by acquiring sequential volumetric datasets during active motion. This allows identification of abnormal motion patterns, including altered intercarpal coordination and subluxations, which cannot be detected using static imaging. Clinical applications include evaluation of scapholunate instability, distal radioulnar joint instability, midcarpal instability, and altered carpal kinematics in conditions such as Kienböck disease. Four-dimensional CT may also be valuable for preoperative planning and postoperative assessment by enabling objective evaluation of treatment-related changes in wrist motion. Comparison with the contralateral wrist provides an internal physiological reference and may improve diagnostic confidence by distinguishing pathological motion from normal anatomical variation. Four-dimensional CT complements conventional imaging and arthroscopy by providing functional information on wrist biomechanics. It should be used selectively when dynamic instability is suspected and conventional imaging is inconclusive. Ongoing advances in automated analysis, dose optimisation, and protocol standardisation are expected to further improve clinical applicability and support broader integration into clinical practice.

PMID:42065227 | DOI:10.1530/EOR-2026-0051

EFORT Open Rev. 2026 May 1;11(5):404-414. doi: 10.1530/EOR-2026-0069.

ABSTRACT

Developmental dysplasia of the hip (DDH) remains a leading cause of early hip osteoarthritis and poses considerable technical challenges during total hip arthroplasty. Existing classification systems focus on the abnormal relationship between the femoral head and the acetabulum without emphasising the femoral morphological variations, which are equally significant in surgical planning. Dysplastic femora often demonstrate excessive neck anteversion, variable neck-shaft angles, reduced offset, and metaphyseal-diaphyseal mismatch with narrow intramedullary canals. These anatomical variations often compromise the abductor mechanism and alter hip biomechanics. Thorough preoperative planning is crucial and should include the evaluation of leg-length discrepancy, reconstruction of the hip centre of rotation, assessment of femoral version and canal morphology, implant selection, and consideration of femoral shortening osteotomy. Computed tomography-based planning can enhance preoperative planning in complex cases. Both cemented and cementless stems align with positive findings in DDH patients. Cemented stems enable reliable version control, decrease intraoperative fracture risk, and may be beneficial for patients with poor bone quality. In mild cases, most uncemented stems are suitable. More severe deformities necessitate specialised implant designs with conical fluted stems, which provide strong fixation and excellent long-term survivorship. Modular and custom-made options also achieve favourable outcomes in high-grade deformities. Femoral shortening osteotomies are often needed to restore biomechanics, correct abnormal version, and prevent nerve injury during reduction. The subtrochanteric osteotomy has been linked with excellent results in treating severe DDH. High-quality research is essential to deepen our understanding of proximal femur morphological abnormalities and to enhance surgical results.

PMID:42065226 | DOI:10.1530/EOR-2026-0069

EFORT Open Rev. 2026 May 1;11(5):372-380. doi: 10.1530/EOR-2026-0056.

ABSTRACT

Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations. Despite MSCs' promising effects, their application should be guided by the pathophysiology of the target disease. The application of MSCs should follow the regulatory frameworks of each country to ensure their safe and effective use in daily clinical practice. It is suggested that further research be conducted on the current guidelines in broader patient populations.

PMID:42065225 | DOI:10.1530/EOR-2026-0056

EFORT Open Rev. 2026 May 1;11(5):437-445. doi: 10.1530/EOR-2026-0043.

ABSTRACT

Two-part surgical neck fractures are the most common displaced proximal humeral fractures in the elderly. Most fractures can be categorized into varus-impacted or medially translated fracture patterns. The natural healing process often involves secondary displacement and partial resorption of the humeral head, but these changes are poorly correlated with shoulder function and patient satisfaction. Randomized trials have been unable to identify any benefits from surgery but report a high proportion of implant-related complications. In large prospective cohort studies, patients aged 60 or older with two-part surgical neck fractures treated non-operatively report shoulder function and quality of life close to the background population six months post-injury. Evidence-based and eminence-based approaches to interventions for osteoporotic proximal humeral fractures appear to collide.

PMID:42065224 | DOI:10.1530/EOR-2026-0043

EFORT Open Rev. 2026 May 1;11(5):426-436. doi: 10.1530/EOR-2026-0053.

ABSTRACT

Multiligament knee injuries (MLKIs) are rare but severe injuries involving bicruciate or collateral ligament disruption, frequently associated with knee dislocation, fractures, and neurovascular compromise. Vascular injury occurs in a mean of approximately 18% of cases and may be present despite palpable pulses; an ankle-brachial index (ABI) < 0.9 demonstrates high sensitivity for arterial injury. Peroneal nerve injury occurs in approximately 10-40% of cases. Early recognition and structured evaluation are critical. Serial vascular examinations, selective CT angiography, and careful neurologic assessment are mandatory. General orthopedic surgeons often make the initial management decisions, and timely diagnosis, stabilization, and referral significantly influence limb salvage and long-term function. The Schenck KD classification remains standard, with recent consensus refinements to the KD V category and proposed modifiers such as '-EM' for extensor mechanism disruption. Associated meniscal, chondral, and rare entities, such as uniplanar coronal tibiofemoral subluxation, require high clinical suspicion. Knee-spanning external fixation is indicated in vascular injury, open or fracture-dislocations, soft-tissue compromise, or persistent instability, with reconstruction commonly performed later at 3-6 weeks. Current evidence shows no clear superiority of early versus delayed reconstruction in functional outcomes, although early surgery increases stiffness risk. Anatomic reconstruction is generally favored over repair for high-grade PLC and MCL injuries due to lower failure and complication rates. At 2 years, patients retain approximately 80-85% of knee function; however, a gradual functional decline over time is observed. Arthrofibrosis (≈10%) remains the most common complication.

PMID:42065223 | DOI:10.1530/EOR-2026-0053

EFORT Open Rev. 2026 May 1;11(5):390-403. doi: 10.1530/EOR-2026-0044.

ABSTRACT

Hip fractures represent a time-critical, systemic condition in older adults, characterised by frailty, multimorbidity, inflammation, immobility, pain, and high risk of medical complications and mortality. While population ageing is expected to drive a continued rise in absolute hip fracture numbers, contemporary evidence demonstrates declining age-standardised incidence in many high-income countries, highlighting the importance of optimising perioperative care pathways to mitigate morbidity and mortality. Contemporary evidence consistently supports early surgical management, typically within 24-48 h, provided reversible medical issues are addressed in parallel rather than through prolonged preoperative workup. Orthogeriatric co-management and structured multidisciplinary pathways reduce time to surgery, delirium incidence, length of stay, and mortality while improving functional recovery. Key optimisation domains include multimodal opioid-sparing analgesia, delirium prevention bundles, targeted cardiovascular stabilisation, pragmatic management of anti-thrombotic therapy, anaemia, infection, and individualised anaesthetic strategies. Evidence supports protocol-driven, multicomponent care bundles over isolated interventions to enable safe early surgery, reduce complications, and improve functional recovery in this vulnerable population.

PMID:42065220 | DOI:10.1530/EOR-2026-0044

EFORT Open Rev. 2026 Apr 7;11(4):338-348. doi: 10.1530/EOR-2025-0096.

ABSTRACT

OBJECTIVE: To systematically review the characteristics, diagnostic methods, and etiologies of rotator cuff (RC) muscle edema.

METHODS: A PRISMA-compliant review of clinical and laboratory studies from PubMed and Embase (PROSPERO ID: 626276); data on edema location, imaging features, and associated pathologies were qualitatively synthesized.

RESULTS: MRI is the most consistent tool for detecting muscle edema, typically showing T2 hyperintensity with variable patterns depending on etiology (traumatic, neurogenic, exertional, myopathic, or iatrogenic). Traumatic edema is associated with tendon retraction, bursal effusion, and fatty infiltration; neurogenic edema is diffuse and symmetric with atrophy; exertional edema appears 'fluffy' or 'feather-like'; myopathic and iatrogenic forms show peripheral or localized changes.

CONCLUSION: The imaging appearance, location, and timing of RC muscle edema provide valuable diagnostic clues and should be considered in the context of the underlying pathology.

LEVEL OF EVIDENCE: Systematic review, level 4.

PMID:41945591 | DOI:10.1530/EOR-2025-0096

EFORT Open Rev. 2026 Apr 7;11(4):250-258. doi: 10.1530/EOR-2025-0034.

ABSTRACT

PURPOSE: To examine the effect of Kinesio taping (KT) on patients with acute ankle sprains (AAS).

METHODS: We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, SPORTDiscus, CINAHL, and Google Scholar for all relevant publications from database inception to January 2025, without language restriction. Randomized controlled trials on KT for AAS were selected according to the participant, intervention, comparison, and outcome measures. A meta-analysis was conducted using R software. Heterogeneity investigation involved sensitivity, subgroup, and meta-regression analysis. Two independent reviewers assessed the quality of the literature using the Cochrane risk of bias tool 2, and the GRADE framework was applied to grade the certainty of the evidence.

RESULTS: Eight trials containing 582 participants were selected in this review. Moderate-certainty evidence indicated that KT was more effective than controls in relieving pain (standard mean difference (SMD) = -0.63; 95% CI: -1.25 to -0.01; I2 = 94.1%, P = 0.047) and improving function (SMD = 0.72; 95% CI: 0.10-1.34; I2 = 94.5%, P = 0.023). Low-certainty evidence was found for its effect on reducing swelling (SMD = -0.29; 95% CI: -0.48 to -0.10; I2 = 77.5%, P = 0.002). Subgroup analysis revealed that KT significantly improved pain, swelling, and function following 3-5 days of intervention. 'I'-shaped KT was found to significantly improve pain, swelling, and function.

CONCLUSION: KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are only observed short-term, and the 'I'-shaped KT method may be the most effective recommendation for AAS.

PMID:41945586 | DOI:10.1530/EOR-2025-0034

EFORT Open Rev. 2026 Apr 7;11(4):243-249. doi: 10.1530/EOR-2024-0201.

ABSTRACT

To synthesise the literature on pre- and intra-operative nerve mapping used to prevent iatrogenic nerve injuries during ankle arthroscopy. This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted using MEDLINE and Embase on 24 July 2024. Findings extracted from eligible studies were tabulated and synthesised. The search identified 270 articles, of which 9 met inclusion/exclusion criteria and were included in the review. Two studies described a mapping technique without reporting any outcomes, and three studies evaluated mapping techniques on cadavers and four on live patients. Four studies reported on visualisation and/or palpation, one study on arthroscopic transillumination, three on ultrasound and two on near-infrared light (NIR). There were only two comparative studies that showed that pre-operative ultrasound mapping places the nerves at safer distances from the portals and that ultrasound is more effective in the identification of the superficial peroneal nerve (SPN) than visualisation and/or palpation. Visualisation and/or palpation of the SPN is the most effective in ankle maximal plantar flexion and inversion and reduces the risk of nerve injury. There was no saphenous nerve injury with percutaneous screw insertion while using NIR. A reduction in nerve injuries during ankle arthroscopy might be achievable by using pre- or intra-operative nerve mapping with visualisation and/or palpation, ultrasound or (for nerves accompanied by the veins) NIR. The limited evidence suggests that pre-operative ultrasound might be potentially the most effective mapping method, but more comparative and prospective studies are needed to fully confirm these findings.

PMID:41945583 | DOI:10.1530/EOR-2024-0201

EFORT Open Rev. 2026 Apr 7;11(4):277-289. doi: 10.1530/EOR-2025-0107.

ABSTRACT

PURPOSE: A periprosthetic joint infection (PJI) is considered the most drastic complication after hip/knee arthroplasty. Despite extensive research into PJI treatment, insights into patients' biopsychosocial needs are sparse. The aim of the current review is to provide an overview of patients' biopsychosocial needs and interventions aimed at these needs.

METHODS: A systematic review incorporating a comprehensive database search of seven major scientific databases. Articles were included if they reported on the biopsychosocial needs of patients with PJI and on interventions aimed at these needs. Quality of the included studies was assessed by two reviewers with the Mixed Methods Appraisal Tool. Characteristics of included studies and the associated results were extracted.

RESULTS: Of the 9,745 identified research articles, 20 were included in the review. All of the included articles reported about biopsychosocial needs, but only two (10%) of them also reported on interventions focused on these needs. Psychological needs were reported most often (n = 19, 95%), followed by physical (n = 14, 70%) and social needs (n = 8, 40%). Improving mental health was the most frequently reported psychological need (n = 13, 65%). Functional improvement emerged as the most common identified physical need (n = 12, 60%), while social support from healthcare professionals (n = 5, 25%) was the most reported social need.

CONCLUSION: The results show a clear need for interventions on top of the primary surgical treatment for patients diagnosed with PJI, especially for psychological and physical support. Interventions targeting needs were described in only two articles (10%) in the current literature. Future studies should explore patient-centered approaches and integrate psychological and physical management into PJI treatment pathways to improve outcomes.

PMID:41945582 | DOI:10.1530/EOR-2025-0107

EFORT Open Rev. 2026 Apr 7;11(4):359-365. doi: 10.1530/EOR-2025-0159.

ABSTRACT

Congenital lumbar stenosis (CLS) is an uncommon disorder marked by a congenitally small spinal canal, which frequently results in early-onset neurogenic symptoms. Sarpyener originally characterized CLS in 1947, and Verbiest later offered a clinical description of lumbar spinal stenosis that did not recognize the congenital nature of the condition. The frequency of absolute CLS is believed to be 2.6%; however, data are lacking. This narrative review will outline current knowledge on CLS, including its prevalence, clinical presentation, genetic implications, aspects in diagnostic imaging for the condition, and treatment options. CLS has similar clinical characteristics to acquired lumbar stenosis; however, individuals with CLS report more severe leg and back pain. Genetic factors may contribute to CLS occurrence; however, research on this aspect is scarce. CLS is usually related to cervical and thoracic stenosis, as well as diseases such disk herniation and spondylolisthesis. The diagnosis is based on imaging criteria, which are continually being refined. The treatment options vary from conservative care to surgical treatments, such as laminoplasty and stability-preserving decompression, although long-term outcome data are limited. CLS poses distinct diagnostic and treatment challenges given its early onset. Further study is needed to provide uniform diagnostic criteria, evaluate long-term treatment results, and identify specific genetic factors that contribute to CLS.

PMID:41945575 | DOI:10.1530/EOR-2025-0159

EFORT Open Rev. 2026 Apr 7;11(4):317-327. doi: 10.1530/EOR-2025-0149.

ABSTRACT

In upper extremity bone tumors, osteochondromas and solitary bone cysts represent the predominant benign entities, with osteosarcoma accounting for the majority of malignant presentations. The proximal humeral metaphysis emerges as the most prevalent anatomical site across both tumor entities. Upper, one-sided extremity pain in children and adolescents should be followed up and diagnosed, since 'growing pain' in the upper extremities is not a common finding. Osteochondromas should be surgically addressed early if they impose a risk of development of a deformity, such as those located on the forearm and the distal tibia, where they can cause growth disorders and thus functional impairments. Reconstructions for pediatric malignant bone tumors of the upper arm or forearm should allow the spatial placement of the hand. Given the longevity of sarcoma survivors, the longevity of the reconstruction is an important planning consideration. Biological reconstructions combining autologous/vascularized bone with tendon repair and transfers appear to be the most appropriate and preferable to prosthesis whenever possible. Multidisciplinary collaboration involving plastic surgeons with hand reconstruction expertise constitutes a critical component in orthopedic oncology treatment planning.

PMID:41945572 | DOI:10.1530/EOR-2025-0149

EFORT Open Rev. 2026 Apr 7;11(4):328-337. doi: 10.1530/EOR-2023-0156.

ABSTRACT

Glenohumeral osteoarthritis (OA) is a disabling disease that leads to poor shoulder function and pain. Primary or idiopathic osteoarthritis occurs in previously intact joints without any inciting agent. Its precise incidence is not known. If conservative treatment fails, there are a variety of surgical procedures described in the literature. Total shoulder arthroplasty (TSA) is primarily indicated in patients above 60 years old with symptomatic glenohumeral OA and intact rotator cuff and failed conservative treatment. However, it is rarely recommended to young or active patients under the age of 50 due to its increased morbidity, limited lifespan, potential for revision surgeries, and difficulty achieving the same preoperative activity level, particularly in patients with high preoperative level of activity. Comprehensive arthroscopic management (CAM), hemiarthroplasty (HA), and TSA provide good results even in the long term for treatment of primary OA in properly selected young patients. A CAM procedure seems to be a reasonable option in case of conservative treatment failure, localized cartilage defect, tendinopathy of the long head of the biceps, stiffness, inferior osteophytes, and humeral head congruity. However, in case of humeral head incongruity, large anterior osteophytes, and an intact rotator cuff, an HA or a TSA is a feasible option.

PMID:41945567 | DOI:10.1530/EOR-2023-0156

EFORT Open Rev. 2026 Apr 7;11(4):259-267. doi: 10.1530/EOR-2025-0008.

ABSTRACT

Periprosthetic joint infections (PJIs) are a serious complication in both primary arthroplasty and revision arthroplasty, posing a major challenge in orthopaedic surgery and creating a substantial financial burden. This literature review examines the current knowledge on PJI prediction, diagnosis and prognosis, with a focus on scoring systems and machine learning (ML) tools developed to improve their management. We conducted a narrative literature review by searching Medline, CENTRAL and Embase up to October 1, 2024, with independent dual-reviewer screening. Nine non-randomized studies were included, covering 297,981 prostheses and 7,190 PJIs. Two studies assessed prediction based on patient history but highlighted the need for refinement and multi-centre prospective validation. Five studies evaluated ML in diagnosis, showing promising accuracy, yet requiring broader validation in larger, more diverse clinical contexts. Two studies addressed prognosis, but models remain limited in providing individualized, treatment-specific insights. The development of ML models represents an interesting approach, given the rising prevalence of PJIs and the need for better management. However, available studies face important limitations, including small sample sizes, lack of external validation and limited transparency regarding parameters and models. To make ML tools clinically relevant, future research should prioritize external validation, larger multi-centre prospective studies and transparent reporting. Ultimately, robust ML models have the potential to enhance PJI management, improve patient outcomes and reduce healthcare costs.

PMID:41945564 | DOI:10.1530/EOR-2025-0008

EFORT Open Rev. 2026 Apr 7;11(4):307-316. doi: 10.1530/EOR-2025-0224.

ABSTRACT

Paediatric spondylodiscitis (SD) is an infection involving the vertebral bodies and adjacent intervertebral discs in populations below 16 years old. It is rarely confined to a single compartment; more often, it spreads to other areas in the spinal column and may cause other infections, such as epidural abscesses, subdural abscesses, septic arthritis of the facet joints, paravertebral abscesses and even meningitis. SD predominantly affects children from 6 to 48 months old, and the lumbar spine seems to be most at risk; no specific markers are currently available for a biological diagnosis of SD. Blood cultures are often negative, and even disc or bone biopsies show limited yields. However, recent advances in nucleic acid amplification tests have laid the foundations for developing and implementing more efficient methods of identifying pathogens in samples. Microbiologically, Kingella kingae dominates in children from 6 to 48 months old, while Staphylococcus aureus is more common in infants under 6 months and in older children. High-throughput sequencing performed on plasma samples (recognised as liquid biopsy) is a promising multi-purpose tool that can detect not only pathogens circulating in the bloodstream but also those emanating from focal infections, something particularly interesting in cases of paediatric SD, where disc sampling is strongly discouraged. Paediatric SD treatments are mainly medical; surgery is rarely indicated, except for abscess drainage, emergency neurological decompression or spinal stabilisation.

PMID:41945563 | DOI:10.1530/EOR-2025-0224

EFORT Open Rev. 2026 Apr 7;11(4):349-358. doi: 10.1530/EOR-2025-0005.

ABSTRACT

PURPOSE: This systematic review aimed to evaluate the effectiveness of surgical versus conservative management in terms of union rates, functional outcomes and complications.

METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomised controlled trials published between January 2017 and November 2023 were sourced from MEDLINE, Embase, PubMed and Cochrane databases. Outcomes assessed included union rates, functional scores and complications.

RESULTS: Six trials, involving 579 patients with midshaft clavicle fractures, met the inclusion criteria. The union rate was higher in the surgical group (93.3-100%) compared to the conservative group (82-94%). Time to union was significantly shorter for surgical management in two out of three studies reporting this outcome. Shoulder scores revealed short-term improvements in surgical groups but no significant differences at 12 months or longer. Complication rates were comparable: hardware irritation was more frequent in surgical groups, while non-union was more prevalent in conservative management. Only two studies found a statistically significant difference in union rates favouring surgery.

CONCLUSION: Surgical management offers higher union rates and faster recovery but does not demonstrate significant long-term advantages in functional outcomes compared to conservative treatment. Complication rates are similar, with distinct profiles. Clinicians should prioritise patient-centred decision-making, considering individual preferences and clinical contexts, as operative intervention may not significantly enhance long-term outcomes. Further research should perform subgroup analyses to refine management strategies.

PMID:41945562 | DOI:10.1530/EOR-2025-0005

EFORT Open Rev. 2026 Apr 7;11(4):268-276. doi: 10.1530/EOR-2025-0170.

ABSTRACT

BACKGROUND: Preoperative hypoalbuminemia is common in patients undergoing total hip or knee arthroplasty (THA/TKA). While it has been linked with poorer postoperative outcomes, there remains a paucity of systematic reviews or meta-analyses dedicated to conducting a comprehensive evaluation of this issue.

METHODS: A comprehensive search was conducted across the PubMed, Embase, and Web of Science databases. Studies were selected and analyzed in adherence to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Data were extracted and subjected to meta-analysis or qualitative synthesis for outcomes. This meta-analysis was registered in the PROSPERO database (NO. CRD42024581376).

RESULTS: Fourteen studies involving 1,194,088 patients were included. Meta-analyses showed that preoperative hypoalbuminemia was associated with a greater risk of all-cause complications (OR: 2.89, 95% CI: 1.94-4.31), sepsis (OR: 2.54, 95% CI: 1.88-3.45), septic shock (OR: 3.44, 95% CI: 1.15-10.25), pneumonia (OR: 3.83, 95% CI: 3.14-4.67), urinary tract infection (OR: 1.59, 95% CI: 1.13-2.23), myocardial infarction (OR: 2.10, 95% CI: 1.47-2.98), superficial incisional infection (OR: 2.16, 95% CI: 1.56-3.00), periprosthetic joint infection (OR: 4.03, 95% CI: 2.15-7.53), wound dehiscence (OR: 1.68, 95% CI: 1.06-2.69), transfusion (OR: 1.84, 95% CI: 1.72-1.98), unplanned reoperation (OR: 1.60, 95% CI: 1.38-1.87), and mortality (OR: 7.14, 95% CI: 5.44-9.37).

CONCLUSION: Preoperative hypoalbuminemia is associated with an increased risk of numerous types of complications, transfusion, unplanned reoperation, and mortality after THA or TKA. Therefore, presurgical protocols formulated to deal with these unfavorable clinical outcomes may pay particular attention to this specific patient group.

PMID:41945558 | DOI:10.1530/EOR-2025-0170

EFORT Open Rev. 2026 Apr 7;11(4):299-306. doi: 10.1530/EOR-2025-0122.

ABSTRACT

Fractures of the lower limbs represent a common cause of hospital admission. Surgical intervention is increasingly indicated in paediatric patients. The gold standard for treating long bone fractures in the immature skeleton is intramedullary fixation with titanium elastic nails. Minimally invasive plating is considered a suitable option when elastic nailing is not feasible. The use of a plate provides adequate mechanical stability for weight-bearing and limb mobility while preserving biological bone integrity and resulting in limited scarring, generally well accepted by patients and families, although it requires a more extensive incision than intramedullary fixation. Potential drawbacks of this technique include a more extensive surgical approach, possible delay in weight-bearing, and the potential need for implant removal.

PMID:41945553 | DOI:10.1530/EOR-2025-0122