Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06626-w. Online ahead of print.

NO ABSTRACT

PMID:40728644 | DOI:10.1007/s00264-025-06626-w

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06625-x. Online ahead of print.

NO ABSTRACT

PMID:40728643 | DOI:10.1007/s00264-025-06625-x

Int Orthop. 2025 Jul 29. doi: 10.1007/s00264-025-06627-9. Online ahead of print.

ABSTRACT

PURPOSE: Shepherd's crook deformity is a characteristic complication of fibrous dysplasia (FD) of the femur, leading to coxa vara and mechanical instability. Two-stage surgical approaches involve initial valgus osteotomy followed by delayed intramedullary femoral stabilization, prolonged treatment, and increasing morbidity. This study evaluates a one-stage surgical correction that employs fibular strut allograft augmentation for both the femoral neck and shaft.

METHODS: A retrospective review was performed on 17 patients with Shepherd's crook deformity who underwent one-stage hip lag screw and side plate fixation with fibular strut allograft augmentation of the femoral neck and shaft between 2002 and 2022. Radiographic and clinical outcomes were assessed, including neck-shaft angle (NSA) restoration, fixation stability, graft incorporation, and functional improvement. The median follow-up of the patients was 96 months.

RESULTS: The mean preoperative NSA was 93° (SD: 13.5°), improving significantly to 130° (SD: 5°) at the latest follow-up (p < 0.001). Stable fixation was achieved in 16 of 17 patients, with one case of fixation failure. Fibular graft resorption was noted in six patients but did not compromise fixation. Clinically, postoperative pain, limping, and activity limitations improved substantially, though seven patients experienced persistent restrictions in outdoor activities. The average limb shortening was 3.5 cm before the operation and 0.9 cm at the end of the follow-up.

CONCLUSION: One-stage correction of Shepherd's crook deformity using lag hip screw fixation and fibular strut allograft augmentation could be a viable alternative to staged procedures, though further studies are needed to confirm its efficacy and generalizability.

PMID:40728642 | DOI:10.1007/s00264-025-06627-9

J Bone Joint Surg Am. 2025 Jul 28. doi: 10.2106/JBJS.25.00532. Online ahead of print.

NO ABSTRACT

PMID:40720550 | DOI:10.2106/JBJS.25.00532

Int Orthop. 2025 Jul 28. doi: 10.1007/s00264-025-06613-1. Online ahead of print.

NO ABSTRACT

PMID:40719875 | DOI:10.1007/s00264-025-06613-1

Injury. 2025 Jul 21;56(10):112618. doi: 10.1016/j.injury.2025.112618. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFPs) in older adults are increasingly recognized as serious injuries with substantial morbidity. However, mortality after FFP has not been comprehensively quantified across timepoints or patient subgroups, limiting the ability to inform prognosis and guide clinical strategies. This systematic review and meta-analysis aimed to assess the 1-year mortality following FFP in patients aged ≥60 years. We also assessed the mortality at 30 days, 3 months, 6 months, 2 years, and 5 years after FFP, and the differences in mortality by geographic region, sex, fracture classification, or treatment modality.

METHODS: We conducted a systematic review and meta-analysis of studies published from inception to May 2024 in MEDLINE, Embase, and CENTRAL databases. Eligible studies reported mortality outcomes in patients aged ≥60 years with FFP. A random-effects model was used to estimate pooled mortality at prespecified time points. We assessed the risk of bias using the Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool. Subgroup analyses were conducted to assess differences by region, sex, fracture classification, and treatment modality. We conducted a sensitivity analysis including only the high-quality studies according to the JBI assessment. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS: The pooled 1-year mortality was 17 % (95 % confidence interval, 14 %-19 %). The certainty of this evidence was rated as low because of publication bias and heterogeneity. The mortality at 30 days, 3 months, 6 months, 2 years, and 5 years were 5 %, 10 %, 14 %, 26 %, and 46 %, respectively. Mortality was lower in studies from Asia than in those from Europe or North America. Male sex, lower-grade FFPs, and nonoperative management showed numerically higher mortality, though not statistically significant.

CONCLUSION: FFPs are associated with substantial short- and long-term mortality, warranting their recognition as high-risk injuries in older adults. Regional and treatment-related variation highlights the need for individualized management. Future research should clarify causal mechanisms and assess targeted interventions to reduce mortality risk.

PMID:40714375 | DOI:10.1016/j.injury.2025.112618

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06618-w. Online ahead of print.

ABSTRACT

PURPOSE: Dislocation after total hip arthroplasty (THA) via the posterior approach remains a serious complication. This cadaveric study compared two soft tissue repair techniques-trans-osseous and direct suturing-regarding their effect on dislocation torque and angle.

METHODS: Ten hips from five fresh-frozen cadavers were used. A Posterior approach identified the short external rotators. Following standard THA, each limb was mounted on a motorized torque wrench. Hips were tested first with no posterior repair (NPR), then with either transosseous or direct repair techniques. Dislocation torque and angle were recorded, with each hip serving as its own control.

RESULTS: Posterior repair significantly increased the force required for dislocation compared to NPR (mean 9.12 Nm vs. 2.73 Nm; p = 0.004). Trans-osseous repair led to a 4.41-fold increase in torque (p = 0.04), and direct repair a 2.47-fold increase (p = 0.03), with a significant difference between the two (p = 0.016). The dislocation angle increased with repair (mean 54.6° vs. 45.1°; p = 0.09), though not significantly. Trans-osseous and direct repairs increased the angle by 1.70× and 1.18×, respectively.

CONCLUSION: Posterior soft tissue repair improves hip stability in THA performed via a posterior approach. Trans-osseous repair provides significantly greater resistance to dislocation torque than direct suturing and may be the preferred technique to reduce postoperative instability.

PMID:40715845 | DOI:10.1007/s00264-025-06618-w

Int Orthop. 2025 Jul 26. doi: 10.1007/s00264-025-06620-2. Online ahead of print.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) is a highly effective procedure for end-stage knee osteoarthritis, but postoperative instability remains a major concern, impacting patient satisfaction and leading to potential revision surgeries. Understanding patient-related risk factors for instability is crucial for optimizing outcomes and minimizing complications.

METHODS: We conducted a retrospective cohort study of patients who underwent revision TKA at our clinic between 1996 and 2021, focusing on those who required revision specifically due to instability. We analyzed a dataset of 39,572 primary TKA patients without documented revisions and 859 revision patients. Data extraction included age, gender, body mass index (BMI), age-adjusted Charlson Comorbidity Index (CCI) score, and comorbidities. Statistical analyses, including binary logistic regression, were performed to identify independent risk factors for instability.

RESULTS: The instability group (n = 859) had a mean age of 65.7 years and a significantly lower proportion of males compared to the control group (mean age 67.5 years, p < 0.001; males 30.7% vs. 38.1%, p < 0.001). Notable risk factors included younger age, female gender, stroke, deep vein thrombosis (DVT), and scleroderma. Specifically, scleroderma was associated with a high risk of instability (P < 0.01 OR [odds ratio] 9.27, CI [confidence interval] 2.01 to 42.7), stroke (P = 0.01 OR 1.8, CI: 1.1 to 3.1), and DVT (p < 0.01 OR: 2.0, CI: 1.4 to 2.8).

CONCLUSION: Patient-related factors such as younger age, female gender, stroke, DVT, and scleroderma significantly influence the risk of instability following primary TKA. These findings highlight the multifactorial nature of TKA instability and underscore the importance of tailored preoperative assessment and postoperative care. Addressing these risk factors can improve patient outcomes and reduce the incidence of instability following TKA.

PMID:40715844 | DOI:10.1007/s00264-025-06620-2

Injury. 2025 Jul 19:112619. doi: 10.1016/j.injury.2025.112619. Online ahead of print.

ABSTRACT

INTRODUCTION: Despite evidence of frequent adverse psychological reactions including PTSD in major trauma survivors, psychological support represents a frequent gap in UK major trauma care pathways. North Bristol Trust Major Trauma and Plastics Psychology Service has been newly developed in response at an NHS Major Trauma Centre (MTC). The service aims to address patients' psychological needs early on and throughout recovery from major trauma, alongside physical and functional recovery. Thus, a qualitative service evaluation was conducted. It aimed to explore major trauma clinicians' perspectives and experiences of the psychology service and to identify areas of strength and opportunity for development.

METHOD: Semi-structured interviews were conducted with a purposive sample of seven major trauma clinicians working at the MTC who make referrals to, and interact with, the psychology service. Data were thematically analysed using a codebook approach.

RESULTS: Thematic analysis of qualitative data revealed five themes: (1) Necessity of specialist psychology for major trauma patients; (2) Psychological involvement facilitates patients' recovery; (3) Psychologists have an important role in supporting clinicians; (4) Requirement for service expansion; (5) Importance of psychologists' integration within a multidisciplinary team. Overall, the importance of the psychology service in facilitating patients' holistic recovery was emphasised, as well as its role in emotionally and professionally supporting major trauma clinicians. Service expansion was suggested to better meet patients' needs by permitting increased provision of training and formalised support sessions for clinicians, greater involvement of psychologists in rehabilitation, and psychological support for patients' families.

CONCLUSIONS: Findings highlighted a perceived positive impact of integrated, specialist psychological support on the recovery of major trauma patients and the psychological wellbeing of major trauma clinicians. A need for future service expansion to overcome current capacity pressures and permit suggested developments was also emphasised. Replication of the psychology service in additional NHS MTCs to reach patients in other regions offers a potential solution to current inequities in post-major trauma psychological care in the UK.

PMID:40713353 | DOI:10.1016/j.injury.2025.112619

Injury. 2025 Jul 16:112612. doi: 10.1016/j.injury.2025.112612. Online ahead of print.

ABSTRACT

BACKGROUND: Shock index (SI) has been used to identify patients at risk for severe injury and predict those who require an emergent intervention. In adults, SI > 0.9 is considered elevated. Shock index pediatric age-adjusted (SIPA) modifies this threshold based on patients' age. This analysis leverages a large dataset to empirically identify threshold values of SI using a composite outcome capturing patients' need for emergent intervention.

METHODS: Pediatric patient data was abstracted from the Trauma Quality Improvement Program Participant Use Files from 2013 - 2020. 484,586 patients were included in the analysis. Area under the receiver-operator characteristic curve (AUROC) was used to empirically derive optimal cutoffs by age group. Need for emergent intervention included craniotomy, thoracotomy, laparotomy, chest tube, angioembolization, endotracheal intubation, and blood transfusion within 24 h of arrival or use of mechanical ventilation or admission to an intensive care unit.

RESULTS: Empirically derived SIPA-E cutoffs (1.23, 1.05, 0.95, and 0.85 for ages 1-3, 4-6, 7-12, and 13-17 years, respectively) were similar to established SIPA-L cutoffs (1.22, 1.22, 1.00, and 0.90). Overall accuracy was consistent between the two cutoffs with nearly equal trades of sensitivity for specificity but remain low overall (empirical cutoff sensitivity = 33.8 %, specificity = 79.5 %; established cutoff sensitivity = 26.5 %, specificity = 86.8 %).

CONCLUSIONS: Empirically derived cutoffs agreed with established cutoffs for SIPA, but overall accuracy is low. Rather than predicting broad outcomes, SIPA seems better suited to narrow cases where it has shown greater accuracy, such as the need for urgent blood transfusion.

LEVEL OF EVIDENCE: Prognostic/epidemiological; Level III.

PMID:40713352 | DOI:10.1016/j.injury.2025.112612

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.25.00574. Online ahead of print.

NO ABSTRACT

PMID:40712043 | DOI:10.2106/JBJS.25.00574

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.24.01520. Online ahead of print.

ABSTRACT

BACKGROUND: Achieving and maintaining global spinal balance is a crucial goal in posterior spinal fusion for adolescent idiopathic scoliosis (AIS). Despite its substantial impact on operative success, there is a noticeable gap in the literature regarding a systematic evaluation of the trajectory and durability of this critical parameter. With this study, we aimed to characterize the evolution of global balance after posterior spinal fusion for AIS.

METHODS: A prospective, multicenter spinal deformity database was retrospectively queried for patients with AIS undergoing posterior spinal fusion. Standing, 2-view radiographs (anteroposterior and lateral) were obtained at the first-erect visit, 6 months, 1 year, 2 years, and 5 years, with a subset of patients having radiographs at the 10-year mark. Coronal balance was defined as the difference, in centimeters, between the C7 plumb line and the central sacral vertical line (CSVL). The sagittal vertical axis (SVA) measured sagittal balance, calculated as the difference, in centimeters, between the C7 plumb line and the posterosuperior corner of the superior end plate of S1.

RESULTS: The study included 477 patients with 5 years of follow-up and 84 patients with a decade of follow-up. The mean patient age was 14.1 years, 67.9% of the patients were White, and 81.6% of the patients were female. Preoperative assessment revealed that 50.7% of the patients demonstrated optimal global balance. The initial postoperative evaluation showed essentially no improvement, with only 55.6% achieving optimal balance (Coronal and Sagittal Harmony [CASH] A0) at the first-erect visit. Subsequent follow-up demonstrated steady improvement, with 81.8% reaching optimal balance at 5 years and 87.7% at the 10-year mark.

CONCLUSIONS: This study offers a comprehensive analysis of global spinal alignment and traces the balance trajectory (in both the coronal and sagittal planes) after posterior spinal fusion in AIS. To our knowledge, it is the largest and longest follow-up study of its kind. The findings highlight a profound and steady postoperative improvement in global balance over time, advancing our understanding of postoperative spinal balance in AIS. The novel CASH classification introduced here serves as a possible tool for evaluating overall alignment and balance in patients with AIS.

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

PMID:40712001 | DOI:10.2106/JBJS.24.01520

J Bone Joint Surg Am. 2025 Jul 25. doi: 10.2106/JBJS.25.00086. Online ahead of print.

ABSTRACT

BACKGROUND: The U.S. Food and Drug Administration has approved a bupivacaine and meloxicam extended-release (ER) intra-articular injection for pain during total knee arthroplasty (TKA). However, the real-world evidence with regard to analgesic efficacy of that medication has been limited. This randomized clinical trial investigated the efficacy of this new medication compared with our standard periarticular injection for postoperative analgesia after primary TKA.

METHODS: Eligible patients undergoing primary, unilateral TKA for osteoarthritis at our academic center were enrolled. Patients were blinded and were randomized 1:1 to the bupivacaine-meloxicam ER (ZYNRELEF) injection group or the standard injection (ropivacaine, ketorolac, epinephrine) control group. A standardized, multimodal analgesic pathway was implemented. Numeric Rating Scale (NRS) pain scores and tallies of opioid consumption were collected. The primary outcome was the area under the curve (AUC) for NRS pain, adjusted for opioid consumption, over 72 hours. The minimal clinically important difference was considered to be 30%. Power analysis determined a minimum of 44 patients per group. The final groups included 53 patients in the experimental group and 48 patients in the control group.

RESULTS: Similar postoperative analgesia was observed, with an AUC for the adjusted NRS pain score up to 72 hours of 331 in the experimental group and 373 in the control group (p = 0.09). The mean maximum NRS pain scores were similar and reflected good, but not complete, analgesia. Scores were 3 to 5 on the day of the surgery, 4 to 6 on postoperative day (POD) 1, 5 to 6 on POD 2, and 4 to 5 on POD 3 (p > 0.05). One patient in the experimental group and 2 patients in the control group had early postoperative complications, none of which was deemed to be related to the analgesic choice.

CONCLUSIONS: This randomized clinical trial demonstrated similar analgesia with a bupivacaine-meloxicam ER solution and a standard periarticular injection up to 72 hours after primary TKA. Cost, reimbursement, and convenience may ultimately prove to be more important than analgesic differences when choosing between these 2 effective options for managing postoperative pain.

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

PMID:40711999 | DOI:10.2106/JBJS.25.00086

Injury. 2025 Jul 8;56(8):112578. doi: 10.1016/j.injury.2025.112578. Online ahead of print.

ABSTRACT

PURPOSE: Acetabular fractures remain one of the most complex injuries in orthopedic trauma surgery. Although the Judet-Letournel classification is widely accepted, it is predominantly descriptive and may offer limited intraoperative guidance. This study aims to present a simplified framework based on functional fracture orientation, distinguishing between column and transverse fracture families. Through this lens, surgical planning, reduction strategy, and fixation method selection can be facilitated.

METHODS: A five-step interpretation model was developed to classify and manage acetabular fractures. The model includes: (1) identification of primary and secondary fracture lines, (2) radiographic analysis from AP and Judet views, (3) axial CT orientation to determine fracture trajectory, (4) identification of the constant fragment, and (5) evaluation of endo-pelvic and exo-pelvic accessibility. Each fracture family was analyzed to correlate fracture morphology with specific reduction maneuvers, clamp positioning, and definitive implant placement.

RESULTS: Column fractures follow a coronal orientation when viewed on an axial CT, while transverse and T-type fractures propagate in a sagittal plane and often involve both columns. T-type fractures present an additional vertical component requiring dual-column reduction. For each fracture pattern, tailored reduction tools and implant configurations are proposed according to anatomical accessibility and biomechanical demands.

CONCLUSION: This structured approach offers a reproducible analytical tool for preoperative planning and intraoperative execution. By simplifying fracture type interpretation and aligning morphology with fixation strategy, it supports accurate surgical decision-making, enhances training for orthopedic trauma surgeons and improves fixation outcomes.

PMID:40706357 | DOI:10.1016/j.injury.2025.112578

SICOT J. 2025;11:42. doi: 10.1051/sicotj/2025038. Epub 2025 Jul 23.

ABSTRACT

PURPOSE: Severe varus knee osteoarthritis (OA) alters weight-bearing mechanics, leading to progressive stress concentration on the posteromedial tibial plateau. In select cases, this results in the development of a Posteromedial Varus Fatigue Fragment (PVFF), a chronic stress-related fracture that remains ununited and influences knee stability, surgical planning, and implant selection. This study aims to evaluate the incidence, radiographic detectability, and intraoperative significance of PVFF in patients undergoing total knee arthroplasty (TKA).

METHODS: A retrospective analysis was conducted of 856 consecutive TKA cases performed by a single surgeon. Preoperative radiographs, intraoperative findings, and surgical modifications were assessed to determine the incidence and implications of PVFF. Correlation with varus severity and absence of ACL was done.

RESULTS: PVFF was detected intraoperatively in 17 of 856 cases (1.99%), but only 9 (53%) were visible on pre-op imaging." All PVFF cases exhibited varus alignment exceeding 15° and complete ACL deficiency. Intraoperatively, fragment removal resulted in an increased medial flexion gap, impacting gap balancing and necessitating adjustments in implant selection, including the use of tibial stems or augments in select cases.

CONCLUSION: PVFF is an underrecognized structural lesion for precision in severe varus knee OA, affecting tibial fixation, load distribution, and medial knee stability. Its presence requires careful intraoperative assessment, as fragment removal can alter gap balancing. Improved preoperative recognition and surgical planning are essential to optimize TKA outcomes in patients. Further prospective studies and biomechanical analyses are needed to better understand PVFF's long-term clinical implications and refine surgical strategies.

PMID:40700623 | PMC:PMC12286574 | DOI:10.1051/sicotj/2025038

Injury. 2025 Jul 8:112601. doi: 10.1016/j.injury.2025.112601. Online ahead of print.

ABSTRACT

BACKGROUND: Controversies remain about the decision to proceed to aortic occlusion (AO) using either REBOA or resuscitative thoracotomy (RT) in severely injured patients worldwide. Present study aims to identify and evaluate the differences in AO technique use related to patients' conditions.

MATERIAL AND METHODS: This was a comparative study using a multicenter registry of postinjury AO (October 2013-February 2022). AO via REBOA was compared with RT performed in the emergency department of facilities experienced in both procedures and documented in Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry. Participants were adult trauma patients 16 years or older who experienced AO via REBOA zone 1 vs RT. The primary outcome was to identify the differences between patients treated with RT or REBOA. Ethical committee study approval number (Maryland IRB #HCR-HP-00,055,545-11).

RESULTS: 1937 patients were included. Median age: 34 (25-49), 1599 (82.5 %) were men. Penetrating trauma: 52.4 %. REBOA was adopted in 501 (25.9 %) patients, RT in 1436 (74.1 %). Patients treated with REBOA were older (40vs32 years, p < 0.001), suffered more frequently blunt trauma (76.3 %vs37.7 %, p < 0.001) and had higher ISS (33vs26, p = 0.003). Fewer of them underwent prehospital cardio-pulmonary-resuscitation (23.2 %vs49.8 % p < 0.001); had higher median SBP and HR (83vs0, p < 0.001 and 106vs0, p < 0.001 respectively), serum lactate levels were lower (7.5vs10.3 p < 0.001). SBP≥ 60 mmHg pre-hospital and at-admission (OR 2.27) and GCS>8 at admission (OR 2.24), trauma cases admitted/year (>4000/year, OR 4.41), transfer from another trauma center (OR 1.94) were related to the use of REBOA. Higher Injury severity score (ISS >55, OR 0.66), lower number of trauma treated (<4000/year, OR 0.66) and penetrating trauma (OR 0.24) were related to the use of RT.

CONCLUSION: REBOA was more frequently used for older patients with blunt trauma, higher prehospital systolic blood pressure, and Glasgow Coma Scale scores above 8. RT was more commonly performed in penetrating trauma, lower injury severity scores, and facilities with fewer annual trauma admissions. These findings suggest that patient characteristics and institutional factors significantly differed between patients treated with REBOA or RT, underscoring the need for further research.

PMID:40701854 | DOI:10.1016/j.injury.2025.112601

Injury. 2025 Jul 8;56(8):112602. doi: 10.1016/j.injury.2025.112602. Online ahead of print.

ABSTRACT

BACKGROUND: Cork University Hospital (CUH) is a model 4 tertiary referral centre in the south of Ireland. A robust Orthopaedic - Orthogeriatric co-management service manages close to 500 hip fractures per year. At CUH all adults aged 60 years or older admitted with hip fracture receive comprehensive geriatric assessment (CGA) and documentation of their frailty status.

OBJECTIVE: This study aims to review the clinical epidemiology of hip fractures in a specialist orthopaedic unit in Ireland, while examining the association between CFS and prespecified patient outcomes.

DESIGN & METHODS: Utilising the Irish hip fracture database (IHFD), we collected data between 1st July 2019 to September 30th 2021. Eligible cases were all adults aged 60 years and older admitted to CUH with hip fracture as defined by IHFD. Prespecified outcomes included Length of Stay (LOS), inpatient mortality and new admission to nursing home care and these were analysed in relation to a patients CFS.

RESULTS: 1132 adults met fracture criteria and were included in the study. Increasing frailty, specifically moderate to severe frailty was associated with increased LOS, inpatient mortality and increased likelihood of discharge to nursing home care when compared to those were not frail or who had very mild to moderate frailty.

CONCLUSIONS: People living with very mild to moderate frailty and severe frailty are at significant risk of hip fracture following low volume trauma. With approximately two years of hip fracture data, we found visible, generalizable data demonstrating the association between frailty and clinical outcomes.

PMID:40700919 | DOI:10.1016/j.injury.2025.112602

Injury. 2025 Jul 11;56(8):112599. doi: 10.1016/j.injury.2025.112599. Online ahead of print.

ABSTRACT

INTRODUCTION: The optimal postoperative weight-bearing regimen for tibial plateau fractures (TPF) remains a topic of debate. It ranges from non- or touch down- weight bearing between 2-12 weeks. More recent studies suggest that early weight-bearing may not result in any loss of reduction or hardware failure.

OBJECTIVES: To describe orthopedic surgeons' preferences for postoperative regimens and factors that influence their decision making in relation to weight-bearing status after treating TPF.

METHODS: A web-based survey was developed by the authors regarding tibial plateau fractures. Participants were asked different questions about timing of weight bearing after osteosynthesis and factors that influenced the surgeon's decision-making process for 3 unicondylar and 3bicondylar tibial plateau fractures.

RESULTS: A web-based survey was developed and 151 surgeons answered our survey. 82 % were men and 62 % of respondents treated > seven tibial plateau fractures per year. In unicondylar fractures 19 % recommended full weight bearing and 81 % recommended restricted weight-bearing. In bicondylar fractures 89 % recommended restricted weight-bearing and 11 % full weight bearing. Restricted weight bearing was recommended for 2, 4, 6, 8, 10 or 12 weeks depending on the surgeon's preference. 73 % of the surgeons stated that the sense of stability in their own construction affects their postoperative weight-bearing plan and in 45 % the regimen was based on "gut feeling". Responders believed they get a stable osteosyntehsis in only 57 % of their own fixations and 48 % responded that they do not believe patients are following the postoperative weight bearing plan.

CONCLUSION: Our survey study demonstrated variability among orthopedic surgeons regarding postoperative weight-bearing in tibial plateau fractures. Further research is required to understand the stability of tibial plateau fractures and quantify whether we can allow patients to weight bear earlier safely.

PMID:40694897 | DOI:10.1016/j.injury.2025.112599

SICOT J. 2025;11:41. doi: 10.1051/sicotj/2025039. Epub 2025 Jul 21.

ABSTRACT

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant concern in orthopedic surgery, particularly in total knee replacement (TKR), where infection can lead to severe complications. In procedures like TKR, where implants act as a foreign body and potential surface for biofilm formation, infections can lead to severe complications, including delayed healing, and implant failure, and often need multiple revision surgeries. Screening for MRSA before surgery has become a standard practice in many hospitals to reduce the risk of infection. This study aims to evaluate the prevalence of MRSA in patients undergoing TKR and analyze demographic characteristics.

METHODS: A retrospective analysis was conducted on patients scheduled for TKR. Demographic data, including age, gender, and other relevant clinical information, were extracted from the patient's medical records. MRSA screening was performed as part of the preoperative protocol, and the results were recorded. Descriptive statistics were used to summarize the data and calculate the prevalence of MRSA.

RESULTS: A total of 938 patients underwent MRSA screening prior to TKR. The mean age was 67.25 years (median: 68; range: 33-87). The majority of patients were female, accounting for 706 (75.0%), while 232 (25.0%) were male. MRSA test results revealed that 938 (99.3%) patients tested negative, whereas 6 (0.7%) tested positive. Among MRSA-positive patients, all were aged 60 years or older, suggesting a potential correlation between advanced age and MRSA positivity.

CONCLUSION: This study found a low MRSA prevalence (0.7%) in TKR patients, with all cases occurring in individuals aged ≥60 years. The findings advocate prioritizing preoperative screening in older patients to optimize resource use in low-prevalence settings and highlight the need to investigate TKR-specific risk factors for tailored infection control strategies.

PMID:40689503 | PMC:PMC12278734 | DOI:10.1051/sicotj/2025039

Injury. 2025 Jul 10;56(8):112600. doi: 10.1016/j.injury.2025.112600. Online ahead of print.

ABSTRACT

BACKGROUND: Missed injuries (MIs) remain a significant and potentially preventable complication in trauma care, often associated with increased morbidity, mortality, prolonged hospitalization, and legal consequences. Despite decades of recognition, MIs continue to challenge trauma teams, particularly in complex, multi-injury scenarios.

OBJECTIVE: This study aims to review the literature and identify the most relevant factors contributing to missed injuries in trauma patients, highlighting opportunities for prevention and clinical improvement.

METHODS: A systematic review was conducted according to PRISMA guidelines using PubMed. Inclusion criteria encompassed studies reporting on trauma patients with MIs, their risk factors, prevalence, and clinical outcomes. Exclusion criteria included non-trauma-focused studies, non-peer-reviewed articles, and case reports. Five key domains were assessed: trauma characteristics, injury-specific factors, diagnostic limitations, patient-related challenges, and human (physician) factors.

RESULTS: High Injury Severity Score (ISS), altered mental status (e.g., low Glasgow Coma Scale), polytrauma, and cognitive biases such as anchoring were consistently associated with higher rates of MIs. Non-spinal orthopedic injuries, abdominal and thoracic lesions, and retroperitoneal or diaphragmatic injuries were among the most frequently missed. Diagnostic limitations included false-negative imaging, misinterpretation of radiological exams, and inadequate protocols in unstable patients. Patient factors-such as obesity, advanced age, alcohol or drug intoxication, and pregnancy-also contributed to delayed diagnosis. Inexperience, fatigue, and poor communication were recurrent human factors linked to diagnostic failures. The implementation of Trauma Tertiary Surveys (TTS) significantly reduced MI incidence and improved detection of occult injuries.

CONCLUSION: Missed injuries are multifactorial events influenced by the complexity of trauma, diagnostic limitations, patient characteristics, and human error. Proactive strategies, including TTS, heightened awareness of injury-specific challenges, improved imaging protocols, and fostering a collaborative trauma culture, are critical to minimizing missed diagnoses and enhancing trauma care quality.

PMID:40690819 | DOI:10.1016/j.injury.2025.112600