Int Orthop. 2025 Aug 30. doi: 10.1007/s00264-025-06644-8. Online ahead of print.

ABSTRACT

PURPOSE: Fracture models in animals are essential to analyze bone healing in musculoskeletal research fields. Especially in small animals, fractures are difficult to simulate and stabilize. Therefore, a fracture model is desirable with a short operation time, high safety of the model without stabilization failure and low costs. Aim of this study is the evaluation of a new open tibial shaft model in mice for musculoskeletal research.

METHODS: In 12 eight week-old wild type mice, an open tibial shaft fracture was simulated and stabilized with a retrograde over the fracture inserted intramedullary pin. X-rays confirmed the correct fracture localization and stabilization. After eight weeks of follow-up, the mice were euthanized. Fracture healing and biomechanical stability were analyzed in a micro-CT scan and in torsional load-to-failure tests.

RESULTS: The whole operations lasted in mean eight min and 50 s. All mice recovered very quickly after the operative intervention and started using the operated leg again on the first postoperative day onwards if not earlier. No infections or failure of the stabilization occurred. All fractures healed completely within 8 weeks and substantial callus formation was confirmed in the micro-CT analysis. Biomechanically, higher torsional moment and stiffness were found for the operated tibia compared to the non-operated tibia in the same mouse.

CONCLUSION: The presented tibial fracture model with open osteotomy and retrograde pin insertion revealed minimal operative intervention and anesthesia, quick recovery and fracture healing with big callus formation. It is an easy to address fracture model for musculoskeletal research.

PMID:40884561 | DOI:10.1007/s00264-025-06644-8

Int Orthop. 2025 Aug 30. doi: 10.1007/s00264-025-06642-w. Online ahead of print.

ABSTRACT

INTRODUCTION: Shoulder dislocations occur in approximately 45% of all joint types, and anterior shoulder dislocations account for more than 90% of cases. The purpose of this study was to assess the functional outcomes of an open Latarjet operation for patients with recurrent anterior shoulder dislocations.

METHODS: A prospective hospital-based study was conducted at the Orthopaedic Department of Al Thawra Modern General Hospital, Sana'a City, between 2015 and 2022. Consecutive patients who experienced recurrent anterior shoulder instability underwent the open Latarjet procedure. Preoperative and postoperative clinical, radiographic, and functional outcomes according to the Rowe score were assessed during the study period.

RESULTS: Twenty patients, with a mean age of 20.9 ± 2.9 years, were included in this study. The most common age group at surgery was ≤ 20 years (70%). The median number of recurrent dislocations before surgery was 25. 40% of the patients presented more than two years after the first dislocation, with a mean duration of 2.5 ± one year. Postoperatively, haematoma, infection, neurovascular injury, graft malposition, graft nonunion and osteoarthritis were not observed in any patient. However, one patient (5%) had a stress fracture in the coracoid graft. All patients showed improvement in the preoperative mean Rowe score of 6.5 ± 4.6 to the postoperative mean Rowe score of 91 ± 7% (an excellent grade) at the last follow-up.

CONCLUSION: The open Latarjet procedure had excellent outcomes with a very low rate of complications in this study. We recommend the open Latarjet procedure for the management of recurrent anterior shoulder dislocation in patients with significant glenoid bone defects, especially in developing countries with limited resources, such as Yemen.

PMID:40883518 | DOI:10.1007/s00264-025-06642-w

Int Orthop. 2025 Aug 29. doi: 10.1007/s00264-025-06646-6. Online ahead of print.

ABSTRACT

PURPOSE: Posterior femoro-acetabular impingement in patients with increased femoral version can result in significant hip pain, chondro-labral injury, and limited range of motion. Femoral rotational osteotomy may address these issues by correcting excessive femoral anteversion.

METHODS: This retro-spective case series included 25 adolescents (mean age 14.8 years) with symptomatic increased femoral version (> 35°) treated between 2015 and 2022. Inclusion required hip pain, limited range of motion, and increased femoral version confirmed on computed tomography. Patients underwent femoral external rotational osteotomy targeting a post-operative femoral version of ~ 15°. Outcomes assessed included femoral version, hip range of motion, and Harris Hip Score pre-operatively, at six months, and at two years post-operatively.

RESULTS: Mean femoral version improved significantly from 39° ± 3° pre-operatively to 19° ± 7° post-operatively (P < 0.001). Internal rotation decreased from 54° ± 9° to 32° ± 8°, while external rotation increased from 38° ± 4° to 44° ± 5° (P < 0.001). Mean Harris Hip Score improved from 62.5 ± 10.3 to 86.1 ± 6.4 at 6 months, with sustained results at two year follow-up. Radiographic union was achieved in all patients, and no major complications were observed.

CONCLUSION: Femoral rotational osteotomy is a safe and effective treatment for posterior hip impingement in young patients with excessive femoral version.

PMID:40879765 | DOI:10.1007/s00264-025-06646-6

Int Orthop. 2025 Aug 23. doi: 10.1007/s00264-025-06621-1. Online ahead of print.

ABSTRACT

This editorial explores the marginalization of women in medieval French surgical practice through a prosopographical analysis of guild records, tax rolls, and legal texts. While women were present in various medical roles-such as barbers and "miresses"-their visibility declined as surgery became a formalized and male-dominated profession. By examining documents like the Livre de la Taille and Livre des Métiers, as well as royal ordinances, the study highlights how linguistic shifts and guild regulations gradually excluded women from professional recognition. The trial of Perette la Pétone in 1410 serves as a case study of this exclusion, marking the transition from informal acceptance to institutional rejection. Although some women maintained workshop privileges, especially as widows, the broader trend reflects a tightening of gender boundaries in the medical field. This study underscores how prosopography can illuminate structural changes in professional identity and reveal the gendered dynamics underlying medieval medical history.

PMID:40847223 | DOI:10.1007/s00264-025-06621-1

Int Orthop. 2025 Aug 20. doi: 10.1007/s00264-025-06641-x. Online ahead of print.

NO ABSTRACT

PMID:40833496 | DOI:10.1007/s00264-025-06641-x

Int Orthop. 2025 Aug 20. doi: 10.1007/s00264-025-06636-8. Online ahead of print.

NO ABSTRACT

PMID:40833495 | DOI:10.1007/s00264-025-06636-8

Int Orthop. 2025 Aug 18. doi: 10.1007/s00264-025-06638-6. Online ahead of print.

ABSTRACT

BACKGROUND: Computer-assisted navigation in total knee arthroplasty (TKA) was developed to enhance implant positioning accuracy and optimize mechanical alignment. However, its impact on clinical outcomes remains controversial. This study aimed to evaluate the influence of navigation on functional and radiological outcomes, safety, and patient-reported quality of life at mid-term follow-up.

METHODS: We conducted a retrospective single-center study including 190 patients who underwent primary TKA between 2015 and 2018, with a mean follow-up of 5.8 years. Ninety-five patients were operated on using optical computer navigation, while 95 underwent conventional instrumentation (sequential allocation). All surgeries were performed by the same two senior surgeons using mechanical alignment in both groups. Outcomes included the Hospital for Special Surgery (HSS) knee score, EQ-5D, SF-12, patient satisfaction, and radiographic alignment. Both univariate and multivariate analyses were performed using SPSS (v28.0/v29.0).

RESULTS: Patients in the navigated group achieved significantly greater improvement in HSS knee scores (mean increase 41.9 vs. 34.9 points; p = 0.043) and a higher proportion of clinically meaningful functional improvement (> 35-point HSS increase: 63.2% vs. 40.0%; p = 0.019) compared to the conventional group. Postoperative knee flexion was also better in the navigated group (118° vs. 113°; p = 0.048). No significant differences were observed in pain improvement (VAS), EQ-5D quality-of-life gain, or complication rates between groups. Navigation significantly reduced the number of outliers in component alignment (6.3% vs. 13.7% outside ± 3° from neutral), although this did not reach statistical significance (p = 0.068). On multivariate analysis, use of navigation was an independent predictor of superior functional improvement (odds ratio 2.65, 95% CI 1.38-5.12; p = 0.003), whereas other factors (age, sex, body mass index, diabetes, baseline HSS) were not significant.

CONCLUSIONS: Computer-assisted navigation in TKA was associated with greater mid-term functional improvement and improved prosthetic alignment, without increasing operative time or complications. Its implementation may be especially beneficial for enhancing stability and precision in mechanically aligned TKA. These findings should be interpreted with caution due to the retrospective design and mid-term follow-up duration.

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

PMID:40820163 | DOI:10.1007/s00264-025-06638-6

Int Orthop. 2025 Aug 18. doi: 10.1007/s00264-025-06622-0. Online ahead of print.

ABSTRACT

PURPOSE: Humeral head osteonecrosis (HHN) is a joint-destructive condition, for which cementless humeral head resurfacing (CHHR) offers a bone-preserving treatment option. The aim of this study was to report long-term outcomes and implant survival of CHHR in patients with HHN.

METHODS: Patients with humeral head osteonecrosis treated with cementless humeral head resurfacing (CHHR) between 2004 and 2007 were included. Implant survival was assessed according to Kaplan-Meier analysis. Clinical evaluation included Constant-Murley-Score (CMS), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV) and patient centered outcomes regarding satisfaction and quality of life. Radiographs were evaluated for glenoid erosion, Walch glenoid types as well as signs of implant loosening. Statistical comparison was performed using students t-tests with a significance level set to p < 0.05.

RESULTS: Seventeen shoulders were retrospectively included in the implant survival analysis. Two patients underwent revision surgery. five patients died with the implant and were therefore censored. Cumulative survival rate was 100% after ten years and 93.3% after 15 years. Seven shoulders were available for clinical and radiological evaluation at a mean follow-up of 19 years (range 17-22 years). Age- and sex-adjusted CMS improved from preoperative to the latest follow-up (44.4% vs. 82.9%; p < 0.01). No glenoid erosion of higher degree (Sperling grade > 2) and no signs of implant loosening were observed. All patients had Walch type A glenoids preoperatively.

CONCLUSION: In this small cohort with long-term follow-up of 17-22 years, CHHR showed promising durability and functional outcomes in carefully selected patients.

LEVEL OF EVIDENCE: Level IV Case series with no comparison group.

PMID:40820162 | DOI:10.1007/s00264-025-06622-0

Int Orthop. 2025 Aug 15. doi: 10.1007/s00264-025-06640-y. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the clinical and radiological outcomes between posterior laminectomy and laminoplasty hybrid decompression and laminectomy with lateral mass screw fixation in multilevel degenerative cervical myelopathy.

METHODS: A total of 158 patients for multilevel degenerative cervical myelopathy (DCM) undergoing surgical treatment were enrolled in this study from May 2018 to December 2023, including 97 patients who underwent posterior laminectomy and laminoplasty hybrid decompression (PLLDH) and 61 patients treated with posterior lateral mass screw fixation (PLMSF). To minimize potential confounding factors, propensity score matching was employed for inter-group comparison. Neurological function scores and radiographic parameters were systematically compared between the two surgical groups.

RESULTS: Following propensity score matching (PSM), baseline characteristics showed no statistically significant differences between the two surgical groups. The matched cohorts demonstrated that operative duration, intraoperative blood loss, VAS scores, Cobb angle, dural sac cross-sectional area at the narrowest level, and posterior dural displacement had no statistically significant differences(P > 0.05). However, significant inter-group differences were observed in JOA scores (P<0.05), NDI scores (P<0.05), and cervical range of motion (P<0.05) postoperatively.

CONCLUSION: Both PLLDH and PLMSF are effective surgical approaches for treating multilevel DCM, demonstrating satisfactory clinical outcomes. However, PLMSF resulted in greater postoperative loss of cervical mobility compared to PLLDH.

PMID:40815488 | DOI:10.1007/s00264-025-06640-y

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06616-y. Online ahead of print.

ABSTRACT

PURPOSE: The Aden Trauma Centre in Yemen, supported by Médecins Sans Frontières (MSF), introduced internal fixation (IF) procedures to address the high burden of fractures as a result of road traffic accidents and conflict-related injuries. This study aimed to describe the clinical characteristics of patients undergoing IF, evaluate their complication and healing outcomes, and explore factors influencing postoperative results.

METHODS: A retrospective cohort design was employed, including all patients who underwent internal fixation-using SIGN nails or plates/screws-between January and December 2022. Demographic information, fracture characteristics, surgical techniques, and postoperative outcomes were analyzed. Cox proportional hazards models were used to identify key predictors of complications and bone healing.

RESULTS: A total of 177 patients (208 fractures) were included. The overall complication rate was 14.4%. Open fractures and comorbidities were significant predictors of complications, while type of implant (SIGN nail vs. plate/screws) did not affect complication risk. Around three-quarters of fractures achieved radiographic healing at a median of five to six months. Infection and other complications emerged as major risk factors for delayed or impaired union. About a quarter of patients defaulted from care, potentially underestimating late complications and nonunion rates.

CONCLUSION: Findings indicate that IF is feasible and effective in this high-need, low-resource context, demonstrating complication rates in line with global estimates. Open fractures, comorbidities, and limited follow-up infrastructure remain the main challenges to optimizing outcomes in such contexts.

PMID:40801987 | DOI:10.1007/s00264-025-06616-y

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06635-9. Online ahead of print.

NO ABSTRACT

PMID:40801986 | DOI:10.1007/s00264-025-06635-9

Int Orthop. 2025 Aug 13. doi: 10.1007/s00264-025-06637-7. Online ahead of print.

ABSTRACT

PURPOSE: Lumbosacral transitional vertebra (LSTV) is a common anomaly linked to the degeneration of the lumbar spine. The aim of this work was to study lumbar spine mobility in subjects with and without LSTV using flexion-extension radiographs.

METHODS: In this retrospective single-center study, we identified subjects with flexion-extension radiographs and abdominopelvic CTs performed between years 2005-2023. LSTVs were graded according to Castellvi classification, and lumbar mobility evaluated through total lumbar lordosis, disc wedging angles, segmental lordosis angles, and range-of-motion (RoM) from the flexion-extension radiographs. Independent samples t-test and Mann-Whitney U-test were used for statistical analyses.

RESULTS: The study group comprised Castellvi types II-IV (n = 29, mean age 59.1 years, 62% males) and control group 20 subjects without LSTV (mean age 65.1 years, 35% males). The study group presented a smaller overall RoM of lumbar spine than controls (33.5°±14.2° vs. 38.3°±12.1°, p = 0.23). Distribution of total lumbar mobility differed in transitional L5/S1-level being 10.7% with study group and 22.2% with controls (p = 0.002); similarly, assessing disc wedging angles, extension and RoM were lower with study group than controls being 8.7 ± 4.8° vs. 12.9 ± 4.7° (p = 0.002) and 3.3 ± 3.8° vs. 7.3 ± 3.8° (p < 0.001), respectively. Same results were seen with segmental lordosis measurements: 15.7 ± 5.6° vs. 23.1 ± 4.5° (p < 0.001) and 3.3 ± 5.5° vs. 8.3 ± 3.8° (p < 0.001), respectively. There were no statistically significant differences of relative distribution of lumbar motion at the upper lumbar levels between the groups.

CONCLUSIONS: LSTV decreases mobility of the lumbar spine in the L5/S1-level but does not increase relative motion at the upper lumbar levels. The overall compensation of mobility seems to distribute equally throughout the superior lumbar segments and not excessively to the superior adjacent level.

PMID:40801985 | DOI:10.1007/s00264-025-06637-7

Int Orthop. 2025 Aug 11. doi: 10.1007/s00264-025-06633-x. Online ahead of print.

NO ABSTRACT

PMID:40788572 | DOI:10.1007/s00264-025-06633-x

Int Orthop. 2025 Aug 9. doi: 10.1007/s00264-025-06628-8. Online ahead of print.

NO ABSTRACT

PMID:40782290 | DOI:10.1007/s00264-025-06628-8

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06631-z. Online ahead of print.

NO ABSTRACT

PMID:40779171 | DOI:10.1007/s00264-025-06631-z

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06629-7. Online ahead of print.

NO ABSTRACT

PMID:40779170 | DOI:10.1007/s00264-025-06629-7

Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06632-y. Online ahead of print.

ABSTRACT

BACKGROUND: Ehlers-Danlos Syndrome (EDS) is a connective tissue disorder characterized by joint hypermobility, ligamentous laxity, and frequent joint injuries. These features could increase the risk of anterior cruciate ligament (ACL) tears, typically managed through ACL reconstruction (ACLR). Surgical intervention in EDS is challenging due to potential complications such as poor wound healing and tissue fragility. Limited evidence exists regarding the outcomes of ACLR in EDS patients; therefore, in this study we aimed to evaluate survival rates of primary and revision ACLR and examine associated demographic and anatomic risk factors for failure after ACLR.

METHODS: A retrospective review of 21 EDS patients (25 knees) who underwent ACLR between 1993 and 2023 was conducted. Patients with vascular EDS were excluded. Demographic and surgical data, including graft type, cause of injury, concomitant procedures such as meniscus repair and anatomical measurements (posterior tibial slope, intercondylar notch width, lateral femoral condyle morphology, tibiofemoral rotation and tibial tubercle- trochlear groove distance), were collected. Survival analysis was performed using Kaplan-Meier curves, with endpoints defined as ACLR failure or conversion to total knee arthroplasty (TKA). A multivariable survival analysis was used to identify predictors of outcomes. In addition, the influence of demographic and anatomical factors on the development of concomitant injuries and concomitant procedures were assessed. Anatomical factors were then compared with non-EDS patients from the existing literature.

RESULTS: The overall survival rate was 85.7% at mean follow-up of 50 months. Primary ACLR showed significantly higher survival rates 93.8% compared to revision ACLR 62.5% at 50 months (p = 0.03). Sports injuries, particularly skiing, were the leading cause of ACL tears (62%). Anatomical differences, such as increased lateral femoral condyle ratio (LFCR) and tibiofemoral rotation (TFR), were observed compared to non-EDS, ACL-intact patients from the literature (p < 0.01). However, these factors did not predict failure or influence concomitant injuries.

CONCLUSION: This study demonstrates that ACLR in EDS patients achieves good survival rates. Anatomical risk factors differed significantly from non-EDS, ACL-intact patients, but were not predictive of failure, highlighting ligamentous laxity as the primary challenge.

PMID:40775375 | DOI:10.1007/s00264-025-06632-y

Int Orthop. 2025 Aug 7. doi: 10.1007/s00264-025-06630-0. Online ahead of print.

ABSTRACT

PURPOSE: Shoulder deformities and impaired function in individuals with birth brachial plexus injury (BBPI) are often caused by internal rotator (IR) contractures and abductor weakness, which may progress to glenohumeral dysplasia. Although subscapularis-complex release and tendon transfer is a time-tested procedure, there are controversies regarding the appropriate management of shoulder contractures, especially in preschool children. Therefore, this study examines the efficiency of arthroscopically done progressive controlled release of IR contracture combined with tendon transfer.

METHODS: This study included 12 children who presented with shoulder soft tissue contractures and functional impairments, specifically, loss of shoulder abduction and external rotation, but with good deltoid function. They underwent a surgical intervention involving arthroscopy-assisted subscapularis-complex release and conjoint muscle transfer onto the infraspinatus footprint on the humeral head. The evaluation of shoulder function was conducted using the Mallet score system, and the range of motion was measured at preoperative and six month postoperative intervals. Statistical analyses were performed to determine the significance of the outcomes.

RESULTS: The average age of participants was 4.83 ± 2.1 years. Preoperatively, the mean Mallet score was 14.08 ± 1.4, which improved to 23.83 ± 1.2 postoperatively. The average gain in shoulder abduction was 66.4 ± 5.6°, and external rotation improved by 85.4 ± 16.6° at 18 months final follow-up. All patients exhibited improvements in shoulder function, with a significant correlation (p value = 0.037) between Naraka grading, and clinical outcomes.

CONCLUSION: The combined surgical approach of arthroscopic subscapularis-complex release with conjoint tendon transfer effectively enhances the shoulder function in the studied cohort. Further research and extended follow-up are needed to evaluate the long-term benefits.

LEVEL OF EVIDENCE: Level IV (Therapeutic case series).

PMID:40772960 | DOI:10.1007/s00264-025-06630-0

Int Orthop. 2025 Aug 5. doi: 10.1007/s00264-025-06617-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Debridement, antibiotics, and implant retention (DAIR) is a commonly employed strategy for managing acute postoperative prosthetic joint infections (PJI) while preserving the prosthesis. However, the clinical value of an unplanned second DAIR - performed due to inadequate infection control - remains controversial and is often considered a potential treatment failure. This study aimed to compare the two year clinical outcomes of patients undergoing a single DAIR versus those requiring an unplanned second DAIR for acute postoperative PJI of the hip or knee.

METHODS: We retrospectively reviewed electronic medical records of patients treated with DAIR for acute postoperative PJI between January 1999 and December 2020. Patients were categorized into two groups: those managed with a single DAIR (DAIR-1 group) and those requiring an unplanned second DAIR within 12 weeks (DAIR-2 group). Treatment failure was defined as any of the following: further debridement beyond 12 weeks, revision surgery with prosthesis removal, initiation of long-term suppressive antibiotic therapy, or PJI-related mortality. Patients lost to follow-up before two years were excluded.

RESULTS: A total of 318 patients were included, with 292 in the DAIR-1 group and 26 in the DAIR-2 group. Mean follow-up was 89.4 months. At two years, revision surgery was required in 19.2% (56/292) of DAIR-1 patients and 42.3% (11/26) of DAIR-2 patients (p = 0.005). Overall failure-free survival at two years was observed in 75.3% (220/292) of DAIR-1 patients compared to 46.2% (12/26) of those in the DAIR-2 group (p = 0.001).

CONCLUSION: Unplanned second DAIR procedures are associated with significantly lower success rates at two years. Nonetheless, given that nearly half of these patients remained free of failure, a second DAIR may still be a reasonable therapeutic option in selected cases, provided that the increased risk of a poorer prognosis is taken into account.

PMID:40762855 | DOI:10.1007/s00264-025-06617-x

Int Orthop. 2025 Aug 1. doi: 10.1007/s00264-025-06623-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the effectiveness of an intelligent fracture reduction robotic system in assisting closed reduction and intramedullary nailing of femoral shaft fractures with that of conventional fluoroscopy-assisted manual reduction and fixation.

METHODS: In this prospective, non-randomized controlled study, 30 patients with newly diagnosed femoral shaft fractures were enrolled, with 15 cases in the experimental group (robot-assisted) and 15 cases in the control group (conventional). The experimental group utilized an orthopaedic surgical navigation system to assist in closed reduction and intramedullary nailing, while the control group underwent fluoroscopy-assisted manual reduction and fixation. The reduction time, total operation time, intraoperative fluoroscopy count, blood loss, and reduction error were compared between the two groups.

RESULTS: Baseline characteristics were similar across both groups. The experimental group required significantly fewer intraoperative fluoroscopies (36.67 ± 25.41 vs. 117.26 ± 61.28, P < 0.001). Postoperative femoral length discrepancy (1.74 ± 1.37 mm) and anteversion difference (3.66 ± 3.37°) were significantly smaller in the experimental group compared to the control group (4.16 ± 2.67 mm, P = 0.004; 13.81 ± 9.58°, P = 0.001). Intraoperative blood loss was comparable between groups (experimental group: 207.33 ± 119.91 mL vs. control group: 240.00 ± 139.13 mL, P = 0.497). Reduction time was not statistically significant (experimental group: 74.27 ± 27.38 min vs. control group: 69.73 ± 34.10 min, P = 0.691).

CONCLUSIONS: The robot-assisted approach provided more precise fracture reduction, required fewer intraoperative X-ray fluoroscopies, and offered significant advantages over the conventional method for the minimally invasive treatment of femoral fractures.

PMID:40748453 | DOI:10.1007/s00264-025-06623-z