JBJS

Enhancing Patient Comprehension in Orthopaedic Surgery: The EXPLAIN Framework for Surgeon-Patient Communication

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.01047. Online ahead of print.

ABSTRACT

➢ Patient comprehension in orthopaedic surgery is frequently limited, with substantial gaps between perceived and actual understanding of conditions, procedures, and recovery timelines.➢ Expectation management is a central communication challenge, as patients often anticipate surgery or outcomes in ways that are unrealistic, directly affecting satisfaction and informed consent.➢ The EXPLAIN framework provides a structured, orthopaedic-specific approach to improve communication through 7 components: Educate, eXample, Purpose, Language/Learn, Analogy/Articulate, Illustrate, and Navigate.➢ Evidence supports the use of strategies such as plain language, teach-back, anatomical models, 3-dimensional aids, and structured navigation programs to improve comprehension, reduce anxiety, and lower readmissions.➢ Implementing EXPLAIN can enhance shared decision-making, reduce communication-related malpractice risk, and improve both patient satisfaction and outcomes.

PMID:41678671 | DOI:10.2106/JBJS.25.01047

Transthyretin Amyloid May Drive Fibrosis and Proliferation of Tenosynovial Fibroblasts in Carpal Tunnel Syndrome

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.00807. Online ahead of print.

ABSTRACT

BACKGROUND: Transthyretin (TTR) amyloid deposition in the tenosynovium in carpal tunnel syndrome (CTS) is a potential early manifestation of systemic amyloidosis. However, its effects on tenosynovial fibroblasts in CTS remain unclear. We aimed to clarify how wild-type and Val30Met mutant TTR amyloids affect tenosynovial fibroblasts in CTS.

METHODS: Synovial tissue from 20 patients undergoing carpal tunnel release surgery was evaluated for TTR amyloid. Expression of genes related to fibrosis, inflammation, and oxidative stress was compared between TTR-positive and TTR-negative groups. Fibroblasts isolated from TTR-negative patients were treated in vitro with wild-type or Val30Met mutant recombinant TTR. Analyses included quantitative RT-PCR (reverse transcription-polymerase chain reaction), Picrosirius Red staining, MTT assays evaluating cell proliferation, reactive oxygen species (ROS) activity measurements, and senescence-related gene expression.

RESULTS: In TTR-positive tissue, fibrosis-related genes (COL1A1, COL3A1, TGFB1, and ACTA2), the inflammatory mediator NFKB1, and oxidative-stress-related genes (KEAP1, NQO1, and SOD1) were significantly upregulated, whereas SOD2 was downregulated. With in vitro treatment in the TTR-negative group, both wild-type and Val30Met TTR increased COL3A1, IL6, and CXCL8 expression, whereas Val30Met TTR further enhanced IL1B expression. Picrosirius Red staining confirmed increased collagen deposition. MTT assays revealed increased cell viability, indicating enhanced fibroblast proliferation, in both groups. The senescence-related genes CDKN2D and GADD45A were downregulated, suggesting enhanced proliferative activity. ROS activity did not differ significantly between groups.

CONCLUSIONS: TTR amyloid was found to promote expression of fibrosis, inflammation, and oxidative-stress-related genes; inhibit senescence pathways; and enhance collagen deposition and fibroblast proliferation in fibroblasts from patients with CTS.

CLINICAL RELEVANCE: CTS with TTR deposition may reflect more than a localized neuropathy, as TTR potentially plays a pathogenic role in CTS development. This finding provides novel insights into the underlying mechanisms of CTS.

PMID:41678652 | DOI:10.2106/JBJS.25.00807

Predictive Factors for Fast Healing Following Surgery for Knee Osteochondritis Dissecans

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.01026. Online ahead of print.

ABSTRACT

BACKGROUND: Osteochondritis dissecans (OCD) healing can be unpredictably slow, incomplete, or absent after surgical treatment. This frustrates patients, families, and the medical team. We aimed to develop an algorithm to predict the speed of OCD radiographic ossification based on patient demographic, physical, surgical, and imaging data.

METHODS: We studied a prospective cohort of patients with knee OCD lesions in a multicenter database. We included patients who were diagnosed with knee OCD lesions of the lateral or medial femoral condyle and were treated operatively at a single center. We collected patient information from medical records and imaging studies. Radiographic healing was defined on the basis of the percentage of the original OCD lesion that had a normal bone density (ossification) compared with the surrounding condyle, rated on a continuous scale from 0 to 100. An OCD lesion that achieved ≥90% of the normal surrounding bone density at 6 months following surgery was defined as fast healing. Follow-up was conducted with radiographs only. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS: This study included 79 OCD lesions in 72 individuals. The mean patient age was 13.79 ± 2.71 years (range, 8.56 to 22.98 years), and 45 (62.5%) of the 72 patients were male. A total of 56 patients (77.8%) were White, and 69 patients (95.8%) were of non-Hispanic ethnicity. In all, 23 lesions (29.1%) fit the of fast healing. A multivariable regression analysis revealed that high preoperative bone density within the OCD lesion (p < 0.001) was the only feature that had an association with fast healing. A preoperative lesion density rating of ≥70% predicted fast ossification with a sensitivity of 87% and a specificity of 66.1%.

CONCLUSIONS: A preoperative OCD density rating that was ≥70% of that of the normal surrounding bone was found to be the only independent predictor of fast ossification following surgery.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:41678591 | DOI:10.2106/JBJS.25.01026

Surgical Robotic System for Precision Femoral Fracture Reduction

J Bone Joint Surg Am. 2026 Feb 11. doi: 10.2106/JBJS.25.00874. Online ahead of print.

ABSTRACT

Malalignment after femoral fracture repair remains common, with up to one-third of patients experiencing malrotations. Manual femoral fracture reduction remains physically demanding and fluoroscopy-dependent. Surgeons must apply traction forces to overcome forces generated by the surrounding muscles during the reduction process. Current orthopaedic robots, designed primarily for arthroplasty or spine procedures, generally cannot deliver the high traction or torque required for long-bone manipulation. To address the need for controlled high-force manipulation during femoral fracture reduction and to reduce reliance on fluoroscopy for assessing alignment, we developed a novel surgical robotic system. The system combines a 6-degrees-of-freedom (6-DOF) parallel mechanism with a high load capacity, an optical tracking system that provides continuous pose feedback, and a gauge-based graphical interface that displays translational and angular offsets between bone fragments and the target alignment. The system is intended to provide controlled application of clinically relevant traction and torque during femoral fracture reduction. These capabilities reduce reliance on sustained manual traction and support reduction maneuvers that are more repeatable, potentially improving intraoperative alignment consistency and procedural workflow. Future work will focus on hardware and software updates to improve operating-room integration and to expand the usable workspace. It will evaluate the use of artificial intelligence (AI)-assisted registration and 3D visualization to support alignment assessment and automated alignment workflows.

PMID:41671345 | DOI:10.2106/JBJS.25.00874

Increased Critical Shoulder Angle Impairs Tendon-Bone Healing in a Rat Model of Chronic Rotator Cuff Tears

J Bone Joint Surg Am. 2026 Feb 10. doi: 10.2106/JBJS.25.00970. Online ahead of print.

ABSTRACT

BACKGROUND: The role of an elevated critical shoulder angle (CSA) in rotator cuff healing following rotator cuff repair (RCR) remains a subject of clinical controversy. The present study aimed to investigate the effect of increased CSA on tendon-bone interface healing following RCR.

METHODS: A bilateral chronic rotator cuff tear model was established in 48 Sprague-Dawley rats. Acromion lateralization (Acr) surgery was performed unilaterally to increase CSA. After 4 weeks, bilateral RCR was performed. Micro-computed tomography was utilized to measure CSA. Tendon-bone interface healing was assessed at 3, 6, and 9 weeks post-RCR with use of magnetic resonance imaging (MRI), biomechanical testing, gait analysis, and histological evaluation.

RESULTS: The mean CSA in the Acr group was significantly greater than that in the RCR-only group (37.2° ± 2.6° versus 29.7° ± 3.1°; p < 0.001). At 6 and 9 weeks postoperatively, the Acr group demonstrated significantly poorer outcomes on MRI (i.e., higher signal-to-noise quotient), biomechanical strength (i.e., lower ultimate failure load and stiffness), and gait parameters compared with the RCR-only group (p < 0.05). Histological analysis revealed inferior tendon-bone interface integration in the Acr group (p < 0.01), including reduced fibrocartilage formation, disorganized collagen fibers, and a lower collagen I/III ratio. Immunohistochemistry showed significantly higher Piezo1 expression in the Acr group (p < 0.001), suggesting a mechanobiological response to increased mechanical stress.

CONCLUSIONS: An increased CSA impaired tendon-bone interface healing following RCR in a rat model. Although these findings were preclinical, they provide experimental evidence that an increased CSA may influence rotator cuff healing, supporting the potential role of CSA modification (e.g., with acromioplasty) in reducing the risk of retear.

CLINICAL RELEVANCE: The present study provides experimental evidence to support the consideration of CSA reduction in selected high-risk patients undergoing RCR to promote rotator cuff healing and potentially reduce retear rates.

PMID:41666274 | DOI:10.2106/JBJS.25.00970

Medial Unicompartmental Versus Total Knee Arthroplasty in the Treatment of Isolated Anteromedial Knee Osteoarthritis: Two-Year Results from a Double-Blinded, Multicenter, Randomized Trial of 350 Patients

J Bone Joint Surg Am. 2026 Feb 9. doi: 10.2106/JBJS.25.00612. Online ahead of print.

ABSTRACT

BACKGROUND: The superiority of medial unicompartmental knee arthroplasty (mUKA) versus total knee arthroplasty (TKA) for isolated anteromedial knee osteoarthritis (AMOA) remains a subject of ongoing debate. We present the 2-year results of a multicenter, randomized trial comparing the patient-reported and clinical outcomes of these 2 implant types in the treatment of AMOA.

METHODS: This double-blinded superiority trial recruited patients with severe AMOA at 10 arthroplasty centers and randomized them to undergo either mUKA or TKA. The primary outcome was the average improvement in the Oxford Knee Score (OKS) over 2 years, analyzed by intention-to-treat. A range of patient-reported outcomes served as secondary outcomes. Death, revision, and other reoperations were analyzed as serious adverse events (SAEs).

RESULTS: Between September 2017 and March 2021, 350 patients were randomized: 177 (79 female, 98 male; mean age, 67.7 ± 7.5 years) to mUKA and 173 (84 female, 89 male; mean age, 66.7 ± 7.8 years) to TKA. The average 2-year OKS improvement differed by 3.5 points (95% CI, 2.3 to 4.7; p < 0.001) in favor of mUKA, although this difference was below the generally accepted minimal clinically important difference (MCID) of 4 to 5 points. Ten of the 12 secondary outcomes favored mUKA, while the remaining 2 were nonsignificant. The differences in the Forgotten Joint Score (FJS) (14.1; 95% CI, 9.5 to 18.6), range of motion during the first 2 years (7.0°; 95% CI, 5.3° to 8.7°) and at 2 years (5.5°; 95% CI, 3.6° to 7.4°), Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms score (10.3; 95% CI, 7.8 to 12.8), and Short Form-36 (SF-36) bodily pain score (7.6; 95% CI, 4.1 to 11.1) all favored mUKA and reached the MCID. Non-revision reoperations were performed in 4 patients (2.3%) after mUKA and in 12 patients (6.9%) after TKA (9 of the 12 underwent manipulation under anesthesia); the difference was 4.7% (95% CI, 0.2% to 9.8%). There were no differences in the rates of revision or death between the groups.

CONCLUSIONS: Averaged over the 2-year follow-up, mUKA demonstrated minor advantages that did not achieve clear clinical superiority on the basis of the OKS difference. However, the FJS, range of motion, KOOS symptoms score, and SF-36 bodily pain score all demonstrated differences in favor of mUKA that were clinically meaningful. The overall findings suggest that mUKA and TKA yield similarly favorable short-term results, with small advantages for mUKA.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41662451 | DOI:10.2106/JBJS.25.00612

The Association Between Perioperative Denosumab and Local Recurrence After Surgical Management of Giant Cell Tumors: A Meta-Analysis

J Bone Joint Surg Am. 2026 Feb 9. doi: 10.2106/JBJS.25.01058. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have assessed the impact of perioperative denosumab on local recurrence (LR) after surgical management of giant cell tumor (GCT), with conflicting results. This meta-analysis evaluates the association between LR in patients undergoing surgical management of GCT and perioperative denosumab, accounting for the type of surgery, number of denosumab doses, and timing of denosumab administration.

METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were searched until December 5, 2024. The extracted outcomes consisted of LR and denosumab-related complications.

RESULTS: Sixteen studies from 15 cohorts were included in the meta-analysis. The number of patients totaled 1,551: 310 (20%) in the denosumab group (mean age, 32 years; mean follow-up, 40 months) and 1,241 (80%) in the control group (mean age, 32 years; mean follow-up, 62 months). Patients in the denosumab group had a significantly higher rate of LR compared with patients in the control group (odds ratio = 1.82; p = 0.03), and this remained true even when looking at studies using curettage as the only surgical management (odds ratio = 2.75; p < 0.001). In a subgroup analysis by the timing of denosumab administration, a significantly higher rate of LR was only found among patients receiving denosumab both preoperatively and postoperatively (odds ratio for recurrence relative to control = 5.57; p < 0.001). Overall, the reported incidence of denosumab-related complications was 6.5%.

CONCLUSIONS: In this meta-analysis, patients receiving denosumab only preoperatively did not have a significantly increased rate of LR compared with controls. Increased recurrence was observed primarily in patients being treated with both preoperative and postoperative denosumab.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41662446 | DOI:10.2106/JBJS.25.01058

Compensatory Load Sharing by Residual Rotator Cuff Subregions Preserves Glenohumeral Mechanics in Partial and Massive Tears

J Bone Joint Surg Am. 2026 Feb 4. doi: 10.2106/JBJS.25.01073. Online ahead of print.

ABSTRACT

BACKGROUND: Rotator cuff (RC) tears are common shoulder injuries that cause pain, dysfunction, and abnormal humeral head translation. Balanced force couples in the transverse and coronal planes help to maintain normal glenohumeral mechanics. Although clinical and biomechanical studies have suggested that compensatory activation of residual RC muscles preserves function, the contribution of individual RC subregions to glenohumeral contact mechanics and humeral head translations across progressively increasing tear sizes remains unclear.

METHODS: Eight fresh-frozen male cadaveric shoulders (mean age, 56 years; 6 Caucasian; 2 Black) were dissected to isolate RC muscle subregions, and 4 progressive RC tear models were created: Tear I (supraspinatus [SSP] + superior region of the infraspinatus [ISP]), Tear II (SSP + complete ISP), Tear III (SSP + ISP + superior one-third of the subscapularis [SSC]), and Tear IV (SSP + ISP + superior one-third of the SSC + coracohumeral ligament). Each model underwent 3 loading conditions: loaded (as in the intact state), unloaded (i.e., unloading of the torn regions), and compensatory (i.e., increased loading of the remaining subregions). Humeral head translations and glenohumeral contact force, area, and pressure were measured at 10° of abduction with neutral rotation.

RESULTS: Unloaded conditions significantly increased superior and posterior humeral head translations and reduced contact force and area in most models, particularly in Tears III and IV. Compensatory loading by residual RC subregions reduced superior translation by 34% to 44% and posterior translation by 60% to 68%, restoring the humeral head center to within 0.1 to 1.7 mm of its position in the intact condition. Contact forces and areas partially recovered under compensatory loading; however, contact pressure remained elevated in the largest tear model.

CONCLUSIONS: Residual RC subregions can partially restore humeral head centering and glenohumeral contact mechanics in progressive RC tears. However, compensation is limited in advanced tear states, highlighting the potential need for surgical intervention to restore force-couple integrity in the transverse plane.

CLINICAL RELEVANCE: These findings support targeted strengthening of the posterior cuff in patients with partial or early-stage massive RC tears to help maintain joint congruency, minimize abnormal glenohumeral contact mechanics and humeral head translation, and potentially delay the progression to cuff tear arthropathy. Surgical repair, particularly of the SSC, may be required in advanced tears to fully restore force coupling and load distribution.

PMID:41637491 | DOI:10.2106/JBJS.25.01073

Risk Factors for Nonunion Following Lateral Locked Plating of Distal Femoral Fractures: A Bayesian Analysis of 560 Patients

J Bone Joint Surg Am. 2026 Feb 4;108(3):235-243. doi: 10.2106/JBJS.25.00498. Epub 2025 Nov 18.

ABSTRACT

BACKGROUND: Lateral locked plating remains an important treatment strategy for distal femoral fractures but has been associated with nonunion rates ranging from 6% to 20%. The objective of this study was to identify factors associated with nonunion following lateral locked plating of distal femoral fractures with use of a Bayesian analysis.

METHODS: All consecutive patients ≥18 years of age who were treated with lateral locked plating for a distal femoral fracture at 2 Level-I trauma centers between 2006 and 2024 and who had ≥3 months of follow-up were included. Multivariable Bayesian logistic regression analysis was performed to identify factors associated with nonunion, which was defined as a reoperation to promote healing, and the results are reported as odds ratios (ORs) with 95% credible intervals (CrIs). Probabilities of >95% were considered very strong evidence of an association with nonunion, and probabilities of 90% to 95% were considered strong evidence.

RESULTS: A total of 560 patients (median age, 68 years; 29% male; 90% White; 97% non-Hispanic; 41% with distal periprosthetic fractures) were included. Fifty-four patients (9.6%) underwent reoperation to promote healing. There was very strong evidence that multifragmentary comminution of the metaphysis (versus simple fracture: OR, 2.60; 95% CrI, 0.91 to 8.06), medial cortical comminution of >0 to 25 mm (versus 0 mm: OR, 3.11; 95% CrI, 1.35 to 7.48), and varus (lateral distal femoral angle [LDFA] of ≥84°: OR, 3.04; 95% CrI, 1.46 to 6.51) or valgus (LDFA of ≤78°: OR, 2.42; 95% CrI, 0.96 to 5.99) malalignment increased the odds of nonunion. A screw density of ≤0.60 proximal to the working length reduced the odds of nonunion (versus ≥0.81: OR, 0.40; 95% CrI, 0.16 to 0.95), although the size and certainty of this effect varied in the sensitivity analysis that utilized alternative thresholds. There was strong evidence that obesity increased the odds of nonunion (OR, 1.64; 95% CrI, 0.86 to 3.13) and that intact wedge fractures reduced the odds of nonunion (versus simple fracture: OR, 0.35; 95% CrI, 0.05 to 1.74).

CONCLUSIONS: One in 10 patients developed nonunion and underwent reoperation to promote healing. Surgeons should restore coronal plane alignment and may consider augmenting fixation in the presence of multifragmentary comminution. Constructs in which all screw holes proximal to the working length are filled should be avoided, although the optimal configuration remains unclear and depends on other construct characteristics influencing biomechanics. Overall, the small to moderate effect sizes highlight the multifactorial etiology of nonunion following lateral locked plating of distal femoral fractures.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41636737 | PMC:PMC12834285 | DOI:10.2106/JBJS.25.00498

The Ultrasound-Assisted Patellar Glide Test: A Novel Examination Method for Quantifying Patellar Instability

J Bone Joint Surg Am. 2026 Feb 4;108(3):227-234. doi: 10.2106/JBJS.25.00707. Epub 2025 Nov 24.

ABSTRACT

BACKGROUND: Patellofemoral instability is a difficult problem to assess because of its dynamic nature, which is not easily quantified using physical examination techniques. This study aimed to describe and evaluate a novel examination method using stress ultrasonography to quantify patellar instability. The secondary aim was to assess the relationship of stress ultrasonography measurements with clinical and morphologic risk factors for patellar instability.

METHODS: Knees with symptomatic patellar instability underwent the ultrasound-assisted patellar glide test. In this test, the patella was translated laterally from its resting position during ultrasound visualization until an endpoint was reached. The medial patellofemoral distance (MPFD) was used to quantify the gap between the medial boundary of the patella and the trochlea, and the difference in MPFD between the resting (unloaded) and loaded conditions was defined as the delta MPFD. Measurements were compared with those in asymptomatic contralateral knees of patients with unilateral instability, asymptomatic knees after patellar stabilization surgery, and control knees. Regression analyses assessed for relationships of MPFD with morphological and clinical risk factors. Receiver operating characteristic (ROC) curve analysis assessed the ability of stress ultrasonography measurements to discriminate between knees with and without symptomatic patellar instability.

RESULTS: Four hundred and seventy-seven knees in 277 patients were included in this study; 173 of the knees had patellar instability (patient age, 24 ± 8 years; 72% female). Delta MPFD was 3 times greater in knees with patellar instability (median, 3.3 mm [95% confidence interval, 3.1 to 3.4 mm]) than in the contralateral asymptomatic (1.1 mm [0.9 to 1.3 mm]), postoperative (1.0 mm [0.8 to 1.2 mm]), and control knees (1.4 mm [1.1 to 1.6 mm]). ROC analysis demonstrated an optimal threshold value for delta MPFD of 2.0 mm, which had an area under the curve (AUC) of 0.97 (0.94 to 0.99), demonstrating excellent discrimination in identifying knees with patellar instability. No relationships of clinical or morphologic risk factors with delta MPFD were found.

CONCLUSIONS: A delta MPFD of ≥2 mm on the ultrasound-assisted patellar glide test had an AUC of 0.97 for identifying knees with symptomatic patellar instability, indicating excellent discriminatory ability. Additional studies utilizing this method are recommended to standardize and quantify assessments of patellar instability.

LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41636736 | DOI:10.2106/JBJS.25.00707

Intimate Partner Violence in a Patient Population with Orthopaedic Trauma: Gender Disparities, Delayed Disclosures, and Poor Clinical Outcomes

J Bone Joint Surg Am. 2026 Feb 4;108(3):212-218. doi: 10.2106/JBJS.25.00407. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: This prospective cohort study determined the prevalence of intimate partner violence (IPV) across gender groups, investigated timing of disclosures during the standard-of-care follow-up period, and examined if there was an association between IPV and clinical outcomes.

METHODS: This study included 314 patients ≥18 years of age presenting with orthopaedic injuries to the fracture clinics at 2 academic hospitals. Participants were asked about experiences with IPV, return to function, and overall health at each routine clinical follow-up. Cox proportional-hazards regression models were used to explore associations between IPV status and return to work, leisure activities, home responsibilities, and overall functioning.

RESULTS: Of the 528 patients approached, 314 provided consent and completed at least the initial visit. Of these, 184 (58.6%) self-identified as women, 126 (40.1%) identified as men, and 3 (1.0%) self-identified as non-binary. Forty-six percent of women reported lifetime experience of IPV, compared with 35% of men and 100% of gender-diverse participants. A smaller proportion of men who disclosed IPV did so at their first visit compared with women, especially with respect to sexual IPV: 6 men (50.0%) compared with 42 women (79.2%). During follow-up, 16 participants (6.7% of 238 who returned to the clinic at least once), including 8 men, 7 women, and 1 gender-diverse participant, disclosed experiencing IPV during their recovery period. Disclosing IPV at any visit was associated with a 45% lower likelihood of returning to a pre-injury level of function with respect to work (hazard ratio [HR], 0.55 [95% confidence interval (CI), 0.33 to 0.91]; p = 0.021) and a 36% lower likelihood of returning to a pre-injury overall level of functioning (HR, 0.64 [95% CI, 0.46 to 0.90]; p = 0.01).

CONCLUSIONS: Results showed an unacceptably high prevalence of IPV in all genders. Gender differences in timing of disclosure emphasize the need for tailored approaches in clinical settings and repeated opportunities for IPV disclosure. This study emphasizes the hidden nature of IPV among patients with orthopaedic trauma and its effects on their health and recovery.

LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

PMID:41636735 | PMC:PMC12834265 | DOI:10.2106/JBJS.25.00407

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