Injury. 2025 May 22;56(8):112452. doi: 10.1016/j.injury.2025.112452. Online ahead of print.

ABSTRACT

BACKGROUND: Fracture healing is a complex biological process involving multiple cellular and molecular mechanisms. Despite advances in understanding, the molecular regulation of bone regeneration remains incompletely understood. MicroRNAs (miRNAs) are emerging as critical post-transcriptional regulators of gene expression, with growing evidence suggesting their roles in osteogenesis and fracture repair. This study investigates the role of miRNA-130b in fracture healing and its molecular mechanisms, particularly focusing on its interaction with phosphatase and tensin homolog (PTEN) and the Wnt/β-catenin signaling pathway.

METHODS: Bone marrow mesenchymal stem cells (BMSCs) were isolated from rats and transfected with miRNA-130b mimic, inhibitor, or siPTEN. Osteogenic differentiation was assessed via alkaline phosphatase (ALP) activity, alizarin red S staining, and scratch wound healing assays. Pathway activation was evaluated using qRT-PCR and Western blotting. A rat tibial fracture model was established, and miRNA-130b mimic was administered intraperitoneally. Fracture healing was assessed via radiography, histology, and biomechanical testing at 2, 4, and 6 weeks post-surgery.

RESULTS: MiRNA-130b overexpression enhanced BMSC proliferation, migration, and osteogenic differentiation by directly targeting PTEN and activating the Wnt/β-catenin signaling pathway. Conversely, miRNA-130b inhibition reduced osteogenic activity. MiRNA-130b mimic accelerated fracture healing, as evidenced by improved callus formation, enhanced bone mineralization, and superior biomechanical properties compared to control groups.

CONCLUSION: miRNA-130b promotes osteogenesis and fracture healing by targeting PTEN and activating the Wnt/β-catenin signaling pathway. These findings highlight miRNA-130b as a promising therapeutic target for improving fracture repair outcomes.

PMID:40479940 | DOI:10.1016/j.injury.2025.112452

Injury. 2025 May 30;56(8):112468. doi: 10.1016/j.injury.2025.112468. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify platelet hypofunction and its associations in severely injured trauma patients presenting with haemorrhage.

DESIGN: Planned sub-study of data collected from the FEISTY trial; an Australian multicentre, randomised controlled pilot trial investigating early fibrinogen replacement in severely injured trauma patients.

SETTING: Four major trauma centres in Queensland, Australia.

PARTICIPANTS: Adult trauma patients (age ≥18 years) presenting with clinically significant haemorrhage or potential for significant transfusion requirements.

MAIN OUTCOME MEASURES: Platelet function parameters arachidonic acid (ASPI), adenosine diphosphate (ADP), and thrombin receptor-activating peptide (TRAP) assessed via Multiplate® analysis, rotational thromboelastometry (ROTEM®) parameters EXTEM, FIBTEM, and PLTEM (EXTEM - FIBTEM), transfusion requirements, and clinical outcomes.

RESULTS: Significant platelet hypofunction was detected in this cohort of severely injured trauma patients at time of presentation, with 70 % of patients having hypofunction in at least one Multiplate® channel. The median ASPI area under the curve and 95 % confidence interval were below the lower reference range, indicating this population had reduced platelet function. In patients with deranged platelet function, significantly lower platelet count (p ≤ 0.001), EXTEM amplitude at five minutes (A5) and maximum clot firmness (MCF) (p = 0.001, p ≤ 0.001), and PLTEM A5 and MCF (p = 0.005, p = 0.003) were identified compared to patients with normal platelet function. A significant improvement in platelet function parameters was not observed following platelet transfusion.

CONCLUSION: Platelet hypofunction is common in severely injured trauma patients. This was true both before and after platelet transfusion, suggesting trauma precipitates alteration of the vascular circulating milieu in a way that impairs platelet function. Characterisation of this change might lead to targeted interventions to improve haemostasis.

PMID:40479939 | DOI:10.1016/j.injury.2025.112468

J Bone Joint Surg Am. 2025 Jun 6. doi: 10.2106/JBJS.24.00866. Online ahead of print.

ABSTRACT

BACKGROUND: The aging-related escalation of muscle degeneration impacts the structure and function of rotator cuff muscles, contributing to spontaneous and tear-induced muscle atrophy. This study investigated how prostaglandin E2 (PGE2), a regulator of muscle regeneration, influences muscular structure and mitochondrial function in aged mice by using SW033291 to inhibit PGE2 degradation, revealing potential therapeutic pathways for mitigating rotator cuff muscle deterioration.

METHODS: A total of 20 young (5 to 6-month-old) and 100 aged (18 to 20-month-old) female C57BL/6J mice were divided into 2 groups: the first group included young, aged, and aged+SW033291 subgroups and was used to study sarcopenia, and the second group consisted of tear, tear+repair, and tear+repair+SW033291 subgroups and was used to examine the outcomes following a rotator cuff tear (RCT). Tissue staining, muscle mass assessments, functional assays, and mitochondrial function tests were performed.

RESULTS: Rotator cuff muscle degeneration was observed in the setting of natural aging and in the setting of an RCT. These conditions together worsened muscle atrophy and fatty infiltration into the muscle, with the aged tear group demonstrating a decrease in muscle mass from a mean and standard deviation of 45.45 ± 4.04 to 25.18 ± 1.82 mg (p < 0.001) and a reduction in fiber cross-sectional area (CSA) from 1,697.3 ± 108.4 to 1,263.0 ± 56.8 μm2 (p < 0.001). This was linked to increased 15-prostaglandin dehydrogenase (15-PGDH) activity and a reduction in PGE2 levels in the aged tear group (from 2.897 ± 0.177 to 1.873 ± 0.179 ng/g muscle; p < 0.001). SW033291 treatment increased the level of PGE2, reversing muscle atrophy by mitigating mitochondrial dysfunction in both models, as demonstrated by a muscle mass of 33.50 ± 3.05 mg and a CSA of 1,423.6 ± 81.3 μm2 in the presence of both conditions.

CONCLUSIONS: These findings support the hypothesis that elevated PGE2 levels can improve muscle health by reversing mitochondrial dysfunction, offering a strategy to combat sarcopenia and to enhance rotator cuff repair.

CLINICAL RELEVANCE: Large or massive RCTs are associated with muscle atrophy, a higher retear rate, and suboptimal surgical outcomes, especially in elderly patients. This study showed that the occurrence of rotator cuff muscle degeneration and muscular mitochondrial dysfunction in both the natural aging and RCT mouse models was mitigated by enhanced PGE2 levels. This finding demonstrates the efficacy of the application of a 15-PGDH inhibitor and suggests a possible new therapeutic approach.

PMID:40479501 | DOI:10.2106/JBJS.24.00866

Injury. 2025 May 23;56(8):112372. doi: 10.1016/j.injury.2025.112372. Online ahead of print.

ABSTRACT

OBJECTIVES: Tibial non-unions have always been extremely difficult to manage for surgeons. This problem becomes all the more compounded in presence of infection and/or bone loss [1-6] The purpose of this study is to evaluate the management of bone loss of 4 to10cm in patients presenting with tibia non unions through monitored acute shortening and subsequent lengthening using Ilizarov ring fixator METHOD: The present study was carried out in the Department of Orthopaedics, R.D. Gardi Medical College, Ujjain. Madhya Pradesh. The study was carried out between August 2019 to August 2024. A total of 15 adult patients with tibia shaft non union with bone gap of 4 - 10 cm were included in the study. All the patients were operated by the same surgeon with the help of ilizarov ring fixator method RESULT: All patients in the present study had fracture union after primary surgery. Bone gap closure and compression at the fracture ends was achieved by one week postoperatively. There was no recurrence of deep infection nor the procedure was associated with any neurovascular complications.

CONCLUSION: With the use of our Monitored Acute Shortening and Lengthening method we were able to manage tibia non unions with Bone gaps ranging from 4 - 10 cm through Ilizarov ring fixator by utilization of natural bone healing potential. We were able to achieve union in all our cases without the requirement of any secondary union enhancing surgery.

PMID:40472528 | DOI:10.1016/j.injury.2025.112372

Injury. 2025 May 27;56(8):112460. doi: 10.1016/j.injury.2025.112460. Online ahead of print.

ABSTRACT

INTRODUCTION: Post-traumatic arthritis and avascular necrosis are common sequelae following acetabular fractures, often leading to conversion to total hip arthroplasty (THA). Traditionally, conversions to THA have been performed through posterior or direct lateral approaches, which navigate through scar tissue and previously placed implants. The direct anterior approach (DAA) is increasingly adopted for these conversions, as it accesses a 'virgin' surgical plane, potentially reducing the risks of infection and neurovascular injury. This study aims to compare clinical outcomes and complication rates between the DAA and traditional approaches in conversion THA after acetabular fracture fixation.

MATERIALS AND METHODS: A retrospective review was conducted of acetabular fractures treated at a Level-I trauma center between 2008 and 2021. Patients were grouped by surgical approach (direct anterior (DA), posterior (P), or direct lateral (DL)). The study included patients with a minimum of one-year follow-up. Outcomes measured included Harris Hip Score (HHS), complications necessitating reoperation, infections, blood loss, surgical time, transfusions heterotopic ossification (HO) removal, acetabular implants encountered during reaming, and THA implants used.

RESULTS: Seventy-one patients were included: 30 in the DA group, 28 in the P group, and 13 in the DL group. The mean follow-up time was 51 months. No significant differences in demographics were found. The DA group had significantly higher HHS (90.1) compared to the P (70.5) and DL groups (84.8, p < 0.001). Blood loss was significantly lower in the DA (440 mL) and direct lateral (304 mL) groups compared to the posterior group (547 mL, p = 0.04). The DA group had no infections, the posterior group had 4 infections, and the DL group had one infection (p = 0.10). At final follow-up, the DA and DL groups had significantly higher HHS: 90.1 (DA) and 84.8 (DL) compared to 70.5 (P) (p < 0.001).

CONCLUSION: Conversion THA after acetabular fracture remains a high-risk procedure with significant complication rates. The DAA offers a safe and effective approach, with lower complication rates and superior functional outcomes compared to traditional approaches. This approach may reduce infection rates and neurovascular complications in straightforward cases. For complex cases involving extensive bone loss or acetabular defects, a more extensile approach may be necessary.

PMID:40472527 | DOI:10.1016/j.injury.2025.112460

Injury. 2025 May 28;56(8):112463. doi: 10.1016/j.injury.2025.112463. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to report on the frequency and correlates of serious unintentional physical injury (SPI), road traffic injury, and near drowning experience as well as the mediation of exposure to interpersonal violence in the relationship between substance use and SPI among adolescents in Philippines in 2019.

METHOD: The 2019 Philippines Global School-based Student Health Survey (GSHS), a nationally representative survey of teenagers aged 11 to 18 (mean age 13.8 years, Standard Deviation-SD=1.5) that used a multistage sampling technique, provided the study's data. In order to determine the variables associated with past 12-month SPI, road traffic injury and near drowning experience, the study used bivariate and multivariable logistic regression analysis as well as causal mediation of interpersonal violence exposure in the relationship between substance use and SPI.

RESULTS: Regression results showed that male sex, food insecurity, psychological distress, suicide attempt, current drug use, bullying victimization, current alcohol use, and school truancy were positively associated with SPI and road traffic injury. Furthermore, soft drink intake, and fast-food consumption were positively associated, and being 15 to 18 years-old and higher parental support were negatively associated with SPI and with near drowning experience, and not aways wearing a seatbelt was associated with road traffic injury. In addition, being religious or spiritual, psychological distress, suicide attempt, current drug use, bullying victimization, and current alcohol use were associated with near drowning experience. Causal mediation analyses found a significant indirect effect of substance use (explaining 5.9 %) on serious injury count via types of bullied, a significant indirect effect of substance use (explaining 42.8 %) on serious injury count via physically attacked counts, and a significant indirect effect of substance use (explaining 54.5 %) on serious injury count via in physical fights counts.

CONCLUSION: Almost half of participants had a SPI and more than one in three had experienced near drowning. Various sociodemographic, protective, and psychosocial associated factors were identified, which can assist in targeting injury prevention among adolescents in the Philippines.

PMID:40472526 | DOI:10.1016/j.injury.2025.112463

J Bone Joint Surg Am. 2025 Jun 5. doi: 10.2106/JBJS.24.01480. Online ahead of print.

ABSTRACT

BACKGROUND: The management of distal radial fractures (DRFs) in elderly patients remains controversial. Although conservative treatment with cast immobilization is widely accepted, the optimal duration for immobilization is unclear. This study aimed to compare pain control, functional outcomes, and complication rates between 4-week and 6-week immobilization periods in elderly patients treated nonoperatively for displaced DRFs.

METHODS: A single-center randomized controlled trial was conducted, including 150 patients who were ≥65 years of age and had displaced DRFs. Patients were randomized into 2 groups: 4-week immobilization and 6-week immobilization. Pain was assessed using a visual analog scale (VAS) at 10 days after removing the cast and then at 3, 6, and 12 months after injury. Functional outcomes were measured using the Patient-Rated Wrist Evaluation (PRWE) and QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) at 3, 6, and 12 months. Radiographs were reviewed for malunion, and complications and range of motion were also evaluated.

RESULTS: In the 135 patients analyzed, no differences were observed in pain or functional outcomes between the 2 groups at any time point. VAS scores 10 days after the cast removal were similar (3.87 for the 4-week immobilization group and 4.00 for the 6-week group; p = 0.67), as were PRWE scores (14.18 for the 4-week group and 15.51 for the 6-week group; p = 0.686) and QuickDASH scores (15.46 for the 4-week group and 17.86 for the 6-week group; p = 0.449) after 1 year. The malunion rates were 29.9% in the 4-week group and 32.8% in the 6-week group (p = 0.85), and there were no significant differences in complications or range of motion between groups.

CONCLUSIONS: A 4-week immobilization period provided equivalent pain control, functional outcomes, and complication rates as a 6-week immobilization period in elderly patients with displaced DRFs treated nonoperatively. Therefore, a shorter immobilization period may be safely recommended for treating these fractures.

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

PMID:40472139 | DOI:10.2106/JBJS.24.01480

Injury. 2025 May 27;56(8):112459. doi: 10.1016/j.injury.2025.112459. Online ahead of print.

ABSTRACT

INTRODUCTION: The gull sign, representing superomedial dome impaction in acetabular fractures, was first described approximately 20 years ago by Anglen and co-workers. They concluded that this sign equates with poor outcomes after open reduction and internal fixation (ORIF), terming it a "harbinger for failure". Since then, the presence of the gull sign has frequently influenced surgical decision-making in geriatric acetabular fractures. The aim of this radiological descriptive study was to revisit the accuracy of the gull sign seen on pelvic radiographs in predicting dome impaction on computed tomography (CT).

PATIENTS AND METHODS: In a retrospective study, conventional pelvic radiographs and CT scans of n = 201 patients (mean age±SD: 68±17y, 75 % male) with acetabular fractures treated surgically between 2009 and 2020 were analyzed. The presence of the gull sign was assessed on anteroposterior pelvic radiographs. CT scans were assessed for true impaction ("brick sign") with focus on the acetabular surface and compared to the findings according to Anglen`s description.

RESULTS: The gull sign was noted on pelvic radiographs in 49 of 201 cases (24 %). In 28 out of these 49 cases (57 %) a dome impaction was noted on CT. In the remaining 21 cases (43 %), CT revealed no actual impaction but rather an elevated dome following displaced fracture fragments. Conversely, among the 152 patients (76 %) without a gull sign, CT identified previously undetected dome impactions in 41 cases. Overall, the gull sign had a sensitivity of 41 %, a specificity of 84 %, and a positive predictive value of 57 % for detecting dome impactions.

CONCLUSION: The gull sign is an unreliable predictor for dome impaction in acetabular fractures for the following reasons: in the presence of the gull sign nearly half of the cases an elevated fragment only (not an impacted fragment) was noted on CT; despite an absence of the gull sign in nearly one-third of these cases dome impactions ("brick sign") were present on CT. Consequently, routine preoperative CT imaging is essential to accurately differentiate true dome impactions ("brick sign") from dome elevation, thereby guiding appropriate surgical decision-making between "disimpaction versus reduction" and in general between the "fix or replace" debate.

PMID:40466585 | DOI:10.1016/j.injury.2025.112459

Injury. 2025 Jun 3;56(8):112461. doi: 10.1016/j.injury.2025.112461. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic acetabular fractures (PPAF) are a rare and serious complication in hip arthroplasty. The increase in the number of hip arthroplasty patients and the long service life of implants are leading to a rise in periprosthetic fractures.

PURPOSE: We hypothesized (1) that modified Stoppa approach in Combination with direct anterior approach of PPAF leads to good patient outcomes in both patients with and without acetabular cup instability; (2) the complication rate of our combined surgical procedures is lower than reported in the literature; (3) that combined surgical procedures for PPAF have a low 1-year mortality.

METHODS: A retrospective analysis was performed from January 2013 to February 2024. Patients were treated with osteosynthesis using the modified Stoppa approach and revision of the cup using the direct anterior approach (DAA). Mobility before and after surgical treatment, modified Harris Hip Score (mHHS), complications, revision rates, and 1-year mortality were recorded using a questionnaire.

RESULTS: A total of 24 PPAF were identified, of which 18 patients were included in this study. Of 18 PPAF that were treated interdisciplinary by the trauma and orthopedic department, 13 cases showed cup instability. Fifty percent of the patients achieved a satisfactory result after mHHS, however, with a mean mHHS of 57±30, showing a wide range between good and poor outcomes. 13 (61.1 %) patients reported the same mobility postoperatively as prior to fracture. The complication and revision rates were 16.6 % and 5.6 %, respectively, which is below the rates reported in the literature. The 1-year mortality rate was 33.3 %.

CONCLUSION: Combined surgery showed low perioperative complication and revision rates. However, a 1/3 mortality rate at 1 year is quite high, which is likely a reflection of these patients' fragility and co-morbidities. Furthermore, there is no advantage for the functional outcome according to the mHHS.

PMID:40466584 | DOI:10.1016/j.injury.2025.112461

J Bone Joint Surg Am. 2025 Jun 4. doi: 10.2106/JBJS.24.00842. Online ahead of print.

ABSTRACT

BACKGROUND: Surgeons often lack objective data on patient functional outcomes, particularly as compared with the patient's baseline. The present study aimed to determine whether gait parameters recorded on Apple iPhones provided longitudinal mobility data following lower-extremity fracture surgery that matched clinical expectations. We hypothesized that iPhones would detect the mobility changes of injury and early recovery, correlate with patient-reported outcome measures, and differentiate nonunion.

METHODS: This cross-sectional study included 107 adult patients with lower-extremity fractures who owned iPhones and had at least 6 months of follow-up. Participants shared Apple Health data and completed Patient Reported Outcomes Measurement Information System (PROMIS) surveys. The primary outcome was the daily step count. Four other gait-related parameters were analyzed: walking asymmetry, double support, walking speed, and step length. Mixed-effects models compared mobility parameters at pre-injury, immediate post-injury, and 6-months post-injury time points. Correlations between mobility parameters and PROMIS surveys were assessed. A mixed-effect model evaluated the relationship between step count recovery and surgery for nonunion.

RESULTS: There was a 93% reduction in daily step count from the pre-injury period to the immediate post-injury period (95% confidence interval [CI], -94% to -93%). Other gait parameters also showed increased impairment from pre-injury to post-injury. At 6 months, step count improved sixfold relative to the immediate post-injury period but remained 52% below baseline (95% CI, -55% to -49%). PROMIS Physical Function correlated moderately with step count (r = 0.42; 95% CI, 0.25 to 0.57) and weakly with other gait parameters. Patients with a known nonunion had a 55% slower recovery of step count than those without a nonunion (95% CI: 44% to 66%).

CONCLUSIONS: Apple Health mobility parameters captured changes in mobility following lower-extremity fracture and throughout the subsequent recovery period. These metrics distinguished between patients with and without nonunions, demonstrating their potential usefulness as objective, real-world functional outcome measures. These "digital biomarkers" may aid clinical decision-making and research and could be utilized for the early identification of patients at risk for poor outcomes.

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

PMID:40465739 | DOI:10.2106/JBJS.24.00842

J Bone Joint Surg Am. 2025 Jun 4. doi: 10.2106/JBJS.25.00203. Online ahead of print.

NO ABSTRACT

PMID:40465698 | DOI:10.2106/JBJS.25.00203

J Bone Joint Surg Am. 2025 Jun 4;107(11):1289. doi: 10.2106/JBJS.25.00216. Epub 2025 Jun 4.

NO ABSTRACT

PMID:40464759 | DOI:10.2106/JBJS.25.00216

J Bone Joint Surg Am. 2025 Jun 4;107(11):1289. doi: 10.2106/JBJS.24.01638. Epub 2025 Jun 4.

NO ABSTRACT

PMID:40464758 | DOI:10.2106/JBJS.24.01638

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06569-2. Online ahead of print.

ABSTRACT

BACKGROUND: Management of Open tibia shaft fractures utilizing the conventional protocol is usually cumbersome; involves several operative procedures and longer periods of hospitalization. The use of external fixators for the definitive management of open tibia shaft fractures has been promising. The Ilizarov frame and linear rail system (LRS) are the commonly used options since they are comparable in efficacy and adaptable in the management of open tibia shaft fractures. The study objective is to determine and compare for any significant difference in the mean radiological union time, union rate, bone outcomes and functional outcomes noted in the management of patients with open tibia shaft fractures using Ilizarov frame fixator and linear rail system (LRS) in Ibadan, Nigeria.

RESEARCH METHOD: This is a prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class (GA II- IIIB). The radiological union time was derived from the length of time in the fixator during which radiological union was confirmed, while the bone and functional outcomes were assessed using the ASAMI criteria.

RESULT: Union was achieved in 27 participants while three (2 in LRS group and 1 in Ilizarov group) had non-union. The union rate was 86.7% for the LRS group and 93.3% for the Ilizarov group. The mean radiological union time was 6.5 ± 1.8 months in the LRS group and 6.4 ± 2.1 months in the Ilizarov group. The bone outcomes showed that in the LRS group, 66.7% had excellent, 20% had good and 13.3% had poor outcomes while the Ilizarov group had 53.3% excellent, 40% good and 6.7% poor outcomes. The functional outcome showed that in the LRS group 53.3% had excellent, 40% good and 6.7% fair outcomes while in the Ilizarov group, 40% excellent, 46,7% good and 13.3% fair outcomes. There is no significant difference noted in the mean radiological union time, union rate, bone and functional outcomes in the management of these open tibia shaft fractures using the two fixators under review.

CONCLUSION: The study has re-iterated the fact that the Ilizarov frame fixator and the LRS are quite versatile tools in the armamentarium of the orthopaedic surgeon for managing open tibia shaft fractures.

PMID:40464907 | DOI:10.1007/s00264-025-06569-2

EFORT Open Rev. 2025 Jun 2;10(6):345-351. doi: 10.1530/EOR-2025-0069.

ABSTRACT

Orthobiologics (OBs) have seen a constant increase in the number of available therapies and their clinical applications. Existing therapies can be categorized into blood-based (e.g., platelet-rich plasma (PRP)) and tissue/cell-based (e.g. mesenchymal stromal cells) approaches. While the popularity of OBs continues to grow, their diverse natures create unique challenges for the establishment of evidence-based guidelines. PRP has been reported by meta-analyses to increase patient-reported outcomes for conditions such as knee osteoarthritis (KOA), lateral epicondylitis and plantar fasciitis. However, the randomized controlled trials (RCTs) included often exhibit a high risk of bias due to the heterogeneity in the PRP preparation protocols and accompanying measures as well as inconsistent trial quality. The development pipeline of cell/tissue-based therapies is typically longer and more cost-intensive than that of blood-based therapies. Nevertheless, several products have demonstrated clinical safety. While some RCTs and meta-analyses on the outcome of cell/tissue-based therapies exist, their number is considerably lower than that of blood-based therapies and they focus mainly on KOA, with limited evidence on other orthopedic indications. Orthopedic societies such as ESSKA and AAOS have taken on the challenge of developing guidelines for OBs by combining high-level synthesized evidence with expert consensus. Patient stratification strategies represent a promising key to unlocking the full potential of OBs and are currently being investigated in ongoing studies. Further efforts to establish guidelines for the use of OBs should focus on developing frameworks for clinical trials and their reporting, alongside standardized protocols for the preparation, application and accompanying measures of OB therapies.

PMID:40459170 | PMC:PMC12139597 | DOI:10.1530/EOR-2025-0069

EFORT Open Rev. 2025 Jun 2;10(6):396-402. doi: 10.1530/EOR-2025-0052.

ABSTRACT

Shoulder arthroplasty is increasingly utilised among patients under 55 years of age due to rising incidences of traumatic injuries, inflammatory arthritis, avascular necrosis, degenerative joint diseases and heightened participation in demanding sports and occupational activities. Anatomic shoulder arthroplasty (ASA) remains the preferred surgical option for younger patients with intact rotator cuffs and minimal glenoid deformities, preserving natural biomechanics, strength and range of motion, and demonstrating high long-term implant survival rates at 10-15 years. Despite favourable outcomes, ASA carries potential long-term risks including implant wear, prosthetic loosening, glenoid erosion and progressive rotator cuff degeneration, particularly relevant for physically active younger patients. Reverse shoulder arthroplasty (RSA) offers a valuable alternative in complex clinical scenarios characterised by irreparable rotator cuff tears, extensive glenoid bone loss, severe anatomical disruption or previous surgical failures. RSA can be used as an alternative to ASR for primary osteoarthritis and an intact rotator cuff, with excellent clinical outcomes and survivorship in patients over 60. RSA is also being used successfully in patients under the age of 55 with excellent short-term results. There remain concerns regarding the longevity and reliability of RSA in younger, highly active individuals. ASA can be revised to RSA with good clinical outcomes, while failure of RSA is extremely challenging to address. If we accept that ASA will fail with time, then the primary ASA should allow for ease of revision to an RSA. Recent advances in modular prosthetic designs facilitate simpler revisions from ASA to RSA.

PMID:40459169 | PMC:PMC12139712 | DOI:10.1530/EOR-2025-0052

EFORT Open Rev. 2025 Jun 2;10(6):424-430. doi: 10.1530/EOR-2025-0055.

ABSTRACT

Crush injury arises from prolonged external force on soft tissues, resulting in muscle necrosis and systemic manifestations known as crush syndrome. Pathophysiology involves ischemia, reperfusion injury and the release of toxic metabolites, which lead to rhabdomyolysis, electrolyte imbalances, acute kidney injury and potential multi-organ failure. Early management emphasizes aggressive fluid resuscitation, urine alkalinization and electrolyte correction to avert life-threatening hyperkalemia and renal impairment. Controversies include the use of mannitol, indications for fasciotomy and optimal dialysis timing. Each must be individualized according to patient status and resource availability. Emerging therapies focus on addressing inflammation and oxidative stress, aiming to transition from largely supportive care to more causative interventions. Despite medical advances, prompt recognition, coordinated multidisciplinary care and proactive measures remain vital to reducing morbidity and mortality in crush syndrome, especially in disaster settings.

PMID:40459168 | PMC:PMC12139709 | DOI:10.1530/EOR-2025-0055

EFORT Open Rev. 2025 Jun 2;10(6):352-360. doi: 10.1530/EOR-2025-0058.

ABSTRACT

Surgical decompression of carpal tunnel syndrome is usually successful, and failure is rare. Diagnosis of persistent or recurrent carpal tunnel syndrome is based on thorough anamnesis and clinical examination, defining underlying comorbidities, nerve conduction studies and distinguish recurrent, persistent or new complaints. Management of failed carpal tunnel release may require revision surgery, which includes redo release of the transversal carpal ligament, external neurolysis and flaps. A hypothenar fat pad flap or other local, regional or distant flaps may be added to a redo release of the carpal tunnel. Currently, convincing evidence to superiority of additional flap surgery is lacking. Postoperative care is evolving toward early motion rather than immobilization, with nerve gliding exercises to prevent adhesions and promote nerve recovery. Virtual reality was recently added to postoperative protocol options.

PMID:40459165 | PMC:PMC12139599 | DOI:10.1530/EOR-2025-0058

EFORT Open Rev. 2025 Jun 2;10(6):431-438. doi: 10.1530/EOR-2025-0054.

ABSTRACT

Psychological consequences of trauma: Acute stress reactions and post-traumatic stress disorder are common psychological conditions that affect the healing process. Early interventions: Psychological first aid and psychoeducation are evidence-based approaches aimed at mitigating post-traumatic symptoms. Social support: It plays a central role in psychological stabilisation and promotion of functional recovery. Multidisciplinary approaches: Cooperation between orthopaedists, psychologists and social workers is crucial for optimal treatment results. Challenges in clinical practice: Limited time, stigmatisation of mental illness and inadequate resources are common barriers to effective care.

PMID:40459162 | PMC:PMC12139708 | DOI:10.1530/EOR-2025-0054

EFORT Open Rev. 2025 Jun 2;10(6):361-368. doi: 10.1530/EOR-2025-0053.

ABSTRACT

The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle. The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem. The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region. Only two stems have been validated with this technique: the Charnley-Kerboull (CK) and the Ceraver Osteal stem, both of which are collared. This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used). A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence. Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.

PMID:40459160 | PMC:PMC12139596 | DOI:10.1530/EOR-2025-0053