J Bone Joint Surg Am. 2025 Jun 18;107(12):e65. doi: 10.2106/JBJS.25.00082.

NO ABSTRACT

PMID:40531111 | DOI:10.2106/JBJS.25.00082

J Bone Joint Surg Am. 2025 Jun 18;107(Suppl 1):1-3. doi: 10.2106/JBJS.24.01376.

NO ABSTRACT

PMID:40531109 | DOI:10.2106/JBJS.24.01376

J Bone Joint Surg Am. 2025 Jun 18;107(12):e69. doi: 10.2106/JBJS.25.00366.

NO ABSTRACT

PMID:40531106 | DOI:10.2106/JBJS.25.00366

J Bone Joint Surg Am. 2025 Jun 18;107(Suppl 1):80. doi: 10.2106/JBJS.25.00257.

NO ABSTRACT

PMID:40531104 | DOI:10.2106/JBJS.25.00257

J Bone Joint Surg Am. 2025 Jun 18;107(12):e64. doi: 10.2106/JBJS.25.00009.

NO ABSTRACT

PMID:40531103 | DOI:10.2106/JBJS.25.00009

J Bone Joint Surg Am. 2025 Jun 18;107(12):e68. doi: 10.2106/JBJS.25.00246.

NO ABSTRACT

PMID:40531102 | DOI:10.2106/JBJS.25.00246

Int Orthop. 2025 Jun 18. doi: 10.1007/s00264-025-06583-4. Online ahead of print.

NO ABSTRACT

PMID:40531209 | DOI:10.1007/s00264-025-06583-4

Int Orthop. 2025 Jun 18. doi: 10.1007/s00264-025-06568-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the effect of failed rotator cuff repair (RCR) on surgical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft.

METHODS: We included 79 patients with irreparable massive rotator cuff tears who underwent SCR using fascia lata autografts between 2018 and 2023, with a minimum follow-up of ≥ one year. Of them, 66 patients underwent primary SCR (primary SCR group) and 13 underwent SCR after structural failure of previous RCR (revision SCR group). Clinical outcomes, including American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analogue scale (VAS) score, and range of motion, were assessed. Radiological outcomes were evaluated using radiographs and magnetic resonance imaging (MRI) scans. The minimal clinically important difference (MCID) values determined the clinical relevance of the difference in functional outcomes. Graft tears were recorded if graft discontinuity was found on MRI.

RESULTS: The revision SCR group showed worse VAS (2.1 vs. 1.1, P = 0.025), ASES (69.7 vs. 82.4, P = 0.008), Constant (57.1 vs. 64.3, P = 0.016) scores and higher graft tear rates (61.5% vs. 21.2%; P = 0.049) than the primary SCR group. The differences in VAS, ASES, and Constant scores exceeded the MCID threshold in the primary SCR group at a mean final follow-up of 2.1 ± 1.0 years. Conversely, in the revision SCR group, only the difference in Constant score exceeded the MCID threshold at a mean final follow-up of 2.2 ± 1.6 years, and patients with intact grafts showed significantly better VAS score and acromiohumeral distance (both P = 0.030) than those with torn grafts.

CONCLUSION: SCR using fascia lata autograft improved surgical outcomes for primary and revision SCRs. However, revision SCR showed worse outcomes and higher graft tear rates compared to primary SCR.

PMID:40531208 | DOI:10.1007/s00264-025-06568-3

Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06580-7. Online ahead of print.

ABSTRACT

BACKGROUND: Lacertus syndrome (LS) involves median nerve compression by the lacertus fibrosus at the elbow. Often misdiagnosed as carpal tunnel syndrome (CTS), it presents primarily with hand weakness, fatigue, and forearm pain, with less common sensory symptoms.

OBJECTIVES: To review current knowledge on the clinical features, diagnostic methods, and treatment options for LS, highlighting the distinct characteristics that differentiate it from similar conditions.

METHODS: A comprehensive review synthesizing literature on anatomy, pathophysiology, prevalence, diagnostic approaches, and treatment outcomes.

RESULTS: Clinical diagnosis relies heavily on specific provocative tests, including the clinical triad (muscle weakness, localized pain, positive Scratch Collapse Test), Lacertus Antagonist Test (LAT), and visible Lacertus Notch Sign. Diagnostic ultrasound is increasingly preferred for real-time, dynamic assessment. Electrodiagnostic studies have limited diagnostic value due to the dynamic nature of the compression. Conservative treatments include activity modification, nerve gliding exercises, kinesiotaping, and injections (corticosteroids, botulinum toxin). Surgical intervention, typically via minimally invasive or percutaneous release under Wide-Awake Local Anaesthesia No Tourniquet (WALANT), achieves immediate intraoperative strength improvement and high patient satisfaction rates (around 88%).

CONCLUSIONS: Improved clinical recognition of Lacertus syndrome through specific provocative tests and dynamic ultrasound enhances accurate diagnosis. Surgical decompression, especially using the WALANT approach, consistently yields excellent functional outcomes, emphasizing its role as the definitive treatment for resistant or severe cases.

PMID:40522492 | DOI:10.1007/s00264-025-06580-7

Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06581-6. Online ahead of print.

ABSTRACT

PURPOSE: Dynamic anterior stabilization (DAS) is a novel soft-tissue procedure for treating anterior shoulder instability in selected cases. The purpose of the present meta-analysis is to provide the up-to-date evidence on DAS's outcomes, safety and characterize study designs to improve future studies and accelerate technical advancements.

METHODS: A PRISMA guided meta-analysis was performed. Inclusion criteria were human studies, comparative or non-comparative in which DAS was performed as an indication for anterior shoulder instability. Four databases were searched PubMed (via MEDLINE), EMBASE, Web of Science, and Science Direct. ROBINS-I was employed for risk of bias analysis. A random-effects meta-analysis was performed using mean difference (MD) as effect size estimator. Heterogeneity was reported using the I2 statistic. Dichotomous variables were counted and reported as % out of total sample size for each study.

RESULTS: Five studies met the inclusion criteria. A total of 137 patients were available for analysis with a mean age of 27.8 ± 9 years and 108 patients were males. Mean follow-up duration was 37 ± 11 months. Postoperative ASES score showed an improvement of MD = -15.09 (95% CI: -22.35 to -7.38), p < 0.01, compared to the preoperative period. The ROWE score showed a similar improvement, MD = -58.38 (95% CI: -69.88 to -46.89), p < 0.01. Postoperative range of motion (ROM) was not significantly influenced. Active anterior elevation had a MD = -6.07° (95% CI: -15.04 to 2.91), p = 0.19, active external rotation had a MD = 3.7° (95% CI: -7.71 to 15.11), p = 0.53, and active internal rotation, MD = 0.16° (95% CI: -1.4 to 1.73), p = 0.84. Return to play ranged from 80 to 100% while return to competitive sports, reported by a single study, was 33%. The overall complication rate was 8.6%. The overall risk of bias was "serious" or "critical" for all included studies.

CONCLUSION: DAS has been shown to improve postoperative PROMs, does not restrict ROM compared to the preoperative period and has an overall complication rate of 8.6%.

PMID:40522491 | DOI:10.1007/s00264-025-06581-6

Injury. 2025 Jun 7:112472. doi: 10.1016/j.injury.2025.112472. Online ahead of print.

NO ABSTRACT

PMID:40518338 | DOI:10.1016/j.injury.2025.112472

Injury. 2025 Jun 9;56(8):112515. doi: 10.1016/j.injury.2025.112515. Online ahead of print.

ABSTRACT

Introduction In 2020, we published a new minimally invasive anteromedial distal approach for plate fixation of the humerus (MIAMDAH) to address extra-articular distal shaft fractures in a cadaveric study. After operating on our first patients, it was noted that the distal MIPO window was too small to comfortably fix the plate distally. So, a wider MIPO window was developed to make the surgical procedure more comfortable. This study aimed to evaluate clinical outcomes in patients who underwent surgery using either the original approach or its modified version and to determine whether the modification provided technical or clinical advantages over the original.

MATERIAL AND PATIENTS: Forty-five patients underwent surgery using either the original or modified approach. Twenty-one received the original technique, and twenty-four received the modified one. The primary outcome measured was the Mayo Elbow Performance Scale (MEPS) score at 18 months. The secondary outcome measures included the University of California at Los Angeles (UCLA) score and the elbow motion of the damaged arm at 18 months. A statistical bivariate analysis was performed to compare various subgroups based on the original or modified approach.

RESULTS: All patients were followed for 18 months. The average distance from the fracture to the coronoid fossa was 3.72 cm for the original approach and 3.95 cm for the modified approach. Both approaches showed no statistically significant differences between primary and secondary outcomes. The original approach yielded good to excellent results in all patients (21/21) at the last follow-up, with a mean MEPS score of 98.5 and a UCLA score of 34.7. The modified approach resulted in good to excellent functional outcomes in 22 of 24 patients, with a mean MEPS score of 95.8 and a UCLA score of 34.3. The mean arch elbow motion was 125.3° (11° less than the undamaged arm) in the original approach and 123.5° (13° less than the undamaged arm) in the modified approach.

CONCLUSION: MIAMDAH provides a reliable alternative to laborious open approaches or risky MIPO approaches described to date. The modified version offers a broader MIPO window, which enhances surgery comfort and may reduce the complication rate.

PMID:40517641 | DOI:10.1016/j.injury.2025.112515

Injury. 2025 Jun 6;56(8):112506. doi: 10.1016/j.injury.2025.112506. Online ahead of print.

ABSTRACT

PURPOSE: Certain trauma populations require rehabilitation services after inpatient management. However, studies have shown implicit bias against African American patients regarding the access to rehabilitation services. The purpose of this study was to assess the variance in rehabilitation discharges of adult patients who sustained lower extremity bilateral long bone fractures comparing African American and Caucasian patients.

METHODS: The study included African American and Caucasian adult patients who sustained bilateral long bone fractures of the lower extremities. Data was extracted from the National Inpatient Sample (NIS) database of 2019. Demographic information, clinical characteristics, comorbidities, and outcomes for all qualifying patients were compared using propensity score matching analysis.

RESULTS: Propensity matching analysis created 361 pairs of patients. The two groups (Caucasian patients and African American patients) had comparable characteristics including age (median years [IQR], 42 [30 - 57] vs. 42 [29 - 58], P = 0.790), sex ([male] 60.7 % vs, 60.7 %), injury severity score (ISS) score (median [IQR], 14 [4 - 26] vs. 14 [5 - 29], P = 0.344) and insurance status (private, 125 (34.6 %) vs. 125 (34.6 %)). The analyses found no significant differences in rehabilitation disposition (199 (56.9 %) vs. 185 (53.8 %), P = 0.460, hospital length of stay (median days [95 % CI], 9 [8, 10] vs. 10 [9, 11], P = 0.116) and overall in-hospital mortality (11 (3.0 %) vs. 17 (4.7 %), P = 0.327) between the groups.

CONCLUSION: Our study identified no significant bias against African American patients who suffered from bilateral long bone fractures of the lower extremities and required rehabilitation services.

PMID:40517640 | DOI:10.1016/j.injury.2025.112506

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06577-2. Online ahead of print.

ABSTRACT

PURPOSE: Unilateral biportal endoscopy (UBE) is a predominantly minimally invasive surgical technique for addressing LDH. Nonetheless, recurrent lumbar disc herniation (rLDH) remains the predominant reason for reoperation following UBE. This retrospective study examined the risk factors and reoperation rates for rLDH following UBE. This study aimed to examine the risk factors associated with rLDH and the reoperation rate after single-level UBE.

METHODS: We retrospectively analyzed 205 patients who underwent UBE for single-level LDH from 2019 to 2023 to determine reoperation causes and related risk variables. Reoperation was characterized as the postoperative radiological evidence of persistent symptomatic disc herniation at the same level, necessitating further surgical intervention. We gathered radiographic and demographic parameters preoperatively and postoperatively. Patients with recurrent LDH had additional evaluation during recurrence and revision operations.

RESULTS: Of the 205 patients, 21 (10.2%) required further rLDH revision surgery. The multivariate analysis indicated that obesity and elevated fasting blood glucose (FBG) levels were independent risk variables with strong predictive value for reoperation after controlling for other potential risk factors. Based on the receiver operating characteristic curve analysis, the cutoff points for UBE were body mass index (BMI) = 25.775 kg/m2 and FBG = 5.155 mmol/L.

CONCLUSION: This study identified obesity (BMI > 25.775 kg/m²) and elevated FBG levels (> 5.155 mmol/L) as independent risk factors for UBE reoperation. Hence, we recommend longer rehabilitation interventions, such as wearing a suitable brace and strengthening the paraspinal muscles, for patients with obesity and high FBG who undergo UBE.

PMID:40515760 | DOI:10.1007/s00264-025-06577-2

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06572-7. Online ahead of print.

ABSTRACT

OBJECTIVE: This comparative cohort study evaluates the clinical efficacy of 3D-printed patient-specific cutting guides (PSCGs) versus conventional manual techniques in correcting rigid midfoot pes cavus deformities.

METHODS: A retrospective analysis of 40 patients (80 feet) undergoing Cole osteotomy between 2021 and 2023 was conducted. Patients were stratified into two matched cohorts: Group A (manual osteotomy, n = 20) and Group B (PSCG-assisted, n = 20). Radiographic parameters (Meary's angle, TMI, TCA, Djian-Annonier angle, Pitch angle) and functional outcomes (VAS, AOFAS, SF-36) were analyzed preoperatively and at mean 17-month follow-up. Surgical metrics including operative time, fluoroscopy frequency, and complication rates were systematically compared.

RESULTS: Radiographic analysis demonstrated superior angular correction in the PSCG-assisted cohort versus conventional osteotomy, with significantly improved bilateral Meary's angle (Right: 1.94°±0.62 vs. 6.04°±2.20, P < 0.05; Left: 1.62°±0.54 vs. 6.39°±2.04, P < 0.05) and TMI angle (Right: 4.32°±3.14 vs. 8.51°±8.12, P < 0.05; Left: 4.74°±2.44 vs. 8.53°±5.93, P < 0.05). The PSCG technique achieved equivalent correction in TCA, Djian-Annonier, and Pitch angles while demonstrating enhanced consistency (38-66% reduction in standard deviations). Functionally, PSCG-assisted procedures yielded superior AOFAS scores (97.71 ± 0.77 vs. 92.07 ± 2.25, Δ = 5.64 [95%CI 4.54-6.74], P < 0.05) and SF-36 outcomes, particularly in general health (Δ = 16.96, P < 0.05) and mental well-being (Δ = 7.92, P = 0.001). Operative metrics favored PSCG with 36% shorter procedure time (82.9 ± 13.9 vs. 129.0 ± 39.6 min, P < 0.05) and 77% reduced intraoperative fluoroscopy (4.65 ± 1.06 vs. 20.07 ± 2.92 exposures, P < 0.05). No surgical site infections occurred in the PSCG group versus one superficial SSI in controls CONCLUSION: 3D-printed PSCGs provide anatomically precise, efficient correction of complex midfoot deformities while minimizing intraoperative radiation exposure, establishing this technology as a safe and reproducible alternative to conventional techniques.

PMID:40515759 | DOI:10.1007/s00264-025-06572-7

Injury. 2025 Jun 6;56(8):112513. doi: 10.1016/j.injury.2025.112513. Online ahead of print.

ABSTRACT

BACKGROUND: Increasing awareness about fall prevention and osteoporosis screening could reduce the incidence of hip fractures in the elderly, and comprehensive care can improve outcomes. There is limited nationwide data on the health outcomes of hip fractures when comparing operative and non-operative approaches. The study objectives were to ascertain the short-term outcomes of older patients hospitalized with hip fractures and to elucidate the variables correlated with in-hospital mortality.

METHODS: This study utilized a retrospective dataset comprising hospitalized individuals aged ≥60 years who were admitted due to hip fractures during the fiscal years spanning from 2019 to 2023. The National Health Security Office conducted the diagnosis, employing the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification (ICD-10-TM) code S72. Surgical procedures pertinent to hip fractures were categorized under ICD-9-79.1, ICD-9-79.3, ICD-9-81.51, ICD-9-81.52, and ICD-9-81.53. Demographic information was analyzed through descriptive statistical methods. Factors associated with in-hospital mortality were assessed through both univariate and multivariate analyses.

RESULTS: Out of 115,333 diagnosed cases, the admission rate was 205.5 per 100,000 population, with 46.9 % undergoing surgery. The overall in-hospital mortality rate was 4.04 per 100,000 individuals. Patients who underwent surgery showed a lower in-hospital mortality rate compared to those who did not, recorded at 1.3 vs 1.9 (p < 0.05) for males and 2.1 vs 2.6 (p < 0.05) for females per 100,000 population. Outcomes at discharge for those receiving operative versus non-operative treatment revealed a mean length of stay (LOS) of 11.5 versus 10.8 days (p < 0.05), mean healthcare costs of $1973 versus $1554 (p < 0.05), and in-hospital mortality rates of 1.8 % versus 2.1 % (p < 0.05). Factors increasing mortality included age (70-80 years: OR 1.51, 95 %CI 1.30-1.74; ≥80 years: OR 2.59, 95 %CI 2.27-2.97), male gender: OR 1.69, 95 %CI 1.55-1.85, extracapsular fracture: OR 1.15, 95 %CI 1.05-1.25, and a LOS ≥10 days: OR 1.63, 95 %CI 1.49-1.78. Surgery associated with lower mortality: OR 0.88, 95 %CI 0.81-0.96.

CONCLUSION: Hip fracture patients who underwent surgery had better mortality outcomes than those who did not. Less than half of patients opted for surgery in the past five years. Therefore, it is essential to encourage surgical treatment for these patients.

PMID:40513174 | DOI:10.1016/j.injury.2025.112513

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06573-6. Online ahead of print.

NO ABSTRACT

PMID:40514517 | DOI:10.1007/s00264-025-06573-6

Injury. 2025 Jun 3:112514. doi: 10.1016/j.injury.2025.112514. Online ahead of print.

ABSTRACT

INTRODUCTION: Major Trauma Hospitals are receiving increasing numbers of older patients after serious injury. Outcomes in these patients vary with the nature of the injury and other factors such as frailty. We aimed to determine the prevalence of frailty and adverse events in older patients managed by acute trauma services during the index hospital admission, and the frequency of adverse outcomes at three, six and twelve months after discharge in an Australian setting.

METHODOLOGY: This study assessed the prevalence of frailty in a prospective multicentre cohort study of seriously injured patients aged ≥ 70 years admitted to three Major Trauma Services in Australia. Patients were followed for twelve months after injury to assess for adverse outcomes associated with the presence of frailty or other factors. During the index admission patients were assessed for frailty, co-morbidities, Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Patients were monitored for adverse events and whether a Geriatrician review occurred. Outcomes assessed at three, six and twelve months included increased dependency, falls, confusion, readmission to hospital, transfer to a Residential Aged Care Facility and death.

RESULTS: 217 patients were recruited between 2018 and 2023 across the three hospitals. At index admission, 32 (14.7%) patients were frail and another 28 (12.9%) were near frail. Geriatrician review was more likely for frail patients and there were similar rates of inpatient complications for both frail and non-frail patients. Frailty at index admission was associated with increased dependency, falls, readmission and confusion at three, six and twelve months and with an increased risk of death at three and six months.

CONCLUSIONS: Frailty was associated with delayed adverse outcomes up to 12 months following admission for serious trauma in older people at three major Australian trauma services. Assessment of frailty on admission may be useful in stratifying outcome risk for older patients. Further research into frailty interventions and pathways is recommended.

PMID:40506331 | DOI:10.1016/j.injury.2025.112514

Injury. 2025 Jun 7;56(8):112520. doi: 10.1016/j.injury.2025.112520. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical outcomes of a novel hybrid bone transport technique using an antibacterial-coated nail for the treatment of infected segmental tibial bone defects.

METHODS: This retrospective study included 19 patients with infected segmental tibial bone defects treated using hybrid bone transport with an antibacterial-coated nail, the ZNN™ Bactiguard® nail. Patients were divided into two groups: nailing after bone transport (NABT, n = 11) and bone transport over nail (BTON, n = 8). These groups were compared with a control group of 10 infected patients treated with conventional external fixation bone transport (EFBT). The primary endpoint was infection eradication, while secondary endpoints included external fixation time (EFT), external fixation index (EFI), complications, and bone regeneration quality.

RESULTS: The mean external fixation time (EFT) for the entire cohort was 280.2 ± 142.7 days. The BTON group had the shortest EFT (150 ± 45 days), significantly lower than both NABT (279 ± 99 days) and EFBT (927 ± 1710 days, p = 0.001). The external fixation index (EFI) was also significantly lower for BTON compared to EFBT (25 ± 10.7 vs. 77.5 ± 38.7 days/cm, p = 0.009). A single case of a recurrent infection was reported in the BTON group (5.3 %), which was managed with nail removal and the continuation of external fixation bone transport without further complications. The infection was fully resolved in all cases (29/29) at the end of the follow-up period. Complication rates were similar across groups. The primary docking site union rate was 89.7 %, with no significant differences between groups.

CONCLUSIONS: The BTON technique using an antibacterial-coated nail reduces EFT by threefold compared to traditional external fixation bone transports methods, without increasing complications. A notable reduction was also observed in the NABT group, although it did not reach statistical significance. This approach offers a promising alternative to conventional methods for the treatment of infected tibial bone defects.

PMID:40505442 | DOI:10.1016/j.injury.2025.112520

Injury. 2025 Jun 4;56(8):112519. doi: 10.1016/j.injury.2025.112519. Online ahead of print.

ABSTRACT

INTRODUCTION: A Fracture-related infection (FRI) is a rare but serious complication of surgical fracture treatment in children and adolescents. Exact data on the incidence of FRI in children and adolescents are not available in the literature. In adults, criteria for the diagnosis and treatment of FRI were published in 2018 by an expert group and divided into suggestive and confirmatory categories. However, there is no recommended approach for diagnosing and treating FRI in children or adolescents.

PURPOSE OF THE STUDY: This study aimed to determine the incidence of FRI in children and adolescents who underwent operative fracture treatment at a Level I trauma center between 2019 and 2023, to evaluate age distribution, anatomical sites and bacterial spectrum of FRI in children and adolescents, to evaluate risk anatomical locations and initial fracture treatment methods in relation to the development of FRI and to assess the applicability of FRI diagnostic criteria in the pediatric patients.

MATERIALS AND METHODS: It is a retrospective monocentric study conducted by reviewing hospital database. The study included all patients under 18 years of age with present growth plates who underwent surgical fracture treatment between 2019 and 2023.

RESULTS: The incidence of FRI in children was 0,95 % among 1156 osteosynthesis procedures performed between 2019 and 2023. The average age of pediatric patients with FRI was 11,18 years. The most common anatomical site of FRI in out cohort was the forearm (36,36 %). High-risk locations in terms of developing FRI relative to the number of osteosyntheses performed included the proximal femur (20 %) and the diaphysis of the humerus (7.69 %). The most common pathogen causing FRI in children was S. aureus (63,6 %). On average, 2.1 additional surgical procedures were required to eradicate the infection.

CONCLUSION: FRI in children is a rare but serious complication, which most commonly occurs in the upper extremity, specifically in the forearm area. However, some anatomical sites with a lower incidence of fractures demonstrate a significantly higher relative risk for the development of FRI. The recommended guidelines developed in 2018, including diagnostic criteria for FRI, can be successfully applied to the pediatric population.

PMID:40505441 | DOI:10.1016/j.injury.2025.112519