Injury. 2025 Jul 4:112585. doi: 10.1016/j.injury.2025.112585. Online ahead of print.

NO ABSTRACT

PMID:40664567 | DOI:10.1016/j.injury.2025.112585

Injury. 2025 Jul 9:112589. doi: 10.1016/j.injury.2025.112589. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as an adjunctive strategy to haemostatic procedures to counteract exsanguination in patients with trauma. However, no consensus has been reached regarding the haemostatic procedures deemed appropriate indications for REBOA. This study aimed to define appropriate indications for REBOA through consensus among trauma specialists and to investigate the characteristics and outcomes of patients undergoing REBOA with or without appropriate indications defined in this study.

METHODS: Using the 42 haemostatic procedures defined in the Japan Trauma Databank (JTDB), we conducted a repeated Delphi survey to obtain consensus from trauma specialists on the haemostatic procedures deemed appropriate indications for REBOA. Subsequently, patients registered in the JTDB who underwent REBOA were divided into two groups based on whether they had appropriate or inappropriate indications, as defined through the Delphi survey. Patient baseline characteristics, door-to-haemostasis time, door-to-blood transfusion time, emergency-department and in-hospital mortality, and complications were compared between the groups. The observed mortality and predicted mortality were compared.

RESULTS: After five rounds of questionnaire assessments including 11 trauma specialists, intraabdominal, retroperitoneal, pelvic, and extremity haemorrhage were defined as consensus-based appropriate indications for REBOA. Among the 361,706 patients with trauma registered in the JTDB, 1833 underwent REBOA: 1077 with appropriate and 756 with inappropriate indications. Crude in-hospital mortality (57.6 vs. 72.9 %, p < 0.001) and crude emergency-department mortality (15.4 vs. 38.6 %, p < 0.001) were significantly higher in patients with inappropriate indications than in those with appropriate indications. The observed mortality was higher than the predicted mortality, but it more closely aligned with the predicted mortality in 2013-2019 than in 2004-2012.

CONCLUSION: In over 40 % of cases in which REBOA was employed, it was used outside the appropriate indications defined in this study. Mortality was higher among patients with inappropriate indications than in those with appropriate indications. Further studies are required to elucidate the association between corresponding haemostatic procedures and outcomes for REBOA.

PMID:40664566 | DOI:10.1016/j.injury.2025.112589

Injury. 2025 Jul 9;56(8):112597. doi: 10.1016/j.injury.2025.112597. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the outcomes of two-stage bone grafting versus amputation for the treatment of distal phalangeal osteomyelitis.

METHODS: We conducted a retrospective multicenter study of 102 patients with distal phalangeal osteomyelitis, of whom 53 underwent amputation and 49 underwent two-stage bone grafting. Preoperative characteristics were analyzed, including sex, age, BMI, prevalence of diabetes and osteoporosis, infection etiology, and fingers involved. The primary endpoint was infection recurrence. Meanwhile, patient-reported outcomes such as hand function and aesthetic satisfaction were also evaluated. Covariance analysis was performed to adjust for the disparity in soft tissue defect scores between the groups.

RESULTS: The two treatment groups were initially comparable in most preoperative characteristics; except for a significant difference in soft tissue defect scores (P-value = 0.011). No differences in the occurrence of reinfection were observed between the groups (1/49 in the bone graft group vs. 0/52 in the amputation group, P-value = 0.960). The two-stage bone grafting group reported significantly lower rates of neuropathic pain (2/49 vs. 18/52, P-value < 0.001) and higher aesthetic satisfaction scores (adjusted P-value = 0.007), while the amputation group exhibited lower hand functional scores, especially in fine motor skills (adjusted P-value = 0.031 for lifting large objects, adjusted P-value < 0.001 for the rest).

CONCLUSION: Both surgical treatments showed comparable efficacy in preventing infection recurrence. However, the two-stage bone grafting group demonstrated better patient-reported outcomes in terms of hand function and aesthetic satisfaction and a lower rate of neuropathic pain.

PMID:40663875 | DOI:10.1016/j.injury.2025.112597

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06612-2. Online ahead of print.

ABSTRACT

BACKGROUND: Managing large to massive rotator cuff tears accompanied by pseudoparalysis poses a considerable challenge in shoulder surgery. Superior capsular reconstruction (SCR) is increasingly considered a viable surgical option, yet optimal graft choices and outcomes in pseudoparalysis patients remain under investigation. This study assesses the clinical effectiveness of arthroscopic SCR using the long head of the biceps tendon (LHBT) in patients with large-to-massive RCT, comparing outcomes between those with and without pseudoparalysis.

METHODS: A prospective analysis was carried out involving 28 patients (14 with pseudoparalysis and 14 without) who underwent SCR using LHBT between January 2022 and December 2023. Clinical outcomes were assessed before surgery and subsequently at three, six and 12 months following the procedure, utilizing the Visual Analog Scale (VAS), University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion metrics.

RESULTS: Each group demonstrated substantial gains in reducing pain, enhancing functional outcomes, and increasing shoulder mobility. VAS scores decreased markedly, and ASES and UCLA scores improved substantially in both groups. Forward elevation and external rotation improved significantly, with a slightly greater range observed in the non-pseudoparalysis group. Pseudoparalysis was successfully reversed in 92.85% of affected patients. No major complications were reported.

CONCLUSION: Arthroscopic SCR using LHBT provides significant functional restoration and pain reduction in patients with massive RCT, effectively reversing pseudoparalysis in most cases. This technique offers a reliable and anatomically favorable graft option, supporting its use in both pseudoparalytic and non-pseudoparalytic patients.

PMID:40664842 | DOI:10.1007/s00264-025-06612-2

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06599-w. Online ahead of print.

ABSTRACT

AIM: Although a severe limb deformity is rare, its management continues to be quite challenging. Various options have been described for correction. However, most of them are expensive, extensive and result in complications. Correction of severe deformities of the extremities has been suggested using the yester biological procedures with successful long term outcome.

MATERIALS AND METHODS: During the last five decades, 50 patients of challenging limb deformities were surgically managed by yester procedures which included corrective osteotomy, arthrodesis and Girdlestone arthroplasty. Eleven patients had upper limb deformity and 39 had lower limb deformity. Sixteen patients had congenital anomaly and 34 acquired. Twelve patients were non-walkers with multiple joint involvement. No metallic implant had been used in any case. No patient had repeat surgery. The age of the patients ranged from five-27 years.

RESULTS: Depending on the procedure adopted in a particular patient, all patients were examined periodically and regularly. The treatment time in a patient with multiple deformities ranged from six-12 months. Out of the twelve non-walkers, eleven could ambulate after the management. Superficial infection was recorded in 27 patients. No deep infection was observed. A long follow-up of 35 years has been available.

CONCLUSION: A rare series of 50 patients with challenging deformities of the extremities has been reported. The patients had been managed with procedures like corrective osteotomy, arthrodesis and Girdlestone arthroplasty with acceptable outcome. After the management 11 out of 12 non-walkers could ambulate themselves. The described procedures are simple, biological, dependable, patient friendly and available at no cost.

PMID:40663166 | DOI:10.1007/s00264-025-06599-w

Int Orthop. 2025 Jul 14. doi: 10.1007/s00264-025-06611-3. Online ahead of print.

ABSTRACT

PURPOSE: There is growing evidence that after moderate and severe slipped capital femoral epiphysis (SCFE), in-situ fixation can result in femoroacetabular impingement (FAI). Several different realignment procedures have been described but their use remains controversial due to high complication rates and technical complexity. Our study aims to evaluate the radiological outcomes and complications of patients who underwent open reduction with subcapital shortening osteotomy for moderate or severe SCFE.

METHODS: Radiographic and clinical data of patients with SCFE treated with subcapital shortening osteotomy performed by a single surgeon between October 2018 and July 2023 were retrospectively analysed. We collected patient demographics, pre- and post-operative radiographic measurements (Southwick slip angle, alpha angle and articulo-trochanteric distance (ADT), and post-operative complications. Patient outcomes were assessed using descriptive statistics.

RESULTS: Eighteen children and adolescents were reviewed, four were excluded due to inadequate follow-up. At the last follow-up, the lateral Southwick slip angle was corrected to a mean of 11 ° (1-31°). The mean alpha angle, measured at the final follow-up, was 59 ° (42-88°). One patient showed signs of radiological coxa breva. There were two patients with severe radiological cam deformities and one case of avascular necrosis (AVN).

CONCLUSION: Our findings suggest that the subcapital shortening osteotomy is an effective method for restoring head-neck anatomy in patients with moderate to severe SCFE, with good radiological outcomes. Our low incidence of avascular necrosis further supports the safety of this procedure.

PMID:40658155 | DOI:10.1007/s00264-025-06611-3

Injury. 2025 Jul 8:112598. doi: 10.1016/j.injury.2025.112598. Online ahead of print.

NO ABSTRACT

PMID:40651873 | DOI:10.1016/j.injury.2025.112598

Injury. 2025 Jul 3:112583. doi: 10.1016/j.injury.2025.112583. Online ahead of print.

NO ABSTRACT

PMID:40651872 | DOI:10.1016/j.injury.2025.112583

Injury. 2025 Jul 4:112581. doi: 10.1016/j.injury.2025.112581. Online ahead of print.

NO ABSTRACT

PMID:40651871 | DOI:10.1016/j.injury.2025.112581

Injury. 2025 Jul 1:112571. doi: 10.1016/j.injury.2025.112571. Online ahead of print.

NO ABSTRACT

PMID:40651870 | DOI:10.1016/j.injury.2025.112571

Injury. 2025 Jul 4:112587. doi: 10.1016/j.injury.2025.112587. Online ahead of print.

NO ABSTRACT

PMID:40645870 | DOI:10.1016/j.injury.2025.112587

Injury. 2025 Jul 3:112575. doi: 10.1016/j.injury.2025.112575. Online ahead of print.

ABSTRACT

BACKGROUND: For acetabular fractures of both columns, the antegrade posterior column screw (APCS) is often inserted via the anterior intrapelvic approach to stabilize both columns. Insertion of the APCS can be technically demanding due to the complex anatomy of the posterior column. Misdirection or mispositioning of the screw during surgery can result in penetrate the hip joint or damage the neurovascular structures. The purpose of this study was to detect the ideal insertion point and angles of the APCS based on anatomical landmarks that can be directly identified intraoperatively.

METHODS: We retrospectively reviewed the pelvic CT of 50 adults who underwent serial slice CT imaging. Three reference plane was determined using image analysis software; (1) iliac plane (IP), which contains the anterior superior iliac spine (ASIS), the anterior margin of sacroiliac joint (AMS), and the posterior margin of pubic symphysis (PMS), (2) pelvic inlet plane (PIP), which contains the AMS of both sides, and the PMS, (3) sagittal midline plane of the pelvis (SMP). The ideal insertion point and angles of the APCS, and its maximum length were measured. The ideal insertion point was measured on the line connecting ASIS and AMS (AA line) at a distance from AMS (APCS horizontal distance) and vertical distance from AA line (APCS vertical distance). The ideal angles were measured between the screw and the PIP and between the screw and the SMP.

RESULTS: The APCS horizontal distance was 27.4 ± 6.4 mm. The APCS vertical distance was 1.6 ± 6.6 mm. The angle between the ideal APCS and yz-plane on the outlet view (α-angle) was 5.8 ± 5.8° The angle between the ideal APCS and y-axis on the xy-plane (β-angle) was 51.6 ± 5.0° The length of the APCS was 125.8 ± 9.5 mm.

CONCLUSION: The ideal insertion point detected as the distance from the AMS on the AA line and the ideal insertion angles relative to the PIP and the SMP may aid in proper insertion of the APCS during surgery.

PMID:40645869 | DOI:10.1016/j.injury.2025.112575

Injury. 2025 Jun 28;56(8):112540. doi: 10.1016/j.injury.2025.112540. Online ahead of print.

ABSTRACT

INTRODUCTION: Periprosthetic proximal femoral fractures (PPFFs) present significant challenges in orthopaedic and trauma care, particularly in older patients with comorbidities. Although guidelines recommend early surgery for native proximal femoral fractures, the optimal time to surgery (TTS) for PPFFs remains uncertain. This study aimed to assess the impact of TTS on survival in patients with PPFFs and investigate the role of patient-specific factors in survival outcomes.

MATERIALS AND METHODS: This retrospective study included 262 patients who underwent surgical treatment for PPFFs at a German trauma centre between 1995 and 2023. Survival outcomes were assessed using Kaplan-Meier analysis with log-rank tests and multivariate Cox regression analysis.

RESULTS: The mean (standard deviation) age was 82.8 (8.1) years, and 68.7% of patients were female, with a mean TTS of 62.8 (27.7) h. Log-rank tests revealed no significant survival difference between the optimal cut-off TTS ≤ 68 h and > 68 h (p = 0.51). Multivariate Cox regression analysis identified age (hazard ratio [HR] = 1.06, 95% CI [1.04, 1.08]), male sex (HR = 1.43, [1.01, 2.02]), dementia (HR = 2.12, [1.50, 3.00]), heart disease (HR = 1.43, [1.02, 2.00]), diabetes (HR = 1.49, [1.03, 2.16]), and tumour disease (HR = 1.62, [1.05, 2.51]) as risk factors for mortality. Protective factors included higher preoperative haemoglobin levels (HR = 0.83, [0.76, 0.90]), and erythrocyte transfusion was associated with improved survival in patients undergoing revision arthroplasty but not in those treated with open reduction and internal fixation. Chronic obstructive pulmonary disease was associated with a reduced mortality risk (HR = 0.68, [0.50, 0.93]).

CONCLUSIONS: Despite limitations related to the retrospective, single-centre design, the long study period, and incomplete documentation of transfusion timing and volume, our findings suggest that TTS did not significantly affect survival. Patient-specific factors, including age, comorbidities, perioperative complications, preoperative haemoglobin levels, and transfusions, were the primary drivers of survival outcomes.

PMID:40644865 | DOI:10.1016/j.injury.2025.112540

Injury. 2025 Jul 1;56(8):112573. doi: 10.1016/j.injury.2025.112573. Online ahead of print.

ABSTRACT

PURPOSE: Combat-related peripheral nerve injuries (CRPNIs) are frequently associated with significant long-term disability. While conventional practice often favors delayed exploration to avoid unnecessary interventions, emerging evidence supports early intervention.

METHODS: We retrospectively reviewed 184 patients (265 CRPNIs) treated during the first ten months of the 2023-2024 Israel-Hamas war. Collected data included demographics, injury details, surgical timing, intraoperative findings, procedures performed, and postoperative complications. Surgical Explorations were considered positive if partial/complete nerve transection or nerve compression (e.g., by shrapnel or bone fragment) were found.

RESULTS: Of 184 patients, 136 (74%) underwent nerve exploration at a median of 8 days post-injury, with positive findings in 72% of these cases. Definitive nerve procedures (DNP), such as direct repair or graft reconstruction, were performed in 48% of explored cases, yielding a 5% perioperative complication rate. Early DNP recipients had significantly fewer secondary nerve procedures than those managed nonoperatively (19% vs. 38%, p=0.01).

CONCLUSIONS: Early surgical exploration in CRPNIs demonstrated a high rate of actionable findings and reduced the subsequent need for surgical interventions, supporting a more aggressive initial approach. Further studies are warranted to determine long-term functional outcomes.

PMID:40644864 | DOI:10.1016/j.injury.2025.112573

J Bone Joint Surg Am. 2025 Jul 11. doi: 10.2106/JBJS.24.01461. Online ahead of print.

ABSTRACT

BACKGROUND: We conducted a randomized controlled trial to compare the outcomes of tension band wiring and precontoured plate fixation for the treatment of 2-part and multifragmented isolated, displaced olecranon fractures.

METHODS: We recruited 200 patients, 18 to 75 years of age, who had isolated, displaced olecranon fractures and randomly allocated them to tension band wiring (n = 100) or plate fixation (n = 100). The patients were followed at 6 weeks, 12 weeks, 12 months, and 24 months. The study was designed as a noninferiority trial. The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 12 months.

RESULTS: More patients in the tension band wiring group were classified as ASA (American Society of Anesthesiologists) grade I; otherwise, the randomization groups were similar. Two patients in the tension band wiring group and 3 in the plate fixation group did not receive the allocated treatment. The duration of the surgical procedure was 64 and 88 minutes in the tension band wiring and plate fixation groups, respectively (p < 0.01). After 12 months, the median QuickDASH score was 5 for both groups, and the median of the differences was 0 (95% 1-sided confidence interval [CI], 2.3). There were no clinically relevant differences between the groups at any time point. In addition, there were no differences in outcomes in subgroup analyses of 2-part and multifragmented olecranon fractures. Complications and secondary surgical procedures were analyzed on the basis of the treatment received (tension band wiring = 101 patients, plate fixation = 99 patients). Sixty-four complications were recorded in 52 patients (tension band wiring, 30 patients; plate fixation, 22 patients; relative risk [RR], 1.20 [95% CI, 0.88 to 1.58]; p = 0.23). In the tension band wiring and plate fixation groups, 49 and 34 patients (RR, 1.33 [95% CI, 1.01 to 1.74]; p = 0.04) required at least 1 additional surgical procedure, respectively. Hardware-related irritation was the most reported indication of secondary surgery.

CONCLUSIONS: When treating isolated, displaced 2-part and multifragmented olecranon fractures, tension band wiring was noninferior compared with plate fixation. The surgical procedure was quicker for tension band wiring, but the frequency of secondary surgical procedures was higher. The majority of secondary surgical procedures were removal of symptomatic hardware.

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

PMID:40644505 | DOI:10.2106/JBJS.24.01461

Int Orthop. 2025 Jul 12. doi: 10.1007/s00264-025-06608-y. Online ahead of print.

ABSTRACT

INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive disease associated with significant morbidity and mortality. Few studies have reported the risk factors for adverse outcomes in NF. Our study aims to investigate the risk factors associated with various clinical outcomes of NF - to better guide decision making and patient counselling regarding outcomes during the crucial initial phase of this time sensitive disease process.

METHODS: A retrospective review of patients diagnosed with NF of the upper and lower extremities over a ten-year period from January 2008 to December 2017 in our tertiary institution was performed. Patient demographics, clinical parameters, microbiological data, and clinical outcomes were collected and analyzed using multivariate regression analysis. The primary clinical outcomes analyzed were mortality, major amputation (proximal to the wrist or ankle), prolonged intensive care unit(ICU) stay (> 7 days), and prolonged hospital stay (> 30 days).

RESULTS: 191 patients were included in the study with a mortality rate of 17%, with predictors for mortality being age > 65 years (OR: 3.04, p = 0.024), female gender (OR: 3.04, p = 0.017), peripheral vascular disease (OR: 8.94, p = 0.003), renal impairment (OR: 5.10, p = 0.002), mean arterial pressure (MAP) < 60mmHg (OR: 3.06, p = 0.040), and bacteraemia (OR: 3.11, p = 0.032). 61 patients underwent major amputation, and the risk factors were peripheral vascular disease (OR: 4.45, p = 0.042), lower limb involvement (OR: 5.67, p < 0.001), soft tissue gas on x-ray (OR: 5.78, p = 0.013), and bacteraemia (OR: 5.20, p < 0.001). The predictors for prolonged ICU admission were female gender (OR: 2.55, p = 0.016) and creatinine > 140µmol/L (OR: 3.44, p = 0.002).

CONCLUSION: This study has helped to identify significant risk factors associated with necrotizing fasciitis for mortality and major amputations. Predictors of mortality included elderly age > 65, female gender, peripheral vascular disease, renal impairment, decreased mean arterial pressure and bacteraemia. Predictors of major amputation were peripheral vascular disease, lower limb involvement, presence of soft tissue gas seen on X-ray and bacteraemia. Factors such as these will assist us in identifying patients with higher probabilities of specific outcomes when they present at an early stage of the disease process, to allow for more accurate patient counselling and management of expectations regarding outcomes of patients with NF.

LEVEL OF EVIDENCE: IV.

PMID:40646259 | DOI:10.1007/s00264-025-06608-y

Injury. 2025 Jul 3:112554. doi: 10.1016/j.injury.2025.112554. Online ahead of print.

NO ABSTRACT

PMID:40640012 | DOI:10.1016/j.injury.2025.112554

Injury. 2025 Jun 30;56(8):112558. doi: 10.1016/j.injury.2025.112558. Online ahead of print.

ABSTRACT

INTRODUCTION: Quality registers are used for quality assessment, cost analyses, and research regarding outcomes of surgical and non-operative treatments. As the Swedish Fracture Register (SFR) expands, and is used as a platform for randomized trials, assuring reliability and accuracy of the data is essential.

AIM: This study aimed to investigate the accuracy of the radiographic classification data for proximal humerus fractures recorded in the SFR.

METHOD: All radiographic images of 171 patients with a proximal humerus fracture registered in the SFR between 2019 and 03-01 and 2019-08-31 at 3 hospitals were included. The radiographs were independently assessed at 2 occasions >3 weeks apart by 1 surgeon at each center and IRR was calculated to validate the modification of the AO/OTA classification used in the register. A "gold standard" classification for each patients' images was then established with a consensus discussion involving 4 shoulder surgeons. The gold standard classification was compared with the classification registered in the SFR.

RESULTS: Intra-rater reliability was moderate (kappa 0.549-0.596) with percent agreement (PA) 61-66 %. Inter-rater reliability was also moderate (kappa 0.508-0.557) with PA 58-62 %. Accuracy of the SFR recordings compared with gold standard was fair with kappa 0.36 (95 % CI 0.297-0.425) and PA 44 %.

CONCLUSION: For registers to be of use the accuracy of data is essential as well as coverage, completeness, validity and reliability. The modified AO/OTA classification for proximal humerus fractures used in the SFR had moderate reliability but registered data only fair accuracy compared with a gold standard. This questions its value as a base for scientific research and clinical decisions.

PMID:40639131 | DOI:10.1016/j.injury.2025.112558

Injury. 2025 Jun 27;56(8):112566. doi: 10.1016/j.injury.2025.112566. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture-related infection (FRI) is a devastating complication of musculoskeletal trauma. Pain and poor functional outcomes are common, however there is limited insight to the long-term opiate use in this cohort. This study aims to 1) compare the rate of chronic opiate use between trauma patients with and without FRI, and 2) identify risk factors for chronic opiate use among patients with FRI.

METHODS: A cohort of adult injured patients hospitalized in Queensland, Australia between 2014 and 2015 undergoing operative fracture management was extracted from the Community Opioid Dispensing after Injury (CODI) study. This included person-linked hospitalization clinical data, community opioid dispensing and mortality. Data were extracted from 3-months prior to the index-hospitalization to 2-years after discharge. Community opioid dispensing was compared for patients with and without FRI. Increased risk of chronic opiate therapy (COT) (≥90 days cumulatively) was examined using multivariable logistic regression, odds ratios (OR) and 95 % Confidence Intervals (95 % CI).

RESULTS: There were 19,218 operatively managed orthopaedic trauma patients, of which 394 (2.1 %) were complicated with FRI. Opioids were dispensed post injury for 9399 patients. Patients with FRI were more likely to be prescribed opioids (68 %) than patients without FRI (48.5 %, p < 0.001). COT was associated with FRI, with 29.0 % of infected patients being dispensed opiates >90 days (23.8 % no FRI group, p < 0.001). The median duration of opiate therapy among patients with FRI who were dispensed opiates was 60 days [IQR 15-237] (versus 23 days [IQR 15-84] for no FRI, p < 0.001) and the median end dose was 14 mg oral morphine equivalent for both groups [FRI IQR 10-30; No FRI IQR 10-28]. Among patients with FRI, pre-injury opiates, high injury severity, length of stay >21 days and >2 revision surgeries were associated with COT.

CONCLUSION: Infection following trauma surgery is associated with long term opiate use. Risk factors identified for with COT include pre-injury opiate use, high injury severity, increased length of stay and multiple revision surgeries. These insights should be utilised to guide opiate stewardship programs, advocate for improved prevention and treatment strategies for FRI and optimise physical and mental rehabilitation.

PMID:40639130 | DOI:10.1016/j.injury.2025.112566

J Bone Joint Surg Am. 2025 Jul 10. doi: 10.2106/JBJS.24.01106. Online ahead of print.

ABSTRACT

BACKGROUND: Hypermobile Ehlers-Danlos syndrome (hEDS) is a collagen disorder affecting multiple organ systems, including the musculoskeletal system. We sought to determine the type and severity of orthopaedic manifestations experienced by these patients. The purpose of this study was to identify the most common orthopaedic manifestations in patients with hEDS and to examine the patient-reported helpfulness of treatments. Of note, collagen disorders such as hEDS may affect the success rates of orthopaedic interventions. The success or failure of treatment is not currently fully understood for this patient population.

METHODS: A total of 1,999 patients who were enrolled in an international EDS registry were contacted to complete a 260-question survey regarding their experience with nonoperative and operative treatments for musculoskeletal instability and/or pain. Participants reported their demographic characteristics, hEDS diagnosis characteristics, symptomatic joints, nonoperative and operative treatments, and satisfaction with each treatment.

RESULTS: Over a 30-day period, 1,075 responses were received. Participants were predominately female (95.3%) and had a median age of 40.0 years (interquartile range width, 17.0 years). The majority (60.8%) of respondents reported a mental health burden every day, with the remainder reporting a mental health burden weekly (24.4%), monthly (11.0%), or never (3.80%). Compared with those who underwent standard physical therapy (n = 378), individuals who underwent physical therapy tailored to EDS (n = 602) more frequently reported improved posture (78.6% versus 43.1%; p < 0.001), greater helpfulness (p < 0.001), and a longer duration of attending therapy (p < 0.001). A total of 1,120 primary and 261 revision operations for joint or spine instability and/or pain were reported. The reported complication rates were 35.7% and 42.9% for joint and spine surgeries, respectively. Physical therapy was the only nonoperative treatment for which the median reported helpfulness sometimes equaled or exceeded that of a joint or spine surgery.

CONCLUSIONS: This study offers insights into the demographics and management of hEDS. The high rate of surgical complications reported by patients indicates the need for a better understanding of surgical indications and treatment options. These findings should guide physicians in managing hEDS and highlight the importance of incorporating this knowledge into clinical practice to improve the management of orthopaedic manifestations in patients with hEDS.

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

PMID:40638721 | DOI:10.2106/JBJS.24.01106