J Bone Joint Surg Am. 2026 Mar 3. doi: 10.2106/JBJS.25.00961. Online ahead of print.

ABSTRACT

BACKGROUND: The longevity of total hip arthroplasty (THA) largely depends on adequate bone formation around the implant. This study used [18F]-fluoride positron emission tomography combined with computed tomography (F-PET/CT) to evaluate skeletal metabolism in the bone surrounding the acetabular cup and to compare the metabolic activity in the periprosthetic regions between cups with 2 different surfaces.

METHODS: Twenty-eight Swedish patients (15 females) with a mean age of 61.3 years were randomly assigned to receive an uncemented cup with either a Trabecular Titanium (TT) surface or a hydroxyapatite (HA) coating. The acetabular bone region surrounding the cup was divided into 9 regions of interest (ROIs). All patients were assessed with use of radiographs and clinical scoring at 36 weeks of follow-up and with use of F-PET/CT at 4, 16, and 36 weeks postoperatively.

RESULTS: F-PET/CT scans demonstrated 17% higher levels of metabolic activity indicating osseointegration in the TT group compared with the HA group at 4 weeks postoperatively. Additionally, both groups had higher standardized uptake values (SUVs) compared with the healthy reference acetabulum groups at 4 and 16 weeks postoperatively.

CONCLUSIONS: A detailed analysis of bone growth on the implant surface revealed that the initial healing phase involves increased mineral accumulation for both TT and HA cups. These findings provide valuable insights into the secondary stabilization of implants, which is critical for prosthesis survival.

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

PMID:41774785 | DOI:10.2106/JBJS.25.00961

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06767-6. Online ahead of print.

ABSTRACT

PURPOSE: Regarding patellar resurfacing in total knee arthroplasty (TKA), no consensus has been reached, but most studies have not addressed specific pathological circumstances. Evidence on the roles of patellar resurfacing and synovectomy in managing postoperative effusion in patients with severe chondrocalcinosis is limited.

MATERIAL AND METHODS: This single-centre observational cohort study included 160 patients who underwent the same TKA for osteoarthritis with severe chondrocalcinosis (grade 4) between January 2000 and December 2010. A matched design created four comparable groups of 40 patients each: (1) TKA without patellar resurfacing or synovectomy, (2) TKA with patellar resurfacing alone, (3) TKA with synovectomy alone, and (4) TKA with both patellar resurfacing and synovectomy. Severe chondrocalcinosis (advanced calcium pyrophosphate deposition disease) was confirmed through radiographic findings, synovial fluid analysis using polarized light microscopy, and histology. Significant postoperative effusion was diagnosed with ultrasound, quantified by sterile joint aspiration, and classified as stage I (10-20 cm3), stage II (21-30 cm3), or stage III (> 30 cm3).

RESULTS: Postoperative joint effusion varied significantly between the strategies. In the patellar resurfacing group, 25% (10/40) of patients developed only stage I effusion without synovectomy. Conversely, 45% (18/40) of patients in the synovectomy-only group developed stage II effusion, while 62.5% (25/40) of patients without either procedure developed stage III effusion (p < 0.0001). TKA with both patella resurfacing and synovectomy resulted in either stage I (7/40) or stage II effusion (6/40). Multivariate regression confirmed patellar resurfacing as an independent protective factor against postoperative effusion (p < 0.01). Average aspirated effusion volumes further supported these findings: 39 ± 6 cm3 for TKA without additional procedures, 18 ± 8 cm3 with synovectomy, 6 ± 4 cm3 with patellar resurfacing, and 7 ± 4 cm3 with both patellar resurfacing and synovectomy. The results showed that as total knee effusion volume increased, inflammatory markers (C-reactive protein level) increased, and range of motion decreased.

CONCLUSION: In severe chondrocalcinosis, patellar resurfacing may be appropriate to prevent joint effusion after TKA.

PMID:41775911 | DOI:10.1007/s00264-026-06767-6

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06764-9. Online ahead of print.

ABSTRACT

PURPOSE: Intraoperative calcar fracture (IOCF) can compromise initial stability, leading to stem subsidence and instability. We aimed to compare 2-year complications and revision rates between patients who sustained IOCF and matched controls without IOCF using short stem total hip arthroplasty (THA).

METHOD: Patients who underwent short stem THA from November 2010 to October 2023 were included. They were categorized into those who sustained IOCF and were treated intraoperatively with double-loops cerclage wiring, and those without IOCF. Propensity score matching was performed to balance baseline characteristics between the two groups. The following outcomes were evaluated at two years: femoral stem subsidence, periprosthetic femoral fracture (PFF), periprosthetic joint infection (PJI), dislocation, aseptic femoral loosening, and revision.

RESULTS: Initially, 844 cases were identified. After matching, 80 and 640 cases were included in IOCF and non-IOCF groups respectively. There was one case (1.25%) of stem subsidence in the IOCF group and 11 cases (1.72%) in the non-IOCF group, with no significant difference (p = 0.76). PFF occurred in one case (1.25%) of the IOCF group and four cases (0.63%) of the non-IOCF group; the difference was not significant (p = 0.53). In the non-IOCF group, there were five cases (0.78%) of PJI, 11 cases (1.72%) of dislocation, one case (0.16%) of aseptic femoral loosening and 13 cases (2%) of revisions. There was no revision in the IOCF group.

CONCLUSION: Short stem THA complicated by IOCF, when promptly recognized and treated intraoperatively, did not increase complications or revision rates at two years.

PMID:41774120 | DOI:10.1007/s00264-026-06764-9

Int Orthop. 2026 Mar 3. doi: 10.1007/s00264-026-06761-y. Online ahead of print.

ABSTRACT

PURPOSE: To compare lesion debridement with bone grafting (LDBG) versus core decompression (CD) in preventing femoral head collapse in early glucocorticoid-associated osteonecrosis (GA-ONFH).

METHODS: This single-center, superiority randomized controlled trial (Level I) enrolled 86 patients (18-60 years) with ARCO stage II GA-ONFH, randomized to CD or LDBG.

PRIMARY OUTCOME: proportion maintaining ARCO stage II at 24 months.

SECONDARY OUTCOMES: interval-specific progression to collapse (0-6, 6-12, 12-24 months) and Harris Hip Scores (HHS) among non-collapsed hips. Safety outcomes included perioperative blood loss, hospital stay, and surgery-related adverse events.

RESULTS: Of 86 patients, 81 completed follow-up. At 24 months, ARCO stage II was maintained in 70% (28/40) of LDBG vs. 41% (17/41) of CD patients (P = 0.010; RR = 1.69; NNT = 4). CD had better HHS at six months (P < 0.001), but no difference at 12/24 months among non-collapsed hips. CD involved less blood loss (P < 0.001) and shorter hospital stays (P = 0.002); serious adverse events were similar (P = 0.72). Prespecified subgroup analyses showed consistent LDBG benefit, especially in females, patients with BMI < 23.9, high glucocorticoid dose, and non-manual occupations.

CONCLUSION: LDBG significantly reduces collapse risk versus CD in early GA-ONFH, with comparable mid-term function and safety, supporting its use as a preferred joint-preserving strategy, particularly for females, patients with lower BMI (< 23.9), high glucocorticoid exposure, and non-manual occupations.

PMID:41774119 | DOI:10.1007/s00264-026-06761-y

EFORT Open Rev. 2026 Mar 2;11(3):224-232. doi: 10.1530/EOR-2025-0176.

ABSTRACT

PURPOSE: Although female sex is a known risk factor for developmental dysplasia of the hip (DDH), limited data exist regarding sex-specific differences in treatment outcomes. This study aimed to analyze whether being male represents a risk factor for unfavorable outcomes in DDH treatment.

METHODS: A systematic search was conducted across PubMed, Embase, and Cochrane Library databases to identify studies comparing DDH treatment outcomes between males and females. The review adhered to PRISMA and PROSPERO guidelines, including studies published from 1995 to 2023.

RESULTS: Out of 327 initially identified articles, 23 met the selection criteria, describing 10,307 total DDH cases (5,296 males; 4,700 females). Only six articles clearly reported outcomes stratified by sex. Our analysis focused on establishing whether male sex was a risk factor for Pavlik harness failure and the incidence of avascular necrosis (AVN). For Pavlik harness failure, the meta-analysis included 93 male and 630 female hips, with failure in 32 male (34%) and 148 female (23%) hips. The meta-analysis indicated a significant association between male sex and Pavlik harness failure (P = 0.03). Pooling data from relevant articles for AVN showed that AVN occurred in 32 out of 91 male (35%) and 77 out of 355 female (22%) hips, suggesting a significant association between male sex and AVN (P = 0.008).

CONCLUSIONS: Overall, male patients exhibited a higher failure rate in Pavlik harness treatment. The pooled analysis of AVN data further suggests that males may demonstrate a poorer prognosis compared to female patients in DDH treatment.

PMID:41770058 | DOI:10.1530/EOR-2025-0176

EFORT Open Rev. 2026 Mar 2;11(3):156-166. doi: 10.1530/EOR-2025-0001.

ABSTRACT

Computed tomography (CT) enables 3D surgical planning for implant size and position, patient-specific instruments, and robotic-assisted lower limb joint replacement. Orthopaedic companies provide CT protocols tailored to specific implant systems and designs, including off-the-shelf and custom-made implants, leading to substantial variability in imaging guidelines for centres and hospitals. This study aims to consolidate CT imaging workflows through harmonised protocols that minimise ambiguity and enhance clarity, clinical practice and patient safety. A multidisciplinary team critically reviewed all 17 hip and 12 knee CT protocols that were available. Imaging elements were assessed, highlighting deficiencies and inconsistencies. These protocols informed the recommendation of five harmonised CT protocols through informal consensus: i) primary hip, ii) revision hip, iii) primary knee, iv) revision knee and v) total femoral replacement. Significant variability was found among company guidelines regarding scan volume, X-ray tube current, voltage and other parameters, resulting in inconsistent image quality and radiation exposure. Lack of harmonisation can lead to scan rejections and repeat imaging. The harmonised protocols prioritise high-resolution imaging with optimal parameters, reduced scan volume and minimal metal artefacts. Designed to be clear, concise, consistent and comprehensive, these user-friendly protocols effectively capture key anatomical structures, landmarks and alignment details crucial for planning and monitoring lower limb arthroplasty. The protocols are sufficiently flexible to accommodate both standard and customised implant planning requirements. These protocols streamline the imaging process, fostering alignment across companies by consolidating existing protocols; they reduce duplication and eliminate inconsistencies, without redefining the content or intent of the original protocols.

PMID:41770057 | DOI:10.1530/EOR-2025-0001

EFORT Open Rev. 2026 Mar 2;11(3):183-190. doi: 10.1530/EOR-2024-0149.

ABSTRACT

Femoral neck fractures remain a significant challenge in orthopaedic surgery, particularly among elderly patients. This review synthesizes the current peer-reviewed literature on initial management strategies, with a particular emphasis on the use of skin traction. Skin traction, which involves the application of adhesive tape, a crepe bandage, and a calibrated pulley system with precise weights, is analysed in terms of its efficacy in clinical practice. The review discusses the benefits and drawbacks of skin traction, drawing on recent studies to assess its role in fracture management. The goal is to provide nuanced scientific insights into the ongoing discourse surrounding the management of femoral neck fractures.

PMID:41770055 | DOI:10.1530/EOR-2024-0149

EFORT Open Rev. 2026 Mar 2;11(3):175-182. doi: 10.1530/EOR-2025-0026.

ABSTRACT

Femoral head fractures are complex and severe injuries, usually associated with hip dislocation. They typically result from high-energy trauma. Therefore, a low index of suspicion is required for diagnosis in these contexts. Initial presentation can vary depending on coexisting injuries but is typically an emergency and requires immediate reduction of the joint. Delays result in worse outcomes for patients. Pelvic radiographs are recommended before and after joint reduction, with Judet, inlet and outlet views to identify any associated acetabular fracture and pelvic ring injury. Computed tomography helps determine the fracture configuration and classification, commonly using the Pipkin classification. Definitive fracture management depends on patient demographics, fracture pattern and associated injuries. Pipkin type I and II fractures with minimal displacement and an anatomically congruent hip joint may be treated conservatively. Otherwise, surgical open reduction internal fixation via the anterior approach is recommended. Young patients with Pipkin type III injuries usually require open reduction internal fixation via the anterior or posterior approach, while elderly patients may need total hip arthroplasty. Pipkin type IV fractures may require a combination of open reduction internal fixation approaches with or without trochanteric flip osteotomy. Femoral head fractures often have poor outcomes, with type III and IV fractures having worse outcomes than types I and II. Early complications include infection and sciatic nerve palsy. Late complications include avascular necrosis, heterotopic ossification and post-traumatic arthritis. This article considers the anatomy, diagnosis and evidence-based management strategies for femoral head fractures.

PMID:41770054 | DOI:10.1530/EOR-2025-0026

EFORT Open Rev. 2026 Mar 2;11(3):199-207. doi: 10.1530/EOR-2025-0181.

ABSTRACT

Langerhans cell histiocytosis (LCH) is a myeloid neoplastic disorder in which bone is the commonly affected organ system. While treatment for its symptomatic bone lesions varies, modern minimally invasive techniques show significant advantages over traditional approaches. Conventional therapies present notable limitations. Curettage, while frequently used, is associated with local recurrence. The efficacy of intralesional corticosteroid injections remains uncertain, especially for lesions in the extremities or pelvis. Although effective, low-dose radiation therapy carries long-term risks and is reserved for specific cases. Systemic chemotherapy, the standard for multifocal disease, is associated with toxicity and high relapse rates. Radiofrequency ablation (RFA) has emerged as a superior alternative that fills this therapeutic gap. RFA is a minimally invasive procedure that uses targeted heat (60-100°C) to destroy tumor cells with curative intent. Validating prior case reports, our recent study of ten patients confirmed that RFA provides complete pain relief with no residual disease or recurrence on follow-up MRI. Importantly, no significant complications were observed in our cohort or have been reported in the literature for LCH patients treated with RFA. In conclusion, RFA offers a safe, rapid, and durable solution for painful LCH lesions. It should be considered a primary curative treatment for symptomatic LCH of the bone, avoiding the risks of more invasive procedures and systemic therapies.

PMID:41770053 | DOI:10.1530/EOR-2025-0181

EFORT Open Rev. 2026 Mar 2;11(3):167-174. doi: 10.1530/EOR-2025-0134.

ABSTRACT

PURPOSE: Locking plates are well established as a powerful plating concept, especially in low-density bone. Construct strength is dependent on the fixation between the screw head and the plate; however, the influence of variations in the torque used to engage the screw head into the plate hole is unclear. The aim of this study was to systematically review the effect of insertion torque on the performance of locking screws.

METHODS: A systematic review was performed with electronic searches of four databases using free and MeSH search terms. Systematic evaluation and data extraction was performed up to 2 April 2025. The principal outcome was the difference in failure load for the locking plate construct following variation of the insertion torque.

RESULTS: The initial search identified 894 potentially relevant studies, of which six were eligible for inclusion. All were in vitro, biomechanical studies. Both stainless steel and titanium plates were tested. The former material showed no consistent performance increase with increased insertion torque in either pushout or cantilever testing. Titanium plates showed an increased pushout force and cantilever strength with more torque for some, but not all designs. Once screw head engagement in the plate hole was achieved, further torque was not clearly beneficial.

CONCLUSION: Increased insertion torque, beyond that required to seat the screw head, did not consistently show performance benefits. Most studies were underpowered and may not be representative of clinical failures. Further work to define optimum torque ranges for locking plate systems is required.

PMID:41770050 | DOI:10.1530/EOR-2025-0134

EFORT Open Rev. 2026 Mar 2;11(3):145-155. doi: 10.1530/EOR-2025-0136.

ABSTRACT

Musculoskeletal infections (MSIs) pose formidable challenges to healthcare resources. Surgical wound irrigation is a crucial step in reducing microbial bioburden in open orthopaedic procedures, yet there remains ambiguity regarding optimal use of lavage agents. For tactical selection of irrigants, orthopaedic wounds can be classified into three major categories (aseptic, acute septic and chronic septic) based upon microbial bioload and presence or absence of biofilm upon implanted hardware and/or musculoskeletal tissues. Irrigant products can be stratified based upon their modes of action: single modal (dilutional), dual modal (dilutional and chemical) and multi-modal (dilutional with multiple mechanisms). Host toxicity is commensurate with increased complexity of an irrigant product. A tailored, stepwise strategy of irrigant selection aligned with wound type is recommended, escalating from simple low toxicity dilutional lavage for low microbial bioloads to potent multi-modal chemical agents for biofilm-laden chronic infections. The method of irrigant delivery and selected volume are integral to wound lavage. The difference between methods is the impact pressure to host tissues and the depth of fluid penetration. Higher impact pressures clear adherent bacteria and foreign debris albeit the cost of host tissue damage.

PMID:41770049 | DOI:10.1530/EOR-2025-0136

EFORT Open Rev. 2026 Mar 2;11(3):191-198. doi: 10.1530/EOR-2025-0163.

ABSTRACT

Partial lateral patellar facetectomy (PLPF) is a surgical procedure that consists in removing a part of the lateral facet of the patella. It has been first described as a surgical treatment for isolated external patellofemoral osteoarthritis. Following the same biomechanical effects, some authors proposed to perform PLPF in primary total knee arthroplasty to enhance patellar tracking and reduce the risk of anterior knee pain, whether the patella resurfaced or not. According to few studies of low level of evidence, functional scores are not improved when performing systematic PLPF. Current data are controversial regarding the role of systematic PLPF in enhancing patellar tracking. No evidence exists that PLPF protects un-resurfaced patella from revision for PF issues after TKA. In light of the available literature, PLPF cannot be recommended systematically in primary or revision TKA. However, precise relevant indications can be proposed.

PMID:41770047 | DOI:10.1530/EOR-2025-0163

EFORT Open Rev. 2026 Mar 2;11(3):208-223. doi: 10.1530/EOR-2025-0114.

ABSTRACT

PURPOSE: Children with cerebral palsy (CP) are at a high risk of progressive hip displacement, defined as lateral migration of the femoral head measured by the Reimers migration percentage. This condition may impair quality of life, highlighting the need for improved hip care. This umbrella review assessed current evidence on the evaluation, prevention, and treatment of hip displacement in children with CP by synthesizing systematic reviews.

METHODS: Systematic reviews published in English between 2004 and 2024 were included, focusing on children with CP aged 0-18 years. Searches were conducted in nine databases: PubMed, MEDLINE, Web of Science, Scopus, BVS, CINAHL, Cochrane Library, PEDro, LILACS, and EMBASE. Methodological quality was assessed using AMSTAR 2 for interventional studies and JBI criteria for non-interventional studies. This review has been registered at PROSPERO (registration number: CRD42024618645).

RESULTS: In total, 25 systematic reviews addressed key aspects of hip management, including hip surveillance; tone management; preventive, reconstructive, and salvage procedures; and antifibrinolytic use. Hip surveillance reduced hip dislocation rates and the need for salvage surgery, whereas postural and tone management showed no consistent preventive effect. Combined pelvic and femoral osteotomies achieved better outcomes than isolated procedures, while soft-tissue surgeries had high recurrence rates. Proximal femoral hemiepiphysiodesis improved radiographic outcomes but frequently required revision. Salvage procedures such as valgus osteotomy and femoral head resection relieved pain, whereas hip arthrodesis showed poor outcomes. Total hip arthroplasty improved pain and function but was associated with high complication rates.

CONCLUSIONS: This umbrella review highlights evidence-based practices and important knowledge gaps in the management of hip instability in children with CP, supporting future research and improved clinical care.

PMID:41770043 | DOI:10.1530/EOR-2025-0114

EFORT Open Rev. 2026 Mar 2;11(3):233-242. doi: 10.1530/EOR-2024-0107.

ABSTRACT

Proximal femoral fractures are common in the elderly population and are associated with significant morbidity, mortality, and major functional consequences. Their management represents an ongoing challenge. Care for this frail population must be coordinated, standardized, and multidisciplinary. These fractures represent a significant public health concern, prompting numerous studies to explore organizational strategies and risk factors aimed at minimizing related complications. This article reviews current recommendations for the management of proximal femoral fractures in the elderly, including definitions of geriatric and frail patients, service organizations, and clinical pathways. It also provides an overview of the latest recommendations for the management of medical problems and anticoagulation in elderly patients with proximal femur fractures.

PMID:41770042 | DOI:10.1530/EOR-2024-0107

J Bone Joint Surg Am. 2026 Mar 2. doi: 10.2106/JBJS.25.01506. Online ahead of print.

NO ABSTRACT

PMID:41770852 | DOI:10.2106/JBJS.25.01506

Int Orthop. 2026 Mar 2. doi: 10.1007/s00264-026-06763-w. Online ahead of print.

ABSTRACT

PURPOSE: Waste management in hospitals is important for environmental sustainability, as disposal of operations waste causes substantial greenhouse gas emissions. This study aimed to identify factors influencing waste generation in orthopaedics and traumatology.

METHODS: In this prospective study, the weight of waste and drapes from 272 orthopaedic and trauma operations was measured. Waste production was analyzed regarding to anatomical region, operation type, and duration.

RESULTS: Analysing all operations, the amount of waste differed significantly between anatomical regions (p < 0.001). When separating drapes, no significant differences between anatomical regions were found in waste, but in drapes (p < 0.001). The amount of waste differed significantly between operation types and correlated significantly with the operation duration (p < 0.001).

CONCLUSION: Operating room waste is influenced by anatomical regions and the drapes required for it. Operation duration significantly increases the amount of waste. These findings can support the development of targeted strategies to reduce waste in operating rooms.

PMID:41772124 | DOI:10.1007/s00264-026-06763-w

Injury. 2026 Feb 27;57(4):113126. doi: 10.1016/j.injury.2026.113126. Online ahead of print.

NO ABSTRACT

PMID:41764816 | DOI:10.1016/j.injury.2026.113126

Injury. 2026 Feb 16;57(4):113112. doi: 10.1016/j.injury.2026.113112. Online ahead of print.

ABSTRACT

BACKGROUND: Polytrauma requiring intensive care remains a leading cause of morbidity and mortality, particularly among patients with orthopedic injuries. Despite advances in trauma systems and surgical management, outcomes for this cohort are influenced by complex interactions between injury burden, physiological status, and pre-existing comorbidities. There remains limited evidence focused specifically on predictors of outcome within orthopedic trauma patients admitted to the intensive care unit (ICU).

METHODS: This retrospective cohort study analyzed all adults (≥18 years) admitted with orthopedic trauma to the ICU of a major Irish tertiary trauma centre between January 2011 and December 2020. Orthopedic injuries included fractures, dislocations, or musculoskeletal trauma requiring specialist management. Demographic, clinical, and injury-related data were extracted from institutional databases. Outcomes assessed were 30-day, 90-day, and 1-year mortality, complication burden (graded by the Adapted Clavien-Dindo in Trauma [ACDiT] score), and discharge destination. Multivariate regression was used to identify independent predictors of adverse outcomes.

RESULTS: Of 720 trauma patients admitted to the ICU over 10 years, 458 with orthopedic injuries were included. The mean age was 56.2 years; 63.8 % were male, and two-thirds had at least one comorbidity. The most common mechanisms were low-level falls and road traffic accidents. The median Injury Severity Score was 16, and 23.4 % required mechanical ventilation. One-year survival was 79.7 %. Key predictors of mortality and complications included advanced age, cervical spine injury, lower Glasgow Coma Scale, higher ASA and ISS, mechanical ventilation, malignancy, and polytrauma. Most patients returned home at discharge, though a significant minority required institutional care or died in-hospital.

CONCLUSIONS: Orthopedic polytrauma patients admitted to ICU represent a high-risk group with substantial mortality and complication rates, particularly among the elderly and those with severe physiological compromise. Early identification of prognostic factors such as age, ISS, GCS, ASA, and need for ventilation may inform tailored management strategies and support improved risk stratification in this vulnerable population.

PMID:41764815 | DOI:10.1016/j.injury.2026.113112

Injury. 2026 Feb 21;57(4):113130. doi: 10.1016/j.injury.2026.113130. Online ahead of print.

ABSTRACT

BACKGROUND: Rigid intramedullary (IM) fixation is avoided in skeletally immature patients because of the risk of physeal injury, causing subsequent growth disturbances. However, with the increasing numbers of high-energy injuries and complex fractures in older adolescents, suprapatellar rigid IM nailing (RIMN) has emerged as an alternative. This study evaluated whether RIMN in skeletally immature adolescents results in coronal or sagittal deformities and to evaluate the clinical outcomes.

METHODS: We retrospectively reviewed skeletally immature patients who underwent suprapatellar RIMN for tibial shaft fractures between January 2014 and October 2024. The inclusion criteria were an open proximal tibial physis, a diaphyseal fracture pattern, and > 12-month follow-up. Radiographic parameters, including the mechanical medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA), were measured twice on standardized anteroposterior and lateral radiographs by a single senior pediatric orthopaedic surgeon. Malalignment was defined as a deviation greater than 5° in the coronal plane or 10° in the sagittal plane relative to the contralateral side. Discrepancies in limb length were considered significant when exceeding 2 cm. Statistical comparisons between the immediate postoperative and final radiographs were performed using the paired t-test and equivalence test.

RESULTS: Twenty-four patients (mean age 15.9 ± 1.3 years) were included, and 17 (70.8%) were classified as having proximal tibial ossification stage III and seven (29.2%) as stage II. All fractures achieved union at a mean of 14.3 ± 5.3 weeks. No significant changes were observed in MPTA or PPTA. Two patients with open fractures developed nonunion requiring secondary surgery. Mild anterior knee pain occurred in ten patients (41.7%) without activity limitation, and four (16.7%) experienced compartment syndrome requiring fasciotomy. No patient demonstrated coronal or sagittal deformity, limb-length discrepancy, or growth disturbance.

CONCLUSIONS: Although physeal preservation remains fundamental in pediatric fracture management, suprapatellar RIMN can provide stable fixation and satisfactory outcomes in adolescents nearing skeletal maturity. For selected patients in whom plating or flexible nailing are suboptimal, rigid IM fixation represents a reasonable alternative.

LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

PMID:41764814 | DOI:10.1016/j.injury.2026.113130

Injury. 2026 Feb 19;57(4):113124. doi: 10.1016/j.injury.2026.113124. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic distal femoral fractures after total knee arthroplasty (TKAPF) are challenging in very elderly patients. This study aimed to identify the incidence and risk factors for post-operative complications in patients aged over 80 years surgically treated for these fractures.

METHODS: A multicentre SOFCOT database (2012-2019) was analyzed. Patients aged >80 years with TKAPF were compared to a < 80 control group. Outcomes included complications, reoperation, mortality, and operative delay. Multivariable logistic regression was used to identify independent risk factors for reoperation and mortality.

RESULTS: Among 376 patients aged >80 (mean age 87.5 ± 4.4 years; 87.5% female), 359 patients (95.5%) were surgically treated, the reoperation rate was 10.0%, the complication rate was 19.5%, and mortality at two-year follow-up reached 29.5%. Mortality was independently associated with ASA score (p = 0.0096), but not with age, fracture pattern, or surgical approach. Operative delay (mean 2.9 days) had no impact on mortality or reoperation but was associated with more infections and implant loosening (p < 0.001).

CONCLUSIONS: In patients over 80 years, systemic frailty, reflected by ASA score, was the main determinant of mortality, while delayed surgery (>72 h) increased local complications, supporting an individualized surgical approach, based on general conditions rather than fracture morphology or surgical preference.

PMID:41762854 | DOI:10.1016/j.injury.2026.113124