J Bone Joint Surg Am. 2026 Apr 2. doi: 10.2106/JBJS.25.01485. Online ahead of print.

NO ABSTRACT

PMID:41926563 | DOI:10.2106/JBJS.25.01485

J Bone Joint Surg Am. 2026 Apr 2. doi: 10.2106/JBJS.25.01655. Online ahead of print.

NO ABSTRACT

PMID:41926559 | DOI:10.2106/JBJS.25.01655

Int Orthop. 2026 Apr 2. doi: 10.1007/s00264-026-06779-2. Online ahead of print.

ABSTRACT

BACKGROUND: ​ Gradual correction of genu varum using circular external fixators is well-established. Although the External Fixation Index (EFI) is widely used in linear bone lengthening, no standardized, time-normalized metric exists for angular deformity correction. This study introduces the angular External Fixation Index (aEFI) as a descriptive tool and evaluates internal consistency within a clinical cohort treated with oblique proximal tibial corticotomy (OPTC).

METHODS: ​ A prospective cohort study included 22 patients (30 knees) who underwent gradual genu varum correction using OPTC and circular external fixation. The aEFI was calculated as total duration of external fixation (weeks) divided by achieved angular correction (degrees). Radiographic evaluation included medial proximal tibial angle (MPTA) and hip-knee-ankle angle measured preoperatively and at final follow-up. Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, and the Stanmore Limb Reconstruction Score.

RESULTS: At a mean follow-up of 16.5 ± 3.25 months, coronal alignment was restored in all knees. Mean fixation duration was 27.4 ± 6.2 weeks, with a mean aEFI of 1.89 ± 0.41 weeks/degree. An inverse association was observed between correction magnitude and aEFI (r = -0.88, p < 0.001), reflecting the reduced proportional effect of fixed treatment phases with larger corrections. Functional scores improved, and minor pin-tract infections occurred in 20% of knees and resolved conservatively.

CONCLUSION: ​ The proposed aEFI serves as a standardized, descriptive, time-normalized metric for reporting treatment duration relative to angular correction. External validation across different constructs and deformity patterns is warranted.

PMID:41925755 | DOI:10.1007/s00264-026-06779-2

Int Orthop. 2026 Apr 2. doi: 10.1007/s00264-026-06798-z. Online ahead of print.

NO ABSTRACT

PMID:41925754 | DOI:10.1007/s00264-026-06798-z

Injury. 2026 Mar 25;57(6):113181. doi: 10.1016/j.injury.2026.113181. Online ahead of print.

ABSTRACT

INTRODUCTION: The optimal surgical strategy for geriatric acetabular fractures remains controversial. While open reduction and internal fixation (ORIF) preserves native anatomy, fixation failure may necessitate conversion to total hip arthroplasty (THA). Conversely, acute THA enables immediate stability but carries higher perioperative risk. This study compared outcomes of ORIF and acute THA and evaluated whether conversion THA achieves comparable results to acute THA.

METHODS: A retrospective cohort analysis using the TriNetX Research Network (2005-2025) identified patients ≥ 65 years with acetabular fractures. ORIF and acute THA cohorts were 1:1 propensity-matched for demographics and comorbidities. The primary outcome was revision arthroplasty within 2 years. Secondary outcomes included infection, dislocation, venous thromboembolism, mortality, ED visits, and readmission. Subgroup analyses compared conversion THA (after ORIF) with acute THA. Statistical significance was set at p < 0.05 with Benjamini-Hochberg correction.

RESULTS: After matching, 2026 patients per group were analyzed. Revision was more frequent after ORIF than acute THA at 2 years (10.4% vs 6.1%; RR 1.69, p < 0.001) and across 15 years. Infection (4.5% vs 7.1%) and dislocation (4.3% vs 5.7%) were lower after ORIF (p < 0.05). Mortality favored ORIF at 5 and 10 years. Conversion and acute THA showed similar long-term revision and mortality rates, with dislocation lower after conversion at 5 years (p = 0.002).

CONCLUSION: In elderly acetabular fractures, ORIF offers lower early morbidity but higher long-term revision risk, whereas acute THA yields greater perioperative complications yet fewer reoperations. Conversion THA achieves outcomes comparable to acute THA, supporting it as an effective salvage strategy.

LEVEL OF EVIDENCE: III (Retrospective cohort study).

PMID:41921410 | DOI:10.1016/j.injury.2026.113181

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.01113. Online ahead of print.

ABSTRACT

BACKGROUND: Optimal surgical treatment for recurrence of lumbar disc herniation (LDH) remains controversial, with options ranging from repeat microdiscectomy (MD) to instrumented fusion (IF). This study aimed to guide surgical decision-making by analyzing reoperation rates, clinical and radiographic risk factors for treatment failure, and functional outcomes following MD versus IF.

METHODS: Prospectively collected data from 450 patients in our outcomes database who underwent surgery for recurrent LDH from 2004 through 2023 were retrospectively analyzed. Clinical assessment included predominant symptoms, neurological deficits, and American Society of Anesthesiologists (ASA) grade. Radiographic assessment included disc height, Pfirrmann grade, facet angle, and Modic changes on magnetic resonance imaging, as well as spinopelvic parameters on standing radiographs. Patient-reported outcomes were assessed using the Core Outcome Measures Index (COMI) and achievement of the minimal clinically important change (MCIC) of ≥2.2 points. Propensity-score matching (PSM) was performed to control for confounding factors. Reoperation rates were analyzed with a minimum 5-year follow-up.

RESULTS: Of 450 patients with recurrent LDH, 316 (70.2%) underwent MD and 134 (29.8%) underwent IF. In 192 patients after PSM, IF showed nonsignificantly higher MCIC achievement (odds ratio [OR] = 1.20, 95% confidence interval [CI]: 0.66 to 2.17, p = 0.65) and lower COMI scores compared with the MD group (3.34 ± 2.89 versus 4.01 ± 2.95, p = 0.059; derived Oswestry Disability Index [ODI]: 23.8 versus 28.1). IF demonstrated significantly lower reoperation risk compared with MD (15.7% [116/316] versus 36.7% [21/34], p < 0.001). The reoperations following MD were predominantly subsequent IF (73.3%) and repeat MD (23.3%), while the reoperations after IF were predominantly adjacent segment surgery (57.1%) and hardware revision (33.3%). BMI of ≥35 kg/m2 was a significant predictor of reoperation after MD (univariate OR = 3.63, p = 0.039), while disc height of <6 mm (OR = 1.97) and Modic type-1 changes (OR = 1.78) showed trends toward increased reoperation risk (both p < 0.10).

CONCLUSIONS: Although both procedures achieved clinical improvement, IF demonstrated superior long-term durability as shown by significantly lower reoperation rates over extended follow-up. Our findings support a risk-stratified surgical selection: IF should be strongly considered in patients with BMI of ≥35 kg/m2 and those with progressive disc degeneration, whereas MD remains appropriate for patients without these risk factors.

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

PMID:41921058 | DOI:10.2106/JBJS.25.01113

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.00879. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this systematic review was to evaluate the impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on medical complications, implant failure rates, and health-care-related costs in patients undergoing hip or knee arthroplasty.

METHODS: A comprehensive search of electronic databases, including PubMed, Embase, Web of Science, the Cochrane Library, the World Health Organization International Clinical Trials Registry Platform (ICTRP), and the UK Clinical Trials Gateway, was conducted and was limited to studies from database inception to March 31, 2025. Inclusion criteria comprised randomized controlled trials or cohort studies involving adults (≥18 years old) undergoing total joint arthroplasty (TJA) while receiving a GLP-1 RA treatment of any dosage or duration. The risk of bias was assessed using the Cochrane risk-of-bias tool and ROBINS-I (Risk Of Bias In Non-Randomized Studies - of Interventions) assessment. Due to substantial heterogeneity in the study designs, a qualitative synthesis approach was employed.

RESULTS: Eight retrospective studies met the inclusion criteria, encompassing 22,611 GLP-1 RA users and 77,810 controls. The mean patient age ranged from 56 to 64 years. Hospital readmission rates showed the most consistently favorable results among GLP-1 RA users, with 3 studies reporting significant reductions of 29% to 47% during the 90-day postoperative period. Five studies demonstrated that GLP-1 RA use was associated with significant reductions, ranging from 30% to 44%, in periprosthetic joint infection (PJI) rates, whereas 3 studies found no significant differences. Hospital resource utilization favored GLP-1 RA therapy, with several studies demonstrating shorter hospital stays and lower 90-day costs. Medical complications yielded variable results: some studies reported increased vascular and pulmonary events among GLP-1 RA users, whereas others observed reduced sepsis and hypoglycemic events in those patients.

CONCLUSIONS: GLP-1 RA therapy was associated with reduced hospital readmissions and decreased hospital costs within 90 days postoperatively, although its benefits for PJI prevention showed mixed results, with some studies demonstrating significant reductions in PJI while others showed no difference. No consistent clinical advantages were observed at the 2-year follow-up.

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

PMID:41921052 | DOI:10.2106/JBJS.25.00879

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.01082. Online ahead of print.

ABSTRACT

BACKGROUND: The study compared health-related quality of life and fracture-healing based on the fixation method following isolated open tibial fractures in Latin America.

METHODS: A prospective study was conducted across 18 trauma centers in 8 countries. Adult patients with isolated open tibial diaphyseal fractures were included. The primary outcome measures were Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Health Survey (SF-12), which was administered at baseline and at follow-up at 6, 12, 26, and 52 weeks. The secondary outcome measure was the modified Radiographic Union Scale for Tibial Fractures (mRUST) score.

RESULTS: Of 422 patients, 389 had a baseline evaluation, with 352 (83.4% of the 422) completing at least 1 SF-12 follow-up and 309 (73.2%) completing at least 1 SF-12 follow-up and having radiographic follow-up within 1 year postoperatively. Initial definitive intramedullary nailing and external fixation or casting followed by staged intramedullary nailing were the most common fixation strategies. Both fixation methods were performed with similar frequency for Gustilo-Anderson (GA) Type-I and II injuries. The majority of GA Type-IIIA and IIIB/C fractures were treated with staged fixation. The presence of minimal or superficial contamination did not influence whether fractures were treated with initial intramedullary nailing or staged intramedullary nailing, whereas the presence of deep contamination was associated with staged management. For all GA types combined, initial definitive intramedullary nailing was associated with significantly higher PCS and MCS scores at 1 year than staged fixation. The mRUST scores at 1 year for all GA types combined were higher with initial definitive intramedullary nailing than with staged intramedullary nailing.

CONCLUSIONS: Staged treatment remains common in Latin America, even for less severe injuries. Initial intramedullary nailing was associated with improved PCS and MCS scores and significantly higher mRUST scores relative to staged intramedullary nailing.

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

PMID:41921051 | DOI:10.2106/JBJS.25.01082

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.00713. Online ahead of print.

ABSTRACT

BACKGROUND: A 2-stage approach is most commonly used to treat periprosthetic joint infection (PJI). Some successful studies of the 1-stage approach were underpowered, lacked a 2-stage comparative group, and excluded patients with draining sinuses, comorbidities, and/or antibiotic-resistant organisms. Given the morbidity and expense associated with 2-stage treatment, we conducted a prospective, multicenter, randomized trial to compare the results of 1- and 2-stage PJI treatment, specifically including patients with draining sinuses, comorbidities, and resistant organisms.

METHODS: Patients presenting for surgical treatment of a chronic PJI with a known organism following primary total hip or knee arthroplasty were included (with infection defined by Musculoskeletal Infection Society [MSIS] criteria). Patients with prior revision, culture-negative infection, or fungal infection, or who were immunosuppressed or had soft-tissue involvement precluding wound closure, were excluded. Patients were classified according to the McPherson host staging system. Clinical success was defined as (1) no clinical failure or reinfection with the same or new organism; (2) no reoperation for PJI; and (3) no PJI-related death. A double-instrument setup was used for all patients, as were similar irrigation and antibiotic protocols. A total of 323 patients (166 one-stage; 157 two-stage) were randomized. Groups were similar with respect to demographics and host classification. After excluding patients who died or were lost to follow-up, 258 of the 323 patients had 2-year follow-up (135 one-stage and 123 two-stage). The rate of patient loss to follow-up was similar between the treatment groups.

RESULTS: Sixteen patients in the 1-stage group and 9 patients in the 2-stage group died prior to 2-year follow-up. Overall, the 2-year success rate of 1-stage treatment was 97% (131 of 135), while the success of 2-stage treatment was 91% (112 of 123) (p = 0.04). Compared with the 2-stage group, the 1-stage group had 3-times the odds of overall success in a regression analysis (unadjusted odds ratio = 3.22 [95% confidence interval = 1.0 to 10.38]). After adjusting for specific variables (McPherson host grade, resistant organism, and draining sinuses), 1-stage treatment also had 3-times the odds of success.

CONCLUSIONS: The results of this prospective randomized trial indicated that 1-stage treatment (97% success) was statistically noninferior to 2-stage treatment (91% success) when treating chronic PJI following primary total hip or knee arthroplasty, provided the protocols described here are explicitly followed. Extrapolation to other patient cohorts and clinical situations should be avoided.

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

PMID:41921050 | DOI:10.2106/JBJS.25.00713

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.01677. Online ahead of print.

NO ABSTRACT

PMID:41921049 | DOI:10.2106/JBJS.25.01677

J Bone Joint Surg Am. 2026 Apr 1. doi: 10.2106/JBJS.25.01359. Online ahead of print.

ABSTRACT

BACKGROUND: Coronal plane angular deformity remains under-investigated in the context of pediatric anterior cruciate ligament (ACL) tears. We hypothesized that baseline coronal alignment in pediatric and adolescent patients with a first-time ACL injury would differ from that in a matched healthy comparison population of patients without knee pathology.

METHODS: Patients ≤18 years of age who underwent primary ACL reconstruction and had preoperative lower-extremity hip-to-ankle alignment radiographs (cases) and individuals without lower-extremity conditions that would influence alignment (controls) were matched 1:1 on the basis of age (±1 year) and sex. Coronal plane parameters included the hip-knee-ankle angle (HKA), mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA). Decision stump analyses were used to identify clinically relevant alignment threshold values.

RESULTS: A total of 200 patients were included in the analysis (100 per group). The mean age was 12.7 ± 2.1 years in the ACL group (58% White/Caucasian, 50% female) and 13.1 ± 2.4 years in the control group (49% White/Caucasian, 50% female). Compared with controls, patients with an ACL tear demonstrated increased valgus alignment across all 4 parameters: MAD (-4.1 ± 7.8 versus -0.3 ± 7.6 mm; p < 0.001), HKA (-1.4° ± 2.6° versus -0.5° ± 2.3°; p = 0.006), mLDFA (85.3° ± 1.9° versus 86.1° ± 1.7°; p = 0.004), and MPTA (88.0° ± 1.8° versus 87.2° ± 1.9°; p = 0.004). Conditional logistic regression demonstrated increased odds of an ACL tear associated with each 1-unit increase in valgus alignment, as measured by MAD (inverse odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.02 to 1.10; p = 0.003), HKA (inverse OR: 1.14; 95% CI: 1.02 to 1.27; p = 0.022), mLDFA (inverse OR: 1.27; 95% CI: 1.08 to 1.50; p = 0.005), and MPTA (OR: 1.28; 95% CI: 1.07 to 1.53; p = 0.006). In the decision stump analysis of HKA, a value of -0.5° demonstrated that 60% of participants with ≥0.5° of valgus alignment had an ACL tear compared with 38% of patients with neutral alignment, varus alignment, or <0.5° of valgus alignment.

CONCLUSIONS: Pediatric and adolescent patients with an ACL tear demonstrated greater valgus alignment than age- and sex-matched controls, with each 1° increase in HKA valgus alignment increasing the odds of an ACL tear by 14%. Routine preoperative assessment is necessary as coronal plane deformity is modifiable through concomitant implant-mediated guided growth in skeletally immature patients. The inclusion of coronal plane alignment parameters in ACL-related investigations is warranted to elucidate their contribution to injury risk and surgical outcomes.

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

PMID:41921048 | DOI:10.2106/JBJS.25.01359

J Bone Joint Surg Am. 2026 Apr 1;108(7):462-463. doi: 10.2106/JBJS.25.01390. Epub 2026 Apr 1.

NO ABSTRACT

PMID:41920184 | DOI:10.2106/JBJS.25.01390

J Bone Joint Surg Am. 2026 Apr 1;108(7):460-461. doi: 10.2106/JBJS.25.01311. Epub 2026 Apr 1.

NO ABSTRACT

PMID:41920183 | DOI:10.2106/JBJS.25.01311

J Bone Joint Surg Am. 2026 Apr 1;108(7):458-459. doi: 10.2106/JBJS.25.01230. Epub 2026 Apr 1.

NO ABSTRACT

PMID:41920182 | DOI:10.2106/JBJS.25.01230

J Bone Joint Surg Am. 2026 Apr 1;108(7):457. doi: 10.2106/JBJS.25.01588. Epub 2026 Apr 1.

NO ABSTRACT

PMID:41920181 | DOI:10.2106/JBJS.25.01588

Int Orthop. 2026 Apr 1. doi: 10.1007/s00264-026-06787-2. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the incidence of surgical complications, particularly periprosthetic fractures, following femoral impaction bone grafting (fIBG) in revision total hip arthroplasty (rTHA).

METHODS: This systematic review followed PRISMA guidelines. Studies reporting on fIBG in rTHA with a minimum follow-up of 12 months were included. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS). A random-effects meta-analysis with inverse-variance weighting was performed. Heterogeneity was assessed using Higgins and Thompson's I2 statistic and Cochran's Q test. Subgroup analyses were conducted based on patient characteristics, revision indication, follow-up period, bone loss severity, stem length, and cementation. Complications requiring intervention, as well as nerve lesions with partial or no recovery, were classified as major.

RESULTS: Forty-five studies including 4,686 hips (4,409 patients) were analyzed. The pooled incidence of major complications was 21% (n = 730; 95% CI 16-26%; I2 = 89%, p < 0.01). Of these, 78% required surgical intervention. The most common major complications were intraoperative fractures (22.7%), postoperative fractures (19.3%), and instability (19.2%). Higher complication rates were reported with long stems (44.1%) compared with short stems (18.8%, p = 0.016) and in cases of severe bone loss (Endo-Klinik grades III/IV, 25.3%) compared with I/II (14.2%, p = 0.028).

CONCLUSION: Major complications following fIBG in rTHA are relatively frequent, although interpretation is limited by substantial study heterogeneity. Higher complication rates were observed in cases with severe bone loss and the use of long stems, likely reflecting greater surgical complexity.

PMID:41920370 | DOI:10.1007/s00264-026-06787-2

Injury. 2026 Mar 26;57(6):113185. doi: 10.1016/j.injury.2026.113185. Online ahead of print.

ABSTRACT

INTRODUCTION: Amid the emerging popularity of recreational vehicles, there has been a subsequent increase in off-road vehicle injuries. The purpose of this study was to delineate trends in the incidence and volume of upper extremity injuries caused by all-terrain vehicles (ATVs), utility task vehicles (UTVs), and dune buggies in the United States and to bring awareness to these trends to guide the development of safety measures and modifications.

METHODS: The National Electronic Injury Surveillance System (NEISS) Database was queried for ATV, UTV, and dune buggy injuries between 2014 and 2024 for upper extremity injuries. Demographic data, diagnosis, injury type and location, descriptions of the accidents, and patient dispositions were accrued from the emergency department encounters collected in this database.

RESULTS: There were an estimated 319,403 cases of off-road vehicle injuries involving the upper extremity in the study period, most of which involved ATVs specifically. The volume of off-road vehicle injuries overall increased from 2014 to 2024, with approximately 105,796 injuries in 2014 and 111,613 injuries in 2024. Fractures were the most common type of injury, accounting for 47% of encounters. The greatest number of injuries in 2014 (10,361) and 2024 (8256) were among the 10- to 19-year-old cohort. There was a 10% decrease in upper extremity injuries from 2014 to 2024, with peaks in 2016 and 2020. Shoulder injuries accounted for the most common upper extremity injury among ATV (33%), UTV (25%), and dune buggy drivers (29%).

CONCLUSION: Fractures were the most common type of injury, and shoulders were the most prevalent injured upper extremity. Despite an overall decline in prevalence, off-road vehicle injuries pose a threat to adolescent safety, and there remains a need for increased safety measures, vehicle modifications, and protective legislation involving off-road vehicle use.

LEVEL OF EVIDENCE: IV.

PMID:41916011 | DOI:10.1016/j.injury.2026.113185

Injury. 2026 Mar 27;57(6):113197. doi: 10.1016/j.injury.2026.113197. Online ahead of print.

ABSTRACT

BACKGROUND: Intramedullary fibular nailing (IFN) offers a minimally invasive alternative to plate fixation for unstable ankle fractures, yet concerns persist regarding potential iatrogenic injury to the peroneal tendons during portal creation. No previous in vivo study has evaluated tendon integrity after IFN using advanced imaging. In this cohort, we examined peroneal tendon morphology and syndesmotic reduction following IFN using serial postoperative magnetic resonance imaging (MRI), comparing findings with a healthy control group.

METHODS: A prospective cohort of 102 adults with unstable Weber B or C ankle fractures underwent IFN and completed at least eight months of follow-up. All patients received standardized ankle MRI at 3 and 8 months postoperatively. Tendon morphology, signal characteristics, and thickness were assessed by a blinded musculoskeletal radiologist. Syndesmotic reduction was evaluated in patients requiring trans-syndesmotic fixation. A control group of ten healthy volunteers underwent the same MRI protocol. Statistical comparisons were performed using independent-samples t tests and equivalence testing with predefined margins.

RESULTS: Peroneal tendons demonstrated no MRI-detectable pathology at both 3 and 8 months. At 8 months, tendon thickness (peroneal brevis: 2.9 ± 0.3 mm; peroneal longus: 3.4 ± 0.4 mm) was comparable to controls (2.8 ± 0.3 mm and 3.4 ± 0.4 mm; p > 0.37), meeting equivalence criteria (TOST p < 0.001). Among patients requiring syndesmotic fixation (n = 28), tibiofibular alignment remained anatomic (clear space: 3.1 ± 0.4 mm; overlap: 8.7 ± 1.2 mm). Union was achieved in all cases, with no infections or tendon-related symptoms.

CONCLUSION: Intramedullary fibular nailing preserves peroneal tendon integrity and provides reliable syndesmotic stability when performed with proper technique. Tendon morphology and signals remained indistinguishable from healthy controls, and postoperative alignment was consistently anatomic. These findings support IFN as a safe, biologically respectful option for the treatment of unstable ankle fractures.

PMID:41916010 | DOI:10.1016/j.injury.2026.113197

Int Orthop. 2026 Mar 31. doi: 10.1007/s00264-026-06788-1. Online ahead of print.

ABSTRACT

STUDY DESIGN: Population-based retrospective cohort study.

OBJECTIVES: To assess the longitudinal association between incident gout and risk of incident cervical ossification of the posterior longitudinal ligament (OPLL).

METHODS: Using National Health Insurance Service data linked to health screening records (2002-2013), adults aged 20-79 years with incident gout were identified (≥ 2 primary diagnoses of ICD-10 M10.0/M10.9 within 30 days) after a two year washout. Controls without gout were propensity score-matched 1:20. Incident cervical OPLL was defined as ICD-10 M48.82 with cervical CT or MRI within 30 days. Participants were followed from index date to OPLL, death, or December 31, 2013. Cox proportional hazards models estimated adjusted hazard ratios (HRs); sensitivity analyses used a stricter OPLL definition (≥ 2 diagnoses > 30 days apart).

RESULTS: The matched cohort included 5,977 gout patients and 119,540 controls (478,828 person-years). OPLL developed in 17 (0.28%) gout patients versus 162 (0.14%) controls, yielding incidence rates of 0.75 vs 0.36 per 1,000 person-years (incidence rate ratio 2.11; 95% CI, 1.28-3.47). Gout was associated with increased OPLL risk in the fully adjusted model (HR 2.13; 95% CI, 1.27-3.56). Findings were consistent under the stricter definition (incidence rate ratio 2.29; 95% CI, 1.26-4.17).

CONCLUSIONS: In this nationwide cohort, incident gout was independently associated with more than a twofold higher risk of incident cervical OPLL.

PMID:41915154 | DOI:10.1007/s00264-026-06788-1

Injury. 2026 Mar 24;57(6):113180. doi: 10.1016/j.injury.2026.113180. Online ahead of print.

ABSTRACT

INTRODUCTION: Interimplant femoral fractures (IFFs), occurring between or adjacent to implants such as hip prostheses and intramedullary nails, pose complex treatment challenges, particularly in osteoporotic patients. Biomechanical research highlights the need to protect the interimplant region from high strains, however, optimal configurations for plate fixation remain unclear. This study analyzes strains in the interimplant region under various protective plate configurations.

MATERIALS AND METHODS: Twelve synthetic proximal femora, mimicking osteoporotic bone, were instrumented with a proximal femoral nail (PFN) and a distal femoral nail (DFN) creating a 40 mm interimplant gap. Four implant configurations were tested: no protective plating (Stage 1), screws placed inside the innermost nail interlocking screws (no overlapping, Stage 2), screws placed outside and close to the innermost nail interlocking screws (short overlapping, Stage 3), and screws placed outside and far from the innermost nail interlocking screws (long overlapping, Stage 4). A non-destructive axial compressive load (200 N) was applied, and bone surface strains were measured beneath the plate using digital image correlation.

RESULTS: Stage 1 (no protective plating) exhibited significantly higher maximum strains versus Stages 2-4 (p ≤ 0.015). Stage 2 (no overlapping) showed maximum strains being significantly higher compared to both short and long overlapping (p ≤ 0.007), without further significant difference between the latter two (p > 0.999). Similar trends were observed for strains at point-specific locations defined intermittently between the innermost nail interlocking screws. The highest point-specific strains were located in the middle of the interimplant region.

CONCLUSION: From a biomechanical perspective, the application of a protective plate fixation of the interimplant region significantly reduces strains, with long and short overlapping providing optimal mechanical protection. Adequate protection with plates should be prioritized to mitigate the risk of interimplant fractures.

PMID:41905180 | DOI:10.1016/j.injury.2026.113180