Injury. 2025 Aug 25;56(11):112727. doi: 10.1016/j.injury.2025.112727. Online ahead of print.

ABSTRACT

PURPOSE: Guidelines recommended early surgery for hip fracture to improve outcomes, yet it is often hindered by prehospital delays. However, it remains unclear whether prehospital delay independently leads to poor outcomes of the well-recognized impact of in-hospital delay for hip fracture surgery.

METHODS: We included patients aged over 60 years old who underwent surgery for their first acute hip fracture between 2000 and 2022 at a national trauma center in Beijing, China. Patients were categorized into short prehospital delay (time from injury to hospital admission ≤ 48 h) or long prehospital delay (> 48 h) groups. The primary outcome was a composite endpoint of postoperative complications, and the secondary outcome was 5-year all-cause mortality. Multivariate logistic and Cox regression models were used to assess the association between exposure and outcomes.

RESULTS: Among 3103 included patients (mean age, 78.1 ± 8.3 years; 69.1 % female), 1152 (37.1 %) experienced a long prehospital delay. Patients with long prehospital delay had a higher risk of postoperative complications (28.8 % vs. 16.8 %; adjusted odds ratio = 1.41, 95 % CI, 1.12-1.76, P < 0.01) and 5-year all-cause mortality (63.9 vs. 43.3 per 1000 person-years; adjusted hazard ratio = 1.25, 95 % CI, 1.01-1.57, P < 0.05) compared to those with short prehospital delay after adjusting for potential confounders including in-hospital delay.

CONCLUSION: Prehospital delays is associated with higher risk of postoperative complications and 5-year mortality in older adults with hip fractures, highlighting the need for public health policies to minimize such delays.

PMID:40907271 | DOI:10.1016/j.injury.2025.112727

EFORT Open Rev. 2025 Sep 4;10(9):679-685. doi: 10.1530/EOR-2024-0040.

ABSTRACT

The normal functioning of the shoulder is characterized by the harmonious coordination between the glenohumeral joint and the scapulothoracic complex, a phenomenon commonly referred to as scapulohumeral rhythm (SHR). Reverse total shoulder arthroplasty (rTSA) shoulders exhibit distinct kinematics compared to normal shoulders. Reduced scapulohumeral rhythm (SHR) in rTSA shoulders implies a greater reliance on scapulothoracic motion over glenohumeral motion for arm elevation. Dynamic analyses suggest heightened scapulothoracic movement after rTSA, implying alterations in rotational movements across various planes. Utilization of reliable tools to measure preoperative scapulothoracic motion and forecast postoperative SHR in rTSA may improve functional results. Posture types and scapulothoracic orientation play an important role in optimal implant configuration and positioning, as well as clinical outcome, and should therefore be considered during patient selection, preoperative planning, and implantation of an rTSA. Recognizing the static position and kinematic changes of the scapulothoracic joint is vital for postoperative rehabilitation and optimizing outcomes in rTSA patients.

PMID:40905937 | PMC:PMC12412366 | DOI:10.1530/EOR-2024-0040

EFORT Open Rev. 2025 Sep 4;10(9):686-694. doi: 10.1530/EOR-2024-0218.

ABSTRACT

The results of our survey conducted among the members of the European Society for Surgery of the Shoulder and the Elbow is presented in this article. The two most important features of frozen shoulder are movement restriction and pain. Frozen shoulder is considered secondary if it occurs after surgery or trauma. Corticosteroid injections are recommended as the first choice of pharmacological therapy. Patient education and physical therapy are the first choice of non-surgical therapy. The rate of remaining symptoms was observed in less than 20% of patients.

PMID:40905931 | PMC:PMC12412373 | DOI:10.1530/EOR-2024-0218

EFORT Open Rev. 2025 Sep 4;10(9):660-670. doi: 10.1530/EOR-2024-0139.

ABSTRACT

Rotator cuff tears are prevalent, affecting 20% of the general population, with massive tears accounting for 40% of these cases. Massive tears, those larger than 5 cm or involving several tendons, pose substantial clinical problems, including poorer surgical outcomes and increased recurrence rates. Multiple classification systems offer varied definitions, complicating treatment strategies. The irreparability of these tears, exacerbated by conditions such as tendon atrophy and advanced imaging abnormalities, can further complicate management. Surgical options include superior capsular reconstruction (SCR) and tendon transfers. SCR, which involves attaching a graft to the superior glenoid and greater tuberosity, has shown promise in individuals with intact subscapularis tendons and minimal arthritis. Graft alternatives include fascia lata (FL) autografts, human dermal allografts, and long head of the biceps tendon (LHBT) autografts. Each graft type has distinct advantages and disadvantages, with FL autografts providing greater results despite donor site morbidity. Tendon transfers, such as latissimus dorsi and lower trapezius transfers, offer alternative treatments, especially for younger, more active individuals. This review thoroughly reviews different therapeutic options, emphasizing the most recent evidence and clinical outcomes to help guide the best management of massive posterosuperior irreparable rotator cuff injuries.

PMID:40905927 | PMC:PMC12412289 | DOI:10.1530/EOR-2024-0139

EFORT Open Rev. 2025 Sep 4;10(9):718-725. doi: 10.1530/EOR-2024-0191.

ABSTRACT

PURPOSE: While the incidence of acetabular fractures keeps rising among our older patient population, age-specific rehabilitation guidelines are lacking. Post-surgery weight-bearing is often restricted for 8-12 weeks to avoid secondary fixation failure. However, non- or restricted weight-bearing commonly results in atrophy, and older patients are at additional risk of long-term mobility and functionality loss. Therefore, if the risk of secondary fracture failure proves to be lower than currently believed, early or permissive weight-bearing might actually be the preferred treatment choice to advance fracture healing and decrease recovery time. This study aims to review the current literature on early weight-bearing outcomes of acetabular fractures in older adults.

METHODS: A systematic search of two databases was conducted following PRISMA guidelines. Eligible studies reported on early weight-bearing outcomes of older patients after surgical management. Data were showed in tables alongside a narrative synthesis. Critical appraisal and risk-of-bias tools assessed the study quality.

RESULTS: Six studies were included with a retrospective or observational design, with a total of 147 patients averaging 64 years old. The majority of studies discussed early weight-bearing protocols after percutaneous fixation (PF), with heterogeneity in terminology across protocols.

CONCLUSIONS: Albeit limited and low in evidence, the included studies suggest that early weight-bearing might be a possible alternative for non- or minimally displaced fractures and displaced fractures after PF and open reduction internal fixation, respectively. When risk assessments and functional outcomes are appropriately investigated, early weight-bearing may help patients, especially older adults, avoid suffering and prolonged rehabilitation periods.

PMID:40905923 | PMC:PMC12412364 | DOI:10.1530/EOR-2024-0191

EFORT Open Rev. 2025 Sep 4;10(9):709-717. doi: 10.1530/EOR-2024-0164.

ABSTRACT

PURPOSE: This study investigates the 1-year mortality of fragility fractures of the pelvis (FFP) in patients categorized under this system and treated with surgery or conservative methods, aiming to assess the algorithm's effectiveness.

METHODS: We systematically searched PubMed, Embase, Scopus, and Web of Science for English studies on the 1-year mortality of FFP, with no publication date restrictions. Study quality was assessed using the Newcastle-Ottawa Scale. Pooled 1-year mortality rates were calculated using random-effects models. In addition, if applicable, odds ratios with 95% confidence intervals were employed. PRISMA guidelines were followed for reporting, and the study was registered with PROSPERO.

RESULTS: Analysis of 22 studies encompassing 3,265 patients with FFP revealed a concerning overall 1-year mortality rate of 15.5%. Mortality varied by fracture type, with FFP IV having the lowest rate (7.5%) and FFP III having the highest (17.0%). All studies concurred on conservative treatment for FFP I. For other fracture types, mortality rates differed between conservative and surgical approaches. Conservative treatment resulted in rates of 14.9, 21.8, and 5.1% for FFP II, III, and IV, respectively. Conversely, surgical treatment yielded mortality rates of 16.8, 19.5, and 24.2% for FFP II, III, and IV, respectively.

CONCLUSION: Fragility fractures of the pelvis have high mortality, especially in FFP III. Conservative treatment may be suitable for FFP I, while surgery might be better for FFP III. The rarity of FFP IV fractures limits conclusions, and FFP II fractures lack a clear treatment consensus. Further research is needed to optimize management for these fracture types.

PMID:40905922 | PMC:PMC12412362 | DOI:10.1530/EOR-2024-0164

EFORT Open Rev. 2025 Sep 4;10(9):695-708. doi: 10.1530/EOR-2024-0216.

ABSTRACT

PURPOSE: This systematic review and meta-analysis assesses the comparative effectiveness of home-based and supervised rehabilitation protocols following anterior cruciate ligament reconstruction, with a focus on functional recovery and muscle strength.

METHODS: Registered in PROSPERO (CRD42024585478) and following PRISMA guidelines, we searched Web of Science, PubMed, Ovid MEDLINE, and Cochrane. For the quality assessment, the Cochrane Collaboration risk of bias (RoB) tool was used. Review Manager v5.4 was used for the analysis.

RESULTS: Twelve studies were included qualitatively, and seven quantitatively. Outcomes included subjective knee scores (Lysholm, Tegner, IKDC) and quadriceps/hamstring strength measures. Our findings indicated a 19% improvement in subjective knee scores for home-based protocols in some studies. However, for hamstring strength measures, the supervised protocol was superior (SMD = -0.48, P = 0.02).

CONCLUSION: Overall, home-based rehabilitation outcomes were comparable to supervised programs in functional recovery. However, supervised approaches slightly enhanced muscle strength. Supervised rehabilitation is recommended to optimize strength, especially for athletes, though further research is needed to assess its impact on return to sport.

PMID:40905919 | PMC:PMC12412367 | DOI:10.1530/EOR-2024-0216

EFORT Open Rev. 2025 Sep 4;10(9):671-678. doi: 10.1530/EOR-2024-0067.

ABSTRACT

PURPOSE: To conduct a meta-analysis of clinical studies evaluating the efficacy and safety of arthroscopic and open surgery for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocation using a suture button.

METHODS: The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted the literature searches based on preferred reporting items from systematic reviews and meta-analyses. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for studies comparing arthroscopic and open surgery for the treatment of acute high-grade ACJ dislocation using a suture button. Constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, operation time, and occurrence of complications were analyzed.

RESULTS: Five studies comprising a total of 198 patients were included in this study. The findings revealed that, in comparison to open fixation, arthroscopic fixation resulted in longer surgical durations. However, there were no significant differences between the two techniques in terms of constant score, visual analog scale, coracoclavicular distance, acromioclavicular distance, or the occurrence of complications.

CONCLUSIONS: Based on current evidence, arthroscopic fixation demonstrates comparable postoperative outcomes to open fixation, albeit with longer surgical durations. With ongoing technological advancements and refinement of surgical techniques, the efficiency and accessibility of arthroscopy are expected to improve, potentially solidifying its role as a superior choice in the future.

PMID:40905916 | PMC:PMC12412284 | DOI:10.1530/EOR-2024-0067

EFORT Open Rev. 2025 Sep 4;10(9):646-659. doi: 10.1530/EOR-2025-0071.

ABSTRACT

PURPOSE: This study aimed to comprehensively review the current research status and trends of joint replacement for arthritis patients worldwide.

METHODS: Literature related to joint replacement for arthritis patients from 2004 to 2024 was extracted from the Web of Science Core Collection (WoSCC) database. A systematic qualitative and quantitative analysis of these publications was conducted. Visualization of results was achieved using CiteSpace and VOSviewer software.

RESULTS: In total, 14,349 publications met the inclusion and exclusion criteria and were selected for further research. Keyword analysis revealed a clinical emphasis on optimizing surgical outcomes through advancements in total knee arthroplasty, total hip arthroplasty, and patient-centered metrics. Emerging research hotspots since 2020 included precision techniques such as robotic-assisted surgery, strategies to address periprosthetic joint infection, and the role of psychological factors such as depression and patient satisfaction. Temporal trends highlighted evolving priorities, including personalized alignment protocols, where the burst intensities of kinematic alignment and mechanical alignment were 16.33 and 13.79, respectively, as well as functional recovery and complication prevention. Historical dominance of rheumatoid arthritis research has transitioned to broader exploration of osteoarthritis management and technological innovations in surgical precision.

CONCLUSION: This study revealed a marked transition from rheumatoid arthritis-focused studies to innovations in osteoarthritis management and precision surgical techniques. Clinically, these findings emphasize the need to integrate technological advancements with multidisciplinary frameworks to standardize infection control, optimize implant durability, and enhance rehabilitation outcomes. Future efforts should prioritize personalized alignment strategies, evidence-based infection control protocols, and multidisciplinary rehabilitation frameworks to improve long-term functional outcomes.

PMID:40905904 | PMC:PMC12412288 | DOI:10.1530/EOR-2025-0071

J Bone Joint Surg Am. 2025 Sep 4. doi: 10.2106/JBJS.25.00343. Online ahead of print.

ABSTRACT

As the field of health care continues to evolve, it requires physician leaders who are not only clinically strong but also knowledgeable in business, public health, health-care administration, and medical law. In this article, we investigate the benefits and challenges of pursuing advanced graduate-level education for orthopaedic surgeons. Advanced training can assist clinicians in the development of leadership skills and career advancement opportunities and deepen their understanding of the modern complexities of health-care systems. Key takeaways include the importance of strategic thinking, emotional intelligence, and the ability to navigate complex health-care environments. The decision to pursue an advanced degree should align with an individual's career goals and personal circumstances. Advanced degrees and leadership programs may provide the requisite competencies and valuable tools for physicians to lead effectively in an increasingly dynamic health-care environment.

PMID:40906821 | DOI:10.2106/JBJS.25.00343

J Bone Joint Surg Am. 2025 Sep 4. doi: 10.2106/JBJS.25.00036. Online ahead of print.

ABSTRACT

The U.S. orthopaedic surgery residency match is among the most competitive in medicine; in 2024, 40% of applicants were unmatched. This drives applicants to differentiate themselves, while residency programs aim to evaluate candidates holistically. In order to understand the process that is used to select and educate the best surgeons, we examined medical student advising, the role of national organizations, and programmatic practices for resident selection. Effective career advising is essential for attracting and supporting highly qualified applicants. Exposure through preclinical courses, clerkships, and accessible mentorship enhances interest in orthopaedics among applicants with an array of experiences, skills, and backgrounds. National initiatives (e.g., the Orthopaedic Residency Information Network [ORIN]) provide centralized resources to address disparities in information access, although further standardization and consolidation are needed. Collaboration among national stakeholders is necessary to ensure fairness in the match process and to attract the best applicants. Initiatives like preference signaling have shown promise, increasing interview rates at preferred programs and better aligning applicants with residency opportunities. However, barriers such as limited access to research, costly away rotations, and expensive applications disproportionately affect underrepresented groups, highlighting the need for systemic changes. Resident selection practices must evolve to counter the inefficiencies and biases. Holistic review processes, structured interviews, and mission-driven scoring can improve alignment with program values. Programs must consider their setting and their population and also consider applicants who demonstrate an understanding of, and have an interest in caring for, that community. Improving orthopaedic residency selection requires collaborative efforts across organizations, advisors, and programs to refine processes and ensure the selection and training of those who will advance clinical orthopaedics and the science of orthopaedic surgery and also meet the needs of all patient populations.

PMID:40906795 | DOI:10.2106/JBJS.25.00036

J Bone Joint Surg Am. 2025 Sep 4. doi: 10.2106/JBJS.25.00781. Online ahead of print.

ABSTRACT

Kyle J. Jeray, MD, presented this Presidential Address, "Out of Left Field: Leadership Lessons I Didn't See Coming," at the Annual Meeting of the American Orthopaedic Association in Minneapolis, Minnesota, in June 2025. During his installation, he focused on the importance of 4 personal leadership lessons: (1) personal connections matter, (2) building a team culture, (3) kindness and humility in leadership, and (4) innovation, precision, and adaptability with resilience.

PMID:40906776 | DOI:10.2106/JBJS.25.00781

Injury. 2025 Aug 28;56(11):112730. doi: 10.1016/j.injury.2025.112730. Online ahead of print.

ABSTRACT

BACKGROUND: Substance use disorders (SUD) are common and associated with trauma [1-5]. Despite the high frequency of patients with SUDs presenting with trauma and the ubiquitous concerns about compliance, follow-up, and complications amongst providers caring for these patients there has been little attempt to quantify outcomes in this everyday group of patients. The purpose of the current study was thus to document basic demographics, follow-up rates, and surgical outcomes in orthopedic trauma patients presenting with substance use disorders.

METHODS: A retrospective review of an observational cohort was performed. All skeletally mature patients younger than 70 and with insurance that allowed long term follow-up and surgically treated for orthopedic trauma by a single author at an urban level-1 trauma center between November 2019 and December 2024 were enrolled. 202 patients did not have a pre-existing substance use disorder (NO-SUD), 96 patients did (SUD). Basic demographic information, injury characteristics, follow-up rates, and surgical complication rates over the first post-operative year were compared.

RESULTS: Mean age and percentage of male/female did not differ between SUD and NO-SUD cohorts. There were more white and fewer Asian/Pacific Islanders in the SUD cohort. Of the 10 most common comorbidities, there was only a significantly higher rate of congestive heart failure (CHF) in the SUD cohort. Injury location did not differ between cohorts. Those in the SUD cohort more often had high grade open fractures. Follow-up rates in both groups were poor, but worse at all time points for those in the SUD cohort. The SUD cohort also had significantly longer lengths of stay and a higher mortality rate at 1 year. Infection, construct failure, and amputations rates were all higher in the SUD cohort.

CONCLUSIONS: Demographics between the SUD and NO-SUD populations were similar. Injury severity, follow-up rates, and complication rates were all significantly worse in the SUD cohort. Such data can be used by surgeons to council patients on prognosis and when discussing the risks and benefits of surgical intervention in the SUD population.

LEVEL OF EVIDENCE: III.

PMID:40902314 | DOI:10.1016/j.injury.2025.112730

Injury. 2025 Aug 24;56(11):112715. doi: 10.1016/j.injury.2025.112715. Online ahead of print.

ABSTRACT

BACKGROUND: Urban expansion into natural habitats has increased human interactions with wild terrestrial and aquatic species, leading to a rise in animal-related injuries. These incidents often result in complex infections, posing major public health challenges. This study examines the epidemiology, therapeutic interventions, and clinical outcomes of infections from non-domesticated animal injuries in the Mornington Peninsula, Australia.

METHODS: This retrospective study (February 2021-April 2024) evaluated medical records of patients presenting with injuries from wild species who subsequently developed infections. Selection criteria included only cases with confirmed infections determined by clinical assessment or positive microbial cultures. Injuries from domestic animals, insects, or humans were excluded. The analysis assessed timing of infection onset, microbial culture results, antibiotic sensitivity profiles, and postoperative trajectories.

RESULTS: A total of 52 bites from non-domesticated animals were documented, with 23 % (12/52) being infected. Most were males with an average age of 43 years. Among the 12 infected cases, Staphylococcus aureus was isolated in 3/12 (25 %), β-haemolytic streptococci in 2/12 (17 %), Enterococcus faecalis in 1/12 (8 %), Pseudomonas aeruginosa in 1/12 (8 %), Prevotella bivia in 1/12 (8 %), and Vibrio vulnificus in 1/12 (8 %); mixed coliform growth was observed in 3/12 (25 %). Compared to typical dog and cat bites, usually caused by Pasteurella multocida, streptococci, staphylococci and anaerobes, our series revealed a higher presence of marine-associated pathogens such as Vibrio species and environmental Gram-negative bacilli. Management involved wound debridement with adjunctive medical therapy (7/12), delayed primary closure (3/12), and medical management alone (3/12). All patients received empirical broad-spectrum antibiotics, which were later adjusted based on culture results. Most isolates were pan-sensitive, except for Vibrio vulnificus (ciprofloxacin-sensitive, resistant to penicillins/cephalosporins) and penicillin-resistant Staphylococcus aureus. All patients recovered without complications following comprehensive wound care and targeted antibiotic therapy. Notably, some marine-derived infections exhibited unique resistance patterns that required specific antimicrobial regimens.

CONCLUSIONS: The necessity for immediate comprehensive wound management and empirically guided antibiotic therapy, adjusted based on culture results, was essential for managing these complex infections. The data derived from this study provides essential insights into the microbial dynamics and clinical management of wild animal bite infections, emphasizing the need for individualized medical strategies.

PMID:40902313 | DOI:10.1016/j.injury.2025.112715

J Bone Joint Surg Am. 2025 Sep 3. doi: 10.2106/JBJS.24.01463. Online ahead of print.

ABSTRACT

BACKGROUND: Low- and middle-income countries (LMICs) are disproportionately affected by trauma, resulting in >5 million deaths annually. An essential treatment for musculoskeletal trauma is external fixation. However, in LMICs, current external fixator assemblies are unaffordable, costing patients upward of $5,000 (USD), leaving LMICs to rely on donations that fail to meet the needs of the patient population.

METHODS: New, affordable external fixator (AEFIX) clamps (SONA Global), designed for use in LMIC settings, were compared with Hoffmann 3 (Stryker Medical) clamps to examine their mechanical efficacy compared with commercially available, industry-standard clamps in the U.S. market. In axial and torsional loading scenarios, mechanical testing was performed at the component level and construct level (uniplanar external fixation of a tibial diaphyseal fracture).

RESULTS: The AEFIX constructs showed no differences in axial or torsional stiffness compared with Stryker constructs. AEFIX constructs yielded at 434.5 N compared with Stryker constructs at 533.6 N (p = 0.04); however, the pins failed before clamp failure could occur in all AEFIX and Stryker constructs. Under cyclic loading at 100 and 300 N, no differences were observed in construct stiffness or interfragmentary gap change. At 500 N of cyclic loading, the AEFIX and Stryker constructs resulted in median gap changes of -4.3 and -1.1 mm, respectively (p < 0.001), with no difference in % change in construct stiffness (p = 0.281).

CONCLUSIONS: AEFIX clamps were comparable to industry-standard Stryker Hoffman 3 clamps in terms of mechanical properties and effectiveness, suggesting that the AEFIX clamps may provide safe external fracture fixation in the non-weight-bearing patient.

CLINICAL RELEVANCE: As a safe and affordable solution, AEFIX clamps provide a foundation for enhancing essential trauma surgery capacity in resource-constrained settings around the globe.

PMID:40901974 | DOI:10.2106/JBJS.24.01463

J Bone Joint Surg Am. 2025 Sep 3. doi: 10.2106/JBJS.24.01390. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to develop a frailty index for pediatric patients undergoing posterior spinal fusion for deformity correction.

METHODS: The National Surgical Quality Improvement Program (NSQIP) Pediatric database was used. Patients <18 years of age who had undergone posterior spinal fusion for the treatment of spinal deformity were included. The outcomes of interest included any adverse events, Clavien-Dindo grade-IV adverse events, mortality, and extended length of stay. Significant variables from the multivariable regression analysis were used to create a frailty index. The frailty index was assessed with use of receiver operating characteristic (ROC) curve analysis of each outcome of interest. The frailty index was externally validated with use of a validation cohort. The rates of the outcomes of interest were expressed as proportions and were stratified by the frailty index score.

RESULTS: The present study included 34,478 patients (28,377 in the derivation cohort and 6,101 in the validation cohort). The frailty index included severe respiratory disease, gastrointestinal disease, neuromuscular disease, cognitive/developmental delay, seizure disorder, and asthma. In the derivation cohort, the area under the curve (AUC) for any adverse event, a Clavien-Dindo grade-IV adverse event, mortality, and extended length of stay were 0.77, 0.85, 0.91, and 0.79, respectively. On external validation, the AUC for any adverse event, a Clavien-Dindo grade-IV adverse event, mortality, and extended length of stay were 0.72, 0.88, 0.90, 0.78, respectively. An increasing frailty index score was associated with increasing rates of all morbidity and mortality outcomes.

CONCLUSIONS: The frailty index had good to excellent discrimination for morbidity and mortality. This frailty index allows for better risk stratification and informed decision-making.

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

PMID:40901929 | DOI:10.2106/JBJS.24.01390

J Bone Joint Surg Am. 2025 Sep 3;107(17):e86. doi: 10.2106/JBJS.25.00669.

NO ABSTRACT

PMID:40900119 | DOI:10.2106/JBJS.25.00669

J Bone Joint Surg Am. 2025 Sep 3;107(17):e87. doi: 10.2106/JBJS.25.00559.

NO ABSTRACT

PMID:40900099 | DOI:10.2106/JBJS.25.00559

Int Orthop. 2025 Sep 3. doi: 10.1007/s00264-025-06643-9. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a major health burden for adults and the elderly globally; however, national radiological and epidemiological data and predictive models for KOA are lacking in China. Most of the existing studies are limited to regional samples, which cannot accurately reflect disease burden and risk factors.

OBJECTIVES: This study aimed to systematically analyze the prevalence and risk factors of adult radiology KOA in China for the first time using a national representative sample and to develop a prediction model to provide a basis for public health strategies.

METHODS: A multi-stage stratified random sampling method was employed to select 30 cities and 10 rural counties from 10 provinces, consisting of 30,455 participants aged 50 years and older who had lived in the area for at least five years. Knee X-rays were assessed using the Kellgren-Lawrence grading system, and demographic, clinical, and geographic data were collected. Samples were randomly divided into modeling and validation groups. A predictive model was developed using multiple logistic regression, and its performance was validated using receiver operating characteristic curves, calibration plots, and decision curve analysis. Further, an interactive web calculator based on R Shiny was developed.

RESULTS: This study enrolled 31,206 individuals. Questionnaires from 751 (2.5%) individuals were ultimately excluded due to missing items, insufficient responses, or logical errors. After exclusions, 30,455 (97.5%) individuals participated in the Chinese National KOA Study, consisting of 11,605 (38%) and 18,850 (62%) from urban and rural areas and 13,444 (44%) and 17,011 (56%) men and women, respectively. A total of 9,145 participants were diagnosed with radiographic KOA, and 3,515 participants, including 969 men and 2,546 women, had symptomatic knees. The population-weighted prevalence of radiographic KOA in China was 27.9 (95% confidence interval: 24.8-31.1) per 1000 people. A predictive model for KOA was developed, and its validity was verified among male and female patients. Significant risk factors for men included age, education, body mass index (BMI), central obesity, and residence in the hills; whereas, for women, age, education, BMI, previous knee impairment, more than two childbirths, and hypertension were risk factors. Two interactive web calculators based on R shiny were developed to access the probability of KOA. The website address for male patients was https://kneeosteoarthritisnomogram.shinyapps.io/DynNomapp/ , and for female patients was https://femalekneeosteoarthritisnomogram.shinyapps.io/DynNomapp/ .

CONCLUSIONS: Our results provide detailed information on knee joint incidence, distribution, and risk factors, which is considered the latest clinical evidence basis for national healthcare planning and prevention efforts in China and other regions. To facilitate KOA prevention, public health policies focusing on risk factors for KOA, such as maintaining a healthy weight, implementing health management, and reducing underlying diseases, should be implemented. Further, men should avoid living in mountainous areas and women should have fewer childbirths and not have knee impairments.

PMID:40900168 | DOI:10.1007/s00264-025-06643-9

Injury. 2025 Aug 28;56(11):112729. doi: 10.1016/j.injury.2025.112729. Online ahead of print.

ABSTRACT

BACKGROUND: Major limb amputation salvage procedures exhibit an increased risk of failure when revascularization is delayed beyond 360 min. Institutional delays persist as critical barriers, even with advancements in surgical techniques.

METHODS: Retrospective cohort study (November 2022- December 2024) at Level I Trauma Center. We implemented a systematized emergency protocol featuring: Prehospital activation → Green channel → OR-direct transport Parallel processing → revascularization.

PRIMARY OUTCOME: Revascularization time (limb arrival → arterial flow).

RESULTS: 30 consecutive amputees (M: F = 21:9; mean age 43.6 ± 14.35 yrs). Included 21 upper limbs (6 wrist, 9 forearm, 6 upper arm) and 9 lower limbs (6 ankle, 3 calf). Revascularization achieved in 142.0 ± 21.17 mins. All cases (100 %) met the ≤180-min golden window. Key timings: Door-to-OR: 19.7 ± 3.2 mins, OR preparation: 20 ± 3.45 mins, Surgery start to revascularization: 102.3 ± 19.8 mins. Limb survival rate reached 96.7 % (29/30). Vascular bridging reconstruction was performed in 17 cases (including 5 cases with emergent anterolateral thigh (ALT) flap arteriovenous bridging). Vascular crisis occurred in 2 cases and was relieved after surgical exploration. The final limb amputation salvage rate was 96.7 % (29/30). One case of ankle-level salvage resulted in postoperative infection and necrosis. At 12-month follow-up, 80 % of upper limbs achieved grasp function (S2-S4 sensibility), and 89 % of lower limbs regained ambulation without prosthesis.

CONCLUSION: The multidisciplinary emergency protocol significantly reduced ischemia time, with rapid revascularization serving as the critical determinant of high limb amputation salvage rates. The protocol achieved functional limb salvage in 83 % of cases, demonstrating that rapid revascularization correlates with both viability and functional recovery.

PMID:40897128 | DOI:10.1016/j.injury.2025.112729