EFORT Open Rev. 2025 Jun 2;10(6):369-377. doi: 10.1530/EOR-2025-0056.

ABSTRACT

Scepticism is still the most common attitude of orthopaedic surgeons toward short stems, despite the excellent survival rate reported in the International Registry, together with an acceptable complication risk. In surgical centres where these types of implants are commonly utilised, they account for a significant percentage of procedures (up to 50% of total hip replacements performed). Potential benefits of bone preservation were evident from the very early phase of introduction. Some complications have been experienced, especially with modular short stems. Some limitations and weak points during the evolution from early designs to modern short stems have been identified. With few exceptions, clinical results and survivorship were very good, despite widened indications (age- and pathology-related), giving an overall retrospective evaluation of our experience with short stems similar to primary hip implants. Failure of short stems is mostly related to the validity of bone preservation in terms of revision strategy. Standard surgical revision was generally performed with two-stage revisions in PJI and stem revision in periprosthetic fracture.

PMID:41223040 | PMC:PMC12139602 | DOI:10.1530/EOR-2025-0056

EFORT Open Rev. 2025 Nov 3;10(11):851-864. doi: 10.1530/EOR-2024-0183.

ABSTRACT

The subacromial bursa is located below the acromion, coracoacromial ligament, and deltoid deep fascia, above the rotator cuff and greater tuberosity of the humerus, and plays a crucial role in physiological processes such as exercise and pathological processes of rotator cuff diseases. The subacromial bursa is associated with inflammatory pain in patients with rotator cuff disease. Removing the bursa during surgery and intra-articular drug injection can both relieve this pain to some degree. Resection of the subacromial bursa improves intraoperative visualization and may loosen an already stiff shoulder joint; however, excessive resection appears to result in more severe adhesion. Current evidence suggests that the subacromial bursa is a source of reparative cytokines and mesenchymal stem cells that may contribute to and enhance the healing of the injured rotator cuff and improve prognosis. Research studies related to the utilization of the subacromial bursa for bioaugmentation is ongoing and shows potential to promote patient recovery. Preservation or bioaugmentation with the subacromial bursa during rotator cuff surgery might lead to a better prognosis, but there is not yet sufficient evidence to prove this.

PMID:41223039 | PMC:PMC12587034 | DOI:10.1530/EOR-2024-0183

EFORT Open Rev. 2025 May 5;10(5):267-276. doi: 10.1530/EOR-2024-0026.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) is performed commonly for various end-stage diseases of the hip joint. However, the likelihood of a subsequent contralateral THA (cTHA) after primary unilateral index THA (iTHA) remains insufficiently defined, with reported rates of 13-29.1% after 5 years and 8.7-54% after 10 years of follow-up. This review aims to determine the long-term likelihood over time of cTHA after iTHA.

METHODS: Systematic review of the literature with meta-analysis, including any clinical study published until July 2022, evaluating or documenting the likelihood over time of cTHA after iTHA, independently of the etiology. Excluded were cTHA within 12 months. A total of 21 studies, including 1,456,071 patients, who subsequently received 249,117 cTHA, were analyzed. Kaplan-Meier analysis was performed, weighting data on sample size, considering death as competing risk.

RESULTS: At 5 years after iTHA, likelihood of cTHA was 17.8% (95% confidence interval 12.3-23.3%). At 10 years, this likelihood increased to 22.7% (16.1-29.4%), with a marginal subsequent increase. The likelihood increased slightly considering death as competing risk.

CONCLUSION: Nearly every fourth THA patient will require cTHA within 10 years. The likelihood of cTHA in this review appears to fall within the lower third of previously published ranges. However, most cTHA are required within the first years. Our findings suggest that the likelihood of requiring cTHA within the initial 10 years is approximately twice as high as the likelihood of requiring revision of the iTHA.

PMID:41223035 | PMC:PMC12061014 | DOI:10.1530/EOR-2024-0026

EFORT Open Rev. 2025 Oct 1;10(10):796-805. doi: 10.1530/EOR-2024-0188.

ABSTRACT

PURPOSE: To evaluate the time taken to recover from arthroscopic rotator cuff repair (ARCR) in terms of pain and function, and to determine if there is an association with the size of the tear.

METHODS: PubMed and EMBASE were searched according to preferred reporting items for systematic reviews and meta-analyses guidelines. The recovery pattern of clinical outcomes and range of motion (ROM) was reported narratively. The percentage of the total improvement at 3 months, 6 months, and 1 year was defined as the recovery rate (%) at each time point. The 2-year score was considered 100% recovery. Subgroup analysis based on tear size was performed.

RESULTS: In total, 28 studies were included in this systematic review. Visual analog scale (VAS) pain score showed over 50% recovery at 3 months, while other clinical scores reached this threshold by 6 months. At 1 year, all clinical scores showed approximately 85% recovery. ROM worsened or showed minimal improvement at 3 months and significant improvement by 6 months or 1 year after ARCR. Tear size did not significantly affect clinical scores at any follow-up period (all P > 0.05).

CONCLUSION: All clinical scores including VAS pain score showed significant improvement at 3 or 6 months after ARCR. Especially, recovery of VAS pain score was faster compared to other clinical scores up to 6 months. ROM recovery slowly started at 6 months after ARCR. Recovery pattern was not different according to the tear size. It can give patients a better understanding of recovery after the operation.

PMID:41223034 | PMC:PMC12495555 | DOI:10.1530/EOR-2024-0188

EFORT Open Rev. 2025 Nov 3;10(11):842-850. doi: 10.1530/EOR-2024-0131.

ABSTRACT

BACKGROUND: Metastatic disease frequently causes pathological fractures, particularly in the proximal femur, significantly impacting patient prognosis and quality of life. With the advancements in cancer treatment leading to longer survival, there is a pressing need to evaluate the outcomes of surgical interventions aimed at managing proximal femoral metastases. This study compares the outcomes of internal fixation (IF) versus prosthesis (P) in the treatment of proximal femoral metastases, focusing on survival times, complication rates, functional outcomes, and reoperation rates.

METHOD: A systematic review and meta-analysis were conducted, searching PubMed, Embase, and Cochrane databases for studies published up to December 31, 2023. The PRISMA guidelines were followed. Studies comparing IF and P for proximal femoral metastases were included. Data on survival times, blood loss, reoperation rates, and functional scores were extracted and analyzed using the forest plot technique and inverse variance method. The quality of included studies was assessed using the Newcastle-Ottawa scale.

RESULTS: In total, 19 studies (16 retrospective and three prospective) involving 4,126 patients were included. The P group demonstrated significantly longer survival times compared with the IF group, with no significant difference in complication and reoperation rates between the two methods. However, IF was associated with shorter operative times and less blood loss.

CONCLUSION: P may provide superior long-term functional outcomes and extended survival compared with IF, with similar rates of complications and reoperations. However, selection bias - where healthier patients with better baseline physiology are more likely to undergo prosthetic reconstruction - significantly impacts the interpretation of these findings, underscoring the need for further prospective studies.

PMID:41223022 | PMC:PMC12587033 | DOI:10.1530/EOR-2024-0131

Injury. 2025 Nov 6:112882. doi: 10.1016/j.injury.2025.112882. Online ahead of print.

ABSTRACT

INTRODUCTION: Social determinants of health (SDOH) and their relationship to patient outcomes have become center-points in efforts to improve healthcare. Most studies rely on aggregated datasets and proxy measures, often using geographic location to assess SDOH, but this approach is prone to ecological fallacy. Using patient-level data, this study sought to analyze the correlation between SDOH and specific outcomes in trauma.

PATIENTS AND METHODS: Patient demographics, social work interview data and trauma admission data were combined for the years 2019-2020 at a large urban academic level 1 trauma center. Missing data were estimated using multiple imputation. Post-operative outcomes were studied including mortality, major complication, readmission, length of stay (LOS), and discharge location. Multivariable analysis was performed by creating models that included the SDOH.

RESULTS: 868 patients with social work evaluations were identified. The mean age was 60.8 years, 62.2 % were male and 77.4 % were white. Financial concerns was the most common SDOH in this population (33.4 %). In multivariable analysis, financial concerns and interpreter requirement were associated with major complication and mortality. Psychiatric history was associated with major complications. Alcohol use was associated with major complications and increased LOS. Male sex, black race, and motor vehicle collision were also associated with an increased LOS.

CONCLUSION: At the patient level, certain demographics and SDOH are predictors of negative outcomes. Early identification of social barriers to discharge in trauma patients may help facilitate disposition, reduce LOS, and help identify patients at risk for post-operative complications and mortality. The mechanism by which SDOH affect post-operative outcomes should be further evaluated.

PMID:41224618 | DOI:10.1016/j.injury.2025.112882

Injury. 2025 Nov 4:112878. doi: 10.1016/j.injury.2025.112878. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt trauma is the main trauma mechanism leading to severe trauma, mortality and disability. Improving data on early death would help in improving current trauma management.

METHODS: This retrospective observational multicentric study was conducted using data from a prospective French national registry (TraumaBase) from January 2017 to December 2022. Inclusion criteria were: blunt trauma who died within the first 24 h in Level 1 Trauma Centers.

RESULTS: Seven hundred twenty-two patients were included. The mean age was 51 (SD 23) years with a male predominance (72.7 %). Mechanisms involved were: road traffic accidents (n = 404, 56.0 %), falls (n = 293, 40.6 %), blunt object traumas (n = 23, 3.2 %), and other mechanisms (n = 2, 0.3 %). Median Injury Severity Score (ISS) was 30 (22-45). The anatomical regions affected were: head/neck (n = 590, 81.7 %), thorax (n = 426, 59.0 %), extremities (n = 339, 47.0 %), abdomen (n = 251, 34.8 %), face (n = 184, 25.5 %), and skin (n = 86, 4.7 %). Two-thirds (n = 508, 70.4 %) of patients presented hemorrhagic shock (HS), with the origin being abdominal (35.0 %), pelvic (25.8 %), or thoracic (15.2 %). Hemostasis was achieved through open surgery (n = 77/126, 61.1 %) or interventional radiology (n = 49/126, 38.9 %). The three main causes of mortality at 24 h were: central nervous system (CNS) injury (n = 310, 42.9 %), hemorrhage (n = 169, 23.4 %), multi-organ failure (MOF) (n = 156, 21.6 %). Potentially Preventable Death (PPD) accounted for 353 patients (48.9 %).

CONCLUSIONS: Early mortality causes after severe blunt trauma in France were neurological (42.9 %), hemorrhagic (23.4 %), and MOF (21.6 %). Among patients with traumatic brain injury (TBI), 65.2 % presented concomitant HS. Hemorrhage remained the second presumed cause of death among PDD, with pelvic origin being the most frequent. Victims of severe blunt trauma should be considered as having isolated or concomitant life-threatening traumatic brain injury and non-compressible extra cranial hemorrhage. Every effort must be made to stabilize these patients, at least temporarily, to obtain rapid injury assessment to identify the "first lethal injury" to treat.

PMID:41224617 | DOI:10.1016/j.injury.2025.112878

Injury. 2025 Oct 31:112877. doi: 10.1016/j.injury.2025.112877. Online ahead of print.

NO ABSTRACT

PMID:41224616 | DOI:10.1016/j.injury.2025.112877

Injury. 2025 Nov 3;56(12):112872. doi: 10.1016/j.injury.2025.112872. Online ahead of print.

ABSTRACT

INTRODUCTION: Humeral shaft fractures are common, often affecting younger patients through high-energy mechanisms. With rising use of e-cigarettes, vapes, and nicotine pouches, the impact of non-tobacco nicotine dependence (NTND) on fracture healing remains unclear. This study evaluates postoperative outcomes following fixation of humeral shaft fractures among NTND patients compared with traditional tobacco users and non-nicotine controls.

METHODS: The US collaborative network (TriNetX) was queried to identify adults undergoing humeral shaft ORIF between the dates of January 1, 2004, and June 1, 2023. Three cohorts were stratified by nicotine status: NTND, tobacco, and nicotine-naive controls. Patients were 1:1 propensity matched by demographics and comorbidities. Significance was set at p < 0.05.

RESULTS: A total of 16,404 patients met inclusion: 1250 with NTND, 2515 with tobacco use, and 12,639 controls. After matching, NTND and control groups each included 1250 patients; NTND and tobacco groups had 1243 each. At 90 days, NTND patients demonstrated higher rates of postoperative complications, including pneumonia (OR 2.19, 95 % CI 1.44-3.31), acute blood loss anemia (OR 1.34, 95 % CI 1.01-1.78), surgical site infection (SSI) (OR 1.785, 95 % CI 1.04-3.07), and ED visits (OR 1.56, 95 % CI 1.22-1.98) compared to non-nicotine controls. Relative to tobacco users, NTND patients experienced increased pneumonia (OR 1.72, 95 % CI 1.17-2.52) at 90 days. At 2 years, NTND patients experienced higher rates of nonunion or malunion (OR 1.63, 95 % CI 1.07-2.49), hardware failure (OR 1.28, 95 % CI 1.01-1.64), and opioid dependence (OR 2.37, 95 % CI 1.289-4.36) compared to non-nicotine controls. There were no significant differences between NTND patients and traditional tobacco users at 2 years.

CONCLUSION: NTND is associated with increased perioperative complications and long-term morbidity following humeral shaft fixation. These findings demonstrate that NTND is not a risk-free alternative to traditional tobacco use and may pose even greater perioperative and long-term risks. NTND should be recognized as a distinct risk factor, underscoring the importance of surgeon awareness in patient counseling and the need for future studies evaluating product-specific effects.

PMID:41223580 | DOI:10.1016/j.injury.2025.112872

Injury. 2025 Nov 5;56(12):112857. doi: 10.1016/j.injury.2025.112857. Online ahead of print.

ABSTRACT

BACKGROUND: Rib fractures are common conditions often associated with significant complications, including respiratory failure, pneumonia, prolonged hospitalisation, and chronic pain. Adequate pain management is crucial to improve outcomes and reduce morbidity in these patients. Despite the wide adoption of multimodal analgesia, the optimal combination of analgesic strategies remains uncertain.

OBJECTIVE: To review and synthesize current evidence on analgesic strategies for acute pain management in patients with rib fractures.

METHODS: We conducted a narrative review by searching scientific literature on PubMed and Scopus to identify randomised controlled trials (RCTs) on analgesia for rib fractures from blunt trauma. Included studies assessed pharmacologic, non-pharmacologic and regional anaesthesia interventions. Studies describing surgical treatment of multiple rib fractures or addressing analgesia for non-traumatic causes of rib fractures (e.g. neoplasms) or study design other than RCTs were excluded. Forty-seven RCTs met the inclusion criteria.

RESULTS: Opioids remain the most studied class of analgesics in the context of rib fracture. While effective for acute pain relief, they pose significant risks, especially in the elderly population. Non-opioid agents - especially non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol -are effective components of opioid-sparing strategies. Thoracic epidural and paravertebral blocks offer superior analgesia and respiratory benefits but are associated with a steep learning curve, are time-consuming, and carry a significant risk of procedural complications. Emerging regional anaesthesia techniques, such as the erector spinae plane (ESP) and serratus anterior plane (SAP) blocks, demonstrated promising results due to their ease of administration and favourable safety profiles. Non-pharmacologic approaches, including cryotherapy, transcutaneous electrical nerve stimulation (TENS), and kinesiotaping, represent additional pain relief options, although evidence remains limited.

CONCLUSIONS: Multimodal analgesia - combining pharmacologic, non-pharmacologic and regional anaesthesia approaches -is considered the most effective strategy to guarantee pain relief in patients with multiple rib fractures. However, substantial heterogeneity remains in the regimens employed. Further research is needed to standardize multimodal analgesic protocols and to assess their impact on long-term, patient-centred outcomes.

PMID:41223579 | DOI:10.1016/j.injury.2025.112857

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06698-8. Online ahead of print.

ABSTRACT

AIM: Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.

METHODS: We retrospectively selected patients > 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.

RESULTS: From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18-75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative Staphylococcus species (n = 10) and Staphylococcus aureus (n = 9) being the most prevalent bacteria, followed by Cutibacterium acnes (n = 5), and Pseudomonas aeruginosa (n = 2). The risk of infection correlated with diabetes mellitus (p = 0.0017), the presence of a fistula (p = 0.001), and the type of index wound according to Cauchoix-Duparc (p = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.

CONCLUSIONS: An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.

LEVEL OF EVIDENCE: Retrospective study, Level III.

PMID:41225170 | DOI:10.1007/s00264-025-06698-8

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06697-9. Online ahead of print.

ABSTRACT

PURPOSE: The goal of surgery for pelvic metastasis is pain-free reconstruction that enables daily activity without complications for the patient's remaining life. The purpose of our study was to assess complications, reoperations, functional outcomes, and survival in patients with pelvic metastasis treated with standard or dual mobility total hip arthroplasty (THA) and antiprotrusio cage.

METHODS: We prospectively analyzed 36 patients with pelvic metastasis who underwent reconstruction with standard (n = 20) or dual mobility (n = 16) bearing THA and antiprotrusio cage between 2015 and 2024 at a single institution. We evaluated complications, reoperations, functional outcomes and survival.

RESULTS: Infection occurred in five of 36 patients (14%): three patients required surgical debridement and two were managed with antibiotics. No dislocations were observed in both standard and dual mobility bearing groups. Local disease progression developed in seven of 36 patients (19%), with only one patient requiring acetabular revision at 63 months postoperatively. Survival of implant was 85.8% (95% CI 74.9%-98.2%) at one year after reconstruction. Median MSTS scores were 22.5 and 20.0 in the standard and dual mobility bearing groups, respectively (p = 0.564), with no difference in ambulation status. Patient survival was 77.7% (95% CI 65.2%-92.6%) at one year and 12.8% (95% CI 4.5%-36.1%) at five years.

CONCLUSION: Patients with pelvic metastasis treated with standard or dual mobility bearing THA with antiprotrusio cage may effectively restore painless function. Despite high risk of infection and local disease progression, no dislocation occurred, supporting this reconstruction as an acceptable surgical option for patients with pelvis metastasis who need surgical treatment.

PMID:41225169 | DOI:10.1007/s00264-025-06697-9

Int Orthop. 2025 Nov 13. doi: 10.1007/s00264-025-06682-2. Online ahead of print.

ABSTRACT

PURPOSE: To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

METHODS: Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

RESULTS: All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

CONCLUSION: Two-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise.

REGISTRY: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.

PMID:41225168 | DOI:10.1007/s00264-025-06682-2

Injury. 2025 Oct 31:112862. doi: 10.1016/j.injury.2025.112862. Online ahead of print.

NO ABSTRACT

PMID:41213847 | DOI:10.1016/j.injury.2025.112862

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06693-z. Online ahead of print.

ABSTRACT

This letter provides a critical commentary on the recent article by Hachadorian et al. entitled "Assessing glenoid orientation on the axillary view: a novel technique using the posterolateral acromion-to-coracoid line." The authors introduced the posterolateral acromion-to-coracoid (PLAC) line as a reproducible reference for assessing glenoid version on axillary radiographs, demonstrating excellent reliability and strong correlation with 3D CT measurements. We highlight the clinical significance of this technique as a cost-effective and radiation-sparing alternative for postoperative evaluation of glenoid orientation. Furthermore, we suggest extending validation to postoperative cases, quantifying projection-related errors, and exploring AI-assisted automation for landmark detection. This work represents a valuable step toward standardized radiographic assessment following shoulder arthroplasty.

PMID:41212192 | DOI:10.1007/s00264-025-06693-z

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06692-0. Online ahead of print.

ABSTRACT

PURPOSE: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA® robotic system, by comparing a senior high-volume surgeon with a low-volume resident.

METHODS: In this single-centre prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA).

RESULTS: Both intra and inter-operator analyses demonstrated good to excellent reproducibility (ICC > 0.75-0.9) for soft tissue and gap assessments. Minor variability was observed in planning parameters (ICC < 0.60), specifically stylus height, femoral flexion, and distal femoral resection, likely reflecting subjective adjustments by the high-volume surgeon.

CONCLUSION: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA® robotic system, while flexibility for individualized surgical strategies is retained.

PMID:41212191 | DOI:10.1007/s00264-025-06692-0

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06691-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Charcot diabetic arthropathy is one of the most serious complications in patients with diabetes mellitus with sensorimotor neuropathy of the lower extremities, accompanied by metabolic disturbances and subsequent destruction of bones and joints. There are many methods of surgical treatment of diabetic charcot's foot described in the literature. A review of the literature found no publications describing the surgical treatment of Charcot arthropathy patients using the method of two-stage replacement of total and subtotal foot bone defects with heterotopic allografts using 3D modelling.

PURPOSE: The aim of the study is to determine the clinical efficacy of surgical treatment of patients with diabetic Charcot foot with destruction of the middle and hindfoot in remission (without active infectious process) and with active purulent infection by two-stage replacement of total and subtotal bone defects of the foot with heterotopic allografts using 3D modeling.

MATERIALS AND METHODS: This study analysed the treatment outcomes of 40 patients with bone defects due to Charcot neuroosteoarthropathy who were treated at the Centre for Foot and Diabetic Foot Surgery, Yudin City Clinical Hospital in 2022 to 2023. The localisation of the pathological process was diagnosed in the bones of the midfoot in seven patients (type 2 to 3, Sanders & Frykberg classification), of the hindfoot in 30 patients (type 4 to 5, Sanders & Frykberg classification) and of the combined midfoot and hindfoot in three patients (type 3 to 4 to 5, Sanders & Frykberg classification). There were 12 men and 23 women. The mean age was 51.1 ± 2.1 M ± σ (24 to 71) years. The average body mass index was 30.0 ± 1.2 M ± σ (18 to 46.9). Type 1 diabetes mellitus was present in 9 patients and type 2 diabetes mellitus was present in 31 patients.

RESULTS: The mean volume of the simulated allografts for the midfoot was 22.7 ± 6.2 cm3 M ± σ, 37.8 ± 2.9 cm3 for the hindfoot and 41.2 ± 7.6 cm3 for combined defects of the hindfoot and midfoot. The duration of follow-up after the end of treatment ranged from 12 to 36 months. Good results were obtained in all patients with midfoot damage and with combined midfoot and hindfoot damage. In isolated hindfoot lesions, a good result was seen in 19 of 30 patients, or 60.7%. In six patients with hindfoot damage (21.4%), crushing of the allograft was observed with the neoarthrosis formation in supporting region with relative limb shortening, which was considered a satisfactory outcome. Non-union or recurrent osteomyelitis was noted in five patients with hindfoot lesions (17.9%), requiring allograft removal and arthrodesis in an external fixation device (EFD) with intraoperative segment shortening. These results were considered unsatisfactory despite the preservation of the limb. Overall, for the entire cohort of patients, 29 of 40 (72.5 per cent) had a good outcome, six (15 per cent) had a satisfactory outcome and five (12.5 per cent) had an unsatisfactory outcome.

CONCLUSION: The utilisation of 3D allografts provides a solution to the issue of restoration total bone defects in Charcot osteoarthropathy, not only at the level of individual bones, but also across the entire segments of the foot while enabling the precise replication of the intricate contours of a complex geometry. The proposed method of restoration bone defects in Charcot arthropathy has been demonstrated to be sustainable and enabling the successful filling of extensive bone defects without complications and the staged compression throughout the entire fixation period, while minimising the risk of implant damage.

PMID:41212190 | DOI:10.1007/s00264-025-06691-1

Int Orthop. 2025 Nov 10. doi: 10.1007/s00264-025-06683-1. Online ahead of print.

ABSTRACT

BACKGROUND: It remains unclear whether altered bone density may be a stability issue in stemless reverse shoulder arthroplasty (RSA).

METHODS: This was a retrospective multicentric study. Patients with stemless RSA with two-year postoperative shoulder X-ray and clinical data were included. Measurement of proximal humeral cortical bone thickness (CBT avg) on postoperative radiography was used to assess bone density.

RESULTS: 68 patients (mean age, 67.0 years) were included. CBT avg < 6 mm (osteoporosis) at two years was reported in 22.2% (2/9) of patients with humeral loosening and 35.6% (21/59) without humeral loosening (p = 0.7073). After adjustment for age and body mass index (BMI), CBT avg < 6 mm was not significantly associated with humeral loosening at two years (OR 0.37; 95% CI 0.04-2.21). Factors associated with humeral loosening vs. no humeral loosening at two years were BMI (24.2 vs. 27.9 kg/m2; p = 0.0131), cervico-diaphyseal angle < 140° at two years (66.7% vs. 16.9%; p = 0.0039) and lateralization of polyethylene (100% vs. 59.3%; p = 0.0217).

CONCLUSIONS: These results suggest that radiological evaluation of bone density does not predict early migration of stemless RSA implants. Some clinical factors such as BMI or implant configuration were associated to early implant migration, but never led to implant removal.

PMID:41212189 | DOI:10.1007/s00264-025-06683-1

Injury. 2025 Nov 1:112880. doi: 10.1016/j.injury.2025.112880. Online ahead of print.

ABSTRACT

BACKGROUND: Trauma patients experience significant stress states, leading to physiological and pathological changes. Severe trauma may result in multiple organ dysfunction syndrome (MODS). This study aims to evaluate the association between the stress hyperglycemia ratio (SHR) and MODS in trauma patients.

METHODS: Clinical data from 784 trauma patients were extracted from the MIMIC-IV (3.1) database. Based on clinical diagnoses, trauma patients were divided into a diabetic trauma group and a non-diabetic trauma group. Each group was further stratified into three subgroups according to SHR tertiles. The outcome was the development of MODS within 7 days of ICU admission. We investigated the association between SHR tertiles and MODS by logistic regression, with additional exploration using restricted cubic splines (RCS) to validate the findings.

RESULTS: Data from 784 trauma patients were analyzed. Among non-diabetic patients, a higher SHR was consistently and significantly associated with an increased risk of MODS. When analyzed by tertiles and compared to the first tertile (T1), the third tertile (T3) showed a crude OR of 2.48 (95 % CI: 1.57-3.98, P < 0.001). This association remained significant after adjustment for covariates (adjusted OR = 2.10, 95 % CI: 1.20-3.72, P = 0.010). This non-linear association was further validated by restricted cubic spline (RCS) analysis, which revealed a risk pattern with little change in the first tertile, a mildly increasing risk in the second tertile, and a continued increase that eventually plateaued at a high level in the third tertile. In contrast, no significant association was observed between high SHR and MODS in the diabetic trauma group.

CONCLUSION: In the non-diabetic trauma group, elevated SHR showed a significant association with MODS occurrence, whereas no significant association was observed between high SHR and MODS in the diabetic trauma group.

PMID:41207853 | DOI:10.1016/j.injury.2025.112880

Injury. 2025 Nov 8;56(12):112854. doi: 10.1016/j.injury.2025.112854. Online ahead of print.

NO ABSTRACT

PMID:41207001 | DOI:10.1016/j.injury.2025.112854