J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01508. Online ahead of print.

NO ABSTRACT

PMID:41460952 | DOI:10.2106/JBJS.25.01508

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00621. Online ahead of print.

ABSTRACT

BACKGROUND: There have been no long-term studies comparing the revision rates of a highly cross-linked polyethylene (HXLPE) bearing with those of a conventional polyethylene (CP) bearing among cruciate-retaining (CR) total knee arthroplasties (TKAs). The aim of the current long-term study was to compare CR TKAs with HXLPE and CP bearings in terms of clinical, radiographic, and computed tomographic (CT) scan results; prevalence of osteolysis; revision rate; and implant survivorship.

METHODS: This study enrolled a consecutive series of 410 Korean patients (mean age, 62.6 ± 8 years) who underwent simultaneous bilateral TKAs during the same anesthetic session. This study included 164 men and 246 women. Each patient underwent a posterior CR high-flexion TKA (NexGen CR-Flex TKA; Zimmer Biomet) with an HXLPE bearing on 1 side and a NexGen CR-Flex TKA with a CP bearing on the opposite side. The mean follow-up period was 17.5 years (range, 15 to 19 years).

RESULTS: At the latest follow-up, there were no significant differences between the HXLPE and CP groups with regard to the Knee Society score (94 compared with 93 points), Western Ontario and McMaster Universities Osteoarthritis Index (19.2 points for both groups), range of motion (125° compared with 126°), radiographic and CT results, or revision rate (2.0% compared with 2.2%). No knee showed osteolysis in either group. The estimated survival rate at 17.5 years, using revision or aseptic loosening as the end point, was 98.0% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with an HXLPE bearing and 97.8% (95% confidence interval, 92% to 100%) for the group with the CR-Flex TKA with a CP bearing.

CONCLUSIONS: The findings of this long-term study (minimum follow-up of 15 years) indicate that CR-Flex TKAs with HXLPE and CP bearings both yielded excellent clinical outcomes and implant survivorship. However, no significant clinical advantage was observed for HXLPE over CP bearings in this patient population.

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

PMID:41460951 | DOI:10.2106/JBJS.25.00621

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01015. Online ahead of print.

ABSTRACT

BACKGROUND: The Lenke classification for adolescent idiopathic scoliosis (AIS) has interobserver variability due to subjective clinical assessment. We developed and validated a fully automated deep learning system for precise Lenke classification using spinal radiographs.

METHODS: This retrospective study included 650 individuals (mean age, 13.75 ± 2.23 years; 433 female, 217 male; 618 Han Chinese, 32 Tibetan), comprising 183 healthy controls and 467 patients with AIS (aged 10 to 18 years; 25° ≤ Cobb angle < 90°) with full-spine radiographs. A multistage deep learning system consisting of (1) Swin-Unet segmentation of vertebrae (C7-S1) for automated Cobb angle measurement, (2) DeepLabv3+ localization of lumbar pedicles (L1-L5) to determine modifiers via the centroid-to-CSVL (central sacral vertebral line) distance, and (3) a fusion module integrating features to curve types and lumbar (A/B/C) and sagittal thoracic (-/N/+) modifiers was designed to perform end-to-end Lenke classification automatically. Validation used an independent test set.

RESULTS: The system achieved 95.6% overall accuracy in Lenke classification and had a macro-averaged F1 score of 0.862. Vertebral segmentation attained Dice coefficients of 0.917 (anteroposterior) and 0.942 (lateral). Cobb angle measurements showed excellent agreement with those of experts (intraclass correlation coefficient, 0.969 to 0.976 for thoracic or thoracolumbar/lumbar curves). Modifier assignment achieved F1 scores of 0.912 (lumbar A/B/C) and 0.928 (sagittal -/N/+), exceeding clinical acceptability thresholds.

CONCLUSIONS: The fully automated system was able to perform rapid, objective, interpretable, and clinically reliable classification of the Lenke type directly from radiographs, with performance comparable with that of expert assessment. It demonstrates potential for standardizing AIS surgical planning, reducing diagnostic variability, and improving surgical workflow efficiency.

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

PMID:41460944 | DOI:10.2106/JBJS.25.01015

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01376. Online ahead of print.

NO ABSTRACT

PMID:41460941 | DOI:10.2106/JBJS.25.01376

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01007. Online ahead of print.

ABSTRACT

BACKGROUND: The trapezius is recognized as a dynamic stabilizer of the acromioclavicular (AC) joint. This function has drawn attention in the treatment of AC joint dislocation. We aimed to clarify the anatomy of the aponeurosis of the trapezius insertion about the AC joint. We hypothesized that the trapezius aponeurosis would exhibit distinctive characteristics in 3 regions: the acromial, AC-joint, and clavicular insertions.

METHODS: We analyzed 21 cadaveric shoulder girdle specimens from 13 donors of Japanese ethnicity (4 male and 9 female; mean age [and standard deviation], 86 ± 7.9 years [range, 72 to 97 years]). Fifteen specimens were analyzed macroscopically and 5 histologically. One specimen was excluded because of osteoarthritis. Macroscopic examination included aponeurosis length measurement and fiber orientation analysis.

RESULTS: The trapezius aponeurosis inserted on the medial edge of the acromion, the posterior end of the AC joint, and the posterior edge of the lateral clavicle. The mean aponeurosis length was longest at the acromial insertion (mean, 28.9 ± 5.4 mm), followed by the AC-joint insertion (20.3 ± 7.7 mm), and shortest at the clavicular insertion (7.2 ± 3.2 mm) (p < 0.001). The trapezius aponeurosis was found to extend to the surface of the acromion and AC joint, connecting these structures to the deltoid origin. The coherency value, which reflects the regularity of fiber orientation, was higher on the osseous surface of the acromial insertion (median [interquartile range], 0.36 [0.26 to 0.55]) and the AC-joint insertion (0.37 [0.23 to 0.44]) than at the clavicular insertion (0.22 [0.18 to 0.30]). Histological observation showed that the aponeurosis was inserted via fibrocartilage only at the acromial insertion, just posterior to the AC joint. The aponeurosis at the AC-joint insertion was thicker than that at the clavicular insertion.

CONCLUSIONS: The trapezius aponeurosis at the acromial and AC-joint insertions formed a contiguous complex with the origin of the deltoid tendon and with the superior AC-joint capsule.

CLINICAL RELEVANCE: The trapezius aponeurosis at the acromial insertion, just posterior to the AC joint, may be critical for the dynamic stability of the joint.

PMID:41460933 | DOI:10.2106/JBJS.25.01007

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00930. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing total joint arthroplasty (TJA) who are on long-term use of clopidogrel for atherothrombotic prophylaxis often continue this drug as venous thromboembolism (VTE) chemoprophylaxis following primary total knee (TKA) and total hip arthroplasty (THA). We sought to assess the 90-day bleeding and thromboembolic risk profiles of patients receiving clopidogrel monotherapy for postoperative VTE chemoprophylaxis compared with those receiving aspirin following TJA.

METHODS: Utilizing a national, all-payer health-care database that captures approximately 25% of all inpatient procedures in the U.S., we identified all adult patients who underwent primary elective TKA or THA between 2016 and 2021. Patients who received clopidogrel monotherapy for postoperative VTE chemoprophylaxis were propensity-score matched in an approximately 1:7 ratio to patients who received aspirin monotherapy on the basis of age, sex, procedure type, perioperative tranexamic acid administration, and known indications for clopidogrel administration. Primary outcomes included the 90-day risks of bleeding and thromboembolic complications.

RESULTS: A total of 21,273 patients who received aspirin were matched to 3,078 patients who received clopidogrel. After matching, there were no significant differences between the 2 cohorts with respect to patient demographics, comorbidities, rates of tranexamic acid administration, and hospital characteristics. After accounting for potential confounding variables, patients who received clopidogrel were at an increased risk for postoperative blood transfusion (adjusted odds ratio [aOR]: 1.69; 95% confidence interval [CI]: 1.30 to 2.21; p < 0.001) and acute anemia (aOR: 1.13; 95% CI: 1.03 to 1.26; p = 0.015) relative to patients receiving aspirin. No significant differences between the cohorts in the risk of deep vein thrombosis, pulmonary embolism, stroke, myocardial infarction, hematoma, or hemorrhage were found.

CONCLUSIONS: Patients who received clopidogrel monotherapy for postoperative VTE chemoprophylaxis had an increased risk of postoperative bleeding complications but a similar risk of thromboembolic complications following TJA compared with patients who received aspirin. These findings suggest that the decision to resume clopidogrel for postoperative thromboprophylaxis should balance the potent antiplatelet activity with the risk of bleeding complications in high-risk cardiovascular patients.

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

PMID:41460931 | DOI:10.2106/JBJS.25.00930

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00025. Online ahead of print.

ABSTRACT

BACKGROUND: After-hours hand trauma care is associated with surgeon fatigue, a higher risk of complications, and increased staffing costs. Dedicated trauma operating rooms (DTORs) have been established in orthopaedic and trauma surgery to improve access to care and patient outcomes. The purpose of this study was to measure the impact of a DTOR for hand surgery on the proportion of after-hours cases and wait times from consultation to surgery at a Canadian urban tertiary-care center.

METHODS: This retrospective cohort study included adult patients undergoing hand trauma surgery during 2 periods: before DTOR implementation, from August 1, 2018, to January 31, 2020 (n = 599), and after DTOR implementation, from August 1, 2022, to January 31, 2024 (n = 541). The main outcomes were the proportion of emergency cases performed after hours and the wait times from consultation to surgery. A post hoc analysis examined total hospital costs. Multivariable logistic regression was used to estimate associations with binary outcomes, and multivariable negative binomial regression was used to estimate associations with continuous outcomes. Other outcomes, including caseload, surgical complications, and revision surgeries, were assessed using univariate analysis.

RESULTS: After DTOR implementation, after-hours cases decreased from 18% (109 of 599) to 8% (45 of 541). Adjusting for covariates, DTOR implementation was associated with fewer emergency hand surgeries being performed after hours (odds ratio, 0.47 [95% confidence interval (CI), 0.23 to 0.95]; p = 0.03). The median wait times were similar before and after DTOR implementation: 6 days before implementation and 8 days after it (rate ratio, 1.03 [95% CI, 0.91 to 1.16]; p = 0.64). DTOR implementation was associated with a 19% adjusted reduction in total hospital costs: in Canadian dollars, $2,578.66 before DTOR implementation and $2,220.98 after it (rate ratio, 0.81 [95% CI, 0.78 to 0.84]; p < 0.001). The hand trauma caseload was similar (p = 0.09) before and after DTOR implementation. Complications became less frequent after DTOR implementation (reduced from 5% to 2%; p = 0.03), whereas revision rates did not change (10% and 11%; p = 0.70).

CONCLUSIONS: DTOR implementation was associated with fewer after-hours surgeries, lower complication rates, and meaningful hospital cost savings, without increasing wait times or revision rates. These findings support integrating DTORs to improve operational efficiency and patient outcomes in hand trauma care.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41460927 | DOI:10.2106/JBJS.25.00025

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00201. Online ahead of print.

ABSTRACT

➢ The incidence of vertebral compression fractures is increasing, particularly in elderly populations and postmenopausal women, in whom low bone mineral density is a key underlying factor.➢ Conservative management remains the first-line treatment option due to its high success rate and avoidance of surgical complications. When surgical intervention is necessary, cement augmentation via kyphoplasty and via vertebroplasty remain the most common options.➢ Kyphoplasty may be favored over vertebroplasty, especially in patients with severe preoperative kyphotic deformities, as kyphoplasty has a lower risk of adjacent vertebral fractures and demonstrates a greater reduction of the kyphotic deformity.➢ Consideration of restoring proper local spinal alignment is essential in preventing adjacent vertebral fractures and maintaining long-term spinal stability.

PMID:41460925 | DOI:10.2106/JBJS.25.00201

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.00054. Online ahead of print.

ABSTRACT

BACKGROUND: Unacceptable pain relief after hemiarthroplasty (HA) has limited its utilization for shoulder replacement. The material properties of pyrolytic carbon-graphite composites may result in less abrasion compared with metal bearing surfaces, theoretically decreasing glenoid-sided pain and erosion. This prospective, single-arm, multicenter study was performed to evaluate the short-term clinical outcomes and implant survivorship of pyrocarbon HA.

METHODS: The enrollment of 157 patients occurred at 18 sites between December 2015 and April 2017 as part of an Investigational Device Exemption protocol. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, patient satisfaction, EuroQol-5 Dimensions (EQ-5D) score, and active range of motion were evaluated. A historical control cohort treated with cobalt-chromium HA was identified through a propensity score subclassification analysis. The pyrocarbon HA and cobalt-chromium HA cohorts were compared on the basis of a Composite Clinical Success (CCS) rate, defined as a ≥17-point change in the Constant score without revision or a device-related adverse event.

RESULTS: Of the 157 patients enrolled, 144 had short-term follow-up (mean, 24.4 ± 1.2 months), 10 were lost to follow-up, and 3 underwent revision prior to 24 months due to pain or low-grade infection. The mean patient age was 52.4 ± 10.9 years (range, 19 to 73 years). There were significant improvements in all active range-of-motion and patient-reported outcomes. The outcomes of the pyrocarbon HA cohort (n = 157) were compared with those of the cobalt-chromium HA group (n = 169) eligible for a minimum 24-month follow-up, in which multiple imputation was employed to address missing data. The CCS was 82.7% for the pyrocarbon HA group and 66.8% for the cobalt-chromium HA group (p < 0.001).

CONCLUSIONS: Pyrocarbon HA demonstrated favorable results at a short-term follow-up and improved outcomes compared with the propensity score subclassification-derived cobalt-chromium HA cohort.

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

PMID:41460921 | DOI:10.2106/JBJS.25.00054

J Bone Joint Surg Am. 2025 Dec 29. doi: 10.2106/JBJS.25.01479. Online ahead of print.

NO ABSTRACT

PMID:41460920 | DOI:10.2106/JBJS.25.01479

Int Orthop. 2025 Dec 29. doi: 10.1007/s00264-025-06730-x. Online ahead of print.

NO ABSTRACT

PMID:41460257 | DOI:10.1007/s00264-025-06730-x

Injury. 2025 Dec 16;57(2):112976. doi: 10.1016/j.injury.2025.112976. Online ahead of print.

ABSTRACT

INTRODUCTION: The indications for fixation of posterior malleolar fragments in ankle fractures remain controversial, and the correct interpretation of the pathology underlying fracture morphology is still unclear. This study focused on the anatomical characteristics of the posterior inferior tibiofibular ligament (PITFL) and the fracture pattern and displacement of posterior malleolar fragments, to determine which types of posterior malleolar fragments contribute to syndesmotic stability.

METHODS: Seventy patients with Weber type B ankle fractures associated with posterior malleolar fragments involving ≤25 % of the articular surface were included. Following fibular fixation, syndesmotic stability was assessed using the Cotton test. The relationship between Mason and Molloy fracture classification, the presence of lateral displacement (LD), and syndesmotic instability were all investigated.

RESULTS: Syndesmotic instability was observed in 7/70 cases (10 %), including in 27.3 % of Mason and Molloy type 1 fractures and 55.6 % of LD-type fractures. Conversely, only 1 of the 54 cases that were neither Mason and Molloy type 1 nor LD-type demonstrated syndesmotic instability.

CONCLUSION: PITFL function is likely preserved in most Weber type B fractures with Mason and Molloy type 2 posterior malleolar fragments caused by external rotation injury. In contrast, LD-type fragments suggest complete disruption of the PITFL, including the deep layer, and require treatment strategies that take this into account.

PMID:41455294 | DOI:10.1016/j.injury.2025.112976

Injury. 2025 Dec 3;57(2):112923. doi: 10.1016/j.injury.2025.112923. Online ahead of print.

ABSTRACT

INTRODUCTION: Cement augmentation has the potential to reduce the high failure rates commonly associated with internal fixation in patients with unstable femoral trochanteric fractures. Although current treatment guidelines for femoral trochanteric fractures are comprehensive, most have not mentioned cement augmentation fixation as a treatment option. The objective of this study is to formulate expert consensus statements on the use of cephalomedullary nails with cement augmentation for managing femoral trochanteric fractures in Japan.

METHODS: A modified Delphi approach, comprising two rounds of anonymous surveys and one Expert Meeting, was used to establish consensus on the use of cement augmentation in unstable femoral trochanteric fractures among 15 orthopaedic surgeons (3 Steering Committee members, 12 Expert Panellists) from Japan who have insights into using cement augmentation. Expert Panellists indicated their agreement with each statement on a 5-point Likert scale. Consensus was defined as ≥75 % of Expert Panellists selecting either "Agree"/"Strongly Agree" or "Disagree"/"Strongly Disagree".

RESULTS: Consensus was reached for 53 % of statements (18/34) in Round 1 and 85 % of statements (11/13) in Round 2. Ultimately, 29 statements reached consensus, of which 10 statements were on "Patient Selection" (primary cases, age, bone density, surgery, revision cases and pre-operative assessments for cement augmentation), 9 were on "Surgical Approaches", 6 were on "Post-Operative Care and Rehabilitation" and 4 were on "Expected Functional Outcomes". There were 2 statements that did not reach consensus.

CONCLUSIONS: Japanese orthopaedic surgeons were largely aligned on patient selection, surgical approaches, post-operative care, rehabilitation, and expected outcomes of cement-augmented cephalomedullary nail fixation for femoral trochanteric fractures. When monitored, this technique lowers the potential risk of cement leakage and may also reduce complications, reoperation rates, and postoperative pain, while improving functional outcomes, indicating a favourable safety profile. This consensus serves as an important reference for orthopaedic surgeons in Japan and beyond, particularly given the growing concern over these fractures in Japan's ageing population and that of the wider region. However, consensus was not reached on some aspects due to the limited availability of Japan-specific evidence. Further studies on efficacy and safety outcomes, particularly among the Japanese population, are needed to establish best practices.

PMID:41453239 | DOI:10.1016/j.injury.2025.112923

J Bone Joint Surg Am. 2025 Dec 26. doi: 10.2106/JBJS.25.00847. Online ahead of print.

ABSTRACT

BACKGROUND: Dysphagia is a common postoperative complaint following anterior cervical discectomy and fusion (ACDF), with incidence rates ranging from 1.7% to 71%. The variability in incidence rates raises the question of whether dysphagia warrants clinical concern or represents a transient, expected symptom. The aim of this study was to characterize the time course and impact of dysphagia following anterior cervical surgery for degenerative pathology with use of both subjective and objective measures.

METHODS: Patients undergoing either lumbar or cervical spine surgery from 2023 to 2024 were prospectively enrolled. Lumbar cases were limited to 1 to 2-level, decompression-only procedures, whereas cervical cases included up to 3-level ACDF and/or cervical disc replacement (CDR). Dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the Yale Swallow Protocol at 5 time points: preoperatively and on postoperative days (PODs) 0, 3, 7, and 30. Postoperative responses were collected electronically. Retropharyngeal radiographic measurements at C3-C7 were obtained preoperatively, immediately postoperatively, and at the first follow-up. Measurements were taken from the vertebral midbody to the posterior airway space.

RESULTS: A total of 134 patients (67 in the cervical group and 67 in the lumbar group) were included. The groups were demographically similar, although the cervical group had a longer mean operative time (86.7 versus 62.2 minutes; p < 0.001). Dysphagia was more prevalent in the cervical group across all postoperative time points: POD0 (70.1% versus 13.4%), POD3 (64.2% versus 10.4%), POD7 (40.3% versus 6.0%), and POD30 (35.8% versus 4.5%) (all p ≤ 0.001). EAT-10 scores correlated strongly across postoperative time points and modestly with procedure duration. Male sex was associated with lower EAT-10 scores through POD7 (p < 0.001). Intraoperative steroid use trended toward reduced EAT-10 scores but was not significant after correction. Retropharyngeal measurements increased immediately postoperatively (notably at C3, C4, C5, and C7), but swelling resolved by the time of follow-up, except at C3 and C4.

CONCLUSIONS: Dysphagia was frequent after anterior cervical surgery, peaking early and partially resolving by 1 month. These findings support its characterization as a common, self-limited postoperative symptom rather than a true complication in most cases.

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

PMID:41452954 | DOI:10.2106/JBJS.25.00847

J Bone Joint Surg Am. 2025 Dec 26. doi: 10.2106/JBJS.25.00389. Online ahead of print.

ABSTRACT

➢ Neurological injury remains the most common reason for ligation following total hip arthroplasty.➢ The main risk factors for neurological injury following total hip arthroplasty are preexisting spinal pathology, revision surgery, complex hip anatomy, female sex, surgeon inexperience, and excessive limb lengthening.➢ Postoperative pelvic computed tomographic scans may be used to assess component positioning and identify any compressive hematomas. Magnetic resonance imaging with a metal artifact reduction protocol may be used to evaluate architectural changes in the affected nerve.➢ Electromyography and nerve conduction studies may help to assess the level and grade of the nerve injury. These tests are most useful when performed in patients who show no signs of neurological improvement 3 to 6 weeks after surgery.➢ The mainstay of nonoperative management is supportive care with physical therapy, an ankle-foot orthosis, and neuropathic pain treatment.➢ The prognosis for a femoral nerve injury is generally more favorable than that for a sciatic nerve injury following total hip arthroplasty.

PMID:41452940 | DOI:10.2106/JBJS.25.00389

Injury. 2025 Dec 4;57(2):112937. doi: 10.1016/j.injury.2025.112937. Online ahead of print.

ABSTRACT

INTRODUCTION: For 20 years, Israel has experienced periods where it has been attacked by missile fire from Gaza resulting in civilian deaths and injuries. The Iron Dome air defense system detects incoming missiles and then triggers an air-raid siren that can result in physical injuries and emotional distress as civilians seek shelter. The objective of this study was to compare the epidemiology of responses by Magen David Adom, Israel's National Emergency Medical System (EMS) during the 2021 Gaza War and the 2023 Israel-Hamas War, that were associated with injuries during air-raid sirens but not directly related to the missiles.

METHODS: This is a retrospective comparative study of all EMS responses during air-raid sirens which occurred during the 2021 Gaza War (May 10 -21, 2021) and the 2023 Israel-Hamas War (data from October 7- November 3, 2023).

RESULTS: The study included a total of 1155 EMS responses. Across both conflicts, physical injuries and anxiety-related responses were more common in women than in men (71.8 % vs. 28.2 %; p ≤ 0.05) and 63.5 % vs. 36.5 %; p ≤ 0.05). Comparative analysis between the two conflicts demonstrated that the odds of a response being for an elderly patient (age >75) was higher in the 2023 Israel-Hamas War compared to the 2021 Gaza War (OR 1.83, 95 % CI 1.35-2.48). In addition, there were more EMS responses for injuries in the 2023 Israel-Hamas War compared to the 2021 Gaza War, whether orthopedic (OR 1.66, 95 % CI 1.22-2.25), light injuries (OR 1.35, 95 % CI 0.98-1.86), or head injury (OR 3.31, 95 % CI 1.74-6.30). Additionally, the mean ratio of responses per air-raid siren was higher in the 2023 Israel-Hamas War compared to the 2021 Gaza War (M = 0.15, SD = 0.08 vs M = 0.06, SD = 0.03; p < 0.0001).

CONCLUSION: Air-raid sirens are important in reducing civilian injuries and deaths from missiles. However, the siren itself may cause significant anxiety and can lead to injury as civilians try to seek shelter. Increased public messaging about staying calm and carefully moving to shelter could help prevent injuries.

PMID:41447871 | DOI:10.1016/j.injury.2025.112937

Injury. 2025 Dec 9;57(2):112953. doi: 10.1016/j.injury.2025.112953. Online ahead of print.

ABSTRACT

Accurate placement of pedicle screws is crucial for avoiding complications such as nerve damage or vascular injury. Screws are typically placed freehand using fluoroscopy-guidance. Recently, portable CT combined with 3D navigation (3D-N-iCT) has been developed to guide the placement of pedicle screws. This study compares the accuracy of pedicle screw placement using 3D-N-iCT versus the conventional freehand fluoroscopy guidance for thoracolumbar surgery. The records of patients who underwent thoracolumbar spine surgery with pedicle screw placement from November 2017 to December 2022 at Kaohsiung Chang Gung Memorial Hospital were retrospectively reviewed. Patients were divided into those in which 3D-N-iCT was used and those in whom screws were placed with freehand fluoroscopy guidance (FH-F). Outcomes compared between the 2 groups included screw placement accuracy assessed using the Gertzbein classification, and post-operative complications. A total of 244 patients were included in the study, with 182 in the 3D-N-iCT group and 62 in the FH-F group. The accuracy of screw placement was significantly higher in the 3D-N-iCT group, with 98 % of screws classified as Grade 0 (indicating perfectly positioned) compared to 93 % in the FH-F group (p = 0.010). The placement time was similar between groups (36.0 vs. 33.0 min, p = 0.120). The 3D-N-iCT group had a significantly lower rate of post-operative neurological defects (0 % vs. 5 %, p = 0.016) and complications (0.5 % vs. 8 %, p = 0.004). In conclusions, the use of 3D-N-iCT is associated with greater accuracy in pedicle screw placement during thoracolumbar spine surgeries compared to the freehand technique, without prolonging placement time.

PMID:41447870 | DOI:10.1016/j.injury.2025.112953

Injury. 2025 Dec 16;57(2):112977. doi: 10.1016/j.injury.2025.112977. Online ahead of print.

ABSTRACT

OBJECTIVES: Road injury is a major cause of fractures, but its global burden remains unclear.

METHODS: Based on data from the Global Burden of Disease (GBD) 2021 study, this study systematically analyzed the incidence, prevalence, and years lived with disability (YLDs) of road injury-related fractures at the global, regional, and national levels, as well as the trends in disease burden from 1990 to 2021. Additionally, the risk factors for road injury deaths and disability-adjusted life years (DALYs) were evaluated through the GBD study's Comparative Risk Assessment framework.

RESULTS: In 2021, global fracture cases from road injuries were 19,113 thousand (95 % uncertainty interval [UI]: 16,571 thousand - 21,839 thousand), a 6.1 % decrease from 1990. From 1990 to 2021, the age-standardized incidence rate (ASIR) fell from 376.5 (95 % UI: 324.43 - 430.91) to 238.2 (95 % UI: 206.63 - 271.01), age-standardized prevalence rate (ASPR) from 1364.4 (95 % UI: 1258.88 - 1471.32) to 825.2 (95 % UI: 764.72 - 884.41), and age-standardized YLD rate (ASYR) from 78.6 (95 % UI: 54.34 - 109.89) to 45.9 (95 % UI: 31.60 - 64.55) per 100,000 population. Among fractures, patellar, tibial/fibular, or ankle fractures had the heaviest burden, with 2021 ASIR of 65.8 (95 % UI: 49.26 - 87.90) per 100,000. Geographically, disease burden varied by region and country: parts of the Middle East, South Asia, Africa, and Latin America remained heavily burdened, while ASIR rose in 19 countries (including Paraguay). Correlation analysis showed ASIR, ASPR, and ASYR correlated positively with Socio-Demographic Index (SDI). Occupational injuries, low bone mineral density, alcohol consumption, high temperature, and smoking have been identified as risk factors for road injuries. Among these, occupational injuries remain the primary global risk factor, though their proportion is decreasing; meanwhile, the risk proportion of low bone mineral density is on the rise.

CONCLUSIONS: Over the past three decades, the global burden of road injury-related fractures has declined, but regional and national disparities persist. While high SDI regions achieved significant reductions, severe challenges remain in the regions such as the Middle East and West Asia. Additionally, apart from occupational injuries, the risk of low bone mineral density in road injury cannot be ignored.

PMID:41447869 | DOI:10.1016/j.injury.2025.112977

Injury. 2025 Dec 4;57(2):112932. doi: 10.1016/j.injury.2025.112932. Online ahead of print.

ABSTRACT

Periprosthetic fracture is a devastating complication of total hip arthroplasty that is associated with significant morbidity and mortality. Cement-in-cement revision of the femoral component is a technique that has been proposed as an efficient revision technique to treat femoral periprosthetic fractures where the femoral stem is loose, but the bone-cement interface is intact. By eliminating the need to remove the existing cement mantle, proposed advantages include shorter operative time, reduced blood loss, easy restoration of pre-fracture version and soft tissue tension, and eliminating the risk of iatrogenic damage from cement removal. However, the technique has not been widely popularised due to concerns over the fixation stability and risk of non-union from cement extrusion into the fracture site. Herein, an up-to-date review of the indications for, surgical technique of, and outcomes of cement-in-cement revision of the femoral component of a total hip arthroplasty for periprosthetic fracture is provided.

PMID:41442906 | DOI:10.1016/j.injury.2025.112932

Injury. 2025 Dec 14;57(2):112972. doi: 10.1016/j.injury.2025.112972. Online ahead of print.

ABSTRACT

INTRODUCTION: Brachial plexus injuries (BPI) are devastating conditions that frequently result in flail, insensate upper limbs associated with severe neuropathic pain and loss of function. When reconstructive options such as nerve grafts, transfers, or free muscle transplantation fail to restore meaningful function, transhumeral amputation may be considered as a salvage strategy. The advent of advanced prosthetic technologies, particularly myoelectric and osseointegrated devices, has renewed interest in elective amputation for select patients.

OBJECTIVES: This systematic review evaluates functional, pain, prosthetic, and quality-of-life outcomes following transhumeral amputation for traumatic BPI.

METHODS: A systematic search of PubMed, Embase, and Scopus (May 2025) was conducted according to PRISMA guidelines. Eligible studies reported outcomes of transhumeral amputation following traumatic BPI. Non-English, non-original, and non-BPI amputation studies were excluded. Data extraction and quality assessment were performed independently by two reviewers using the MINORS tool. Continuous data (e.g. DASH, VAS) were pooled using a random-effects meta-analysis (RevMan 5.4). Heterogeneity was assessed using the I² statistic, and subgroup analyses explored differences by prosthesis type (myoelectric vs. cosmetic/traditional).

RESULTS: Ten studies encompassing 93 patients met inclusion criteria (Level III-IV evidence, follow-up 3-19 years). Mean postoperative DASH score was 35.0 (95 % CI 28.0-42.0), indicating moderate residual disability but a significant functional improvement from preoperative values (ΔDASH = -13.5; 95 % CI -21.9 to -5.1). Myoelectric users demonstrated superior functional outcomes (mean DASH 30.7) compared with cosmetic or traditional users (means 37-43; p = 0.008). Pooled VAS pain score was 5.6 (95 % CI 3.1-8.1) with a nonsignificant trend towards improvement (ΔVAS -1.2). Regular prosthesis use occurred in 51 % (95 % CI 27-74 %), and approximately 37 % of patients returned to work. Patient satisfaction exceeded 80 % in most series, particularly among myoelectric prosthesis users.

CONCLUSION: Transhumeral amputation following brachial plexus injury yields clinically meaningful functional gains and high patient satisfaction, especially when combined with modern prosthetic technology. Pain reduction is variable, and return-to-work rates remain modest. Amputation should be considered a valid reconstructive endpoint in selected patients when conventional nerve reconstruction fails. Future multicentre prospective studies employing standardised outcome measures are essential to refine patient selection, quantify long-term benefit, and optimise multidisciplinary rehabilitation strategies.

PMID:41442905 | DOI:10.1016/j.injury.2025.112972