Feed aggregator

Risk factors for elbow stiffness after surgery for AO / OTA type C distal humerus fractures

Injury -

Injury. 2025 Jun 25;56(8):112560. doi: 10.1016/j.injury.2025.112560. Online ahead of print.

ABSTRACT

OBJECTIVE: The aim of this study is to identify risk factors for elbow stiffness following surgery for AO/OTA type C distal humerus fractures with a follow-up investigation.

METHODS: Data were collected from patients who underwent treatment for AO/OTA type C distal humerus fractures between March 2015 and March 2022.The patients were divided into a stiffness group and a control group based on whether their elbow flexion-extension or rotation range of motion was less than 100°at the final follow-up. Univariate analysis and multivariate logistic regression analysis was performed to identify independent risk factors. A nomogram prediction model was then constructed based on the factors identified. Receiver operating characteristic (ROC), calibration curve and decision curve analysis (DCA) were used to evaluate its discriminant and calibration. The subjects were randomly divided into modeling set and validation set according to 7:3, and the model was internally validated by random split validation.

RESULTS: Of the 207 patients, 68 developed elbow stiffness after ORIF for AO/OTA type C distal humerus fracture. Multivariate logistic regression analysis identified age,AO/OTA fracture classification,time from injury to surgery,postoperative professional functional rehabilitation, transverse screw,and modified trochleocapitellar index (mTCI), as independent risk factors for postoperative elbow stiffness (all P < 0.05). The modeling set curve demonstrated an AUC value of 0.877, while the validation set curve showed an AUC of 0.869. The calibration curve of the nomogram closely approximated the diagonal line, and decision curve analysis (DCA) revealed that utilizing the nomogram for prediction yielded greater net benefits within the threshold probability range of 0.3-0.8.

CONCLUSION: Age, AO/OTA type C classification, transverse screw, postoperative professional functional rehabilitation, mTCI and time from injury to surgery were identified as risk factors for postoperative elbow stiffness.

PMID:40617199 | DOI:10.1016/j.injury.2025.112560

Predictive modeling and long-term outcomes in optimizing fusion strategies for congenital scoliosis: a retrospective analysis of posterior hemivertebra resection

International Orthopaedics -

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06595-0. Online ahead of print.

ABSTRACT

PURPOSE: This study compares short-segment (2-level) versus longer-segment (> 2-level) fusion after posterior hemivertebra resection in congenital scoliosis (CS) and identifies preoperative thresholds to guide fusion strategy selection.

METHODS: Eighty-eight CS patients (mean age: 5.42 years) undergoing hemivertebra resection with fusion (31 short-segment [Fused_2], 57 longer-segment [Fused_GT2]) were retrospectively analyzed. Radiographic parameters, complications, and reoperations were assessed. Logistic regression derived predictive thresholds for fusion length.

RESULTS: Both groups achieved comparable initial (~ 77%) and final (~ 61%) main curve correction. The Fused_2 group had shorter operative time (154 vs. 204 min, p < 0.001) and lower blood loss (249 vs. 356 mL, p = 0.011). Reoperation rates (20.5% overall), crankshaft phenomenon (25.0%), and neurological complications (5.7%) did not differ between groups. Preoperative main curve ≤ 41.8° and thoracic kyphosis ≤ 30.2° predicted suitability for 2-segment fusion.

CONCLUSION: Short-segment fusion reduces invasiveness without compromising correction in select CS patients. Preoperative thresholds (main curve ≤ 41.8°, kyphosis ≤ 30.2°) may guide strategy, though individualized assessment remains essential.

PMID:40616658 | DOI:10.1007/s00264-025-06595-0

Efficacy of focused low intensity pulsed ultrasound in reducing lower-extremity swelling and pain after total knee arthroplasty: a randomized study

International Orthopaedics -

Int Orthop. 2025 Jul 5. doi: 10.1007/s00264-025-06601-5. Online ahead of print.

ABSTRACT

PURPOSE: Low-intensity pulsed ultrasound (LIPUS) is a non-invasive physiotherapy that is often utilized to treat swelling and pain caused by musculoskeletal trauma. We aimed to evaluate the efficacy and safety of LIPUS in reducing lower-extremity swelling and pain following total knee arthroplasty (TKA).

METHODS: This randomized, controlled study evaluated 116 patients undergoing primary TKA, randomly assigning them to either an LIPUS group receiving active LIPUS therapy (0.8 MHz, 1.35 W) or a control group receiving sham treatment. The LIPUS intervention was administered to the operated knee for 25-minute sessions, three times daily for three consecutive days, beginning four hours postoperatively. The primary study outcome measured lower extremity swelling during the first 14 postoperative days, while secondary outcomes included knee pain (assessed by visual analogue scale ranging from 0 to 10 points), Hospital for Special Surgery (HSS) score, range of knee motion (ROM), serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), myoglobin, and complications.

RESULTS: The LIPUS (n = 55) and control (n = 56) groups showed similar baseline characteristics. LIPUS treatment significantly improved clinical outcomes compared to sham treatment, reducing calf swelling by 2.37-2.74%, thigh swelling by 2.76-4.81%, and patellar swelling by 2.30-3.28% (all p < 0.001). Patients receiving LIPUS also reported less walking pain (1.16-2.48 point reduction, p < 0.001) and showed lower inflammatory markers (CRP reduction of 2.53-13.85 mg/L, p = 0.047; IL-6 reduction of 3.64-17.27 pg/mL, p = 0.041). However, the treatment did not significantly affect resting pain, HSS scores, ROM, serum myoglobin levels, or complication rates.

CONCLUSION: This study found that short-term LIPUS use markedly decreased lower-extremity swelling and walking pain post-TKA, with no major safety concerns. However, future studies are needed to determine the optimal protocol and long-term safety of LIPUS in TKA patients.

PMID:40616657 | DOI:10.1007/s00264-025-06601-5

Defining treatment outcome in fracture-related infections: A scoping review

Injury -

Injury. 2025 Jun 25;56(8):112563. doi: 10.1016/j.injury.2025.112563. Online ahead of print.

ABSTRACT

BACKGROUND: The fracture-related infection (FRI) consensus definition, published in 2018, marked a crucial advance for clinical practice and research, enabling treatment standardization and better comparison of clinical studies. However, a lack of clear, standardized outcome parameters still impedes the evaluation of treatment success, potentially leading to a misreporting of treatment failure in current literature. This scoping review provides an overview of outcome parameters used in the current literature to describe treatment success or failure in FRI.

METHODS: A comprehensive literature search across four databases (PubMed, Embase, Scopus and Web of Science) was performed. Studies that reported on treatment outcome in adults with long-bone FRI, published between 2018 and 2023, were eligible for inclusion. The primary outcomes were the reporting of the persistence, eradication or recurrence of infection as well as radiological and functional outcome and the need for a return to theatre for infection control. The secondary aim was to screen the current FRI literature for applied follow-up duration.

RESULTS: A total of 111 studies were included for analysis and synthesis. Only 15.3 % (17/111) of the included studies used a clear definition of treatment success and/or failure in their methodology. Despite a high general reporting (85.6 %; 95/111) of infection eradication, recurrence and/or persistence, only few studies defined these parameters accurately: 16.2 % for eradication (18/111), 15.3 % for recurrence (17/111), 0 % for persistence. Bone healing was reported by 90.9 % (101/111) of the studies, with a standardized approach of radiological evaluation in 64.4 % (65/101). In total, 76 studies (68.5 %) assessed functional outcome, whereas no standardized score set was used. Correspondingly, no standardized follow-up duration could be identified. An unplanned return to theatre was considered by 16.2 % of the studies (18/111) to report outcome.

CONCLUSION: This scoping review highlights the lack of standardized outcome reporting in FRI. A clear definition on outcome reporting in FRIs is urgently needed to promote comparability and transparency in clinical research.

PMID:40614539 | DOI:10.1016/j.injury.2025.112563

Is surgical resection of the primary site associated with longer survival in patients with metastatic chondrosarcoma at initial diagnosis?

International Orthopaedics -

Int Orthop. 2025 Jul 4. doi: 10.1007/s00264-025-06600-6. Online ahead of print.

ABSTRACT

PURPOSE: Patients with metastatic chondrosarcoma at presentation have a poor prognosis. Owing to the lack of sensitivity to chemotherapy and radiotherapy, surgical resection is the mainstay of treatment of localized chondrosarcoma. The aim of this study was to investigate whether surgical resection of the primary site was associated with improved survival in patients with metastatic chondrosarcoma at presentation.

METHODS: Sixty-two patients with distant metastases at initial diagnosis who were pathologically diagnosed with grade 2 or 3 conventional chondrosarcoma, dedifferentiated chondrosarcoma, or mesenchymal chondrosarcoma between 2001 and 2022 and registered in the Japanese National Bone and Soft Tissue Tumour Registry database were analysed retrospectively. Propensity score matching was performed to correct for differences in background characteristics, including the number of organs affected by metastases, performance of metastasectomy, and performance of chemotherapy, between patients who underwent surgical resection of the primary site (N = 31) and those who did not (N = 31).

RESULTS: The median disease-specific survival was six months for the whole cohort, 12 months for the patients who underwent surgical resection of the primary site, and two months for the patients who did not. Overall, 37 patients (59.7%) died of the disease. Univariate analysis showed a better disease-specific survival for patients who underwent surgical resection of the primary site compared with patients who did not (2-year disease-specific survival 51.0% [95% CI: 32.3-69.4] vs. 19.3% [95% CI: 6.9-43.7]; P = 0.005).

CONCLUSION: Surgical resection of the primary site may increase the survival of patients with metastatic chondrosarcoma at presentation.

PMID:40613902 | DOI:10.1007/s00264-025-06600-6

Tracking the prehospital time course of open fracture patients

Injury -

Injury. 2025 Jun 21;56(8):112536. doi: 10.1016/j.injury.2025.112536. Online ahead of print.

ABSTRACT

OBJECTIVES: A tenet of open fracture management is timely administration of antibiotics to reduce risk of fracture-related infection (FRI). Trauma centers strive to administer intravenous antibiotics within one hour of patient arrival. The foundation for this recommendation is based on relatively few studies, which base their findings on time from hospital arrival to antibiotic administration. Little attention has been paid to the prehospital time course of open fracture patients. We hypothesized that a significant portion of open fracture patients arrive at the hospital greater than one hour after their injury, which would represent an opportunity for improved care.

METHODS: Design: Retrospective Case Series Setting: Urban/Suburban Academic Level I Trauma Center Patient Selection Criteria: Subjects were identified using a retrospective search for open fracture patients arriving via emergency medical services (EMS). Patients were included if they were age 18 or greater, presented with an open fracture, and had complete pre-hospital documentation, in-hospital documentation, and radiographs. Outcome Measures and Comparisons: Data collected included patient demographics, fracture location, Gustilo-Anderson classification, dispatch time, on scene time, enroute to hospital time, arrival at hospital time, transfer of care time, modality of transport, whether intravenous antibiotics were administered prior to arrival at the hospital, and development of FRI. Descriptive statistics were used to analyze the findings.

RESULTS: 454 patients met the inclusion criteria. Mean time from dispatch to transfer of care was 66.8 ± 26.9 min in all transports; 84.1 ± 25.6 min with helicopter EMS; and 64.8 ± 26.4 min with ground EMS. 239 patients (52.6 %) had transfer of care time greater than one hour after dispatch time. Only 3.7 % of open fracture patients received antibiotics prior to hospital arrival. There was a positive correlation with the development of FRI and prolonged pre-hospital time.

CONCLUSIONS: Many patients with open fractures had transfer of care more than one hour after dispatch. FRI was associated with increased prehospital time. These results suggest an opportunity for prehospital antibiotic administration to mitigate the risk of infection in patients with open fractures.

LEVEL OF EVIDENCE: Level IV.

PMID:40609244 | DOI:10.1016/j.injury.2025.112536

A comparative finite element study of novel design hook plates for fixation of patella fracture

Injury -

Injury. 2025 Jun 27;56(8):112567. doi: 10.1016/j.injury.2025.112567. Online ahead of print.

ABSTRACT

PURPOSE: To test the mechanical properties of novel design hook plates for fixation of the patellar fracture by finite element analysis.

METHODS: Finite element analysis was used to construct a model of transverse patellar fracture and inferior pole fracture of the patella (IPFP) based on the CT data of the knee joint of a healthy young male volunteer. For the transverse fracture, stress distribution within the winged hook plate fixation and displacement of the fracture was compared to that of tension-band wiring (TBW) fixation. For the IPFP, the stress distribution within the wingless plate and displacement of the fracture were calculated under the four different application methods. All the models were created by assuming the knee flexion in 45° during non-weight-bearing, and applying the quadriceps tension on the superior pole of the patella.

RESULTS: In the model of transverse patellar fracture: The displacement and stress incurred in the fixation of patellar fractures with winged hook plates are much less than with TBW fixation (0.05 mm vs 0.3 mm; 121 MPa vs 268 MPa). In the model of IPFP: The wingless hook plate-cable wire-screw construction resulted in the least amount of displacement, followed by the wingless hook plate-cable wire (0.18 mm vs 0.297 mm). Displacement of the inferior pole of the patella would be more obvious in the two constructions that did not combine cable wires, especially the construction with neither cable wires nor screws.

CONCLUSION: In consideration of improvement of mechanical rigidity, winged hook plate was superior to TBW technique when being used for fixation of transverse patellar fracture, while combination of cable wire should be recommended when wingless hook plate being used for fixation of IPFP.

PMID:40609243 | DOI:10.1016/j.injury.2025.112567

Distal biceps injuries: an overview

Injury -

Injury. 2025 Jun 25;56(8):112556. doi: 10.1016/j.injury.2025.112556. Online ahead of print.

ABSTRACT

Distal biceps injuries frequently occur in middle-aged males after an eccentric load to the elbow in flexion. The diagnosis is often clinical with the aid of imaging where appropriate. Tears can be partial or full thickness. Surgery is the mainstay of treatment with non-operative management typically reserved for older, lower-demand patients. Those treated without an operation can expect a loss of a proportion of supination and flexion power. There are several surgical techniques described. In the acute setting, a repair may be performing using a number of available devices. In the chronic setting, reconstruction with a graft may be required. Surgical management carries with it complications such as damage to the surrounding structures, heterotopic ossification and re-rupture.

PMID:40609242 | DOI:10.1016/j.injury.2025.112556

Biomechanical evaluation of three different fixation methods for treating displaced tibial avulsion fracture of the posterior cruciate ligament: a finite element analysis

Injury -

Injury. 2025 Jun 27;56(8):112568. doi: 10.1016/j.injury.2025.112568. Online ahead of print.

ABSTRACT

OBJECTIVE: Displaced tibial avulsion fractures of the posterior cruciate ligament (PCL) significantly compromise knee stability; however, existing clinical data regarding treatment and prognosis are limited. There exists a paucity of biomechanical research concerning various surgical methods for tibial avulsion fractures of the PCL, and optimal management remains controversial. Therefore, the objective of this study was to investigate the biomechanical stability of displaced tibial avulsion fracture using suture bridge fixation, screw fixation, and TightRope fixation at varying flexion angles.

METHODS: Finite element analysis was employed to evaluate the biomechanical stability of three surgical approaches. A type III PCL tibial avulsion fracture model was established, followed by the assembly of models for suture bridge fixation, screw fixation, and TightRope fixation. Varying angles of knee flexion were simulated, and the stress distribution on the implant, the PCL, and the bone fragment, as well as the displacement of the fragment, were assessed.

RESULTS: The findings indicated that the peak stress distribution on the implant for screw fixation was the highest, occurring near the midsection and tail of the implant, followed by TightRope fixation, which occurred near both ends of the fixation. In contrast, suture bridge fixation exhibited the lowest stress, occurring near the junction between the anchor and the suture. The stress distribution of the PCL in screw and TightRope fixation was slightly higher than that observed with suture bridge fixation. This stress was primarily concentrated in the upper portion and gradually increased, reaching a maximum at 120° The peak von Mises stress (VMS) on the bone fragment in the suture bridge fixation group was the highest, followed by the screw fixation group, and subsequently the TightRope fixation group. Furthermore, the displacement of the bone fragment was comparable among the three fixation methods across various angles of knee flexion.

CONCLUSION: The biomechanical properties of suture bridge fixation are superior to those of both TightRope and screw fixation. They are all alternative surgical treatment methods for displaced tibial avulsion fractures of the PCL. The ideal surgical approach should be selected based on the clinical context and a comprehensive evaluation.

PMID:40609241 | DOI:10.1016/j.injury.2025.112568

Pages

Subscribe to SICOT aggregator