Int Orthop. 2026 Feb 24. doi: 10.1007/s00264-026-06762-x. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the incidence, magnitude, and risk factors for secondary angular deformity after tibial lengthening with a circular external fixator in skeletally immature patients. We hypothesized that younger age and low bone healing index would predispose to late valgus drift.

METHODS: A retrospective review was conducted on 98 children who underwent tibial lengthening using a circular external fixator, with a minimum follow-up of one year. Radiographic assessment included full-length standing AP radiographs and lateral tibial views obtained preoperatively, at fixator removal, six months post-removal, and at final follow-up. Measured parameters included the mechanical Medial Proximal Tibial Angle, Center of Rotation of Angulation, and Posterior Proximal Tibial Angle. Risk factors for secondary deformity were analyzed using independent T test, Chi-Square test, Pearson test and multivariate logistic regression.

RESULTS: A valgus deformity greater than 3° developed in 36 patients (37%), primarily within the first six months after frame removal. Younger age at surgery (p = 0.017) and a bone healing index ≤ 40 days/cm (OR 2.3; p = 0.049) were significantly associated with valgus drift. A progressive valgus shift in CORA correlated with a shorter consolidation index (p = 0.021). Sagittal alignment showed a small but significant early decrease.

CONCLUSION: Secondary valgus deformity is a common and under-recognized complication following tibial lengthening with a circular external fixator in skeletally immature patients. Younger age at surgery and low bone healing index are the principal risk factors for this late angular drift. Furthermore, they question the efficacy of intentional frontal overcorrection to reliably prevent secondary deformity and suggest that additional corrective strategies may be required.

PMID:41731236 | DOI:10.1007/s00264-026-06762-x

Injury. 2026 Feb 17;57(4):113125. doi: 10.1016/j.injury.2026.113125. Online ahead of print.

ABSTRACT

BACKGROUND: Acromioclavicular joint (ACJ) injuries, accounting for approximately 12 % of all shoulder ligament injuries, are common. Conservative treatment is recommended for Rockwood type Ⅰ and Ⅱ dislocations, while the optimal treatment for type Ⅲ remains debated. For Rockwood type Ⅳ, Ⅴ, and VI dislocations, most scholars advocate surgical treatment. However, other studies have found no significant difference in clinical outcomes between conservative and surgical treatments for Rockwood type Ⅴ dislocations.

METHODS: This systematic review and meta-analysis, conducted following PRISMA guidelines, evaluated randomized controlled trials using the PICO framework. Searches were conducted across four databases: PubMed, Cochrane Library, Embase, and Web of Science. Data were extracted and assessed after evaluating the evidence levels in the selected articles. This study was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY).

RESULTS: The study included 367 patients with Rockwood type Ⅲ-Ⅴ ACJ dislocations: 193 underwent surgical treatment and 174 received conservative treatment. Analyses of three outcomes-Constant Score (CS), complications, and delayed additional surgical treatment-revealed no significant differences in functional outcomes or the necessity for additional surgeries. However, the surgical group exhibited a significantly higher complication rate compared to the conservative treatment group. Notably, for Rockwood type Ⅲ dislocations, complication rates did not differ between the treatment modalities.

CONCLUSION: This systematic review and meta-analysis, encompassing patients with an average age ranging from 30 to 54 years, found no evidence of superiority for surgical intervention over conservative management in treating Rockwood type Ⅲ ACJ dislocations concerning functional outcomes, rates of delayed surgical interventions, or complications. Nonetheless, additional evaluations targeting other age demographics or patients with specific athletic requirements remain necessary. Furthermore, evidence concerning Rockwood type Ⅳ dislocations is notably insufficient, and available data on type Ⅴ dislocations remain limited. Given the paucity of comprehensive imaging studies and objective functional assessments, coupled with a limited number of high-quality studies, further randomized controlled trials focusing explicitly on Rockwood types Ⅲ (including subtypes ⅢA and ⅢB), Ⅳ, andⅤ are urgently warranted. Future research should particularly emphasize functional comparisons relative to pre-injury status and contralateral shoulder performance to enhance the objectivity and clinical applicability of the findings.

PMID:41724020 | DOI:10.1016/j.injury.2026.113125

Injury. 2026 Feb 17;57(4):113108. doi: 10.1016/j.injury.2026.113108. Online ahead of print.

ABSTRACT

BACKGROUND: Although various dermal substitutes are available, their use in the acute setting or for extensive surface areas is often constrained by high costs and labor-intensive application procedures. Despite these challenges, they have proven effective in treating different skin and soft tissue defects.

METHODS: In this prospective case series, 26 adults with acute complex deep soft tissue defects resulting from different etiologies were treated with Glyaderm. Glyaderm is a low-cost acellular dermal substitute and can be applied in either a one- or two-stage procedure with a split skin graft for epidermal coverage. Primary outcomes were graft take in percentage of the total covered wound area and time to complete wound closure.

RESULTS: In total, 25 patients with an average age of 55.9 years completed the follow-up period. Etiologies of the acute complex wounds consisted of defects after oncological surgery (28%), debridement of soft tissue infections (28%), trauma (24%), donor site defects after free flap reconstruction (16%), and other (4%). Mean affected Total Body Surface Area was 2.2%, the mean size was 203 cm2. At 5 to 7 days post-application, the mean graft take rate was 89.7%. The average time for wound closure was 30 days. A complication occurred in 16% of cases: three patients developed wound infection resulting in incomplete graft loss, while one patient experienced complete graft loss without an identifiable cause. All cases were regrafted using Glyaderm and subsequently healed without complications.

CONCLUSION: Glyaderm appears to be a valid and effective reconstructive option for acute complex wounds.

PMID:41724019 | DOI:10.1016/j.injury.2026.113108

Injury. 2026 Feb 14;57(4):113099. doi: 10.1016/j.injury.2026.113099. Online ahead of print.

ABSTRACT

BACKGROUND: Avalanches present a significant risk in mountainous environments, frequently causing severe trauma and death. While asphyxia is often the primary cause of mortality (65-100 %), the incidence of traumatic injuries, particularly bone fractures, may be increasing due to evolving recreational practices and climate change. This study aims to characterize the distribution and types of fractures in avalanche fatalities.

METHODS: We conducted a retrospective study at Grenoble Alpes University Hospital from April 2023 to April 2025. It included deceased adult avalanche victims with post-mortem computed tomography (CT) scans showing at least one bone fracture. MPR, MIP, and 3D reconstructions were used for image analysis.

RESULTS: Thirteen individuals were included (61.5 % male; mean age 37 years). The thorax was the most affected region (92 % of cases). Analysis of 265 fractured bones (79 distinct bones) showed primary fracture distribution in the thorax (52 %), spine (21 %) and skull (14 %). A strong correlation existed between external trauma signs and vital skull lesions, but vital spinal and thoracic lesions often lacked clear external indicators.

CONCLUSION: These preliminary findings contribute to a better understanding of avalanche-specific bone injuries, which could optimize initial management strategies. While extremity fractures are important due to their potential contribution to non-traumatic death and ease of on-site detection, thoracic, spinal and pelvic fractures are challenging to detect in the field. Their accurate identification is yet essential for determining appropriate hospital destination. This exploratory work highlights the need for further larger-cohort studies to establish robust correlations between traumatic mechanisms and avalanche characteristics.

PMID:41724018 | DOI:10.1016/j.injury.2026.113099

Injury. 2026 Feb 16;57(4):113104. doi: 10.1016/j.injury.2026.113104. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional fracture fixation has long provided reliable mechanical stability, yet it remains largely passive in the biological process of healing. The persistence of nonunion, delayed union, and implant-related complications reveals the limitations of a fixation-centric paradigm. Emerging advances in materials science, biology, digital technologies, and implant design have progressively challenged this model, opening the door to a broader reframing of fracture management.

PURPOSE: To propose a conceptual and strategic reframing of fracture management-shifting emphasis from mechanical support alone toward a dynamic, multidimensional dialogue where implants actively sense, respond, and adapt to the biological environment.

METHODS: A narrative and conceptual synthesis of contemporary literature integrating evidence from materials science, biomechanics, bioengineering, immunology, and digital health. Core design principles and translational pathways are identified to outline how modern technologies support a biologically centred reframing of fracture care.

FINDINGS: Five foundational principles - designed temporality, biological integration, mechanical modulation, therapeutic multifunctionality, and feedback intelligence - underpin a framework for a dynamic host-implant dialogue. Ten technological pathways demonstrate how this interactive paradigm translates into practice, encompassing material, mechanical, biological, and data-enabled strategies that integrate mechanical, biological, and digital intelligence.

CONCLUSIONS: This evolution reframes fracture care: from fixing bones to orchestrating healing. It marks a genuine philosophical shift - from implants as static hardware to treatment as a dynamic partnership between biology, technology, and clinical judgement.

PMID:41724017 | DOI:10.1016/j.injury.2026.113104

Injury. 2026 Feb 13;57(4):113097. doi: 10.1016/j.injury.2026.113097. Online ahead of print.

ABSTRACT

OBJECTIVE: Quadriceps tendon rupture is a rare disabling injury, predominantly affecting older males. Prompt surgical intervention is essential to restore knee extensor mechanism. Patellar trans-osseous tunnels technique is considered the treatment of choice, however recently suture anchors technique is suggested as a comparative method to restore the integrity of the quadriceps tendon. This study aimed to compare patient-reported outcomes, operative times, and complication rates between trans-osseous tunnel and suture anchor fixation techniques for acute quadriceps tendon rupture.

METHODS: A retrospective, IRB-approved cohort study was conducted at an academic level I trauma center. Eighty-five patients who underwent surgical repair for acute quadriceps tendon rupture using either trans-osseous tunnels (n=46) or suture anchors (n=39) were included, with one-year follow-up. Demographic, clinical, and surgical data were extracted from electronic medical records. Patient-reported outcome measures (PROMs) assessed at one year included the International Knee Documentation Committee (IKDC) score, Lysholm score, and Visual Analog Scale (VAS) for pain. Operative times and complications were also analyzed.

RESULTS: There were no significant differences in age or gender distribution between groups. The anchor group demonstrated a significantly shorter mean operative time. At one-year follow-up, no statistically significant differences were observed in PROMs: IKDC, and VAS. Complication rates were similar between groups, with two fixation failures (anchor group) and two infections (one per group), all managed successfully.

CONCLUSION: Both trans-osseous tunnel and suture anchor techniques yield comparable functional outcomes and complication rates in the surgical management of acute quadriceps tendon rupture. Suture anchors offer reduced operative time significantly.

PMID:41724016 | DOI:10.1016/j.injury.2026.113097

Injury. 2026 Feb 16;57(4):113113. doi: 10.1016/j.injury.2026.113113. Online ahead of print.

ABSTRACT

Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in trauma patients, rising from a complex interplay of direct lung injury, systemic inflammation, transfusion and mechanical ventilation-related factors. Optimal management requires a multifaceted approach that balances lung-protective ventilation strategies, hemodynamic stability and supportive interventions. Positive end-expiratory pressure (PEEP) and prone positioning improve alveolar recruitment, ventilation homogeneity and oxygenation, moderating ventilator-induced lung injury (VILI). Extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO, provides a rescue strategy in refractory hypoxemia but carries significant bleeding risks in multi-trauma patients due to necessary anticoagulation. Fluid management remains critical: both overload and excessive restriction can exacerbate pulmonary compromise or hemodynamic instability. Transfusion practices, including the timing and volume of blood products, significantly influence ARDS development, with blunt thoracic trauma, emergent surgery and high BMI identified as independent risk factors. Despite the progress that has been made, the heterogeneity of ARDS pathophysiology and patient's specific variables necessitate individualized, multidisciplinary management to optimize outcomes in critically ill, trauma patients.

PMID:41724015 | DOI:10.1016/j.injury.2026.113113

Injury. 2026 Feb 16:113114. doi: 10.1016/j.injury.2026.113114. Online ahead of print.

ABSTRACT

OBJECTIVE: Brachial plexus injuries (BPIs) in adults can lead to significant disability and substantial healthcare demands. Despite their profound impact, key predictors of inpatient outcomes, such as discharge disposition, complications, and resource utilization, remain understudied. This study examines demographic, clinical, and injury-related factors influencing these outcomes in hospitalized adults with BPIs.

METHODS: A retrospective analysis of 2292 adult BPI patients admitted between 2019 and 2021 was conducted using the American College of Surgeons Trauma Quality Program database. Patients were stratified into three age groups (18-39, 40-69, ≥70 years). Multivariable logistic regression models identified predictors of home discharge, complications, ICU admission, and mechanical ventilation. Linear regression models assessed factors associated with hospital length of stay (LOS).

RESULTS: The cohort included predominantly males (77.1 %) with a mean age of 38.7 years. Older adults (≥70 years) had significantly reduced odds of home discharge (OR 0.2, 95 % CI 0.1-0.3, p < 0.001) and increased complication rates (OR 2.6, 95 % CI 1.5-4.8, p = 0.001). Severe injuries, particularly to the spine (OR 0.6, p = 0.002) and lower extremities (OR 0.4, p < 0.001), further decreased discharge odds. Medicare/Medicaid insurance was associated with lower odds of home discharge (OR 0.7, p = 0.013), while self-pay increased discharge likelihood (OR 1.9, p < 0.001). ICU admission (60.5 %) and mechanical ventilation (33.6 %) were strongly linked to polytrauma and low GCS scores. Hospital LOS was significantly prolonged by age, female sex, and Injury Severity Score.

CONCLUSIONS: Age, injury severity, and socioeconomic factors critically influence inpatient outcomes in BPI patients, underscoring the need for age-specific care protocols and resource allocation strategies. Future research should explore long-term recovery trajectories and functional outcomes to guide management of this complex injury population.

PMID:41723012 | DOI:10.1016/j.injury.2026.113114

Injury. 2026 Feb 13;57(4):113098. doi: 10.1016/j.injury.2026.113098. Online ahead of print.

ABSTRACT

INTRODUCTION: Acromioclavicular dislocations account for 9 % of all dislocations. Although numerous treatment techniques have been described, there is still no universally recognized gold standard. Stabilization with Tight-Rope® (TR) represents one of the most effective methods for restoring the normal alignment of the AC joint, ensuring early mobilization and good functional outcomes. Purpose of this study is to review our results using TR to treat high-grade acromioclavicular dislocations, analyzing complications, functional and radiological results.

MATERIALS AND METHODS: This is a retrospective analysis of patients treated with Tight-Rope® between August 2016 and June 2024 for high-grade acromioclavicular dislocation. In 42 cases, only TR stabilization was performed, while in 36 cases, a K-wire was used to enhance stability. Clinical and radiographic evaluations were conducted during outpatient visits. No patients were lost to follow-up. Every kind of complication was assessed. Radiographic results were assessed by measuring Coracoid-Clavicle Distance (CCD) on the X-Rays between the last follow-up and the postoperative control. To evaluate functional outcomes, two scores were used: the ASES and the Constant-Murley Score.

RESULTS: Seventy-eight patients with an average age of 41 years (range, 17 -75 y) were evaluated. There were a total of 46 Rockwood III, 10 Rockwood IV, and 22 Rockwood V dislocations. At an average follow-up of 48,72 months (range, 6- 98 m), two cases (2.5 %) of reduction loss occurred, associated with functional limitation and pain, leading to reoperation. In seven patients, the reduction loss exceeded 25 % but no further treatments were necessary. Functional results were excellent in most cases (97,4 %), with mean CSS of 90 (min 55 - max 100), CSn and CSi of 96 %, ASES score of 96 (range, 65 - 100).

DISCUSSION: In patients treated with this technique, the initial dislocation grade does not seem to affect clinical results. Reduction loss was very limited with system settling in most cases. According to this study, reduction loss over time seems to result in a worse clinical outcome. The use of a K-wire is useless to increase the stability and guarantee the same results as the traditional technique.

CONCLUSIONS: The treatment of acromioclavicular dislocations with Tight-Rope® represents a valid option based on excellent clinical, functional, radiographic results, and a low incidence of complications.

PMID:41722264 | DOI:10.1016/j.injury.2026.113098

Injury. 2026 Feb 16;57(4):113111. doi: 10.1016/j.injury.2026.113111. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic vertebral artery injury (TVAI) is a rare yet clinically significant condition, carrying a high risk for posterior circulation stroke. Endovascular therapy (EVT) is increasingly used in selected cases. This systematic review and meta-analysis aimed to assess the effectiveness and safety of EVT in patients with TVAI.

METHODS: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for articles published up to October 2025. Eligible studies included clinical trials, cohort studies, and case series investigating EVT in TVAI. Primary outcomes included angiographic success, mortality, and stroke. Quality assessment was conducted using the Newcastle-Ottawa Scale and Joanna Briggs Institute tools. We performed proportional meta-analysis, with subgroup analyses stratified by injury mechanism and EVT indication. A random-effects model was used to account for heterogeneity.

RESULTS: Fourteen studies (n = 174 patients) were included for meta-analysis. Overall, the pooled rates were 99 % [95 % CI: 95 % to 100 %; I2 = 19 %] for angiographic success, 2 % [95 % CI: 0 % to 6 %; I2 = 0 %] for mortality, and 2 % [95 % CI: 0 % to 5 %, I2 = 0 %] for stroke. Secondary outcomes included clinical complications (1 % [95 % CI: 0 % to 6 %]), procedural complications (1 % [95 % CI: 0 % to 6 %]), surgical intervention (6 % [95 % CI: 0 % to 21 %; I2 = 58 %]), and clinical improvement (95 % [95 % CI: 81 % to 100 %; I2 = 66 %]). The overall quality of the included studies scored moderate to high.

CONCLUSION: In our analysis, EVT has demonstrated high technical success and low rates of stroke, complications, and mortality, which may support its use as an effective, safe alternative option for selected patients with TVAI. However, the available evidence is limited, and further well-designed prospective and comparative studies are needed to clarify its optimal role among other treatment options, including medical treatment and surgery.

PMID:41722263 | DOI:10.1016/j.injury.2026.113111

Injury. 2026 Feb 16;57(4):113115. doi: 10.1016/j.injury.2026.113115. Online ahead of print.

ABSTRACT

INTRODUCTION: Pelvic ring injuries (PRI) are complex and potentially life-threatening lesions requiring precise classification and timely management. The increasing reliance on computed tomography (CT) imaging has led some institutions to bypass standard pelvic x-rays, potentially missing crucial diagnostic information. This study aimed to evaluate whether standard anteroposterior (AP) pelvic x-rays, particularly when obtained with and without a pelvic binder (PB), alter injury classification and treatment plans in comparison to CT imaging alone.

METHODS: A retrospective cohort study was conducted at a level 1 trauma center, including all adult patients (≥18 years) with surgically treated PRI between January 2012 and December 2023. Inclusion required a complete imaging set (CT, AP x-ray with PB and AP x-ray without PB). An international PRI expert group independently assessed each patient's imaging in sequential order (CT alone, then additional AP x-ray with PB, then additional AP x-ray without PB). After each step, they provided injury classifications (Young and Burgess, AO/OTA) and a treatment plan. Changes in classification and treatment at each step were recorded and compared to surgical reports. Interobserver reliability was assessed using Fleiss' kappa.

RESULTS: Among 28 patients with complete imaging sets, classification or treatment changes occurred in 60.7% and 42.9% of cases, respectively. Agreement with the baseline classification improved by 35.7% with sequential imaging. A direct correlation with treatment changes was found in 58% of classification changes. Interobserver reliability was slight to fair (k = 0.192-0.300), with modest improvement in Young and Burgess agreement (k = 0.192 to 0.261) but limited change in AO/OTA agreement.

CONCLUSION: Sequential imaging that includes standard AP pelvic x-rays, both with and without a PB, provides additional diagnostic clarity and can influence PRI classification and treatment planning for PRI. These findings support the continued use of standard AP pelvic x-rays alongside CT in acute trauma evaluation.

PMID:41722262 | DOI:10.1016/j.injury.2026.113115

Injury. 2026 Feb 16:113105. doi: 10.1016/j.injury.2026.113105. Online ahead of print.

ABSTRACT

INTRODUCTION: The pre-hospital care and transport of trauma patients by trained providers remains a cornerstone of practice in the United States. Some studies suggested a survival benefit for patients transported via police or private vehicles, particularly in severe penetrating injuries. Prior work has focused on penetrating trauma and relied on outdated data. Further, most studies compare EMS with police, often excluding private transport.. This study evaluates whether non-EMS transport offers a risk-adjusted mortality or length of stay benefit using a large regional dataset across an entire decade.

METHODS: This retrospective cohort study utilized the Michigan Trauma Quality Improvement Program data (2014-2024). Adults with trauma activation were included; transfers, direct admissions, air transport, and dead on arrival were excluded. 69,092 patients met our eligibility criteria. We used demographic data and measures of injury severity to assess for differences between the groups, and then multivariable logistic regression to assess risk-adjusted outcomes of interest.

RESULTS: The mean age of our population was 50.5 (S.D 21.3) years, and the mean New Injury Severity Score was 13.3 (S.D 9). The cohort was predominantly male (67.3 %) and White (67.6 %), with the majority sustaining blunt trauma (87.3 %). In the cohort, 87.6 % were transported by EMS, 0.4 % by police, and 12 % by private vehicles. Police transported patients were significantly more in shock, (mean shock index=0.8). Private transport had lower odds of mortality than ground EMS (OR 0.35, CI 0.29-0.43). Both private (LOS ratio 0.69, 95 % CI 0.67-0.70) and police transport (LOS ratio 0.81, 95 % CI 0.74-0.90) were associated with shorter LOS.

CONCLUSION: In our region, private transport of injured patients is associated with substantially lower odds of mortality and shorter length of stay compared to EMS. It is difficult to dismiss the idea that if it can be done safely, private transport should be considered as part of stakeholder discussions to improve trauma outcomes, particularly in urban settings. Police transport demonstrated a shorter length of stay, though its impact on mortality was not clear. Future research should address gaps in prehospital timing, evaluate specific EMS interventions, and explore how system-level adaptations can optimize outcomes across different transport modalities.

PMID:41720739 | DOI:10.1016/j.injury.2026.113105

Injury. 2026 Feb 9;57(3):113092. doi: 10.1016/j.injury.2026.113092. Online ahead of print.

ABSTRACT

The utility of using the patient's native fracture hematoma as an autograft after performing open reduction and internal fixation (ORIF) for fractures is highlighted. The fracture hematoma may be effectively used in closed fractures as a standalone autograft for filling in or around the fracture site, or used in combination with other structural autografts, allografts, or bioceramics to potentially enhance fracture healing. We advocate surgeons to support and consider in their practice the 'Save The Haematoma Campaig'.

PMID:41719885 | DOI:10.1016/j.injury.2026.113092

Injury. 2026 Feb 10;57(4):113093. doi: 10.1016/j.injury.2026.113093. Online ahead of print.

NO ABSTRACT

PMID:41719763 | DOI:10.1016/j.injury.2026.113093

J Bone Joint Surg Am. 2026 Feb 20. doi: 10.2106/JBJS.25.01231. Online ahead of print.

NO ABSTRACT

PMID:41719370 | DOI:10.2106/JBJS.25.01231

Injury. 2026 Feb 10;57(4):113094. doi: 10.1016/j.injury.2026.113094. Online ahead of print.

NO ABSTRACT

PMID:41713206 | DOI:10.1016/j.injury.2026.113094

Injury. 2026 Feb 11;57(3):113095. doi: 10.1016/j.injury.2026.113095. Online ahead of print.

NO ABSTRACT

PMID:41713157 | DOI:10.1016/j.injury.2026.113095

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06753-y. Online ahead of print.

ABSTRACT

PURPOSE: To establish a national consensus on the minimum expected competencies that orthopaedic surgery residents in Chile should achieve by the end of training, providing a foundation for competency-based curriculum development in comparable training contexts.

METHODS: A multicentre modified Delphi study was conducted involving academic leaders from orthopaedic residency programmes across Chile. An initial round of open-ended questions among programme directors generated draft competency statements, which were refined through two subsequent rounds using a 5-point Likert scale. Consensus was predefined as ≥ 80% agreement (ratings of 4 or 5) with an interquartile range ≤ 1. Competencies were organised into six ACGME core competencies and one CanMEDS role.

RESULTS: Twenty-eight experts completed the final rounds. Consensus was achieved on 32 competency statements spanning patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, system-based practice, and scholar-research. Agreement was observed for non-procedural competencies and foundational surgical skills. In contrast, consensus was not reached regarding autonomy, even under supervision, for advanced surgical procedures, particularly arthroplasty and selected soft-tissue procedures. Qualitative feedback attributed disagreement to patient-safety considerations, procedural complexity, and differing views on the boundary between residency and fellowship-level competence.

CONCLUSIONS: This national Delphi study establishes the first consensus-based definition of minimum expected competencies for orthopaedic surgery residency training in Chile. The resulting framework provides a shared reference aligned with international competency-based principles while remaining responsive to local training contexts, and is intended to inform educational development and accreditation discussions in similar training settings rather than mandate a uniform training model.

PMID:41714458 | DOI:10.1007/s00264-026-06753-y

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06758-7. Online ahead of print.

ABSTRACT

PURPOSE: The measurement of glenoid and reverse total shoulder arthroplasty (rTSA) inclination has both clinical and research relevance. The purpose of this study was to better understand if and how much radiographic projection and scapula position affect the perception of glenoid inclination.

MATERIALS AND METHODS: Twenty computed-tomography (CT) scans of arthritic shoulders were used to create digitally reconstructed radiographs (DRR) through 3° increments of inclination, retraction and protraction on a scapular coordinate system. The reverse total shoulder arthroplasty (rTSA) and total shoulder arthroplasty (TSA) angles were measured on each image.

RESULTS: The mean range (difference between maximum and minimum values) of rTSA and TSA angle measurements based on simulation of scapula inclination was 14° and 17°, respectively. Nineteen of 20 cases showed a trend towards a higher rTSA and TSA angle with greater forward inclination. With simulated scapula retraction, the maximum difference between rTSA and TSA angle measurements was a mean 11° and 14°, respectively. With simulated scapula protraction, the maximum difference observed for rTSA and TSA angle measurements based was a mean 14° and 11°, respectively. Scapula protraction and retraction did not produce consistent or linear trends in rTSA or TSA angle measurement.

CONCLUSION: The radiographic measurement of rTSA and TSA angles is moderately variable based on scapula protraction, retraction and inclination. Forward inclination may increase the perception of superior tilt.

PMID:41711821 | DOI:10.1007/s00264-026-06758-7

Int Orthop. 2026 Feb 19. doi: 10.1007/s00264-026-06757-8. Online ahead of print.

ABSTRACT

BACKGROUND: Currently, the primary treatment for ulnar neuropathy at the elbow is open in-situ decompression surgery. The effectiveness of ultrasound localization therapy, especially small-incision surgery using ultrasound combined with SWE, remains unclear.

OBJECTIVES: To evaluate the effect of small-incision ulnar nerve release in treating ulnar neuropathy at the elbow by ultrasound combined with shear wave elastography (SWE).

METHODS: A retrospective analysis of 98 patients treated in our hospital for ulnar neuropathy at the elbow was conducted from June 2023 to March 2025. According to the treatment style, these patients were divided into a traditional open in-situ decompression surgery group (n = 51) and an ultrasound combined with SWE small-incision surgery group (n = 47). The maximum proximal Cross-sectional Area (CSA), Sensory Conduction Velocity (SCV), Motor Conduction Velocity (MCV), modified Bishop score, Quick-DASH score, and Visual Analogue Scale(VAS) score were compared between the two groups. Additionally, the amount of intraoperative blood loss, operation duration, hospital stay, patients' satisfaction with postoperative incision aesthetics, the postoperative complications of different operation methods, and the degree of damage to the medial cutaneous nerve of the forearm were studied.

RESULTS: All patients underwent surgical treatment, with preoperative ultrasonography confirming no ulnar nerve subluxation. No statistically significant differences in age, preoperative SCV, MCV, CSA, Quick-DASH score, or VAS score were found between the two groups. The postoperative and the last follow-up SCV, MCV, and CSA were similar in the two groups. In addition, the improved Bishop score, Quick-DASH score, VAS score, postoperative hematoma rate, elbow stiffness rate, and postoperative protection of the medial cutaneous nerve of the forearm in the ultrasound combined with SWE surgery group were better than those in the traditional open surgery group. What's more, compared with the traditional open surgery group, the ultrasound combined with SWE surgery reduced the amount of intraoperative blood loss, shortened the operation duration and hospital stay, and the patients were more satisfied with the scar of the incision.

CONCLUSIONS: For patients with ulnar neuropathy at the elbow who are amenable to in situ decompression, this study highlights the potential of preoperative ultrasound combined with SWE to guide a targeted, minimally invasive surgical approach.

PMID:41711820 | DOI:10.1007/s00264-026-06757-8