EFORT Open Rev. 2025 Apr 1;10(4):186-192. doi: 10.1530/EOR-2024-0126.

ABSTRACT

Trauma induced by surgery stimulates a neuroendocrine stress response, substantially increasing cortisol levels in the post-surgical setting. This has substantial effects on metabolism, water and electrolyte balance as well as on the cardiovascular, nervous and immune systems. While there are valid data on cortisol level courses in a variety of specific pathologies, such as septic shock, acute respiratory distress syndrome, bacterial meningitis, cardiac arrest, community-acquired pneumonia and influenza, there is a persisting lack of data on the cortisol stress response after musculoskeletal surgery. The present review provides an overview of the current state of research regarding trauma-induced cortisol response after musculoskeletal interventions, including both elective orthopedic surgery and trauma surgery. Trauma induced by musculoskeletal surgery triggers a cortisol response, which varies significantly depending on the type of surgery and its invasiveness. Notably, elective orthopedic procedures demonstrate a smaller range of cortisol levels compared to musculoskeletal trauma and surgery. In the future, high-quality prospective trials need to analyze the factors that may modulate the adequate adrenal response to stress, such as preoperative long-term treatments with glucocorticoids, as well as the potential impact of low cortisol levels and perioperative cortisol substitution therapy on pain management, blood requirements, catecholamine dependency, delirium and mortality after musculoskeletal surgery.

PMID:40167425 | DOI:10.1530/EOR-2024-0126

Injury. 2025 Mar 22:112284. doi: 10.1016/j.injury.2025.112284. Online ahead of print.

NO ABSTRACT

PMID:40169293 | DOI:10.1016/j.injury.2025.112284

Injury. 2025 Mar 23;56(6):112293. doi: 10.1016/j.injury.2025.112293. Online ahead of print.

ABSTRACT

INTRODUCTION: Traumatic brain injuries (TBI) are a considerable health burden on adolescents and young adults. This study aims to assess the influence of health compromising behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI in a large cohort of Finnish adolescents with an average 25-year follow-up.

MATERIALS AND METHODS: Baseline Finnish Adolescent Health and Lifestyle survey data gathered biennially (1981-1997) was linked with the diagnosis of subsequent TBI from the Finnish Care Register for Health Care. A structural equation modeling (SEM) was used to analyze the associations between health behavior, poor perceived health, poor school success, and low family socioeconomic background during adolescence on subsequent TBI.

RESULTS: Total of 41 336 persons were included in the analyses. During the follow-up, 1 459 (3.5 %) TBIs occurred. Men were more likely to suffer a TBI. The mean follow-up time was 25.3 years (SD 4.0) and the mean age at the time of TBI was 32.1 years (SD 7.7). Health compromising behavior and not living with both parents in adolescence were associated with the increased risk of TBI. Also, poor perceived health and stress symptoms increased the risk of TBI. Low family socioeconomic status (SES) was only indirectly associated with TBI trough health compromising behavior.

CONCLUSION: The main finding was that health compromising behavior was associated with TBI, and low family SES was associated with TBI through health compromising behavior in later life. Poor perceived health, stress symptoms, and not living with both parents in adolescence increased the risk of TBI, too. Our findings suggest that adolescents who are at risk of drifting into health compromising behavior and report stress symptoms have an increased risk of TBI in later life.

PMID:40168891 | DOI:10.1016/j.injury.2025.112293

Injury. 2025 Mar 24;56(6):112296. doi: 10.1016/j.injury.2025.112296. Online ahead of print.

ABSTRACT

BACKGROUND: Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD: Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS: In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS: The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

PMID:40168890 | DOI:10.1016/j.injury.2025.112296

Injury. 2025 Mar 26;56(6):112287. doi: 10.1016/j.injury.2025.112287. Online ahead of print.

ABSTRACT

BACKGROUND: The ear is one of the most technically difficult areas to reconstruct following traumatic injury. Utilizing the largest national multicenter patient sample to date, this study seeks to provide a critical overview of the epidemiology of traumatic ear injuries.

METHODS: The NEISS database was searched from 2003-2022 to identify patients with related traumatic ear injuries. Three age groups were examined: geriatric (65+), adult (18-64), and pediatric (2-17). Variables including race, sex, incident location, commercial products involved, and emergency department disposition were evaluated between the groups utilizing two-proportion z-tests with Bonferroni correction.

RESULTS: 25,285 patients who sustained ear injuries were identified from the NEISS database. The top five types of ear injuries were laceration, contusion, puncture, hematoma, and burn. Geriatric patients experienced a significantly higher frequency of ear lacerations (82.5 % vs 68.6 %, p < 0.001) relative to non-geriatric adults, while children had a significantly greater frequency of hematomas (3.7 % vs 2.8 %, p = 0.001), and contusions (18.0 % vs 16.0 %, p = 0.006). The top five products involved for ear injuries were tables, first aid equipment, bed/bedframe, jewelry, and chairs. Geriatric adults had a significantly higher frequency of ear injuries from bed frames relative to non-geriatric adults (20.0 % vs 3.2 %, p < 0.001) and were over five times more likely to be admitted to the hospital..

CONCLUSIONS: This study offers novel insights into the epidemiology of traumatic ear injuries in the U.S especially across different age demographics. The greater prevalence of ear injuries from tables, first aid equipment, and with sporting activities among children highlights needs for childproofing homes and providing greater patient education and regulation on ear safety. The increased fragility of tissue and greater prevalence of fall injuries among geriatric patients demonstrates need for ongoing physical therapy and fall risk measures to be implemented. Collectively, the results help inform public health strategies to prevent such injuries as well as provide invaluable clinical context for reconstructive surgeons.

PMID:40168889 | DOI:10.1016/j.injury.2025.112287

J Bone Joint Surg Am. 2025 Apr 1. doi: 10.2106/JBJS.24.01007. Online ahead of print.

ABSTRACT

BACKGROUND: Neurofibromatosis type 1 (NF1) is a genetic condition predisposing children to fracture pseudarthroses. MEK inhibitors are U.S. Food and Drug Administration-approved or are under study for the treatment of malignant pathologies associated with NF1. However, their potential to treat pseudarthrosis is largely unknown.

METHODS: Primary cells cultured from control bone or fracture pseudarthroses from children with NF1 were treated with vehicle or with the MEK inhibitors trametinib or selumetinib. Gene expression was evaluated with use of transcriptome sequencing (RNAseq), and the activation of the downstream signaling pathway was evaluated with use of western blotting. Results were replicated in an independent cohort of patient fracture pseudarthrosis-derived primary cells.

RESULTS: Pseudarthrosis samples were reproducibly associated with the reduced expression of gene signatures implicated in osteoblast differentiation, skeletal development, and the formation of the extracellular matrix. The expression of these gene signatures was significantly rescued following treatment with MEK inhibitors and concomitant reduced MEK/ERK (MAPK) pathway activation.

CONCLUSIONS: Our study identified molecular signatures associated with fracture pseudarthrosis that were rescued with MEK inhibitor treatment.

CLINICAL RELEVANCE: MEK inhibitors may promote the healing of fracture pseudarthroses in children with NF1.

PMID:40168468 | DOI:10.2106/JBJS.24.01007

J Bone Joint Surg Am. 2025 Apr 1. doi: 10.2106/JBJS.24.01406. Online ahead of print.

ABSTRACT

Adaptive learning is a powerful educational tool that uses computer algorithms to personalize and streamline an individual's learning experience. These algorithms allow for continual assessment and real-time customization of the delivery of educational content based on a specific learner's knowledge base; such algorithms mimic a 1-to-1 learning model. The current symposium describes the application of adaptive learning to orthopaedics, as well as the development of an online educational platform that utilizes this promising technology.

PMID:40168460 | DOI:10.2106/JBJS.24.01406

Int Orthop. 2025 Apr 2. doi: 10.1007/s00264-025-06503-6. Online ahead of print.

ABSTRACT

PURPOSE: Effective patient comprehension is critical for informed consent, particularly in Total Hip Arthroplasty (THA), a globally prevalent procedure. This study evaluates the efficacy of an informational video to improve the patients' understanding, self-perceived knowledge, and emotional comfort in the context of THA informed consent. This randomized controlled trial investigates the impact of an additional informational video on (I) the patients' understanding, (II) self-precepted knowledge and (III) emotional comfort during the informed consent process for THA.

METHODS: Participants were randomized to receive either the standard informed consent procedure or the standard procedure supplemented with an informational video. The effect of the video was tested with post-consent questionnaires.

RESULTS: The informational video significantly (p = 0.014) improved the patients' understanding from 78.6% to 86.5%. Self-precepted knowledge and Emotional comfort was not effected by the video (p = 0.986; p = 0.333).

CONCLUSIONS: The informational video significantly improved patient comprehension during the informed consent process before THA.

PMID:40169412 | DOI:10.1007/s00264-025-06503-6

Int Orthop. 2025 Apr 1. doi: 10.1007/s00264-025-06511-6. Online ahead of print.

ABSTRACT

PURPOSE: The aim is to showcase the urgent need for improved data infrastructure and international collaboration by highlighting the barriers to comprehensive orthopaedic documentation and quantifying the scope and nature of scholarly research on Gaza's healthcare crisis.

METHODS: Data was collected through integration of observational field notes, informal interviews, patient record reviews and a bibliometric analysis of peer-reviewed articles on the 2023-2025 armed escalations in Gaza.

RESULTS: The review of patient documentation during surgical missions in Gaza revealed significant gaps in critical clinical information, including surgical history, microbiology data, and postoperative instructions, which hindered patient care. Frequent damage to records due to resource shortages and bombardments, along with issues in retrieving imaging data, further exacerbated these challenges. Bibliometric analysis showed that most studies were retrospective, focusing on trauma care and limb salvage, reflecting the difficulty of conducting prospective research in a conflict zone. Of the 114 publications reviewed, only three (2.6%) met inclusion criteria, with two of them involving Gaza-based Palestinian authors, despite barriers like power outages, limited journal access, and resource constraints.These findings highlight the resilience of Gaza's healthcare workers and the need for improved infrastructure, standardized documentation, and international partnership to enhance patient outcomes and strengthen global orthopaedic research.

CONCLUSION: Orthopaedic documentation in Gaza is hampered by the compound impacts of recurrent conflict, infrastructural decay, and constrained academic output. Observational findings reveal the fragility of paper-based systems, while a bibliometric survey underscores the paucity of locally driven, empirical research. International efforts are needed to overcome these barriers for improved data infrastructure.

PMID:40167759 | DOI:10.1007/s00264-025-06511-6

Injury. 2025 Mar 22:112278. doi: 10.1016/j.injury.2025.112278. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death and disability in children globally. Studies indicate that severe traumatic brain injury (TBI) negatively affects quality of life (QoL) in children, but little is known about QoL after injury in children without TBI. This study aimed to investigate QoL in this group six months post-discharge.

METHODS: Trauma patients aged 13-17 years admitted to a major Scandinavian trauma center were eligible if they met the following criteria: received by a trauma team, ISS > 9, required ICU monitoring, and hospital stay > 4 days. Patients with moderate to severe head injuries (AIS > 2) were excluded. Eighteen consenting adolescents were interviewed six to nine months after discharge.

RESULTS: The main finding was that most participants were "coping well after experienced injuries." A minority reported challenges in daily life, including fatigue and difficulty in keeping up. Few used regular painkillers, and most were unconcerned about long-term consequences. However, many felt that more structured follow-up post-discharge would have been helpful.

CONCLUSION: Among 18 moderate to severely injured adolescents, we found that the majority were coping well. Strong social relationships and involvement in school and social activities was important in all interviews. While several experienced fatigue and challenges in keeping up, the negative impact on daily life was manageable at the time of the interviews.

PMID:40164532 | DOI:10.1016/j.injury.2025.112278

Injury. 2025 Mar 25;56(6):112302. doi: 10.1016/j.injury.2025.112302. Online ahead of print.

ABSTRACT

OBJECTIVES: Management of civilian gunshot wound (GSW) fractures is controversial, with limited data on infection risk and controversy regarding treatment. While lower-energy GSWs are considered lower risk than other open fractures, complication rates remain high. This study aimed to identify risk factors for infection in operatively treated ballistic fractures.

METHODS: After institutional review board approval, we identified 2136 GSW-related fractures from 01/01/2012 to 12/31/2021 at our level one trauma center. After excluding articular, hand, foot, injuries through viscera and pre-existing infections, 110 patients with 125 long bone fractures were retrospectively reviewed. The primary outcome was infection requiring reoperation. Statistical analysis included Mann-Whitney U, T-tests, Pearson's Chi-square, ROC analysis, and Youden's index.

RESULTS: Sixteen patients (14.5 %) developed infections requiring reoperation. The cohort had a mean age of 30 years, 90 % male, BMI 27.7 ± 7.2 kg/m², Charlson comorbidity index <1, and 37 % smokers. Increased infection risk was associated with admission glucose (p < 0.001) and length of stay (p < 0.001). Admission glucose >156 mg/dL increased odds of infection sixfold (OR 6.1, 95 % CI 2.0-19.0), while a hospital stay >10 days increased odds of infection twentyfold (OR 21.1, 95 % CI 5.3-82.7). Transfusion (p = 0.004), abdominal (p = 0.007), and chest trauma (p = 0.010) also correlated with infection risk. No significant associations were found with nicotine use, Charlson comorbidity index, or BMI.

CONCLUSIONS: Operatively treated long bone injuries had a 14.5 % infection rate. Elevated admission glucose and prolonged hospital stay significantly increased infection risk, particularly in polytrauma patients. Identifying high-risk patients, promoting early mobilization, and ensuring glycemic control may help reduce infections. Further research is needed to develop targeted prevention strategies.

LEVEL OF EVIDENCE: 3 (Retrospective Comparative Study).

PMID:40163958 | DOI:10.1016/j.injury.2025.112302

Injury. 2025 Mar 25;56(6):112282. doi: 10.1016/j.injury.2025.112282. Online ahead of print.

ABSTRACT

OBJECTIVE: Fragility fractures in the elderly population is increasing due to the global aging population. Rehabilitation following hip fracture surgery plays a crucial role in restoring functional independence and quality of life. There are currently limited bedside rehabilitation tool for geriatric hip fracture patients. A novel tool (Time-Up and Flex [TUF]) was designed with the aim to allow patients perform bedside rehab exercises, provide objective feedback and enhance recovery.

DESIGN: A single centre, double-blinded, prospective validation study. A 3D printed TUF tool measures time taken to actively flex the operated hip to 30° on post-operative days [POD] 1, 7 and 14. The time is compared against subjective (Numerical Patient Reported Pain Scale [NPRS]) and objective outcomes (Tinetti Scale [TS], Functional Ambulation Category [FAC]). Assessors of the TUF score are blinded to the assessors of patient report outcome measures.

RESULTS: Mean time for TUF were 12.7 s (seconds), 9.5 s and 6.7 s, NPRS were 7.3, 4.8, 3.2, TS were 9.8, 14.1, 18.6, FAC were 1.2, 2.0, 3.1 on POD1, 7 and 14 respectively. Coefficient of correlation for TUF time against NPRS was 0.729 (p < 0.05), TUF time against TS was -0.721 (p < 0.05), TUF time against FAC -0.688 (p < 0.05). A decrease in TUF time correlated to a statistically significant decrease in NPRS, increase in TS and FAC. The calculated Cohen's D and Cronbach Alpha for TUF tool supported its ability to produce consistent and valid results.

CONCLUSION: TUF tool is valid and correlates with patient's subjective and objective outcomes. It has a good predictor value for the patient's pain, mobility and future falls risk. TUF tool has potential to be incorporated into geriatric hip fracture rehabilitation pathway in the future.

PMID:40163957 | DOI:10.1016/j.injury.2025.112282

Int Orthop. 2025 Mar 31. doi: 10.1007/s00264-025-06515-2. Online ahead of print.

ABSTRACT

PURPOSE: In orthopaedic surgery, achieving optimal exposure for acetabular and pelvic ring fractures with minimal invasiveness remains a challenge. This study compares bone exposure in key pelvic zones using an endoscopic approach versus the AIP (Modified Stoppa) in cadaveric specimens.

MATERIALS AND METHODS: We dissected ten adult cadaveric bodies, obtained from our institution's body donation program, using an extraperitoneal endoscopic dissection on one side and an AIP approach on the other. Bone areas were marked at each step of dissection by drill holes to measure the bone exposure surface for each zone (true and false pelvis) between the laparoscopic and open approaches. A Student's t test was used to compare the exposure areas obtained.

RESULTS: The average age of the cadavers was 83 years, with a balanced representation of genders (60% male, 40% female). Comparison of zones between endoscopy and AIP found for Zone 1: 1.4 cm2 (range - 3.813 to 1.013) for AIP with no statistical significance. For Zone 2: 0.5 cm2 (range - 1.9141 to 2.9141) for AIP with no statistical significance. For Zone 3: 0,6 cm2 (range - 1.0243 to 2.2243) for AIP with no statistical significance. And for Zone 4: 3.5 cm2 (1.874; 5.126) for endoscopy with statistical significance (p = 0.001).

CONCLUSION: Our study demonstrates that the endoscopic method provides comparable visualization of the different pelvic zones compared to the open method (AIP), with enhanced access to Zone 4, a crucial area in managing acetabulum and pelvic ring fractures.

LEVEL OF EVIDENCE: Level V, cadaveric study.

PMID:40163078 | DOI:10.1007/s00264-025-06515-2

Injury. 2025 Mar 24;56(6):112300. doi: 10.1016/j.injury.2025.112300. Online ahead of print.

ABSTRACT

- A 49yo woman was involved in a car crash. She suffered an isolated, open, left both bones forearm mid-diaphyseal fracture. She had a sling applied at the scene but had a 16-hour transport time from an isolated rural location. She was found to have no other injuries upon her careful work-up at the Level 1 emergency department. The injury had not compromised the distal neurovascular status of the limb. The ER staff admitted the patient to the orthopedic team. The patient had an evaluation by a senior resident and their assessment was that this was a grade 3A open fracture of the dorsum of the mid forearm (Figure 1 and Figure 2). By the time surgery could be initiated at the Trauma center, fully 36 hours had passed. Most of the delay at the Trauma center was due to other very significant injuries in the Trauma room that day. PAST MEDICAL HISTORY AND SOCIAL HISTORY: - She is a married woman and lives with her husband and a university aged teenager. She has been a nonsmoker. She has no medical problems that she sees a physician about. She works as a secretary but presently is unemployed. She has only had obstetrical surgery, has no allergies and takes no medications. She is a regular wine drinker.

PMID:40158403 | DOI:10.1016/j.injury.2025.112300

Injury. 2025 Mar 24:112286. doi: 10.1016/j.injury.2025.112286. Online ahead of print.

NO ABSTRACT

PMID:40157870 | DOI:10.1016/j.injury.2025.112286

Injury. 2025 Mar 20:112277. doi: 10.1016/j.injury.2025.112277. Online ahead of print.

NO ABSTRACT

PMID:40157869 | DOI:10.1016/j.injury.2025.112277

Injury. 2025 Mar 22;56(4):112291. doi: 10.1016/j.injury.2025.112291. Online ahead of print.

ABSTRACT

Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.

PMID:40157338 | DOI:10.1016/j.injury.2025.112291

Injury. 2025 Mar 20;56(6):112274. doi: 10.1016/j.injury.2025.112274. Online ahead of print.

ABSTRACT

The long-term effects of injuries have significant implications for forensic practice. There is a dearth of research highlighting long-term psychological problems resulting from various injuries in under-researched populations like Mozambique. This study employed multiple logistic regression analyses on the 2022-2023 Mozambique Demographic and Health Survey (DHS) data to determine injury types predictive of emotional trauma, limb function loss, and chronic pain as continuing health problems. The data from the Accidents and Injury module was used for all participants. The injuries analyzed included broken bones, wounds, internal injuries, and burns. Additionally, we investigated the predictive capacity of unintentional and violent injuries on emotional trauma as a continuing health problem. The total number of injured people (whether due to traffic or non-traffic accidents) was 419. The proportion of unintentional injuries was much higher than violent injuries (86.4% vs 7.7%). Our results indicated that burn injuries were strongly associated with emotional trauma (Odds Ratio (OR) = 4.15, 95% CI: [1.24-13.84], P = 0.021), broken-bone injuries predicted both limb function loss (OR = 2.67, 95% CI: [1.17- 6.09], P = 0.02) and emotional trauma (OR = 3.73, 95% CI: [1.51-9.22], P = 0.005), internal injuries predicted chronic pain (OR = 2.52, 95% CI: [1.18-5.38], P = 0.018), and violent injuries predicted emotional trauma (OR = 4.41, 95% CI: [1.16-16.67], P = 0.03). These findings enhance comprehension of how injury types predict long-term psychological complications in Mozambique and provide valuable insights regarding the enduring consequences of various injuries in similar populations.

PMID:40157228 | DOI:10.1016/j.injury.2025.112274

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06484-6. Online ahead of print.

ABSTRACT

PURPOSE: Despite the increasing understanding of femoroacetabular impingement (FAI), the impact of specific patient characteristics, including inflammatory pathologies like axial spondyloarthritis (axSpA), on its pathophysiology and clinical outcomes following treatment remains inadequately defined. Therefore, the purpose of this scoping review was to evaluate the relationship between FAI and sacroiliac (SI) joint abnormalities and FAI and axSpA.

METHODS: The study was conducted following the framework established by Arksey and O'Malley and Levac et al., adhering to the PRISMA scoping review extension checklist. A systematic search was performed across MEDLINE, EMBASE, and Cochrane Library databases for articles published until August 2024. A total of 120 articles were screened and eight finally met the inclusion criteria.

RESULTS: The review analysed data from the eight retrospective studies with a total of 1,723 patients. We found that the prevalence of SI joint abnormalities in patients with FAI can be as high as 25-28%. Furthermore, the prevalence of FAI morphology in patients with axial spondyloarthritis can be as high as 20-37%. Finally, patients undergoing hip arthroscopy for FAI with axSpA and/or SI joint abnormalities have lower postoperative outcome scores reported in comparison with those patients who do not have these comorbidities.

CONCLUSION: Over a quarter of patients with FAI can have concomitant radiographic SI joint abnormalities. We cannot overemphasise the importance of assessing the spine, specifically the SI joint, and ruling out symptoms emanating from the SI joint in all patients with FAI. There is clearly a knowledge gap in understanding the underlying pathophysiology linking FAI and axSpA. We require further research to elucidate the underlying mechanisms of this relationship, standardise evaluation methods, and explore long-term outcomes in this cohort of patients.

PMID:40156722 | DOI:10.1007/s00264-025-06484-6

Int Orthop. 2025 Mar 29. doi: 10.1007/s00264-025-06514-3. Online ahead of print.

ABSTRACT

We discuss the study by Xiao Han et al., titled " Comprehensive Comparison Between Conservative Therapy and Surgical Management for Completely Displaced and Comminuted Mid-Shaft Clavicle Fractures " The authors compared outcomes between conservative and surgical treatments in 105 patients, finding higher union rates, faster healing, and no malunion in the surgical group, albeit with a notable incidence of postoperative numbness. While long-term functional outcomes were comparable, surgery offered quicker recovery of strength and return to work. However, as a retrospective study, potential selection bias exists-more active, younger patients tended to undergo surgery, while older patients with comorbidities opted for conservative care. The absence of propensity score matching (PSM) further limits comparability. Moreover, the relatively short follow-up (mean: 21.24 months) restricts insights into long-term complications. Previous long-term studies suggest surgical benefits may wane over time. Future randomized, long-term, and cost-focused studies would be valuable to guide treatment decisions more robustly.

PMID:40155447 | DOI:10.1007/s00264-025-06514-3