Int Orthop. 2026 May 4. doi: 10.1007/s00264-026-06818-y. Online ahead of print.

ABSTRACT

BACKGROUND: Focal periphyseal edema (FOPE) is a characteristic magnetic resonance imaging (MRI) finding in adolescent knee joints with open physes. Although described as a benign and likely self-limiting condition, large population-based studies are scarce. The aim of this study was to retrospectively analyse the incidence and the epidemiological background of this MRI finding, and to correlate FOPE lesions with clinical symptoms and treatment.

METHODS: This retrospective case-control study included a total of 1201 knee MRI scans from 897 patients, performed between 2007-2016 at our institution in patients aged ten to 16 years. MRIs were screened for the presence of FOPE and other pathologies. FOPE severity was categorised as mild, moderate and severe, based on lesion size and MRI appearance. Patients' medical records were screened for symptoms, trauma history and treatment.

RESULTS: Out of the 1201 MRI scans, 97 FOPE lesions (10.8%) in 93 patients (10.4%) were identified. FOPE was significantly more frequent in girls than in boys (p = 0.007). FOPE was the main MRI finding in 53.6% of patients. Mild FOPE was most common (53.6%). Severe FOPE occurred only when FOPE was the main pathology (p = 0.005). Most FOPE patients (74.2%) were treated conservatively.

CONCLUSION: FOPE lesions are a common MRI finding in adolescents presenting with knee pain. They tend to be more severe when occurring as the sole finding and have a significantly higher incidence in females. In this large clinical cohort, FOPE was mainly managed conservatively, supporting its interpretation as a benign, self-limiting differential diagnosis of adolescent knee pain.

PMID:42080945 | DOI:10.1007/s00264-026-06818-y

Injury. 2026 Apr 23:113300. doi: 10.1016/j.injury.2026.113300. Online ahead of print.

ABSTRACT

INTRODUCTION: The timing of Emergency Medical Services (EMS) notification, crash scene arrival, and hospital arrival may impact motor vehicle fatalities. We examined EMS response time intervals over the past three decades, considering the effects of weather, vehicles involved, time of day, and location.

METHODS: We used the Fatal Accident Reporting System to compute and describe annual (1987-2020) EMS response time intervals. This included total time (i.e., crash-to-hospital), as well as the intervals between four key timepoints: crash, crash notification, crash scene arrival, and hospital arrival. We examined the proportion of fatal crashes with total intervals under 60 min (i.e., the "golden hour"), and where the crash arrival-to-hospital interval was under 30 min (the "beneficial timeframe"). Additionally, analyses were stratified by crash factors including weather (poor/clear) number of vehicles involved (single/multiple), time of day (early morning/rest of the day), and location (urban/rural).

RESULTS: A total of 310,001 fatal crashes were analyzed. Between 1987-1994 total median response times ranged between 40 and 42 min. By 1999, intervals had increased to 45 min; elevated intervals were evident through 2009. By 2020, observed intervals had returned to 41 min. Paralleling this pattern, crashes with "golden hour" intervals decreased from 77.0% in 1987 to 72.4% in 2009 and increased to 78.0% by 2020. Similarly, crashes with a "beneficial timeframe" decreased from 60% in 1987 to 52% in 2009 and increased to 56.0% by 2020. The largest discrepancies for crash strata were evident for location: rural crash total response time intervals were 15-23 min longer than urban.

CONCLUSIONS: From 1987-2020, the total time response interval following a fatal crash remained relatively stable. However, steady increases in intervals between crash notification and both crash scene and hospital arrival are evident.

PRACTICAL APPLICATIONS: Future research should focus on approaches to reduce response time intervals.

PMID:42069492 | DOI:10.1016/j.injury.2026.113300

Injury. 2026 Apr 28;57(7):113301. doi: 10.1016/j.injury.2026.113301. Online ahead of print.

ABSTRACT

INTRODUCTION: Non-home discharge after orthopedic trauma is associated with worse outcomes, increased costs, and greater resource utilization. Existing prediction tools often rely on hospital course variables unavailable at presentation or are limited to specific fracture populations. This study aimed to develop and validate the Fracture Orthopedic Risk of Non-Home Discharge (FORD) Score, a bedside tool using only emergency department-available variables to predict non-home discharge in adult fracture patients.

METHODS: A retrospective cohort study was conducted of adult fracture patients treated at an ACS-verified Level I trauma center from 2015 to 2023. Patients were randomly split into derivation (67%) and validation (33%) cohorts. Candidate predictors available immediately upon patient arrival were evaluated using univariate logistic regression, followed by multivariate logistic regression after collinearity assessment. Independent predictors were converted into an integer-based point system to construct the FORD Score. Model discrimination, calibration, and classification performance were assessed in the validation cohort and compared with established trauma severity measures.

RESULTS: The final cohort included 8422 patients, of whom 8.1% had non-home discharge. Fifteen independent predictors comprised the FORD Score, including age, physiologic abnormalities, fracture characteristics, and transport mode. In the validation cohort, FORD demonstrated good discrimination (AUROC 0.818, 95% CI 0.791-0.846) and excellent calibration. At the optimal threshold (score ≥4), sensitivity was 74.1%, specificity 75.8%, PPV 21.3%, and NPV 97.1%. FORD outperformed GTOS-II (AUROC 0.777; DeLong p = 0.018) and TRIAGES (AUROC 0.746; p < 0.001). Non-home discharge rates ranged from 1.7% in the lowest risk group to 34.1% in the highest, a 20-fold gradient.

CONCLUSION: The FORD Score is a validated bedside tool that accurately predicts non-home discharge in adult orthopedic trauma patients using only admission data, enabling early discharge planning and optimized resource allocation.

PMID:42068850 | DOI:10.1016/j.injury.2026.113301

EFORT Open Rev. 2026 May 1;11(5):366-371. doi: 10.1530/EOR-2026-0055.

ABSTRACT

The European Union Medical Device Regulation (MDR 2017/745) has introduced stricter requirements for clinical evidence, limited reliance on equivalence and expanded post-market surveillance for orthopaedic implants. While designed to improve patient safety following high-profile device failures, MDR implementation has been associated with longer certification timelines, increased costs and withdrawal of established implants, particularly in lower-volume indications. The central regulatory challenge is proportionality: novel devices require robust prospective evidence, whereas long-established implants with extensive clinical track records may warrant risk-based recertification pathways. Uniform regulatory application risks unintended consequences for intermediate- and lower-volume indications that fall between orphan-device provisions and standard MDR requirements. Orthopaedic societies may play a key role in developing speciality-specific evidence guidance to support regulators and notified bodies, improving clarity while maintaining patient safety and sustainable innovation.

PMID:42065230 | DOI:10.1530/EOR-2026-0055

EFORT Open Rev. 2026 May 1;11(5):415-425. doi: 10.1530/EOR-2026-0076.

ABSTRACT

Proximal femoral osteotomy remains an important joint-preserving option for adolescents and young adults with symptomatic proximal femoral deformity, preserved cartilage, and deformity amenable to correction. Surgical hip dislocation provides circumferential access to the femoral head, neck, and acetabulum while preserving the retinacular blood supply, and it allows direct dynamic assessment of impingement together with concomitant treatment of intra-articular pathology. The extended retinacular flap has expanded the indications for intra-articular correction at the femoral neck and head level, enabling larger corrections closer to the deformity with less secondary displacement when compared to extra-articular osteotomies. Preoperative planning must combine standardized radiographs, CT- or MRI-based torsion analysis, and MRI-based cartilage assessment; outcomes depend mainly on cartilage status, patient age, timing of correction, and technical precision.

PMID:42065229 | DOI:10.1530/EOR-2026-0076

EFORT Open Rev. 2026 May 1;11(5):381-389. doi: 10.1530/EOR-2026-0051.

ABSTRACT

Carpal instability is fundamentally a dynamic disorder that may not be detected using conventional static imaging modalities such as radiography, CT, and MRI. This diagnostic limitation may delay diagnosis and treatment, potentially leading to progressive instability and degenerative changes. Four-dimensional CT enables dynamic, in vivo visualisation and quantitative analysis of wrist kinematics by acquiring sequential volumetric datasets during active motion. This allows identification of abnormal motion patterns, including altered intercarpal coordination and subluxations, which cannot be detected using static imaging. Clinical applications include evaluation of scapholunate instability, distal radioulnar joint instability, midcarpal instability, and altered carpal kinematics in conditions such as Kienböck disease. Four-dimensional CT may also be valuable for preoperative planning and postoperative assessment by enabling objective evaluation of treatment-related changes in wrist motion. Comparison with the contralateral wrist provides an internal physiological reference and may improve diagnostic confidence by distinguishing pathological motion from normal anatomical variation. Four-dimensional CT complements conventional imaging and arthroscopy by providing functional information on wrist biomechanics. It should be used selectively when dynamic instability is suspected and conventional imaging is inconclusive. Ongoing advances in automated analysis, dose optimisation, and protocol standardisation are expected to further improve clinical applicability and support broader integration into clinical practice.

PMID:42065227 | DOI:10.1530/EOR-2026-0051

EFORT Open Rev. 2026 May 1;11(5):404-414. doi: 10.1530/EOR-2026-0069.

ABSTRACT

Developmental dysplasia of the hip (DDH) remains a leading cause of early hip osteoarthritis and poses considerable technical challenges during total hip arthroplasty. Existing classification systems focus on the abnormal relationship between the femoral head and the acetabulum without emphasising the femoral morphological variations, which are equally significant in surgical planning. Dysplastic femora often demonstrate excessive neck anteversion, variable neck-shaft angles, reduced offset, and metaphyseal-diaphyseal mismatch with narrow intramedullary canals. These anatomical variations often compromise the abductor mechanism and alter hip biomechanics. Thorough preoperative planning is crucial and should include the evaluation of leg-length discrepancy, reconstruction of the hip centre of rotation, assessment of femoral version and canal morphology, implant selection, and consideration of femoral shortening osteotomy. Computed tomography-based planning can enhance preoperative planning in complex cases. Both cemented and cementless stems align with positive findings in DDH patients. Cemented stems enable reliable version control, decrease intraoperative fracture risk, and may be beneficial for patients with poor bone quality. In mild cases, most uncemented stems are suitable. More severe deformities necessitate specialised implant designs with conical fluted stems, which provide strong fixation and excellent long-term survivorship. Modular and custom-made options also achieve favourable outcomes in high-grade deformities. Femoral shortening osteotomies are often needed to restore biomechanics, correct abnormal version, and prevent nerve injury during reduction. The subtrochanteric osteotomy has been linked with excellent results in treating severe DDH. High-quality research is essential to deepen our understanding of proximal femur morphological abnormalities and to enhance surgical results.

PMID:42065226 | DOI:10.1530/EOR-2026-0069

EFORT Open Rev. 2026 May 1;11(5):372-380. doi: 10.1530/EOR-2026-0056.

ABSTRACT

Mesenchymal stem cells (MSCs) have been used in clinical practice in orthopaedics and traumatology in accordance with government health regulations. Despite MSCs' promising effects, their application should be guided by the pathophysiology of the target disease. The application of MSCs should follow the regulatory frameworks of each country to ensure their safe and effective use in daily clinical practice. It is suggested that further research be conducted on the current guidelines in broader patient populations.

PMID:42065225 | DOI:10.1530/EOR-2026-0056

EFORT Open Rev. 2026 May 1;11(5):437-445. doi: 10.1530/EOR-2026-0043.

ABSTRACT

Two-part surgical neck fractures are the most common displaced proximal humeral fractures in the elderly. Most fractures can be categorized into varus-impacted or medially translated fracture patterns. The natural healing process often involves secondary displacement and partial resorption of the humeral head, but these changes are poorly correlated with shoulder function and patient satisfaction. Randomized trials have been unable to identify any benefits from surgery but report a high proportion of implant-related complications. In large prospective cohort studies, patients aged 60 or older with two-part surgical neck fractures treated non-operatively report shoulder function and quality of life close to the background population six months post-injury. Evidence-based and eminence-based approaches to interventions for osteoporotic proximal humeral fractures appear to collide.

PMID:42065224 | DOI:10.1530/EOR-2026-0043

EFORT Open Rev. 2026 May 1;11(5):426-436. doi: 10.1530/EOR-2026-0053.

ABSTRACT

Multiligament knee injuries (MLKIs) are rare but severe injuries involving bicruciate or collateral ligament disruption, frequently associated with knee dislocation, fractures, and neurovascular compromise. Vascular injury occurs in a mean of approximately 18% of cases and may be present despite palpable pulses; an ankle-brachial index (ABI) < 0.9 demonstrates high sensitivity for arterial injury. Peroneal nerve injury occurs in approximately 10-40% of cases. Early recognition and structured evaluation are critical. Serial vascular examinations, selective CT angiography, and careful neurologic assessment are mandatory. General orthopedic surgeons often make the initial management decisions, and timely diagnosis, stabilization, and referral significantly influence limb salvage and long-term function. The Schenck KD classification remains standard, with recent consensus refinements to the KD V category and proposed modifiers such as '-EM' for extensor mechanism disruption. Associated meniscal, chondral, and rare entities, such as uniplanar coronal tibiofemoral subluxation, require high clinical suspicion. Knee-spanning external fixation is indicated in vascular injury, open or fracture-dislocations, soft-tissue compromise, or persistent instability, with reconstruction commonly performed later at 3-6 weeks. Current evidence shows no clear superiority of early versus delayed reconstruction in functional outcomes, although early surgery increases stiffness risk. Anatomic reconstruction is generally favored over repair for high-grade PLC and MCL injuries due to lower failure and complication rates. At 2 years, patients retain approximately 80-85% of knee function; however, a gradual functional decline over time is observed. Arthrofibrosis (≈10%) remains the most common complication.

PMID:42065223 | DOI:10.1530/EOR-2026-0053

EFORT Open Rev. 2026 May 1;11(5):390-403. doi: 10.1530/EOR-2026-0044.

ABSTRACT

Hip fractures represent a time-critical, systemic condition in older adults, characterised by frailty, multimorbidity, inflammation, immobility, pain, and high risk of medical complications and mortality. While population ageing is expected to drive a continued rise in absolute hip fracture numbers, contemporary evidence demonstrates declining age-standardised incidence in many high-income countries, highlighting the importance of optimising perioperative care pathways to mitigate morbidity and mortality. Contemporary evidence consistently supports early surgical management, typically within 24-48 h, provided reversible medical issues are addressed in parallel rather than through prolonged preoperative workup. Orthogeriatric co-management and structured multidisciplinary pathways reduce time to surgery, delirium incidence, length of stay, and mortality while improving functional recovery. Key optimisation domains include multimodal opioid-sparing analgesia, delirium prevention bundles, targeted cardiovascular stabilisation, pragmatic management of anti-thrombotic therapy, anaemia, infection, and individualised anaesthetic strategies. Evidence supports protocol-driven, multicomponent care bundles over isolated interventions to enable safe early surgery, reduce complications, and improve functional recovery in this vulnerable population.

PMID:42065220 | DOI:10.1530/EOR-2026-0044

J Bone Joint Surg Am. 2026 May 1. doi: 10.2106/JBJS.26.00277. Online ahead of print.

NO ABSTRACT

PMID:42066067 | DOI:10.2106/JBJS.26.00277

Int Orthop. 2026 May 1. doi: 10.1007/s00264-026-06817-z. Online ahead of print.

ABSTRACT

PURPOSE: This scoping review aimed to collate and synthesize reports of bioinductive scaffold augmentation for patellar tendon pathology, focusing on indications, surgical techniques, and early outcomes. Additionally, it aimed to contextualize these findings through the more established rotator cuff literature and consider tendon property variation to inform future research and implant development.

METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed, Embase, Scopus, and Web of Science were searched from inception to 25 December 2025 for human studies of bioinductive scaffold augmentation in patellar tendon pathology. Two reviewers screened studies and extracted data. Findings were synthesized narratively and in tables.

RESULTS: The search identified 633 records, with ten studies ultimately included (6 technical notes, 3 case reports, and 1 case series), published between 2019 and 2025. Across all reports, 47 patients were described (ages 17-50; 76% male where reported); most studies used scaffolds for acute patellar tendon rupture (7/10), with fewer addressing chronic tendinopathy (3/10). Augmentation was most often indicated for poor tissue quality in rupture settings, revision after re-rupture, or persistent symptoms after failed conservative management in tendinopathy. Implants comprised a bovine Achilles tendon-derived collagen scaffold (6 studies), a decellularized human dermal allograft (2), a collagen-PLLA composite scaffold (1), and an autologous platelet-rich fibrin matrix construct (1). Post-operative rehabilitation was variably reported. Reported clinical outcomes were limited but suggested some improvements in pain, functional scores and MRI appearance.

CONCLUSION: The adoption of bioinductive scaffold augmentation in patellar tendon surgery may be considered theoretically plausible. However, fundamental pre-clinical biomechanical and histological work in human(-cadaveric) models is not available at present, and longitudinal (comparative) clinical research is ultimately needed to investigate the effects of this application, and allow for the meaningful interpretation of results. The intrinsic mechanical and biological properties of the patellar tendon warrant a more nuanced consideration in technique standardization and future device iterations.

PMID:42065726 | DOI:10.1007/s00264-026-06817-z

Injury. 2026 Apr 24:113294. doi: 10.1016/j.injury.2026.113294. Online ahead of print.

ABSTRACT

BACKGROUND: U.S. Consumer Product Safety Commission reported that from 2018 to 2020 there were 94,700 off-highway vehicle accidents with 92% of those injuries related to all-terrain vehicles (ATV). An estimated 300 deaths were in children less than age 16. There has not been any previous evaluation of urethral injuries resulting from ATV accidents. We sought to define the volume and demographics of ATV-related urethral injuries.

METHODS: Data was obtained from the National Trauma Database (NTDB) Trauma Quality Program over a 7-year period (2016-2022). ICD-10 codes were used to identify patients who sustained urethral injury in ATV-related accidents. Injury and patient related demographic data was reviewed. R: A Language and Environment for Statistical Computing was used for data review and statistical analysis. Data were presented and analyzed using standard statistical methods RESULTS: During this time frame, there was a total of 7679,101 injuries recorded in the NTDB. There was a total of 7398 urethral injuries (0.1%), with 181 (2.5%) of those being related to ATV-accidents. 90.6% of patients were male, and there was a median age of 30 (range 5-76, IQR 29). The median injury severity score (ISS) was 17 (range 4-50, IQR 15). There was no association between age and higher ISS (r = 0.07, p = 0.36). Passengers were more likely to be less than age 16 (p = 0.001). Interestingly, 17% (26/153) of drivers were less than age 16. Non-traffic ATV accidents were associated with higher ISS (medians 21.5 versus 17, p = 0.003).

CONCLUSIONS: Urethral injuries are uncommon, however over 2% of these are related to ATV accidents alone. A high proportion of these injuries are severe, involving young patients, speaking to significant potential long-term morbidity.

PMID:42062182 | DOI:10.1016/j.injury.2026.113294

Int Orthop. 2026 Apr 30. doi: 10.1007/s00264-026-06823-1. Online ahead of print.

ABSTRACT

PURPOSE: There are no long-term results (> 30 years) of cemented and cementless total knee arthroplasty (TKA) with respect to clinical outcomes, radiographic and computer tomographic (CT) findings, incidence of osteolysis, revision rates, and implant survivorship.

METHODS: A consecutive cohort of 210 patients (mean age, 62 ± 4.6 years) underwent simultaneous bilateral TKA during a single anaesthetic session using the same posterior-stabilized prosthetic design. In each patient, one knee received a cemented implant and the contralateral knee received a cementless implant. The mean duration of follow-up was 30.3 years (range, 29-31 years).

RESULTS: At the final evaluation, no statically significant differences were observed between the two groups. The mean Knee Society scores (92 vs 93 points), Western Ontario and McMaster Universities Osteoarthritis Index scores (21 vs 10 points), range of motion (125° vs 127°) were not significantly different between the two groups. Revision was required in 3.8% of cemented knees and 4.8% of cementless knees. Kaplan-Meier analysis demonstrated a 30.3-year survival rate of 96.2% (95% confidence interval ([CI], 90%-100%) in the cemented group and 95.2% (95% [CI], 90%-100%) in the cementless group.

CONCLUSIONS: Both cemented or cementless fixation methods demonstrated durable and favourable long-term outcomes at more than 30 years. However, cementless TKA did not show superior survivorship compared with cemented TKA. At present, the routine preference of cementless fixation over established cemented techniques remains unsupported by long-term evidence.

PMID:42060141 | DOI:10.1007/s00264-026-06823-1

SICOT J. 2026;12:22. doi: 10.1051/sicotj/2026017. Epub 2026 Apr 29.

ABSTRACT

INTRODUCTION: This pilot study investigated the effects of ovariectomy-induced estrogen deficiency on the biomechanical properties of intact anterior cruciate ligaments (ACLs) in a porcine model, a biological condition that may influence ligament integrity and injury susceptibility.

METHODS: A bilateral ovariectomy model was used to induce systemic estrogen deficiency. Fourteen two-month-old female pigs were included. Four pigs (8 knees) underwent bilateral ovariectomy (OV group). The left knees of 10 pigs that underwent laparotomy without ovariectomy for a separate study were analyzed as controls (C group). At 12 weeks, knee joints were examined macroscopically, followed by biomechanical testing consisting of cyclic anterior drawer loading and load-to-failure.

RESULTS: All ACLs were intact without arthrofibrosis or cartilage degeneration. During cyclic testing, anterior tibial translation was significantly lower in the OV group compared with controls (0.47 ± 0.14 mm vs. 0.82 ± 0.32 mm, P = 0.017). Failure mode differed between groups: all posterolateral bundles in controls avulsed at their insertions, whereas six of eight in the OV group ruptured in the midsubstance (P = 0.0070). No significant between-group differences were observed in yield load, maximum load, stiffness, or elongation at failure.

CONCLUSION: Ovariectomy-induced estrogen deficiency altered ACL failure characteristics and reduced translation without affecting ultimate strength. These findings suggest that ovarian hormone deficiency compromises ligament quality, providing a potential mechanism for increased ACL injury risk in young female athletes. These findings should be interpreted as pilot, hypothesis-generating data.

LEVEL OF EVIDENCE: Experimental laboratory study.

PMID:42053188 | PMC:PMC13127120 | DOI:10.1051/sicotj/2026017

SICOT J. 2026;12:21. doi: 10.1051/sicotj/2026015. Epub 2026 Apr 29.

ABSTRACT

BACKGROUND: Patient positioning for proximal femoral nailing (PFN) in unstable intertrochanteric fractures remains controversial and may influence operative efficiency, radiation exposure, and reduction quality. This study compared lateral decubitus PFN without traction versus the conventional supine traction-table technique in geriatric patients.

METHODS: This prospective randomized comparative study enrolled patients aged >60 years with AO/OTA A2 unstable intertrochanteric fractures who were randomized to supine traction-table PFN (Group A) or lateral decubitus PFN on a radiolucent table (Group B). Primary outcomes were setup time, fluoroscopy (radiation) exposure, and operative time. Secondary outcomes included blood loss, need for open reduction, neck-shaft angle (NSA), tip-apex distance (TAD), and modified Baumgartner reduction quality.

RESULTS: Setup time was markedly shorter with lateral positioning (13.73 ± 2.26 vs 43.73 ± 6.19 min; P < 0.001), and radiation exposure was lower (60.53 ± 15.98 vs 68.48 ± 14.65 s; P = 0.023). Blood loss was higher in the lateral group (328.75 ± 84.65 vs 288.75 ± 48.68 mL; P = 0.011), and open reduction was more frequent (57.5% vs 17.5%; P < 0.001). Operative time was comparable (78.53 ± 15.13 vs 74.48 ± 8.56 min; P = 0.145). NSA (135.88 ± 5.94 vs 136.12 ± 6.27°; P = 0.864), TAD (23.58 ± 2.14 vs 23.15 ± 1.73 mm; P = 0.331), and reduction quality (good: 90% in both; P = 1.000) did not differ.

CONCLUSIONS: Lateral decubitus PFN without traction improved setup efficiency and reduced radiation exposure while maintaining comparable radiographic outcomes, at the expense of more frequent open reduction and modestly higher blood loss.

PMID:42053187 | PMC:PMC13127122 | DOI:10.1051/sicotj/2026015

SICOT J. 2026;12:20. doi: 10.1051/sicotj/2026020. Epub 2026 Apr 29.

ABSTRACT

BACKGROUND: Distal femoral megaprosthetic reconstruction is a standard limb-salvage procedure after tumor resection. This study aimed to evaluate implant survival and associated factors, the incidence of mechanical failure, and functional outcomes following reconstruction with cemented custom-made distal femoral megaprostheses.

METHODS: Fifty-seven patients who underwent distal femoral tumor resection followed by reconstruction with a cemented custom-made distal femoral megaprosthesis between 2010 and 2024 were retrospectively analyzed. Implant survival was evaluated using Kaplan-Meier analysis, and associations with outcomes were assessed using Cox proportional hazards and Fine-Gray competing-risk regression models. The analyzed risk factors included age, sex, resection length, stem diameter, fixation length, and functional score. Functional outcomes were assessed using the Musculoskeletal Tumor Society (MSTS) score.

RESULTS: Implant survival remained above 60% at the latest follow-up, with survival rates of 100% at 12 months, 93.5% at 24 months, and 72.9% at 60 months. No clinical or implant-related geometric variables were significantly associated with implant survival. The cumulative incidence of mechanical failure was 7% at 48 months and approximately 15% at the latest follow-up, with no association between mechanical failure and resection length, stem diameter, or fixation length. Functional outcomes were favorable, with a mean MSTS score of 21.6 ± 3.9.

CONCLUSION: Cemented custom-made distal femoral megaprostheses demonstrated satisfactory mid- to long-term survival following tumor resection. In this cohort, none of the evaluated variables were significantly associated with implant survival. The incidence of mechanical failure remained relatively low, and geometric implant parameters were not significantly associated with mechanical failure. Functional outcomes were favorable, with most patients achieving good or excellent MSTS scores.

PMID:42053186 | PMC:PMC13127123 | DOI:10.1051/sicotj/2026020

SICOT J. 2026;12:E2. doi: 10.1051/sicotj/2026006. Epub 2026 Apr 29.

ABSTRACT

Volume 11 (2025) of SICOT-J showcases high-quality global orthopaedic research spanning spine, trauma, arthroplasty, sports, and perioperative care. Through impactful original studies, reviews, and editorials, the volume reinforces evidence-based practice, surgical innovation, and multidisciplinary approaches to contemporary musculoskeletal challenges worldwide.

PMID:42053185 | PMC:PMC13127121 | DOI:10.1051/sicotj/2026006

Injury. 2026 Apr 24:113304. doi: 10.1016/j.injury.2026.113304. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to assess the learning curve of REBOA from the first case in trauma centers using cumulative sum (CUSUM) analysis.

MATERIALS AND METHODS: This study enrolled consecutive trauma patients who visited five trauma centers from December 2015 to December 2021. To monitor the effectiveness of REBOA, we performed risk-adjusted cumulative sum (RA-CUSUM) analysis for mortality due to exsanguination. For individual risk adjustment, we implemented the least absolute shrinkage and selection operator (LASSO) logistic regression model. We then calculated the CUSUM for: (1) the time from common femoral artery (CFA) access to confirmation of REBOA placement (RP-CUSUM), (2) the total occlusion time (OT-CUSUM), (3) door-to-balloon time (DB-CUSUM), and (4) the time from injury to admission (IA-CUSUM). To determine whether observed deviations were statistically significant, a V-mask was superimposed on the CUSUM curve.

RESULTS: A total of 251 patients were enrolled. The overall mortality rate was 67.7% (170/251), and the mortality rate due to exsanguination was 49.0% (123/251). The RA-CUSUM model was developed using a LASSO logistic regression approach. In three hospitals, the RA-CUSUM showed an improvement after 5-34 procedures. However, the RA-CUSUM showed fluctuations with deterioration in the other two hospitals. The RA-CUSUM fluctuations exceeded the V-mask control limits. RA-CUSUM charts for five hospitals deviated beyond the V-mask boundaries, indicating that the processes were out of control. Other CUSUM charts-such as RP-, OT-, DB-, and IA-CUSUM-exhibited fluctuations limited within V-mask boundaries, which suggests no significant change.

CONCLUSION: CUSUM analysis demonstrated that a reduction in risk-adjusted mortality may be achieved with experience. Nevertheless, trauma surgeons should exercise caution due to a potential decline in the performance of REBOA, particularly the rate of mortality due to exsanguination.

PMID:42055837 | DOI:10.1016/j.injury.2026.113304