Injury. 2025 Aug 7;56(10):112671. doi: 10.1016/j.injury.2025.112671. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVE: Medial column disruption in proximal humeral fractures (PHFs) is associated with poor outcomes following reduction and internal fixation. Current assessments of unstable medial columns rely on qualitative descriptors such as disrupted hinges and insufficient osseous contact, often overlooking the quantification of bone defects. This study aims to quantitatively analyze bone defect characteristics in varus PHFs using advanced computer image processing techniques.

METHODS: A retrospective cohort study was conducted on 202 patients diagnosed with varus proximal humeral fractures who received treatment at two tertiary hospitals between January 2017 and December 2022. Three-dimensional (3D) fracture models were reconstructed using Mimics software based on preoperative computed tomography (CT) scans, followed by virtual reduction procedures performed in 3-matic software. Comprehensive demographic and morphological data were collected, including patient age, gender distribution, fracture classification, and quantitative parameters of bone defects the volume of bone defect (VBD), extent of bone defect area (EBDA), main defect region (MDR), and maximal defect height (MDH).

RESULTS: Quantile regression demonstrated that age exhibited strong positive associations with VBD across all quantiles (P < 0.001). EBDA and MDH showed consistently significant positive associations with VBD at every quantile level (all P < 0.001). For Sex, males showed no statistically significant differences compared to females (all P > 0.05). Among fracture classifications, 2-part fracture and 3-part fracture had comparable VBD values to 4-part fracture in most quantiles (all P > 0.05), except for 2-part fracture at Q90 (P = 0.017).

CONCLUSION: This study demonstrates that all varus PHFs with significant displacement are associated with bone defects. Age, EBDA, and MDH are positively correlated with VBD, highlighting the importance of considering these factors in surgical planning.

PMID:40795797 | DOI:10.1016/j.injury.2025.112671

Injury. 2025 Aug 5;56(10):112648. doi: 10.1016/j.injury.2025.112648. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility ankle and distal tibia fractures in the elderly population present a complex clinical situation, due to the poor bone quality, soft tissue condition and medical comorbidities in this age group. This study aims to assess the outcome of long hindfoot nail fixation using standard tibial nails in managing these injuries. This is the largest and possibly first study to date of this implant used in ankle trauma hindfoot fixation.

METHODS: This was a retrospective observational study across two level 1 major trauma centres in the United Kingdom, from January 2019 to December 2024. Patients included were above the age of 60 years, with acute ankle or distal tibia fractures and underwent long hindfoot nail fixation with standard tibial nails. Postoperative complications, early weightbearing and mortality rates were assessed.

RESULTS: A total of 36 patients were included, of which 44.4 % were malleolar fractures, 38.9 % distal tibia extra-articular fractures, and 16.7 % distal tibia intra-articular fractures. Half of the cases were open fractures. There were no cases of periprosthetic fracture, re-fracture, fixation or implant failure. There were six (16.7 %) postoperative complication cases, of which only one (2.8 %) was deemed a major complication; re-operation for removal of proximal locking bolt due to infection. 88.9 % were able to full weightbear within 30 days after surgery. The mortality rate was 8.3 % at 30 days and 16.7 % at 1 year.

CONCLUSION: The use of standard tibial nails, a universally available and feasible implant, for long hindfoot nail fixation in fragility ankle and distal tibia fractures is a safe and reliable treatment option, with a success rate of 97.2 % without major complications. They permit early weightbearing and provide a stable construct with reduced risk of periprosthetic fractures and fixation failure. The mortality rate was comparable to fragility hip fractures, highlighting the medical complexity of patients with these injuries.

PMID:40795796 | DOI:10.1016/j.injury.2025.112648

Injury. 2025 Aug 6;56(10):112670. doi: 10.1016/j.injury.2025.112670. Online ahead of print.

ABSTRACT

OBJECTIVE: To identify risk factors and develop a scoring system based on static x-rays that can predict late displacement and deformity of non-operatively treated Young-Burgess lateral compression type 1 (LC1) pelvic ring injuries METHODS: A retrospective review of all non-operatively treated low-energy LC1 (AO/OTA 61-B2/B3) pelvic ring injuries in patients aged ≥50 associated with incomplete zone 1 sacral fractures and minimum three-month follow-up between January 2019 through January 2024 from two academic level 1 trauma centers. Exclusion criteria were non-acute presentations, nonunions, pathological fractures and non-ambulatory patients. Anterior-posterior, inlet and outlet radiographic imaging at initial, post-operative and final follow-up were assessed.The primary outcome measure was greater than 1 cm of pelvic ring displacement from initial to final radiographs showing fracture healing. Patient demographic and radiographic factors were described with univariate analyses. Statistically significant variables (P < 0.05) entered a multivariable logarithmic regression to develop a scoring system through stepwise elimination, which was assessed via receiver operator characteristic (ROC) curve analysis.

RESULTS: A total of 197 LC1 injuries in patients managed non-operatively (mean age 75.6 (50-103) years, n= 147 (74.6 %) female) were included for analyses. Variables correlated with pelvic deformity development on univariate analysis included, increasing age (p = 0.038), whether the anterior ring had initial displacement present (p < 0.001), bilateral anterior ring involvement (p = 0.027), unstable superior ramus fracture angle (p < 0.001), superior ramus comminution (p < 0.001), Nakatani zone 1 of ipsilateral fracture (p < 0.001), and Nakatani zone 1 of contralateral fracture (if bilateral) (p = 0.031). After multivariate analysis with stepwise elimination, only superior ramus fracture angle (oblique OR 4.88, 95 % CI 2.09-12.25; longitudinal OR 15.55, 95 % CI 4.81-56.42), anterior ring initial displacement present (OR 5.05, 95 % CI 1.93-14.29) and superior ramus comminution (OR 4.43 95 % CI 1.99-10.15) remained significant as variables correlating with the development of pelvic deformity (all p ≤ 0.001).

CONCLUSIONS: The statistically significant variables that correlated with late displacement and deformity of LC1 fracture patterns were superior ramus fracture angle, comminution, and initial anterior ring displacement. A combination of these factors increased the risk of displacement.

PMID:40795795 | DOI:10.1016/j.injury.2025.112670

J Bone Joint Surg Am. 2025 Aug 11. doi: 10.2106/JBJS.25.00061. Online ahead of print.

ABSTRACT

BACKGROUND: Surgeons often recommend weight loss for patients with obesity before total knee arthroplasty (TKA). However, it is unknown whether preoperative weight loss affects outcomes. The goals of this study were to determine how many patients with obesity lost weight before TKA, to identify weight loss predictors, and to evaluate if preoperative weight loss affected postoperative outcomes.

METHODS: Among 23,726 primary TKAs performed between 2002 and 2019, we identified 3,665 patients who had a body mass index (BMI) of ≥30 kg/m2 measured 1 to 24 months before surgery and had a weight measured at surgery. The mean patient age was 68 years, and 59% of patients were female. The mean patient BMI was 36 kg/m2. Univariable linear regressions evaluated weight loss predictors. Univariable and multivariable logistic regressions and Cox proportional hazards models evaluated the impact of preoperative weight change on discharge, operative time, periprosthetic joint infections (PJIs), complications, revisions, and reoperations. The mean follow-up was 6 years.

RESULTS: Overall, 20% of patients gained ≥5 pounds (1 pound = 0.45 kg), 39% maintained weight, 17% lost 5 to <10 pounds, 15% lost 10 to <20 pounds, and 9% lost ≥20 pounds before TKA. Male patients lost slightly more weight (-4.6 pounds) than female patients (-4.3 pounds) (p = 0.05). In univariable analyses, gaining >5 pounds was associated with increased odds of extended hospital length of stay (odds ratio [OR], 1.4; p = 0.01) and risk of complications (hazard ratio [HR], 1.7; p < 0.01). Losing 10 to <20 pounds was associated with increased risks of revision (HR, 2.0; p = 0.01), PJI (HR, 3.1; p < 0.01), and complications (HR, 1.6; p = 0.03). In multivariable analyses, compared with maintaining weight, losing 10 to <20 pounds was associated with an increased risk of PJI (HR, 2.6; p = 0.01), whereas gaining >5 pounds was associated with an increased risk of complications (HR, 1.5; p = 0.03).

CONCLUSIONS: Few patients with obesity lost substantial weight before primary TKA, and reaching common preoperative weight loss goals was not associated with improved outcomes. Although a healthy weight is important for general health, weight loss before TKA may not be sufficient to improve postoperative outcomes for most patients with obesity.

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

PMID:40788982 | DOI:10.2106/JBJS.25.00061

Injury. 2025 Aug 7;56(10):112666. doi: 10.1016/j.injury.2025.112666. Online ahead of print.

ABSTRACT

BACKGROUND: Severe thoracic trauma is a leading contributor to mortality in critically injured patients, particularly when complicated by concomitant severe traumatic brain injury (TBI), which may independently impair neurological and respiratory function. Accurate assessment and timely intervention play a crucial role in these patients. However, risk factors for severe thoracic trauma remain unclear, and a prediction rule remains to be established. We developed and internally validated a nomogram that allows clinicians to quantify the risk of severe thoracic trauma.

METHODS: Clinical data from the MIMIC-IV database were retrospectively searched to identify a study cohort comprising patients with severe thoracic trauma. Using LASSO regression analysis, We screened out independent risk factors associated with 28-day mortality and incorporated them into nomogram model. The performance of each model was assessed by calculating receiver operating characteristic (ROC) curves, calibration plots and decision curve analysis (DCA).

RESULTS: The final analysis incorporated 2159 patients, with 192 deaths (8.9 %) occurring within 28-day of ICU admission. we constructed a nomogram that incorporates risk factors including heart rate (HR), traumatic brain injury (TBI), oxygen saturation (SpO2), systolic blood pressure (SBP), ventilation, and Sequential Organ Failure Assessment (SOFA) score on the first day of admission to ICU. The nomogram outperformed SOFA and Model 1 (risk factors including SBP, SpO2, TBI and ventilation) with an area under the receiver operating characteristic curve (ROC) of 0.854 (95 %CI 0.736-0.791, P < 0.001) in the training cohort and 0.859 (95 %CI 0.713-0.794, P < 0.001) in the validation cohort. The analysis of the calibration curve demonstrated that the nomogram exhibited a strong alignment with the observed 28-day mortality rates in severe thoracic trauma patients.

CONCLUSIONS: The study identified independent risk factors associated with the 28-day mortality risk and developed predictive nomogram models for ICU patients suffering from severe thoracic trauma. The nomogram shows promise in guiding strategies aimed at improving prognosis for patients with such injuries.

PMID:40789237 | DOI:10.1016/j.injury.2025.112666

Int Orthop. 2025 Aug 11. doi: 10.1007/s00264-025-06633-x. Online ahead of print.

NO ABSTRACT

PMID:40788572 | DOI:10.1007/s00264-025-06633-x

Injury. 2025 Jul 15;56(10):112616. doi: 10.1016/j.injury.2025.112616. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic posttraumatic sequelae, such as chronic ankle joint infection with loss of the articular cartilage, significant ankle deformities with advanced osteoarthritis, or significant bone loss of the distal tibia or talus, cause chronic ankle pain and functional impairment. Arthrodesis is usually required to relieve pain and improve function. These disabling conditions cannot be treated with ordinary arthrodesis methods, particularly if they are associated with severe osteoporosis and/or poor soft-tissue coverage. The present study aimed to report the outcomes and complications of ankle arthrodesis with circular external fixators in patients with end-stage, posttraumatic ankle arthritis, infection, and/or bone loss.

METHODS: Patients treated with tibiotalar and tibiocalcaneal fusion for posttraumatic sequelae using the circular external fixator between January 2001 and January 2022 were retrospectively reviewed. The outcomes were evaluated using the Catagni tibiotarsal fusion score, and the complications were recorded.

RESULTS: The study included 81 consecutive patients; 58 were males, and 23 were females. The mean age of the patients was 41.52 years (range, 18-75). Successful arthrodesis was obtained in 73 patients (90.1 %). Twenty-four patients (29.6 %) developed complications. Most complications were minor except for unacceptable deformity in four patients, refracture of the arthrodesis site in one patient, and failure of arthrodesis in seven patients. At the final evaluation, the mean Catagni Score was 85.4 (range, 52-96). Fifty-eight patients achieved excellent results, 13 patients achieved good results, two patients achieved fair results, and eight patients achieved poor results. Higher Catagni scores were associated with patients without pre-operative infection, with union, without unplanned additional surgical procedures, without complications, and with better final results (all p < 0.001). In the multivariate regression analyses, we observed that the Catagni score tends to decrease as patient age increases (p = 0.010). Catagni scores of the anterior arthrodesis position were higher than the cases of the sinus tarsi position (p < 0.001).

CONCLUSION: Tibiotarsal arthrodesis with the circular external fixator can effectively treat complex ankle joint problems resulting from severe injuries. The Catagni score is a simple and reliable evaluation score after tibiotarsal arthrodesis surgeries.

PMID:40784318 | DOI:10.1016/j.injury.2025.112616

Injury. 2025 Jul 27:112631. doi: 10.1016/j.injury.2025.112631. Online ahead of print.

ABSTRACT

BACKGROUND: The reverse sural artery flap (RSAF) was reported to be a less technically demanding method for the coverage of defects in the distal lower leg, which can be elevated with short operative times. However, several studies pointed out the high frequency of partial necrosis in patients with comorbidities, which was primarily attributed to inadequate venous drainage. To overcome this challenge, we hypothesized that venous supercharging could effectively alleviate congestion of RSAF, potentially minimizing partial necrosis and related complications not only in healthy patients but also in comorbid patients.

METHODS: A single-center retrospective observational study was conducted. We reviewed patients with severe limb trauma who underwent RSAF for soft tissue defects on the distal lower legs, ankles, and feet from 2009 to 2022. All flaps were performed within 2 months of the injuries. Patients were divided into the Supercharge group and the Control group based on the presence of supercharge. The flap necrosis, major and minor complications, and nonunion were compared between the two groups. Additionally, these outcomes were also evaluated among high-risk patients with at least one comorbidity, including diabetes mellitus, peripheral arterial disease, venous insufficiency, advanced age over 50 years, or history of smoking.

RESULTS: A total of 30 patients including 16 males met the criteria, with 9 cases in the Supercharge group and 21 cases in the Control group. The Supercharge group decreased the frequencies of overall necrosis (11 % vs 71 %) as well as wound dehiscence (22 % vs 67 %). The Supercharge group also exhibited a relatively lower frequency of major complications (0 % vs 29 %) and minor complications (0 % vs 33 %) compared to the Control group. Among 21 high-risk patients with 7 supercharged cases and 14 control cases, supercharging decreased overall necrosis (14 % vs 71 %) and relatively suppressed major and minor complications (both of them: 0 % vs 36 %).

CONCLUSION: Venous supercharging of RSAF decreased the overall necrosis, potentially enhancing its clinical utility even in high-risk patients. Supercharged RSAF can be a valuable option as initial flap reconstruction for traumatic distal limb defects.

PMID:40783329 | DOI:10.1016/j.injury.2025.112631

Injury. 2025 Jul 27:112632. doi: 10.1016/j.injury.2025.112632. Online ahead of print.

NO ABSTRACT

PMID:40783328 | DOI:10.1016/j.injury.2025.112632

Injury. 2025 Aug 7:112651. doi: 10.1016/j.injury.2025.112651. Online ahead of print.

ABSTRACT

INTRODUCTION: The delivery of optimal trauma care requires an interdisciplinary team approach. However, the composition of these teams often varies across health services and systems. Moreover, different models of care exist which impact the way trauma teams operate, including consultative models and admitting models. This study aimed to explore contextual factors (e.g., barriers and facilitators) influencing trauma service model optimisation, propose strategies to address the factors, and understand implementation outcomes of the model.

METHODS: Staff and patients within a large public, major trauma referral centre with statewide outreach were interviewed, and data were analysed using a hybrid qualitative inductive and deductive design. The predominantly inductive approach used interpretive description methodology to produce a narrative and themes related to the interviews. The deductive approach used the Consolidated Framework for Implementation Research (CFIR 2.0) to understanding the influence of multi-level factors on implementation, and mapped data to five implementation outcomes. Finally, strategies addressing the factors were mapped to the nine domains of Expert Recommendations for Implementing Change (ERIC) to inform future research and service redesign.

RESULTS: Twelve staff and six patient interviews were conducted. 'Connecting with people' was a concept that underpinned all three themes of caring for the patient as a whole person; coming together to create a cohesive team identity; and securing a place in the bigger health system. The findings suggest that the Trauma Service improved continuity and enabled patient-centred care, but its perceived effectiveness was hindered by hospital attitudes, leadership changes, staff shortages, and dependence on key individuals. Participants highlighted acceptability and sustainability as key implementation outcomes, with patients viewing the Trauma Service positively while staff had mixed opinions. Fourteen implementation strategies were identified, including restructuring the Trauma Service for continuity of care, pre-planning with stakeholders, using cohorted trauma wards and advocating for funding to ensure sustainability.

CONCLUSIONS: The themes highlighted that optimal trauma care delivery is focussed on connecting with people; recognising and caring for the trauma patient as a whole person; and knowing individual and collective strengths. The findings may have implications for designing or redesigning similar trauma services in the future by ensuring external and internal risks to service provision are mitigated.

PMID:40783327 | DOI:10.1016/j.injury.2025.112651

Injury. 2025 Aug 7;56(10):112647. doi: 10.1016/j.injury.2025.112647. Online ahead of print.

ABSTRACT

BACKGROUND: Acute extensor tendon injuries of the hand, commonly managed by plastic surgeons, require timely repair to optimize outcomes. This study evaluates the functional results, complications, and patient-reported outcomes of acute extensor tendon repairs performed in an outpatient setting using the Wide Awake Local Anaesthetic No Tourniquet (WALANT) technique in Northern Ireland.

METHODS: A retrospective service evaluation analyzed 222 patients undergoing extensor tendon repair between 2018 and 2023. Inclusion criteria were adults (>18 years) with open injuries repaired via sutures. Exclusions included partial tears, fractures, and chronic injuries. Primary outcomes included Total Active Motion (TAM) and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores. Secondary outcomes were infection, rupture rates, and grip strength.

RESULTS: Mean age was 41 years, with 72.5 % males and 54.1 % non-dominant hand injuries. Mechanisms included lacerations (64 %), crush injuries (22 %), and avulsions (14 %). TAM was comparable across injury zones (Verdan classification), though distal zones (e.g., Zone 1) showed ∼30° lower TAM. PRWHE scores (mean: 8.2/50) indicated minimal pain/functional disability. Complications included two superficial infections (0.82 %) and one re-rupture (0.41 %). Grip strength matched normative values. Controlled Active Motion (CAM) rehabilitation yielded satisfactory outcomes, with proximal zones (Zones 7-8) associated with poorer PROMs.

CONCLUSION: Outpatient extensor tendon repair under WALANT is safe and effective, with low complication rates and favorable functional outcomes. Timely repair (<3 days), meticulous technique, and CAM rehabilitation contributed to success, supporting cost-effective management outside main operating theatres. Proximal injuries and rehabilitation protocols warrant further optimization. This study addresses a regional literature gap, advocating for prospective research to refine surgical and therapeutic strategies.

THERAPEUTIC LEVEL: IV.

PMID:40782631 | DOI:10.1016/j.injury.2025.112647

Int Orthop. 2025 Aug 9. doi: 10.1007/s00264-025-06628-8. Online ahead of print.

NO ABSTRACT

PMID:40782290 | DOI:10.1007/s00264-025-06628-8

SICOT J. 2025;11:47. doi: 10.1051/sicotj/2025042. Epub 2025 Aug 8.

ABSTRACT

INTRODUCTION: Tourniquet use in total knee arthroplasty (TKA) can cause ischaemia-reperfusion (I-R) injury via oxidative stress. This study evaluated whether combined administration of the antioxidant N-acetylcysteine (NAC) and the iron-chelator Deferiprone can mitigate oxidative damage and improve clinical outcomes.

MATERIALS AND METHODS: Twenty TKA patients were randomized into two groups, one group receiving NAC (600 mg, 6 h pre-op) and Deferiprone (1000 mg, 2 h pre-op) (intervention group) and the other group serving as placebo (control). Lipid hydroperoxides (LOOH) and protein malondialdehyde (PrMDA) were measured from quadriceps muscle tissue samples at 5 min (T1) and 40 min (T2) after tourniquet inflation, and 5 min after deflation (T3). Blood markers including serum ferritin, white blood cell (WBC) count, and polymorphonuclear neutrophils (PMNs) were assessed along with tissue PrMDA and LOOH as primary outcome measurements, while pain scores and knee flexion were recorded postoperatively as secondary outcome measurements.

RESULTS: LOOH levels were significantly lower in the intervention group at T2 and T3. PrMDA levels showed no significant differences. Ferritin levels rose by 69% in controls vs. 18% in the intervention group. WBC and PMNs normalized faster, with reduced pain and improved range of motion in the intervention group.

CONCLUSION: The attenuation of LOOH elevation, the faster PMN deactivation, the inhibition of ferritin release from the cells along with the improved clinical outcomes suggest that combined NAC and Deferiprone administration may reduce tourniquet-related oxidative stress and inflammation, enhancing early recovery in TKA patients.

PMID:40779705 | PMC:PMC12334122 | DOI:10.1051/sicotj/2025042

J Bone Joint Surg Am. 2025 Aug 8. doi: 10.2106/JBJS.24.01180. Online ahead of print.

ABSTRACT

BACKGROUND: Persistent sedentary lifestyles are prevalent after complex lumbar surgery. Inactivity often is due to habit, is not necessary, and results in both adverse general health and adverse spine health. We tested a multicomponent behavioral intervention administered in surgical practices to increase lifestyle walking after recuperation from surgery involving ≥3 lumbar levels or fusion. This analysis reports the main objective of measuring change in physical activity; subsequent analysis will address the additional objective of measuring change in disability due to lumbar pain.

METHODS: At 3 months postoperatively, patients were interviewed in person, completed the self-reported Paffenbarger Physical Activity and Exercise Index measuring energy expenditure in kcal/week from walking and total activity, and were randomized to the control or a behavioral intervention. Patients in the intervention group made a contract to increase walking and received a pedometer and information about activity benefits, followed by telephone contacts over 1 year to reinforce the intervention and assess activity change. Controls received only information about activity benefits and fewer telephone contacts to assess activity change. The primary outcome was the difference in within-patient change in kcal/week from walking (as measured by the Paffenbarger Index) from enrollment to 4 months later. Additional assessments and outcomes included changes in the total Paffenbarger Index from enrollment to 4 and 12 months and changes in the walking domain to 12 months.

RESULTS: Among 250 patients (mean age, 63 years; 53% men; 96% White patients and 6% Latino patients), 123 received the intervention and 127 were controls. The mean energy expenditure from walking increased from enrollment to 4 months for patients in the intervention group (1,437 to 2,582 kcal/week; p < 0.0001) and for controls (1,320 to 1,870 kcal/week; p < 0.0001), with a greater difference for the intervention group (1,165 compared with 600 kcal/week; p = 0.03). At 12 months, the effectiveness of the intervention was sustained (estimated effect, 588 kcal/week [95% confidence interval (CI), 119 to 1,056 kcal/week]; p = 0.01) when accounting for new events that potentially affect activity, such as another lumbar surgery (estimate, -1,396 kcal/week [95% CI, -2,116 to -676 kcal/week]; p = 0.0002) and new arthroplasty or foot or ankle surgery (estimate, -701 kcal/week [95% CI, -1,212 to -189 kcal/week]; p = 0.007). Similar results were obtained for changes in total activity. Retention in this study was 92%; 72% of all patients reported that being in the study did not affect spine symptoms, and 28% reported that being in the study made symptoms better. No adverse events were associated with the trial.

CONCLUSIONS: A behavioral intervention was effective in increasing lifestyle walking after recuperation from complex lumbar surgery. These findings support integrating counseling about physical activity into routine postoperative care in surgical practices.

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

PMID:40779643 | DOI:10.2106/JBJS.24.01180

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06631-z. Online ahead of print.

NO ABSTRACT

PMID:40779171 | DOI:10.1007/s00264-025-06631-z

Int Orthop. 2025 Aug 8. doi: 10.1007/s00264-025-06629-7. Online ahead of print.

NO ABSTRACT

PMID:40779170 | DOI:10.1007/s00264-025-06629-7

SICOT J. 2025;11:46. doi: 10.1051/sicotj/2025045. Epub 2025 Aug 7.

ABSTRACT

PURPOSE: Intraoperative periprosthetic femoral fracture (IPFF) is a known complication during hemiarthroplasty (HA), which may lead to inferior outcomes. Few studies have assessed the outcomes of IPFF in HA for displaced femoral neck fractures (FNF). This study aims to evaluate the incidence of IPFF in cementless HA for displaced FNF and compare long-term outcomes between patients with and without IPFF.

METHODS: We retrospectively reviewed institutional surgical data of patients who underwent cementless HA for displaced FNF from January 2010 to January 2022. The presence, location, and treatment of IPFF, as well as the effect of IPFF on postoperative weight-bearing, status were assessed. Mortality, readmission, and revision rates were compared between the IPFF and non-IPFF group.

RESULTS: A total of 1,586 patients were included in the study. 104 patients (6.6%) in the IPFF group vs. 1,482 patients (93.4%) in the non-IPFF group. The IPFF location was mostly the calcar (59.6%), followed by the greater trochanter (35.5%) and the femoral shaft (8.6%). Most fractures were treated with fixation (92.3%) and full weight-bearing postoperatively (95.1%). Surgery duration was longer in the IPFF group (p < 0.001). However, there were no significant differences between groups regarding 30-day, 90-day, and 1-year mortality rates, 90-day readmission rates, or revision rates at the latest follow-up. A multivariate binary logistic regression found similar long-term results.

CONCLUSIONS: While IPFF remains a recognized complication of cementless HA for displaced FNF, its occurrence does not adversely affect long-term outcomes when appropriately managed.

PMID:40773666 | PMC:PMC12331202 | DOI:10.1051/sicotj/2025045

SICOT J. 2025;11:45. doi: 10.1051/sicotj/2025041. Epub 2025 Aug 7.

ABSTRACT

INTRODUCTION: The learning curve associated with adopting new surgical systems in total knee arthroplasty (TKA) can significantly impact surgical efficiency and patient outcomes. This study aimed to evaluate the evolution of operative time with the KNEO® (Groupe Lépine, Genay, France) posterior stabilized knee system and to analyze the learning curve for postoperative complications to achieve surgical proficiency.

METHOD: This retrospective, multicentric study analyzed 481 patients who underwent primary TKA with the KNEO® implant in a high-volume university center between 2020 and 2024. The evolution of operative time and postoperative complications requiring reoperation surgery were evaluated, with a follow-up period extending until January 2025, during which complications were monitored. The study included 481 patients with a mean age of 71.7 ± 8.0 years and a mean Body Mass Index of 29.0 ± 4.0 kg/m2. The cohort comprised 308 female (64%) and 173 male (36%) patients.

RESULTS: The mean operative time significantly decreased from 83.5 min in the initial case to 63.0 min after 481 cases (p < 0.001). The learning curve showed an initial learning phase with high variability, followed by stabilization around 150 procedures and subsequent optimization. Postoperative complication rates showed a 31.9% reduction per group of 100 patients (β = -0.3848, p = 0.0075), indicating improved surgical proficiency and patient safety over time.

CONCLUSION: The findings suggest that the KNEO® system follows a measurable learning curve, with operative efficiency and complication rates improving as case volume increases. These results emphasize the importance of structured training and experience accumulation in optimizing patient outcomes when implementing new implant technologies.

PMID:40773665 | PMC:PMC12331203 | DOI:10.1051/sicotj/2025041

Injury. 2025 Jul 29;56(10):112634. doi: 10.1016/j.injury.2025.112634. Online ahead of print.

ABSTRACT

PURPOSE: Malrotation of the radius following a shaft fracture can lead to persistent pain, limited motion, and adjacent joint instability. This study aimed to evaluate radial torsion patterns by specific location.

METHODS: We included 50 patients with uninjured radii on computed tomography (CT). The torsion measuring zone (TMZ), defined along the longitudinal axis from just proximal to the watershed line to the distal end of the radial tuberosity, was divided into 3 mm intervals, generating cross-sectional images for torsion evaluation. Distal and proximal 30 mm segments were defined as distal end zone (DEZ) and proximal end zone (PEZ), respectively. The area with the largest 30 mm angular difference in distal half was designated the distal shaft torsion zone (DSTZ). The area between the proximal end of DSTZ and distal end of PEZ was the mid-shaft zone (MSZ). Angle change rate was evaluated in each zone, with the DSTZ compared to DEZ, MSZ, and PEZ.

RESULTS: The cohort included 27 men and 23 women, mean age of 54.8 ± 19.6 years. TMZ length was 160.5 ± 16.3 mm, with torsion angle of 49.8 ± 13.3° The angle change rate was 4.6 ± 1.9°/cm in the DEZ and 5.1 ± 3.3°/cm in the PEZ. The centre of the DSTZ was 4.8 ± 1.4 cm from distal end, with an angle change rate of 6.5 ± 1.8°/cm. The MSZ length was 6.7 ± 1.7 cm, with angle change rate of 0.3 ± 1.6°/cm. DSTZ showed significantly higher angle change rates compared to DEZ (P < 0.001) and MSZ (P < 0.001).

CONCLUSION: The DSTZ, located about 5 cm from the distal end, exhibited the most significant torsion, while the MSZ showed minimal torsion. Recognising these torsion patterns will guide proper plate positioning and prevent iatrogenic malrotation during plate osteosynthesis for radius shaft fracture.

PMID:40774028 | DOI:10.1016/j.injury.2025.112634

J Bone Joint Surg Am. 2025 Aug 7. doi: 10.2106/JBJS.24.01098. Online ahead of print.

ABSTRACT

BACKGROUND: Managing soft-tissue balance and selecting an appropriate alignment target are crucial factors in modern total knee arthroplasty (TKA). Medial soft-tissue release has been widely performed in posterior-stabilized (PS) TKA; however, recent approaches to medial structure management have been reconsidered. This retrospective study aimed to assess the effectiveness of minimizing medial structure invasion using personalized alignment (PA) with precise additional bone cutting in PS-TKA compared with conventional mechanically aligned (MA) PS-TKA.

METHODS: Overall, 188 patients who underwent PS-TKA were enrolled; propensity score matching on the basis of preoperative patient characteristics was used to ensure that the groups were similar. Additional medial soft-tissue release was performed if necessary in the MA group for inappropriate ligament balance. Adequate bone recutting, as an alternative to medial release, was performed in the PA group, permitting a maximum of 3° tibial varus alignment.

RESULTS: Additional medial soft-tissue release was performed in 33 knees (35.1%) in the MA group, whereas bone recutting was performed in 37 knees (39.4%) in the PA group. The PA group had a significantly more varus postoperative medial proximal tibial angle than the MA group (mean ± standard deviation, 89.1° ± 1.2° versus 90.3° ± 1.8°; p < 0.0001). The postoperative patient satisfaction score of the 2011 New Knee Society Score (KSS) in the PA group was significantly higher than that in the MA group (mean, 29.4 ± 6.7 versus 27.5 ± 7.3; p = 0.04). Moreover, PA with bone recutting resulted in a significantly greater postoperative extension angle (mean, -1.5° ± 3.7° versus -3.0° ± 3.5°; p = 0.02) and higher KSS patient satisfaction (30.1 ± 7.7 versus 26.7 ± 7.2; p = 0.04) compared with MA with medial release.

CONCLUSIONS: This novel surgical strategy achieved appropriate balance without excessive medial release and resulted in superior clinical outcomes in PS-TKA.

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

PMID:40773529 | DOI:10.2106/JBJS.24.01098