J Bone Joint Surg Am. 2025 Feb 25. doi: 10.2106/JBJS.24.00580. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a substantial problem. Bone grafting may be beneficial in the treatment of large osteolytic cysts; however, the literature regarding the outcomes of bone grafting is limited. This study analyzed the outcomes of autogenous bone grafting performed for the management of periprosthetic osteolysis following TAA.

METHODS: We retrospectively reviewed 42 ankles (41 Korean patients) that underwent autogenous bone grafting for periprosthetic osteolysis following TAA. Clinical outcomes were evaluated using visual analog scale for pain scores, Ankle Osteoarthritis Scale pain and disability scores, and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores. Computed tomography (CT) was performed preoperatively and for at least 2 years postoperatively in order to evaluate the treatment response. Histology, prosthesis survivorship, reoperations, and complications were also evaluated.

RESULTS: The mean time to autogenous bone grafting was 64.4 months (range, 10 to 128 months), and the mean follow-up duration after autogenous bone grafting was 70.7 months (range, 24 to 137 months). All clinical scores significantly improved from preoperatively to the last follow-up visit. The mean osteolytic cyst volume improved from 4.8 cm3 (range, 1.1 to 19.4 cm3) to 0.8 cm3 (range, 0 to 6.5 cm3). A Kaplan-Meier survival analysis revealed that TAA with subsequent bone grafting was associated with similar prosthesis survivorship (100% and 85.7% at 5 and 10 years, respectively) but inferior reoperation-free survivorship (93.4% and 68.4% at 5 and 10 years, respectively) compared with TAA without osteolysis or with non-progressive osteolysis.

CONCLUSIONS: Autogenous bone grafting performed for the management of periprosthetic osteolysis after TAA produced favorable clinical and radiographic outcomes. However, there was still a higher risk of subsequent surgery even after successful bone grafting, compared with TAA without osteolysis or with non-progressive osteolysis. Our results suggest that autogenous bone grafting and serial CT scan monitoring over time may prolong the survivorship of TAA prostheses in ankles with periprosthetic osteolysis.

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

PMID:39999208 | DOI:10.2106/JBJS.24.00580

J Bone Joint Surg Am. 2025 Feb 25. doi: 10.2106/JBJS.24.01628. Online ahead of print.

NO ABSTRACT

PMID:39999199 | DOI:10.2106/JBJS.24.01628

J Bone Joint Surg Am. 2025 Feb 25. doi: 10.2106/JBJS.24.00481. Online ahead of print.

ABSTRACT

BACKGROUND: Accurately determining the presence and severity of pediatric musculoskeletal infection (MSKI) is crucial for effective triage and treatment. Although the white blood-cell (WBC) count is often used as a marker for MSKI, we hypothesized that the use of the WBC count is limited by age-related variability in children. We proposed that the absolute neutrophil-to-lymphocyte ratio (NLR), which has less age-related variability, is a more reliable indicator for both diagnosing and assessing the severity of MSKI. The present study aims to compare the utility of WBC against that of the NLR, as well as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), for predicting MSKI presence and severity in children.

METHODS: A retrospective cohort study was conducted with use of a database of pediatric orthopaedic consultations for suspected MSKI between January 2013 and July 2022. Diagnoses were categorized as MSKI or no infection, and the severity of any present infection was stratified as local or disseminated. Admission laboratory values were collected. Statistical modeling was performed to assess the capabilities of the WBC, NLR, CRP, and ESR to diagnose MSKI and to assess infection severity, with cutoff thresholds established for clinical use.

RESULTS: This study included 650 patients (median age, 5.2 years; 63% male; 75% White). Of these, 247 patients had no infection, while 403 were diagnosed with an MSKI. Median WBC count, NLR, CRP, and ESR were all significantly higher in pediatric cases of confirmed MSKI. WBC was a poor predictor of infection severity, whereas NLR, CRP, and ESR each positively correlated with infection severity. At the time of admission, an NLR of 4 was highly specific for detecting the presence of infection, and an NLR of 5.8 was highly specific for predicting infection dissemination. CRP was the best predictor of both infection presence and severity, demonstrating the highest specificity and sensitivity, followed by NLR, which outperformed ESR and WBC.

CONCLUSIONS: Because of considerable age-related variability, the predictive value of the WBC count for pediatric MSKI presence and severity is limited. NLR, which is less affected by age-related variability, is superior at predicting MSKI severity. Although CRP remains the benchmark, the NLR offers a valuable alternative to the WBC. Our study provides a comparative framework for these biomarkers, enhancing MSKI assessment across various clinical settings.

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

PMID:39999195 | DOI:10.2106/JBJS.24.00481

Int Orthop. 2025 Feb 24. doi: 10.1007/s00264-025-06435-1. Online ahead of print.

ABSTRACT

PURPOSE: Complete acromioclavicular (AC) dislocation associated with fracture of the coracoid process (CP) is uncommon. The strong coracoclavicular ligaments, instead of rupture, may avulse the CP near its base, and with disruption of the AC joint may allow complete dislocation of the clavicle. We report ten cases, one of the largest series in literature, and reviewed the findings and treatment previous reported cases, to allow potential readers to establish the most appropriate treatment.

METHODS: We have prospectively collected those cases in which we had identified an association of an AC dislocation with a fracture of the CP, as well as retrospectively reviewed the records that were coded as AC dislocations and CP fracture looking for this association in the senior author institutions. A literature search was completed on PubMed, Web of Science and Scholar Google, using a sensitive search strategy.

RESULTS: We have collected a total of ten patients with the association of a CP fracture to an AC dislocation in a period of twenty-five years. A review of the cases reported in literature shows a great variability in treatment methods from conservative to more surgically in recent years.

CONCLUSIONS: When an AC dislocation is identified by clinical examination and X-rays, one should be aware of a possible fracture of the CP. It is possible this association to be more frequent than shown in literature because of the CP fracture can easily be missed out or mistaken with an unfussed epiphysis in routine anteroposterior radiography. Multiple approaches have been opted for by surgeons to deal with this combined injury and are the basis of this review.

PMID:39992382 | DOI:10.1007/s00264-025-06435-1

Injury. 2025 Jan 31;56(3):112179. doi: 10.1016/j.injury.2025.112179. Online ahead of print.

ABSTRACT

INTRODUCTION: The older population, especially centenarians, is growing. Hip fractures significantly affect this demographic; however, studies on centenarians are limited. This study aimed to compare hip fracture mortality and associated risk factors between centenarians, nonagenarians, and octogenarians with focus on centenarians.

METHODS: Data from the Korean Health Insurance Review and Assessment database were retrospectively analyzed. Individuals aged ≥ 80 years with an ICD-10 diagnosis code (S72) and procedure codes indicative of hip fracture surgery between 2012 and 2022 were included. The primary outcome was mortality at 1, 3, 6 months, and 1 year postoperatively. The secondary outcomes included the prevalence of comorbidities and postoperative complications.

RESULTS: 131,746 patients were included (106,244 [80.6 %] octogenarians, 24,842 [18.9 %] nonagenarians, and 660 [0.5 %] centenarians). Centenarians had lower Charlson Comorbidity Index than that of nonagenarians and octogenarians (4.4, 4.9, and 5.7, respectively; P < 0.000). However, perioperative medical complications such as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), pneumonia, sepsis, and urinary tract infection increased linearly with age, significantly affecting centenarians. Mortality rates were highest in centenarians, especially within the first 3 postoperative months. The risk factors for 3-month mortality included the male sex (odds ratio [OR] 1.79, 95 % confidence interval [CI] 1.01-3.12, P = 0.046), and heart failure (OR 1.72, 95 % CI 1.07-2.79, P = 0.026) preoperatively, and AKI (OR 3.92, 95 % CI 1.97-7.82, P < 0.000), ARDS (OR 2.92, 95 % CI 1.04-8.23, P = 0.04), pneumonia (OR 1.91, 95 % CI 1.11-3.29, P = 0.02), and sepsis (OR 10.01, 95 % CI 3.52-28.45, P < 0.000) postoperatively.

CONCLUSION: Despite having fewer comorbidities, centenarians had the highest postoperative mortality, primarily due to organ dysfunction such as pneumonia, AKI, ARDS, and sepsis, rather than vascular events. Tailored medical management strategies focusing on these complications are crucial for improving centenarians outcomes.

PMID:39985925 | DOI:10.1016/j.injury.2025.112179

Injury. 2025 Feb 15;56(3):112215. doi: 10.1016/j.injury.2025.112215. Online ahead of print.

ABSTRACT

BACKGROUND: Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.

PURPOSE: This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.

METHODS: We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams-specifically broad-spectrum penicillins and cephalosporins-in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.

RESULTS: Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of -0.06 % (95 % confidence interval [CI], -0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, -0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, -0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).

CONCLUSIONS: In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.

PMID:39983535 | DOI:10.1016/j.injury.2025.112215

Injury. 2025 Feb 15;56(3):112217. doi: 10.1016/j.injury.2025.112217. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the proximal femur are common injuries with significant morbidity and mortality. The use of direct oral anticoagulant (DOAC) medications is increasing among the elderly and is associated with perioperative bleeding-related complications. The primary aim of this study was to examine how DOAC use affects surgical timing and postoperative hematologic complications in patients treated operatively for fragility fractures of the proximal femur. The effect of an institutional tranexamic acid (TXA) protocol implemented during the study period was investigated as a secondary aim.

MATERIALS AND METHODS: This was a retrospective analysis performed at a Level I trauma center. Between March 1, 2018 and April 1, 2022, 746 patients age 50 years and older who underwent surgical treatment for a fragility fracture of the femoral neck, intertrochanteric, or subtrochanteric region of the proximal femur (AO/OTA 31A, 31B, 32) and who were either on no chemical anticoagulation, warfarin, or a DOAC at the time of injury were included. The primary outcomes were time to operating room (TTOR), postoperative transfusion, 30-day venous thromboembolism (VTE), and 30-day hospital readmission. Multivariable logistic regression modeling was used to analyze the effect of anticoagulant, TXA use, and TTOR on these outcomes.

RESULTS: TTOR was increased for patients on warfarin (38.3 ± 26.1 h) or a DOAC (46.4 ± 23.4 h) compared to patients not on anticoagulation (28.0 ± 19.0 h) (p < 0.001). There was no significant difference in transfusion rates among patients not on anticoagulants (31.8 %), warfarin (43.4 %), or a DOAC (29.6 %). Multivariable regression showed a decrease in transfusion rate (OR 0.35, 95 % CI 0.23-0.53) and 30-day readmission (OR 0.31, 95 % CI 0.15-0.61) for intravenous (IV) TXA.

CONCLUSIONS: DOAC use was associated with an increase in TTOR without increased rates of transfusion, VTE, or hospital readmission in patients with fragility fractures of the proximal femur. Intravenous TXA was associated with reduced postoperative transfusion and 30-day readmission.

PMID:39983534 | DOI:10.1016/j.injury.2025.112217

Injury. 2025 Feb 15;56(3):112219. doi: 10.1016/j.injury.2025.112219. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Nevertheless, previous studies have demonstrated low rates of osteoporosis screening. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures, however not much is known about the factors associated with receiving BMD testing in this patient population. The purpose of this study was to evaluate the prevalence, timing, and predictors of BMD testing following distal radius fractures (DRF) in menopausal women.

METHODS: We queried a national insurance database to identify menopausal women aged 45-64 years with a DRF between years 2013 and 2020. The rate of BMD testing within 1 year of injury was calculated. Multivariable logistic regression analysis was used to evaluate the effect of patient- and injury-related variables on the likelihood of undergoing BMD testing following DRF.

RESULTS: Among 31,728 patients meeting inclusion criteria (mean ± SD age: 57.5 ± 4.3), 3,886 (12.2 %) received a BMD test within 1 year following DRF. The rate of BMD tests decreased with the highest rate of 14.5 % in 2015 and the lowest rate of 10.5 % in 2020. Mean time from DRF to BMD testing was 143 ± 102 days. Patients aged 60-64 had the highest adjusted odds of receiving BMD testing (OR 2.85 [95 % CI: 2.26 to 3.64]). Factors associated with increased likelihood of BMD testing included surgical intervention (OR 1.38 [1.28-1.48]), rheumatoid arthritis (OR 1.22 [1.06-1.40]), osteoarthritis (OR 1.28 [1.19-1.37]), breast cancer (OR 1.35 [1.16-1.56]), and vitamin D deficiency (OR 1.29 [1.17-1.43]). Factors associated with decreased likelihood of testing included tobacco use (OR 0.90 [0.84-0.97]), patients with Medicaid (OR 0.73 [0.61-0.86]) or Medicare (OR 0.76 [0.65-0.88]) insurance, and living in Southern (OR 0.67 [0.62-0.73]) or Western (OR 0.69 [0.62-0.77]) regions of the United States. Obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.

CONCLUSIONS: Despite guidelines recommending BMD testing after low-energy fractures, rates of BMD testing were low and decreased among menopausal women with DRF. Mean time to BMD testing was 4.7 months, indicating substantial delays in workup. Known risk factors for osteoporosis did not reliably predict likelihood of BMD testing.

LEVEL OF EVIDENCE: Level III, prognostic.

PMID:39983533 | DOI:10.1016/j.injury.2025.112219

Injury. 2025 Feb 9;56(3):112206. doi: 10.1016/j.injury.2025.112206. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) present a growing challenge in aging populations. However, standardized classifications and treatment guidelines remain scarce.

OBJECTIVE: This scoping review examines the application of fracture classifications, treatment strategies, and outcome evaluations for FFP, identifying gaps in the literature, and suggesting directions for future research.

METHODS: A systematic search of multiple electronic databases yielded 117 studies discussing FFP names, classifications, treatment approaches, and outcomes. Data extraction focused on study characteristics, classification systems, treatment details, outcomes, and follow-up periods. Residual analysis using the Chi-square test assessed statistical associations and underrepresentation.

RESULTS: The FFP classification was the most common (51.3%), with additional treatment indicators focused on immobility (44.4%) and pain assessment (using the Visual Analog Scale [VAS] or Numeric Rating Scale [NRS], 37.6%), consistent with existing guidelines. In contrast, the sacral insufficient fractures were statistically associated with pain indications but lacked corresponding classification application. Initial management typically involved conservative or observation period. Regarding the management indications and outcomes, surgical interventions were categorized into osteosynthesis and sacroplasty. Outcome evaluations often incorporated mobility and functional status (59.0%), hospitalization length (49.6%), mortality rates (41.0%), and post-treatment living conditions (41.0%). Patient recovery was assessed through VAS scores (59.0%) and Activities of Daily Living Patient-Reported Outcomes (ADL-PROs, 34.2%). However, inconsistencies in standardized outcomes, particularly in sacroplasty studies, hinder comparative analysis.

CONCLUSION: FFP classifications, along with pain and mobility assessments, were frequently applied as management indicators for FFP. Standardizing treatment indications and establishing consistent outcome measures, including the evidenced gap treatments (sacral insufficient fracture and cement augmentation), could significantly improve comparability across studies.

PMID:39983532 | DOI:10.1016/j.injury.2025.112206

J Bone Joint Surg Am. 2025 Feb 21. doi: 10.2106/JBJS.24.00332. Online ahead of print.

ABSTRACT

BACKGROUND: The medial patellofemoral ligament (MPFL) is the most important passive restraint of the medial patella and provides approximately 53% to 80% of medial soft-tissue restraints, although its relationship to the parapatellar structures is still not completely understood.

METHODS: Twenty-six formalin-fixed knees (13 for P45 plastination, 10 for dissection, and 3 for histology) were obtained from cadavers donated to the Department of Anatomy at Dalian Medical University. The mean age of the donors was 78.1 years (range, 52 to 95 years). These specimens were obtained from 4 women and 10 men. The integration of the anterior end of the MPFL with the extensor apparatus of the knee was observed, and the morphological observations were captured using a digital camera.

RESULTS: The MPFL was found to be attached to the extensor apparatus in 3 ways: its main fibers ran deep to the vastus medialis obliquus (VMO) tendon and ultimately inserted into it; its upper portion extended from, and was reinforced by, the vastus intermedius (VI) tendon; and its lower portion merged weakly into the parapatellar tendon. No direct attachment to the patella was found.

CONCLUSIONS: The MPFL attachments to the extensor apparatus occur in 3 locations: the VMO tendon, the VI tendon, and the parapatellar tendon-and not the patella. No direct attachment to that bone was identified. This study provides a comprehensive anatomical relationship between the MPFL and the extensor apparatus of the knee (the patella and quadriceps). Clinically, we suggest that reconstruction of the MPFL be performed with fixation of its anterior end to the VMO rather than to the patella.

PMID:39983008 | DOI:10.2106/JBJS.24.00332

J Bone Joint Surg Am. 2025 Feb 21. doi: 10.2106/JBJS.24.01274. Online ahead of print.

NO ABSTRACT

PMID:39982981 | DOI:10.2106/JBJS.24.01274

Int Orthop. 2025 Feb 21. doi: 10.1007/s00264-025-06438-y. Online ahead of print.

ABSTRACT

PURPOSE: Subtalar arthroereisis (STA) is a clinical intervention used for the correction of flexible flatfoot (FFF) in the paediatric population. This study aims to evaluate the radiographic, clinical, and patient-reported outcomes of STA for symptomatic FFF in paediatric patients with a minimum follow-up period of nine years.

METHODS: A cohort of 19 patients (38 feet) who underwent STA for FFF treatment between 2011 and 2015 was analyzed. This study featured a minimum follow-up period of nine years and involved comprehensive radiographic measurements. Clinical function assessment included footprint analysis classified using the Viladot classification, the Foot and Ankle Outcome Score (FAOS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. We calculated the association between preoperative and postoperative angles and functional results. Receiver operating characteristic (ROC) curve analyses were conducted to establish the optimal threshold to predict good clinical outcomes.

RESULTS: The average age at the time of surgery was 11 ± 1.79 years, and the mean duration of follow-up was ten ± 1.4 years. After the surgical intervention, all foot angles showed statistically significant improvements. Normal foot alignment according to the Viladot classification was noted in 71% of patients. Good to excellent functional outcomes, as measured by both the AOFAS-hindfoot score and FAOS score, were reported in 84.2% of patients. Significant correlations were found between the preoperative and postoperative angles and functional results. Based on ROC curve analysis, the cut-off values were determined to be 28.5 degrees for the talonavicular coverage angle, 19.5 degrees for Meary's angle, and 37.5 degrees for the talar declination angle.

CONCLUSION: Our study indicates that STA is an effective procedure for durable deformity correction in paediatric patients with FFF. Restoring the medial longitudinal arch and correcting forefoot abduction are essential for improving functional outcomes. Both preoperative and postoperative angles were significantly associated with functional results, and the identified preoperative cut-off values are helpful for selecting surgical candidates.

PMID:39982464 | DOI:10.1007/s00264-025-06438-y

SICOT J. 2025;11:10. doi: 10.1051/sicotj/2025004. Epub 2025 Feb 20.

NO ABSTRACT

PMID:39977647 | PMC:PMC11841981 | DOI:10.1051/sicotj/2025004

SICOT J. 2025;11:9. doi: 10.1051/sicotj/2025003. Epub 2025 Feb 20.

ABSTRACT

There are many variables that influence the decision-making process in the treatment of rotator cuff calcifications. The stage of the deposit, prognostic factors, previous failed treatments, pain level, and functional disability must all be considered. The tendency for spontaneous resolution is an important reason to always exhaust conservative treatment, being non-invasive options the first line of treatment. The emergence of focused shock wave therapy offered a powerful tool for the non-invasive management of rotator cuff calcifications. High-energy focused shock waves have a high degree of recommendation for the treatment of rotator cuff calcifications, supported by meta-analyses and systematic reviews. If non-invasive techniques fail, there is the possibility of moving to a minimally invasive procedure such as ultrasound-guided barbotage. Finally, classic invasive techniques are also a frequent indication, including open surgery and arthroscopy. As each treatment has advantages and disadvantages, the most advisable strategy is to progress from the least invasive therapeutic methods to the most invasive ones without losing sight of the clinical stage of the disease and the general context of each patient.

PMID:39977646 | PMC:PMC11841982 | DOI:10.1051/sicotj/2025003

Injury. 2025 Feb 16;56(3):112221. doi: 10.1016/j.injury.2025.112221. Online ahead of print.

ABSTRACT

BACKGROUND: Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.

METHODS: We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.

RESULTS: From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15-49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.

CONCLUSION: While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.

PMID:39978035 | DOI:10.1016/j.injury.2025.112221

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.01336. Online ahead of print.

NO ABSTRACT

PMID:39977550 | DOI:10.2106/JBJS.24.01336

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00371. Online ahead of print.

ABSTRACT

BACKGROUND: Nerve injuries in pediatric supracondylar humeral (SCH) fractures occur in 2% to 35% of patients. Previous research has suggested that isolated anterior interosseous nerve injuries are not influenced by the time to surgery; however, little is known about other nerve injuries or mixed, motor, and sensory injuries. With this study, we aimed to examine the impact of time to surgery on nerve recovery in patients with traumatic nerve injuries associated with SCH fractures.

METHODS: Patients <18 years of age with SCH fractures stabilized using percutaneous pins during the period of January 2009 to June 2022 were retrospectively reviewed. Patients presenting with any traumatic nerve injury noted preoperatively were included, while those with iatrogenic or postoperative nerve injuries and incomplete documentation were excluded. Demographic data, injury characteristics, time to surgery, and number of days to nerve recovery were collected. Comparisons of nerve recovery time by anatomic distribution and functional deficit using an 8-hour time-to-surgery cutoff were made in bivariate and multivariate analyses.

RESULTS: A total of 2,753 patients with SCH fractures were identified, with 214 of the patients having an associated nerve injury. Documentation of nerve recovery was available for 197 patients (180 patients with complete recovery) with an overall mean age of 6.8 ± 2.1 years. Time to recovery differed significantly when comparing the motor, sensory, and mixed-deficit cohorts (p < 0.001). Early surgery (≤8 hours from injury to surgery) was significantly associated with shorter overall time to nerve recovery (p = 0.002), recovery of multiple nerve distributions (p = 0.011), and recovery of mixed motor and sensory deficits (p = 0.007). On multivariable analysis, mixed nerve deficits (hazard ratio [HR], 0.537 [95% CI, 0.396 to 0.728]; p < 0.001) and time from injury to treatment of >8 hours (HR, 0.542 [95% CI, 0.373 to 0.786]; p = 0.001) were significantly associated with delayed nerve recovery.

CONCLUSIONS: Surgical timing impacts the time to recovery of complex nerve injuries. Early surgical management of patients with mixed motor-sensory deficits may help to reduce the time to complete nerve recovery.

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

PMID:39977536 | DOI:10.2106/JBJS.24.00371

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00108. Online ahead of print.

ABSTRACT

BACKGROUND: Changing from standing to sitting positions requires rotation of the femur from an almost vertical plane to the horizontal plane. Osteoarthritis of the hip limits hip extension, resulting in less ability to recruit spinopelvic tilt (SPT) while standing and requiring increased SPT while sitting to compensate for the loss of hip range of motion. To date, the effect of total hip arthroplasty (THA) on spinopelvic sitting and standing mechanics has not been reported, particularly in the setting of patients with coexistent sagittal plane spinal deformity.

METHODS: A retrospective review was performed of patients ≥18 years of age undergoing unilateral THA for hip osteoarthritis with sitting and standing radiographs made before and after THA. Alignment was analyzed at baseline and follow-up after THA in both standing and sitting positions in a relaxed posture with the fingers resting on top of the clavicles. Patients were grouped according to the presence or absence of sagittal plane deformity preoperatively into 3 groups: no sagittal plane deformity (normal), thoracolumbar (TL) deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10° and/or T1-pelvic angle [TPA] > 20°), or apparent deformity (PI-LL ≤ 10° and TPA ≤ 20°, but sagittal vertical axis [SVA] > 50 mm).

RESULTS: In this study, 192 patients were assessed: 64 had TL deformity, 39 had apparent deformity, and 89 had normal alignment. Overall, patients demonstrated a reduction in standing SVA (45 to 34.1 mm; p < 0.001) and an increase in SPT (14.6° to 15.7°; p = 0.03) after THA. There was a greater change in standing SVA (p < 0.001) among patients with apparent deformity (-29.0 mm) compared with patients with normal alignment (0.9 mm) and patients with TL deformity (-16.3 mm). Those with apparent deformity also experienced the greatest difference (p = 0.03) in postural SPT change (moving from standing to sitting) (-10.1°) from before to after THA when compared with those with normal alignment (-3.6°) and TL deformity (-1.2°). The difference in postural SVA change from before to after THA was also greatest (p < 0.001) in those with apparent deformity (32.1 mm) compared with those with normal alignment (6.5 mm) and TL deformity (17.3 mm).

CONCLUSIONS: Postural changes in spinopelvic alignment vary after THA depending on the presence of TL deformity or apparent deformity due to hip flexion contracture. Patients with apparent deformity had larger changes in standing and sitting alignment than patients with TL deformity or patients with normal alignment. The assessment of global sagittal alignment findings can be used to predict the likelihood of improvement in sagittal alignment after THA.

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

PMID:39977534 | DOI:10.2106/JBJS.24.00108

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.01339. Online ahead of print.

NO ABSTRACT

PMID:39977532 | DOI:10.2106/JBJS.24.01339