Injury. 2025 Jun 18:112525. doi: 10.1016/j.injury.2025.112525. Online ahead of print.

ABSTRACT

BACKGROUND: Rib fractures are common after blunt chest trauma and are associated with significant morbidity, mortality, and prolonged hospital stays due to pulmonary complications. Effective pain management is crucial in preventing these complications. The 'STUdy of the Management of BLunt chest wall trauma' (STUMBL) score can identify patients with rib fractures at risk of complications and assist with Emergency Department (ED) disposition decisions. Its role in guiding Acute Pain Service (APS) and Intensive Care Unit (ICU) referrals was previously unexplored.

DESIGN AND OBJECTIVES: We conducted a retrospective cohort study on adults with radiologically confirmed rib fractures who presented to The Royal Melbourne Hospital between April 2021 and March 2022. We aimed to assess the association between STUMBL scores and advanced analgesia prescription or ICU admission. Participants were categorised into five STUMBL groups (<11, 11-20, 21-25, 26-30, ≥31). The primary outcome of interest was regional analgesia insertion. The secondary outcomes were patient-controlled analgesia (PCA) use, APS and ICU referrals, and medical emergency team (MET) calls within 48 h. Modified Poisson regression was used to analyse associations, with the <11 group used as the reference.

RESULTS: Among 344 participants, the median STUMBL score was 17 (interquartile range [IQR] 10-24). Higher STUMBL scores were strongly associated with regional analgesia insertion in the STUMBL 26-30 group (RR 15.3, 95 % CI 1.8-130.3, p = 0.013) and the STUMBL ≥31 group (RR 29.3, 95 % CI 4.0-212.5, p = 0.001). Significant associations were also observed for PCA prescription (RR 5.0, 95 % CI 2.6-9.7, p < 0.001), APS referral (RR 4.7, 95 % CI 2.7-8.1, p < 0.001), and ICU admission (RR 3.8, 95 % CI 2.0-6.9, p < 0.001) in the STUMBL ≥31 group.

CONCLUSION: The STUMBL score is a valuable tool for identifying patients likely to require advanced analgesia and APS input, with high scores strongly associated with regional analgesia insertion and PCA prescription. Additionally, patients with STUMBL scores ≥26 were more likely to require ICU admission. Incorporating STUMBL thresholds into rib fracture guidelines could facilitate early APS involvement, guide appropriate admission destinations, optimise hospital resource allocation and improve patient outcomes. Further studies should validate these findings in larger, multi centre cohorts and explore patient-reported outcomes.

PMID:40562589 | DOI:10.1016/j.injury.2025.112525

Injury. 2025 Jun 19;56(8):112538. doi: 10.1016/j.injury.2025.112538. Online ahead of print.

ABSTRACT

AIM: Friction burns are a common paediatric injury that can result in significant morbidity and long-term disability. This systematic review aimed to evaluate the management and outcomes of these injuries.

METHODS: A protocol was developed a priori and registered on the PROSPERO database (CRD42022376782). A comprehensive search of MEDLINE, EMBASE, CENTRAL, CINAHL and trial registries was conducted to identify studies evaluating the management and outcomes of paediatric upper limb friction injuries. Primary outcome measures were healing time, functional outcomes, and the need for surgical intervention. Secondary outcomes included complications such as problematic scarring and cost.

RESULTS: Twenty-two studies met the inclusion criteria, encompassing 842 paediatric patients with upper limb friction injuries, predominantly treadmill-related (95 %). Most injuries (58.7 %) were deep partial-thickness to full-thickness. Conservative management with dressings was the primary treatment in 70.4 % of cases, while 29.6 % underwent acute surgery, predominately full-thickness skin grafting followed by split-thickness skin grafting. Mean healing times ranged from 19.4 to 31.5 days. Problematic scarring affected 20.5 % of patients, with 38.3 % of this group undergoing further scar revision surgery. Functional outcomes were generally positive, with minimal long-term disability reported.

CONCLUSION: Paediatric upper limb friction injuries, particularly those caused by treadmills, have typically been managed conservatively, with good functional outcomes. However, deeper injuries and delayed healing increase the risk of problematic scarring and need for scar revision surgery. Further research is needed to standardise treatment protocols and minimise long-term complications.

PMID:40561811 | DOI:10.1016/j.injury.2025.112538

Injury. 2025 Jun 18;56(8):112526. doi: 10.1016/j.injury.2025.112526. Online ahead of print.

ABSTRACT

BACKGROUND: Displaced distal radial fractures are common among all age groups, but increasingly in older patients, and are frequently managed by emergency nurse practitioners. Most can be manipulated and reduced in the emergency department, often by procedural sedation and analgesia, which can be time consuming and often requiring multiple resources. Using haematoma blocks may offer advantages.

AIM: To examine the use and efficacy of haematoma blocks in managing close reduction of distal radial fractures by emergency nursing practitioners compared to procedural sedation.

DESIGN: Matched case-control study.

RESULTS: Compared to those who had procedural sedation and analgesia (n = 100), the haematoma block group (n = 100) had a shorter procedure time (0.4 hrs vs. 0.7 hrs, Z= -1.24, p < .001), time from reduction to discharge (1.5 hrs vs. 4.6 hrs, Z= -2.98, p < .001), overall ED length of stay (2.8 hrs vs. 4.9 hrs, Z= -3.49, p < .001) and minimal pain post reduction (0/10 vs. 4/10, Z= -2.6, p = .001). No adverse events were noted in the haematoma block group compared to 23 % in the procedural sedation and analgesia group.

CONCLUSION: Hematoma block is a safe, effective and efficient alternative to procedural sedation in the reduction of distal radial fractures by emergency nurse practitioners.

PMID:40561810 | DOI:10.1016/j.injury.2025.112526

Injury. 2025 Jun 11;56(8):112367. doi: 10.1016/j.injury.2025.112367. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemorrhage causes 40 % of deaths from trauma. Low- and middle- income countries (LMICs) claim the majority of these deaths, in part due to lack of resources and organization in the prehospital and hospital arenas. Guatemala experiences a high burden of trauma-related injuries but does not have the resources nor the emergency response system to deal with it. In Guatemala, firefighters (bomberos) lead trauma responses, yet do not receive medical training. Recognizing these gaps in LMICs, we developed "CrashSavers", a low cost, openly accessible, self-training mobile phone-based platform to teach hemorrhage control techniques to first responders in Guatemala City. In this manuscript, we present the evaluation and outcomes of the bomberos who were trained with CrashSavers.

METHODS: Our self-administered educational program teaches first responders to train themselves in the decision making and psychomotor skills of tourniquet placement. This free platform, accessible via mobile phone, provides didactic material, virtual reality cases and instructions to construct a bleeding extremity simulator. Sixty-four bomberos were trained from July-August 2022. Eighteen months later they were retested to assess knowledge retention. Interviews were conducted with all bomberos to elicit feedback, which were then analyzed with narrative synthesis. We assessed medical knowledge, confidence, and surgical skills pre and post training.

RESULTS: After training, bomberos were able to apply the tourniquet more efficiently and more confidently. The time taken to stop a bleed on the simulator dropped from 58.5 s to 39.2 s, p < 0.003. Assessment of their skills 18 months after initial training showed that they were able to retain both confidence and psychomotor skill of tourniquet placement. Qualitative analysis showed overall positive experience with the course.

CONCLUSIONS: A low cost, easily accessible, self-taught course of didactics, VR cases and simulation successfully trained bomberos to control a bleeding extremity. This may be a solution for the large gaps in LMIC trauma response, as traditional programs designed for high income countries (HICs) are inaccessible, expensive and time intensive. With CrashSavers, learners became faster and more confident in stopping a bleed, and in a situation where time is blood and blood is life, efficiency is key.

PMID:40561809 | DOI:10.1016/j.injury.2025.112367

J Bone Joint Surg Am. 2025 Jun 25. doi: 10.2106/JBJS.24.01489. Online ahead of print.

ABSTRACT

BACKGROUND: The Roussouly classification is a popular system for the categorization of spinal alignment, although the categorization of continuous measures may compromise efforts toward a precision-medicine approach to sagittal alignment in spine surgery. Vertebral-pelvic angles provide continuous measures of sagittal alignment without the risk of misclassification.

METHODS: We performed a cross-sectional study of asymptomatic adult volunteers with normal spines (no evidence of disc degeneration or scoliosis). Full-spine radiographs were obtained, and radiographic parameters were collected, including pelvic incidence (PI), sacral slope, lumbar lordosis, the apex of lordosis, the L1-pelvic angle (L1PA), and the T4-pelvic angle (T4PA). All spines were classified as Roussouly Type 1, 2, 3, or 4 on the basis of sacral slope and the apex of lumbar lordosis. Associations between the L1PA and PI, the L1PA and T4PA, and the T4-L1PA mismatch and PI were assessed for the whole cohort and when stratified by Roussouly type. A multinomial logistic regression model was fit to estimate Roussouly type based on PI, the L1PA, and the T4PA. Agreement (weighted κ), accuracy, and area under the receiver operating characteristic curve (1 type versus the rest) were computed. A subanalysis assessed potential variations in the relationships when Roussouly Type-3 spines were further classified as Type 3A (anteverted) versus Type 3.

RESULTS: The 320 included volunteers had a median age of 37 years (interquartile range [IQR], 27 to 47 years), and 193 (60%) were female. By self-reported race or ethnicity, the highest percentage of patients were Caucasian (White, 38%) or East Asian (36%), followed by Arabo-Bèrbère (16%). Spines were classified as Roussouly Type 1 in 18 (6%) of the volunteers, as Type 2 in 63 (20%), as Type 3 in 161 (50%), and as Type 4 in 78 (24%). The L1PA was strongly associated with PI across Roussouly types (weakest in Roussouly Type-1 spines). A multinomial logistic regression model estimating Roussouly type by PI, the L1PA, and the T4PA showed strong agreement (weighted κ, 0.84), excellent discrimination, and overall accuracy of 0.82.

CONCLUSIONS: The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment. Goals of surgical realignment incorporating the T4-L1-Hip axis will be comparable with alignment planning using the Roussouly classification but with improved accuracy and precision.

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

PMID:40560977 | DOI:10.2106/JBJS.24.01489

J Bone Joint Surg Am. 2025 Jun 25. doi: 10.2106/JBJS.24.00009. Online ahead of print.

ABSTRACT

BACKGROUND: The diagnosis of acute compartment syndrome (ACS) using a single-point pressure measurement device has demonstrated low specificity. Recently, sensors that allow for continuous monitoring of compartment pressure have been introduced, with improved specificity and sensitivity compared with single-point measurement. In this article, we present an economic model used to evaluate the cost-benefits of continuous pressure measurement in patients at risk for ACS.

METHODS: The model used a decision-tree structure to estimate the treatment costs of ACS at 60 days and 1 year after admission and over the patient's lifetime. It assumed systematic use of the diagnostic devices for all tibial shaft and tibial plateau fractures and estimated the cost-effectiveness of continuous pressure measurement compared with noncontinuous pressure measurement by comparing costs, quality-adjusted life-years (QALYs), and length of stay (LOS).

RESULTS: The improved specificity of continuous pressure measurement reduced unnecessary fasciotomies by 94%. The inflation-adjusted cost of an uncomplicated tibial fracture averaged $57,144; the performance of an unnecessary fasciotomy increased that cost by $27,790. The gain in QALYs was 0.004 per patient, with a net health benefit of 0.06 QALYs. Over a 60-day time horizon, the model showed an estimated decrease in LOS of 2.73 days, on average, per patient. The net monetary benefit was $2,789 (range, -$1,246 to $6,151) in favor of the continuous measurement, increasing to $4,085 (range, -$745 to $8,103) over the lifetime of the patient following the most conservative scenario of equal ACS grade distribution.

CONCLUSIONS: Most of the ACS economic burden lies in the lack of specificity of the current diagnostic methods. The low incidence of ACS and the high risk associated with prophylactic treatment indicate that improvement in health and economic outcomes should focus on reducing the rate of unnecessary fasciotomies.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:40560966 | DOI:10.2106/JBJS.24.00009

J Bone Joint Surg Am. 2025 Jun 25. doi: 10.2106/JBJS.24.01419. Online ahead of print.

ABSTRACT

BACKGROUND: The Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) has undergone numerous changes to promote care for patients at high social risk. However, the effect of these changes on surgeon MIPS performance and caseload selection remains unclear. Thus, the purpose of this study was to evaluate how orthopaedic surgeon MIPS scores, demographics, practice characteristics, and patient populations varied on the basis of patient social risk in 2017 compared with 2021.

METHODS: CMS data were utilized to examine U.S. orthopaedic surgeons. Surgeons were placed into social-risk quintiles on the basis of the proportion of their patients who were dually eligible for Medicare and Medicaid, with the highest quintile representing the highest social risk. Demographics, practice location characteristics, patient data, and MIPS performance were assessed for the years 2017 and 2021. Differences between social-risk quintiles were assessed utilizing chi-square, Student t, and Wilcoxon signed-rank tests and multivariable logistic regression.

RESULTS: In 2017, surgeons with caseloads at the highest, compared with the lowest, social risk had lower MIPS performance scores (mean [and standard deviation], 66.0 ± 37.6 versus 70.1 ± 33.5; p < 0.001). However, in 2021, orthopaedic surgeons with caseloads at the highest, compared with the lowest, social risk had significantly higher MIPS performance scores (mean, 88.7 ± 16.9 versus 81.5 ± 18.3; p < 0.001). In terms of demographics, in 2021, orthopaedic surgeons with caseloads at the highest, compared with the lowest, social risk were more often women (9.2% versus 3.6%; p < 0.001), more often had a DO degree (11.2% versus 6.6%; p < 0.001), more recently graduated from medical school (mean, 23.0 ± 12.9 versus 25.7 ± 10.9 years; p < 0.001), and worked in areas with higher Distressed Communities Index (DCI) distress scores (mean, 56.9 ± 27.3 versus 35.1 ± 25.2; p < 0.001). Similar findings were present in 2017.

CONCLUSIONS: The addition of the Complex Patient Bonus to the MIPS in 2020 may have reduced performance inequities in MIPS scoring for surgeons with caseloads at high social risk. However, the demographics and practice patterns of the orthopaedic surgeons caring for populations at the highest social risk remained consistent between years.

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

PMID:40560965 | DOI:10.2106/JBJS.24.01419

J Bone Joint Surg Am. 2025 Jun 25. doi: 10.2106/JBJS.24.01126. Online ahead of print.

ABSTRACT

BACKGROUND: Glenoid component loosening remains a challenge in anatomic total shoulder arthroplasty (aTSA). The aims of this study were to evaluate complications, implant survival, and revision rates in patients with primary and secondary osteoarthritis (OA) undergoing stemless aTSA using the Arthrex Eclipse humeral implant with a cemented pegged all-polyethylene glenoid component and to identify risk factors leading to revision.

METHODS: Of 211 patients who underwent primary stemless aTSA (using the Eclipse humeral component with a cemented pegged all-polyethylene glenoid) with prospectively documented data in a local registry, 197 were evaluated, grouped by OA pathology (primary OA, 153 patients; secondary OA, 44 patients). Demographic and functional data (e.g., age, sex, shoulder function) and the cause of OA were documented preoperatively in both groups. Comparative analyses were conducted to assess complications and implant revisions between the study groups. In addition, various radiographic parameters (e.g., glenoid morphology, critical shoulder angle, lateral acromion index, implant sizing [humeral component overhang], radial matching of the humeral and glenoid components, glenohumeral distance, and medial glenoid cement penetration) were evaluated to explore their potential association with revision. A subset of these parameters was subsequently included in the multivariable Cox model on the basis of clinical relevance.

RESULTS: After a median postoperative period of 72 months, the overall revision rate was 51%. The reasons for revision were glenoid component loosening (85%), periprosthetic humeral fracture (9%), early rotator cuff failure (3%), and low-grade infection (3%). The median implant survival in patients with primary OA (95 months; 95% confidence interval [CI]: 84 to 108) was significantly longer than that in patients with secondary OA (71 months; 95% CI: 60 to 88; p = 0.027). Female patients had a significantly shorter time to revision than male patients (p = 0.016). There were no significant differences in complications or revision rates by OA pathology. Secondary OA, the presence of medial glenoid cement penetration, and an anterior overhang of the humeral component were associated with an increased risk of revision.

CONCLUSIONS: Our findings indicate a high rate of glenoid component loosening as the primary cause of revision in patients with primary and secondary OA undergoing stemless aTSA with the Eclipse and a cemented pegged all-polyethylene glenoid component. This outcome emphasizes the need for careful consideration of implant design, patient selection criteria, and implant positioning and cementation in order to optimize implant survival.

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

PMID:40560961 | DOI:10.2106/JBJS.24.01126

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06588-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Shelf acetabuloplasty, one of surgical containment methods, have been employed to preserve hip joint congruity in the management of Legg-Calvé-Perthes disease (LCPD). However, its long-term effect on radiographic and functional outcomes remains unclear due to limited evidence. Moreover, comparative studies against conservative treatment are lacking. This study aimed to (1) compare the mid- to long-term outcomes between children with advanced-stage LCPD treated with shelf acetabuloplasty and those receiving conservative management, and (2) evaluate isokinetic hip muscle strength compared to age- and gender-matched healthy controls.

MATERIALS AND METHODS: This retrospective age- and gender-matched study included 28 children with unilateral LCPD, divided into Shelf (n = 14) and Conservative (n = 14) treatment groups. A healthy control group (n = 14) was also recruited for isokinetic comparisons. Radiographic outcomes were assessed using modified Stulberg classification and several quantitative parameters. Functional outcomes were assessed using the Harris Hip Score (HHS) and isokinetic testing of hip muscle strength.

RESULTS: The Shelf group (median follow-up: 5.5 years, IQR: 4-7) showed significantly better HHS (67.9 ± 15.9) compared to the Conservative group (median follow-up: 6 years, IQR: 5-8) (54.6 ± 13.3; p = 0.024) at the final follow-up. Shelf acetabuloplasty also resulted in significantly improved radiographic parameters, including centre-edge angle (p < 0.001) and femoral head coverage (p = 0.002). Isokinetic testing revealed that the Conservative group had significantly lower hip extension (p = 0.021), abduction (p = 0.018), and adduction (p = 0.027) torque values, as well as greater muscle fatigue (p = 0.014). In contrast, the Shelf and Control groups exhibited comparable performance in most strength and endurance parameters.

CONCLUSIONS: Shelf acetabuloplasty, when applied as a salvage procedure in advanced-stage LCPD, may provide better functional outcomes and improved hip muscle performance compared to conservative treatment, despite comparable long-term femoral head morphology. Following Shelf acetabuloplasty, comparable hip flexor and extensor strength to healthy controls can be expected, although mild abductor and adductor weakness may persist.

PMID:40560220 | DOI:10.1007/s00264-025-06588-z

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06589-y. Online ahead of print.

NO ABSTRACT

PMID:40560219 | DOI:10.1007/s00264-025-06589-y

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06579-0. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate how changing the native posterior tibial slope (PTS) through implantation of a cemented medial unicompartmental knee arthroplasty (UKA) impacts clinical and radiographic outcomes, specifically whether it correlates with the occurrence of tibial periprosthetic radiolucency or tibial aseptic loosening (AL).

METHODS: This retrospective study analyzed 63 patients with cemented medial UKAs with a minimum follow-up of five years. Patient-reported outcomes (PROMs) included the Oxford Knee Score (OKS). Radiographic parameters assessed were: PTS, mechanical axis, prosthetic joint space height, tibial component obliquity, intraprosthetic divergence, and tibial periprosthetic radiolucency. Partial Pearson correlation and multiple linear regression analyses were used to evaluate the relationship between tibial periprosthetic radiolucency and demographic or radiographic parameters.

RESULTS: Of 63 patients (mean age 68.9 ± 7.9 years, follow-up 62.5 ± 8.8 months), 5 knees (7.9%) demonstrated tibial periprosthetic radiolucency ≥ 2 mm. The mean postoperative PTS change was 3.8 ± 2.6°, mechanical axis change: 2.5 ± 1.8°, prosthetic joint space height: 9.2 ± 3.1 mm, tibial component obliquity: 2.5° ± 3°, and intraprosthetic divergence angle: 5° ± 4°. OKS averaged 43.9 (range 22-48), with a mean knee flexion of 123.4 ± 6.8°. Statistical analysis showed no significant associations between tibial periprosthetic radiolucency and demographics, radiographic parameters, or PROMs. Changes in PTS did not correlate with a range of motion (ROM), PROMs, or radiolucency.

CONCLUSION: In our cohort, the deviation from native PTS following implantation of the cemented tibial component did not show a significant correlation with tibial periprosthetic radiolucency, PROMs, or ROM at mid-term follow-up.

PMID:40560218 | DOI:10.1007/s00264-025-06579-0

Int Orthop. 2025 Jun 25. doi: 10.1007/s00264-025-06591-4. Online ahead of print.

ABSTRACT

PURPOSE: To explore the historical case of Saint Ignatius of Loyola's leg injury and subsequent surgical interventions as a potential early instance of limb lengthening and reconstruction surgery.

METHODS: A detailed analysis of "A Pilgrim's Journey" (Ignatius of Loyola's autobiography) was conducted, focusing on orthopaedic descriptions of his injury and treatments.

RESULTS: In 1521, Íñigo López de Loyola sustained a severe, comminuted open fracture of the tibia due to a cannonball wound during the siege of Pamplona. Initial attempts at reduction were unsuccessful, leading to a non-union with significant deformity and shortening. He underwent a revision surgery, a procedure described as "carnage" and endured without a single lament. Although the fracture eventually united, residual shortening and a prominent bone deformity persisted. Unwilling to accept this disfigurement for social reasons, Ignatius requested a second, highly painful osteotomy to remove the protruding bone followed by continuous traction for "days and days of martyrdom" for progressive lengthening. Crucially, after these arduous treatments, Ignatius was able to walk and even ride a horse again. The only significant residual symptom was swelling in his leg by evening.

CONCLUSION: St. Ignatius of Loyola's case provides a compelling historical account of complex orthopaedic challenges in the early 16th century. The documented surgeries represent remarkably early attempts at managing non-union, deformity, and potentially achieving limb lengthening, predating modern reconstructive techniques by centuries. This historical narrative offers valuable insights into the nascent stages of orthopaedic surgery and highlights how a physical ordeal can profoundly shape one's life path.

PMID:40560217 | DOI:10.1007/s00264-025-06591-4

Injury. 2025 Jun 17:112532. doi: 10.1016/j.injury.2025.112532. Online ahead of print.

ABSTRACT

BACKGROUND: The frequent use of computed tomography (CT) scan in the evaluation of trauma patients has led to an increase in the diagnosis of hemothorax. This study aimed to assess whether a hemothorax volume of <300 ml, as determined by CT imaging, can be managed without tube thoracostomy and to identify the factors that recommend its use.

METHODS: A retrospective observational study was conducted at XXX Trauma Center, including all patients with traumatic hemothorax from June 2014 to January 2020. Patient demographics, injury mechanism, severity, associated chest injuries, indications for tube thoracostomy, mechanical ventilation, hospital length of stay, complications, and outcomes were reviewed. The study compared patients with hemothorax volumes < 300 ml and ≥300 ml and assessed the outcomes of conservative management without tube thoracostomy (conservative management) vs therapeutic management with tube thoracostomy placement (failed observation).

RESULTS: A total of 254 patients with hemothorax were included. Most patients (79 %) were successfully managed without tube thoracostomy insertion, while 53 patients (21 %) required tube thoracostomy after failure of conservative management. Patients with larger hemothorax volumes were significantly more likely to require tube thoracostomy (p = 0.001) and had significantly longer hospital stays (p = 0.021). Those with failed observation had higher injury severity scores (p = 0.001), more associated lung contusions (p = 0.015), pneumothorax (p = 0.024), and rib fractures (p = 0.001). They also had larger hemothorax volumes (p = 0.001), a greater need for mechanical ventilation (p = 0.001), and prolonged hospitalization (p = 0.001). Predictors of failed observation included high hemothorax volume (≥300 ml), ISS, and greater number of fractured ribs.

CONCLUSION: Conservative management (without tube thoracostomy) was adequate for most patients with <300 ml of hemothorax volumes. Quantitative assessment of hemothorax volume should be considered part of the clinical decision-making algorithm. Further research is needed to refine management strategies and improve outcomes for traumatic hemothorax.

PMID:40555636 | DOI:10.1016/j.injury.2025.112532

Injury. 2025 Jun 17;56(8):112529. doi: 10.1016/j.injury.2025.112529. Online ahead of print.

ABSTRACT

INTRODUCTION: Sternal fractures are uncommon but may result in significant morbidity when associated with respiratory compromise or severe pain. Conventional methods such as plate fixation are often invasive and technically challenging.

METHODS: We retrospectively reviewed eight cases of transverse sternal fractures treated using an intramedullary fixation technique with cannulated cancellous screws (CCS). Preoperative computed tomography with 3D reconstruction was used for surgical planning. Reduction was achieved percutaneously or through a limited incision, followed by guidewire insertion and screw fixation.

RESULTS: The minimally invasive procedure was completed in 18-35 min (mean, 22 min) with little blood loss (mean, 23 mL). Among six patients with ventilatory compromise, four were successfully extubated within three days postoperatively. There were no complications related to screw insertion, and bone union was confirmed in all cases.

CONCLUSION: Intramedullary screw fixation represents a safe, minimally invasive, and mechanically robust alternative for the management of sternal fractures, particularly in patients with flail chest or severe pain.

PMID:40554841 | DOI:10.1016/j.injury.2025.112529

Injury. 2025 Jun 18;56(8):112522. doi: 10.1016/j.injury.2025.112522. Online ahead of print.

ABSTRACT

OBJECTIVES: To determine (1) if early routine radiographic follow-up at 2-3 weeks for patients with operatively treated tibia, fibula or ankle fractures identified complications (i.e., complications only visible on radiographs and not associated with symptoms on history taking or clinical examination) and (2) if these complications were clinically relevant (i.e., led to treatment change).

METHODS: All adult patients who underwent operative treatment for a tibia, fibula or ankle fracture between January 2021 and January 2023 and who received early routine radiographic follow-up between 10 and 30 days postoperatively were included in this retrospective case series. Routine radiographs were defined as radiographs that were scheduled and obtained as part of the institution's standardized follow-up protocol. The primary outcome was the rate of complications detected on early routine radiographs, stratified by the presence of associated symptoms based on history taking or findings on physical examination. The secondary outcome was any documented treatment change for complications.

RESULTS: Six hundred and twenty-eight patients (median age of 47 years, 42 % male) were included. A total of 5 complications in 628 patients (0.8 %) were seen on early routine radiographs, of which 3 complications (0.5 %) were exclusively identified on radiographs (i.e., not associated with symptoms). None of these 3 complications led to a change in treatment strategy. The remaining 2 complications were visible on radiographs but were accompanied by symptoms on history taking or physical examination.

CONCLUSION: The results of the current study suggest that radiographs at 2-3 weeks following operative treatment of tibia, fibula or ankle fractures may not need to be ordered routinely. Obtaining radiographs should be guided by clinical indication or by patient and surgeon preference (e.g., for reasons beyond complications). These findings should be considered in light of increasing healthcare expenditures and the time investment required of patients and healthcare professionals.

PMID:40554111 | DOI:10.1016/j.injury.2025.112522

J Bone Joint Surg Am. 2025 Jun 24. doi: 10.2106/JBJS.24.01373. Online ahead of print.

ABSTRACT

Medical slang is commonly used in the orthopaedic community to improve communication, enhance team cohesion, and provide humor in intense work environments. However, when used carelessly, inappropriate terminology can alienate certain groups of physicians. When encountered in clinical settings, these terms can create uncomfortable environments, reduce trust, and discourage trainees from pursuing orthopaedics. To create more inclusive and effective clinical teams, it is important to regularly reassess medical slang and develop alternative terms that are respectful, practical, and consistent. This contemporary article highlights 8 examples of inappropriate terminology that are used in the orthopaedic community, explores their history of use, and suggests more appropriate alternatives.

PMID:40554618 | DOI:10.2106/JBJS.24.01373

J Bone Joint Surg Am. 2025 Jun 24. doi: 10.2106/JBJS.24.01538. Online ahead of print.

ABSTRACT

BACKGROUND: The usage of medial unicompartmental knee arthroplasty (mUKA) is increasing, but concerns remain regarding the risk of early periprosthetic tibial fracture (PPTF), particularly following cementless mUKA. The aims of this study were to compare the risk of PPTF between cemented and cementless mUKAs and to analyze risk factors for early PPTF.

METHODS: Using data from the Danish Knee Arthroplasty Register and the Danish National Patient Registry, all mUKAs from 1997 to 2022 were identified and stratified as cemented or cementless mUKAs. Subsequent fractures were identified through the reason for revision, diagnosis codes, and fracture-specific procedure codes.

RESULTS: This study included 9,700 cemented mUKAs (mean follow-up of 9 years) and 12,380 cementless mUKAs (mean follow-up of 3 years). The 4-month cumulative proportions of PPTF were 0.2% (95% confidence interval [CI], 0.2% to 0.4%) after cemented mUKA and 0.7% (95% CI, 0.6% to 0.9%) after cementless mUKA. Risk factors for early PPTF (≤4 months) were cementless mUKA (hazard ratio [HR], 2.9; 95% CI, 1.6 to 5.5), female sex (HR, 2.6; 95% CI, 1.6 to 4.2), an age of ≥70 years (HR, 4.0; 2.5 to 6.4), body mass index (BMI) of ≥40 kg/m2 (HR, 2.4; 95% CI, 1.0 to 5.8), and a height of <160 cm (HR, 2.2; 95% CI, 1.3 to 3.6). Female patients ≥70 years of age with a BMI of ≥40 kg/m2 and/or a height of <160 cm represented 3% of all mUKAs. In this group, patients with cementless mUKA had a 4-month cumulative proportion of PPTF of 4.5% (95% CI, 2.9% to 6.9%).

CONCLUSIONS: The risk of early, surgery-related PPTF was higher after cementless mUKA compared with cemented mUKA. Risk factors for early PPTF include cementless mUKA, female sex, an age of ≥70 years, a BMI of ≥40 kg/m2, and a height of <160 cm. Our data highlight the need for careful, bone-conserving tibial preparation and consideration of cemented tibial fixation for female patients ≥70 years of age with a height of <160 cm and/or a BMI of ≥40 kg/m2.

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

PMID:40554616 | DOI:10.2106/JBJS.24.01538

Int Orthop. 2025 Jun 23. doi: 10.1007/s00264-025-06590-5. Online ahead of print.

NO ABSTRACT

PMID:40549194 | DOI:10.1007/s00264-025-06590-5

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PMID:40549193 | DOI:10.1007/s00264-025-06586-1

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PMID:40544747 | DOI:10.1016/j.injury.2025.112449