Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06516-1. Online ahead of print.

NO ABSTRACT

PMID:40202543 | DOI:10.1007/s00264-025-06516-1

SICOT J. 2025;11:23. doi: 10.1051/sicotj/2025022. Epub 2025 Apr 8.

ABSTRACT

Advances in technology, prosthetic components and rehabilitation techniques have improved the quality of life for amputees. Wearing a prosthesis enabled them to participate in sports at a high level. Participating in competitive sports puts them at risk of joint injury. This case describes a disabled professional paralympic athlete with a transtibial amputation who has torn his anterior cruciate ligament (ACL). This patient underwent anterior cruciate ligament reconstruction one year before the Paris 2024 Paralympic Games. Surgery had to be adapted in terms of the patient's operative position, choice of graft and incisions to limit conflict with the prosthesis. Anterior cruciate ligament reconstruction with an ipsilateral quadriceps tendon graft enabled the patient to return to competition and place 4th in his category at the Paris 2024 Paralympic Games. This is the first case of ACL reconstruction in a transtibial amputee reported in the literature. It highlights a rare and difficult surgical procedure that can yield good results.

PMID:40198809 | PMC:PMC11978240 | DOI:10.1051/sicotj/2025022

Injury. 2025 Mar 24;56(6):112294. doi: 10.1016/j.injury.2025.112294. Online ahead of print.

ABSTRACT

BACKGROUND: Spontaneously reduced hip dislocation or reduced hip dislocation with a missing reduction history are challenge to the treating surgeon as the signs are usually subtle in such cases. The purpose of this study is to investigate and report on the incidence of the signs of femoral head notching and the presence of intracapsular air bubble in the computed tomography (CT) scans of hip dislocation cases in our center.

METHODS: Cases of traumatic hip dislocation, either without associated acetabular fractures or with acetabular fractures that did not require surgery from 2002 to 2021 were included retrospectively. Their CT scan films were analyzed to look for the presence and direction of femoral head notching and appearance of intracapsular air-bubble.

RESULTS: 30 hips with traumatic hip dislocation and 28 hips with acetabular posterior wall fracture without dislocation were included in this study. We noted notching on the femoral head in the CT axial scans of 23 of 30 hips (76.7 %). 17 cases of notching were noted in association with posterior dislocation, and there were 6 cases associated with anterior dislocation (p = 0.543). We observed intracapsular air bubbles in the CT scans of 28 of the 30 hips in our series (93.3 %). The sensitivity and specificity of notching sign were 56.7 % (95 % CI 37.4∼74.5 %) and 100 % (95 % CI 87.7∼100 %), respectively. For the bubble sign, the sensitivity and specificity were 90 % (95 % CI 73.5∼97.9 %) and 100 % (87.7∼100 %), respectively.

CONCLUSION: We recommend an early CT scan in patients presented with a history of suspected hip dislocation without an obvious finding on plain radiography. The presence of femoral head notching or intracapsular air-bubble would strongly suggest a history of hip dislocation.

LEVEL OF EVIDENCE: Diagnostic Level III, Retrospective cohort study.

PMID:40198971 | DOI:10.1016/j.injury.2025.112294

Injury. 2025 Mar 25;56(6):112303. doi: 10.1016/j.injury.2025.112303. Online ahead of print.

ABSTRACT

BACKGROUND: Open fractures of the lower extremity have a higher risk of fracture-related infections (FRI) or nonunion. The purpose of this study was to identify risk factors for complications and evaluate outcomes.

METHODS: In this retrospective, single center study, we identified and included 187 patients with extraarticular and intraarticular fractures of the tibia or fibula between 2010 and 2018. Patient characteristics, treatment protocols, and complications were assessed, with a focus on soft tissue management and timing of wound closure versus fracture fixation. To analyze risk factors for FRI and nonunion, a univariate logistic regression model was used.

RESULTS: The open fractures included were 52 Gustilo-Anderson type-I (28 %), 99 type-II (53 %), and 36 type-III (19 %) fractures. The mean time from admission to first surgical intervention was 3.47 h (SD 1.4), with 122 (60 %) patients treated within 3 h and 182 (97 %) patients, within 6 h. During primary surgery, definitive fracture fixation was carried out in 112 (60 %) patients and wound closure in 122 (65 %) patients. FRI was reported in 27 (14 %) patients with the highest prevalence in type-III fractures (31 %). Secondary wound closure was associated with a significantly higher risk for FRI than primary wound closure (odds ratio [OR] = 3.3; p = 0.004). Nonunion was reported in 37 (20 %) patients. Significant risk factors for nonunion were FRI (OR=11.9, p < 0.001) and definitive fracture fixation before wound closure compared to fracture fixation and wound closure at the same time (OR = 8.2, p < 0.001). Gustilo-Anderson type-IIIb and -IIIc fractures had a significant lower FRI-free survival compared to other fractures. No patient underwent amputation during the follow-up.

CONCLUSION: Open fractures of the tibia and fibula are associated with a high risk of FRI and nonunion. FRI is the strongest predictor of nonunion in open fractures of the lower extremity. Primary wound closure and simultaneous definitive fracture fixation are protective even in higher Gustilo-Anderson fracture types and prevent complications. Early antibiotic therapy and surgical treatment are crucial, as evidenced by all cases receiving treatment within 6 h post trauma.

PMID:40198970 | DOI:10.1016/j.injury.2025.112303

Injury. 2025 Apr 2;56(6):112322. doi: 10.1016/j.injury.2025.112322. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to investigate incidence rates of acetabular, pelvic, and proximal femur fractures in The Netherlands over a 10-year period (2012-2022). With an aging population, understanding trends in these osteoporotic fractures is essential for improving patient outcomes and guiding healthcare strategies.

METHODS: A retrospective cohort study was conducted using data from two national databases, forming a 'hospitalised' and an 'all patients' cohort. The study population included patients diagnosed with acetabular, pelvic, and proximal femur fractures in The Netherlands during the study period. Incidence rates were calculated per 100,000 person-years and linear regression was used to assess temporal trends. Age-adjustments were performed using Dutch population data from the Central Bureau of Statistics (CBS). Comparative analyses between the two cohorts were conducted to identify discrepancies.

RESULTS: A total of 283,991 patients were identified (12,020 acetabular, 70,595 pelvic and 201,376 proximal femur fractures). Of these patients, 159,563 were hospitalised (7123 acetabular, 24,192 pelvic, and 128,252 proximal femur fractures). Incidence rates of acetabular fractures increased by 26 % (hospitalised) and 98 % (all patients), while pelvic fractures showed stagnation in hospitalised patients (-0.13 %) but a 44 % rise in all patients. Proximal femur fractures increased by 5 % (hospitalised) and 15 % (all patients). Significant differences between the databases were noted across all fracture types.

CONCLUSION: The incidence of acetabular, pelvic, and proximal femur fractures has significantly increased in the last decade, most notably in acetabular and pelvic fractures. Furthermore, a shift toward out-patient treatment of acetabular and pelvic fractures was found. These findings highlight the need for improved fracture prevention and out-patient management strategies, while also underscoring the need for a nationwide registration for these injuries.

PMID:40198969 | DOI:10.1016/j.injury.2025.112322

Injury. 2025 Apr 1;56(6):112320. doi: 10.1016/j.injury.2025.112320. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.

METHODS: A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.

RESULTS: 67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).

CONCLUSIONS: Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.

LEVEL OF EVIDENCE: Therapeutic Level 3.

PMID:40198968 | DOI:10.1016/j.injury.2025.112320

Int Orthop. 2025 Apr 9. doi: 10.1007/s00264-025-06521-4. Online ahead of print.

ABSTRACT

PURPOSE: This research was designed to explore the incidence of anaemia before surgery and the rate of mortality one year after surgery for femoral neck fractures in older adults. It also investigated whether anaemia prior to surgery influences the likelihood of mortality within one year after the procedure.

METHODS: A retrospective cohort analysis was undertaken at Honghui Hospital, a tertiary academic medical institution affiliated with Xi'an Jiaotong University in China. This investigation included elderly individuals who underwent surgery for femoral neck fractures within the year spanning from January to December 2021. The research team gathered data encompassing demographic details, levels of haemoglobin prior to surgery, existing comorbid conditions, and mortality statistics after one year.

RESULTS: In this retrospective study, 994 patients were analyzed, with 84 reported fatalities. The incidence of anaemia in this group was 71.1%, affecting 707 individuals. Of these, 486 (48.8%) had mild anaemia, and 221 (22.2%) exhibited moderate to severe anaemia. Independent factors correlating with heightened one-year mortality risk included operative blood transfusions (odds ratio [OR] = 1.8, p = 0.0327), coronary artery disease presence (OR = 1.85, p = 0.0077), and moderate to severe anaemia (OR = 3.18, p = 0.0006). In contrast, higher body mass index (OR = 0.8, p < 0.0001) and red blood cell count (OR = 0.6, p = 0.0253) were linked to reduced one-year mortality risk. Multivariate logistic regression analyses underscored the independent association of moderate to severe anaemia with increased one-year mortality risk, with varying ORs across models: non-adjusted OR at 3.18 (p = 0.0006), Adjust I model OR at 3.08 (p = 0.0191), and Adjust II model OR at 2.96 (p = 0.0278).

CONCLUSION: At Honghui Hospital, affiliated with Xi'an Jiaotong University in China, anemia has been identified as a common condition among elderly patients undergoing surgery for femoral neck fractures, and it significantly contributes to an elevated risk of mortality within one year post-surgery. It is advisable to implement interventions aimed at managing anaemia before surgery, which should include setting haemoglobin thresholds that are not specific to any gender for its diagnosis.

PMID:40199757 | DOI:10.1007/s00264-025-06521-4

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06524-1. Online ahead of print.

ABSTRACT

We study Hernigou P's paper "Is synovectomy still of benefit today in total knee arthroplasty with rheumatoid arthritis?" It highlights the need for further research and progress in this field. Future studies should address limitations like small sample sizes, inadequate patient stratification, lack of quantifiable metrics for synovectomy extent, and limited early postoperative analyses to provide stronger evidence for clinical practice.

PMID:40198386 | DOI:10.1007/s00264-025-06524-1

Int Orthop. 2025 Apr 8. doi: 10.1007/s00264-025-06522-3. Online ahead of print.

NO ABSTRACT

PMID:40198385 | DOI:10.1007/s00264-025-06522-3

Injury. 2025 Apr 5;56(6):112327. doi: 10.1016/j.injury.2025.112327. Online ahead of print.

ABSTRACT

BACKGROUND: Patients undergoing surgery are at significant risk of developing pressure injuries due to immobility and fixed positioning on the operating table, particularly during lengthy procedures. Therefore, implementing effective prevention strategies for pressure injuries should begin as early as the surgical phase. This study aims to compare the two methods of curvilinear position and micromovement in preventing pressure injuries among patients undergoing general surgery in the supine position.

METHOD: This was a double-blind, prospective, randomized, controlled trial conducted from October 2024 to January 2025. The study included a sample size of 120 patients randomly divided into three groups: control (n = 40), micromovement (n = 40), and curvilinear (n = 40). Skin assessments were conducted using the National Pressure Ulcer Scale immediately after surgery and again one day later.

RESULTS: A total of 114 patients were included in the analysis: 39 in the control group, 38 in the micromovement group, and 37 in the curvilinear group. A significant difference was found between the three groups regarding the incidence of pressure injuries (p < 0.05). However, there was no considerable difference regarding the location and stage of the pressure injury between groups (p > 0.05).

CONCLUSION: Micromovement and curvilinear supine position can significantly reduce the incidence of intraoperative acquired pressure injuries. Therefore, it is recommended that these methods be utilized as an effective intervention by the surgical team, especially for high-risk patients and those undergoing prolonged surgeries.

PMID:40194328 | DOI:10.1016/j.injury.2025.112327

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06507-2. Online ahead of print.

ABSTRACT

BACKGROUND: Modular dual mobility (MDM) cups are constituted by a cobalt-chromium (CoCr) liner inserted into a standard acetabular shell, allowing for intra-operative decision and supplementary screw fixation of the acetabular component. MDM could face mechanical issues and biological issues, with the associated risk of elevated blood metal ions levels and adverse local tissue reactions (ALTRs).

MATERIALS AND METHODS: A systematic review of the literature on minimum five years outcomes of modular dual mobility in primary total hip arthroplasty (THA) was performed on PubMed, Cochrane, and Google Scholar databases, in adherence with PRISMA guidelines. Risk of bias in each study was assessed through the JBI checklist for case series.

RESULTS: A total of 381 primary THAs with MDM acetabular cup were performed. At minimum five years follow-up, mean revision rate was 2.3% and implant survivorship was 98.2%. No MDM acetabular construct was revised specifically due to liner mechanical failure, neck-rim impingement, or ALTRs. No intraprosthetic dislocation or iliopsoas tendinitis was observed. No cases of THA dislocation were reported. Mean serum metal ion levels were observed to be within laboratory reference ranges. Greater-than-normal values of serum Co were observed in 9.4% of cases, while greater-than-normal values of serum Cr were observed in 1.6% of patients.

CONCLUSIONS: The main finding of this systematic review is that modular dual mobility acetabular construct appears to be a safe and effective option for primary THA at minimum five years follow-up. Longer follow-up time is needed in order to investigate modular dual mobility long-term survivorship, revision and complication rates, clinical and radiological outcomes.

PMID:40192789 | DOI:10.1007/s00264-025-06507-2

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06470-y. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the incidence and associated risk factors of ischaemic muscle sequelae in patients with traumatic femoropopliteal artery injuries following revascularization, as well as to develop a nomogram to predict the risk of ischaemic muscle sequelae.

METHODS: Data from patients with acute traumatic femoropopliteal artery injuries between January 2008 and December 2022 were collected. All patients with successful limb salvage were divided into two groups based on the occurrence of ischaemic muscle sequelae: the ischemic muscle sequelae group (IG) and the non-ischaemic muscle sequelae group (NG). Univariate and multivariate logistic regression analyses were used to identify potential predictive factors associated with ischaemic muscle sequelae. A predictive nomogram was constructed and internally validated.

RESULTS: Among the 102 patients, 30 cases (29.41%) developed ischaemic muscle sequelae. Independent predictors of ischaemic muscle sequelae were identified as crush injury, HCT, and CKMB. A nomogram was constructed based on these three parameters. The area under the receiver operating characteristic (ROC) curve of the predictive model was 0.894, indicating excellent discrimination. The calibration curve demonstrated a high degree of consistency between the predicted probabilities and the observed outcomes. Additionally, the decision curve analysis (DCA) showed that the nomogram model had good predictive capability.

CONCLUSIONS: Our study demonstrated that crush injury, HCT, and CKMB were independent predictors of ischaemic muscle sequelae in patients with acute traumatic femoropopliteal artery injuries following revascularization. The nomogram integrating clinical factors and blood markers can assist physicians in conveniently predicting the risk of ischaemic muscle sequelae in patients.

PMID:40192788 | DOI:10.1007/s00264-025-06470-y

Int Orthop. 2025 Apr 7. doi: 10.1007/s00264-025-06510-7. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of data evaluating the impact of tourniquet versus no tourniquet surgery in patients with sickle cell disease (SCD).

METHODS: The records of 233 sickle cell patients who underwent orthopaedic surgery with a tourniquet between 1978 and 2018 were retrospectively reviewed. This study group (233 patients) was compared to a control group of 574 SCD patients followed by the same surgical team in the same hospital undergoing the same procedures in the same period between 1978 and 2018 but without a tourniquet. Outcomes assessed skin complications, thrombophlebitis, bone necrosis, muscle necrosis or abnormal muscle function, peripheral nerve impairment, elevated blood pressure, post-operative sickle cell crises, and blood loss under a tourniquet.

RESULTS: The pneumatic tourniquet was primarily applied proximally in both lower and upper limbs. The median tourniquet duration was 65 minutes, with most procedures lasting between 30 and 90 minutes . Postoperative medical complications occurred in both groups, with no significant difference in hospital stay (6.7 vs. 7.1 days). Painful sickling crises affected 86 patients, with a lower prevalence in transfused patients (p = 0.04). Blood loss was significantly lower in the tourniquet group during knee surgeries (438 ml vs. 731 ml, p = 0.031), resulting in fewer transfusions. Skin complications did not affect wound healing. The 90-day incidence of venous thromboembolism (VTE) was 0.4%, with no significant difference between groups. Muscle biopsies showed no necrosis immediately post-surgery, but some necrosis appeared after 12 weeks in the tourniquet group. New bone osteonecrosis cases and infection rates were similar between groups.

CONCLUSION: this study provides valuable insights into the use of tourniquets in sickle cell disease.

PMID:40192787 | DOI:10.1007/s00264-025-06510-7

Injury. 2025 Apr 1:112313. doi: 10.1016/j.injury.2025.112313. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic gallbladder injury has historically been associated with high morbidity and mortality. Whether treatment patterns have changed over time as non-operative management has been adopted for abdominal trauma care remains unclear. We sought to evaluate trends in cholecystectomy as a treatment for traumatic gallbladder injury and estimate the association between operative or non-operative management of traumatic gallbladder injury and patient outcomes.

METHODS: Retrospective cohort analysis of the National Trauma Data Bank from 2007-2021 evaluating patients with traumatic gallbladder injury and determining whether they received no intervention, endoscopic retrograde cholangiopancreatography (ERCP), or cholecystectomy. The probability of a patient receiving cholecystectomy or operative intervention was evaluated with an adjusted multivariable logistic regression model. To estimate the effect of intervention choice on in-hospital mortality, length of stay, and intensive care unit (ICU) length of stay, an adjusted multivariable logistic regression model was used, treating the year as a fixed effect.

RESULTS: There were 6160 traumatic gallbladder injuries recorded from 2007-2021. 3909 (63.5 %) of these patients underwent some form of intervention (drainage or cholecystectomy), including 3722 (60.4 %) undergoing cholecystectomy. The odds of cholecystectomy compared to non-operative management were decreased in several, but not all, years of study as time progressed. There was no statistically significant difference in the odds of ERCP over time. Cholecystectomy was associated with decreased odds of in-hospital mortality (aOR 0.26, 95 % CI 0.22, 0.30; p < 0.001) and 16.5 % longer length of stay (coefficient 0.15, 95 % CI 0.10-0.20; p < 0.001) compared to non-operative management.

CONCLUSIONS: Cholecystectomy use for traumatic gallbladder injury has decreased from 2007-2021 without a concurrent increase in ERCP. Patients who underwent cholecystectomy had lower odds of mortality in adjusted models. The increasing use of non-operative management for traumatic gallbladder injury may carry greater risk to patients, and operative intervention should remain the standard of care.

PMID:40189437 | DOI:10.1016/j.injury.2025.112313

Injury. 2025 Mar 24:112279. doi: 10.1016/j.injury.2025.112279. Online ahead of print.

NO ABSTRACT

PMID:40189436 | DOI:10.1016/j.injury.2025.112279

Injury. 2025 Mar 26;56(6):112290. doi: 10.1016/j.injury.2025.112290. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of the study is to describe the development of bicycle related injuries over the last four decades among young children and to describe their role as a passenger or cyclist.

METHODS: Retrospective study of 7368 children aged 0-9 years that sustained a bicycle related injury in the period 1980-2023. Incidence rates (IR) where analyzed in three age groups; 0-2 years, 3-5 years and 6-9 years. Data was analyzed in regards to age, gender, severity of injury, usage of bicycle helmet and whether the child was a cyclist or a passenger on a bike.

RESULTS: Bicycle related injury accounted for 74.5 % of all traffic related injuries for children 0-9 years treated at Odense University Hospital, Denmark 1980-2023. There was a decrease in IRs for all age groups and both genders in the study period with an overall IR decrease by 69.0 %. The IR for major and minor injury decreased for all age groups and both genders with an overall decrease of 75.6 % and 84.8 %, respectively. In the study period, 85.0 % of children were injured as cyclists and 15.0 % as passengers.

CONCLUSIONS: The study showed a significant decrease in overall IR when stratifying by age, gender, injury severity and the role of the child as cyclist or passenger. The study provides useful information for future studies and campaigns regarding children's bicycle safety.

PMID:40188610 | DOI:10.1016/j.injury.2025.112290

Injury. 2025 Mar 25;56(6):112295. doi: 10.1016/j.injury.2025.112295. Online ahead of print.

NO ABSTRACT

PMID:40188609 | DOI:10.1016/j.injury.2025.112295

Injury. 2025 Apr 5;56(6):112292. doi: 10.1016/j.injury.2025.112292. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary contusion (PC) is considered a relative contraindication to surgical stabilization of rib fractures (SSRF). This study compared outcomes in patients undergoing SSRF vs. non-operative management (NOM).

METHODS: ACS-TQIP 2017-2020 was queried to identify patients with PC and severe chest wall injuries admitted to the intensive care unit (ICU). Outcomes included mortality, length of stay (LOS), and in-hospital complications. Subgroup analyses stratifying patients according to PC severity and institutional SSRF volume were performed. Multivariable logistic regression was used to adjust for confounders.

RESULTS: A total of 17,344 were included; 1789 (10.3 %) underwent SSRF, and 15,555 (89.7 %) did not. SSRF was associated with lower mortality (OR: 0.47, 95 % CI: 0.33-0.68, p < 0.001) but increased ventilator-associated pneumonia, tracheostomy, unplanned ICU admissions, and intubations. It was also associated with increased hospital LOS by 3.46 days (95 % CI: 2.94-3.98) and ICU LOS by 2.33 days (95 % CI: 1.99-2.68). Institutional volume above the median level of 7 SSRF cases was associated with reduced ventilator days by 1.3 days (95 % CI:2.54 to -0.05), hospital LOS by 1.7 days (95 % CI:2.58 to -0.82), and ICU LOS by 1.4 days (95 % CI:2.11 to -0.64), with no significant effects on other outcomes.

CONCLUSIONS: In patients with severe chest wall injury and PC, SSRF is associated with lower mortality at the expense of longer LOS.

PMID:40188608 | DOI:10.1016/j.injury.2025.112292

J Bone Joint Surg Am. 2025 Apr 6. doi: 10.2106/JBJS.24.00984. Online ahead of print.

ABSTRACT

BACKGROUND: Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact of intravenous (IV) dexamethasone on blood glucose levels, insulin requirements, postoperative pain, and postoperative nausea and vomiting (PONV) in patients with well-controlled type-2 DM.

METHODS: A total of 83 Asian patients with well-controlled type-2 DM (defined as a preoperative glycated hemoglobin level of ≤7.0%) undergoing primary TKA were randomized to receive either IV dexamethasone or normal saline solution. Blood glucose and insulin requirements were monitored postoperatively up to day 5, and pain and PONV were assessed using a numeric rating scale.

RESULTS: Compared with the control, IV dexamethasone transiently elevated blood glucose levels on the day of surgery and on postoperative day 1, with the levels returning to baseline by day 3. Insulin requirements were higher in the intervention group on postoperative day 1 (p = 0.004). While IV dexamethasone did not significantly reduce PONV, it effectively alleviated postoperative pain up to day 3.

CONCLUSIONS: In patients with DM who underwent TKA, IV dexamethasone administration transiently increased blood glucose on the day of surgery and on postoperative day 1 and elevated insulin requirements on postoperative day 1. Despite having no impact on PONV, IV dexamethasone provided clinical benefits by reducing early postoperative pain. These findings suggest the potential benefits of IV dexamethasone in enhancing perioperative management strategies for patients with DM who are undergoing TKA.

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

PMID:40188461 | DOI:10.2106/JBJS.24.00984

Injury. 2025 Mar 26;56(6):112280. doi: 10.1016/j.injury.2025.112280. Online ahead of print.

ABSTRACT

BACKGROUND: Snowboarding, skateboarding, and water surfing have emerged as popular pediatric sports. While prior work has examined differences among some types of board sports in certain populations, no prior study has directly compared pediatric injury patterns in board sports with similar techniques but on different terrains. The aim of this study was to compare the frequency and severity of orthopedic and craniofacial trauma sustained by pediatric skateboarders, snowboarders, and surfers. These injury types were selected as they encompass the majority of board sport-related trauma, providing a broad overview of injury patterns across different terrains.

HYPOTHESIS: We hypothesized that pediatric skateboarders and snowboarders sustained more fractures and strains/sprains to the upper extremity, while pediatric surfers sustained more injuries to the head and neck.

METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for orthopedic and craniofacial trauma related to unpowered skateboarding, snowboarding, and surfing between 2014 and 2023. Annualized trends in injury type, injury location, and injury prevalence were examined over the study period and across sport type. Univariate analyses were utilized to compare injury characteristics and patient demographics across board sport cohorts.

RESULTS: NEISS case criteria identified an estimated 546,231 board sport injuries over the study period. Early-adolescent males were the most commonly injured cohort (76.0 %; CI: 73.8-78.2 %). Fractures to the upper extremity were the most common orthopedic injury among skateboarders (31.6 %; CI: 24.8-38.4 %) and snowboarders (45.7 %; CI: 38.9-52.5 %), while lacerations to the head and neck were the most common injury among surfers (24.5 %; CI: 22.0-26.95 %). Pediatric snowboarders sustained more upper extremity fractures and concussions, but sustained less trauma to the lower extremity.

CONCLUSIONS: Findings from this study indicate that pediatric board sport athletes sustain injuries that are analogous but unique. Upper extremity fractures are common in skateboarding and snowboarding. While surfing has a higher incidence of laceration injuries, snowboarding has a higher incidence of concussions but lower incidence of lower extremity injuries. It is important for healthcare personnel to be aware of these injury patterns, especially in settings where immediate healthcare is limited.

PMID:40187108 | DOI:10.1016/j.injury.2025.112280