J Bone Joint Surg Am. 2025 Nov 19;107(22):2486-2487. doi: 10.2106/JBJS.25.01070. Epub 2025 Nov 19.

NO ABSTRACT

PMID:41315027 | DOI:10.2106/JBJS.25.01070

J Bone Joint Surg Am. 2025 Nov 19;107(22):2485. doi: 10.2106/JBJS.25.01071. Epub 2025 Nov 19.

NO ABSTRACT

PMID:41315026 | DOI:10.2106/JBJS.25.01071

Injury. 2025 Nov 20:112898. doi: 10.1016/j.injury.2025.112898. Online ahead of print.

ABSTRACT

BACKGROUND: Equestrian sports have been found to cause high rates of injuries. In clinical practise after such injuries, polytrauma protocol workups usually include whole-body computed tomography (WBCT), CT of the chest, abdomen and pelvis with intravenous iodine contrast medium, and CT of the cervical spine and brain without contrast. The purpose was to investigate the use of WBCT in equestrian-related accidents, to analyse demographics, mechanism of injury (MOI), therapy and severity of equine-related accidents, radiology, and the use of protecting equipment.

MATERIAL AND METHODS: This is a retrospective study including a cohort of patients who were admitted to trauma centres at Queen Silvia Children's Hospital (paediatric <16 years) and Sahlgrenska University Hospital (adult ≥16 years) in Gothenburg in the period 2010 - 2020 due to equestrian-related injuries. Medical records were studied concerning patient demographics, MOI, protective equipment, injuries suffered, Injury Severity Score (ISS), surgery, and hospital length of stay.

RESULTS: There were 1341 patients (97 % female, 43 % paediatric) with equestrian-related accidents who were admitted to the hospitals. Of these, 262 were assessed as polytrauma, of whom 77 % were adults with median age of 38 years and 23 % were paediatric with median age of 13 years. WBCT was performed in 54 % of adult and 52 % of paediatric patients. The MOI was mainly fall from a horse 241/262 (92 %), and in 27/241 (11 %) the horse also fell on the rider. In the 262 patients, spine injury was seen in 32 %, thoracic injury in 29 %, cerebral hemorrhages in 22 (8 %), tetraplegia in 2 (0.8 %), and paraplegia in 1 (0.4 %). Abdominal injury was mostly seen in liver 13/262 (5 %). The median ISS was 4 (IQR 1-9). There were 59 % of paediatric and 48 % of adult patients hospitalized for a median of 2 days (IQR 1-5), and 14 needed intensive care. Surgery was required in 33 patients. Wearing of helmets and vests was recorded in 146 (56 %) and 58 (22 %) of the individuals, respectively.

CONCLUSIONS: Only 54 % of adult and 52 % of paediatric patients underwent a WBCT after equestrian - related polytrauma indicating inadequate assessment. The documentation rate of safety equipment was low.

PMID:41309434 | DOI:10.1016/j.injury.2025.112898

Injury. 2025 Oct 31:112879. doi: 10.1016/j.injury.2025.112879. Online ahead of print.

NO ABSTRACT

PMID:41309433 | DOI:10.1016/j.injury.2025.112879

Injury. 2025 Nov 19;57(2):112895. doi: 10.1016/j.injury.2025.112895. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study is to compare the clinical outcomes of robot-assisted percutaneous screw fixation with traditional ORIF for treating displaced intra-articular glenoid Ideberg Ia fractures.

METHODS: This retrospective study included all patients diagnosed with displaced intra-articular glenoid fractures between January 1, 2021, and December 31, 2024, at our Level 3 hospital who met the inclusion and exclusion criteria. Patient demographics and intraoperative parameters were meticulously documented. Clinical outcomes were measured using the Constant Murley Shoulder score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the Visual Analogue Scale for pain. Each patient was asked to assess their satisfaction with the appearance of their scars using a 10-point Likert scale. The range of motion and any complications were thoroughly documented for further analysis. In addition, the time taken to resume work, sports activities, and recover the previous range of motion in the shoulder was also recorded.

RESULTS: 18 patients were included in the final analysis-8 in the robot-assisted group and 9 in the ORIF group. The robot-assisted group required significantly less operative time (70.00 ± 16.04 vs. 108.22 ± 34.67minutes, P < 0.05), reduced blood loss (11.25 ± 7.44 vs. 120.00 ± 65.00 mL, P < 0.05), smaller incision length (1.18 ± 0.26 vs. 12.24 ± 2.74 cm, P < 0.05), faster resume work (13.13 ± 1.81 vs. 23.78 ± 15.57 weeks), quicker return to sports (17.00 ± 1.85 vs. 27.53 ± 13.63 weeks, P < 0.05), a shorter time to regain full range of motion (13.00 ± 1.85 vs. 29.00 ± 12.05 weeks, P < 0.05), and a higher scar cosmesis score (9.88 ± 0.35 vs. 5.17 ± 3.4, P < 0.05). The robot-assisted group achieved bone union substantially faster, with an average time of 8.12 ± 0.35weeks compared to 13.33 ± 2.46 weeks in the ORIF group (P < 0.05). In terms of active range of motion, patients in the robot-assisted group had a significantly better function in forward flexion, abduction, and internal rotation (150.00 ± 9.26 vs. 126.67 ± 21.94, 138.75 ± 12.46 vs. 106.25 ± 32.27, 84.38 ± 4.96 vs. 59.58 ± 15.73, respectively) (P < 0.05).

CONCLUSION: Robot-assisted percutaneous screw fixation offers a safe and minimally invasive treatment option for displaced intra-articular glenoid Ideberg Ia fractures. This technique not only promotes faster healing but also provides superior cosmetic results and excellent functional outcomes when compared to traditional ORIF.

PMID:41308429 | DOI:10.1016/j.injury.2025.112895

Int Orthop. 2025 Nov 27. doi: 10.1007/s00264-025-06709-8. Online ahead of print.

ABSTRACT

PURPOSE: Platelet-rich plasma (PRP) is a promising treatment for enhancing the outcomes of bone marrow stimulation for osteochondral lesions of the talus (OLT) and has demonstrated efficacy in alleviating symptoms due to its biological properties. However, the role of leukocyte concentration in PRP remains unclear, particularly regarding cartilage regeneration. This study aimed to compare the clinical outcomes and time to return to activity between leukocyte-poor PRP (LP-PRP) and leukocyte-rich PRP (LR-PRP) in OLT surgery.

METHODS: Data from 29 patients with ≥ two year follow-up were retrospectively reviewed: 18 who received LP-PRP and 11 who received LR-PRP with OLT surgery. The study assessed the timeline of return to activity and Self-Managed Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and at three months, six months, and two years postoperatively.

RESULTS: The LP-PRP group resumed jogging and sports significantly earlier than the LR-PRP group (P = 0.03, P < 0.01). No patients in either group experienced complications. Both groups showed improved SAFE-Q scores at six months, but at two years, the LP-PRP group maintained significantly higher scores compared to their preoperative levels, whereas the LR-PRP group showed declines in some domains.

CONCLUSION: LP-PRP enabled an earlier return to sports compared with LR-PRP. Additionally, LP-PRP maintained good clinical scores two years after surgery. In contrast, the LR-PRP group showed some decline from their early postoperative peak, although absolute scores remained above preoperative levels. These findings suggest that LP-PRP may be an effective adjuvant treatment for OLT surgery.

LEVEL OF EVIDENCE: III.

PMID:41307669 | DOI:10.1007/s00264-025-06709-8

Int Orthop. 2025 Nov 27. doi: 10.1007/s00264-025-06708-9. Online ahead of print.

ABSTRACT

INTRODUCTION: Accurate cup sizing is crucial in total hip arthroplasty (THA). Conventional templating and intra-operative head sizing show inconsistent accuracy, whereas CT-based planning in robotic-assisted THA may offer superior precision. We aimed to compare implanted cup size with both CT-based planning and intra-operative native head sizing, hypothesising that CT planning would provides greater accuracy and consistency.

METHODS: This single-centre study included 619 consecutive robot-assisted primary THAs templated with pre-operative CT scans. Implanted cup size was compared with the pre-operative CT-planned size in all hips, and with the intra-operative measurement of the native femoral head in 299 hips.

RESULTS: CT-based planning closely predicted the implanted cup (exact 94.3%; ±1 size 98.7%; mean difference 0.05 ± 0.67 mm; r = 0.984, p < 0.001). Implant-native head comparisons showed larger mismatches (3.14 ± 2.31 mm; exact 9.4%; ±1 size 40.5%; r = 0.817, p < 0.001). Plan-implant agreement was modestly better in females (p = 0.039) and in smaller head categories (< 50 and 50-54 mm) versus > 54 mm (p = 0.007). For implant versus head, mismatch magnitude varied by head size, smaller heads tended toward greater relative oversizing, without a sex effect (p = 0.76).

CONCLUSION: In robotic THA, CT-based 3-D planning provides near-perfect cup-size prediction and substantially outperforms using the native head as a sizing reference. Residual variation reflects patient-specific factors, chiefly native head size and, to a lesser extent, sex, which should be considered alongside the CT plan. Using native head diameter as a complementary check may further refine pre-operative algorithms and guide intra-operative choices, optimizing component selection for long-term stability and function.

PMID:41307668 | DOI:10.1007/s00264-025-06708-9

Injury. 2025 Nov 19:112899. doi: 10.1016/j.injury.2025.112899. Online ahead of print.

ABSTRACT

BACKGROUND: In recent years, more studies have focused on the outcome parameter (health-related) Quality of Life (QOL) after a severe injury. Psychological complaints are known to be associated with QOL. However, little is known about long-term QOL. Studies in other fields, have shown that, apart from disease, patients' personality may be associated with (long-term) QOL.

AIM: The aim of this study was to evaluate QOL, psychological complaints, and physical limitations about ten years after a severe injury and to compare this with the patients' situation 7 years earlier. Furthermore, the association between long-term QOL and patients' personality was examined.

METHODS: The 156 patients who participated in a study to investigate QOL, psychological problems and physical limitations seven years ago, were reassessed to determine their current situation using the same questionnaires as seven years earlier. In addition, patients' personality was assessed.

RESULTS: The response rate was 58%. Except for the social component, no significant differences in patients' QOL, psychological complaints and physical limitations were found in comparison with seven years earlier. The social domain scores had decreased. Personality was significantly associated with all QOL domains. Psychological complaints were not an important confounder in the association between personality and long-term QOL, but they did in the relationship between personality and physical complaints.

CONCLUSION: The QOL, psychological, and physical situation of severely injured patients ten years after their injury is comparable to their situation three years after their injury. Personality was an important factor, strongly associated with long-term QOL. Therapy focused at extending coping strategies may be helpful for patients at risk for low QOL, since no further spontaneous recovery was observed.

LEVEL OF EVIDENCE: This is a Basic Science paper and, therefore, does not require a level of evidence.

PMID:41298216 | DOI:10.1016/j.injury.2025.112899

Injury. 2025 Nov 19;57(2):112896. doi: 10.1016/j.injury.2025.112896. Online ahead of print.

ABSTRACT

BACKGROUND: The surgical strategy of displaced intra-articular calcaneal fractures (DIACFs) remains technically challenging. While sinus tarsi approach (STA) is widely applied for DIACFs, increasing concerns regarding the wound-related sequelae drive surgeons to target and advance minimally invasive surgery (MIS). This study aims to introduce a tailored distractor-assisted MIS and compares its medium-term outcomes with conventional STA approach reduction and fixation in patients with Sanders Ⅱ and Ⅲ calcaneus fractures.

METHODS: From Jan 2021 to Jun 2023, 133 cases (133 feet) diagnosed as DIACFs are prospectively randomized to receive either the tailored distractor-assisted MIS (MIS-arm) or conventional STA (STA-arm) reduction and fixation in the city trauma center. A 2-year follow-up is scheduled to record surgical outcomes. The medical records and radiological measurements during the follow-up are retrospectively retrieved and compared between the two treatment-arms for curative effect evaluation. At the last follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hind foot score and Visual Analog Scale (VAS) score are used to evaluate the functional rehabilitation.

RESULTS: The basic demographic characteristics and clinical presentations were comparable among the MIS-arm (67 feet) and the STA-arm (66 feet). Perioperatively, the MIS-arm vs STA-arm showed significant advantages in the interval between injury to operation, the operation time, and the hospital stay (average 1.3 vs 3.8 days, P < .05; 40.1 vs 65.4 min, P < .05; 4.9 vs 8.5 days, P < .05; respectively). Notably, the MIS-arm vs STA-arm was less likely to develop wound infection (0 % vs 6.1 %, P < .05). For postoperative radiological measurements, the MIS-arm achieved significant improvement from pre-operation with regards to calcaneal height, width, Bohler's angle, and Gissane angle (p < 0.05, respectively) as the STA-arm done and there were no differences between those two-arms in any above radiological indices (p > 0.05, respectively). At the last follow-up, the functional outcomes including AOFAS and the VAS were comparable between the two cohorts (81.4 ± 7.6 vs 79.5 ± 8.8, t = -2.20, P > .05; 1.3 ± 1.5 vs 2.30 ± 0.9, t = -4.33, P > .05; respectively). During the 2-year follow-up, no failure of reduction were observed. Further subgroup analysis confirmed no technical preference regarding MIS among Sanders type II and III.

CONCLUSION: The tailored distractor-assisted MIS actually worked out as conventional STA strategy did in radiological and functional outcomes for Sanders Ⅱ and Ⅲ calcaneus fractures. Lower rate of incision-related complications showed advantages of the tailored distractor-assisted MIS over STA. Further cohort study is required to clarify its clinical significance vs other MIS techniques.

PMID:41297369 | DOI:10.1016/j.injury.2025.112896

Injury. 2025 Nov 20;57(2):112901. doi: 10.1016/j.injury.2025.112901. Online ahead of print.

ABSTRACT

BACKGROUND: The use of an electromagnetic motorized intramedullary telescopic nail (MITN) simplifies humeral lengthening in patients with significant shortening.

PATIENTS AND METHODS: We conducted a retrospective single-surgeon series of five adult patients (2017-2022) with humeral length discrepancies treated using an electromagnetic-controlled MITN.

RESULTS: All patients underwent an antegrade approach. In four cases an extended lengthening technique exceeded the 5 cm limit of the 8.5 mm MITN. All patients achieved the planned length, were satisfied with the outcome, and regained their preoperative shoulder range of motion by the end of treatment.

CONCLUSION: Motorized intramedullary humeral lengthening is an effective treatment option for humeral length discrepancies.

PMID:41289967 | DOI:10.1016/j.injury.2025.112901

Int Orthop. 2025 Nov 25. doi: 10.1007/s00264-025-06703-0. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to report the 10-year clinical and radiological outcomes, survivorship, and patient-reported results of the Persona posterior-stabilized (PS) total knee arthroplasty (TKA) performed in a single centre.

METHODS: This retrospective cohort study was based on a prospectively institutional database. A total of 293 primary Persona PS TKAs performed between 2012 and 2015 were identified. After applying inclusion and exclusion criteria, 185 knees (168 patients) were available for analysis at a minimum follow-up of ten years. Clinical evaluation included the Knee injury and Osteoarthritis Outcome Score (KOOS) and the 2011 Knee Society Score (KSS). Radiological assessment consisted of the hip-knee-ankle (HKA) angle. Implant survivorship was analyzed using Kaplan-Meier methods.

RESULTS: At 10 years, Kaplan-Meier survivorship for revision for any reason was 94.1% (95% CI 90.3-97.9%). Four revisions were performed (2 infections, 2 aseptic loosening). Mean KOOS scores improved significantly from preoperative to ten year follow-up (Pain 48→86; Symptoms 45→84; ADL 50→89; Sport 25→72; QoL 30→82; all p < 0.001). The KSS 2011 domains also significantly improved. The mean postoperative HKA angle was 179° ± 2°, with 7.8% of knees outside ± 3° from neutral. No radiographic evidence of radiolucent lines, osteolysis, or loosening was observed.

CONCLUSION: At ten years, the Persona PS knee system demonstrated excellent survivorship and durable functional results comparable to other contemporary TKA designs. Further comparative studies are required to determine whether its morphometric concept provides additional clinical benefit.

LEVEL OF EVIDENCE: IV Retrospective cohort study.

PMID:41288690 | DOI:10.1007/s00264-025-06703-0

Injury. 2025 Nov 19:112903. doi: 10.1016/j.injury.2025.112903. Online ahead of print.

ABSTRACT

INTRODUCTION: Urotrauma requiring intervention can be managed by trauma surgery (TS), urologic surgery (US) or interventional radiology (IR). There is no clear consensus on preferable specialty for intervention, and limited data compare outcomes by specialty. This study aims to characterize interventions for urotrauma by specialty and analyze outcomes at our institution.

METHODS: We conducted a retrospective review of patients at our Level I Trauma Center with urotrauma requiring intervention from 2020-2023. We performed a descriptive analysis of demographics, injury type, specialty involved, intervention type, injury severity score (ISS), and post-operative course.

RESULTS: Of 387 patients identified, 23 % (87/387) required intervention with median age 32 (IQR 24-48) years. Kidney injuries were most common (68 %, 59/87), followed by ureteral (13 %, 11/87) and bladder (13 %, 11/87). TS performed most of the interventions (47 %, 41/87), followed by US (41 %, 36/87), and IR (12 %, 10/87). TS performed nephrectomy at a higher rate than US (67 %, 24/36 vs 8 %, 1/13). Of the cohort, 20 % (17/87) were readmitted, with 65 % (11/17) requiring a procedure and 63 % (7/11) of which were related to initial urologic injury. US was not initially consulted in nearly 60 % (4/7) of cases requiring urologic intervention upon readmission. The rate of urologic intervention upon readmission was 38 % (3/8) among patients who had an initial urologic consultation, compared to 100 % (4/4) among those who did not. Median length of stay (LOS) for readmitted patients was 76.7 h among those who received an initial US consultation and 134.1 h among those who did not. Follow-up occurred in 86 % (24/28) and 70 % (27/37) of patients treated by US and TS, respectively.

DISCUSSION: TS conducted most urotrauma interventions, while US managed most non-renal cases. The nephrectomy rate for renal trauma was lower when managed by US, suggesting a more organ-preserving approach. Patients without initial US consultation had a nearly 3-fold higher rate of readmission for urologic intervention, longer readmission hospital LOS, and lower follow-up rates. These clinically meaningful trends suggest that US consultation may improve outcomes by reducing the need for nephrectomy, minimizing reinterventions, reducing hospitalization length, and improving continuity of care. Multidisciplinary collaboration should be pursued in the management of urotrauma.

PMID:41276419 | DOI:10.1016/j.injury.2025.112903

Injury. 2025 Nov 19;56(12):112893. doi: 10.1016/j.injury.2025.112893. Online ahead of print.

ABSTRACT

INTRODUCTION: Digital necrosis (DN) is a critical postoperative complication following finger replantation surgery. This can necessitate additional surgical interventions that can adversely affect the patient's hand functionality, psychological well-being, and financial standing. The timely identification and management of the risk of post-replantation DN are thus crucial for enhancing patient outcomes. The objective of this study was to create and validate an easily understandable machine learning (ML) model for predicting the risk of DN following finger replantation surgery.

PATIENTS AND METHODS: Data from 1579 patients who underwent finger replantation surgery at Suzhou Ruihua Orthopaedic Hospital between September 2018 and September 2023 were collected and divided into training and internal validation sets. Additionally, 293 data points from two other institutions were employed as independent external validation sets. Ten machine-learning methods, including Gradient Boosting Machine (GBM), were utilized for modeling. The performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA). SHapley Additive exPlanation (SHAP) was utilized to provide both global and local interpretations of the final model.

RESULTS: Nine indices, including the seniority of the doctor and the neutrophil count, were identified as independent predictors of DN. The GBM model showed optimal model with high predictive accuracy for DN risk in both the training set (AUC: 0.995) and the internal validation set (AUC: 0.978), which was confirmed using external validation (AUC: 0.983). The reliability and utility of the GBM model and the web-based computing platform were confirmed by DCA, calibration curve, accuracy, and sensitivity analyses.

CONCLUSION: An interpretable machine-learning model based on complete blood counts and related inflammatory marker levels was constructed and validated to predict the likelihood of developing DN following finger replantation. This model can assist clinicians in the prompt identification of high-risk patients post-replantation, enabling timely intervention.

PMID:41275725 | DOI:10.1016/j.injury.2025.112893

Int Orthop. 2025 Nov 24. doi: 10.1007/s00264-025-06696-w. Online ahead of print.

NO ABSTRACT

PMID:41276699 | DOI:10.1007/s00264-025-06696-w

Injury. 2025 Nov 14;56(12):112891. doi: 10.1016/j.injury.2025.112891. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the effects of obesity and sex on 90-day medical outcomes and two-year outcomes following open reduction and internal fixation (ORIF) of upper extremity fractures.

METHODS: A retrospective analysis was conducted using a nationwide database to identify patients who underwent ORIF of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) between 2003-2023 and had a minimum of 2 year follow-up. Patients were divided into two cohorts based on their BMI: nonobese (BMI<30) and obese (BMI≥30). Further subanalyses were conducted based on BMI categories. Patients were 1:1 propensity score-matched yielding 27,810 patients per group. Primary outcomes included fracture related outcomes at 2 years postoperatively while secondary outcomes were healthcare utilization and medical outcomes at 90 days postoperatively.

RESULTS: At 90 days, obese patients had higher risks of pulmonary embolism (RR 1.57, p = 0.001), deep vein thrombosis (DVT) (RR 1.32, p = 0.011), hospital readmission (RR 1.13, p = 0.042), and wound complications (RR 1.16, p = 0.005), while stroke incidence was lower (RR 0.68, p = 0.034). At 2 years, obese patients had increased risks of malunion/nonunion repair (RR 1.25, p = 0.002), malunion (RR 1.35, p = 0.009), and nonunion (RR 1.18, p = 0.001).

CONCLUSION: Obesity increases 90 day and 2 year complications following upper extremity ORIF. This highlights the need for tailored perioperative management for obese patients undergoing surgical fixation of upper extremity fractures.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort.

PMID:41273807 | DOI:10.1016/j.injury.2025.112891

Injury. 2025 Nov 14;56(12):112889. doi: 10.1016/j.injury.2025.112889. Online ahead of print.

ABSTRACT

INTRODUCTION: Non-tobacco nicotine dependence (NTND) has become an increasing alternative to traditional tobacco use. However, limited data exists in NTND patients undergoing operative fixation for unicondylar tibial plateau fractures. The purpose of this study was to investigate differences in perioperative complications and mortality among patients with and without NTND undergoing tibial plateau open reduction internal fixation (ORIF).

METHODS: The TriNetX US Collaborative Network database was queried using ICD-10 and CPT codes to identify patients aged 18 and older undergoing unicondylar tibial plateau ORIF between 2004 and 2024. Patients were divided into two cohorts depending on history of NTND. These cohorts were propensity-matched based on age, gender, race, ethnicity, body mass index, and various medical comorbidities. Rates of complications and mortality were compared between cohorts.

RESULTS: A total of 99,060,931 patients aged 18 and older were identified, of which 13,589 underwent ORIF for unicondylar tibial plateau fractures. Among these, 12,055 (88.7 %) were non-nicotine users and 1534 (11.3 %) were NTND. After 1:1 propensity score matching, each cohort included 1498 patients. Complications including stroke (OR 1.658), pneumonia (OR 2.036), emergency department (ED) visits (OR 1.536), and death (OR 1.883) were significantly higher in NTND patients 90 days postoperatively (p < 0.05). Furthermore, rates of pneumonia (OR 1.733), osteomyelitis (OR 3.456), and ED visits (OR 1.798) were significantly elevated in the NTND cohort compared to their counterparts 1 year postoperatively (p < 0.05).

CONCLUSIONS: NTND patients have higher rates of mortality and numerous postoperative complications including stroke, pneumonia, osteomyelitis, ED visits, and death following tibial plateau ORIF. Overall, this study suggests providers should counsel patients with NTND pre-operatively and consider screening patients prior to operatively managing unicondylar tibial plateau fractures.

LEVEL OF EVIDENCE: Retrospective cohort study; Level of evidence III.

PMID:41270685 | DOI:10.1016/j.injury.2025.112889

J Bone Joint Surg Am. 2025 Nov 21. doi: 10.2106/JBJS.25.00100. Online ahead of print.

ABSTRACT

BACKGROUND: Intra-articular (IA) corticosteroid injections are commonly used for pain relief and improved function in patients with knee osteoarthritis (OA). However, the optimal corticosteroid preparation remains controversial. The aim of this study was to compare the efficacy of single-shot long-acting corticosteroid (betamethasone) and intermediate-acting corticosteroid (triamcinolone acetonide) injections in knee OA.

METHODS: This single-center, double-blinded, randomized controlled trial included 120 patients with symptomatic knee OA who were randomized to receive either a betamethasone (7-mg) or triamcinolone acetonide (40-mg) IA injection and were followed for 6 months. The primary outcomes were the visual analog scale (VAS) pain scores (0 to 100) at rest and during movement at 6 months. The secondary outcomes were the VAS pain during movement, knee flexion angle, modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, University of California Los Angeles (UCLA) activity score, Timed Up-and-Go test (TUG), 2-minute walk test (2MWT), and side effects. The analysis focused on between-group comparisons using multilevel regression models.

RESULTS: The study population consisted of 120 Thai individuals. Both the betamethasone and triamcinolone groups demonstrated significant reductions in VAS pain at rest starting from day 1 and lasting for up to 6 months. At 6 months, the between-group mean difference in VAS pain at rest was -1 (95% confidence interval [CI], -11 to 8; p = 0.77), indicating no significant difference. Similarly, at 6 months, no significant between-group differences were observed in VAS pain during movement (-3 [95% CI, -13 to 7]; p = 0.51), flexion angle (6 [95% CI, 1 to 10]; p = 0.20), WOMAC score (-4 [95% CI, -11 to 4]; p = 0.91), UCLA activity score (0 [95% CI, -0.5 to 0.6]; p = 0.46), TUG (-1 second [95% CI, -3 to 1]; p = 0.88), or 2MWT (9 meters [95% CI, -1 to 19]; p = 0.47). Acetaminophen and tramadol use were numerically, but not significantly, lower in the betamethasone group (p > 0.05). No serious adverse events occurred.

CONCLUSIONS: No significant differences were observed between IA betamethasone and triamcinolone acetonide with respect to VAS pain, functional scores, or performance-based outcomes at 6 months.

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

PMID:41270194 | DOI:10.2106/JBJS.25.00100

Int Orthop. 2025 Nov 21. doi: 10.1007/s00264-025-06704-z. Online ahead of print.

ABSTRACT

PURPOSE: Platelet-rich plasma (PRP) is a promising orthobiologic therapy for musculoskeletal pathologies. However, its clinical application is influenced by varying legal and regulatory frameworks across regions. This narrative review aims to discuss the regulatory and legal framework for PRP therapy in musculoskeletal pathologies in South America.

METHODS: The authors searched and reviewed contemporary literature on laws and regulations governing platelet-rich plasma use for musculoskeletal pathologies in South America in electronic databases, summarising the findings in a narrative review.

RESULTS: PRP regulation in South America falls into three categories: (1) countries with clear regulatory frameworks (Argentina, Bolivia, Colombia, Peru), where PRP is legally recognised and governed by specific provisions; (2) countries with emerging or developing regulations (Chile, Ecuador, Paraguay, Suriname, Uruguay, Venezuela, Guyana), where PRP is indirectly regulated under broader blood or tissue laws; and (3) countries permitting PRP only for experimental or research purposes (Brazil). Despite regional efforts to align with international standards, significant disparities exist in legal clarity, safety protocols, and clinical guidelines. These inconsistencies pose risks such as unregulated medical tourism and hinder scientific progress.

CONCLUSION: PRP in South America presents three distinct regulatory scenarios: clear, established regulations; emerging or developing frameworks; and use restricted to experimental or research contexts. While most countries align with international safety standards, significant variation persists in how orthobiologics are clinically governed. The future challenge is to unify these regulations and build an international consensus on processing standards that guarantee patient safety and quality, while enabling innovation and legal clarity for clinicians.

PMID:41269299 | DOI:10.1007/s00264-025-06704-z

Injury. 2025 Nov 13;56(12):112892. doi: 10.1016/j.injury.2025.112892. Online ahead of print.

ABSTRACT

Fat embolism syndrome (FES) is a severe complication of orthopedic trauma and surgery, associated with high mortality. Traditional mechanical obstruction and biochemical lipotoxicity models explain only part of its pathogenesis and cannot account for the sustained progression, multi-organ involvement, and irreversibility of FES. We propose a novel concept of Lipid Pathological Resonance (LPR)-a self-reinforcing loop involving triglyceride (TG) extravasation, hydrolysis into free fatty acids (FFA), hypoxic signaling, and inflammatory amplification. This model integrates lipid metabolic imbalance, immune activation, and structural injury into a unified kinetic framework, clearly distinguishing it from the classical lipotoxicity theory. Drawing upon multi-omics, pathological, and clinical evidence, we highlight the central role of LPR in the pathogenesis of FES and explore potential therapeutic strategies, including lipase modulation, vascular barrier protection, and inflammation control.

PMID:41265295 | DOI:10.1016/j.injury.2025.112892

Injury. 2025 Nov 11;56(12):112887. doi: 10.1016/j.injury.2025.112887. Online ahead of print.

NO ABSTRACT

PMID:41265294 | DOI:10.1016/j.injury.2025.112887