SICOT J. 2025;11:36. doi: 10.1051/sicotj/2025036. Epub 2025 Jul 16.

ABSTRACT

BACKGROUND: Perioperative blood loss remains a challenge in total hip arthroplasty (THA). Although tranexamic acid (TXA) is widely used for hemostasis, the efficacy of oxidized regenerated cellulose (ORC) powder as an adjunct in blood management for THA via the direct anterior approach (DAA) remains underexplored. This study aimed to evaluate the effects of ORC powder on perioperative blood loss, hematological parameters, and clinical outcomes in direct anterior THA.

METHODS: A total of 133 patients who underwent primary THA via the DAA were enrolled in the study. The patients were divided into two groups: the ORC powder group (combination of ORC powder and topical TXA, n = 53) and the control group (topical TXA alone, n = 80). The demographic and clinical information, operative time, intraoperative bleeding volume, estimated total blood loss (eTBL), hidden blood loss (HBL), trends in hemoglobin, hematocrit, postoperative pain scores using a numeric rating scale (NRS), and adverse events were analyzed. Clinical outcomes were assessed using the Japanese Orthopedic Association score.

RESULTS: The ORC powder group had significantly lower eTBL (679.1 ± 230.1 mL vs. 875.8 ± 292.9 mL, p < 0.0001) and HBL (424.1 ± 194.5 mL vs. 558.6 ± 264.2 mL, p = 0.002). Postoperative pain scores at postoperative day 7 were lower in the ORC powder group (1.9 ± 1.6 vs. 2.9 ± 2.2, p = 0.009). The clinical outcomes were excellent, and no significant differences were observed in complication rates between the groups.

CONCLUSION: ORC powder effectively reduced perioperative blood loss in THA via the DAA without increasing complication rates. ORC powder has the potential to be a valuable adjunct in optimizing blood management strategies in THA.

PMID:40668976 | PMC:PMC12266662 | DOI:10.1051/sicotj/2025036

Injury. 2025 Jul 8:112590. doi: 10.1016/j.injury.2025.112590. Online ahead of print.

NO ABSTRACT

PMID:40670206 | DOI:10.1016/j.injury.2025.112590

Injury. 2025 Jul 8:112603. doi: 10.1016/j.injury.2025.112603. Online ahead of print.

NO ABSTRACT

PMID:40670205 | DOI:10.1016/j.injury.2025.112603

Injury. 2025 Jul 15;56(8):112588. doi: 10.1016/j.injury.2025.112588. Online ahead of print.

NO ABSTRACT

PMID:40669261 | DOI:10.1016/j.injury.2025.112588

Injury. 2025 Jul 11;56(8):112610. doi: 10.1016/j.injury.2025.112610. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to compare the safety and efficacy of ultrasound-guided and arthrogram-guided techniques in the treatment of radial neck fractures in early childhood using the percutaneous leverage technique.

METHODS: This retrospective case series study included children under 7 years of age with closed radial neck fractures who underwent surgery between November 2015 and July 2021. Patients were divided into two groups based on the guidance techniques employed: the ultrasound guidance group (19 cases) and the arthrogram guidance group (14 cases). The primary outcomes included operative time, radiation exposure, and postoperative functional outcomes assessed using the Métaizeau criteria and the Mayo Elbow Performance Score (MEPS).

RESULTS: No statistically significant differences were observed between the two groups concerning age, gender, injured side, or type of fractures. The ultrasound guidance group had a significantly shorter operative time (23.7 ± 5.9 min) compared to the arthrogram guidance group (33.1 ± 10.0 min) (P < 0.05). The ultrasound guidance group did not require radiation exposure (mean 0), in contrast to the arthrogram guidance group (mean 60.55±46.46 mGy) (P = 0.000). According to the Métaizeau criteria, there were no significant differences in the postoperative anatomical reduction between the two groups. Similarly, no significant differences were observed in the functional outcomes based on MEPS, with excellent results in 94.7 % of the ultrasound guidance group and 85.7 % of the arthrogram guidance group (P = 0.380). Complications were comparable between the groups, with no cases of secondary displacement, pin tract infection, or nerve injury.

CONCLUSION: Ultrasound-guided reduction offers several distinct advantages, including enhanced real-time visualization, the absence of radiation exposure, and reduced operative times. Although outcomes are comparable, ultrasound may be considered a viable alternative to arthrogram for guiding percutaneous leverage reduction in the early childhood population.

LEVEL OF EVIDENCE: Therapeutic Level III.

PMID:40669260 | DOI:10.1016/j.injury.2025.112610

Injury. 2025 Jul 11;56(8):112580. doi: 10.1016/j.injury.2025.112580. Online ahead of print.

ABSTRACT

OBJECTIVES: Hardware removal is a common procedure performed by orthopaedic surgeons, yet there is not a consensus on the disposition of explanted hardware. There seems to be increasing discordance between institutional policy and surgeon or patient preference. The purpose of this study was to gain insight on hardware removal polices across North America and determine surgeons' opinions regarding the return of orthopedic fixation devices to patients and if these opinions are related to surgeon-specific demographic factors.

METHODS: A voluntary Qualtrics Survey was created and distributed to orthopedic surgeons with a self-identified substantial practice in trauma. Survey items included information about the surgeon's practice, hospital hardware removal policy, and personal opinion on institutional explant management. We also sought to evaluate variability in hospital policy among different geographic regions and types of hospitals/institutions.

RESULTS: One hundred forty-two surgeons met inclusion criteria for this survey. 88 % of respondents believe that patients should be entitled to keep their explanted hardware. Years in practice, frequency of hardware removal procedures, and subspecialty were not correlated with surgeon opinion. 66 % of hospitals have a policy allowing patients to keep their explanted hardware. There was no correlation between hospital policy and region or type of institution.

CONCLUSIONS: While 88 % of surgeons believe that patients should be allowed to keep their explanted hardware, only 66 % of hospitals currently allow this practice. Despite the clear consensus among orthopedic surgeons, hospital policy across North America is not standardized and does not correlate with the opinions held by the majority of surgeons.

PMID:40669259 | DOI:10.1016/j.injury.2025.112580

Injury. 2025 Jul 11;56(8):112608. doi: 10.1016/j.injury.2025.112608. Online ahead of print.

ABSTRACT

Eighty-eight patients with chronic wounds with financial difficulties were enrolled in a philanthropic programme implemented in Zhejiang Province (China) from August 1, 2021 to July 31, 2022. The patients were divided into surgical and non-surgical groups based on their demographic and wound characteristics, and the outcomes were then compared between the groups. In total, 54 (61.36 %) patients were males and 34 (38.64 %) females. The mean age of the patients was 55.27 ± 19.80 years, and the (81.82 %) had physical disabilities. The most common type of chronic wound was pressure injury (46.59 %), followed by traumatic wounds (19.32 %). In the surgical group, the average hospital stay was 24.50 days (range: 18.00-44.50 days), and the treatment efficacy rate was 76.92 %. In the non-surgical group, the average treatment duration was 35 days (range: 21.75-78.25 days), and the efficacy rate was 51.61 %. The overall wound healing rate was 60 % on the 1-year follow-up. In conclusion, most chronic wound patients were middle-aged or elderly, and pressure injury was the most common wound type. Although dressing change was the most common treatment, surgical treatment could get a better result in large and deep chronic wounds.

PMID:40669258 | DOI:10.1016/j.injury.2025.112608

J Bone Joint Surg Am. 2025 Jul 16;107(14):e75. doi: 10.2106/JBJS.25.00221.

NO ABSTRACT

PMID:40668210 | DOI:10.2106/JBJS.25.00221

J Bone Joint Surg Am. 2025 Jul 16;107(14):e78. doi: 10.2106/JBJS.ER.24.00224.

NO ABSTRACT

PMID:40668200 | DOI:10.2106/JBJS.ER.24.00224

J Bone Joint Surg Am. 2025 Jul 16;107(14):e77. doi: 10.2106/JBJS.25.00333.

NO ABSTRACT

PMID:40668199 | DOI:10.2106/JBJS.25.00333

J Bone Joint Surg Am. 2025 Jul 16;107(14):e76. doi: 10.2106/JBJS.25.00234.

NO ABSTRACT

PMID:40668193 | DOI:10.2106/JBJS.25.00234

Injury. 2025 Jul 8:112593. doi: 10.1016/j.injury.2025.112593. Online ahead of print.

ABSTRACT

INTRODUCTION: Management of patients after blunt splenic injury treated with Splenic Artery Embolisation (SAE) varies. This includes vaccination, post-procedure antibiotic use, and follow-up. This study aimed to assess current practice of management and infection prevention across Australia.

METHODS: A 29-question survey was sent via the Australian and New Zealand Trauma Registry to all 28 contributing trauma hospitals in Australia. Questions were based on data from the 2022 calendar year.

RESULTS: Responses were received from 12 sites (43 %) including 6 of 8 Australian regions (75 %). Of responding sites, 10 (83 %) offer SAE via a 24-hour 7-day rostered service. Of a total 568 splenic injuries, there were 177 SAE treatments with a median of 8 per site (range 0-65). SAE constituted 31 % of all splenic management, conservative management in 65 %, and splenectomy in 4 %. 8 sites (67 %) had a protocol for splenic trauma. Prophylactic SAE was performed for AAST IV-V injuries at 8 sites (67 %), which included 80 % of adult hospitals. Distal SAE was the predominant treatment type (70 %). Patients were routinely admitted for median 4 days after SAE (range 2-5). Routine inpatient antibiotics were administered to SAE patients at 2 sites (17 %) while 1 site (8 %) routinely recommended lifelong antibiotics after SAE. Routine inpatient vaccinations were used by 4 of 11 sites (36 %), while 3 sites (25 %) recommend vaccinations in the future. 11 sites (92 %) follow-up patients post-discharge. Written information on SAE was given to patients at 9 hospitals (75 %) while splenic function testing was performed at 5 sites (42 %), mostly assessment for Howell-Jolly Bodies (80 %). 11 sites (92 %) would change clinical practice in the future if evidence on splenic immune function evolved.

CONCLUSION: Across responding Australian hospitals, the use of vaccinations, antibiotics, and splenic function testing after SAE was low, which reflects existing evidence for preserved splenic function after SAE, plus unpublished experience of key stakeholders. Key societies should consider clinical practice guidelines that merge existing evidence with modern practice.

PMID:40664568 | DOI:10.1016/j.injury.2025.112593

Injury. 2025 Jul 4:112585. doi: 10.1016/j.injury.2025.112585. Online ahead of print.

NO ABSTRACT

PMID:40664567 | DOI:10.1016/j.injury.2025.112585

Injury. 2025 Jul 9:112589. doi: 10.1016/j.injury.2025.112589. Online ahead of print.

ABSTRACT

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as an adjunctive strategy to haemostatic procedures to counteract exsanguination in patients with trauma. However, no consensus has been reached regarding the haemostatic procedures deemed appropriate indications for REBOA. This study aimed to define appropriate indications for REBOA through consensus among trauma specialists and to investigate the characteristics and outcomes of patients undergoing REBOA with or without appropriate indications defined in this study.

METHODS: Using the 42 haemostatic procedures defined in the Japan Trauma Databank (JTDB), we conducted a repeated Delphi survey to obtain consensus from trauma specialists on the haemostatic procedures deemed appropriate indications for REBOA. Subsequently, patients registered in the JTDB who underwent REBOA were divided into two groups based on whether they had appropriate or inappropriate indications, as defined through the Delphi survey. Patient baseline characteristics, door-to-haemostasis time, door-to-blood transfusion time, emergency-department and in-hospital mortality, and complications were compared between the groups. The observed mortality and predicted mortality were compared.

RESULTS: After five rounds of questionnaire assessments including 11 trauma specialists, intraabdominal, retroperitoneal, pelvic, and extremity haemorrhage were defined as consensus-based appropriate indications for REBOA. Among the 361,706 patients with trauma registered in the JTDB, 1833 underwent REBOA: 1077 with appropriate and 756 with inappropriate indications. Crude in-hospital mortality (57.6 vs. 72.9 %, p < 0.001) and crude emergency-department mortality (15.4 vs. 38.6 %, p < 0.001) were significantly higher in patients with inappropriate indications than in those with appropriate indications. The observed mortality was higher than the predicted mortality, but it more closely aligned with the predicted mortality in 2013-2019 than in 2004-2012.

CONCLUSION: In over 40 % of cases in which REBOA was employed, it was used outside the appropriate indications defined in this study. Mortality was higher among patients with inappropriate indications than in those with appropriate indications. Further studies are required to elucidate the association between corresponding haemostatic procedures and outcomes for REBOA.

PMID:40664566 | DOI:10.1016/j.injury.2025.112589

Injury. 2025 Jul 9;56(8):112597. doi: 10.1016/j.injury.2025.112597. Online ahead of print.

ABSTRACT

BACKGROUND: This study aims to evaluate the outcomes of two-stage bone grafting versus amputation for the treatment of distal phalangeal osteomyelitis.

METHODS: We conducted a retrospective multicenter study of 102 patients with distal phalangeal osteomyelitis, of whom 53 underwent amputation and 49 underwent two-stage bone grafting. Preoperative characteristics were analyzed, including sex, age, BMI, prevalence of diabetes and osteoporosis, infection etiology, and fingers involved. The primary endpoint was infection recurrence. Meanwhile, patient-reported outcomes such as hand function and aesthetic satisfaction were also evaluated. Covariance analysis was performed to adjust for the disparity in soft tissue defect scores between the groups.

RESULTS: The two treatment groups were initially comparable in most preoperative characteristics; except for a significant difference in soft tissue defect scores (P-value = 0.011). No differences in the occurrence of reinfection were observed between the groups (1/49 in the bone graft group vs. 0/52 in the amputation group, P-value = 0.960). The two-stage bone grafting group reported significantly lower rates of neuropathic pain (2/49 vs. 18/52, P-value < 0.001) and higher aesthetic satisfaction scores (adjusted P-value = 0.007), while the amputation group exhibited lower hand functional scores, especially in fine motor skills (adjusted P-value = 0.031 for lifting large objects, adjusted P-value < 0.001 for the rest).

CONCLUSION: Both surgical treatments showed comparable efficacy in preventing infection recurrence. However, the two-stage bone grafting group demonstrated better patient-reported outcomes in terms of hand function and aesthetic satisfaction and a lower rate of neuropathic pain.

PMID:40663875 | DOI:10.1016/j.injury.2025.112597

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06612-2. Online ahead of print.

ABSTRACT

BACKGROUND: Managing large to massive rotator cuff tears accompanied by pseudoparalysis poses a considerable challenge in shoulder surgery. Superior capsular reconstruction (SCR) is increasingly considered a viable surgical option, yet optimal graft choices and outcomes in pseudoparalysis patients remain under investigation. This study assesses the clinical effectiveness of arthroscopic SCR using the long head of the biceps tendon (LHBT) in patients with large-to-massive RCT, comparing outcomes between those with and without pseudoparalysis.

METHODS: A prospective analysis was carried out involving 28 patients (14 with pseudoparalysis and 14 without) who underwent SCR using LHBT between January 2022 and December 2023. Clinical outcomes were assessed before surgery and subsequently at three, six and 12 months following the procedure, utilizing the Visual Analog Scale (VAS), University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion metrics.

RESULTS: Each group demonstrated substantial gains in reducing pain, enhancing functional outcomes, and increasing shoulder mobility. VAS scores decreased markedly, and ASES and UCLA scores improved substantially in both groups. Forward elevation and external rotation improved significantly, with a slightly greater range observed in the non-pseudoparalysis group. Pseudoparalysis was successfully reversed in 92.85% of affected patients. No major complications were reported.

CONCLUSION: Arthroscopic SCR using LHBT provides significant functional restoration and pain reduction in patients with massive RCT, effectively reversing pseudoparalysis in most cases. This technique offers a reliable and anatomically favorable graft option, supporting its use in both pseudoparalytic and non-pseudoparalytic patients.

PMID:40664842 | DOI:10.1007/s00264-025-06612-2

Int Orthop. 2025 Jul 15. doi: 10.1007/s00264-025-06599-w. Online ahead of print.

ABSTRACT

AIM: Although a severe limb deformity is rare, its management continues to be quite challenging. Various options have been described for correction. However, most of them are expensive, extensive and result in complications. Correction of severe deformities of the extremities has been suggested using the yester biological procedures with successful long term outcome.

MATERIALS AND METHODS: During the last five decades, 50 patients of challenging limb deformities were surgically managed by yester procedures which included corrective osteotomy, arthrodesis and Girdlestone arthroplasty. Eleven patients had upper limb deformity and 39 had lower limb deformity. Sixteen patients had congenital anomaly and 34 acquired. Twelve patients were non-walkers with multiple joint involvement. No metallic implant had been used in any case. No patient had repeat surgery. The age of the patients ranged from five-27 years.

RESULTS: Depending on the procedure adopted in a particular patient, all patients were examined periodically and regularly. The treatment time in a patient with multiple deformities ranged from six-12 months. Out of the twelve non-walkers, eleven could ambulate after the management. Superficial infection was recorded in 27 patients. No deep infection was observed. A long follow-up of 35 years has been available.

CONCLUSION: A rare series of 50 patients with challenging deformities of the extremities has been reported. The patients had been managed with procedures like corrective osteotomy, arthrodesis and Girdlestone arthroplasty with acceptable outcome. After the management 11 out of 12 non-walkers could ambulate themselves. The described procedures are simple, biological, dependable, patient friendly and available at no cost.

PMID:40663166 | DOI:10.1007/s00264-025-06599-w

Int Orthop. 2025 Jul 14. doi: 10.1007/s00264-025-06611-3. Online ahead of print.

ABSTRACT

PURPOSE: There is growing evidence that after moderate and severe slipped capital femoral epiphysis (SCFE), in-situ fixation can result in femoroacetabular impingement (FAI). Several different realignment procedures have been described but their use remains controversial due to high complication rates and technical complexity. Our study aims to evaluate the radiological outcomes and complications of patients who underwent open reduction with subcapital shortening osteotomy for moderate or severe SCFE.

METHODS: Radiographic and clinical data of patients with SCFE treated with subcapital shortening osteotomy performed by a single surgeon between October 2018 and July 2023 were retrospectively analysed. We collected patient demographics, pre- and post-operative radiographic measurements (Southwick slip angle, alpha angle and articulo-trochanteric distance (ADT), and post-operative complications. Patient outcomes were assessed using descriptive statistics.

RESULTS: Eighteen children and adolescents were reviewed, four were excluded due to inadequate follow-up. At the last follow-up, the lateral Southwick slip angle was corrected to a mean of 11 ° (1-31°). The mean alpha angle, measured at the final follow-up, was 59 ° (42-88°). One patient showed signs of radiological coxa breva. There were two patients with severe radiological cam deformities and one case of avascular necrosis (AVN).

CONCLUSION: Our findings suggest that the subcapital shortening osteotomy is an effective method for restoring head-neck anatomy in patients with moderate to severe SCFE, with good radiological outcomes. Our low incidence of avascular necrosis further supports the safety of this procedure.

PMID:40658155 | DOI:10.1007/s00264-025-06611-3

Injury. 2025 Jul 8:112598. doi: 10.1016/j.injury.2025.112598. Online ahead of print.

NO ABSTRACT

PMID:40651873 | DOI:10.1016/j.injury.2025.112598

Injury. 2025 Jul 3:112583. doi: 10.1016/j.injury.2025.112583. Online ahead of print.

NO ABSTRACT

PMID:40651872 | DOI:10.1016/j.injury.2025.112583