J Bone Joint Surg Am. 2025 Aug 5. doi: 10.2106/JBJS.24.01269. Online ahead of print.

ABSTRACT

BACKGROUND: The smallest worthwhile effect (SWE) enables patients to evaluate the expected value of a treatment by weighing its benefits, risks, and costs. It has emerged as an alternative to the minimal clinically important difference (MCID) for interpreting patient-reported outcome measures (PROMs). The purposes of this study were to determine the SWE estimates and MCID thresholds in patients undergoing surgery for adult idiopathic scoliosis (AdIS) and to verify whether meeting or exceeding the SWE estimates correlates with satisfaction at a minimum of 2 years postoperatively.

METHODS: Patients with postoperative satisfaction measured at a minimum of 2 years were prospectively recruited between July 2017 and August 2022. The Scoliosis Research Society-22 revised (SRS-22r) questionnaire was preoperatively administered to estimate the SWE thresholds using the benefit-harm trade-off method. The baseline SRS-22r and the SRS-30 at a minimum of 2 years postoperatively were recorded to determine the MCID estimates using the anchor-based approach, with questions 24 to 30 of the SRS-30 used as anchors. A construct validity assessment was performed to evaluate the association between meeting or exceeding the 50th percentile of the SWE (SWE50) threshold and postoperative satisfaction (defined as a score of ≥4 on both SRS-22r satisfaction questions). Race and ethnicity data were collected from the medical records.

RESULTS: A total of 119 Asian participants (19 male and 100 female) with a mean age of 26.5 ± 7.2 years were included. The absolute SWE50 estimates for the SRS-22r were 0.8 (interquartile range [IQR], 0.6 to 1.2) for self-image, 0.0 (IQR, 0.0 to 0.2) for function, 0.0 (IQR, 0.0 to 0.6) for pain, 0.4 (IQR, 0.0 to 0.6) for mental health, and 0.4 (IQR, 0.2 to 0.6) for the total score. The MCID thresholds for the corresponding domains or total score were 0.7, 0.1, 0.1, 0.3, and 0.3, respectively. Achieving or exceeding the absolute SWE50 threshold for the total score (p < 0.001) or the self-image (chi-square, 11.3; p < 0.001), function (chi-square, 6.3; p = 0.012), or pain (chi-square, 5.7; p = 0.017) domain was significantly correlated with postoperative satisfaction at a minimum of 2 years.

CONCLUSIONS: The SWE could serve as an effective alternative to the MCID for interpreting PROMs at a minimum of 2 years postoperatively in patients with AdIS.

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

PMID:40763206 | DOI:10.2106/JBJS.24.01269

Int Orthop. 2025 Aug 5. doi: 10.1007/s00264-025-06617-x. Online ahead of print.

ABSTRACT

INTRODUCTION: Debridement, antibiotics, and implant retention (DAIR) is a commonly employed strategy for managing acute postoperative prosthetic joint infections (PJI) while preserving the prosthesis. However, the clinical value of an unplanned second DAIR - performed due to inadequate infection control - remains controversial and is often considered a potential treatment failure. This study aimed to compare the two year clinical outcomes of patients undergoing a single DAIR versus those requiring an unplanned second DAIR for acute postoperative PJI of the hip or knee.

METHODS: We retrospectively reviewed electronic medical records of patients treated with DAIR for acute postoperative PJI between January 1999 and December 2020. Patients were categorized into two groups: those managed with a single DAIR (DAIR-1 group) and those requiring an unplanned second DAIR within 12 weeks (DAIR-2 group). Treatment failure was defined as any of the following: further debridement beyond 12 weeks, revision surgery with prosthesis removal, initiation of long-term suppressive antibiotic therapy, or PJI-related mortality. Patients lost to follow-up before two years were excluded.

RESULTS: A total of 318 patients were included, with 292 in the DAIR-1 group and 26 in the DAIR-2 group. Mean follow-up was 89.4 months. At two years, revision surgery was required in 19.2% (56/292) of DAIR-1 patients and 42.3% (11/26) of DAIR-2 patients (p = 0.005). Overall failure-free survival at two years was observed in 75.3% (220/292) of DAIR-1 patients compared to 46.2% (12/26) of those in the DAIR-2 group (p = 0.001).

CONCLUSION: Unplanned second DAIR procedures are associated with significantly lower success rates at two years. Nonetheless, given that nearly half of these patients remained free of failure, a second DAIR may still be a reasonable therapeutic option in selected cases, provided that the increased risk of a poorer prognosis is taken into account.

PMID:40762855 | DOI:10.1007/s00264-025-06617-x

SICOT J. 2025;11:44. doi: 10.1051/sicotj/2025044. Epub 2025 Aug 4.

ABSTRACT

BACKGROUND: To evaluate whether the use of patient-specific instrumentation (PSI) or conventional instrumentation (CI) is associated with superior implant positioning and knee alignment in total knee arthroplasty (TKA).

METHODS: Clinical data, pre- and post-operative knee X-rays of 95 patients, who underwent TKA with use of either patient-specific instrumentation (group PSI) or conventional intra-/extramedullary cutting guides (group CI) were retrospectively collected. Preoperative measurements of knee alignment were done by assessing the femorotibial axis, the lateral femoral distal angle, and the medial tibial proximal angle. Postoperative measurements of the mechanical TKA alignment were performed by assessing the relative position of components to the femur and tibia and the femorotibial axis angle. Only when all three parameters were within generally accepted limits was the postoperative radiological outcome considered optimal.

RESULTS: Preoperative measurements and demographics were similar among the two groups. No statistically significant differences were found between postoperative radiographic findings in patients operated on with PSI or CI. A restoration of the femorotibial axis was achieved in 87.8% and 87.0% of patients treated with PSI and CI, respectively (p = 0.583). Coronal alignment of the femoral component was within acceptable limits in 97.6% and 94.4% (p = 0.631) of patients of the PSI and CI groups, respectively. The respective percentages for the tibial component were 85.3% and 83.3% (p = 0.510) of patients. An accurate coronal plane radiological outcome was achieved in 82.9% and 77.8% of patients treated with PSI and CI, respectively (p = 0.611) Conclusions: The use of PSI does not increase the accuracy of component positioning and leg axis restoration compared to CI in TKA in patients with mild deformity.

PMID:40758900 | PMC:PMC12321163 | DOI:10.1051/sicotj/2025044

SICOT J. 2025;11:43. doi: 10.1051/sicotj/2025046. Epub 2025 Aug 4.

ABSTRACT

INTRODUCTION: Knee dislocations, particularly high-grade injuries such as Schenck class KDIV, are complex injuries often resulting from high-energy trauma. While magnetic resonance imaging (MRI) is widely used preoperatively to assess ligamentous damage, its diagnostic accuracy remains uncertain.

METHODS: A retrospective review was conducted on 92 patients who underwent surgery for a knee dislocation at a Level I trauma center over 10 years. Patients who had a preoperative MRI report and intraoperative confirmation of a KDIV injury without a tibial plateau fracture were included, which left 31 patients. MRI sensitivity was determined by comparing radiology reports to operative findings with fluoroscopic examination under anesthesia (EUA) for injuries to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and posterolateral corner (PLC). Postoperative follow-up documents were reviewed for functional outcomes. A one-way analysis of variance (ANOVA) was performed to evaluate differences in sensitivity across ligament types, followed by a Tukey post hoc test for pairwise comparisons. Mean flexion ROM at final follow-up (≥6 months) was compared between the accurate and inaccurate MRI cohorts using an independent t-test.

RESULTS: Only 35.5% of MRI reports fully matched operative findings. MRI sensitivity was 71.0% for the ACL (22/31), 61.3% for the PCL (19/31), 93.5% for the MCL (29/31), 64.5% for the LCL (20/31), and 51.6% for the PLC (16/31). ANOVA revealed that MCL sensitivity was significantly higher than that of the PLC, PCL, and LCL. The difference in mean flexion ROM at final follow-up between accurate and inaccurate MRI cohorts was not statistically significant (p = 0.56).

DISCUSSION: Preoperative MRI radiology reports demonstrated substantial limitations in accurately identifying ligamentous injuries in KDIV knee dislocations, particularly involving the PLC, PCL, and LCL. These findings highlight a gap between radiologic interpretation and surgical findings. Surgeons should interpret MRI reports with caution and incorporate fluoroscopic EUA at the time of surgery to ensure a comprehensive assessment of ligamentous damage.

PMID:40758899 | PMC:PMC12321162 | DOI:10.1051/sicotj/2025046

EFORT Open Rev. 2025 Aug 4;10(8):589-599. doi: 10.1530/EOR-2024-0105.

ABSTRACT

PURPOSE: The objective of this study was to assess the benefits of the PENG block on pain control and functional recovery.

METHODS: Randomized controlled trials in PubMed, Web of Science, Embase, and the Cochrane Library were selected, and data were meta-analyzed using a random-effects model to estimate mean difference (MD) or standardized mean differences (SMD).

RESULTS: Eleven trials involving 1,135 patients were included. The PENG block was associated with significantly lower total opioid consumption than sham/no block (MD: -25.23, 95% CI: -27.01 to -23.45, I 2 = 0%), as well as better functional recovery. The PENG block was noninferior to the suprainguinal fascia iliaca block regarding postoperative pain scores and functional recovery and had a significant reduction in total opioid consumption (MD: -8.25, 95% CI: -16.48 to -0.02, I 2 = 68%). The PENG block was associated with similar total opioid consumption and functional recovery as the periarticular anesthetic infiltration (PAI), but worse static pain scores at 12 h (SMD: 0.41, 95% CI: 0.08-0.75, I 2 = 51%) and dynamic pain scores at 48 h after surgery (SMD: 0.36, 95% CI: 0.08-0.64, I 2 = 0%).

CONCLUSIONS: While current evidence supports the PENG block as a viable alternative to other types of peripheral analgesia in THA, existing data remain insufficient to conclude that the PENG block outperforms other peripheral analgesia when it comes to pain control or functional recovery. More well-designed randomized controlled trials are needed in the future to thoroughly explore whether the PENG block has superiority over other analgesic techniques.

PMID:40757814 | PMC:PMC12326972 | DOI:10.1530/EOR-2024-0105

EFORT Open Rev. 2025 Aug 4;10(8):574-588. doi: 10.1530/EOR-2024-0049.

ABSTRACT

PURPOSE: Diagnosing osteomyelitis in the foot/ankle region is challenging primarily due to anatomical constraints. While bone biopsy is the gold standard, non-invasive methods such as SPECT (single photon emission computed tomography) and MRI are sensitive but lack specificity. This study aims to evaluate SPECT/CT's potential, integrating functional and structural imaging, to improve osteomyelitis diagnosis in this region.

METHODS: A systematic review following PRISMA guidelines and the Cochrane Handbook was conducted, including comprehensive research across major databases (inception to October 2022). Diagnostic studies using SPECT/CT for suspected foot/ankle bone lesions or inflammation were included. We carried out descriptive analysis, SROC curve generation, and calculated mean sensitivities and specificities. Subgroup analyses were conducted for various tracers, CT resolutions, and evaluation strategies. Sensitivity and heterogeneity analyses, bias risk, and publication bias were assessed.

RESULTS: Eleven diagnostic studies (463 patients) were reviewed, with seven focusing on diabetic patients. Tracers included labeled leukocytes (WBC), antigranulocyte antibodies, phosphonates (BS), and gallium citrate. Clinical follow-up was the primary reference standard. Mean sensitivity of SPECT/CT for osteomyelitis diagnosis was 93.8% (95% CI: 89.7-96.4%), and specificity was 84.6% (95% CI: 65.1-94.2%). WBC SPECT/CT was more specific (79.4%) but less sensitive (89.2%) than BS SPECT/CT (specificity 46.5%, sensitivity 93.1%). Combined tracers yielded the highest mean specificity (96.4%).

CONCLUSION: SPECT/CT shows promising diagnostic performance for osteomyelitis in the foot/ankle region, especially when applying combined tracer methods. It is particularly advantageous in chronic, postoperative, and post-traumatic cases, offering added value compared to MRI.

PMID:40757813 | PMC:PMC12326970 | DOI:10.1530/EOR-2024-0049

EFORT Open Rev. 2025 Aug 4;10(8):623-635. doi: 10.1530/EOR-2024-0120.

ABSTRACT

Total knee arthroplasty is a highly effective intervention for end-stage osteoarthritis, yet nearly 20% of patients report dissatisfaction with clinical outcomes. This dissatisfaction is often linked to intraoperative parameters, particularly whole-leg alignment and component positioning, which might play a role in ensuring both satisfaction and long-term implant survival. Over the past two decades, alignment techniques have progressed from systematic, two-dimensional methods focused on the frontal plane to more personalized, three-dimensional approaches. This evolution has introduced inconsistencies and confusion among surgeons regarding alignment techniques, terminology, and application, underscoring the need for standardized definitions that can be universally adopted. This work provides standardized definitions for six main knee alignment techniques to enhance communication within the scientific community, particularly in clinical research. While not an exhaustive analysis of each method, this effort focuses on the foundational principles of these techniques, organized using a standardized framework to facilitate comparison and improve clarity in the field.

PMID:40757810 | PMC:PMC12326975 | DOI:10.1530/EOR-2024-0120

EFORT Open Rev. 2025 Aug 4;10(8):636-645. doi: 10.1530/EOR-2024-0135.

ABSTRACT

Hamstring injuries are a significant concern in high-speed running and kicking sports, contributing to a high incidence and recurrence rate among athletes. Anatomical and biomechanical properties of the hamstrings, especially the biceps femoris long head, make them susceptible to strain, contributing to the high injury rate observed in athletes. Key risk factors, including prior injury history, neuromuscular deficiencies, excessive load, and muscle-tendon architecture, have been identified as contributors to injury prevalence. Eccentric strengthening exercises, particularly the Nordic hamstring exercise, are highlighted for their effectiveness in reducing the incidence of hamstring injuries. Stretching protocols, when combined with strengthening exercises, have shown potential in enhancing muscle flexibility and reducing injury risk, although their standalone effectiveness remains a subject of ongoing research.

PMID:40757809 | PMC:PMC12326974 | DOI:10.1530/EOR-2024-0135

EFORT Open Rev. 2025 Aug 4;10(8):611-622. doi: 10.1530/EOR-2024-0119.

ABSTRACT

The main goal of a successful total knee arthroplasty is to relieve pain and restore function. While mechanical alignment provides excellent long-term implant survivorship, clinical and functional outcomes remain less than ideal. As a result, the focus has gradually shifted to a more personalized surgical approach based on the patient's specific characteristics. There is a pressing need for agreement on definitions of key terms to standardize limb alignment measurements and improve understanding and communication within the field. This work aims to clarify the concept of native limb alignment, outline how it is measured, and propose a standardized terminology to describe it.

PMID:40757805 | PMC:PMC12326966 | DOI:10.1530/EOR-2024-0119

EFORT Open Rev. 2025 Aug 4;10(8):600-610. doi: 10.1530/EOR-2024-0128.

ABSTRACT

PURPOSE: Meniscal extrusion (ME) can have detrimental effects. The aim of this study was to analyze the evidence about the reliability, potential of standing and dynamic evaluations, and influencing factors identified by using ultrasound (US) to evaluate knee ME.

METHODS: A systematic review of the literature was performed in February 2024 on PubMed, Scopus, and the Cochrane Library databases to select all articles, dealing with the US evaluation of ME. Relevant data of the involved articles, including study type, number of patients, age, sex, US technique, and data comparison with other radiological examinations, were extracted and collected for the study analysis.

RESULTS: Sixty studies on 4,742 patients were included: 38 cross-sectional, ten longitudinal, two case-control, and ten biomechanical studies. A strong correlation was found between MRI and US, with good US sensitivity (96%) and specificity (82%), and moderate to excellent interrater and intrarater reliability. US examinations in the standing position with weight-bearing or more complex dynamic conditions reported a significant influence of weight-bearing on MME. US was able to identify a relationship between meniscus posterior root tear and MME, as well as between ME and both pain and early osteoarthritis.

CONCLUSIONS: US is a valuable tool for the study of ME and the identification of the association between ME and various conditions. US in dynamic and weight-bearing evaluations is useful to characterize this anatomical abnormality in different pathologies, including OA, meniscal lesions, and in the follow-up of surgical procedures, providing important data to choose the best treatment to address patients affected by ME.

PMID:40757803 | PMC:PMC12326973 | DOI:10.1530/EOR-2024-0128

J Bone Joint Surg Am. 2025 Aug 4. doi: 10.2106/JBJS.24.01619. Online ahead of print.

ABSTRACT

BACKGROUND: Flatfoot, or pes planus, is a common anatomical variation marked by a reduced or absent longitudinal arch. Although it is often considered benign, the condition can progress to progressive collapsing foot deformity (PCFD), a debilitating pathology. This study aimed to identify imaging biomarkers that distinguish asymptomatic flatfoot from PCFD by comparing 3D measurements among normally aligned feet, asymptomatic flatfeet, and feet with PCFD.

METHODS: A prospective, comparative, and controlled study was conducted on 561 feet in 475 subjects: 88 control subjects with 98 normally aligned feet, 66 control subjects with 132 asymptomatic flatfeet, and 321 patients with 331 feet with symptomatic PCFD. Bilateral weight-bearing computed tomography (WBCT) scans were performed, and various 3D measurements were analyzed, focusing on hindfoot valgus (Class A deformity), midfoot and/or forefoot abduction (Class B), arch collapse (Class C), and peritalar subluxation (PTS) (Class D). Statistical analysis, including multivariable nominal regression, was used to identify significant predictors of symptoms.

RESULTS: Progressive increases in Class A, B, and C deformity parameters were observed from normally aligned feet to asymptomatic flatfeet and finally to feet with PCFD. Significant differences in PTS (Class D deformity) were found only in the comparison between the feet with PCFD and the control groups, with reduced joint coverage and increased sinus tarsi coverage, indicating extra-articular impingement. Multivariable analysis identified the minimum sinus tarsi distance as the strongest predictor of symptoms, with a threshold of 1.9 mm best distinguishing symptomatic from asymptomatic feet.

CONCLUSIONS: This study demonstrated that although hindfoot valgus, midfoot and/or forefoot abduction, and arch collapse deformities progressively increase from normal alignment to PCFD, significant subtalar joint subluxation and sinus tarsi impingement were unique to symptomatic PCFD. These findings suggest that PTS can serve as a crucial biomarker for diagnosing pathologic flatfoot (PCFD) and differentiating it from asymptomatic flatfoot. Future research should explore the predictive value of PTS biomarkers in identifying flatfoot at high risk for collapse and their impact on clinical management and surgical decision-making.

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

PMID:40758778 | DOI:10.2106/JBJS.24.01619

J Bone Joint Surg Am. 2025 Aug 4. doi: 10.2106/JBJS.24.01404. Online ahead of print.

ABSTRACT

BACKGROUND: This study was performed to determine if the Patient-Reported Outcomes Measurement Information System (PROMIS), the 9-item Oswestry Disability Index (ODI-9), and back pain intensity predict abnormal magnetic resonance imaging (MRI) findings in pediatric patients with back pain.

METHODS: We performed a retrospective review from April 2021 to June 2023 of 300 children (200 girls and 100 boys) aged 5 to 18 years with caregiver-reported back pain who underwent MRI of the spine and had completed the PROMIS Pediatric computerized adaptive testing measures for Pain Interference, Mobility, and Anxiety and the ODI-9, and had rated back pain intensity on a scale ranging from 0 to 5. Patients were excluded if they had neuromuscular or syndromic scoliosis, a history of previous spinal surgeries, or isolated neck pain. MRI findings were grouped as non-spinal and spinal findings, and then categorized into subgroups as incidental, correlative, and causative findings. Incidental findings were considered those in children with normal MRI findings. Patient-reported outcome measures (PROMs) were compared between children with normal and abnormal MRI findings (defined by the presence of correlative and/or causative findings) with use of Mann-Whitney U tests and logistic regression analysis.

RESULTS: Of the 300 children, 126 (42%) had abnormal MRI findings and 174 (58%) had normal MRI findings. Lower PROMIS Mobility scores (39.2 versus 42.8, p = 0.001) and higher ODI-9 percentages (27.4 versus 23.3, p = 0.015) were associated with abnormal MRI findings. A PROMIS Mobility threshold of 40.5 and an ODI percentage threshold of 21.1 were optimal for predicting abnormal MRI findings. We did not find an association between PROMIS Anxiety, PROMIS Pain Interference, or pain intensity with abnormal MRI findings.

CONCLUSIONS: Lower PROMIS Mobility scores and higher ODI-9 scores, which reflect worsening functional disability, were associated with abnormal MRI findings in pediatric patients with back pain. Additionally, the minimum clinically important difference was met for the PROMIS Mobility score between those with normal and abnormal MRI.

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

PMID:40758775 | DOI:10.2106/JBJS.24.01404

Injury. 2025 Jul 27;56(10):112626. doi: 10.1016/j.injury.2025.112626. Online ahead of print.

ABSTRACT

Burn injuries result in profound and enduring consequences that extend well beyond the initial physical trauma. Although survival rates have significantly improved in recent decades, particularly in high-income countries, many survivors continue to experience complex psychological and social challenges that persist long after discharge from hospital care. This review outlines the current understanding of the psychological and social impacts of burn injuries and highlights key strategies to support survivors and their families through each stage of recovery. Common psychological concerns include post-traumatic stress, anxiety, depression, and disruptions to self-perception. These issues frequently emerge early in the recovery process and may endure for several years, influencing daily functioning, interpersonal relationships, and the ability to return to work. Caregivers are also affected, often experiencing emotional fatigue and psychological strain, particularly when access to support services is limited. Reintegration into everyday life is frequently marked by social stigma and exclusion, with children and adolescents being especially vulnerable due to ongoing identity development. Holistic recovery requires more than physical rehabilitation; it requires a coordinated, multidisciplinary approach that incorporates psychological support, social reintegration, and long-term follow-up. Interventions such as cognitive-behavioural therapy, peer and family support programs, and digital health platforms have shown promise in addressing these needs. While some individuals report personal growth following burn trauma, outcomes are influenced by various factors, including mental health history, community context and available support. Psychosocial care must be responsive to cultural and developmental differences and accessible across diverse settings. Innovations such as virtual reality and telehealth are increasingly valuable in bridging service gaps, particularly for individuals in rural or underserved areas.

PMID:40753695 | DOI:10.1016/j.injury.2025.112626

Injury. 2025 Jul 29;56(10):112635. doi: 10.1016/j.injury.2025.112635. Online ahead of print.

ABSTRACT

INTRODUCTION: The far cortical locking (FCL) system reduces axial stiffness in locked plating constructs while maintaining construct strength, thereby promoting secondary bone healing following fracture fixation. However, studies evaluating its efficacy compared with standard locked plating (LP) systems for upper extremity fractures remain limited. This study compared humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) using either the FCL or LP system.

MATERIALS AND METHODS: We analyzed 40 patients with diaphyseal humeral fractures treated with MIPO using either FCL or LP and conducted a matched-pair comparative analysis. Prospective data were collected from 20 consecutive patients who underwent MIPO with FCL. A matched case-control cohort was constructed by pairing MIPO cases using LP with the most closely matched FCL cases. The primary outcome was a comparison of radiographic and clinical fracture healing, as well as complications, between the two groups using statistical analysis. Statistical significance was set at p < 0.05.

RESULTS: Union was achieved in 18 of 20 cases (90 %) in the FCL group at a mean of 13.6 weeks. All 20 cases in the LP group achieved union after a mean of 20.1 weeks. Time to union was significantly shorter in the FCL group (p < 0.05), though the union rate did not differ significantly (p = 0.49). Near cortex healing occurred at a mean of 11.2 weeks in the FCL group and 18.8 weeks in the LP group (p < 0.01). Two FCL cases required revision surgery due to screw breakage or pull-out at the proximal fracture segment. Mean coronal and sagittal angulations were 2.9° and 4.8° in the FCL group, and 2.4° and 3.3° in the LP group, with no significant differences (p = 0.60 and 0.24). No significant differences in functional outcomes were observed between the groups.

CONCLUSIONS: The FCL group showed significantly faster union compared to the LP group, but no significant differences in union rate, alignment, or functional outcomes. Although not statistically significant, a 10 % complication rate was observed in the FCL group. Caution is warranted, as FCL screws may fail at the proximal fracture segment, either by breakage due to mechanical overload or by pull-out.

PMID:40753694 | DOI:10.1016/j.injury.2025.112635

Injury. 2025 Jul 24;56(10):112621. doi: 10.1016/j.injury.2025.112621. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate and compare the medium- to long-term outcomes of the Femoral Neck System (FNS), FNS combined with the Anti-Rotation Screw (ARS), and Multiple Cancellous Screws (MCS) in the treatment of femoral neck fractures in young and middle-aged patients.

METHODS: A retrospective, multi-group comparative cohort study was conducted on 731 young and middle-aged patients with femoral neck fractures treated at Level I Trauma Center between September 2019 and January 2024. Patients were divided into three groups based on the surgical method: FNS group (327 cases), FNS+ARS group (120 cases), and MCS group (284 cases). Postoperative follow-up assessments included fracture healing time, functional scores (Harris Hip Score [HHS], Oxford Hip Score [OHS], Hip Outcome Score [HOS]), and complication rates (femoral neck shortening, femoral head necrosis, nonunion, and implant-related complications).

RESULTS: Key findings demonstrated the FNS+ARS group achieved significantly faster fracture healing (10.21 ± 1.33 weeks) versus FNS (12.52 ± 1.91) and MCS (13.57 ± 2.13 weeks; P = 0.036). Functional outcomes consistently favored FNS+ARS across all timepoints:3 months: HHS (61.54 ± 2.98 vs 58.15 ± 2.34 vs 54.43 ± 2.79, P < 0.001), OHS (37.19 ± 2.35 vs 43.20 ± 2.91 vs 42.89 ± 3.00, P < 0.001), HOS (33.59 ± 2.39 vs 32.21 ± 2.32 vs 30.39 ± 2.72, P < 0.001);6 months: HHS (87.35 ± 5.58 vs 81.95 ± 5.99 vs 76.54 ± 5.45, P < 0.001), OHS (22.66 ± 2.78 vs 25.96 ± 3.64 vs 27.66 ± 4.81, P < 0.001), HOS (76.02 ± 5.47 vs 75.42 ± 7.63 vs 73.38 ± 6.75, P < 0.001);Final follow-up: HHS (91.95 ± 9.06 vs 90.38 ± 11.21 vs 87.67 ± 11.71, P < 0.001), OHS (21.04 ± 8.71 vs 20.41 ± 7.88 vs 23.40 ± 10.18, P < 0.001), HOS (87.51 ± 12.93 vs 85.84 ± 16.22 vs 85.98 ± 15.00, P < 0.001);Complication rates were significantly lower with FNS+ARS, particularly for femoral neck shortening (2.50 % vs 8.87 % vs 5.28 %; P = 0.031) and avascular necrosis (6.67 % vs 10.92 %; P = 0.040).

CONCLUSION: FNS combined with ARS outperformed FNS and MCS in promoting fracture healing, reducing postoperative complication rates, and accelerating functional recovery.

PMID:40752181 | DOI:10.1016/j.injury.2025.112621

Injury. 2025 Jul 28:112625. doi: 10.1016/j.injury.2025.112625. Online ahead of print.

ABSTRACT

INTRODUCTION: Uncontrolled rib fracture pain can lead to hypoventilation, impaired airway clearance, and progression to respiratory failure and death. Pain control is a mainstay of treatment, but pain assessments are most commonly obtained while a patient is at rest. A novel approach is to assess movement-evoked pain in order to better capture pain that limits physical function. We hypothesized that movement-evoked pain scores (MPS) for patients with rib fractures would be higher than resting pain scores (RPS) and would better correlate with opioid administration.

METHODS: A retrospective observational study was performed at a single Level 1 trauma center. Adult trauma patients (≥18 years old) admitted between January and March of 2022 with at least one rib fracture were included. Patients with other significant injuries (non-chest AIS >2) or those unable to self-report pain scores were excluded. Pain was scored on a 0-10 scale, with 10 indicating the most severe pain. RPS and MPS obtained at the same time during the first ten hospital days were averaged, and the means were compared using paired t-tests. Additionally, mean daily morphine milligram equivalents (MME) were analyzed.

RESULTS: The cohort consisted of 80 patients (median age 69 [IQR 48-79]; 65 % male; 88 % white). The majority were involved in blunt trauma (95 %) with a median length of admission of 4 days (IQR 2-8). The median number of rib fractures was 4 (IQR 2-6), and the median injury severity score was 10 (IQR 9-14). A total of 1692 paired pain scores from 416 patient hospital days were analyzed with higher mean daily MPS across all hospital days (p < 0.001). MPS and RPS differed for 79 % of patient hospital days, with a mean difference of 2.3 (SD 1.4, p < 0.001). Higher mean daily MPS were correlated with higher mean daily opioid use (R2=0.54), and days with differing scores had higher mean MME [42.5 (SD 49.6) vs 23.6 (56.1)].

CONCLUSIONS: Resting and movement-evoked pain scores for patients with rib fractures varied significantly, and movement-evoked pain scores were consistently higher. Opioid use was positively correlated with movement-evoked pain scores. Utilization of movement-evoked pain scores may improve patient pain control and outcomes.

PMID:40750533 | DOI:10.1016/j.injury.2025.112625

Injury. 2025 Jul 27:112628. doi: 10.1016/j.injury.2025.112628. Online ahead of print.

NO ABSTRACT

PMID:40750532 | DOI:10.1016/j.injury.2025.112628

Int Orthop. 2025 Aug 1. doi: 10.1007/s00264-025-06623-z. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the effectiveness of an intelligent fracture reduction robotic system in assisting closed reduction and intramedullary nailing of femoral shaft fractures with that of conventional fluoroscopy-assisted manual reduction and fixation.

METHODS: In this prospective, non-randomized controlled study, 30 patients with newly diagnosed femoral shaft fractures were enrolled, with 15 cases in the experimental group (robot-assisted) and 15 cases in the control group (conventional). The experimental group utilized an orthopaedic surgical navigation system to assist in closed reduction and intramedullary nailing, while the control group underwent fluoroscopy-assisted manual reduction and fixation. The reduction time, total operation time, intraoperative fluoroscopy count, blood loss, and reduction error were compared between the two groups.

RESULTS: Baseline characteristics were similar across both groups. The experimental group required significantly fewer intraoperative fluoroscopies (36.67 ± 25.41 vs. 117.26 ± 61.28, P < 0.001). Postoperative femoral length discrepancy (1.74 ± 1.37 mm) and anteversion difference (3.66 ± 3.37°) were significantly smaller in the experimental group compared to the control group (4.16 ± 2.67 mm, P = 0.004; 13.81 ± 9.58°, P = 0.001). Intraoperative blood loss was comparable between groups (experimental group: 207.33 ± 119.91 mL vs. control group: 240.00 ± 139.13 mL, P = 0.497). Reduction time was not statistically significant (experimental group: 74.27 ± 27.38 min vs. control group: 69.73 ± 34.10 min, P = 0.691).

CONCLUSIONS: The robot-assisted approach provided more precise fracture reduction, required fewer intraoperative X-ray fluoroscopies, and offered significant advantages over the conventional method for the minimally invasive treatment of femoral fractures.

PMID:40748453 | DOI:10.1007/s00264-025-06623-z

Injury. 2025 Jul 16:112617. doi: 10.1016/j.injury.2025.112617. Online ahead of print.

ABSTRACT

OBJECTIVE: Electrical burn injuries associated with copper wire theft represent a unique and dangerous subset of injuries observed in clinical practice. Economic hardship and the high value of copper wires drive some individuals to engage in the risky act of scavenging wires, often cutting them directly from live electrical poles. This study aims to investigate the prevalence and clinical outcomes of electrical burn injuries resulting from copper wire theft.

METHODS: This retrospective analysis reviewed medical records of patients presenting with electrical burns caused by contact with live electrical wires in urban settings. Cases were included if patient histories, eyewitness accounts, or police reports confirmed illegal wire cutting as the cause of injury. Data collected included demographic information, total body surface area (TBSA) burned, associated injuries such as fractures and amputations, creatine kinase (CK) levels, and mortality outcomes.

RESULTS: Thirty-six patients were included, with an average age of 27.72 (14.58) years, the majority of whom were male (97 %). The mean TBSA burned was 16.19 %. Fractures were reported in 22 patients (61 %), and 10 patients (28 %) underwent amputations of digits or limbs. Eight individuals (22 %) did not survive their injuries. Statistical analysis revealed a significant relationship between mortality and factors such as TBSA (P = 0.0001), amputation (P = 0.0001), CK levels, and ICU length of stay (P = 0.0001). Additionally, elevated CK levels were strongly correlated with longer ICU stays (P = 0.0001).

CONCLUSION: Electrical burn injuries linked to copper wire theft are severe and frequently lead to debilitating outcomes such as amputations, fractures, and high mortality rates. These injuries highlight the intersection of economic desperation and public health risk. Preventive efforts should prioritize educational campaigns, socio-economic interventions, and stringent measures to deter copper wire theft.

PMID:40744782 | DOI:10.1016/j.injury.2025.112617

Injury. 2025 Jul 27:112630. doi: 10.1016/j.injury.2025.112630. Online ahead of print.

ABSTRACT

BACKGROUND: Ideal blood transfusion practices have evolved over the last decade, with updated recommendations for the plasma:red blood cell (RBC) ratio. A ≥ 1:1 ratio of plasma:RBC has been associated with improved survival. The objective of the current study was to evaluate interhospital variation in plasma:RBC ratio and the associated inpatient mortality.

METHODS: All adult patients (≥18 years) with severe injuries undergoing transfusion within 4 hours of admission were identified in the 2020-2021 Trauma Quality Improvement Program database. Transfusion was considered balanced when whole blood or a ≥ 1:1 ratio of plasma:RBC units was administered. Multilevel mixed-effects models were utilized to generate empirical Bayesian estimates of random intercepts for risk-adjusted plasma:RBC ratio at each center, with centers in the highest quartile labeled High-Ratio Centers (HRC). Multivariable logistic regression was constructed to identify factors independently associated with mortality.

RESULTS: Of 35,215 patients receiving care across 424 facilities, 38.0% were admitted to HRC. An estimated 17% of plasma:RBC variation was attributable to hospital effects (intraclass correlation coefficient = 0.17). Following risk-adjustment, HRC (Adjusted Odds Ratio [AOR] 0.81, 95% Confidence Interval [CI] 0.76-0.86) and balanced transfusion (AOR 0.92, 95%CI 0.86-0.98) were associated with reduced odds of mortality. The association of HRC with lower odds of mortality persisted when examining only unbalanced transfusions (n = 28,280, AOR 0.84, 0.78-0.90 95%CI).

DISCUSSION: Care at centers with high plasma:RBC ratios was linked to reduced mortality, even among unbalanced transfusion. Our findings demonstrate the utility of this value as a hospital quality metric.

PMID:40744781 | DOI:10.1016/j.injury.2025.112630