Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06453-z. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: The purpose of this narrative review is to highlight upper extremity nerve compression syndromes and peripheral neuropathies reported in throwing and overhead athletes.

RECENT FINDINGS: The overhead-throwing athlete may experience unique patterns of injuries and pathology related to the biomechanics and demands of the throwing motion, a demanding manoeuvre that places a significant amount of stress across the upper limb. Nerve injuries that may appear in high-level throwers include suprascapular and long thoracic neuropathy, quadrilateral space syndrome, and thoracic outlet syndrome. Nerve compression syndromes around the shoulder may appear with pain, paresthesia, and upper limb weakness. Overlapping features may be common among these compression neuropathies or mimic other common shoulder pathologies. Prompt differential diagnosis and successful treatment should be based on knowledge of key anatomical features, pathophysiology, clinical examination, and appropriate paraclinical studies.

PMID:39960507 | DOI:10.1007/s00264-025-06453-z

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06445-z. Online ahead of print.

ABSTRACT

PURPOSE: The aim of this study was to assess functional and radiological outcomes of radial head arthroplasty (RHA) compared to open reduction and internal fixation (ORIF) in isolated Mason type-III fractures with a minimum of five years follow-up.

METHODS: This was a retrospective single-center study of closed isolated Mason type-III radial head fractures operated between January 2008 and December 2017. Nineteen patients were included in group RHA and 35 patients in group ORIF. The mean age was 51 years old in group RHA and 41 years old in group ORIF (p = 0.02). Functional and radiological outcomes were evaluated.

RESULTS: Mean follow up was eight years (range, 5-14). Clinical results and functional scores showed no significant differences, except a better pronation in group RHA (p = 0.04). Two secondary radial head resection or implant removal were performed in each group (p = 0.56) with poor functional outcomes in group ORIF. There was less heterotopic ossification in group RHA (15.8% vs. 42.8%; p = 0.03). Capitulum wear was found in 63% in group RHA against 25.7% in group ORIF (p < 0.05).

CONCLUSION: Functional results of RHA and ORIF were comparable for isolated Mason type-III fractures at a mean follow-up of eight years. We recommend to perform RHA for isolated Mason type-III fracture if articular reduction or stability of the fixation is not satisfying.

LEVEL OF EVIDENCE: III.

PMID:39960506 | DOI:10.1007/s00264-025-06445-z

Int Orthop. 2025 Feb 15. doi: 10.1007/s00264-025-06449-9. Online ahead of print.

ABSTRACT

PURPOSE: The goal of this study was to report the duration of pain relief and need for subsequent surgical intervention following intra-articular steroid injection of the elbow in the setting of arthritis.

METHODS: The authors' institutional database was accessed to identify patients who underwent a corticosteroid injection of the elbow for arthritis. For included patients, demographic information, steroid dosage, duration of symptoms relief, complications, and progression to surgical management were recorded. A chi-squared or Fisher exact test was utilized for categorical variables while a two-way Analysis of Variance (ANOVA) or Wilcoxon ranked sum test was utilized for continuous variables as appropriate. Statistical significance was defined as p < 0.05.

RESULTS: There were 67 patients included in the study who underwent between one and 14 injections. Patients experienced some degree of pain relief 80% of the time for an average of 12.5 (range 0-64) weeks after their first injections. There was only one documented complication following steroid injection. Twenty-one (7.9%) patients ultimately underwent surgical intervention for their elbow arthritis. Younger age was associated with progression to surgical intervention (p = 0.01).

CONCLUSION: Corticosteroid injections to the elbow are an effective method of pain control in patients with elbow arthritis.

LEVEL OF EVIDENCE: IV.

PMID:39954053 | DOI:10.1007/s00264-025-06449-9

Int Orthop. 2025 Feb 15. doi: 10.1007/s00264-025-06446-y. Online ahead of print.

ABSTRACT

PURPOSE: Symphyseal diastasis accounts for 13-16% of pelvic ring injuries. Symphyseal plating via a Pfannenstiel approach was the standard method of fixation for symphysis diastasis. Recently, percutaneous reduction and fixation of pelvic fractures have been employed to treat various pelvic ring and acetabulum injuries. The current study aims to compare the clinical and radiological results of treatment of symphysis pubis diastasis using symphyseal plating and percutaneous symphyseal screws.

METHODS: It is a retrospective study conducted at a trauma centre at academic level I. One hundred and ten patients were identified in our records. Sixty patients were excluded according to our exclusion criteria. Fifty patients were included in this study. Among which were 26 patients treated with anterior symphyseal plating (Group A) and 24 patients treated with percutaneous symphyseal screws (Group B). Posterior pelvic injury was fixated according to the existing pathology. In both groups, we recorded operation time, intraoperative blood loss, length of the incision, number of x-ray shots, changes in symphysis distance (preoperative, immediate postoperative, and in the last follow-up), and time for union. At the last follow-up, the clinical evaluation was conducted using the Visual Analogue Scale (VAS), and the functional evaluation was conducted using the Majeed scoring method for both groups.

RESULTS: All patients have followed up for at least two years. According to the Majeed Score, group A's functional classification was excellent for fourteen patients, good for seven, fair for two, and poor for three cases. Group B's functional classification was excellent for seventeen patients, good for six, and poor for one. The operative time and intraoperative time were significantly different between both groups, while the symphysis diastasis at the last follow-up was insignificant. Five patients in group A showed metal failure in the form of plate breakage, screw loosening, and screw backing out. In Group B, one case showed implant failure and loss of reduction in the form of screw backing out and widening of the symphysis pubis. Two patients in group A had infections at the incision site, which were treated with antibiotics and daily dressings and resolved adequately. No recorded cases of infection in group B.

CONCLUSION: Both techniques showed favourable results. The group with symphyseal plating showed a higher failure rate than the group with percutaneous screw fixation. The symphyseal screw group had shorter operative time, smaller incision, and less intraoperative blood loss than the symphyseal plating group but more radiation exposure. The symphyseal screw technique is a technically demanding technique and requires a high learning curve. It involves more radiation exposure, especially in inexperienced surgeons.

PMID:39954052 | DOI:10.1007/s00264-025-06446-y

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06411-9. Online ahead of print.

ABSTRACT

PURPOSE: Post-operative LLD is a major concern after THA. The anterior approach on a standard table allows surgeons for a direct control of the leg length. Intra-operative radiography (IR) helps in assessment of hip biomechanics and anatomic parameters. The aim of this study is to evaluate the LLD after THA through anterior approach with or without a position table and with or without the use of intra-operative radiographs. The hypothesis is that leg length may be better control when IR and a standard table are used.

METHODS: This is a single-centre retrospective comparative cohort study of three matched groups of 80 patients receiving anterior approach THA with three different techniques (Group A: positioning table with IR; Group B: standard table with IR; Group C: standard table without IR). Pre-operative and post-operative LLD was calculated. Age, sex, BMI, acetabular cup and femoral stem size, operative time, and blood loss were recorded.

RESULTS: In Group A, 15 patients (19%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group B, 20 patients (25%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group C, 16 patients (20%) had a LLD greater than 5 mm, and three patients (3,7%) had a LLD greater than 10 mm. No statistically significant differences were found for LLD > 5 mm, for LLD > 10 mm, nor for the mean LLD between the three groups (p > 0.05). Mean operative time was statistically longer in Group B (p < 0.05).

CONCLUSION: Neither the use of a standard/positioning table neither the use of IR seemed to be superior in restoring leg length after anterior approach THA. Together with the contradictory results in literature, findings of the current study indicate that no technique is clearly superior to one other and surgeons' experience may play the most relevant role.

PMID:39951054 | DOI:10.1007/s00264-025-06411-9

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06432-4. Online ahead of print.

ABSTRACT

PURPOSE: Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained significant attention since its introduction in 2005. Over 343 publications since 2013 highlight its increasing use in nerve decompression surgeries. WALANT is known for its safety benefits, cost-effectivenes and improved patient experience compared to traditional sedation and tourniquet-based methods. This review examines the advantages of WALANT in nerve decompression surgery, emphasizing its growing adoption and benefits.

METHODS: A comprehensive review of the WALANT technique is provided, focusing on injection strategies, including buffered lidocaine with epinephrine, proper needle placement and generous volume of tumescent anesthesia. Specific injection protocols and surgical approaches are discussed for various nerve decompression procedures such as carpal tunnel, lacertus, cubital tunnel, radial tunnel and lateral intermuscular septum releases.

RESULTS: WALANT eliminates sedation-related risks such as nausea, aspiration pneumonia and thromboembolism, making it suitable for high-risk patients (ASA 4). It reduces healthcare costs by decreasing the need for post-anesthesia care units and operating in minor procedure rooms. The technique fosters greater surgeon-patient interaction, reduces hospital stays and avoids preoperative fasting and testing. WALANT has demonstrated positive outcomes across multiple nerve decompression procedures.

CONCLUSION: WALANT provides a transformative approach in nerve decompression surgery, offering enhanced safety, cost-effectiveness and improved patient-centered care. It significantly contributes to positive surgical outcomes, making it a valuable technique for both patients and healthcare providers.

PMID:39951053 | DOI:10.1007/s00264-025-06432-4

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06422-6. Online ahead of print.

ABSTRACT

PURPOSE: Debridement, Antibiotic Treatment, and Implant Retention (DAIR) is considered the first-line treatment for early acute Prosthetic Joint Infection (PJI). This study aims to evaluate the five year success rates of early acute PJI managed with DAIR taking into consideration the time from the index surgery.

MATERIALS AND METHODS: A retrospective analysis of medical charts for 291 consecutive patients with acute PJI occurring within the first three months after primary or revision arthroplasty was conducted. Patients were stratified into two groups based on DAIR timing: Group (A) patients who underwent DAIR within the first four weeks post-arthroplasty; Group (B) patients who underwent DAIR between five and 12 weeks post- arthroplasty. Success rate was defined as implant in place, without signs of infection and not under suppressive antibiotic treatment.

RESULTS: The overall five year success rate for the entire cohort at five years was 62.2%. The mortality rate during the study period was 8.2%. The five year success rate was 64.4% (141 of 219) for Group A and 55.6% (40 of 72) for Group B (p = 0.21). Including deceased patients without signs of infection and retained implants as successful cases, the five year success rates increased to 69.9% for Group A (153 out of 219) and 69.4% for Group B (50 out of 72). The implant survival rate at five years was 73% for Group A and 71% for Group B.

CONCLUSION: Our findings indicate that there are no significant differences between patients who undergo a DAIR procedure within four weeks from those performed between week five and 12. Importantly, the overall success rate decreased from 75.6 to 62.2% in the last three years of follow-up.

PMID:39951052 | DOI:10.1007/s00264-025-06422-6

Int Orthop. 2025 Feb 13. doi: 10.1007/s00264-025-06447-x. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to describe our experience with French Elbow Connection (FEC) (i.e. elbow reduction and triple ligamentoplasty) for patients with chronic elbow dislocation (CED).

MATERIALS AND METHODS: We performed a retrospective review of 12 patients in two departments of orthopaedic surgery undergoing the FEC procedure for CED between 2019 and 2024. The median follow-up was 1.80 years (IQR 1.00; 1.97). Range of motion, mean Mayo Elbow Performance score (MEPS), visual analog scale (VAS), elbow stability, and radiographic outcome were recorded.

RESULTS: Median MEPS and VAS were 90.00 points (IQR 75.60; 100.00) and 0 (IQR 0; 1.50), respectively. Eight (66%) patients reported no pain. The median active flexion-extension and prono-supination arcs were 145°(IQR 102.60; 150.00), and 170°(IQR 155.03; 170.00) respectively. Persistent valgus or varus instability was identified in 2 (17%), and 1 (8%) patient respectively. Size patients (50%) were diagnosed with osteoarthritis (OA) and 1 patient experienced worsening postop OA (from grade 1(preop) to 3(postop)).

CONCLUSION: CED is a complex condition that presents elbow surgeons with unique challenges. The FEC procedure allows for immediate active ROM and yielded satisfactory short-term outcomes in our hands. Larger, longer-term studies will be necessary to assess reproducibility and confirm results can be maintained over time.

LEVEL OF EVIDENCE: level IV; therapeutic study (case series [no, or historical, control group]).

PMID:39945805 | DOI:10.1007/s00264-025-06447-x

Int Orthop. 2025 Feb 13. doi: 10.1007/s00264-025-06427-1. Online ahead of print.

ABSTRACT

PURPOSE: This is a preliminary study with short-term follow up to determine the safety and efficacy of the S-design osteotomy and internal fixation for acute varus and rotational correction technique in infantile Blount's disease.

METHODS: We performed a retrospective series in our institutional hospital. An S-design osteotomy for multiplanar, acute correction followed by internal fixation was performed for Blount's disease patients. Effectiveness was measured by comparing pre-and post-operative tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Safety was determined by the number of neurological deficits and compartment syndromes occurred post operatively. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS). All patients underwent a one-year follow-up after surgery.

RESULTS: Nineteen patients (total of 31 extremities) were included in this study and classified into TFA less than 40 degree (group A) and more than 40 degree (group B). No neurological deficits nor compartment syndrome occured in either group. Regardless the severity of pre-operative deformity, both groups achieved significant corrections. Post operatively there was no significant difference in TFA in Group A and Group B (1.70 and 3.00 respectively, with p value of 0.147) and MDA (4,60 and 6,0 respectively, with p value of 0.327). This indicated there was no correlation between preoperative deformity and postoperative results. LEFS score of group A (73.85 ± 2.73) and Group B (73.85 ± 2.73) showed equally good results in both groups (p = 0.293).

CONCLUSION: This preliminary study with short-term follow up suggested that the S-design osteotomy effectively corrected internal rotation and varus while aiding limb length. The correction of internal rotation is accomodated by performing box osteotomy between the two horizontal (proximal and distal) lines of osteotomy, with safe and effective results. Acute correction is a safe and effective strategy for severe Blount's disease. Longer-term follow-up is awaited.

LEVEL OF EVIDENCE: V.

PMID:39945804 | DOI:10.1007/s00264-025-06427-1

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06437-z. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup.

METHODS: All primary elective MoM and CoP THAs performed 1998-2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs.

RESULTS: Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2% (95% CI 10.6 to 16.3) in MoM and 6.3% (95% CI 4.8 to 8.3) in CoP group. Adjusted hazard ratio for all-cause revision was 1.88 (95% CI 1.34 to 2.65) comparing MoM vs. CoP. Diagnoses at revision were mainly aseptic loosening (33%) and adverse local tissue reactions (33%) in MoM and aseptic loosening in CoP group (44%). The smoothed hazard function revealed the largest difference in instantaneous revision rate between three and 14 years postoperative. After that period no difference was observed.

CONCLUSION: Overall, the cumulative risk of all-cause revision was almost twice as high in patients with a small head MoM as compared to a CoP THA over the 20-year period. However, most of the excess in revisions among MoM patients occurred between three and 14 years postoperative.

PMID:39937240 | DOI:10.1007/s00264-025-06437-z

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06439-x. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is the preferred treatment for end-stage knee osteoarthritis, but challenges arise with severe angular deformities and associated tibial bone loss. The cement screw construct has emerged as a promising technique for managing these defects, offering advantages such as cost-effectiveness, accessibility, and ease of implementation. This research evaluated the clinical, functional and radiological outcome of screw-cement construct for the tibial defects in TKA.

METHOD: This retrospective study aimed to evaluate the long-term functional outcomes and success rate of the cement screw construct in patients with significant tibial defects. Sixty-five patients (104 knees) undergoing TKA were divided into two groups: conventional TKA (Group A) and TKA with screw-cement construct (Group B). Demographic, clinical, and radiological data were collected, with a follow-up duration of at least eight years.

RESULTS: The study revealed comparable demographic characteristics between groups. Both cohorts exhibited significant postoperative improvements in knee morphology and clinical outcomes. Group B demonstrated a higher incidence of radiolucency around the tibial tray, although no progressive complications were observed. Implant survival rates were similar between groups, with complications such as aseptic loosening and infections occurring in both without significant difference.

CONCLUSIONS: This study emphasised the viability of the screw-cement construct for managing uncontained tibial defects during TKA, providing evidence of its efficacy, and cost-effectiveness and suggesting its potential as a standard approach for tibial defects till 20 mm.

PMID:39937239 | DOI:10.1007/s00264-025-06439-x

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06440-4. Online ahead of print.

ABSTRACT

Neuropathic pain is a complex and challenging condition that arises from abnormal processing of somatosensory information, often following nerve injury or dysfunction. Its diagnosis involves a detailed clinical history, sensory examination, and diagnostic tests such as electromyography, nerve conduction studies, and MRI to identify nerve damage or structural causes. In athletes, neuropathic pain can result from nerve entrapment syndromes, post-surgical complications, or peripheral nerve injuries, with unique challenges in pain assessment due to psychological factors and exercise-induced changes. Pharmacological management primarily includes anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., tricyclics, SNRIs), tailored to minimize side effects that could impair athletic performance. Effective treatment requires a careful balance to manage pain while maintaining physical capabilities. When treating athletes for neuropathic pain, healthcare providers must ensure prescribed medications comply with World Anti-Doping Agency (WADA) regulations. Narcotics (opioids) and cannabinoids are prohibited in-competition. Glucocorticoids are also banned in-competition if administered via injection, orally, or rectally, and elevated levels in urine may lead to sanctions.

PMID:39937238 | DOI:10.1007/s00264-025-06440-4

Int Orthop. 2025 Feb 11. doi: 10.1007/s00264-025-06441-3. Online ahead of print.

ABSTRACT

PURPOSE: There is a lack of long-term data evaluating the impact of synovectomy versus no synovectomy during total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). This study aimed to assess and compare bilateral TKA outcomes with and without synovectomy in the same patients over a similar follow-up period.

METHODS: A retrospective review was conducted on 65 bilateral staged posterior-stabilized (PS) fixed-bearing TKAs (28 men, 37 women) performed by a single surgeon on RA-affected knees, with an average follow-up of 17 years (range: 15-24 years). In the first knee, synovectomy was performed during TKA, while no synovectomy for the contralateral TKA. Outcomes assessed included Knee Society scores for knee and function, radiographic findings, complications, and patellar position using the Insall-Salvati ratio.

RESULTS: The synovectomy group had a higher rate of blood transfusion (23.3% vs. 16.6%; P < 0.01) and longer hospital stays (mean 9.60 days [95% CI: 6.56-13.63] vs. 6.51 days [95% CI: 5.50-9.52]; P < 0.001). The group without synovectomy demonstrated significantly better Knee Society Scores (89.1 vs. 80.2 points; P = 0.02) and greater range of motion (ROM) for flexion (130° vs. 102°; P = 0.01). Both groups had similar knee alignment, stability, and femoral and tibial component alignment. Patella baja was observed in six patients in the synovectomy group. Severe haematoma (n = 6) and deep infections (n = 4) were noted exclusively in the synovectomy group. Kaplan-Meier survivorship at 15 years was 81% (95% CI: 78-95) for TKA with synovectomy and 95% (95% CI: 90-100) for TKA without synovectomy.

CONCLUSION: Knees undergoing synovectomy during primary TKA exhibited reduced knee flexion, inferior Knee Society pain scores, and higher complication rates compared to contralateral knees without synovectomy. Omitting synovectomy in RA patients did not increase the risk of implant loosening.

PMID:39932578 | DOI:10.1007/s00264-025-06441-3

Int Orthop. 2025 Feb 10. doi: 10.1007/s00264-025-06436-0. Online ahead of print.

ABSTRACT

Compressive neuropathies of the upper extremity are a common cause of pain, weakness, and functional impairment, often resulting from chronic mechanical compression or entrapment of peripheral nerves in anatomical regions such as osteofibrous tunnels, fibrous bands, or muscular pathways. While traditional diagnostic methods, including clinical evaluation and electrophysiological studies, are essential, they are limited in localizing lesions and identifying underlying causes. Advances in ultrasonography (US) and magnetic resonance imaging (MRI), particularly MR neurography and high-resolution 3D volumetric imaging, have significantly improved the evaluation of peripheral nerves by enabling detailed visualization of nerve anatomy, adjacent structures, and muscle denervation patterns. This article reviews the role of these imaging techniques in diagnosing and managing compressive neuropathies affecting the brachial plexus, suprascapular, axillary, median, ulnar, and radial nerves, highlighting key imaging findings such as nerve thickening, signal abnormalities, and muscle changes. The integration of advanced imaging modalities into clinical practice enhances diagnostic accuracy, facilitates surgical planning, and improves treatment outcomes for patients with peripheral nerve compression.

PMID:39928139 | DOI:10.1007/s00264-025-06436-0

Int Orthop. 2025 Feb 10. doi: 10.1007/s00264-025-06433-3. Online ahead of print.

ABSTRACT

INTRODUCTION: The implementation of Virtual Reality technology is approaching a breakthrough within the medical, and rehabilitation fields. The level of immersion in the virtual environment is profound and the potential applications are vast.

METHODS: This article reviews the capabilities of Virtual Reality in conjunction with the rehabilitation of nerve entrapments in sport athletes and examines the interactions between our body and brain within the virtual realm. In clinical practice it could be used as a complement to face-to-face therapy to asynchronous use by the patient in any location as a telerehabilitation system.

CONCLUSION: The use of Virtual Reality is a novel, potential, and promising tool in the treatment of nerve entrapments, even possible in the form of telerehabilitation. The response of body and brain in a virtual setting is good, the evolutions in technology can only improve this and this need to be substantiated by further scientific research.

PMID:39928138 | DOI:10.1007/s00264-025-06433-3

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06444-0. Online ahead of print.

ABSTRACT

PURPOSE: Total hip arthroplasty (THA) with severe acetabular bone defect remains a challenge in clinic. The purpose of this study is to investigate the treatment technique by using the three-dimensional (3D) printing technology, and analyze the feasibility and preliminary effect of 3D printed personalized titanium blocks for acetabular defect reconstruction in primary THA.

METHODS: The clinical data of 35 patients with Paprosky type 3 acetabular defect, who underwent initial THA with 3D-printed titanium implants in our hospital from January 2017 to December 2019, were retrospectively analyzed. Among them, 21 cases were Paprosky type 3 A bone defects and 14 cases were Paprosky type 3B bone defects. The Harris Hip Score (HHS) was used to evaluate clinical outcomes, while imaging results were analyzed by hip rotation centres (V-COR and H-COR). In addition, postoperative complications were recorded.

RESULTS: The mean follow-up was 79.4 months (ranging from 63 to 94 months) and no patient was lost to follow-up. The total in-hospital blood loss of all patients was 462.9 ± 227.8 mL, accompanied with a blood transfusion rate of 31.4%. HHS improved from 44.5 ± 10.0 preoperatively to 85.1 ± 7.4 at the last follow-up (p < 0.001). Postoperative X-rays exhibited a good match between the 3D-printed titanium block and the acetabulum. V-COR decreased from 50.1 ± 4.7 mm preoperatively to 19.7 ± 1.8 mm postoperatively (p < 0.001). Similarly, H-COR improved from 33.1 ± 11.8 mm preoperatively to 29.7 ± 1.7 mm postoperatively (p > 0.05). Additionally, there were no significant changes in V-COR and H-COR at the last follow-up (p > 0.05). During follow-up, three cases of complications were observed, including two cases of wound redness and one case of partial sciatic nerve paralysis.

CONCLUSIONS: The 3D-printed personalized titanium block revealed accurate reconstruction, satisfactory radiographic and clinical outcomes, and low complication rates. This technique provides a reliable treatment strategy for primary THA in patients with severe acetabular bone defect.

PMID:39921749 | DOI:10.1007/s00264-025-06444-0

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06431-5. Online ahead of print.

ABSTRACT

PURPOSE: No previous studies have reported the presence of sleep disturbances or their association with baseline factors in elderly patients with distal radius fracture (DRF). This study aimed to describe the proportion of patients with sleep disturbances and analyze their association with baseline factors in patients older than 60 years with conservatively treated DRFs.

METHODS: This prospective observational study included 220 patients with extra-articular DRFs who completed the Pittsburgh Sleep Quality Index at two time points: two weeks after cast removal and at the one year follow-up. Sociodemographic, anthropometric, clinical, radiological, and patient-reported outcome measures were analyzed as baseline predictors, with measurements performed two weeks after cast removal.

RESULTS: At two weeks after cast removal, 166 (75.5%) patients had sleep disturbances. Sleep disturbances were associated with the affected dominant hand (β = 1.6; p = 0.04), high-energy injury (β = 3.8; p < 0.001), extra-articular comminuted metaphyseal DRFs (β = 2.3; p < 0.001), higher Tampa Scale of Kinesiophobia scores (β = 2.4; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.4; p < 0.001), higher Pain Anxiety Symptoms Scale-20 scores (β = 2.1; p < 0.001), and higher visual analogue scale scores (β = 4.1; p < 0.001). At the one year follow-up, 85 (38.6%) patients had sleep disturbances, which were associated with higher Tampa Scale of Kinesiophobia scores (β = 2.6; p < 0.001), higher Pain Catastrophizing Scale scores (β = 2.5; p < 0.001), and higher Pain Anxiety Symptoms Scale-20 scores (β = 1.8; p = 0.02).

CONCLUSIONS: A high proportion of elderly patients with DRF experienced sleep disturbances. Expanding our understanding of the interplay between sleep disturbances and baseline risk factors may lead to improved care and clinical outcomes for these patients. Future studies should incorporate the clinical management of sleep disturbances in patients with DRFs.

PMID:39921748 | DOI:10.1007/s00264-025-06431-5

Int Orthop. 2025 Feb 8. doi: 10.1007/s00264-025-06442-2. Online ahead of print.

ABSTRACT

PURPOSE: Cutibacterium is commonly isolated from deep tissue samples taken at the time of revision shoulder arthroplasty, but the significance of these positive cultures is debated, and the impact of increasing bacterial loads on clinical outcomes is unclear. The objectives of this study were to (1) identify factors independently associated with high bacterial loads, and (2) compare patient-reported outcomes (PROs) and revision rates in patients found to have high Cutibacterium loads.

MATERIALS AND METHODS: Male patients undergoing single stage exchange with a minimum 2-year follow-up were included. Culture data were semi-quantitatively scored with the total Cutibacterium score (TShCuS). Two groups were compared: patients with a High Cutibacterium Load (HCL) group and those with Low Cutibacterium Load (LCL) group. PROs and revision rates were compared, and a multivariable analysis was conducted.

RESULTS: Of 68 male patients that underwent revision shoulder arthroplasty, 29 (42.6%) met the inclusion criteria for the HCL group, while 27 patients (39.7%) were in the LCL group. Mean follow-up was 4.7 ± 3 years. Patients with intraoperative humeral loosening had an 18.4 times increased risk of having high Cutibacterium loads (95% CI 2.1-154.4, p < 0.001). There were no significant differences in PROs or re-revision rates between the HCL and LCL groups.

CONCLUSIONS: Intraoperative humeral loosening was independently associated with high Cutibacterium loads found at the time of revision shoulder arthroplasty. Male patients with high bacterial loads treated with complete single stage exchange and antibiotics had patient-reported outcomes similar to those of patients with minimal to no load.

LEVEL OF EVIDENCE: III.

PMID:39921747 | DOI:10.1007/s00264-025-06442-2

Int Orthop. 2025 Feb 7. doi: 10.1007/s00264-025-06423-5. Online ahead of print.

ABSTRACT

PURPOSE: Early major complications following total hip replacement (THR) occur rarely, but given the high volumes of THR, represent a major burden to patients and the system. The purpose of this study was to determine the influence of hospital-level surgical practices on early major complications across Ontario.

METHODS: We conducted a population-based retrospective cohort study of all adults in Ontario, Canada who underwent primary THR for osteoarthritis between January 1, 2009 and December 31, 2019. The primary outcome was early major surgical complications (composite of deep infection, periprosthetic fracture, dislocation, or revision surgery occurring within 1 year of surgery). Medical complications (thromboembolism, myocardial infarction, pneumonia) occurring within 30 days of surgery also were assessed. THR performed at centres with very low volumes were excluded a priori. Two-level hierarchical logistic regression models adjusted for age, sex and Charlson co-morbidity score were used to calculate each hospital's unique adjusted complication rate and 95% confidence interval.

RESULTS: During the study period, 95,912 patients (mean [SD] age 67 [11.0] years; 51,216 (53.4%) women) underwent THA at 56 hospitals across Ontario. Overall, 1,656 (1.7%) patients had a major surgical complication within 1 year. Major surgical complication rates varied seven fold between hospitals from 0.6 to 4.1%. After adjustment, 4 of 56 hospitals were low outliers (adjusted complication rate significantly below average) and 5 of 56 were high outliers (adjusted complication rate significantly above average). There were no hospital outliers for medical complications.

CONCLUSIONS: There was significant variation in early major surgical complication rates between Ontario hospitals that persisted after adjustment for patient age, sex and medical comorbidity. Feeding back adjusted outcomes in benchmarking reports may enable individual hospitals and surgeons better consider their own performance and scale up best practices from low outlier hospitals, which can play a role in educating other centres in their region.

PMID:39918565 | DOI:10.1007/s00264-025-06423-5

Int Orthop. 2025 Feb 5. doi: 10.1007/s00264-025-06428-0. Online ahead of print.

ABSTRACT

PURPOSE: In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC).

METHODS: We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts.

RESULTS: PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5 mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5 cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2 cm, and five patients with PPC complained of postoperative pain.

CONCLUSIONS: Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5 mm are at a higher risk for PPC.

LEVEL OF EVIDENCE: Observational study.

PMID:39907773 | DOI:10.1007/s00264-025-06428-0