Int Orthop. 2025 Oct 21. doi: 10.1007/s00264-025-06676-0. Online ahead of print.

ABSTRACT

PURPOSE: Eccentric rotational acetabular osteotomy (ERAO) is an effective treatment for acetabular dysplasia, but delayed union of the superior pubic ramus is a concern. This study identified risk factors for delayed pubic union post-ERAO and evaluated its clinical impact.

METHODS: This retrospective study included 101 patients who underwent ERAO during 2014-2022, grouped according to one year pubic union status: union (n = 78) and delayed union (n = 23). We compared demographics, pre-and postoperative radiographic parameters (including lateral, anterior, and posterior centre-edge angles; acetabular sector angles; acetabular anteversion; pubic osteotomy site; and femoral head centre lateralisation), and clinical outcomes.

RESULTS: Multivariate logistic regression identified older age (odds ratio [OR], 1.07; 95% CI, 1.00-1.13), a more medial pubic osteotomy site relative to the iliopectineal eminence (OR, 1.28; 95% CI, 1.10-1.49), and insufficient femoral head centre medialisation (OR, 1.40; 95% CI 1.12-1.74) as independent risk factors for delayed union. The pubic osteotomy site cutoff was 12.0 mm medial to the iliopectineal eminence (AUC 0.759). The delayed union group exhibited significantly higher rates of inferior pubic ramus stress fractures (17.4% vs. 1.3%, p = 0.009), although two year JOA scores were similar between groups.

CONCLUSION: Older age, pubic osteotomy more medial to the iliopectineal eminence, and insufficient femoral head medialisation are key risk factors for delayed pubic union after ERAO. While these factors did not directly affect hip function at two years postoperatively, they significantly increased the risk of inferior pubic ramus stress fractures. Therefore, accurate pubic osteotomy and careful avoidance of femoral head lateralisation are essential.

PMID:41117916 | DOI:10.1007/s00264-025-06676-0

Injury. 2025 Oct 11;56(12):112807. doi: 10.1016/j.injury.2025.112807. Online ahead of print.

ABSTRACT

INTRODUCTION: Avulsion fractures of the anterior inferior tibiofibular ligament (AITFL), historically described as Wagstaffe-Le Fort fractures, are under-recognized indicators of syndesmotic injury. This study aimed to determine the prevalence of AITFL avulsion fractures in ankle fractures, classify their morphology, evaluate fragment size, and assess correlations with established fracture classification systems.

MATERIALS AND METHODS: We retrospectively reviewed 1022 patients admitted with distal tibial and/or fibular fractures between January 2016 and June 2024 at a level I trauma center. After exclusions, 573 patients with ankle fractures and complete radiographic data were included. All patients underwent plain radiography. AITFL avulsion fractures were identified and classified into five types according to morphological criteria. Fracture mechanisms were analyzed using the Weber and Lauge-Hansen systems. Fragment size was measured and reported as median with interquartile range (IQR).

RESULTS: AITFL avulsion fractures were identified in 116 of 573 patients, yielding a prevalence of 20.2 %. Type 2 was the most common variant (82.8 %), followed by type 4 (8.6 %). Type 2 fractures showed a strong association with supination-external rotation injuries and Weber B patterns, whereas type 4 fractures correlated predominantly with pronation-external rotation injuries and Weber C patterns (p< 0.05). Rare types (1 and 5) accounted for < 3 % of cases. The median fragment size was 16.6 mm (IQR 9.2-21.5), notably larger than previously reported. In several cases, fragment dimensions were sufficient to potentially interfere with syndesmotic alignment or fibular reduction.

CONCLUSION: AITFL avulsion fractures are more frequent than traditionally appreciated, with reproducible associations between fracture morphology and specific injury mechanisms. Their relatively large size in many cases suggests potential feasibility for direct fixation, though treatment thresholds remain unproven. Recognition of these lesions may improve detection of syndesmotic injury and guide surgical planning. Prospective studies are needed to validate proposed size-based criteria and clarify their impact on clinical outcomes.

PMID:41110375 | DOI:10.1016/j.injury.2025.112807

Injury. 2025 Oct 14;56(12):112812. doi: 10.1016/j.injury.2025.112812. Online ahead of print.

ABSTRACT

BACKGROUND: To explore the impact of the ERAS-based (Enhanced Recovery After Surgery) Multidisciplinary Treatment Model (MDT) on perioperative management indicators of elderly patients with hip fractures in primary hospitals.

METHODS: A retrospective study was conducted on 120 elderly patients with hip fractures treated at our hospital from October 2020 to October 2024. The patients were divided into two groups: one group received the conventional model, while the other group received the ERAS-guided MDT model, with 58 and 62 patients in each group, respectively. Perioperative indicators and secondary outcomes (pain scores, symptom self-assessment scores, hip joint function, daily living abilities, and postoperative complication rates) were compared between the two groups. Data that met normality assumptions were compared using repeated measures ANOVA.

RESULTS: Patients in the ERAS-MDT group had a shorter time to mobilization (16.55 ± 1.17 h) compared to the conventional group and walked for a longer duration daily (2.00 ± 0.66 h). Compared to preoperative, VAS (Visual Analog Scale) scores significantly decreased on postoperative day 7 in both groups (P < 0.05), with the ERAS-MDT group showing superior results (P < 0.05). At discharge, SCL-90 (Symptom Checklist-90) scores were significantly lower in the ERAS-MDT group compared to the conventional group (P < 0.05). Harris scores for hip function in the ERAS-MDT group were significantly higher than those in the conventional group at all time points (P < 0.05). Before intervention, there was no difference in daily living ability between the two groups (P > 0.05), but postoperative daily living abilities improved significantly in the ERAS-MDT group (P < 0.05). The complication rate during hospitalization was significantly lower in the ERAS-MDT group compared to the conventional group (P < 0.05).

CONCLUSIONS: The ERAS-based MDT model has a potential impact on perioperative management indicators for elderly hip fracture patients in primary hospitals.

PMID:41108798 | DOI:10.1016/j.injury.2025.112812

Injury. 2025 Oct 14;56(12):112818. doi: 10.1016/j.injury.2025.112818. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if (1) fixation of the anterior ring is required, (2) is indirect (external fixator or InFix) or internal fixation favored, and (3) are there differences between long and short percutaneous screws for stabilization of the anterior ring in patients receiving surgical fixation of lateral compression type 1 (LC1) pelvic ring injuries when the posterior ring is stabilized?

METHODS: A retrospective review of all acute LC1 (AO/OTA 61-B1/B2) pelvic ring injuries from January 2019 to January 2024 managed operatively with posterior ring fixation at Two Level I Trauma Centers. Indications for operative management were radiographic evidence of instability or a failed "trial of mobilization." Minimum three month follow-up and until confirmation of radiographic healing was required. Anterior-posterior, inlet and outlet radiographic imaging at initial, post-operative and final follow-up were assessed. The primary outcome measure was the presence of pelvic ring deformity defined as >1 cm of medial pelvic ring displacement from immediate post-operative radiographs to final radiographs showing fracture healing. Secondary outcomes were major unplanned surgical procedures (reoperation for loss of fixation, deformity, non-union repair, removal of symptomatic implants or infection) and other surgical complications. It was recorded if anterior ring fixation was applied and whether fixation was indirect (external fixator or InFix) or internal. Percutaneous screws were noted to be antegrade or retrograde, and length noted (long or short). A comparison of outcome measures was made between the different anterior ring constructs.

RESULTS: 120 patients were included; most were female (n = 69; 58 %) and the mean age was 63.9 years (18.6SD, range 17-93). Surgical fixation of the anterior ring was most common (n = 86, 72 %) and produced lower rates of deformity compared with no fixation (20 % vs. 41 %, p = 0.016), despite the presence of an increased amount of superior ramus fracture comminution (48 % vs. 26 %, p = 0.034) and unstable superior ramus fracture patterns (p = 0.034). Indirect fixation (n = 15, 17 %) had a higher rate of deformity relative to internal fixation (n = 71, 83 %) (53 % vs. 13 %, p < 0.001). A long percutaneous screw (n = 50, 72 %) was most often applied antegrade (p = 0.014), and long screws had lower rates of deformity when compared with short screws (n = 19, 28 %) (4 % vs. 32 %, p = 0.004).

CONCLUSIONS: When surgical fixation of LC1 injuries was indicated, the application of anterior ring fixation in conjunction with posterior ring fixation decreased the risk of fracture displacement. Long percutaneous screws stabilizing the anterior ring best maintained reduction and prevented deformity.

LEVEL OF EVIDENCE: Level III, therapeutic study.

PMID:41108797 | DOI:10.1016/j.injury.2025.112818

Injury. 2025 Oct 10;56(12):112798. doi: 10.1016/j.injury.2025.112798. Online ahead of print.

ABSTRACT

BACKGROUND: Factors associated with injuries and performance have been less studied in trail running than in road running. Our original research carried out on a large sample of trail runners had 3 aims: 1) describe the habits and health of runners 2) evaluate the causal effect of training variables, anthropometric factors, lifestyle, recovery on the incidence of injuries 3) evaluate causal effect of these parameters on performance.

METHODS: We developed a 65 questions trail-running-specific survey including 97 variables characterizing 3 dimensions. This anonymous questionnaire was distributed via social networks and the MSOChrono® mailing list between May 2019 and May 2020. We tested all potentially predictive variables with all injuries using standard frequentist tests. Then, we used causal Bayesian networks to evaluate the effect of a specific set of variables on injury probability and performance.

RESULTS: 697 subjects were included (468 men). Sixteen types of injury were reported. The risk of injury was higher with weight, less interval trainings, lower weekly training volume and yearly elevation gain, lower regular passive recovery practice, lower sleeping time. The number of previous injuries didn't affect the risk of current injury. Performance increased with training, passive recovery and sleeping, but decreased with increasing age, weight, and height.

CONCLUSION: The analysis of this cohort showed that some aspects of training and recovery were protective factors against injuries. There might however exist an upper limit, where some of these variables could become detrimental. More research is needed to determine this threshold.

PMID:41108796 | DOI:10.1016/j.injury.2025.112798

Injury. 2025 Oct 11;56(12):112805. doi: 10.1016/j.injury.2025.112805. Online ahead of print.

ABSTRACT

INTRODUCTION: Appropriate surgical management of hip fractures has major clinical and economic consequences. Recently Intramedullary nail (IMN) use has increased compared to Sliding Hip Screw (SHS) constructs, despite no clear evidence demonstrating superiority of outcome. We therefore set out to provide further evidence about the clinical and economic implications of implant choice when considering hip fracture fixation strategies.

METHODS: A retrospective cohort study using Scottish hip fracture audit (SHFA) data was performed for the period 2016-2022. Patients ≥50 with a hip fracture and treated with IMN or SHS constructs at Scottish Hospitals were included. Comparative analyses, including adjustment for confounders. A sub-group analysis was also performed focusing on AO-A1/A2 fracture configurations. Cost differences in Length of Stay (LOS) were calculated using defined costs from the NHS Scotland Costs book.

RESULTS: There were 13,638 fractures (72 % female) identified which included 9867 (72 %) that received a SHS. No significant differences were identified in 30 or 60-day survival (Odds Ratio [OR] 1.05, 95 %CI 0.90-1.23; p = 0.532), (OR 1.10, 95 %CI 0.97-1.24; p = 0.138) between SHS and IMN, respectively. There was however a significantly lower early mobilisation rate with IMN (OR 0.64, 95 %CI 0.59-0.70; p < 0.001), and lower likelihood of discharge to domicile by day-30 post-admission (OR 0.77, 95 %CI 0.71-0.84; p < 0.001) compared to SHS. Acute and overall, LOS were significantly lower for SHS vs IMN (11 vs 12 days and 20 vs 24 days respectively; p < 0.001). Findings were similar across a sub-group analysis of 559 AO A1/A2 fracture configurations. Differences in LOS was associated with an increase cost of £1481 per-patient, irrespective of the higher implant costs of an IMN compared to a SHS.

CONCLUSIONS: Appropriate SHS use is associated with early mobilisation, reduced LOS and likely with reduced cost of treatment. Further research exploring potential reasons for the identified differences in early mobilisation are warranted.

PMID:41108795 | DOI:10.1016/j.injury.2025.112805

J Bone Joint Surg Am. 2025 Oct 15;107(20):e98. doi: 10.2106/JBJS.25.00901. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091100 | DOI:10.2106/JBJS.25.00901

J Bone Joint Surg Am. 2025 Oct 15;107(20):e97. doi: 10.2106/JBJS.25.00977. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091099 | DOI:10.2106/JBJS.25.00977

J Bone Joint Surg Am. 2025 Oct 15;107(20):2227. doi: 10.2106/JBJS.25.00999. Epub 2025 Oct 15.

NO ABSTRACT

PMID:41091098 | DOI:10.2106/JBJS.25.00999

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06672-4. Online ahead of print.

ABSTRACT

PURPOSE: Registry data suggests that robotic-assisted unicompartmental knee arthroplasty (rUKA) significantly reduces all-cause revisions compared to conventional implantation (cUKA). This study aims to compare joint line-related parameters and their reconstruction accuracy between rUKA and cUKA.

METHODS: Five databases were searched using a pre-defined strategy and inclusion criteria: (1) comparative studies reporting radiological outcomes, (2) human studies, (3) English language, and (4) meta-analyses for cross-referencing. Cadaveric or saw-bone studies were excluded. Data extracted included demographics data, pre- and postoperative radiological parameters (HKA, MPTA, LDFA, posterior tibial slope, femoral sagittal angle, joint line height, implant congruency), and outliers. A random-effects meta-analysis was conducted using mean difference (MD) and odds ratio (OR) as main effect estimators. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated with funnel plots.

RESULTS: A total of 18 studies assessing 2470 patients (1112 rUKA, 1358 cUKA) were included in the analysis. No significant baseline differences were found in age, sex, BMI, follow-up period, MPTA, LDFA, or tibial slope. Postoperative radiological parameters showed no significant differences between groups for HKA, LDFA, MPTA, or tibial slope (p > 0.05). Joint line height was significantly lower in cUKA compared to rUKA (MD = -1.37 mm, 95% CI: -2.06 to -0.69, p < 0.001). Outlier analysis revealed that rUKA had significantly fewer outliers across relevant radiological parameters, including HKA, joint line height, tibial slope, femoral flexion, femoral implant congruency, and medial, anterior, and posterior tibial congruency.

CONCLUSION: Reporting pre- and postoperative mean alignment parameters undermines patient-specific anatomy reconstruction with advanced technologies. Outlier reporting showed significant variability, with limited evidence supporting its clinical relevance. Future studies should focus on patient-specific reconstruction and define clinical thresholds for outliers.

PMID:41091159 | DOI:10.1007/s00264-025-06672-4

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06670-6. Online ahead of print.

NO ABSTRACT

PMID:41087774 | DOI:10.1007/s00264-025-06670-6

Int Orthop. 2025 Oct 15. doi: 10.1007/s00264-025-06666-2. Online ahead of print.

NO ABSTRACT

PMID:41087773 | DOI:10.1007/s00264-025-06666-2

Injury. 2025 Oct 8:112788. doi: 10.1016/j.injury.2025.112788. Online ahead of print.

ABSTRACT

BACKGROUND: Mild traumatic brain injury (mTBI) is commonly associated with alcohol use. We investigated how inpatient admission patterns after mTBI vary for patients with alcohol use disorder (AUD).

METHODS: This was a retrospective cohort study of patients with mTBI from the American College of Surgeons Trauma Quality Program dataset. Mixed regression models measured associations with inpatient admission, including among a subgroup of patients with AUD. Effect modification was tested for age, race, and acute intoxication.

RESULTS: 78,937 patients with mTBI were included, and 7.0 % had AUD. AUD was associated with increased admission odds (OR, 1.83; 95 % CI, 1.67-2.01). Black patients and those presenting intoxicated had this effect reduced. Among a subgroup of patients with AUD, acute intoxication reduced admission odds (OR, 0.73; 95 % CI, 0.59-0.91).

CONCLUSIONS: AUD increased inpatient admission odds after mTBI, while acute intoxication reduced these odds among patients with AUD. These findings help contextualize care for the common diagnostic constellation of mTBI and AUD.

PMID:41077492 | DOI:10.1016/j.injury.2025.112788

Injury. 2025 Oct 4;56(12):112785. doi: 10.1016/j.injury.2025.112785. Online ahead of print.

ABSTRACT

INTRODUCTION: The treatment options of orthopedic surgeons for older adults with proximal humeral fractures (PHF) may vary according to chronological age. This study aimed to present the treatment modalities, complications, and mortality rates after PHF in octogenarians, nonagenarians, and centenarians from the Turkish national database.

METHODS: This retrospective study was conducted using health records from the National Health Record System of Ministry of Health Turkey for individuals aged 80 and over who presented to public, private, and university hospitals from January 2016, to October 2024. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S42.2 (code for closed PHFs) was used to identify patients. A total of 9799 patients were included and categorized into three age groups: octogenarians (80-89 years), nonagenarians (90-99 years), and centenarians (≥100 years) and 4 groups according to treatment modalities (conservative, osteosynthesis, reverse shoulder arthroplasty (RSA), and hemiarthroplasty). Early systemic complications, revision surgery and mortality rates regarding 30-day and 90-day were recorded.

RESULTS: The mean age of the study population was 85.1 ± 4.2, ranging between 80-106 years. The female ratio was 76.1 %. Octogenarians comprised 84.3 % of the entire study population, whereas 15.5 % were nonagenarians and 0.3 % were centenarians. Conservative treatment was the most preferred across all age groups (62.3 %). Among patients initially managed conservatively, 7.0 % (n = 425) subsequently required surgical intervention, with no statistically significant difference in surgical conversion rates across the three age groups. Only 77 patients (0.8 %) underwent RSA. No differences were observed in the ratio of early systemic complications between octogenarians, nonagenarians, and centenarians. 30-day and 90-day mortality rates were 4.9 % and 10.2 %, respectively. RSA was associated with the highest risk of 90-day mortality (HR: 2.222, 95 % CI: 1.328-3.718; p = 0.002), with centenarians exhibiting an even greater risk (HR: 2.879, 95 % CI: 1.193-6.949; p = 0.019).

CONCLUSION: Conservative treatment remains the most preferred approach for PHFs in the patient population over the age of 80. Given the significantly higher mortality rates in centenarians and in patients undergoing RSA, individualized treatment decisions should prioritize functional outcomes, patient comorbidities, and life expectancy.

PMID:41075714 | DOI:10.1016/j.injury.2025.112785

Injury. 2025 Oct 4;56(12):112783. doi: 10.1016/j.injury.2025.112783. Online ahead of print.

ABSTRACT

BACKGROUND: Upper extremity fractures (UEFs) are a growing public health concern in China, yet comprehensive epidemiological data remain limited. This study examines the burden, trends, and risk factors of UEFs in China from 1990 to 2021.

METHODS: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the incidence, years lived with disability (YLDs), and causes of UEFs in China. Age-standardized rates (ASRs) were calculated, and trends were assessed using regression models. Sociodemographic index (SDI) associations and global comparisons were evaluated.

RESULTS: In 2021, China recorded 11.1 million new UEF cases, a 31.92% increase since 1990. The age-standardized incidence rate (ASIR) rose by 7.97%, contrasting with a 20.92% global decline. Fractures of the radius and/or ulna had the highest ASIR (404.52 per 100,000), while shoulder fractures saw the steepest YLD increase (42.69%). UEFs were more prevalent in males, except among children (<1, 10-14 years) and older adults (≥65 years), where females predominated. Falls accounted for 72.98% of UEFs, followed by road injuries (13.38%). Rehabilitation needs (YLDs) grew by 32.28%, with SDI-linked trends showing a plateau at SDI 0.59-0.72.

CONCLUSIONS: China's increasing burden of UEF, influenced by factors such as falls, an aging population, and urbanization, contrasts with the global downward trends. Immediate targeted actions (implementing fall prevention strategies for the elderly, enhancing road safety for young people, and broadening access to rehabilitation services) are essential to address this escalating public health issue.

PMID:41075713 | DOI:10.1016/j.injury.2025.112783

Injury. 2025 Sep 30;56(12):112779. doi: 10.1016/j.injury.2025.112779. Online ahead of print.

ABSTRACT

AIM: The aim of this study was to investigate on the influence of physical workload and workers' compensation status on fulfillment of patients' expectations, return to initial work, and functional outcome after surgical treatment of complex proximal tibial fractures.

METHODS: This prospective study included 114 patients with complex tibial fractures (AO/OTA type B and C). At final follow-up, an individualized questionnaire based on the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES) was used to assess whether preoperative expectations had been met. In addition, the condition of the knee joint, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Physical workload was assessed using the REFA classification. Physical workload and workers' compensation status was corelated to duration of incapacity to work (weeks), fulfillment of expectations, and functional outcome.

RESULTS: Patients with higher physical workloads showed longer incapacity to work (20.1 weeks on average) and were significantly less likely to report a complete return to their initial professional activity (r=-0.21). Their preoperative expectations were significantly less frequently fulfilled (r=-0.29). Workers' compensation status was associated with lower satisfaction and higher workload demands. Reintegration programs proved effective, enabling a high percentage of patients to return to work without restrictions (p = 0.04). Significant negative correlations were found between workload and functional outcomes (KOOS dimensions, residual pain, quality of life).

CONCLUSION: Individualized, job-oriented rehabilitation with realistic expectations is crucial for improving return to work, especially for high-workload patients. Future research should integrate physical and psychosocial factors in rehabilitation strategies.

PMID:41072123 | DOI:10.1016/j.injury.2025.112779

Injury. 2025 Sep 30:112778. doi: 10.1016/j.injury.2025.112778. Online ahead of print.

ABSTRACT

OBJECTIVE: Prehospital performed Extended Focused Assessment with Sonography in Trauma (EFAST) has poor sensitivity for pneumothorax (PTX) when compared to scans performed in hospital. This study describes the computed tomography (CT) location of PTX detected after an initial negative prehospital EFAST.

METHODS: Trauma patients treated by New South Wales Ambulance (Aeromedical Operations) who underwent prehospital EFAST between 1st August 2022 and 31st December 2023 were included if they were found to have PTX on CT imaging following a negative or indeterminate prehospital EFAST ultrasound. Patients were excluded if prehospital pleural decompression was undertaken. Corresponding CT imaging was manually analysed for the location of each PTX and mapped to two-dimensional coordinates on an unfurled thoracic cage.

RESULTS: Of 58 patients median (IQR) age was 29 (20, 58) years. The majority (76 %) were male who had sustained blunt trauma. The median (IQR) estimated PTX volume was 8 % (4-10) with 43 % of patients having a pneumothorax located to either the second intercostal space or most anterior portion of the chest on CT-mapping. The midpoints of each locule were anatomically distributed with a median (IQR) of 4th (3rd-5th) intercostal space and distance from the sternal edge (cm) of 4.1 (2.5-5.1) on the right, and 4.4 (3.5-5.2) on the left. Most PTX were sonographically occult due to apical, retrosternal, or posterior position.

CONCLUSION: Most traumatic PTX missed by prehospital EFAST were truly sonographically occult, but a significant number corresponded with the traditional scanning landmarks, particularly the parasternal 4th intercostal space. This reinforces current literature advocating this scanning region. The balance between optimal detection and sono-paralysis should be considered for ongoing education and governance.

PMID:41067963 | DOI:10.1016/j.injury.2025.112778

Int Orthop. 2025 Oct 9. doi: 10.1007/s00264-025-06665-3. Online ahead of print.

ABSTRACT

PURPOSE: Conserving the subscapularis tendon during reverse shoulder arthroplasty (RSA) has proven its impact on postoperative outcomes, particularly regarding stability and range of motion. A subscapularis preserving approach has been developed: the Anterior Muscle Sparing (AMS) approach that enables not to violate the subscapularis tendon. Our aim was to compare this approach with the conventional approach, which consists of reinserting the subscapularis at the end of the procedure, with a specific focus on intraoperative complications and postoperative position of the implants.

METHODS: A retrospective consecutive study was performed of patients undergoing a primary RSA between January 2021 and December 2024 performed by the same surgeon. We included 32 patients receiving the standard approach (SA) and 24 patients receiving the AMS approach. Implant positioning was assessed through three different variables: the glenoid implant inclination relative to the floor of the supraspinatus fossa; the glenoid implant height described as the distance between the inferior border of the glenoid bone surface and the inferior part of the glenoid baseplate; and the humeral stem alignment relative to the intramedullary humeral shaft axis.

RESULTS: There were no significant differences in terms of glenoid implant inclination (-4.71 ± 6.3° Vs -3.8 ± 7.17°; p = 0.68), glenoid implant height (0.608 ± 1.94 mm Vs 0.315 ± 0.896 mm ; p = 0.655), and PERFORM® humeral stem alignment ( 1.34 ± 4.11° Vs 1.89° ± 4.63°; p = 0.715) between the two groups. The intraoperative complication rate was not significant different between the groups, with only two cases within the AMS approach group (p = 0.181). The mean operative times were not significantly different between the groups (94.06 min ± 18,71 Vs 81,73 min. ±16,58; p = 0,06). Since September 2023, when the senior author started performing RSAs with the described technique only one patient was converted from an AMS to a traditional approach during surgery due to an intraoperative complication.

CONCLUSION: When compared to the standard approach, the AMS showed no significant difference in terms of implant positioning, surgical operative times and intraoperative complication rate. An attempt to preserve the subscapularis tendon seems to be always justified, as this method is a safe and reliable alternative to the traditional approach.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort Comparison Treatment study.

PMID:41065821 | DOI:10.1007/s00264-025-06665-3

Injury. 2025 Sep 30;56(12):112780. doi: 10.1016/j.injury.2025.112780. Online ahead of print.

ABSTRACT

OBJECTIVES: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ketorolac, are commonly used for postoperative pain management. Concerns about their potential impact on bone healing have been raised. This study investigated the relationship between ketorolac use and postoperative complications following clavicle surgery, including nonunion rates.

METHODS: This retrospective cohort study used the TriNetX Research Database to identify patients who underwent surgical fixation of clavicle fractures between 2002 and 2022. Two propensity-matched cohorts were created: patients who received postoperative ketorolac and those who did not. Primary outcomes included nonunion diagnosis and revision surgery; secondary outcomes included opioid use, wound disruption, surgical site infection, and infected hardware at 30 days, 90 days, 1 year, and 2 years postoperatively.

RESULTS: 5,264 patients were in each cohort after matching. Nonunion diagnosis was similar between the ketorolac and no-ketorolac groups at 30 days (16 vs. 18, P=0.731), 90 days (31 vs. 40, P=0.284), 1 year (93 vs. 88, P=0.708), and 2 years (104 vs. 100, P=0.777). Similarly, revision surgery for nonunion was comparable between the two groups at all time points, 30 days (<10 vs <10, P=1), 90 days (<10 vs <10, P=1), 1 year (24 vs. 20, P=0.546), and 2 years (27 vs 26, P=0.890). Opioid prescription rates were comparable across all time points but trended lower in the ketorolac group: 30 days (1,827 vs. 1,906, P=0.108), 90 days (1,967 vs. 2,051, P=0.092), 1 year (2,340 vs. 2,428, P=0.085), and 2 year (2,574 vs 2,642, P=0.185).

CONCLUSION: Ketorolac use following clavicle surgery was not associated with increased nonunion or revision surgery rates. Although opioid prescription rates trended lower in the ketorolac group, the difference was not statistically significant.

PMID:41061370 | DOI:10.1016/j.injury.2025.112780

Int Orthop. 2025 Oct 8. doi: 10.1007/s00264-025-06668-0. Online ahead of print.

NO ABSTRACT

PMID:41060390 | DOI:10.1007/s00264-025-06668-0