Int Orthop. 2025 Feb 13. doi: 10.1007/s00264-025-06427-1. Online ahead of print.

ABSTRACT

PURPOSE: This is a preliminary study with short-term follow up to determine the safety and efficacy of the S-design osteotomy and internal fixation for acute varus and rotational correction technique in infantile Blount's disease.

METHODS: We performed a retrospective series in our institutional hospital. An S-design osteotomy for multiplanar, acute correction followed by internal fixation was performed for Blount's disease patients. Effectiveness was measured by comparing pre-and post-operative tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Safety was determined by the number of neurological deficits and compartment syndromes occurred post operatively. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS). All patients underwent a one-year follow-up after surgery.

RESULTS: Nineteen patients (total of 31 extremities) were included in this study and classified into TFA less than 40 degree (group A) and more than 40 degree (group B). No neurological deficits nor compartment syndrome occured in either group. Regardless the severity of pre-operative deformity, both groups achieved significant corrections. Post operatively there was no significant difference in TFA in Group A and Group B (1.70 and 3.00 respectively, with p value of 0.147) and MDA (4,60 and 6,0 respectively, with p value of 0.327). This indicated there was no correlation between preoperative deformity and postoperative results. LEFS score of group A (73.85 ± 2.73) and Group B (73.85 ± 2.73) showed equally good results in both groups (p = 0.293).

CONCLUSION: This preliminary study with short-term follow up suggested that the S-design osteotomy effectively corrected internal rotation and varus while aiding limb length. The correction of internal rotation is accomodated by performing box osteotomy between the two horizontal (proximal and distal) lines of osteotomy, with safe and effective results. Acute correction is a safe and effective strategy for severe Blount's disease. Longer-term follow-up is awaited.

LEVEL OF EVIDENCE: V.

PMID:39945804 | DOI:10.1007/s00264-025-06427-1

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06437-z. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup.

METHODS: All primary elective MoM and CoP THAs performed 1998-2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs.

RESULTS: Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2% (95% CI 10.6 to 16.3) in MoM and 6.3% (95% CI 4.8 to 8.3) in CoP group. Adjusted hazard ratio for all-cause revision was 1.88 (95% CI 1.34 to 2.65) comparing MoM vs. CoP. Diagnoses at revision were mainly aseptic loosening (33%) and adverse local tissue reactions (33%) in MoM and aseptic loosening in CoP group (44%). The smoothed hazard function revealed the largest difference in instantaneous revision rate between three and 14 years postoperative. After that period no difference was observed.

CONCLUSION: Overall, the cumulative risk of all-cause revision was almost twice as high in patients with a small head MoM as compared to a CoP THA over the 20-year period. However, most of the excess in revisions among MoM patients occurred between three and 14 years postoperative.

PMID:39937240 | DOI:10.1007/s00264-025-06437-z

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06439-x. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is the preferred treatment for end-stage knee osteoarthritis, but challenges arise with severe angular deformities and associated tibial bone loss. The cement screw construct has emerged as a promising technique for managing these defects, offering advantages such as cost-effectiveness, accessibility, and ease of implementation. This research evaluated the clinical, functional and radiological outcome of screw-cement construct for the tibial defects in TKA.

METHOD: This retrospective study aimed to evaluate the long-term functional outcomes and success rate of the cement screw construct in patients with significant tibial defects. Sixty-five patients (104 knees) undergoing TKA were divided into two groups: conventional TKA (Group A) and TKA with screw-cement construct (Group B). Demographic, clinical, and radiological data were collected, with a follow-up duration of at least eight years.

RESULTS: The study revealed comparable demographic characteristics between groups. Both cohorts exhibited significant postoperative improvements in knee morphology and clinical outcomes. Group B demonstrated a higher incidence of radiolucency around the tibial tray, although no progressive complications were observed. Implant survival rates were similar between groups, with complications such as aseptic loosening and infections occurring in both without significant difference.

CONCLUSIONS: This study emphasised the viability of the screw-cement construct for managing uncontained tibial defects during TKA, providing evidence of its efficacy, and cost-effectiveness and suggesting its potential as a standard approach for tibial defects till 20 mm.

PMID:39937239 | DOI:10.1007/s00264-025-06439-x

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06440-4. Online ahead of print.

ABSTRACT

Neuropathic pain is a complex and challenging condition that arises from abnormal processing of somatosensory information, often following nerve injury or dysfunction. Its diagnosis involves a detailed clinical history, sensory examination, and diagnostic tests such as electromyography, nerve conduction studies, and MRI to identify nerve damage or structural causes. In athletes, neuropathic pain can result from nerve entrapment syndromes, post-surgical complications, or peripheral nerve injuries, with unique challenges in pain assessment due to psychological factors and exercise-induced changes. Pharmacological management primarily includes anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., tricyclics, SNRIs), tailored to minimize side effects that could impair athletic performance. Effective treatment requires a careful balance to manage pain while maintaining physical capabilities. When treating athletes for neuropathic pain, healthcare providers must ensure prescribed medications comply with World Anti-Doping Agency (WADA) regulations. Narcotics (opioids) and cannabinoids are prohibited in-competition. Glucocorticoids are also banned in-competition if administered via injection, orally, or rectally, and elevated levels in urine may lead to sanctions.

PMID:39937238 | DOI:10.1007/s00264-025-06440-4

Injury. 2025 Feb 5:112200. doi: 10.1016/j.injury.2025.112200. Online ahead of print.

NO ABSTRACT

PMID:39933980 | DOI:10.1016/j.injury.2025.112200

Int Orthop. 2025 Feb 11. doi: 10.1007/s00264-025-06441-3. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of long-term data evaluating the impact of synovectomy versus no synovectomy during total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). This study aimed to assess and compare bilateral TKA outcomes with and without synovectomy in the same patients over a similar follow-up period.

METHODS: A retrospective review was conducted on 65 bilateral staged posterior-stabilized (PS) fixed-bearing TKAs (28 men, 37 women) performed by a single surgeon on RA-affected knees, with an average follow-up of 17 years (range: 15-24 years). In the first knee, synovectomy was performed during TKA, while no synovectomy for the contralateral TKA. Outcomes assessed included Knee Society scores for knee and function, radiographic findings, complications, and patellar position using the Insall-Salvati ratio.

RESULTS: The synovectomy group had a higher rate of blood transfusion (23.3% vs. 16.6%; P < 0.01) and longer hospital stays (mean 9.60 days [95% CI: 6.56-13.63] vs. 6.51 days [95% CI: 5.50-9.52]; P < 0.001). The group without synovectomy demonstrated significantly better Knee Society Scores (89.1 vs. 80.2 points; P = 0.02) and greater range of motion (ROM) for flexion (130° vs. 102°; P = 0.01). Both groups had similar knee alignment, stability, and femoral and tibial component alignment. Patella baja was observed in six patients in the synovectomy group. Severe haematoma (n = 6) and deep infections (n = 4) were noted exclusively in the synovectomy group. Kaplan-Meier survivorship at 15 years was 81% (95% CI: 78-95) for TKA with synovectomy and 95% (95% CI: 90-100) for TKA without synovectomy.

CONCLUSION: Knees undergoing synovectomy during primary TKA exhibited reduced knee flexion, inferior Knee Society pain scores, and higher complication rates compared to contralateral knees without synovectomy. Omitting synovectomy in RA patients did not increase the risk of implant loosening.

PMID:39932578 | DOI:10.1007/s00264-025-06441-3

SICOT J. 2025;11:8. doi: 10.1051/sicotj/2025002. Epub 2025 Feb 10.

ABSTRACT

BACKGROUND: Anterior cruciate ligament (ACL) rupture is a common knee injury, and with advancements in knee arthroscopy, ACL reconstruction has become common. Techniques like single-double bundle and femoral tunnel drilling via transtibial or anteromedial portal approaches are available. This study evaluates the accuracy of femoral tunnel placement via these approaches in single-bundle ACL reconstruction.

MATERIALS AND METHODS: Forty-three ACL reconstructions using hamstring grafts were analyzed. Initially, femoral tunnels were drilled via the anteromedial portal from 09:30 to 10:00 (14:00 to 14:30 for left knees). Tibial tunnels (mean anteroposterior angle: 63.5°, sagittal: 64.2°) were then created with the same diameter, accompanied by radiological documentation. A femoral aiming device was used to place a K-wire at the center of the femoral tunnel, recorded photographically. Tunnel diameters included 7 mm (20 cases), 7.5 mm (11 cases), 8 mm (7 cases), 8.5 mm (3 cases), and 9 mm (1 case). Two observers evaluated all radiological and photographic data, focusing on the deviation of the transtibial K-wire from the femoral tunnel center.

RESULTS: Of 38 evaluated cases, the transtibial K-wire was within the femoral tunnel in 11 cases (28.9%) - 7 cases with 7 mm, 2 cases each with 7.5 mm and 8 mm diameters. In 23 cases (60.5%), the K-wire was at the perimeter or outside the femoral tunnel - 11 cases with 7 mm, 8 with 7.5 mm, 4 with 8 mm, 3 with 8.5 mm, and 1 with 9 mm diameters.

CONCLUSION: Transtibial aiming for anatomical femoral tunnel positioning is challenging. No significant correlation was found between the transtibial deviation and the tibial tunnel diameter.

PMID:39927689 | PMC:PMC11809194 | DOI:10.1051/sicotj/2025002

SICOT J. 2025;11:7. doi: 10.1051/sicotj/2025001. Epub 2025 Feb 10.

ABSTRACT

BACKGROUND: Functional knee positioning (FKP) represents an innovative personalized approach for total knee arthroplasty (TKA) that reconstructs a three-dimensional alignment based on the optimal balance of soft tissue and bony structures, but it has mostly been described for varus knee deformity.

SURGICAL TECHNIQUE: Valgus deformities present specific challenges due to altered bone remodeling and soft tissue imbalances. Using robotic assistance, FKP enables precise intraoperative assessment and correction of compartmental gaps, accommodating each individual's unique anatomy and laxities. The distal femoral cut is calibrated for 9 mm resection at the intact medial femoral condyle and adjusted on the lateral side to accommodate bone wear, while the tibial plateau resection aims for 8 mm from the medial side and 4-6 mm from the lateral side. Intraoperative evaluations of mediolateral laxities are performed at extension and 90° flexion. Adjustments are made to femoral and tibial cuts to balance gaps, aiming for 0 mm in posterior stabilized implants and minimal discrepancies in cruciate-retaining designs with lateral gap looser in flexion.

DISCUSSION: FKP emphasizes soft tissue-driven adjustments with the use of robotic platforms. Hence, intact soft tissue envelope of the knee is essential. This technique holds significant promise for managing valgus deformities in TKA, but further research is needed to evaluate its functional outcomes.

PMID:39927688 | PMC:PMC11809196 | DOI:10.1051/sicotj/2025001

Injury. 2025 Jan 31:112203. doi: 10.1016/j.injury.2025.112203. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injury (TBI) presents significant challenges in prehospital care, particularly during on-scene triage, where accurate decision-making is crucial for improving patient outcomes. This study, part of a mixed-methods project, aims to explore these challenges and identify gaps in current on-scene triage practices. Additionally, it seeks to understand paramedics' perspectives on potential diagnostic tools such as brain biomarkers, near-infrared spectroscopy, and decision aids.

METHODS: This study involved conducting semi-structured interviews by video conference, including interviews with paramedics of various experience levels who were recruited from UK ambulance trusts. The interviews were guided by a predeveloped and piloted topic guide. The interviews were audio-recorded, transcribed, and analysed using a thematic analysis approach.

RESULTS: Between June and December 2022, twenty participants (15 males and 5 females) with 4 to 24 years of experience were interviewed. Four key themes were identified. Theme 1, "Challenges in TBI Recognition," highlighted difficulties in identifying non-obvious TBI, especially in older adults or patients with comorbidities, and differentiating TBI from other conditions. Theme 2, "Need for Specific Triage and Diagnostic Tools," emphasised paramedics' need for a simple, evidence-based head injury-specific triage tool, as they felt that current tools lack the necessary specificity. Participants also highlighted the potential of new diagnostic technologies to improve decision-making. Theme 3, "Need for Evidence to Support Diagnostic Tools," stressed the importance of clinical effectiveness, feasibility, and cost before implementing new diagnostic technologies. Theme 4, "Implementation Requires Planning and Training," highlighted the need for effective implementation strategies, as well as adequate and ongoing training to ensure proficiency and proper use in the prehospital setting.

CONCLUSIONS: This study provides critical insights into the complexities of on-scene prehospital triage for patients with suspected TBI. Key recommendations include developing specific triage tools, exploring advanced technologies to support on-scene decision-making, enhancing paramedic training on TBI recognition, and addressing both barriers and facilitators to the implementation of new diagnostic technologies.

PMID:39929756 | DOI:10.1016/j.injury.2025.112203

Injury. 2025 Feb 4;56(3):112207. doi: 10.1016/j.injury.2025.112207. Online ahead of print.

ABSTRACT

This study investigates the impact of extraperitoneal pelvic packing (EPP) on the definitive surgical treatment of pelvic fractures (PF) in trauma patients. While EPP is recognized as an effective life-saving technique for controlling non-compressible retroperitoneal bleeding, concerns persist about its potential to complicate subsequent surgical interventions. A total of 220 trauma patients treated in a single First Level Trauma Centre from October 2016 to December 2021 were analysed. Demographic data, trauma mechanisms, hemodynamic stability, Injury Severity Scores (ISS), New ISS, PF classification (Tile), surgical timelines, and postoperative complications according to the Clavien-Dindo classification were collected. The study population was divided into two groups: those who underwent EPP (n = 42) and those who did not (n = 178). Statistical analyses included propensity score matching to balance baseline characteristics and reduce selection bias. Key findings show that EPP effectively improved survival rates in hemodynamically unstable patients, achieving a survival rate of 71.43 %. However, EPP was associated with delays in definitive surgical treatment and a higher incidence of major postoperative complications (41.67 % vs. 17.65 %, p = 0.014). Despite these delays, EPP did not significantly limit the possibility of achieving definitive surgery or the choice of fixation technique. Patients who underwent both EPP and open reduction internal fixation did not show a higher rate of severe complications compared to those managed without EPP. The study concludes that while EPP should be considered a practical emergency intervention for critically unstable PF patients, and even though it may affect the timing of definitive PF treatment, it does not prevent further surgical management.

PMID:39929088 | DOI:10.1016/j.injury.2025.112207

J Bone Joint Surg Am. 2025 Feb 10. doi: 10.2106/JBJS.24.00460. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, orthopaedic surgeons have attempted to decrease opioid consumption through multimodal pain management. However, a limited effort has been made to eliminate opioids entirely in the perioperative period. The purpose of this study was to compare the efficacy and safety of a novel opioid-free pain management pathway with that of an opioid-containing pathway across 5 common orthopaedic subspecialty surgical procedures.

METHODS: In a 1:1, unblinded fashion, 315 patients were randomized to a perioperative pain management pathway that was either opioid-free (n = 157) or opioid-containing (n = 158). Pain was measured with a numeric rating scale (NRS) for pain of 0 to 10 at 6 hours, 12 hours, 24 hours (the primary outcome assessing noninferiority), 2 weeks, 6 weeks, and 1 year after the surgical procedure. Data on patient characteristics, deviations from the pain management pathway, morphine milligram equivalents (MME), readmissions, adverse events, and patient-reported outcomes were collected.

RESULTS: There were 315 patients in the final group, with a mean age of 63.6 years. Of the patients in the study, 59.7% were female, 85.7% were White, 12.4% were Black/African-American, 1.0% were Hispanic/Latino, 0.6% were American Indian, and 0.3% were unknown. At 24 hours, the median NRS for pain in the opioid-free group (2 [interquartile range (IQR), 0 to 4]) was statistically noninferior (p < 0.0001) to the opioid-containing group (4 [IQR, 2 to 6]). Pain levels were significantly lower in the opioid-free group than in the opioid-containing group at 12 hours (p = 0.0173) and 2 weeks (p = 0.0003). Pain scores at 6 hours, 6 weeks, and 1 year were similar. Patients in the opioid-free group reported significantly greater comfort at 24 hours (p = 0.0392) and higher satisfaction with pain control (p = 0.0355) at 6 weeks. There were no reported adverse events or unplanned readmissions. Demographic characteristics were similar between the 2 groups.

CONCLUSIONS: Across 5 common orthopaedic subspecialty procedures, an opioid-free pain management pathway was safe and effective and provided noninferior pain control at 24 hours compared with the opioid-containing pathway.

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

PMID:39928724 | DOI:10.2106/JBJS.24.00460

J Bone Joint Surg Am. 2025 Feb 10. doi: 10.2106/JBJS.24.00955. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic surgery is a critical field, impacting global health-care expenditure and patient outcomes. Despite substantial research funding, issues of transparency and reproducibility persist, undermining the credibility of published in-print findings. Data-sharing initiatives aim to address these challenges by promoting accessibility and enhancing research reliability. We aimed to assess the landscape of data-sharing practices within the field of orthopaedic surgery, focusing on the top orthopaedic journals from 2020 to 2023.

METHODS: Original research articles from 10 of the top orthopaedic journals were screened and analyzed for data-sharing statements (DSSs). Furthermore, we identified variables that were influential on the inclusion of DSSs in orthopaedic clinical studies, and thematically analyzed DSS content to identify prevalent themes. Lastly, corresponding authors were contacted to assess their willingness to share their data.

RESULTS: Of the 1,084 reviewed articles, only 14% included a DSS. The Journal of Bone & Joint Surgery demonstrated the highest proportion of articles with a DSS. Over time, clinical trials exhibited an increasing trend in DSS adoption, contrasting with consistently low rates among cohort studies. Thematic analysis identified the gatekeeper role and conditional data availability as predominant themes in orthopaedic DSSs. Of the 115 emails sent to corresponding authors, only 22 (19.1%) yielded responses, and of those who responded, only 12 (54.5%) expressed a willingness to share their data.

CONCLUSIONS: Our findings underscore a substantial disparity in data-sharing practices across orthopaedic journals, highlighting the need for standardization and mandates for DSSs. Adopting the Transparency and Openness Promotion (TOP) Guidelines can enhance accountability and foster a culture of open science within the field. By addressing these shortcomings, orthopaedic journals can improve research reproducibility and advance scientific knowledge effectively.

PMID:39928713 | DOI:10.2106/JBJS.24.00955

J Bone Joint Surg Am. 2025 Feb 10. doi: 10.2106/JBJS.24.00359. Online ahead of print.

ABSTRACT

BACKGROUND: In Ethiopia, orthopaedic services are limited, and many injured children undergo traditional bonesetting (TBS) despite its association with limb- and life-threatening complications. We sought to identify the risk factors for amputation and a prolonged hospitalization of >7 days in children who presented to hospitals after undergoing TBS.

METHODS: Over a 15-month period, we prospectively enrolled children who presented to 8 Ethiopian hospitals after undergoing TBS. Separately for each outcome (amputation and prolonged hospitalization), we used multivariable logistic regression to evaluate associations between the outcome and 16 covariates, including demographic and injury characteristics, parent or guardian preference for TBS, and TBS topical treatments and immobilization methods.

RESULTS: We enrolled 460 children (mean age, 9.0 ± 4.0 years; 75% male) representing 8 Ethiopian regions and diverse demographic and socioeconomic backgrounds. Elbow injuries (194 patients; 42.2%) and closed fractures and/or dislocations (364 patients; 79.1%) were most common. TBS treatments included topical inorganic (190 patients; 41.3%) or organic (82 patients; 17.8%) material application and rigid (166 patients; 36.1%) or soft (182 patients; 39.6%) immobilization. Twenty-six children (5.7%) underwent an amputation, and 102 (22.2%) had a prolonged hospitalization. The odds of amputation were higher for children from rural communities (adjusted odds ratio [AOR], 6.71; 95% confidence interval [CI], 2.01 to 22.41) and for children with only non-osseous injuries (AOR, 5.76; 95% CI, 1.56 to 21.28). The odds of prolonged hospitalization were higher for children who were 11 to 17 years old (AOR, 2.77; 95% CI, 1.18 to 6.50) and for children with open fractures with a grade of ≥2 (AOR, 4.52; 95% CI, 1.33 to 15.28) but were lower for children from households with secondary education or higher (AOR, 0.40; 95% CI, 0.21 to 0.79). TBS with rigid immobilization increased the odds of amputation (AOR, 5.84; 95% CI, 1.74 to 19.60) and prolonged hospitalization (AOR, 2.20; 95% CI, 1.02 to 4.73). TBS organic topical treatment (with mud, leaves, or butter) increased the odds of amputation (AOR, 3.88; 95% CI, 1.40 to 10.73).

CONCLUSIONS: For children who underwent TBS prior to hospital presentation, rigid splinting by bonesetters increased the odds of amputation and prolonged hospitalization. TBS organic topical treatments also increased the odds of amputation. Training bonesetters to avoid these dangerous practices may prevent devastating complications for children in Ethiopia.

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

PMID:39928712 | DOI:10.2106/JBJS.24.00359

Int Orthop. 2025 Feb 10. doi: 10.1007/s00264-025-06436-0. Online ahead of print.

ABSTRACT

Compressive neuropathies of the upper extremity are a common cause of pain, weakness, and functional impairment, often resulting from chronic mechanical compression or entrapment of peripheral nerves in anatomical regions such as osteofibrous tunnels, fibrous bands, or muscular pathways. While traditional diagnostic methods, including clinical evaluation and electrophysiological studies, are essential, they are limited in localizing lesions and identifying underlying causes. Advances in ultrasonography (US) and magnetic resonance imaging (MRI), particularly MR neurography and high-resolution 3D volumetric imaging, have significantly improved the evaluation of peripheral nerves by enabling detailed visualization of nerve anatomy, adjacent structures, and muscle denervation patterns. This article reviews the role of these imaging techniques in diagnosing and managing compressive neuropathies affecting the brachial plexus, suprascapular, axillary, median, ulnar, and radial nerves, highlighting key imaging findings such as nerve thickening, signal abnormalities, and muscle changes. The integration of advanced imaging modalities into clinical practice enhances diagnostic accuracy, facilitates surgical planning, and improves treatment outcomes for patients with peripheral nerve compression.

PMID:39928139 | DOI:10.1007/s00264-025-06436-0

Int Orthop. 2025 Feb 10. doi: 10.1007/s00264-025-06433-3. Online ahead of print.

ABSTRACT

INTRODUCTION: The implementation of Virtual Reality technology is approaching a breakthrough within the medical, and rehabilitation fields. The level of immersion in the virtual environment is profound and the potential applications are vast.

METHODS: This article reviews the capabilities of Virtual Reality in conjunction with the rehabilitation of nerve entrapments in sport athletes and examines the interactions between our body and brain within the virtual realm. In clinical practice it could be used as a complement to face-to-face therapy to asynchronous use by the patient in any location as a telerehabilitation system.

CONCLUSION: The use of Virtual Reality is a novel, potential, and promising tool in the treatment of nerve entrapments, even possible in the form of telerehabilitation. The response of body and brain in a virtual setting is good, the evolutions in technology can only improve this and this need to be substantiated by further scientific research.

PMID:39928138 | DOI:10.1007/s00264-025-06433-3

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06444-0. Online ahead of print.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) with severe acetabular bone defect remains a challenge in clinic. The purpose of this study is to investigate the treatment technique by using the three-dimensional (3D) printing technology, and analyze the feasibility and preliminary effect of 3D printed personalized titanium blocks for acetabular defect reconstruction in primary THA.

METHODS: The clinical data of 35 patients with Paprosky type 3 acetabular defect, who underwent initial THA with 3D-printed titanium implants in our hospital from January 2017 to December 2019, were retrospectively analyzed. Among them, 21 cases were Paprosky type 3 A bone defects and 14 cases were Paprosky type 3B bone defects. The Harris Hip Score (HHS) was used to evaluate clinical outcomes, while imaging results were analyzed by hip rotation centres (V-COR and H-COR). In addition, postoperative complications were recorded.

RESULTS: The mean follow-up was 79.4 months (ranging from 63 to 94 months) and no patient was lost to follow-up. The total in-hospital blood loss of all patients was 462.9 ± 227.8 mL, accompanied with a blood transfusion rate of 31.4%. HHS improved from 44.5 ± 10.0 preoperatively to 85.1 ± 7.4 at the last follow-up (p < 0.001). Postoperative X-rays exhibited a good match between the 3D-printed titanium block and the acetabulum. V-COR decreased from 50.1 ± 4.7 mm preoperatively to 19.7 ± 1.8 mm postoperatively (p < 0.001). Similarly, H-COR improved from 33.1 ± 11.8 mm preoperatively to 29.7 ± 1.7 mm postoperatively (p > 0.05). Additionally, there were no significant changes in V-COR and H-COR at the last follow-up (p > 0.05). During follow-up, three cases of complications were observed, including two cases of wound redness and one case of partial sciatic nerve paralysis.

CONCLUSIONS: The 3D-printed personalized titanium block revealed accurate reconstruction, satisfactory radiographic and clinical outcomes, and low complication rates. This technique provides a reliable treatment strategy for primary THA in patients with severe acetabular bone defect.

PMID:39921749 | DOI:10.1007/s00264-025-06444-0

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06431-5. Online ahead of print.

ABSTRACT

PURPOSE: No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

METHODS: This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

RESULTS: At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

CONCLUSIONS: A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

PMID:39921748 | DOI:10.1007/s00264-025-06431-5

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06442-2. Online ahead of print.

ABSTRACT

PURPOSE: Cutibacterium is commonly isolated from deep tissue samples taken at the time of revision shoulder arthroplasty, but the significance of these positive cultures is debated, and the impact of increasing bacterial loads on clinical outcomes is unclear. The objectives of this study were to (1) identify factors independently associated with high bacterial loads, and (2) compare patient-reported outcomes (PROs) and revision rates in patients found to have high Cutibacterium loads.

MATERIALS AND METHODS: Male patients undergoing single stage exchange with a minimum 2-year follow-up were included. Culture data were semi-quantitatively scored with the total Cutibacterium score (TShCuS). Two groups were compared: patients with a High Cutibacterium Load (HCL) group and those with Low Cutibacterium Load (LCL) group. PROs and revision rates were compared, and a multivariable analysis was conducted.

RESULTS: Of 68 male patients that underwent revision shoulder arthroplasty, 29 (42.6%) met the inclusion criteria for the HCL group, while 27 patients (39.7%) were in the LCL group. Mean follow-up was 4.7 ± 3 years. Patients with intraoperative humeral loosening had an 18.4 times increased risk of having high Cutibacterium loads (95% CI 2.1-154.4, p < 0.001). There were no significant differences in PROs or re-revision rates between the HCL and LCL groups.

CONCLUSIONS: Intraoperative humeral loosening was independently associated with high Cutibacterium loads found at the time of revision shoulder arthroplasty. Male patients with high bacterial loads treated with complete single stage exchange and antibiotics had patient-reported outcomes similar to those of patients with minimal to no load.

LEVEL OF EVIDENCE: III.

PMID:39921747 | DOI:10.1007/s00264-025-06442-2

Injury. 2025 Feb 1:112202. doi: 10.1016/j.injury.2025.112202. Online ahead of print.

ABSTRACT

INTRODUCTION: Trauma care frequently happens in emergency departments (ED) outside of major trauma centers. Many injuries often exceed the specialty capabilities of referring hospitals, requiring transfer to larger trauma centers. However, the proportion of patients discharged home without admission from receiving facilities remains unclear, suggesting potential overutilization of transfers. We sought to determine the proportion of transfer patients that are discharged home from the receiving ED.

METHODS: We studied patients ≥15 years captured in the Trauma Quality Improvement Program (TQIP) database who were transferred from a referring institution and were subsequently discharged home from the receiving ED without additional services planned.

RESULTS: From 2020 to 2022, there were 744,623 patients ≥15 years of age, of which, 82,316 (11 %) were discharged home with (1 %) or without (99 %) additional services planned. The median age was 40 (26-60), and 70 % were male. The most common mechanism of injury was a collision (40 %), followed by falls (30 %). The median composite injury severity score was 5 (1-5). Serious injury by body region was most frequent for the craniomaxillofacial (11 %) followed by the thorax (5 %). Most of the transfers were to level 1 centers (85 %). The most frequently performed procedures were CT brain followed by a CT cervical spine, abdominal ultrasound, MRI cervical spine, hand laceration repair, ocular evaluation, scalp repair, forearm fracture reduction, assessment of ocular pressure, and MRI of the lumbar spine. The most frequent diagnoses were nasal fracture, orbital floor fracture, macular fracture, subdural hematoma, dental fracture, pneumothorax, rib fracture, hand laceration, burns, and vertebral fracture.

CONCLUSIONS: We found that approximately 1 in 9 patients transferred to a higher level of care are discharged home from the ED, with most requiring neurosurgical, ophthalmologic, dental and craniomaxillofacial services. These findings suggest that virtual communication technology could reduce unnecessary transfers and associated costs.

PMID:39920022 | DOI:10.1016/j.injury.2025.112202

Injury. 2025 Jan 31;56(3):112198. doi: 10.1016/j.injury.2025.112198. Online ahead of print.

ABSTRACT

Unstable ankle injuries often comprise multiple fracture lines; including a posterior malleolus fracture in up to 40% of cases. Surgical fixation of such injuries often requires multiple incisions. The configuration of the posterior malleolus fracture can also vary greatly, and the presence of this fracture is known to poorly affect patient outcomes. In this paper, the authors describe a modified posterolateral approach to the ankle which provides three windows for fixation of complex ankle fractures.

PMID:39919672 | DOI:10.1016/j.injury.2025.112198