J Bone Joint Surg Am. 2025 Apr 18. doi: 10.2106/JBJS.24.00542. Online ahead of print.

ABSTRACT

BACKGROUND: Accelerated recovery from bone injuries is a paramount health-care goal with substantial impacts on physical status and overall well-being. The aim of this study was to evaluate the impact of colostrum supplementation on bone healing in patients with a traumatic extracapsular hip fracture (ECF).

METHODS: Patients with an ECF undergoing internal fixation were randomly assigned to receive either bovine colostrum or whey protein. Bone healing was assessed using the Radiographic Union Score for Hip (RUSH). Physical rehabilitation was evaluated using the Harris hip score (HHS) and the Short Musculoskeletal Functional Assessment (SMFA) within 3 months postoperatively. A generalized estimating equation (GEE) was used to assess the time-by-group interactions of these longitudinal variables. Patients were monitored for postoperative complications for 12 months, with the risk difference (RD) and risk ratio (RR) calculated.

RESULTS: A total of 116 patients with an ECF were included in the final analysis (colostrum group, n = 59; whey group, n = 57). Baseline characteristics, including age, gender, ethnicity, and body mass index, were similar between the groups (p > 0.05 for all). The colostrum group had a significantly greater increase in the RUSH score (β = 0.88; p = 0.001) and HHS (β = 1.2; p = 0.001) over time compared with the whey group. SMFA dysfunction and bother indices demonstrated significantly greater decreases over time in the colostrum group compared with the whey group (β = -1.2 and -2.4, respectively; p < 0.001 for both).

CONCLUSIONS: The present study provides preliminary evidence suggesting that colostrum may accelerate bone healing and enhance short-term physical rehabilitation outcomes more effectively than whey protein.

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

PMID:40249794 | DOI:10.2106/JBJS.24.00542

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.24.00810. Online ahead of print.

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a substantial cause of morbidity and mortality among hospitalized patients. Although rare in the general pediatric population, VTE remains a potential concern in hospitalized children, particularly those with lower-extremity (LE) fractures. With this study, we aimed to determine the risk of VTE in pediatric patients with surgically treated LE fractures through a retrospective, propensity-matched, cohort analysis.

METHODS: The TriNetX Research Network, encompassing data from >80 health-care organizations and >120 million patient records, was utilized for this retrospective cohort study comparing 3 age-based cohorts (children [age of <14 years], adolescents [age of 14 to 17 years], and adults [age of ≥18 years]) who underwent surgical treatment of LE fractures between January 1, 2003, and January 1, 2023.

RESULTS: A total of 634,880 patients with surgically treated LE fractures were included; 13.3% were children, 5.6% were adolescents, and 81.1% were adults. Propensity-score matching was used to compare VTE incidence across cohorts, resulting in 3 independent matched comparisons. Overall, the incidence of VTE (either DVT or PE) was 0.2% in children, 1.0% in adolescents, and 4.1% in adults. Adults had a significantly higher risk of developing DVT (risk ratio [RR]: 17.0; 95% confidence interval [CI]: 14.5 to 20.0) and PE (RR: 21.8; 95% CI: 17.0 to 28.1) compared with children. Similarly, adolescents had a higher risk of DVT (RR: 3.5; 95% CI: 2.7 to 4.4) and PE (RR: 3.1; 95% CI: 2.2 to 4.4) compared with children. The incidence of VTE varied by fracture location, with femoral and knee joint (incidence: 0.5% in children, 2.5% in adolescents) and pelvic and hip joint (incidence: 1.2% in children, 2.8% in adolescents) fractures presenting the highest risk across all age groups.

CONCLUSIONS: The incidence of VTE in a large cohort of pediatric patients undergoing surgical treatment of LE fractures was higher in adolescents than in children. These findings may warrant prophylactic VTE measures in adolescents undergoing surgical treatment of femoral or pelvic fractures.

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

PMID:40245162 | DOI:10.2106/JBJS.24.00810

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.23.01088. Online ahead of print.

ABSTRACT

BACKGROUND: The treatment of ankle fractures involving the posterior malleolus (PM) has changed in favor of open reduction and internal fixation (ORIF), and the need for additional syndesmotic stabilization has decreased; however, there are still doubts regarding the diagnosis and treatment of residual syndesmotic instability. The aim of the present study was to evaluate the effect of fixation of the PM and to assess the need for additional stabilization methods. We hypothesized that ORIF of the PM would not sufficiently stabilize the syndesmosis and that additional syndesmotic reconstruction would restore kinematics.

METHODS: Eight unpaired, fresh-frozen, cadaveric lower legs were tested in a 6-degrees-of-freedom robotic arm with constant loading (200 N) in the neutral position and at 10° dorsiflexion, 15° plantar flexion, and 30° plantar flexion. The specimens were evaluated in the following order: intact state; osteotomy of the PM; transection of the anterior inferior tibiofibular ligament (AITFL) and interosseous ligament (IOL); ORIF of the PM; additional syndesmotic screw; combination of syndesmotic screw and AITFL augmentation; and AITFL augmentation.

RESULTS: A complete simulated rupture of the syndesmosis (PM osteotomy with AITFL and IOL transection) caused translational (6.9 mm posterior and 1.8 mm medial displacement) and rotational instability (5.5° external rotation) of the distal fibula. ORIF of the PM could eliminate this instability in the neutral ankle position, whereas sagittal and rotational instability remained in dorsiflexion and plantar flexion. The remaining instability could be eliminated with an additional procedure, without notable differences between screw and AITFL augmentation.

CONCLUSIONS: In our model, isolated PM osteotomy and isolated AITFL and IOL rupture (after PM refixation) only partially increased fibular motion in dorsiflexion and plantar flexion, whereas the combination of PM osteotomy and AITFL and IOL rupture resulted in an unstable syndesmosis in all planes.

CLINICAL RELEVANCE: In complex ankle fractures, ORIF of the PM is essential to restore syndesmotic stability; however, residual syndesmotic instability can be detected by a specific posterior shift of the fibula on stress testing. In these cases, anatomical AITFL augmentation is biomechanically equivalent to the use of a syndesmotic screw.

PMID:40245116 | DOI:10.2106/JBJS.23.01088

J Bone Joint Surg Am. 2025 Apr 17. doi: 10.2106/JBJS.24.01493. Online ahead of print.

ABSTRACT

Orthopaedic surgeons are called upon to lead in numerous clinical settings, but the importance of physician leadership is also relevant to administrative roles. As the complexity of health care has increased, the challenges confronting the orthopaedic physician leader have increased as well. During the past century, there has been a substantial increase in the number of non-physician CEO leaders, and this is particularly critical in the academic health system, for which investment in the research and education missions is heavily dependent upon the clinical enterprise. Therefore, physician leadership becomes even more important, with heightened influence. Being an orthopaedic surgeon, or any type of physician, is not synonymous with excellence in leadership. Rather, growth as a leader requires hard work dedicated to the acquisition and nurturing of the knowledge, behaviors, and competencies that result in excellence. We readily acknowledge that physicians must work with a multidisciplinary administrative team of content experts but believe that true expert leaders also possess the inherent knowledge and expertise in the core business for which the organization exists. We encourage our physician colleagues to work to become stronger leaders regardless of their ultimate career aspirations.

PMID:40245106 | DOI:10.2106/JBJS.24.01493

J Bone Joint Surg Am. 2025 Apr 16;107(8):e38. doi: 10.2106/JBJS.24.01481. Epub 2025 Apr 16.

NO ABSTRACT

PMID:40237720 | DOI:10.2106/JBJS.24.01481

J Bone Joint Surg Am. 2025 Apr 16;107(8):e37. doi: 10.2106/JBJS.24.01375. Epub 2025 Apr 16.

NO ABSTRACT

PMID:40237719 | DOI:10.2106/JBJS.24.01375

J Bone Joint Surg Am. 2025 Apr 10. doi: 10.2106/JBJS.24.01080. Online ahead of print.

ABSTRACT

BACKGROUND: Vitamin C shows strong anti-inflammatory and analgesic effects, so we explored whether it can replace glucocorticoids in reducing pain and inflammation after total hip arthroplasty (THA).

METHODS: In this prospective trial, a consecutive series of 107 patients (43.0% men, 56.8 ± 10.1 years of age, 100% Han Chinese) who underwent THA due to end-stage hip disease at our medical center between January 2023 and January 2024 were randomized to receive vitamin C, dexamethasone, or neither dexamethasone nor vitamin C after surgery. The 3 groups were compared in terms of the primary outcomes of pain reported on a visual analogue scale (VAS), perioperative morphine use, and blood indices of inflammation and fibrinolysis as well as in terms of secondary outcomes of efficacy and safety.

RESULTS: Compared with patients in the control group, those who received vitamin C or dexamethasone reported a significantly lower VAS pain score on postoperative day 1, had significantly lower perioperative morphine consumption, and demonstrated significantly lower blood levels of C-reactive protein on days 1 and 2. The 2 groups also showed a significantly lower rate of rescue analgesia on postoperative day 1 and significantly higher Harris hip scores of joint function at 2 and 12 weeks after surgery, as well as significantly smaller thigh circumference and a lower rate of swelling on the first 2 days after surgery. Either treatment was associated with a significantly lower rate of postoperative nausea and vomiting. Dexamethasone was associated with greater blood glucose levels after surgery.

CONCLUSIONS: Vitamin C may be an effective substitute for glucocorticoids for reducing morphine use and the risk of nausea or vomiting and for improving joint function after THA without side effects causing blood glucose fluctuations.

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

PMID:40208930 | DOI:10.2106/JBJS.24.01080

J Bone Joint Surg Am. 2025 Apr 9. doi: 10.2106/JBJS.24.01181. Online ahead of print.

ABSTRACT

BACKGROUND: The present study aimed to assess the long-term outcomes of lumbosacral hemivertebra (LSHV) resection and short segmental fusion in a pediatric population and to assess the evolution of deformity curves.

METHODS: Patients who sought medical attention at our institution between 2010 and 2018 were assessed for eligibility. A classification of R10 and U9 or higher for the distal radius and ulna, respectively, was used to indicate maturity. Imaging parameters and quality-of-life scores were recorded at postoperative follow-up visits. Analyses were performed for the entire group and for subgroups of patients with and without a curve progression.

RESULTS: A total of 15 male and 15 female patients were included, with a mean age of 6.9 ± 2.4 years at the time of surgery. The main curve averaged 26.6° ± 6.5° preoperatively, 7.5° ± 4.6° (p < 0.001) at 3 months postoperatively, and 8.6° ± 3.2° (p = 0.205) at the latest follow-up. In the coronal plane, the coronal balance averaged 21.3 ± 16.7 mm preoperatively, 11.4 ± 8.5 mm (p = 0.007) at 3 months postoperatively, and 11.2 ± 8.9 mm (p = 0.858) at the latest follow-up. A total of 7 complications were recorded in 6 patients (20.0%). The Scoliosis Research Society 22-Item Questionnaire (SRS-22) total score (p < 0.001), appearance score (p < 0.001), and satisfaction score (p < 0.001) were all significantly different from preoperatively to postoperatively. Compared with the compensatory curve progression group, the non-progression group had a higher SRS total score (p = 0.013) and satisfaction (p < 0.001).

CONCLUSIONS: For pediatric patients <10 years old, LSHV resection and short segmental fusion could provide correction and global spine balance improvement. However, the observed loss of correction in the compensatory curve in some patients during the follow-up may compromise the satisfaction.

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

PMID:40203129 | DOI:10.2106/JBJS.24.01181

J Bone Joint Surg Am. 2025 Apr 9. doi: 10.2106/JBJS.24.01119. Online ahead of print.

ABSTRACT

BACKGROUND: The sequelae of open reduction of developmental and/or syndromic hip dislocations include osteonecrosis/proximal femoral growth disturbance and residual dysplasia. There is limited information comparing the rates of these sequelae in patients with developmental dysplasia of the hip (DDH) and arthrogryposis multiplex congenita (AMC). We performed a dual-center retrospective cohort study to compare rates of proximal femoral growth disturbance and residual dysplasia between patients with DDH and AMC who had undergone open hip reduction for the treatment of non-traumatic hip dislocations.

METHODS: We identified patients <18 years of age who had undergone open reduction for the treatment of hip dislocation between 1981 and 2020 at 2 tertiary pediatric hospitals. Patients with AMC were matched by age against patients with DDH in a 1:2 ratio. Preoperative data included demographic characteristics, the severity of dislocation according to the International Hip Dysplasia Institute (IHDI) classification system, and the acetabular index. Outcomes included the acetabular index at 2 years postoperatively, the IHDI classification at the time of final follow-up, and the presence and grade of proximal femoral growth disturbance according to the Salter criteria at 2 years postoperatively and according to the Kalamchi and MacEwen (KM) classification system at the time of final follow-up.

RESULTS: Eighty-two patients (98 hips) with DDH were matched against 39 patients (49 hips) with AMC. The mean follow-up was 107 months (range, 24 to 443 months). There was no difference in the mean age at surgery (1.5 ± 0.7 versus 1.4 ± 1.3 years; p = 0.86), preoperative IHDI classification, acetabular index, or spica cast duration (p > 0.05 for all), but the DDH cohort had more females (83% versus 56%; p = 0.003). Postoperatively, the prevalence of proximal femoral growth disturbance was higher in the AMC group than in the DDH group according to the Salter criteria at 2 years (57% versus 21%; p < 0.001) and according to the KM criteria at the time of final follow-up (59% versus 16%; p < 0.001). At 2 years postoperatively, there was no difference between the DDH and AMC groups in terms of the acetabular index (31° ± 6.2° versus 29° ± 6.9°; p = 0.3) or reoperation rate (24% versus 20%; p = 0.68), but the AMC cohort had more IHDI grade II-IV hips than the DDH cohort (24% versus 9%; p = 0.02), reflecting re-subluxation/dislocation.

CONCLUSIONS: Open reduction for hip dislocation in patients with AMC was associated with a significantly higher rate of proximal femoral growth disturbance and re-subluxation/dislocation compared with that in patients with DDH, despite similar preoperative characteristics. This information may guide perioperative counseling for families of patients with AMC.

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

PMID:40203125 | DOI:10.2106/JBJS.24.01119

J Bone Joint Surg Am. 2025 Apr 6. doi: 10.2106/JBJS.24.00984. Online ahead of print.

ABSTRACT

BACKGROUND: Effective perioperative blood glucose control is crucial for reducing postoperative complications in patients with diabetes mellitus (DM) who are undergoing total knee arthroplasty (TKA). The aim of this study was to assess the impact of intravenous (IV) dexamethasone on blood glucose levels, insulin requirements, postoperative pain, and postoperative nausea and vomiting (PONV) in patients with well-controlled type-2 DM.

METHODS: A total of 83 Asian patients with well-controlled type-2 DM (defined as a preoperative glycated hemoglobin level of ≤7.0%) undergoing primary TKA were randomized to receive either IV dexamethasone or normal saline solution. Blood glucose and insulin requirements were monitored postoperatively up to day 5, and pain and PONV were assessed using a numeric rating scale.

RESULTS: Compared with the control, IV dexamethasone transiently elevated blood glucose levels on the day of surgery and on postoperative day 1, with the levels returning to baseline by day 3. Insulin requirements were higher in the intervention group on postoperative day 1 (p = 0.004). While IV dexamethasone did not significantly reduce PONV, it effectively alleviated postoperative pain up to day 3.

CONCLUSIONS: In patients with DM who underwent TKA, IV dexamethasone administration transiently increased blood glucose on the day of surgery and on postoperative day 1 and elevated insulin requirements on postoperative day 1. Despite having no impact on PONV, IV dexamethasone provided clinical benefits by reducing early postoperative pain. These findings suggest the potential benefits of IV dexamethasone in enhancing perioperative management strategies for patients with DM who are undergoing TKA.

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

PMID:40188461 | DOI:10.2106/JBJS.24.00984

J Bone Joint Surg Am. 2025 Apr 4. doi: 10.2106/JBJS.24.01226. Online ahead of print.

ABSTRACT

BACKGROUND: High body mass index (BMI) is a risk factor for tibial baseplate loosening following total knee arthroplasty (TKA) but may not adequately correlate with stresses at the tibial baseplate. In this study, we aimed to determine an optimal cutoff of a weight-to-tibial baseplate surface-area ratio (weight/SA) for predicting aseptic tibial baseplate loosening. We further examined whether tibial stem extensions have a protective effect.

METHODS: We identified 16,368 patients who underwent primary, elective TKA from June 2011 to March 2023. Patient demographics, including age, sex, and race, implants used, and revision surgeries were extracted. Revisions were manually reviewed to confirm revision indications. The exact surface areas of tibial baseplates were obtained from manufacturers. Receiver operating characteristic (ROC) analysis of patients without tibial stem extensions was utilized to examine the utility of BMI and weight/SA for predicting aseptic tibial baseplate loosening. Optimal weight/SA and BMI cutoffs for predicting loosening were determined. The effect of tibial stem extensions on loosening was then examined in patients at or above (n = 7,698; 3.7% with stem extension) and below (n = 8,670; 1.3% with stem extension) the determined weight/SA cutoff.

RESULTS: There were 16,368 patients in the final sample (median age, 67 years; 68.9% female; 54.1% White). Weight/SA (area under the curve [AUC] = 0.653; p < 0.001) was a better predictor of aseptic tibial baseplate loosening requiring revision compared with patient BMI (AUC = 0.624; p < 0.001). The optimal weight/SA cutoff for predicting loosening was 0.0162 kg/mm2 (sensitivity = 0.747, specificity = 0.537). Multivariable logistic regression demonstrated that being at or above the weight/SA cutoff (odds ratio [OR] = 3.17; p < 0.001) but not the BMI cutoff (p = 0.911) was a significant predictor of revision for tibial baseplate loosening in patients without stem extensions. No cases of revision for aseptic tibial baseplate loosening in patients with stem extensions occurred either at or above or below the cutoff. The rate of revision for aseptic tibial baseplate loosening in patients without stem extensions was 0.3% for patients below and 1.0% for patients at or above the weight/SA cutoff.

CONCLUSIONS: The ratio of weight-to-tibial baseplate surface area was more predictive of revision for aseptic tibial baseplate loosening following TKA compared with BMI alone. For patients with obesity with small tibial baseplate sizes, utilization of a tibial stem extension may protect against tibial loosening.

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

PMID:40184472 | DOI:10.2106/JBJS.24.01226

J Bone Joint Surg Am. 2025 Apr 3. doi: 10.2106/JBJS.24.00224. Online ahead of print.

ABSTRACT

BACKGROUND: Directed growth modulation is commonly utilized as a surgical treatment for early-onset scoliosis. Growing rods are instrumented on the spine and apply sustained tension on the immature spine for a substantial amount of time, with the clinical goal of accommodating axial expansion of the spine. Despite the use of growing rods in humans, the mechanobiology of the spinal tissues under tensile loading remains relatively unknown. To bridge this knowledge gap, we developed a preclinical mouse model that allows for mechanistic investigations of sustained tension on the spine.

METHODS: Using custom 3D-printed washers and tunable springs, we distracted across the seventh and ninth caudal vertebrae of adolescent and young adult C57BL/6 female mice with forces that were approximately 2 times the body mass of the animal. The springs were replaced weekly to maintain tension for the duration of the experiment. A set of 6-week-old animals were first instrumented for 10 weeks to evaluate the feasibility and tolerability. Subsequently, the 6- and 12-week-old experimental animals were instrumented until they were 20 weeks of age in order to evaluate the effects of tension until adulthood. The spines were monitored using digital radiography and micro-computed tomography (µCT), and the intervertebral discs (IVDs) were evaluated using mechanical testing and compositional assays.

RESULTS: The device was well tolerated and caused no notable complications. The tensile forces lengthened the vertebrae in the 6-week-old animals that were instrumented for 14 weeks and in the 12-week-old animals that were instrumented for 8 weeks. Increased IVD heights were observed in the 6-week-old animals but not in the 12-week-old animals. The porosity of the vertebral end plates increased following instrumentation in all groups but progressively recovered over time.

CONCLUSIONS: Distraction accelerated the lengthening of the vertebrae and the heightening of the IVD, with no observable degeneration or decline in the mechanical performance of the IVDs for these distraction conditions.

CLINICAL RELEVANCE: This model will be useful for investigating how spinal tissues adapt to directed growth modulation with maturation and aging.

PMID:40179155 | DOI:10.2106/JBJS.24.00224

J Bone Joint Surg Am. 2025 Apr 2. doi: 10.2106/JBJS.24.01087. Online ahead of print.

ABSTRACT

BACKGROUND: The indications for unicompartmental knee arthroplasty (UKA) are restricted by multiple criteria. The aim of this study was to explore the functional results of UKA in a population of patients outside the classical criteria.

METHODS: This study included a population of 197 patients who underwent UKA for medial osteoarthritis between 2017 and 2020. Two groups of patients were compared: those meeting the classical criteria and those presenting with ≥1 contraindication (e.g., age of ≥75 years, body mass index [BMI] of ≥30 kg/m2, or coronal limb deformity of >8°). The implant that was used was a modern fixed-bearing primary medial UKA component. The minimal follow-up was 3 years. The primary outcome was the functional results, including the Knee Society Score (KSS), and the secondary outcomes were the complication and revision rates.

RESULTS: There were 100 patients in the indication group and 97 in the off-indication group. No significant differences were observed between the 2 groups for height, sex ratio, operated side, or osteoarthritis stage (p > 0.05). There was no significant difference in the KSS between the 2 groups (p = 0.96). At 3 years of follow-up, the survival rate without revision was 100% in the indication group and 95.38% in the off-indication group (p = 0.57). The rate of complications was 12.9% in the indication group and 8.96% in the off-indication group (p = 0.47).

CONCLUSIONS: UKA for medial osteoarthritis yielded the same functional results for patients presenting with ≥1 theoretical contraindication, including a BMI of ≥30 kg/m2, age of ≥75 years, and coronal limb deformity of >8°, without altering the complication or revision rates at 3 years of follow-up.

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

PMID:40173264 | DOI:10.2106/JBJS.24.01087

J Bone Joint Surg Am. 2025 Apr 2. doi: 10.2106/JBJS.25.00089. Online ahead of print.

NO ABSTRACT

PMID:40173251 | DOI:10.2106/JBJS.25.00089

J Bone Joint Surg Am. 2025 Apr 2;107(7):e31. doi: 10.2106/JBJS.24.01282. Epub 2025 Apr 2.

NO ABSTRACT

PMID:40172568 | DOI:10.2106/JBJS.24.01282

J Bone Joint Surg Am. 2025 Apr 2;107(7):e30. doi: 10.2106/JBJS.24.01369. Epub 2025 Apr 2.

NO ABSTRACT

PMID:40172567 | DOI:10.2106/JBJS.24.01369

J Bone Joint Surg Am. 2025 Apr 2;107(7):e29. doi: 10.2106/JBJS.25.00033. Epub 2025 Apr 2.

NO ABSTRACT

PMID:40172566 | DOI:10.2106/JBJS.25.00033

J Bone Joint Surg Am. 2025 Apr 2;107(7):e28. doi: 10.2106/JBJS.24.01171. Epub 2025 Apr 2.

NO ABSTRACT

PMID:40172565 | DOI:10.2106/JBJS.24.01171

J Bone Joint Surg Am. 2025 Apr 2;107(7):771-777. doi: 10.2106/JBJS.24.00850. Epub 2025 Feb 24.

ABSTRACT

➢ Physiologic changes during pregnancy alter the biomechanics of the spine, including increased ligamentous laxity, lumbar lordosis, and pelvic tilt.➢ Patients with adolescent idiopathic scoliosis treated with a fusion construct with the lowest instrumented vertebra of L3 and below have an increased risk of developing low back pain during pregnancy.➢ There is a low risk of curve progression during pregnancy for patients with adolescent idiopathic scoliosis treated with spinal fusion.➢ Although neuraxial anesthesia is possible in patients who had previously undergone spinal fusion for adolescent idiopathic scoliosis, successful placement may require a more experienced provider and more attempts to place the epidural.

PMID:40172564 | DOI:10.2106/JBJS.24.00850

J Bone Joint Surg Am. 2025 Apr 1. doi: 10.2106/JBJS.24.01007. Online ahead of print.

ABSTRACT

BACKGROUND: Neurofibromatosis type 1 (NF1) is a genetic condition predisposing children to fracture pseudarthroses. MEK inhibitors are U.S. Food and Drug Administration-approved or are under study for the treatment of malignant pathologies associated with NF1. However, their potential to treat pseudarthrosis is largely unknown.

METHODS: Primary cells cultured from control bone or fracture pseudarthroses from children with NF1 were treated with vehicle or with the MEK inhibitors trametinib or selumetinib. Gene expression was evaluated with use of transcriptome sequencing (RNAseq), and the activation of the downstream signaling pathway was evaluated with use of western blotting. Results were replicated in an independent cohort of patient fracture pseudarthrosis-derived primary cells.

RESULTS: Pseudarthrosis samples were reproducibly associated with the reduced expression of gene signatures implicated in osteoblast differentiation, skeletal development, and the formation of the extracellular matrix. The expression of these gene signatures was significantly rescued following treatment with MEK inhibitors and concomitant reduced MEK/ERK (MAPK) pathway activation.

CONCLUSIONS: Our study identified molecular signatures associated with fracture pseudarthrosis that were rescued with MEK inhibitor treatment.

CLINICAL RELEVANCE: MEK inhibitors may promote the healing of fracture pseudarthroses in children with NF1.

PMID:40168468 | DOI:10.2106/JBJS.24.01007