Injury. 2025 Jan 23;56(3):112182. doi: 10.1016/j.injury.2025.112182. Online ahead of print.

ABSTRACT

INTRODUCTION: Blunt chest trauma represents a major risk factor for complications in polytrauma patients. Various scoring systems have emerged, but their impact is not fully appreciated. This review evaluates changes in chest trauma scoring over time and potential shifts in complication rates linked to modified surgical approaches in long bone fractures.

METHODS: A systematic review was performed utilizing Medline and EMBASE. Included studies analyzed the clinical course following blunt chest trauma with orthopedic injuries requiring surgical fixation. Quantification of chest injury severity was assessed based on the utilized scores in the respective publication such as the Abbreviated Injury Scale, Injury Severity Score, Thoracic Trauma Score (TTS) or the Chest Trauma Score (CTS). The studies were categorized into two groups: "ante-millenium" (AM) (<31.12.2000) and "post-millenium" (PM) (>01.01.2000). Endpoint analysis focused on chest-injury-related complications, including acute respiratory distress syndrome (ARDS), pneumonia, multiple organ failure (MOF), and pulmonary embolism. A meta-analysis examined the influence of surgical timing (early vs. late) on clinical outcomes.

RESULTS: Of 9,682 studies on chest trauma, 20 (4,079 patients) met the inclusion criteria. Most studies in both AM and PM reported the thoracic AIS scale for severity assessment. In group PM more clinical parameters were included in the decision making. Incidences of pooled and weighted mortality were higher in AM (5.1 %) compared to PM (2.3 %, p = 0.003), and ARDS incidence was also greater in AM (12.1 %) versus PM (8.9 %, p = 0.045), though these findings were not confirmed through indirect meta-analysis. Early fracture fixation (<24 h) displayed a non-significant trend toward lower ARDS (OR: 0.60; 95 % CI, 0.23-1.52) and mortality (OR: 0.66; 95 % CI, 0.28-1.55), but significantly reduced pneumonia risk (OR, 0.53; 95 % CI, 0.40-0.71).

CONCLUSION: Prior to 2000, chest injuries were quantified using the AIS alone, while afterwards multiple scoring systems that incorporated pathophysiologic response were utilized. Possibly related to changes in timing of surgery, fixation techniques, or general improvements in-patient care seems to have improved in patients with concomitant thoracic trauma regarding mortality and ARDS. Overall, polytrauma patients with concomitant thoracic injuries might benefit from early definitive fracture care if their physiology and overall injury pattern allows it.

LEVEL OF EVIDENCE: Systematic Review; Level IV.

PMID:39874866 | DOI:10.1016/j.injury.2025.112182

J Bone Joint Surg Am. 2025 Jan 28. doi: 10.2106/JBJS.24.00894. Online ahead of print.

ABSTRACT

BACKGROUND: In this study, we estimated the risk of surgically treated postoperative periprosthetic femoral fractures (POPFFs) associated with femoral implants frequently used for total hip arthroplasty (THA).

METHODS: In this cohort study of patients who underwent primary THA in England between January 1, 2004, and December 31, 2020, POPFFs were identified from prospectively collected revision records and national hospital records. POPFF incidence rates, adjusting for potential confounders, were estimated for common stems. Subgroup analyses were performed for patients >70 years of age, with non-osteoarthritic indications, and with femoral neck fracture.

RESULTS: POPFFs occurred in 0.6% (5,100) of 809,832 cases during a median follow-up of 6.5 years (interquartile range [IQR], 3.9 to 9.6 years). After cemented stem implantation, the majority of POPFFs were treated with fixation. Adjusted prosthesis time incidence rates (PTIRs) for POPFFs varied by stem design, regardless of cement fixation. Cemented composite beam (CB) stems demonstrated the lowest risk of POPFF. Collared cementless stems had an equivalent or lower rate of POPFF compared with the current gold standard of a polished taper slip cemented stem.

CONCLUSIONS: Cemented CB stems were associated with the lowest POPFF risk, and some cementless stem designs outperformed modern cemented stem designs. Stem design was strongly associated with POPFF risk, regardless of the presence of cement. Surgeons, policymakers, and patients should consider these findings when considering femoral implants in those most at risk for POPFF.

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

PMID:39874379 | DOI:10.2106/JBJS.24.00894

J Bone Joint Surg Am. 2025 Jan 28. doi: 10.2106/JBJS.24.00829. Online ahead of print.

ABSTRACT

BACKGROUND: Previous studies have reported normative data for sagittal spinal alignment in asymptomatic adults. The sagittal spinal alignment change in European children was recently reported. However, there is a lack of studies on the normative reference values of sagittal spinal and pelvic alignment and how these parameters change at different growth stages in Chinese children. The aims of this study were to establish the normative reference values of sagittal spinopelvic parameters in Chinese children, to investigate their variation during growth, and to compare these parameters between Chinese and European populations.

METHODS: The radiographic data of 1,916 healthy Chinese children (female:male sex ratio, 1.02:1; mean age, 11.9 ± 4.3 years) were analyzed in a retrospective, single-center study. Full-spine radiographs were utilized to measure several sagittal parameters, including pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser sign, and triradiate cartilage status).

RESULTS: During skeletal growth, pelvic incidence (PI) increased from 31.3° to 38.4° (p < 0.001), and pelvic tilt (PT) increased from 7.8° to 12.2° (p < 0.001). There were also increases in LL (from 45.0° to 46.3°; p = 0.020) and proximal LL (from 14.5° to 15.9°; p = 0.023). The peak of change in PI occurred between Groups 1 and 2 (from 31.3° to 35.8°; p = 0.011). The peak of change in LL was observed between Groups 1 and 3 (from 45.0° to 47.7°; p = 0.008). The peak of change in proximal LL (from 14.5° to 15.9°; p = 0.039) and distal TK (from 6.1° to 6.9°; p = 0.039) occurred between Groups 1 and 5. A subgroup comparison showed that age and TK were significantly higher in male patients than in female patients across the skeletal growth groups.

CONCLUSIONS: This was a comprehensive study of sagittal alignment in a large cohort of Chinese children. These findings can serve as age, sex, and ethnicity-specific reference values for spine surgeons when assessing and planning correction surgery for pediatric patients. The sagittal alignment variations during skeletal growth were different from those in European children, representing a unique cascade effect occurring during skeletal maturation in the Chinese population.

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

PMID:39874374 | DOI:10.2106/JBJS.24.00829

Int Orthop. 2025 Jan 29. doi: 10.1007/s00264-025-06415-5. Online ahead of print.

ABSTRACT

PURPOSE: Hinge fractures show a relatively high incidence in varus and valgus distal femoral osteotomy (DFO) and can lead to delayed- or non-union. Another observed complication of a hinge fracture is an unintentional change of the postoperative femoral torsion of up to + 9.5° in conventionally performed DFO. We hypothesize that the change of femoral torsion in case of a hinge fracture is less pronounced when DFO is performed using patient-specific instruments (PSI) compared to the literature of conventionally performed DFO.

METHODS: All patients who underwent varus or valgus DFO using PSI from January 2014 to September 2023 were included. Radiographs and computed tomography (CT) scans were used to screen for hinge fractures. Pre- and postoperative femoral torsion was measured in CT.

RESULTS: Thirty-five medial closing-wedge DFO (MCW-DFO), 27 lateral closing-wedge DFO (LCW-DFO), and 27 lateral opening-wedge DFO (LOW-DFO) were included, resulting in a total of 89 included osteotomies. A total of 55 hinge fractures (61.8%) were observed. The femoral torsion changed significantly from 20.5° ± 7.7° to 15.5° ± 8.1° (p < 0.001) in LOW-DFO with a hinge fracture, whereas the other two techniques showed no significant change of femoral torsion.

CONCLUSION: The use of PSI in varus and valgus DFO showed only small changes of the postoperative femoral torsion, even in case of a hinge fracture. The change of femoral torsion was depending on the type of DFO and was only significant in LOW-DFO, however, not exceeding a mean change of 5°.

PMID:39875640 | DOI:10.1007/s00264-025-06415-5

Int Orthop. 2025 Jan 28. doi: 10.1007/s00264-025-06419-1. Online ahead of print.

ABSTRACT

Entrapment neuropathies of the lower extremity are often underdiagnosed due to limitations in clinical examination and electrophysiological testing. Advanced imaging techniques, particularly MR neurography and high-resolution ultrasonography (US), have significantly improved the evaluation and diagnosis of these conditions by enabling precise visualization of nerves and their surrounding anatomical structures. This review focuses on the imaging features of compressive neuropathies affecting the lumbosacral plexus and its branches, including the femoral, obturator, sciatic, common peroneal, and tibial nerves. Key conditions such as meralgia paraesthetica, piriformis syndrome, and tarsal tunnel syndrome are discussed, highlighting findings such as nerve thickening, T2 hypersignal, fascicular changes, and associated muscle denervation patterns. The ability to detect structural causes, including anatomical variations, fibrous bands, and space-occupying lesions, underscores the value of these imaging modalities in facilitating early diagnosis, guiding therapeutic interventions, and improving patient outcomes.

PMID:39873711 | DOI:10.1007/s00264-025-06419-1

Int Orthop. 2025 Jan 28. doi: 10.1007/s00264-025-06413-7. Online ahead of print.

ABSTRACT

PURPOSE: This study reports the relationship between posterior cruciate ligament (PCL) retention vs resection and soft tissue laxity and balance throughout flexion using a robotically controlled ligament tensioner.

METHODS: 55 robotic-assisted TKAs (Total knee arthroplasty) were retrospectively reviewe. The robotic ligament tensioner collected laxity data both before and after PCL resection. Medial and lateral coronal laxity were compared before and after PCL resection at 10°, 45°, and 90° flexion. Gap opening was compared between pre-operative coronal hip-knee-ankle groups.

RESULTS: Lateral laxity was greater after PCL resection at 60° (12.7 ± 2 vs 11.5 ± 3 mm), 75° (13.2 ± 2 vs 11.8 ± 3 mm), and 90° (13.7 ± 2 vs 12.1 ± 3 mm). Medial laxity was significantly greater after PCL resection at 90° (10.1 ± 2 vs 9 ± 2 mm). After PCL resection, laxity in valgus knees increased more compared to neutral/varus knees laterally at 30° (1.2 ± 1 vs 0.3 ± 1 mm), 45° (1.6 ± 1 vs 0.6 ± 1 mm), and 60° (2.1 ± 2 vs 1 ± 1 mm). A similar, but non-significant trend was observed at 90° (2.7 ± 2 vs 1.5 ± 1 mm, p = 0.09).

CONCLUSION: PCL resection increases flexion laxity laterally by up to 1.6 mm and medially by 1.1 mm on average, with valgus knees increasing more than neutral/varus knees. The findings emphasize that surgeons should consider the interplay between PCL resection and coronal deformity when planning and executing TKA procedures.

PMID:39873710 | DOI:10.1007/s00264-025-06413-7

Injury. 2024 Dec 18;56(2):112045. doi: 10.1016/j.injury.2024.112045. Online ahead of print.

ABSTRACT

Frame configuration for the management of complex tibial fractures is highly variable and is dependent upon both fracture pattern and surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally larger, multi-ring-per-segment constructs have been assumed to offer optimal stability and therefore favourable conditions for fracture healing but there is little in-vivo evidence for this and the recent concept of reverse dynamisation challenges this approach. We compared the clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a stable two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The mean time in frame was 168 days for the 2-ring group and 202 days for the 3+ rings group (p = 0.003). No significant differences were found in the rate of malunion or the requirement for secondary surgical intervention to achieve union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, post-treatment alignment and presence of an open fracture. This study finds that 2-ring frame constructs are a reliable option associated with shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations.

PMID:39870047 | DOI:10.1016/j.injury.2024.112045

Injury. 2025 Jan 17;56(3):112162. doi: 10.1016/j.injury.2025.112162. Online ahead of print.

ABSTRACT

INTRODUCTION: Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.

METHODS: Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.

RESULTS: The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, p < 0.001) and LG (96.8 ± 3.2 %, p < 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (p < 0.001), though it did not reach levels comparable to the MD and LG groups (p > 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (p < 0.001), while no difference was observed in coronal implant alignment.

CONCLUSION: These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.

PMID:39869959 | DOI:10.1016/j.injury.2025.112162

Injury. 2025 Jan 11:112149. doi: 10.1016/j.injury.2025.112149. Online ahead of print.

ABSTRACT

INTRODUCTION: Optimizing treatment strategies in polytrauma patients is a key focus in trauma research and timing of major fracture care remains one of the most actively discussed topics. Besides physiologic factors, associated injuries, and injury patterns also require consideration. For instance, the exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated.

METHODS: In this retrospectively cohort study at a level one trauma center, patients requiring trauma team activations from 2015 to 2020 were screened. Patients with an injury severity score >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24 h were stratified as group SDS (Safe Definitive Surgery) and >24 h as group DFC (Delayed Fracture Care). Outcomes were early mortality (<72 h), SIRS and sepsis, timing to first definitive surgery and completed reconstruction, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using the Fisher`s exact test with conditional maximum likelihood estimate.

RESULTS: From a total of 901 patients screened, 239 were included in the analyzes (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had a significantly lower mean number of operations (4.3 vs. 5.3; p = 0.037) and a significantly shorter mean time until completion of reconstructive operations (10 days vs. 15 days; p = 0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; 95 % CIs: 1.56 to 5.33 and OR: 5.59; 95 % CIs: 1.63 to 29.85), while the presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; 95 % CIs: 0.63 to 2.34).

CONCLUSION: The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients, while the presence of IB without NSI had less impact. In this cohort, early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.

PMID:39864965 | DOI:10.1016/j.injury.2025.112149

Injury. 2025 Jan 22;56(3):112180. doi: 10.1016/j.injury.2025.112180. Online ahead of print.

ABSTRACT

INTRODUCTION: External fixators are utilized to temporarily stabilize bicondylar tibial plateau fractures. They can be prepped during definitive surgery to help maintain fracture length and alignment. However, there is a potential for increased infection by leaving the external fixator on during the surgery. We hypothesize that maintaining the external fixator during surgery will result in no difference in rates of deep infection but improve reduction quality.

METHODS: We performed a retrospective cohort study of all bicondylar tibial plateau fractures treated at an academic, level one trauma center over a 10-year period. The primary outcome analyzed was the rate of deep infection. Secondary outcomes analyzed included reduction quality by comparing the medial proximal tibia angle (MPTA) and posterior proximal tibia angle (PPTA), complication rate, and reoperation rate.

RESULTS: One hundred and thirty-nine fractures in 133 patients met the inclusion criteria. There was no difference between the external fixator removed and prepped groups in terms of baseline patient characteristics except for more motor vehicle collisions in the removed group (42 % vs 22.99 %, p = 0.0193) and more open fractures in the prepped group (6 % vs 18.39 %). Operative characteristics were also not statistically different except for more patients in the prepped group underwent preoperative skin shaving (22 % vs 48.28 %, p = 0.0023) and more patients in the removed group had fixation constructs with plate and pin site overlap (46 % vs 24.14 %, p = 0.0083). There was no difference in deep infection between the groups (16.00 % vs 8.05 %, p = 0.1511). There was no difference in reduction quality when comparing the MPTA (87.64° vs 87.40°, p = 0.6607) and PPTA (83.18° vs 83.97°, p = 0.3592). The rates of superficial infection (20 % vs 29.89 %, p = 0.2056), unplanned reoperation (30 % vs 18.39 %, p = 0.1179), complications (58 % vs 44.83 %, p = 0.1376), and nonunion (8 % vs 6.89 %, p = 0.8111) were also similar.

CONCLUSIONS: Bicondylar tibial plateau fractures are challenging injuries with a high complication profile. Our findings suggest that maintaining the external fixator is not associated with increased rates of deep infection or complications. However, maintaining the external fixator during surgery did not lead to differences in final coronal or sagittal alignment reduction quality.

PMID:39864400 | DOI:10.1016/j.injury.2025.112180

Injury. 2025 Jan 17;56(3):112163. doi: 10.1016/j.injury.2025.112163. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults make up an increasing portion of orthopedic trauma care. Proxy reports are particularly valuable when patients face difficulties formulating answers due to pre-existing or temporary cognitive impairment, and provide critical insights into patient well-being.

QUESTIONS/PURPOSES: This study examines the agreement between patient- and proxy-reported outcome measures across various health domains of older adult orthopedic trauma patients, including those with mild cognitive impairment.

PATIENTS AND METHODS: A prospective cohort study was conducted in the Orthopedic trauma clinic of two Level 1 trauma centers, involving 108 patients aged 70 years or older, with or without mild cognitive impairment, and a self-identified discernible proxy. Participants were evaluated using PROMIS measures for physical function, pain intensity, anxiety, depression, fatigue, and social roles and (instrumental) activities of daily living questionnaires. Agreement between patient and proxy assessments was analyzed using Intraclass Correlation Coefficient and Bland-Altman analyses. Subgroup comparison was made using confidence intervals.

RESULTS: Most patients were married women with a mean age of 78 years (SD 6.2), 61 % had higher education, 67 % were walking independently, and 53 % had fractures of the pelvic ring or femur. Proxies were younger (mean age 64 years, SD 15), with 41 % being children and 40 % spouses. Significant correlations were found between patient and proxy assessments in physical function (ICC 0.74, 95 % CI 0.61-0.82), pain intensity (ICC 0.83, 95 % CI 0.74-0.89), (instrumental) activities of daily living (both ICC 0.86, 95 % CI 0.80-0.91). Moderate correlations were observed in anxiety, depression, fatigue, and participation in social roles (ICCs ranging from 0.56 to 0.66). Bland-Altman analyses confirmed good agreement with none to minimal systematic bias across all these domains.

CONCLUSION: Proxy-reported outcomes are valuable for evaluating health domains in older adult orthopedic trauma patients, including those with cognitive impairments. While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. Future research should explore longitudinal agreements to better understand recovery perceptions over time and mitigate bias proxy-reporting, ultimately enhancing both patient care and outcomes research in geriatric orthopedic trauma patients.

PMID:39864399 | DOI:10.1016/j.injury.2025.112163

Injury. 2025 Jan 20;56(3):112176. doi: 10.1016/j.injury.2025.112176. Online ahead of print.

ABSTRACT

BACKGROUND: Proximal femoral fractures has been associated with high mortality risk, while little is known about more distal lower extremity fractures. The aim was to report 30- and 365-days mortality in surgically treated lower extremity fractures in individuals above 65 years.

MATERIALS AND METHODS: We extracted data from the Danish National Patient Register on all surgically treated lower extremity fracture in the period 1998-2017. The primary outcome was mortality reported by fracture site defined by ICD-10 codes (femur S72*, tibia S82*, foot/ankle S92*S825-8). The secondary outcomes were mortality divided on sex, age groups (5-year span), and comorbidity. This study was conducted using descriptive statistics.

RESULTS: We identified 182,013 operatively treated lower extremity fractures of which 73 % occurred in females. The 30-day mortality was 10 % for patients with femoral fractures, 2 % for tibia and 1 % for foot/ankle. The 30-day mortality were similar in femoral fractures regardless of location in the femur (8-11 %). The 365-day mortality was 29 % for femoral fractures, 8 % for tibia and 6 % for foot/ankle. Men with a femoral fracture had higher mortality (15 % at 30 days, 37 % at 356 days) in comparison to women (8.2 % at 30 days, 26 % at 356 days). For the above 85+ year age group, the fracture location was less important for 365-day mortality.

CONCLUSION: There was an observed high risk of mortality in surgically treated femoral fractures. The mortality risks seems to rapidly decline when the fractures are below the knee.

PMID:39862495 | DOI:10.1016/j.injury.2025.112176

Injury. 2025 Jan 20;56(3):112169. doi: 10.1016/j.injury.2025.112169. Online ahead of print.

ABSTRACT

BACKGROUND: Unstable posterior pelvic-ring fractures are rare and difficult to manage. There are many injury patterns, they are associated with high morbidity and mortality, and optimal surgical management remains contentions. This study aims to compare outcomes and complications for different surgical management of these injuries.

METHODS: This was a multi-centre observational study of patients with traumatic posterior pelvic-ring injuries that underwent operative management between 1st January 2010 and 1st January 2020 at three Australian MTS. Cases were identified using internal hospital databases and the Victorian State Trauma registry. Data was retrieved from medical records and included surgeries, fixation method, length of stay, and outcomes (revision surgery, infection, hardware breakage, screw misplacement and hardware removal), time to each outcome was also recorded. The extracted data was collated and then analysed using RStudio; generalised liner models and linear regression models were developed to calculate mean differences and odd ratios.

RESULTS: There were 439 cases (309 males and 130 females) in the cohort with a median age of 39 years. The overall prevalence of revision was 7.7 %; 4.8 % for infection, 1.8 % for hardware failure and 13.2 % for removal of hardware. Bulkier, more prominent fixation methods had higher rates of metalware removal. Numbers were too small in subgroups to detect a significant difference in complication rates between fixation method. However, bilateral injuries had a significant effect on revision with a calculated prevalence of 16.7 % vs 5.6 % for unilateral injuries. Cases managed with open-reduction had a calculated infection rate of 15.6 % vs 4.6 %. Length-of-stay was increased in patients managed with temporising external fixators, who had bilateral injuries, where infection occurred or were restricted to non-weight bearing postoperatively.

CONCLUSIONS: This study highlight bilateral posterior-pelvic ring injuries as a greater management challenge than unilateral injuries. It supports the use of percutaneous fixation with closed-reduction, decreased infection risk and decreased length-of-stay. It challenges the use of external fixators and supports less restrictive post-operative restrictions. This study also serves as a descriptive analysis for the current management of pelvic fractures in an Australian setting, shedding light on complication rates and profiles.

PMID:39862494 | DOI:10.1016/j.injury.2025.112169

Injury. 2025 Jan 16;56(3):112170. doi: 10.1016/j.injury.2025.112170. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.

METHODS: Design: Prognostic Level IV SETTING: Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.

INTERVENTION: 3D reconstructions of the pelvis were created, and a virtual 3.5 mm cylindrical implant was placed from the pubic tubercle to the lateral cortex of the ilium. Success was defined as a bicortical virtual screw path from the ramus to the lateral ilium without cortical perforation. The cylinder was then expanded to model varying screw diameters. We then repeated this same process for unicortical retrograde screw insertion ending medial to the acetabular joint.

MAIN OUTCOME MEASURES: Successful screw placement and maximum screw diameter.

RESULTS: A 3.5 mm screw was successfully placed in 187 patients (93.5 %). One male (1/107, 0.9 %) and 12 females (12/93, 12.9 %) could not accommodate a 3.5 mm screw. All cases of perforation occurred lateral to the obturator foramen. Increasing height was associated with success, and male gender was associated with the ability to accommodate screws with a diameter 6.5 mm and larger.

CONCLUSIONS: Most patients can accommodate a 3.5 mm screw from the pubic tubercle to the ilium. Height and gender should be noted when planning medullary ramus fixation.

PMID:39862493 | DOI:10.1016/j.injury.2025.112170

Injury. 2025 Jan 23;56(3):112167. doi: 10.1016/j.injury.2025.112167. Online ahead of print.

ABSTRACT

OBJECTIVE: Our primary objective was to identify and describe demographic trends in head and neck injuries incurred while participating in horseback riding.

STUDY DESIGN: Cross-sectional analysis.

SETTING: National Database.

METHODS: Head and neck injuries related to horseback riding over a ten-year period (2014-2023) were analyzed using data from the National Electronic Injury Surveillance System (NEISS). A total of 3,177 cases were identified. Inclusion criteria encompassed injuries to the head, neck, face, mouth, or ear. Variables included age, gender, injury type, anatomical location, and patient disposition. Chi-squared analyses were employed to compare the aforementioned injury variables.

RESULTS: Among the 3,177 reported injuries of males and females, females (mean age 27.51 years, SD = 19.04) were more likely to be treated and released (83.29 %, n= 2023), while males (mean age 34.65 years, SD = 22.58) were more likely to be hospitalized. There was a significant association between gender and concussion diagnosis (p<.001), with females more likely to be diagnosed with concussions (n = 687) compared to males (n = 129). Females experienced more head and face injuries compared to males. Age distribution varied significantly across disposition categories, indicating different management practices for various age groups. The dataset indicates that the average age of females (27.51 years) is notably lower than that of males (34.65 years), suggesting a younger demographic among females overall.

CONCLUSIONS: The study highlights a significant gender disparity in horseback riding-related head and neck injuries, with females more likely to be treated and released and males more often requiring hospitalization.

PMID:39862492 | DOI:10.1016/j.injury.2025.112167

Injury. 2025 Jan 11;56(2):112161. doi: 10.1016/j.injury.2025.112161. Online ahead of print.

ABSTRACT

INTRODUCTION: The development of national registries from routinely collected health data has transformed the research landscape by improving access to large sample populations. This growing volume of data enables researchers to address critical questions but also challenges clinicians in conducting, evaluating, and applying the research. The National Trauma Data Bank (NTDB), the largest aggregate of deidentified trauma data in the world, is increasingly utilized for retrospective studies on trauma. This scoping review aimed to assess the quality of reporting of NTDB-based orthopedic trauma publications.

METHODS: We queried the Dimensions database for orthopedic studies using the NTDB. The quality of reporting was assessed by adherence to two international publication guidelines: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the REporting of studies Conducted using Observational routinely collected data (RECORD).

RESULTS: From a total of 3,720 identified articles, 137 manuscripts were available for analysis. The median scores and interquartile ranges (IQR) for STROBE and RECORD were 19 (IQR 18-20) and 7 (IQR 7-8), respectively. For STROBE scoring, the lowest fulfilled items were handling missing data and potential sources of bias. For RECORD scoring, the lowest fulfilled items were accessibility to protocol, raw code and data, validation studies, and data cleaning. A greater proportion of high-scoring studies were published in high-impact journals versus low-impact journals and in journals that enforced guidelines versus those that did not.

CONCLUSION: This study highlights the methodological gaps in the NTDB-based orthopedic trauma publications and identifies areas for improvement, including the management of missing data, selection of the study population through data cleaning, identification of sources of bias, and transparency in data accessibility. Future work should test the reproducibility of these studies and evaluate adherence to established guidelines across a broader range of databases and disciplines.

PMID:39854810 | DOI:10.1016/j.injury.2025.112161

J Bone Joint Surg Am. 2025 Jan 24. doi: 10.2106/JBJS.24.00394. Online ahead of print.

ABSTRACT

BACKGROUND: To date, no studies have evaluated the longevity of calcaneal lengthening osteotomy (CLO) in patients with cerebral palsy (CP) and pes planovalgus. This study aimed to explore the changes in foot alignment following CLO in patients with CP, utilizing both radiographic evaluations and dynamic foot-pressure assessments.

METHODS: A retrospective study of 282 feet in 180 ambulatory patients was performed. The mean patient age at the surgical procedure was 8.9 ± 2.6 years. The mean follow-up period was 8.0 ± 4.3 years, and the mean age at the final follow-up 16.9 ± 4.4 years. Weight-bearing radiographs at 3 separate time points (before the surgical procedure, 6 months postoperatively, and at the final follow-up) were used. The feet were classified as corrected, undercorrected, or overcorrected on the basis of the radiographic parameters.

RESULTS: At the final follow-up, we classified 98 feet (34.8%) as corrected, 58 (20.6%) as undercorrected, and 126 (44.7%) as overcorrected. Foot-pressure analysis demonstrated that the undercorrected feet had higher relative vertical impulses in the medial forefoot and medial midfoot than in the other groups, whereas the overcorrected feet had higher impulse in the lateral midfoot. There were no significant differences in preoperative radiographic parameters between the 3 groups, except for the calcaneal pitch angle. At 6 months after the surgical procedure, we classified 181 feet (64.2%) as corrected, 58 (20.6%) as undercorrected, and 43 (15.2%) as overcorrected. However, 53.6% of initially corrected feet changed to being undercorrected or overcorrected during further follow-up, 43.1% of the undercorrected feet became corrected or overcorrected, and 16.3% of the overcorrected feet became corrected. A younger age at the surgical procedure and lower naviculocuboid overlap at 6 months after the surgical procedure were the risk factors for overcorrection.

CONCLUSIONS: Although CLO is an effective method for correcting planovalgus foot deformities and enhancing foot-pressure distribution, the extent of correction observed early after the surgical procedure was not necessarily sustained over the follow-up period in individuals with CP. Furthermore, our findings highlight a noticeable tendency toward the overcorrection of the deformity, as evidenced by increased pressure exerted on the lateral midfoot.

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

PMID:39854489 | DOI:10.2106/JBJS.24.00394

J Bone Joint Surg Am. 2025 Jan 24. doi: 10.2106/JBJS.24.00113. Online ahead of print.

ABSTRACT

BACKGROUND: Although delays in musculoskeletal care in low- and middle-income countries (LMICs) are well documented in the open fracture literature, the impact of surgical delays on closed fractures is not well understood. This study aimed to assess the impact of surgical delay on the risk of infection in closed long-bone fractures treated with intramedullary nailing in LMICs.

METHODS: Using the SIGN (Surgical Implant Generation Network) Surgical Database, patients ≥16 years of age who were treated with intramedullary nailing for closed diaphyseal femoral and tibial fractures from January 2018 to December 2021 were identified. Infection was diagnosed based on the assessment by the treating surgeon. A logistic regression model, adjusting for potential confounders, was used to analyze the association between delays to surgery (in weeks) and infection.

RESULTS: Of the 9,477 closed fractures that were included in this study, 58% were femoral fractures and 42% were tibial fractures. The mean age was 35 years, and 76.2% of the patients were men. The mean delay to surgery was 10.5 days, and the median delay to surgery was 6 days. The overall infection rate was 3.1%. The odds of developing an infection increased by 9.2% with each week of delayed surgical treatment (odds ratio,1.092; 95% confidence interval, 1.042 to 1.145). Increasing delays were also associated with longer surgery duration and higher rates of open reduction.

CONCLUSIONS: Surgical delays in LMICs were associated with an increased risk of infection in closed long-bone fractures. This study quantified the increased risk of infection due to delays in receiving care, highlighting the importance of timely surgery for closed fractures in LMICs.

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

PMID:39854435 | DOI:10.2106/JBJS.24.00113

J Bone Joint Surg Am. 2024 Oct 2;106(19):e43. doi: 10.2106/JBJS.24.00710. Epub 2024 Oct 2.

NO ABSTRACT

PMID:39853225 | DOI:10.2106/JBJS.24.00710

J Bone Joint Surg Am. 2024 Oct 2;106(19):e41. doi: 10.2106/JBJS.24.00586. Epub 2024 Oct 2.

NO ABSTRACT

PMID:39853224 | DOI:10.2106/JBJS.24.00586