Int Orthop. 2025 Oct 7. doi: 10.1007/s00264-025-06667-1. Online ahead of print.

NO ABSTRACT

PMID:41055733 | DOI:10.1007/s00264-025-06667-1

Injury. 2025 Sep 20;56(11):112770. doi: 10.1016/j.injury.2025.112770. Online ahead of print.

ABSTRACT

INTRODUCTION: A dedicated Major Trauma Ward (MTW) is core to the function of a Major Trauma Centre (MTC). MTCs are central to the hub-and-spoke model of an inclusive Major Trauma System (MTS). The implementation of the London Major Trauma System is heralded to have increased the in-hospital odds ratio of survival of traumatically injured patients by 19 %. There is no one universal definition of Major Trauma, but the National Institute for Health and Clinical Excellence (NICE) provides the definition, "Major trauma is defined as an injury or combination of injuries that are life-threatening and could be life changing because it may result in long-term disability". Major Trauma is a disease requiring multidisciplinary and multi-specialty input at every stage of the continuum of care. However, there is no formal education for staff on a MTW on the care of these complex, severely injured patients. The Trauma ORchestration of Continuing Healthcare (TORCH) course was established in 2018 to help to address this educational void. The aims of this paper are to describe the rationale for the course, report the feedback, and identify key strengths and areas for improvement.

METHODS: A mixed methods study was undertaken with simultaneous quantitative and qualitative analysis. Descriptive statistics of quantitative data was undertaken to describe delegate demographics. Thematic analysis of the 136 attendee responses to course feedback was performed. Course feedback was assimilated contemporaneously at the end of each course via online survey.

RESULTS AND DISCUSSION: There was an 88 % (136/154) response rate to feedback. Attendees included 96 doctors, and 16 nurses and allied health professionals. The 2019 course of 24 delegates did not stratify participant demographics. The largest group of doctors (39 %) were Senior House Officer grade, with 41 % of all doctors coming from a surgical background. Feedback themes identified as course strengths include the multidisciplinary curriculum approach. Speakers include Consultants from 12 different specialties and multiple therapists across the continuum of trauma care. Lectures based on real life case discussion was found to be an engaging and thought provoking medium of education with the focus on MTW based decision making commonly required of MTW junior staff. Areas for future development include the continued delivery of the TORCH course outside of London and consideration of course validation for quality assurance, and a "train the trainer" model to allow for course expansion and sustainability in other MTSs of the UK and Ireland to implement formal, high quality education for staff on MTWs.

PMID:41045758 | DOI:10.1016/j.injury.2025.112770

Injury. 2025 Sep 30;56(11):112777. doi: 10.1016/j.injury.2025.112777. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior shoulder dislocations are common in emergency settings, requiring effective procedural sedation and analgesia (PSA). Ketofol (ketamine-propofol) and etofen (etomidate-fentanyl) are widely used, but their comparative efficacy remains debated.

OBJECTIVES: The aim of this study was to compare the efficacy and safety of ketofol versus etofen for PSA in shoulder dislocation reduction.

METHODS: This randomized clinical trial enrolled 92 patients (46 per group). Ketofol (0.75 mg/kg) or etofen (0.15 mg/kg etomidate + 1.5 µg/kg fentanyl) was administered. Outcomes included sedation depth, hemodynamics, adverse events, and recovery times.

RESULTS: Ketofol provided deeper sedation (RSS 4.5 vs. 4.1, p < 0.001), better analgesia (VAS 1.64 vs. 2.64, p < 0.001), and easier reduction but had more emergence reactions. Etofen showed faster onset and fewer respiratory events but caused myoclonus.

CONCLUSION: Ketofol offers superior analgesia and sedation, while etofen ensures rapid recovery and hemodynamic stability. The choice depends on clinical priorities.

CLINICAL TRIAL REGISTRATION: IRCT20220824055790N1.

PMID:41045757 | DOI:10.1016/j.injury.2025.112777

Injury. 2025 Sep 24;56(11):112775. doi: 10.1016/j.injury.2025.112775. Online ahead of print.

ABSTRACT

OBJECTIVE: Although rare, shark bites can cause complex injuries requiring specialized management. This study aims to describe the surgical and medical management of shark bite injuries in New Caledonia.

METHODS: A retrospective, descriptive, single-center study including 22 patients hospitalized between 2011 and 2023. Demographic data, attack context, injury types, surgical treatments, infectious complications, and length of hospital stay were analyzed.

RESULTS: The median age was 33.5 years (IQR 15); 82 % were male. Spearfishing was the most common context (32 %). Injuries predominantly affected limbs, with musculoskeletal damage (82 %), nerve injuries (32 %), vascular injuries (27 %), and fractures (18 %). Infectious complications were rare (9 %), but identified pathogens were polymicrobial and marine-derived. The median hospital stay was 5 days (IQR 6, range 1-50 days).

CONCLUSION: Shark bites require rapid, specialized surgical care. Local organization enabled effective management. Empirical antibiotic therapy should cover marine pathogens.

LEVEL OF EVIDENCE: IV.

PMID:41037958 | DOI:10.1016/j.injury.2025.112775

EFORT Open Rev. 2025 Oct 1;10(10):733-744. doi: 10.1530/EOR-2023-0179.

ABSTRACT

Hip pain can be caused by extra-articular conditions such as subspine impingement, iliopsoas impingement, and ischiofemoral impingement. These syndromes are frequently secondary to underlying pathologies involving the hip joint or lumbar spine. While most cases are managed conservatively through activity modification and physiotherapy, surgical intervention is considered for refractory cases. Imaging, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) is crucial for diagnosing these conditions, as clinical symptoms can be nonspecific. CT scans help identify predisposing factors such as acetabular morphology, femoral version, and acetabular version, while MRI is useful for ruling out other conditions and detecting soft tissue pathology. Although positive treatment outcomes are generally observed, there are variations in results and procedures, and long-term follow-up studies are lacking. Complications of the treatments are a concern, but most reported complications are minor in nature.

PMID:41031635 | PMC:PMC12494060 | DOI:10.1530/EOR-2023-0179

EFORT Open Rev. 2025 Oct 1;10(10):771-781. doi: 10.1530/EOR-2025-0027.

ABSTRACT

PURPOSE: This study aimed to systematically evaluate the efficacy and safety of oral versus intravenous tranexamic acid (TXA) in total knee arthroplasty (TKA).

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched. Data extraction and quality assessment were performed independently by two investigators. The primary outcomes were hemoglobin (Hb) decrease and blood loss, while secondary outcomes included transfusion rate, operation time, hospital stay, and complications. The analysis used random-effects models and assessed heterogeneity with I 2 values.

RESULTS: Nine studies were included in the meta-analysis, comprising a total of 1,227 participants. Across the included studies, oral TXA was most commonly administered as 1.95-2 g given 1-2 h before surgery, with some regimens including postoperative doses. Intravenous TXA was typically given as 1 g before surgery, sometimes with additional doses before wound closure or after surgery. The results showed no significant difference between oral and intravenous TXA in terms of Hb decrease and transfusion rates. Similarly, there was no significant difference in complications, operation time, and length of hospital stay. Comparable findings were observed in both RCTs and non-RCTs. Sensitivity analysis demonstrated that the overall results remained robust, with no single study exerting a substantial influence on the pooled estimates.

CONCLUSIONS: Based on available evidence, there is no significant difference observed between oral and intravenous TXA in patients undergoing TKA. However, the wide confidence intervals for several outcomes indicate important uncertainty, and further high-quality studies are needed to confirm the comparative effectiveness and safety.

PMID:41031630 | PMC:PMC12495541 | DOI:10.1530/EOR-2025-0027

EFORT Open Rev. 2025 Oct 1;10(10):815-828. doi: 10.1530/EOR-2025-0041.

ABSTRACT

OBJECTIVE: Primary spondylodiscitis poses significant diagnostic and therapeutic challenges, with delayed diagnosis or improper treatment potentially resulting in severe complications. This systematic review aimed to summarize the latest diagnostic and therapeutic approaches for primary spondylodiscitis.

METHODS: Adhering to PRISMA 2020 guidelines, we conducted a systematic literature review. PubMed was comprehensively searched for English-language original studies from January 1, 1990, to October 31, 2024. Structured queries combined keywords and MeSH terms relevant to spondylodiscitis, vertebral osteomyelitis, spinal infection, and associated treatments. Two reviewers independently screened titles, abstracts, and full texts, with manual bibliography searches as a supplement. A total of 147 articles were finally included.

RESULTS: The literature indicates that diagnosis can be based on clinical suspicion, using serological, radiological, and microbiological tests. Newer methods such as metagenomics next-generation sequencing (mNGS) and positron emission tomography-computed tomography (PET-CT) can enhance diagnostic sensitivity and specificity. For confirmed cases, appropriate antibiotic therapy is crucial. Surgical treatment can benefit patients with neurological deficits, sepsis, spinal instability/deformity, epidural abscesses, or failed conservative treatment, accelerating recovery and reducing complications. Minimally invasive surgical approaches may also serve as an alternative to open surgery for select patients.

CONCLUSION: Although new technologies have improved diagnostic accuracy and treatment success rates for primary spondylodiscitis, establishing a robust staging system is vital to ensure patients receive effective, evidence-based treatment options.

PMID:41031628 | PMC:PMC12495883 | DOI:10.1530/EOR-2025-0041

EFORT Open Rev. 2025 Oct 1;10(10):756-762. doi: 10.1530/EOR-2024-0179.

ABSTRACT

PURPOSE: The surgical reconstruction of the medial patellofemoral ligament (MPFL) is a commonly used treatment for recurrent patellar dislocations. A surgical method which is frequently used is the dynamic reconstruction of the MPFL (dMPFLr), which involves attaching the released end of a hamstring muscle to the medial patella using a pulley. The aim of this systematic review and meta-analysis is to evaluate the evidence of this method in terms of patient-reported outcomes, the rate of recurrent instabilities, and other complications.

METHODS: MEDLINE® and Web of Science™ were used to identify eligible studies. We used a random-effects meta-analysis to estimate the pooled rates of the Kujala scores, rates of recurrent instabilities, and complication rates.

RESULTS: A total of 1,087 studies were screened for eligibility. Six studies, comprising a total of 267 treated knees, met the inclusion criteria and were included. All the publications included were retrospective analyses (level of evidence III). The random-effects model showed an overall mean postoperative Kujala score of 86.74 (95% CI: 79.37-94.11; heterogeneity: I 2 = 94%), a recurrent instability rate of 13% (95% CI: 9-18%; heterogeneity: I 2 = 0%), and additional complications mentioned at a rate of 9% (95% CI: 5-16%; heterogeneity: I 2 = 0%).

CONCLUSION: Although good results are achieved with regard to the patient-reported outcomes and complication rates, there is a high rate of recurrent instabilities. Despite these results, dMPFLr can be considered an option for the treatment of skeletally immature patients, as it avoids the need for intraoperative fluoroscopy and the risk of epiphyseal joint injury due to femoral fixation.

PMID:41031627 | PMC:PMC12494057 | DOI:10.1530/EOR-2024-0179

EFORT Open Rev. 2025 Oct 1;10(10):782-795. doi: 10.1530/EOR-2025-0022.

ABSTRACT

PURPOSE: To quantify the response to intra-articular saline administration in terms of pain, function, and quality of life, with a focus on the evolution of placebo response over time and the identification of influencing factors on the placebo response to knee osteoarthritis injections.

METHODS: After registration on PROSPERO, a systematic review was conducted following PRISMA guidelines to identify double-blind, placebo-controlled randomised clinical trials on intra-articular knee injections for knee osteoarthritis. The placebo response was evaluated through meta-analyses of VAS pain, WOMAC, KOOS, and responder rates at 1-, 3-, 6-, and 12-months on placebo arms of included trials. The evolution of placebo response over time was assessed, and meta-regression was conducted. Risk of bias and quality of evidence were assessed following Cochrane guidelines.

RESULTS: From the initial 2,746 records, 73 articles on 5,895 patients were included. The meta-analysis demonstrated statistically and clinically significant improvements at the 1-, 3-, and 6-month follow-ups. At the 12-month follow-up, placebo response declined and was no longer clinically significant for some sub-scores. Responder rates exceeded 50% at 1-, 3-, and 6-months. The placebo response was stronger in studies with a higher proportion of female participants and in more recently published trials.

CONCLUSIONS: Placebo response to intra-articular injections is statistically and clinically significant in knee osteoarthritis for pain, function improvement, and patients' quality of life, with responses peaking at 4-8 months but evidence up to 12 months. Among influencing factors, female sex and recent publications seem to present stronger placebo responses, emphasising the importance of placebo-controlled trials to evaluate knee osteoarthritis treatments.

PMID:41031623 | PMC:PMC12495556 | DOI:10.1530/EOR-2025-0022

EFORT Open Rev. 2025 Oct 1;10(10):806-814. doi: 10.1530/EOR-2025-0010.

ABSTRACT

Teardrop fractures of the cervical spine are characterized by a triangular-shaped fragment located in the anteroinferior corner of the vertebral body. Flexion-type teardrop fractures are highly unstable injuries resulting from a flexion-compression mechanism. A notable feature of these injuries is retrolisthesis of the vertebral body, which is often associated with a high risk of neurological compromise. The anterior approach is the most commonly used surgical treatment for flexion-type teardrop fractures. In contrast, extension-type teardrop fractures primarily affect the axis vertebral body and are generally stable injuries that can be treated nonoperatively.

PMID:41031621 | DOI:10.1530/EOR-2025-0010

EFORT Open Rev. 2025 Oct 1;10(10):745-755. doi: 10.1530/EOR-2024-0155.

ABSTRACT

This review presents a standardized, stepwise method for biplanar radiographic analysis of knee alignment, integrating both coronal and sagittal measurements for use in arthritic and non-arthritic knees. It critically compares leading classification systems, including the coronal plane alignment of the knee (CPAK) and the functional knee phenotype classifications. While CPAK provides a simplified 2D coronal model, the functional phenotype system offers a more granular, 3D approach that includes segmental deformities and has recently been expanded to incorporate laxity parameters. Sagittal plane parameters - including posterior tibial slope and femoral component flexion/extension - are essential for comprehensive alignment assessment. These factors influence implant positioning, knee kinematics, and postoperative function. The review outlines preferred measurement techniques, highlighting the value of long-leg weight-bearing radiographs and discussing the limitations and variability of 2D versus 3D imaging approaches. Incorporating both alignment and soft tissue behavior provides a more individualized approach to total knee arthroplasty planning and may lead to improved outcomes by better replicating native knee biomechanics.

PMID:41031620 | PMC:PMC12494059 | DOI:10.1530/EOR-2024-0155

EFORT Open Rev. 2025 Oct 1;10(10):726-732. doi: 10.1530/EOR-2024-0056.

ABSTRACT

PURPOSE: To synthesize and critically appraise the literature on long-term outcomes of proximal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis and to assess the long-term HV recurrence rates of studies with a minimum follow-up of 5 years.

METHODS: This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase®, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of proximal osteotomies of the M1 for non-inflammatory and non-degenerative HV at a minimum follow-up of 5 years were included. We found four eligible studies comprising four datasets, and all assessed proximal osteotomies with a mean follow-up that ranged from 8 to 18 years.

RESULTS: The systematic search returned 7,918 records, of which 2,693 were duplicates, leaving 5,225 for screening. Of these, four studies were included, covering a total of 158 feet with a mean follow-up that ranged from 8 to 18 years. The pooled HVA following proximal osteotomies was 20.4° (CI: 11.3°-29.4°; I 2 = 95%), pooled IMA was 8.8° (CI: 3.3°-14.2°; I 2 = 98%), and pooled AOFAS was 82.1 (CI: 62.4-101.8; I 2 = 97%).

CONCLUSIONS: At a minimum follow-up of 8 years following proximal osteotomies of M1, the HVA was 20.4° and the IMA was 8.8°. Furthermore, the recurrence rates considering the various thresholds of HVA were 12% having >30°, 73% having >20°, and 13% if recurrence is a >10° increase in HVA.

LEVEL OF EVIDENCE: Meta-analysis, level IV.

PMID:41031617 | PMC:PMC12493268 | DOI:10.1530/EOR-2024-0056

EFORT Open Rev. 2025 Oct 1;10(10):763-770. doi: 10.1530/EOR-2024-0213.

ABSTRACT

In patients with knee osteoarthritis, tibial stress fractures are mostly associated with osteoporosis and lower limb malalignment. Nonoperative management may lead to knee stiffness (due to prolonged immobilization), persistence of pain (due to the underlying knee osteoarthritis), and fracture nonunion. Acute unstable tibial stress fractures can be managed with long-stem total knee arthroplasty. Exposing the fracture site should be avoided as much as possible because it may be associated with skin necrosis and delayed union. In irreducible cases or fractures with persistent gaps, fibular osteotomy, by increasing the mobility and compression across the fracture site, may help with fracture reduction and decrease the rate of nonunion.

PMID:41031615 | PMC:PMC12494058 | DOI:10.1530/EOR-2024-0213

J Bone Joint Surg Am. 2025 Oct 1;107(19):e96. doi: 10.2106/JBJS.25.00711. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032024 | DOI:10.2106/JBJS.25.00711

J Bone Joint Surg Am. 2025 Oct 1;107(19):e95. doi: 10.2106/JBJS.25.00703. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032023 | DOI:10.2106/JBJS.25.00703

J Bone Joint Surg Am. 2025 Oct 1;107(19):e94. doi: 10.2106/JBJS.25.00395. Epub 2025 Oct 1.

NO ABSTRACT

PMID:41032022 | DOI:10.2106/JBJS.25.00395

J Bone Joint Surg Am. 2025 Oct 1;107(19):2216-2219. doi: 10.2106/JBJS.25.00505. Epub 2025 Aug 12.

NO ABSTRACT

PMID:41032021 | DOI:10.2106/JBJS.25.00505

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06661-7. Online ahead of print.

ABSTRACT

PURPOSE: In shoulder arthroplasty, three-dimensional computed tomography (3D CT) has become the gold standard for preoperative version assessment. Meanwhile, postoperative version is usually evaluated using radiographs (XR), in particular an axillary view, in which the view of the scapular body is often truncated, preventing the scapular plane from being used as a reference. This study introduces the posterolateral acromion-to-coracoid (PLAC) line, which can be assessed on a standard truncated axillary radiograph.

MATERIALS AND METHODS: Forty-six shoulders were studied. Four angles were measured including 3D CT (CT Version), 3D CT PLAC line to glenoid face angle (CT PLAC-GFA), 2) radiographic PLAC line to glenoid face angle (XR PLAC-GFA), and 3) the radiographic glenoid vault line to glenoid face angle (XR GV-GFA). Variation and linear relationship between these angles were calculated.

RESULTS: The mean difference between CT PLAC-GFA and XR PLAC-GFA was 1.0º (95% CI -0.7 to 2.8)(IQR = 8.5º, -3.0º to 5.4º), with a strong correlation on linear regression (R2 = 0.76, p < 0.001). XR PLAC-GFA and XR GV-GFA demonstrated strong correlations with CT measured version (R2 = 0.72 and 0.70, respectively; p < 0.001). Inter-rater reliability was excellent for all metrics (ICC ≥ 0.93).

CONCLUSIONS: The PLAC and the glenoid vault lines are highly reproducible references on truncated axillary views. These alternative reference lines allow accurate comparison of preoperative and postoperative glenoid orientation using standard axillary radiographs.

PMID:41032114 | DOI:10.1007/s00264-025-06661-7

Int Orthop. 2025 Oct 1. doi: 10.1007/s00264-025-06664-4. Online ahead of print.

ABSTRACT

BACKGROUND: Posturography is a diagnostic technique that quantifies postural control through Centre of Pressure (CoP) displacement analysis on a force platform. Footwear characteristics, particularly heel-to-toe drop, may influence balance by modifying plantar pressure distribution and proprioceptive feedback. The aim of this study was to evaluate the impact of different footwear drops (0 mm, 5 mm, 10 mm) on postural control in healthy young adults, considering sex, BMI, and shoe size.

METHODS: A cross-sectional study was conducted in 117 participants (56 men, 61 women) using the Dinascan/IBV® platform and the Romberg test. CoP displacement and velocity were analyzed.

RESULTS: Significant differences were observed in CoP total displacement (p < 0.001), mean velocity (p < 0.001), and medio-lateral dispersion (p = 0.024) when comparing 0 mm to 5 mm and 10 mm drops. Sex differences were significant at 0 mm drop for maximum medio-lateral force (p < 0.001) and mean velocity (p = 0.042), with men exhibiting greater values. At 5 mm drop, men showed significantly higher swept area (p = 0.029) and anteroposterior displacement (p = 0.007) than women.

CONCLUSIONS: Small variations in footwear drop can affect postural control, particularly in the medio-lateral plane. Sex and BMI significantly influence CoP behavior, suggesting the need to consider these factors in footwear design and clinical balance assessments.

PMID:41032113 | DOI:10.1007/s00264-025-06664-4

Injury. 2025 Sep 23:112772. doi: 10.1016/j.injury.2025.112772. Online ahead of print.

ABSTRACT

BACKGROUND: While domestic violence (DV) - encompassing abusive action towards children, intimate partners, and elderly patients - is frequently reported at US trauma centers each year, contemporary data on DV trends and outcomes remain limited.

METHODS: We identified all trauma patients with DV using the 2018-2021 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database. Temporal trends were analyzed using the Cochran-Armitage test. Multivariable logistic and linear regression models were used to assess the association of DV with in-hospital mortality, hospital duration of stay (LOS) and non-home discharge.

RESULTS: Among 4190,728 trauma admissions, 8677 (0.2 %) involved DV, with the majority being children (73.6 %), followed by adults (19.5 %) and elderly patients (7.0 %). DV-related trauma admissions increased significantly from 2018 to 2021 (1.7 to 2.0 per 1000 trauma admissions, trend test P < 0.001). DV victims were more frequently female (48.8 vs 39.0 %), Black (30.7 vs 15.2 %), and insured by Medicaid (61.8 vs 18.0 %). DV was associated with higher in-hospital mortality among children (AOR 4.86, 95 % CI 3.88-6.10) and elderly patients (AOR 2.59, 95 % CI 1.42-4.73). Children with DV had significantly longer LOS by 2.1 days (95 % CI 1.8-2.4 days). Children (AOR 2.98, 95 %CI 2.30-3.85) and elderly DV patients (AOR 1.60, 95 %CI 1.15-2.23) had increased odds of non-home discharge.

CONCLUSION: DV-related trauma admissions have risen significantly across national trauma centers. Enhanced protocols at trauma centers may provide critical opportunities for DV identification and intervention as well as prevention strategies.

PMID:41033958 | DOI:10.1016/j.injury.2025.112772