Injury. 2025 Oct 14;56(12):112817. doi: 10.1016/j.injury.2025.112817. Online ahead of print.

ABSTRACT

INTRODUCTION: Spinopelvic injuries represent some of the most challenging patterns in trauma surgery due to the complex anatomy and the high-energy mechanisms typically involved. Stabilization is critical to restore lumbopelvic alignment, enable early mobilization, and reduce long-term disability. Triangular osteosynthesis has emerged as a technique that combines lumbopelvic fixation with sacroiliac stabilization, providing robust mechanical stability. Despite its growing use, concerns remain regarding its complication profile, particularly implant prominence and wound-related morbidity. This review sought to collate and critically appraise the available evidence on triangular osteosynthesis for spinopelvic injuries, with a focus on reported complications and functional outcomes.

METHODS: A systematic search of PubMed, EMBASE, and Web of Science was performed in line with PRISMA recommendations, covering studies published up to June 2024. Eligible studies were restricted to English-language articles with abstracts and excluded reports on non-traumatic conditions, technical notes, expert commentaries, animal models, and purely biomechanical investigations.

RESULTS: Eighteen studies met the inclusion criteria, comprising 431 patients with a minimum follow-up of eight months. The majority were retrospective case series or cohort designs (12 retrospective, 6 prospective; levels III-IV evidence). Patient age ranged between 15 and 78 years. Falls from height represented the leading injury mechanism, followed by road traffic accidents. Reported complications included prominent hardware in 61 cases (14.35 %) and surgical site infection in 29 cases (6.73 %). Nonunion and sacral malunion were rare, each affecting only two patients (0.46 %). Functional outcomes, reported in nine studies using the Majeed score, showed 78 % excellent results (n = 137), 21.1 % good or fair (n = 37), and one poor outcome (0.57 %).

CONCLUSION: Although implant prominence and wound-related complications are relatively frequent, triangular osteosynthesis remains a dependable treatment for complex spinopelvic injuries, demonstrating very low nonunion rates and generally favourable functional recovery.

PMID:41237660 | DOI:10.1016/j.injury.2025.112817

Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06699-7. Online ahead of print.

ABSTRACT

BACKGROUND: Essex-Lopresti injuries, defined by a combination of radial head fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) disruption, result in forearm longitudinal instability, ulnar-positive variance, pain, and loss of rotation. Although radial head replacement (RHR) is commonly performed, the biomechanical contribution of IOM reconstruction remains controversial. This study quantified the relationship between sequential disruption of forearm stabilizers and resultant longitudinal and rotational instability, and evaluated the extent to which RHR with IOM reconstruction restores forearm stability.

METHODS: Ten fresh-frozen cadaveric forearms underwent sequential sectioning of the proximal radioulnar joint (PRUJ), DRUJ, partial and complete IOM, and radial head, followed by anatomic, overstuffed, and understuffed RHR with IOM reconstruction. Rotational motion was assessed using a custom jig and goniometer, while longitudinal displacement under axial load was measured using a materials testing machine. Data were analyzed with paired t-tests and repeated-measures ANOVA.

RESULTS: Sequential sectioning significantly increased both rotation and longitudinal translation. Total forearm rotation expanded from 84° (intact) to 171° (complete injury; p < 0.001), primarily due to increased supination. Longitudinal displacement rose by ~ 30% after PRUJ/DRUJ injury, 100% after partial IOM sectioning, 200% after complete IOM disruption, and 435% following radial head removal (p < 0.001). RHR with IOM reconstruction restored near-normal rotation (90°, p = 0.518 vs. intact) and axial displacement (neutral, 4.37 mm; supination, 6.34 mm; p = 1.000 vs. intact). Overstuffed RHR restricted rotation, while understuffed RHR showed no significant difference from intact.

CONCLUSIONS: RHR combined with IOM reconstruction effectively restores forearm rotational and longitudinal stability in Essex-Lopresti injuries.

PMID:41238929 | DOI:10.1007/s00264-025-06699-7

Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06700-3. Online ahead of print.

ABSTRACT

BACKGROUND: Femoroacetabular impingement affects 14%-17% of young adults; nonoperative physiotherapy has demonstrated outcomes comparable to surgery in selected cohorts. However, age-specific treatment responses remain poorly defined, impeding evidence-based management across age cohorts.

METHODS: We conducted a prospective observational cohort study of 120 participants with femoroacetabular impingement at three specialized centres. Participants were stratified into adolescent (≤ 18 years; n = 60) and adult (19-45 years; n = 60) cohorts, each receiving standardized physiotherapy over six months. The primary outcome was a change in the International Hip Outcome Tool-33 score at six months. Secondary outcomes included Hip Outcome Score subscales, biomechanical measures, and return-to-sport rates assessed at six and 12 months. Statistical analysis employed two-sample t-tests and chi-square tests with a two-sided α = 0.025 for primary outcomes.

RESULTS: At six months, adolescents achieved significantly higher International Hip Outcome Tool-33 scores (72.4 ± 18.3 vs. 61.8 ± 19.7; difference, 10.6 points (95% CI, 3.2-18.0); p = 0.006 and faster time to clinically meaningful improvement (8.2 ± 4.1 vs. 10.7 ± 5.3 weeks; p = 0.012). Adolescents demonstrated superior Hip Outcome Score Activities of Daily Living (88.3 ± 14.2 vs. 82.1 ± 16.8; p = 0.037), modified Harris Hip Scores (85.7 ± 12.8 vs. 79.3 ± 15.2; p = 0.007), and hip range of motion. Return-to-sport rates favored adolescents at 12 months (89.6% vs. 77.6%). Advantages persisted throughout the 12-month follow-up.

CONCLUSIONS: Adolescent femoroacetabular impingement patients demonstrate superior functional recovery trajectories compared to adults following nonoperative physiotherapy management. These findings support age-stratified treatment algorithms and suggest more favorable prognoses for younger patients pursuing conservative management.

PMID:41236571 | DOI:10.1007/s00264-025-06700-3

EFORT Open Rev. 2025 Jun 2;10(6):388-395. doi: 10.1530/EOR-2025-0062.

ABSTRACT

The orthoplastic approach refers to an integrated evaluation of the surgical approach, the preoperative planning of surgical margins of resection, the loss of healthy tissue, the size of the resultant tissue defect, the functional defect, the impact of neoadjuvant therapies on local tissue, the patient's comorbidities, and predicted survival in order to decide the most favorable reconstruction option for the individual patient with a sarcoma. Microsurgical techniques are an essential component of the tissue reconstruction ladder. The vascularity of the flap used for reconstruction does not compromise the oncological outcomes, nor does it increase local recurrence or reduce overall survival. Free-vascularized fibula grafts are the most common osseous flaps used for bone defect reconstruction. Adequate fixation is necessary to provide mechanical stability and to increase the rate of primary bone union. Soft tissue wound closure under tension results in wound failure, especially when preoperative radiation therapy is used. Flap reconstruction decreases the rate of wound healing complications, allowing for continuation of adjuvant therapies. Soft-tissue local flaps are frequently used to treat tissue defects with a low complication rate. Plastic reconstruction should be tailored to the specific needs of patients.

PMID:41231048 | PMC:PMC12139711 | DOI:10.1530/EOR-2025-0062

Injury. 2025 Nov 12:112847. doi: 10.1016/j.injury.2025.112847. Online ahead of print.

ABSTRACT

BACKGROUND: The clamshell thoracotomy (CST) is a rare, but lifesaving procedure often performed in austere environments. The closure of a CST is challenging and can be fraught with post-operative complications/failure resulting in debilitating chest wall instability. The recent advent of rib and sternal fixation hardware has provided additional tools possibly offering better ways to close a CST. The objective of this study was to examine the use of plates and screws to close CSTs, hypothesizing it is safe and effective, providing good functional outcomes.

METHODS: This was a multi-institutional, international, retrospective review of patients undergoing CST closure with plates and screws utilized in rib/sternal fixation. Exclusion criteria included patients that died prior to hospital discharge. Exact methods for closure were left to the discretion of the operating surgeon, however plates and screws were the main foundation. Basic demographics were obtained. Outcomes of interest included number of plates used, days to closure, complications post-operatively, length of follow-up, and post-operative functional status (1=worst functional status; 5=best functional status). Descriptive statistics were reported.

RESULTS: Nineteen patients from 7 centers were included. Two patients were excluded as they died inpatient. Of the remaining 17 patients, mean age was 34.6 (±18.8) years and 82.4 % were male. 35.3 % percent were white, 41.2 % were black, and 23.5 % were Hispanic. 82.4 % suffered penetrating trauma. Median number of plates used per patient was 1 (Interquartile range (IQR) 1,3). Median time to closure was 1 day (IQR 1,2). Four patients (23.5 %) experienced post-operative complications. Mean follow-up was 197.4 (±206.4) days with all patients obtaining satisfactory chest x-rays during this time. Median functional status reported by patients at follow-up was 4 (IQR 3,5).

CONCLUSION: Clamshell thoracotomy closure with plates and screws appears to be safe and effective. Most patients reported favorable long-term functional status.

LEVEL OF EVIDENCE: Level V, Therapeutic/care management.

PMID:41233201 | DOI:10.1016/j.injury.2025.112847

Injury. 2025 Oct 27:112849. doi: 10.1016/j.injury.2025.112849. Online ahead of print.

ABSTRACT

AIM: This study evaluates the efficacy and safety of Dynatract®, a novel device designed to facilitate early primary closure and prevent aponeurotic retraction in patients with an open abdomen (OA).

METHOD: A preclinical trial was conducted using a porcine model, comparing two groups: one treated solely with AbThera™ Negative Pressure Wound Therapy (NPWT), and another combining AbThera™ NPWT with Dynatract®. The primary endpoint was to evaluate the distance between fascial edges, with secondary measures including the force required to achieve abdominal closure and overall closure success.

RESULTS: "The Dynatract® group showed a progressive reduction in fascial edge distance over time compared to the control group, with statistically significant differences observed at the caudal and midpoint positions (but not at the cranial position), as well as in the force required to achieve closure after 36 h. Complete fascial closure was achieved in all animals in both groups.

PMID:41233200 | DOI:10.1016/j.injury.2025.112849

Injury. 2025 Oct 31;56(12):112856. doi: 10.1016/j.injury.2025.112856. Online ahead of print.

ABSTRACT

BACKGROUND: Hip fractures are a leading orthopaedic injury worldwide, often causing disability, cognitive decline, and loss of independence. Identifying early predictors is therefore a major healthcare priority yet the impact of weather on hip fracture incidence remains poorly understood. This study is the first to examine hip fracture admissions in England and Wales in relation to weather. We hypothesised that (a) lower ambient temperatures are associated with increased hip fracture admissions, and (b) the strength of this association differs by age and baseline mobility status.

MATERIALS AND METHODS: Weather data from the United Kingdom Meteorological Office and patient data from the National Hip Fracture Database (NHFD) were analysed to investigate associations between weather variables and hip fracture in the period from 2015 to 2023.

RESULTS: A total of 567,623 patients with hip fractures were admitted during the nine year period. Hip fracture admissions dropped by about 10 % on weekends. Mobile individuals aged 60-79 years experienced more hip fractures during cold weather with minimal seasonal variation, while less mobile individuals aged 80-99 years had higher rates of fractures in winter.

CONCLUSIONS: The findings highlight trends that inform future strategies to mitigate hip fracture risks and adapt healthcare planning.

PMID:41232178 | DOI:10.1016/j.injury.2025.112856

Injury. 2025 Nov 8;56(12):112885. doi: 10.1016/j.injury.2025.112885. Online ahead of print.

ABSTRACT

BACKGROUND: Subsequent contralateral hip fractures pose a significant challenge in the management of geriatric patients. This study aimed to evaluate the impact of contralateral hip fractures within the past six months in patients with hip fractures.

METHODS: A registry-based cohort study with prospective follow-up was conducted using data from hip fracture patients (femoral neck and pertrochanteric fractures) in Germany, Switzerland, and Austria. Patients with a contralateral hip fracture in the past six months (risk group) were compared to those without (control group). Matching analysis was performed to adjust for confounding factors, including age, sex, American Society of Anesthesiologists (ASA) grade, pre-fracture mobility, and fracture type. The primary outcome was mobility seven days postoperatively, while secondary outcomes included the EQ-5D-5 L index, length of hospital stay, necessity for intensive care unit, reoperation rate, discharge destination, mortality, and complications.

RESULTS: Before matching, patients in the risk group exhibited significantly worse mobility and functional outcomes than those in the control group. However, after adjusting for confounders, no significant differences in mobility or the EQ-5D-5 L index remained. No significant difference was found in the in-house and mid-term mortality rate. The risk group was prone to having a higher risk of delirium and decubitus ulcers without statistical significance. In contrast, the risk of renal failure was significantly lower.

CONCLUSION: Contralateral hip fractures in the past six months are associated with inferior early mobility and functional outcomes in general. However, this association was not independent.

PMID:41232177 | DOI:10.1016/j.injury.2025.112885

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00494. Online ahead of print.

NO ABSTRACT

PMID:41231959 | DOI:10.2106/JBJS.25.00494

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00772. Online ahead of print.

NO ABSTRACT

PMID:41231937 | DOI:10.2106/JBJS.25.00772

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00021. Online ahead of print.

NO ABSTRACT

PMID:41231932 | DOI:10.2106/JBJS.25.00021

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00487. Online ahead of print.

NO ABSTRACT

PMID:41231931 | DOI:10.2106/JBJS.25.00487

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.24.01623. Online ahead of print.

ABSTRACT

BACKGROUND: Financial conflicts of interest (COIs) are arguably a powerful form of COI in scientific journal publishing. The purposes of this paper were to explore the financial COIs of the 6 most highly ranked U.S.-based orthopaedic surgery journals, to more thoroughly examine financial COIs in the journal with the highest industry payments, and to discuss possible approaches to mitigating the potential negative impact of financial COIs.

METHODS: Two publicly available sources of data were used to characterize editor industry funding: the websites or mastheads of high-impact U.S.-based journals and the Open Payments database from the Centers for Medicare & Medicaid Services.

RESULTS: From 2021 to 2023, the median General and Research Payments per editor varied substantially, from a low of $0 to Clinical Orthopaedics and Related Research editors to $2,735,566 to The Journal of Arthroplasty editors.

CONCLUSIONS: Financial COIs existed for some editors at each of the 6 most highly ranked U.S.-based orthopaedic surgery journals. For The Journal of Arthroplasty, the sixth-highest-ranking journal, the majority of the editors and editorial board members had financial COIs. Adverse journal consequences related to financial COIs could be mitigated by enhancing the transparency of disclosures and prominently displaying journal policies for handling COIs on journal websites.

PMID:41231923 | DOI:10.2106/JBJS.24.01623

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00364. Online ahead of print.

NO ABSTRACT

PMID:41231921 | DOI:10.2106/JBJS.25.00364

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.01253. Online ahead of print.

NO ABSTRACT

PMID:41231920 | DOI:10.2106/JBJS.25.01253

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.24.01479. Online ahead of print.

ABSTRACT

BACKGROUND: The primary purpose of this randomized controlled trial was to evaluate serum metal levels in patients after total hip arthroplasty (THA) with a conventional compared with a modular dual-mobility bearing. The secondary aim was to compare patient-reported outcome measure (PROM) scores between the 2 cohorts.

METHODS: Patients undergoing primary THA for osteoarthritis were randomized to receive either a modular dual-mobility or conventional polyethylene bearing. All patients received the same titanium acetabular and femoral components and a ceramic femoral head. Serum cobalt and chromium levels were measured preoperatively and annually at 1 through 5 years postoperatively. A total of 53 patients were enrolled. The 2 cohorts did not differ significantly in terms of demographics. In the conventional-bearing cohort, 76% of the patients were White and 24% were Black, African American; 48% of the patients were male and 52% were female. In the dual-mobility cohort, 86% of the patients were White and 14% were Black, African American; 79% of the patients were male and 21% were female.

RESULTS: Forty-one patients who were randomized to a modular dual-mobility (n = 24) or conventional (n = 17) bearing and had a minimum follow-up of 2 years underwent serum metal analysis. No differences in serum cobalt levels (mean, 0.14 ng/mL [range, 0.075 to 0.29 ng/mL] versus 0.21 ng/mL [range, 0.075 to 0.57 ng/mL]; p = 0.22) or chromium levels (mean, 0.14 ng/mL [range, 0.05 to 0.50 ng/mL] versus 0.12 ng/mL [range, 0.05 to 0.35 ng/mL]; p = 0.65) were identified between the modular dual-mobility and conventional cohorts, respectively, at the 2-year postoperative time point.

CONCLUSIONS: There were no significant differences in serum cobalt or chromium levels at 1 and 2 years postoperatively in patients who received a ceramic femoral head and this specific dual-mobility bearing compared with a ceramic head and a conventional acetabular component. While modest expected elevations in postoperative relative to preoperative serum cobalt and chromium levels were observed in the dual-mobility group, in no case did the cobalt level exceed the laboratory reference range or the threshold of 1 ng/mL that has been associated with adverse local tissue reactions due to mechanically assisted crevice corrosion.

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

PMID:41231919 | DOI:10.2106/JBJS.24.01479

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.01234. Online ahead of print.

NO ABSTRACT

PMID:41231918 | DOI:10.2106/JBJS.25.01234

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00517. Online ahead of print.

ABSTRACT

BACKGROUND: Alcohol negatively affects bone health and fracture repair, yet its effects on implant osseointegration remain poorly understood. This in vivo study utilized a previously developed murine model to evaluate implant osseointegration before and after continuous ethanol consumption.

METHODS: Adult mice were given regular drinking water (control group) or 10% to 15% ethanol in their drinking water for 3 months before undergoing surgical implantation of a load-bearing, porous titanium implant in the proximal tibia. Ethanol consumption was continued until euthanasia at 4 weeks post-implantation (ethanol group) or stopped immediately post-implantation (abstinence group) to mimic postoperative ethanol cessation. Osseointegration was assessed using micro-computed tomography (micro-CT), biomechanical pullout testing, and histological analysis.

RESULTS: Mice with continuous ethanol consumption exhibited significantly reduced peri-implant bone formation, as measured with histology and micro-CT, compared with controls. Biomechanical testing demonstrated a weaker bone-implant interface in the ethanol group compared with controls. In contrast, postoperative abstinence restored the peri-implant bone formation and bone-implant interface strength to levels similar to those in the control group.

CONCLUSIONS: Ethanol consumption compromised implant osseointegration in mice, while postoperative abstinence promoted the recovery of peri-implant bone formation and interface strength.

CLINICAL RELEVANCE: Future clinical studies are needed to assess the impact of preoperative and postoperative abstinence of ethanol on osseointegration of orthopaedic implants.

PMID:41231916 | DOI:10.2106/JBJS.25.00517

J Bone Joint Surg Am. 2025 Nov 13. doi: 10.2106/JBJS.25.00163. Online ahead of print.

ABSTRACT

BACKGROUND: This study evaluated the progression of humeral head medialization in patients who underwent pyrocarbon hemiarthroplasty (PyC-HA). The authors hypothesized that glenoid erosion would not dramatically progress between the short-term and final imaging evaluations, and that there would be excellent clinical outcomes at ≥5-year follow-up.

METHODS: Patients who underwent PyC-HA with ≥60 months of follow-up were included in this prospective study. Relevant data included preoperative demographic characteristics, Walch glenoid classification, changes in clinical outcomes, and revision-free and failure-free survival rates. An investigator, who was blinded to patient outcomes, assessed the glenoid morphology, changes in medialization, joint space, acromiohumeral distance (AHD), critical shoulder and β angles, and posterior subluxation in decentered glenoids at the 2-year and final follow-up visits.

RESULTS: Forty-five patients with a mean age of 52 years and a mean follow-up of 73 months met the inclusion criteria. Significant improvements were observed across all outcome measures. The 7-year revision-free survival rate was 95.7%. Posterior subluxation in decentered shoulders decreased from 27.1% preoperatively to 19.8% postoperatively (p = 0.008). The mean medialization of the humeral head was 2.9 ± 2.8 mm at the 2-year follow-up and increased to 4.0 ± 3.3 mm at the time of the final follow-up (p = 0.096). A >2-mm decrease in AHD from early postoperative to final imaging was observed in 82.2% of patients (p < 0.001). All other radiographic changes were not significant.

CONCLUSIONS: PyC-HA is a reliable procedure for treating glenohumeral joint disease, demonstrating excellent clinical outcomes and stabilized glenoid morphology in the majority of patients between the 2-year and intermediate-term follow-up.

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

PMID:41231915 | DOI:10.2106/JBJS.25.00163

Int Orthop. 2025 Nov 14. doi: 10.1007/s00264-025-06673-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the functional and radiological outcome of transpedicular fixation system for managing unstable sacral fractures in adults.

METHODS: This prospective case series study included 21 patients with unstable type C sacral fractures according to AO Spine classification of sacral fractures. The patients were treated by a transpedicular fixation system connecting the lower lumbar spine to the ilium, as a vertical element, which was bilateral in seven cases and unilateral in 14 cases. A transverse element connecting both sides of the posterior pelvic ring was added to augment fixation in the transverse plane. The minimum period of follow-up was 12 months.

RESULTS: Mean Majeed Score was 84,29 ± 9.97; excellent, good and fair classes were present in 14 (66.7%), five (23.8%) and two (9.5%) patients, respectively. There was a significant reduction of the vertical, anterior posterior and rotational displacement postoperatively in comparison to preoperative measures. There was a significant improvement in neurological deficit postoperatively. Eight (38.1%) patients developed complications postoperatively. Wound Infection was the most common complication.

CONCLUSION: The use of transpedicular fixation as a vertical element combined with a transverse element connecting both sides of the posterior pelvic ring, to treat unstable sacral fractures, offers adequate fixation strength that helps to achieve union in a well reduced position, leads to satisfactory functional outcome and improves neurological deficit.

TRIAL REGISTRATION: (ID/NCT06888583) retrospectively registered.

PMID:41233652 | DOI:10.1007/s00264-025-06673-3