J Bone Joint Surg Am. 2026 Feb 3. doi: 10.2106/JBJS.25.01568. Online ahead of print.

NO ABSTRACT

PMID:41632853 | DOI:10.2106/JBJS.25.01568

J Bone Joint Surg Am. 2026 Feb 3. doi: 10.2106/JBJS.25.01195. Online ahead of print.

NO ABSTRACT

PMID:41632837 | DOI:10.2106/JBJS.25.01195

J Bone Joint Surg Am. 2026 Feb 2. doi: 10.2106/JBJS.25.00863. Online ahead of print.

ABSTRACT

BACKGROUND: Surgical hip reduction is an accepted treatment option for infantile developmental dysplasia of the hip (DDH) but may be complicated by the development of osteonecrosis, recently re-termed proximal femoral growth disturbance (PFGD). Since the etiology of PFGD is likely related to compromised vascular supply to the femoral head, the need exists for an intraoperative method of assessing changes in femoral head perfusion prior to irreversible injury. This study sought to utilize contrast-enhanced ultrasound (CEUS) to assess intraoperative changes in perfusion following surgical reduction for infantile DDH, with the ultimate goal of predicting and eventually preventing PFGD.

METHODS: In this prospective study, CEUS was performed before and immediately after surgical reduction and spica casting in infants undergoing surgery for DDH between 4 and 18 months of age. Delta projections were used to quantitatively analyze changes in perfusion, and a statistical analysis was performed to assess the relationships between patient factors, including casting position, and changes in epiphyseal perfusion.

RESULTS: The study population of 32 patients included 34 hips, comprising 30 hips of female patients (88.2%) and 4 hips of male patients (11.8%), with a mean age and standard deviation of 9.3 ± 3.3 months. A lower perfusion index following surgical reduction (p = 0.003) was seen in the majority (79.4%) of hips. In the remaining hips, a higher perfusion index was observed following reduction (p = 0.03). The greatest significant decreases in perfusion index were observed in the central region of the femoral head epiphysis (p = 0.002), followed by the peripheral region of the femoral head epiphysis (p = 0.03). Axial abduction was correlated with a post-reduction decrease in perfusion index (r = 0.35; p = 0.04). There was a moderately positive correlation between body mass index (BMI) and a post-reduction change in perfusion index (r = 0.45; p = 0.01).

CONCLUSIONS: There was wide variation in post-reduction changes in femoral head perfusion after surgical hip reduction and spica casting for infantile DDH, with a gradient of change across the regions of the femoral head. In addition, BMI and in-cast hip position seemed to influence perfusion changes. With continued analysis of these relationships and longer follow-up from our ongoing prospective investigation, we aim to identify the risk factors for PFGD development.

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

PMID:41628265 | DOI:10.2106/JBJS.25.00863

Int Orthop. 2026 Feb 2. doi: 10.1007/s00264-026-06744-z. Online ahead of print.

ABSTRACT

BACKGROUND: Enhanced Recovery After Surgery (ERAS®) is a coordinated, evidence-based program delivered through a multidisciplinary team, which objective is to improve outcomes and patient satisfaction, while minimizing complications. The objective of this two-cohort study is to evaluate the clinical impact of an ERAS program on elective primary hip (THA) and knee (TKA) arthroplasties with regards to hospital length of stay, during the first 12 months after implementation.

METHODS: We compared a retrospective pre-ERAS with a prospective ERAS cohort. Key aspects of this program included preoperative education, minimal fasting, standardised, anaesthetic and surgical techniques, multimodal analgesia, and early mobilization. The primary outcome was hospital length of stay. Other outcomes included rest, dynamic pain scores, and rates of complications.

RESULTS: From December 1st, 2021 to November 30th, 2022, data from 267 patients (138 THA, 129 TKA) were compared with data from 258 patients (128 THA, 130 TKA) collected between December 1st, 2022, and November 30th, 2023, who underwent the ERAS® program (total: 525 patients). The mean hospital length of stay for THA patients before ERAS® was 5.5 ± 2.9 days versus 4.5 ± 2.0 days after ERAS® implementation (p = 0.002). For TKA patients, it was 6.6 ± 3.1 days before vs 5.6 ± 1.9 days after ERAS® implementation (p = 0.001). Rest, dynamic pain scores, and rates of complications were similar between groups except for pneumonia in patients undergoing TKA.

CONCLUSION: The implementation of an ERAS® program for hip and knee arthroplasty led to a reduced hospital length of stay, below the Swiss national average, without impacting pain outcomes and rates of complications.

PMID:41627408 | DOI:10.1007/s00264-026-06744-z

Int Orthop. 2026 Feb 2. doi: 10.1007/s00264-026-06743-0. Online ahead of print.

ABSTRACT

PURPOSE: Postoperative stiffness is a common and incapacitating complication after total knee arthroplasty (TKA), significantly impacting functional outcomes. Open arthrolysis remains a less-studied surgical option. The objective of this study was to assess the use and outcomes of open arthrolysis in post-TKA stiffness management. We hypothesised that open arthrolysis is the least frequently used technique.

METHODS: This was a retrospective multicentre study conducted as part of the 2024 SOFCOT symposium on post-TKA stiffness management, including 13 centres in France. Patients who underwent open arthrolysis for post-TKA stiffness between 2015 and 2019 were included. Demographic, radiographic, and clinical data were collected, and functional outcomes were evaluated using KOOS, Oxford, and JFS-12 scores preoperatively and postoperatively. Range of motion (ROM) was assessed and compared across different treatment modalities.

RESULTS: Among 490 patients treated for post-TKA stiffness, 12 (2.4%) underwent open arthrolysis. The mean follow-up duration was seven years. Open arthrolysis patients were treated later than those undergoing manipulation under anaesthesia (28.1 vs. 7.2 months, p = 0.001) and later than arthroscopic arthrolysis patients without statistical difference (9.9 months, p = 0.216). Mean ROM improved by 27° postoperatively but remained lower than in other treatment groups (74° vs. 98°, p = 0.011). More than 90% of open arthrolysis patients reported dissatisfaction, compared to 26% for other techniques (p < 0.001).

CONCLUSION: Open arthrolysis is rarely performed for post-TKA stiffness with higher patient dissatisfaction rates than other treatment modalities. These findings suggest that open arthrolysis may have a limited role in post-TKA stiffness management.

PMID:41627407 | DOI:10.1007/s00264-026-06743-0

Injury. 2026 Jan 22:113068. doi: 10.1016/j.injury.2026.113068. Online ahead of print.

ABSTRACT

INTRODUCTION: Preliminary results suggest that placement of stent grafts is a safe method of treating carotid traumatic injuries, but data on late follow-up are limited, therefore this study evaluated in hospital and long-term outcomes of endovascular treatment of carotid artery injuries DESIGN: single centred, retrospective METHODS: This study evaluated patients admitted at University of São Paulo School of Medicine from 2011 to 2024. Complications, mortality, stroke rates and carotid patency were assessed.

RESULTS: Sixteen patients underwent endovascular treatment of their carotid artery injuries during the study period. They were male; with a mean age of 34 ± 11 years. Most injuries resulted from penetrating trauma (12 out of 16). At hospital admission, the median Injury Severity Score (ISS) was 13 (IQR 9-18.5), Revised Trauma Score (RTS) was 8 (IQR 6.75-8) and Glasgow Coma Score (GCS) was 15 (IQR 4.25-15) and five patients had neurological deficits. The common carotid artery was the most frequently injured artery (9/16), while pseudoaneurysms constituted the most common type of arterial injury (13/16). Patients underwent endovascular repair of their vascular injuries via stent graft implantation (nine stent grafts were placed in the common carotid artery, three in the carotid bulb and four in the internal carotid artery). There was no intervention related stroke. Eleven patients were discharged in good condition, four patients had neurological impairment (stable comparing to their deficit at hospital admission) and one patient died due to a contralateral haemorrhagic stroke. Ipsilateral stroke-free survival rate was 62 % at hospital discharge. The mean follow-up time was 43.5 months (IQR 16-61.75). The primary patency of the stent grafts was 100 % at 12 months, 83 % at 24 months, and 73 % at 24 months. Three occlusions were reported, all occurring in stent grafts located within the internal carotid artery. these occlusions were asymptomatic.

CONCLUSION: This study highlights the safety of stent graft repair in a selected cohort of patients with carotid injury. It was observed that stent grafts implanted in the internal carotid artery are prone to late, often asymptomatic occlusion, underscoring the importance of surveillance. However, multicentre prospective studies are still needed to establish best practice.

PMID:41622057 | DOI:10.1016/j.injury.2026.113068

Injury. 2026 Jan 22;57(3):113053. doi: 10.1016/j.injury.2026.113053. Online ahead of print.

ABSTRACT

OBJECTIVES: Artificial intelligence (AI) has revolutionized public access to extensive information with large language model (LLM)-based chatbots allowing users to receive comprehensive, individualized responses. In this study, we aimed to evaluate the quality of LLM responses to questions about common orthopedic conditions. We hypothesized that both ChatGPT and Gemini would demonstrate high quality, evidence-based responses across evaluation criteria.

METHODS: Responses from ChatGPT and Gemini to prompts based on the 14 AAOS Clinical Practice Guidelines for clavicle fracture management were evaluated on six criteria by seven fellowship-trained shoulder and trauma orthopedic surgeons. Statistical analyses including mean scoring, standard deviation and two-sided t-tests were calculated to compare performance between ChatGPT and Gemini. Scores were then evaluated for inter-rater reliability (IRR).

RESULTS: ChatGPT and Gemini demonstrated overall mean scores greater than 3.5 for both platforms. Mean overall score for ChatGPT was highest in evidence-based (4.52 ± 0.16) and lowest in clarity (4.22 ± 0.19). Mean overall score for Gemini was highest in clarity (4.31 ± 0.17) and lowest in evidence-based (3.81 ± 0.22). ChatGPT had significantly better performance in the overall completeness category (4.50 ± 0.17 vs 4.11 ± 0.19, p < 0.005) than Gemini but scores were otherwise not significantly different. Over 70 % of respondents rated the responses of ChatGPT as higher quality than Gemini.

CONCLUSIONS: ChatGPT and Gemini produced responses that were generally in line with the 2022 AAOS guidelines on the treatment of clavicle fractures. Scores were comparable in every overall category except completeness, with ChatGPT outperforming Gemini. These results suggest that both LLMs are capable of providing clinically relevant responses to questions related to clavicle fracture management.

PMID:41621222 | DOI:10.1016/j.injury.2026.113053

Injury. 2026 Jan 22;57(3):113056. doi: 10.1016/j.injury.2026.113056. Online ahead of print.

ABSTRACT

PURPOSE: This pilot study aims to validate the "ground truth" accuracy and consistency of proximal femur fracture classification using a large radiographic image database. The project, a collaboration between expert groups from the University of Turin and the AO Foundation, seeks to ensure that expert consensus-based annotations are reliable for future artificial intelligence (AI) model development.

METHODS: A cross-sectional, diagnostic accuracy study was conducted using a randomly selected subset of 300 anteroposterior pelvic radiographs from a single-center image repository created at the University of Turin within the AO Innovation Translation Center framework. Fracture classification annotations were independently provided by the local clinical expert group (LC-EG) and by an independent AO expert group of surgeons (AO-EG). To assess interrater reliability between the two groups, Cohen's kappa coefficient was calculated for categorical agreement on the presence of a fracture and AO/OTA classification.

RESULTS: The comparison of annotations from LC-EG and AO-EG yielded a Cohen's kappa of 0.81 (95 % confidence interval: 0.75-0.87) and a percentage agreement of 87.67 % (95 % confidence interval: 87.63-87.70) for the classification of proximal femur fractures into three defined categories: no fracture, fracture type 31A, and fracture type 31B. These results confirm a high level of consistency between the two expert groups in annotating the image dataset.

CONCLUSION: The observed interrater reliability between the LC-EG and AO-EG supports the credibility of the reference annotations, establishing a validated ground truth for proximal femur fractures. This evidence justifies using the radiographic image database as a benchmark for future studies and as a foundation for transparent, reproducible AI development and evaluation, thereby facilitating safer integration of decision support tools into orthopedic trauma workflows.

PMID:41616725 | DOI:10.1016/j.injury.2026.113056

Injury. 2026 Jan 22;57(3):113066. doi: 10.1016/j.injury.2026.113066. Online ahead of print.

ABSTRACT

INTRODUCTION: Ankle fractures are among the most common fractures in older adults, associated with substantial morbidity and healthcare burden. This study aimed to evaluate recent trends in incidence and injury characteristics of ankle fractures among adults aged ≥65 years presenting to United States emergency departments.

METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for ankle fractures in adults aged ≥65 years from 2016 to 2023. Demographics, injury mechanisms, fracture types, and hospitalization rates were analyzed. Annual incidence rates per 100,000 persons were calculated. Trends over time, as well as age- and sex-specific differences, were analyzed.

RESULTS: An estimated 241,449 ankle fractures occurred among adults aged ≥65 years between 2016 and 2023, with an overall incidence rate of 55.8 per 100,000 person-years. The incidence increased from 49.1 to 63.0 per 100,000 persons during the study period (P < 0.0001). Incidence rates increased significantly in both males (from 25.7 to 34.7 per 100,000 persons; P < 0.0001) and females (from 67.7 to 86.4 per 100,000 persons; P < 0.0001). Most fractures occurred in women (76.2 %), resulted from low-energy trauma (92.8 %), and were closed fractures (96.9 %). Open fracture incidence rose from 0.64 to 2.40 per 100,000 persons, representing a 275 % increase (P < 0.0001). Hospitalization rates increased from 20.3 to 29.7 per 100,000 persons (P < 0.0001). Women aged ≥80 years accounted for the highest fracture burden. Women were more likely to sustain low-energy injuries (P < 0.0001), while men had a higher proportion of open fractures (P = 0.011). Hospitalization rates increased with age, reaching 56.6 % among patients aged ≥80 years (P < 0.0001).

CONCLUSIONS: Ankle fracture incidence among older adults in the U.S. increased significantly from 2016 to 2023, with rising rates in both males and females. Low-energy mechanisms remain the predominant cause in this population. Further studies are needed to identify optimal surgical treatments and rehabilitation strategies. Improving bone health and reducing morbidity and mortality remain key priorities in managing geriatric ankle fractures.

PMID:41616724 | DOI:10.1016/j.injury.2026.113066

Injury. 2026 Jan 22;57(3):113067. doi: 10.1016/j.injury.2026.113067. Online ahead of print.

ABSTRACT

BACKGROUND: Revision amputation is a common treatment in the emergency department (ED) for traumatic finger injuries, yet there is limited data on outcomes for procedures completed in the emergency room versus the operating room. This study aims to assess outcome differences between ED revision amputation and delayed OR management.

METHODS: 103 consecutive patients with traumatic finger(s) amputations were identified from a single tertiary care center. Patients were evaluated by the on-call hand team and staffed with a fellowship-trained hand attending. ED revision amputations were performed with the goal of definitive care. Data was collected for injury/patient demographics, follow-up, and further revision procedures. Odds ratios were calculated to assess for predictive factors for ED management failure.

RESULTS: 55 patients were treated with ED revision amputation, 18 of whom (32.7 %) required further surgical management. Presence of multiple digit amputations was associated with increased initial treatment in the operating room. The most common indication for surgery was revision amputation and soft tissue coverage (88.9 %), followed by additional bony fixation for underlying fractures (44.4 %). Number of fingers amputated, fracture presence, and significant soft tissue injury were not associated with failure. Of the 48 patients with planned delayed management in the OR, 11 were treated with nonoperative wound care.

CONCLUSIONS: Definitive ED revision amputation was associated with a high rate of failure, need for revision surgery, and loss to follow up. Injuries with complex wound coverage or bony fixation may be better suited to OR management. Some patients may ultimately be appropriate for management without revision amputation and may be overtreated with this procedure in the ED.

PMID:41616723 | DOI:10.1016/j.injury.2026.113067

Injury. 2026 Jan 29;57(3):113032. doi: 10.1016/j.injury.2026.113032. Online ahead of print.

ABSTRACT

INTRODUCTION: Safe return to driving after orthopaedic injury or surgery is important, but standardised and feasible in-hospital assessments are lacking. We evaluated the feasibility of a simple simulator-based fitness-to-drive assessment in an orthopaedic outpatient department and its ability to discriminate between orthopaedic patients and professional drivers.

METHODS: In this prospective feasibility study (January 2024-January 2025), two identical driving simulators were installed in an orthopaedic outpatient department and a vocational training centre for professional drivers. Participants were ≥18 years, held a driving licence, and had no medical driving ban. All completed a 3-lap, 6-event scenario with predefined speed progression (50/60/70 km/h). Outcomes were completion, errors, speed progression, maximum reaction time and braking length (metres) at 50 km/h, simulator sickness, perceived realism, and subgroup test-retest reliability.

RESULTS: We included 57 patients and 92 drivers. Overall completion was 96.6% (144/149); 31.2% achieved speed progression. Patients were older, more often female, and more functionally impaired than drivers. Drivers had a shorter braking distance (23.3 m; 95% CI 22.1-24.5) and faster reaction time (0.5 s; 95% CI 0.5-0.6) than patients (39.4 m; 95% CI 36.7-42.1 and 1.2 s; 95% CI 1.0-1.4). Simulator sickness leading to discontinuation occurred in 3.4%. Most patients (98.2%) and 64.0% of drivers perceived simulator driving as comparable to real driving. Repeat testing showed a shorter braking distance, particularly in patients.

CONCLUSION: The simulated assessment was feasible, well tolerated, and discriminated between patients and professional drivers. Variation indicates a need for individualised assessment. Validation against on-road driving is required before clinical implementation.

PMID:41616722 | DOI:10.1016/j.injury.2026.113032

J Bone Joint Surg Am. 2026 Jan 29. doi: 10.2106/JBJS.25.00952. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Centers for Medicare & Medicaid Services (CMS) has set the substantial clinical benefit (SCB) for the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) after primary total knee arthroplasty (TKA) at 20 points. We aimed to determine the percentages of patients who achieved the minimal clinically important difference (MCID) and the SCB for KOOS-JR at 1 year following TKA and to evaluate factors associated with benchmark achievement.

METHODS: We queried the American Joint Replacement Registry (AJRR) and screened 1,284,404 primary TKA cases performed from 2018 to 2023. We determined attainment of the KOOS-JR distribution-based MCID (7.5), anchor-based MCID (14), and SCB (20) at 12 months by each patient. Associations of covariates with the achievement of the MCIDs and the SCB were evaluated using a generalized linear model for binary outcomes that accounted for clustering within institutions. Unadjusted and adjusted odds ratios (ORs) for the outcomes of interest with 95% confidence intervals (CIs) were reported. Covariates included the preoperative KOOS-JR, sex, race or ethnicity, body mass index (BMI), Charlson Comorbidity Index (CCI), fixation type, use of technology, year of the procedure, region, institution type, teaching status, and number of beds.

RESULTS: Linked scores were recorded by 64,773 patients. The mean patient age was 68.35 ± 8.60 years, 61.29% of patients were female, and 83.52% of patients were non-Hispanic White. The KOOS-JR threshold achievement rate was 86.8% for the calculated distribution-based MCID, 76.5% for the anchor-based MCID, and 65.7% for the SCB. Patients with higher preoperative scores (adjusted OR, 0.93 [95% CI, 0.93 to 0.93]; p < 0.001), Asian patients (adjusted OR, 0.59 [95% CI, 0.46 to 0.74]; p < 0.001), Black patients (adjusted OR, 0.55 [95% CI, 0.49 to 0.62]; p < 0.001), Hispanic patients (adjusted OR, 0.71 [95% CI, 0.51 to 0.99]; p = 0.042), non-Hispanic patients of other races (adjusted OR, 0.84 [95% CI, 0.74 to 0.95]; p = 0.007), male patients (adjusted OR, 0.89 [95% CI, 0.85 to 0.94]; p < 0.001), and patients with higher BMI (adjusted OR, 0.93 [95% CI, 0.87 to 0.99]; p = 0.025) showed lower odds of achieving the SCB. A CCI of ≥5 was additionally found to be associated with lower odds of achieving the distribution-based MCID (adjusted OR, 0.89 [95% CI, 0.79 to 0.99]; p = 0.032) and anchor-based MCID (adjusted OR, 0.89 [95% CI, 0.81 to 0.97]; p = 0.012).

CONCLUSIONS: The CMS relatively arbitrarily defined the SCB at a value that is too high for an operation that routinely yields >80% patient satisfaction.

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

PMID:41610198 | DOI:10.2106/JBJS.25.00952

SICOT J. 2026;12:4. doi: 10.1051/sicotj/2025068. Epub 2026 Jan 28.

ABSTRACT

INTRODUCTION: Functional alignment (FA) or functional knee positioning is a patient-specific strategy for total knee arthroplasty (TKA) that utilizes robotics to balance coronal, sagittal, and axial planes while preserving joint-line orientation and soft-tissue tension within predefined guardrails. Although early clinical outcomes are encouraging, the radiographic profile and workflow consistency of robotic FA have not been clearly synthesized.

METHODS: In accordance with PRISMA guidelines, English-language studies of primary robotic FA-TKA with ≥2-year follow-up were searched. Eligible designs included RCTs, prospective/retrospective cohorts, and large case series (≥50 patients). Information on pre- and postoperative coronal alignment [hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA)], component positioning (femoral valgus/rotation/flexion; tibial varus/rotation/slope), and explicit FA workflow boundaries (guardrails) was extracted.

RESULTS: Twenty-one cohorts (5,360 knees) reported at least one radiographic or workflow endpoint. Preoperatively, the predominant deformity was varus. Postoperatively, limb alignment converged near neutral: HKA clustered around 178-179.5°, with LDFA ~89-91° and MPTA ~87-89°. Component positions were tightly distributed within FA targets: femoral valgus ≈ 0.5-1.5°, tibial varus ≈ ~3°, femoral flexion ~6-9°, and tibial slope ~0-3°; tibial rotation was overwhelmingly referenced to Akagi's line, and femoral rotation to the TEA in most series. Reported guardrails showed strong convergence: typical workflows included femoral valgus -3° to +6°, tibial varus 0-6°, tibial slope 0-3°, and femoral ER ~3-6° to TEA. Across cohorts, achieved radiographs closely tracked these limits, indicating high adherence and reproducibility. Most observational studies had a moderate risk of bias; the lone RCT was low risk.

DISCUSSION: Robotic FA-TKA delivers a radiographic profile with slight femoral valgus and modest tibial varus, while keeping components within narrow, pre-specified guardrails.

LEVEL OF EVIDENCE: Level III, systematic review and meta-analysis.

PMID:41603463 | PMC:PMC12849696 | DOI:10.1051/sicotj/2025068

SICOT J. 2026;12:3. doi: 10.1051/sicotj/2025066. Epub 2026 Jan 28.

ABSTRACT

PURPOSE: In distal femoral osteotomy (DFO), using longer distal screws in fixation plates may improve stability. This study examined the insertion direction of three distal screws at the horizontal cross-section to determine if posterior angulation enables deeper placement.

METHODS: Forty-seven varus knees that underwent DFO were included (medial closed-wedge DFO [MCWDFO], 30 knees; lateral closed-wedge DFO [LCWDFO], 17 knees). Postoperative plain CT images were obtained from a plane parallel to the three distal screws, with the most distal screw designated as A, the anterior of the second distal row as B, and the posterior of the second distal row as C. For each case, a curve passing through the center of the bony cortex on the cross-section parallel to each screw and over its entire length was drawn, and the curve and the lower edge of the screw were projected onto a graph. The maximum angle at which the lower edge of each screw touches the intercondylar region without interfering with the intercondylar region was designated as (AnA), (AnB), and (AnC) for A-, B-, and C-screws, respectively. The angle between the line connecting the insertion points of the B- and C-screws on the plate and the tangent line to the medial and lateral bony cortex was designated as (AnP).

RESULTS: In the MCWDFO group, the mean values for each parameter were AnA, 10.9 ± 5.4; AnB, 27.0 ± 4.2; AnC, 9.2 ± 3.4; and AnP, -2.6 ± 6.9. In the LCWDFO group, the mean values for each parameter were AnA, 18.2 ± 6.9; AnB, 30.4 ± 7.1; AnC, 16.1 ± 7.2; AnP, -0.2 ± 6.1°.

CONCLUSIONS: The medial surface is inclined compared to the epicondylar axis and posterior condyle, usually resulting in plate positioning that is parallel to the placement surface. The optimal screw insertion from the anterior to posterior was generally achieved; however, there was still room for posterior angulation margins of 9-11° for A- and C-screws and approximately 27° for the B-screw. In contrast, the lateral surface is flatter with less inclination, causing anterior plate placement and wider posterior angulation - approximately 16-18° for A- and C-screws and 30° for the B-screw - allowing a greater range of posterior swing than the medial side.

PMID:41603462 | PMC:PMC12849697 | DOI:10.1051/sicotj/2025066

Injury. 2026 Jan 22:113064. doi: 10.1016/j.injury.2026.113064. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic Brain Injury (TBI) affects 64-74 million people annually, often causing long-term disability. The influence of social determinants of health (SDOH), particularly neighborhood and built environments, on functional outcomes post-TBI remains underexplored. This study examines the association between census tract-level median household income- a proxy for area income- and self-reported functional outcomes in TBI-patients seen in a Southern California TBI clinic.

METHODS: A retrospective cohort study of Neurology TBI & Concussion Clinic data (9/2022-1/2025) included patients ≥18 years with a known TBI mechanism and neurological symptoms who completed SDOH and functional assessments. SDOH factors included sex, race, ethnicity, insurance status, and median area income, determined by ZIP code using 2023 US census data. Disability was defined as Glasgow Outcome Scale-Extended-score ≤6 at index clinic-visit. Multivariable logistic regression was performed.

RESULTS: Among 148 patients (median age 46.5 years; 41% female, 75% mild TBI), the disabled cohort had higher proportions of poor insurance status (38% vs. 8%, p < 0.001), greater injury severity score (ISS) (9.0 vs. 1.0, p = 0.002), and lower median household income ($104,981 vs. $114,747, p = 0.020). Regression analysis showed poor insurance status (OR 5.80, CI 2.01-21.24, p = 0.003) and ISS (OR 1.06, CI 1.01-1.12, p = 0.027) predicted disability, but area income did not (OR 0.93, CI 0.79-1.10, p = 0.387).

CONCLUSION: Lower area income was associated with disability in unadjusted analysis but was not an independent predictor after adjusting for insurance and ISS. Findings highlight the need to explore individual and community factors influencing long-term TBI outcomes for targeted screening.

PMID:41605747 | DOI:10.1016/j.injury.2026.113064

Injury. 2026 Jan 11;57(3):113046. doi: 10.1016/j.injury.2026.113046. Online ahead of print.

ABSTRACT

OBJECTIVE: Patients with deep second- and third-degree burns are at high risk of bloodstream infections (BSIs) due to skin barrier disruption and immune suppression, with poor prognosis. Early risk identification is crucial for improving outcomes. This study aimed to construct and validate a machine learning model using multidimensional clinical indicators to accurately predict BSI risk in such patients.

METHODS: A retrospective cohort study enrolled 301 patients with deep second- and third-degree burns (75 with BSIs) from Yongchuan Hospital Affiliated to Chongqing Medical University between January 2020 and January 2025. Multidimensional data on burn characteristics, laboratory indicators, and therapeutic measures were collected within 72 h of admission. After data preprocessing and feature screening, four models were built: logistic regression (LR), support vector machine (SVM), naive Bayes (NB), and back propagation artificial neural network (BP-ANN). Model performance was evaluated via stratified sampling and 5-fold cross-validation.

RESULTS: Eight key predictors were identified: total body surface area, lymphocytes (LYM, most important), platelet crit, total bilirubin, creatinine, C-reactive protein, procalcitonin, and 24-hour rehydration. The BP-ANN model performed best in the test set, with accuracy, recall, precision, F1 value, and AUC all reaching 0.857, good calibration (Hosmer-Lemeshow test, P = 0.142), and significant net benefit in the 0-0.3 risk threshold interval (decision curve analysis). The LR model had an AUC of 0.891 and high generalization stability (0.999) but less balanced indicators. SVM was overfitted (limited practical value), and NB had insufficient generalization (test set AUC=0.775).

CONCLUSION: The BP-ANN model based on multidimensional clinical indicators accurately predicts BSI risk in patients with deep second- and third-degree burns, with good differentiation, calibration, and clinical utility, providing a reliable tool for early intervention.

PMID:41604758 | DOI:10.1016/j.injury.2026.113046

J Bone Joint Surg Am. 2026 Jan 27. doi: 10.2106/JBJS.25.01349. Online ahead of print.

ABSTRACT

BACKGROUND: Cefazolin, a first-generation cephalosporin, is the standard antibiotic for perioperative prophylaxis in patients undergoing hip or knee arthroplasty. Research has demonstrated significantly higher periprosthetic joint infection (PJI) rates when non-cefazolin antibiotics are used for prophylaxis. Notably, cefazolin contains an R1 side chain that has not shown cross-reactivity with other cephalosporins. However, in patients with a reported cephalosporin allergy, there is often uncertainty about the optimal antibiotic choice. This study aimed to determine the safety of perioperative cefazolin in patients with a documented cephalosporin allergy undergoing joint arthroplasty.

METHODS: We reviewed the records of 1,268 patients who had a documented cephalosporin allergy and underwent total hip or knee arthroplasty at a high-volume academic center from 2016 to 2024. We compared patients who received cefazolin despite a cephalosporin allergy (n = 482) and patients who received an alternative antibiotic prophylaxis (n = 786). The primary outcome was the incidence of immunoglobulin E (IgE)-mediated allergic reactions or "severe" Type-IV delayed hypersensitivity reactions with end organ dysfunction within 72 hours postoperatively. The secondary outcomes included 90-day rates of complications including PJI, Clostridioides difficile infections, adverse events related to the antibiotic, and readmission.

RESULTS: The incidence of an allergic reaction in patients with an allergy to cephalosporin who received cefazolin was 0.0% (0 of 482) compared with 0.51% (4 of 786) in patients who received an alternative antibiotic prophylaxis (p = 0.30). There were no significant differences in the rates of PJI after primary arthroplasty (0.21% compared with 0.26%; p = 0.83), C. difficile infection (0.0% compared with 0.0%), or readmission within 90 days (3.95% compared with 4.33%; p = 0.75). One patient who received cefazolin experienced mild, self-limited urethral irritation. Five patients receiving alternative antibiotics experienced antibiotic-related adverse events, including skin reactions, gastrointestinal distress, pancreatitis, and headache.

CONCLUSIONS: In this cohort of patients undergoing joint arthroplasty, cefazolin administration in patients with a cephalosporin allergy was associated with a 0.0% incidence of IgE-mediated or severe Type-IV allergic reactions.

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

PMID:41592154 | DOI:10.2106/JBJS.25.01349

J Bone Joint Surg Am. 2026 Jan 26. doi: 10.2106/JBJS.25.00860. Online ahead of print.

ABSTRACT

BACKGROUND: Sex-based disparities remain a major challenge in musculoskeletal medicine. Women and men experience different anterior cruciate ligament (ACL) injury rates and severity, but the causes remain unclear. We hypothesized that cellular differences in human progenitor cells contribute to the higher ACL tear risk observed in females.

METHODS: ACL samples were collected from 4 male and 5 female patients undergoing ACL reconstruction surgery. Live cells were collected through flow cytometry and sent for single-cell RNA sequencing. Significantly greater expression in either sex relative to the other was defined as a >25% increase in expression level (log2 fold change > 0.32) and p < 0.05). Subpopulation characterization was performed with immunofluorescence on tissue sections.

RESULTS: We discovered sex-based differences in all of the native cell types within the ACL. In particular, fibroblast progenitor-like (TPPP3+) cells from female patients expressed genes associated with dysregulation and degradation of collagen more highly than progenitor cells from male patients.

CONCLUSIONS: These results highlight a ligament progenitor population with a sex-dependent gene expression profile. This work suggests that sex-based differences in stem cell populations may drive differential injury rates and outcomes between male and female patients with musculoskeletal injuries.

CLINICAL RELEVANCE: The differential gene expression among TPPP3+ progenitor-like cells provides a possible target population for studying ligamentous injury and regeneration. Differential expression of collagen and extracellular matrix-related genes provides evidence of specific genes that could be therapeutically targeted to strengthen the ACL and reduce the risk of rupture, particularly in female athletes.

PMID:41587266 | DOI:10.2106/JBJS.25.00860

J Bone Joint Surg Am. 2026 Jan 26. doi: 10.2106/JBJS.25.00681. Online ahead of print.

ABSTRACT

BACKGROUND: Although clinical guidelines endorse enoxaparin for the prevention of venous thromboembolism in patients with orthopaedic trauma, recent evidence from a large clinical trial has demonstrated that aspirin provides comparable protection against death and pulmonary embolism. This study evaluated the cost-effectiveness of thromboprophylaxis with enoxaparin compared with that with aspirin in patients with orthopaedic trauma from the perspective of the U.S. health-care system.

METHODS: The study modeled a hypothetical cohort of adult patients with an operatively treated extremity, pelvic, or acetabular fracture based on data from a recent clinical trial and national databases. We used a decision analysis model to compare 30 mg of enoxaparin with 81 mg of aspirin, administered twice daily in-hospital and prescribed for 21 days after discharge. Health-care costs and quality-adjusted life-years (QALYs) within 1 year after the injury derived from published research and publicly available cost data were based on potential disease states, including death or a combination of pulmonary embolism, proximal deep vein thrombosis, distal deep vein thrombosis, or a bleeding complication. We assessed cost-effectiveness compared with a willingness-to-pay threshold of $150,000 per QALY.

RESULTS: Our model estimated that the 1-year health-care costs among patients prescribed enoxaparin were $35,301, producing 0.6705 QALYs. Aspirin was associated with $35,067 in 1-year health-care costs and 0.6701 QALYs. The overall health-care costs were $234 higher with enoxaparin but yielded only a 0.0004 improvement in QALYs, for an incremental cost-effectiveness ratio for enoxaparin of $635,340 per QALY, indicating that enoxaparin is not cost-effective compared with aspirin. In a sensitivity analysis, the probability of enoxaparin thromboprophylaxis being cost-effective compared with aspirin was 9.8% in 10,000 iterations.

CONCLUSIONS: The findings suggest that enoxaparin is not cost-effective relative to aspirin for thromboprophylaxis in patients with orthopaedic trauma. The results support consideration of aspirin as a preferred agent in future guidelines, especially given the consistent patient preference for its oral administration.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41587264 | DOI:10.2106/JBJS.25.00681

Int Orthop. 2026 Jan 26. doi: 10.1007/s00264-026-06737-y. Online ahead of print.

NO ABSTRACT

PMID:41586912 | DOI:10.1007/s00264-026-06737-y