Int Orthop. 2026 Feb 7. doi: 10.1007/s00264-026-06749-8. Online ahead of print.

NO ABSTRACT

PMID:41653230 | DOI:10.1007/s00264-026-06749-8

Int Orthop. 2026 Feb 7. doi: 10.1007/s00264-026-06748-9. Online ahead of print.

ABSTRACT

PURPOSE: Reverse Shoulder Arthroplasty (RSA) is widely used to treat shoulder joint pathologies. However, this procedure may result in reduced range of motion (ROM), scapular notching, and prosthetic instability. These complications vary among patients, highlighting the need for individualized preoperative planning. This study introduces a novel parametric methodology to determine optimal glenoid component positioning by evaluating ROM, instability ratio, and the percentage of bone resected.

METHOD: The proposed approach was applied to four patient models treated with two prosthetic designs. The methodology consists of four steps within a patient-specific parametric tool: 3D anatomical reconstruction, virtual surgical planning, biomechanical and geometric evaluation, and identification of optimal configurations. Fifteen glenoid component orientations were generated by varying tilt angles. The best configurations were identified based on ROM and instability assessments, while bone resection volume was calculated as an additional parameter.

RESULTS: Maximum values of abduction-adduction, internal rotation, and external rotation were 87.23°, 90°, and 70.59°, respectively, although not achieved in a single configuration. Instability ratios ranged from 0.23 to 0.62. Bone resection varied between 0.4% and 5.5%, depending on the configuration.

CONCLUSIONS: This methodology provides a patient-specific framework to support preoperative planning in RSA. By combining ROM analysis, instability assessment, and bone preservation, the approach enables the identification of glenoid component orientations that improve mobility while minimizing instability risk and surgical invasiveness.

PMID:41653229 | DOI:10.1007/s00264-026-06748-9

Injury. 2026 Jan 30:113082. doi: 10.1016/j.injury.2026.113082. Online ahead of print.

ABSTRACT

BACKGROUND: The Noto Peninsula earthquake of January 1, 2024, was the most destructive seismic event in Japan since 2011, affecting a region characterized by its super-aging population, geographical isolation, and status as a medically underserved area. These vulnerabilities require a detailed analysis of the acute-phase medical response to improve disaster preparedness in similar environments. This study aims to characterize the morbidity and features of earthquake-affected patients admitted to a regional tertiary university hospital.

METHODS: We conducted a retrospective observational study of patients presenting to the emergency department of Kanazawa University Hospital between January 1, 2024, and January 31, 2024, with earthquake-related conditions. Patients with direct trauma or secondary health issues (e.g., exacerbation of chronic illness) were identified by a multidisciplinary Disaster Response Committee. All patients were triaged using the Japan Triage and Acuity Scale (JTAS). Descriptive statistics were used to summarize demographics, clinical characteristics, and transport modalities.

RESULTS: A total of 144 earthquake-related patients were managed. The cohort was characterized by a high mean age (79.7 years) and a female predominance (61.1%). The primary medical burden was the exacerbation of intrinsic diseases (74.3%), while trauma cases were less frequent (23.6%). The majority of patients presented with low to moderate acuity; severe cases (JTAS Levels 1-2) constituted 7.0% of the cohort, whereas low-acuity Level 4 was the largest (63.2%). Patient transport peaked on day five, almost exclusively by air evacuation (97.7% of arrivals that day), which was essential to overcome extensive road damage. The base-isolated hospital sustained no major damage and remained fully operational, serving as a regional DMAT command post.

CONCLUSIONS: The medical response to the Noto earthquake highlights a paradigm shift in disaster care for aging societies, where management of geriatric and chronic diseases takes precedence over mass-casualty trauma care. In isolated regions, air evacuation is a critical yet weather-vulnerable modality for effective patient transport. Future disaster preparedness requires a dual focus: medical response plans must prioritize systems for chronic and geriatric care, and strategic investment in seismically resilient tertiary hospitals is essential for them to function as stable operational hubs, ensuring regional continuity of care.

PMID:41651684 | DOI:10.1016/j.injury.2026.113082

Injury. 2026 Jan 30:113077. doi: 10.1016/j.injury.2026.113077. Online ahead of print.

ABSTRACT

INTRODUCTION: Post Traumatic Stress Disorder (PTSD) is not uncommon following major trauma. Despite increasing awareness of the psychological sequelae of trauma, there is often inadequate mental health follow-up for trauma patients. This can lead to significant rates of under-diagnosis and under-treatment.

AIMS: To examine rates of under-diagnosis and under-treatment of probable PTSD amongst major trauma patients admitted to Christchurch Hospital, New Zealand.

METHODS: A prospective questionnaire-based cohort study including patients 16 years and older who presented to Christchurch Hospital with major trauma (Injury Severity Score >/=12) between May 2016 and September 2018. Patients with severe brain injury were excluded. Patients who consented completed the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), plus answered questions on any assessment, treatment or diagnosis of PTSD, depression or anxiety before and/or after injury. Demographic, injury-specific and hospital care data were collated from the New Zealand Major Trauma Registry.

RESULTS: There were 836 patients who met the eligibility criteria and were invited to participate in the study, with a 24% response rate (203 patients). Thirty-seven (18%) scored at or above the PTSD threshold, however only 8 (22%) reported having received a formal diagnosis of PTSD. All 8 patients who had received a formal diagnosis of PTSD were receiving some form of mental health treatment (either medication, 'talk therapy' or both). By comparison, within the group of 29 patients who had not received a diagnosis of PTSD but met criteria, only 11 (38%) were receiving any form of mental health treatment.

CONCLUSION: Many people who develop PTSD following trauma fail to receive appropriate assessment, diagnosis or treatment. Further work is needed to ensure adequate systems are in place to allow identification and treatment of patients who develop PTSD following a major trauma.

PMID:41651683 | DOI:10.1016/j.injury.2026.113077

Injury. 2026 Jan 26:113065. doi: 10.1016/j.injury.2026.113065. Online ahead of print.

ABSTRACT

BACKGROUND: Early and adequate analgesia is a critical component of injury care. While sociodemographic factors have been shown to impact the adequacy of analgesia in a variety of clinical settings, these relationships are poorly understood in trauma care. Our objective was to evaluate the association between patient and provider characteristics and time to analgesia during trauma resuscitation.

METHODS: We performed a retrospective cohort study of adult (age ≥ 16) patients presenting as trauma activations at a level I trauma center over 2 years (2019-2020). Data were derived from the institutional trauma registry and chart review. Time from presentation to first administration of analgesia was recorded. The primary outcome was delayed analgesia, defined as analgesia administered later than the 75th percentile of time to analgesia for all patients. Multivariable logistic regression was used to evaluate the effect of age, sex, and socioeconomic status on analgesia timing.

RESULTS: Among 2497 patients meeting inclusion criteria (mean age 44.8 years [SD 21.6], 25.7% female), 1957 (77.5%) received analgesia in the trauma bay. Among patients who received analgesia in the trauma bay, median time to analgesia was 9 min (IQR 7-14). The only sociodemographic characteristic independently associated with delayed analgesia was age. Relative to patients aged 16-54, those aged 55-64 were 1.5-fold more likely to receive delayed analgesia (OR 1.46; 95% CI 1.05-2.03), while those aged ≥ 65 were twice as likely to have delayed analgesia (OR 2.16; 95% CI 1.58-2.95). Irrespective of age or injury severity, patients injured in falls were more likely to experience delayed analgesia (OR 1.64; 95% CI 1.20-2.23).

CONCLUSION: Older adults and patients injured in a fall are more likely to experience delays in receiving analgesia. Strategies that ensure equity in pain management are needed such that all patients have equitable access to early and adequate pain control after injury.

PMID:41644342 | DOI:10.1016/j.injury.2026.113065

Injury. 2026 Jan 30:113076. doi: 10.1016/j.injury.2026.113076. Online ahead of print.

ABSTRACT

INTRODUCTION: Rapid economic growth may impact trauma mortality. We investigated the epidemiology, risk factors and trends in hospital mortality of admitted trauma patients in Guyana during a 5-year period of rapid economic growth in this country.

PATIENTS AND METHODS: The study was conducted at the Georgetown Public Hospital Corporation, Guyana's largest tertiary healthcare facility. The medical records of all patients admitted following trauma between 2018 and 2022 were reviewed. Patient demographics, injury characteristics, and clinical outcomes (mortality and length of stay) were obtained for each study year. Univariate analyses assessed the distributions of all variables while adjusted regression analyses were used to identify potential risk factors for in-hospital mortality. P-values ≤ 0.05 were considered statistically significant.

RESULTS: The in-hospital mortality rate was 3.5% (n=190). The highest in-hospital mortality rate occurred among burns patients (11.2%), and the lowest from assaults (1.9%). Risk factors for death were mechanism of injury, ethnicity, injury severity at presentation, and age. The leading mechanisms of injury for trauma-related deaths were motor vehicle crashes (39.5%) and falls (24.7%). Females had over twice the rate of death from falls compared to males (6.3% vs. 3.1%). Among ethnicities, Indo-Guyanese patients had the highest odds of dying from trauma compared to Afro-Guyanese (OR 2.37 CI 1.57-3.56, p<0.01) primarily driven by motor vehicle crashes (OR 3.29, CI 1.65, 6.55 p<0.01). The median (Q1, Q3) length of stay was 3 (1, 6) days. Most patients (73.5%) died within 7 days of admission. Late deaths (≥24h of admission) occurred in 53.6% of patients. Annual mortality rates fluctuated during the study period coinciding with Covid -19 restrictions but rose overall by 86.5% from 3.7% in 2018 to 6.9% in 2022. Annual comparisons of mortality rate with GDP growth rate showed parallel increases over most of the study period.

CONCLUSION: This study provides evidence to support targeted clinical practice and public health initiatives to prevent increases in trauma mortality in Guyana and other rapidly developing countries facing rising injury risks.

PMID:41644341 | DOI:10.1016/j.injury.2026.113076

Injury. 2026 Jan 30;57(3):113081. doi: 10.1016/j.injury.2026.113081. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma is a leading global health challenge, with hemorrhage being a major cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively halts hemorrhage but poses risks such as ischemic injury, especially to the kidneys. Partial REBOA (pREBOA) mitigates these effects by allowing limited distal blood flow. This study investigates crystalloid resuscitation as an alternative to whole blood during pREBOA release in a swine model, where all groups received an additional 2000 mL of Ringer's acetate prior to balloon deflation.

MATERIALS AND METHODS: 15 castrated male swine weighing 51-65 kg underwent controlled mean (SD) hemorrhage of 1200 (233) mL, followed by 60 minutes of pREBOA application and a 20-minute resuscitation phase, where the animals were randomized into three groups: low Ringer's acetate (0 mL) (n=5), high Ringer's acetate (2000 mL) (n=5), or whole blood transfusion (1000 mL)+ Ringer's acetate (1000 mL) (n=5). Hemodynamic variables, metabolic parameters, and renal blood flow were continuously monitored. Animals were observed for 60 minutes post-REBOA deflation.

RESULTS: High-volume Ringer's acetate improved stroke volume compared to low-volume crystalloids (p<0.001) and reduced heart rate (p<0.005) and systemic vascular resistance (p<0.01) immediately post-resuscitation. Hemoglobin levels were lower in the high-volume group than in the low-volume group (p<0.01), persisting for 40 minutes. Potassium remained within physiological limits.

CONCLUSION: Crystalloid resuscitation during pREBOA maintained mean arterial pressure and cardiac output comparable to whole blood, with high-volume crystalloids offering superior hemodynamic support compared to low-volume resuscitation. High-volume crystalloids improved stroke volume. Metabolic stability was preserved across groups, with no severe derangements observed. These findings highlight crystalloids as a potential alternative in resource-limited settings, although reduced renal perfusion warrants further investigation to optimize outcomes and ensure broader clinical applicability.

PMID:41643361 | DOI:10.1016/j.injury.2026.113081

Injury. 2026 Jan 25;57(3):113037. doi: 10.1016/j.injury.2026.113037. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to enhance wound healing using a novel natural cocktail gel dressing composed of purslane, human amniotic membrane (hAM), and platelet-rich plasma (PRP). In addition, a new ratio-based analytical approach was applied to evaluate the healing dynamics in each treatment group, revealing correlations between the healing rate and the respective treatment compound.

METHODS: Under aseptic conditions, specific amounts of freeze-dried decellularized hAM, PRP, and hydroalcoholic extract of purslane (HAEP) powder were prepared. The study groups included hAM gel, PRP gel, HAEP gel, a cocktail gel (HAEP + PRP + hAM), and phenytoin gel (positive control). Cytotoxicity was evaluated using the MTT assay. In vivo, seven groups were assessed on days 7, 14, and 21. Wound closure rate was analyzed via photographic imaging, and tissue samples were collected for H&E staining. Wound healing dynamics were further evaluated using 14/7-day and 21/14-day ratios.

RESULTS: The cocktail gel significantly enhanced wound healing compared with other groups (p < 0.05), improving cell migration, M2 macrophage polarization, and angiogenesis. The ratio-based analysis indicated that the cocktail group exhibited the fastest healing between days 7 and 14, while purslane and hAM groups showed superior healing between days 14 and 21.

CONCLUSIONS: This study introduces the use of 14/7 and 21/14-day ratios for the first time as a quantitative measure of healing progression, bridging macroscopic closure rates with underlying cellular and molecular changes. The combination of purslane, PRP, and hAM significantly accelerated healing and reduced closure time, suggesting a synergistic effect. The proposed ratio-based approach provides a more accurate evaluation of wound healing phases.

PMID:41643360 | DOI:10.1016/j.injury.2026.113037

Injury. 2026 Jan 23;57(3):113059. doi: 10.1016/j.injury.2026.113059. Online ahead of print.

ABSTRACT

Acute compartment syndrome (ACS) is a surgical emergency that remains challenging to diagnose. Diagnosis is primarily clinical, with invasive intracompartmental pressure (ICP) monitoring recommended when available. However, clinical findings can be unreliable, and invasive ICP measurement carries procedural risks. Ultrasound has increasingly been investigated as a noninvasive diagnostic method for ACS. This review analyzed all reported uses of ultrasound in the context of ACS. Six primary ultrasound techniques were identified: conventional two-dimensional (2D) ultrasound, Doppler ultrasound, pulse phase-locked loop (PPLL) ultrasound, contrast-enhanced ultrasound (CEUS), pressure-related ultrasound (PrUS), and shear-wave elastography (SWE). Each method was described according to its mechanism and theoretical basis, then evaluated for its current clinical relevance. SWE appeared to hold the greatest promise for clinical implementation, with additional potential noted for Doppler ultrasound and tibial fascia angle (TFA) measurements. PrUS, CEUS, and PPLL showed practical limitations that currently restrict clinical application, though further research may address these concerns. Ultrasound offers a noninvasive, repeatable means of quantitatively assessing multiple compartments without the pain or infection risk associated with invasive ICP monitoring. While several methods demonstrate promise, none have yet been validated for clinical adoption. Larger, standardized clinical trials are needed to confirm their diagnostic accuracy and utility.

PMID:41643359 | DOI:10.1016/j.injury.2026.113059

EFORT Open Rev. 2026 Feb 4;11(2):119-130. doi: 10.1530/EOR-2025-0139.

ABSTRACT

BACKGROUND: Stress shielding of the proximal humerus represents an increasing challenge for the implantation of total shoulder arthroplasty (TSA). The literature on this topic is heterogeneous, and many studies analysing its clinical impact are underpowered, justifying a systematic review of current evidence.

MATERIALS AND METHODS: On 1 September 2024, the Cochrane Library, PubMed, and Web of Science were searched for studies on stress shielding in shoulder arthroplasty. All studies meeting inclusion criteria were included in the qualitative review. Clinical significance was assessed through a meta-analysis of studies comparing patients with and without stress shielding using Constant-Murley score (CS) and American Shoulder and Elbow Surgeons (ASES) score.

RESULTS: Of 299 identified studies, 58 studies were included in the qualitative review and 13 studies were included in the meta-analysis. Key risk factors consistently associated with stress shielding were press-fit or long stems and high stem-to-humerus filling ratios (FRs), with threshold values of <0.7 or <0.8. Other potential risk factors include older age, poor bone quality, fracture arthroplasty, and stem length. The meta-analysis showed a statistically significant 5.6-point improvement in Constant scores for the non-stress shielding group at two years, although this fell below the minimal clinically important difference threshold and did not affect revision rates at mid-term follow-up.

CONCLUSION: Stress shielding is a frequent radiographic finding in TSA and RTSA. Although statistically significant, its clinical impact appears limited, and revision rates remain unaffected in the mid-term. Avoiding high FRs and careful implant selection may help reduce its occurrence and preserve bone stock.

PMID:41636254 | PMC:PMC12881896 | DOI:10.1530/EOR-2025-0139

EFORT Open Rev. 2026 Feb 4;11(2):96-106. doi: 10.1530/EOR-2024-0060.

ABSTRACT

PURPOSE: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of minimally invasive (MIS) posterior/posterolateral approaches and traditional posterolateral approaches in total hip arthroplasty (THA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted literature searches based on the PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies comparing MIS and traditional posterolateral approaches in THA. Harris Hip Score (HHS), visual analog scale (VAS), operation time, incision length, intraoperative blood loss, and complications were analyzed.

RESULTS: Twenty studies with 1,713 patients were included in our meta-analysis. The pooled results showed that MIS approaches resulted in significantly higher HHSs, lower VAS scores, reduced intraoperative blood loss, and shorter incision length compared to the traditional posterolateral approach. While no significant difference was found in operation time and complication between the two groups.

CONCLUSION: Based on current evidence, MIS approaches appear to offer superior efficacy compared to traditional posterolateral approaches in THA.

PMID:41636253 | PMC:PMC12880965 | DOI:10.1530/EOR-2024-0060

EFORT Open Rev. 2026 Feb 4;11(2):107-118. doi: 10.1530/EOR-2024-0146.

ABSTRACT

PURPOSES: Femoral shortening osteotomy is a promising surgical intervention for patients with the sequelae of high hip dysplasia who need a THA. It offers potential benefits such as preserving limb length, reducing joint stiffness, and preventing neurovascular damage. However, it is considered a complex procedure with a high risk of complications. Various techniques are employed, and their relative safety remains unclear. What is the prevalence of complications (e.g. non-union and dislocations) and rates of revision associated with different techniques of femoral shortening osteotomy?

METHODS: A systematic review was conducted according to the PRISMA guidelines. Multiple databases were searched for studies reporting complications of various femoral shortening osteotomies. Two independent reviewers selected studies, extracted data, and assessed bias. Proportional meta-analysis was employed to estimate non-union rates, while other complications and revisions were described using alluvial diagrams. The study has been registered in the PROSPERO database (CRD42023488761).

RESULTS: In total, 53 studies (comprising 1,925 hips undergoing osteotomy) were included. The transverse subtrochanteric shortening osteotomy emerged as the most frequently utilized technique. There was an overlapping prevalence of non-union rates among the different osteotomy techniques, ranging from 0% (step-cut osteotomies) to 2% (transverse osteotomies). A higher non-union prevalence was observed with cemented stems in transverse osteotomies (4%, 95% CI: 0-9%). Dislocation rates were similar among techniques. The rate of stem aseptic loosening ranged from 7.14% (Z osteotomy) to 0% (step-cut and V-shaped osteotomies). Oblique osteotomy exhibited the highest infection rate (2.63%).

CONCLUSION: Overall, comparable rates of non-union were observed across osteotomy techniques. Heterogeneous results for other complications showed a low risk for all osteotomies.

LEVEL OF EVIDENCE: Level IV, therapeutic study.

PMID:41636252 | PMC:PMC12881905 | DOI:10.1530/EOR-2024-0146

EFORT Open Rev. 2026 Feb 4;11(2):72-84. doi: 10.1530/EOR-2025-0147.

ABSTRACT

Bone homeostasis, a dynamic equilibrium essential for skeletal development and repair, is coordinately regulated by osteoclasts, osteoblasts, and osteocytes. Hereditary metabolic bone diseases arise from genetic mutations that impair the function of these key bone cells, disrupting the homeostatic balance. This review specifically addresses four prevalent hereditary metabolic bone diseases: osteogenesis imperfecta, Paget's disease of bone, hypophosphatemic rickets, and osteopetrosis. Dysfunction in major signaling pathways - notably the Wnt/β-catenin, RANK/RANKL/OPG, and TGF-β/BMP pathways - plays a central role in the aberrant bone remodeling underlying these disorders. Elucidating the molecular mechanisms involving these cells and pathways is fundamental to understanding disease pathogenesis and is crucial for the development of novel therapeutic interventions, presenting significant promise for future research.

PMID:41636248 | PMC:PMC12881898 | DOI:10.1530/EOR-2025-0147

EFORT Open Rev. 2026 Feb 4;11(2):131-144. doi: 10.1530/EOR-2024-0136.

ABSTRACT

PURPOSE: There is a lack of consensus regarding the optimal intramedullary nailing (IMN) strategy for humeral shaft fractures (HSFs): both antegrade IMN (aIMN) and retrograde IMN (rIMN) are used. We aim to compare both strategies in terms of outcomes and complications.

METHODS: MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases were searched for articles in English or Spanish from inception to Nov 23, 2023. All studies reporting on primary treatment of acute HSFs (OTA/AO 12A, 12B, and 12C) with rigid locked IMN, in patients aged 16 years or older, were analyzed. Two independent reviewers screened studies for eligibility, performed data extraction, and used RoB 2, ROBINS-I and JBI's critical appraisal tools to assess bias of the included studies. Stata 18.0 software for data analysis was used. Subgroup analysis was performed to explore heterogeneity. We applied GRADE to appraise our evidence.

RESULTS: Nine studies involving 565 fractures were included. aIMN showed significantly faster operative time than rIMN (MD = -14.40 min (95% CI: -17.75 to -11.04); I 2 = 0%; P < 0.001), and rIMN showed significantly higher odds of intraoperative fractures than aIMN (RD = 0.05% (95% CI: -0.08% to -0.02%); I 2 = 0%; P < 0.005). In contrast, aIMN showed significantly higher odds of worse shoulder function and pain complaints and worse Neer scores than rIMN (P = 0.02, P = 0.03 and P = 0.02, respectively).

CONCLUSIONS: Compared with rIMN, aIMN demonstrated a significantly faster operative time and lower rates of intraoperative fractures. Conversely, rIMN demonstrated lower rates of shoulder pain complaints and better shoulder function and Neer score outcomes.

PMID:41636245 | PMC:PMC12881897 | DOI:10.1530/EOR-2024-0136

EFORT Open Rev. 2026 Feb 4;11(2):85-95. doi: 10.1530/EOR-2025-0165.

ABSTRACT

The need to collect objective outcome parameters digitally is increasing in both clinical practice and research. Step count is a frequently utilized digital mobility outcome (DMO) in orthopedic traumatology; however, its usefulness to monitor the patient recovery process remains unclear. The aim of this scoping review is to investigate the application and utility of daily patient step count as a DMO in musculoskeletal injuries. PubMed and consensus.app were queried. Eligibility criteria included the following: articles published within 20 years including patients with orthopedic trauma conditions and utilizing daily step count as an outcome. The type of study, case numbers, conditions investigated, use/usefulness of step count, duration of assessment, sensor use and location, and data harvesting specifics were assessed. Totally, 40 articles were analyzed, revealing an increasing trend in annual publications. The majority of studies were observational (93%), with a mean of 103 participants (range: 9-666). Proximal femur fractures (n = 7), anterior curciate ligament (ACL) injuries (n = 6), and joint replacement (n = 5) were the most frequently investigated conditions. Overall, 30% of studies used step count to demonstrate an association with patient-reported outcome measures, while 27% employed it to identify differences between study groups. Research-grade accelerometers/inertial measurement units (73%) were the most common sensors, with continuous measurement durations from 4 to 14 days. This review indicates an increasing use of step count as an objective DMO in the orthopedic trauma surgery literature. However, the implementation, application, setup, and data acquisition methodologies remain underexplored. This review highlights current trends and identifies key areas requiring further investigation in future research.

PMID:41636244 | PMC:PMC12881899 | DOI:10.1530/EOR-2025-0165

Injury. 2026 Jan 29;57(3):113054. doi: 10.1016/j.injury.2026.113054. Online ahead of print.

ABSTRACT

BACKGROUND: Literature increasingly suggests that suture button (SB) fixation yields higher functional outcome scores, specifically the American Orthopaedic Foot Ankle Society (AOFAS) Ankle-Hindfoot score and the Olerud-Molander Ankle Score (OMAS), compared with syndesmotic screws (SS). This umbrella review evaluates whether these differences extend beyond statistical significance and meet thresholds for clinical relevance, using the Minimal Clinically Important Difference (MCID) as reference standard.

METHOD: A comprehensive PubMed search identified systematic reviews and meta-analyses published between 2010 and 2025. The methodological quality was assessed using the Joanna Briggs Institute checklist. Reported AOFAS and OMAS outcomes, as well as mean differences between SB and SS fixation, were extracted or independently calculated. These values were evaluated against established MCID ranges (OMAS 7.5-11.4, AOFAS 4.1-7.8), to determine whether statistically significant findings corresponded to clinically meaningful improvements RESULTS: Nineteen systematic reviews were included, of which fifteen performed a meta-analysis. Across these reviews, SB fixation was reported 18 times to result in statistically higher AOFAS and/or OMAS compared with SS fixation. However, most weighted mean differences fell below the MCID thresholds: in 11 reviews for OMAS and in 12 reviews for the AOFAS did not reach clinical relevance. Only one review reported an OMAS difference within the MCID range, and seven reviews reported AOFAS differences within or above the MCID range. These findings indicate that, although statistically significant results were observed, the corresponding functional gains were generally too small to be clinically meaningful.

CONCLUSION: While SB fixation often demonstrates superior functional scores relative to SS fixation, these differences seldom exceed established MCID thresholds. The clinical relevance of these improvements therefore remains uncertain. As routine removal of syndesmotic screws is no longer advocated in the contemporary literature, and considering the findings of the present study, one could argue that the cost-effectiveness of using a suture-button in under scrutiny. Future studies should focus on refining MCID values for ankle-specific PROMs and improving methodological rigour in systematic reviews and meta-analyses to better determine whether SB fixation provides a meaningful advantage for patients.

PMID:41638088 | DOI:10.1016/j.injury.2026.113054

Injury. 2026 Jan 23;57(3):113063. doi: 10.1016/j.injury.2026.113063. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal locking during intramedullary femoral nailing remains a technically demanding and radiation-intensive procedure. Since the last systematic review by Whatling et al., numerous innovations over the past two decades have aimed to improve accuracy, shorten operative time, reduce radiation exposure, and simplify the learning curve. A comprehensive synthesis of available techniques is lacking in the recent literature.

METHODS: A systematic review was conducted, according to PRISMA guidelines, including all studies published between January 2006 and January 2025 that reported on distal locking techniques for femoral intramedullary nails. Five databases (PubMed, Cochrane, Embase, Web of Science, Google Scholar) were screened using predefined keywords. Data were extracted on technique type, associated advantages and disadvantages, operative time, radiation exposure, accuracy, and complication rates. Risk of bias was assessed using RoB 2, ROBINS-I, JBI, NOS, and ROBIS as appropriate. PROSPERO registration: CRD42025626521 RESULTS: Thirty-six studies met the inclusion criteria, covering several categories: fluoroscopy-free techniques, modification of traditional freehand, targeting devices, and navigation-assisted systems (electromagnetic, robotic, optical, laser-guided). Low-tech solutions such as the "nail-over-nail" or auditory-guided techniques demonstrated promising accuracy in low-resource settings but lacked standardization. Meta-analyses confirmed the efficacy of electromagnetic navigation systems, particularly in reducing radiation exposure and operative time, without compromising success rates. Overall, navigation-based systems showed significant reductions in radiation time and promising accuracy across multiple trials.

CONCLUSION: This review highlights the broad spectrum of available distal locking techniques, from conventional approaches to advanced technological solutions. Navigation-assisted systems offer measurable benefits but remain limited by cost and accessibility. Simpler mechanical or acoustic methods remain relevant alternatives in specific contexts. No universal gold standard currently exists that can fully replace "freehand technique". Technique selection should be guided by clinical context, surgeon experience, and available resources. Ultimately, technique adoption will depend on clinical context, available resources, and surgeon familiarity.

PMID:41638087 | DOI:10.1016/j.injury.2026.113063

Injury. 2026 Jan 27;57(3):113061. doi: 10.1016/j.injury.2026.113061. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal radius fractures (DRFs) are frequently managed with volar locking plates (VLP). The Soong classification, which grades plate prominence relative to the volar rim, is widely used because of its association with flexor tendon irritation, but its value in predicting postoperative radiographic restoration and patient-reported outcomes is less clear. This study examined whether Soong grade correlates with alignment (radial height and radial inclination) and patient-rated outcomes after VLP fixation of DRFs.

METHODS: We conducted a retrospective review of consecutive patients undergoing surgical fixation for DRF, 44 met the inclusion criteria. Demographics, fracture characteristics, operator grade, time from injury to operation, radiation dose, postoperative imaging and clinic utilisation, antibiotic use, and a patient-rated outcome score were collected. Pre- and postoperative anteroposterior radiographs were used to measure radial height and radial inclination. Plate prominence was graded as Soong 0-2.

RESULTS: The cohort was predominantly female (72.7%) with a mean age of 53.5 years (range 23-82, SD 16.3). Most fractures were intra-articular (88.6%) and dorsally angulated (79.5%). Mean time from injury to operation was 9.8 days (SD 5.8). Patient-rated outcome scores typically ranged 60-80 and did not appear to vary by sex, operator grade, or fracture configuration. By Soong grade, Grade 0 (n = 23) demonstrated the most favourable radiological restoration with mean postoperative radial height 13.6 mm and inclination 26.4°, alongside the highest mean patient-rated outcome score of 74.1. Grade 1 (n = 14) showed slightly lower restoration (radial height 12.1 mm, inclination 26.4°) and a mean outcome score of 65.3 with wider variability. Grade 2 (n = 7) had the least favourable radiology (radial height 11.7 mm, inclination 24.3°) and the lowest mean outcome score of 61.5; one patient in this group underwent plate removal for flexor tendon irritation.

CONCLUSIONS: In this single-centre retrospective series of VLP fixation for DRF, lower Soong grade-particularly Grade 0-was associated with better restoration of radial height and inclination and higher patient-rated outcome scores, whereas higher grades demonstrated a stepwise reduction in radiographic and functional results. These findings support meticulous plate positioning to minimise volar rim prominence and justify prospective, adequately powered studies to confirm the observed trends and evaluate longer-term tendon-related complications.

PMID:41638086 | DOI:10.1016/j.injury.2026.113061

Injury. 2026 Jan 9;57(3):113028. doi: 10.1016/j.injury.2026.113028. Online ahead of print.

ABSTRACT

Hydrogels have emerged as effective tools in medication delivery and tissue engineering due to their adjustable characteristics and water retention capabilities. The purpose of this work was to investigate the potential of a novel thermosensitive hydrogel composed of Pluronic F127 and polyglutamic acid (PGA) to enhance the treatment of MRSA-infected full-thickness excision wounds. The viscosity and gelation temperature of the hydrogels were evaluated using viscometry and rheometry, while their injectability was assessed with a texture analyzer. Swelling and biodegradation were measured in PBS at 37 °C, and antibacterial and antioxidant activity was determined using MIC/MBC tests and DPPH radical scavenging. In mouse infected wound healing investigations, hydrogels were applied to wounds, and tissue examination was done with Masson's Trichrome staining and biochemical assays for TAC and MDA. The F127/PGA hydrogel converted from a liquid to a gel at body temperature more efficiently than F127 alone, with lower gelation temperatures and improved mechanical characteristics. F127/PGA had higher swelling capacity and a slower degradation rate than F127. In antibacterial assays, the F127/PGA hydrogel showed stronger inhibitory and bactericidal activity against MRSA, as reflected by its lower MIC and higher MBC values. In addition, the hydrogel showed increased antioxidant activity and lower oxidative stress during wound healing, resulting in much better wound contraction and tissue regeneration than F127 and control treatments. These characteristics make F127/PGA an attractive choice for improved drug delivery systems and wound healing applications.

PMID:41638085 | DOI:10.1016/j.injury.2026.113028

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