Injury. 2025 Sep 8;56(11):112752. doi: 10.1016/j.injury.2025.112752. Online ahead of print.

ABSTRACT

The impact of gun violence on the well-being of children in the United States is a vital public health issue. Gaps remain in characterizing the population health burden, exacerbated by gun violence data limitations and research policy restrictions. This study explores the association between neighborhood-level gun violence and the general health status of children nationwide in the Environmental influences on Child Health Outcomes (ECHO) study. 13,450 children ages 0-17 and parents reported general health status. Gun violence incidents, defined as any death or injury caused by a gun, were extracted from the publicly available Gun Violence Archive by census tract between 2020 and 2023. Census tracts were categorized as low gun violence (< 2 incidents between 2020-2023) and high gun violence (≥ 2 incidents). A generalized estimating equation logistic model with robust variance was used to estimate the association between binary general health status (Good/Fair/Poor vs. Excellent/Very good) and neighborhood-level gun violence events adjusting for individual and census tract-level sociodemographic covariates. 11,329 (84 %) reported Excellent/Very Good general health and 2121 (16 %) reported Good/Fair/Poor general health. The adjusted odds of Excellent/Very Good general health were 20 % lower among children living in census tracts with high gun violence compared to low gun violence (OR 0.804; 95 % CI: 0.721, 0.897). When stratified by age group, the odds of Excellent/Very Good general health among younger children (ages 0 - 7) were 17.3 % lower (OR 0.827; 95 % CI: 0.687, 0.997) and 19.7 % lower among older children (ages 8 - 17) among those living in census tracts with high gun violence compared to those with low gun violence (OR 0.803; 95 % CI: 0.702, 0.919). Among children living in high socioeconomic vulnerability census tracts, the odds of Excellent/Very Good general health were 23 % lower in children living in census tracts with high gun violence compared to those with low gun violence (OR 0.767, 95 % CI 0.669, 0.880). Findings underscore the importance of community violence prevention efforts and the need to strengthen our understanding of community risk factors such as gun violence that hinder optimal child growth and development.

PMID:40945226 | DOI:10.1016/j.injury.2025.112752

Injury. 2025 Sep 9;56(11):112755. doi: 10.1016/j.injury.2025.112755. Online ahead of print.

ABSTRACT

INTRODUCTION: Obesity is a growing global concern. Bariatric surgery (BS) is the only intervention which leads to significant and long-lasting weight reduction. However, it has been associated with an increased risk of fracture. We aimed to investigate the association between BS and distal radius fractures (DRF).

METHODS: A retrospective cohort study of patients with obesity who underwent BS was conducted. The incidence of DRF and the non-osteoporotic scaphoid fracture in the six-years pre-and post-BS was compared. Sub-analysis for surgical type, weight loss, nutritional supplements, and treatment modality was conducted.

RESULTS: Seventeen-thousand, nine-hundred and four patients, aged 40 (SD 2.7) were included in the study, most of whom were females (71.2%). Most underwent restrictive gastric surgery (82.6%). The incidence of both fractures increased following BS (OR 2.091, 95% CI [1.524,2.896], p<0.001 for DRF and OR 6.013, 95% CI [2.819,14.720], p<0.001 for scaphoid fracturs). Women were affected more. DRFs were less common following restrictive surgery (0.6% versus 1.15% for gastric bypass surgery, OR 0.52 95% CI [0.35,0.79], p.=0.002), and their incidence was not associated with the time elapsed from BS. A greater weight reduction was not related with increased fracture risk, regardless of the fracture type, as was nutritional supplements consumption. DRF surgery rates were not affected by BS.

CONCLUSIONS: BS was found to relate with increased risk for DRFs. The risk was greater for gastric bypass patients and independent of the increasing cohort age, the amount of weight lost, the time elapsed from surgery, and the intake of nutritional supplements.

PMID:40945225 | DOI:10.1016/j.injury.2025.112755

Injury. 2025 Sep 5;56(11):112749. doi: 10.1016/j.injury.2025.112749. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture related infection (FRI) is a serious complication of orthopedic trauma. The DAIR (Debridement, Antibiotics, and Implant Retention) approach has been used as a limb- and implant-sparing strategy in selected early infections, but the factors associated with clinical success and bone healing remain incompletely defined.

OBJECTIVE: To evaluate the effectiveness of DAIR in treating early FRI and to identify clinical, surgical, and microbiological factors associated with infection remission, recurrence and fracture consolidation.

METHODS: This retrospective cohort study included adult patients diagnosed with early FRI and treated with DAIR between 2017 and 2023. Clinical remission was defined as infection resolution without further surgery or suppressive antibiotic therapy at 12-month follow-up. Recurrence was defined as clinical or microbiological evidence of infection reappearance. Fracture consolidation was evaluated radiographically. Univariate analyses were performed using logistic regression, Fischer's exact text, chi-square, and t-test where appropriate.

RESULTS: A total of 59 patients were included. Clinical remission was achieved in 86.4 % of cases, while recurrence occurred in 32.2 %. All patients with recurrence had failed clinical remission (p < 0.001). Remission was significantly lower in patients with prior external fixation (72.7 % vs. 94.6 %; p = 0.031) and lower extremity infections (77.1 % vs. 100 % for pelvis and upper limb; p = 0.002). Fracture consolidation was observed in 86.4 % of patients. Although not statistically significant, trends indicated better consolidation in those with remission (90.2 % vs. 62.5 %) and lower healing in patients with comorbidities, or polymicrobial infections.

CONCLUSIONS: DAIR is effective treatment for early FRI, achieving high clinical remission and consolidation rates. Remission is a strong predictor of both infection control and bone healing. Prior external fixation and lower limb involvement were associated with reduced treatment success.

PMID:40945224 | DOI:10.1016/j.injury.2025.112749

J Bone Joint Surg Am. 2025 Sep 12. doi: 10.2106/JBJS.25.00428. Online ahead of print.

ABSTRACT

BACKGROUND: Acetabular development in pediatric hips is driven by growth from the triradiate cartilage (TRC) and secondary ossification centers (SOCs) of the os pubis, os ischium, and os ilium. These SOCs appear and fuse at different ages, with sex-specific differences affecting their morphology. This study quantifies the impact of SOCs on acetabular coverage, version, tilt, and surface area during adolescence.

METHODS: Three-dimensional (3D) surface reconstructions of 540 normal hips (in 128 male and 142 female patients) aged 8 to 19 years with no hip pathology were generated from computed tomography (CT) scans. Acetabular parameters, including coverage angles in predefined octants, version, tilt, and surface area, were extracted with use of a previously published algorithm. The Proximal Femur Maturity Index (PFMI) was used to assess skeletal maturity. Contributions to acetabular morphology from the 3 SOCs were analyzed using generalized linear mixed models. Significance was defined as p < 0.05.

RESULTS: PFMI grades strongly correlated with chronological age (rs = 0.91; p < 0.001). Os ilium ossification was significantly associated with increased superior coverage (p < 0.001), and os ischium ossification was associated with increased posterior coverage (p < 0.001). Superior coverage demonstrated a strong correlation with lateral tilt (rs = 0.837; p < 0.001), and posterior coverage was strongly correlated with anteversion (rs = 0.788; p < 0.001). Female patients exhibited greater acetabular anteversion (17.7° ± 6.4° versus 12.2° ± 6.4°; p < 0.001) and lateral tilt (38.5° ± 4.7° versus 36.6° ± 5.7°; p < 0.001), whereas male patients demonstrated larger acetabular surface area (31.9 ± 6.4 versus 28.8 ± 4.2 cm2; p < 0.001). We did not find a significant association between os pubis ossification and increased anterior coverage in male (p = 0.38) or female (p = 0.065) patients, nor did we find a correlation between anterior coverage and age (p = 0.115).

CONCLUSIONS: Os ilium and os ischium ossification were associated with increased superior and posterior acetabular coverage, respectively, during adolescence. In contrast, os pubis ossification was not associated with changes in anterior coverage. The timing of SOC appearance and closure aligns with key developmental changes in acetabular morphology, reinforcing the role of SOCs in determining hip stability.

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

PMID:40939009 | DOI:10.2106/JBJS.25.00428

J Bone Joint Surg Am. 2025 Sep 12. doi: 10.2106/JBJS.25.00796. Online ahead of print.

NO ABSTRACT

PMID:40938971 | DOI:10.2106/JBJS.25.00796

J Bone Joint Surg Am. 2025 Sep 12. doi: 10.2106/JBJS.25.00480. Online ahead of print.

ABSTRACT

➢ Adherence to accepted definitions of the various alternative total knee arthroplasty alignment strategies is important for research and communication between surgeons.➢ Technological advances, including robotics and navigation-assisted systems, have made precise execution of alternative alignment strategies feasible.➢ Modern studies have suggested that minor deviations (±3°) from neutral mechanical alignment do not significantly impact long-term total knee arthroplasty implant survivorship.➢ Individualized alignment strategies, such as kinematic, restricted kinematic, and functional alignment, aim to respect native anatomy and soft-tissue balance.➢ The majority of studies comparing intermediate-term outcomes of kinematic and mechanical alignment suggest noninferior outcomes with kinematic alignment; however, some studies have suggested superior outcomes with kinematic alignment.

PMID:40938970 | DOI:10.2106/JBJS.25.00480

J Bone Joint Surg Am. 2025 Sep 12. doi: 10.2106/JBJS.25.00427. Online ahead of print.

ABSTRACT

BACKGROUND: Gluteus medius tears and atrophy cause lateral hip pain, limp, and functional impairment. We developed the "broken wing sign," a novel physical examination test for detecting gluteus medius tendon tears and muscle degeneration. This study evaluated its diagnostic accuracy and clinical utility against magnetic resonance imaging (MRI) and intraoperative findings.

METHODS: We prospectively examined 59 patients (75 hips; mean age, 69.5 ± 10.8 years; 48 women) with suspected hip abductor insufficiency. The broken wing sign was tested with patients prone, the knee flexed at 90°, and the hip actively extended. A positive sign involved ≥10° of compensatory external hip rotation, visible as an inward drift of the foot, indicating gluteus medius (and resulting internal rotation) weakness. MRI served as the reference standard for classifying gluteus medius integrity as no tear, partial, full-thickness, or massive. Fatty infiltration was graded (Goutallier grades 0 to 4), quantified, and analyzed for a correlation with the examination findings. Diagnostic accuracy metrics were calculated.

RESULTS: The broken wing sign demonstrated high accuracy (sensitivity, 81.8%; specificity, 80.0%; positive predictive value [PPV], 91.8%; negative predictive value, 61.5%; diagnostic odds ratio, 17.8). An external rotation threshold of ≥30° yielded 100% specificity and 100% PPV for a tear. The sign detected acute tears with no or minimal fatty infiltration (100% sensitivity for massive tears). The degree of the external rotation angle was strongly correlated with muscle atrophy with fatty infiltration, showing 88.0% sensitivity for Goutallier grade ≥3 and 100% sensitivity for grade 4.

CONCLUSIONS: The broken wing sign is clinically useful for diagnosing gluteus medius tendon tears and muscle atrophy, particularly massive tears and advanced fatty degeneration. It effectively guides MRI utilization and surgical planning, serving as a valuable initial diagnostic tool in the clinical setting.

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

PMID:40938961 | DOI:10.2106/JBJS.25.00427

J Bone Joint Surg Am. 2025 Sep 12. doi: 10.2106/JBJS.25.00131. Online ahead of print.

ABSTRACT

➢ Obesity is associated with increased postoperative complications and reoperation following total joint arthroplasty.➢ Meaningful functional improvement can be achieved with appropriate measures.➢ Preoperative measures include medical optimization, weight management, and consideration of bariatric surgery and glucagon-like peptide-1 receptor agonists.➢ Perioperative optimization requires an experienced multidisciplinary team and awareness of technical considerations for patients with obesity undergoing total joint arthroplasty.

PMID:40938955 | DOI:10.2106/JBJS.25.00131

Int Orthop. 2025 Sep 12. doi: 10.1007/s00264-025-06650-w. Online ahead of print.

ABSTRACT

PURPOSE: Variability in the resting arm position may influence impingement-free range of motion (ROM) after reverse total shoulder arthroplasty (rTSA). The relationship between the neck-shaft angle (NSA) and arm position remains unclear. This study evaluated the humerothoracic angle (HTA) as a proxy for the resting arm position in the coronal plane, its variability and change after rTSA, and its associations with NSA.

METHODS: This multicenter prospective study included 172 patients who underwent rTSA by nine surgeons. Standard radiographs were obtained preoperatively and at two years. Radiographic measurements of HTA and true NSA were blinded. Intraclass correlation coefficients (ICC) were calculated for HTA. Paired t-tests and ANOVA assessed group differences. Regression analyses evaluated predictors of postoperative HTA and HTA changes.

RESULTS: Preoperative HTA (9.5° ± 8.6°) increased significantly to 13.2° ± 10.2° postoperatively (p < .001). NSA > 145° resulted in higher postoperative HTA than NSA < 135° (p < .0001). Multiple regression showed that NSA (β = 0.4; p < .0001) and preoperative HTA (β = 0.3; p = .0003) were strong predictors of postoperative HTA. Measurement reliability of HTA was excellent (intra-observer ICC = 0.92; inter-observer ICC = 0.89).

CONCLUSION: The resting arm position in the coronal plane, as quantified by HTA, exhibits significant variability pre- and post-rTSA, with a postoperative shift towards greater abduction. NSA strongly influenced the arm position, with larger NSAs being associated with more abducted arm positions. Consideration of how implant alignment and design affect the resting arm position may help refine preoperative planning and optimize impingement-free ROM after rTSA.

PMID:40938414 | DOI:10.1007/s00264-025-06650-w

J Bone Joint Surg Am. 2025 Sep 11. doi: 10.2106/JBJS.24.01233. Online ahead of print.

ABSTRACT

BACKGROUND: Congenital cervical scoliosis at the craniovertebral junction is an exceedingly rare condition, with limited existing research. In this study, we aimed to elucidate the clinical characteristics, surgical strategies, and postoperative outcomes associated with this unique pathology, providing a comprehensive analysis to enhance clinical understanding and management.

METHODS: We conducted a retrospective analysis involving 27 patients with congenital cervical scoliosis at the craniovertebral junction who underwent surgery at a mean age of 7.81 ± 1.52 years. The median follow-up duration was 36.00 months. Patients were categorized into Group A and Group B on the basis of the absence or presence of concomitant subaxial cervical scoliosis, respectively. Three distinct surgical strategies were employed accordingly. Radiographic parameters were measured preoperatively, within 5 days postoperatively, and at the final follow-up. Other clinical and surgical characteristics were also collected.

RESULTS: Patients exhibited preoperative coronal imbalance, with a mean structural Cobb angle of 30.75° ± 13.09° and a mean head shift of 20.34 ± 13.23 mm. At the final follow-up, these parameters had significantly improved to a median of 3.00° and 8.59 mm (both p < 0.05). The mean operative time was 473.74 ± 134.29 minutes, and the mean intraoperative blood loss was 336.11 ± 166.52 mL. Among the 27 patients, 10 were in Group A and the other 17 were in Group B. Twenty-three patients/families reported being "satisfied" or "very satisfied" with the surgical outcome at the final follow-up. Postoperative complications occurred in 11 patients; no nerve root or vertebral artery injuries were observed.

CONCLUSIONS: Congenital cervical scoliosis at the craniovertebral junction is a complex deformity that severely influences coronal alignment. Nevertheless, tailored surgical strategies have shown promising effectiveness in achieving satisfactory clinical and psychological results.

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

PMID:40934292 | DOI:10.2106/JBJS.24.01233

Injury. 2025 Sep 5;56(11):112748. doi: 10.1016/j.injury.2025.112748. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate the efficacy of nail dynamization in patients with delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing, and systematically analyze the associated factors to guide surgeons.

METHODS: A comprehensive search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify relevant studies. We screened the literature based on the eligibility criteria, extracted relevant data, and assessed the quality of the included studies. A single-arm meta-analysis using a random-effects model was conducted to estimate overall union rates, while meta-regression and subgroup analyses explored sources of heterogeneity and contributing factors. Sensitivity analyses were used to assess result stability.

RESULTS: 11 studies consisting of 318 patients met the inclusion criteria. The pooled union rate after nail dynamization was 77.2 % with significant heterogeneity. Meta-regression identified the time of dynamization, the method of dynamization, and Fracture Healing Index (FHI) as critical factors affecting union rates. Subgroup analysis revealed that dynamization within 6 months, preserving the dynamic locking screw, and an FHI >1.17 were significantly associated with higher union rates.

CONCLUSION: Nail dynamization is an effective treatment for delayed union and nonunion of femur and tibia shaft fractures following intramedullary nailing. Early dynamization (within 6 months), preserving the dynamic locking screw, and ensuring an FHI >1.17 are crucial strategies for maximizing union rates.

PMID:40929874 | DOI:10.1016/j.injury.2025.112748

J Bone Joint Surg Am. 2025 Sep 9. doi: 10.2106/JBJS.24.01584. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have investigated the risk of complex regional pain syndrome (CRPS) and its prevention with vitamin C. However, evidence regarding the effectiveness of vitamin C for prevention of CRPS development or recurrence after total knee arthroplasty (TKA) is lacking.

METHODS: This retrospective single-center observational cohort study, which utilized propensity-score matching (PSM), was conducted from January 2017 to December 2021. It initially included 1,088 TKAs, 49 of which were in patients who had a previous CRPS. After exclusion of 50 TKAs, the study included 467 TKAs (45%) in patients who received vitamin C prophylaxis (1 g daily for 40 days) after surgery and 571 (55%) in patients who did not. After 1:1 matching on the basis of sex, age, body mass index, presence of diabetes mellitus and hypertension, use of tobacco and alcohol, anesthesia modality, tourniquet use, and anxiety and depression, the vitamin C group and the no-vitamin C group comprised 480 patients each. Twenty-eight of these 960 patients had a history of CRPS.

RESULTS: In the PSM population, 6.9% (33) of the 480 patients who received vitamin C prophylaxis after TKA developed CRPS compared with 11.0% (53) of the 480 who did not receive vitamin C (odds ratio [OR] = 0.59 [95% confidence interval (CI), 0.37 to 0.9], p = 0.024). The rate of CRPS was significantly higher in patients with a history of CRPS (32% versus 8% for patients with no previous CRPS; OR = 5.4 [95% CI, 2.57 to 11.4], p < 0.001). In the 28 patients with a history of CRPS, vitamin C prophylaxis reduced the rate of CRPS recurrence after TKA to 19% (4 of 21) compared with 71% (5 of 7) in the patients not treated with vitamin C (OR = 0.09 [95% CI, 0.01 to 0.64], p = 0.02). In multivariable regression of the matched patients, vitamin C was also found to be independently associated with a lower rate of CRPS recurrence after TKA (OR = 0.53 [95% CI, 0.3 to 0.86], p = 0.011).

CONCLUSIONS: Vitamin C prophylaxis may be appropriate for preventing CRPS after TKA. Furthermore, the study highlights the beneficial role of vitamin C in reducing the rate of CRPS recurrence in patients with a history of CRPS who are undergoing TKA.

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

PMID:40924823 | DOI:10.2106/JBJS.24.01584

Injury. 2025 Aug 29:112721. doi: 10.1016/j.injury.2025.112721. Online ahead of print.

ABSTRACT

BACKGROUND: Hemorrhage remains the principal cause of death on the battlefield. It is suggested that Tranexamic acid (TXA) can improve survival of severely-bleeding casualties. The intravenous approach is not always available in the pre-hospital setting. It was shown that for every 15 min delay, the efficiency of TXA decreases by 10 %. This study was designed to assess the pharmacokinetic, pharmacodynamic, and pre-clinical efficacy of a TXA autoinjector in uncontrolled hemorrhage in swine.

METHODS: Non-compressible hemorrhage was induced by laparoscopic partial liver resection. TXA was administered intramuscularly by autoinjector (n = 25) or intravenously (control, n = 5). Blood levels of TXA and dynamics of clot formation were determined. Euthanasia was performed ninety minutes after injury followed by a laparotomy for the measurement of free blood and clots in the abdomen.

RESULTS: The TXA levels in the autoinjector group exceeded the effective therapeutic threshold within <5 min and remained above the 10 mg/L threshold throughout the experiment. Intra-abdominal blood volumes, hemodynamic parameters, and indices of clot formation were similar between autoinjector-delivered and intravenouslyadministered groups.

CONCLUSIONS: Autoinjector-based TXA provides sustained, anti-fibrinolytic levels within 2-5 min of administration in a swine model of uncontrolled hemorrhage emphasizing its important.

PMID:40915868 | DOI:10.1016/j.injury.2025.112721

Injury. 2025 Sep 2;56(11):112746. doi: 10.1016/j.injury.2025.112746. Online ahead of print.

ABSTRACT

INTRODUCTION: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for Type 2 diabetes and obesity due to their cardiometabolic benefits. However, their effects on fracture healing remain controversial. This study investigates perioperative GLP-1 RA use and outcomes following surgical treatment of lower extremity (LE) fractures.

METHODS: A retrospective analysis utilizing a large multicenter database compared patients on GLP-1 RAs within one year prior to and after lower extremity index surgery (+GLP) with those not on GLP-1 RAs (-GLP). Propensity score matching was performed on 275,970 included patients, matching 1:1 on age, sex, tobacco use, diabetes mellitus, primary hypertension, hyperlipidemia, chronic ischemic heart disease, chronic lower respiratory disease, and body mass index (BMI), resulting in 6125 "best-matched" patients per group. This was conducted utilizing multivariate logistic regression with a 0.1 caliper. Outcomes were assessed at 1 month, 3 months, and 1 year.

RESULTS: At 1-year follow-up, GLP-1 RA users demonstrated a significantly higher rate of nonunion compared to matched controls (5.4% vs 4.4%, Risk Ratio 1.2, 95% CI 1.0-1.4, P < 0.05) when assessing patients who also continued GLP-1 RAs postoperatively. There were no significant differences in wound dehiscence, deep or superficial surgical site infections, or hematoma. Importantly, the +GLP group experienced significantly lower rates of cardiac arrest (0.8% vs 1.6%, RR 0.5, 95% CI 0.3-0.7, P < 0.01) and all-cause mortality (4.4% vs 8.0%, RR 0.5, 95% CI 0.4-0.6, P < 0.01).

CONCLUSIONS: Perioperative GLP-1 RA use was associated with a higher risk of nonunion following lower extremity fracture surgery, though without increased wound complication rates. Importantly, GLP-1 RA use was linked to reduced cardiac arrest and mortality within one year. These findings suggest that while the increased rate of nonunion is statistically significant, its clinically significance is limited. Thus, the mortality reduction may be more clinically meaningful for patient counseling and perioperative management. Further study is required to clarify the balance between systemic benefits and surgical outcomes of GLP-1 RAs in orthopedic trauma.

PMID:40915058 | DOI:10.1016/j.injury.2025.112746

Injury. 2025 Aug 28;56(11):112718. doi: 10.1016/j.injury.2025.112718. Online ahead of print.

ABSTRACT

BACKGROUND: Critical size bone defects represent a clinical challenge, associated with considerable morbidity, and frequently trigger the requirement of secondary procedure. To fill osseous gaps, multiple steps are required, such as proliferation and differentiation on the cellular level and the building of extracellular matrix. In addition, the osteogenic potential of cell-derived extracellular matrices (CD-ECM) is known to enhance bone healing. We therefore examined the osteogenic potential of fibroblast-derived ECM (Fibro-ECM) and assessed the influence of Dextran-sulfate (Dx-S) addition regarding the production of extracellular matrix (ECM).

METHODS: ECMs were generated by culturing human dermal fibroblasts, adipose-derived stromal cells (ASCs), and osteoblasts derived from ASCs (Osteo-ECM) for four days, with or without Dx-S supplementation. After decellularization, skeletal stem cells (SSCs) isolated from femoral head aspirations were seeded onto the ECMs and differentiated under osteogenic conditions for 17 days. Osteogenesis was assessed by Alizarin Red S staining for calcium deposition and RT-qPCR analysis of osteogenic marker genes.

RESULTS: SSCs cultured on Fibro-ECM exhibited enhanced osteogenesis compared to Osteo-ECM and ASC-derived ECM, as evidenced by increased calcium deposition. Notably, Dx-S supplementation further improved the osteoinductive capacity of Fibro-ECM, leading to an upregulation of osteocalcin (OCN) and bone morphogenetic protein 2 (BMP2). In contrast, Dx-S had no significant effect on Osteo-ECM.

CONCLUSION: The addition of Dx-S in autologous fibroblast-derived ECM induces an improvement in osteoinductivity. Addition of Dx-S may therefore be a useful adjunct in the in vitro bone generation models. Whether these results may represent a piece in the puzzle for difficult healing situations in patients with nonunions and bone defects should be subject to further study.

PMID:40915057 | DOI:10.1016/j.injury.2025.112718

Injury. 2025 Aug 26;56(11):112720. doi: 10.1016/j.injury.2025.112720. Online ahead of print.

ABSTRACT

BACKGROUND: Lateral-sided tibial plateau fractures are most common and can range from minor to very extensive injuries of the lateral plateau. The impact of fracture location and extent on functional outcomes remains unclear. This study aimed to investigate this relationship.

METHODS: A retrospective cross-sectional study was performed in 529 patients treated for a lateral tibial plateau fracture within 6 hospitals between 2003-2018. Patients were approached by posted mail and completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire after a median follow-up of six years (IQR: 4-9 years). Fractures were classified according to the Krause 'Ten segment method'. The seven most prevalent fracture patterns were identified and compared using descriptive statistics. Multivariate regression analysis, adjusted for age, sex, Schatzker classification, treatment, and residual incongruity, was performed to assess the association between fracture location, number of affected segments, and patient-reported outcome.

RESULTS: The most frequent lateral tibial plateau fracture patterns were: pattern 1 - two posterior segments (KOOS = 82, IQR:66-93); pattern 2 - four lateral segments (KOOS = 74, IQR:53-94); pattern 3 - two anterolateral and one posterior segment (KOOS = 82, IQR:62-93); pattern 4 - anterolateral involvement (KOOS = 87, IQR:59-97); pattern 5 - involvement of the entire lateral plateau (KOOS = 60, IQR:40-71); pattern 6 - two posterior and one anterolateral segment (KOOS = 81, IQR:67-93); and pattern 7 - isolated lateral involvement (KOOS = 60, IQR:46-84). Patterns 5 and 7 showed the lowest KOOS scores (p = 0.008). Overall KOOS declined by 2.59 points per additional segment involved (p = 0.010), with similar trends observed in the ADL, sport, and QoL subscales (p < 0.05).

CONCLUSION: Surgeons should be aware during management of lateral tibial plateau fractures that all regions of the plateau-anterior, medial, lateral, and posterior-are crucial in preserving function. Fractures involving the entire lateral plateau (pattern 5) and isolated lateral segments (pattern 7) result in worse functional outcomes, likely due to the severity of the injury and associated soft tissue involvement, especially in the meniscal area. Greater fracture extent, as indicated by increased segment involvement, correlates with worse patient-reported outcomes.

PMID:40913857 | DOI:10.1016/j.injury.2025.112720

Injury. 2025 Aug 25;56(11):112728. doi: 10.1016/j.injury.2025.112728. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to comprehensively describe the clinical characteristics of rib fractures in patients with traumatic thoracic vertebral fractures (TVFs), and to develop machine learning (ML) models for predicting the risk of rib fractures.

METHODS: We retrospectively reviewed patients diagnosed with TVFs at a single hospital between January 2007 and November 2024, enrolling 1420 patients and 20 variables. Chest CT scans were used to confirm the presence of rib fractures and to examine their distribution characteristics. Several ML models, including Support Vector Machine (SVM), XGBoost, Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), Naive Bayes (NB), Neural Network (NN), and Ensemble Learning (EL), were applied. Model performance was evaluated using indicators such as area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1 score, density, discrimination slope, and a scoring system. Additionally, the prediction performance of the ML models was compared with that of three experienced clinicians.

RESULTS: Rib fractures were identified in 222 patients (15.6 %), with a total of 1035 rib fractures recorded. Only 22.5 % were single rib fractures, and the distribution of unilateral and bilateral fractures was comparable (54.5 % vs. 45.5 %). Multivariate logistic regression revealed four significant predictors of rib fractures: gender (P = 0.004), cardiovascular disease (P = 0.003), trauma mechanism (P < 0.001), and the number of thoracic fractures (P < 0.001). Among all models, the EL model demonstrated the best predictive performance, achieving an accuracy of 0.920, F1 score of 0.767, sensitivity of 0.683, specificity of 0.977, PPV of 0.875, NPV of 0.928, and the highest overall score (48). Notably, its performance surpassed that of all three clinicians.

CONCLUSIONS: Rib fractures are relatively common in patients with TVFs and may be underdiagnosed, especially in the absence of clear symptoms. The EL model developed in this study offers strong predictive capability and may serve as a valuable clinical decision-support tool to identify high-risk patients and reduce the likelihood of missed diagnoses.

PMID:40913856 | DOI:10.1016/j.injury.2025.112728

Int Orthop. 2025 Sep 6. doi: 10.1007/s00264-025-06648-4. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the clinical outcomes of Vancouver B1 periprosthetic femoral fractures (PFF) treated with the Ortho-bridge system (OBS) internal fixation and assess the potential benefits of 3D printing technology in preoperative planning and surgical execution for these cases.

METHOD: This retrospective study analyzed 55 consecutive Vancouver B1 periprosthetic femoral fracture cases treated surgically at Yan'an Affiliated Hospital of Kunming Medical University (2014-2022) with minimum 1-year follow-up. Patients were divided into conventional ORIF (n = 21) and OBS fixation groups (n = 34), with the OBS group further stratified into standard procedure (n = 18) and 3D-printing-assisted (n = 16) subgroups. Treatment outcomes were evaluated using Harris Hip Scores, while surgical parameters including incision length, operative time, and intraoperative blood loss were compared between groups.

RESULT: The study included 55 Vancouver B1 PFF cases (ORIF = 21, OBS = 34), with the OBS group further divided into conventional (n = 18) and 3D-assisted (n = 16) subgroups. While no significant differences existed between ORIF and OBS groups in operative time (159.52 ± 56.35 vs. 165.03 ± 49.09 min), blood loss (734.29 ± 545.89 vs. 682.06 ± 341.88 mL), or incision length (22.62 ± 5.84 vs. 22.24 ± 6.72 cm), the 3D-assisted OBS subgroup demonstrated 18.6% shorter operative time (147.19 ± 39.54 vs. 180.89 ± 52.28 min, p < 0.05) and 26.0% reduced blood loss (575.00 ± 327.45 vs. 777.22 ± 334.52 mL, p < 0.05) compared to conventional OBS. All fractures healed (mean 4.78 months) with no revisions, though DVT occurred in two ORIF and two OBS cases. Functional outcomes were comparable across groups (Harris scores: ORIF 74.38 ± 9.39, OBS 74.18 ± 12.08; 3D-assisted OBS 75.31 ± 11.09 vs. conventional OBS 73.17 ± 13.13, p > 0.05).

CONCLUSION: The OBS internal fixation system demonstrates comparable efficacy to conventional ORIF for Vancouver B1 periprosthetic fractures, with equivalent functional outcomes and fracture healing rates. When combined with 3D-printing-assisted preoperative planning, OBS offers significant advantages including reduced operative time (18.6%) and decreased blood loss (26.0%). These findings suggest that the OBS system, particularly when enhanced by 3D printing technology, represents a viable alternative for PFF management, providing stable fixation while maintaining biological osteosynthesis principles.

PMID:40913735 | DOI:10.1007/s00264-025-06648-4

Int Orthop. 2025 Sep 6. doi: 10.1007/s00264-025-06624-y. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with secondary hip osteoarthritis due to developmental dysplasia of the hip (DDH) often have abnormal femoral morphology, making stem design critical for long-term outcomes. The FMS-anatomic stem previously demonstrated favourable mid-term results. Its successor, the Anatomic Fit stem, was developed with a reduced hydroxyapatite-coated area to enhance proximal load transfer and a narrower lateral flare to facilitate insertion. This study aimed to analyze the long-term clinical and radiographic outcomes of these stems.

METHODS: The one-hundred seventy-eight hips underwent total hip arthroplasty using either the FMS-anatomic or Anatomic Fit stem. After applying exclusion criteria, 119 hips (36 FMS-anatomic and 83 Anatomic Fit) were analyzed. Clinical and radiographic outcomes were assessed, and stem survival was evaluated using Kaplan-Meier analysis with stem revision as the endpoint.

RESULTS: The 15- and 20-year survival rates were 97.2% and 94.4% for the FMS-anatomic stem, and 98.8% for the Anatomic Fit stem at both time points, with no significant difference. Spot welds were observed in nearly all cases, but their distribution differed significantly: zones 2 and 6 in the FMS-anatomic group and zones 1 and 7 in the Anatomic Fit group (P < 0.05). Stress shielding of Grade 3 or higher occurred in 16.5% of FMS-anatomic stems and 33.7% of Anatomic Fit stems (P < 0.05).

CONCLUSIONS: Both stems showed excellent long-term survival and proximal fixation. However, the Anatomic Fit stem did not reduce stress shielding, despite its modified design intended to improve load transfer.

PMID:40913734 | DOI:10.1007/s00264-025-06624-y

Injury. 2025 Aug 23;56(11):112692. doi: 10.1016/j.injury.2025.112692. Online ahead of print.

ABSTRACT

INTRODUCTION: Mass casualty incidents (MCIs) involving extensive ballistic and explosive injuries place considerable pressure on healthcare resources. This study aimed to evaluate the rehabilitation resources required for individuals who sustained blast and ballistic injuries during an MCI.

METHODS: A retrospective review was conducted using Electronic Medical Records (EMRs) of patients admitted to Sheba Medical Center (SMC), Israel, following an MCI on 7 October 2023. Patients diagnosed with gunshot wounds (GSW), or blast injuries (BI) were included. Data were collected over an almost 7-month period, focusing on injury patterns, rehabilitation department admissions, total hospital length of stay, and associated budgetary requirements.

RESULTS: A total of 419 patients received rehabilitation at SMC: 205 with BI, 175 with GSW, 10 with both, and 9 with unknown injury causes. Two patients were under 18; the majority (76 %) of adults were aged 18-29. Military personnel comprised 90 % of the cohort, with 95 % male. Paediatric rehabilitation admitted the two minors, while adult patients were distributed across respiratory (n = 7), neurological (n = 32), head trauma (n = 44), and orthopaedic (n = 68) rehabilitation units. Additionally, 266 patients were treated in three newly established rehabilitation wards. BI patients experienced more complex, multi-trauma injuries, including traumatic brain injuries (11 %) and spinal cord injuries (11 %), underwent more surgical procedures, and had longer hospital stays. Consequently, the average rehabilitation cost per BI patient exceeded that of GSW patients.

CONCLUSION: Through strategic planning and multidisciplinary collaboration, SMC effectively managed a high volume of MCI-related injuries. BIs required significantly more rehabilitation resources than GSWs. These findings underscore the importance of preparedness, resource allocation, and interdepartmental coordination in managing rehabilitation during MCIs. SMC's experience offers valuable insights for global healthcare systems facing similar high-demand emergency scenarios.

PMID:40912126 | DOI:10.1016/j.injury.2025.112692