Injury. 2025 Mar 8;56(4):112233. doi: 10.1016/j.injury.2025.112233. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to explore the impact of different planes of popliteal artery injury (PAI) on the risk of amputation in affected limbs.

METHODS: A retrospective analysis was conducted on ninety-four patients who underwent PAI; these patients were divided into an amputation group (n = 26) and a nonamputation group (n = 68) on the basis of whether limb preservation was successful. The data were reconstructed from computed tomography angiography (CTA) of the patients' lower limbs and measured via AW Volume Share 5 software. The height of the popliteal artery injury surface was quantified as follows: "L" was defined as the distance from the origin of the descending genicular artery of the contralateral limb to the origin of the anterior tibial artery; "S" was defined as the distance from the origin of the descending genicular artery of the affected limb to the blood flow interruption site; and "R" was defined as the ratio of S to L (S/L). The risk factors for amputation in patients with PAI were also analysed.

RESULTS: Univariate and multivariate logistic regression analyses revealed that R (odds ratio [OR]=0.876, P = 0.006,95 % CI:0.797-0.963), S (OR=0.792, P = 0.166,95 % CI:0.570-1.102), ischemic time (OR=1.195, P = 0.017,95 % CI:1.032-1.383), and compartment syndrome (OR=5.509, P = 0.055,95 % CI:0.967-31.376) were independent risk factors for amputation in patients with PAI. The receiver operating characteristic (ROC) curve revealed that the AUC values were 0.887 (P < 0.000, 95 % CI: 0.805-0.943) and 0.775 (P < 0.000, 95 % CI: 0.677-0.854) for R and S, respectively. The diagnostic efficiency was highest when the diagnostic threshold values were 0.573 and 11.3 cm, for R and S, respectively. Moreover, the AUCR was greater than the AUCS (Z = 2.403, P = 0.0162).

CONCLUSION: The height of the PAI plane is an independent risk factor for amputation in patients with PAI. Greater planes of vascular injury result in greater risk of amputation. R is better than S in the diagnosis of amputation risk in patients with PAI.

PMID:40073711 | DOI:10.1016/j.injury.2025.112233

J Bone Joint Surg Am. 2025 Mar 10. doi: 10.2106/JBJS.23.01137. Online ahead of print.

ABSTRACT

BACKGROUND: Identifying patients at high risk for failure of primary anterior cruciate ligament reconstruction (ACLR) on the basis of preoperative magnetic resonance imaging (MRI) measurements has received considerable attention. In this study, we aimed to identify potential risk factors for primary ACLR failure from preoperative MRI measurements and to determine optimal cutoff values for clinical relevance.

METHODS: Retrospective review and follow-up were conducted in this nested case-control study of patients who underwent primary single-bundle ACLR using hamstring tendon autograft at our institution from August 2016 to January 2018. The failed ACLR group included 72 patients with graft failure within 5 years after primary ACLR, while the control group included 144 propensity score-matched patients without failure during the 5-year follow-up period. Preoperative MRI measurements were compared between the 2 groups. Receiver operating characteristic (ROC) curve analyses were conducted to determine the optimal cutoff values for the significant risk factors. Odds ratios (ORs) were calculated, and survival analyses were performed to evaluate the clinical relevance of the determined thresholds.

RESULTS: A greater lateral femoral condyle ratio (LFCR) (p = 0.0076), greater posterior tibial slope in the lateral compartment (LPTS) (p = 0.0002), and greater internal rotational tibial subluxation (IRTS) (p < 0.0001) were identified in the failed ACLR group compared with the control group. ROC analyses showed that the optimal cutoff values for IRTS and LPTS were 5.8 mm (area under the curve [AUC], 0.708; specificity, 89.6%; sensitivity, 41.7%) and 8.5° (AUC, 0.655; specificity, 71.5%; sensitivity, 62.5%), respectively. Patients who met the IRTS (OR, 6.14; hazard ratio [HR], 3.87) or LPTS threshold (OR, 4.19; HR, 3.07) demonstrated a higher risk of primary ACLR failure and were significantly more likely to experience ACLR failure in a shorter time period.

CONCLUSIONS: Preoperative MRI measurements of increased IRTS, LPTS, and LFCR were identified as risk factors for primary ACLR failure. The optimal cutoff value of 5.8 mm for IRTS and 8.5° for LPTS could be valuable in the perioperative management of primary ACLR.

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

PMID:40063685 | DOI:10.2106/JBJS.23.01137

Int Orthop. 2025 Mar 10. doi: 10.1007/s00264-025-06483-7. Online ahead of print.

NO ABSTRACT

PMID:40063117 | DOI:10.1007/s00264-025-06483-7

Int Orthop. 2025 Mar 10. doi: 10.1007/s00264-025-06479-3. Online ahead of print.

ABSTRACT

PURPOSE: This retrospective cohort study aimed to compare the clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) with those of posterior lumbar interbody fusion (PLIF) for the treatment of degenerative lumbar scoliosis (DLS) with lumbar spinal stenosis (LSS).

METHODS: In this study, 143 DLS patients who met the inclusion criteria from January 2016 to March 2019 were retrospectively analyzed and divided into the PTED and PLIF groups. The propensity score matching (PSM) method was used to adjust for imbalanced confounding variables between the groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were then used to compare the clinical outcomes between the two groups. Furthermore, changes in radiological characteristics and surgical complications were assessed.

RESULTS: After PSM, 86 patients were included in the study with a followup duration of at least five years. Postoperative VAS and ODI scores were significantly improved in both groups at all time points compared with preoperative values (p < 0.001). However, the PTED group had higher VAS scores for back pain and ODI scores than the PLIF group at five years postoperatively (p < 0.05). For radiological parameters, the Cobb angle decreased in the PLIF group but increased in the PTED group at the final followup (p < 0.05). A decrease in the adjacent disc height was observed in the PLIF group at the final followup (p < 0.001).

CONCLUSION: Both PTED and PLIF achieved relatively satisfactory outcomes in treating DLS with LSS after a minimum five year followup. However, further studies are required to better determine the characteristics of spinal deformities amenable to each procedure.

PMID:40063116 | DOI:10.1007/s00264-025-06479-3

Injury. 2025 Mar 3:112238. doi: 10.1016/j.injury.2025.112238. Online ahead of print.

ABSTRACT

INTRODUCTION: Enhanced Recovery Protocols (ERPs) are designed to improve postoperative recovery. Since their inception, ERPs have become the standard of care across multiple surgical specialities, with numerous guidelines established for elective procedures. While ERP principles have been extended to emergency abdominal surgeries, their application in trauma laparotomy remains limited. This study details the development of an ERP tailored for trauma laparotomy patients and evaluates outcomes following its implementation.

METHODS: A multidisciplinary team developed an ERP, termed the Trauma Laparotomy Care Pathway (TLCP), grounded in best available evidence and adapted to our clinical setting through a rigorous consensus process. Following implementation, we conducted a single-center pilot study as part of a quality improvement initiative, comparing trauma laparotomy patients managed with TLCP from February to July 2024 to a historical cohort as the baseline group. We analyzed adherence to five key postoperative components and assessed impacts on postoperative outcomes.

RESULTS: In the first six months post-implementation, 31 patients were managed using TLCP. The median age was 32.0 years, with males comprising 87.1 % of patients. Stab wounds were the most frequent injury mechanism, followed by motor vehicle-related accidents and falls. Isolated abdominal injuries accounted for 64.5 % of cases. Adherence to key pathway components ranged from 54.5 % to 67.7 %. The hospital length of stay was significantly shorter for the TLCP group, showing a two-day reduction compared to the historical cohort (4.0 days [3.5, 6.5] vs 6.0 days [4.0, 10.0], p = 0.002). There was no significant difference in in-hospital complications or 30-day readmission rates between the groups.

CONCLUSION: Following TLCP implementation, a reduction in hospital length of stay was observed, with no apparent increase in complications or 30-day readmission rates. These findings suggest that ERPs may be applicable to selected trauma laparotomy patients, with the potential to improved clinical outcomes. Further large-scale studies are warranted to validate these results.

PMID:40059024 | DOI:10.1016/j.injury.2025.112238

Injury. 2025 Mar 3;56(4):112234. doi: 10.1016/j.injury.2025.112234. Online ahead of print.

ABSTRACT

INTRODUCTION: Assessment of mobility in orthopaedic trauma patients is commonly performed using the Lower Extremity Functional Assessment (LEFS). Computerized adaptive testing (CAT) utilizing the Patient-Reported Outcomes Measurement Information System (PROMIS) is an advanced method for assessing multiple aspects of patient-reported health and may provide an effective alternative for this purpose. The objective of this study was to correlate and psychometrically compare PROMIS (Mobility (MOB) and Physical Function (PF)) CATs to legacy mobility PROMs (Lower Extremity Functional Scale (LEFS)/ Short Musculoskeletal Function Assessment (SMFA)), and to evaluate factors associated with worse mobility.

PATIENTS AND METHODS: In this Cross-sectional study performed in a single Level-I trauma center, 123 patients were recruited who were treated for a lower-extremity fracture (October 1, 2021-July 1, 2023). Correlations (Pearson), known-group validity (Two-sample T test), reliability (Standard error (SE) and Cronbach's alpha), items and completion time, and floor/ceiling effects were assessed. Factors associated with PROMIS-MOB scores were also identified based on multivariable regression analysis.

RESULTS: PROMIS-MOB and LEFS/SMFA (0.75/0.86), PROMIS-PF and LEFS/SMFA (0.76/0.84), and both PROMIS-CATs (0.88) were highly correlated. Regarding know-group validity, all PROM scores were worse among patients with moderate-extreme pain. Only PROMIS-CATs scores were worse among older (≥65 years) and short-term follow-up (3≤months) patients. Reliability was very high for PROMIS-MOB (SE2.1), PROMIS-PF (SE2.0), LEFS (alpha0.97) and SMFA (apha0.97). Fewer items were needed for PROMIS-MOB (6) and PROMIS-PF (5) compared to LEFS (20) and SMFA (34). Completion time (mean seconds) of PROMIS-MOB (65) and PROMIS-PF (70) was less compared to LEFS (338) and SMFA (367) (p<0.001). Neither PROMIS-CATs nor LEFS/SMFA exhibited floor/ceiling effects. Advancing age, depression, pain intensity, shorter follow-up were associated with worse PROMIS-MOB scores.

CONCLUSION: PROMIS-MOB and PROMIS-PF CATs exhibited a strong correlation with the LEFS and SMFA, indicating that they offer the same information regarding mobility and general physical functioning. Nonetheless, CATs took less time to complete and were better able to detect (subtle) differences between certain groups than traditionally used PROMs. Given that both PROMIS-MOB and PROMIS-PF CATs were also highly correlated, it is questionable whether the more specific mobility CAT provides distinct information in lower extremity fracture patients.

LEVELS OF EVIDENCE: Diagnostic study, Level II.

PMID:40058156 | DOI:10.1016/j.injury.2025.112234

Injury. 2025 Mar 4:112229. doi: 10.1016/j.injury.2025.112229. Online ahead of print.

ABSTRACT

INTRODUCTION: Effective pre-hospital care is critical for improving trauma outcomes, yet pre-hospital systems are underdeveloped in low-and middle-income countries (LMICs) like Nepal, where trauma-related deaths are rising. Community health responders (CHRs) have the potential to reduce time to post-injury care in rural settings, where other health infrastructure may be unavailable. This pilot study assessing the feasibility and preliminary impact of CHR based program in rural Nepal.

METHODS: This quasi-experimental study adapted and implemented a trauma training intervention for CHRs in Achham, Nepal. The program adapting the trauma portion of the World Health Organization's (WHO) Basic Emergency Care (BEC) course for the Achham context through a modified Delphi process. The final implemented program included three items: initial two-day skills-based training, a pictorial guide handbook for CHR's quick reference, and a one-day refresher training at three months. Two rural municipalities of Achham district were assigned into intervention or control. All CHRs from the intervention municipality underwent the training program. Assessment includes the program's impact on CHRs' knowledge and confidence, and impact on pre-hospital trauma care metrics, which was assessed through pre-, immediately, and six-months post-course evaluations, and pre-hospital service metrics data, respectively. A repeated measures ANOVA was used to assess change in knowledge over time by study groups. Bivariate analysis was performed to explore differences in pre-hospital patient metrics of trauma care by study group.

RESULTS: The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus. 22.1) and trauma mechanism (p = 0.14) across two groups. The most common mechanism was falls (n = 165, 77.5 %). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4 % versus. 17.1 %, p < .001) and cervical collar use, compared to controls.

CONCLUSION: This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results shows early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that requires further investigation.

PMID:40057400 | DOI:10.1016/j.injury.2025.112229

Injury. 2025 Mar 4;56(4):112239. doi: 10.1016/j.injury.2025.112239. Online ahead of print.

ABSTRACT

AIM: Information on patient-reported recovery from lower limb fractures includes limited information with >10 years follow-up. The aim was to investigate the long-term effect of lower limb fractures on the Hip Disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Outcome Score (FAOS) five subscales.

METHODS: Study design was a national register-based cohort study. A representative national sample of 26,877 citizens were invited to participate by completing the HOOS, KOOS or FAOS. Individual information on fractures to the foot/ankle, knee and hip as well as date/year of diagnoses was derived from the Danish National Patient Register.

RESULTS: HOOS, KOOS or FAOS were completed by 7,850 citizens. 489 (2 %) patients were registered with a lower limb fracture. The mean follow-up time from fracture to survey was 16.7 years, ranging from 0 to 45 years. The mean age of participants with a lower extremity fracture was 62.9 years and 61 % were women, compared to patients without a lower extremity fracture with a mean age of 60.2 years and 54 % were women. The HOOS/KOOS/FAOS mean differences between patients with and without a lower limb fracture were pain:4.4 (95 % CI -6.1- -2.7); symptoms:4.2 (95 % CI -5.9- -2.6); ADL:3.8 (95 % CI -5.4- -2.1); sport/rec:8.2 (95 % CI -10.9- -5.5); and QOL:6.5 (95 % CI -8.7- -4.2). Further subgroups analysis comparing hip-related fractures to the HOOS, knee-related fractures to the KOOS and foot/ankle-related fractures to the FAOS showed comparable results.

CONCLUSION: We showed that long-term patient-perceived complaints following lower limb fractures are common even decades after treatment. Most complaints were observed in high performance activities such as running, jumping and kneeling as well as QOL. More research is needed to address questions regarding causality.

PMID:40056731 | DOI:10.1016/j.injury.2025.112239

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06478-4. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Periprosthetic joint infection (PJI) is a significant and challenging healthcare issues. Accurate diagnosis is essential for effective treatment. The aim of our study is to underscore the usefulness of the new EBJIS definition and criteria when applied in a developing country department.

METHODS: We conducted a retrospective analysis of a single-center cohort of consecutive revision arthroplasties (January 2018-June 2024). This study was carried out at the Department of Orthopedics and Trauma Surgery in the University Hospital Fattouma Bourguiba in Monastir, Tunisia. Were included in our research patients who underwent revision surgery for arthroplasties due to septic failure. Exclusion criteria were: surgery performed within the previous six weeks, antibiotic-loaded bone cement spacer in place, the second step of a two-stage revision and periprosthetic fractures.

RESULTS: A total of 46 patients were included in the study. According to the EBJIS criteria, our cohort was divided into two groups: "likely infection" including 12 patients (26.1%) and "confirmed infection" with 34 patients (73.9%). Clinical signs like inflammation (Se 85.3%, PPV 76.32%) and pain (Se 76.47%, PPV 70.27%) demonstrate higher sensitivity but low specificity. Among paraclinical tests, a CRP level > 10 mg/dL is highly sensitive (97.06%), while PMN > 80% shows perfect specificity (100%). Tissue samples with more than two positives and cultures with the same microorganism exhibit high sensitivity (96.66% and 80%) and PPV (84.85% and 85.71%).

CONCLUSION: Establishing PJI diagnosis is challenging and depends on paraclinical testing. We highlight the lack of important diagnostic instruments in settings with limited resources.

PMID:40053070 | DOI:10.1007/s00264-025-06478-4

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06467-7. Online ahead of print.

ABSTRACT

BACKGROUND: Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by pain, paresthesia, and numbness in the anterolateral thigh. Despite its well-documented etiology, diagnosing MP remains challenging, as complementary tests such as electromyography (EMG) and ultrasound may yield normal results due to anatomical variations and the dynamic nature of nerve compression.

OBJECTIVE: This study introduces the Hip Abduction Maneuver (HAM) as a novel diagnostic tool for LFCN compression and investigates its utility in clinical and intraoperative assessments METHOD: The maneuver, inspired by Hagert's triad, evaluates hip abduction weakness as a functional indicator of LFCN entrapment. MP can result from mechanical, metabolic, iatrogenic, traumatic, or anatomical factors. Compression occurs under the inguinal ligament, where orthogonal taping (OKT) can serve as a mechanical relief test to support diagnosis. HAM exploits afferent inhibitory responses, assessing hip abduction strength before and after decompression maneuvers. The Scratch Collapse Test (SCT) further improves diagnostic accuracy. The Hip Abduction Maneuver (HAM) and Orthogonal KinesioTaping (OKT) enhance the clinical assessment of meralgia paresthetica, particularly in cases with inconclusive imaging.

CONCLUSION: Their integration into preoperative evaluation and intraoperative validation may improve diagnostic precision and optimize surgical outcomes. Further studies are required to validate reproducibility and long-term efficacy.

PMID:40053069 | DOI:10.1007/s00264-025-06467-7

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06452-0. Online ahead of print.

ABSTRACT

PURPOSE: Peripheral nerve compression syndromes are a common cause of pain, weakness, and functional limitations, yet they often remain underdiagnosed due to the limitations of traditional diagnostic methods such as electromyography and imaging. This article describes the clinical triad-manual muscle testing (MMT), sensory-collapse testing (SCT), and pain evaluation-as a structured, integrative approach to improving the diagnosis of nerve compressions.

METHODS: This narrative review examines the anatomical basis and diagnostic application of the clinical triad across common peripheral nerve compression syndromes. The review focuses on the median, ulnar, and radial nerves in the upper extremity, as well as the peroneal nerve in the lower extremity. Each component of the triad is analyzed for its role in detecting nerve compressions, including the reliability of MMT for identifying muscle weakness patterns, the specificity of SCT as a confirmatory tool, and the role of pain assessment in localizing entrapment sites.

RESULTS: The clinical triad provides a structured and accessible diagnostic framework that enhances the detection of nerve compressions, even in early-stage presentations that may evade standard diagnostic tools. It demonstrates adaptability to complex cases, including double- and multiple-crush syndromes, and offers a non-invasive, cost-effective alternative to traditional diagnostic approaches.

CONCLUSION: The clinical triad enhances diagnostic precision in peripheral nerve compression syndromes by integrating motor, sensory, and pain assessments. Its structured methodology facilitates early detection and targeted interventions, potentially improving patient outcomes while reducing reliance on invasive or resource-intensive diagnostic methods.

PMID:40053068 | DOI:10.1007/s00264-025-06452-0

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06463-x. Online ahead of print.

ABSTRACT

PURPOSE: Meralgia paraesthetica (MP) is a rare neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by thigh pain, paraesthesia, or sensory loss. When conservative treatments fail, surgical interventions such as neurolysis or neurectomy are considered. This study aims to evaluate the effectiveness of surgical decompression of the LFCN in alleviating pain, addressing sensory deficits, and improving quality of life.

METHODS: A prospective study was conducted on 26 patients who underwent LFCN decompression surgery between 2015 and 2023, with a minimum follow-up period of one year. Outcomes were assessed using pre- and postoperative questionnaires, including the Brief Pain Inventory (BPI) and the Pain Disability Index (PDI).

RESULTS: The cohort consisted of 15 males and 11 females, with 81% reporting symptom onset following prior surgeries or trauma. Postoperatively, 95.8% of patients experienced pain relief, with 76.9% achieving complete pain resolution (NRS 0). There was a significant reduction in average perceived pain (from 6.6 ± 1.9 to 0.7 ± 1.1; p < 0.001) and maximum perceived pain (8.0 ± 1.54 to 1.0 ± 1.67; p < 0.001). Full sensory function was restored in 61.2% of patients, and quality of life scores improved markedly, with an average increase of 8.4 out of 10 points (± 1.9; p < 0.001).

CONCLUSION: These results demonstrate that neurolysis of the LFCN is highly effective in the treatment of refractory MP, offering substantial pain relief, sensory restoration, and improved quality of life. Furthermore, patients with previous injuries or surgeries benefited most from NL, suggesting that these factors serve as positive prognostic indicators.

PMID:40053067 | DOI:10.1007/s00264-025-06463-x

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06468-6. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study is to compare the functional outcomes and donor site morbidities after anterior cruciate ligament reconstruction (ACLR) using peroneus longus (PL) tendon versus hamstring (HST) tendon autografts.

METHODS: The PL tendon autograft was used for ACLR in 36 patients, and in another group, ACLR was performed using the HST tendon autograft in 35 patients between September 2022 and April 2023. The knee functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) and the Lysholm scores at preoperative and at 18 months following ACLR. In addition, the autograft diameter was measured intraoperatively in both groups. Ankle joint donor site morbidities were estimated using the American Orthopedic Foot and Ankle Score (AOFAS) in the PL autograft group.

RESULTS: A total of 71 patients, who underwent ACLR, were assessed with a minimum follow-up of 18 months (range 18-20 months). The diameter of the PL tendon autograft was significantly greater than that of the HST tendon autograft (P < 0.001). No significant differences were found in the functional outcomes between both groups at 18 months follow-up. Evaluation of the AOFAS showed no significant ankle joint dysfunction in the PL tendon autograft group.

CONCLUSIONS: PL tendon autograft can be used as a safe and effective autograft choice for ACLR with excellent functional outcomes comparable to HST tendon autograft and minimal donor site morbidity.

LEVEL OF EVIDENCE: Level II, Prospective randomized comparative study.

PMID:40053066 | DOI:10.1007/s00264-025-06468-6

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06477-5. Online ahead of print.

ABSTRACT

PURPOSE: Rotator cuff tears were a prevalent cause of shoulder pain and impairment, often necessitating arthroscopic rotator cuff repair. The optimal timing of postoperative mobilization initiation remains a subject of debate implicating patient outcomes. Therefore, this study aimed to evaluate the effectiveness of early and delayed mobilization after arthroscopic rotator cuff repair.

METHODS: A total of 84 patients who underwent unilateral arthroscopic rotator cuff repair were included in the study and divided into early and delayed mobility exercise groups. Outcome measures included range of motion, shoulder strength, pain assessment, re-tear rates, return to work and pre-injury activity, as well as patient-reported outcomes at various postoperative time points.

RESULTS: Early mobility exercise after arthroscopic rotator cuff repair led to a significantly greater recovery of range of motion at six weeks postoperatively (P < 0.05) and shoulder strength at 12 weeks postoperatively (P < 0.05), as compared to the delayed mobility exercise group. However, the early mobility exercise resulted in non-significant excess in the pain assessment at the six-month postoperative mark (P > 0.05). Additionally, there were no statistically significant differences between the two groups in several outcome measures, including re-tear rates, return to work and pre-injury activity, and long-term patient-reported outcomes at one year post-operatively (P > 0.05).

CONCLUSION: Both early and delayed mobilization exercises safely improve range of motion, shoulder strength, and pain relief after arthroscopic rotator cuff repair. Early mobilization within six to 12 weeks post-surgery enhances range of motion and strength without increasing re-tear rates.

TRIAL REGISTRATION: Not applicable.

PMID:40053065 | DOI:10.1007/s00264-025-06477-5

Int Orthop. 2025 Mar 7. doi: 10.1007/s00264-025-06407-5. Online ahead of print.

ABSTRACT

PURPOSE: Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to summarise the most up to date evidence surrounding the treatment and associated outcomes of adult femoral shaft fractures in sub-Saharan Africa - giving a clear understanding of current practices and highlighting potential areas for further research.

METHODS: PubMed, Google Scholar, Africa Journals Online, Cochrane, Clinicaltrial.gov were searched using Boolean search strategies. Data collected included demographics, fracture classification, interventions, union rates, time to union, patient-reported outcomes / functional outcome scores, and secondary outcomes (orthopaedic and medical complications, malunion / non-union, length of admission).

RESULTS: Twenty-three studies reporting 2,180 patients were included-73% (1592/2180) of patients were male, with a mean age of 35 years. Overall, 59% of patients were treated with intramedullary nailing (IMN), 23% with skeletal traction, and 14% with open reduction internal fixation (ORIF). There was a heterogeneity in practice in different regions, with the highest reported rates of IMN in Tanzania (99%), and lowest in Malawi (29.4%). Union rates were highest in IMN (82.4-100%) versus traction (48 - 100%) and ORIF (83.3-87%). Intramedullary nailing demonstrated a super complication profile, with better functional outcomes, shorter hospital stays and time to mobilisation.

CONCLUSION: Intramedullary nailing demonstrated superior clinical and functional outcomes compared to other modalities for the treatment of femur shaft fractures across sub-Saharan Africa. However, there is significant sparsity of research and variable management approaches across the region. Focused research to determine the burden of injury, current healthcare resources and cost-effective and appropriate interventions to improve outcomes are now a public health priority.

PMID:40053064 | DOI:10.1007/s00264-025-06407-5

SICOT J. 2025;11:13. doi: 10.1051/sicotj/2025007. Epub 2025 Mar 7.

ABSTRACT

Ceramic fractures in total hip arthroplasty (THA) are rare complications that pose significant challenges for revision surgery. This case report describes a 68-year-old male who experienced a spontaneous alumina (ceramic) insert and head fracture four years after the initial THA. The first revision with cobalt-chrome and polyethylene components led to severe metallosis, including subcutaneous tissue discoloration. A second revision utilized a ceramic-on-ceramic (CoC) bearing couple, resulting in excellent functional outcomes and resolution of symptoms. Cutaneous pigmentation post-THA is rare and has not been previously reported following a ceramic fracture. The case underscores the need for careful material selection in revision surgery to minimize complications such as metallosis. The decision to use a ceramic-on-ceramic bearing couple in this case proved effective, ensuring durability and reducing the risk of third-body wear, which can result from inadequate management of ceramic fractures and lead to joint, systemic, or cutaneous complications.

PMID:40053848 | PMC:PMC11888584 | DOI:10.1051/sicotj/2025007

J Bone Joint Surg Am. 2025 Mar 7. doi: 10.2106/JBJS.24.01099. Online ahead of print.

ABSTRACT

BACKGROUND: A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient's pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries.

METHODS: We analyzed data from a previous multicenter RCT that had been conducted from 2011 to 2019. Patients who had sustained acute, unstable chest wall injuries were randomized to operative or nonoperative treatment. In-hospital pain medication logs were evaluated, and daily morphine milligram equivalents (MMEs) were calculated. The patients' symptoms were also assessed, including generalized pain, chest wall pain, chest wall tightness, and shortness of breath. Additionally, patients completed the 36-Item Short Form Health Survey (SF-36), and they were followed for 1 year postinjury.

RESULTS: In the original trial, 207 patients were analyzed: 99 patients received nonoperative treatment, and 108 received operative treatment. There were no significant differences in pain medication usage between the 2 groups at any of the examined time points (p = 0.477). There were no significant differences in generalized pain, chest wall pain, chest wall tightness, or shortness of breath at any time postinjury in the 2 groups. There were also no significant differences in the SF-36 scores.

CONCLUSIONS: This secondary analysis of a previous RCT suggested that operative treatment of patients with flail chest injuries does not reduce in-hospital daily opioid requirements. There were also no reductions in generalized pain, chest wall pain, chest wall tightness, or shortness of breath with operative treatment. The SF-36 scores were similar for both groups. Further work is needed to identify those patients most likely to benefit from operative treatment of flail chest injuries.

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

PMID:40053576 | DOI:10.2106/JBJS.24.01099

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06475-7. Online ahead of print.

NO ABSTRACT

PMID:40047875 | DOI:10.1007/s00264-025-06475-7

Int Orthop. 2025 Mar 6. doi: 10.1007/s00264-025-06485-5. Online ahead of print.

ABSTRACT

PURPOSE: Elbow joint instability results from the disruption of one or more stabilizing anatomical structures. The two most common forms of instability are posterolateral rotatory instability (PLRI) and medial elbow instability (MEI), particularly in athletes. This review aims to explore the anatomical foundations, diagnostic methods, and therapeutic approaches for PLRI and MEI in athletes.

METHODS: A comprehensive literature review was performed to investigate the study objective.

RESULTS: Regarding the anatomical background, the primary stabilizing structures of the elbow joint include the humeroulnar joint (trochlea, olecranon, and coronoid process), the medial collateral ligament (MCL), and the lateral ulnar collateral ligament (LUCL). PLRI is primarily caused by LUCL insufficiency, while MEI results from MCL dysfunction. A thorough clinical evaluation, combined with advanced imaging-magnetic resonance imaging (MRI) or MR arthrography is essential for an accurate diagnosis. For high-level athletes, surgical intervention is often required, with the timing and type of surgery tailored to the athlete's specific needs, expectations, and the chronicity of the injury.

CONCLUSION: PLRI and MEI present diagnostic and therapeutic challenges, especially in athletes. Advanced imaging and clinical evaluation are crucial for the diagnosis. Surgical intervention, particularly arthroscopy, is often required for optimal outcomes.

PMID:40047874 | DOI:10.1007/s00264-025-06485-5