Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06540-1. Online ahead of print.

ABSTRACT

PURPOSE: Spondylodiscitis is a serious infection of the intervertebral discs and vertebrae, with rising incidence. This study provides an updated evaluation by analyzing causative microorganisms in tuberculous (TS), brucellar (BS), and pyogenic spondylodiscitis (PS). Our findings offer contemporary data to enhance understanding and management of spondylodiscitis.

METHODS: This retrospective study included 109 adult patients diagnosed with spondylodiscitis between 2011 and 2021 at a tertiary research center. Patients were categorized into three groups based on the causative pathogen. Demographic data, clinical presentations, laboratory findings, radiological imaging, and microbiological results were analyzed.

RESULTS: Among 109 patients, 59 (54.1%) had PS, 33 (32%) BS, and 17 (15.5%) TS. The cohort included 65 males (59.6%) and 44 females (40.4%), with a mean age of 57.6 ± 13.8 years. Back pain was the most common symptom (85.3%). Night sweats were more prevalent in BS (p < 0.001), while weight loss was less frequent in PS (p < 0.05). Diabetes was more common in PS (p < 0.001). PS cases had higher inflammatory markers (p < 0.001). Blood culture positivity was 53.6% in BS and 53.8% in PS. Surgery with tissue sampling was performed in 62 cases (56.9%). S. aureus was the most frequent pathogen, followed by Brucella spp.

CONCLUSION: Spondylodiscitis requires a multidisciplinary diagnostic approach due to its variable clinical presentations. PS is characterized by elevated inflammatory markers and concurrent infectious foci, BS by endemic risk factors and systemic symptoms, and TS by prolonged symptoms and thoracic involvement.

PMID:40261338 | DOI:10.1007/s00264-025-06540-1

Int Orthop. 2025 Apr 22. doi: 10.1007/s00264-025-06541-0. Online ahead of print.

ABSTRACT

Surgical approaches in bone surgery have undergone a long evolution over more than 130 years. While a number of publications have been devoted to the history of internal fixation, surgical approaches have remained neglected from this perspective. The development of approaches in musculoskeletal surgery is inextricably linked to four personalities. Theodor Kocher, in 1892, pointed out that descriptions of surgical approaches must be an essential part of surgical textbooks of operative techniques; James Edwin Thompson, in 1918, formulated the basic requirements for the surgical approaches to the skeleton of limbs; Arnold Kirkpatrick Henry published the first textbook of surgical approaches in 1927 and presented the concept of internervous planes in 1945; in the same year, Toufick Nicola created the first comprehensive atlas of surgical approaches to bones and joints of limbs, the pelvis and spine.

PMID:40261337 | DOI:10.1007/s00264-025-06541-0

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06532-1. Online ahead of print.

ABSTRACT

PURPOSE: Implant wastage in trauma and orthopaedic (T&O) surgery remains an under-reported yet significant issue, contributing to rising healthcare costs and environmental concerns. With increasing surgical demand driven by an ageing population and the growing prevalence of conditions like osteoporosis, this study aimed to quantify implant wastage in T&O procedures at a Level 1 Major Trauma Centre in London, assessing both its frequency and financial impact.

METHODS: A retrospective cohort study was conducted on all weekday T&O procedures performed between 1st December 2023 and 31st January 2024. Two of the authors identified wasted implants using intraoperative implant logbooks, and cross-referencing implant stickers with post-operative radiographs. Data pertaining to patient demographics, procedure types, surgical sites, and implant usage were collected. Cost analysis was performed using procurement data to determine the financial impact of implant wastage.

RESULTS: Among 184 procedures analysed, 131 (71.2%) used implants, with wastage observed in 108 (82.4%) cases. A total of 141 implants were wasted, with screws accounting for 92.9% (n = 131) of wasted implants. Locking screws were the most frequently discarded (n = 65; 46.1%). Across ORIF and intramedullary nailing procedures, an overall screw wastage rate of 20% (17-31%) was observed with 2.4 screws wasted per trauma procedure. The financial cost of implant wastage over the 44-day study period amounted to approximately £335 per day and £136 per case.

CONCLUSION: This study highlights the substantial economic burden associated with implant wastage in T&O surgery, with screws, particularly locking screws, being the primary contributors. Targeted interventions, including improved preoperative planning, precision-based implant selection, and enhanced intraoperative decision-making, are essential to reducing waste and improving cost-efficiency and sustainability in surgical practices. Further research should explore the broader economic and environmental impact of implant wastage, incorporating factors such as operative time and carbon footprint to develop comprehensive waste-reduction strategies.

LEVEL OF EVIDENCE: IV.

PMID:40257588 | DOI:10.1007/s00264-025-06532-1

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06534-z. Online ahead of print.

ABSTRACT

PURPOSE: There is still a debate regarding the removal of the femoral stem due to the risk of trunnion. To answer this question, we conducted a study to compare long terms outcomes of isolated acetabular to total revision of MoM THA using an institutional arthroplasty registry.

METHODS: From 1996 to 2019, 150 patients (12.5%) of the 1202 revision THAs (rTHA) recorded in Geneva Arthroplasty Registry (GAR) underwent a revision of a MoM THA. After matching the two groups,126 patients were finally included: 63 in each group. The mean age was 64.4 (SD 11.6) years, 48.4% (61/126) were women with a mean BMI of 27.2 (SD 5.5) Kg/m2.

RESULTS: The overall survival rate was 88.1% [79.9-97.2%] at ten years. 10-year survival rate was 93.5% [86.2-100.0%] after isolated acetabular rTHA and 79.5% [61.7-100.0%] after total rTHA (p = 0.16). Regarding Hip Harris score and Merle d'Aubigne score, no difference at last follow-up was observed between the two groups (respectively: p = 0.39; p = 0.33). Regarding the chrome, cobalt, and nickel level reduction, no difference was observed between the two groups (respectively, p = 0.38, 0.81 and 0.97).

CONCLUSION: No difference was observed between isolated acetabular and total revision of MoM THAs regarding survival rate and ions levels at long term. It seems advisable to perform an isolated acetabular revision of a MoM THA when it is indicated.

LEVELS OF EVIDENCE: Level III, case control studies.

PMID:40257587 | DOI:10.1007/s00264-025-06534-z

Int Orthop. 2025 Apr 21. doi: 10.1007/s00264-025-06533-0. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of clinical studies examining outcomes following surgical revision in cases of histologically confirmed arthrofibrosis after total hip arthroplasty (THA). Consequently, the aim of this study is to present the clinical outcomes and to identify risk factors for poor clinical and functional outcome following surgical intervention for histologically confirmed arthrofibrosis following THA.

METHODS: This study included 51 patients (51 hips) with histologically confirmed arthrofibrosis of the hip based on the synovial-like interface membrane (SLIM) criteria. These were selected from 7983 revision THA cases performed during the study period After exclusion criteria were applied, 42 cases (59.5% women) with an average age of 63.6 years were included. The mean duration of follow up was 70 months (range 30-122 months). Of these, 73.8% underwent index surgery after primary THA implantation. The primary indication for revision surgery was predominantly the clinical suspicion of arthrofibrosis (n = 35). The Harris Hip Score (HHS) and the EQ-5D-3 L scores were calculated for all cases at the time of follow-up. For the risk analysis of a poor clinical outcome, two groups were divided according to the Harris Hip Score. The group with a poor clinical outcome was defined as a HHS < 55.

RESULTS: Open arthrolysis was performed in all cases with a modular component being replaced in 73.8% of cases (n = 31) and only two cases requiring additional revision of the femoral and acetabular components due to aseptic loosening.The mean pre op Harris Hip Score (HHS) was 53.2 before revision surgery. This increased to 65.7 post op (p < 0.001). Only 34.1% of patients achieved the minimum clinical significance difference (MCID) of 18 HHS points after surgical revision. The EQ-5D Visual Analogue Scale (VAS) score and the Time Trade-Off (TTO) score averaged 0.226 (SD 0.245) and 0.221 (SD 0.37). Complications occurred in seven cases (16.7%,), with dislocation in 2 cases and persistent AF symptoms in 3 cases. Six cases required further revision surgery (14.3%). In three cases, a further open arthrolysis was performed due to persistent symptoms. Increased BMI (30.1 vs. 26.7 BMI, p < 0.05) or higher body weight (88.4 kg vs. 78.7 kg, p = 0.086), smoking and a lower preoperative HHS (p = 0.022) were identified as risk factors for a poor clinical outcome, defined as HHS < 55.

CONCLUSION: Results of this study suggest that mid-term clinical results following surgical intervention for arthrofibrosis following THA show a moderate to poor postoperative outcome with an acceptable complication rate. Risk factors for a poor outcome such as increased weight, BMI or smoking should be considered and critically assessed preoperatively.

PMID:40257586 | DOI:10.1007/s00264-025-06533-0

Injury. 2025 Apr 8;56(6):112328. doi: 10.1016/j.injury.2025.112328. Online ahead of print.

ABSTRACT

INTRODUCTION: Bone fractures are recognized as the second most prevalent cause of pain for patients seeking treatment in medical facilities. This study aims to evaluate the efficacy of intranasal and intravenous ketamine in comparison to intravenous morphine in alleviating severe pain in patients presenting to emergency departments with various bone fractures.

METHOD & MATERIAL: The clinical trial was conducted on patients over the age of 18 who presented at the emergency department of Imam Reza Educational and Medical Center with bone fractures. These patients were divided into three groups for treatment: intranasal ketamine at a dose of 1 mg/kg body weight, intravenous ketamine at a dose of 0.5 mg/kg body weight, and intravenous morphine at a dose of 0.1 mg/kg body weight. The severity of pain experienced by patients was documented using the numerical pain rating scale at the time of admission, and then at 15 min, 30 min, and 60 min after drug administration.

RESULTS: The results of the study revealed that there was no statistically significant difference in the efficacy of pain relief among the three study groups (p=0.77). The interaction of (time*type of drug) had no significant effect on pain intensity (p=0.58). There was no statistically significant difference in side effects reported by patients between the three study groups, with the intranasal ketamine group reporting only minor side effects.

CONCLUSION: The results of this study showed significant effects of intranasal ketamine and intravenous ketamine in reducing pain in patients with bone fractures. The findings further suggest that the analgesic effect of intranasal ketamine is comparable to that of intravenous ketamine and morphine, with no significant adverse effects observed.

PMID:40253928 | DOI:10.1016/j.injury.2025.112328

Injury. 2025 Apr 9;56(6):112326. doi: 10.1016/j.injury.2025.112326. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study.

OBJECTIVES: To identify outcomes, in particular employment, >5 years following traumatic thoracic and/or lumbar fracture/s.

METHODS: 235 patients between the ages of 18 and 65 were identified from hospital radiology databases having sustained a traumatic thoracic and/or lumbar fracture on CT and/or MRI between 01/01/2013 and 31/12/2017. Questionnaires were sent via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and > 5 years post-injury.

RESULTS: 26 (11 %) patients died before follow-up, leaving 209 patients. 108 (52 %) were treated surgically and 101 (48 %) conservatively. 106 replies were received, with 85 (80 %) opting in and 21 (20 %) out. 68 (80 %) patients completed full questionnaires, and 17 (20 %) filled out a shortened questionnaire via phone conversation. Of the 85 enrolled patients, 52 (61 %) had undergone surgery, and 33 (39 %) had been treated conservatively. The mean follow-up time was 7.9 years (range 5-11 years). Prior to injury, 66 patients (78 %) were employed and 19 (22 %) unemployed (6 were full-time students, 8 retired). 49 (74 %) previously employed patients had returned to work at follow-up, with 35 (53 %) working the same or increased hours. Regarding employment, there was no significant difference between the treatment groups (p = 0.355) or the fracture classification (p = 0.303). 16 (19 %) patients reported back pain before their injury, whilst 69 (81 %) did not. There were 58 (68 %) cases of new pain, with the most affected area being the lumbar region in 43 (51 %) patients. 32 (38 %) patients reported neurological deficit post-injury: 19 with subjective symptoms, 9 objective symptoms and 4 suffered paralysis.

CONCLUSION: After 5 years or more following a traumatic thoracic and/or lumbar fracture, most individuals return to employment. There was no significant difference between the severity of the fracture or treatment on their employment outcomes.

PMID:40253927 | DOI:10.1016/j.injury.2025.112326

Injury. 2025 Apr 3;56(6):112329. doi: 10.1016/j.injury.2025.112329. Online ahead of print.

NO ABSTRACT

PMID:40250091 | DOI:10.1016/j.injury.2025.112329

J Bone Joint Surg Am. 2025 Apr 18. doi: 10.2106/JBJS.24.00542. Online ahead of print.

ABSTRACT

BACKGROUND: Accelerated recovery from bone injuries is a paramount health-care goal with substantial impacts on physical status and overall well-being. The aim of this study was to evaluate the impact of colostrum supplementation on bone healing in patients with a traumatic extracapsular hip fracture (ECF).

METHODS: Patients with an ECF undergoing internal fixation were randomly assigned to receive either bovine colostrum or whey protein. Bone healing was assessed using the Radiographic Union Score for Hip (RUSH). Physical rehabilitation was evaluated using the Harris hip score (HHS) and the Short Musculoskeletal Functional Assessment (SMFA) within 3 months postoperatively. A generalized estimating equation (GEE) was used to assess the time-by-group interactions of these longitudinal variables. Patients were monitored for postoperative complications for 12 months, with the risk difference (RD) and risk ratio (RR) calculated.

RESULTS: A total of 116 patients with an ECF were included in the final analysis (colostrum group, n = 59; whey group, n = 57). Baseline characteristics, including age, gender, ethnicity, and body mass index, were similar between the groups (p > 0.05 for all). The colostrum group had a significantly greater increase in the RUSH score (β = 0.88; p = 0.001) and HHS (β = 1.2; p = 0.001) over time compared with the whey group. SMFA dysfunction and bother indices demonstrated significantly greater decreases over time in the colostrum group compared with the whey group (β = -1.2 and -2.4, respectively; p < 0.001 for both).

CONCLUSIONS: The present study provides preliminary evidence suggesting that colostrum may accelerate bone healing and enhance short-term physical rehabilitation outcomes more effectively than whey protein.

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

PMID:40249794 | DOI:10.2106/JBJS.24.00542

SICOT J. 2025;11:26. doi: 10.1051/sicotj/2025020. Epub 2025 Apr 17.

ABSTRACT

INTRODUCTION: Intramedullary anterograde femoral nailing is a standard treatment for femoral deformity and fracture in osteogenesis imperfecta (OI). This study evaluates the clinical and radiological outcomes of a novel retrograde femoral nailing technique.

METHODS: A retrospective analysis was performed on 31 patients with OI who underwent retrograde femoral nailing using Dubow-Bailey nails from 2004 to 2019. A total of 54 femurs were treated for femoral deformity or fracture by three senior surgeons, with a mean follow-up of 2.7 years. Clinical outcomes, including knee range of motion and pain, were assessed. Radiological outcomes included deformity angle (DA), neck shaft angle (NSA), mechanical lateral distal femoral angle (mLDFA), and nail positioning on AP and lateral X-rays. Potential complications, including hip osteonecrosis, distal femoral growth arrest, and infections, were also evaluated.

RESULTS: The procedure showed favorable outcomes, with no postoperative knee motion limitations or persistent pain. The mean pre-operative DA on AP and lateral views was 29° and 40°, respectively, with no residual deformity after surgery. The mean NSA and mLDFA were 132° and 101° before surgery, compared to 143° and 89° post-operatively. Nail alignment was optimal in 81% of the femurs, with proper positioning in both the distal epiphysis and femoral neck. No cases of hip osteonecrosis, distal femoral growth arrest, or infection were reported. Hardware migration occurred in seven cases.

CONCLUSION: Retrograde femoral nailing is a safe and effective technique for managing femoral deformities and fractures in OI.

PMID:40245284 | PMC:PMC12005622 | DOI:10.1051/sicotj/2025020

Injury. 2025 Apr 8;56(6):112317. doi: 10.1016/j.injury.2025.112317. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Percutaneous screw osteosynthesis is the gold standard for managing sacral fragility fractures in geriatric patients with immobilizing pain. However, comparative evidence regarding the optimal type, length, or insertion position of sacroiliac screws remains limited.

PURPOSE: This study aimed to compare outcomes between long transsacral screws bridging both sacroiliac joints and short sacroiliac screws.

STUDY DESIGN/SETTING: Retrospective cohort single-center study.

PATIENT SAMPLE: Geriatric patients treated with percutaneous sacroiliac screws for sacral fragility fractures.

OUTCOME MEASURES: Primary outcome: screw loosening at 3-, 6-, and 12-month follow-ups.

SECONDARY OUTCOMES: surgical duration, postoperative pain, mobility improvement, and hospital stay length.

METHODS: Data from 122 patients (median age 81, 84 % female) treated between 2018 and 2021 were analyzed. Patients were categorized into three groups [1]: two long transsacral screws [2], a combination of one long and two short screws, and[3] four short sacroiliac screws. Fracture characteristics, FFP classification, and risk factors for screw loosening were evaluated.

RESULTS: Fractures were bilateral in 73 %, with FFP classifications of type 2 (48 %), type 3 (12 %), and type 4 (40 %). Anterior pelvic fractures were present in 63 %, comminuted fractures in 34 %, and H-type fractures in 29 %. Loosening rates were 17 % in the long-screw group, 6 % in the combination group, and 4 % in the short-screw group. Surgical duration was shortest for long screws (mean 52.6 min) compared to the combination (61.8 min) and short-screw (83.4 min) groups. Pain scores decreased below 5 in 88 % of patients at 3 months and 92 % at 12 months. Screw length was a significant risk factor for loosening (p = 0.04).

CONCLUSIONS: Long transsacral screws offer minimally invasive fixation with reduced surgical duration but higher loosening rates. Osteosynthesis with four short sacroiliac screws demonstrates superior long-term stability, making it a promising option for sacral fragility fractures.

PMID:40245455 | DOI:10.1016/j.injury.2025.112317

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.24.00810. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial cause of morbidity and mortality among hospitalized patients. Although rare in the general pediatric population, VTE remains a potential concern in hospitalized children, particularly those with lower-extremity (LE) fractures. With this study, we aimed to determine the risk of VTE in pediatric patients with surgically treated LE fractures through a retrospective, propensity-matched, cohort analysis.

METHODS: The TriNetX Research Network, encompassing data from >80 health-care organizations and >120 million patient records, was utilized for this retrospective cohort study comparing 3 age-based cohorts (children [age of <14 years], adolescents [age of 14 to 17 years], and adults [age of ≥18 years]) who underwent surgical treatment of LE fractures between January 1, 2003, and January 1, 2023.

RESULTS: A total of 634,880 patients with surgically treated LE fractures were included; 13.3% were children, 5.6% were adolescents, and 81.1% were adults. Propensity-score matching was used to compare VTE incidence across cohorts, resulting in 3 independent matched comparisons. Overall, the incidence of VTE (either DVT or PE) was 0.2% in children, 1.0% in adolescents, and 4.1% in adults. Adults had a significantly higher risk of developing DVT (risk ratio [RR]: 17.0; 95% confidence interval [CI]: 14.5 to 20.0) and PE (RR: 21.8; 95% CI: 17.0 to 28.1) compared with children. Similarly, adolescents had a higher risk of DVT (RR: 3.5; 95% CI: 2.7 to 4.4) and PE (RR: 3.1; 95% CI: 2.2 to 4.4) compared with children. The incidence of VTE varied by fracture location, with femoral and knee joint (incidence: 0.5% in children, 2.5% in adolescents) and pelvic and hip joint (incidence: 1.2% in children, 2.8% in adolescents) fractures presenting the highest risk across all age groups.

CONCLUSIONS: The incidence of VTE in a large cohort of pediatric patients undergoing surgical treatment of LE fractures was higher in adolescents than in children. These findings may warrant prophylactic VTE measures in adolescents undergoing surgical treatment of femoral or pelvic fractures.

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

PMID:40245162 | DOI:10.2106/JBJS.24.00810

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.23.01088. Online ahead of print.

ABSTRACT

BACKGROUND: The treatment of ankle fractures involving the posterior malleolus (PM) has changed in favor of open reduction and internal fixation (ORIF), and the need for additional syndesmotic stabilization has decreased; however, there are still doubts regarding the diagnosis and treatment of residual syndesmotic instability. The aim of the present study was to evaluate the effect of fixation of the PM and to assess the need for additional stabilization methods. We hypothesized that ORIF of the PM would not sufficiently stabilize the syndesmosis and that additional syndesmotic reconstruction would restore kinematics.

METHODS: Eight unpaired, fresh-frozen, cadaveric lower legs were tested in a 6-degrees-of-freedom robotic arm with constant loading (200 N) in the neutral position and at 10° dorsiflexion, 15° plantar flexion, and 30° plantar flexion. The specimens were evaluated in the following order: intact state; osteotomy of the PM; transection of the anterior inferior tibiofibular ligament (AITFL) and interosseous ligament (IOL); ORIF of the PM; additional syndesmotic screw; combination of syndesmotic screw and AITFL augmentation; and AITFL augmentation.

RESULTS: A complete simulated rupture of the syndesmosis (PM osteotomy with AITFL and IOL transection) caused translational (6.9 mm posterior and 1.8 mm medial displacement) and rotational instability (5.5° external rotation) of the distal fibula. ORIF of the PM could eliminate this instability in the neutral ankle position, whereas sagittal and rotational instability remained in dorsiflexion and plantar flexion. The remaining instability could be eliminated with an additional procedure, without notable differences between screw and AITFL augmentation.

CONCLUSIONS: In our model, isolated PM osteotomy and isolated AITFL and IOL rupture (after PM refixation) only partially increased fibular motion in dorsiflexion and plantar flexion, whereas the combination of PM osteotomy and AITFL and IOL rupture resulted in an unstable syndesmosis in all planes.

CLINICAL RELEVANCE: In complex ankle fractures, ORIF of the PM is essential to restore syndesmotic stability; however, residual syndesmotic instability can be detected by a specific posterior shift of the fibula on stress testing. In these cases, anatomical AITFL augmentation is biomechanically equivalent to the use of a syndesmotic screw.

PMID:40245116 | DOI:10.2106/JBJS.23.01088

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.24.01493. Online ahead of print.

ABSTRACT

Orthopaedic surgeons are called upon to lead in numerous clinical settings, but the importance of physician leadership is also relevant to administrative roles. As the complexity of health care has increased, the challenges confronting the orthopaedic physician leader have increased as well. During the past century, there has been a substantial increase in the number of non-physician CEO leaders, and this is particularly critical in the academic health system, for which investment in the research and education missions is heavily dependent upon the clinical enterprise. Therefore, physician leadership becomes even more important, with heightened influence. Being an orthopaedic surgeon, or any type of physician, is not synonymous with excellence in leadership. Rather, growth as a leader requires hard work dedicated to the acquisition and nurturing of the knowledge, behaviors, and competencies that result in excellence. We readily acknowledge that physicians must work with a multidisciplinary administrative team of content experts but believe that true expert leaders also possess the inherent knowledge and expertise in the core business for which the organization exists. We encourage our physician colleagues to work to become stronger leaders regardless of their ultimate career aspirations.

PMID:40245106 | DOI:10.2106/JBJS.24.01493

Injury. 2025 Apr 9:112321. doi: 10.1016/j.injury.2025.112321. Online ahead of print.

ABSTRACT

BACKGROUND: Multimodal pain control is the cornerstone of managing acute traumatic rib fractures. We employed surgeon-administered, ultrasound-guided percutaneous cryoneurolysis of intercostal nerves (USPCNIN) as an adjunct opioid-sparing analgesic modality at the bedside.

METHODS: This was a single-institution case series. Patients between 18-64 years of age who sustained traumatic rib fracture between ribs 3-9, deemed ineligible for surgical stabilization, and had pre-procedure numeric pain scores ≥5 underwent USPCNIN within 24 h of study enrollment by an attending chest wall surgeon. Primary outcomes were changes in daily narcotic use and numeric pain score from pre-intervention up to 30-day follow-up visits. Additional outcomes included hospital length of stay, procedure-related adverse events, and rib-specific readmission.

RESULTS: Fifteen patients were identified. Median (IQR) patient age was 52 (43, 58) years and four (27 %) were female. Median (IQR) number of rib fractures was 5 (4, 8). Median (IQR) hospital length of stay was 4 (3, 7) days. Daily opioid use (measured in morphine milligram equivalents, MME) and present pain intensity (PPI) decreased significantly from pre-intervention to hospital discharge (median MME 96.5 vs. 49.5, p = 0.043; median PPI 10 vs. 7, p = 0.020). Twelve patients completed 30-day follow-up and had significantly decreased MME and PPI from hospital discharge (median MME 62.3 vs. 5, p = 0.014; median PPI 6.5 vs. 3, p = 0.001). There were no complications directly attributable to the procedure. There were no rib-specific readmissions.

CONCLUSION: USPCNIN is a minimally-invasive, bedside procedure that can be safely performed by trauma surgeons and augment pain control for acute traumatic rib fractures.

PMID:40240230 | DOI:10.1016/j.injury.2025.112321

J Bone Joint Surg Am. 2025 Apr 16;107(8):e38. doi: 10.2106/JBJS.24.01481. Epub 2025 Apr 16.

NO ABSTRACT

PMID:40237720 | DOI:10.2106/JBJS.24.01481

J Bone Joint Surg Am. 2025 Apr 16;107(8):e37. doi: 10.2106/JBJS.24.01375. Epub 2025 Apr 16.

NO ABSTRACT

PMID:40237719 | DOI:10.2106/JBJS.24.01375

Int Orthop. 2025 Apr 16. doi: 10.1007/s00264-025-06519-y. Online ahead of print.

ABSTRACT

PURPOSE: Unicompartmental Knee Arthroplasty (UKA) has garnered increasing attention in recent years. Robotic-assisted systems have demonstrated enhanced precision, contributing to improved patient survival rates, satisfaction, soft-tissue balancing, alignment, and component sizing. The purpose of this study is to evaluate the early clinical outcomes of Naton robotic-assisted medial UKA by analyzing postoperative radiographic positioning of the unicompartmental prosthesis and comparing preoperative and postoperative functional outcomes in patients.

METHODS: A retrospective analysis was conducted on the clinical data of 32 patients (32 knees) who underwent Naton robotic-assisted medial UKA at Suining Central Hospital of Sichuan Province from November 2023 to January 2024. The cohort included ten males and 22 females, with a mean age of 70.53 ± 8.08 years, ranging from 53 to 88 years. All patients underwent surgery using the Naton robotic system and the Zhengtian Unique fixed-bearing UKA prosthesis. Radiographic (X-ray) findings, knee function, and complications were evaluated during follow-up. Radiographic assessments included prosthesis position, angle deviation, and posterior tibial slope (PTS). Knee function was assessed using a range of motion (ROM), Knee Society Score (KSS), Oxford Knee Score (OKS), and Forgotten Joint Score (FJS).

RESULTS: All patients in the study were followed for a period of eight to ten months, with a mean follow-up of (9.16 ± 0.68) months. No complications such as poor incision healing, periprosthetic infection, periprosthetic fracture, or prosthesis loosening were observed during the follow-up period. The medial unicondylar prostheses were found to be in place in all 32 cases, and no abnormal deviation of the prosthesis implantation angle was observed compared to immediate postoperative radiographs. The posterior tibial slope (PTS) was reduced from 13.00 ± 2.72° preoperatively to 5.08 ± 1.14° postoperatively, with a statistically significant difference (P ≤ 0.05). At the final follow-up, the knee range of motion (ROM) was improved from 107.03 ± 11.69° preoperatively to 128.25 ± 16.52° postoperatively. The KSS was improved from 46.28 ± 7.27 to 82.34 ± 14.72, and the OKS was improved from 36.13 ± 4.71 to 15.78 ± 3.52, all with statistically significant differences compared to preoperative values (P ≤ 0.05). The Forgotten Joint Score (FJS) was recorded as 89.2 ± 2.9.

CONCLUSIONS: The short-term follow-up indicates a favorable prosthesis in situ rate for unicompartmental knee arthroplasty assisted by the Naton robot, with satisfactory knee function and patient-reported outcomes. The short-term clinical outcomes are satisfactory.

PMID:40237792 | DOI:10.1007/s00264-025-06519-y

SICOT J. 2025;11:25. doi: 10.1051/sicotj/2025021. Epub 2025 Apr 14.

ABSTRACT

INTRODUCTION: This study evaluates complications associated with the bikini-incision direct anterior approach (DAA) total hip arthroplasty (THA) performed by a single surgeon on a standard operating table, with a focus on cases requiring large acetabular cups (≥56 mm). Secondary objectives include assessing clinical outcomes and implant survivorship.

METHODS: A retrospective analysis was conducted on primary bikini-incision DAA THAs performed by a single surgeon between 2013 and 2024. Cases involving acetabular cups ≥56 mm were included, while emergency hip fracture cases and those requiring posterolateral approaches were excluded. Clinical data, radiographs, and Kaplan-Meier survival analysis were used to assess complications, Harris Hip Scores (HHS), and implant survivorship.

RESULTS: This study included 215 THA procedures performed on 210 male patients (mean age 67 years, BMI 28.6), with an average follow-up of 3.9 years. The primary indication was osteoarthritis (88.4%). The mean preoperative HHS was 41.8, which significantly improved to 92.6 postoperatively (p < 0.001). Complications included lateral femoral cutaneous nerve (LFCN) neuropraxia (2.3%), periprosthetic fractures (0.93%), and femoral stem subsidence (0.93%). The revision rate was 0.93%, with Kaplan-Meier analysis indicating a 99% survival rate for the stem and 100% survival for the acetabular cup at the final follow-up.

DISCUSSION: The bikini-incision DAA THA using a standard operating table provides excellent short- to mid-term functional outcomes and implant survivorship for patients requiring large acetabular cups (≥56 mm). The approach is associated with low complication and revision rates, supporting its safety and efficacy in this cohort.

PMID:40233248 | PMC:PMC11999402 | DOI:10.1051/sicotj/2025021

Injury. 2025 Apr 7:112331. doi: 10.1016/j.injury.2025.112331. Online ahead of print.

ABSTRACT

BACKGROUND: Emergency finger thoracostomy (EFT) has been implemented in several European prehospital settings for intubated and ventilated patients with chest injuries. The indication for intervention in cardiac arrest and peri‑arrest situations is clear. EFT may also be applicable in ventilated but macrohemodynamically compensated patients. This study aims to help prehospital providers understand the benefits and applicability of EFT.

PATIENTS AND METHODS: A retrospective analysis was conducted consisting of 114 EFT cases over 53 months. All chest-injured patients had suspected intrapleural pathology and potential compensated obstructive shock state. Two groups were compared: I. Positive clinical finding after EFT: audible air (pneumothorax (PTX)) and/or blood (hemothorax (HTX)) (n = 85); II. Negative clinical finding: no audible air and/or blood escaping during the procedure (n = 29). The primary endpoint was the effect of EFT on the physiologic parameters. The secondary endpoint was the association between intrathoracic pathology observed during EFT and the physiologic effect.

RESULTS: In 75 % of all cases, after EFT, intrapleural pathology was detectable by on-site physical examination. After EFT SpO2 levels increased from 89.6 % (SD 10.7) to 94.9 % (SD 6.7) (p < 0.001). The other physiological parameters did not change significantly (p = 0.346 or higher). In subgroup analysis, there were appreciable increases in SpO2 for those with PTX or PTX with HTX, that were not seen in those with HTX alone or those with negative clinical findings (p < 0.001). No significant adverse effects of EFT were noted during the prehospital phase or in the hospital follow-up period.

DISCUSSION: EFT performed in ventilated patients with suspected compensated obstructive shock (and stable macrohemodynamic) resulted in audible air and/or blood escape and an improvement in oxygenation if PTX or PTX with HTX were the underlying pathology.

CONCLUSION: Performing an EFT should be considered not only for deteriorating obstructive shock state but also for potentially compensated shock. Even with diagnostic uncertainty, the benefits of an EFT may outweigh the risks.

PMID:40234110 | DOI:10.1016/j.injury.2025.112331