Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06509-0. Online ahead of print.

ABSTRACT

PURPOSE: Pelvic ring and acetabular fractures pose significant morbidity and mortality risks due to substantial haemorrhage and internal organ injury. Many percutaneous reduction techniques involve manipulating the injured side while stabilizing the uninjured side, often requiring specific or costly equipment. This article presents a technique for creating a pelvic reduction frame using a standard external fixator.

METHOD: We included surgical pelvic ring fractures between 2018 and 2022. Pelvic reduction was achieved using an external fixator (Hoffmann III, Stryker Corporation, Kalamazoo, Michigan, USA). Reduction quality was assessed according to the technique described by Lefaivre et al., based on the following criteria: mean asymmetry (mm), mean deformity index (mm), and mean maximum horizontal or vertical displacement (mm).

RESULTS: 15 patients (10 men, 5 women, mean age 35 years) underwent surgical treatment for pelvic fractures using an external fixator and percutaneous fixation. Mean operative time was 130 min (range, 80-276). Postoperative imaging showed a mean maximum displacement of 5.4 mm and a mean asymmetry of 3.7 mm, with excellent or good reductions in 11 cases.

CONCLUSION: This system uses widely available equipment and enables the benefits of percutaneous techniques, but surgical expertise remains the key to success.

PMID:40172657 | DOI:10.1007/s00264-025-06509-0

Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06503-6. Online ahead of print.

ABSTRACT

PURPOSE: Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS: Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS: The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS: The informational video significantly improved patient comprehension during the informed consent process before THA.

PMID:40169412 | DOI:10.1007/s00264-025-06503-6

Int Orthop. 2025 Apr 1. doi: 10.1007/s00264-025-06511-6. Online ahead of print.

ABSTRACT

PURPOSE: The aim is to showcase the urgent need for improved data infrastructure and international collaboration by highlighting the barriers to comprehensive orthopaedic documentation and quantifying the scope and nature of scholarly research on Gaza's healthcare crisis.

METHODS: Data was collected through integration of observational field notes, informal interviews, patient record reviews and a bibliometric analysis of peer-reviewed articles on the 2023-2025 armed escalations in Gaza.

RESULTS: The review of patient documentation during surgical missions in Gaza revealed significant gaps in critical clinical information, including surgical history, microbiology data, and postoperative instructions, which hindered patient care. Frequent damage to records due to resource shortages and bombardments, along with issues in retrieving imaging data, further exacerbated these challenges. Bibliometric analysis showed that most studies were retrospective, focusing on trauma care and limb salvage, reflecting the difficulty of conducting prospective research in a conflict zone. Of the 114 publications reviewed, only three (2.6%) met inclusion criteria, with two of them involving Gaza-based Palestinian authors, despite barriers like power outages, limited journal access, and resource constraints.These findings highlight the resilience of Gaza's healthcare workers and the need for improved infrastructure, standardized documentation, and international partnership to enhance patient outcomes and strengthen global orthopaedic research.

CONCLUSION: Orthopaedic documentation in Gaza is hampered by the compound impacts of recurrent conflict, infrastructural decay, and constrained academic output. Observational findings reveal the fragility of paper-based systems, while a bibliometric survey underscores the paucity of locally driven, empirical research. International efforts are needed to overcome these barriers for improved data infrastructure.

PMID:40167759 | DOI:10.1007/s00264-025-06511-6

Int Orthop. 2025 Mar 31. doi: 10.1007/s00264-025-06515-2. Online ahead of print.

ABSTRACT

PURPOSE: In orthopaedic surgery, achieving optimal exposure for acetabular and pelvic ring fractures with minimal invasiveness remains a challenge. This study compares bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) in cadaveric specimens.

MATERIALS AND METHODS: We dissected ten adult cadaveric bodies, obtained from our institution's body donation program, using an extraperitoneal endoscopic dissection on one side and an AIP approach on the other. Bone areas were marked at each step of dissection by drill holes to measure the bone exposure surface for each zone (true and false pelvis) between the laparoscopic and open approaches. A Student's t test was used to compare the exposure areas obtained.

RESULTS: The average age of the cadavers was 83 years, with a balanced representation of genders (60% male, 40% female). Comparison of zones between endoscopy and AIP found for Zone 1: 1.4 cm2 (range - 3.813 to 1.013) for AIP with no statistical significance. For Zone 2: 0.5 cm2 (range - 1.9141 to 2.9141) for AIP with no statistical significance. For Zone 3: 0,6 cm2 (range - 1.0243 to 2.2243) for AIP with no statistical significance. And for Zone 4: 3.5 cm2 (1.874; 5.126) for endoscopy with statistical significance (p = 0.001).

CONCLUSION: Our study demonstrates that the endoscopic method provides comparable visualization of the different pelvic zones compared to the open method (AIP), with enhanced access to Zone 4, a crucial area in managing acetabulum and pelvic ring fractures.

LEVEL OF EVIDENCE: Level V, cadaveric study.

PMID:40163078 | DOI:10.1007/s00264-025-06515-2

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06484-6. Online ahead of print.

ABSTRACT

PURPOSE: Despite the increasing understanding of femoroacetabular impingement (FAI), the impact of specific patient characteristics, including inflammatory pathologies like axial spondyloarthritis (axSpA), on its pathophysiology and clinical outcomes following treatment remains inadequately defined. Therefore, the purpose of this scoping review was to evaluate the relationship between FAI and sacroiliac (SI) joint abnormalities and FAI and axSpA.

METHODS: The study was conducted following the framework established by Arksey and O'Malley and Levac et al., adhering to the PRISMA scoping review extension checklist. A systematic search was performed across MEDLINE, EMBASE, and Cochrane Library databases for articles published until August 2024. A total of 120 articles were screened and eight finally met the inclusion criteria.

RESULTS: The review analysed data from the eight retrospective studies with a total of 1,723 patients. We found that the prevalence of SI joint abnormalities in patients with FAI can be as high as 25-28%. Furthermore, the prevalence of FAI morphology in patients with axial spondyloarthritis can be as high as 20-37%. Finally, patients undergoing hip arthroscopy for FAI with axSpA and/or SI joint abnormalities have lower postoperative outcome scores reported in comparison with those patients who do not have these comorbidities.

CONCLUSION: Over a quarter of patients with FAI can have concomitant radiographic SI joint abnormalities. We cannot overemphasise the importance of assessing the spine, specifically the SI joint, and ruling out symptoms emanating from the SI joint in all patients with FAI. There is clearly a knowledge gap in understanding the underlying pathophysiology linking FAI and axSpA. We require further research to elucidate the underlying mechanisms of this relationship, standardise evaluation methods, and explore long-term outcomes in this cohort of patients.

PMID:40156722 | DOI:10.1007/s00264-025-06484-6

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06514-3. Online ahead of print.

ABSTRACT

We discuss the study by Xiao Han et al., titled " Comprehensive Comparison Between Conservative Therapy and Surgical Management for Completely Displaced and Comminuted Mid-Shaft Clavicle Fractures " The authors compared outcomes between conservative and surgical treatments in 105 patients, finding higher union rates, faster healing, and no malunion in the surgical group, albeit with a notable incidence of postoperative numbness. While long-term functional outcomes were comparable, surgery offered quicker recovery of strength and return to work. However, as a retrospective study, potential selection bias exists-more active, younger patients tended to undergo surgery, while older patients with comorbidities opted for conservative care. The absence of propensity score matching (PSM) further limits comparability. Moreover, the relatively short follow-up (mean: 21.24 months) restricts insights into long-term complications. Previous long-term studies suggest surgical benefits may wane over time. Future randomized, long-term, and cost-focused studies would be valuable to guide treatment decisions more robustly.

PMID:40155447 | DOI:10.1007/s00264-025-06514-3

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06505-4. Online ahead of print.

NO ABSTRACT

PMID:40152988 | DOI:10.1007/s00264-025-06505-4

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06506-3. Online ahead of print.

ABSTRACT

PURPOSE: Firearm-related injuries in children and adolescents have increased over the past decade. The standard of care for ballistic fractures in children is complex, resulting in a burden of healthcare follow-up that many families find challenging. Consistent follow-up is crucial, especially in orthopaedic trauma and firearm cases, to prevent complications. This study aims to identify demographic and clinical variables associated with loss to follow-up (LTFU) in paediatric patients with ballistic fractures.

METHODS: This is a retrospective registry study at a Level I trauma centre for patients aged zero to 21 who presented with a ballistic-induced fracture. Patients with isolated skull, facial, or rib fractures were excluded. Follow-up was dichotomized at the median number of follow-up days for analysis. Logistic regression analysis was used to identify predictors of LTFU.

RESULTS: The study included 144 patients with a median age of 18 years. The majority were male (89%) and White (72%). Most patients had government insurance (44%) or were uninsured (33%). The mechanism of injury was primarily assault (71%). Operative intervention occurred in 55% of cases. Key factors increasing follow-up adherence included male sex (p = 0.011), higher injury severity scores (p = 0.009), requiring operative intervention (p < 0.001), air transportation (p < 0.001), or injury at a private residence (p = 0.040). Uninsured status (p = 0.007), opioid use (p = 0.047), and greater distance from the hospital (p = 0.002) were associated with low follow-up.

CONCLUSIONS: This study identifies key factors influencing follow-up adherence in pediatric patients with ballistic fractures. Identifying these factors allows for tailoring future interventions to improve follow-up adherence for this vulnerable population.

PMID:40152987 | DOI:10.1007/s00264-025-06506-3

Int Orthop. 2025 Mar 26. doi: 10.1007/s00264-025-06512-5. Online ahead of print.

ABSTRACT

PURPOSE: The direct anterior approach (DAA) in total hip arthroplasty (THA) has a risk of lateral femoral cutaneous nerve (LFCN) injury. Long-term outcomes and therapeutic options for such injuries are poorly investigated. This study evaluates the impact of iatrogenic LFCN lesions on long-term outcomes and investigates treatments like ultrasound-guided nerve infiltration or neurolysis.

METHODS: Our institutional database of primary THAs (2014-2022) was searched for patients with iatrogenic LFCN lesions after DAA, confirmed via ultrasound or electroneurography. First, retrospective analysis of the effects of ultrasound-guided nerve infiltration and neurolysis. Second, clinical-radiological assessment of pain, function, incision, and affected skin area. Patient-reported outcomes (OHS, COMI Hip, UCLA) were compared to a matched non-LFCN injury control group.

RESULTS: Of 8136 patients, 29 (0.36%) met inclusion criteria, with 22 undergoing ultrasound diagnostics. Eighteen received nerve infiltration (improvement after one (n = 7), two (n = 3) or three (n = 1) infiltrations), and two had neurolysis. After a mean follow-up of 4.95 years, 13 patients were assessed. Common symptoms included hypesthaesia (11), dysesthesia (6), and tingling (3), with a mean affected area of 253cm2 ± 64.8. 24-months questionnaires for the LFCN group (OHS 39.2 ± 8.6, COMI Hip 2.4 ± 2.7, UCLA 6.5 ± 1.6) were worse than the control group (OHS 46.2 ± 2.3, COMI Hip 0.6 ± 0.8, UCLA 7.2 ± 1.5), though differences were not statistically significant.

CONCLUSION: Instrumentally proven LFCN lesions after DAA THA are rare but lead to worse long-term outcomes. Ultrasound-guided nerve infiltration shows favorable results for symptom management.

PMID:40140107 | DOI:10.1007/s00264-025-06512-5

Int Orthop. 2025 Mar 26. doi: 10.1007/s00264-025-06504-5. Online ahead of print.

NO ABSTRACT

PMID:40137944 | DOI:10.1007/s00264-025-06504-5