J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.01047. Online ahead of print.

ABSTRACT

➢ Patient comprehension in orthopaedic surgery is frequently limited, with substantial gaps between perceived and actual understanding of conditions, procedures, and recovery timelines.➢ Expectation management is a central communication challenge, as patients often anticipate surgery or outcomes in ways that are unrealistic, directly affecting satisfaction and informed consent.➢ The EXPLAIN framework provides a structured, orthopaedic-specific approach to improve communication through 7 components: Educate, eXample, Purpose, Language/Learn, Analogy/Articulate, Illustrate, and Navigate.➢ Evidence supports the use of strategies such as plain language, teach-back, anatomical models, 3-dimensional aids, and structured navigation programs to improve comprehension, reduce anxiety, and lower readmissions.➢ Implementing EXPLAIN can enhance shared decision-making, reduce communication-related malpractice risk, and improve both patient satisfaction and outcomes.

PMID:41678671 | DOI:10.2106/JBJS.25.01047

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.00807. Online ahead of print.

ABSTRACT

BACKGROUND: Transthyretin (TTR) amyloid deposition in the tenosynovium in carpal tunnel syndrome (CTS) is a potential early manifestation of systemic amyloidosis. However, its effects on tenosynovial fibroblasts in CTS remain unclear. We aimed to clarify how wild-type and Val30Met mutant TTR amyloids affect tenosynovial fibroblasts in CTS.

METHODS: Synovial tissue from 20 patients undergoing carpal tunnel release surgery was evaluated for TTR amyloid. Expression of genes related to fibrosis, inflammation, and oxidative stress was compared between TTR-positive and TTR-negative groups. Fibroblasts isolated from TTR-negative patients were treated in vitro with wild-type or Val30Met mutant recombinant TTR. Analyses included quantitative RT-PCR (reverse transcription-polymerase chain reaction), Picrosirius Red staining, MTT assays evaluating cell proliferation, reactive oxygen species (ROS) activity measurements, and senescence-related gene expression.

RESULTS: In TTR-positive tissue, fibrosis-related genes (COL1A1, COL3A1, TGFB1, and ACTA2), the inflammatory mediator NFKB1, and oxidative-stress-related genes (KEAP1, NQO1, and SOD1) were significantly upregulated, whereas SOD2 was downregulated. With in vitro treatment in the TTR-negative group, both wild-type and Val30Met TTR increased COL3A1, IL6, and CXCL8 expression, whereas Val30Met TTR further enhanced IL1B expression. Picrosirius Red staining confirmed increased collagen deposition. MTT assays revealed increased cell viability, indicating enhanced fibroblast proliferation, in both groups. The senescence-related genes CDKN2D and GADD45A were downregulated, suggesting enhanced proliferative activity. ROS activity did not differ significantly between groups.

CONCLUSIONS: TTR amyloid was found to promote expression of fibrosis, inflammation, and oxidative-stress-related genes; inhibit senescence pathways; and enhance collagen deposition and fibroblast proliferation in fibroblasts from patients with CTS.

CLINICAL RELEVANCE: CTS with TTR deposition may reflect more than a localized neuropathy, as TTR potentially plays a pathogenic role in CTS development. This finding provides novel insights into the underlying mechanisms of CTS.

PMID:41678652 | DOI:10.2106/JBJS.25.00807

J Bone Joint Surg Am. 2026 Feb 12. doi: 10.2106/JBJS.25.01026. Online ahead of print.

ABSTRACT

BACKGROUND: Osteochondritis dissecans (OCD) healing can be unpredictably slow, incomplete, or absent after surgical treatment. This frustrates patients, families, and the medical team. We aimed to develop an algorithm to predict the speed of OCD radiographic ossification based on patient demographic, physical, surgical, and imaging data.

METHODS: We studied a prospective cohort of patients with knee OCD lesions in a multicenter database. We included patients who were diagnosed with knee OCD lesions of the lateral or medial femoral condyle and were treated operatively at a single center. We collected patient information from medical records and imaging studies. Radiographic healing was defined on the basis of the percentage of the original OCD lesion that had a normal bone density (ossification) compared with the surrounding condyle, rated on a continuous scale from 0 to 100. An OCD lesion that achieved ≥90% of the normal surrounding bone density at 6 months following surgery was defined as fast healing. Follow-up was conducted with radiographs only. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS: This study included 79 OCD lesions in 72 individuals. The mean patient age was 13.79 ± 2.71 years (range, 8.56 to 22.98 years), and 45 (62.5%) of the 72 patients were male. A total of 56 patients (77.8%) were White, and 69 patients (95.8%) were of non-Hispanic ethnicity. In all, 23 lesions (29.1%) fit the of fast healing. A multivariable regression analysis revealed that high preoperative bone density within the OCD lesion (p < 0.001) was the only feature that had an association with fast healing. A preoperative lesion density rating of ≥70% predicted fast ossification with a sensitivity of 87% and a specificity of 66.1%.

CONCLUSIONS: A preoperative OCD density rating that was ≥70% of that of the normal surrounding bone was found to be the only independent predictor of fast ossification following surgery.

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

PMID:41678591 | DOI:10.2106/JBJS.25.01026

Injury. 2026 Feb 6:113089. doi: 10.1016/j.injury.2026.113089. Online ahead of print.

ABSTRACT

OBJECTIVE: Neuroworsening portends poor outcomes after traumatic brain injury (TBI) and is protocolized in intensive care unit (ICU) settings. The utility of neuroworsening assessments in non-ICU settings for intervention and prognostication requires further understanding. This study assessed relationships among neuroworsening in the emergency department (ED), clinicoradiological injury, blood-based biomarkers, neurosurgical interventions, and outcomes in TBI patients without Glasgow Coma Scale-Motor Score (GCS-M) impairment at ED arrival.

METHODS: Adult subjects from the 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI; ClinicalTrials.gov #NCT02119182) Study with ED arrival GCS-M = 6 and ED disposition GCS-M were analyzed. Neuroworsening was defined as ED disposition GCS-M < 6. Subjects received clinically-indicated head computed tomography (CT) scan within 24-hours (h) post-TBI. Clinical characteristics, acute plasma TBI biomarker levels (glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase-L1 (UCH-L1); pg/ml), neurosurgical procedural interventions, hospital outcomes, and 3- and 6-month outcomes (Glasgow Outcome Scale-Extended (GOSE)) were compared. Multivariable logistic regressions examined predictors of neurosurgical interventions and unfavorable outcomes (GOSE ≤ 4) using adjusted odds ratios (AOR [95 % confidence intervals (CI)]). Cox proportional hazards model examined hospital discharge rate over time using adjusted hazard ratios (AHR).

RESULTS: In 1210 subjects, 36 (3.0 %) had ED neuroworsening. Neuroworsening was associated with features of more severe injuries, including ICU admission (91.7 % vs. 30.3 %, p < 0.0001), post-traumatic amnesia duration (>24 h: 26.7 % vs. 4.2 %, p < 0.0001), and traumatic intracranial injuries on CT (72.2 % vs. 39.7 %, p = 0.00020). Neuroworsening subjects had higher GFAP (median = 1400 [Q1-Q3:864-3663] vs. 306 [82-839], p < 0.0001) and UCH-L1 (median = 459 [287-1036] vs. 170 [94-322], p < 0.0001), neurosurgical procedural interventions (38.9 % vs. 2.1 %, p < 0.0001), in-hospital mortality (8.6 % vs. 1.0 %, p = 0.018), hospital length of stay (6.9 days [Q1-Q3:4.8-16.8] vs. 2.2 days [1.3-4.0], p < 0.0001), and 3- and 6-month unfavorable outcomes (26.1 % vs. 3.5 %, p = 0.00040; 26.1 % vs. 3.7 %, p = 0.00050). Neuroworsening independently predicted neurosurgical interventions (AOR = 18.7 [95 % CI: 7.9-44.1], p < 0.0001), lower discharge rate [AHR = 0.35 [0.24-0.50], p < 0.0001), 3-month unfavorable outcome (AOR = 9.8 [3.0-31.9], p = 0.00010), and 6-month unfavorable outcome (AOR = 11.0 [3.1-38.7], p = 0.00020).

CONCLUSIONS: ED neuroworsening is an early indicator of clinicoradiological TBI severity, and predicted neurosurgical procedural interventions, longer hospitalizations, and 3- and 6-month unfavorable outcomes. Higher blood-based TBI biomarker levels were associated with ED neuroworsening, suggesting their potential role to aid in the assessment of TBI patients at high risk of neurological deterioration.

PMID:41672813 | DOI:10.1016/j.injury.2026.113089

Injury. 2026 Feb 3;57(4):113079. doi: 10.1016/j.injury.2026.113079. Online ahead of print.

ABSTRACT

Guidelines and practices in trauma care constantly evolve based on evidence available, and every healthcare provider who treats trauma should be up-to-date in trauma-care concepts. The Eleventh Edition of Advanced Trauma Life Support, released in 2025, contains a complete revamp of the foundational principles of acute trauma care, content design, delivery, and training, based on medical and educational evidence. In this edition, a significant update is the emphasis on control of exsanguinating/major haemorrhage (ABCDE to x-ABCDE where x stands for control of exsanguinating haemorrhage in trauma resuscitation. In addition to damage control resuscitation, some of the significant changes include recommendations for permissive hypotension, limiting crystalloids, early transfusion, neuroprotective focus, and modifications in operational principles in spine motion restriction. Some of these conceptual changes with their rationale are briefly described in this review as an update for any healthcare provider involved in trauma resuscitation.

PMID:41671886 | DOI:10.1016/j.injury.2026.113079

Injury. 2026 Feb 6;57(4):113087. doi: 10.1016/j.injury.2026.113087. Online ahead of print.

ABSTRACT

BACKGROUND: Masquelet induced membrane surgery is a viable option for the reconstruction of extensive bone defects. This study aimed to comprehensively compare the clinical efficacy of 3D printed microporous tantalum prosthesis and autologous bone graft in the final stage of Masquelet induced membrane surgery during the treatment of lower extremity fracture-related infections(FRI) with large segmental bone defect.

METHODS: We retrospectively analyzed the clinical data of 43 patients with large segmental bone defect caused by lower extremity FRI treated with Masquelet induced membrane surgery. Among these, 21 patients were implanted 3D printed microporous tantalum prosthesis (Prosthesis group), while 22 patients were implanted autologous bone graft (Autologous bone group) in the final-stage surgery. Follow-up was conducted for 12 months postoperatively. Clinical efficacy was evaluated using the Paley grade for bone defect healing, Visual analog scale (VAS), Lower extremity functional scale (LEFS), Fernandez-Esteve eschar score, and time to full weight-bearing. The clinical outcomes between the two treatment groups were compared.

RESULTS: Postoperatively, the scores of VAS and LEFS significantly improved compared to preoperative values in both groups (all P < 0.001). Compared to the Autologous bone group, the Prosthesis group demonstrated significantly higher LEFS scores and Fernandez-Esteve eschar scores, along with a significantly shorter time to full weight-bearing (all P < 0.05). The complication rate was 19.0% (4/21) in the Prosthesis group and 9.1% (2/22) in the Autologous bone group; there was no statistically significant difference between the two groups (P > 0.05). Patients experiencing complications received effective and targeted interventions.

CONCLUSION: Both implants show remarkable efficacy in the reconstruction of large segmental bone defect caused by lower limb FRI. However, 3D printed microporous tantalum prosthesis exhibits certain advantages over the autologous bone graft in terms of limb function recovery, bone callus growth, and early weight-bearing. However, when using this technique, one should be vigilant about the risk of complications.

PMID:41671885 | DOI:10.1016/j.injury.2026.113087

J Bone Joint Surg Am. 2026 Feb 11. doi: 10.2106/JBJS.25.00874. Online ahead of print.

ABSTRACT

Malalignment after femoral fracture repair remains common, with up to one-third of patients experiencing malrotations. Manual femoral fracture reduction remains physically demanding and fluoroscopy-dependent. Surgeons must apply traction forces to overcome forces generated by the surrounding muscles during the reduction process. Current orthopaedic robots, designed primarily for arthroplasty or spine procedures, generally cannot deliver the high traction or torque required for long-bone manipulation. To address the need for controlled high-force manipulation during femoral fracture reduction and to reduce reliance on fluoroscopy for assessing alignment, we developed a novel surgical robotic system. The system combines a 6-degrees-of-freedom (6-DOF) parallel mechanism with a high load capacity, an optical tracking system that provides continuous pose feedback, and a gauge-based graphical interface that displays translational and angular offsets between bone fragments and the target alignment. The system is intended to provide controlled application of clinically relevant traction and torque during femoral fracture reduction. These capabilities reduce reliance on sustained manual traction and support reduction maneuvers that are more repeatable, potentially improving intraoperative alignment consistency and procedural workflow. Future work will focus on hardware and software updates to improve operating-room integration and to expand the usable workspace. It will evaluate the use of artificial intelligence (AI)-assisted registration and 3D visualization to support alignment assessment and automated alignment workflows.

PMID:41671345 | DOI:10.2106/JBJS.25.00874

Int Orthop. 2026 Feb 12. doi: 10.1007/s00264-026-06746-x. Online ahead of print.

ABSTRACT

PURPOSE: To investigate whether ultrasound-guided preoperative portal localization in a modified double-medial-portal endoscopic technique reduces postoperative complications while maintaining comparable clinical outcomes in patients with recalcitrant plantar fasciitis.

METHODS: A retrospective study was performed on 62 patients suffering from stubborn plantar fasciitis with a calcaneal spur from January 2023 to August 2024. 32 patients had a traditional endoscopic partial release of the plantar fascia, whereas 30 patients underwent a modified release guided by ultrasound. Two medial portals were used by both the traditional and altered groups. Every patient was monitored for a minimum of 12 months. The clinical results for both groups were assessed using the Visual Analogue Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the medial longitudinal arch angle (MLAA), and the Arch Index (AI).

RESULTS: Both groups showed significant improvements in VAS and AOFAS scores at one, six and 12 months postoperatively. No significant between-group differences were observed in pain relief, functional recovery, or foot structural parameters at any follow-up time point. The ultrasound-guided group demonstrated a significantly lower incidence of postoperative complications. Patient-reported satisfaction appeared to be higher in the ultrasound-guided group.

CONCLUSION: Ultrasound-guided modified double-medial-portal endoscopic surgery provides comparable clinical outcomes with fewer postoperative complications, suggesting a safety advantage rather than superior efficacy in recalcitrant plantar fasciitis.

PMID:41673124 | DOI:10.1007/s00264-026-06746-x

Int Orthop. 2026 Feb 11. doi: 10.1007/s00264-026-06738-x. Online ahead of print.

ABSTRACT

BACKGROUND: Scapular neck fractures, typically caused by high-energy trauma, often require surgical fixation. Conventional reconstruction plates (RPs) are limited by poor anatomical conformity and extended operative times. We developed a novel scapular neck anatomical locking compression plate (SNALCP) and assessed its biomechanical stability and clinical performance.

METHODS: Finite element analysis (FEA) was used to compare the biomechanical behaviour of SNALCP and RP in Miller type IIA/B fractures, simulating forward flexion (FF), abduction (AB), internal rotation (IR), and external rotation (ER). Clinically, 40 patients treated between January 2021 and August 2023 were enrolled: RP group (n = 22) and SNALCP group (n = 18). Operative time, blood loss, Visual Analog Scale (VAS) pain scores, healing time, complications, and Constant-Murley scores were evaluated.

RESULTS: SNALCP demonstrated lower stress and displacement than RP across all loading conditions. For type IIA fractures, AB and FF stresses were 10.133 < 19.223 and 36.698 < 65.761 MPa; for type IIB, AB 63.089 < 97.578, FF 74.346 < 137.110, IR 379.290 < 540.640, and ER 1982.300 < 2253.100 MPa. Clinically, SNALCP yielded shorter surgical times (97.7 ± 19.3 min), less blood loss (152.6 ± 58.5 mL), faster healing (7.6 ± 1.4 weeks), and superior VAS and Constant-Murley scores (all p < 0.05). Only three cases of transient shoulder stiffness were observed.

CONCLUSION: SNALCP provides superior biomechanical stability and improved functional outcomes compared with RP. Larger, multicenter studies are warranted to validate these findings.

PMID:41670660 | DOI:10.1007/s00264-026-06738-x

Injury. 2026 Feb 6;57(4):113088. doi: 10.1016/j.injury.2026.113088. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the clinical efficacy, wound healing quality, and functional recovery of a composite grafting technique using acellular dermal matrix (ADM) and autologous split-thickness skin graft (ASTSG) for reconstructing complex ankle soft tissue defects.

METHODS: A retrospective cohort study included 108 patients with ankle soft tissue defects (≥3 cm²). Patients were divided into an observation group (n = 55, ADM+ASTSG) and a control group (n = 53, pedicled skin flap). Primary outcomes were graft survival, wound healing time, and scar quality (Vancouver Scar Scale). Secondary outcomes included ankle function (range of motion, gait analysis), operative parameters, cost, and histological assessment of neotissue.

RESULTS: The ADM+ASTSG group demonstrated a significantly higher graft survival rate (96.80 % vs. 78.22 %, P < 0.05) and superior scar quality at 6 months (VSS total score: 2.3 ± 0.8 vs. 4.7 ± 1.1, P < 0.05). Functional recovery was better, evidenced by greater ankle range of motion and gait symmetry (68.3 ± 5.2 % vs. 59.6 ± 4.8 %, P < 0.05). The technique also resulted in shorter operative time (36.6 ± 6.3 vs. 118.6 ± 11.4 min, P < 0.05) and lower hospitalization costs. Histologically, the ADM group showed more organized collagen fibers and a higher collagen I/III ratio, indicating more mature tissue regeneration.

CONCLUSION: The ADM+ASTSG composite grafting technique promotes high-quality wound healing and functional recovery in ankle soft tissue defects, offering a clinically effective and cost-efficient alternative to traditional flaps. Its ability to support structured tissue regeneration translates into superior scar quality and mechanical adaptability for the dynamic ankle joint.

PMID:41666526 | DOI:10.1016/j.injury.2026.113088

J Bone Joint Surg Am. 2026 Feb 10. doi: 10.2106/JBJS.25.00970. Online ahead of print.

ABSTRACT

BACKGROUND: The role of an elevated critical shoulder angle (CSA) in rotator cuff healing following rotator cuff repair (RCR) remains a subject of clinical controversy. The present study aimed to investigate the effect of increased CSA on tendon-bone interface healing following RCR.

METHODS: A bilateral chronic rotator cuff tear model was established in 48 Sprague-Dawley rats. Acromion lateralization (Acr) surgery was performed unilaterally to increase CSA. After 4 weeks, bilateral RCR was performed. Micro-computed tomography was utilized to measure CSA. Tendon-bone interface healing was assessed at 3, 6, and 9 weeks post-RCR with use of magnetic resonance imaging (MRI), biomechanical testing, gait analysis, and histological evaluation.

RESULTS: The mean CSA in the Acr group was significantly greater than that in the RCR-only group (37.2° ± 2.6° versus 29.7° ± 3.1°; p < 0.001). At 6 and 9 weeks postoperatively, the Acr group demonstrated significantly poorer outcomes on MRI (i.e., higher signal-to-noise quotient), biomechanical strength (i.e., lower ultimate failure load and stiffness), and gait parameters compared with the RCR-only group (p < 0.05). Histological analysis revealed inferior tendon-bone interface integration in the Acr group (p < 0.01), including reduced fibrocartilage formation, disorganized collagen fibers, and a lower collagen I/III ratio. Immunohistochemistry showed significantly higher Piezo1 expression in the Acr group (p < 0.001), suggesting a mechanobiological response to increased mechanical stress.

CONCLUSIONS: An increased CSA impaired tendon-bone interface healing following RCR in a rat model. Although these findings were preclinical, they provide experimental evidence that an increased CSA may influence rotator cuff healing, supporting the potential role of CSA modification (e.g., with acromioplasty) in reducing the risk of retear.

CLINICAL RELEVANCE: The present study provides experimental evidence to support the consideration of CSA reduction in selected high-risk patients undergoing RCR to promote rotator cuff healing and potentially reduce retear rates.

PMID:41666274 | DOI:10.2106/JBJS.25.00970

Int Orthop. 2026 Feb 11. doi: 10.1007/s00264-026-06747-w. Online ahead of print.

ABSTRACT

PURPOSE: Smoking is a potentially modifiable risk factor for adverse outcomes after total hip arthroplasty (THA), but evidence on early postoperative complications in Asian populations remains limited. This study examined the association between smoking and early postoperative complications after elective THA using a nationwide inpatient database in Japan.

METHODS: This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Patients undergoing elective primary THA for osteoarthritis, osteonecrosis of the femoral head, or rheumatoid arthritis were included. Smoking status was identified using administrative codes. One-to-one propensity score matching was used to balance baseline characteristics between smokers and non-smokers. Primary outcomes were early postoperative surgical complications, medical complications, and in-hospital mortality. Dose-dependent effects were assessed using the Brinkman Index, with heavy smoking defined as ≥ 600.

RESULTS: After propensity score matching, 52,551 patients were included in each group. Smoking was associated with a higher risk of postoperative infection (odds ratio [OR] 1.31; 95% confidence interval [CI] 1.15-1.49; p < 0.001) and a lower likelihood of blood transfusion (OR 0.83; 95% CI 0.80-0.85; p < 0.001). No significant associations were observed with dislocation, periprosthetic fracture, wound dehiscence, reoperation, major medical complications, or in-hospital mortality. Heavy smoking (Brinkman Index ≥ 600) was not associated with postoperative complications.

CONCLUSIONS: Smoking was associated with an increased risk of early postoperative infection following elective THA, but not with other major complications or in-hospital mortality. Smoking cessation should be considered an important component of perioperative optimisation.

PMID:41667730 | DOI:10.1007/s00264-026-06747-w

SICOT J. 2026;12:8. doi: 10.1051/sicotj/2025055. Epub 2026 Feb 9.

ABSTRACT

Lateral unicompartmental knee arthroplasty (UKA) represents 1-2% of knee replacement procedures, yet offers distinct advantages including reduced surgical burden, bone stock preservation, and faster functional recovery. However, lateral UKA presents unique technical difficulties due to the surgical complexity of the lateral compartment. Recent advances in image-based robotic systems have demonstrated improved accuracy in implant positioning and promoted more individualized surgical strategies. This article presents a step-by-step surgical technique for lateral UKA using Functional Positioning (FP) principles in combination with an image-based robotic system. The technique ensures precise preoperative planning based on CT imaging, real-time intraoperative kinematic evaluation, and accurate component placement tailored to individual patient anatomy. The key steps of this surgical technique include comprehensive preoperative planning with 3D anatomical modeling, intraoperative kinematic evaluation following osteophyte removal, achieving centered femorotibial contact points throughout the full range of motion with precise lateral laxity gap boundaries, and cartilage mapping to ensure optimal component positioning and avoid overstuffing. FP addresses the characteristic posterior cartilage wear pattern of valgus knees while preserving pre-arthritic coronal alignment and avoiding varus overcorrection. This systematic approach demonstrates reproducible surgical steps that may translate into improved long-term outcomes and implant survivorship for lateral UKA procedures.

PMID:41660880 | PMC:PMC12884707 | DOI:10.1051/sicotj/2025055

J Bone Joint Surg Am. 2026 Feb 9. doi: 10.2106/JBJS.25.00612. Online ahead of print.

ABSTRACT

BACKGROUND: The superiority of medial unicompartmental knee arthroplasty (mUKA) versus total knee arthroplasty (TKA) for isolated anteromedial knee osteoarthritis (AMOA) remains a subject of ongoing debate. We present the 2-year results of a multicenter, randomized trial comparing the patient-reported and clinical outcomes of these 2 implant types in the treatment of AMOA.

METHODS: This double-blinded superiority trial recruited patients with severe AMOA at 10 arthroplasty centers and randomized them to undergo either mUKA or TKA. The primary outcome was the average improvement in the Oxford Knee Score (OKS) over 2 years, analyzed by intention-to-treat. A range of patient-reported outcomes served as secondary outcomes. Death, revision, and other reoperations were analyzed as serious adverse events (SAEs).

RESULTS: Between September 2017 and March 2021, 350 patients were randomized: 177 (79 female, 98 male; mean age, 67.7 ± 7.5 years) to mUKA and 173 (84 female, 89 male; mean age, 66.7 ± 7.8 years) to TKA. The average 2-year OKS improvement differed by 3.5 points (95% CI, 2.3 to 4.7; p < 0.001) in favor of mUKA, although this difference was below the generally accepted minimal clinically important difference (MCID) of 4 to 5 points. Ten of the 12 secondary outcomes favored mUKA, while the remaining 2 were nonsignificant. The differences in the Forgotten Joint Score (FJS) (14.1; 95% CI, 9.5 to 18.6), range of motion during the first 2 years (7.0°; 95% CI, 5.3° to 8.7°) and at 2 years (5.5°; 95% CI, 3.6° to 7.4°), Knee injury and Osteoarthritis Outcome Score (KOOS) symptoms score (10.3; 95% CI, 7.8 to 12.8), and Short Form-36 (SF-36) bodily pain score (7.6; 95% CI, 4.1 to 11.1) all favored mUKA and reached the MCID. Non-revision reoperations were performed in 4 patients (2.3%) after mUKA and in 12 patients (6.9%) after TKA (9 of the 12 underwent manipulation under anesthesia); the difference was 4.7% (95% CI, 0.2% to 9.8%). There were no differences in the rates of revision or death between the groups.

CONCLUSIONS: Averaged over the 2-year follow-up, mUKA demonstrated minor advantages that did not achieve clear clinical superiority on the basis of the OKS difference. However, the FJS, range of motion, KOOS symptoms score, and SF-36 bodily pain score all demonstrated differences in favor of mUKA that were clinically meaningful. The overall findings suggest that mUKA and TKA yield similarly favorable short-term results, with small advantages for mUKA.

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

PMID:41662451 | DOI:10.2106/JBJS.25.00612

J Bone Joint Surg Am. 2026 Feb 9. doi: 10.2106/JBJS.25.01058. Online ahead of print.

ABSTRACT

BACKGROUND: Several studies have assessed the impact of perioperative denosumab on local recurrence (LR) after surgical management of giant cell tumor (GCT), with conflicting results. This meta-analysis evaluates the association between LR in patients undergoing surgical management of GCT and perioperative denosumab, accounting for the type of surgery, number of denosumab doses, and timing of denosumab administration.

METHODS: Following the PRISMA guidelines, PubMed, Cochrane, and Google Scholar were searched until December 5, 2024. The extracted outcomes consisted of LR and denosumab-related complications.

RESULTS: Sixteen studies from 15 cohorts were included in the meta-analysis. The number of patients totaled 1,551: 310 (20%) in the denosumab group (mean age, 32 years; mean follow-up, 40 months) and 1,241 (80%) in the control group (mean age, 32 years; mean follow-up, 62 months). Patients in the denosumab group had a significantly higher rate of LR compared with patients in the control group (odds ratio = 1.82; p = 0.03), and this remained true even when looking at studies using curettage as the only surgical management (odds ratio = 2.75; p < 0.001). In a subgroup analysis by the timing of denosumab administration, a significantly higher rate of LR was only found among patients receiving denosumab both preoperatively and postoperatively (odds ratio for recurrence relative to control = 5.57; p < 0.001). Overall, the reported incidence of denosumab-related complications was 6.5%.

CONCLUSIONS: In this meta-analysis, patients receiving denosumab only preoperatively did not have a significantly increased rate of LR compared with controls. Increased recurrence was observed primarily in patients being treated with both preoperative and postoperative denosumab.

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

PMID:41662446 | DOI:10.2106/JBJS.25.01058

Int Orthop. 2026 Feb 9. doi: 10.1007/s00264-026-06742-1. Online ahead of print.

ABSTRACT

BACKGROUND: While the original Paul Grammont Inlay design had a 155° neck-shaft angle (NSA), developments in humeral stem designs have led to the emergence of the Onlay design with a more vertical angle. The purpose of the study is to compare three year clinical and radiological outcomes of two humeral stem designs, namely Inlay versus Onlay designs, with a 145° NSA and identical glenoid component.

METHODS: In this multicentric retrospective study, 227 patients (141 Inlay versus 86 Onlay) that underwent primary reverse shoulder arthroplasty (RSA) between March 2019 and April 2020, were reviewed at a minimum follow-up of three years. Clinical evaluation included pain on visual analogue scale (VAS), active range of motion, subjective shoulder value (SSV), and Constant score. Radiological assessment included in situ stem inclination, cortical contact bone remodelling, and scapular notching.

RESULTS: The two groups were comparable in terms of age, sex, diagnosis, and follow-up (mean follow-up, 3.3 ± 0.5 years). No significant differences were found for pain on VAS, SSV or Constant score. The Onlay group had significantly greater external rotation with 90° of abduction (ISA-Inlay, 52.2 ± 24.2; versus ISA-Onlay, 59.2 ± 25; p = 0.037), more valgus alignment (ISA-Inlay, -0.573; versus ISA-Onlay, -5.55; p < 0.001), and a higher rate of cortical contact (ISA-Inlay, 9%; versus ISA-Onlay, 39%; p < 0.001). No significant differences were found in terms of bone remodelling around the stem and scapular notching.

CONCLUSION: At a follow up of three years, both humeral stem designs resulted in comparable clinical and radiological outcomes, while the Onlay design seemed to improve external rotation without increasing the risk of bony complications. The choice of stem design should be motivated by patient specific functional needs and surgeon experience. However, the conclusions of the present study are limited to mid-term follow-up.

PMID:41663586 | DOI:10.1007/s00264-026-06742-1

Injury. 2026 Feb 1:113080. doi: 10.1016/j.injury.2026.113080. Online ahead of print.

ABSTRACT

INTRODUCTION: To help address the continuing epidemic of firearm-related trauma in the United States (US), we conducted a detailed analysis of recent trauma center discharge data and compared firearm-related injuries to mechanisms such as falls, pedestrian injuries, and motor vehicle crashes.

METHODS: We combined Trauma Quality Improvement Program (TQIP) data for 2011 to 2022 and analyzed variables for patient demographics, injury mechanisms, disposition, and hospital characteristics over time. Analyses consisted of descriptive statistics, bar plots, time series plots, and comparative tables.

RESULTS: There were 3,597,688 US trauma hospital discharges in the TQIP data set for 2011 to 2022 of which 307,062 (8.4%) involved firearms-a higher proportion than those involving pedestrian injuries (3.8%), pedal cycles (2.0%), or motorcycles (6.2%). The case-fatality rate of inpatient hospital deaths for firearm injuries was 8.8%, surpassed only by that of pedestrian injuries (9.9%). Firearms accounted for the youngest patient population over the 12-year study period for the six injury mechanisms analyzed. Over time, firearm-related assaults increased from 75.7% of all firearm injuries in 2011 to 88.6% in 2020. Most, if not all, of this increase appeared to occur in the post-2014 time period.

CONCLUSIONS: Better defining national injury trends allows for targeted injury prevention efforts, prioritized research endeavors, and optimized resource allocation.

PMID:41654437 | DOI:10.1016/j.injury.2026.113080

Injury. 2026 Jan 30;57(3):113083. doi: 10.1016/j.injury.2026.113083. Online ahead of print.

ABSTRACT

BACKGROUND: This study examines 90-day outcomes and one-year outcomes following surgical fixation of upper extremity fractures in homeless patients.

METHODS: A retrospective analysis was conducted using a nationwide database to identify patients who underwent open reduction and internal fixation of upper extremity fractures including (shoulder and upper arm, elbow and forearm, wrist and hand) and had documented homelessness status. Patients were 1:1 propensity score-matched to controls based on demographic factors, comorbidities (including chronic kidney disease, hypertension, heart failure, diabetes mellitus, liver diseases, substance abuse and opioid dependence) and BMI yielding 2,584 patients per group. Primary outcomes included fracture related outcomes while secondary outcomes were healthcare utilization, medical and substance related outcomes. Relative risks (RR), 95% confidence intervals (CI), and p-values were calculated.

RESULTS: At 90 days, homeless patients had significantly higher risks of emergency department visits (RR: 5.18, p < 0.001), sepsis (p = 0.002), opioid dependence (RR: 2.88, p = 0.002), substance abuse (RR: 5.87, p < 0.001), renal failure (RR: 3.34, p < 0.001), pneumonia (RR: 2.90, p < 0.001), transfusion (RR: 2.61, p = 0.003), readmission (RR: 3.22, p < 0.001), wound complications (RR: 1.97, p < 0.001), and postoperative infection (RR: 2.70, p < 0.001). At 1 year, homeless patients had elevated risks of opioid dependence (RR: 4.69, p < 0.001), substance abuse (RR: 5.72, p < 0.001), opioid use (RR: 1.58, p = 0.011), revision surgery (RR: 1.78, p = 0.017), and malunion (RR: 1.92, p = 0.013).

CONCLUSION: Homeless patients undergoing upper extremity fractures ORIF face significantly higher risks of 90 day and 1 year adverse outcomes compared to housed patients. These findings highlight the critical need for tailored interventions to improve care continuity, minimize risks and improve outcomes in homeless individuals.

LEVEL OF EVIDENCE: Level III, Retrospective Cohort.

PMID:41653540 | DOI:10.1016/j.injury.2026.113083

Injury. 2026 Jan 30;57(3):113078. doi: 10.1016/j.injury.2026.113078. Online ahead of print.

ABSTRACT

BACKGROUND: Violence-related injuries (VRIs) remain a major contributor to trauma-related mortality worldwide. We evaluated the case fatality rates (CFRs) of VRIs stratified by sex. We hypothesized that sex differences affect the CRF following VRIs.

METHODS: A retrospective analysis was conducted using data from the American College of Surgeons Trauma Quality Programs and ICD-10 for VRIs.

RESULTS: Among 522,939 VRIs patients, males accounted for 82.8% with higher mortality than females (7.5% vs. 5.6%). Males had higher CFRs than females among firearm-related injuries (16.3% vs. 15.2%), and Self-inflicted harm (SIH) (21.9% vs. 12.1%). In Interpersonal violence, CFRs among White females and Black males were 19.7% and 15.8%, respectively. For SIH, firearm lethality was higher among older White males ≥ 65 years (64.3%) and young Black males aged 36-45 (57.8%). Firearm injury (OR 18.49) and male sex (OR 1.21) were independent predictors for mortality.

CONCLUSION: Sex-based disparities in VRIs in the United States are evident, notably in firearm injuries and SIH, underscoring the need for targeted injury prevention.

PMID:41653539 | DOI:10.1016/j.injury.2026.113078

Int Orthop. 2026 Feb 7. doi: 10.1007/s00264-026-06740-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Despite its clinical importance, nationwide data on long-term hospitalization and surgical management trends in Germany remain scarce.

METHODS: A retrospective analysis was conducted using the German Federal Statistical Office's hospital discharge database covering all inpatient cases with the primary diagnosis of DCM (ICD-10-GM code M50.0) from 2005 to 2024. Annual case numbers, age and sex distributions, and surgical procedures were analyzed descriptively. Hospitalization rates per 100,000 inhabitants were calculated using mid-year population data.

RESULTS: Between 2005 and 2024, approximately 70,000 hospital discharges with a primary diagnosis of DCM were recorded in Germany. Annual hospitalizations increased from 2,477 cases in 2005 to a peak of 4,076 cases in 2015, followed by a decline to 3,037 cases in 2024. Corresponding hospitalization rates rose from 3.0 to 4.96 per 100,000 inhabitants before decreasing to 3.7 per 100,000 in 2024. Segmented Poisson regression demonstrated a significant increase until 2015 followed by a significant decline thereafter. Age-specific analyses demonstrated a stable predominance of middle-aged and older adults, with consistently highest hospitalization volumes in patients aged 50-70 years. After age standardization to the 2015 reference population, the temporal pattern remained largely unchanged, indicating that observed trends were not solely attributable to population ageing. Mean length of hospital stay decreased steadily over time. Anterior surgical approaches accounted for the majority of procedures throughout the study period, while the proportion of surgically treated cases per hospitalization increased over time.

CONCLUSIONS: This nationwide, discharge-based analysis demonstrates substantial temporal changes in hospitalizations and surgical treatment patterns for DCM in Germany over the past two decades. Hospitalization volumes increased until approximately 2015 and declined thereafter, a pattern that persisted after age standardization. DCM predominantly affected patients aged 50-70 years throughout the study period, without a pronounced shift toward progressively older age groups. The increasing ratio of surgical procedures to hospitalizations suggests more selective inpatient admissions focusing on operative management. These findings provide a descriptive reference for long-term hospitalization and surgical trends in DCM.

PMID:41653231 | DOI:10.1007/s00264-026-06740-3