Injury. 2025 Sep 23;56(11):112771. doi: 10.1016/j.injury.2025.112771. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to evaluate the feasibility and efficacy of longitudinal bending measurements to monitor the progression of fracture healing. Standard methods for evaluating bone healing rely on the assessment of radiographs, which is subjective in nature and intractable during the first several weeks of healing due to the delayed timeframe of radiographically visible mineralization. In contrast, bending measurements can provide a direct objective measurement of fracture stability that is sensitive to soft callus formation during the acute healing phase.

METHODS: In this study, a direct electromagnetic coupling (DEC) sensing system, which measures bending compliance, was evaluated in an exploratory observational study of diaphyseal tibial fracture patients. Longitudinal measurements were obtained from five patients at their clinical visits and remotely from 14 patients in their homes.

RESULTS: The DEC bending data satisfied repeatability criteria of less than 10 % precision error in 12 of 14 remote patients. As expected, bending compliance decreased with time for 17 of 18 fractures that resulted in union. One fracture resulted in non-union, and the corresponding bending compliance increased with time. The bending compliance rate of change, determined as early as 4 weeks post-injury, detected significant differences between patients with and without non-steroidal anti-inflammatory drug (NSAID) use and between patients with and without co-morbidities.

CONCLUSIONS: These results demonstrated the feasibility of remote bending measurements using DEC, which provide a precise metric of early fracture healing rate that may be invaluable for clinical patient management and as an outcome measure in clinical research.

PMID:41033087 | DOI:10.1016/j.injury.2025.112771

SICOT J. 2025;11:56. doi: 10.1051/sicotj/2025051. Epub 2025 Sep 30.

ABSTRACT

BACKGROUND: Ankle pain frequently occurs in patients with medial compartment knee osteoarthritis (OA), particularly in those with varus deformity. In these patients, an atypical alignment of the ankle joint line relative to the ground is often observed in the coronal plane. The purpose of this study was to evaluate changes in ankle pain and ankle joint orientation after high tibial osteotomy as a treatment of medial compartment knee OA.

METHODS: This prospective work was conducted on 100 patients, aged 40-55 years old, with symptomatic medial compartment knee OA associated with ankle pain, with a good range of motion and intact lateral compartment. All patients treated with high tibial osteotomy fixed by plate. Ankle pain was measured by visual analogue score (VAS) preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. The following parameters were assessed preoperatively and at 3 months postoperatively: the ankle joint line orientation (AJLO), medial proximal tibial angle (MPTA), and the hip-knee-ankle angle (HKA).

RESULTS: The ankle pain significantly improved postoperatively and at last follow-up after HTO; VAS significantly reduced from 5 (4-5) preoperatively to 2 (1-2) at last follow-up (P < 0.001). AJLO was substantially decreased from 9.58 ± 2.74° preoperative to 0.41 ± 1.88° postoperative (P < 0.001). MPTA increased significantly following surgery, from a preoperative value of 85.78 ± 1.84° to a postoperative value of 90.71 ± 1.58° (P < 0.001). Similarly, HKA improved significantly from -7.73 ± 1.50° preoperatively to 2.43 ± 0.88° postoperatively (P < 0.001). A positive correlation was found between ankle pain improvement via VAS and changes in AJLO, MPTA, and HKA (P < 0.05).

CONCLUSION: In patients with medial unicompartmental knee OA associated with ankle pain, both ankle pain and ankle joint orientation improved following high tibial osteotomy.

PMID:41026917 | PMC:PMC12483354 | DOI:10.1051/sicotj/2025051

SICOT J. 2025;11:55. doi: 10.1051/sicotj/2025054. Epub 2025 Sep 30.

ABSTRACT

PURPOSE: This study aimed to assess hindfoot height (HFH) changes 12 months after posterior arthroscopic subtalar arthrodesis without bone grafting. We hypothesized that HFH reduction would be minimal and would not impact fusion or functional results.

METHODS: A retrospective study was conducted on 39 patients who underwent posterior arthroscopic subtalar arthrodesis. HFH was measured on CT scans preoperatively and at 12 months postoperatively. Inter- and intra-observer reliability of the measurement was also assessed as a secondary outcome. Clinical outcomes included pain (numeric analog scale, NAS) and AOFAS Ankle-Hindfoot scores. Subtalar fusion ratios were evaluated via CT.

RESULTS: Mean HFH loss was 0.85 ± 1.1 mm (range, 0-5 mm). The average fusion ratio was 72 ± 30%. Pain and AOFAS scores significantly improved (NAS: -4 ± 2, p < 0.0001; AOFAS: +31 ± 13, p < 0.0001). No correlation was found between HFH loss and fusion ratio or clinical outcomes. HFH loss > 1 mm was more frequent in women and smokers. HFH measurement on CT showed excellent inter- and intra-observer reliability (ICC intra: 0.989; inter: 0.976).

CONCLUSIONS: Posterior arthroscopic subtalar arthrodesis without bone graft results in minimal hindfoot height loss, with no negative impact on subtalar fusion or functional outcomes. This technique reliably preserves hindfoot alignment and provides excellent clinical results. While the assessment of hindfoot height on CT demonstrated excellent inter- and intra-observer reliability, this was a secondary finding and supports the utility of CT-based measurements in the postoperative evaluation of subtalar arthrodesis.

PMID:41026916 | PMC:PMC12483349 | DOI:10.1051/sicotj/2025054

Int Orthop. 2025 Sep 30. doi: 10.1007/s00264-025-06634-w. Online ahead of print.

NO ABSTRACT

PMID:41026200 | DOI:10.1007/s00264-025-06634-w

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06639-5. Online ahead of print.

ABSTRACT

This study evaluated the outcomes of double mobility trapeziometacarpal prostheses for treating osteoarthritis (OA) of the trapeziometacarpal (TMC) joint. A prospective observational analysis was conducted on 150 implants with a maximum follow-up of four years, including a clinical and radiographic assessment and an evaluation of complications. The results indicate a prosthesis survival rate of 97.9% after the first two years post-surgery, calculated using the Kaplan-Meier method. Significant improvements were observed in pain reduction (mean VAS at 3 months post-surgery 2,9 and 1.5 after 6 months), hand grip strength (25.93 kg at 6 months post-surgery), and range of motion (Kapandji score from 8.8 to 9.2, comparing the preoperative mean with the mean after the first postoperative month). The complication rate was low, with only two cases of cup migration and one case of trapezium resorption. Patient satisfaction was high due to the rapid functional recovery and reduced invasiveness compared to traditional techniques. Double-mobility prostheses offer a highly effective treatment for stage II and III TMC OA according to the Eaton-Littler classification, with minimal need for revision surgeries.

PMID:41020960 | DOI:10.1007/s00264-025-06639-5

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06663-5. Online ahead of print.

ABSTRACT

PURPOSE: Calcium pyrophosphate dihydrate (CPPD) deposition, often visible radiographically as chondrocalcinosis, frequently accompanies knee osteoarthritis and is usually encountered at the time of arthroplasty. Whether its presence influences the outcome of patellofemoral arthroplasty (PFA) remains uncertain.

METHODS: We reviewed 100 PFAs performed in 82 patients between 1997 and 2005, and followed them for an average of 22 years (range, 20-25 years). At surgery, 35 knees showed radiographic chondrocalcinosis, and an additional 33 developed calcification during follow-up.

RESULTS: Fifteen knees (15%) required revision to total knee arthroplasty (TKA) at a mean of 12 years after PFA. The main reasons for revision were tibiofemoral osteoarthritis progression (6 knees), patellar malalignment (7 knees), one implant loosening, and one patella fracture. The 20-year survival rates were 87% for knees without chondrocalcinosis and 90% for those with chondrocalcinosis, with no significant difference in revision timing between groups (log-rank p = 0.64).

CONCLUSION: Although chondrocalcinosis became more prevalent with age and follow-up, it did not increase the risk of conversion to TKA. These findings suggest that PFA remains a suitable option in carefully selected patients, regardless of the presence of chondrocalcinosis.

PMID:41020959 | DOI:10.1007/s00264-025-06663-5

Int Orthop. 2025 Sep 29. doi: 10.1007/s00264-025-06662-6. Online ahead of print.

ABSTRACT

PURPOSE: Recurrent hip dislocation after total hip arthroplasty is among the most distressing complications for patients, often reshaping their everyday lives. Beyond the immediate physical consequences, repeated instability generates fear of movement, social withdrawal, and emotional strain. Yet, the extent of this burden has rarely been quantified using patient-centered methods.

METHODS: We evaluated 170 patients who had experienced at least three dislocations and were scheduled for revision surgery. To capture the impact on health-related quality of life (HRQoL), patients completed a Time Trade-Off (TTO) assessment, estimating how many years of life they would exchange for a dislocation-free state. A parallel measure, the Survival Implant TTO, explored whether patients would sacrifice implant longevity in favor of greater stability. Their preferences were compared with surgeons' attitudes toward balancing implant durability and stability.

RESULTS: Patients consistently described instability as a devastating experience, with many reporting restrictions in daily activities and a loss of independence. On average, patients were prepared to exchange nearly one quarter of their remaining life expectancy for stability and were also willing to shorten projected implant survival if this reduced the likelihood of further dislocations. In contrast, surgeons-particularly when treating younger patients-often emphasized implant durability over stability.

CONCLUSIONS: Recurrent hip dislocation has a far-reaching impact on quality of life, comparable to or exceeding that of chronic systemic diseases. Importantly, patient priorities differ from those of surgeons: stability is consistently valued over implant longevity. Incorporating these perspectives into revision planning is essential for truly patient-centered care.

PMID:41020958 | DOI:10.1007/s00264-025-06662-6

Injury. 2025 Sep 15;56(11):112764. doi: 10.1016/j.injury.2025.112764. Online ahead of print.

ABSTRACT

BACKGROUND: A nonvascularized fibular graft (NVFG) is considered to be an alternative option in managing segmental bone loss of the tibia. Nevertheless, there has been no consensus on optimal graft position and graft fixation technique. The purposes of the present study were to mechanically test the influences of various NVFG fixation techniques on the overall stability of the fixation construct by use of finite element analysis.

METHODS: Seven FE models of tibias with segmental bone loss stabilized with various fixation techniques were developed including medial and lateral plate-screw, medial and lateral plate-screw with a NVGF on the opposite cortex, medial and lateral plate-screw with an additional locking screw inserting into a NVGF, and intramedullary nail. Single-legged loading with 388 N applying on the tibial plateau was under consideration.

RESULTS: A NVGF placed on opposite cortex to the plate played an important role in withstanding bending moment which could reduce implant stress. An additional locking screw inserted into the NVGF helped to keep the NVGF in position and was essential for maintaining fracture gap width.

CONCLUSION: A NVFG with locking screw fixation could be an effective modality in managing segmental bone loss of the tibia. A construct of lateral LCP with a NVFG stabilized by a locking screw was mechanically superior to the others.

PMID:41004973 | DOI:10.1016/j.injury.2025.112764

Injury. 2025 Sep 22;56(11):112769. doi: 10.1016/j.injury.2025.112769. Online ahead of print.

NO ABSTRACT

PMID:41004972 | DOI:10.1016/j.injury.2025.112769

Injury. 2025 Sep 19;56(11):112768. doi: 10.1016/j.injury.2025.112768. Online ahead of print.

ABSTRACT

INTRODUCTION: The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates.

HYPOTHESIS: The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates.

MATERIALS AND METHODS: This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; n = 210) involved osteosynthesis with PB, immobilization (6-7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; n = 353) was characterized by osteosynthesis with PE, immobilization (4-6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications).

RESULTS: No patients were lost to follow-up (n = 563) and the mean follow-up was 6.6 ± 7.3 months (3-70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; p < 0.001). Clinical and functional outcomes were similar (p = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-B = 8 %/8.6 %-6 %/7.1 %; p = 0.733 and p = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-B = 71.5°-74° (p < 0.001); A-B = 32.8°-35.6° (p < 0.001); A-B = 32-10 (p < 0.001); A-B = 0.2-0.1 (p = 0.020)].

DISCUSSION: This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that decrease of rotational disorders is more likely related to osteolysis of rotational spur than bone remodeling. Despite limitations, this is the largest French series comparing these two protocols, showing equivalent functional outcomes but greater efficiency and safety in Group B.

CONCLUSION: Both therapeutic protocols have comparable clinical outcomes and complication rates. Leaving pins exposed does not increase the risk of infection.

LEVEL OF EVIDENCE: III comparative retrospective study.

PMID:41004971 | DOI:10.1016/j.injury.2025.112768

Injury. 2025 Sep 17;56(11):112763. doi: 10.1016/j.injury.2025.112763. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to assess the effect of an acute traumatic meniscus tear that required repair in association with a tibial plateau fracture repair on outcomes.

METHODS: Over a 17-year period, 843 patients presented with a tibial plateau fracture and were followed prospectively. 721 patients with Schatzker I-VI fractures were treated operatively via a standardized algorithm. 161 tibial plateau fractures (22.3 %) had an associated meniscus tear that underwent acute repair at the time of bony fixation. These patients were compared to operatively repaired tibial plateau fracture patients with no meniscus injury (NMR). Demographics were collected and outcomes including: radiographic healing, knee range of motion (ROM), and complication rates, were recorded. In addition, re-operation rates were compared and any reoperation for meniscus repair failure identified. All patients had a minimum of 1 year follow up.

RESULTS: A total of 524 patients with a mean of 21.4 (range: 12-120) months follow up met inclusion criteria. Patients in the meniscus repair (MR) cohort had poorer knee extension (1.01 degrees, range: 0-30 degrees) compared to the NMR cohort (0.07 degrees, range: 0-10 degrees) (p < 0.001), in addition to poorer knee flexion (123 degrees, range: 0-145 degrees, p = 0.024). Additionally, MR patients reported higher pain scores (mean: 3 and range: 0-8, p = 0.005) at latest follow up. Finally, MR patients had higher rates of infection (8.1 % vs. 3.3 %, p = 0.025) and lateral collapse of the joint (p = 0.032).

CONCLUSION: Patients who had a meniscus repair at the time of tibial plateau fracture repair were found to have poorer knee ROM, more patient reported pain at minimum 12 (mean 24) months post-operation. Additionally, these patients developed more post-operative complications than those patients who did not undergo a meniscus repair.

PMID:41004970 | DOI:10.1016/j.injury.2025.112763

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06655-5. Online ahead of print.

NO ABSTRACT

PMID:41003786 | DOI:10.1007/s00264-025-06655-5

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06653-7. Online ahead of print.

ABSTRACT

PURPOSE: We examined The Seven Works of Mercy, painted by the Master of Alkmaar in 1504, through the lens of orthopaedic pathology. This study approaches the panels from a medical perspective, aiming to uncover visual indicators of disease and disability. The findings offer insight into how physical abnormalities were observed and depicted in the early sixteenth century. To our knowledge, this is the first study to explore orthopaedic pathology in the Seven Works of Mercy.

METHODS: An interdisciplinary analysis of The Seven Works of Mercy was undertaken, with a focus on the visual representation of illness and physical disabilities. The seven panels were examined to identify physical abnormalities. The findings were compared with clinical features of the suggested illnesses and disabilities and with known medical conditions prevalent in the fifteenth and sixteenth century in Europe.

RESULTS: Several depicted orthopaedic disabilities were suggested in the panels of The Seven Works of Mercy. Possible underlying conditions included clubfeet, spinal tuberculosis (Pott's disease), syphilis, poliomyelitis, ergotism, and genu recurvatum. The physical deformities, depicted with remarkable anatomical detail, were cross-referenced with known clinical presentations. In several cases, assistive devices and posture supported the proposed diagnoses.

CONCLUSION: The Seven Works of Mercy by the Master of Alkmaar is a mirror of society in the early sixteenth century, in which a number of depicted orthopaedic conditions were identified. While artistic interpretation must be considered, several physical deformities and disabilities are reproduced with remarkable detail. The artist captured in this masterpiece, a gallery of orthopaedic pathologies common in his time.

PMID:41003785 | DOI:10.1007/s00264-025-06653-7

J Bone Joint Surg Am. 2025 Sep 25. doi: 10.2106/JBJS.24.01196. Online ahead of print.

ABSTRACT

BACKGROUND: Arthroscopic partial meniscectomy (APM) for degenerative meniscal tears is one of the most common orthopaedic procedures. Surgeons often encounter chondral lesions during APM, and often debride them. The Chondral Lesions And Meniscus Procedures (ChAMP) trial found no benefit to debriding chondral lesions during APM at 1 and 5-year follow-up intervals. To gauge longer-term patient outcomes, we evaluated the original ChAMP trial patients 9 years after surgery.

METHODS: We collected patient-reported outcome measures (PROMs) with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain (VAS-Pain), and Short Form-36 (SF-36); performed a physical examination including evaluation of the range of motion, quadriceps circumference, and effusion; measured radiographic joint space narrowing; and recorded any subsequent surgery. We compared treatment groups (observation versus debridement) with t tests, multiple linear regression analysis, chi-square tests, and adjusted logistic regression. P values of <0.05 were considered significant. All analyses were completed using R statistical software.

RESULTS: Of the 190 patients in the original ChAMP trial, 140 (64 [69.6%] of those in the observation group and 76 [77.6%] of those in the debridement group; p = 0.278) were available for outcome collection at the 9-year follow-up. The majority of patients were male (62.6%), and the average age was 63.9 ± 7.2 years at the 9-year follow-up. Of those 140 patients, 25 (17.9%) had had subsequent surgery on the index knee. Of the remaining patients, 115 completed PROMs, 106 underwent the physical assessment, and 109 underwent radiographic examination. There were no differences between the treatment groups with regard to demographics, except for preoperative weight, which was adjusted for in the modeling. There were no significant differences between the groups with respect to the WOMAC pain score (p = 0.15), other PROMs, physical assessment measurements, radiographic measurements of joint-space narrowing in the surgically treated knees, or rates of subsequent surgery.

CONCLUSIONS: Data collected at 9 years, including PROMs, findings on physical examination, joint space narrowing, and rates of subsequent surgery, indicated that there was no benefit to debriding unstable chondral lesions at the time of APM.

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

PMID:40997153 | DOI:10.2106/JBJS.24.01196

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06658-2. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the demographics and outcomes of patients with Parkinson's disease (PD) undergoing total knee arthroplasty (TKA) to those without PD. Additionally, it aimed to assess the impact of implant design on TKA survival in PD patients.

METHODS: Using data from the Emilia Romagna Registry of Orthopedic Prosthetic Implants, 551 TKA procedures in patients with PD were identified and compared to 52,022 TKAs in patients without PD. Kaplan-Meier survivorship analysis was used to compare implant survival, with revision surgery as the endpoint. Cox multivariate analysis was performed to assess the influence of age, gender, PD diagnosis, and implant design on implant failure.

RESULTS: The average age of PD patients was 72.2 years, with 66.2% being female. Implant survival was significantly lower in the PD group compared to the control group (p < 0.001). At 13 years, the survival rate was 88.8% in the PD group and 94.3% in the control group. PD patients had a 2.7 times higher risk of implant failure after adjusting for age and gender. Constrained implant designs were associated with a 1.7 times higher risk of failure compared to non-constrained designs in PD patients.

CONCLUSION: PD negatively affects implant survival in patients undergoing TKA. Careful consideration should be given to patient selection and implant design in this patient population.

PMID:40996522 | DOI:10.1007/s00264-025-06658-2

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06656-4. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) are highly prevalent among the elderly. However, spinal metastases can also lead to pathological fractures that are often misdiagnosed as OVCFs. This study aimed to determine the prevalence of unsuspected malignant vertebral compression fractures (VCFs) among patients initially suspected to have OVCFs.

METHODS: From October 2020 to December 2023, 141 patients with suspected OVCFs underwent routine vertebral biopsy during percutaneous kyphoplasty (PKP) at our institution. All patients received standardized treatment and prospective clinical data collection. Follow-up questionnaires were completed in person or via telephone.

RESULTS: A total of 168 biopsy specimens were obtained from 141 patients, and all samples (100%) were successfully evaluated histopathologically. Unexpected spinal metastases were identified in six patients (4.3%). Of the 19 patients with a known history of malignancy but without characteristic radiographic features of pathological fracture, only two cases (10.5%) were confirmed as metastatic involvement from the primary cancer. Among the remaining 112 patients without a cancer history, four unexpected malignancies were identified (one lymphoma and three lung cancers). The overall prevalence of unsuspected malignant VCFs in this cohort was 4.3%.

CONCLUSIONS: Given the observed prevalence of unsuspected malignant VCFs, we recommend that routine vertebral biopsy be performed during every PKP procedure for patients with OVCFs to ensure early detection of occult malignancy.

PMID:40996521 | DOI:10.1007/s00264-025-06656-4

Injury. 2025 Sep 17:112766. doi: 10.1016/j.injury.2025.112766. Online ahead of print.

ABSTRACT

Not applicable.

PMID:40992972 | DOI:10.1016/j.injury.2025.112766

Injury. 2025 Sep 17;56(11):112767. doi: 10.1016/j.injury.2025.112767. Online ahead of print.

ABSTRACT

Lower limb amputations have a prevalence of about 26 per 100,000 in the United Kingdom. A significant proportion of these patients suffer from chronic pain and/or phantom limb pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have been found to help improve these symptoms, however these are usually used as a treatment as opposed to prevention. These techniques work on the principle of giving the nerves somewhere to go and something to do, but it is not yet standard practice. Central neural reorganisation and adaptation to chronic/phantom limb pain suggest that preventing the symptom in the first place could yield a superior result to treatment after the problem has arisen. We present a series of 24 cases of where TMR and/or RPNI were performed primarily at the time of initial amputation. Patients were followed up approximately one year after procedure and assessed their pain scores according to a numerical rating scale (NRS) and the PROMIS Pain Interference Short form 6b Significant improvements of pain scores were found for these patients when compared to patients without previous TMR or RPNI. PLP is a debilitating, life limiting and an economic burden on patients who have undergone limb amputations, and with no clear medical or surgical intervention yet widely accepted to offer a definitive management option for this problem, TMR and RPNI may be able to fill a void. This is a good proof of principle showing promising results, and suggests that further investigations with randomised control studies are warranted.

PMID:40992116 | DOI:10.1016/j.injury.2025.112767

Injury. 2025 Sep 18;56(11):112765. doi: 10.1016/j.injury.2025.112765. Online ahead of print.

ABSTRACT

PURPOSE: Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.

METHODS: A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.

RESULTS: MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.

CONCLUSION: Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries-such as those involving the patellar ligament or meniscus-are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.

LEVEL OF EVIDENCE: Level III.

PMID:40992115 | DOI:10.1016/j.injury.2025.112765

SICOT J. 2025;11:54. doi: 10.1051/sicotj/2025052. Epub 2025 Sep 24.

ABSTRACT

INTRODUCTION: Worldwide, more than 1 million Total Hip Arthroplasties (THAs) are performed annually, with this number predicted to increase by 37.7% by the year 2060. This places a significant financial burden on the healthcare system, with the average cost of a THA being approximately $40,000. Several factors ultimately contribute to patient outcomes and complications, including surgical approach, surgeon's experience, patient age, BMI, and most importantly, the preoperative diagnosis. Our paper aimed was to describe the various aetiologies of hip pathologies in patients presenting for primary elective THA to a tertiary academic sub-Saharan African institution.

MATERIALS AND METHODS: We retrospectively reviewed 1400 consecutive patients presenting for elective primary THA between January 2015 and December 2021. Patients' preoperative clinical notes, radiological records, and intraoperative results were independently assessed by two examiners to diagnose the hip pathology. A comparison of the presenting preoperative aetiologies was made between those seen in developed countries and those seen in more developing countries.

RESULTS: 2176 pathological hips were evaluated. Bilateral pathology was present in 56% of patients, of which 92% had the same pathology. There were 427 (31%) males and 973 (69%) females, with an average patient age of 58 ± 14.13 years and an average BMI of 31.01 ± 15.13 kg/m2. The preoperative aetiologies included primary osteoarthritis (OA) (n = 406 [29%]) and avascular necrosis of the femoral head (AVN) (n = 322 [23%]), of which (n = 162 (58%) had bilateral pathology. The primary cause of AVN was HIV (49%). Patients presenting with AVN were significantly younger (p < 0.0001) and had a lower BMI (p < 0.0001) in comparison to patients presenting for other pathologies.

CONCLUSION: This study underscores the significance of aetiology in THA outcomes and highlights the unique challenges faced in developing countries. By identifying the specific causes of hip pathology in this population, healthcare providers can better allocate resources and develop tailored treatment strategies to improve outcomes in resource-limited settings.

PMID:40990380 | PMC:PMC12459105 | DOI:10.1051/sicotj/2025052