Injury. 2025 Jul 29;56(10):112635. doi: 10.1016/j.injury.2025.112635. Online ahead of print.

ABSTRACT

INTRODUCTION: The far cortical locking (FCL) system reduces axial stiffness in locked plating constructs while maintaining construct strength, thereby promoting secondary bone healing following fracture fixation. However, studies evaluating its efficacy compared with standard locked plating (LP) systems for upper extremity fractures remain limited. This study compared humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using either the FCL or LP system.

MATERIALS AND METHODS: We analyzed 40 patients with diaphyseal humeral fractures treated with MIPO using either FCL or LP and conducted a matched-pair comparative analysis. Prospective data were collected from 20 consecutive patients who underwent MIPO with FCL. A matched case-control cohort was constructed by pairing MIPO cases using LP with the most closely matched FCL cases. The primary outcome was a comparison of radiographic and clinical fracture healing, as well as complications, between the two groups using statistical analysis. Statistical significance was set at p < 0.05.

RESULTS: Union was achieved in 18 of 20 cases (90 %) in the FCL group at a mean of 13.6 weeks. All 20 cases in the LP group achieved union after a mean of 20.1 weeks. Time to union was significantly shorter in the FCL group (p < 0.05), though the union rate did not differ significantly (p = 0.49). Near cortex healing occurred at a mean of 11.2 weeks in the FCL group and 18.8 weeks in the LP group (p < 0.01). Two FCL cases required revision surgery due to screw breakage or pull-out at the proximal fracture segment. Mean coronal and sagittal angulations were 2.9° and 4.8° in the FCL group, and 2.4° and 3.3° in the LP group, with no significant differences (p = 0.60 and 0.24). No significant differences in functional outcomes were observed between the groups.

CONCLUSIONS: The FCL group showed significantly faster union compared to the LP group, but no significant differences in union rate, alignment, or functional outcomes. Although not statistically significant, a 10 % complication rate was observed in the FCL group. Caution is warranted, as FCL screws may fail at the proximal fracture segment, either by breakage due to mechanical overload or by pull-out.

PMID:40753694 | DOI:10.1016/j.injury.2025.112635

Injury. 2025 Jul 24;56(10):112621. doi: 10.1016/j.injury.2025.112621. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and compare the medium- to long-term outcomes of the Femoral Neck System (FNS), FNS combined with the Anti-Rotation Screw (ARS), and Multiple Cancellous Screws (MCS) in the treatment of femoral neck fractures in young and middle-aged patients.

METHODS: A retrospective, multi-group comparative cohort study was conducted on 731 young and middle-aged patients with femoral neck fractures treated at Level I Trauma Center between September 2019 and January 2024. Patients were divided into three groups based on the surgical method: FNS group (327 cases), FNS+ARS group (120 cases), and MCS group (284 cases). Postoperative follow-up assessments included fracture healing time, functional scores (Harris Hip Score [HHS], Oxford Hip Score [OHS], Hip Outcome Score [HOS]), and complication rates (femoral neck shortening, femoral head necrosis, nonunion, and implant-related complications).

RESULTS: Key findings demonstrated the FNS+ARS group achieved significantly faster fracture healing (10.21 ± 1.33 weeks) versus FNS (12.52 ± 1.91) and MCS (13.57 ± 2.13 weeks; P = 0.036). Functional outcomes consistently favored FNS+ARS across all timepoints:3 months: HHS (61.54 ± 2.98 vs 58.15 ± 2.34 vs 54.43 ± 2.79, P < 0.001), OHS (37.19 ± 2.35 vs 43.20 ± 2.91 vs 42.89 ± 3.00, P < 0.001), HOS (33.59 ± 2.39 vs 32.21 ± 2.32 vs 30.39 ± 2.72, P < 0.001);6 months: HHS (87.35 ± 5.58 vs 81.95 ± 5.99 vs 76.54 ± 5.45, P < 0.001), OHS (22.66 ± 2.78 vs 25.96 ± 3.64 vs 27.66 ± 4.81, P < 0.001), HOS (76.02 ± 5.47 vs 75.42 ± 7.63 vs 73.38 ± 6.75, P < 0.001);Final follow-up: HHS (91.95 ± 9.06 vs 90.38 ± 11.21 vs 87.67 ± 11.71, P < 0.001), OHS (21.04 ± 8.71 vs 20.41 ± 7.88 vs 23.40 ± 10.18, P < 0.001), HOS (87.51 ± 12.93 vs 85.84 ± 16.22 vs 85.98 ± 15.00, P < 0.001);Complication rates were significantly lower with FNS+ARS, particularly for femoral neck shortening (2.50 % vs 8.87 % vs 5.28 %; P = 0.031) and avascular necrosis (6.67 % vs 10.92 %; P = 0.040).

CONCLUSION: FNS combined with ARS outperformed FNS and MCS in promoting fracture healing, reducing postoperative complication rates, and accelerating functional recovery.

PMID:40752181 | DOI:10.1016/j.injury.2025.112621

Injury. 2025 Jul 28:112625. doi: 10.1016/j.injury.2025.112625. Online ahead of print.

ABSTRACT

INTRODUCTION: Uncontrolled rib fracture pain can lead to hypoventilation, impaired airway clearance, and progression to respiratory failure and death. Pain control is a mainstay of treatment, but pain assessments are most commonly obtained while a patient is at rest. A novel approach is to assess movement-evoked pain in order to better capture pain that limits physical function. We hypothesized that movement-evoked pain scores (MPS) for patients with rib fractures would be higher than resting pain scores (RPS) and would better correlate with opioid administration.

METHODS: A retrospective observational study was performed at a single Level 1 trauma center. Adult trauma patients (≥18 years old) admitted between January and March of 2022 with at least one rib fracture were included. Patients with other significant injuries (non-chest AIS >2) or those unable to self-report pain scores were excluded. Pain was scored on a 0-10 scale, with 10 indicating the most severe pain. RPS and MPS obtained at the same time during the first ten hospital days were averaged, and the means were compared using paired t-tests. Additionally, mean daily morphine milligram equivalents (MME) were analyzed.

RESULTS: The cohort consisted of 80 patients (median age 69 [IQR 48-79]; 65 % male; 88 % white). The majority were involved in blunt trauma (95 %) with a median length of admission of 4 days (IQR 2-8). The median number of rib fractures was 4 (IQR 2-6), and the median injury severity score was 10 (IQR 9-14). A total of 1692 paired pain scores from 416 patient hospital days were analyzed with higher mean daily MPS across all hospital days (p < 0.001). MPS and RPS differed for 79 % of patient hospital days, with a mean difference of 2.3 (SD 1.4, p < 0.001). Higher mean daily MPS were correlated with higher mean daily opioid use (R2=0.54), and days with differing scores had higher mean MME [42.5 (SD 49.6) vs 23.6 (56.1)].

CONCLUSIONS: Resting and movement-evoked pain scores for patients with rib fractures varied significantly, and movement-evoked pain scores were consistently higher. Opioid use was positively correlated with movement-evoked pain scores. Utilization of movement-evoked pain scores may improve patient pain control and outcomes.

PMID:40750533 | DOI:10.1016/j.injury.2025.112625

Injury. 2025 Jul 27:112628. doi: 10.1016/j.injury.2025.112628. Online ahead of print.

NO ABSTRACT

PMID:40750532 | DOI:10.1016/j.injury.2025.112628

Int Orthop. 2025 Aug 1. doi: 10.1007/s00264-025-06623-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the effectiveness of an intelligent fracture reduction robotic system in assisting closed reduction and intramedullary nailing of femoral shaft fractures with that of conventional fluoroscopy-assisted manual reduction and fixation.

METHODS: In this prospective, non-randomized controlled study, 30 patients with newly diagnosed femoral shaft fractures were enrolled, with 15 cases in the experimental group (robot-assisted) and 15 cases in the control group (conventional). The experimental group utilized an orthopaedic surgical navigation system to assist in closed reduction and intramedullary nailing, while the control group underwent fluoroscopy-assisted manual reduction and fixation. The reduction time, total operation time, intraoperative fluoroscopy count, blood loss, and reduction error were compared between the two groups.

RESULTS: Baseline characteristics were similar across both groups. The experimental group required significantly fewer intraoperative fluoroscopies (36.67 ± 25.41 vs. 117.26 ± 61.28, P < 0.001). Postoperative femoral length discrepancy (1.74 ± 1.37 mm) and anteversion difference (3.66 ± 3.37°) were significantly smaller in the experimental group compared to the control group (4.16 ± 2.67 mm, P = 0.004; 13.81 ± 9.58°, P = 0.001). Intraoperative blood loss was comparable between groups (experimental group: 207.33 ± 119.91 mL vs. control group: 240.00 ± 139.13 mL, P = 0.497). Reduction time was not statistically significant (experimental group: 74.27 ± 27.38 min vs. control group: 69.73 ± 34.10 min, P = 0.691).

CONCLUSIONS: The robot-assisted approach provided more precise fracture reduction, required fewer intraoperative X-ray fluoroscopies, and offered significant advantages over the conventional method for the minimally invasive treatment of femoral fractures.

PMID:40748453 | DOI:10.1007/s00264-025-06623-z

Injury. 2025 Jul 16:112617. doi: 10.1016/j.injury.2025.112617. Online ahead of print.

ABSTRACT

OBJECTIVE: Electrical burn injuries associated with copper wire theft represent a unique and dangerous subset of injuries observed in clinical practice. Economic hardship and the high value of copper wires drive some individuals to engage in the risky act of scavenging wires, often cutting them directly from live electrical poles. This study aims to investigate the prevalence and clinical outcomes of electrical burn injuries resulting from copper wire theft.

METHODS: This retrospective analysis reviewed medical records of patients presenting with electrical burns caused by contact with live electrical wires in urban settings. Cases were included if patient histories, eyewitness accounts, or police reports confirmed illegal wire cutting as the cause of injury. Data collected included demographic information, total body surface area (TBSA) burned, associated injuries such as fractures and amputations, creatine kinase (CK) levels, and mortality outcomes.

RESULTS: Thirty-six patients were included, with an average age of 27.72 (14.58) years, the majority of whom were male (97 %). The mean TBSA burned was 16.19 %. Fractures were reported in 22 patients (61 %), and 10 patients (28 %) underwent amputations of digits or limbs. Eight individuals (22 %) did not survive their injuries. Statistical analysis revealed a significant relationship between mortality and factors such as TBSA (P = 0.0001), amputation (P = 0.0001), CK levels, and ICU length of stay (P = 0.0001). Additionally, elevated CK levels were strongly correlated with longer ICU stays (P = 0.0001).

CONCLUSION: Electrical burn injuries linked to copper wire theft are severe and frequently lead to debilitating outcomes such as amputations, fractures, and high mortality rates. These injuries highlight the intersection of economic desperation and public health risk. Preventive efforts should prioritize educational campaigns, socio-economic interventions, and stringent measures to deter copper wire theft.

PMID:40744782 | DOI:10.1016/j.injury.2025.112617

Injury. 2025 Jul 27:112630. doi: 10.1016/j.injury.2025.112630. Online ahead of print.

ABSTRACT

BACKGROUND: Ideal blood transfusion practices have evolved over the last decade, with updated recommendations for the plasma:red blood cell (RBC) ratio. A ≥ 1:1 ratio of plasma:RBC has been associated with improved survival. The objective of the current study was to evaluate interhospital variation in plasma:RBC ratio and the associated inpatient mortality.

METHODS: All adult patients (≥18 years) with severe injuries undergoing transfusion within 4 hours of admission were identified in the 2020-2021 Trauma Quality Improvement Program database. Transfusion was considered balanced when whole blood or a ≥ 1:1 ratio of plasma:RBC units was administered. Multilevel mixed-effects models were utilized to generate empirical Bayesian estimates of random intercepts for risk-adjusted plasma:RBC ratio at each center, with centers in the highest quartile labeled High-Ratio Centers (HRC). Multivariable logistic regression was constructed to identify factors independently associated with mortality.

RESULTS: Of 35,215 patients receiving care across 424 facilities, 38.0% were admitted to HRC. An estimated 17% of plasma:RBC variation was attributable to hospital effects (intraclass correlation coefficient = 0.17). Following risk-adjustment, HRC (Adjusted Odds Ratio [AOR] 0.81, 95% Confidence Interval [CI] 0.76-0.86) and balanced transfusion (AOR 0.92, 95%CI 0.86-0.98) were associated with reduced odds of mortality. The association of HRC with lower odds of mortality persisted when examining only unbalanced transfusions (n = 28,280, AOR 0.84, 0.78-0.90 95%CI).

DISCUSSION: Care at centers with high plasma:RBC ratios was linked to reduced mortality, even among unbalanced transfusion. Our findings demonstrate the utility of this value as a hospital quality metric.

PMID:40744781 | DOI:10.1016/j.injury.2025.112630

Injury. 2025 Jul 26:112629. doi: 10.1016/j.injury.2025.112629. Online ahead of print.

NO ABSTRACT

PMID:40744780 | DOI:10.1016/j.injury.2025.112629

Injury. 2025 Jul 15;56(10):112615. doi: 10.1016/j.injury.2025.112615. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the economic burden of hip fracture hospitalizations associated with mental health and substance use (MHSU) disorder.

METHODS: We retrospectively analyzed the National Inpatient Sample 2016-2020. Patients 65 years and older with hip fracture-related ICD-10 diagnosis and discharge codes were selected. Pre-defined by Clinical Classification Software (CCS), we identified 34 MHSU groups. We analyzed MHSU disorders in two ways: first, we looked at patients with at least one MHSU disorder to compare demographic and clinical characteristics; and second, we examined individual MHSU categories separately to assess their prevalence and compare costs. The dependent variable was the hospitalization cost adjusted for 2024 inflation. Multiple regression analysis with a log transformation of costs was used to assess hospitalization costs by individual MHSU categories, adjusting for confounding factors.

RESULTS: Of 274,784 inpatient hip fracture admissions, 35 % had at least one diagnosis related to MHSU. Among the 34 MHSU categories, only five had a prevalence greater than 1 %: depression (15 %), anxiety or fear-related disorders (14 %), alcohol use (3 %), opioid use (3 %), and tobacco use (9 %). Patients with MHSU were younger and had longer hospital length of stay (LOS) than patients with no MHSU (NoMHSU) (median age 80 vs. 84 years, p < 0.001; median LOS 5 days vs. 4 days, p < 0.001). The total estimated cost of hospitalization for the cohort was $30.5 billion during the study period. Patients with MHSU incurred higher mean hospitalization costs compared to NoMHSU ($22,634 vs. $22,000, p < 0.001). After adjusting for demographic, regional, and clinical factors, costs were 4 % (p < 0.001) and 6 % higher (p < 0.001) for patients with alcohol-related and opioid-related disorders, respectively, compared to those without these conditions.

CONCLUSIONS: The economic burden of hip fractures in older adults is significant and exacerbated by the presence of substance use disorders, particularly alcohol- and opioid-related, underscoring the need for targeted policies and clinical interventions to optimize care and resource allocation for this population.

PMID:40743636 | DOI:10.1016/j.injury.2025.112615

J Bone Joint Surg Am. 2025 Jul 31. doi: 10.2106/JBJS.24.01197. Online ahead of print.

ABSTRACT

As orthopaedic surgeons, we embrace a lifestyle and career defined by action, seeking to improve not only our patients' lives but also our profession. One critical area where we can improve lies in diversity, equity, and inclusion (DEI). Despite mounting evidence of the profound value that diverse teams bring to innovation, problem-solving, and patient care, orthopaedics has lagged behind most medical specialties in achieving a representative workforce. Addressing this disparity is important in advancing our profession and improving the equitable treatment of our patients. Recognizing this imperative, the American Orthopaedic Association (AOA) hosted a DEI symposium in June 2024, in conjunction with its annual meeting, that brought together orthopaedic surgeons, researchers, and educators to build upon the importance of creating inclusive spaces in order to ensure that diverse voices are present and are actively contributing to the future of the profession of orthopaedics. A standout feature of the 2024 symposium was a fireside chat format that was accompanied by dynamic audience participation, offering valuable insights and actionable strategies drawn from both the business world and medical oncology. These fields have made substantial strides in promoting diversity and inclusivity, providing a model for orthopaedics in overcoming similar challenges. The discussions illuminated the critical concept of allyship and examined the tangible steps that individuals and institutions can take. Allyship, as emphasized during the forum, requires deliberate, sustained effort. It is an active commitment to understanding and supporting underrepresented individuals and groups within the orthopaedic community. This means listening to their experiences, challenging biases, and working collaboratively to dismantle structural barriers. For institutions, it involves cultivating policies, mentorship opportunities, and recruitment strategies that prioritize equity and that reflect the diverse patient populations that we serve. By embracing allyship and adopting lessons from other fields, this symposium demonstrated opportunities to transform our profession and the lives of those who depend on our care, ensuring that our actions align with the ideals that we strive to uphold.

PMID:40743367 | DOI:10.2106/JBJS.24.01197

J Bone Joint Surg Am. 2025 Jul 31. doi: 10.2106/JBJS.24.01530. Online ahead of print.

ABSTRACT

BACKGROUND: Meniscal ramp lesions can impact knee stability, particularly when associated with anterior cruciate ligament (ACL) injuries. Although magnetic resonance imaging (MRI) is the primary diagnostic tool, its diagnostic accuracy remains suboptimal. We aimed to determine whether deep learning technology could enhance MRI-based ramp lesion detection.

METHODS: We reviewed the records of 236 patients who underwent arthroscopic procedures documenting ACL injuries and the status of the medial meniscal posterior horn. A deep learning model was developed using MRI data for ramp lesion detection. Ramp lesion risk factors among patients who underwent ACL reconstruction were analyzed using logistic regression, extreme gradient boosting (XGBoost), and random forest models and were integrated into a final prediction model using Swin Transformer Large architecture.

RESULTS: The deep learning model using MRI data demonstrated superior overall diagnostic performance to the clinicians' assessment (accuracy of 73.3% compared with 68.1%, specificity of 78.0% compared with 62.9%, and sensitivity of 64.7% compared with 76.4%). Incorporating risk factors (age, posteromedial tibial bone marrow edema, and lateral meniscal tears) improved the model's accuracy to 80.7%, with a sensitivity of 81.8% and a specificity of 80.9%.

CONCLUSIONS: Integrating deep learning with MRI data and risk factors significantly enhanced diagnostic accuracy for ramp lesions, surpassing that of the model using MRI alone and that of clinicians. This study highlights the potential of artificial intelligence to provide clinicians with more accurate diagnostic tools for detecting ramp lesions, potentially enhancing treatment and patient outcomes.

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

PMID:40743295 | DOI:10.2106/JBJS.24.01530

Injury. 2025 Jul 3:112562. doi: 10.1016/j.injury.2025.112562. Online ahead of print.

ABSTRACT

Not available.

PMID:40738828 | DOI:10.1016/j.injury.2025.112562

Injury. 2025 Jul 22:112623. doi: 10.1016/j.injury.2025.112623. Online ahead of print.

ABSTRACT

PURPOSE: Inferior vena cava (IVC) filters are considered for preventing fatal pulmonary embolism (PE) in patients unable to undergo anticoagulant therapy. Trauma patients face a heightened risk of PE due to immobility and hypercoagulability. Although effective, IVC filters have long-term risks and should be removed when no longer indicated. A dedicated follow-up clinic can improve IVC filter retrieval rates and minimize complications. This study evaluates the impact of a dedicated clinic on retrieval rates, complications, and follow-up.

METHODS AND MATERIALS: A retrospective analysis was conducted on trauma patients with IVC filters inserted between October 2011 and October 2021. A dedicated trauma clinic, established in January 2018, followed discharged patients with inserted IVC filters. Inclusion criteria included prophylactic and therapeutic indications and emergent presentations. Patients who died during hospitalization or had filters retrieved at other hospitals were excluded.

RESULTS: During the pre-clinic period, 639 IVC filters were inserted, and 380 (59.5 %) were retrieved, with an average dwell time of 200 days. In the post-clinic period, 332 filters were inserted, and 278 (83.8 %) were retrieved, with a reduced average dwell time of 150 days. Complications decreased from 37 cases (average dwell time: 303 days) pre-clinic to 10 cases (average dwell time: 187 days) post-clinic.

CONCLUSION: The establishment of a dedicated follow-up clinic significantly improved IVC filter retrieval rates and reduced dwell times at this trauma center. This study highlights the value of follow-up clinics in ensuring timely IVC filter retrieval and minimizing complications when filters are no longer clinically required.

PMID:40738827 | DOI:10.1016/j.injury.2025.112623

Injury. 2025 Jul 24;56(10):112611. doi: 10.1016/j.injury.2025.112611. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.

MAIN OUTCOMES AND MEASURES: The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.

RESULTS: Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (p < 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; p < 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.

CONCLUSION AND RELEVANCE: Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.

PMID:40738012 | DOI:10.1016/j.injury.2025.112611

Injury. 2025 Jul 22:112622. doi: 10.1016/j.injury.2025.112622. Online ahead of print.

NO ABSTRACT

PMID:40731241 | DOI:10.1016/j.injury.2025.112622

Injury. 2025 Jul 10;56(10):112609. doi: 10.1016/j.injury.2025.112609. Online ahead of print.

ABSTRACT

INTRODUCTION: Intraarticular scapular fractures occur mostly in high-energy injuries in contrast to glenoid fractures, which occur mostly in humeral head dislocations. In addition to open repositioning and osteosynthesis, minivascular osteosynthesis under the control of fluoroscopy and arthroscopy has been also used. Arthroscopy allows debridement of the fracture line in the intraarticular area as well as its repositioning during repositioning maneuvers under direct visualization. Furthermore, arthroscopy allows full control over the placement of osteosynthetic material in the subchondral region.

MATERIAL AND METHODS: Between 2013 and 2020, we performed osteosyntheses of 15 intraarticular fractures of the scapula using arthroscopy in addition to perioperative fluoroscopy. Patients were followed up at regular intervals at a mean of 10 days, 4 weeks, 3, 6, 12 and 24 months and 5 years after surgery including radiographic follow-up. Clinical outcomes and signs of radiological fracture healing were assessed continuously. Additionally, at 2 and 5 years after surgery, we evaluated the results according to the Constant score system. In particular, we evaluated ventral flexion of the arm, which we consider the dominant indicator of shoulder joint function.

RESULTS: There were 11 males and 4 females, mean age 37.5 (24-52) years. Perioperatively, we achieved fracture reduction with dislocation in the intraarticular region up to a maximum of 2 mm, which was measured arthroscopically and on perioperative and postoperative radiographs. We did not observe any inflammatory complications in the postoperative period. The mean duration of fracture healing was 112 days. The mean Constant score at two years after surgery was 85 points, and at five years was 87 points.

DISCUSSION: There are relatively few papers on similar topics in the world literature, but those that exist present the benefits of arthroscopy in some types of osteosyntheses of intraarticular fractures of the scapula. The most reported are osteosyntheses of the anterior glenoid in bony Bankart lesions. The numbers of patients in each paper are comparable or smaller.

CONCLUSION: Minimally invasive osteosynthesis of intraarticular fractures of the scapula under arthroscopic control allows precise reduction of fragments. Our study demonstrated favourable outcomes of this method with minimal complications.

PMID:40729990 | DOI:10.1016/j.injury.2025.112609

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00471. Online ahead of print.

ABSTRACT

BACKGROUND: We revaluated the radiographic results of a 2004 landmark, multicenter prospective study of patients with Legg-Calvé-Perthes disease (LCP). In the current study, we developed a new classification to evaluate the femoral head, acetabulum, and greater trochanter in the hips of patients with LCP, to address what we found to be deficiencies in the Stulberg rating system, which is based mainly on femoral head shape.

METHODS: We digitized and analyzed approximately 5,000 radiographs and related data sheets of 337 patients (345 hips) with LCP from the 2004 study. We found many unexpected abnormalities, including serious lesions of the femoral head, that had not been noted in that study. To record our findings in the femoral head, acetabulum, and greater trochanter, we developed a classification system that we termed the HAT (Head, Acetabulum, Trochanter) classification, which assigns the femoral head 1 to 5 points, the acetabulum 1 point if dysplastic, and the greater trochanter 1 point if elevated to or above the femoral head. The sum is the HAT score, which we compared with the Stulberg score, other predictive factors, and the Nonarthritic Hip Score (NAHS) from two 20-year follow-up studies of a number of patients from the 2004 study.

RESULTS: The intraclass correlation coefficient (ICC) of the HAT score was 0.93 (95% confidence interval [CI]: 0.90 to 0.95), and the total HAT score correlated strongly with the NAHS. Forty-nine percent of all hips had acetabular dysplasia, which correlated with a worse NAHS. A HAT of ≤3 was considered a good result. The odds of a patient developing acetabular dysplasia at skeletal maturity were lower after surgical treatment than after nonoperative treatment. In addition, surgically treated patients had better HAT scores than nonoperatively treated patients, especially if their skeletal age was ≥6 years at LCP onset. Better outcomes were also associated with a favorable lateral pillar classification, a younger skeletal at onset, and male sex.

CONCLUSIONS: The HAT classification is reproducible and allows a more comprehensive analysis of the radiographic outcomes of LCP. The system is flexible and would allow for different measures of its 3 components in future studies.

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

PMID:40729461 | DOI:10.2106/JBJS.24.00471

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00835. Online ahead of print.

ABSTRACT

BACKGROUND: Aseptic loosening remains a main complication following total knee arthroplasty (TKA), requiring revision surgery. Radiostereometric analysis (RSA) can assess the risk of aseptic loosening. This study evaluated the migration and segmental motion of cemented and uncemented femoral and asymmetrical tibial Persona components (Zimmer Biomet) with model-based RSA.

METHODS: We conducted a randomized controlled trial with 63 patients (22 male patients and 41 female patients, with a mean age of 62 years) and compared patients who underwent TKA with cemented and uncemented Persona components. The primary outcome measure was the maximal total point motion (MTPM) after 2 years. The Mann-Whitney U test was used to compare groups. Migration was visualized by plotting the mean and 95% confidence interval (CI).

RESULTS: After 3 months, femoral components demonstrated an MTPM of 0.41 mm (95% CI, 0.35 to 0.48 mm) in the cemented group and 0.65 mm (95% CI, 0.50 to 0.80 mm) in the uncemented group. Subsequently, a stabilization occurred, and the MTPM after 24 months was 0.51 mm (95% CI, 0.41 to 0.61 mm) in the cemented group and 0.83 mm (95% CI, 0.65 to 1.02 mm) in the uncemented group. There was a significant difference between fixation types at 3 months (p = 0.04), 6 months (p = 0.03), 12 months (p = 0.02), and 24 months (p = 0.02). At 3 months postoperatively, the tibial component demonstrated an MTPM of 0.70 mm (95% CI, 0.53 to 0.88 mm) in the cemented group and 0.76 mm (95% CI, 0.61 to 0.91 mm) in the uncemented group. A stabilization was then observed, and migration after 24 months was 0.72 mm (95% CI, 0.55 to 0.89 mm) for cemented components and 0.78 mm (95% CI, 0.64 to 0.92) for uncemented components.

CONCLUSIONS: TKA with cemented and uncemented Persona components showed migration values within acceptable ranges, suggesting successful long-term fixation; however, significant differences in mean MTPM between cemented and uncemented femoral components were found.

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

PMID:40729455 | DOI:10.2106/JBJS.24.00835

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.01205. Online ahead of print.

ABSTRACT

BACKGROUND: Lumbar spinal fusion (LSF) is a common surgical procedure for treating lumbar degenerative conditions. The use of osteobiologics to enhance fusion has emerged as a promising alternative to address the limitations of autologous iliac crest bone graft (AICBG), but their comparative efficacy and safety remain unclear. This systematic review and network meta-analysis (NMA) aimed to assess the fusion rates, safety profiles, and clinical outcomes of the use of osteobiologics in LSF.

METHODS: PubMed/MEDLINE and Scopus databases were searched for randomized controlled trials (RCTs) comparing different osteobiologics to AICBG in LSF. Data on fusion rates, complications, pain, disability, blood loss, operative time, and length of stay (LOS) were extracted. The risk of bias was evaluated using the Cochrane Risk of Bias-2 tool, and the certainty of evidence was assessed using the GRADE framework. The NMA was performed using a frequentist random-effects model to compare the efficacy and safety of various osteobiologics, along with associated perioperative and clinical outcomes.

RESULTS: Forty-three RCTs including a total of 3,823 patients were identified. The use of rhBMP-2 (recombinant human bone morphogenetic protein-2) significantly improved fusion rates (odds ratio [OR]: 3.71; 95% confidence interval [CI]: 2.59 to 5.32; p < 0.0001) and reduced complications (OR: 0.30; 95% CI: 0.13 to 0.68; p < 0.0001) compared with AICBG, with moderate certainty of the evidence. Other osteobiologics, including ABM/P-15 (anorganic bone matrix/15-amino acid peptide fragment) and allograft, demonstrated reduced complication rates, although the quality of the evidence was low to very low. No significant differences were observed for pain, disability, or LOS. The use of rhBMP-2, autologous local bone, and silicate-substituted calcium phosphate was associated with decreased operative time, with rhBMP-2 additionally associated with lower intraoperative blood loss.

CONCLUSIONS: Use of rhBMP-2 was associated with significantly higher fusion and lower complication rates compared with AICBG, as well as decreased operative time and blood loss. Other osteobiologics may also offer benefits, but the supporting evidence is low-quality and limited by the notable underrepresentation of these materials in the published literature.

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

PMID:40729448 | DOI:10.2106/JBJS.24.01205

J Bone Joint Surg Am. 2025 Jul 29. doi: 10.2106/JBJS.24.00792. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior cruciate ligament tears are a common injury that is often treated with arthroscopic anterior cruciate ligament reconstruction (ACLR). This meta-analysis investigates the impact of tourniquet use on ACLR and the outcomes of this procedure.

METHODS: Searches were conducted across 4 databases: Embase, PubMed, Scopus, and the Web of Science. The quality of the included studies was assessed using the Consolidated Standards Of Reporting Trials (CONSORT) 2010 checklist. A meta-analysis was performed to compare the outcomes between patients who underwent ACLR with versus without a tourniquet.

RESULTS: Eight studies were eligible for systematic review; of these, 6 were eligible for meta-analysis. The CONSORT scores for the studies ranged from 22 to 37. No significant differences were found between the groups in terms of intraoperative blood loss (standardized mean difference, with versus without a tourniquet [SMD], -2.15; 95% confidence interval [CI]: -5.87, 1.58; I2 = 99%), surgery time (SMD, -0.57; 95% CI: -1.32, 0.18; I2 = 94%), or Lysholm knee scores after 1 year (SMD, -0.06; 95% CI: -0.33, 0.21; I2 = 0%). The quality of the arthroscopic visual field varied across the studies. Postoperative pain levels were significantly higher in the tourniquet group (SMD6-hour follow-up, 1.77; 95% CI: 0.07, 3.47; I2 = 93%), although morphine consumption did not differ significantly between the groups (SMD, 0.25; 95% CI: -0.83, 1.33; I2 = 93%). The no-tourniquet group had significantly greater thigh (SMD, -0.46; 95% CI: -0.79, -0.14; I2 = 36%) and calf (SMD, -0.26; 95% CI: -0.49, -0.03; I2 = 70%) circumferences postoperatively.

CONCLUSIONS: Tourniquet use during ACLR did not significantly impact intraoperative blood loss, hemoglobin levels, or surgery time but was associated with increased postoperative pain. The use of epinephrine solution may be a viable alternative to the use of a tourniquet to improve visualization.

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

PMID:40729445 | DOI:10.2106/JBJS.24.00792