Injury. 2026 Jan 8;57(2):113014. doi: 10.1016/j.injury.2026.113014. Online ahead of print.

NO ABSTRACT

PMID:41546990 | DOI:10.1016/j.injury.2026.113014

Int Orthop. 2026 Jan 17. doi: 10.1007/s00264-025-06733-8. Online ahead of print.

ABSTRACT

INTRODUCTION: In recent years, the interest in hip shelf arthroplasty (HSA) has been increasing and the number of studies documenting long-term results with minimal complications has been growing. The aim of this study is to present long-term results of HSA and analyze the factors that influence them.

MATERIAL AND METHODS: The group of 24 patients (38 hips) with a mean age of 30 years (range, 16 to 52 years), with acetabular dysplasia, was treated by HSA (Bosworth technique). The mean follow-up time for all hips was 26 years (range, 22 to 35 years). The endpoint of the follow-up was total hip arthroplasty.

RESULTS: In all 38 hips, the positive effect of HSA lasted for at least 20 years. In 28 hips followed up on average for 24.5 years (range, 22 to 35 years), the positive effect still persisted at the latest follow-up. Three patients (3 hips), followed up for 26, 26 and 31 years, respectively, deteriorated in the last three years, but they rated their condition as good at the latest follow-up and did not require THA. Seven hips had to be converted to THA. The mean age of these patients at the time of HSA was 29 years (range, 16 to 41 years). The average interval between HSA and THA was 25 years (range, 22 to 31 years). In 3 converted hips, the subluxation was identified as a risk factor. No serious complication (infection, neurovascular injury) was recorded. Kaplan-Meier survival curve at 20-year follow-up was 100% in the study cohort and 70.1% in the worst-case scenario and at 30-year follow-up it was 79.6% in the study cohort and 70.1% in the worst-case scenario.

CONCLUSION: Properly indicated and technically accurately performed HSA can provide very good long-term results. The best results can be expected in dysplastic spherical centered hips with minimal or no osteoarthritic changes (OAC).

PMID:41546705 | DOI:10.1007/s00264-025-06733-8

Injury. 2026 Jan 10:113044. doi: 10.1016/j.injury.2026.113044. Online ahead of print.

ABSTRACT

INTRODUCTION: As screening protocols for blunt cerebrovascular injuries (BCVI) have improved, the incidence of these injuries has increased among trauma patients. Grade 2 BCVIs represent a heterogeneous group of vascular injuries and include injuries with thrombus. We hypothesize that the presence of intraluminal thrombus in patients with grade 2 BCVI is associated with a higher incidence of stroke compared to those without thrombus.

METHODS: We conducted a single-center retrospective review of trauma patients diagnosed with BCVI at a Level I Trauma Center from November 2015 to October 2023. Demographic and injury characteristics were obtained from the institutional trauma registry. Detailed chart reviews were performed to assess imaging findings, stroke incidence, interventions, and follow-up outcomes. Additionally, all grade 2 BCVIs underwent secondary review by neuroradiologists to confirm grade and to identify whether thrombus was present.

RESULTS: We identified a total of 39 patients with at least one grade 2 BCVI. The overall stroke rate among those with grade 2 BCVI was 23% (n = 9). Intraluminal thrombus was present in 31% of patients (n = 12); however, the stroke rate among these patients was similar (25%, n = 3). Incidence of stroke did not significantly differ based on whether patients received an intervention, anti-platelet therapy, or no therapy. Follow-up imaging was performed in 64% of patients (n = 25), demonstrating that 24% of injuries resolved, 24% improved, 40% remained stable, and 16% progressed. Nearly two-thirds of patients (n = 25) underwent at least one repeat CTA during their hospitalization or outpatient follow-up with a median number of 38 days to repeat imaging when performed.

CONCLUSION: Although grade 2 BCVIs are often considered lower risk injuries, our findings indicate that over 20% of affected patients experience a stroke. The presence of intraluminal thrombus was not associated with an increased risk of stroke. These findings support the early initiation of antithrombotic therapy in patients with grade 2 BCVI to mitigate stroke risk.

PMID:41545242 | DOI:10.1016/j.injury.2026.113044

Injury. 2026 Jan 10:113020. doi: 10.1016/j.injury.2026.113020. Online ahead of print.

ABSTRACT

BACKGROUND: Gamified virtual patients (VPs) can enhance motivation and learning in military trauma management. However, there is a need to better understand design preferences and expectations regarding VP features and game elements. This study explores how such elements are experienced and interpreted by military trauma care professionals.

METHODS: This qualitative study applied systematic text condensation to analyze the shared experiences of 17 participants, consisting of military medics and instructors, who interacted with a gamified VP system.

RESULTS: Five main themes were identified: Feeling Challenged; Supporting Reflection and Learning; Realism Matters; Developing Confidence; and Balancing Learning and Playing. Participants expressed mixed views on game rewards, competition, and time-pressure, with instructors warning that such features could detract from learning objectives. Instructors emphasized the value of feedback that explains consequences, while both instructors and medics highlighted the importance of immediate corrective feedback.

DISCUSSION: Gamified VPs can support military trauma training by enhancing engagement, building confidence, and supporting reflection and learning. However, the inclusion of game elements requires careful consideration. Elements that contribute to realism and immersion, such as narrative, multimedia, and tactical challenges, were viewed as valuable for maintaining authenticity and contextual relevance. Hints and progressive difficulty levels were also perceived as beneficial for supporting gradual skill development. Features such as scoring, competition, rewards and time-pressure elicited mixed responses. While some participants found these elements engaging, others perceived them as distracting or misaligned with the goal of acquiring life-saving skills. Instructors were critical of mechanisms that induced artificial stress or rewarded speed over reasoning, warning that such features could shift focus from learning to performance. Therefore, rather than adopting gamification features uncritically, designers and educators should carefully evaluate which elements enhance learning in high-stakes environments and which risk undermining it.

PMID:41545241 | DOI:10.1016/j.injury.2026.113020

Injury. 2025 Dec 10;57(2):112955. doi: 10.1016/j.injury.2025.112955. Online ahead of print.

ABSTRACT

BACKGROUND: The posterior cervical canal plays a critical role in the protection and function of the cervical nerve roots, particularly the C5 nerve root. Variations in its anatomical structure, notably the number of single-door segments, may impact the traction forces experienced by the C5 nerve root during surgical interventions or pathological conditions. This study aims to quantify how the number of single-door segments affects traction forces on the C5 nerve root.

METHODS: A biomechanical model was developed to simulate traction forces on the C5 nerve root based on varying anatomical configurations of the posterior cervical canal. MRI scans from 60 patients were analyzed, and traction forces were calculated for different segmental configurations, specifically focusing on the number of single-door segments.

RESULTS: The study revealed a statistically significant correlation between the number of single-door segments and the traction force on the C5 nerve root. As the number of segments increased from one to three, traction forces increased by 25%, with the mean force rising from 12.5 N to 17.2 N (p < 0.05). Furthermore, the force increased by an additional 6% when the number of segments reached four, reaching a maximum traction force of 18.3 N. These findings suggest that anatomical variations in the posterior cervical canal influence the magnitude of traction forces and could potentially alter surgical outcomes, especially in nerve root preservation during decompression procedures.

CONCLUSION: This study underscores the significant role of single-door segments in the posterior cervical canal in modulating traction forces on the C5 nerve root. These biomechanical insights offer valuable information for preoperative planning, particularly in surgeries involving cervical spine decompression. Understanding these dynamics could enhance the preservation of nerve root integrity and improve patient outcomes in cervical spine surgeries.

PMID:41544535 | DOI:10.1016/j.injury.2025.112955

Injury. 2026 Jan 11;57(3):113045. doi: 10.1016/j.injury.2026.113045. Online ahead of print.

ABSTRACT

PURPOSE: The sural flap is widely recognized as an effective method for soft tissue coverage in severe lower limb trauma or sequelae. This retrospective cohort study investigates the impact of vascular pedicle length in reverse sural fasciocutaneous flaps on vascular complications, specifically whether longer pedicles are associated with increased complications.

METHODS: We included patients with distal third leg and foot soft tissue defects, treated between March 2008 and March 2021, with a minimum follow-up of 1 year. The cohort was divided into two groups based on the location of the flap: those with flaps above the ankle joint (short pedicle) and those below (long pedicle). Patient demographics, comorbidities (e.g., diabetes, peripheral vascular disease, smoking), and the causes of defects (including fractures, ulcers, and degloving injuries) were assessed. The occurrence of complications, including epidermolysis, partial necrosis, and total necrosis, were compared between groups using bivariate linear regression.

RESULTS: A total of 44 patients received flaps above the ankle joint, while 34 had flaps below the ankle joint. Overall, 35% of patients experienced complications: 5% epidermolysis, 20% partial necrosis, and 10% total necrosis. In the short-pedicle group (flaps above the ankle), 13 complications were observed: 3 cases of epidermolysis, 5 of partial necrosis, and 5 of total necrosis. In the long-pedicle group (flaps below the ankle), 15 complications occurred: 1 case of epidermolysis, 11 of partial necrosis, and 3 of total necrosis. Although complication rates were similar between the two groups, a trend toward a higher incidence of partial necrosis was observed in the longer pedicle group. Statistical analysis using bivariate linear regression found no significant difference in complication rates based on pedicle length (p=0.407). For individual complications, there were no statistically significant differences: epidermolysis (p=0.504), total necrosis (p=0.808), and partial necrosis (p=0.098).

CONCLUSION: Flap rotation points positioned 5-6 cm above the lateral malleolus, with a wide, short pedicle, may reduce vascular complications. For defects beyond the ankle joint, careful surgical planning is crucial, to minimize the risk of partial necrosis and other complications.

PMID:41544493 | DOI:10.1016/j.injury.2026.113045

Injury. 2026 Jan 10;57(3):113048. doi: 10.1016/j.injury.2026.113048. Online ahead of print.

ABSTRACT

BACKGROUND: Posterior pelvic ring injuries, including sacral fractures and sacroiliac (SI) joint disruption, can have potentially serious sequelae and are becoming increasingly common. Management, especially in the setting of instability, consists of internal fixation to decrease the risk of complications. Placement of SI screws requires a thorough knowledge of normal pelvic anatomy and the available osseous fixation pathways. The aim of this study was to define the prevalence of individual features of sacral dysmorphism in the general population.

METHODS: We conducted a retrospective review of standard and 3D-reconstructed computed tomography (CT) images of the pelvis to record the presence or absence of each dysmorphic feature. All adult trauma patients who presented within a 5-year period at a single, academic, Level I trauma center were eligible for inclusion. Patients <18 years of age, without advanced pelvic imaging, or who presented with any current or prior pelvic ring injury, tumor, or instrumentation were excluded. The prevalence of each dysmorphic feature was calculated and associations between dysmorphism and demographic factors were investigated.

RESULTS: A total of 2667 patients were eligible for inclusion and the first 1000 were selected for review. Six subjects were excluded during review of CT images. One or more dysmorphic feature was seen in 96.8% of subjects. Each subject displayed an average of 2.7 abnormal features. Residual S1 discs were the most prevalent feature (72.2%). While tongue-in-groove (TIG) sacroiliac (SI) joints were the rarest (7.7% prevalence), they were associated with a significantly higher average number of concurrent dysmorphic features (3.29, P < .0001). Demographic subgroup analysis demonstrated a significantly higher prevalence of S1 discs (P = .0007), TIG SI joints (P < .0001), and colinear upper sacra (P < .0001) in women. Residual S1 discs were also significantly more common in White patients (P < .0001).

CONCLUSIONS: Sacral anatomy exists on a spectrum from normal to dysmorphic. This study demonstrates that completely "normal" sacral morphology is seen in <4% of patients. TIG sacroiliac joints may serve as a quick indicator for a higher degree of dysmorphism which may complicate or preclude transiliac-transsacral screw placement.

PMID:41544492 | DOI:10.1016/j.injury.2026.113048

Injury. 2025 Dec 13;57(3):112966. doi: 10.1016/j.injury.2025.112966. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the clinical application value of a novel tappable, lateral-hole, variable-angle bone grafting tool for injured vertebra bone grafting combined with screw placement in the injured vertebra, in the context of short-segment fixation via an intermuscular approach for thoracolumbar fractures.

METHODS: A retrospective study was conducted on 74 patients treated between January 2022 and June 2024. Patients were divided into three groups: Group A (n = 25) received conventional bone grafting without screw placement in the injured vertebra; Group B (n = 26) received conventional bone grafting with screw fixation; Group C (n = 23) received grafting with the novel tool plus screw fixation. Vertebral kyphosis angle (VKA), local kyphosis angle (LKA), superior endplate displacement (SED), Visual Analog Scale (VAS) scores, and complications were analyzed preoperatively, postoperatively, and at 3-month follow-up. Bone defect volume in Groups B and C was assessed using Mimics software on CT 3D reconstructions.

RESULTS: There were no significant differences in sex, age, operative time, or hospital stay among the three groups (P > 0.05). Preoperative and 1-week postoperative VAS scores were similar among the groups (P > 0.05). At 3 months postoperatively, VAS scores in Group C were significantly lower than in Groups A and B (P < 0.05). Groups B and C exhibited significantly less loss of vertebral kyphosis angle (VKAloss) compared to Group A (p = 0.011). There were no significant differences in LKA among the three groups before surgery, after surgery, or at the 3-month follow-up (P > 0.05). Changes in SED values before and after surgery were consistent with VKA, and the SEDloss value in Group C was significantly lower than in Groups A and B at 3 months postoperatively (p < 0.001). Compared to Group B, Group C showed a significant reduction in fracture defect volume at 3 months postoperatively (p = 0.006).

CONCLUSION: The novel bone grafting tool provides effective vertebral support with high grafting efficiency, reduced pedicle damage, and improved postoperative outcomes. Its ease of use makes it a valuable addition to thoracolumbar fracture treatment via the intermuscular approach.

PMID:41544491 | DOI:10.1016/j.injury.2025.112966

Injury. 2026 Jan 8;57(3):113015. doi: 10.1016/j.injury.2026.113015. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic femoral fractures (PFFs) are increasingly common as arthroplasty rates rise, with incidence projected to double in the next two decades. Mortality approaches that of hip fractures, with 1-year rates of 22-27 % reported in multicentre datasets. While favourable outcomes are often described from high-volume centres, most PFFs present to secondary care, where resources and surgical expertise may be limited. This study evaluates whether a structured multidisciplinary team (MDT) pathway with a weekly dedicated periprosthetic theatre list can achieve outcomes comparable to national and international benchmarks in a UK district hospital.

METHODS: We retrospectively reviewed all PFFs managed between 2013 and 2024 at a district hospital (n = 258) in a trauma unit with fellowship trained arthroplasty surgeons, a dedicated Orthogeriatric team and weekly periprosthetic lists. Demographics, comorbidities (Charlson Comorbidity Index, ASA), fracture type (Vancouver classification), surgical management (fixation vs revision), and outcomes were analysed. Primary outcomes were 30-day and 1-year mortality. Secondary outcomes included discharge destination, restoration of mobility, complications, and reoperation rates. Results were compared with national and international studies.

RESULTS: Mean age was 80 years (median 82) with majority (60 %) being female. 213 (82.8 %) patients were managed operatively after multidisciplinary discussions. In-hospital mortality was 1.2 % (n = 3), 30-day mortality 3.5 %(n = 9) and one year mortality rate was 19.8 %. Mean CCI was 4.8 and one-year mortality was markedly higher in patients with CCI ≥4. Length of hospital stay increased progressively with surgical delay. Among those managed operatively, 63.5 % (n = 87) returned to their original place of residence.

CONCLUSION: A weekly dedicated periprosthetic list with MDT involvement allowed a district hospital to achieve mortality and functional outcomes equal to, or better than, those reported from high-volume centres. These findings highlight that system-level interventions, not hospital size, are the decisive factor in PFF outcomes, and provides a scalable model for hospitals globally.

PMID:41544490 | DOI:10.1016/j.injury.2026.113015

Injury. 2026 Jan 9;57(3):113022. doi: 10.1016/j.injury.2026.113022. Online ahead of print.

ABSTRACT

OBJECTIVES: To biomechanically compare triangular osteosynthesis (TOS) and a minimally invasive triangular spinopelvic stabilization (TMSS) technique for Type IV fragility fractures of the pelvis (FFP) in a cadaveric model.

METHODS: Six fresh-frozen lumbopelvic specimens (L3-pelvis; mean age 61.5 ± 11.5 yrs) with simulated Type IV U-shaped sacral fractures were sequentially instrumented with TOS (bilateral iliosacral screws + lumbopelvic fixation) and TMSS (bilateral iliac screws with transverse connecting rod + lumbopelvic fixation). Constructs were cyclically loaded (200-430 N; 25,000 cycles or 1 cm axial displacement) to simulate postoperative single-leg stance loading. Fracture displacement was quantified using a motion capture system.

RESULTS: All but one TOS specimen completed 25,000 cycles. Bone mineral density had no effect on displacement. TMSS showed lower maximum fracture displacement (6.05 mm) than TOS (12.12 mm; p= 0.071). Displacement after 1000 cycles averaged 56% (TOS) and 62% (TMSS) of the maximum.

CONCLUSIONS: TMSS provided comparable or improved stability versus TOS and, with its minimally invasive design, may offer a viable alternative for FFP Type IV treatment. Further clinical validation is warranted.

PMID:41544489 | DOI:10.1016/j.injury.2026.113022

J Bone Joint Surg Am. 2026 Jan 16. doi: 10.2106/JBJS.25.00876. Online ahead of print.

ABSTRACT

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:41544179 | DOI:10.2106/JBJS.25.00876

Int Orthop. 2026 Jan 16. doi: 10.1007/s00264-026-06739-w. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this study was to compare subjective and objective outcomes of conservative and operative treatment of complete distal biceps tendon ruptures in young and physically active patients.

METHODS: Eleven patients were treated conservatively. Subjective and objective results were compared with those of a matched group of 11 surgically treated patients. At final follow-up, duration of work incapacity, complications, patient satisfaction, range of motion, flexion strength, supination torque, MEPS and DASH score were assessed.

RESULTS: All conservatively treated patients were satisfied and able to fully return to work and sports activities. Two patients in the surgical group experienced complications requiring revision surgery. The mean duration of work incapacity was four days in the conservative group compared with 120 days in the surgical group. No differences were observed between groups with respect to range of motion, DASH score or MEPS. Compared with the contralateral side, mean loss of flexion strength was 12% in the conservative group and 10% in the surgical group. The mean side-to-side loss of supination torque was 13% in conservatively treated patients and 4% in surgically treated patients.

CONCLUSION: Conservative treatment of acute distal biceps tendon ruptures allows a rapid return to occupational and recreational activities and results in good clinical outcomes and high patient satisfaction, even among young and physically active patients. Losses in flexion and supination strength are modest and not functionally relevant in daily life. Conservative treatment is also cost effective and should therefore be explained and made available to all patients who have sustained a complete rupture of the distal biceps tendon.

PMID:41543579 | DOI:10.1007/s00264-026-06739-w

Int Orthop. 2026 Jan 15. doi: 10.1007/s00264-026-06735-0. Online ahead of print.

NO ABSTRACT

PMID:41537829 | DOI:10.1007/s00264-026-06735-0

J Bone Joint Surg Am. 2026 Jan 13. doi: 10.2106/JBJS.25.01513. Online ahead of print.

NO ABSTRACT

PMID:41529096 | DOI:10.2106/JBJS.25.01513

Int Orthop. 2026 Jan 13. doi: 10.1007/s00264-025-06734-7. Online ahead of print.

ABSTRACT

PURPOSE: Patellofemoral osteoarthritis (PFOA) substantially impairs quality of life, and isolated patellofemoral arthroplasty (PFA) is a surgical option for therapy-refractory symptoms. This study evaluated the clinical and functional outcomes and survivorship of an onlay PFA implant, hypothesizing favourable results in the mid- to long-term follow-up.

METHODS: Between 2009 and 2023, 128 knees (123 patients) with PFOA underwent onlay PFA (Journey™ PFJ, Smith & Nephew) and were retrospectively analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form-12 (SF-12) and the numerical analog scale (NAS) for pain and function were assessed preoperatively and at the final follow-up. Postoperative complications and revisions were recorded.

RESULTS: Follow-up data were available for 91 knees (88 patients; mean age 60.7 ± 10.3 years) over 6.1 ± 3.4 years. Significant improvements in the WOMAC total score (57.3% to 22.5%; p < 0.001), SF-12 physical (29.6 to 43.5; p < 0.001) and mental scores (46.8 to 52.7; p < 0.001), and NAS function (4.7 to 7.2; p < 0.001) and pain (7.8 to 3.1; p < 0.001) were observed. Patients who did not achieve the minimal clinically important difference (MCID) had higher preoperative WOMAC scores (61.3% vs. 46.0%; p = 0.018). The SF-12 mental component summary (MCS) scores was correlated with the pre- and postoperative WOMAC scores (r2 = 0.21-0.32; p ≤ 0.002). Kaplan-Meier analysis revealed PFA survivorship rates of 89%, 75%, and 67% at five, ten and 15 years, respectively.

CONCLUSION: Onlay PFA provides significant and sustained improvements in pain, function, and quality of life in patients with PFOA, with satisfactory mid- to long-term implant survivorship. A high preoperative WOMAC score and poor mental health, as indicated by the SF-12 MCS, may be associated with less favourable postoperative outcomes.

PMID:41528470 | DOI:10.1007/s00264-025-06734-7

Injury. 2025 Dec 3;57(2):112925. doi: 10.1016/j.injury.2025.112925. Online ahead of print.

ABSTRACT

INTRODUCTION: Comparative data describing patterns of injury occurring in the home and in the community across ages are limited yet may guide family- and community-based interventions. We sought to assess potential differences in patient characteristics, injury mechanisms, and outcomes, as well as between injuries occurring at home compared to those in the community across all ages.

METHODS: Patients from a level I pediatric and level I adult trauma center who resided and were injured in a single metropolitan county from 2016 - 2022 were included. Demographics, mechanism of injury, and outcome measures were compared. The top three injury mechanisms (falls, motor vehicle crash (MVC), and firearm) were included for analysis. Patients' residential address and injury location were geocoded. Injuries that occurred at home were those <0.1miles from the patient's residence. Statistical analysis included Kruskal-Wallis and Wilcoxon rank-sum tests, and Spearman correlation to evaluate the relationship between age and distances (straight line and driving) from residence to injury location.

RESULTS: There were 1235 and 7680 patients in the pediatric and adult registries, respectively. Male patients accounted for the majority of those <65 years. Trends emerging in the 10-14-year-old age group continued through the 25-44-year-old group; these include increased firearm and MVC injury, injury among Black individuals, assaultive injuries, worse injury severity, and injury in the community. Falls were most prevalent among those aged <10 and >44 years. White children and adults were more likely to be injured at home; other races were disproportionately injured in the community. Injury in the community was more likely to result in higher injury severity in both adults and children.

CONCLUSION: Mechanism-specific injury trends emerging in children and youth that occur in the community continue into adulthood. Community-based intervention strategies are needed. Injuries at home, however, occur in a bimodal age-related pattern and may inform interventions and family-based education initiatives.

PMID:41518851 | DOI:10.1016/j.injury.2025.112925

EFORT Open Rev. 2026 Jan 9;11(1):57-69. doi: 10.1530/EOR-2025-0032.

ABSTRACT

BACKGROUND: The efficacy and safety of robot-assisted pedicle screw placement versus freehand and computer-assisted navigation techniques remain debatable. This umbrella review synthesizes meta-analytic evidence on the associated accuracy, safety, and clinical outcomes.

METHODS: A comprehensive search was performed in PubMed, Embase, Scopus, Web of Science, Ovid, and Cochrane databases, from inception to October 2025, with no language restrictions. Researchers independently assessed meta-analyses that compared robot-assisted with freehand and computer-assisted navigation techniques. Methodological quality was assessed using the AMSTAR-2 tool, and evidence was graded using the GRADE framework. The primary outcomes included accuracy metrics (acceptable and perfect screw placement) and safety indicators (intraoperative blood loss, radiation exposure, and hospital stay). The protocol was registered with PROSPERO (registration number: CRD42024556304).

RESULTS: A total of 38 meta-analyses comprising 414 primary studies were included. Convincing evidence (class I) supported robotic superiority for acceptable placement versus freehand (eOR = 2.74; 95% CI: 2.33-3.22) and versus navigation (eOR = 2.36; 95% CI: 1.73-3.22), and for perfect placement versus navigation (eOR = 2.47; 95% CI: 1.84-3.32). Highly suggestive evidence (class II) supported superior perfect placement (vs freehand) and shorter hospital stays. Suggestive evidence (class III) indicated reductions in intraoperative blood loss and radiation exposure.

CONCLUSION: Robot-assisted pedicle screw placement demonstrates superior accuracy versus freehand and navigation-guided methods, supported by convincing (class I) evidence. Highly suggestive (class II) evidence also supports its superiority in perfect placement and shortening hospital stays, while suggestive (class III) evidence indicates reduced blood loss and radiation. These findings, supported by a robust evidence base, underscore the need for standardized clinical guidelines to maximize impact on patient outcomes.

PMID:41511896 | DOI:10.1530/EOR-2025-0032

EFORT Open Rev. 2026 Jan 9;11(1):17-33. doi: 10.1530/EOR-2025-0093.

ABSTRACT

Staphylococcus aureus is the most common pathogen in periprosthetic joint infections (PJIs), capable of biofilm formation and resistance mechanisms, complicating diagnosis and treatment. PJIs remain a leading cause of total joint arthroplasty failure and are associated with significant morbidity, mortality, and healthcare and economic burdens. Biofilm formation by S. aureus on prosthetic materials is central to PJI persistence and antibiotic resistance. Novel treatment strategies, including copper-coated implants, show promise as adjunct therapies but require further clinical validation.

PMID:41511894 | DOI:10.1530/EOR-2025-0093

EFORT Open Rev. 2026 Jan 9;11(1):46-56. doi: 10.1530/EOR-2025-0076.

ABSTRACT

PURPOSE: The use of intravenous (IV) tranexamic acid (TXA) in arthroscopic shoulder surgery remains controversial. This meta-analysis aimed to evaluate the efficacy of IV TXA in improving perioperative outcomes during shoulder arthroscopy.

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science from inception to February 2025. Randomized-controlled trials (RCTs) comparing IV TXA with group without TXA in patients undergoing arthroscopic shoulder surgery were included. Data were synthesized using random-effects models, with results presented as weighted mean differences (WMDs) and standardized mean differences (SMDs), with 95% confidence intervals (CIs).

RESULTS: Eleven RCTs involving 904 patients were included. Overall, seven trials were rated as high quality, while four trials were rated as moderate quality. Pooled results showed no statistically differences between TXA and control groups in terms of visual clarity (SMD: 0.25, 95% CI: -0.21 to 0.70), visual analog scale score (WMD: -0.33, 95% CI: -0.76 to 0.10), operative time (WMD: -4.48 min, 95% CI: -10.25 to 1.28), irrigation volume (SMD: -0.14, 95% CI: -0.52 to 0.24), estimated blood loss (SMD: -0.62, 95% CI: -1.86 to 0.61), and mean arterial pressure (WMD: -0.10 mmHg, 95% CI: -3.05 to 2.86). No complications were reported in either group across six studies.

CONCLUSIONS: Current evidence does not support a significant clinical benefit of IV TXA in arthroscopic shoulder surgery. Further high-quality RCTs are needed to clarify its role under standardized protocols.

PMID:41511893 | DOI:10.1530/EOR-2025-0076

EFORT Open Rev. 2026 Jan 9;11(1):3-16. doi: 10.1530/EOR-2025-0038.

ABSTRACT

PURPOSE: Diagnosing ligament injuries remains a challenge for musculoskeletal clinicians due to the lack of standardized classification, evaluation, and management protocols. Machine learning (ML) and deep learning (DL) models offer potential to improve diagnostic accuracy. This study aimed to evaluate the diagnostic performance of various ML and DL models in identifying ligament injuries across different medical imaging modalities.

METHODS: A meta-analysis was conducted following the PRISMA 2020 checklist. Searches were performed in PubMed, SCOPUS, Web of Science, and the Cochrane Library. Study quality was assessed using the QUADAS-2 tool and Robvis software. Diagnostic performance measures - true positive, true negative, false positive, and false negative - were analyzed. A random-effects model was applied, and heterogeneity and subgroup analyses were conducted. Statistical and graphical analyses were performed using R. The study was registered in PROSPERO (CRD42025646317).

RESULTS: Fifty-nine ML and DL algorithms from 23 studies were analyzed. Pooled sensitivity and specificity were 0.890 (95% CI: 0.829-0.938) and 0.926 (95% CI: 0.820-0.959), respectively. Pooled estimates for PLR, NLR, lnDOR, and AUC were 1,644.37 (95% CI: 73.56-3,215.18), 0.179 (95% CI: 0.095-0.263), 4.130 (95% CI: 3.570-4.700), and 95%, respectively, with P < 0.001.

CONCLUSION: ML and DL models demonstrate high diagnostic accuracy in detecting ligament injuries. Their strong performance supports ongoing integration into clinical practice, offering valuable support for musculoskeletal specialists in image interpretation and diagnosis.

PMID:41511891 | DOI:10.1530/EOR-2025-0038