Int Orthop. 2025 Nov 4. doi: 10.1007/s00264-025-06681-3. Online ahead of print.

ABSTRACT

PURPOSE: Pelvic-ring injuries in women often result in urinary dysfunction owing to the proximity of pelvic organs to the urinary tract, significantly affecting quality of life. However, detailed research on urinary sequelae remains limited. This study aimed to assess the incidence of urinary dysfunction in women after pelvic-ring injuries and to identify risk factors influencing urinary function.

METHODS: We conducted a retrospective cohort study of women who underwent osteosynthesis for pelvic-ring injuries between January 2022 and June 2023 with ≥ 12 months of follow-up. Urinary dysfunction was evaluated using the Questionnaire for Urinary Incontinence Diagnosis and Female Urinary Symptom Score at one, three, six and 12 months postoperatively.

RESULTS: Fifty-eight patients (mean age, 43.2 years) were included, with motor-vehicle collisions being the most common cause for pelvic-ring injuries (74.1%). Most injuries (84.5%) were classified as Type B. Nearly half of the patients reported urinary symptoms one month post-surgery, which significantly improved over 12 months (P < 0.05). In the multivariate analysis, greater injury severity was independently associated with urinary dysfunction at six months (adjusted odds ratio: 1.05, 95% confidence interval 1.00-1.12, p = 0.049), while no other clinical or procedural factors, including age, arterial embolisation, or surgical approach, stayed significant. Functional recovery correlated with reduced symptoms over time.

CONCLUSION: Urinary dysfunction is a frequent but under-recognised complication after pelvic-ring injuries. Although most patients experience gradual improvement over time, greater injury severity is independently associated with early urinary symptoms. Continuous monitoring and timely rehabilitation may help optimise long-term functional recovery.

PMID:41186674 | DOI:10.1007/s00264-025-06681-3

Int Orthop. 2025 Nov 4. doi: 10.1007/s00264-025-06687-x. Online ahead of print.

ABSTRACT

PURPOSE: Aseptic loosening of the acetabular cup component is the primary cause for complex revision surgery following total hip arthroplasty. However, the extent to which the different zones of the prosthetic contribute to successful osseointegration and how reliable this integration can be assessed using conventional radiographs remain unclear. The aim of the study was to evaluate the osseointegration of cementless threaded acetabular cups through a combination of radiological analysis and histological validation.

METHODS: Eight hemipelves of body donors with cementless threaded acetabular cups were included in this study. Conventional radiographs were used to assess the specimens for existing radiolucent lines, periprosthetic osteolysis, or fractures. For histological analysis, thin sections of the acetabular cup were examined for the presence of a periprosthetic membrane, particle debris or inflammatory cells. The areas of visible contact were identified and the bone-to-implant contact (BIC) was calculated.

RESULTS: Radiographic analysis revealed no signs of insufficient osseointegration, osteolytic lesions, or periprosthetic loosening, in any of the specimens. Histological examination showed an average osseointegration rate of 41.84%. Bone-to-implant contact analysis showed no significant differences between different sectors or zones, or between conical and bi-conical acetabular cups.

CONCLUSION: This study highlights successful osseointegration of cementless threaded acetabular cups, with a mean survival of 18.2 years. Radiological imaging aligned closely to histological finding, confirming implant stability and long-term clinical effectiveness.

PMID:41186673 | DOI:10.1007/s00264-025-06687-x

Injury. 2025 Oct 25;56(12):112846. doi: 10.1016/j.injury.2025.112846. Online ahead of print.

ABSTRACT

BACKGROUND: Computed tomography (CT) is the current reference standard for evaluating intra-articular distal radius fractures, however concerns remain regarding radiation exposure and limited soft tissue assessment. Zero Echo Time (ZTE) MRI is a novel technique that enables direct cortical bone imaging with contrast similar to CT, while avoiding radiation. This proof-of-concept study aimed to compare the diagnostic performance of ZTE MRI with CT in fracture classification, articular involvement, and treatment planning.

METHODS: In this prospective comparative study, 28 patients with acute intra-articular distal radius fractures underwent both CT and ZTE MRI within 7 days of injury. Fractures were classified according to AO/OTA, Fernandez classifications, quantitative parameters (angulation, radial inclination, ulnar variance, articular fragment count) and binary findings (distal ulna fracture, distal radioulnar joint (DRUJ) involvement) were assessed. Two orthopedic surgeons and two musculoskeletal radiologists independently reviewed all images. Inter- and intraobserver agreement was calculated using Cohen's and Fleiss' kappa and intraclass correlation coefficients.

RESULTS: Agreement among surgeons for AO/OTA classification was good on CT (κ = 0.767) and good on ZTE MRI (κ = 0.680). For Fernandez classification, agreement was good on CT (κ = 0.780) and ZTE (κ = 0.736). Surgeons demonstrated higher agreement (κ ≈0.68-0.78) than radiologists (κ ≈0.56-0.65). For binary parameters, agreement among radiologists was very good (κ = 0.820-0.880), while inter-surgeon agreement ranged from moderate to good (κ = 0.500-0.714). Continuous measures showed good reproducibility for angulation (ICC = 0.762-0.858), but lower values for inclination among surgeons (ICC ≤ 0.492-0.531). ZTE MRI demonstrated sensitivity, specificity, and accuracy comparable to CT for classification and detection of DRUJ involvement and distal ulna fractures (approximately 85-93 %). Treatment decisions showed very good agreement (κ = 0.855), with ZTE altering CT-based management in 3/28 (10.7 %) cases for Surgeon 1 and 2/28 (7.1 %) for Surgeon 2.

CONCLUSION: ZTE MRI provides diagnostic performance comparable to CT for intra-articular distal radius fractures, with high reliability for fracture classification, joint involvement, and treatment decision-making. As a radiation-free modality that also permits concurrent soft tissue assessment, ZTE MRI may serve as a promising alternative to CT in selected clinical scenarios.

PMID:41187521 | DOI:10.1016/j.injury.2025.112846

Injury. 2025 Oct 29;56(12):112844. doi: 10.1016/j.injury.2025.112844. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with moderate to severe traumatic brain injury (TBI) often face prolonged rehabilitation. These individuals experience elevated nutrition needs and barriers to normal eating behaviours, necessitating effective nutrition therapy to enhance rehabilitation and recovery. Existing nutrition research focuses on intensive and acute care settings, with a notable lack of evidence in the rehabilitation and subacute contexts. This scoping review aims to describe evidence on nutrition therapy and outcomes for adult patients with moderate to severe TBI in inpatient rehabilitation and subacute settings and identify gaps to guide future research.

METHODS: A systematic scoping review was conducted in accordance with PRISMA guidelines, comprising of a literature search of CINAHL and MEDLINE for studies published between January 2010 and August 2024. Articles were included if they were: quantitative studies in adults (≥16 years) with a moderate to severe TBI, admitted to a rehabilitation or subacute facility, that addressed an aspect of nutrition therapy. Data were extracted on study design, patient characteristics, TBI severity, and nutrition-related results. Data were categorised and synthesised according to the study design, nutrition intervention, and outcomes.

RESULTS: A total of seventeen studies were identified, comprising between 7 to 1701 participants. Among these, nine studies were prospective observational, seven were retrospective observational, and one was a randomised controlled trial. The investigations covered various aspects of nutrition management: ten focused on the route of nutrition delivery, four assessed nutrition status, three evaluated specific nutrient intakes, and one examined eating behaviours (two studies addressed multiple interventions).

CONCLUSION: Evidence on nutrition management practices for patients with a TBI admitted to a rehabilitation or subacute setting is sparce, with only one interventional study identified, and observational studies predominantly exploring route of nutrition delivery. Further research is essential to delineate optimal nutritional therapies for adults with TBI in rehabilitation and subacute settings to guide clinical care.

PMID:41187520 | DOI:10.1016/j.injury.2025.112844

EFORT Open Rev. 2025 Nov 3;10(11):829-841. doi: 10.1530/EOR-2025-0100.

ABSTRACT

PURPOSE: Phosphaturic mesenchymal tumors (PMTs) are rare neoplasms causing tumor-induced osteomalacia (TIO), usually through fibroblast growth factor 23 (FGF-23) secretion. They arise in bone or soft tissue and present with non-specific symptoms, often leading to delayed diagnosis. This study evaluates tumor characteristics, the role of surgical therapy, and its impact on outcomes while highlighting key aspects of PMT management.

METHODS: A systematic review was conducted according to PRISMA guidelines, including 188 studies and 584 PMT cases, focusing on clinical presentation, treatment modalities, and outcomes. In addition, we retrospectively analyzed four patients treated at our institution.

RESULTS: The mean patient age was 49 ± 15 years, with a slight male predominance (56%). Tumors were evenly distributed between bone and soft tissue, most commonly affecting the lower extremities. Frequent symptoms included pain (90%) and pathological fractures (69%). Elevated FGF-23 levels were detected preoperatively in over 90% of cases. Complete remission was achieved in 66.2% of surgically treated patients compared to 29.4% of non-operatively managed patients (P < 0.001). Complete resection was associated with significantly higher remission rates (55.7 vs 6.6%, P = 0.001), particularly in bone-localized PMT. In our case series, all patients undergoing complete resection showed no evidence of disease and relief of TIO-associated symptoms.

CONCLUSIONS: PMTs often lead to diagnostic delays due to non-specific symptoms. Complete surgical resection is the strongest predictor of favorable outcomes, especially for bone-localized tumors. An interdisciplinary approach is critical for early diagnosis, optimal treatment, and maximizing favorable clinical outcomes.

PMID:41182108 | PMC:PMC12587032 | DOI:10.1530/EOR-2025-0100

Injury. 2025 Oct 29;56(12):112850. doi: 10.1016/j.injury.2025.112850. Online ahead of print.

ABSTRACT

INTRODUCTION: Sacral fractures are an increasingly recognized clinical entity, particularly among older adults with osteoporosis. However, national-level data on long-term trends in incidence, diagnostic imaging, treatment strategies, and the recognition of underlying bone fragility remain limited. This study aimed to evaluate nationwide trends in sacral fracture care in Germany over a 19-year period.

METHODS: We conducted a retrospective analysis of all inpatient cases with a primary diagnosis of sacral fracture (ICD-10-GM: S32.1) recorded in the German Federal Statistical Office database from 2005 to 2023. Fragility fractures were defined as cases in patients aged ≥65 years. Outcomes included use of CT and MRI (OPS codes), surgical versus conservative treatment, and coded diagnoses of osteoporosis (ICD-10: M80-M82). Time trends were analyzed using linear regression; group comparisons were conducted with t-tests and chi-square tests (p < 0.05).

RESULTS: A total of 162,116 sacral fractures were identified. Annual cases increased from 1,861 in 2005 to 7,695 in 2023. Fragility fractures in women aged ≥65 years rose significantly, from 985 to 12,901 cases (p < 0.0001). CT use increased by 241% and MRI by 175%, with a significant shift toward CT as the preferred modality (p < 0.0001). Despite increased access to minimally invasive options, surgical treatment rates remained stable at approximately 20% (p = 0.15). Osteoporosis was documented in only 1.5% of cases.

CONCLUSIONS: The incidence of sacral fractures in Germany has risen markedly, driven by an aging population and under-recognized bone fragility. While cross-sectional imaging use has expanded, surgical treatment remains underutilized, and osteoporosis continues to be grossly underdiagnosed. These findings underscore a systemic gap in secondary prevention and highlight the need for integrated, bone-focused trauma care models.

PMID:41183411 | DOI:10.1016/j.injury.2025.112850

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00543. Online ahead of print.

NO ABSTRACT

PMID:41184173 | DOI:10.2106/JBJS.25.00543

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00055. Online ahead of print.

NO ABSTRACT

PMID:41183159 | DOI:10.2106/JBJS.25.00055

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00120. Online ahead of print.

ABSTRACT

BACKGROUND: The effectiveness of the Latarjet procedure in stabilizing the glenohumeral joint (GHJ) in the abducted and externally rotated position is well documented. However, evidence of its ability to restore the GHJ kinematics in other positions and without anterior-directed load is sparse. The purpose of this study was to evaluate the GHJ kinematics, throughout external rotation, following the Latarjet procedure in shoulders with 15% anterior glenoid bone loss.

METHODS: Eight human donor arms were examined using dynamic radiostereometry during GHJ external rotation with anterior-directed loads of 0 to 30 N. Kinematics, measured on the basis of the humeral head center and the contact point relative to the glenoid, were assessed at 30° and 60° of GHJ abduction for 3 conditions: the native GHJ, 15% glenoid bone loss, and following the Latarjet procedure.

RESULTS: Following the Latarjet procedure, the humeral head center and contact point were up to 9.7 mm (95% confidence interval [CI], 0.5 to 18.8 mm) more posterior and 7.4 mm (95% CI, 0.3 to 14.4 mm) more superior compared with 15% glenoid bone loss. With a 30 N anterior-directed load, the contact point was up to 4.4 mm (95% CI, 2.4 to 6.4 mm) more anterior compared with 15% glenoid bone loss. No significant differences in kinematics between the native GHJ and following the Latarjet procedure were observed with anterior-directed load application. However, without an anterior-directed load, the humeral head center and contact point were up to 7.9 mm (95% CI, 2.3 to 13.5 mm) more posterior and 6.1 mm (95% CI, 0.0 to 12.2 mm) more inferior following the Latarjet procedure compared with the native GHJ.

CONCLUSIONS: With anterior-directed loading, the Latarjet procedure to treat 15% glenoid bone loss restored the native GHJ kinematics, with the largest stabilizing effect at the end-range external rotation. However, without anterior-directed loading, the humeral head center and contact point were more posterior and inferior following the Latarjet procedure than in the native GHJ, suggesting potential excessive posterior humeral head translation.

CLINICAL RELEVANCE: Posterior subluxation of the humeral head during resting and non-loaded activities following the Latarjet procedure may be a concern in terms of future posterior glenoid cartilage wear and GHJ osteoarthritis. However, these results need to be confirmed in a clinical setting.

PMID:41183158 | DOI:10.2106/JBJS.25.00120

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.24.00387. Online ahead of print.

ABSTRACT

BACKGROUND: Globally, traditional bonesetters (TBSs) often provide patients with care for their orthopaedic concerns, from musculoskeletal injuries to oncological pathologies, often using techniques that may differ from Western methods. The aim of this study was to investigate the motivations for seeking care from a TBS, the types of treatments received, and the attitudes toward traditional bonesetting, and to determine any differences between patients with traumatic versus nontraumatic musculoskeletal pathologies.

METHODS: We surveyed patients who presented to the Orthopaedic Outpatient Clinic at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda, who had previously seen a TBS for their orthopaedic concern, in order to determine their reasons for seeking care from a TBS and the impressions of their care.

RESULTS: This study included 168 patients: 109 presented with traumatic injury, and 59 presented with another orthopaedic concern. The trauma group had a higher monthly family income (p < 0.001) and a higher level of education (p = 0.006) than the nontrauma cohort. Treatments provided by the TBS included cutting or puncturing of the skin, locally applied herbs, casting, and other traditional methods. The greatest motivation for seeking traditional bonesetting among trauma patients was belief in its efficacy; the patients in the nontrauma cohort believed that a TBS could reverse the witchcraft or curse that had caused their ailment. Failure of management was the reason that was cited most by both the trauma and nontrauma groups for discontinuing treatment with a TBS.

CONCLUSIONS: Orthopaedic pathology influences the way that individuals seek traditional bonesetting and their motivations for doing so. For nontraumatic pathologies, superstitious beliefs and a belief in its efficacy play a role in the selection of traditional bonesetting. Additional surveys of individuals may further elucidate the outcomes of seeking care from a TBS.

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

PMID:41183157 | DOI:10.2106/JBJS.24.00387

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.24.01051. Online ahead of print.

ABSTRACT

BACKGROUND: Isolated grade-III posterior cruciate ligament (PCL) injuries are defined as PCL injuries without any other ligamentous pathology that have a posterior translation of ≥12 mm compared with the contralateral knee. The aims of this study were to investigate isolated grade-III PCL injuries and to compare the clinical outcomes of 2 surgical methods.

METHODS: Patients with a PCL injury between 2008 and 2020 were retrospectively reviewed. Patients with an isolated grade-III PCL injury underwent either PCL reconstruction or combined PCL and posterolateral corner (PLC) reconstruction. Stress radiographs (Telos) and International Knee Documentation Committee (IKDC) subjective score, Lysholm knee score, and Tegner activity scale values were obtained preoperatively and at each follow-up.

RESULTS: Of 448 patients with a PCL injury, 254 patients with an isolated PCL injury were identified. Sixty of the 254 patients had a grade-III posterior translation. Thirty patients were excluded due to a lack of follow-up or medical information, leaving a cohort of 30 patients. The 17 patients who underwent isolated PCL reconstruction (Group I) and the 13 patients who underwent combined PCL and PLC reconstruction (Group II) had a mean age of 36.2 years (range, 16 to 59 years) and 31.8 years (range, 16 to 58 years) (p = 0.438), respectively, with a mean follow-up of 4.9 years (range, 2 to 11.8 years) and 4.3 years (range, 2 to 10 years) (p = 0.623), respectively. In Groups I and II, posterior translation, compared with the contralateral knee, improved from 13.7 ± 1.7 mm to 7.2 ± 3.2 mm (p < 0.0001) and from 14.6 ± 2.0 to 7.1 ± 2.4 mm (p = 0.001), respectively. In Group I, the mean IKDC, Lysholm, and Tegner scores improved from 54.8 to 71.8 (p = 0.001), from 56.7 to 77.9 (p = 0.004), and from 3.8 to 5.5 (p = 0.021), respectively. In Group II, the mean IKDC, Lysholm, and Tegner scores improved from 47.1 to 69.5 (p = 0.003), from 54.2 to 77.8 (p = 0.003), and from 4.0 to 5.2 (p = 0.042), respectively. No differences were observed between the groups.

CONCLUSIONS: Patients with an isolated grade-III PCL injury who underwent isolated PCL reconstruction showed significant improvements in subjective and objective outcomes. No significant difference was observed between patients who underwent isolated PCL reconstruction and those who underwent combined PCL and PLC reconstruction.

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

PMID:41183155 | DOI:10.2106/JBJS.24.01051

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00958. Online ahead of print.

NO ABSTRACT

PMID:41183154 | DOI:10.2106/JBJS.25.00958

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00486. Online ahead of print.

NO ABSTRACT

PMID:41183153 | DOI:10.2106/JBJS.25.00486

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00294. Online ahead of print.

ABSTRACT

BACKGROUND: While some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics.

METHODS: This retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients ≥60 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk.

RESULTS: The study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of ≥3). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of ≥3 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex.

CONCLUSIONS: In this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation.

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

PMID:41183152 | DOI:10.2106/JBJS.25.00294

J Bone Joint Surg Am. 2025 Nov 3. doi: 10.2106/JBJS.25.00448. Online ahead of print.

NO ABSTRACT

PMID:41183151 | DOI:10.2106/JBJS.25.00448

Injury. 2025 Oct 19;56(12):112843. doi: 10.1016/j.injury.2025.112843. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate total ankle arthroplasty (TAA) using 3D-printed navigation-assisted osteotomy with patient-specific cutting guides and standard implants, compared with conventional TAA.

METHODS: This retrospective analysis included 82 individuals diagnosed with end-stage ankle arthritis who received total ankle arthroplasty (TAA) between January 2020 and June 2023.Based on surgical technique, patients were divided into a patient-specific instrumentation (PSI) group (n = 33) and a control group (n = 49). The PSI group received preoperative 3D CT-based planning for personalized osteotomy guides patient-specific and implants, while the control group underwent standard procedures. Perioperative parameters, functional recovery (dorsiflexion, plantarflexion, MOXFQ, FAAM), radiographic alignment (α angle, β angle, ADTA), and complication rates were compared.

RESULTS: The PSI group showed significant advantages over the control group in operative time (1.01 ± 0.09 h vs. 1.47 ± 0.15 h)(P < 0.01). At 12 months postoperatively, the PSI group demonstrated significantly greater improvements in ankle dorsiflexion and plantarflexion range of motion, MOXFQ, and FAAM scores (all P < 0.01). Radiographic assessments indicated that the PSI group achieved superior correction and consistency in α angle, β angle, and ADTA compared to the control group (P < 0.01). The overall complication rate was significantly lower in the PSI group (2/33 vs 6/49, P < 0.05), with no cases of prosthesis subsidence or revision reported.

CONCLUSIONS: This approach improves surgical accuracy and efficiency, accelerates recovery, and reduces complications, supporting its use for precise management of end-stage ankle arthritis.

PMID:41175699 | DOI:10.1016/j.injury.2025.112843

Int Orthop. 2025 Nov 1. doi: 10.1007/s00264-025-06684-0. Online ahead of print.

ABSTRACT

PURPOSE: Preoperative anxiety (Pop-Anx) is highly prevalent among patients undergoing orthopaedic surgery. Pop-Anx can stem from fears related to the procedure, anaesthesia, or the recovery process. It has been linked to poorer postoperative outcomes, including greater pain, reduced function, and a lower quality of life. Despite its clinical significance, Pop-Anx is inconsistently assessed due to a lack of standardized tools and clear guidelines. The objective was to identify instruments used for measuring Pop-Anx in patients undergoing orthopaedic surgeries.

METHODS: A systematic search was conducted across five databases up to September 2024, following PRISMA guidelines. Data on anxiety assessment tools, timing, administration, and related outcomes were extracted. Meta-analyses were conducted on studies with a low risk of bias using random-effects models.

RESULTS: Screening of the literature revealed that 42 studies assessed Pop-Anx, involving a total of 115,380 patients. Ten different tools were used to measure Pop-Anx, with the Hospital Anxiety and Depression Scale (HADS) being the most frequent. Significant variability was observed in assessment timing and methodology. A meta-analysis showed that Pop-Anx was positively correlated with postoperative anxiety (z = 0.60) and pain (z = 0.22) and negatively correlated with joint function (z = -0.25). Females reported higher Pop-Anx (g = 0.38). The timing of outcome assessment did not significantly moderate these relationships.

CONCLUSION: Although Pop-Anx is associated with worse postoperative outcomes, it is assessed using heterogeneous and sometimes inadequate tools. Standardized, context-specific assessment methods are needed. Despite its clinical relevance, Pop-Anx remains underassessed in some common orthopaedic procedures.

PMID:41174327 | DOI:10.1007/s00264-025-06684-0

Int Orthop. 2025 Nov 1. doi: 10.1007/s00264-025-06689-9. Online ahead of print.

ABSTRACT

PURPOSE: Fractures in persons with haemophilia (PWH) exhibit similarities and distinctions compared to typical fractures. However, complications confer an added increase in the risk of fractures. This study aimed to summarize the treatment experience of fractures in PWH based on a classification.

METHODS: A retrospective cohort study was conducted on PWH between 2001 and 2023. The classification was developed into three types according to PWH's clinical presentations and imaging findings. Subsequently, the distribution and distinctions among subtypes were analyzed, followed by an exploration of risk factors for fracture-related complications.

RESULTS: A total of 61 fractures in PWH met the inclusion and exclusion criteria. The median follow-up duration was 6.87 years. Type II and III fractures in PWH exhibited a longer time of fracture healing and hospital stay, along with increased fracture-related complication rates. In further analysis, the operative time and intraoperative blood loss also increased significantly. Furthermore, compared to non-surgical approaches, the surgical treatment appeared to reduce the incidence of fracture-related complications. Next, the femur was identified as the most frequently fractured site. Plate fixation was the predominant surgical approach for types II (20/29) and III (8/13).

CONCLUSION: This study reviews treatment experience for fractures in PWH according to a classification and stresses the importance of surgery. The classification may provide a potential strategy for post-operative care. However, further classification is required.

PMID:41174326 | DOI:10.1007/s00264-025-06689-9

SICOT J. 2025;11:57. doi: 10.1051/sicotj/2025048. Epub 2025 Oct 31.

ABSTRACT

INTRODUCTION: Osteoporosis is a prevalent and often underdiagnosed condition that significantly increases the risk of fragility fractures. Dual-energy X-ray absorptiometry (DXA) is the standard diagnostic tool; however, many patients remain unscreened. Preoperative computed tomography (CT) scans obtained for robotic-assisted total knee arthroplasty (TKA) planning present an opportunity for opportunistic osteoporosis screening without additional radiation exposure.

METHODS: A retrospective observational study was conducted on 637 patients (307 males, 330 females) who underwent robotic-assisted TKA between January 2023 and December 2024. Preoperative CT scans were analyzed using quantitative computed tomography (QCT) software to determine T-scores, Z-scores, and percentage of bone mineral density (BMD) relative to a young-adult reference. Patients were categorized as normal (T-score ≥ -1.0), osteopenic (-2.5 < T-score < -1.0), or osteoporotic (T-score ≤ -2.5).

RESULTS: Among 597 patients with available T-score data, 41.0% were classified as normal, 32.3% as osteopenic, and 26.6% as osteoporotic. Notably, 37.0% of female patients were osteoporotic compared to 15.3% of male patients. Bone density parameters declined progressively with age, with females over 80 years exhibiting a mean T-score of -2.53 and BMD at 68.25% of the young-adult reference.

DISCUSSION: Opportunistic screening using preoperative CT scans in robotic-assisted TKA patients reveals a high prevalence of undiagnosed low BMD, particularly among elderly women. Integrating QCT analysis into the preoperative workflow may facilitate early identification of at-risk individuals, informing surgical planning and enabling timely interventions to improve bone health.

PMID:41172241 | PMC:PMC12578436 | DOI:10.1051/sicotj/2025048

Injury. 2025 Oct 25:112845. doi: 10.1016/j.injury.2025.112845. Online ahead of print.

ABSTRACT

INTRODUCTION: American College of Surgeons Committee on Trauma (ACS/COT) policy now requires that United States trauma centers perform mandatory posttraumatic stress disorder (PTSD) screening and referral, as well as alcohol screening and intervention. Few investigations, however, have evaluated patterns of trauma center mental health and substance use inpatient service delivery.

METHODS: The investigation was a secondary analysis of a randomized clinical trial in which screening and referral practices mirrored ACS/COT policy requirements. Hospitalized physical injury survivors ≥18 years of age underwent screening for elevated levels of PTSD symptoms. Symptomatic patients were randomized to either enhanced usual care control or collaborative care intervention conditions. Patients randomized to the enhanced usual care control condition underwent PTSD screening followed by a study team orchestrated trauma surgery referral recommendation for mental health and/or substance use services. One or more inpatient referral suggestions were made for the Psychiatry Consultation Liaison, Rehabilitation Psychology, Social Work, Spiritual Care, and Alcohol Screening, Brief Intervention and Referral (SBIRT)/Addiction Medicine Consult services. Patients randomized to the intervention condition were screened and received care from a trauma center based collaborative care team that addressed mental health and substance use problems, but did not receive inpatient referrals. Electronic medical record review documented the frequency of mental health and substance use consulting service visits. Analyses determined if randomization status or referral significantly contributed to the likelihood of receiving inpatient services.

RESULTS: Enhanced usual care patients were significantly more likely to receive one or more visits from any service when compared to intervention patients (odds ratio (OR)=1.91, 95 % confidence interval (95 % CI) =1.05, 3.57). Study team referral suggestions were associated with an increased likelihood of Addiction Medicine Consult (OR=9.14, 95 % CI =3.36, 25.60) and SBIRT visits (OR=7.15, 95 % CI =3.33, 15.39) for enhanced usual care patients.

CONCLUSION: Usual care patients experienced significantly enhanced inpatient service delivery when randomized to procedures that mirror ACS/COT policy requirements. In the United States, ACS/COT screening, intervention, and referral requirements may be associated with improved quality of trauma center mental health and substance use service delivery.

CLINICAL TRIAL REGISTRATION: NCT03569878.

PMID:41173731 | DOI:10.1016/j.injury.2025.112845