Int Orthop. 2025 Jun 20. doi: 10.1007/s00264-025-06585-2. Online ahead of print.

ABSTRACT

BACKGROUND: Shoulder pain is a common reason for patients to seek care from general practitioners or orthopaedic specialists. Prior studies suggest a correlation between acromial morphology and shoulder pathologies. This study aimed to determine acromion characteristics in the Indonesian population and evaluate associations between acromion type, radiographic parameters, sex, and shoulder disorders.

METHODS: A cross-sectional study was conducted on 487 patients with shoulder disorders, using consecutive sampling and data from our institution's radiology database (2020-2021). Acromion morphology was classified using the Bigliani system. Diagnoses were based on clinical and radiological records. Radiographic parameters assessed included critical shoulder angle (CSA), acromion index (AI), lateral acromial angle (LAA), acromioclavicular (AC) joint distance, acromiohumeral (AH) joint distance, and acromial tilt.

RESULTS: Among 487 patients, type II acromion was most common (59.5%), followed by type I (33.3%), type IV (4.5%), and type III (2.7%). Mean CSA was 38.36 ± 5.13, AI 0.72 ± 0.09, LAA 72.52 ± 6.01, AC joint distance 3.18 ± 0.89, AH distance 8.61 ± 1.86, and acromial tilt 28.84 ± 4.52. No significant association was found between acromion type and shoulder disorders (p = 0.34), or between sex and acromion type (p = 0.516). Radiographic parameters also showed no significant correlation with shoulder disorders.

CONCLUSION: Type II acromion was the most prevalent in this Indonesian population. No significant associations were observed between acromion type, sex, or radiographic parameters and shoulder pathologies. Acromial morphology may represent normal anatomical variation rather than a pathological finding.

PMID:40540035 | DOI:10.1007/s00264-025-06585-2

Int Orthop. 2025 Jun 20. doi: 10.1007/s00264-025-06571-8. Online ahead of print.

ABSTRACT

PURPOSES: To compare radiological and clinical outcomes of TiRobot-assisted versus traditional freehand percutaneous anterior column screw fixation for transverse with or without posterior wall fractures of acetabulum based on the Kocher‑Langenbeck (K‑L) approach.

METHODS: Patients suffering transverse with or without posterior wall fractures of acetabulum that were fixed by TiRobot-assisted or traditional freehand percutaneous anterior column screw fixation via the K-L approach were divided into two groups:group A (TiRobot-assisted fixation) and group B (traditional freehand fixation). Surgical time, blood loss, postoperative complications, follow-up length, hospital stay and fracture healing time were recorded. Fracture reduction quality was estimated via criteria described by Matta.Fracture healing was evaluated on the pelvic radiographs at each follow-up. Functional outcomes were examined using the Postel Merle D'Aubigné score system at the final follow-up.

RESULTS: A total of 29 patients who met the inclusion and exclusion criteria were evaluated for eligibility in this study, with 16 patients assigned to group A and 13 to group B.The mean intraoperative blood loss was 581.3 ± 242.8 ml in group A and 761.5 ± 193.8 ml in group B(P < 0.05). The average intraoperative fluoroscopy in group A was 8.3 ± 1.5 times, while that in group B was 12.7 ± 2.0 times(P < 0.001). The mean number of needle adjustments was 0.6 ± 0.6 in group A and 2.0 ± 0.7 in group B(P < 0.001). No signifcant differences in surgical time of the anterior column screw fixation,hospital stay,reduction quality, fracture healing time, complications and functional outcomes were noted between the two groups. It is worth noting that, in TiRobotic-assistance early-stage group the mean surgical time of anterior fracture fixation was 29.3 ± 2.5 min, while it was 19.3 ± 2.2 and 26.7 ± 4.2 min in Tirobotic-assistance late-stage group and freehand group respectively, with a statistically significant inter-group difference (P < 0.001).

CONCLUSIONS: The K‑L approach combined with TiRobot‑aided anterior column screw fixation is a safe and effective option for transverse with or without posterior wall fractures of acetabulum. Compared with traditional freehand percutaneous anterior column screw fixation, TiRobot‑aided screw fixation has obvious advantages on blood loss, invasiveness, screw placement accuracy, patient and physician radiation exposure. Tirobot‑aided screw fixation involves a learning curve. During the initial phase, the surgical time is prolonged due to unfamiliarity with the technology; however, as proficiency improves, the surgical time is significantly reduced compared to traditional freehand technique. The K‑L approach combined with traditional freehand percutaneous anterior column screw fixation can also be a reliable alternative for transverse with or without posterior wall fractures of acetabulum, with the similar reduction quality, complications and functional outcomes.

PMID:40540034 | DOI:10.1007/s00264-025-06571-8

Int Orthop. 2025 Jun 19. doi: 10.1007/s00264-025-06582-5. Online ahead of print.

NO ABSTRACT

PMID:40536561 | DOI:10.1007/s00264-025-06582-5

Int Orthop. 2025 Jun 18. doi: 10.1007/s00264-025-06583-4. Online ahead of print.

NO ABSTRACT

PMID:40531209 | DOI:10.1007/s00264-025-06583-4

Int Orthop. 2025 Jun 18. doi: 10.1007/s00264-025-06568-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the effect of failed rotator cuff repair (RCR) on surgical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft.

METHODS: We included 79 patients with irreparable massive rotator cuff tears who underwent SCR using fascia lata autografts between 2018 and 2023, with a minimum follow-up of ≥ one year. Of them, 66 patients underwent primary SCR (primary SCR group) and 13 underwent SCR after structural failure of previous RCR (revision SCR group). Clinical outcomes, including American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analogue scale (VAS) score, and range of motion, were assessed. Radiological outcomes were evaluated using radiographs and magnetic resonance imaging (MRI) scans. The minimal clinically important difference (MCID) values determined the clinical relevance of the difference in functional outcomes. Graft tears were recorded if graft discontinuity was found on MRI.

RESULTS: The revision SCR group showed worse VAS (2.1 vs. 1.1, P = 0.025), ASES (69.7 vs. 82.4, P = 0.008), Constant (57.1 vs. 64.3, P = 0.016) scores and higher graft tear rates (61.5% vs. 21.2%; P = 0.049) than the primary SCR group. The differences in VAS, ASES, and Constant scores exceeded the MCID threshold in the primary SCR group at a mean final follow-up of 2.1 ± 1.0 years. Conversely, in the revision SCR group, only the difference in Constant score exceeded the MCID threshold at a mean final follow-up of 2.2 ± 1.6 years, and patients with intact grafts showed significantly better VAS score and acromiohumeral distance (both P = 0.030) than those with torn grafts.

CONCLUSION: SCR using fascia lata autograft improved surgical outcomes for primary and revision SCRs. However, revision SCR showed worse outcomes and higher graft tear rates compared to primary SCR.

PMID:40531208 | DOI:10.1007/s00264-025-06568-3

Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06580-7. Online ahead of print.

ABSTRACT

BACKGROUND: Lacertus syndrome (LS) involves median nerve compression by the lacertus fibrosus at the elbow. Often misdiagnosed as carpal tunnel syndrome (CTS), it presents primarily with hand weakness, fatigue, and forearm pain, with less common sensory symptoms.

OBJECTIVES: To review current knowledge on the clinical features, diagnostic methods, and treatment options for LS, highlighting the distinct characteristics that differentiate it from similar conditions.

METHODS: A comprehensive review synthesizing literature on anatomy, pathophysiology, prevalence, diagnostic approaches, and treatment outcomes.

RESULTS: Clinical diagnosis relies heavily on specific provocative tests, including the clinical triad (muscle weakness, localized pain, positive Scratch Collapse Test), Lacertus Antagonist Test (LAT), and visible Lacertus Notch Sign. Diagnostic ultrasound is increasingly preferred for real-time, dynamic assessment. Electrodiagnostic studies have limited diagnostic value due to the dynamic nature of the compression. Conservative treatments include activity modification, nerve gliding exercises, kinesiotaping, and injections (corticosteroids, botulinum toxin). Surgical intervention, typically via minimally invasive or percutaneous release under Wide-Awake Local Anaesthesia No Tourniquet (WALANT), achieves immediate intraoperative strength improvement and high patient satisfaction rates (around 88%).

CONCLUSIONS: Improved clinical recognition of Lacertus syndrome through specific provocative tests and dynamic ultrasound enhances accurate diagnosis. Surgical decompression, especially using the WALANT approach, consistently yields excellent functional outcomes, emphasizing its role as the definitive treatment for resistant or severe cases.

PMID:40522492 | DOI:10.1007/s00264-025-06580-7

Int Orthop. 2025 Jun 16. doi: 10.1007/s00264-025-06581-6. Online ahead of print.

ABSTRACT

PURPOSE: Dynamic anterior stabilization (DAS) is a novel soft-tissue procedure for treating anterior shoulder instability in selected cases. The purpose of the present meta-analysis is to provide the up-to-date evidence on DAS's outcomes, safety and characterize study designs to improve future studies and accelerate technical advancements.

METHODS: A PRISMA guided meta-analysis was performed. Inclusion criteria were human studies, comparative or non-comparative in which DAS was performed as an indication for anterior shoulder instability. Four databases were searched PubMed (via MEDLINE), EMBASE, Web of Science, and Science Direct. ROBINS-I was employed for risk of bias analysis. A random-effects meta-analysis was performed using mean difference (MD) as effect size estimator. Heterogeneity was reported using the I2 statistic. Dichotomous variables were counted and reported as % out of total sample size for each study.

RESULTS: Five studies met the inclusion criteria. A total of 137 patients were available for analysis with a mean age of 27.8 ± 9 years and 108 patients were males. Mean follow-up duration was 37 ± 11 months. Postoperative ASES score showed an improvement of MD = -15.09 (95% CI: -22.35 to -7.38), p < 0.01, compared to the preoperative period. The ROWE score showed a similar improvement, MD = -58.38 (95% CI: -69.88 to -46.89), p < 0.01. Postoperative range of motion (ROM) was not significantly influenced. Active anterior elevation had a MD = -6.07° (95% CI: -15.04 to 2.91), p = 0.19, active external rotation had a MD = 3.7° (95% CI: -7.71 to 15.11), p = 0.53, and active internal rotation, MD = 0.16° (95% CI: -1.4 to 1.73), p = 0.84. Return to play ranged from 80 to 100% while return to competitive sports, reported by a single study, was 33%. The overall complication rate was 8.6%. The overall risk of bias was "serious" or "critical" for all included studies.

CONCLUSION: DAS has been shown to improve postoperative PROMs, does not restrict ROM compared to the preoperative period and has an overall complication rate of 8.6%.

PMID:40522491 | DOI:10.1007/s00264-025-06581-6

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06577-2. Online ahead of print.

ABSTRACT

PURPOSE: Unilateral biportal endoscopy (UBE) is a predominantly minimally invasive surgical technique for addressing LDH. Nonetheless, recurrent lumbar disc herniation (rLDH) remains the predominant reason for reoperation following UBE. This retrospective study examined the risk factors and reoperation rates for rLDH following UBE. This study aimed to examine the risk factors associated with rLDH and the reoperation rate after single-level UBE.

METHODS: We retrospectively analyzed 205 patients who underwent UBE for single-level LDH from 2019 to 2023 to determine reoperation causes and related risk variables. Reoperation was characterized as the postoperative radiological evidence of persistent symptomatic disc herniation at the same level, necessitating further surgical intervention. We gathered radiographic and demographic parameters preoperatively and postoperatively. Patients with recurrent LDH had additional evaluation during recurrence and revision operations.

RESULTS: Of the 205 patients, 21 (10.2%) required further rLDH revision surgery. The multivariate analysis indicated that obesity and elevated fasting blood glucose (FBG) levels were independent risk variables with strong predictive value for reoperation after controlling for other potential risk factors. Based on the receiver operating characteristic curve analysis, the cutoff points for UBE were body mass index (BMI) = 25.775 kg/m2 and FBG = 5.155 mmol/L.

CONCLUSION: This study identified obesity (BMI > 25.775 kg/m²) and elevated FBG levels (> 5.155 mmol/L) as independent risk factors for UBE reoperation. Hence, we recommend longer rehabilitation interventions, such as wearing a suitable brace and strengthening the paraspinal muscles, for patients with obesity and high FBG who undergo UBE.

PMID:40515760 | DOI:10.1007/s00264-025-06577-2

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06572-7. Online ahead of print.

ABSTRACT

OBJECTIVE: This comparative cohort study evaluates the clinical efficacy of 3D-printed patient-specific cutting guides (PSCGs) versus conventional manual techniques in correcting rigid midfoot pes cavus deformities.

METHODS: A retrospective analysis of 40 patients (80 feet) undergoing Cole osteotomy between 2021 and 2023 was conducted. Patients were stratified into two matched cohorts: Group A (manual osteotomy, n = 20) and Group B (PSCG-assisted, n = 20). Radiographic parameters (Meary's angle, TMI, TCA, Djian-Annonier angle, Pitch angle) and functional outcomes (VAS, AOFAS, SF-36) were analyzed preoperatively and at mean 17-month follow-up. Surgical metrics including operative time, fluoroscopy frequency, and complication rates were systematically compared.

RESULTS: Radiographic analysis demonstrated superior angular correction in the PSCG-assisted cohort versus conventional osteotomy, with significantly improved bilateral Meary's angle (Right: 1.94°±0.62 vs. 6.04°±2.20, P < 0.05; Left: 1.62°±0.54 vs. 6.39°±2.04, P < 0.05) and TMI angle (Right: 4.32°±3.14 vs. 8.51°±8.12, P < 0.05; Left: 4.74°±2.44 vs. 8.53°±5.93, P < 0.05). The PSCG technique achieved equivalent correction in TCA, Djian-Annonier, and Pitch angles while demonstrating enhanced consistency (38-66% reduction in standard deviations). Functionally, PSCG-assisted procedures yielded superior AOFAS scores (97.71 ± 0.77 vs. 92.07 ± 2.25, Δ = 5.64 [95%CI 4.54-6.74], P < 0.05) and SF-36 outcomes, particularly in general health (Δ = 16.96, P < 0.05) and mental well-being (Δ = 7.92, P = 0.001). Operative metrics favored PSCG with 36% shorter procedure time (82.9 ± 13.9 vs. 129.0 ± 39.6 min, P < 0.05) and 77% reduced intraoperative fluoroscopy (4.65 ± 1.06 vs. 20.07 ± 2.92 exposures, P < 0.05). No surgical site infections occurred in the PSCG group versus one superficial SSI in controls CONCLUSION: 3D-printed PSCGs provide anatomically precise, efficient correction of complex midfoot deformities while minimizing intraoperative radiation exposure, establishing this technology as a safe and reproducible alternative to conventional techniques.

PMID:40515759 | DOI:10.1007/s00264-025-06572-7

Int Orthop. 2025 Jun 14. doi: 10.1007/s00264-025-06573-6. Online ahead of print.

NO ABSTRACT

PMID:40514517 | DOI:10.1007/s00264-025-06573-6

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06576-3. Online ahead of print.

NO ABSTRACT

PMID:40498111 | DOI:10.1007/s00264-025-06576-3

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06578-1. Online ahead of print.

ABSTRACT

BACKGROUND: Adequate postoperative analgesia is critical for elderly patients undergoing total hip arthroplasty (THA). The pericapsular nerve group (PENG) block relieves pain while preserving motor function, but its limited duration necessitates adjuncts. This study evaluates the efficacy of perineural dexamethasone in prolonging PENG block analgesia in geriatric THA patients.

METHODS: In this double-blinded, randomized controlled trial, 60 patients (≥ 65 years) undergoing THA under spinal anaesthesia were assigned to the PENG group - PENG block with 20 mL 0.2% ropivacaine and the PENG + DEX group - PENG block with 20 mL 0.2% ropivacaine + 4 mg perineural dexamethasone. The primary outcome was time to first rescue opioid administration. The secondary outcomes included total opioid consumption, pain scores (NRS), quadriceps strength, and adverse effects over 48 h.

RESULTS: Dexamethasone significantly prolonged analgesia (16.0 ± 1.3 vs. 9.0 ± 1.7 h, p < 0.0001) and reduced opioid use (0.9 ± 1.2 vs. 2.1 ± 1.4 mEQ, p = 0.0003). Pain scores were lower at six, 12, and 24 h (p < 0.05). Quadriceps strength remained intact in both groups. No nerve injuries were observed (p > 0.9999). Blood glucose levels at 12, 24, and 48 h showed no significant differences between groups (p > 0.05).

CONCLUSIONS: Perineural dexamethasone effectively prolongs PENG block duration, reduces opioid consumption, and does not compromise motor function, nerve integrity, or glycaemic control. It is a promising strategy for optimizing pain control in elderly THA patients.

PMID:40498110 | DOI:10.1007/s00264-025-06578-1

Int Orthop. 2025 Jun 11. doi: 10.1007/s00264-025-06574-5. Online ahead of print.

ABSTRACT

PURPOSE: Bone deformities, such as cubitus varus, can lead to abnormal joint alignment and impaired function. Corrective osteotomy aims to restore anatomical alignment, and its precision may be enhanced using various guidance methods. Emerging mixed reality systems allow for the placement and manipulation of virtual objects and may offer effective surgical navigation. This study aimed to validate the accuracy and precision of holographic guidance compared with classic visual estimation and a printed triangle gauge in a controlled laboratory setting.

METHODS: Closed-wedge osteotomies at angles of 15° and 30° were performed on fresh-frozen porcine femora. Three techniques were evaluated: Group EB (eyeballing)-visual estimation; Group PW (printed wedge)-using 15° and 30° plastic templates; and Group HW (holographic wedge)-using a mixed reality system (RSQ HOLO, RSQ Technologies, Poznań, Poland, and HoloLens 2, Microsoft). In the HW group, a holographic wedge tool guided the osteotomy. The angle of the excised bone wedge and post-osteotomy alignment in the anteroposterior (AP) and lateral planes were measured physically (goniometer) and digitally (radiographs). Statistical analysis assessed accuracy (closeness to 15°/30°) and precision (standard deviation [SD], mean deviation, coefficient of variation [CV]).

RESULTS: At 15°, the PW and HW techniques demonstrated greater accuracy and lower error compared with EB (T = 3.60; p < 0.01), with HW yielding the lowest systematic error (SE = 0.12). Alignment in the AP plane was similar across groups (T < 2.11; p > 0.05), whereas lateral alignment showed significant differences (T > 2.11; p < 0.05). At 30°, HW achieved the best alignment in both AP (T = 2.48; p = 0.01) and lateral views (T = 2.35; p = 0.02). Lateral alignment was improved by more than 5° with holographic guidance compared to other techniques (p = 0.01). The HW group exhibited the highest precision for both 15° and 30° angles (lowest SD and CV; p < 0.05).

CONCLUSIONS: Augmented reality provides accurate and precise intraoperative guidance, outperforming both visual estimation and printed wedge templates in deformity correction.

PMID:40498109 | DOI:10.1007/s00264-025-06574-5

Int Orthop. 2025 Jun 9. doi: 10.1007/s00264-025-06575-4. Online ahead of print.

NO ABSTRACT

PMID:40484887 | DOI:10.1007/s00264-025-06575-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06567-4. Online ahead of print.

ABSTRACT

PURPOSE: Bone nonunion, a condition where fractures fail to heal within an expected timeframe, presents significant physical, psychological, and socioeconomic challenges. While various risk factors for nonunion have been extensively studied, the role of psychological factors, particularly anxiety, remains underexplored. This study aims to assess anxiety levels in patients with nonunion fractures and examine its associations with demographic factors such as age and gender.

METHODS: This cross-sectional study included 180 adults with a history of repeated surgical interventions due to nonunion diaphyseal fractures of long bones. Participants' anxiety levels were measured using the State-Trait Anxiety Inventory (STAI), a validated psychological assessment tool. Data were retrospectively collected from hospital records, and statistical analyses were conducted to compare anxiety levels across different age groups and between genders.

RESULTS: A substantial proportion of participants with a history of nonunion fractures exhibited moderate to high anxiety levels, with 70.6% reporting moderate to high state anxiety and 85.6% experiencing moderate to high trait anxiety. While state anxiety was not significantly associated with age, trait anxiety levels were notably higher in older adults. No significant gender-based differences in anxiety levels were observed.

CONCLUSION: The findings underscore the psychological burden of nonunion fractures, particularly among older patients, highlighting the need for integrating mental health assessments into orthopaedic care. Given the potential impact of anxiety on fracture healing, future studies should employ prospective designs to evaluate the role of anxiety in long-term orthopaedic outcomes. Addressing psychological factors in nonunion patients may improve overall recovery and quality of life.

PMID:40481834 | DOI:10.1007/s00264-025-06567-4

Int Orthop. 2025 Jun 7. doi: 10.1007/s00264-025-06560-x. Online ahead of print.

ABSTRACT

PURPOSE: Central sensitization (CS) plays a critical role in prolonged pain and poor outcomes after total knee arthroplasty (TKA), but its prevalence and impact in high-altitude populations remain unexplored. This study aims to examine the prevalence of CS, its associated factors, and short-term postoperative outcomes in high-altitude TKA patients.

METHODS: This prospective, single-centre cohort study included high-altitude (above 2,500 m) TKA patients with primary knee osteoarthritis (OA). Central sensitization (CS) was diagnosed using the Central Sensitization Inventory (CSI), with a cutoff score of ≥ 40. Propensity score matching (PSM) was applied to balance baseline characteristics between the CS and non-CS groups. Preoperative factors, postoperative outcomes (pain levels, complications, opioid consumption, hospital stay), and the incidence of chronic pain and dissatisfaction at six months were collected and analyzed using SPSS software.

RESULTS: A total of 230 patients were included, with 36 (15.7%) classified as having CS. Multivariable logistic regression identified female gender (OR: 3.9, 95% CI: 1.0-14.3, P = 0.043), higher body mass index (BMI) (OR: 1.2, 95% CI: 1.1-1.3, P = 0.006), and residence above 4,000 m (OR: 5.1, 95% CI: 1.7-15.1, P = 0.003) as significant factors associated with CS. After PSM, the CS group had significantly worse short-term outcomes, with higher pain scores at 24, 48, and 72 h (P < 0.001), increased incidence of postoperative nausea and vomiting (PONV) (P < 0.001), longer hospital stays (P < 0.001), greater cumulative opioid consumption (P < 0.001), higher rates of chronic postoperative pain (46.9% vs. 21.9%, P = 0.014), and greater patient dissatisfaction (25.0% vs. 6.3%, P = 0.039) compared to the non-CS group.

CONCLUSION: This study found a 15.7% prevalence of CS among high-altitude TKA patients. Female gender, higher BMI, and residence at altitudes above 4,000 m were identified as factors associated with CS. Furthermore, CS was linked to worse short-term postoperative outcomes, including higher pain levels, increased incidence of PONV, greater opioid consumption, longer hospital stays, and a higher prevalence of chronic postoperative pain and dissatisfaction.

PMID:40481833 | DOI:10.1007/s00264-025-06560-x

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06569-2. Online ahead of print.

ABSTRACT

BACKGROUND: Management of Open tibia shaft fractures utilizing the conventional protocol is usually cumbersome; involves several operative procedures and longer periods of hospitalization. The use of external fixators for the definitive management of open tibia shaft fractures has been promising. The Ilizarov frame and linear rail system (LRS) are the commonly used options since they are comparable in efficacy and adaptable in the management of open tibia shaft fractures. The study objective is to determine and compare for any significant difference in the mean radiological union time, union rate, bone outcomes and functional outcomes noted in the management of patients with open tibia shaft fractures using Ilizarov frame fixator and linear rail system (LRS) in Ibadan, Nigeria.

RESEARCH METHOD: This is a prospective study involving thirty (30) patients of both sexes, divided into two (2) groups; Ilizarov frame fixator group and LRS group. All patients had open tibia shaft fractures of Gustillo-Anderson Class (GA II- IIIB). The radiological union time was derived from the length of time in the fixator during which radiological union was confirmed, while the bone and functional outcomes were assessed using the ASAMI criteria.

RESULT: Union was achieved in 27 participants while three (2 in LRS group and 1 in Ilizarov group) had non-union. The union rate was 86.7% for the LRS group and 93.3% for the Ilizarov group. The mean radiological union time was 6.5 ± 1.8 months in the LRS group and 6.4 ± 2.1 months in the Ilizarov group. The bone outcomes showed that in the LRS group, 66.7% had excellent, 20% had good and 13.3% had poor outcomes while the Ilizarov group had 53.3% excellent, 40% good and 6.7% poor outcomes. The functional outcome showed that in the LRS group 53.3% had excellent, 40% good and 6.7% fair outcomes while in the Ilizarov group, 40% excellent, 46,7% good and 13.3% fair outcomes. There is no significant difference noted in the mean radiological union time, union rate, bone and functional outcomes in the management of these open tibia shaft fractures using the two fixators under review.

CONCLUSION: The study has re-iterated the fact that the Ilizarov frame fixator and the LRS are quite versatile tools in the armamentarium of the orthopaedic surgeon for managing open tibia shaft fractures.

PMID:40464907 | DOI:10.1007/s00264-025-06569-2

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06566-5. Online ahead of print.

ABSTRACT

PURPOSE: To compare the treatment approaches for foot compartment syndrome (FCS) and evaluate their outcomes.

METHODS: A systematic review was conducted in MEDLINE, EMBASE, Mayo journals via OVID Databases, Web of Science, and Scopus from each database's inception to December 2024. Two reviewers, independently working in duplicate, assessed each manuscript's title, abstract, and full text for eligibility. Study characteristics, quality of evidence, and outcomes were obtained and analyzed.

RESULTS: A total of 45 articles were included in the qualitative analysis, 38 case reports, and seven cohort studies. Among the case reports, only two patients underwent conservative management, while all remaining cases, as well as all cohort studies, reported fasciotomy as the primary treatment. Trauma was the most frequently identified cause of FCS, and the diagnostic criterion commonly used was an intracompartmental pressure exceeding 30 mmHg. There was no consensus on the number or anatomical location of incisions. Due to the heterogeneity of the data, a meta-analysis could not be performed to assess the risk associated with different incision approaches.

CONCLUSION: Fasciotomy remains the standard treatment for FCS. However, there is insufficient evidence to determine the optimal number and location of surgical incisions. While existing data suggest that using two or more incisions may be associated with fewer long-term sequelae, further research is needed to establish specificity of compartment decompression to enhance treatment recommendations.

PMID:40461896 | DOI:10.1007/s00264-025-06566-5

Int Orthop. 2025 Jun 2. doi: 10.1007/s00264-025-06552-x. Online ahead of print.

ABSTRACT

PURPOSE: This study documented changes in cartilage lesions in the arthritic medial knee compartment after medial opening wedge high tibial osteotomy (MOWHTO), their impact on clinical outcomes and possible factors influencing this improvement.

METHODS: Forty-nine patients indicated for MOWHTO (per ISAKOS criteria) underwent arthroscopy at osteotomy and implant removal (mean interval: 22.2 months). Cartilage lesions (medial femoral condyle [MFC], medial tibial plateau [MTP]) and clinical scores (Lysholm score and KOOS) were documented. No cartilage restoration procedures were performed.

RESULTS: The mean age was 47.5 years and most were females (n = 32). Arthroscopically, cartilage improvement occurred in 32 (65.3%) MFC and 25 (51%) MTP lesions. MOWHTO significantly improved the mechanical tibiofemoral angle (TFA) (7.88 ± 3.66 vs. - 2.71 ± 1.98 (°); P < 0.001). Lysholm knee score (77 ± 16.2 vs. 48.4 ± 16.3, p < 0.001) and KOOS (64.1 ± 13.6 vs. 43.8 ± 12.5, p < 0.001) significantly improved after osteotomy. On the femoral side, cartilage repair was documented in patients who achieved relatively more valgus correction, with a mean final TFA of 3.32 ± 1.7, compared with 1.57 ± 2 in the no improvement group (P = 0.001). For the MTP, no factor of statistical significance could be detected.

CONCLUSIONS: MOWHTO can improve articular cartilage lesions as a standalone procedure. A greater incidence of cartilage repair is expected with more valgus correction of the mechanical axis of the limb. This cartilage infill is associated with slightly better clinical outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT04541342) registered on 9.9.2020, https://clinicaltrials.gov/study/NCT04541342 .

PMID:40455268 | DOI:10.1007/s00264-025-06552-x

Int Orthop. 2025 May 30. doi: 10.1007/s00264-025-06565-6. Online ahead of print.

NO ABSTRACT

PMID:40445355 | DOI:10.1007/s00264-025-06565-6