Injury. 2026 Mar 20;57(4):113182. doi: 10.1016/j.injury.2026.113182. Online ahead of print.

ABSTRACT

BACKGROUND: Many studies have attempted to define which injured children should undergo computed tomography (CT) imaging. Specifically, the Pediatric Emergency Care Applied Research Network (PECARN), a conglomerate of pediatric trauma centers, prospectively collected data on a large population of patients and have published multiple studies with recommendations on when to image based on the likelihood of a clinically important injury. Using these data and others, the Utah Pediatric Trauma Network (UPTN) created guidelines to help determine when imaging of injured children should be performed at our participating non-pediatric hospitals (non-PED1). The purpose of this study was to evaluate compliance to these guidelines.

METHODS: The UPTN REDCap® database was retrospectively reviewed between 1/2019-12/2022. An analysis of injured Utah children who underwent CT imaging based on UPTN guidelines was performed.

RESULTS: Of the 5224 cases reviewed, 4162 (80 %) underwent CT scan for evaluation, of which 3275 (79 %) received CT imaging at a non-PED1 center. Those treated at a non-PED1 hospital tended to be older (mean 10.2 v. 9.1 years, p = 0.002) and more likely to be ≥ 14 years (33 %v.28 %,p = 0.003). They were also less likely to have a traumatic brain injury (81 %v.91 %,p < 0.0001) or an orthopedic injury (14 %v.21 %,p < 0.0001). Children treated at non-PED1 hospitals were less likely to undergo a CT of the head (59 % v. 88 %,p < 0.0001) and abdomen (18 % v. 32 %,p < 0.0001), but more likely of the chest (17 %v.11 %,p = 0.01) or a pan scan (13 %v.8 %,p = 0.001). Compliance to guidelines was lower compared to the PED1 center for CT of the head (67 %v.87 %,p < 0.0001). Overall, compliance increased in the later years of the study for cervical spine and abdomen/pelvis (p = 0.0002,p < 0.0001 respectively), and decreased for head (p = 0.001).

CONCLUSIONS: Across Utah, CT imaging is highly utilized in the evaluation of injured children. Non-compliance to imaging guidelines was found to be highest for imaging of the cervical-spine, chest, and abdomen.

STUDY TYPE/LEVEL OF EVIDENCE: Level III, Prognostic/epidemiological.

PMID:41887082 | DOI:10.1016/j.injury.2026.113182

Injury. 2026 Mar 23;57(4):113186. doi: 10.1016/j.injury.2026.113186. Online ahead of print.

ABSTRACT

OBJECTIVE: Despite one-third of all trauma admissions occurring over the weekend in Australia, most acute trauma patients only receive allied health input within traditional Monday to Friday service models. This study aimed to determine the acceptability, fidelity and feasibility of a new seven-day allied health model of care within one of Australia's busiest trauma hospitals.

METHODS: An implementation study evaluated the commencement of a new model of care with an additional seven full-time-equivalent, predominantly senior, allied health clinicians over seven days. Acceptability was evaluated through surveys completed by medical, nursing and allied health staff working in the trauma service (n = 151), pre- and post-implementation. Fidelity was evaluated by reviewing referral response time, weekend occasions of service, and at pre-implementation (n = 484 patients), 6-months (n = 456) and 18-months (n = 532) post-implementation. Feasibility was evaluated through practicality and limited efficacy testing (changes in length of stay and Monday discharges) using the Mann-Whitney U or chi-squared tests.

RESULTS: Survey results indicated improved accessibility, adequacy, and continuity of staffing. Recruitment and work-life balance were cited as practical challenges. There were significant reductions in referral response times across allied health (from median 17.0 [IQR 6.0- 25.0] hours to median 12.0 [5.0-21.0] hours, p < 0.001), a 53% increase in weekend occasions of service, and although length of stay remained unchanged, the proportion of Monday discharges increased (13% to 18%, p = 0.02).

CONCLUSION: A seven-day allied health trauma service was successfully implemented with outcomes indicating it will be sustainable. Findings are useful for scalability to other hospitals and clinical specialties.

PMID:41887081 | DOI:10.1016/j.injury.2026.113186

Injury. 2026 Mar 20;57(4):113173. doi: 10.1016/j.injury.2026.113173. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture-related infection (FRI) remains a major complication after Tibial Plateau Fracture (TPF) fixation, particularly in high-energy injuries. The efficacy of locally applied antibiotic-impregnated calcium sulfate as infection prophylaxis is unclear.

METHODS: A retrospective study was conducted on 209 adult patients treated surgically for TPF from March 2010 to December 2023 at a major trauma centre. The exclusion criteria were defined as: patients under the age of 18, open fractures, compartment syndrome, pathological fractures and conservative treatment. Patients were administered either vancomycin-gentamycin impregnated calcium sulfate (Stimulan ®; n = 75) or no local antibiotic (n = 134) during fracture fixation. Infection rates (FRI Consensus Group Criteria), demographics and fracture characteristics were compared. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors.

RESULTS: Mean follow-up period was 21 months. FRI occurred in 18.9 % of the antibiotic group and 18.2 % of non-antibiotic group (p = 0.896). A statistically significant difference for FRI was identified between high-energy fractures (Schatzker IV-VI) and low-energy fractures (27.9 % vs 6.9 %; p < 0.001). Diabetes showed a trend toward increased FRI (p = 0.051) but was not independently significant. No calcium sulfate related complications were observed.

CONCLUSION: Local use of vancomycin and gentamycin loaded calcium sulfate in TPF fixation did not significantly reduce postoperative infection rates. High-energy fractures have been identified as the primary predictor for FRI. Further prospective studies are required to delineate the role of local antibiotic bone substitutes for infection prophylaxis after TPF fixation.

PMID:41887080 | DOI:10.1016/j.injury.2026.113173

Injury. 2026 Mar 20;57(4):113183. doi: 10.1016/j.injury.2026.113183. Online ahead of print.

ABSTRACT

BACKGROUND: Malnutrition is common in orthopaedic trauma and may increase postoperative morbidity. This study evaluated the association between laboratory-defined malnutrition and 90-day medical complications and 2-year fracture-related complications after femoral shaft fracture fixation.

METHODS: Using the TriNetX Research Network (112 healthcare organizations), adults (≥18 years) undergoing operative fixation of femoral shaft fractures were identified. Malnutrition was defined as albumin ≤ 3.5 g/dL and/or leukocytes ≤ 1.5× 10³ /µL measured within 1 year before the index procedure; patients without documented laboratory-defined malnutrition served as controls. Cohorts were propensity score-matched 1:1 on demographics, comorbidities, and selected laboratory measures. Complications were assessed from postoperative day 1 through 90 days (acute respiratory failure/mechanical ventilation, DVT/PE, transfusion, postoperative infection, wound disruption, myocardial infarction, sepsis, acute kidney injury, and emergency department visit) and through 730 days (nonunion/malunion, osteomyelitis, revision fixation, and hardware removal). Risk ratios (RR) with 95 % confidence intervals (CI) were reported.

RESULTS: After matching, 10,943 patients remained in each cohort with good covariate balance (all standardized mean differences <0.10). Within 90 days, malnutrition was associated with higher risk of acute respiratory failure/mechanical ventilation (21.7 % vs 9.5 %; RR 2.29 [95 % CI 2.14-2.45]), sepsis (6.1 % vs 2.9 %; RR 2.09 [1.84-2.39]), DVT/PE (9.7 % vs 5.8 %; RR 1.68 [1.53-1.85]), acute kidney injury (12.8 % vs 8.3 %; RR 1.55 [1.44-1.68]), postoperative infection (4.4 % vs 2.6 %; RR 1.68 [1.46-1.94]), wound disruption (3.1 % vs 1.9 %; RR 1.68 [1.42-2.00]), transfusion (10.9 % vs 8.5 %; RR 1.29 [1.19-1.40]), myocardial infarction (2.4 % vs 1.8 %; RR 1.30 [1.08-1.56]), and emergency department visit (16.4 % vs 14.3 %; RR 1.15 [1.08-1.23]) (all p ≤ 0.005). At 2 years, malnutrition was associated with higher risk of osteomyelitis (1.1 % vs 0.4 %; RR 2.43 [1.74-3.38]), revision fixation (5.9 % vs 4.0 %; RR 1.47 [1.31-1.66]), and hardware removal (9.3 % vs 8.1 %; RR 1.15 [1.06-1.26]) (all p ≤ 0.001), while nonunion/malunion did not differ (3.0 % vs 2.9 %; RR 1.06 [0.91-1.23]; p = 0.472).

CONCLUSIONS: Laboratory-defined malnutrition was independently associated with substantially increased 90-day morbidity and higher 2-year infectious and reoperative complications after femoral shaft fracture fixation. These findings support nutritional risk stratification and motivate prospective studies evaluating targeted perioperative optimization.

PMID:41887079 | DOI:10.1016/j.injury.2026.113183

J Bone Joint Surg Am. 2026 Mar 26. doi: 10.2106/JBJS.26.00074. Online ahead of print.

NO ABSTRACT

PMID:41886543 | DOI:10.2106/JBJS.26.00074

J Bone Joint Surg Am. 2026 Mar 25. doi: 10.2106/JBJS.25.01239. Online ahead of print.

ABSTRACT

BACKGROUND: Unplanned excisions (UEs) of soft-tissue sarcoma are resections performed without appropriate preoperative imaging or biopsy confirmation. These procedures represent a large proportion of referrals to sarcoma centers and can negatively influence oncologic outcomes. Limited evidence exists regarding the impact of consultation timing after UE. This study aimed to compare oncologic outcomes of patients evaluated early versus late at a sarcoma center following UE.

METHODS: Of 397 patients treated for soft-tissue sarcoma from 2012 to 2020 at 2 tertiary centers, 117 underwent UE followed by later tumor bed excision and were analyzed. Consultation with a sarcoma specialist was defined as the patient's first visit with a multidisciplinary sarcoma team member, marking entry into the coordinated cancer center. Patients were stratified into early (≤2 months) and late (>2 months) consultation groups. Demographic, clinical, and tumor characteristics were collected. Primary outcomes included local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). Chi-square and t tests were used for univariate comparisons, and Kaplan-Meier analyses were performed. Multivariable Cox regression and logistic regression analyses were performed, adjusting for patient age, sex, and comorbidities; tumor size, depth, grade, stage, and margin status; and/or follow-up duration.

RESULTS: Among the 117 patients (mean age, 56 years; 55% female; 84% White; 65% non-Hispanic), 26 were seen early and 91 late. The rate of metastasis was significantly higher in the late cohort (48.4% versus 11.5%, p = 0.0016), as was mortality (30.8% versus 3.8%, p = 0.0109). Five-year Kaplan-Meier survival outcomes favored early consultation, including LRFS (84.6% versus 63.7%, p = 0.041), MFS (88.5% versus 50.5%, p = 0.003), and OS (96.2% versus 64.8%, p = 0.005). On multivariable analysis, late consultation was independently associated with inferior LRFS (hazard ratio [HR] = 1.95, p = 0.046), MFS (HR = 2.76, p = 0.004), and OS (HR = 2.53, p = 0.022). Logistic regression showed increased odds of metastasis (odds ratio [OR] = 7.11, p = 0.0027) and mortality (OR = 11.29, p = 0.021) at 5 years in the late group.

CONCLUSIONS: Delayed consultation after UE was associated with significantly worse outcomes, including higher rates of metastasis and mortality and lower LRFS, MFS, and OS. These results emphasize the importance of timely referral to sarcoma centers for early multidisciplinary management.

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

PMID:41880536 | DOI:10.2106/JBJS.25.01239

Int Orthop. 2026 Mar 25. doi: 10.1007/s00264-026-06792-5. Online ahead of print.

ABSTRACT

PURPOSE: The modified Broström operation is the gold standard surgical approach for chronic lateral ankle instability. The aim of surgical treatment for chronic lateral ankle instability is to shorten and repair the lax lateral ligaments, once the healing process is complete, the sutures will no longer be necessary. While non-absorbable sutures are commonly used, they may cause complications, such as inflammation and foreign body reactions. The purpose of this study was to evaluate the clinical outcomes of the modified Broström operation using absorbable sutures, which we expected to yield favorable results.

METHODS: From 2019 to 2023, 157 cases of mechanical chronic lateral ankle instability treated with the modified Broström operation using absorbable sutures were analyzed retrospectively Functional outcomes were assessed using preoperative and postoperative AOFAS Ankle-Hindfoot scores and Karlsson-Peterson scores.

RESULTS: The mean AOFAS score improved from 66.84 (range: 36-98) preoperatively to 88.20 (range: 55-100) postoperatively, and the mean Karlsson score improved from 53.67 (range: 25-95) to 82.29 (range: 35-100). Recurrence of instability or sprains occurred in 6.3% of cases, with only two patients (1.2%) requiring reoperation. Complications other than recurrence were rare, limited to a single case of superficial peroneal nerve injury and one deep infection. Multivariate analysis revealed that younger age was associated with a higher risk of recurrence.

CONCLUSION: The modified Broström operation using absorbable sutures demonstrated favorable functional improvement with low recurrence and complication rates, suggesting that it may represent a safe and effective surgical option.

PMID:41879989 | DOI:10.1007/s00264-026-06792-5

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01102. Online ahead of print.

ABSTRACT

BACKGROUND: Vertebral body tethering (VBT) aims to gradually correct scoliosis using patients' growth while preserving spinal motion. We report 5 to 8-year outcomes and complications in skeletally immature patients.

METHODS: This prospective single-center cohort study included 74 patients who had idiopathic scoliosis and a ≥5-year follow-up. Preoperative, first postoperative visit, 1-year, 2-year, and ≥5-year radiographs were analyzed. A ≥5° increase in the interscrew angle suggested tether breakage.

RESULTS: All 74 patients (5 male and 69 female) were skeletally immature at surgery. The mean age at surgery was 11.8 ± 1.3 years, and the mean follow-up time was 63.4 ± 8.4 months. Of the 74 patients, 68 patients were White, 4 were Black, and 2 were Middle Eastern or North African. VBT was performed on a mean of 7.4 vertebral levels. The maximum Cobb angle was 47.9° ± 9.4° preoperatively, whereas the instrumented Cobb angle measured 17.2° ± 12.3° at 2 years and 25.7° ± 14.0° at ≥5 years postoperatively. An unplanned return to the operating room occurred in 16 patients (21.6%). Forty-nine patients (66%) had a suspected broken tether at the final follow-up. The mean time of the first tether breakage was 38.1 ± 15 months. Forty-nine patients (66%) also had a curve of <40° without an unplanned return to the operating room at a minimum of 5 years postoperatively.

CONCLUSIONS: In our cohort, 66% (49 patients) had a radiographically suspected tether breakage after 5 years and 13.5% (10 patients) required posterior spinal fusion to date. VBT yielded significant correction in the coronal plane (p < 0.001) and transverse plane (p = 0.006) postoperatively, with a reoperation rate of 21.6%.

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

PMID:41875234 | DOI:10.2106/JBJS.25.01102

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.26.00157. Online ahead of print.

NO ABSTRACT

PMID:41875229 | DOI:10.2106/JBJS.26.00157

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.00976. Online ahead of print.

ABSTRACT

➢ Computed tomography (CT) remains the gold standard for bone imaging, but radiation risks, especially in children, are driving interest in alternatives.➢ Magnetic resonance imaging (MRI)-based techniques are emerging as a radiation-free alternative to CT, using sequences such as zero echo time, ultrashort echo time, and 3-dimensional (3D) gradient recalled echo, along with deep learning-based synthetic CT.➢ Zero echo time MRI stands out for its high-resolution and silent imaging, whereas 3D gradient recalled echo offers widespread availability and minimal requirements for implementation.➢ Early studies have shown high agreement of all modalities with CT across multiple anatomical sites, supporting broader clinical use, especially in pediatrics, surgical planning, and cost-reduction efforts.➢ Deep learning-based synthetic CT demonstrates strong potential given its ability to improve over time and to generate highly accurate CT-like images, although current applications are limited by existing training data.

PMID:41875228 | DOI:10.2106/JBJS.25.00976

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01108. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Centers for Medicare & Medicaid Services (CMS) requires the collection of patient-reported outcome measures (PROMs) after primary total joint arthroplasty (TJA), with penalties for noncompliance affecting all Medicare reimbursement. The CMS will publish risk-standardized improvement rates based on substantial clinical benefit (SCB) thresholds of 22 points for the HOOS JR (Hip disability and Osteoarthritis Outcome Score for Joint Replacement) and 20 points for the KOOS JR (Knee injury and Osteoarthritis Outcome Score for Joint Replacement). Our aims were to determine if preoperative scores predicted postoperative PROMs, to externally validate the SCB thresholds, and to analyze them with different anchors.

METHODS: We retrospectively identified patients who underwent TJA at our institution between 2015 and 2023. The HOOS JR and KOOS JR were prospectively collected in the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI); all other variables were obtained from electronic medical records. Logistic regression analyses and anchor-based receiver operating characteristic curves were generated to determine threshold values and the efficacy of using preoperative and postoperative scores as predictors of patient improvement, satisfaction, and willingness to repeat surgery.

RESULTS: In total, 3,465 cases (1,498 total knee arthroplasties [TKAs] and 1,967 total hip arthroplasties [THAs]) were included. Preoperative scores failed as predictors (area under the curve [AUC], <0.6) of patient improvement, satisfaction, and willingness to repeat surgery. The change in scores for TKA, particularly at 1 year postoperatively, was predictive of improvement (AUC, 0.79), satisfaction (AUC, 0.77), and willingness to repeat surgery (AUC, 0.71); and the change in scores for THAs was predictive of improvement (AUC, 0.85), satisfaction (AUC, 0.82), and willingness to repeat surgery (AUC, 0.77). The Youden index indicated that change thresholds of 24 points for patient improvement, 24 points for satisfaction, and 26 points for willingness to repeat surgery provided the best predictions at 1 year after THA. Similarly, change thresholds of 21 points for patient improvement, 22 points for satisfaction, and 24 points for willingness to repeat surgery provided the best predictions at 1 year after TKA. Twenty percent of patients did not achieve CMS-proposed SCB thresholds.

CONCLUSIONS: Although preoperative scores were not predictive of patient-reported outcomes, the degree of score improvement postoperatively was strongly associated with patient improvement, satisfaction, and willingness to repeat surgery. CMS-proposed SCB thresholds appear to be validated in our population and compare favorably with the thresholds produced in this study.

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

PMID:41875225 | DOI:10.2106/JBJS.25.01108

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01338. Online ahead of print.

ABSTRACT

BACKGROUND: We aimed to develop automated data extraction pipelines with large language models (LLMs) to extract registry data from total hip arthroplasty (THA) operative notes and compare the performance with that of existing natural language processing (NLP) algorithms.

METHODS: We randomly sampled 1,000 primary THA cases from our institutional registry. Two human annotators manually reviewed each operative note for 3 data points: surgical approach, bearing surface, and fixation technique. All labeled THA notes were split into the development set (n = 239) and the testing set (n = 719). We developed a custom data extraction pipeline for each data point by combining an iteratively customized prompt with an LLM. The performance was compared with that of existing rules-based NLP algorithms.

RESULTS: The accuracy of LLMs was superior to that of NLP algorithms for all data points: surgical approach (96% compared with 94%), bearing surface (89% compared with 74%), and fixation technique (96% compared with 95%). Furthermore, the LLM accurately inferred the bearing surface for 80% of the notes that were ambiguous about the bearing surface.

CONCLUSIONS: We developed LLM pipelines for extracting 3 registry-relevant data points from THA operative notes, demonstrating superior performance to existing NLP algorithms.

CLINICAL RELEVANCE: LLMs have the potential to impact clinical care, including the evaluation of electronic medical record free-text data. As registries serve as a cornerstone of orthopaedic evidence, this work demonstrates promise for LLMs to simplify, improve, and democratize the construction of registry databases from operative notes.

PMID:41875224 | DOI:10.2106/JBJS.25.01338

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.00787. Online ahead of print.

ABSTRACT

BACKGROUND: Carpal tunnel syndrome (CTS) diagnosis has traditionally relied on electrodiagnosis (EDX) to confirm the diagnosis and to assess severity. Ultrasound has shown potential in measuring median nerve cross-sectional area (CSA) for CTS diagnosis, and magnetic resonance imaging (MRI) can be used for wrist soft-tissue evaluation. This study explored the correlation between CTS diagnosis and median nerve CSA measured on MRI at different wrist levels.

METHODS: A retrospective review of an electronic medical record database identified patients who underwent both wrist MRI and EDX within a 90-day interval between January 2000 and December 2022. Median nerve CSA was measured on axial T2-weighted images at 3 levels: proximal to the carpal tunnel inlet (the distal radioulnar joint [DRUJ]), the inlet, and the outlet. Continuous variables are presented as means ± standard deviations. A logistic regression model was constructed to evaluate the diagnostic accuracy of median nerve CSA, at the 3 anatomical levels, in identifying CTS. Empirical cut point estimation determined optimal cutoffs and corresponding areas under the receiver operating characteristic curve (AUCs).

RESULTS: Sixty-eight patients (76 wrists; mean age, 51.4 ± 14.2 years; male-to-female ratio, 26 to 50; 59 White patients, 8 Hispanic patients, and 1 Asian patient) were included. The mean median nerve CSA in the EDX-negative group compared with the EDX-positive group was 10.6 ± 3.4 versus 11.7 ± 4.0 mm2 (p = 0.248) at the DRUJ level, 11.1 ± 3.1 versus 14.4 ± 5.1 mm2 (p = 0.007) at the inlet level, and 9.8 ± 2.4 versus 11.0 ± 5.2 mm2 (p = 0.833) at the outlet level. The inlet CSA cutoff for CTS was 11.3 mm2 (AUC = 0.67), with a sensitivity of 74% and a specificity of 60%.

CONCLUSIONS: MRI-based measurements of median nerve CSA, particularly at the inlet level, suggest that relying solely on CSA measurements may not be an optimal diagnostic strategy for CTS in patients with equivocal clinical symptoms. Even with MRI and highly standardized measurement protocols, only poor-to-fair diagnostic accuracy was achieved. This study raises questions about the diagnosis of CTS based on CSA measurements.

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

PMID:41875223 | DOI:10.2106/JBJS.25.00787

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.00880. Online ahead of print.

ABSTRACT

BACKGROUND: Recent evidence suggests that variations in overall scapular morphology may predispose individuals to specific shoulder pathologies. The purposes of this study were to provide a comprehensive 3D analysis of scapular anatomy in a healthy population and to investigate potential age-related differences and associations with pathological thresholds described in the literature.

METHODS: This study included computed tomography scan data from 369 healthy scapulae of subjects ≥18 years of age without shoulder pathology. The scapulae were analyzed to measure key morphological parameters, including glenoid version, acromial coverage, posterior acromial height, coracoid angles, and scapular spine angle. Scapulae of individuals <60 years old were compared with those of individuals ≥60 years old. Morphological thresholds described in previous studies were used to identify the percentage of healthy scapulae that demonstrated values exceeding pathological thresholds.

RESULTS: Significant differences were observed between the scapulae of patients <60 years old and those ≥60 years old, with younger patients generally exhibiting scapular morphologies more closely resembling those reported in pathological cases. Key differences included posterior acromial height, posterior acromial coverage, scapular spine angle, and coracoacromial coverage (p < 0.05 for each). Across the cohort, a small percentage of healthy scapulae exceeded pathological thresholds published in the literature for posterior instability (posterior acromial height: 12.2%; posterior acromial coverage: 12.7%), anterior instability (coracoid pillar angle 2: 9.5%; scapular spine angle 2: 13.3%; glenoid rotation: 0.5%), and primary osteoarthritis (anterior coracoid plane coverage: 6.5%; coracoacromial plane coverage: 10.8%; posterior acromial coverage: 10.3%; critical shoulder angle: 6.0%).

CONCLUSIONS: This study provides a comprehensive reference for the 3D morphology of the healthy scapula. The results reveal relatively low variability in shape among healthy scapulae; however, specific morphological variations appear to predispose individuals to certain pathologies. As degenerative conditions develop over time, younger subjects with such predispositions may gradually transition out of the healthy cohort. Conversely, individuals who remain healthy beyond 60 years of age likely possess a "healthy" anatomy that does not favor pathology, representing the true cohort of healthy subjects.

CLINICAL RELEVANCE: Understanding the 3D morphology of the healthy scapula could enhance our knowledge of the etiology of conditions such as posterior and anterior instability and primary osteoarthritis, potentially improving their surgical management.

PMID:41875222 | DOI:10.2106/JBJS.25.00880

J Bone Joint Surg Am. 2026 Mar 24. doi: 10.2106/JBJS.25.01084. Online ahead of print.

ABSTRACT

➢ The Medicare Transforming Episode Accountability Model (TEAM) is a 5-year payment model that started on January 1, 2026, with mandatory participation from >700 U.S. hospitals in 5 surgery categories, 3 of which are orthopaedic.➢ The TEAM encompasses a specified operation from the day of the admission or outpatient procedure to 30 days after discharge, with payment based on a hospital-specific target price that is adjusted for hospital demographic characteristics and a Composite Quality Score multiplier.➢ Although hospitals hold the financial risk and benefit, orthopaedic surgeons will drive the TEAM's success, making their strategic engagement with leadership essential.➢ Robust data infrastructure, along with timely collection and analysis, forms the foundation for the TEAM implementation and compliance.➢ Many hospitals are unprepared for the TEAM, and the inclusion of high-variability procedures, such as the surgical treatment of hip and femoral fractures and spinal fusion, heightens financial risk, underscoring the need for a clear strategic framework and orthopaedic surgeon leadership.

PMID:41875221 | DOI:10.2106/JBJS.25.01084

Int Orthop. 2026 Mar 24. doi: 10.1007/s00264-026-06778-3. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic produced a substantial reduction in arthroplasties, which could have affected patient quality of life. This study investigated quality of life in Australians undergoing elective arthroplasty before and during the COVID-19 pandemic.

METHODS: Using data from the Australian Orthopaedic Association National Joint Replacement Registry, quality of life was assessed in patients before and six months after primary total hip arthroplasty (THA), total knee arthroplasty (TKA) and reverse total shoulder arthroplasty (RTSA) using the EQ-5D-5L instrument. Patients with an EQ-5D Utility score less than zero were considered to have a quality of life worse than dead. Secondary outcomes included Oxford Scores, joint-specific pain, patient perceived change, responder status and patient satisfaction. Quality of life was compared before (1 July 2018-10 March 2020) and during the pandemic (11 March 2020-10 March 2023) using linear or logistic regression models.

RESULTS: The analysis included preoperative data for more than 24,000 THA patients, 20,000 TKA patients and 1,100 RTSA patients. Compared to the pre-pandemic period, preoperative and postoperative quality of life significantly reduced during the pandemic for THA and TKA, but not by a meaningful amount (adjusted mean difference ≤ 0.03 points, p < 0.001). The likelihood of having quality of life worse than dead increased during the pandemic but was only significant for preoperative THA (ORs 1.24 to 1.40, p < 0.02). For secondary outcomes, joint-specific scores deteriorated, and joint pain increased to a small degree during the pandemic for THA and TKA (p < 0.05), but not for RTSA. The proportion of THA and TKA patients satisfied with their surgery outcome increased modestly during the pandemic by approximately five percentage points, compared to pre-pandemic.

CONCLUSION: The COVID-19 pandemic was not associated with a clinically meaningful deterioration in pre- or post-operative quality of life, on average, for patients undergoing THA, TKA or RTSA in Australia.

PMID:41872348 | DOI:10.1007/s00264-026-06778-3

J Bone Joint Surg Am. 2026 Mar 23. doi: 10.2106/JBJS.25.01652. Online ahead of print.

NO ABSTRACT

PMID:41871183 | DOI:10.2106/JBJS.25.01652

Int Orthop. 2026 Mar 21. doi: 10.1007/s00264-026-06782-7. Online ahead of print.

ABSTRACT

PURPOSE: To compare platelet-rich plasma (PRP) with hyaluronic acid (HA), corticosteroid (CS), or saline placebo (NS) for symptomatic knee osteoarthritis (OA) and to assess whether total blood-draw volume, a proxy for platelet dose, is associated with treatment effect.

METHODS: Following PRISMA, randomized controlled trials comparing intra-articular PRP with HA, CS, or NS were identified. Random-effects meta-analyses estimated mean differences (MDs) in pain (VAS) and function (WOMAC) at six and twelve months. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Subgroup analyses stratified PRP vs HA trials by total blood draw volume (< 40 mL vs ≥ 40 mL).

RESULTS: Sixty-two trials (n = 4,969) were included. PRP improved VAS and WOMAC versus HA, CS, and NS at six months and remained superior versus HA and CS at twelve months (insufficient studies for twelve-month PRP vs NS). In PRP vs HA trials, blood draw volume ≥ 40 mL was associated with larger improvements in six-month WOMAC (P = 0.004) and twelve-month VAS (P = 0.029). Heterogeneity was substantial (I2 > 90% for most analyses), and evidence certainty ranged from moderate to very low.

CONCLUSION: PRP provides superior patient-reported pain and function outcomes compared with HA, CS, and NS through six months, with benefits maintained to twelve months versus HA and CS in longer-term trials. Blood-draw volume may be a useful alternate when platelet dose is unreported.

PMID:41863556 | DOI:10.1007/s00264-026-06782-7

Injury. 2026 Mar 15;57(4):113161. doi: 10.1016/j.injury.2026.113161. Online ahead of print.

ABSTRACT

BACKGROUND: Extra-articular distal tibial fractures treated with locked intramedullary nails present a high rate of malunion, particularly rotational deformities. Concomitant fibular fixation has been associated with a reduction in malalignment; however, some studies suggest it may increase nonunion and complication rates, including infection. There is currently no consensus regarding the influence of fibular stabilization in these fractures.

OBJECTIVE: To compare radiographic outcomes, functional results, and complication rates of extra-articular distal tibial fractures treated with locked intramedullary nails, with or without concomitant fibular fixation.

METHODS: A randomized prospective study was conducted including patients aged 18-60 years with displaced extra-articular distal tibial fractures, including open fractures up to Gustilo type IIIA, associated with fibular fractures located below the middle third. Patients lost to follow-up or who did not complete all radiographic or functional assessments were excluded. Primary outcomes included fracture union assessed by a modified RUST score ≥ 11 at 12 months, malalignment assessed by postoperative radiographs and CT scan at one year, functional evaluation of the knee and ankle using the Lysholm and AOFAS scores, respectively, and complication rates.

RESULTS: At the end of follow-up, 43 patients without fibular fixation (HIMB group) and 34 with fixation (HIMBF group) were analyzed. The nonunion rate was 4.7 % in the HIMB group and 5.9 % in the HIMBF group, with no significant difference. Fracture healing progression was similar between groups. Malunion occurred in 18.6 % of the HIMB group and 11.8 % of the HIMBF group, without statistical significance. There were no significant differences in complication rates or in knee and ankle functional outcomes at one year.

CONCLUSION: Concomitant fibular fixation does not influence nonunion or malunion rates, does not increase complication rates, and does not affect knee or ankle function in the treatment of extra-articular distal tibial fractures stabilized with locked intramedullary nails.

PMID:41861501 | DOI:10.1016/j.injury.2026.113161

Injury. 2026 Mar 13;57(4):113156. doi: 10.1016/j.injury.2026.113156. Online ahead of print.

ABSTRACT

BACKGROUND: Appropriate triage is essential to reducing preventable deaths and optimizing the allocation of limited medical resources in trauma care. Although the mechanism of injury (MOI) has been incorporated into prehospital triage protocols, its predictive accuracy remains controversial. This study aimed to investigate the association of MOI and anatomical injury sites with the need for emergency procedures and in-hospital outcomes using a nationwide trauma registry in Japan.

METHODS: This retrospective cohort study analyzed data from the Japan Trauma Data Bank (JTDB) between 2019 and 2021. Adult trauma patients (age ≥18 years) directly transported from the scene were included. The primary outcome was the implementation of emergency procedures upon hospital arrival, and the secondary outcome was in-hospital mortality. Multivariable logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI). Discriminatory ability was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS: Among 42,124 eligible patients, 16,580 (39.3%) underwent emergency procedures. Railway-related trauma (OR, 95% CI: 5.50, 3.73-8.11), crush injuries (2.03, 1.50-2.75), head injuries (4.35, 4.12-4.59), and abdominal injuries (20.06, 16.66-24.16) were significantly associated with emergency procedures. The AUCs for predicting emergency procedures were 0.57 for MOI and 0.72 for injury sites, and 0.53 and 0.77, respectively, for in-hospital mortality.

CONCLUSIONS: Anatomical injury sites demonstrated greater discriminative performance than MOI in predicting the need for emergency procedures and in-hospital mortality. These findings highlight the limitations of mechanism-based triage and suggest that incorporating anatomical assessment may improve triage accuracy and resource utilization.

PMID:41861500 | DOI:10.1016/j.injury.2026.113156