Int Orthop. 2026 Mar 9. doi: 10.1007/s00264-026-06769-4. Online ahead of print.

NO ABSTRACT

PMID:41796240 | DOI:10.1007/s00264-026-06769-4

Injury. 2026 Feb 28;57(4):113144. doi: 10.1016/j.injury.2026.113144. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate outcomes of a series of consecutive, atypical femur fractures (AFFs) treated exclusively with closed reduction and reamed, statically locked intramedullary nailing.

METHODS: Design: Retrospective review.

SETTING: Single North American Level I trauma center. Patient Selection Criteria: All skeletally mature patients treated between 2012 and 2024 with closed reduction and reamed, statically locked IMN of a complete AFFs (OTA/AO 32) with > 6 months follow-up were eligible. Radiographic inclusion required fractures distal to the lesser trochanter and proximal to the supracondylar flare that met ≥4 of 5 American Society for Bone and Mineral Research (ASBMR) major criteria Outcome Measures and Comparisons: Primary outcome was radiographic and clinical union. Secondary measures included time to union, alignment quality, implant failure, and the relationship of neck-shaft angle (NSA) restoration with union.

RESULTS: There was a total of 52 AFFs with a mean age of 68 years (52-89 years). Overall, 46 (88%) patients were female and 6 (12%) were male. The mean BMI was 25.6 ± 4.51 kg/m2 and 52 (100%) patients reported bisphosphonate use. The mean follow-up was 21 months (range, 6-102). Thirty-nine (75%) were subtrochanteric and 13 (25%) were diaphyseal femur fractures. Overall, fracture union occurred in 49 AFFs (94%) at a mean of 6 months (range, 3-14). Three fractures (6%) progressed to nonunion. Notably, 7 AFFs were incompletely healed at 6 months, but 6 of 7 united by 12 months. Reduction quality was excellent in 98% of cases. Restoration of native NSA was significantly associated with union; nonunion cases demonstrated greater deviation from the contralateral NSA (p = 0.034). Implant-related variables (nail type, diameter, interlocking configuration) were not associated with union. Complications were limited to two cases of broken distal interlocking screws and one superficial surgical site infection.

CONCLUSIONS: Treatment of atypical femur fractures with solely closed reduction and reamed, statically locked intramedullary nailing provides reliable healing, with a 94% union rate.

PMID:41795353 | DOI:10.1016/j.injury.2026.113144

Injury. 2026 Feb 27;57(4):113141. doi: 10.1016/j.injury.2026.113141. Online ahead of print.

ABSTRACT

Taylor Spatial Frame (TSF) is a hexapod circular external fixator, i.e. built with six struts connecting two rings to support bone fragments by fixating them to the rings by wires or pins. Struts are length adjustable and have universal joints (U-joints) at both ends which attach to the rings. Behaviour of struts is crucial to the biomechanics of the TSF. However, no study on struts' mechanical characteristics has been reported. In this work, TSF struts and their components and pieces of materials were tested and their mechanical properties are reported. For doing so, the followings tests were conducted: 1) three sizes of TSF Fast-FX struts at different lengths in axial compression, 2) three short struts in oblique compression, 3) two long struts, gripped at and after their U-joints, in axial tension, and 4) two pairs of separated U-joints in compression. Pieces of the strut body and threaded rod were also machined out and tested for material properties. All tests continued till failure and their load-deflection data are plotted. Curve-fitting was applied to the plot of the average load-deflections (of strut sizes at their minimum length). The stiffness characteristics, buckling failure loads and failure load of the universal joints are also reported. Results show that the preponderance of deflections occurs in universal joints, which makes the results relevant to all strut types using the same U-joints.

PMID:41795352 | DOI:10.1016/j.injury.2026.113141

SICOT J. 2026;12:11. doi: 10.1051/sicotj/2025033. Epub 2026 Mar 3.

ABSTRACT

INTRODUCTION: A major complication of hip arthroplasty is dislocation. In revision, the rate of dislocation is even higher, especially among patients with hip prosthetic joint infection treated with two-stage surgery. The utility of a dual-mobility cup (DMC) in revision was already demonstrated but with a relatively low level of confidence due to the lack of direct comparison with other surgical techniques. We hypothesized that the dislocation rate for patients undergoing cementless DMC total hip arthroplasty (THA) would be similar between single and two-stage revisions.

METHODS: We conducted a single-center, retrospective, and case-control study from January 2011 through December 2020. During this period, 220 patients underwent a revision of their total hip arthroplasty. Among these, 40 patients experienced THA two-stage revision. This group constituted the cases in this case-control study. Each of the 40 cases was matched with 2 controls, single-stage surgery, on age, sex, and Paprosky grade, and we defined the groups according to primary endpoint: dislocation rate.

RESULTS: There was no significant difference in dislocation rate between two-stage and single-stage revisions (7.5% vs 3.8%, p = 0.40). In univariate analysis, auto-inflammatory disease and immunosuppressive agent use were risk factors for dislocation. There was no significant difference in dislocation-free survival (log-rank test, p = 0.40) or re-revision (log-rank test, p = 0.92) between single-stage and two-stage revision THA. At the end of follow-up, the mortality rate did not differ between the two groups. No chronic instability was noted at the last follow-up (80.4 ± 38.5 months) in both groups.

CONCLUSION: The dislocation rate was similar between single and two-stage revision THA using DMC. Further studies are warranted to highlight the potential benefits of DMC in preventing dislocation in two-stage revision THA.

PMID:41789833 | PMC:PMC12965059 | DOI:10.1051/sicotj/2025033

SICOT J. 2026;12:E1. doi: 10.1051/sicotj/2025067. Epub 2026 Mar 6.

ABSTRACT

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RA) help people control blood glucose and lose weight. They may also help with bone metabolism, healing fractures, keeping joints healthy, and recovering after surgery. There is growing amount of evidence of their ability to modulate the activity of osteoblasts and osteoclasts, affect inflammatory pathways, and interact with neuroprotective and psychological systems. Although the growing importance of GLP-1 receptor agonists in orthopaedics marks a major shift in how metabolic medicines affect musculoskeletal health, current knowledge is still basic and lacks information on long-term results, safety, and how well different treatments work compared to one another. This paper summarizes the existing evidence on the effects of GLP-1RA drugs on bone metabolism and healing, and discusses their role in current orthopaedics.

PMID:41789832 | PMC:PMC12965058 | DOI:10.1051/sicotj/2025067

Injury. 2026 Feb 20;57(4):113128. doi: 10.1016/j.injury.2026.113128. Online ahead of print.

ABSTRACT

BACKGROUND: The period following orthopedic trauma is a critical window for developing psychological burden, prolonged opioid use, and opioid-related stigma. Stigma refers to shame or perceived judgment related to opioid use, which may impair postoperative pain management and patient-provider trust. Although stigma is increasingly recognized as a recovery barrier, its relationship to pain, psychological factors, and opioid use duration remains poorly understood.

OBJECTIVE: To characterize patterns of psychological factors, substance use, concerning opioid use (opioid misuse), and stigma by opioid use duration (0-29 days, 30 -59 days, and ≥ 60 days) during the three-month period following hospitalization for musculoskeletal trauma.

METHODS: In this prospective observational cohort study, 170 adults hospitalized for orthopedic traumatic injuries were enrolled and followed for three months post-discharge. Clinical data were obtained from electronic health records and the state prescription drug monitoring program, and participants completed validated assessments of pain, psychological symptoms, opioid misuse, and stigma. Participants were categorized by opioid use duration into 0-29 days, 30-59 days, and ≥ 60 days.

RESULTS: Of the 170 participants, 135 (79 %) completed follow-up. Longer opioid use duration was significantly associated with greater inpatient pain intensity, depression, anxiety, pain-related anxiety, and traumatic distress. These trends persisted at follow-up, where participants with longer use demonstrated higher pain intensity, greater opioid exposure, and worse psychological and functional outcomes. Indicators concerning opioid use (opioid misuse) were common; the most frequently endorsed behaviors included running out of medication early (33 %) and anxiety when medication ran out (36 %). Experiences of stigma were reported by 17 % of participants and increased to 52 % among those using opioids for ≥ 60 days (p < .001). Internalized stigma (31 %) and stigma-related behaviors, including taking less medication than needed (24 %), also increased with longer opioid use duration.

CONCLUSIONS: Prolonged opioid use after traumatic musculoskeletal injury was associated with greater pain, psychological burden, concerning opioid use, and experiences of stigma. Findings underscore the interrelated nature of pain, mental health, and stigma in post-injury recovery and highlight the need for integrated interventions targeting pain-related distress, effective coping, and stigma reduction to support safer opioid use and improved functional outcomes.

PMID:41785541 | DOI:10.1016/j.injury.2026.113128

Injury. 2026 Feb 28;57(4):113140. doi: 10.1016/j.injury.2026.113140. Online ahead of print.

ABSTRACT

STUDY TYPE: Retrospective cohort.

PURPOSE: Complex regional pain syndrome (CRPS) is a rare but debilitating complication that may develop following distal radius fracture (DRF). Concomitant nerve-related injury may increase risk. The current study aimed to evaluate the incidence and odds of developing CRPS following DRF with or without need for open reduction and internal fixation (ORIF) and/or carpel tunnel release (CTR).

METHODS: Unilateral DRF patients between 2010-2022 were abstracted from the PearlDiver M170 Ortho database. Cohorts were defined as: (1) DRF managed non-operatively, (2) DRF treated with ORIF without same-day CTR, and (3) DRF treated operatively with ORIF and same-day CTR. ICD-10 laterality coding was used to ensure side-specific matching of DRF and CRPS diagnoses. Management cohorts were matched 1:1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI). Monthly incidence of CRPS diagnosis through 1-year post-injury was determined for each matched cohort. Multivariable regression was performed to identify factors independently associated with CRPS.

RESULTS: After matching, there were 7656 patients in each management cohort. At 1 year, the incidence of CRPS was 24 (0.31 %) in the non-operative group, 44 (0.57 %) in the ORIF-only group, and 110 (1.44 %) in the ORIF+CTR group. Compared with non-operative management, ORIF-only was associated with an odds ratio for CRPS of 2.19 at 3 months and 1.84 at 1 year, while ORIF+CTR demonstrated an odds ratio for CRPS of 6.42 at 3 months and 4.60 at 1 year. A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73).

CONCLUSIONS: Patients undergoing ORIF with concomitant CTR demonstrated the highest odds of CRPS at both early and late timepoints, likely related to median nerve injury or irritation at the time of injury in cases requiring acute CTR.

LEVEL OF EVIDENCE: III.

PMID:41785540 | DOI:10.1016/j.injury.2026.113140

Injury. 2026 Feb 27;57(4):113143. doi: 10.1016/j.injury.2026.113143. Online ahead of print.

NO ABSTRACT

PMID:41780467 | DOI:10.1016/j.injury.2026.113143

Injury. 2026 Feb 27;57(4):113142. doi: 10.1016/j.injury.2026.113142. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the pelvis (FFP) from low-energy trauma are increasingly frequent in older patients. FFP type IIIa, with displaced posterior ilium fracture, usually needs surgical treatment and its optimal fixation technique is unclear. Here, construct stiffness and failure load after fixation of an FFP type IIIa with anterior plate osteosynthesis (PO) with an additional lateral compression 2 (LC2) screw, was compared with PO alone under weight-bearing conditions.

MATERIALS AND METHODS: Twelve artificial left hemipelvises with simulated FFP type IIIa fractures were assigned into the PO (for fixation with an anteriorly fixed 3.5-mm plate) or PO with a 7.3-mm fully threaded antegrade LC2 screw (POLC2) groups (n = 6 per group). All specimens underwent ramped loading (at 18 N/s) from 20 N (preload) to 200 N, followed by progressively increasing cyclic testing at 2 Hz until failure, performed at 0.05 N/cycle on a servohydraulic material test system. Relative displacements and bone fragment angles were monitored using motion tracking.

RESULTS: Initial stiffness (N/mm) did not differ significantly in the PO vs POLC2 group (139.8 ± 31.7 vs 140.1 ± 27.0). After 5000 cycles, dynamic stiffness was significantly higher in the POLC2 group than in the PO group (199.0 ± 20.4 vs 163.8 ± 25.2, p = 0.041) while fracture displacement, torsional fracture displacement, and gap angle were significantly increased in the PO group than in the POLC2 group (p < 0.0001). Cycles to failure and load to failure were higher in the POLC2 group (6922 ± 1133 and 892.2 ± 113.3 N, respectively) when compared with the PO group (4979 ± 943 and 697.9 ± 94.3 N, respectively) (p = 0.015).

CONCLUSION: Compared with plate osteosynthesis alone in an FFP type IIIa model, antegrade LC2 screw augmentation demonstrated significantly increased stability against axial and torsional loading. The combined plate-LC2 screw construct might be an ideal fixation option for posterior iliac fracture of FFP, safely allowing early weight bearing and rehabilitation.

PMID:41780466 | DOI:10.1016/j.injury.2026.113142

Injury. 2026 Feb 27;57(4):113139. doi: 10.1016/j.injury.2026.113139. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femoral periprosthetic fractures following TKA are increasingly common in elderly patients. Surgical management most commonly involves either open reduction and internal fixation (ORIF) or distal femoral replacement (DFR); however, comparative data regarding short-term and long-term complications remain limited. As such, this study compared complications between ORIF and DFR in elderly patients with distal femoral periprosthetic fractures following TKA.

METHODS: A retrospective cohort study was performed using the TriNetX Research Network. Patients aged ≥65 years with distal femoral periprosthetic fractures were identified and categorized by operative treatment. Propensity score matching was performed to balance cohorts. Short-term complications were assessed at 90 days, and long-term complications were evaluated at 1 and 5 years. Complications were compared using risk differences and risk ratios with 95% confidence intervals, and Kaplan-Meier survival methods.

RESULTS: After matching, 698 patients remained in each cohort. Most 90-day complications were similar between groups. However, DFR was associated with higher rates of wound disruption (7.6% vs 2.7%, RR 2.79 [95% CI 1.67-4.66], p<0.001) and transfusion (17.5% vs 13.0%, RR 1.34 [1.04-1.72], p=0.021). At 5-year follow-up, DFR demonstrated higher risks of periprosthetic joint infection (22.5% vs 5.3%, RR 4.24 [3.01-5.98], p<0.001), revision TKA (15.5% vs 3.3%, RR 4.70 [3.03-7.27], p<0.001), and subsequent knee procedures (24.4% vs 14.9%, RR 1.64 [1.31-2.04], p<0.001). Conversely, repeat periprosthetic fractures were more frequent following ORIF (55.3% vs 44.8%), with DFR demonstrating a lower relative risk (RR 0.81 [0.73-0.90], p<0.001). Similarly, additional fixation procedures occurred more often after ORIF (4.9% vs 1.6%), while DFR was associated with a reduced relative risk (RR 0.32 [0.17-0.63], p<0.001). Mortality was similar between approaches at both 30 days (2.2% vs 2.2%, RR 1.00 [0.48-2.08], p=1.00) and 5 years (16.0% vs 15.4%, RR 1.04 [0.81-1.33], p=0.764).

CONCLUSION: Short-term systemic complication rates were comparable between approaches, although DFR was associated with greater perioperative morbidity. Over longer follow-up, DFR demonstrated higher implant-related infection and revision risks, whereas ORIF carried higher risks of refracture and secondary fixation. These findings highlight a tradeoff between the immediate stability and mobilization of DFR and longer-term implant-related complications, supporting individualized treatment selection based on patient-specific risk factors.

PMID:41780465 | DOI:10.1016/j.injury.2026.113139

Injury. 2026 Feb 23;57(4):113119. doi: 10.1016/j.injury.2026.113119. Online ahead of print.

ABSTRACT

BACKGROUND: Pediatric supracondylar humeral fractures (SCHFs) with coronal obliquity pose unique intraoperative challenges and are believed to carry a higher risk of postoperative loss of reduction and delayed functional recovery. However, high-quality evidence supporting this association remains limited.

METHODS: This retrospective comparative study analyzed pediatric patients under 16 years of age who underwent closed reduction and percutaneous pinning for Gartland type III or IV SCHFs between 2016 and 2022. Based on preoperative radiographs, patients were classified into transverse or coronal oblique groups, with coronal obliquity defined as >10° on the anterior-posterior view. Postoperative radiographic parameters, complications, and recovery of elbow range of motion (ROM) were compared between groups.

RESULTS: Among 88 patients, 52 had transverse and 36 had coronal oblique fractures. The coronal oblique group showed significantly higher rates of reduction outliers (anterior humeral line non-intersection: 36.1 % vs. 13.5 %, p = 0.013; malrotation: 22.2 % vs. 3.8 %, p = 0.008), loss of reduction (LOR) requiring reoperation (13.9 % vs. 0 %, p = 0.006), and delayed ROM recovery (19.4 % vs. 1.9 %, p = 0.011). No significant differences were observed in cosmetic or functional outcomes at six months (p = 0.311).

CONCLUSIONS: Coronal obliquity in pediatric SCHFs is significantly associated with a higher incidence of reduction outliers and postoperative LOR. Consequently, these fractures are more likely to require revision surgery and demonstrate slower functional recovery of elbow motion during the early postoperative period compared with transverse-type fractures.

PMID:41780464 | DOI:10.1016/j.injury.2026.113119

J Bone Joint Surg Am. 2026 Mar 4. doi: 10.2106/JBJS.25.01537. Online ahead of print.

ABSTRACT

Robotic-assisted reverse shoulder arthroplasty has recently entered early limited clinical use, with the goal of improving the execution of preoperative plans and reducing malposition outliers that increase complication rates and health-care costs. This Innovation article reviews the rationale for this technology, explores its potential impact, examines key implementation challenges, and highlights the future directions needed to determine its ultimate value.

PMID:41779866 | DOI:10.2106/JBJS.25.01537

J Bone Joint Surg Am. 2026 Mar 4;108(5):363-369. doi: 10.2106/JBJS.25.00600. Epub 2025 Nov 26.

ABSTRACT

BACKGROUND: Revision total hip arthroplasty (THA) presents several unique challenges, one of which is the removal of osseointegrated uncemented femoral stems. Traditional techniques, such as extended trochanteric osteotomy, are associated with complications and patient morbidity. Recently, the advent of osteotome systems designed to facilitate femoral stem extraction has improved the capacity for complete fixation disruption without the need for osteotomy. This study describes our experience with one such novel system in a large series of revision THAs.

METHODS: Patients undergoing femoral component revision during revision THA from December 2017 to July 2024 were identified from our institutional database. We included and analyzed patients undergoing revision for any indication so long as the revised femoral component was cementless and confirmed to be osseointegrated at the time of revision surgery. Extraction was attempted with the femoral-extraction osteotome system of interest in all cases.

RESULTS: Of the 92 included cases, 65% involved single-taper wedge stems; 16%, fit-and-fill style designs; and 9%, fully hydroxyapatite (HA)-coated stems. Using the osteotome system, femoral extraction was successful (no intraoperative fracture or requirement for osteotomy) in 73% of the cases. Osteotomy was required in 10% of the cases but was not required for extraction of any single-taper wedge stem. Of those with fit-and-fill or fully HA-coated stems, 57% required osteotomy or sustained an extraction-related fracture. Extraction-related intraoperative fractures occurred in 13% of the cases.

CONCLUSIONS: In this large series of revision THAs, the use of a novel osteotome system designed for femoral component extraction led to successful extraction in 73% of the cases. The relatively low rate of osteotomy (10%) suggests that this technique is useful, but it also highlights limitations and the need for further innovation given the contemporary shift toward the use of collared, fully coated triple-tapered stems.

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

PMID:41778989 | DOI:10.2106/JBJS.25.00600

J Bone Joint Surg Am. 2026 Mar 4;108(5):339. doi: 10.2106/JBJS.25.00555. Epub 2025 Nov 13.

NO ABSTRACT

PMID:41778988 | DOI:10.2106/JBJS.25.00555

J Bone Joint Surg Am. 2026 Mar 4;108(5):337-338. doi: 10.2106/JBJS.25.00717. Epub 2025 Nov 20.

NO ABSTRACT

PMID:41778987 | DOI:10.2106/JBJS.25.00717

J Bone Joint Surg Am. 2026 Mar 4;108(5):333-334. doi: 10.2106/JBJS.25.01103. Epub 2026 Mar 4.

NO ABSTRACT

PMID:41778986 | DOI:10.2106/JBJS.25.01103

J Bone Joint Surg Am. 2026 Mar 4;108(5):331-332. doi: 10.2106/JBJS.25.01309. Epub 2026 Mar 4.

NO ABSTRACT

PMID:41778985 | DOI:10.2106/JBJS.25.01309

J Bone Joint Surg Am. 2026 Mar 4;108(5):329-330. doi: 10.2106/JBJS.25.01155. Epub 2026 Mar 4.

NO ABSTRACT

PMID:41778984 | DOI:10.2106/JBJS.25.01155

J Bone Joint Surg Am. 2026 Mar 4;108(5):327-328. doi: 10.2106/JBJS.25.01134. Epub 2026 Mar 4.

NO ABSTRACT

PMID:41778983 | DOI:10.2106/JBJS.25.01134

Injury. 2026 Feb 23;57(4):113127. doi: 10.1016/j.injury.2026.113127. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate whether preoperative use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) is associated with increased risk of reoperation, nonunion, infection, hospital readmission, or emergency department (ED) visits following operative fixation of isolated long bone fractures.

METHODS: This retrospective, multicenter cohort study was conducted using the TriNetX Research Network. Adults (≥18 years) who underwent operative fixation of isolated tibial, femoral, or humeral shaft fractures between 2012 and 2024 were included. Patients prescribed an SSRI or SNRI within 180 days prior to fracture and within 12 months after surgery were compared with controls without antidepressant prescriptions before or within 12 months after fracture. Polytrauma, pathologic fractures, and prior surgery at the same site were excluded. Propensity score matching (1:1) was performed for demographics, fracture location, and relevant medical and psychiatric comorbidities. The primary outcome was reoperation within 12 months. Secondary outcomes included nonunion, infection, hospital readmission, and ED visits. Analyses were stratified by fracture type (open vs closed) and location.

RESULTS: A total of 5293 SSRI/SNRI users were matched to 5293 controls. In closed fractures, antidepressant use was associated with higher rates of nonunion (5.2% vs 4.0%; RR 1.29, 95% CI 1.06-1.56). Open fractures demonstrated a trend towards greater rates of nonunion (4.8% vs 3.1%) and reoperation (15.2% vs 13.9%); however, this was not significant. 30-day ED visits, 30-day surgical site infection, and 90-day readmissions were comparable between groups.

CONCLUSIONS: Preoperative SSRI or SNRI use was associated with increased risk of nonunion following operative fixation of closed long bone fractures. Outcomes following open fractures were largely unaffected, likely due to the dominant biological and mechanical risks inherent to open injuries. These findings suggest the need for increased clinical vigilance in patients with closed fractures receiving serotonergic antidepressants and highlight the importance of prospective studies to further clarify causality and guide management strategies.

PMID:41775053 | DOI:10.1016/j.injury.2026.113127