J Bone Joint Surg Am. 2026 Apr 22. doi: 10.2106/JBJS.25.01516. Online ahead of print.

ABSTRACT

Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic "gold standard." This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.

PMID:42018608 | DOI:10.2106/JBJS.25.01516

Injury. 2026 Apr 15;57(6):113291. doi: 10.1016/j.injury.2026.113291. Online ahead of print.

ABSTRACT

INTRODUCTION: A lag screw, or a lag screw combined with a neutralization plate, is commonly used for compressive fixation of simple fracture patterns. There are several surgical variables that potentially affect fixation stability including lag screw angle, fracture gap, screw countersinking, screw diameter, and neutralization plate configuration.

METHODS: This study involved finite element modeling of these biomechanics in a diaphyseal bicortical oblique fracture model of (1) lag screw application under controlled torque; and (2) postoperative stability with 4.5 mm diameter lag screw and corresponding neutralization plate combinations, subject to external compression, bending, and torsion.

RESULTS: In models of lag screw application, predicted interfragmentary misalignment had good agreement with corresponding validation experiments. When the screw was applied perpendicular to the fracture, with moderate countersinking and no initial fracture gap, fracture compression was maximized and interfragmentary misalignment minimized. A 30° deviation from perpendicular screw placement reduced fracture compression by 19% and produced 0.7 mm of interfragmentary misalignment, while screw deviation at 15° had negligible effects. Not countersinking the screw head also decreased fracture compression and increased lag screw stress at the head-shaft junction, with the model predicting larger effects on compression than observed in the experiment. During postoperative loading, the addition of a neutralization plate limited shear interfragmentary motion to < 0.4 mm under all loadings, and reduced lag screw stress and bone strains, particularly under torsion.

CONCLUSION: The study quantifies the decreases in fracture compression in lag screw fixation due to screw angular deviation and not countersinking the screw head, and characterizes the biomechanical benefits of combining lag screw fixation with a neutralization plate.

PMID:42019156 | DOI:10.1016/j.injury.2026.113291

J Bone Joint Surg Am. 2026 Apr 21. doi: 10.2106/JBJS.25.01393. Online ahead of print.

ABSTRACT

BACKGROUND: Pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) are powerful techniques for correcting severe spinal deformities. Although PSO has been proposed as a viable alternative to VCR, their comparative efficacies and safety profiles require further elucidation.

METHODS: This single-center retrospective study analyzed 169 patients (mean age, 22 years; 84 male; 169 ethnic Chinese) with severe kyphoscoliosis who underwent primary corrective surgery via PSO (n = 85) or VCR (n = 84). Radiographic parameters, surgical data, intraoperative neuromonitoring (IOM) changes, Scoliosis Research Society (SRS)-22 scores, and complications were compared between groups.

RESULTS: Both techniques significantly improved all radiographic parameters and SRS-22 scores (p < 0.001). The VCR group demonstrated superior correction of the major curve (65.5% versus 56.9%, p = 0.003), segmental kyphosis (68.1% versus 61.5%, p = 0.03), and apical vertebral rotation (48.5% versus 34.4%, p = 0.001). At the critical osteotomy stage, 105 (62.1%) of 169 patients experienced IOM signal decline. The neurological complications rate was significantly higher in the VCR group (13 of 84 versus 7 of 85, p = 0.038), as was the overall complication rate (43 of 84 versus 29 of 85, p = 0.008). Each 1° increase in correction achieved with VCR was associated with a 1.6% higher risk of complications (OR = 1.016, p = 0.045).

CONCLUSIONS: Although both PSO and VCR were highly effective for major deformity correction, VCR provided a greater magnitude of correction in the coronal, sagittal, and axial planes. However, this advantage was counterbalanced by a significantly higher risk of complications, including neurological deficits. Despite the frequent reversibility of IOM signal declines, VCR retained a higher risk profile due to its higher overall complication rate.

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

PMID:42013198 | DOI:10.2106/JBJS.25.01393

J Bone Joint Surg Am. 2026 Apr 21. doi: 10.2106/JBJS.26.00230. Online ahead of print.

ABSTRACT

➢ Meniscal preservation has become the central management principle of meniscal tears. Biomechanical evidence has demonstrated that meniscal resection increases joint contact stress, accelerates osteoarthritis progression, and worsens long-term outcomes compared with repair and nonoperative management.➢ Treatment decisions should be individualized based on tear morphology, tissue quality, and patient-specific factors.➢ Repair technique selection (all-inside, inside-out, or outside-in) should be dictated by the tear location and pattern.➢ Adjunct treatment strategies, such as biologic augmentation, may be used selectively to increase the potential for meniscal healing, although these strategies have inconsistent outcomes.

PMID:42013196 | DOI:10.2106/JBJS.26.00230

J Bone Joint Surg Am. 2026 Apr 21. doi: 10.2106/JBJS.25.01037. Online ahead of print.

ABSTRACT

BACKGROUND: Effective pain management following total knee arthroplasty (TKA) is crucial to optimizing patient outcomes and experiences. Multimodal pain management protocols vary between institutions, with some recently proposing the addition of an intraosseous (IO) injection of morphine intraoperatively. The purpose of this study was to investigate whether the addition of an intraoperative, IO injection of morphine during elective primary TKA would lead to improved pain control and decreased narcotic consumption during the postoperative period.

METHODS: In this double-blinded, randomized controlled trial, 100 patients undergoing elective primary TKA were prospectively enrolled. All patients received spinal anesthesia and intravenous sedation combined with an intraoperative, surgeon-administered adductor canal block. The experimental group received an intraoperative, IO injection containing 10 mg of morphine and 500 mg of vancomycin in 110 mL of normal saline solution. The control group received the same injection but without morphine. All patients received 6 daily text-message surveys (3 in the morning and 3 in the evening) for 14 days postoperatively to collect pain scores, morphine milligram equivalent (MME) consumption, and nausea and vomiting events. Data on demographics, operative factors, post-anesthesia care unit (PACU) pain scores, PACU MME consumption, and patient-reported outcomes were also collected. Linear mixed-effects (LME) models were utilized.

RESULTS: A total of 88 patients (52.3% [n = 46] female; mean age, 69.1 ± 9.0 years [range, 46 to 89 years]; 89.8% [n = 79] White) were included in the analysis. The LME model demonstrated no differences between the groups with respect to daily pain scores at any time point within 14 days postoperatively (p = 0.969). There were no differences between the groups with respect to daily MME consumption at any time point within 14 days postoperatively (p = 0.377). There were also no differences in total MME consumption or weekly MME consumption postoperatively (p ≥ 0.878).

CONCLUSIONS: IO morphine did not significantly improve postoperative pain control or decrease narcotic consumption up to 2 weeks postoperatively among patients undergoing elective primary TKA.

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

PMID:42013190 | DOI:10.2106/JBJS.25.01037

Injury. 2026 Apr 16;57(6):113266. doi: 10.1016/j.injury.2026.113266. Online ahead of print.

ABSTRACT

INTRODUCTION: Individuals with psychiatric disorders and substance use are at greater risk of sustaining severe injuries due to behavioral impulsivity, impaired judgment, and medication effects. The influence of psychiatric comorbidities on the hospitalization of patients with pelvic fractures remains underexplored. This study investigates the impact of psychiatric disorders and substance abuse on hospitalization outcomes for these patients.

MATERIALS AND METHODS: This retrospective, single-center cohort study was conducted from 2014 to 2023, including patients aged ≥ 18 years with high-energy pelvic and acetabular fractures and documented psychiatric disorders or substance abuse history. Exclusion criteria included subjects with incomplete or missing data, pathological pelvic fractures, patients younger than 18 years, non-trauma admissions, conservative fractures. Patients were divided into two groups: the mental group (with psychiatric comorbidities and/or substance abuse) and the control group. We analyzed factors such as emergency department length of stay, Injury-to-surgery interval, surgery-to-discharge readiness interval, discharge readiness-to-discharge interval and the necessity of discharge support service.

RESULTS: A total of 208 patients were included, of whom 22 (10.6%) had psychiatric comorbidities. Patients with psychiatric disorders were significantly younger and had more severe injuries than control group. Despite a shorter injury-to-surgery interval (3.5 vs. 6.1 days, p = 0.007), psychiatric patients had significantly longer hospital stays (44.7 vs. 18.5 days, p = 0.050). There was no significant difference in the surgery-to discharge readiness interval, but psychiatric patients experiencing a prolonged discharge readiness-to-discharge interval (19.2 vs. 3.4 days, p = 0.032).

DISCUSSION: Psychiatric comorbidities significantly influence hospitalization dynamics in pelvic fracture patients. Although psychiatric patients undergo surgery more quickly and achieved clinical recovery at similar times, compared to controls, their hospital stays are prolonged due to psycho-social and organizational barriers rather than ongoing medical needs. A higher proportion of psychiatric patients required discharge support services, emphasizing the role of non-medical factors in discharge delays.

CONCLUSIONS: Our findings indicate that the higher proportion of patients in the mental health group requiring discharge support services suggests that non-medical factors are major contributors to discharge delays. The higher rate of discharge-support activation further confirms the greater dependence of this population on structured continuity-of-care pathways.

PMID:42013718 | DOI:10.1016/j.injury.2026.113266

Int Orthop. 2026 Apr 21. doi: 10.1007/s00264-026-06802-6. Online ahead of print.

ABSTRACT

PURPOSE: Our retrospective study focused on long-term outcomes of converting a fused hip to a cementless metaphyseal-fitting anatomic hip system including: (1) validated clinical scores; (2) radiographic assessment; (3) impact on neighbouring joints; (4) osteolysis and revision rates; (5) complication profiles; (6) implant survivorship; and (7) patient satisfaction.

METHODS: We reviewed 96 THAs in 88 patients (mean age, 42.3 years [range, 21 to 74]) who underwent conversion of fused hip through a posterolateral approach to a cementless a metaphyseal-fitting anatomic cementless total hip system, performed by one surgeon. The third generation Biolox Forte at 28 mm as the bearing surface was used in all hips. The mean follow-up was 23.5 years (range, 14 to 30 years).

RESULTS: At the final follow-up, the mean Harris hip score was 91.2 points (range, 52 to 100 points). Mean hip flexion was 89° (range, 70° to 120°). Three acetabular (3%) and five femoral components (5%) that were revised. About 70 to 80% of patients expressed overall satisfaction and 66% of patients reported marked improvement in quality of life. A Kaplan-Meier survivorship analysis at 23.5 years showed a 97% survival rate (95% CI, 93 to100%) for the acetabular component and 91% (95% CI, 89 to 98%) for the femoral component.

CONCLUSIONS: Conversion of hip fusion to THA using metaphyseal-fitting anatomic cementless hip system appears to provide good long-term outcomes. The risk for postoperative complication including abductor dysfunction and nerve injury should be carefully discussed with patients prior to surgery.

PMID:42012520 | DOI:10.1007/s00264-026-06802-6

SICOT J. 2026;12:19. doi: 10.1051/sicotj/2026002. Epub 2026 Apr 20.

ABSTRACT

INTRODUCTION: Implant subsidence remains one of the complications following lumbar interbody fusion and total lumbar disc replacement, often attributed to excessive and uneven preparation of the subchondral bone. To address this limitation, we describe a novel surgical approach - en bloc discectomy - designed to enable more controlled disc removal, preserve subchondral endplate integrity, and minimize the risk of implant subsidence.

METHODS: We describe the procedural steps for the en bloc discectomy, including patient positioning, surgical approach, and the specific technique using a Cobb spinal elevator to remove the cartilaginous en bloc. The technique's advantages include controlled disc removal, minimized subsidence, and even subchondral endplate preparation.

RESULTS: En bloc discectomy was successfully performed in our patient. No intraoperative or postoperative complications occurred, and all patients reported immediate and sustained symptomatic improvement.

CONCLUSION: En bloc discectomy provides a safe and reproducible alternative to conventional (standard piecemeal discectomy) disc excision. By reducing endplate damage and implant subsidence, this technique has the potential to improve long-term stability and clinical outcomes in patients undergoing lumbar interbody procedures.

PMID:42007623 | PMC:PMC13094346 | DOI:10.1051/sicotj/2026002

SICOT J. 2026;12:18. doi: 10.1051/sicotj/2026009. Epub 2026 Apr 20.

ABSTRACT

INTRODUCTION: The knee is a biomechanically complex joint supported by multiple anatomical structures, making it vulnerable to multiple injuries. Finite element analysis is a valuable tool for studying joint biomechanics, particularly in pre-operative planning and injury evaluation. However, most models are based on computed tomography, which limits soft tissue visualization. Thus, a magnetic resonance imaging-based finite element model of the knee, incorporating bones, ligaments, tendons, cartilage, and menisci, was developed to improve realism and clinical relevance in biomechanical simulations.

MATERIALS AND METHODS: Magnetic resonance imaging data were obtained from a healthy adult male using a 1.5T scanner and processed using RETOMO and Rhinoceros software for 3D reconstruction and modeling. Meshes were cleaned, optimized, and anatomically validated. All major knee structures were modeled, including the femur, tibia, fibula, patella, cruciate and collateral ligaments, patellofemoral ligaments, quadriceps and patellar tendons, menisci, and articular cartilage.

RESULTS: The resulting model reconstructed both hard and soft tissues of the knee joint with high anatomical fidelity, based on direct MRI segmentation and literature-supported anatomical definitions. The use of magnetic resonance imaging enabled high-resolution identification of soft tissues, while advanced mesh refinement preserved anatomical detail with optimized file management. The inclusion of structures like the anterolateral ligament and patellofemoral ligaments expands the model's clinical relevance in addressing a wider range of knee pathologies.

CONCLUSION: This magnetic resonance imaging-based finite element analysis model provides a detailed and comprehensive, representation of the healthy human knee, including bones, cartilage, menisci, and tendons. While some ligament attachment points were derived from literature rather than MRI data, the model provides a foundation for future biomechanical studies, surgical planning and personalized treatment simulations.

PMID:42007622 | PMC:PMC13094345 | DOI:10.1051/sicotj/2026009

SICOT J. 2026;12:17. doi: 10.1051/sicotj/2026004. Epub 2026 Apr 20.

ABSTRACT

BACKGROUND: Rotator cuff calcific tendinopathy (RCCT) has traditionally been described as a localized enthesopathy. However, calcium deposits sometimes extend beyond the enthesis into adjacent soft tissues or humeral bone, resulting in atypical patterns not considered in existing classification systems. Failure to recognize these patterns can lead to diagnostic errors or the indication of unnecessary invasive diagnostic procedures.

METHODS: In order to describe atypical patterns and to assess their incidence, 100 consecutive shoulder cases with radiographically confirmed RCCT were retrospectively reviewed. Calcific deposits were categorized by tendon involvement, size, and morphology. Based on imaging findings, deposits were also classified according to their anatomic location and extension into: Type I (enthesis-confined), Type II (extension into soft tissue), and Type III (bone involvement). Associations between patient characteristics, calcification size, morphology, and location were analyzed.

RESULTS: According to the proposed classification, 67% of cases were Type I, 14% showed soft tissue extension (Type II), and 19% involved bone (Type III). Type III group showed a significantly higher proportion of females (83%) compared to the entire cohort (54%) (p < 0.001). Larger deposits (>15 mm) were significantly associated with bone involvement (p < 0.01).

CONCLUSION: Extension of calcium deposits beyond the rotator cuff enthesis was a frequent finding in this series. Incorporating an anatomic extension-based classification may enhance diagnostic precision, possibly avoiding invasive differential diagnostic procedures.

LEVEL OF EVIDENCE: IV.

PMID:42007621 | PMC:PMC13094347 | DOI:10.1051/sicotj/2026004

J Bone Joint Surg Am. 2026 Apr 20. doi: 10.2106/JBJS.25.01237. Online ahead of print.

ABSTRACT

BACKGROUND: Lower surgeon case-volume has been associated with a greater risk of postoperative complications such as dislocation following total hip arthroplasty (THA). However, robotic assistance and computer navigation may mitigate the volume-dependent risk of instability. This study sought to compare dislocation rates between lower-volume surgeons performing technology-assisted (TA) THAs and higher-volume surgeons utilizing conventional instrumentation (CI).

METHODS: The Premier Healthcare Database was queried to identify adult patients who underwent primary elective THA from 2016 to 2023. Surgeons with <10% technology use formed the CI group, and surgeons with ≥90% technology use formed the TA group. These groups were further subdivided into higher-volume (HV) and lower-volume (LV) on the basis of surgeon annual case-volume, using a previously validated threshold of 109 cases/year. Mixed-effects modeling was used to compare the 90-day risk of dislocation between patients treated by low-volume surgeons using TA (LV-TA group) and high-volume surgeons using CI (HV-CI group).

RESULTS: A total of 669,098 patients undergoing THA were identified. Of these, 5,447 patients were treated by LV-TA surgeons and 190,550, by HV-CI surgeons. Notably, LV-TA surgeons achieved a similar rate of dislocation compared with HV-CI surgeons (0.48% versus 0.42%, p = 0.510). After controlling for confounding factors, the risk of dislocation remained comparable between LV-TA and HV-CI surgeons (adjusted odds ratio: 1.062, 95% confidence interval: 0.677 to 1.668, p = 0.793).

CONCLUSIONS: Surgeons with a lower case-volume who used technology assistance achieved a rate of dislocation similar to that of surgeons with a higher case-volume who used conventional instrumentation. These findings demonstrate that technology assistance, including computer navigation and robotic assistance, may attenuate the association between surgeon case-volume and dislocation risk following primary THA.

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

PMID:42008602 | DOI:10.2106/JBJS.25.01237

Int Orthop. 2026 Apr 20. doi: 10.1007/s00264-026-06812-4. Online ahead of print.

NO ABSTRACT

PMID:42008188 | DOI:10.1007/s00264-026-06812-4

Injury. 2026 Apr 10;57(6):113267. doi: 10.1016/j.injury.2026.113267. Online ahead of print.

ABSTRACT

BACKGROUND: Even though the radiological and functional outcomes following femoral head fractures have been reported earlier, Quality Adjusted Life Years (QALY) after fixation of these fractures has not yet been studied. This study aims at a subgroup analysis of the Pipkins classification of fractures, radiological and functional outcomes, and the burden of femoral head fractures by QALY.

METHODS: A retrospective analysis of 101 patients with femoral head fractures was performed between 2008 and 2022 with a minimum follow-up of 2 years and maximum of 15 years. Serial radiographs were studied from PACS (radiological outcome) and the patients were interviewed using Harris Hip Score (functional outcome) and the EuroQoL EQ-5D-3L questionnaires to assess the Quality Adjusted Life Years (QALY).

RESULTS: Patients who underwent immediate reduction of the hip joint (<6 h) demonstrated better QALY in the long term follow up. Those with Pipkins type 3 (n = 10) fractures who had to undergo Primary THR showed the best functional outcomes, followed by types 4,1, and 2. Infra foveal fractures gave a better outcome than supra foveal fractures. Heterotopic ossification (7%), AVN (4%), and the need for conversion to secondary THR (3%) was more common in patients who had a prolonged injury to reduction interval or a comminuted fracture of the femoral head. Despite a 2% incidence of infection, short-term functional outcomes remained positive in these patients.

CONCLUSION: In this cohort, well-fixed femoral head fractures across Pipkin subtypes showed satisfactory radiological and functional outcomes with acceptable long-term health utility. Pipkin type II fractures with extensive comminution and Pipkin type III fractures appeared to have better outcomes with primary total hip replacement, potentially reducing the need for secondary surgery.

PMID:42000478 | DOI:10.1016/j.injury.2026.113267

Injury. 2026 Apr 15;57(6):113286. doi: 10.1016/j.injury.2026.113286. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the prevalence of barriers to care and IPV risk and assessed associations between economic hardship and violence.

METHODS: A prospective, cross-sectional survey was performed recruiting adult orthopedic trauma patients presenting for clinical follow up at one Level 1 orthopaedic trauma center. Primary outcomes were SDoH domains and IPV risk. Associations between patient characteristics, barriers to care, and IPV risk were analyzed using Fisher's exact tests with false discovery rate control.

RESULTS: Among 261 respondents, 50.6% reported difficulty paying for basic needs, while 26.2% reported food insecurity and 25.2% transportation barriers. Positive IPV screens were driven largely by emotional abuse (17.7%), compared with physical hurt (3.3%). Financial hardship was the strongest predictor of barriers to care (OR 48.8, p < 0.001) and was associated with overall IPV risk (OR 3.31, p < 0.001), increasing the odds of threats of harm by over 28-fold. Tobacco use (OR 3.35, p < 0.001) and monthly alcohol use (OR 3.26, p = 0.01) were also associated with IPV risk. Nearly one-third of patients (28.8%) requested connection to supportive resources.

CONCLUSIONS: Orthopaedic trauma patients experience a substantial burden of unmet social needs and IPV risk. Financial hardship and substance use are associated with barriers to care and IPV exposure, and many patients desired connection to resources. Trauma clinics represent a critical point for identification, but screening alone is insufficient without embedded referral pathways to provide timely support.

LEVEL OF EVIDENCE: Level II; survey study.

PMID:42000477 | DOI:10.1016/j.injury.2026.113286

Injury. 2026 Apr 15;57(6):113293. doi: 10.1016/j.injury.2026.113293. Online ahead of print.

NO ABSTRACT

PMID:42000476 | DOI:10.1016/j.injury.2026.113293

Injury. 2026 Apr 15;57(6):113260. doi: 10.1016/j.injury.2026.113260. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the pathophysiological mechanisms, risk factors, and conditions contributing to the occurrence of paralyzing disc herniation (PDH) following L4-L5 disc herniation surgery. Despite the significance of PDH, comprehensive understanding remains limited due to the inherent challenges in recruiting patients with neurologic deficits and the variability in research methodologies.

METHODS: Our retrospective analysis includes 1285 patients who underwent surgery for disc herniation over a decade, identifying an incidence rate of 7.69% for PDH among the cohort. Notable risk factors include age, obesity, diabetes mellitus, a narrow lumbar canal, and trauma.

RESULTS: The recovery rate of 66.66% observed in our study aligns with existing literature, indicating a comparable average age of participants (48.64 years).

CONCLUSIONS: The restricted volume of research focusing on postoperative outcomes has resulted in a lack of consensus on optimal management strategies for PDH. Consequently, the timing of intervention remains ambiguous, aside from recognized emergency situations. Our study underscores the need for further prospective research to enhance understanding and establish definitive management protocols for PDH.

PMID:42000475 | DOI:10.1016/j.injury.2026.113260

Injury. 2026 Apr 15:113287. doi: 10.1016/j.injury.2026.113287. Online ahead of print.

ABSTRACT

BACKGROUNDS: The objective of this study is to closely examine the preferred anastomoses of the superior thyroid artery, facial artery, lingual artery, maxillary artery, and superficial temporal artery anastomoses for the reconstruction of maxillomandibular defects caused by firearm injuries. The study will also examine the reasons for choosing these arteries, their advantages and disadvantages, surgical techniques, complications, and their postoperatively clinically and scintigraphically assessable viability.

METHODS: The present study encompasses a cohort of ten patients who sustained maxillomandibular injuries and underwent surgical intervention employing a multisegment fibular flap. In all cases, following bone fixation, microvascular anastomoses were sutured under a microscope using 9-0 nylon sutures. Flap viability was initially assessed clinically; in addition, all patients underwent a bone scan on the fifth day after surgery using an intravenous infusion of Tc-99m methylene diphosphonate (MDP).

RESULTS: In the study, 10 patients who underwent maxillomandibular multisegment flap surgery received the most appropriate microvascular anastomosis for their pathology. Of these patients, the six most demonstrative cases, which best represent the relevant artery used for anastomosis, have been detailed.

CONCLUSIONS: Although the aim of this study was not to establish a definitive algorithm based on the 10 cases presented, it is hypothesised that the findings may provide some guidance to surgeons working in this field.

PMID:42000208 | DOI:10.1016/j.injury.2026.113287

Injury. 2026 Apr 11:113271. doi: 10.1016/j.injury.2026.113271. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma is the leading cause of death in younger adults and children. Severe polytrauma predisposes patients to the failure of multiple organ systems, including the cardiovascular and respiratory systems, at times necessitating extracorporeal membrane oxygenation (ECMO). ECMO use in the setting of trauma is increasing, yet little data exists describing current practice patterns. We performed an epidemiological analysis of ECMO use and outcomes in trauma patients.

STUDY DESIGN AND METHODS: We analyzed data from the Trauma Quality Improvement Program Registry from 2017 to 2023. Procedure codes were used to identify the application of ECMO. Pediatric patients were those < 18 years of age. We analyzed two groups from this data set: one including all patients who required ECMO and a separate group including only pediatric cases. We used descriptive and inferential statistical methods.

RESULTS: There were 8,014,737 encounters of which 1919 had documented ECMO use. Within that group, 224 were < 18 years of age. The median time from hospital arrival to the first initiation of ECMO was 44 h (interquartile range [IQR] 5-147). The incidence per year ranged from 1.9 to 2.9 events per 10,000 encounters. Survival ranged from 59% to 68% per year. The number of facilities with documented ECMO use annually ranged from 103 to 158 and overall increased during the time of the study. Interfacility transfer was common but was not related to survival.

DISCUSSION: ECMO use demonstrated steady growth in the number of performing facilities throughout the study period. Survival was similar to previous reports. Our findings will help inform targeted clinical guidelines for the use of ECMO in adult and pediatric trauma populations.

PMID:42000207 | DOI:10.1016/j.injury.2026.113271

Int Orthop. 2026 Apr 18. doi: 10.1007/s00264-026-06809-z. Online ahead of print.

ABSTRACT

BACKGROUND: Medial opening wedge high tibial osteotomy (MOWHTO) is a widely used procedure for treating varus knee osteoarthritis. While achieving an appropriate postoperative coronal alignment is considered important, it is not well established whether optimal alignment actually translates into better patient-reported outcomes.

METHODS: We retrospectively evaluated 203 knees in 173 patients, who underwent MOWHTO. Based on postoperative hip-knee-ankle (HKA) alignment, patients were classified into optimal and non-optimal groups. Clinical outcomes were assessed using the Knee Society Score, Knee Society Functional Score, Oxford Knee Score and WOMAC. Conversion to Total Knee Arthroplasty (TKA) was defined as failure. Surgical survivorship was analysed using Kaplan-Meier method and the log-rank test. Patient Related Outcome Measures (PROM) analysis included only patients who retained their native knee at final follow-up.

RESULTS: Preoperative and early postoperative HKA angles were similar between groups. However, at a mean follow-up period of approximately 11.5 years, patients in the non-optimal group showed significantly greater loss of correction, reflected by a higher ΔHKA (p < 0.001). Among patients who did not undergo TKA, postoperative PROMs were comparable between the two groups. Although the overall rate of conversion to TKA was similar, survivorship analysis showed that failure occurred significantly earlier in the non-optimal alignment group (log-rank χ2 = 29.11, p < 0.001).

CONCLUSION: While optimal alignment after MOWHTO does not appear to improve patient-reported outcomes, it is associated with better long-term survivorship of the osteotomy. In contrast, non-optimal alignment is linked to earlier failure and earlier conversion to TKA, suggesting that alignment accuracy primarily influences longevity rather than long-term function.

PMID:42000869 | DOI:10.1007/s00264-026-06809-z

Int Orthop. 2026 Apr 18. doi: 10.1007/s00264-026-06813-3. Online ahead of print.

NO ABSTRACT

PMID:41999423 | DOI:10.1007/s00264-026-06813-3