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

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

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

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

Injury. 2025 Jun 24:112545. doi: 10.1016/j.injury.2025.112545. Online ahead of print.

NO ABSTRACT

PMID:40603238 | DOI:10.1016/j.injury.2025.112545

Injury. 2025 Jun 23:112546. doi: 10.1016/j.injury.2025.112546. Online ahead of print.

NO ABSTRACT

PMID:40603237 | DOI:10.1016/j.injury.2025.112546

Injury. 2025 Jun 25;56(8):112557. doi: 10.1016/j.injury.2025.112557. Online ahead of print.

ABSTRACT

The global rise in total knee arthroplasty (TKA), driven by an aging population, has led to an increased incidence of periprosthetic fractures (PPFs). Dual implants for distal femur periprosthetic fractures (PDFFs) are a growing area of interest for these challenging fractures with dual plating (DP) and plate-retrograde femoral intramedullary nail (PN) emerging as viable constructs for these injuries. However, dual implants have inherent limitations. Herein we focus on describing a modified PN fixation-retrograde tibial intramedullary nail (RTN) combined with a less invasive stabilization system (LISS) for PDFFs following TKA in elderly patients and providing the technical trick of this modified PN fixation.

PMID:40602036 | DOI:10.1016/j.injury.2025.112557

J Bone Joint Surg Am. 2025 Jul 2;107(13):e74. doi: 10.2106/JBJS.25.00400.

NO ABSTRACT

PMID:40600896 | DOI:10.2106/JBJS.25.00400

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06597-y. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study is to explore the representation of professionals engaged in medico-surgical practices within seventeenth-century Dutch and Flemish genre painting. The research focuses on how these works of art mirror the rich diversity of healthcare practitioners, the techniques employed, the spaces of care depicted, and the societal perception of medical knowledge.

MATERIALS AND METHODS: An extensive review has been conducted of the foremost museums and painting databases devoted to seventeenth-century Dutch and Flemish art related to the treatment of illness. Over one hundred and fifty works, created by some sixty painters active during this period, have been subjected to a meticulous formal and iconographic analysis.

RESULTS: The study unveils the coexistence of a multifaceted array of medical figures - from physicians and barber-surgeons to empirics and charlatans - and illustrates how paintings of the time portrayed urban, rural, and mercantile settings of medical practice. These visual narratives document surgical techniques, orthopaedic interventions, and the complex social dynamics between patients and healthcare providers. Furthermore, the works frequently incorporate satirical and allegorical elements that critique the pretensions of the medical elite, highlight surgical ineptitude, or expose the cunning of itinerant healers.

CONCLUSION: Seventeenth-century genre painting serves as a vivid visual testament to the popular perception of medicine and provides invaluable insight into the tensions between academic medicine and empirical practice. These works offer a critical and nuanced lens through which to apprehend the medical culture and epistemologies of the period.

PMID:40600997 | DOI:10.1007/s00264-025-06597-y

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06596-z. Online ahead of print.

ABSTRACT

PURPOSE: To determine the functional impact and complications associated with os acromiale after the implantation of a reverse total shoulder arthroplasty (RTSA) with medialization of the centre of rotation.

METHODS: A retrospective case-control study with cross-sectional evaluation was conducted. Between 2004 and 2021, patients who underwent RTSA for cuff arthropathy, GH osteoarthritis or massive irreparable rotator cuff tears with os acromiale (OA) and more thantwo years of follow-up, were identified. A control cohort (2:1) without acromial compromise (NOOA) was also identified. Functional (Constant, ASES, Quick-DASH, VAS, ROM) and radiological assessment (os acromiale type, acromiohumeral distance, acromion tilt) were performed.

RESULTS: RTSA was implanted in 432 cases during the study period, 221 with rotator cuff arthropathy, irreparable tears, or osteoarthritis, of these, 12 had an os acromiale (OA) (5.4%) and were compared to 24 patients without os acromiale (NOOA). Epidemiologic data OA/NOOA were: female 10/20, mean follow-up 47.2 ± 25/56.1 ± 30 months, mean age 73.5 ± 4.7/75.4 ± 4.1 years. Regarding the difference in preoperative and final follow-up functional outcomes (OA/NOOA): Constant 20.2/30.9 (p =.012), ASES 28/54 (p =.017), Quick-DASH - 19.6/-27.2 (p =.220), VAS - 5/-7 (p =.007), difference in pre-surgery/last follow-up ROM: elevation 50º/60º (p =.138), abduction 60º/60º (p =.775). The os acromiale group presented two prosthetic dislocations (16.7%).

CONCLUSION: Patients with os acromiale improve their preoperative condition after RTSA implantation; however, although there are no differences in joint balance, this improvement is significantly lower in the Constant and ASES scores, primarily due to a decrease in strength and pain relief experienced by patients with os acromiale.

PMID:40600996 | DOI:10.1007/s00264-025-06596-z

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06592-3. Online ahead of print.

NO ABSTRACT

PMID:40600995 | DOI:10.1007/s00264-025-06592-3

Int Orthop. 2025 Jul 2. doi: 10.1007/s00264-025-06570-9. Online ahead of print.

ABSTRACT

PURPOSE: MRI plays an important role in the evaluation of rotator cuff tears. Our study aimed to determine if specific MRI criteria can be used to distinguish between acute traumatic and pre-existing degenerative lesions.

MATERIALS AND METHODS: The study included 40 MRIs or MR-arthrograms with rotator cuff tears. Twenty tears were traumatic and 20 were non-traumatic. Two radiologists specialized in musculoskeletal imaging, an experienced shoulder surgeon and a registrar trained in shoulder surgery assessed on each MRI the presence or absence of the following 11 parameters: tendon oedema, oedema in the muscles of the rotator cuff and the deltoid, edema and cysts in the greater tuberosity, tendon stump at the insertion site, tangent sign, tendon kinking, cobra sign, superior and posterior decentering of the humeral head. All investigators were blinded to the age and sex of the patients, the cause of the tendon lesion, the duration of the symptoms and the proportions of traumatic and non-traumatic tears. They were also asked for their assessment regarding the cause of each patient's tear, traumatic or degenerative.

RESULTS: All features could be observed with varying percentages in both groups. It was therefore impossible to assign a specific MRI to one group or the other, even with a combination of two or three features. One observer categorized 25 of 40 cases correctly (62.5%), two observers assigned 22 cases (55%), and one observer 19 cases (47.5%) correctly.

CONCLUSION: In individual cases, a partial or full-thickness lesion of the supraspinatus tendon or a postero-superior rotator cuff tear without advanced fatty infiltration cannot be correctly assigned to an acute traumatic or a preexisting lesion based on MRI.

PMID:40600994 | DOI:10.1007/s00264-025-06570-9

EFORT Open Rev. 2025 Jun 30;10(7):572-573. doi: 10.1530/EOR-2025-0029.

NO ABSTRACT

PMID:40591688 | PMC:PMC12226823 | DOI:10.1530/EOR-2025-0029

EFORT Open Rev. 2025 Jun 30;10(7):562-569. doi: 10.1530/EOR-2024-0147.

ABSTRACT

PURPOSE: This scoping review examines the epidemiology and incidence of complications associated with incorrect screw length in orthopaedic trauma surgeries, aiming to underscore its impact on clinical outcomes and healthcare costs.

METHODS: Guided by Arksey and O'Malley's framework and PRISMA guidelines, a thorough search was conducted across PubMed, Web of Science, Cochrane, and Google Scholar up to April 2024. Studies included must be human-based orthopaedic procedures involving screw length, published in peer-reviewed journals with full text available, and report complications from incorrect screw length; studies excluded were systematic reviews/meta-analyses. Paper characteristics and data on incident rates of complications due to screw protrusion were extracted and presented in a supplementary table using Microsoft Excel.

RESULTS: Of 2,285 studies identified, 31 met the inclusion criteria. Incorrect screw length led to severe complications, including neurovascular damage (7 studies), avascular necrosis (4 studies), delayed union or pseudoarthrosis (9), tendinitis/tendon rupture (12 studies), and pain (10 studies). Notably, improperly sized screws increased neurovascular and avascular necrosis complications, especially in weight-bearing joints. In addition, incorrect screw length was linked to higher hardware removal rates, contributing to increased healthcare costs. Limitations include the inability of some studies to definitively attribute complications to screw protrusion and the exclusion of cases involving joint collapse or solely mechanical complications.

CONCLUSION: This review underscores the importance of precise screw length selection to prevent complications and improve surgical outcomes. It calls for further research on the medico-legal and economic impacts of screw length errors and the need for better surgical practices.

PMID:40591687 | PMC:PMC12229280 | DOI:10.1530/EOR-2024-0147

EFORT Open Rev. 2025 Jul 1;10(7):510-519. doi: 10.1530/EOR-2024-0069.

ABSTRACT

PURPOSE: Dexmedetomidine is a widely employed adjunct in nerve block anesthesia for shoulder arthroscopy. This study aimed to assess the analgesic efficacy of dexmedetomidine as a nerve block adjuvant in patients undergoing shoulder arthroscopy.

METHODS: A thorough search of PubMed/MEDLINE, Embase, Web of Science and the Cochrane Library databases was conducted to identify randomized-controlled trials comparing the effects of dexmedetomidine-enhanced shoulder arthroscopy nerve blocks against those without dexmedetomidine. This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane-recommended risk of bias tool was employed for quality and bias assessment. Statistical analysis, utilizing Review Manager 5.4 with a significance level of P < 0.05, focused on primary outcomes: duration of analgesia and postoperative 24 h morphine consumption, and secondary outcomes: motor and sensory block duration, visual analog scale pain scores and adverse events.

RESULTS: Out of 307 articles retrieved, ten randomized-controlled trials involving 672 patients were included. Dexmedetomidine supplementation significantly prolonged the duration of analgesia (MD = 3.58, 95% CI: 2.53- 4.63, P < 0.00001, I 2 = 77%) and decreased postoperative morphine consumption (MD = -11.88, 95% CI: -17.25 to -6.52, P < 0.0001, I 2 = 41%). In addition, the dexmedetomidine group exhibited lower VAS pain scores at 1, 12 and 24 h postoperatively. No significant differences were observed in motor block duration, bradycardia (P = 0.18), hypotension (P = 0.50) and nausea and vomiting (P = 0.76). Sensitivity analyses validated the robustness of these findings.

CONCLUSIONS: This meta-analysis supports dexmedetomidine as an effective adjuvant in nerve blocks for shoulder arthroscopy. It enhances postoperative analgesia without increasing adverse events such as bradycardia, hypotension and nausea and vomiting.

PMID:40591683 | DOI:10.1530/EOR-2024-0069

EFORT Open Rev. 2025 Jun 30;10(7):570-571. doi: 10.1530/EOR-2024-0140.

NO ABSTRACT

PMID:40591682 | PMC:PMC12226824 | DOI:10.1530/EOR-2024-0140

EFORT Open Rev. 2025 Jul 1;10(7):439-444. doi: 10.1530/EOR-2025-0126.

NO ABSTRACT

PMID:40591679 | DOI:10.1530/EOR-2025-0126

EFORT Open Rev. 2025 Jul 1;10(7):475-486. doi: 10.1530/EOR-2024-0093.

ABSTRACT

While conventional structural magnetic resonance imaging (MRI) can detect cruciate ligament anatomy and injuries, it has inherent limitations. Recently, novel MRI technologies such as quantitative MRI and artificial intelligence (AI) have emerged to mitigate these shortcomings, providing critical quantitative insights beyond gross morphological imaging and poised to expand current knowledge in assessing cruciate ligament injuries and to facilitate clinical decision making. Quantitative MRI serves as a noninvasive histological and quantification tool, which significantly improves the evaluation of degeneration and repair processes. AI plays a crucial role in automating radiological estimations and enabling data-driven predictions of future events. Despite the transformative impact of advanced MRI techniques on the analytical and diagnostic algorithms related to cruciate ligament disorders, future efforts are warranted to address challenges such as economic burdens and ethical considerations.

PMID:40591678 | DOI:10.1530/EOR-2024-0093

EFORT Open Rev. 2025 Jun 30;10(7):534-542. doi: 10.1530/EOR-2024-0053.

ABSTRACT

Occurring in 0.5-3% of cases, periprosthetic humerus fractures pose a challenge, necessitating effective management strategies. A comprehensive review was conducted using PubMed. Used terms included 'Periprosthetic humerus fractures; complications; periprosthetic fractures shoulder arthroplasty; periprosthetic humeral fracture treatment; nerve palsy humeral revision arthroplasty; infections after shoulder arthroplasty; postoperative complications AND open reduction AND humeral fractures; allograft AND long humeral stem'. Studies were excluded if they did not meet the actual topic, included more than primary shoulder arthroplasty and/or were in non-English or non-German language. Thirty-eight papers with evidence levels ranging from two to three were selected for this review. Various classification systems have been implemented; their validation though was based on studies with only a limited number of patients. Risk factors include osteopenia/osteoporosis, rheumatoid arthritis, age, age-related lifestyle and gender. Treatment options range from conservative approaches to plate osteosynthesis or revision to a longer stem. Nevertheless, there is a lack of biomechanic studies and randomized-controlled clinical studies; hence, the evidence is low. Complications in revision arthroplasty encompass infections, nonunions, and nerve palsies, highlighting the importance of individualized treatment planning. The management of periprosthetic humeral fractures requires careful consideration of risk factors and tailored treatment plans. Existing literature relies on small case series and expert opinions, highlighting the need for further research to establish optimal treatment strategies for these challenging fractures.

PMID:40591677 | DOI:10.1530/EOR-2024-0053

EFORT Open Rev. 2025 Jul 1;10(7):466-474. doi: 10.1530/EOR-2024-0167.

ABSTRACT

PURPOSE: To evaluate the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of osteonecrosis of the femoral head (ONFH).

METHODS: Search for term systems related to ONFH and HBOT in PubMed, Cochrane Library, Embase and Web of Science databases. The risk ratio (RR) was used as the effective index for dichotomous variables while mean difference (MD) and 95% confidence interval (CI) were used as the effective index for continuous variables, with a two-sided P < 0.05 considered statistically significant. I2 statistic and Q test were used to evaluate the statistical heterogeneity of the included studies.

RESULTS: Ten studies were included, involving 568 participants. Pre-post meta-analyses to show the visual analog scale after HBOT (MD = -2.94, 95% CI: -4.27, -1.60, P < 0.0001), short form 12 physical component summary scale (SF12 PCS) (MD = 17.28, 95% CI: 8.26, 26.31, P = 0.0002), short form 12 mental component summary scale (SF12 MCS) (MD = 4.26, 95% CI: 2.56, 5.95, P < 0.00001), Harris hip score (HHS) (MD = 26.91, 95% CI: 0.35, 53.46, P = 0.05), modified Harris hip score (mHHS) (MD = 44.31, 95% CI: 13.75, 74.87, P = 0.004) were significantly different from those before treatment. The results of SF12 PCS (MD = -0.39, 95% CI: -7.85, 7.06, P = 0.92) and SF12 MCS (MD = 0.76, 95% CI: -7.02, 8.52, P = 0.85), patients' improved events (RR = 1.83, 95% CI: 0.37, 9.09, P = 0.46) showed no significant difference between the HBO and non-HBO groups.

CONCLUSION: The results of this study indicate that HBOT cannot be regarded as an effective measure for the treatment of early-stage necrosis of the femoral head and more large-scale randomized controlled trials are needed for further verification.

PMID:40591670 | DOI:10.1530/EOR-2024-0167