J Bone Joint Surg Am. 2024 Aug 7;106(15):1384-1394. doi: 10.2106/JBJS.23.01203. Epub 2024 Jun 5.

ABSTRACT

BACKGROUND: This study aimed to identify implant positioning parameters and patient factors contributing to acromial stress fractures (ASFs) and scapular spine stress fractures (SSFs) following reverse shoulder arthroplasty (RSA).

METHODS: In a multicenter retrospective study, the cases of patients who underwent RSA from June 2013 to May 2019 and had a minimum 3-month follow-up were reviewed. The study involved 24 surgeons, from 15 U.S. institutions, who were members of the American Shoulder and Elbow Surgeons (ASES). Study parameters were defined through the Delphi method, requiring 75% agreement among surgeons for consensus. Multivariable logistic regression identified factors linked to ASFs and SSFs. Radiographic data, including the lateralization shoulder angle (LSA), distalization shoulder angle (DSA), and lateral humeral offset (LHO), were collected in a 2:1 control-to-fracture ratio and analyzed to evaluate their association with ASFs/SSFs.

RESULTS: Among 6,320 patients, the overall stress fracture rate was 3.8% (180 ASFs [2.8%] and 59 SSFs [0.9%]). ASF risk factors included inflammatory arthritis (odds ratio [OR] = 2.29, p < 0.001), a massive rotator cuff tear (OR = 2.05, p = 0.010), osteoporosis (OR = 2.00, p < 0.001), prior shoulder surgery (OR = 1.82, p < 0.001), cuff tear arthropathy (OR = 1.76, p = 0.002), female sex (OR = 1.74, p = 0.003), older age (OR = 1.02, p = 0.018), and greater total glenoid lateral offset (OR = 1.06, p = 0.025). Revision surgery (versus primary surgery) was associated with a reduced ASF risk (OR = 0.38, p = 0.019). SSF risk factors included female sex (OR = 2.45, p = 0.009), rotator cuff disease (OR = 2.36, p = 0.003), osteoporosis (OR = 2.18, p = 0.009), and inflammatory arthritis (OR = 2.04, p = 0.024). Radiographic analysis of propensity score-matched patients showed that a greater increase in the LSA (ΔLSA) from preoperatively to postoperatively (OR = 1.42, p = 0.005) and a greater postoperative LSA (OR = 1.76, p = 0.009) increased stress fracture risk, while increased LHO (OR = 0.74, p = 0.031) reduced it. Distalization (ΔDSA and postoperative DSA) showed no significant association with stress fracture prevalence.

CONCLUSIONS: Patient factors associated with poor bone density and rotator cuff deficiency appear to be the strongest predictors of ASFs and SSFs after RSA. Final implant positioning, to a lesser degree, may also affect ASF and SSF prevalence in at-risk patients, as increased humeral lateralization was found to be associated with lower fracture rates whereas excessive glenoid-sided and global lateralization were associated with higher fracture rates.

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

PMID:40305832 | DOI:10.2106/JBJS.23.01203

Injury. 2025 Apr 18;56(6):112350. doi: 10.1016/j.injury.2025.112350. Online ahead of print.

ABSTRACT

BACKGROUND: Avascular necrosis (AVN) of the femur head (FH) is an incapacitating disease caused by chronic overconsumption of alcohol and corticosteroids. AVN impairs blood circulation to the FH, causing varying degrees of cell death. AVN progressively reduces the macroscopic mechanical strength of the bone's necrotic area, leading to FH collapse.

MATERIAL AND METHOD: This study aims to comprehend the efficacy of core decompression (CD) on biomechanical, microstructural, and compositional determinants of bone quality. In this work, 30 FH are taken of the patients who underwent total hip replacement due to AVN. These 30 samples are categorized into two groups (15 each), i.e. with CD (individuals who underwent core decompression treatment at the early stages of AVN) or without CD (individuals who did not receive any invasive therapy in the past following a hip fracture due to AVN). Bone morphometry, biomechanical, material, and nano-level properties are analyzed across necrotic and sclerotic zones of FH through micro-CT scanning, histo-pathology, Uni-axial compression, and Nano-indentation tests.

RESULTS: The obtained results demonstrated a notable increment in bone volume fraction, ultimate strength, and osteocytes of the sclerotic zone of both groups compared to the necrotic region. A significant improvement was observed in the quality of trabecular bone at multiple scales of human bone tissue including higher bone volume fraction (22.87 %, P < 0.05), increased Young's modulus (28.80 %, P = 0.0183) and increment in Mineral/Matrix ratio (53.20 %, P = 0.0429) and reduction in % of empty lacunae (22.39 %, P < 0.01) in the necrotic region of patients with core decompression compared to patients without any invasive treatment.

CONCLUSION: The optimum core decompression enhances the stability of the femur head by increasing the macroscopic mechanical strength of necrotic bone and decreasing the strength of sclerotic bone. This brings the strength of both bones nearly equal, further reducing the stress gradient and probability of collapse of the AVN femur head.

PMID:40306042 | DOI:10.1016/j.injury.2025.112350

J Bone Joint Surg Am. 2024 Jun 5;106(11):939-940. doi: 10.2106/JBJS.24.00413. Epub 2024 Jun 5.

NO ABSTRACT

PMID:40305831 | DOI:10.2106/JBJS.24.00413

J Bone Joint Surg Am. 2025 Apr 29. doi: 10.2106/JBJS.24.00983. Online ahead of print.

ABSTRACT

BACKGROUND: While most total ankle arthroplasty (TAA) procedures utilize an anterior approach for implantation, the Zimmer Biomet Trabecular Metal implant is unique in that it utilizes a lateral transfibular approach. We present the largest mid-term study to date to analyze the implant survivorship and clinical and radiographic outcomes of transfibular TAA at a minimum 5-year follow-up.

METHODS: We retrospectively identified and evaluated 130 ankles (122 patients; mean age, 60.8 years; 50% female) with a mean follow-up of 5.9 years (range, 5.0 to 10.1 years) after primary TAA performed between October 2012 and December 2018. Patient-reported outcome measures (PROMs) included the 12-item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS), Ankle Osteoarthritis Scale (AOS) for pain and disability, and visual analog scale (VAS) for pain. Radiographic measurements for range of motion, coronal and sagittal alignment, and implant subsidence were evaluated. The presence of periprosthetic radiolucency was determined using a 12-zone classification system. Adverse events were reported using the Canadian Orthopaedic Foot and Ankle Society (COFAS) Reoperation Coding System (CROCS).

RESULTS: The cohort had mean postoperative values of 41.5 for the SF-12 PCS, 54.9 for the SF-12 MCS, 2.3 for VAS pain, 19.1 for AOS pain, and 28.5 for AOS disability. The postoperative tibiotalar range of motion was 7.5° of dorsiflexion and 17.3° of plantar flexion. A total of 42 valgus ankles (mean coronal tibiotalar angle, 10.4°; range, 1.0° to 25.3°) and 44 varus ankles (mean, -9.1°; range, -1.0° to -25.0°) were corrected to neutral. Twenty-six ankles (20%) had 1 zone of radiolucency, and none of the ankles had >7 zones. There were 3 cases of cysts (2.3%) and 0 cases of subsidence, septic or aseptic loosening, or fibular nonunion. Adverse events occurred in 47 ankles (36.2%) at a mean of 26.7 months, with the most common reoperation being medial gutter debridement (22 ankles; 16.9%). There were 2 ankles (1.5%) with acute infection treated with debridement, antibiotics, and polyethylene exchange with metal component retention. Overall implant survivorship, defined as retention of the metal components, was 100% at the time of final follow-up.

CONCLUSIONS: The clinical and radiographic data in this study suggest that transfibular TAA is an effective and durable treatment option for end-stage ankle arthritis, with excellent mid-term implant survivorship. Periprosthetic radiolucency was limited and did not lead to implant subsidence or loosening. The most common reoperation was medial gutter debridement.

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

PMID:40299950 | DOI:10.2106/JBJS.24.00983

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06536-x. Online ahead of print.

NO ABSTRACT

PMID:40298955 | DOI:10.1007/s00264-025-06536-x

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06537-w. Online ahead of print.

ABSTRACT

PURPOSE: This study aims to evaluate changes in the coagulation profile of patients with knee periprosthetic infections (PJI) and determine its diagnostic value in this complication.

METHODS: A prospective study was conducted with 112 patients who underwent revision surgery for total knee arthroplasty in a single tertiary hospital between January 2021 and December 2022.

RESULTS: 51 patients were diagnosed with PJI. D-dimer (p = 0.001), fibrinogen (p = 0.0007), platelets (0.01), and international normalized ratio (p = 0.01) were significantly higher in patients with PJI.

CONCLUSIONS: Patients with PJI display altered coagulation profile. The evaluation of coagulation-related markers has limited value for diagnosing PJI. Further studies are needed to understand the impact of such alterations on patients' outcomes.

PMID:40298954 | DOI:10.1007/s00264-025-06537-w

Int Orthop. 2025 Apr 29. doi: 10.1007/s00264-025-06549-6. Online ahead of print.

ABSTRACT

PURPOSE: Osteoarthritis (OA) of the knee significantly impairs mobility and quality of life. Knee arthroplasties have dramatically improved patient outcomes, allowing individuals to regain independence. Unicompartmental knee arthroplasty (UKA) is a surgical option for patients with isolated single-compartment disease, offering the benefits of reduced surgical time and minimized surgical risks. However, the appropriateness of UKA is often underestimated. Therefore, this study aims to determine the proportion of patients with varus knee OA who are suitable candidates for UKA.

METHODS: A prospective cross-sectional study was conducted on 207 knees undergoing knee arthroplasty surgery for varus knee OA. Pre-operative radiographs were graded using both the Kellgren-Lawrence (KL) and modified Keyes classifications. Intra-operatively, the knees were inspected, and photographs of the tibial cut were reviewed by a neutral observer. The appropriateness of UKA was determined based on these evaluations.

RESULTS: The lateral compartment was not involved in 169 (81.6%) knees. Only six (2.9%) knees had a KL grade 4 involvement of the lateral compartment. After excluding patients with isolated medial compartment OA, no radiographic evidence of lateral and patellofemoral involvement, and a grade 1 on the modified Keyes classification, we found that 79 (38.2%) patients were suitable candidates for a medial UKA. Intraoperatively, 84 (40.6%) patients had a functional ACL with no observable wear in the lateral and patellofemoral joint (PFJ) compartments.

CONCLUSION: In patients with varus knee OA, a significant proportion have wear patterns suitable for management with a UKA. Identifying these patients requires targeted examinations and specific radiographic views.

PMID:40298953 | DOI:10.1007/s00264-025-06549-6

Injury. 2025 Apr 4;56(6):112281. doi: 10.1016/j.injury.2025.112281. Online ahead of print.

ABSTRACT

Management with a functional brace results in successful union in the majority of patients with a humeral shaft fracture. An important factor in a patient's decision for operative vs. nonoperative management is how long it will take to know if the fracture will unite if treated nonoperatively. In this prospective multicenter evaluation subset analysis, we sought to address the following: (1) What is the positive and negative predictive value of gross motion at the fracture site on physical exam at 8 weeks post-injury for union in patients with humeral shaft fractures treated nonoperatively? (2) does callus present on radiographs correlate with clinical exam findings in terms of gross motion?

METHODS: We performed a prospective multicenter observational trial to evaluate the PPV and NPV of gross motion at 8 weeks on the outcome of union. There was a proscription against surgery for a minimum of 12 weeks. We additionally evaluated the presence of callus on each cortex for those with gross motion.

RESULTS: Of those available from the enrolled 101 patients, 62 (77 %) had no gross motion at 8 weeks following injury and went on to union (PPV=100 %). and 18 (23 %) patients had gross motion at the fracture site and 9 went on to nonunion (NPV =56 %), Callus was present on 3 of 4 cortices in 6 of the 7 patients with gross motion who went on to union and only 3 of the 9 who went on to nonunion (p = 0.06).

CONCLUSIONS: The lack of gross motion at the fracture site in patients treated nonoperatively for a humeral shaft fracture is highly predictive of union. The presence of gross motion does not predict nonunion as well, especially if callus is present on at least 3 of the 4 cortices. This information can be used to counsel patients at the inception of treatment and at 8 weeks.

LEVEL OF EVIDENCE: II.

PMID:40294453 | DOI:10.1016/j.injury.2025.112281

Injury. 2025 Apr 18;56(6):112347. doi: 10.1016/j.injury.2025.112347. Online ahead of print.

ABSTRACT

Finding a suitable replacement tissue for bone loss in comminuted fractures and bone tumors with large bone defect or for treatment of delayed unions and non-unions is still the main challenge for orthopedic surgeons. The present study has been designed in vivo to evaluate the effects of xenogenic calf fetal bone and cartilage grafts in treatment of experimental critical bone defect in a rabbit model. 30 native male rabbits, 12 months old, weighing 3.0±0.5 kg were used in this study. Rabbits were randomly divided into five groups of six (negative control (NC), osteochondral group (OstCar), bone group (Ost), cartilage group (Car), and positive control (PC)). In the NC group the created empty space was left intact. In the OstCar group the osteochondral fragment of the same size as the expulsion was inserted into place. In the Ost group, the bone fragment of the fetal calf replaced the extracted bone fragment from the radius bone. The created defects were filled in 6 rabbits of the Car group with cartilage fragments of the fetal calf. In the PC group, after separating the fragment of radius bone midsection and removing from the site, it was re-placed at the site. This study investigated three types of replacement tissue for the missing bone and compared the results of radiology, CT scan, biomechanics and histopathology evaluations with positive and negative control groups. In conclusion, this study demonstrated that the calf's fetal bone fragment could promote bone regeneration in the long bone defects like the autograft in the rabbit model.

PMID:40294452 | DOI:10.1016/j.injury.2025.112347

J Bone Joint Surg Am. 2025 Apr 28. doi: 10.2106/JBJS.24.00830. Online ahead of print.

ABSTRACT

BACKGROUND: The direct superior approach (DSA) is a modification of the posterior approach (PA) that is intended to preserve the iliotibial band and short external rotators, except for the piriformis and conjoined tendon, during total hip arthroplasty (THA). The objective of this study was to compare postoperative pain scores between patients undergoing the DSA versus the PA for THA.

METHODS: This study included 80 patients with symptomatic hip arthritis undergoing primary THA. Patients were prospectively randomized to receive either the DSA or PA for THA. Surgery was undertaken using identical implant designs in both groups, and all patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes were recorded by blinded observers at regular intervals for 2 years after THA.

RESULTS: Patients in the PA and DSA groups had comparable baseline characteristics for age (mean and standard deviation, 67.3 ± 7.4 and 67.8 ± 7.8 years, respectively; p = 0.962), sex (26 male and 14 female patients, and 21 male and 19 female patients, respectively; p = 0.499) and body mass index (29.0 ± 4.3 and 29.1 ± 5.3 kg/m2; respectively; p = 0.298). There was no significant difference between the PA and DSA groups with respect to postoperative pain scores at 24 hours as assessed using the visual analogue scale (4.5 ± 1.2 and 4.2 ± 2.0, respectively; p = 0.312). The overall time to hospital discharge was 43.6 ± 9.7 hours in the PA group and 45.4 ± 8.9 hours in the DSA group. Two patients in the PA group and 1 in the DSA group developed superficial wound infections, which were successfully treated with oral antibiotics. There were no further complications or harm sustained by patients in either treatment group.

CONCLUSIONS: This study showed that the intended benefits of the DSA in preserving the iliotibial band and the short external rotators, except for the piriformis and conjoined tendon, did not translate to any difference in postoperative pain scores when compared with the PA for THA.

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

PMID:40294151 | DOI:10.2106/JBJS.24.00830

J Bone Joint Surg Am. 2025 Apr 28. doi: 10.2106/JBJS.24.01305. Online ahead of print.

ABSTRACT

BACKGROUND: After a lower-extremity fracture, the patient's priority is to regain function. To date, our ability to measure function has been limited. However, high-fidelity sensors in smartphones continuously measure mobility, providing an expansive pre- and post-injury gait history. We assessed whether pre-injury mobility data, combined with demographic and injury data, reliably predicted post-fracture mobility.

METHODS: We enrolled 107 adult patients (mean age, 45 years; 43% female, 62% White, 36% Black, 1% Asian, 1% more than one race) ≥6 months after the surgical treatment of a lower-extremity fracture. Consenting patients exported their Apple iPhone mobility metrics, including step count, walking speed, step length, walking asymmetry, and double-support time. We integrated these mobility measures with demographic and injury data. Using nonlinear modeling, we assessed whether pre-injury mobility metrics combined with baseline data predicted post-fracture mobility.

RESULTS: All models were well calibrated and had model fits ranging from an adjusted R2 of 0.18 (walking asymmetry) to 0.61 (double-support time). Pre-injury function strongly predicted post-injury mobility in all models. After the injury, the average daily step count increased by 65 steps each week (95% confidence interval [CI], 56 to 75). Weekly gains were significantly greater within 6 weeks after the injury (92 daily steps per week; 95% CI, 58 to 127) than 20 to 26 weeks post-injury (19 daily steps per week; 95% CI, 11 to 27; p < 0.001). Greater pre-injury steps were associated with increased post-injury mobility (301 daily steps post-injury per 1,000 steps pre-injury; 95% CI, 235 to 367). Mean walking speed declined by 0.200 m/s (95% CI, -0.257 to -0.143) from injury to 8 weeks post-injury. From 12 to 26 weeks post-injury, the average walking speed increased by 0.071 m/s (95% CI, 0.044 to 0.097).

CONCLUSIONS: These proof-of-concept findings highlight the value of high-fidelity pre-injury mobility data in predicting recovery. Individualized recovery projections can provide patient-friendly counseling tools and useful clinical insight for surgeons.

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

PMID:40294149 | DOI:10.2106/JBJS.24.01305

J Bone Joint Surg Am. 2025 Apr 28. doi: 10.2106/JBJS.24.00489. Online ahead of print.

ABSTRACT

BACKGROUND: Most femoral stem designs used in total hip arthroplasty (THA) take into account the proximal femoral morphotype in terms of lateralization and neck-shaft angle (NSA) but not version. The objective of this study was to analyze the acetabular anteversion and femoral anteversion (FA) values in a large cohort according to the 3-dimensional (3D) morphotype of the proximal femur. Our hypothesis was that FA is an anatomic parameter independent of the coronal morphotype (varus, neutral, valgus).

METHODS: A retrospective study based on prospectively collected data included all patients who underwent, from January 2009 to December 2021, a THA planned on the basis of a low-dose computed tomographic (CT) scan 3D. The anatomic acetabular anteversion was calculated in the anterior pelvic plane. The 3D volume models were used to measure the NSA and the FA. We used a multivariable linear regression model to assess the relationship between the NSA and the other hip parameters.

RESULTS: The study included 849 consecutive patients (430 women and 419 men), with a mean age of 62 ± 15 years and a mean body mass index of 26.8 ± 5.7 kg/m2. The etiology was primary osteoarthritis in 616 patients, osteonecrosis in 141 patients, and dysplasia in 92 patients. The mean NSA was 129° ± 7°. The femoral morphotype was vara in 112 cases and valga in 105 cases. Acetabular anteversion was significantly lower in the vara group (mean, 21° ± 9°) and higher in the valga group (mean, 26° ± 9°) compared with the neutral group (mean, 24° ± 8°) (p < 0.001). The FA did not vary significantly according to the femoral morphotype (mean, 20° ± 12°; p = 0.3), with no significant association found between the NSA and FA (β = -0.004 [95% confidence interval, -0.5 to 0.05]; p = 0.8).

CONCLUSIONS: The FA was not associated with the NSA. A hip morphotype classification combining the NSA and FA is presented for use in guiding preoperative planning in THA. Customized patient-specific stems may be of interest in some morphotypes to accurately restore the hip anatomy.

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

PMID:40294145 | DOI:10.2106/JBJS.24.00489

Int Orthop. 2025 Apr 28. doi: 10.1007/s00264-025-06546-9. Online ahead of print.

ABSTRACT

PURPOSE: To compare the long-term efficacy of anterior lumbar interbody fusion (ALIF) and posterior transforaminal lumbar interbody fusion (TLIF) in treating lumbar degenerative diseases.

METHODS: A retrospective analysis was conducted on 57 patients with lumbar degenerative diseases who underwent either ALIF or TLIF from March 2003 to October 2007. Patients were divided into an ALIF group (n = 27) and a TLIF group (n = 30). Pain was evaluated using the visual analogue scale (VAS), and the Oswestry Disability Index (ODI) was used to assess clinical outcomes. Radiographic adjacent segment degeneration (rASD) was evaluated using the Modified Pfirrmann Scale. Three-dimensional CT was used to assess the fusion rate at the last follow-up.

RESULTS: Follow-up duration ranged from 58 to 120 months, with an average of 90.6 months. No significant difference was observed in VAS and ODI scores between the two groups (P > 0.05). However, significant differences were noted before and after the operation (P < 0.05). The intervertebral disc height (IDH) and lumbar lordosis (LL) increased after the operation and during follow-ups. The IDH and LL in the ALIF group were significantly higher than those in the TLIF group both postoperatively and at follow-ups (P < 0.05). At the last follow-up, the incidence of rASD in the ALIF group was significantly lower than in the TLIF group (P < 0.05).

CONCLUSIONS: Both ALIF and TLIF provide satisfactory long-term outcomes for lumbar degenerative diseases. ALIF more effectively restores and maintains lumbar intervertebral height and lumbar lordosis, potentially reducing the incidence of adjacent segment degeneration.

PMID:40293512 | DOI:10.1007/s00264-025-06546-9

Int Orthop. 2025 Apr 28. doi: 10.1007/s00264-025-06531-2. Online ahead of print.

ABSTRACT

AIM: We aimed to compare the diagnostic performance of physicians in the detection of arthroscopically confirmed meniscus and anterior cruciate ligament (ACL) tears on knee magnetic resonance imaging (MRI), with and without assistance from a deep learning (DL) model.

METHODS: We obtained preoperative MR images from 88 knees of patients who underwent arthroscopic meniscal repair, with or without ACL reconstruction. Ninety-eight MR images of knees without signs of meniscus or ACL tears were obtained from a publicly available database after matching on age and ACL status (normal or torn), resulting in a global dataset of 186 MRI examinations. The Keros® (Incepto, Paris) DL algorithm, previously trained for the detection and characterization of meniscus and ACL tears, was used for MRI assessment. Magnetic resonance images were individually, and blindly annotated by three physicians and the DL algorithm. After three weeks, the three human raters repeated image assessment with model assistance, performed in a different order.

RESULTS: The Keros® algorithm achieved an area under the curve (AUC) of 0.96 (95% CI 0.93, 0.99), 0.91 (95% CI 0.85, 0.96), and 0.99 (95% CI 0.98, 0.997) in the detection of medial meniscus, lateral meniscus and ACL tears, respectively. With model assistance, physicians achieved higher sensitivity (91% vs. 83%, p = 0.04) and similar specificity (91% vs. 87%, p = 0.09) in the detection of medial meniscus tears. Regarding lateral meniscus tears, sensitivity and specificity were similar with/without model assistance. Regarding ACL tears, physicians achieved higher specificity when assisted by the algorithm (70% vs. 51%, p = 0.01) but similar sensitivity with/without model assistance (93% vs. 96%, p = 0.13).

CONCLUSIONS: The current model consistently helped physicians in the detection of medial meniscus and ACL tears, notably when they were combined.

LEVEL OF EVIDENCE: Diagnostic study, Level III.

PMID:40293511 | DOI:10.1007/s00264-025-06531-2

Int Orthop. 2025 Apr 26. doi: 10.1007/s00264-025-06471-x. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate long-term radiological and functional outcomes in tibia plateau fractures (TPFs) patients treated using minimally invasive percutaneous plate osteosynthesis (MIPPO) and Double Reverse Traction Repositor (DRTR).

METHODS: We reviewed 85 patients treated with MIPPO and DRTR at our hospital from January 2015 to December 2017. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), and Kellgren-Lawrence classification, were assessed, while functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form (SF)-36, and Hospital for Special Surgery Knee Score (HSS score). Data from medium follow-up (4.39 ± 0.58 years) and final follow-up (7.75 ± 0.53 years) were analyzed with the Wilcoxon signed-rank test.

RESULTS: We included 65 patients with three(4.62%), 26(40.00%), eight(12.31%), six(9.23%), 11(16.92%), and 11(16.92%) were Schatzker I- VI, respectively. The mean follow-up time was 7.75 ± 0.53 years, with surgery performed in 5.72 ± 2.37 days post-injury and mean operation time of 96.72 ± 31.15 min. Short-term complications included two superficial infections (3.08%). Significant improvements in functional outcomes were observed at final follow-up: range of motion was 138.38° ± 8.49°, enhancements in WOMAC scores, HSS knee scores, and SF-36 (P < 0.05). No further progression of osteoarthritis was observed (K-L classification) during seven-year follow-up (P = 0.655).

CONCLUSIONS: MIPPO with DRTR is a promising and safe technique for the TPFs, leading to satisfactory outcomes up to seven years postoperatively, especially in reducing the incidence for knee osteoarthritis.

PMID:40285874 | DOI:10.1007/s00264-025-06471-x

Injury. 2025 Apr 17:112353. doi: 10.1016/j.injury.2025.112353. Online ahead of print.

ABSTRACT

INTRODUCTION: Ophthalmic care of incarcerated individuals is understudied, particularly in the inpatient setting. We evaluated ophthalmic consultation findings, interventions and outcomes at a tertiary care center.

METHODS: For this retrospective noncomparative cohort study, data were collected on demographics, diagnoses, interventions, and outcomes for incarcerated patients for whom ophthalmic consultation was ordered at an academic medical center between December 2011 and December 2022.

RESULTS: The study cohort included 163 patients (mean age = 38 years) in custody at Maryland state correctional facilities. The majority of patients were male (95.7 %) and/or Black (71.8 %). The most common reason for consultation was trauma (135 of 163, 82.8 %). Among patients presenting for trauma, the mechanism of injury was documented as assault in 117 cases (86.7 %). Among trauma patients, 56 (41 %) required surgical intervention. In total, 20 open reduction and internal fixation of orbital fractures, 11 open globe repairs, and 36 eyelid laceration repairs, as well as 3 other surgeries (anterior chamber washout, vitrectomy, and placement of an orbital implant after autoenucleation) were performed. Loss to follow-up was high; 68 patients (42 %) had no follow-up visits despite recommendations for follow-up at discharge.

CONCLUSION: Ocular trauma was the most common reason for ophthalmic consultation for incarcerated patients in the hospital setting, accounting for >80 % of consults. Over 40 % of prisoners presenting for ocular trauma required surgery. Even in the custody of the state, inmates are not protected from ocular trauma. These findings suggest a need for creative, humane interventions and policy initiatives to address violence in correctional facilities.

PMID:40280775 | DOI:10.1016/j.injury.2025.112353

Injury. 2025 Apr 15;56(6):112349. doi: 10.1016/j.injury.2025.112349. Online ahead of print.

ABSTRACT

BACKGROUND: Radial nerve injury is one of the most common peripheral nerve injuries and can be effectively treated with nerve grafting. However, the efficacy of nerve grafting combined with exercise therapy for the treatment of radial nerve injury remains unclear.

METHODS: In this study, we conducted a follow-up of at least one year in 40 patients with radial nerve injuries who received nerve grafting combined with exercise therapy, to evaluate their rehabilitation outcomes and identify the prognostic factors influencing the combined treatment.

RESULTS: 62.5 % (n = 25) patients achieved M3+ extension strength. Shorter defect length and delayed repair time and more cables of nerve graft were significantly associated with the recovery of finger extension. Moreover, multivariate analysis showed that defect length and delay in repair were the independent predictors of extensor digitorum communis reinnervation. Additionally, receiver operating characteristic (ROC) curve suggested that both delay in repair (AUC = 0.808) and cables of nerve graft (AUC = 0.837) had a high accuracy in predicting the prognosis of nerve graft combined with exercise therapy, while delay in repair+cables of nerve graft (AUC = 0.960) had the highest accuracy. The optimal time for transplantation is 6.89 months (sensitivity = 86.7 %, specificity = 58.7 %) post-injury, and the optimal number of nerve grafts is 2.5 (sensitivity = 80 %, specificity = 53.3 %).

CONCLUSION: We demonstrated that the effectiveness of nerve grafting combined with exercise therapy in treating radial nerve injury, and delay in repair and cables of nerve graft may act as the prognostic predictors of nerve graft combined with exercise therapy. These findings may provide a novel therapeutic method for radial nerve injury.

PMID:40279806 | DOI:10.1016/j.injury.2025.112349

Injury. 2025 Apr 18;56(6):112348. doi: 10.1016/j.injury.2025.112348. Online ahead of print.

ABSTRACT

BACKGROUND: Distal radius diaphyseal-metaphyseal junction (DRDMJ) fractures in children often require surgical intervention due to the unique anatomical characteristics and high failure rate of nonoperative treatment. However, the choice of internal fixation remains a challenge for pediatric orthopedic surgeons. Traditional fixation methods, including plate and screw fixation, crossed Kirschner wires (K-wires), and external fixators, have drawbacks such as extensive local trauma and the risk of physeal injury. This study evaluates the clinical efficacy of antegrade elastic stable intramedullary nailing (ESIN) for DRDMJ fractures in children, comparing it with the crossed K-wire technique.

METHODS: A retrospective analysis was conducted on 47 pediatric patients with DRDMJ fractures treated between June 2018 and January 2023. Patients were divided into an antegrade ESIN group (n = 20) and a crossed K-wire group (n = 27). Demographic data, perioperative parameters (operative time, radiation exposure), and postoperative recovery indicators (duration of internal/external fixation, radiographic healing time, wrist function recovery) were collected. All patients were followed up for at least 12 months, and complications were recorded. The Garland-Werley score was used to assess wrist function. Additionally, a cadaveric study was performed to validate the neurovascular safety of antegrade ESIN insertion via the middle third of the radial head-radial tuberosity axis within the Kocher interval.

RESULTS: All patients achieved radiographic union, with no cases of dorsal interosseous nerve injury, tendon rupture, or refracture. There were no significant differences between the two groups in terms of radiographic healing time or wrist function scores at 12 months postoperatively (P > 0.05). However, compared to the crossed K-wire group, the antegrade ESIN group demonstrated a significantly shorter operative time by 10.71 min (P = 0.002), reduced fluoroscopy use by 2.74 exposures (P = 0.001), and a shorter postoperative cast immobilization duration by 9.11 days (P < 0.001). Additionally, the antegrade ESIN group exhibited a higher rate of excellent wrist function scores at the 3-month follow-up. The cadaveric study confirmed that needle insertion through the middle third of the Kocher interval safely avoided the dorsal interosseous nerve, with no risk of nerve injury in either pronation or supination positions.

CONCLUSION: Antegrade ESIN and crossed K-wire fixation provide comparable long-term functional and radiographic outcomes for pediatric DRDMJ fractures. The antegrade ESIN technique, performed through the middle third of the radial head-radial tuberosity axis within the Kocher interval, effectively avoids dorsal interosseous nerve injury while significantly reducing operative time, minimizing intraoperative radiation exposure, and promoting early functional recovery. This technique may serve as a valuable surgical option for treating DRDMJ fractures in children.

PMID:40279805 | DOI:10.1016/j.injury.2025.112348

Injury. 2025 Apr 8;56(6):112304. doi: 10.1016/j.injury.2025.112304. Online ahead of print.

ABSTRACT

BACKGROUND: Standard antibiotic therapy for abdominal gunshot wounds (GSWs) with hollow viscus injury involves up to 24 h of prophylactic broad-spectrum antibiotics. However, antibiotic management strategies are poorly defined in treating gunshot wounds with bowel-to-bone trajectories. These injuries threaten fracture-related infection as missiles can carry contaminating material along their intracorporeal trajectory. This study seeks to determine whether the duration of prophylactic antibiotic therapy used in bowel-to-bone injuries is associated with fracture-related infection prevention or overall infectious sequelae.

METHODS: This six-year retrospective review identified all patients experiencing abdominal GSWs with a trajectory causing bowel injury and simultaneous fracture. Patient demographics, duration of antibiotic therapy, and subsequent infectious complications were compared with nonparametric tests as indicated.

RESULTS: 140 patients experienced GSWs with bowel-to-bone trajectory; the median duration of prophylactic antibiotic therapy was four days (IQR 2 - 5 days); two patients were diagnosed with fracture-related infection and 65 patients experienced an infectious complication during their index hospitalization. Duration of prophylactic antibiotic therapy was not associated with the development of overall infection (p = 0.31). Comparing three days of prophylactic antibiotic therapy to more than three days of therapy, no difference occurred in overall infection (p = 1.0).

CONCLUSION: The development of fracture-related infections in bowel-to-bone gunshot wounds is rare. The duration of prophylactic antibiotic therapy in bowel-to-bone injuries did not correlate with an increase in overall infectious complications. Notably, three days of prophylactic antibiotic therapy was not inferior compared to longer-duration therapy in the development of infectious sequelae. Thus, patients with a bowel-to-bone gunshot trajectory likely do not require extended antibiotic coverage for prevention of fracture-related infections.

PMID:40279804 | DOI:10.1016/j.injury.2025.112304

Injury. 2025 Apr 18;56(6):112355. doi: 10.1016/j.injury.2025.112355. Online ahead of print.

ABSTRACT

BACKGROUND: Blunt mechanism chest wall injury (CWI) is a common traumatic presentation to acute hospitals globally and it is associated with high levels of mortality and morbidity. The role of the physiotherapist in the management of this injured population needs clearer definition.

AIM: To synthesise existing evidence relating to the 'work' of physiotherapists in the assessment, management and evaluation of patients with blunt mechanism CWI.

DESIGN: A systematic integrative review of relevant literature with a narrative synthesis.

DATA SOURCES: Embase (Ovid), MEDLINE (Ovid), CINAHL Plus with Full Text (EBSCO), Cochrane Central Register of Controlled Trials (Wiley), PEDro (Physiotherapy Evidence Database), AMED (Ovid). Further searches for grey literature and hand searches were applied. Databases were searched from their inception to December 2024. Analysis and data integration was undertaken through narrative synthesis following a process of thematic coding.

RESULTS: From 7433 identified papers, 92 were included in the final evidence synthesis. Fifty were full published empirical studies, 14 were evidence reviews, 19 were conference abstracts, three were case presentations and six were opinion pieces. Analysis identified the broad scope of clinical care provided by physiotherapists covering (i) initial assessment and emergency care; (ii) acute care priorities and care planning; (iii) patient education and optimising patient self-management; and (iv) post-acute care and follow-up.

CONCLUSION: There is a need for a more standardised approach to the care provided to this patient group. Clinicians need to acquire and develop formal competencies and capacities and knowledge in a more structured approach.

PMID:40279803 | DOI:10.1016/j.injury.2025.112355