Int Orthop. 2026 Feb 28. doi: 10.1007/s00264-026-06765-8. Online ahead of print.

NO ABSTRACT

PMID:41762244 | DOI:10.1007/s00264-026-06765-8

SICOT J. 2026;12:10. doi: 10.1051/sicotj/2025071. Epub 2026 Feb 26.

ABSTRACT

INTRODUCTION: The optimal timing to initiate the Ponseti method for congenital idiopathic clubfoot remains uncertain. This systematic review and meta-analysis aimed to evaluate whether starting treatment within the first four weeks of life improves outcomes compared to later initiation.

METHODS: Following PRISMA guidelines (PROSPERO ID: CRD42025650117), MEDLINE, Embase, Cochrane Library, and Google Scholar were searched for studies comparing early (≤4 weeks) versus late (>4 weeks) initiation of the Ponseti method. Outcomes included the number of casts, the relapse rate, and the need for tenotomy. Data were pooled using a random-effects model, and study quality was assessed using the MINORS tool.

RESULTS: Six studies involving 467 patients (689 feet) met the inclusion criteria. Early initiation was associated with a slightly higher mean number of casts (MD = 0.72, 95% CI [0.33-1.10], p = 0.0002), but this difference was not significant in the overall pooled analysis (MD = 0.06, 95% CI [-1.08-1.21], p = 0.91). Relapse (OR = 0.70, p = 0.68) and tenotomy rates (OR = 0.68, p = 0.41) were comparable between groups.

DISCUSSION: Although earlier treatment may require more casts, it does not reduce relapse or tenotomy rates. These findings suggest that initiating treatment after four weeks yields comparable outcomes, offering flexibility in clinical practice without compromising results. Variability across studies highlights the need for standardized treatment protocols and well-designed randomized controlled trials to confirm the optimal initiation age.

PMID:41757814 | PMC:PMC12947636 | DOI:10.1051/sicotj/2025071

Injury. 2026 Feb 16:113106. doi: 10.1016/j.injury.2026.113106. Online ahead of print.

ABSTRACT

OBJECTIVES: To describe the outcomes of a protocol using ultrasound-guided pericardiocentesis with pericardial drain placement as definitive treatment for penetrating cardiac injury with tamponade in a resource-limited war zone setting, where emergency thoracotomy is often unavailable.

DESIGN: Single-center prospective case series.

SETTING: Nasser Medical Complex, a major tertiary trauma center in southern Gaza, over a period of 24 months during active conflict.

PARTICIPANTS: 25 patients (21 male, 4 female), aged 4-65 years, not in cardiac arrest, with traumatic pericardial effusions and hematoma caused by penetrating injury presenting within approximately 3 hours.

INTERVENTIONS: Ultrasound-guided pericardiocentesis via a large-bore 16 gauge dialysis catheter, aggressive aspiration of fresh blood, instilling 1 gram of intrapericardial tranexamic acid (TXA) and pericardial drain placement for 48 hours with serial echocardiographic monitoring.

MAIN OUTCOME MEASURES: Survival to hospital discharge, need for subsequent thoracotomy and complications.

RESULTS: This study demonstrated a high survival rate of 96%, with 24 out of 25 patients surviving to hospital discharge (the sole non-survivor died from other injuries). The protocol successfully prevented the need for thoracotomy in 100% of cases, establishing it as a definitive treatment. A recurrence rate of 8% was observed, requiring repeat drainage in two patients, while follow-up was maintained for 83% of survivors.

CONCLUSIONS: In a warzone setting, a protocol of pericardiocentesis with pericardial drain placement and intrapericardial TXA served as definitive management for selected patients with penetrating cardiac tamponade, resulting in high survival and avoiding the need for thoracotomy. This approach challenges current practice and offers a life-saving alternative in resource-constrained environments.

PMID:41760498 | DOI:10.1016/j.injury.2026.113106

Injury. 2026 Feb 13;57(4):113100. doi: 10.1016/j.injury.2026.113100. Online ahead of print.

ABSTRACT

INTRODUCTION: Transporting injured patients to an appropriate level of care remains a complex challenge. In our trauma system, paramedics are mostly limited to basic life support and perform field triage guided by an algorithm that considers the type of injury and the estimated transport time to a Level 1 Trauma Center (L1TC). This study evaluates the effect of this triage protocol by comparing patient mortality between those transported directly to a L1TC and those initially transferred from another facility.

METHODS: This retrospective study queried a Canadian L1TC trauma registry, which included all adult trauma patients who were admitted or died in the emergency department, between 2016 and 2022. Isolated burns, hanging, isolated hip fractures, arrival ≥ 72 h post-injury, death within 2 h of arrival at L1TC, or direct ward admissions were excluded from the study. We used multivariable logistic regression to compare in-hospital mortality between direct transport and interfacility transfer cohorts. Sensitivity and subgroup analyses were performed to further aid in refining triage criteria.

RESULTS: Of 9488 registry patients, 1645 were excluded, leaving 4702 direct transports and 3141 interfacility transfers. Transferred patients were younger (median 59 vs. 67 years, p < 0.001), more severely injured (44.1 % vs 31.1 % ISS>15, p < 0.001) and had longer times to definitive care (9.32 h vs 1.15 h, p < 0.001). Overall, interfacility transfer was associated with a decreased odds of in-hospital mortality [aOR 0.54 (95 % CI 0.42-0.69)]. However, in our sensitivity and subgroup analyses, interfacility transfer was associated with an increased odds of mortality [aOR 4.17 (95 % 1.02-17.1)] if time to definitive care was <1 h.

CONCLUSION: The application of a provincial prehospital triage criteria translates to improved survival for select patients through interfacility transfers. However, our results support direct transport to a L1TC if the time to definitive care can be achieved within an hour. These findings should be used to further refine prehospital triage protocols and interfacility transport policies.

PMID:41759436 | DOI:10.1016/j.injury.2026.113100

J Bone Joint Surg Am. 2026 Feb 26. doi: 10.2106/JBJS.25.00982. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic patient education materials (PEMs) within Epic's Elsevier library often exceed the recommended sixth-grade reading level, with a mean grade of 8.6 in English and 5.8 in Spanish, risking poor patient comprehension and adherence. The present study evaluated whether artificial intelligence (AI)-based text simplification can improve readability while preserving clinical accuracy. The objectives were to use previously established readability data for English and Spanish PEMs as baselines, to assess the impact of human-based and ChatGPT-based simplification on reading grade level, and to compare the fidelity of simplified texts against standard materials.

METHODS: In March 2025, 806 orthopaedic PEM documents were simplified using standardized ChatGPT prompts. Readability was reassessed using validated English and Spanish formulas, and fidelity was evaluated in the 86 PEMs that also had human easy-to-read versions. Two blinded clinicians compared human and ChatGPT-4o outputs with the originals to identify hallucinations, omissions, and inconsistencies according to severity. Following the release of ChatGPT-5, an unblinded post hoc analysis was performed using identical criteria.

RESULTS: ChatGPT-4o-simplified PEMs showed mean reading grade levels of 6.1 in English and 3.5 in Spanish. Compared with human simplifications, ChatGPT-4o showed fewer English omissions, similar Spanish omissions, fewer inconsistencies in both languages, and comparable English hallucinations, but higher Spanish hallucinations. Compared with ChatGPT-4o, ChatGPT-5 preserved English performance and improved Spanish fidelity, reducing hallucinations to human-comparable rates.

CONCLUSIONS: AI-driven simplification can produce orthopaedic PEMs that are easier to read while maintaining acceptable fidelity. The improvements observed with ChatGPT-5 highlight its potential for clinician-supervised use in generating accessible and reliable PEMs.

CLINICAL RELEVANCE: This study is clinically relevant because orthopaedic PEMs are routinely delivered through the Epic electronic health record and directly affect patient understanding, consent, and adherence in both English and Spanish. By evaluating the readability and fidelity of AI-simplified materials across languages, this study informs safe, scalable strategies to improve patient communication in everyday orthopaedic practice.

PMID:41747019 | DOI:10.2106/JBJS.25.00982

Injury. 2026 Feb 22;57(4):113129. doi: 10.1016/j.injury.2026.113129. Online ahead of print.

ABSTRACT

BACKGROUND: Nutritional Vulnerability may increase complications and reintervention after calcaneus fracture care. This study compared 90-day and 2-year outcomes among malnourished adults treated with closed management, percutaneous fixation, or open reduction and internal fixation (ORIF).

METHODS: Adults (≥18 years) with calcaneus fracture and laboratory-defined nutritional vulnerability (albumin ≤3.5 g/dL and/or leukocytes ≤1.5 × 10³/µL within 1 year pre-index) were identified. Three independent 1:1 propensity score-matched comparisons were performed (closed vs ORIF, percutaneous vs ORIF, and closed vs percutaneous). Outcomes were assessed at 90 and 730 days.

RESULTS: Matched cohorts included 981 per group (closed vs ORIF), 403 per group (percutaneous vs ORIF), and 386 per group (closed vs percutaneous). At 90 days, closed treatment had higher acute respiratory failure/mechanical ventilation than ORIF (11.5% vs 7.7%, P=.005); otherwise no differences were detected. Percutaneous fixation had lower wound disruption than ORIF (6.2% vs 10.4%, P=.03) but higher acute respiratory failure/mechanical ventilation (13.4% vs 8.2%, P=.017); no differences were detected between closed and percutaneous. By 2 years, subsequent fixation was higher after closed reduction compared to ORIF (6.9% vs 3.8%, P=.002) and percutaneous vs ORIF (9.5% vs 4.0%, P=.002), and salvage procedures were lower after closed reduction compared to ORIF (2.9% vs 4.6%, P=.035); otherwise no differences were detected.

CONCLUSION: Among malnourished adults with calcaneus fracture, less invasive strategies were associated with lower short-term wound disruption compared with ORIF but higher subsequent fixation by 2 years, highlighting clinically important management tradeoffs. These findings underscore the importance of preoperative host optimization and individualized strategy selection in high-risk patients, weighing early soft-tissue morbidity against the potential need for later conversion to ORIF and downstream reintervention in routine practice.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:41747641 | DOI:10.1016/j.injury.2026.113129

J Bone Joint Surg Am. 2026 Feb 26. doi: 10.2106/JBJS.25.01031. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to ascertain whether mild cartilage damage of the lateral condyle of the femur influences the mid-term clinical outcomes of medial unicompartmental knee arthroplasty (mUKA) and exacerbates the progression of osteoarthritis in the lateral compartment.

METHODS: Patients with normal cartilage or mild cartilage damage of the lateral femoral condyle (Outerbridge grade, ≤II) who underwent mUKA between March 2016 and December 2020 were retrospectively divided into 4 groups: a normal cartilage group and a cartilage damage group that was subdivided on the basis of the damage location (weight-bearing area, posterior weight-bearing area, and medial side of the lateral condyle). Patients with postoperative overcorrection of limb alignment or preoperative lateral meniscal extrusion were excluded. Outcomes that were compared among the groups included the hip-knee-ankle angle (HKA), lateral compartment Kellgren-Lawrence (K-L) grade, Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Kujala score, patient satisfaction, and complications.

RESULTS: The study included 203 knees in 177 patients (136 female patients; 177 East Asian; mean age, 68.3 ± 7.1 years) with a mean follow-up of 70.8 months (range, 48 to 106 months). The postoperative OKS, FJS, and Kujala score showed no significant differences among the groups. Mid-term full-length standing radiographs of the lower limbs were obtained for 99 of the 203 knees, with a mean follow-up of 54.1 months (range, 49 to 104 months). Of the 99 knees, 26 (26.3%) showed an increase of 1 K-L grade in the lateral compartment and 73 (73.7%) remained unchanged. Three knees (1.5%) from the normal group experienced complications, including 1 periprosthetic fracture, 1 bearing dislocation, and 1 bearing rotation, but none required conversion to TKA.

CONCLUSIONS: In patients in whom postoperative alignment is not overcorrected and preoperative lateral meniscal function is intact, mild cartilage damage (Outerbridge grade I or II) of the lateral femoral condyle does not impact the mid-term clinical outcomes of mUKA and does not exacerbate the progression of osteoarthritis in the lateral compartment.

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

PMID:41747016 | DOI:10.2106/JBJS.25.01031

Injury. 2026 Feb 16;57(4):113107. doi: 10.1016/j.injury.2026.113107. Online ahead of print.

ABSTRACT

PURPOSE: The primary aim of this study was to present an up-to-date overview of postoperative complications during hospitalization of patients undergoing hip fracture surgery in a Western European country. The secondary aim of this study was to evaluate clinical outcomes (length of hospital stay and mortality) in relation to postoperative complications.

PATIENTS AND METHODS: A prospective proximal femoral fracture database was used to obtain data. In total, 2603 patients older than 18 years undergoing hip fracture surgery between January 2018 and January 2021 were included. Baseline characteristics, clinical outcomes and postoperative complications were retrospectively analyzed. Complications were categorized as minor or major (requiring medical intervention and prolonged hospital stay).

RESULTS: Of 2603 patients, 51% experienced at least one complication. Major complications occurred in 30% of all cases. The most frequent major complications were delirium (16%), pneumonia (9%), and urinary tract infections (UTI) (8%). Minor complications occurred in 19% of all cases. The most frequent minor complication was anemia requiring transfusion (19%). Of all major complications delirium, pneumonia, and acute kidney injury (AKI) were significantly associated with increased 30-day and 1-year mortality (p < 0.001).

CONCLUSION: Proximal femoral fractures are associated with a high overall incidence of complications. Most complications are associated with either a significantly longer hospitalization or higher 30-day and 1-year mortality rates.

LEVEL OF EVIDENCE: Level II prospective multicenter cohort study.

PMID:41747640 | DOI:10.1016/j.injury.2026.113107

Injury. 2026 Feb 18;57(4):113118. doi: 10.1016/j.injury.2026.113118. Online ahead of print.

ABSTRACT

INTRODUCTION: The axillary nerve is a crucial peripheral branch arising from the posterior cord of the brachial plexus. It provides both motor and sensory innervation to the shoulder girdle, enabling essential movements such as abduction and external rotation-functions that are crucial for daily activities and various athletic movements. Despite its significance, detailed documentation of the axillary nerve's branching patterns remains limited. This study aimed to examine the branching configurations of the axillary nerve in a South African cadaveric sample.

MATERIALS AND METHODS: Thirty adult cadavers (15 females and 15 males) were examined. To minimise the risk of damaging the axillary nerve during dissection, key surface anatomy landmarks-including the acromion and coracoid process-were identified and marked, enabling accurate location of the nerve as it traversed the deltoid muscle. Dissection followed established protocols, involving careful incision and reflection of the deltoid and pectoral muscles to expose the axillary nerve and associated neurovascular structures.

RESULTS: The study identified and classified four distinct axillary nerve branching patterns. Type 1, in which the nerve branches before entering the quadrangular space, was observed in 16.67% of cases. Type 2, characterized by branching within the quadrangular space, was noted in 18.33%. Type 3, where branching occurred after exiting the quadrangular space, was observed in 25.00%. Type 4, a combination of the previous three patterns, was the most prevalent, occurring in 40.00% of specimens. No significant differences were observed between the left and right shoulders regarding branching pattern (p = 0.9998). However, a significant difference was found in the overall distribution of branching types across all categories (p = 0.01299).

CONCLUSION: These findings suggest that the axillary nerve does not exhibit a definitive branching pattern, highlighting the anatomical complexity and variability of this structure. This underscores the need for a more nuanced and comprehensive classification system when analyzing the axillary nerve morphology.

PMID:41747639 | DOI:10.1016/j.injury.2026.113118

Injury. 2026 Feb 13;57(4):113101. doi: 10.1016/j.injury.2026.113101. Online ahead of print.

ABSTRACT

BACKGROUND: Pretibial lacerations are a common and costly injury in elderly patients. At present, no standardised evidence-based guidelines exist to aid in their management. This systematic review aims to collate and evaluate all available evidence on the assessment and management of pretibial lacerations, including outcomes such as wound healing time, complications and mortality.

METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, CENTRAL, and clinicaltrials.gov was conducted from inception to November 2024. Studies were eligible if they investigated patients with pretibial lacerations and reported at least one clinical outcome.

RESULTS: Twenty-nine studies published between 1973 and 2023 were included. This included 11 case series, 12 cohort studies and six randomised controlled trials, with a total of 2893 patients. The weighted mean age for patients was 75.4 years. For studies that reported gender data, 85.1% were female. Management strategies varied widely, with 12 studies reporting operative management, four reporting non-operative management and 13 reporting both. Operative management was associated with shorter healing times compared to non-operative management. Infection was the most common complication across both groups (0% to 63%). One month mortality rates were as high as 15%. Risk of bias was high in the majority (55%) of studies.

CONCLUSION: Considerable variability exists in the assessment and management of pretibial lacerations, with a lack of high-quality evidence to inform clinical practice. Further research is required to establish best practice for this common injury within our ageing population.

PMID:41747638 | DOI:10.1016/j.injury.2026.113101

Injury. 2026 Feb 17;57(4):113123. doi: 10.1016/j.injury.2026.113123. Online ahead of print.

ABSTRACT

Mesenchymal stromal cells (MSCs) have been used for inducing skin regeneration in patients with severe cutaneous wounds. However, transportation of these cells from cellular therapy units to hospitals is an important issue for clinical use. Several types of synthetic biomaterial scaffolds have been used for carrying different type of cells. Among them, polyethylene terephthalate (PET) scaffolds have shown that maintains the viability and biological functionality of MSCs. Here, we aimed to evaluate the viability and functionality of MSCs seeded on PET membranes, maintained under different cell culture conditions, as a possible system for cell transportation. In this work, human MSCs were seeded and cultured on PET membranes (MSCs/PET) at 37 °C or room temperature (RT) for 24 h. Adhesion, viability, proliferation, migration and multipotential differentiation were evaluated in all experimental conditions. MSCs survival, viability, proliferation and multipotential differentiation were similar on both PET membranes and plastic culture dishes, after 24 h of culture at 37 °C or RT. Microscopic observation of MSCs seeded on PET membranes or plastic culture dishes showed their characteristic fibroblastoid morphology at both temperature conditions. Our results show that PET membranes constitute an optimal scaffold for MSCs transportation. The MSCs-PET system might be used not only for transporting MSCs to health center but also as cell-based wound dressing system for inducing skin regeneration in patients with cutaneous wounds such as burned patients.

PMID:41747637 | DOI:10.1016/j.injury.2026.113123

J Bone Joint Surg Am. 2026 Feb 25. doi: 10.2106/JBJS.25.01106. Online ahead of print.

ABSTRACT

➢ Despite substantial health-care spending, both the U.S. and U.K. lack standardized, operational definitions of value in specialty care, limiting their ability to optimize patient-centric health outcomes and appropriate selection and utilization of resources.➢ First-generation value-based specialty care models in the U.S., like the Bundled Payments for Care Improvement Initiative and Comprehensive Care for Joint Replacement, have achieved modest savings by focusing on post-acute care and procedural efficiency, without negatively impacting quality metrics. Similarly, the Getting It Right First Time initiative in the U.K. aimed to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices. However, there remains no true understanding of impact on value, of efficacy based on measurement of patient-centric health outcomes that matter to patients, or of whether interventions were appropriately selected in the first place.➢ A standardized value metric, specifically the incremental cost-effectiveness ratio (ICER), is critical to measuring quality in specialty care, enabling health-care systems to compare treatment options on the basis of both cost and patient-centric outcomes.➢ The ICER integrates quality-adjusted life years, cost data, and the duration of effectiveness, providing a framework for shared decision-making, care variation reduction, and more strategic site-of-service decisions.➢ Health-care systems and policymakers should adopt ICER-based frameworks to transition from volume-based incentives to value-based models that support innovation, accountability, and whole-person musculoskeletal specialty care.

PMID:41739900 | DOI:10.2106/JBJS.25.01106

Injury. 2026 Feb 17;57(4):113103. doi: 10.1016/j.injury.2026.113103. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) are increasing with the aging population and differ from high-energy pelvic trauma. The Rommens classification and the more recent OF classification guide treatment decisions. The OF pelvis score aims to objectify therapy choice by integrating fracture type, mobility, and pain among other variables. However, the rationale behind key thresholds, such as the VAS cut-off of 5 and the emphasis on mobilization remains unclear. This study seeks to define evidence-based thresholds to improve treatment decision-making.

MATERIAL AND METHODS: This retrospective single-center study includes all patients ≥65 years with an FFP treated as inpatients between 2018 and 2023. Demographics, comorbidities, diagnostics, treatment type, pain level (VAS), mobility, and length of stay are demonstrated. A custom Likert-based mobility score is calculated for each patient. Statistical analysis is performed on pain level and mobilization between conservatively and operatively treated patients.

RESULTS: Totally 428 patients were included in the study. The median age was 85 (80-90) years. While 60.0% (n=257) were treated conservatively, 40.0% (n=171) underwent surgical treatment. The median time to decision for surgical treatment was 3 (2-7) days. At the third day of inpatient stay conservatively treated patients had a significantly better mobilization level (p<0.01) and lower pain level (p=0.015) than patient treated surgically. The suggested Likert Score for mobilization showed a cut-off value of <4 for operative treatment. Patients with a VAS >4 at the third day of the inpatient stay were more likely to be treated surgically. There was no significant difference in proportions of analgesics. Classification, mobilization and pain level had significant influence on the choice of treatment, with classification having the most impact.

CONCLUSION: This study presents comprehensive demographic data and inpatient information on pain level, analgesia, and mobility in FFP patients. A novel Likert-based mobility score is introduced to objectively quantify mobilization. For the first time, the typical timing of surgical decision-making is determined and used to compare pain level and mobility levels between treatment groups. Multivariable analysis identifies and weighs key factors influencing treatment decisions.

PMID:41740217 | DOI:10.1016/j.injury.2026.113103

Injury. 2026 Feb 18;57(4):113102. doi: 10.1016/j.injury.2026.113102. Online ahead of print.

ABSTRACT

INTRODUCTION: Venous thromboembolism (VTE) is a major contributor to morbidity and mortality following traumatic injury. The optimal pharmacological VTE prophylaxis (VTEp) regimen is uncertain. There are limited data on VTE events and VTEp practice, particularly in the trauma population requiring admission to an intensive care unit (ICU).

OBJECTIVE: To describe the incidence and timing of VTE events, VTEp regimens, and associated risk factors for VTE in a severe trauma cohort requiring ICU admission.

METHODS: Retrospective cohort study of all trauma patients (n = 969) admitted to the ICU of the Royal Brisbane and Women's Hospital between 1/2/19 and 31/12/23. Data collected included baseline characteristics, VTEp administered, VTE investigations and outcomes including VTE events, length of stay, and mortality. Competing risks survival analysis was used to describe the association between baseline characteristics and risk of VTE development.

RESULTS: The median injury severity score was 22 (IQR 16-29). The incidence of new VTE events, as diagnosed on imaging, within 28 days of injury was 12 %. The median time to first VTE event was 9 days (IQR 4.8-13.1), and 5 of the 121 (4 %) events occurred within 24 h of injury. In the group that were admitted within 24 h of injury, the median time to VTEp commencement was 48 h (IQR 29-71) and 74 % received unfractionated heparin as the first VTEp administered. In those that had not experienced the competing risks of death or hospital discharge, only the presence of a severe lower extremity injury (cause specific HR 1.81, 95 % CI 1.19-2.76, p= 0.005) and increasing weight (cause specific HR 1.02, 95 % CI 1.01-1.03) were associated with an increased adjusted rate of developing a VTE by day 28.

CONCLUSIONS: Although the incidence of VTE in our cohort was lower than reported in international studies, it remains a significant burden of disease. These data can be used to inform the design of clinical trials that seek to address the evidence gaps in the optimal post-trauma VTEp regimen in the severely injured trauma population.

PMID:41740216 | DOI:10.1016/j.injury.2026.113102

Int Orthop. 2026 Feb 25. doi: 10.1007/s00264-026-06760-z. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to explore the biomechanical interrelationships in Progressive Collapsing Foot Deformity (PCFD), also known as flatfoot, with concurrent hallux valgus (HV), first metatarsal pronation and sesamoid bone displacement. The primary purposes were to quantify correlations between arch collapse, first metatarsal rotation, HVA (hallux valgus angle), and sesamoid displacement using weight-bearing computed tomography (WBCT), which provides superior three-dimensional insights compared to traditional radiographs. The central research question was: How is M1 rotation related to alterations in arch angles in PCFD and to sesamoid malposition, and is it independent?

METHODS: A retrospective analysis was conducted on WBCT scans from 22 patients (aged 18-65) with symptomatic PCFD, collected between 2023 and 2025. Inclusion required arch angle > 131°; exclusions included prior surgery or systemic conditions. Scans used a cone-beam system (96 kV, 7.5 mAs, 0.4 mm slices) in bipedal stance. Two observers measured: forefoot arch angle (FAA) for PCFD severity, alpha angle for metatarsal rotation, HVA via axial axes, and sesamoid displacement graded as 0-3 on axial views. Inter-observer reliability was assessed with intraclass correlation coefficients (ICC > 0.8). Spearman's correlations evaluated relationships, with p < 0.05 significant, using SPSS.

RESULTS: Analysis revealed a strong positive correlation between increased arch angle and increased first metatarsal rotation (r = 0.72, p < 0.01), strong positive correlation between greater arch angle and HVA (r = 0.67, p < 0.01), and moderate positive correlation between greater M1 rotation and sesamoid bone displacement (r = 0.5, p < 0,01). No correlation was found between HVA and metatarsal rotation (r = 0.1, p > 0,01).

CONCLUSION: PCFD is strongly associated with hallux valgus deformity and first metatarsal rotation, which is closely linked to sesamoid displacement. Metatarsal rotation appears to be an independent and likely early component of HV deformity, related to foot pronation and sesamoid malposition, and should be specifically evaluated and addressed in both diagnosis and treatment. No significant association exists between hallux valgus angle and metatarsal rotation. Additionally, hallux valgus deformity is associated with increased arch angle, which should be considered in the management of both conditions.

PMID:41741891 | DOI:10.1007/s00264-026-06760-z

J Bone Joint Surg Am. 2026 Feb 24. doi: 10.2106/JBJS.25.00867. Online ahead of print.

ABSTRACT

BACKGROUND: Humeral shaft fractures commonly affect working-age adults and can lead to prolonged work absence and substantial economic burden. Although surgical fixation and functional bracing offer comparable functional outcomes, their relative cost-effectiveness remains unclear.

METHODS: We conducted a prespecified economic evaluation alongside a multicenter, superiority, randomized clinical trial at 2 Finnish university hospitals between 2012 and 2018. Eighty-two adults (mean age, 48.9 years; 38 women) with displaced, closed humeral shaft fractures were randomly assigned to surgical fixation (n = 38) or functional bracing (n = 44) and followed for 2 years. The primary outcome was the incremental net monetary benefit (INMB) based on quality-adjusted life years (QALYs) measured with the 15-dimensional (15D) instrument, analyzed from both societal and health-care perspectives.

RESULTS: From a societal perspective, surgical treatment was both more effective and less costly than bracing. The mean total cost per patient was €23,680 for surgery and €30,389 for bracing, yielding an INMB of €9,423 (95% confidence interval [CI], €4,139 to €14,609). Cost-effectiveness acceptability curves showed that surgery was highly likely to be cost-effective across all willingness-to-pay thresholds up to €120,000 per QALY. The cumulative QALYs from 6 weeks to 2 years post-injury were 1.776 (95% CI, 1.725 to 1.827) for surgery and 1.705 (95% CI, 1.641 to 1.769) for bracing, corresponding to a QALY difference of 0.071 (95% CI, 0.012 to 0.130) in favor of surgery. From the health-care perspective, functional bracing was less costly (€4,904 versus €10,967) and therefore more cost-effective, with an INMB of -€4,087 (95% CI, -€5,215 to -€3,054). When considering only direct medical costs, surgery was unlikely to be cost-effective at thresholds below €80,000 per QALY, reaching a 75% probability of cost-effectiveness only at €120,000 per QALY.

CONCLUSIONS: Surgery is cost-effective when societal costs are considered. Functional bracing remains a reasonable option, particularly for patients less affected by time away from work. Shared decision-making should incorporate both economic and individual patient factors.

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

PMID:41734249 | DOI:10.2106/JBJS.25.00867

Int Orthop. 2026 Feb 25. doi: 10.1007/s00264-026-06759-6. Online ahead of print.

ABSTRACT

BACKGROUND: While curved intertrochanteric varus osteotomy is an effective treatment for osteonecrosis of the femoral head, whether this procedure is applicable to bilateral cases remains unclear. The aim of this study was to compare the clinical outcomes of bilateral curved intertrochanteric varus osteotomy and unilateral curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head.

METHODS: This comparative study included 60 patients with osteonecrosis of the femoral head; 15 (30 hips) underwent bilateral curved intertrochanteric varus osteotomy (bilateral group) and 45 (45 hips) underwent unilateral curved intertrochanteric varus osteotomy (unilateral group). Patients in the bilateral group were followed up for a mean of 8.0 years, whereas those in the unilateral group were followed-up for a mean of 8.2 years. The Harris Hip Score, complication rates, radiographic parameters, and survival rates were assessed. Conversion to total hip arthroplasty and radiographic failure were the endpoints.

RESULTS: The postoperative Harris Hip Score was significantly lower in the bilateral group than in the unilateral group. Complication rates and radiographic parameters were not significantly different between the groups. Ten-year survival rates, with conversion to total hip arthroplasty and radiographic failure as endpoints, did not differ significantly between the groups. In bilateral curved intertrochanteric varus osteotomy, the survival rate, with radiographic failure as the endpoint, tended to be poorer on the contralateral side than on the initial side.

CONCLUSION: The clinical outcomes of bilateral curved intertrochanteric varus osteotomy were not necessarily favorable. When planning for bilateral curved intertrochanteric varus osteotomy, surgeons should ensure that the contralateral hip could undergo surgical intervention timeously.

PMID:41735567 | DOI:10.1007/s00264-026-06759-6

SICOT J. 2026;12:9. doi: 10.1051/sicotj/2025069. Epub 2026 Feb 23.

ABSTRACT

BACKGROUND: Stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are commonly treated with partial arthrodeses or motion-preserving techniques such as midcarpal tenodeses. Comparative evidence with long-term follow-up remains limited.

PURPOSE: To compare long-term clinical and functional outcomes of midcarpal tenodeses and partial arthrodeses in patients with stage II SLAC/SNAC, by evaluating grip strength, range of motion, patient-reported outcomes, and reoperation rates.

METHODS: A retrospective review was performed on 21 patients operated by a single surgeon with a mean follow-up of 103 months. Nine underwent midcarpal tenodeses (FCR or ECRB based), and twelve underwent partial arthrodeses (four-corner fusion or capitolunate fusion). Outcomes included grip strength, range of motion, radiographs, and PROMs (VAS, DASH, PRWE, Mayo Wrist Score).

RESULTS: Both procedures produced comparable long-term outcomes. Mean postoperative grip strength was 27.9 kg (~75% of the contralateral side). PROMs were similar between groups (DASH 12.1, PRWE 15.5). Importantly, no complications, non-unions, or conversions to salvage arthrodesis occurred in either group during long-term follow-up.

CONCLUSION: Midcarpal tenodeses and partial arthrodeses yield similarly durable outcomes in stage II SLAC/SNAC wrists. Tenodeses preserve motion and are suitable for patients with preserved cartilage, whereas partial arthrodeses offer predictable stability when midcarpal degeneration is present. Treatment should be individualized according to cartilage status, functional demands, and patient expectations.

PMID:41728890 | PMC:PMC12927466 | DOI:10.1051/sicotj/2025069

J Bone Joint Surg Am. 2026 Feb 23. doi: 10.2106/JBJS.25.01094. Online ahead of print.

ABSTRACT

BACKGROUND: Sarcopenia, characterized by the progressive loss of skeletal muscle mass and strength, is associated with adverse outcomes, including increased postoperative complications in patients with orthopaedic conditions. Although computed tomography (CT) and magnetic resonance imaging (MRI) remain the gold-standard modalities for assessing sarcopenia, their cost, radiation exposure, and limited availability restrict widespread screening. This study investigated the potential of lumbar spine radiographs as a practical alternative for sarcopenia screening.

METHODS: We retrospectively reviewed data of patients who underwent surgery for degenerative lumbar spine diseases at our hospital's Department of Orthopedic Surgery between June 2013 and April 2024 and had both preoperative standing lumbar spine radiographs and supine CT scans. Demographic variables (age and sex) were collected. The psoas muscle width at the caudal end plate of L3 was measured on anteroposterior lumbar spine radiographs and was compared with CT-based cross-sectional psoas muscle area. Sarcopenia was defined on the basis of previously established psoas muscle index thresholds. Interobserver reliability was assessed with the intraclass correlation coefficient (ICC), and correlation analyses, multivariable regression, and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS: There were 305 patients (177 male patients [58.0%], with a median age of 71.7 years; and 128 female patients [42.0%], with a median age of 69.8 years; all ethnic Japanese) included in the analysis. Of these 305 patients, 114 (37.4%) were classified as having sarcopenia (78 male patients and 36 female patients). Radiographic psoas muscle width demonstrated excellent interobserver reliability (ICC, 0.94) and strongly correlated with the CT-measured psoas muscle area (male patients, r = 0.71; female patients, r = 0.64; both p < 0.001). Multivariable analysis identified the psoas width as a significant predictor of the psoas muscle area. ROC curve analysis revealed that optimal cutoff values for sarcopenia screening were 118.8 mm (area under the curve [AUC], 0.847) for male patients and 99.9 mm (AUC, 0.777) for female patients.

CONCLUSIONS: Radiographic psoas muscle width measurement is a simple and reliable method for sarcopenia screening that may facilitate early sarcopenia identification, enabling timely interventions and improving surgical outcome predictions. Lumbar spine radiographs hold potential as a novel screening tool for sarcopenia beyond their conventional diagnostic role.

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

PMID:41730017 | DOI:10.2106/JBJS.25.01094

Int Orthop. 2026 Feb 24. doi: 10.1007/s00264-026-06762-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the incidence, magnitude, and risk factors for secondary angular deformity after tibial lengthening with a circular external fixator in skeletally immature patients. We hypothesized that younger age and low bone healing index would predispose to late valgus drift.

METHODS: A retrospective review was conducted on 98 children who underwent tibial lengthening using a circular external fixator, with a minimum follow-up of one year. Radiographic assessment included full-length standing AP radiographs and lateral tibial views obtained preoperatively, at fixator removal, six months post-removal, and at final follow-up. Measured parameters included the mechanical Medial Proximal Tibial Angle, Center of Rotation of Angulation, and Posterior Proximal Tibial Angle. Risk factors for secondary deformity were analyzed using independent T test, Chi-Square test, Pearson test and multivariate logistic regression.

RESULTS: A valgus deformity greater than 3° developed in 36 patients (37%), primarily within the first six months after frame removal. Younger age at surgery (p = 0.017) and a bone healing index ≤ 40 days/cm (OR 2.3; p = 0.049) were significantly associated with valgus drift. A progressive valgus shift in CORA correlated with a shorter consolidation index (p = 0.021). Sagittal alignment showed a small but significant early decrease.

CONCLUSION: Secondary valgus deformity is a common and under-recognized complication following tibial lengthening with a circular external fixator in skeletally immature patients. Younger age at surgery and low bone healing index are the principal risk factors for this late angular drift. Furthermore, they question the efficacy of intentional frontal overcorrection to reliably prevent secondary deformity and suggest that additional corrective strategies may be required.

PMID:41731236 | DOI:10.1007/s00264-026-06762-x