SICOT J. 2026;12:12. doi: 10.1051/sicotj/2025070. Epub 2026 Mar 10.

ABSTRACT

INTRODUCTION: This study aims to assess the functional and radiological outcomes of combining minimally invasive medial displacing calcaneal osteotomy (MDCO) with subtalar arthroereisis (STA) for the treatment of symptomatic planovalgus feet in young adults.

METHODS: A single-centre, prospective cohort study was conducted between November 2015 and February 2022. The study included a total of 32 patients with flexible flatfoot who were treated with subtalar arthroereisis combined with medialising calcaneal osteotomy with at least three years of follow-up. Radiographic evaluation included talar coverage angle, AP talo-first metatarsal (T1MT), AP talo-calcaneal, lateral talo-first metatarsal, and calcaneal pitch angles. Function was assessed by the AOFAS score.

RESULTS: Angles and scores were compared preoperatively and at the third-year follow-up. The mean talo-navicular coverage angle TNCA reduced from 32.72° (±8.33) preoperatively to 8.84° (±5.70) at the last follow-up. The mean AP T1MT improved from 21.59° (±8.47) preoperatively to 7.78° (±4.03) at three years postoperatively. Meary's angle decreased from 20.84° (±7.14) preoperatively to 4.78° (±3.20) following the correction. The mean preoperative AOFAS score was 62.69 (±9.26), and significantly improved to 94.19 (±3.80) at the last follow-up. Four feet experienced sinus tarsi pain (12.5%), and three patients (9.3%) needed removal of the arthroereisis implant.

CONCLUSIONS: The combination of MDCO and STA holds significant promise for treating flexible flatfeet in adolescents and young adults, particularly in cases of moderate to severe deformity. This combination demonstrates a synergistic interaction, with the STA implant providing internal bracing to support MDCO and reducing stresses over the medial arch by preventing hyper-pronation. Simultaneously, the MDCO reinforces the reconstruction, achieving the necessary increased correction in moderate to severe flatfoot cases, while also reducing stresses over the STA implant.

PMID:41805662 | PMC:PMC12975123 | DOI:10.1051/sicotj/2025070

SICOT J. 2026;12:11. doi: 10.1051/sicotj/2025033. Epub 2026 Mar 3.

ABSTRACT

INTRODUCTION: A major complication of hip arthroplasty is dislocation. In revision, the rate of dislocation is even higher, especially among patients with hip prosthetic joint infection treated with two-stage surgery. The utility of a dual-mobility cup (DMC) in revision was already demonstrated but with a relatively low level of confidence due to the lack of direct comparison with other surgical techniques. We hypothesized that the dislocation rate for patients undergoing cementless DMC total hip arthroplasty (THA) would be similar between single and two-stage revisions.

METHODS: We conducted a single-center, retrospective, and case-control study from January 2011 through December 2020. During this period, 220 patients underwent a revision of their total hip arthroplasty. Among these, 40 patients experienced THA two-stage revision. This group constituted the cases in this case-control study. Each of the 40 cases was matched with 2 controls, single-stage surgery, on age, sex, and Paprosky grade, and we defined the groups according to primary endpoint: dislocation rate.

RESULTS: There was no significant difference in dislocation rate between two-stage and single-stage revisions (7.5% vs 3.8%, p = 0.40). In univariate analysis, auto-inflammatory disease and immunosuppressive agent use were risk factors for dislocation. There was no significant difference in dislocation-free survival (log-rank test, p = 0.40) or re-revision (log-rank test, p = 0.92) between single-stage and two-stage revision THA. At the end of follow-up, the mortality rate did not differ between the two groups. No chronic instability was noted at the last follow-up (80.4 ± 38.5 months) in both groups.

CONCLUSION: The dislocation rate was similar between single and two-stage revision THA using DMC. Further studies are warranted to highlight the potential benefits of DMC in preventing dislocation in two-stage revision THA.

PMID:41789833 | PMC:PMC12965059 | DOI:10.1051/sicotj/2025033

SICOT J. 2026;12:E1. doi: 10.1051/sicotj/2025067. Epub 2026 Mar 6.

ABSTRACT

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) help people control blood glucose and lose weight. They may also help with bone metabolism, healing fractures, keeping joints healthy, and recovering after surgery. There is growing amount of evidence of their ability to modulate the activity of osteoblasts and osteoclasts, affect inflammatory pathways, and interact with neuroprotective and psychological systems. Although the growing importance of GLP-1 receptor agonists in orthopaedics marks a major shift in how metabolic medicines affect musculoskeletal health, current knowledge is still basic and lacks information on long-term results, safety, and how well different treatments work compared to one another. This paper summarizes the existing evidence on the effects of GLP-1RA drugs on bone metabolism and healing, and discusses their role in current orthopaedics.

PMID:41789832 | PMC:PMC12965058 | DOI:10.1051/sicotj/2025067

SICOT J. 2026;12:10. doi: 10.1051/sicotj/2025071. Epub 2026 Feb 26.

ABSTRACT

INTRODUCTION: The optimal timing to initiate the Ponseti method for congenital idiopathic clubfoot remains uncertain. This systematic review and meta-analysis aimed to evaluate whether starting treatment within the first four weeks of life improves outcomes compared to later initiation.

METHODS: Following PRISMA guidelines (PROSPERO ID: CRD42025650117), MEDLINE, Embase, Cochrane Library, and Google Scholar were searched for studies comparing early (≤4 weeks) versus late (>4 weeks) initiation of the Ponseti method. Outcomes included the number of casts, the relapse rate, and the need for tenotomy. Data were pooled using a random-effects model, and study quality was assessed using the MINORS tool.

RESULTS: Six studies involving 467 patients (689 feet) met the inclusion criteria. Early initiation was associated with a slightly higher mean number of casts (MD = 0.72, 95% CI [0.33-1.10], p = 0.0002), but this difference was not significant in the overall pooled analysis (MD = 0.06, 95% CI [-1.08-1.21], p = 0.91). Relapse (OR = 0.70, p = 0.68) and tenotomy rates (OR = 0.68, p = 0.41) were comparable between groups.

DISCUSSION: Although earlier treatment may require more casts, it does not reduce relapse or tenotomy rates. These findings suggest that initiating treatment after four weeks yields comparable outcomes, offering flexibility in clinical practice without compromising results. Variability across studies highlights the need for standardized treatment protocols and well-designed randomized controlled trials to confirm the optimal initiation age.

PMID:41757814 | PMC:PMC12947636 | DOI:10.1051/sicotj/2025071

SICOT J. 2026;12:9. doi: 10.1051/sicotj/2025069. Epub 2026 Feb 23.

ABSTRACT

BACKGROUND: Stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are commonly treated with partial arthrodeses or motion-preserving techniques such as midcarpal tenodeses. Comparative evidence with long-term follow-up remains limited.

PURPOSE: To compare long-term clinical and functional outcomes of midcarpal tenodeses and partial arthrodeses in patients with stage II SLAC/SNAC, by evaluating grip strength, range of motion, patient-reported outcomes, and reoperation rates.

METHODS: A retrospective review was performed on 21 patients operated by a single surgeon with a mean follow-up of 103 months. Nine underwent midcarpal tenodeses (FCR or ECRB based), and twelve underwent partial arthrodeses (four-corner fusion or capitolunate fusion). Outcomes included grip strength, range of motion, radiographs, and PROMs (VAS, DASH, PRWE, Mayo Wrist Score).

RESULTS: Both procedures produced comparable long-term outcomes. Mean postoperative grip strength was 27.9 kg (~75% of the contralateral side). PROMs were similar between groups (DASH 12.1, PRWE 15.5). Importantly, no complications, non-unions, or conversions to salvage arthrodesis occurred in either group during long-term follow-up.

CONCLUSION: Midcarpal tenodeses and partial arthrodeses yield similarly durable outcomes in stage II SLAC/SNAC wrists. Tenodeses preserve motion and are suitable for patients with preserved cartilage, whereas partial arthrodeses offer predictable stability when midcarpal degeneration is present. Treatment should be individualized according to cartilage status, functional demands, and patient expectations.

PMID:41728890 | PMC:PMC12927466 | DOI:10.1051/sicotj/2025069

SICOT J. 2026;12:8. doi: 10.1051/sicotj/2025055. Epub 2026 Feb 9.

ABSTRACT

Lateral unicompartmental knee arthroplasty (UKA) represents 1-2% of knee replacement procedures, yet offers distinct advantages including reduced surgical burden, bone stock preservation, and faster functional recovery. However, lateral UKA presents unique technical difficulties due to the surgical complexity of the lateral compartment. Recent advances in image-based robotic systems have demonstrated improved accuracy in implant positioning and promoted more individualized surgical strategies. This article presents a step-by-step surgical technique for lateral UKA using Functional Positioning (FP) principles in combination with an image-based robotic system. The technique ensures precise preoperative planning based on CT imaging, real-time intraoperative kinematic evaluation, and accurate component placement tailored to individual patient anatomy. The key steps of this surgical technique include comprehensive preoperative planning with 3D anatomical modeling, intraoperative kinematic evaluation following osteophyte removal, achieving centered femorotibial contact points throughout the full range of motion with precise lateral laxity gap boundaries, and cartilage mapping to ensure optimal component positioning and avoid overstuffing. FP addresses the characteristic posterior cartilage wear pattern of valgus knees while preserving pre-arthritic coronal alignment and avoiding varus overcorrection. This systematic approach demonstrates reproducible surgical steps that may translate into improved long-term outcomes and implant survivorship for lateral UKA procedures.

PMID:41660880 | PMC:PMC12884707 | DOI:10.1051/sicotj/2025055

SICOT J. 2026;12:7. doi: 10.1051/sicotj/2025061. Epub 2026 Feb 3.

ABSTRACT

INTRODUCTION: Chronic low back pain (CLBP) is a leading global cause of disability. Acupuncture is increasingly integrated into its management, yet its standalone effectiveness compared to usual care remains uncertain. This review aimed to assess the immediate (≤2 weeks) and intermediate (2 weeks-6 months) effects of acupuncture versus usual care on pain and disability in adults with CLBP.

METHODS: A systematic review and meta-analysis of randomized controlled trials was conducted, searching MEDLINE, CENTRAL, Scopus, and PEDro through November 2024. Eligible studies compared acupuncture (body, electroacupuncture, scalp) to usual care (physiotherapy, education, medication, and exercise) in adults with CLBP. Outcomes included pain and disability at immediate and intermediate follow-up. Data were pooled using a random-effects model. Risk of bias was assessed with the PEDro scale, and GRADE was used to evaluate evidence certainty. Sensitivity and subgroup analyses were conducted to explore clinical and methodological heterogeneity and test the reliability of findings.

RESULTS: A total of 2.956 records were identified, and 8 RCTs (n = 1,123 participants) were included in this study. Acupuncture significantly reduced pain at both immediate (SMD = -0.73, 95% CI -1.04 to -0.42) and intermediate (SMD = -1.13, 95% CI -1.82 to -0.43) timepoints. Disability also improved at both follow-ups (immediate: SMD = -0.49, 95% CI -0.68 to -0.30 and intermediate: SMD = -0.79, 95% CI -1.18 to -0.41). Sensitivity analyses confirmed effect robustness, especially in electroacupuncture subgroups. Certainty of evidence ranged from low to very low due to risk of bias, inconsistency, and suspected publication bias.

DISCUSSION: Acupuncture appears more effective than usual care for reducing pain and disability in adults with CLBP, but the certainty of evidence is low, warranting cautious interpretation.

PMID:41632890 | PMC:PMC12867475 | DOI:10.1051/sicotj/2025061

SICOT J. 2026;12:6. doi: 10.1051/sicotj/2025064. Epub 2026 Feb 3.

ABSTRACT

INTRODUCTION: Effective postoperative pain management is imperative in total hip arthroplasty (THA) to enable early mobilization and accelerate recovery pathways. This study investigated the patterns of inpatient opioid consumption following THA and identified the factors associated with increased opioid usage.

METHODS: In this large-scale, single-institution study, we analyzed data from 1,867 primary THAs between April 2019 and July 2023. We collected data on demographics, length of stay (LOS), type of anaesthesia, Post Anaesthesia Care Unit (PACU) admissions, 30-day readmissions, total opioid consumption (MME; morphine milligram equivalents), implant fixation techniques, surgical characteristics and pre- and postoperative haemoglobin (Hb) levels. Factors associated with increased opioid consumption (patients in the ≥ 75th percentile of inpatient opioid consumption; MME ≥ 211.9 mg) were identified through univariate and multivariate logistic regression models.

RESULTS: The cohort included 1150 women (61.6%) and 717 men (38.4%). The median inpatient opioid use was 88 mg (IQR = 39.3-211.9). In the univariate model, significant predictors included age, American Society of Anaesthesiologists (ASA) score, manual THA technique, general anaesthesia, pre- and postoperative Hb levels, need for PACU admission and year of surgery. After adjusting for baseline demographics in the hierarchical multivariate logistic regression model, significant predictors of higher opioid utilization were age (OR 0.989 [95% CI 0.981-0.997], p = 0.01), general anaesthesia (OR 2.386 [95% CI 1.865-3.054], p < 0.001), PACU admission (OR 2.098 [95% CI 1.310-3.358], p = 0.002), ASA score (OR 1.492 [95% CI 1.193-1.866], p < 0.001), postoperative Hb levels (OR 0.981 [95% CI 0.970-0.992], p < 0.001), and year of surgery (OR 0.638 [95% CI 0.579-0.703], p < 0.001) indicating that later years were associated with lower odds of high opioid consumption).

DISCUSSION: Younger age, higher ASA scores, lower postoperative haemoglobin, the need for PACU admission and general anaesthesia were significantly associated with increased opioid consumption following THA. Recognizing these factors can facilitate the development of tailored postoperative pain management protocols, enabling targeted interventions that minimize opioid reliance while enhancing recovery.

PMID:41632889 | PMC:PMC12867471 | DOI:10.1051/sicotj/2025064

SICOT J. 2026;12:5. doi: 10.1051/sicotj/2025057. Epub 2026 Feb 3.

ABSTRACT

Dysplasia Epiphysealis Hemimelica (DEH), or Trevor's disease, is a rare, nonhereditary skeletal disorder involving abnormal cartilaginous overgrowth of the epiphysis. To our knowledge, malignant transformation has not been previously documented. We report a unique case of chondrosarcoma arising from a DEH lesion in the proximal humerus nearly 30 years after the initial diagnosis. The patient was treated with wide resection and reconstruction using a proximal humeral replacement with a reverse-constrained total shoulder arthroplasty. This case highlights the need for long-term follow-up in patients with DEH, especially when new symptoms suggest possible malignant transformation.

PMID:41632888 | PMC:PMC12867468 | DOI:10.1051/sicotj/2025057

SICOT J. 2026;12:4. doi: 10.1051/sicotj/2025068. Epub 2026 Jan 28.

ABSTRACT

INTRODUCTION: Functional alignment (FA) or functional knee positioning is a patient-specific strategy for total knee arthroplasty (TKA) that utilizes robotics to balance coronal, sagittal, and axial planes while preserving joint-line orientation and soft-tissue tension within predefined guardrails. Although early clinical outcomes are encouraging, the radiographic profile and workflow consistency of robotic FA have not been clearly synthesized.

METHODS: In accordance with PRISMA guidelines, English-language studies of primary robotic FA-TKA with ≥2-year follow-up were searched. Eligible designs included RCTs, prospective/retrospective cohorts, and large case series (≥50 patients). Information on pre- and postoperative coronal alignment [hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA)], component positioning (femoral valgus/rotation/flexion; tibial varus/rotation/slope), and explicit FA workflow boundaries (guardrails) was extracted.

RESULTS: Twenty-one cohorts (5,360 knees) reported at least one radiographic or workflow endpoint. Preoperatively, the predominant deformity was varus. Postoperatively, limb alignment converged near neutral: HKA clustered around 178-179.5°, with LDFA ~89-91° and MPTA ~87-89°. Component positions were tightly distributed within FA targets: femoral valgus ≈ 0.5-1.5°, tibial varus ≈ ~3°, femoral flexion ~6-9°, and tibial slope ~0-3°; tibial rotation was overwhelmingly referenced to Akagi's line, and femoral rotation to the TEA in most series. Reported guardrails showed strong convergence: typical workflows included femoral valgus -3° to +6°, tibial varus 0-6°, tibial slope 0-3°, and femoral ER ~3-6° to TEA. Across cohorts, achieved radiographs closely tracked these limits, indicating high adherence and reproducibility. Most observational studies had a moderate risk of bias; the lone RCT was low risk.

DISCUSSION: Robotic FA-TKA delivers a radiographic profile with slight femoral valgus and modest tibial varus, while keeping components within narrow, pre-specified guardrails.

LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

PMID:41603463 | PMC:PMC12849696 | DOI:10.1051/sicotj/2025068

SICOT J. 2026;12:3. doi: 10.1051/sicotj/2025066. Epub 2026 Jan 28.

ABSTRACT

PURPOSE: In distal femoral osteotomy (DFO), using longer distal screws in fixation plates may improve stability. This study examined the insertion direction of three distal screws at the horizontal cross-section to determine if posterior angulation enables deeper placement.

METHODS: Forty-seven varus knees that underwent DFO were included (medial closed-wedge DFO [MCWDFO], 30 knees; lateral closed-wedge DFO [LCWDFO], 17 knees). Postoperative plain CT images were obtained from a plane parallel to the three distal screws, with the most distal screw designated as A, the anterior of the second distal row as B, and the posterior of the second distal row as C. For each case, a curve passing through the center of the bony cortex on the cross-section parallel to each screw and over its entire length was drawn, and the curve and the lower edge of the screw were projected onto a graph. The maximum angle at which the lower edge of each screw touches the intercondylar region without interfering with the intercondylar region was designated as (AnA), (AnB), and (AnC) for A-, B-, and C-screws, respectively. The angle between the line connecting the insertion points of the B- and C-screws on the plate and the tangent line to the medial and lateral bony cortex was designated as (AnP).

RESULTS: In the MCWDFO group, the mean values for each parameter were AnA, 10.9 ± 5.4; AnB, 27.0 ± 4.2; AnC, 9.2 ± 3.4; and AnP, -2.6 ± 6.9. In the LCWDFO group, the mean values for each parameter were AnA, 18.2 ± 6.9; AnB, 30.4 ± 7.1; AnC, 16.1 ± 7.2; AnP, -0.2 ± 6.1°.

CONCLUSIONS: The medial surface is inclined compared to the epicondylar axis and posterior condyle, usually resulting in plate positioning that is parallel to the placement surface. The optimal screw insertion from the anterior to posterior was generally achieved; however, there was still room for posterior angulation margins of 9-11° for A- and C-screws and approximately 27° for the B-screw. In contrast, the lateral surface is flatter with less inclination, causing anterior plate placement and wider posterior angulation - approximately 16-18° for A- and C-screws and 30° for the B-screw - allowing a greater range of posterior swing than the medial side.

PMID:41603462 | PMC:PMC12849697 | DOI:10.1051/sicotj/2025066

SICOT J. 2026;12:2. doi: 10.1051/sicotj/2025063. Epub 2026 Jan 22.

ABSTRACT

When treating extremities affected by giant cell tumor of bone (GCTB), curettage should be performed to preserve the joint as much as possible in order to obtain a good functional outcome. The local recurrence risk is high following curettage, but new techniques are being developed to reduce local recurrence. We present a review of the literature reporting favorable results of radiofrequency ablation alone in locally recurrent small GCTB. New filling materials are also being developed to prevent non-oncological complications such as arthrosis and fractures. Routine measurement of tartrate-resistant acid phosphatase 5b in serum may be helpful in detecting early instances of local recurrence. For unresectable or metastatic GCTB, there is an urgent need for a new drug that is as effective as denosumab, avoids side effects, and can be administered to pregnant women.

PMID:41568883 | PMC:PMC12825416 | DOI:10.1051/sicotj/2025063

SICOT J. 2026;12:1. doi: 10.1051/sicotj/2025056. Epub 2026 Jan 22.

ABSTRACT

INTRODUCTION: Image-based robotic systems in total knee arthroplasty (TKA) allow for precise implant positioning and soft tissue balance through patient-specific preoperative planning. Functional alignment (FA) leverages the native soft tissue envelope to guide implant placement. However, its application in partial TKA conversion remains limited. This study evaluates the outcomes of image-based robotic-assisted partial-to-TKA conversion under FA principles, comparing them to a cohort of primary robotic TKAs.

METHODS: This retrospective study analyzed eight partial-to-TKA conversions performed using the image-based robotic system, with a minimum follow-up of 12 months. Demographics, implant constraints, intraoperative positioning, and postoperative outcomes were assessed. The mean age of the revision cohort was 73.3 ± 9.0 years, with a mean follow-up of 39.0 ± 11.5 months. A control group of 50 primary robotic TKAs was used for comparison.

RESULTS: Osteoarthritis progression (75%) and aseptic loosening (25%) were the primary reasons for revision. No stems were used, and only one patient (12.5%) required a tibial augment. Postoperative coronal alignment was 1.1° ± 1.9°, and functional outcomes (Knee Society Score-Knee: 84.5 ± 6.7, Knee Society Score-Function: 83.0 ± 7.1, Forgotten Joint Score: 72.8 ± 8.2) were comparable to the primary TKA cohort. No complications or revisions were recorded.

CONCLUSION: FA-based robotic-assisted partial-to-TKA conversion yields functional and implant positioning outcomes comparable to primary robotic TKA while minimizing the need for stems, augments, or constrained implants. Further studies with larger cohorts are needed to confirm these findings.

LEVEL OF EVIDENCE: III.

PMID:41568882 | PMC:PMC12825415 | DOI:10.1051/sicotj/2025056

SICOT J. 2025;11:60. doi: 10.1051/sicotj/2025062. Epub 2026 Jan 6.

ABSTRACT

INTRODUCTION: There is a paucity of data regarding the surgical treatment of distal femoral metastatic lesions. In this retrospective study, we aim to describe the outcome of surgery in this location and further analyze the findings based on the type of surgical reconstruction.

METHODS: 47 patients (48 fractures) who underwent surgery due to pathological fractures of the distal third of the femur, between 2000 and 2024, were included in the analysis. There were 29 prostheses and 19 osteosyntheses (10 plates, 9 nails). Local complications, implant revision rate, functional outcome regarding pain and ambulatory capacity, and overall survival were analyzed depending on the type of surgical treatment.

RESULTS: The complication pattern was different among implants used, with severe infections seen in prostheses (3/29 implants) and tumor recurrence in osteosynthesis (2/19 implants). In cases of osteosynthesis, failures resulting in revision surgery were documented only in cases of plate reconstruction (none when nails were used), resulting in a marginally higher revision rate (p = 0.14). Surgical treatment resulted in the restoration of the ambulatory capacity in 85% of patients, and pain levels were minor or moderate in 93%, without any significant difference between the surgical methods. Prostheses were used in patients with better overall survival (p = 0.015).

DISCUSSION: The patterns of local complications and their management differed between the different reconstruction techniques. Plate osteosynthesis had the highest risk for re-operation. The overall postoperative result was satisfactory, and functional outcomes were generally comparable. Patients with a good prognosis should be considered for reconstruction with a prosthesis when the bone quality does not allow nail osteosynthesis.

LEVEL OF EVIDENCE: IV, retrospective study.

PMID:41499667 | PMC:PMC12779260 | DOI:10.1051/sicotj/2025062

SICOT J. 2025;11:59. doi: 10.1051/sicotj/2025058. Epub 2026 Jan 6.

ABSTRACT

INTRODUCTION: Combined C1-C2 fractures are common upper cervical injuries with high morbidity and mortality. Controversy exists regarding which patients benefit from surgery because this is an understudied population with only class III evidence available. We examined surgical intervention and its impact on outcomes in patients with C1-C2 fractures.

METHODS: This retrospective cohort study of the National Trauma Data Bank included patients admitted between 1/2017 and 1/2023 for combined C1-C2 fractures (ICD-10 diagnosis codes S12.0 and S12.1). Exclusions were admission to a level III-V or non-trauma center, not admitted (died or discharged from the ED), and non-index/readmission. The first aim was to identify predictors of surgical intervention (vertebral fusion or internal fixation); multivariate backward regression included the following covariates: Patient demographics, injury severity, concomitant injuries, and specific C1 and C2 fractures. The second aim was to compare hospital outcomes between operative and nonoperative groups utilizing a propensity-matched (1:1) analysis: Mortality, ICU admission, complications, and hospital and ICU LOS.

RESULTS: There were 19,264 patients, and 3,759 (19.5%) were surgically managed. The adjusted odds of surgical intervention were greater with unstable injuries (displaced C1 fracture, displaced C2 fracture, spinal cord injury, vertebral ligament dislocation), specific C1 and C2 fractures (odontoid fracture, Jefferson burst fracture, posterior arch fracture), whereas surgical intervention odds decreased for frailty (mFI ≥2), ED hemodynamic instability, ED Glasgow coma score ≤8, and increasing age quintile. Propensity matching resulted in 6,710 well-matched patients. After matching, surgical intervention was associated with lower mortality (4.8% vs. 11.3%, p < 0.001) but higher ICU rates, longer LOS, and greater complication rates compared to the nonoperative group.

CONCLUSION: This study of nearly 20,000 patients with combined C1-C2 fractures provides class II evidence for surgical intervention, highlighting the balance between injury characteristics and patient resilience. Surgical intervention was associated with a significant survival benefit, emphasizing its role in select patients.

PMID:41499666 | PMC:PMC12779261 | DOI:10.1051/sicotj/2025058

SICOT J. 2025;11:E3. doi: 10.1051/sicotj/2025059. Epub 2025 Dec 10.

NO ABSTRACT

PMID:41380039 | PMC:PMC12698073 | DOI:10.1051/sicotj/2025059