Injury. 2025 Sep 15;56(11):112764. doi: 10.1016/j.injury.2025.112764. Online ahead of print.

ABSTRACT

BACKGROUND: A nonvascularized fibular graft (NVFG) is considered to be an alternative option in managing segmental bone loss of the tibia. Nevertheless, there has been no consensus on optimal graft position and graft fixation technique. The purposes of the present study were to mechanically test the influences of various NVFG fixation techniques on the overall stability of the fixation construct by use of finite element analysis.

METHODS: Seven FE models of tibias with segmental bone loss stabilized with various fixation techniques were developed including medial and lateral plate-screw, medial and lateral plate-screw with a NVGF on the opposite cortex, medial and lateral plate-screw with an additional locking screw inserting into a NVGF, and intramedullary nail. Single-legged loading with 388 N applying on the tibial plateau was under consideration.

RESULTS: A NVGF placed on opposite cortex to the plate played an important role in withstanding bending moment which could reduce implant stress. An additional locking screw inserted into the NVGF helped to keep the NVGF in position and was essential for maintaining fracture gap width.

CONCLUSION: A NVFG with locking screw fixation could be an effective modality in managing segmental bone loss of the tibia. A construct of lateral LCP with a NVFG stabilized by a locking screw was mechanically superior to the others.

PMID:41004973 | DOI:10.1016/j.injury.2025.112764

Injury. 2025 Sep 22;56(11):112769. doi: 10.1016/j.injury.2025.112769. Online ahead of print.

NO ABSTRACT

PMID:41004972 | DOI:10.1016/j.injury.2025.112769

Injury. 2025 Sep 19;56(11):112768. doi: 10.1016/j.injury.2025.112768. Online ahead of print.

ABSTRACT

INTRODUCTION: The osteosynthesis of supracondylar fractures (SC) using pins buried under the skin (PB) or externalized (PE) is a subject of debate. The aim of this study was to compare two treatment protocols, one using PB and the other using PE, in terms of clinical and radiographic outcomes, complication rates.

HYPOTHESIS: The hypothesis of the study was that both protocols are equivalent in terms of clinical, radiological outcomes, and complication rates.

MATERIALS AND METHODS: This was a retrospective bicentric comparative study analyzing 296 boys and 267 girls (mean age 6.2 ± 2.7 years) who underwent SC fracture surgery between 1/1/2010 and 31/12/2020 using two therapeutic protocols. The first protocol (group A; n = 210) involved osteosynthesis with PB, immobilization (6-7 weeks), and pin removal in the operating room under general anesthesia. The second protocol (group B; n = 353) was characterized by osteosynthesis with PE, immobilization (4-6 weeks), and pin removal in an outpatient setting. Functional outcomes were assessed using the QuickDASH questionnaire, radiographic outcomes [Baumann angle, lateral capitulum-humeral angle (LCHA), rotational disorders according to the Von Laer quotient], and postoperative complication rates (infection, recurrent fracture, stiffness, vasculo-nerve complications).

RESULTS: No patients were lost to follow-up (n = 563) and the mean follow-up was 6.6 ± 7.3 months (3-70). The mean immobilization duration was longer in group A (45.8 ± 7.4 vs 39.7 ± 12.0 days; p < 0.001). Clinical and functional outcomes were similar (p = 0.316), and the pre- and postoperative complication rates were comparable between the two groups (A-B = 8 %/8.6 %-6 %/7.1 %; p = 0.733 and p = 0.512), while the postoperative Baumann angle, LCHA, number of rotational disorders, and Von Laer quotient were significantly different [A-B = 71.5°-74° (p < 0.001); A-B = 32.8°-35.6° (p < 0.001); A-B = 32-10 (p < 0.001); A-B = 0.2-0.1 (p = 0.020)].

DISCUSSION: This retrospective study compared two surgical protocols for pediatric supracondylar (SC) fractures in 563 children. Functional and clinical outcomes were similar between groups, with no significant difference in complication rates. Group B had better radiographic results and a lower rate of postoperative rotational deformities. Pin buried (Group A) increased costs and required a second general anesthesia for removal. Group B's protocol allowed outpatient pin removal under nitrous oxide, reducing risks and costs. Infection rates were no significant different between both groups. Whereas the decrease of number of rotational disorsders, the increase of Baumann angle and decrease of LCHA in this patient show that decrease of rotational disorders is more likely related to osteolysis of rotational spur than bone remodeling. Despite limitations, this is the largest French series comparing these two protocols, showing equivalent functional outcomes but greater efficiency and safety in Group B.

CONCLUSION: Both therapeutic protocols have comparable clinical outcomes and complication rates. Leaving pins exposed does not increase the risk of infection.

LEVEL OF EVIDENCE: III comparative retrospective study.

PMID:41004971 | DOI:10.1016/j.injury.2025.112768

Injury. 2025 Sep 17;56(11):112763. doi: 10.1016/j.injury.2025.112763. Online ahead of print.

ABSTRACT

INTRODUCTION: The purpose of this study was to assess the effect of an acute traumatic meniscus tear that required repair in association with a tibial plateau fracture repair on outcomes.

METHODS: Over a 17-year period, 843 patients presented with a tibial plateau fracture and were followed prospectively. 721 patients with Schatzker I-VI fractures were treated operatively via a standardized algorithm. 161 tibial plateau fractures (22.3 %) had an associated meniscus tear that underwent acute repair at the time of bony fixation. These patients were compared to operatively repaired tibial plateau fracture patients with no meniscus injury (NMR). Demographics were collected and outcomes including: radiographic healing, knee range of motion (ROM), and complication rates, were recorded. In addition, re-operation rates were compared and any reoperation for meniscus repair failure identified. All patients had a minimum of 1 year follow up.

RESULTS: A total of 524 patients with a mean of 21.4 (range: 12-120) months follow up met inclusion criteria. Patients in the meniscus repair (MR) cohort had poorer knee extension (1.01 degrees, range: 0-30 degrees) compared to the NMR cohort (0.07 degrees, range: 0-10 degrees) (p < 0.001), in addition to poorer knee flexion (123 degrees, range: 0-145 degrees, p = 0.024). Additionally, MR patients reported higher pain scores (mean: 3 and range: 0-8, p = 0.005) at latest follow up. Finally, MR patients had higher rates of infection (8.1 % vs. 3.3 %, p = 0.025) and lateral collapse of the joint (p = 0.032).

CONCLUSION: Patients who had a meniscus repair at the time of tibial plateau fracture repair were found to have poorer knee ROM, more patient reported pain at minimum 12 (mean 24) months post-operation. Additionally, these patients developed more post-operative complications than those patients who did not undergo a meniscus repair.

PMID:41004970 | DOI:10.1016/j.injury.2025.112763

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06655-5. Online ahead of print.

NO ABSTRACT

PMID:41003786 | DOI:10.1007/s00264-025-06655-5

Int Orthop. 2025 Sep 26. doi: 10.1007/s00264-025-06653-7. Online ahead of print.

ABSTRACT

PURPOSE: We examined The Seven Works of Mercy, painted by the Master of Alkmaar in 1504, through the lens of orthopaedic pathology. This study approaches the panels from a medical perspective, aiming to uncover visual indicators of disease and disability. The findings offer insight into how physical abnormalities were observed and depicted in the early sixteenth century. To our knowledge, this is the first study to explore orthopaedic pathology in the Seven Works of Mercy.

METHODS: An interdisciplinary analysis of The Seven Works of Mercy was undertaken, with a focus on the visual representation of illness and physical disabilities. The seven panels were examined to identify physical abnormalities. The findings were compared with clinical features of the suggested illnesses and disabilities and with known medical conditions prevalent in the fifteenth and sixteenth century in Europe.

RESULTS: Several depicted orthopaedic disabilities were suggested in the panels of The Seven Works of Mercy. Possible underlying conditions included clubfeet, spinal tuberculosis (Pott's disease), syphilis, poliomyelitis, ergotism, and genu recurvatum. The physical deformities, depicted with remarkable anatomical detail, were cross-referenced with known clinical presentations. In several cases, assistive devices and posture supported the proposed diagnoses.

CONCLUSION: The Seven Works of Mercy by the Master of Alkmaar is a mirror of society in the early sixteenth century, in which a number of depicted orthopaedic conditions were identified. While artistic interpretation must be considered, several physical deformities and disabilities are reproduced with remarkable detail. The artist captured in this masterpiece, a gallery of orthopaedic pathologies common in his time.

PMID:41003785 | DOI:10.1007/s00264-025-06653-7

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06658-2. Online ahead of print.

ABSTRACT

PURPOSE: This study compared the demographics and outcomes of patients with Parkinson's disease (PD) undergoing total knee arthroplasty (TKA) to those without PD. Additionally, it aimed to assess the impact of implant design on TKA survival in PD patients.

METHODS: Using data from the Emilia Romagna Registry of Orthopedic Prosthetic Implants, 551 TKA procedures in patients with PD were identified and compared to 52,022 TKAs in patients without PD. Kaplan-Meier survivorship analysis was used to compare implant survival, with revision surgery as the endpoint. Cox multivariate analysis was performed to assess the influence of age, gender, PD diagnosis, and implant design on implant failure.

RESULTS: The average age of PD patients was 72.2 years, with 66.2% being female. Implant survival was significantly lower in the PD group compared to the control group (p < 0.001). At 13 years, the survival rate was 88.8% in the PD group and 94.3% in the control group. PD patients had a 2.7 times higher risk of implant failure after adjusting for age and gender. Constrained implant designs were associated with a 1.7 times higher risk of failure compared to non-constrained designs in PD patients.

CONCLUSION: PD negatively affects implant survival in patients undergoing TKA. Careful consideration should be given to patient selection and implant design in this patient population.

PMID:40996522 | DOI:10.1007/s00264-025-06658-2

Int Orthop. 2025 Sep 25. doi: 10.1007/s00264-025-06656-4. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporotic vertebral compression fractures (OVCFs) are highly prevalent among the elderly. However, spinal metastases can also lead to pathological fractures that are often misdiagnosed as OVCFs. This study aimed to determine the prevalence of unsuspected malignant vertebral compression fractures (VCFs) among patients initially suspected to have OVCFs.

METHODS: From October 2020 to December 2023, 141 patients with suspected OVCFs underwent routine vertebral biopsy during percutaneous kyphoplasty (PKP) at our institution. All patients received standardized treatment and prospective clinical data collection. Follow-up questionnaires were completed in person or via telephone.

RESULTS: A total of 168 biopsy specimens were obtained from 141 patients, and all samples (100%) were successfully evaluated histopathologically. Unexpected spinal metastases were identified in six patients (4.3%). Of the 19 patients with a known history of malignancy but without characteristic radiographic features of pathological fracture, only two cases (10.5%) were confirmed as metastatic involvement from the primary cancer. Among the remaining 112 patients without a cancer history, four unexpected malignancies were identified (one lymphoma and three lung cancers). The overall prevalence of unsuspected malignant VCFs in this cohort was 4.3%.

CONCLUSIONS: Given the observed prevalence of unsuspected malignant VCFs, we recommend that routine vertebral biopsy be performed during every PKP procedure for patients with OVCFs to ensure early detection of occult malignancy.

PMID:40996521 | DOI:10.1007/s00264-025-06656-4

Injury. 2025 Sep 17:112766. doi: 10.1016/j.injury.2025.112766. Online ahead of print.

ABSTRACT

Not applicable.

PMID:40992972 | DOI:10.1016/j.injury.2025.112766

Injury. 2025 Sep 17;56(11):112767. doi: 10.1016/j.injury.2025.112767. Online ahead of print.

ABSTRACT

Lower limb amputations have a prevalence of about 26 per 100,000 in the United Kingdom. A significant proportion of these patients suffer from chronic pain and/or phantom limb pain. Targeted muscle reinnervation (TMR) and regenerative peripheral nerve interfaces (RPNI) have been found to help improve these symptoms, however these are usually used as a treatment as opposed to prevention. These techniques work on the principle of giving the nerves somewhere to go and something to do, but it is not yet standard practice. Central neural reorganisation and adaptation to chronic/phantom limb pain suggest that preventing the symptom in the first place could yield a superior result to treatment after the problem has arisen. We present a series of 24 cases of where TMR and/or RPNI were performed primarily at the time of initial amputation. Patients were followed up approximately one year after procedure and assessed their pain scores according to a numerical rating scale (NRS) and the PROMIS Pain Interference Short form 6b Significant improvements of pain scores were found for these patients when compared to patients without previous TMR or RPNI. PLP is a debilitating, life limiting and an economic burden on patients who have undergone limb amputations, and with no clear medical or surgical intervention yet widely accepted to offer a definitive management option for this problem, TMR and RPNI may be able to fill a void. This is a good proof of principle showing promising results, and suggests that further investigations with randomised control studies are warranted.

PMID:40992116 | DOI:10.1016/j.injury.2025.112767

Injury. 2025 Sep 18;56(11):112765. doi: 10.1016/j.injury.2025.112765. Online ahead of print.

ABSTRACT

PURPOSE: Tibial tuberosity fractures are rare physeal injuries in adolescents and are frequently overlooked on radiographs, despite a high risk of associated soft tissue injury. This study analyzed magnetic resonance imaging (MRI) findings and concurrent injuries in 63 cases to improve diagnostic accuracy and guide clinical management. This study aimed to investigate the MRI features and associated injury patterns of tibial tuberosity fractures in adolescents.

METHODS: A retrospective analysis was performed on 63 adolescent patients with tibial tuberosity fractures admitted to our hospital between June 2017 and January 2025. The cohort comprised 62 males and 1 female, with ages ranging from 11 to 16 years (mean: 13.9 years). Fractures occurred on the right side in 22 cases, the left side in 40 cases, and bilaterally in 1 case. Body mass index (BMI) ranged from 20.8 to 33.3 kg/m², with a mean of 26.8 kg/m². Upon admission, all patients underwent MRI examinations within 48 h (3.0 T, including T1-, T2-, and STIR-weighted sequences). Fracture types were classified according to the Ogden classification, and associated injuries involving ligaments and the meniscus were simultaneously documented.

RESULTS: MRI revealed patellar tendon injuries in all patients (patellar tendon rupture in 6 cases). Associated injuries included anterior cruciate ligament (ACL) injuries in 28 cases (44.4 %) and posterior cruciate ligament (PCL) injuries in 3 cases (4.8 %). Meniscal injuries were observed in 25 cases (39.7 %), comprising 9 cases of grade I, 12 cases of grade II, and 4 cases of grade III. Peripatellar retinacular injuries were present in 28 cases (44.4 %), and medial or lateral collateral ligament injuries of the knee were identified in 13 cases (20.6 %). Additional associated injuries included 1 case (1.6 %) of fibular fracture, 10 cases (15.9 %) of patellar fracture, and 5 cases (7.9 %) of patellar subluxation.

CONCLUSION: Plain radiography is the preferred imaging modality for diagnosing tibial tuberosity fractures in adolescents, while computed tomography (CT) can be useful for further classification of fracture types. In cases where concomitant soft tissue injuries-such as those involving the patellar ligament or meniscus-are suspected, MRI provides significant diagnostic value and plays a crucial role in surgical planning and complication prevention.

LEVEL OF EVIDENCE: Level III.

PMID:40992115 | DOI:10.1016/j.injury.2025.112765

SICOT J. 2025;11:54. doi: 10.1051/sicotj/2025052. Epub 2025 Sep 24.

ABSTRACT

INTRODUCTION: Worldwide, more than 1 million Total Hip Arthroplasties (THAs) are performed annually, with this number predicted to increase by 37.7% by the year 2060. This places a significant financial burden on the healthcare system, with the average cost of a THA being approximately $40,000. Several factors ultimately contribute to patient outcomes and complications, including surgical approach, surgeon's experience, patient age, BMI, and most importantly, the preoperative diagnosis. Our paper aimed was to describe the various aetiologies of hip pathologies in patients presenting for primary elective THA to a tertiary academic sub-Saharan African institution.

MATERIALS AND METHODS: We retrospectively reviewed 1400 consecutive patients presenting for elective primary THA between January 2015 and December 2021. Patients' preoperative clinical notes, radiological records, and intraoperative results were independently assessed by two examiners to diagnose the hip pathology. A comparison of the presenting preoperative aetiologies was made between those seen in developed countries and those seen in more developing countries.

RESULTS: 2176 pathological hips were evaluated. Bilateral pathology was present in 56% of patients, of which 92% had the same pathology. There were 427 (31%) males and 973 (69%) females, with an average patient age of 58 ± 14.13 years and an average BMI of 31.01 ± 15.13 kg/m2. The preoperative aetiologies included primary osteoarthritis (OA) (n = 406 [29%]) and avascular necrosis of the femoral head (AVN) (n = 322 [23%]), of which (n = 162 (58%) had bilateral pathology. The primary cause of AVN was HIV (49%). Patients presenting with AVN were significantly younger (p < 0.0001) and had a lower BMI (p < 0.0001) in comparison to patients presenting for other pathologies.

CONCLUSION: This study underscores the significance of aetiology in THA outcomes and highlights the unique challenges faced in developing countries. By identifying the specific causes of hip pathology in this population, healthcare providers can better allocate resources and develop tailored treatment strategies to improve outcomes in resource-limited settings.

PMID:40990380 | PMC:PMC12459105 | DOI:10.1051/sicotj/2025052

SICOT J. 2025;11:E2. doi: 10.1051/sicotj/2025053. Epub 2025 Sep 24.

ABSTRACT

Physicians often grapple with the delicate balance between providing full disclosure and shielding patients from harsh realities. Honesty, empathy, and patient-centered care are crucial elements influencing patient outcomes and well-being. The revelation process of life-threatening diseases triggers distinct psychological coping stages, emphasizing the need for sensitive communication. Cultural factors further shape communication dynamics, necessitating individualized approaches. As such, this paper discusses the need for truth in the relationships and interactions of doctors and patients, emphasizes adequate information of patients based on honesty and consideration of their expectations, environment, and cultural values, and explores the pivotal role of bioethics education and training in preparing medical professionals to navigate these complex situations. By integrating bioethics education into medical curricula, fostering open and honest communication, and building strong patient-doctor relationships, we can enhance the quality of care and empower patients to embrace their medical journey with dignity and acceptance.

PMID:40990379 | PMC:PMC12459106 | DOI:10.1051/sicotj/2025053

Injury. 2025 Sep 11;56(11):112759. doi: 10.1016/j.injury.2025.112759. Online ahead of print.

ABSTRACT

PURPOSE: The disability and pain after a neglected scaphoid non-union fracture are well recorded in the literature. We aimed to compare and detect the short-term results of non-united scaphoid waist fracture treated by internal fixation and bone graft with the volar buttress plate utilization versus the Herbert screw.

METHODS: This is a therapeutic study. This randomized, prospective comparative an intervention study was carried out on 30 cases with non-union scaphoid waist fractures. They were randomly categorized into two equal groups, group (A) treated by volar buttress plate fixation with bone graft, and group (B) managed by Herbert screw fixation along with bone graft. Bone graft in both groups was taken from the distal radius. All cases underwent clinical examination and radiological evaluation.

RESULTS: With an average of 18 months, thirty cases were followed up. Both groups had similar baseline characteristics. The union rate and time were insignificant difference between both groups. Insignificant differences were determined across either intervention groups in terms of grip strength, the visual analogue pain scale (VAS), the Mayo wrist score, and the quick disabilities of arm, shoulder and hand score (quick DASH score) during the early interval of follow-up postoperatively (at 3, 6, 9 and 12 months). Group (A) demonstrated shorter operative time and lower numbers of image intensifier intraoperatively in contrast to group (B). Hardware removal after union was needed in 3 patients of group (A) in variance to group (B), in which no cases need implant removal. The Radio-scaphoid (RS) impingement and flexor carpi radialis (FCR) tenosynovitis exhibited a significant elevation in group (A) in contrast to group (B). Among the patients with scaphoid fracture non-union who underwent surgery, some cases did not achieve union after the initial procedure. We had to employ an alternative fixation method for these cases, and we followed them until union was achieved, and their function was restored. Specifically, three patients from group (A) (20%) [one case was fixed with a miniplate 2 mm, and two cases were fixed with a microplate 1.5 mm] and two patients from group (B) (13.3 %) required this approach.

CONCLUSIONS: The functional and radiological outcomes are comparable between volar buttress plate and Herbert screw in the treatment of non-united waist scaphoid fracture. The rate of removal of the implant is higher in the volar buttress plate.

PMID:40987252 | DOI:10.1016/j.injury.2025.112759

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06660-8. Online ahead of print.

ABSTRACT

PURPOSE: Three-dimensional robotic planning may oblige the surgeon to accept an anterior overhang of the acetabular cup. Whether this planned overhang compromises short-term outcomes is unknown.

METHODS: We retrospectively reviewed 437 consecutive robotic total hip arthroplasties (THA) performed between November 2018 and March 2022; 192 hips with complete 3-D screenshots and 12-month follow-up formed the study cohort. Anterior overhang on the definitive plan was graded minor (≤ 2 mm), moderate (between 2 and 4 mm), or major (≥ 4 mm). Primary outcome was psoas pain at one year, defined by pain on resisted-hip-flexion testing; psoas impingement was confirmed if infiltration or tenotomy was performed. Secondary endpoints were Harris Hip Score (HHS), Oxford Hip Score (OHS) and Forgotten Joint Score (FJS-12).

RESULTS: Planned overhang occurred in 52 of 192 hips (27%): 33 minor, 18 moderate and one major. Psoas pain was more frequent with overhang (16% vs. 3.8%; p = 0.008); no differences were recorded for confirmed psoas impingement, groin pain, re-operation or revision of implants. Differences of mean HHS, OHS and FJS-12 at three and twelve months were non-significant between groups. Anterior wall index < 0.33, lateral center-edge angle < 25° and female sex are associated with overhang.

CONCLUSIONS: Minor anterior cup overhang is common in robotic THA. It increases the likelihood of clinical psoas impingement but does not impair early hip function or raise revision risk. Accepting minor overhang is clinically acceptable when necessary, provided patients are counselled about increased psoas pain risk and high-risk anatomies are monitored.

PMID:40986041 | DOI:10.1007/s00264-025-06660-8

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06657-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the effectiveness and safety of anterior scoliosis correction (ASC) in patients over 40 years of age.

METHODS: This prospective study included 29 patients (mean age 46.6 ± 8.8 years) with idiopathic or adult spinal deformity and a Cobb angle > 30°, who underwent ASC. The follow-up two to five years. Outcomes assessed were Cobb angle correction, quality of life (ODI, SRS-22, SF-36), and postoperative complications.

RESULTS: The mean Cobb angle correction was 59% (from 52.5° to 21.3°). At final follow-up (2.8 ± 1.1), a slight increase to 24.0° was observed, mainly due to curve subsidence. No complications occurred in 62% of patients. Subsidence > 5° was noted in 17% (n = 5), and loss of correction > 15° in 3% (n = 1). One patient experienced persistent pain managed conservatively. Higher risk of subsidence was associated with age > 50 years and preoperative Cobb angle > 50°. Quality of life improved across all measures: ODI decreased from 45% to 32%, SF-36 increased from 50 to 65, and SRS-22 declined slightly from 3.9 to 3.7 in patients with tether settling.

CONCLUSION: ASC demonstrates high effectiveness and acceptable safety for scoliosis correction in patients over 40 years. Subsidence is the primary adverse event, warranting further investigation and careful patient selection.

PMID:40986040 | DOI:10.1007/s00264-025-06657-3

Int Orthop. 2025 Sep 23. doi: 10.1007/s00264-025-06659-1. Online ahead of print.

ABSTRACT

INTRODUCTION: In medial opening wedge high tibial osteotomy (MOWHTO), the goal extends beyond lateralizing the mechanical axis; restoring a horizontal joint line is crucial for optimal biomechanics. The Coronal Plane Alignment of the Knee (CPAK) classification, which incorporates mechanical axis deviation and joint line obliquity (JLO), offers a phenotype-based framework, though its application in MOWHTO remains underexplored.

MATERIALS AND METHODS: A retrospective review included 147 knees from 123 patients undergoing MOWHTO with at least 24 months of follow-up. Radiographic parameters assessed were mFTA, MPTA, mLDFA, JLCA, aHKA, and JLO. Knees were categorized based on postoperative weight-bearing line (WBL) positions, and CPAK phenotypes were recorded pre- and postoperatively. Clinical outcomes were evaluated using the Hospital for Special Surgery (HSS) knee score.

RESULTS: Preoperatively, CPAK type I (varus, apex distal JLO) predominated (82.3%). Postoperatively, many transitioned to Types V (neutral, apex neutral JLO, 24.5%) and VI (valgus, apex neutral JLO, 17.7%), both yielding significantly higher HSS scores (p < 0.001). Optimal outcomes were observed with a WBL between 50% and 60%. The mean aHKA improved from - 7.35° to + 1.59°, while JLO corrected from 172.4° to 180.8°.

CONCLUSION: This study demonstrates that transitions to CPAK Types V-VI, with 50-60% WBL and horizontal joint line restoration, are linked to improved HSS scores, highlighting the CPAK classification's potential for guiding individualized correction strategies in MOWHTO.

LEVEL OF EVIDENCE: Level III (retrospective comparative study).

PMID:40986039 | DOI:10.1007/s00264-025-06659-1

Injury. 2025 Sep 14;56(11):112760. doi: 10.1016/j.injury.2025.112760. Online ahead of print.

ABSTRACT

INTRODUCTION: Posterior sternoclavicular joint (SCJ) dislocations are rare, accounting for <1 % of all joint dislocations. Despite their rarity, these injuries warrant urgent recognition due to the SCJ's proximity to mediastinal structures, including the trachea, esophagus, and great vessels. While not always surgical emergencies, delayed or unstable cases can result in life-threatening complications if not managed in an appropriately equipped hospital setting.

CASE PRESENTATION: A 28-year-old male presented two weeks after sustaining a right SCJ injury while sliding during a softball game. He reported persistent pain, difficulty breathing, and limited shoulder function. Initial radiographs were unremarkable; however, CT imaging revealed a posterior dislocation of the medial clavicle. Given the delayed presentation and potential mediastinal involvement, the patient underwent open reduction and internal fixation (ORIF) with cardiothoracic surgical assistance. Fixation was achieved using unicortical screws in the sternum and bicortical screws in the clavicle. He recovered without complications and returned to full activity CONCLUSION: : Posterior SCJ dislocations are challenging to diagnose on radiographs and often require CT for accurate assessment. Although closed reduction is an option in acute cases, delayed presentations typically necessitate surgical stabilization. Plate fixation offers reliable alignment and secure fixation. This case underscores the importance of timely diagnosis, hospital-based care, and multidisciplinary surgical planning when managing posterior SCJ dislocations.

PMID:40982998 | DOI:10.1016/j.injury.2025.112760

Int Orthop. 2025 Sep 22. doi: 10.1007/s00264-025-06651-9. Online ahead of print.

NO ABSTRACT

PMID:40982037 | DOI:10.1007/s00264-025-06651-9

Injury. 2025 Sep 15:112761. doi: 10.1016/j.injury.2025.112761. Online ahead of print.

ABSTRACT

INTRODUCTION: Blunt Thoracic trauma (BTT) affects over 10 % of trauma patients and may lead to delayed respiratory complications. The STUMBL (STUdy of the Management of BLunt chest wall trauma) score was developed to identify patients at high risk of complications. This study aimed to validate the STUMBL score in a Canadian setting.

METHODS: We conducted a retrospective cohort study of adult patients with isolated BTT presenting to a Canadian emergency department (ED) of a Level-1 trauma center between 2018 and 2020. STUMBL scores were calculated for each patient. The primary outcome was a composite of in-hospital mortality, early pulmonary complications, ICU admission, or prolonged hospital stay (≥7 days). Secondary outcomes were delayed pulmonary complications and unplanned return to the ED. Receiver operating characteristic (ROC) curves were used to evaluate predictive performance, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed for each score cutoff.

RESULTS: Among 344 included patients (mean age: 57.8 ± 17.0, male sex: 64.2 %), 18.3 % experienced the primary outcome. The STUMBL score showed good discrimination (AUROC 0.87). A cutoff of ≤10 yielded a sensitivity of 90.5 % and NPV of 97.0 %, while a cutoff of ≤15 showed a sensitivity of 66.7 % and NPV of 92.2 % to predict the composite outcome. In patients with a score ≤15, delayed pulmonary complications occurred in <2 %, and unplanned ED visits in <7 %. Conversely, 82.4 % of patients with STUMBL scores ≥21 experienced the composite outcome. This cutoff was associated with a specificity of 97.9 % and PPV of 82.4 %.

CONCLUSIONS: The STUMBL score demonstrated good performance in predicting early adverse outcomes in Canadian patients with isolated BTT. Patients with a STUMBL score ≤15 and no early complications represent a low-risk group that may be safely discharged. Those with scores ≥21 warrant ICU evaluation. Further prospective validation or refinement is recommended before widespread implementation.

PMID:40976766 | DOI:10.1016/j.injury.2025.112761