Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06454-y. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the impact of implant-associated and radiographic factors on survival rates and revisions of total shoulder arthroplasty (TSA) in patients with primary osteoarthritis (OA).

METHODS: This retrospective study included 68 patients who underwent TSA for primary OA at a single institution between 2008 and 2015, with a minimum follow-up of 60 months. Patients with prior shoulder surgeries, perioperative infections, or revisions within 12 months postoperatively were excluded. Patients were divided into Group A (Survivors) and Group B (Revisions) based on implant survival. Radiographic parameters analyzed included critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral offset (LO), humeral head-stem index (HSI), centre of rotation (COR), and glenoid erosion, categorized using Sirveaux, Lévigne, Franceschi, and Walch classifications. Demographic data were also assessed.

RESULTS: Of 68 patients, 57 were in Group A (mean age: 58.5 ± 10.1 years; follow-up: 115.8 months) and 11 in Group B (mean age: 61.4 ± 8.3 years; follow-up: 113.9 months). Implant survival was 84% after 115.8 ± 34.5 months. Baseline demographics were comparable (e.g., smoking: p = 0.75), as was osteolysis prevalence (Group A: 47%; Group B: 45%; p = 0.91). HSI was significantly higher in Group B (0.5 ± 0.1 vs. 0.4 ± 0.1; p = 0.03). No other radiographic differences were significant.

CONCLUSION: Patients undergoing anatomic total shoulder arthroplasty can expect favourable mid- to long-term outcomes, with implant survival rates of 84% and relatively low complication rates. Although osteolysis is common, it rarely necessitates revision surgery. The role of the humeral head-stem index (HSI) warrants further investigation.

STUDY DESIGN: Level IV; retrospective case study.

PMID:40024944 | DOI:10.1007/s00264-025-06454-y

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06474-8. Online ahead of print.

ABSTRACT

PURPOSE: In this study, we aimed to evaluate the effectiveness and safety of UBS (Ultrasonic Bone Scalpel) and HSD (High-speed drill) for performing anterior or posterior decompressions in patients with pathologies in cervical and lumbar regions.

METHODS: Between October 2022 and June 2024, 60 patients underwent surgery in which a UBS (Sonopet UST-2001; Stryker Neuro Spine ENT, MI, USA) and High-speed Midas Rex MR8 (Medtronic, Fort Worth, TX, USA) drill was used. Informed consent was obtained from all patients. The study included 27 men and 33 women with a mean age of 59,5 ± 14.6 years (range: 28-85). The following patient data were recorded: preoperative and postoperative JOA scores, intraoperative blood loss, and operative time for decompression in lumbar and cervical region.

RESULTS: In UBS group, the mean intraoperative blood loss was 166.0 ± 64.3 ml. The mean preoperative and postoperative JOA scores were 4.5 ± 1.0 and 8.6 ± 1.8 and the mean postoperative follow-up duration was 6.1 ± 4.4 months in UBS group. The mean intraoperative blood loss was 221.2 ± 93.4 ml in HSD group. The mean preoperative and postoperative JOA scores were 5.2 ± 1.1 and 8.2 ± 1.2 in HSD group. In the HSD group, the blood loss (BL) value was significantly higher (p < 0.05) compared to the UBS group. The preoperative/postoperative JOA score improvement in the UBS group was significantly higher (p < 0.05) than in the HSD group.

CONCLUSIONS: The UBS can be safely used in spinal surgery. It reduces intraoperative blood loss and provide better clinical improvement. Authors would like to emphasize that the UBS resects the bone with oscillatory movements rather than rolling motions and this mechanism of action is important in reducing the risk of dura mater injury.

PMID:40024943 | DOI:10.1007/s00264-025-06474-8

Int Orthop. 2025 Mar 1. doi: 10.1007/s00264-025-06473-9. Online ahead of print.

ABSTRACT

PURPOSE: Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP).

METHODS: This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates.

RESULTS: Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5-97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8-27%).

CONCLUSION: Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary.

PMID:40021549 | DOI:10.1007/s00264-025-06473-9

Int Orthop. 2025 Feb 28. doi: 10.1007/s00264-025-06459-7. Online ahead of print.

NO ABSTRACT

PMID:40019503 | DOI:10.1007/s00264-025-06459-7

Int Orthop. 2025 Feb 27. doi: 10.1007/s00264-025-06462-y. Online ahead of print.

ABSTRACT

PURPOSE: If the pain persists for a long time in the treatment of plantar fasciitis (PF) or if there is no response to treatment, central sensitization (CS) may develop and the pain may transform into nociplastic pain (NP). This study aimed to evaluate the frequency of CS and NP in patients with PF.

METHODS: This cross-sectional study was undertaken between November 2023 and March 2024. The Foot Function Index (FFI) scale, which evaluates the foot's functionality, was applied to the patient group. The Visual Analog Scale (VAS), which evaluates pain intensity; the Pain-DETECT scale, which evaluates NP; and the Central Sensitization Scale (CSI), which evaluates CS, were applied to patient and control groups.

RESULTS: A total of 206 people were included in the study; 106 were in the patient group with PF, and 100 constituted the control group. While we detected NP in 67 (63.2%) patients according to Pain-DETECT and CS was detected in 91 (85.8%) patients according to CSI among 106 patients with chronic PF; we detected NP in seven (7%) patients according to Pain-DETECT and CS in 44 (44.0%) patients according to CSI among 100 control patients. VAS-score and FFI-pain are moderately and positively correlated with pain-DETECT scores and fairly and positively correlated with CSI scores in the PF group. The pain-DETECT score is moderately and positively correlated with the CSI score in the two groups.

CONCLUSIONS: This is the first study to evaluate the presence of CS and NP in PF patients. We found NP and CS to be common in patients with chronic PF. Effective pain management in patients with PF before it becomes chronic can prevent the development of CS and NP.

PMID:40014141 | DOI:10.1007/s00264-025-06462-y

Int Orthop. 2025 Feb 26. doi: 10.1007/s00264-025-06455-x. Online ahead of print.

ABSTRACT

PURPOSE: The optimal coronal alignment in total knee arthroplasty (TKA) remains debatable, necessitating a clear, simple, and universal classification system. The Coronal Plane Alignment of the Knee (CPAK) classification introduced in 2021 provides a nuanced method for categorizing knee alignment. This study aimed to evaluate the distribution of CPAK types among Chinese patients with osteoarthritis (OA) and clarify the differences in surgical outcomes among different CPAK types.

METHODS: We analyzed the data from 961 patients with OA. All patient information was derived from a single-centre retrospective cohort. Radiological measurements from full-length radiographs were used to classify patients into CPAK types. Propensity score matching was used to compare outcomes among different CPAK types. Demographic and clinical data, information regarding patient satisfaction, and Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Forgotten Joint Score (FJS) scores were also collected.

RESULTS: Among Chinese patients with OA, the most common type was Type I (56.8%), followed by Type II (16.1%). After TKA, CPAK types IV and V, were predominant, accounting for 28% and 31% of patients; CPAK types did not change with OA progression. No significant differences in satisfaction, KSS, or WOMAC scores were observed among patients with CPAK types IV, V, and VII. However, Type V patients had significantly higher FJS scores, potentially due to corrected preoperative varus alignment.

CONCLUSION: This study established the CPAK type distribution among Chinese patients with OA to guide alignment strategies for TKA. Different CPAK types did not significantly affect overall satisfaction but influenced functional recovery, underscoring the need for personalized TKA approaches.

PMID:40009175 | DOI:10.1007/s00264-025-06455-x

Int Orthop. 2025 Feb 26. doi: 10.1007/s00264-025-06466-8. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a common surgical procedure aimed at relieving pain and restoring function in patients with advanced knee osteoarthritis. However, up to 25% of patients report persistent postoperative pain, which remains a major clinical challenge. While mechanical and biological causes are well-documented, neuropathic pain due to dynamic nerve compression is often overlooked, particularly involving the common peroneal and saphenous nerves.

OBJECTIVE: This study aims to highlight the role of dynamic nerve compressions in persistent post-TKA pain and propose an enhanced diagnostic approach by expanding Hagert's triad into a tetrad (pain, weakness, Scratch Collapse Test + , and orthogonal taping).

METHOD: Dynamic nerve compression differs from static entrapment as it occurs intermittently, often escaping detection in standard electromyography (EMG) or imaging studies. The common peroneal nerve is commonly compressed in the peroneal tunnel, leading to lateral knee pain, ankle weakness, and gait instability. The saphenous nerve, entrapped in Hunter's canal, is associated with medial knee pain, fatigability in standing, and pain while climbing stairs. Incorporating orthogonal taping in the clinical assessment enhances diagnostic sensitivity by providing a reproducible mechanical relief test.

CONCLUSION: Dynamic nerve compression should be systematically considered in cases of persistent post-TKA pain. A thorough clinical examination, including Hagert's tetrad, helps improve early detection. When conservative management fails, surgical nerve release offers a valuable solution, with significant potential for pain relief and functional recovery. Further studies are needed to optimize treatment protocols and validate long-term outcomes.

PMID:40009174 | DOI:10.1007/s00264-025-06466-8

Int Orthop. 2025 Feb 24. doi: 10.1007/s00264-025-06435-1. Online ahead of print.

ABSTRACT

PURPOSE: Complete acromioclavicular (AC) dislocation associated with fracture of the coracoid process (CP) is uncommon. The strong coracoclavicular ligaments, instead of rupture, may avulse the CP near its base, and with disruption of the AC joint may allow complete dislocation of the clavicle. We report ten cases, one of the largest series in literature, and reviewed the findings and treatment previous reported cases, to allow potential readers to establish the most appropriate treatment.

METHODS: We have prospectively collected those cases in which we had identified an association of an AC dislocation with a fracture of the CP, as well as retrospectively reviewed the records that were coded as AC dislocations and CP fracture looking for this association in the senior author institutions. A literature search was completed on PubMed, Web of Science and Scholar Google, using a sensitive search strategy.

RESULTS: We have collected a total of ten patients with the association of a CP fracture to an AC dislocation in a period of twenty-five years. A review of the cases reported in literature shows a great variability in treatment methods from conservative to more surgically in recent years.

CONCLUSIONS: When an AC dislocation is identified by clinical examination and X-rays, one should be aware of a possible fracture of the CP. It is possible this association to be more frequent than shown in literature because of the CP fracture can easily be missed out or mistaken with an unfussed epiphysis in routine anteroposterior radiography. Multiple approaches have been opted for by surgeons to deal with this combined injury and are the basis of this review.

PMID:39992382 | DOI:10.1007/s00264-025-06435-1

Int Orthop. 2025 Feb 21. doi: 10.1007/s00264-025-06438-y. Online ahead of print.

ABSTRACT

PURPOSE: Subtalar arthroereisis (STA) is a clinical intervention used for the correction of flexible flatfoot (FFF) in the paediatric population. This study aims to evaluate the radiographic, clinical, and patient-reported outcomes of STA for symptomatic FFF in paediatric patients with a minimum follow-up period of nine years.

METHODS: A cohort of 19 patients (38 feet) who underwent STA for FFF treatment between 2011 and 2015 was analyzed. This study featured a minimum follow-up period of nine years and involved comprehensive radiographic measurements. Clinical function assessment included footprint analysis classified using the Viladot classification, the Foot and Ankle Outcome Score (FAOS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. We calculated the association between preoperative and postoperative angles and functional results. Receiver operating characteristic (ROC) curve analyses were conducted to establish the optimal threshold to predict good clinical outcomes.

RESULTS: The average age at the time of surgery was 11 ± 1.79 years, and the mean duration of follow-up was ten ± 1.4 years. After the surgical intervention, all foot angles showed statistically significant improvements. Normal foot alignment according to the Viladot classification was noted in 71% of patients. Good to excellent functional outcomes, as measured by both the AOFAS-hindfoot score and FAOS score, were reported in 84.2% of patients. Significant correlations were found between the preoperative and postoperative angles and functional results. Based on ROC curve analysis, the cut-off values were determined to be 28.5 degrees for the talonavicular coverage angle, 19.5 degrees for Meary's angle, and 37.5 degrees for the talar declination angle.

CONCLUSION: Our study indicates that STA is an effective procedure for durable deformity correction in paediatric patients with FFF. Restoring the medial longitudinal arch and correcting forefoot abduction are essential for improving functional outcomes. Both preoperative and postoperative angles were significantly associated with functional results, and the identified preoperative cut-off values are helpful for selecting surgical candidates.

PMID:39982464 | DOI:10.1007/s00264-025-06438-y

Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06457-9. Online ahead of print.

ABSTRACT

PURPOSE: Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH.

METHODS: Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV.

RESULTS: On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01).

CONCLUSION: Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

PMID:39976738 | DOI:10.1007/s00264-025-06457-9

Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06434-2. Online ahead of print.

ABSTRACT

PURPOSE: Compression neuropathy is a common problem that results in impaired axonal conduction, and with time, numbness, tingling and weakness from muscle atrophy. Supercharge reverse end-to-side (SETS) nerve transfers have emerged as a novel approach to augment function in chronic nerve compression syndromes with minimal donor site morbidity. This review answers the question, "What are the indications, surgical techniques, and nuances of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies?".

METHODS: This article reviews current literature and technical components of the use of SETS in chronic nerve compression syndromes.

RESULTS: SETS nerve transfers improve functional outcomes and reduce disability in chronic nerve compression syndromes with limited donor site morbidity. SETS nerve transfers for ulnar, axillary, and femoral compressive neuropathy improve muscle strength, as demonstrated by increased MRC scores. It has also been shown that SETS transfers decrease clawing in ulnar nerve compression and pain in axillary nerve compression. More research is needed for SETS transfers for radial nerve compression neuropathies.

CONCLUSION: SETs nerve transfers have emerged as a novel approach to restore function and reduce pain and dysfunction in chronic nerve compression syndromes. SETS nerve transfers have minimal donor site morbidity and improve the strength and function of muscles innervated by the effected "recipient" nerve. This review explores the indications and surgical techniques of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies as well as their reported outcomes.

PMID:39976737 | DOI:10.1007/s00264-025-06434-2

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06448-w. Online ahead of print.

ABSTRACT

BACKGROUND: Knee synovial chondromatosis (SC) is a rare joint disorder involving loose cartilaginous bodies, leading to pain, swelling, and impaired function. Arthroscopy has become a primary treatment option, but its efficacy and recurrence rates remain debated. This systematic review evaluates the effectiveness and safety of arthroscopic interventions, focusing on loose body removal, partial synovectomy, and total synovectomy.

METHODS: A systematic search of PubMed and EMBASE (1985-2024) identified studies on arthroscopic treatment of knee SC, adhering to PRISMA guidelines. Inclusion criteria targeted original studies detailing outcomes of loose body removal with or without synovectomy. Data on patient demographics, surgical techniques, and outcomes were extracted, with recurrence as the primary outcome. Qualitative synthesis was conducted due to heterogeneity among studies.

RESULTS: The review included 84 patients (median age: 36 years, range: 7-67). Loose body removal alone was performed in 57.8%, partial synovectomy in 30.9%, and total synovectomy in 13%. Median follow-up was 28 months. Recurrence occurred in 22.6%, predominantly after loose body removal alone. Complication rates were negligible, with only one reported instance unrelated to the arthroscopic procedure.

CONCLUSIONS: Arthroscopic treatment is safe and effective for knee SC. Recurrence rates underscore the importance of synovectomy in preventing disease recurrence. Total synovectomy may offer superior outcomes for advanced cases. Further research with standardized protocols and extended follow-up is needed to optimize treatment strategies.

PMID:39969591 | DOI:10.1007/s00264-025-06448-w

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06424-4. Online ahead of print.

ABSTRACT

PURPOSE: Implant-associated infections are the most challenging complication in orthopaedics and trauma surgery as they often lead to long courses of illness and are a financial burden for the healthcare system. There is a need for fast, simple, and cheap identification of pathogens but the ideal detection method was not found yet. The work aims to test whether the detection of pathogens culturing the removed implant is more successful than from simultaneously taken tissue samples or punction fluid.

METHODS: Implants were removed due to infection, irritation, or loosening. Tissue samples and joint fluids were processed for bacterial growth in sterile conditions. Samples were incubated and checked for growth. Bacterial identification and antibiotic sensitivity testing were performed. Data were anonymized, and statistical analysis was done using Excel and SAS, employing tests like Shapiro-Wilk, Mann-Whitney-U, and Kruskal-Wallis. Ethical approval was obtained for this study.

RESULTS: Between February 2018 and April 2019, a total of 163 patients (175 cases) underwent orthopaedic implant removal for various reasons. 30 cases were not usable or analyzable due to missing or damaged reference material, so 145 cases could be evaluated due to study protocol. The range of detected bacteria was as expected and included low-virulent bacteria such as Micrococcus luteus and Corynebacteria. Pathogen detection by culture of the the explant´s was more sensitive (84.83%) than pathogen detection from tissue samples and punction fluid (64.14%, p<0.0001). Comorbidities did not play any role in the quality of detection but prior antibiotic treatment did influence the results of tissue diagnostics.

CONCLUSION: This study showed with a higher frequency of bacterial detection of orthopedic explant´s surface compared to tissue samples or punction fluid. This may reduce the number of samples and cost but enhances the quality of orthopaedic implant-related infection diagnostics.

PMID:39969590 | DOI:10.1007/s00264-025-06424-4

Int Orthop. 2025 Feb 18. doi: 10.1007/s00264-025-06443-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effects of adding immediate weight-bearing to tolerance into a post-operative rehabilitation program for surgically treated Tibial Plateau (TP) fractures on clinical and radiological outcomes.

METHODS: A randomized control trial. 106 Patients were recruited following open reduction internal fixation (ORIF) TP fracture, with 54 patients meeting the criteria for inclusion. Patients were assigned randomly into one of two groups: (1) the traditional group (TG) and (2) the weight-bearing group (WG). The TG was given the non-weight-bearing (NWB) rehabilitation protocol for six weeks. The WG was allowed immediate weight-bearing, and the same therapeutic exercise program was given to both groups. The dependent variables, including clinical and radiological measurements, were recorded six weeks, three months, and six months after the surgery.

RESULTS: A total of 45 patients (11 women and 34 men), with a mean age of 43 ± 14 years, completed the study. There were significant differences between groups in favor of the WG at 6-months for the total clinical Rasmussen score (p =.002) as well as for the pain (p =.005), walking capacity (p =.002), and knee ROM (p =.047). We found neither difference between groups regarding radiological CT- Scan and X-ray measures nor Rasmussen's radiological scores (p =.854). Fracture type (Schatzker I-IV) did not affect any radiological measures between the groups. Four of 45 patients had intra-articular collapse, three in TG and one in WG (p =.571).

CONCLUSION: Immediate weight-bearing as tolerated after ORIF of TP fractures (Schatzker I-IV) resulted in better clinical outcomes with no significant differences in the radiological measures.

PMID:39964437 | DOI:10.1007/s00264-025-06443-1

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06405-7. Online ahead of print.

ABSTRACT

PURPOSE: To examine the effectiveness of a novel bone graft reduction technique with a bone tamp impactor instrument in minimally invasive treatment of tibial plateau collapse fractures through arthroscopic and imaging evaluation.

METHODS: This is a retrospective analysis of prospectively collected data on patients with tibial plateau collapse fracture who received the novel bone graft reduction procedure with a bone tamp impactor instrument for minimally invasive treatment of tibial plateau collapse fractures in a tertiary referral university hospital from February 2021 to March 2023. Patients were classified according to a classification combined with Schatzker classification, AO classification and three-column classification. Arthroscopy evaluation and radiographs were used to measure the reduction effect.

RESULTS: A total of 196 patients were eligible and included. Compared to the preoperative values, post-ADD(c) showed a significant reduction improvement (P = 0.000-0.007), ranging from 87.9 to 96.6% for different classifications. The post-ADD (s) have decreased by 87-96.8% (P = 0.000-0.039), the post-FFG and post-TPW reduced by 87.5-100% (P = 0.000-0.026) and 34.2-63.5% (P = 0.000-0.075) respectively. Additionally, the lower limb alignment have been significantly corrected, with notable changes in post-MPTA (P = 0.000-0.081), post-PTSA (P = 0.000-0.178) and post-FTA (P = 0.000-0.069) for different types of fracture, measured one day after surgery. Arthroscopic evaluation indicated that the average articular surface depression depth was less than 4 mm, and over 60% achieved a depression depth of less than 2 mm. All patient achieved a less than 2 mm of postoperative fracture fragment gap, with over 50% achieving a gap of less than 1 mm. None of patients experienced neurovascular injury or wound infection.

CONCLUSION: The novel bone graft reduction technique utilizing a bone tamp impactor instrument can achieve effective reduction in all types of tibial plateau collapse fractures. This method may prove to be a useful option for minimally invasive treatment of tibial plateau fractures.

PMID:39960508 | DOI:10.1007/s00264-025-06405-7

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06453-z. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: The purpose of this narrative review is to highlight upper extremity nerve compression syndromes and peripheral neuropathies reported in throwing and overhead athletes.

RECENT FINDINGS: The overhead-throwing athlete may experience unique patterns of injuries and pathology related to the biomechanics and demands of the throwing motion, a demanding manoeuvre that places a significant amount of stress across the upper limb. Nerve injuries that may appear in high-level throwers include suprascapular and long thoracic neuropathy, quadrilateral space syndrome, and thoracic outlet syndrome. Nerve compression syndromes around the shoulder may appear with pain, paresthesia, and upper limb weakness. Overlapping features may be common among these compression neuropathies or mimic other common shoulder pathologies. Prompt differential diagnosis and successful treatment should be based on knowledge of key anatomical features, pathophysiology, clinical examination, and appropriate paraclinical studies.

PMID:39960507 | DOI:10.1007/s00264-025-06453-z

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06445-z. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to assess functional and radiological outcomes of radial head arthroplasty (RHA) compared to open reduction and internal fixation (ORIF) in isolated Mason type-III fractures with a minimum of five years follow-up.

METHODS: This was a retrospective single-center study of closed isolated Mason type-III radial head fractures operated between January 2008 and December 2017. Nineteen patients were included in group RHA and 35 patients in group ORIF. The mean age was 51 years old in group RHA and 41 years old in group ORIF (p = 0.02). Functional and radiological outcomes were evaluated.

RESULTS: Mean follow up was eight years (range, 5-14). Clinical results and functional scores showed no significant differences, except a better pronation in group RHA (p = 0.04). Two secondary radial head resection or implant removal were performed in each group (p = 0.56) with poor functional outcomes in group ORIF. There was less heterotopic ossification in group RHA (15.8% vs. 42.8%; p = 0.03). Capitulum wear was found in 63% in group RHA against 25.7% in group ORIF (p < 0.05).

CONCLUSION: Functional results of RHA and ORIF were comparable for isolated Mason type-III fractures at a mean follow-up of eight years. We recommend to perform RHA for isolated Mason type-III fracture if articular reduction or stability of the fixation is not satisfying.

LEVEL OF EVIDENCE: III.

PMID:39960506 | DOI:10.1007/s00264-025-06445-z

Int Orthop. 2025 Feb 15. doi: 10.1007/s00264-025-06449-9. Online ahead of print.

ABSTRACT

PURPOSE: The goal of this study was to report the duration of pain relief and need for subsequent surgical intervention following intra-articular steroid injection of the elbow in the setting of arthritis.

METHODS: The authors' institutional database was accessed to identify patients who underwent a corticosteroid injection of the elbow for arthritis. For included patients, demographic information, steroid dosage, duration of symptoms relief, complications, and progression to surgical management were recorded. A chi-squared or Fisher exact test was utilized for categorical variables while a two-way Analysis of Variance (ANOVA) or Wilcoxon ranked sum test was utilized for continuous variables as appropriate. Statistical significance was defined as p < 0.05.

RESULTS: There were 67 patients included in the study who underwent between one and 14 injections. Patients experienced some degree of pain relief 80% of the time for an average of 12.5 (range 0-64) weeks after their first injections. There was only one documented complication following steroid injection. Twenty-one (7.9%) patients ultimately underwent surgical intervention for their elbow arthritis. Younger age was associated with progression to surgical intervention (p = 0.01).

CONCLUSION: Corticosteroid injections to the elbow are an effective method of pain control in patients with elbow arthritis.

LEVEL OF EVIDENCE: IV.

PMID:39954053 | DOI:10.1007/s00264-025-06449-9

Int Orthop. 2025 Feb 15. doi: 10.1007/s00264-025-06446-y. Online ahead of print.

ABSTRACT

PURPOSE: Symphyseal diastasis accounts for 13-16% of pelvic ring injuries. Symphyseal plating via a Pfannenstiel approach was the standard method of fixation for symphysis diastasis. Recently, percutaneous reduction and fixation of pelvic fractures have been employed to treat various pelvic ring and acetabulum injuries. The current study aims to compare the clinical and radiological results of treatment of symphysis pubis diastasis using symphyseal plating and percutaneous symphyseal screws.

METHODS: It is a retrospective study conducted at a trauma centre at academic level I. One hundred and ten patients were identified in our records. Sixty patients were excluded according to our exclusion criteria. Fifty patients were included in this study. Among which were 26 patients treated with anterior symphyseal plating (Group A) and 24 patients treated with percutaneous symphyseal screws (Group B). Posterior pelvic injury was fixated according to the existing pathology. In both groups, we recorded operation time, intraoperative blood loss, length of the incision, number of x-ray shots, changes in symphysis distance (preoperative, immediate postoperative, and in the last follow-up), and time for union. At the last follow-up, the clinical evaluation was conducted using the Visual Analogue Scale (VAS), and the functional evaluation was conducted using the Majeed scoring method for both groups.

RESULTS: All patients have followed up for at least two years. According to the Majeed Score, group A's functional classification was excellent for fourteen patients, good for seven, fair for two, and poor for three cases. Group B's functional classification was excellent for seventeen patients, good for six, and poor for one. The operative time and intraoperative time were significantly different between both groups, while the symphysis diastasis at the last follow-up was insignificant. Five patients in group A showed metal failure in the form of plate breakage, screw loosening, and screw backing out. In Group B, one case showed implant failure and loss of reduction in the form of screw backing out and widening of the symphysis pubis. Two patients in group A had infections at the incision site, which were treated with antibiotics and daily dressings and resolved adequately. No recorded cases of infection in group B.

CONCLUSION: Both techniques showed favourable results. The group with symphyseal plating showed a higher failure rate than the group with percutaneous screw fixation. The symphyseal screw group had shorter operative time, smaller incision, and less intraoperative blood loss than the symphyseal plating group but more radiation exposure. The symphyseal screw technique is a technically demanding technique and requires a high learning curve. It involves more radiation exposure, especially in inexperienced surgeons.

PMID:39954052 | DOI:10.1007/s00264-025-06446-y

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06411-9. Online ahead of print.

ABSTRACT

PURPOSE: Post-operative LLD is a major concern after THA. The anterior approach on a standard table allows surgeons for a direct control of the leg length. Intra-operative radiography (IR) helps in assessment of hip biomechanics and anatomic parameters. The aim of this study is to evaluate the LLD after THA through anterior approach with or without a position table and with or without the use of intra-operative radiographs. The hypothesis is that leg length may be better control when IR and a standard table are used.

METHODS: This is a single-centre retrospective comparative cohort study of three matched groups of 80 patients receiving anterior approach THA with three different techniques (Group A: positioning table with IR; Group B: standard table with IR; Group C: standard table without IR). Pre-operative and post-operative LLD was calculated. Age, sex, BMI, acetabular cup and femoral stem size, operative time, and blood loss were recorded.

RESULTS: In Group A, 15 patients (19%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group B, 20 patients (25%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group C, 16 patients (20%) had a LLD greater than 5 mm, and three patients (3,7%) had a LLD greater than 10 mm. No statistically significant differences were found for LLD > 5 mm, for LLD > 10 mm, nor for the mean LLD between the three groups (p > 0.05). Mean operative time was statistically longer in Group B (p < 0.05).

CONCLUSION: Neither the use of a standard/positioning table neither the use of IR seemed to be superior in restoring leg length after anterior approach THA. Together with the contradictory results in literature, findings of the current study indicate that no technique is clearly superior to one other and surgeons' experience may play the most relevant role.

PMID:39951054 | DOI:10.1007/s00264-025-06411-9