Injury. 2026 Apr 8;57(6):113257. doi: 10.1016/j.injury.2026.113257. Online ahead of print.

ABSTRACT

OBJECTIVES: Acute cervical spine injury is an uncommon but serious sequela of blunt trauma. Patients presenting with multi-trauma to the Emergency Department usually receive CT imaging for cervical spine clearance; however, many of these patients have ongoing pain despite a negative CT and proceed to an MRI. This can entail delays in care, transfer between hospitals, prolonged periods of cervical spine immobilisation, and increased healthcare costs. The aim of the study is to identify the rate of acute cervical spine injury detected on MRI following negative CT and the impact of these findings on subsequent patient management.

METHODS: A retrospective analysis was conducted to identify adults presenting with blunt trauma from 2015 to 2023 who underwent MRI following a negative CT for possible cervical spine injury.

RESULTS: Of 849 patients who proceeded to MRI after a negative CT, 161 (19.0%) demonstrated evidence of cervical spine injury on MRI. 19 patients (11.8% of patients with positive findings; 2.2% of the overall cohort) had radiological injuries which were unstable or potentially unstable. 70 patients (8.3% of all patients who proceeded to MRI, 43.5% of those with abnormal findings) had a change in management based on MRI findings. In most cases, this was a hard collar with no need for surgery. 7 patients in the cohort (0.82%) required acute neurosurgical intervention. Patients with positive findings were older (OR 1.01 (1.01-1.02), p = 0.003) and less likely to have had a motor vehicle accident (OR 0.69 (0.48-0.997), p = 0.048). Increasing age and focal neurology were predictors of need for acute neurosurgical intervention.

CONCLUSIONS: MRI for evaluation of suspected cervical cord injury has low yield for alert patients following blunt trauma with a negative CT, with a minority of patients requiring change in management and very few proceeding to acute neurosurgical intervention. More judicious patient selection including consideration of age, mechanism and presence of neurology may improve resource use and avoid unnecessarily prolonged immobilisation.

PMID:41962196 | DOI:10.1016/j.injury.2026.113257

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.00551. Online ahead of print.

ABSTRACT

BACKGROUND: Bone density can impact treatment decisions for orthopaedic conditions. While ad-hoc intraoperative surgeon assessment of bone quality is common, the accuracy of such evaluation remains unknown. The primary purpose of this study was to determine whether orthopaedic surgeons' intraoperative assessment of bone quality closely correlated with validated measures.

METHODS: In this prospective cross-sectional study, we enrolled adult patients undergoing orthopaedic surgery at a Level-I trauma center. Eligibility required an opportunistic computed tomography (CT) scan of the lumbar spine, glenoid, wrist, pelvis/femur, proximal tibia, or calcaneus. Seven surgeons, blinded to objective measures of bone quality, provided intraoperative bone-quality assessments using a 10-point Likert scale and categorized bone quality as normal, osteopenic, or osteoporotic. Hounsfield units (HUs) were measured on CT using a previously published technique. All images were reviewed by a single orthopaedic surgeon, blinded to intraoperative bone-quality assessments.

RESULTS: Of the 229 patients enrolled, 215 had available CT data and were included in the study. The average age of these patients was 44 years (range, 18 to 95 years), with 40.5% being female. Over half of the patients (61%) were Black or African American, while a quarter of the patients (25%) were White. The most common surgical sites included the femur (39 patients, 18.1%), ankle (31, 14.4%), and acetabulum (26, 12.1%). A positive linear relationship between HU and surgeon bone-quality assessments was observed (r = 0.66; p < 0.0001), which was consistent across surgical anatomic sites. Abnormal bone quality was correctly identified by surgeon assessment with 84% sensitivity and 97% specificity.

CONCLUSIONS: This study demonstrated that surgeons can reliably detect abnormal bone quality through intraoperative assessment across numerous surgical sites. Intraoperative assessments may provide actionable and reliable feedback regarding bone density without additional cost or radiation in cases when opportunistic scans are not available. This information can inform intraoperative decision-making and presents opportunities for bone-health interventions.

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

PMID:41961974 | DOI:10.2106/JBJS.25.00551

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.01494. Online ahead of print.

NO ABSTRACT

PMID:41961968 | DOI:10.2106/JBJS.25.01494

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.01438. Online ahead of print.

ABSTRACT

BACKGROUND: Female surgeons more commonly delay childbearing and experience higher rates of infertility than women in the general population. More women are entering orthopaedic surgery but face unique challenges in family building. The accessibility of fertility preservation strategies among female orthopaedic surgeons remains underexplored. We aimed to investigate facilitators of and barriers to oocyte cryopreservation, especially during orthopaedic residency.

METHODS: A survey regarding family planning and experiences surrounding oocyte cryopreservation was designed and distributed via residency program directors, regional orthopaedic societies, and the Ruth Jackson Orthopaedic Society. Female orthopaedic surgery residents, fellows, and attending physicians were invited to participate.

RESULTS: Of 169 participants, 107 (63%) reported intentionally delaying childbearing and 58 (34%) reported delaying or planning to delay for ≥4 years. Although 91 respondents (54%) had considered oocyte cryopreservation, only 36 (21%) had undergone or planned to undergo at least 1 cycle and 55 (33%) ultimately decided not to undergo it. Inflexible scheduling of work, lack of insurance coverage, and restrictive leave policy were the most important barriers to oocyte cryopreservation during residency. Among current residents and fellows, 30 (38%) would not have been comfortable telling program leadership that they were planning to undergo oocyte cryopreservation and 25 (32%) reported that they would not have been provided adequate scheduling flexibility. When given 5 multiple-choice questions about female fertility and the oocyte cryopreservation process, respondents answered a mean of 1.46 questions correctly.

CONCLUSIONS: This study revealed a high degree of interest in oocyte cryopreservation among survey respondents but identified persistent barriers of financial burden, inflexible scheduling, institutional stigma, and limited fertility knowledge. Residency programs should prioritize schedule flexibility, proactive leadership support, and privacy-conscious accommodations for fertility-related care as well as structured reproductive health education for trainees.

CLINICAL RELEVANCE: Barriers to fertility preservation during orthopaedic training directly affect physician well-being and the ability to recruit and retain women in this specialty, which, in turn, impact patient access to quality care from a diverse physician workforce.

PMID:41961966 | DOI:10.2106/JBJS.25.01438

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.26.00202. Online ahead of print.

NO ABSTRACT

PMID:41961961 | DOI:10.2106/JBJS.26.00202

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.01236. Online ahead of print.

ABSTRACT

BACKGROUND: Major anxiety symptoms are commonly observed in patients undergoing total hip arthroplasty (THA); these symptoms exacerbate pain and compromise hip recovery. Olanzapine demonstrates clinically meaningful efficacy in reducing anxiety; thus, we investigated its anxiolytic effect and benefits for enhancing recovery in these high-risk patients.

METHODS: We prospectively enrolled 135 patients who were scheduled for primary THA at our institution between April 2024 and March 2025 and who scored at least 40 points on the State-Trait Anxiety Inventory-State (STAI-S) before surgery. Patients randomly received oral olanzapine (2.5 mg), alprazolam (0.4 mg), or a placebo once nightly for 5 days beginning on the day of admission. The 3 groups (45 patients in the olanzapine group, 45 in the alprazolam group, and 44 in the placebo group after 1 patient was lost to follow-up) were compared postoperatively in terms of the STAI-S score, Pittsburgh Sleep Quality Index (PSQI), visual analog scale (VAS) pain score, opioid consumption, and functional recovery of the hip. Adverse events related to drugs and surgery were recorded.

RESULTS: Compared with placebo and alprazolam, olanzapine was associated with significantly lower STAI-S scores on postoperative days (PODs) 1 and 3, significantly lower resting VAS pain scores on PODs 1 to 3, and significantly lower incidence of postoperative nausea and vomiting. The olanzapine group and the alprazolam group demonstrated significantly better sleep quality based on the PSQI on POD 3 compared with the placebo group. Moreover, the olanzapine group had lower opioid consumption on PODs 1 to 3 than the placebo group. Patients in the olanzapine group exhibited better Harris hip scores and Hip Disability and Osteoarthritis Outcome Scores. The 3 groups did not significantly differ in terms of adverse events.

CONCLUSIONS: Perioperative low-dose olanzapine may be an effective option for reducing anxiety levels, sleep disorders, and postoperative nausea and vomiting, mitigating postoperative pain and enhancing hip recovery among patients with anxiety symptoms undergoing THA.

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

PMID:41961954 | DOI:10.2106/JBJS.25.01236

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.26.00394. Online ahead of print.

NO ABSTRACT

PMID:41961952 | DOI:10.2106/JBJS.26.00394

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.26.00389. Online ahead of print.

NO ABSTRACT

PMID:41961951 | DOI:10.2106/JBJS.26.00389

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.00837. Online ahead of print.

ABSTRACT

BACKGROUND: Contemporary rotating-hinge total knee arthroplasties (RH-TKAs) have shown reasonable short-term survivorship in smaller series, but concerns remain regarding risks of aseptic and septic failure. The purpose of this study was to assess outcomes of contemporary RH-TKAs in one of the largest series to date.

METHODS: We retrospectively identified 575 RH-TKAs (60% used for aseptic etiologies and 40% used during reimplantation in 2-stage treatment of periprosthetic joint infection [PJI]) from 2002 to 2021 at a single institution. The mean age was 67 years, 58% were female, and the mean body mass index was 33 kg/m2. Sixty-five percent had Anderson Orthopaedic Research Institute (AORI) type-2B or 3 bone loss. Kaplan-Meier survivorship analyses were performed. The mean follow-up was 6 years (range, 2 to 19 years).

RESULTS: Survivorship free from any revision was 76% at 5 years and 64% at 10 years. The most common revision indications were PJI (54%) and aseptic loosening (20%). RH-TKA used in the primary setting showed better survivorship compared with RH-TKA used during reimplantation after PJI (79% versus 60% at 10 years). Survivorship free from revision for aseptic loosening was 96% at 5 years and 90% at 10 years. Survivorship free from revision for PJI was 84% at 5 years and 81% at 10 years. Survivorship free from revision for PJI was even lower for RH-TKAs used during reimplantation, 74% at 5 years and 73% at 10 years. RH-TKA used during reimplantation in the treatment of PJI was associated with an increased risk of any revision (HR = 2, p < 0.001). Radiographic analysis of 425 knees that were not revised and had radiographs available for review showed that 6% of femoral components and 8% of tibial components had evidence of loosening at the time of final follow-up. The mean Knee Society Score improved from 33 to 69 at 2 years (p < 0.001).

CONCLUSIONS: The 10-year survivorship free from aseptic loosening was 90% in this large series of RH-TKAs. This represents one of the best survivorships free from aseptic loosening published to date. Knees with prior PJI had markedly poorer survivorship than knees treated for aseptic etiologies, with double the risk of revision.

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

PMID:41961950 | DOI:10.2106/JBJS.25.00837

J Bone Joint Surg Am. 2026 Apr 10. doi: 10.2106/JBJS.25.01616. Online ahead of print.

ABSTRACT

BACKGROUND: Nontraumatic osteonecrosis of the femoral head (ONFH) can lead to major disability in patients of all ages. It presents at various levels of severity and can be either symptomatic or asymptomatic. There is a vast array of management strategies. Treatment is often subject to physician bias. Clinical practice guidelines that are broad-based, internationally developed, consensus-driven, and strictly evidence-based are needed. The aim of this guideline by the Association Research Circulation Osseous (ARCO) was to develop international evidence-based recommendations to assist physicians and patients in managing ONFH.

METHODS: ARCO convened an international, multidisciplinary guideline panel that was balanced to minimize potential bias from conflicts of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was utilized, including GRADE Evidence-to-Decision frameworks. The panel prioritized clinical questions, defined criteria for the systematic review of evidence, evaluated the statistical analysis, and, by consensus, approved recommendation statements, which were then subject to external review by content experts and stakeholders (a health policy-maker and a patient).

RESULTS: The panel agreed on 12 recommendations for the diagnosis, evaluation, and management of ONFH.

CONCLUSIONS: Key recommendations of these guidelines require accurately staging ONFH and determining when pain may be due to ONFH. They establish principles for optimal decision-making by assessing the quality of evidence backing various treatments and identifying numerous areas for additional investigation.

CLINICAL RELEVANCE: This international evidence-based guideline provides standardized recommendations for the diagnosis and management of nontraumatic ONFH. It synthesizes all available evidence using GRADE methodology and offers practical, consensus-supported guidance for accurate staging, imaging selection, treatment decision-making, and the identification of patients who would benefit from joint-preserving interventions. The guideline supports clinicians in reducing practice variation, improving diagnostic accuracy, and optimizing treatment pathways for patients with ONFH.

PMID:41961916 | DOI:10.2106/JBJS.25.01616

Int Orthop. 2026 Apr 9. doi: 10.1007/s00264-026-06789-0. Online ahead of print.

ABSTRACT

BACKGROUND: Long-term prospective data on periacetabular osteotomy (PAO) from Middle Eastern populations are limited. This study evaluated ≥ seven year clinical, functional, and radiographic outcomes following PAO and identified predictors of survivorship.

METHODS: Thirty-six consecutive patients (34.6 ± 7.2 years; 78% female) undergoing PAO (2014-2018) were prospectively followed. Inclusion required symptomatic dysplasia with Tönnis 0-2. Outcomes included HHS, WOMAC, HOS, SF-36, radiographic parameters (LCEA, AI), complications, and THA conversion. Reliability, multivariate regression, and Kaplan-Meier analyses were performed.

RESULTS: At 7.8 ± 1.2 years, HHS improved from 63.5 ± 11.2 to 89.6 ± 7.8 (p < 0.001). LCEA increased from 16.2 ± 4.3° to 31.8 ± 3.9° and AI decreased from 22.8 ± 5.1° to 7.2 ± 3.6°. ICC for measurements was 0.92. Complications occurred in 16.7% (mostly minor). THA conversion was 5.6%, both with preoperative Tönnis 2 and correction < 12°. Magnitude of LCEA correction independently predicted HHS improvement (β = 0.41, p < 0.01).

CONCLUSIONS: PAO achieved durable correction and sustained functional improvement with low THA conversion at mid- to long-term follow-up. Preoperative cartilage status and adequacy of correction are key determinants of outcome.

PMID:41954625 | DOI:10.1007/s00264-026-06789-0

SICOT J. 2026;12:13. doi: 10.1051/sicotj/2026008. Epub 2026 Apr 8.

ABSTRACT

BACKGROUND: Osteonecrosis is a disabling complication of sickle cell disease (SCD), with a disproportionate burden in Africa, where healthcare resources are limited. Despite this, the region remains underrepresented in the literature on SCD-related osteonecrosis. This scoping review synthesises current evidence on the epidemiology, management practices, and outcomes of SCD-related osteonecrosis in African healthcare settings.

METHODS: Following PRISMA-ScR guidelines, we systematically searched MEDLINE, Embase, Web of Science, Google Scholar, and African Journals Online through February 2025. Eligible studies reported clinical features, management, or outcomes of osteonecrosis in SCD patients in Africa. Data on demographics, staging, imaging, treatment modalities, and outcomes were narratively synthesised.

RESULTS: Thirty-two studies involving 779 patients met the inclusion criteria. Most were small, descriptive case series. Patients typically presented late: 85% at Ficat stage III-IV, with delays exceeding 20 years in some cases. The femoral head was affected in 98% of cases. Diagnosis relied almost exclusively on radiographs, with MRI reported in only 6% of studies. Conservative management, mainly traction and immobilisation, showed benefit in paediatric early-stage cases but was largely ineffective in adults. Joint-preserving surgeries were rarely reported but included core decompression and vascularised grafting with variable success. Arthroplasty predominated, yielding functional improvement but was technically demanding and prone to complications, particularly in SS genotype patients.

CONCLUSION: Late presentation, diagnostic limitations, and reliance on salvage arthroplasty mark SCD-related osteonecrosis in Africa. Strengthening early detection, expanding capacity for joint-preserving interventions, and generating robust regionally relevant evidence are critical to improving outcomes in this high-burden, resource-constrained setting.

PMID:41949177 | PMC:PMC13059667 | DOI:10.1051/sicotj/2026008

Int Orthop. 2026 Apr 9. doi: 10.1007/s00264-026-06797-0. Online ahead of print.

NO ABSTRACT

PMID:41951828 | DOI:10.1007/s00264-026-06797-0

EFORT Open Rev. 2026 Apr 7;11(4):338-348. doi: 10.1530/EOR-2025-0096.

ABSTRACT

OBJECTIVE: To systematically review the characteristics, diagnostic methods, and etiologies of rotator cuff (RC) muscle edema.

METHODS: A PRISMA-compliant review of clinical and laboratory studies from PubMed and Embase (PROSPERO ID: 626276); data on edema location, imaging features, and associated pathologies were qualitatively synthesized.

RESULTS: MRI is the most consistent tool for detecting muscle edema, typically showing T2 hyperintensity with variable patterns depending on etiology (traumatic, neurogenic, exertional, myopathic, or iatrogenic). Traumatic edema is associated with tendon retraction, bursal effusion, and fatty infiltration; neurogenic edema is diffuse and symmetric with atrophy; exertional edema appears 'fluffy' or 'feather-like'; myopathic and iatrogenic forms show peripheral or localized changes.

CONCLUSION: The imaging appearance, location, and timing of RC muscle edema provide valuable diagnostic clues and should be considered in the context of the underlying pathology.

LEVEL OF EVIDENCE: Systematic review, level 4.

PMID:41945591 | DOI:10.1530/EOR-2025-0096

EFORT Open Rev. 2026 Apr 7;11(4):250-258. doi: 10.1530/EOR-2025-0034.

ABSTRACT

PURPOSE: To examine the effect of Kinesio taping (KT) on patients with acute ankle sprains (AAS).

METHODS: We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, SPORTDiscus, CINAHL, and Google Scholar for all relevant publications from database inception to January 2025, without language restriction. Randomized controlled trials on KT for AAS were selected according to the participant, intervention, comparison, and outcome measures. A meta-analysis was conducted using R software. Heterogeneity investigation involved sensitivity, subgroup, and meta-regression analysis. Two independent reviewers assessed the quality of the literature using the Cochrane risk of bias tool 2, and the GRADE framework was applied to grade the certainty of the evidence.

RESULTS: Eight trials containing 582 participants were selected in this review. Moderate-certainty evidence indicated that KT was more effective than controls in relieving pain (standard mean difference (SMD) = -0.63; 95% CI: -1.25 to -0.01; I2 = 94.1%, P = 0.047) and improving function (SMD = 0.72; 95% CI: 0.10-1.34; I2 = 94.5%, P = 0.023). Low-certainty evidence was found for its effect on reducing swelling (SMD = -0.29; 95% CI: -0.48 to -0.10; I2 = 77.5%, P = 0.002). Subgroup analysis revealed that KT significantly improved pain, swelling, and function following 3-5 days of intervention. 'I'-shaped KT was found to significantly improve pain, swelling, and function.

CONCLUSION: KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are only observed short-term, and the 'I'-shaped KT method may be the most effective recommendation for AAS.

PMID:41945586 | DOI:10.1530/EOR-2025-0034

EFORT Open Rev. 2026 Apr 7;11(4):243-249. doi: 10.1530/EOR-2024-0201.

ABSTRACT

To synthesise the literature on pre- and intra-operative nerve mapping used to prevent iatrogenic nerve injuries during ankle arthroscopy. This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted using MEDLINE and Embase on 24 July 2024. Findings extracted from eligible studies were tabulated and synthesised. The search identified 270 articles, of which 9 met inclusion/exclusion criteria and were included in the review. Two studies described a mapping technique without reporting any outcomes, and three studies evaluated mapping techniques on cadavers and four on live patients. Four studies reported on visualisation and/or palpation, one study on arthroscopic transillumination, three on ultrasound and two on near-infrared light (NIR). There were only two comparative studies that showed that pre-operative ultrasound mapping places the nerves at safer distances from the portals and that ultrasound is more effective in the identification of the superficial peroneal nerve (SPN) than visualisation and/or palpation. Visualisation and/or palpation of the SPN is the most effective in ankle maximal plantar flexion and inversion and reduces the risk of nerve injury. There was no saphenous nerve injury with percutaneous screw insertion while using NIR. A reduction in nerve injuries during ankle arthroscopy might be achievable by using pre- or intra-operative nerve mapping with visualisation and/or palpation, ultrasound or (for nerves accompanied by the veins) NIR. The limited evidence suggests that pre-operative ultrasound might be potentially the most effective mapping method, but more comparative and prospective studies are needed to fully confirm these findings.

PMID:41945583 | DOI:10.1530/EOR-2024-0201

EFORT Open Rev. 2026 Apr 7;11(4):277-289. doi: 10.1530/EOR-2025-0107.

ABSTRACT

PURPOSE: A periprosthetic joint infection (PJI) is considered the most drastic complication after hip/knee arthroplasty. Despite extensive research into PJI treatment, insights into patients' biopsychosocial needs are sparse. The aim of the current review is to provide an overview of patients' biopsychosocial needs and interventions aimed at these needs.

METHODS: A systematic review incorporating a comprehensive database search of seven major scientific databases. Articles were included if they reported on the biopsychosocial needs of patients with PJI and on interventions aimed at these needs. Quality of the included studies was assessed by two reviewers with the Mixed Methods Appraisal Tool. Characteristics of included studies and the associated results were extracted.

RESULTS: Of the 9,745 identified research articles, 20 were included in the review. All of the included articles reported about biopsychosocial needs, but only two (10%) of them also reported on interventions focused on these needs. Psychological needs were reported most often (n = 19, 95%), followed by physical (n = 14, 70%) and social needs (n = 8, 40%). Improving mental health was the most frequently reported psychological need (n = 13, 65%). Functional improvement emerged as the most common identified physical need (n = 12, 60%), while social support from healthcare professionals (n = 5, 25%) was the most reported social need.

CONCLUSION: The results show a clear need for interventions on top of the primary surgical treatment for patients diagnosed with PJI, especially for psychological and physical support. Interventions targeting needs were described in only two articles (10%) in the current literature. Future studies should explore patient-centered approaches and integrate psychological and physical management into PJI treatment pathways to improve outcomes.

PMID:41945582 | DOI:10.1530/EOR-2025-0107

EFORT Open Rev. 2026 Apr 7;11(4):359-365. doi: 10.1530/EOR-2025-0159.

ABSTRACT

Congenital lumbar stenosis (CLS) is an uncommon disorder marked by a congenitally small spinal canal, which frequently results in early-onset neurogenic symptoms. Sarpyener originally characterized CLS in 1947, and Verbiest later offered a clinical description of lumbar spinal stenosis that did not recognize the congenital nature of the condition. The frequency of absolute CLS is believed to be 2.6%; however, data are lacking. This narrative review will outline current knowledge on CLS, including its prevalence, clinical presentation, genetic implications, aspects in diagnostic imaging for the condition, and treatment options. CLS has similar clinical characteristics to acquired lumbar stenosis; however, individuals with CLS report more severe leg and back pain. Genetic factors may contribute to CLS occurrence; however, research on this aspect is scarce. CLS is usually related to cervical and thoracic stenosis, as well as diseases such disk herniation and spondylolisthesis. The diagnosis is based on imaging criteria, which are continually being refined. The treatment options vary from conservative care to surgical treatments, such as laminoplasty and stability-preserving decompression, although long-term outcome data are limited. CLS poses distinct diagnostic and treatment challenges given its early onset. Further study is needed to provide uniform diagnostic criteria, evaluate long-term treatment results, and identify specific genetic factors that contribute to CLS.

PMID:41945575 | DOI:10.1530/EOR-2025-0159

EFORT Open Rev. 2026 Apr 7;11(4):317-327. doi: 10.1530/EOR-2025-0149.

ABSTRACT

In upper extremity bone tumors, osteochondromas and solitary bone cysts represent the predominant benign entities, with osteosarcoma accounting for the majority of malignant presentations. The proximal humeral metaphysis emerges as the most prevalent anatomical site across both tumor entities. Upper, one-sided extremity pain in children and adolescents should be followed up and diagnosed, since 'growing pain' in the upper extremities is not a common finding. Osteochondromas should be surgically addressed early if they impose a risk of development of a deformity, such as those located on the forearm and the distal tibia, where they can cause growth disorders and thus functional impairments. Reconstructions for pediatric malignant bone tumors of the upper arm or forearm should allow the spatial placement of the hand. Given the longevity of sarcoma survivors, the longevity of the reconstruction is an important planning consideration. Biological reconstructions combining autologous/vascularized bone with tendon repair and transfers appear to be the most appropriate and preferable to prosthesis whenever possible. Multidisciplinary collaboration involving plastic surgeons with hand reconstruction expertise constitutes a critical component in orthopedic oncology treatment planning.

PMID:41945572 | DOI:10.1530/EOR-2025-0149

EFORT Open Rev. 2026 Apr 7;11(4):328-337. doi: 10.1530/EOR-2023-0156.

ABSTRACT

Glenohumeral osteoarthritis (OA) is a disabling disease that leads to poor shoulder function and pain. Primary or idiopathic osteoarthritis occurs in previously intact joints without any inciting agent. Its precise incidence is not known. If conservative treatment fails, there are a variety of surgical procedures described in the literature. Total shoulder arthroplasty (TSA) is primarily indicated in patients above 60 years old with symptomatic glenohumeral OA and intact rotator cuff and failed conservative treatment. However, it is rarely recommended to young or active patients under the age of 50 due to its increased morbidity, limited lifespan, potential for revision surgeries, and difficulty achieving the same preoperative activity level, particularly in patients with high preoperative level of activity. Comprehensive arthroscopic management (CAM), hemiarthroplasty (HA), and TSA provide good results even in the long term for treatment of primary OA in properly selected young patients. A CAM procedure seems to be a reasonable option in case of conservative treatment failure, localized cartilage defect, tendinopathy of the long head of the biceps, stiffness, inferior osteophytes, and humeral head congruity. However, in case of humeral head incongruity, large anterior osteophytes, and an intact rotator cuff, an HA or a TSA is a feasible option.

PMID:41945567 | DOI:10.1530/EOR-2023-0156