Int Orthop. 2025 Dec 19. doi: 10.1007/s00264-025-06721-y. Online ahead of print.

ABSTRACT

PURPOSE: Orthopaedic surgery patients are at an elevated risk of venous thromboembolic events thus necessitating effective prophylaxis strategies.

METHODS: This IRB-approved, single-center retrospective study evaluated patients who underwent orthopaedic surgery and were protected with Inferior Vena Cava (IVC) filters from January 2007 to December 2021. Study outcomes include incidence of venous thromboembolism (VTE) in the form of deep vein thrombosis (DVT) and pulmonary embolism (PE), and filter-related complications.

RESULTS: A total of 104 patients (median age 57 years, range: 18 - 78; 53% women) who underwent orthopaedic surgery were protected against PE with IVC filters. This cohort was surgically diverse with 50 patients (48%) having underwent arthroplasty, 17 (16%) underwent amputations, disarticulations, and hemipelvectomies, 16 (15%) had resections and 16 (15%) had open reduction and internal fixations (ORIF), three patients (3%) underwent incision and drainages (I&D), and two patients (2%) had complex multi-operational surgeries. Patients were high-risk given the large burden of comorbidities, including low functional status (88%), VTE history (62%), malignancy (57%), and history of tobacco use (47%). All filters were placed without complication. A majority of filters were retrieved (58%; n = 60), with an average dwell time of 6.7 months (1-31 months). In the post-placement period, 16 patients (15%) experienced DVTs with four patients (4%) experiencing PEs. There were three removal attempts that encountered difficulty, leading to aborted attempts of which two were later successful.

CONCLUSION: IVC filters were placed and retrieved in orthopaedic patients with a low complication rate while achieving a low incidence of VTE in this high-risk cohort.

PMID:41417049 | DOI:10.1007/s00264-025-06721-y

Injury. 2025 Dec 11;57(2):112961. doi: 10.1016/j.injury.2025.112961. Online ahead of print.

ABSTRACT

INTRODUCTION: Proximal humerus fractures are common, especially in older adults, and often result in complications such as varus collapse after open reduction and internal fixation (ORIF). Despite successful surgical methods, complication rates remain significant, with varus collapse being a primary cause of failure. Ensuring proper screw placement, particularly the calcar screw, is vital to prevent this issue. This study introduces a modified calcar ratio (MCR) that combines two key measurements - tip distance and calcar distance - to predict varus collapse and improve surgical outcomes.

METHODS: This retrospective study analyzed patients treated for proximal humerus fractures from September 2022 to June 2024. Inclusion criteria were adults with 3- or 4-part fractures who underwent ORIF with a proximal humerus plate within two weeks of injury. Preoperative and postoperative radiographs were evaluated to determine fracture classification, reduction quality, and radiological parameters, including MCR. MCR was calculated as the sum of the tip distance and calcar distance divided by the humeral head radius. Statistical analysis, including ROC curve analysis, assessed MCR's ability to predict varus collapse.

RESULTS: A total of 108 patients were included. MCR was significantly higher in patients who experienced varus collapse (median MCR: 0.7) compared to those who healed (median MCR: 0.5). Varus collapse occurred in 17.6 % of patients, with a median onset time of 8 weeks post-surgery. Statistical analysis showed a strong correlation between higher MCR and varus collapse, with a sensitivity of 100 % and a specificity of 47 %, at a cut-off point of 0.46 for predicting failure. The ROC curve demonstrated 78 % discriminatory ability for MCR.

CONCLUSION: The MCR is a reliable, practical tool for predicting varus collapse following ORIF in proximal humerus fractures. By considering both the tip and calcar distances, MCR provides a single, effective measure to optimize surgical outcomes. An intraoperative MCR value below 0.46 demonstrated high sensitivity for predicting lower risk of varus collapse, and may serve as a useful intraoperative reference.

PMID:41411836 | DOI:10.1016/j.injury.2025.112961

Injury. 2025 Dec 11;57(2):112967. doi: 10.1016/j.injury.2025.112967. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior iliac crescent fracture-dislocations (PICFDs) were originally considered rotationally unstable and vertically stable injuries, strongly associated with lateral compression (LC) mechanism. However, it is currently recognized that PICFDs may exhibit variable injury patterns and result from different mechanisms. The purpose of this study was to evaluate relevant morphological aspects and the mechanism of injury of PICFDs in a cohort of patients presenting unstable pelvic ring injuries (PRIs) PATIENTS AND METHODS: Patients presenting unstable PRIs that underwent surgical treatment at two level 1 trauma centers from January 2019 to December 2024 were retrospectively reviewed. Individuals presenting PICFDs were recorded, and relevant morphological aspects scrutinized.

RESULTS: 363 unstable PRIs were identified and a PICFD was present in 29 (8.0%) individuals. Among these, 23 (79.3%) were attributed to LC, 4 (13.8%) to APC (anteroposterior compression) and 2 (6.9%) to CCM (complex/combined mechanism). According to Day's classification, PICFDs were categorized as type I (n=8, 27.6%), type II (n=16, 55.2%), and type III (n=5, 17.2%). Most PICFDs (n=26, 89.6%) were displaced, 72.4% (n=21) exhibited posterior dislocation and 96,5% (n=28) presented associated ipsilateral anterior pelvic ring disruption. Comminution of the crescent-shaped fragment was seen in 13.8% (n=4) patients and vertical instability was observed in 34.5% (n=10) PICFDs.

CONCLUSION: This investigation reinforced modern concepts regarding PICFDs, suggesting that the understanding of this infrequent injury pattern warrants constant refinement. Morphological aspects of PRIs presenting with PICFDs were detailed, exhibiting variable deformity, displacement and comminution. Furthermore, PICFDs can be caused by different injury mechanisms and carry the potential to cause vertical instability.

PMID:41411835 | DOI:10.1016/j.injury.2025.112967

Int Orthop. 2025 Dec 18. doi: 10.1007/s00264-025-06726-7. Online ahead of print.

ABSTRACT

OBJECTIVE: In the context of the widespread implementation of enhanced recovery after surgery (ERAS) in orthopaedics, postoperative supportive interventions for patients with lower limb fractures remain limited. This study aimed to introduce a vibration-stimulation device designed in accordance with ERAS principles and to evaluate its clinical effectiveness.

METHODS: This prospective randomized controlled trial consecutively screened 1,241 patients aged 18-75 years with lower limb fractures admitted to a tertiary university-affiliated orthopaedic hospital between January and December 2024, of whom 707 met the inclusion criteria. Patients were randomly assigned in a 1:1 ratio by a random number table to a vibration group or a blank control group. The primary outcomes were the seven day postoperative pain visual analogue scale (VAS) score and the incidence of lower limb deep vein thrombosis (DVT). Secondary outcomes were radiographic fracture-healing time and postoperative functional scores. The primary analysis followed the intention-to-treat (ITT) principle, comparing all randomized patients with available outcome data according to their original allocation, and a per-protocol (PP) sensitivity analysis was additionally performed.

RESULTS: A total of 707 patients completed six to 12 months of follow-up and were included in the ITT analysis (350 in the vibration group and 357 in the control group). In the overall population, the seven day postoperative incidence of lower limb DVT was significantly lower in the vibration group than in the control group [10.9% (38/350) vs 22.6% (81/357); absolute risk difference (ARD) = 11.7%]. The seven day postoperative pain scores were lower in the vibration group (weighted mean approximately 5.1 vs 5.7), radiographic fracture-healing time was shorter (approximately 5.2 vs 5.5 months), and functional scores at final follow-up were higher (approximately 127.8 vs 123.2). PP sensitivity analyses yielded results consistent in direction with the ITT analyses, further supporting the robustness of the study conclusions.

CONCLUSION: Vibration-stimulation therapy facilitates rapid postoperative recovery in patients with lower limb fractures and has a favourable safety profile, and may represent a promising component of postoperative ERAS strategies in the future.

PMID:41413326 | DOI:10.1007/s00264-025-06726-7

Int Orthop. 2025 Dec 18. doi: 10.1007/s00264-025-06713-y. Online ahead of print.

ABSTRACT

PURPOSE: Longus colli acute calcific tendinitis (LCCT) is a painful disease characterized by a triad of neck pain, neck stiffness and odynophagia. It is a relatively rare cause of neck pain, often unknown or underdiagnosed, but it is important to be aware of its existence as it can mimic other potentially more dangerous illnesses.

METHODS: We present a short series of five cases in which we gathered demographic and clinical data including imaging studies and compared our findings to previous reports by other authors. The diagnosis of LCCT was made by the combination of a compatible clinical presentation and blood workup plus the identification of a calcific deposit in the proximal oblique fibers of the longus colli muscle and retropharyngeal edema via computed tomography.

RESULTS: Five patients were analyzed. Mean age was 44 years, three female and two male. All patients initially presented neck pain and painful mobilization, while only 60% presented with odynophagia. There were no patients with radiculopathy nor fever. The mean values for ESR, CRP and White Blood Cell (WBC) were 23.2 mm/h, 2.97 mg/dl and 10.21 * 10^9/L respectively. On CT and/or MRI exploration all the patients presented a visible calcific deposit on the anteroinferior border of the anterior C1 arch and visible signs of retropharyngeal oedema.

CONCLUSIONS: LCCT is a self-limited pathology that is caused by a foreign-body type reaction in the retropharyngeal space secondary to the degradation and resorption of calcium hydroxyapatite deposits usually found at the anteroinferior border of the anterior C1 arch. It is necessary to create awareness of this pathology amongst physicians because it can mimic more serious illness like retropharyngeal abscess, meningitis and spondylodiscitis and this may lead to unnecessary expenditures and antibiotic usage.

PMID:41410695 | DOI:10.1007/s00264-025-06713-y

Injury. 2025 Dec 4:112942. doi: 10.1016/j.injury.2025.112942. Online ahead of print.

NO ABSTRACT

PMID:41407605 | DOI:10.1016/j.injury.2025.112942

Injury. 2025 Dec 11;57(2):112971. doi: 10.1016/j.injury.2025.112971. Online ahead of print.

ABSTRACT

BACKGROUND: The gull sign was described as a radiographic marker of superomedial dome impaction in acetabular fractures and was considered predictive of failure after osteosynthesis in older patients (≥ 60 years).

AIM: To determine whether the radiographic gull sign is associated with higher conversion rates to total hip arthroplasty (THA) within 24 months after open reduction and internal fixation (ORIF) for displaced acetabular fractures in patients aged ≥ 60 years.

METHODS: In this retrospective cohort study, 126 patients aged ≥ 60 years (mean 76 years, range 60.1-93.6) underwent ORIF for displaced acetabular fractures via the Pararectus approach between 2009 and 2020. Preoperative pelvic radiographs were assessed for the presence of the gull sign, and CT scans were evaluated for dome impaction. Failure was defined as conversion to total hip arthroplasty (THA) within 24 months after ORIF. Kaplan-Meier analyses with log-rank tests were performed on the entire cohort, and diagnostic performance was analysed in the subset with complete two-year follow-up (n = 93).

RESULTS: At two years, 20 of 93 patients (22 %) had undergone THA, occurring on average 12.1 months after the index surgery (range 2-45 months). A radiographic gull sign was identified in 21 patients (23 %). The subsequent THA conversion rate was similar between those with and without the sign (5/21 [24 %] vs 15/72 [21 %]; p = 0.99). Concordance between radiographs and CT was limited: only 12 of 21 gull-positive patients (57 %) showed a true dome impaction on CT, while CT nevertheless revealed impaction in 21 of 72 gull-negative patients (29 %). Among patients with CT-confirmed impaction, 8 of 33 (24 %) underwent THA within 24 months, compared with 12 of 60 (20 %) without impaction (p = 0.79). Kaplan-Meier analysis of the entire cohort (n = 126) likewise showed no difference in THA-free survival between groups.

CONCLUSION: Neither a radiographic gull sign nor CT-confirmed dome impaction predicted early conversion in our series of acetabular fractures managed via Pararectus approach; overall conversion rates were acceptable. Accordingly, the gull sign is not a harbinger per se for failure of osteosynthesis in older adults.

PMID:41406758 | DOI:10.1016/j.injury.2025.112971

Injury. 2025 Dec 11;57(2):112957. doi: 10.1016/j.injury.2025.112957. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the diagnostic performance of ChatGPT in identifying acute shoulder dislocations and to compare its accuracy with that of orthopedic specialists and emergency medicine residents.

METHODS: A total of 250 anteroposterior (AP) shoulder radiographs were included. All images were evaluated for the presence or absence of dislocation and for dislocation subtype (anterior, posterior, inferior) by four groups: orthopedic specialists (n = 10), orthopedic residents (n = 10), emergency medicine residents (n = 10), and ChatGPT. ChatGPT-4o (OpenAI, May 2024) and ChatGPT-5.1 (OpenAI, July 2025) were accessed through the web interface using a standardized single image + text-based prompt. The models had no prior training with radiological images. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, overall accuracy, area under the ROC curve (AUC), F1 score, and Cohen's kappa for inter-reader agreement.

RESULTS: In the detection of shoulder dislocation (yes/no), orthopedic specialists demonstrated the highest accuracy (95.0 %), whereas ChatGPT-4o showed the lowest (72.4 %). Orthopedic residents achieved 90.1 % accuracy, emergency medicine residents 89.0 %, and ChatGPT-5.1 78.0 %. When subtype classification (anterior, posterior, inferior) was included, orthopedic specialists again performed best (89.7 %), while ChatGPT-4o had the lowest accuracy (68.0 %). Orthopedic residents (84.7 %) outperformed emergency medicine residents (76.7 %), while ChatGPT-5.1 achieved 69.6 % accuracy. Internal-rotation AP images of nondislocated shoulders were frequently misinterpreted as posterior dislocations.

CONCLUSION: This study demonstrates that the diagnostic accuracy for acute shoulder dislocation varies according to the clinicians' level of experience. The use of a single AP shoulder radiograph alone is not sufficient for diagnosing shoulder dislocation. Clinicians most frequently misinterpreted internally rotated AP shoulder radiographs as posterior dislocations. ChatGPT models showed moderate performance and are not yet suitable as standalone diagnostic tools in clinical decision-making. However, with further development of artificial intelligence-based systems, these models may serve as rapid preliminary screening aids in emergency settings.

PMID:41406757 | DOI:10.1016/j.injury.2025.112957

J Bone Joint Surg Am. 2025 Dec 17;107(24):2735-2743. doi: 10.2106/JBJS.25.00424. Epub 2025 Nov 17.

ABSTRACT

BACKGROUND: Novel osteoconductive and osteoinductive therapies for posterior-based lumbar interbody fusion surgery are needed. Bezeotermin alfa (recombinant human bone morphogenetic protein [rhBMP]-6, previously referred to as AGA111) is a potential potent stimulator of bone regeneration. This prospective, multicenter, randomized, double-blinded, placebo-controlled Phase-2 trial evaluated the safety and preliminary efficacy of bezeotermin carried by autologous blood coagulum (ABC) in patients undergoing lumbar interbody fusion surgery between L3 and S1 for degenerative disc disease.

METHODS: Adult patients scheduled for single-level elective lumbar interbody fusion surgery across 6 clinical trial sites in the People's Republic of China were randomized 1:1:1 to placebo, 0.25 mg bezeotermin, or 0.5 mg bezeotermin and followed for 12 months. The primary end point was the incidence of adverse events (AEs). Secondary end points included anti-rhBMP-6 antibodies, the success rate of radiographic fusion, changes in the Oswestry Disability Index (ODI) score, changes in the pain score on a visual analogue scale (VAS), and serum drug concentrations.

RESULTS: Sixty-three patients with a mean age of 59.2 years (52% female, 98.4% Han) were enrolled in the study. Twenty-one, 20, and 22 of the patients were randomized to placebo, 0.25 mg bezeotermin, and 0.5 mg bezeotermin, respectively. All patients reported at least 1 AE during the study, but most AEs were mild to moderate in severity. No drug-related serious AEs were reported in the bezeotermin groups. There was a trend toward a higher rate of successful radiographic fusion and greater improvement of the ODI and VAS scores in the bezeotermin groups than in the placebo group from month 3 to month 12.

CONCLUSIONS: This prospective, randomized, double-blinded, placebo-controlled trial demonstrated that bezeotermin/ABC was safe and well tolerated during posterior-based single-level lumbar interbody fusion. The preliminary efficacy of bezeotermin in accelerating spinal fusion and improving clinical outcomes supports its further clinical development.

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

PMID:41405575 | DOI:10.2106/JBJS.25.00424

J Bone Joint Surg Am. 2025 Dec 17;107(24):2726-2734. doi: 10.2106/JBJS.25.00394. Epub 2025 Nov 18.

ABSTRACT

➢ Medical malpractice litigation in orthopaedic surgery remains a major challenge, as the field consistently ranks among the most frequently litigated specialties. Malpractice claims in orthopaedics often involve surgical errors, misdiagnoses, delayed treatment, and inadequate postoperative care, with substantial financial and emotional consequences for health-care providers.➢ Malpractice risk varies by orthopaedic subspecialty, with adult reconstruction and spine surgeons facing the highest litigation rates, often due to nerve injuries, delayed or missed diagnoses, or postoperative complications. Although defense verdicts are the most common outcome, substantial settlements and plaintiff verdicts occur in cases involving irreversible damages, inadequate informed consent, or technical errors.➢ Proactive risk management and legal preparedness can help to mitigate liability and protect physicians. Preventative strategies include clear, supportive communication to build patient trust, comprehensive documentation ensuring adherence to evidence-based guidelines, and diagnostic accuracy through use of objective tools.

PMID:41405574 | DOI:10.2106/JBJS.25.00394

J Bone Joint Surg Am. 2025 Dec 17;107(24):2709-2710. doi: 10.2106/JBJS.25.00387. Epub 2025 Nov 18.

NO ABSTRACT

PMID:41405573 | DOI:10.2106/JBJS.25.00387

J Bone Joint Surg Am. 2025 Dec 17;107(24):2705-2708. doi: 10.2106/JBJS.25.00495. Epub 2025 Nov 13.

NO ABSTRACT

PMID:41405572 | DOI:10.2106/JBJS.25.00495

J Bone Joint Surg Am. 2025 Dec 17;107(24):2688. doi: 10.2106/JBJS.25.01136. Epub 2025 Dec 17.

NO ABSTRACT

PMID:41405571 | DOI:10.2106/JBJS.25.01136

J Bone Joint Surg Am. 2025 Dec 17;107(24):2686-2687. doi: 10.2106/JBJS.25.01078. Epub 2025 Dec 17.

NO ABSTRACT

PMID:41405570 | DOI:10.2106/JBJS.25.01078

J Bone Joint Surg Am. 2025 Dec 17;107(24):2684-2685. doi: 10.2106/JBJS.25.01372. Epub 2025 Dec 17.

NO ABSTRACT

PMID:41405569 | DOI:10.2106/JBJS.25.01372

J Bone Joint Surg Am. 2025 Dec 17;107(24):2682-2683. doi: 10.2106/JBJS.25.00940. Epub 2025 Dec 17.

NO ABSTRACT

PMID:41405568 | DOI:10.2106/JBJS.25.00940

Injury. 2025 Dec 10;57(2):112951. doi: 10.1016/j.injury.2025.112951. Online ahead of print.

ABSTRACT

BACKGROUND: Cervical spine (c-spine) injuries can lead to significant disability and mortality. Although stabilization is the primary management for suspected c-spine injuries, lapses in stabilization frequently occur during trauma resuscitation. To facilitate evaluation of c-spine management, we developed a computer vision system to detect stabilization techniques. This system would enable scalable monitoring, including the timing and duration of c-spine stabilization.

METHODS: We developed a 2-stage computer vision system to detect prehospital rigid c-collar, hospital semi-rigid c-collar, and manual in-line stabilization. The system was trained, tested, and validated using image frames extracted from 86 pediatric trauma resuscitation videos at a level 1 pediatric trauma center from October 2022 to May 2023. The first stage identified the patient in each image, and the second stage classified the stabilization technique. A 5-fold cross-validation was performed on the first 68 resuscitation videos for training/testing, with the latest 18 cases reserved for validation. System performance was evaluated using accuracy, precision, recall, F1 score, and Matthews correlation coefficient (MCC). To assess system potential for manual in-line detection, 10 simulation videos were added (eight for training, two for testing).

RESULTS: In the 18 validation cases, the system achieved high accuracy for binary classification (0.91) and for detecting specific stabilization techniques: prehospital rigid c-collar (0.95), hospital semi-rigid c-collar (0.93), and manual in-line stabilization (0.97). The precision scores were 0.89 for binary classification of any stabilization method, 0.71 for prehospital rigid c-collar, 0.89 for hospital semi-rigid c-collar, and 0.04 for manual in-line. Recall, F1, and MCC scores aligned with these findings, with the highest values observed for detecting the hospital semi-rigid c-collar among the stabilization techniques. Adding simulation videos improved manual in-line stabilization detection, with accuracy 0.62, precision 0.88, recall 0.58, F1 score 0.70, and MCC 0.27.

CONCLUSION: The 2-stage computer vision system showed excellent performance for detecting c-spine stabilization, with limitations for manual in-line stabilization due to its rarity. Simulation data improved manual in-line detection, highlighting potential benefits of a more balanced dataset. The computer vision system may serve as a prototype for automated monitoring of trauma resuscitation using the camera infrastructure in the resuscitation room.

PMID:41401500 | DOI:10.1016/j.injury.2025.112951

Injury. 2025 Dec 11;57(2):112965. doi: 10.1016/j.injury.2025.112965. Online ahead of print.

ABSTRACT

BACKGROUND: Acetabular fracture with concomitant hip dislocation (dislocation-fracture) is a high-energy injury requiring urgent management. Although less life-threatening than pelvic ring fractures, these injuries are often associated with ipsilateral knee trauma, which may be overlooked in the acute setting. Delayed recognition can lead to secondary meniscal and chondral damage.

PURPOSE: To investigate whether hip dislocation in the setting of acetabular fracture is an independent risk factor for ipsilateral knee injury.

METHODS: We retrospectively reviewed 180 patients (146 men, 34 women; mean age, 57.3 ± 19.8 years) admitted with acetabular fractures between July 2006 and December 2024. Clinical variables included age, sex, mechanism of injury, concomitant upper extremity injuries, initial knee evaluation, and the presence of ipsilateral knee injuries. Knee injury was defined as ligament injury, tibial plateau fracture, or meniscal injury. Notably, tibial plateau fractures that were not clearly identified on radiographs were diagnosed by MRI. Patients were stratified according to the presence of hip dislocation, and logistic regression analysis was performed to identify independent risk factors for knee injury.

RESULTS: Mechanisms of injury included falls (25.6 %), traffic accidents (69.4 %), and tumbling (5.0 %). Concomitant upper extremity injuries were found in 21.7 % of patients. Ipsilateral hip dislocation-fracture occurred in 46 patients (25.6 %), with directions and fracture types recorded as Thompson and Epstein classification. Knee injury was significantly more frequent in Group pH (12/46, 26.1 %) than in Group AH (5/134, 3.7 %) (P < 0.001). Logistic regression showed that age, sex, mechanism of injury, and upper extremity injuries were not independent predictors of knee or PCL injury, whereas hip dislocation-fracture significantly increased the risk (OR 7.25; 95 % CI, 2.30-22.9; P < 0.001). Among knee injuries, posterior cruciate ligament (PCL) injury was most common (41.2 %), followed by meniscal injury (17.6 %) and anterior cruciate ligament (ACL) injury (5.6 %). Concomitant tibial plateau fractures were observed in 23.5 % of cases, all confirmed by MRI. Soft-tissue-only knee injuries (ligament and/or meniscus without fracture) accounted for 10 cases.

CONCLUSION: Hip dislocation-fracture significantly increases the risk of ipsilateral knee injury, particularly PCL injury. Clinicians should maintain a high index of suspicion and perform systematic knee evaluation, including MRI when feasible, to enable early diagnosis and prevent secondary joint deterioration.

PMID:41401499 | DOI:10.1016/j.injury.2025.112965

J Bone Joint Surg Am. 2025 Dec 16. doi: 10.2106/JBJS.25.01110. Online ahead of print.

NO ABSTRACT

PMID:41401257 | DOI:10.2106/JBJS.25.01110

J Bone Joint Surg Am. 2025 Dec 9. doi: 10.2106/JBJS.25.01408. Online ahead of print.

ABSTRACT

➢ The Spanish National Health System delivers equitable, high-quality musculoskeletal care through a nationwide network that connects community-based primary care with tertiary trauma and orthopaedic referral centers.➢ The highly competitive and standardized residency program in trauma and orthopaedic surgery in Spain ensures uniform training quality, the possibility for subspecialization, and well-grounded clinical and surgical competency across all regions.➢ Orthopaedic research in Spain has expanded considerably. It is supported by national and regional networks, an increasing participation in multicenter international trials and cross-border collaboration, and a growing academic output of global relevance.➢ The integration of women in Spanish orthopaedics has been increasing, such that the proportion of female orthopaedic residents in Spain was well above that of many other countries in 2022.➢ Spain combines a broadly extended hospital network with a dynamic academic ecosystem, positioning the country as a leading European hub for trauma and orthopaedic innovation, research, and education.

PMID:41401252 | DOI:10.2106/JBJS.25.01408