Injury. 2025 Jan 31;56(3):112179. doi: 10.1016/j.injury.2025.112179. Online ahead of print.

ABSTRACT

INTRODUCTION: The older population, especially centenarians, is growing. Hip fractures significantly affect this demographic; however, studies on centenarians are limited. This study aimed to compare hip fracture mortality and associated risk factors between centenarians, nonagenarians, and octogenarians with focus on centenarians.

METHODS: Data from the Korean Health Insurance Review and Assessment database were retrospectively analyzed. Individuals aged ≥ 80 years with an ICD-10 diagnosis code (S72) and procedure codes indicative of hip fracture surgery between 2012 and 2022 were included. The primary outcome was mortality at 1, 3, 6 months, and 1 year postoperatively. The secondary outcomes included the prevalence of comorbidities and postoperative complications.

RESULTS: 131,746 patients were included (106,244 [80.6 %] octogenarians, 24,842 [18.9 %] nonagenarians, and 660 [0.5 %] centenarians). Centenarians had lower Charlson Comorbidity Index than that of nonagenarians and octogenarians (4.4, 4.9, and 5.7, respectively; P < 0.000). However, perioperative medical complications such as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), pneumonia, sepsis, and urinary tract infection increased linearly with age, significantly affecting centenarians. Mortality rates were highest in centenarians, especially within the first 3 postoperative months. The risk factors for 3-month mortality included the male sex (odds ratio [OR] 1.79, 95 % confidence interval [CI] 1.01-3.12, P = 0.046), and heart failure (OR 1.72, 95 % CI 1.07-2.79, P = 0.026) preoperatively, and AKI (OR 3.92, 95 % CI 1.97-7.82, P < 0.000), ARDS (OR 2.92, 95 % CI 1.04-8.23, P = 0.04), pneumonia (OR 1.91, 95 % CI 1.11-3.29, P = 0.02), and sepsis (OR 10.01, 95 % CI 3.52-28.45, P < 0.000) postoperatively.

CONCLUSION: Despite having fewer comorbidities, centenarians had the highest postoperative mortality, primarily due to organ dysfunction such as pneumonia, AKI, ARDS, and sepsis, rather than vascular events. Tailored medical management strategies focusing on these complications are crucial for improving centenarians outcomes.

PMID:39985925 | DOI:10.1016/j.injury.2025.112179

Injury. 2025 Feb 15;56(3):112215. doi: 10.1016/j.injury.2025.112215. Online ahead of print.

ABSTRACT

BACKGROUND: Cefazolin is the primary antibiotic for surgical prophylaxis in orthopedic procedures. The cessation of cefazolin supply in approximately 60 % of Japanese hospitals from 2019 to 2020 provided an opportunity to evaluate the effectiveness of alternative beta-lactams for preventing surgical site infection (SSI). Given the global potential for antibiotics shortages, confirming the effectiveness of alternative beta-lactams is critical.

PURPOSE: This study aims to evaluate the differences in risk of reoperation for SSI between cefazolin and alternative beta-lactams in patients undergoing lower extremity fracture surgeries.

METHODS: We emulated a target trial to compare the effectiveness of cefazolin with alternative beta-lactams-specifically broad-spectrum penicillins and cephalosporins-in preventing SSI using a Japanese hospital administrative database provided by JMDC Inc. We included patients undergoing initial open reduction and internal fixation for closed lower extremity fractures between March 1, 2019, and February 29, 2020. The outcome was reoperation for SSI within 30 days after surgery. Risks were estimated using pooled logistic regression with adjustment for confounders via inverse probability weighting. Sensitivity analyses extended the follow-up period to 90 and 365 days.

RESULTS: Of the 16,602 patients analyzed, 35 patients (0.30 %) in the cefazolin group (11,538 patients) and 16 patients (0.32 %) in the alternative beta-lactam group (5,064 patients) underwent reoperation for SSI within 30 days. The estimated 30-day risk was 0.31 % in the cefazolin group and 0.37 % in the alternative beta-lactam group, resulting in a risk difference of -0.06 % (95 % confidence interval [CI], -0.33 to 0.14) and a risk ratio of 0.82 (95 % CI, 0.50 to 1.52). In sensitivity analyses, the estimated 90-day risk was 0.67 % in the cefazolin group and 0.57 % in the alternative beta-lactam group, with a risk difference of 0.10 % (95 % CI, -0.15 to 0.32) and a risk ratio of 1.19 (95 % CI, 0.80 to 1.62). The 365-day risk was 1.02 % and 0.90 %, respectively, with a risk difference of 0.12 % (95 % CI, -0.29 to 0.39) and a risk ratio of 1.13 (95 % CI, 0.78 to 1.51).

CONCLUSIONS: In surgeries for lower extremity fractures, substituting cefazolin with alternative beta-lactams did not result in substantial differences in the risk of reoperation for SSI.

PMID:39983535 | DOI:10.1016/j.injury.2025.112215

Injury. 2025 Feb 15;56(3):112217. doi: 10.1016/j.injury.2025.112217. Online ahead of print.

ABSTRACT

INTRODUCTION: Fragility fractures of the proximal femur are common injuries with significant morbidity and mortality. The use of direct oral anticoagulant (DOAC) medications is increasing among the elderly and is associated with perioperative bleeding-related complications. The primary aim of this study was to examine how DOAC use affects surgical timing and postoperative hematologic complications in patients treated operatively for fragility fractures of the proximal femur. The effect of an institutional tranexamic acid (TXA) protocol implemented during the study period was investigated as a secondary aim.

MATERIALS AND METHODS: This was a retrospective analysis performed at a Level I trauma center. Between March 1, 2018 and April 1, 2022, 746 patients age 50 years and older who underwent surgical treatment for a fragility fracture of the femoral neck, intertrochanteric, or subtrochanteric region of the proximal femur (AO/OTA 31A, 31B, 32) and who were either on no chemical anticoagulation, warfarin, or a DOAC at the time of injury were included. The primary outcomes were time to operating room (TTOR), postoperative transfusion, 30-day venous thromboembolism (VTE), and 30-day hospital readmission. Multivariable logistic regression modeling was used to analyze the effect of anticoagulant, TXA use, and TTOR on these outcomes.

RESULTS: TTOR was increased for patients on warfarin (38.3 ± 26.1 h) or a DOAC (46.4 ± 23.4 h) compared to patients not on anticoagulation (28.0 ± 19.0 h) (p < 0.001). There was no significant difference in transfusion rates among patients not on anticoagulants (31.8 %), warfarin (43.4 %), or a DOAC (29.6 %). Multivariable regression showed a decrease in transfusion rate (OR 0.35, 95 % CI 0.23-0.53) and 30-day readmission (OR 0.31, 95 % CI 0.15-0.61) for intravenous (IV) TXA.

CONCLUSIONS: DOAC use was associated with an increase in TTOR without increased rates of transfusion, VTE, or hospital readmission in patients with fragility fractures of the proximal femur. Intravenous TXA was associated with reduced postoperative transfusion and 30-day readmission.

PMID:39983534 | DOI:10.1016/j.injury.2025.112217

Injury. 2025 Feb 15;56(3):112219. doi: 10.1016/j.injury.2025.112219. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporosis screening guidelines recommend bone mineral density (BMD) testing following fragility fractures. Nevertheless, previous studies have demonstrated low rates of osteoporosis screening. Diagnosis and treatment of osteoporosis is essential for prevention of future fractures, however not much is known about the factors associated with receiving BMD testing in this patient population. The purpose of this study was to evaluate the prevalence, timing, and predictors of BMD testing following distal radius fractures (DRF) in menopausal women.

METHODS: We queried a national insurance database to identify menopausal women aged 45-64 years with a DRF between years 2013 and 2020. The rate of BMD testing within 1 year of injury was calculated. Multivariable logistic regression analysis was used to evaluate the effect of patient- and injury-related variables on the likelihood of undergoing BMD testing following DRF.

RESULTS: Among 31,728 patients meeting inclusion criteria (mean ± SD age: 57.5 ± 4.3), 3,886 (12.2 %) received a BMD test within 1 year following DRF. The rate of BMD tests decreased with the highest rate of 14.5 % in 2015 and the lowest rate of 10.5 % in 2020. Mean time from DRF to BMD testing was 143 ± 102 days. Patients aged 60-64 had the highest adjusted odds of receiving BMD testing (OR 2.85 [95 % CI: 2.26 to 3.64]). Factors associated with increased likelihood of BMD testing included surgical intervention (OR 1.38 [1.28-1.48]), rheumatoid arthritis (OR 1.22 [1.06-1.40]), osteoarthritis (OR 1.28 [1.19-1.37]), breast cancer (OR 1.35 [1.16-1.56]), and vitamin D deficiency (OR 1.29 [1.17-1.43]). Factors associated with decreased likelihood of testing included tobacco use (OR 0.90 [0.84-0.97]), patients with Medicaid (OR 0.73 [0.61-0.86]) or Medicare (OR 0.76 [0.65-0.88]) insurance, and living in Southern (OR 0.67 [0.62-0.73]) or Western (OR 0.69 [0.62-0.77]) regions of the United States. Obesity, diabetes, renal disease, and early menopause were not associated with BMD testing.

CONCLUSIONS: Despite guidelines recommending BMD testing after low-energy fractures, rates of BMD testing were low and decreased among menopausal women with DRF. Mean time to BMD testing was 4.7 months, indicating substantial delays in workup. Known risk factors for osteoporosis did not reliably predict likelihood of BMD testing.

LEVEL OF EVIDENCE: Level III, prognostic.

PMID:39983533 | DOI:10.1016/j.injury.2025.112219

Injury. 2025 Feb 9;56(3):112206. doi: 10.1016/j.injury.2025.112206. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis (FFP) present a growing challenge in aging populations. However, standardized classifications and treatment guidelines remain scarce.

OBJECTIVE: This scoping review examines the application of fracture classifications, treatment strategies, and outcome evaluations for FFP, identifying gaps in the literature, and suggesting directions for future research.

METHODS: A systematic search of multiple electronic databases yielded 117 studies discussing FFP names, classifications, treatment approaches, and outcomes. Data extraction focused on study characteristics, classification systems, treatment details, outcomes, and follow-up periods. Residual analysis using the Chi-square test assessed statistical associations and underrepresentation.

RESULTS: The FFP classification was the most common (51.3%), with additional treatment indicators focused on immobility (44.4%) and pain assessment (using the Visual Analog Scale [VAS] or Numeric Rating Scale [NRS], 37.6%), consistent with existing guidelines. In contrast, the sacral insufficient fractures were statistically associated with pain indications but lacked corresponding classification application. Initial management typically involved conservative or observation period. Regarding the management indications and outcomes, surgical interventions were categorized into osteosynthesis and sacroplasty. Outcome evaluations often incorporated mobility and functional status (59.0%), hospitalization length (49.6%), mortality rates (41.0%), and post-treatment living conditions (41.0%). Patient recovery was assessed through VAS scores (59.0%) and Activities of Daily Living Patient-Reported Outcomes (ADL-PROs, 34.2%). However, inconsistencies in standardized outcomes, particularly in sacroplasty studies, hinder comparative analysis.

CONCLUSION: FFP classifications, along with pain and mobility assessments, were frequently applied as management indicators for FFP. Standardizing treatment indications and establishing consistent outcome measures, including the evidenced gap treatments (sacral insufficient fracture and cement augmentation), could significantly improve comparability across studies.

PMID:39983532 | DOI:10.1016/j.injury.2025.112206

J Bone Joint Surg Am. 2025 Feb 21. doi: 10.2106/JBJS.24.00332. Online ahead of print.

ABSTRACT

BACKGROUND: The medial patellofemoral ligament (MPFL) is the most important passive restraint of the medial patella and provides approximately 53% to 80% of medial soft-tissue restraints, although its relationship to the parapatellar structures is still not completely understood.

METHODS: Twenty-six formalin-fixed knees (13 for P45 plastination, 10 for dissection, and 3 for histology) were obtained from cadavers donated to the Department of Anatomy at Dalian Medical University. The mean age of the donors was 78.1 years (range, 52 to 95 years). These specimens were obtained from 4 women and 10 men. The integration of the anterior end of the MPFL with the extensor apparatus of the knee was observed, and the morphological observations were captured using a digital camera.

RESULTS: The MPFL was found to be attached to the extensor apparatus in 3 ways: its main fibers ran deep to the vastus medialis obliquus (VMO) tendon and ultimately inserted into it; its upper portion extended from, and was reinforced by, the vastus intermedius (VI) tendon; and its lower portion merged weakly into the parapatellar tendon. No direct attachment to the patella was found.

CONCLUSIONS: The MPFL attachments to the extensor apparatus occur in 3 locations: the VMO tendon, the VI tendon, and the parapatellar tendon-and not the patella. No direct attachment to that bone was identified. This study provides a comprehensive anatomical relationship between the MPFL and the extensor apparatus of the knee (the patella and quadriceps). Clinically, we suggest that reconstruction of the MPFL be performed with fixation of its anterior end to the VMO rather than to the patella.

PMID:39983008 | DOI:10.2106/JBJS.24.00332

J Bone Joint Surg Am. 2025 Feb 21. doi: 10.2106/JBJS.24.01274. Online ahead of print.

NO ABSTRACT

PMID:39982981 | DOI:10.2106/JBJS.24.01274

Int Orthop. 2025 Feb 21. doi: 10.1007/s00264-025-06438-y. Online ahead of print.

ABSTRACT

PURPOSE: Subtalar arthroereisis (STA) is a clinical intervention used for the correction of flexible flatfoot (FFF) in the paediatric population. This study aims to evaluate the radiographic, clinical, and patient-reported outcomes of STA for symptomatic FFF in paediatric patients with a minimum follow-up period of nine years.

METHODS: A cohort of 19 patients (38 feet) who underwent STA for FFF treatment between 2011 and 2015 was analyzed. This study featured a minimum follow-up period of nine years and involved comprehensive radiographic measurements. Clinical function assessment included footprint analysis classified using the Viladot classification, the Foot and Ankle Outcome Score (FAOS), and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale. We calculated the association between preoperative and postoperative angles and functional results. Receiver operating characteristic (ROC) curve analyses were conducted to establish the optimal threshold to predict good clinical outcomes.

RESULTS: The average age at the time of surgery was 11 ± 1.79 years, and the mean duration of follow-up was ten ± 1.4 years. After the surgical intervention, all foot angles showed statistically significant improvements. Normal foot alignment according to the Viladot classification was noted in 71% of patients. Good to excellent functional outcomes, as measured by both the AOFAS-hindfoot score and FAOS score, were reported in 84.2% of patients. Significant correlations were found between the preoperative and postoperative angles and functional results. Based on ROC curve analysis, the cut-off values were determined to be 28.5 degrees for the talonavicular coverage angle, 19.5 degrees for Meary's angle, and 37.5 degrees for the talar declination angle.

CONCLUSION: Our study indicates that STA is an effective procedure for durable deformity correction in paediatric patients with FFF. Restoring the medial longitudinal arch and correcting forefoot abduction are essential for improving functional outcomes. Both preoperative and postoperative angles were significantly associated with functional results, and the identified preoperative cut-off values are helpful for selecting surgical candidates.

PMID:39982464 | DOI:10.1007/s00264-025-06438-y

SICOT J. 2025;11:10. doi: 10.1051/sicotj/2025004. Epub 2025 Feb 20.

NO ABSTRACT

PMID:39977647 | PMC:PMC11841981 | DOI:10.1051/sicotj/2025004

SICOT J. 2025;11:9. doi: 10.1051/sicotj/2025003. Epub 2025 Feb 20.

ABSTRACT

There are many variables that influence the decision-making process in the treatment of rotator cuff calcifications. The stage of the deposit, prognostic factors, previous failed treatments, pain level, and functional disability must all be considered. The tendency for spontaneous resolution is an important reason to always exhaust conservative treatment, being non-invasive options the first line of treatment. The emergence of focused shock wave therapy offered a powerful tool for the non-invasive management of rotator cuff calcifications. High-energy focused shock waves have a high degree of recommendation for the treatment of rotator cuff calcifications, supported by meta-analyses and systematic reviews. If non-invasive techniques fail, there is the possibility of moving to a minimally invasive procedure such as ultrasound-guided barbotage. Finally, classic invasive techniques are also a frequent indication, including open surgery and arthroscopy. As each treatment has advantages and disadvantages, the most advisable strategy is to progress from the least invasive therapeutic methods to the most invasive ones without losing sight of the clinical stage of the disease and the general context of each patient.

PMID:39977646 | PMC:PMC11841982 | DOI:10.1051/sicotj/2025003

Injury. 2025 Feb 16;56(3):112221. doi: 10.1016/j.injury.2025.112221. Online ahead of print.

ABSTRACT

BACKGROUND: Road injuries remain a significant global health issue, contributing to a high burden of mortality and disability, particularly in low- and middle-income countries. Understanding the global trends in incidence, mortality, and Years Lived with Disability (YLDs) due to road injuries is essential for developing effective prevention strategies.

METHODS: We used data from the Global Burden of Disease (GBD) 2021 to analyze road injury trends from 1990 to 2021. Age-standardized incidence rates (ASIR), mortality rates (ASMR), and YLDs were calculated across different socio-demographic index (SDI) regions. Trends were assessed using the Estimated Annual Percentage Change (EAPC), and disparities by age, sex, and cause of injury were evaluated.

RESULTS: From 1990 to 2021, the global ASIR, ASMR, and YLDs due to road injuries showed a declining trend. However, road injury cases and deaths increased in low and middle-SDI regions, while declining in high-SDI regions. In 2021, the highest ASIR was observed in high-SDI regions (851.75 per 100,000 population), while low-SDI regions experienced the highest mortality rates (22.6 per 100,000 population). Males, particularly those aged 15-49 years, bore the greatest burden of road injuries, accounting for over 60% of YLDs globally. Pedestrian and motorcycle-related injuries were predominant in low-SDI regions.

CONCLUSION: While global road safety interventions have reduced the burden of road injuries, substantial disparities remain between SDI regions. Targeted interventions are needed to address the high burden of road injuries in low-SDI regions, focusing on improving infrastructure and healthcare access.

PMID:39978035 | DOI:10.1016/j.injury.2025.112221

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.01336. Online ahead of print.

NO ABSTRACT

PMID:39977550 | DOI:10.2106/JBJS.24.01336

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00371. Online ahead of print.

ABSTRACT

BACKGROUND: Nerve injuries in pediatric supracondylar humeral (SCH) fractures occur in 2% to 35% of patients. Previous research has suggested that isolated anterior interosseous nerve injuries are not influenced by the time to surgery; however, little is known about other nerve injuries or mixed, motor, and sensory injuries. With this study, we aimed to examine the impact of time to surgery on nerve recovery in patients with traumatic nerve injuries associated with SCH fractures.

METHODS: Patients <18 years of age with SCH fractures stabilized using percutaneous pins during the period of January 2009 to June 2022 were retrospectively reviewed. Patients presenting with any traumatic nerve injury noted preoperatively were included, while those with iatrogenic or postoperative nerve injuries and incomplete documentation were excluded. Demographic data, injury characteristics, time to surgery, and number of days to nerve recovery were collected. Comparisons of nerve recovery time by anatomic distribution and functional deficit using an 8-hour time-to-surgery cutoff were made in bivariate and multivariate analyses.

RESULTS: A total of 2,753 patients with SCH fractures were identified, with 214 of the patients having an associated nerve injury. Documentation of nerve recovery was available for 197 patients (180 patients with complete recovery) with an overall mean age of 6.8 ± 2.1 years. Time to recovery differed significantly when comparing the motor, sensory, and mixed-deficit cohorts (p < 0.001). Early surgery (≤8 hours from injury to surgery) was significantly associated with shorter overall time to nerve recovery (p = 0.002), recovery of multiple nerve distributions (p = 0.011), and recovery of mixed motor and sensory deficits (p = 0.007). On multivariable analysis, mixed nerve deficits (hazard ratio [HR], 0.537 [95% CI, 0.396 to 0.728]; p < 0.001) and time from injury to treatment of >8 hours (HR, 0.542 [95% CI, 0.373 to 0.786]; p = 0.001) were significantly associated with delayed nerve recovery.

CONCLUSIONS: Surgical timing impacts the time to recovery of complex nerve injuries. Early surgical management of patients with mixed motor-sensory deficits may help to reduce the time to complete nerve recovery.

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

PMID:39977536 | DOI:10.2106/JBJS.24.00371

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00108. Online ahead of print.

ABSTRACT

BACKGROUND: Changing from standing to sitting positions requires rotation of the femur from an almost vertical plane to the horizontal plane. Osteoarthritis of the hip limits hip extension, resulting in less ability to recruit spinopelvic tilt (SPT) while standing and requiring increased SPT while sitting to compensate for the loss of hip range of motion. To date, the effect of total hip arthroplasty (THA) on spinopelvic sitting and standing mechanics has not been reported, particularly in the setting of patients with coexistent sagittal plane spinal deformity.

METHODS: A retrospective review was performed of patients ≥18 years of age undergoing unilateral THA for hip osteoarthritis with sitting and standing radiographs made before and after THA. Alignment was analyzed at baseline and follow-up after THA in both standing and sitting positions in a relaxed posture with the fingers resting on top of the clavicles. Patients were grouped according to the presence or absence of sagittal plane deformity preoperatively into 3 groups: no sagittal plane deformity (normal), thoracolumbar (TL) deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10° and/or T1-pelvic angle [TPA] > 20°), or apparent deformity (PI-LL ≤ 10° and TPA ≤ 20°, but sagittal vertical axis [SVA] > 50 mm).

RESULTS: In this study, 192 patients were assessed: 64 had TL deformity, 39 had apparent deformity, and 89 had normal alignment. Overall, patients demonstrated a reduction in standing SVA (45 to 34.1 mm; p < 0.001) and an increase in SPT (14.6° to 15.7°; p = 0.03) after THA. There was a greater change in standing SVA (p < 0.001) among patients with apparent deformity (-29.0 mm) compared with patients with normal alignment (0.9 mm) and patients with TL deformity (-16.3 mm). Those with apparent deformity also experienced the greatest difference (p = 0.03) in postural SPT change (moving from standing to sitting) (-10.1°) from before to after THA when compared with those with normal alignment (-3.6°) and TL deformity (-1.2°). The difference in postural SVA change from before to after THA was also greatest (p < 0.001) in those with apparent deformity (32.1 mm) compared with those with normal alignment (6.5 mm) and TL deformity (17.3 mm).

CONCLUSIONS: Postural changes in spinopelvic alignment vary after THA depending on the presence of TL deformity or apparent deformity due to hip flexion contracture. Patients with apparent deformity had larger changes in standing and sitting alignment than patients with TL deformity or patients with normal alignment. The assessment of global sagittal alignment findings can be used to predict the likelihood of improvement in sagittal alignment after THA.

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

PMID:39977534 | DOI:10.2106/JBJS.24.00108

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.01339. Online ahead of print.

NO ABSTRACT

PMID:39977532 | DOI:10.2106/JBJS.24.01339

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00908. Online ahead of print.

ABSTRACT

BACKGROUND: Minimally invasive techniques such as percutaneous screw fixation have previously been shown to be mostly successful for pain relief and functional improvement in patients with pelvic metastases. In this study, we retrospectively reviewed the largest single-center cohort to date to further characterize the impact of this treatment on pain palliation, ambulation, and function; the predictors of suboptimal outcomes; and complications.

METHODS: Electronic medical records were reviewed. The primary outcome measures were pain, as assessed with use of the visual analog scale (VAS) score; functional status, as assessed with use of the Eastern Cooperative Oncology Group (ECOG) score; and ambulation, as assessed with use of the Combined Pain and Ambulatory Function Score (CPAFS), including preoperatively and postoperatively. Secondary outcome measures included radiographic evidence of fracture healing and the need for narcotics.

RESULTS: The study included 103 consecutive patients (42 men, 61 women) with a mean age of 64.1 years (range, 34 to 93 years) and a median follow-up of 14.4 months (range, 3 to 64 months) who underwent 107 procedures (bilateral in 4 patients). Sixty-nine had periacetabular lesions, whereas 38 had non-periacetabular lesions. VAS, ECOG, and CPAFS values improved from preoperatively at all time points (p < 0.001). Fifty-seven (85.1%) of the 67 patients presenting with a pathologic fracture demonstrated radiographic healing. A lack of radiographic healing was associated with a prolonged need for narcotics (p < 0.001). Six hips were converted to total hip arthroplasties, and 1 underwent a Girdlestone procedure. Complications were observed in 3 cases (2.8%).

CONCLUSIONS: Percutaneous screw fixation provided sustained benefits of pain relief and functional improvement in the treatment of metastatic pelvic lesions, with a low rate of complications. Bone healing after fixation was common. The risk of prolonged narcotic usage was higher in patients without evidence of bone healing.

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

PMID:39977531 | DOI:10.2106/JBJS.24.00908

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00888. Online ahead of print.

ABSTRACT

BACKGROUND: This study compared the functional outcomes of patients with open tibial shaft fractures who were randomized to either modern external ring fixation (EF) or internal fixation (IF). We hypothesized that there would be differences in patient-reported function between the treatment groups.

METHODS: This preplanned analysis of secondary outcomes from the FIXIT study, a multicenter randomized clinical trial, included patients 18 to 64 years of age with a Gustilo-Anderson Type-IIIB or severe-Type IIIA diaphyseal or metaphyseal tibial fracture who were randomly assigned to either IF (n = 132) or EF (n = 122). Follow-up visits occurred at 6 weeks and 3, 6, and 12 months after randomization. Outcomes included Short Musculoskeletal Function Assessment (SMFA) scores, the Veterans RAND 12-Item Health Survey (VR-12) physical component score (PCS), use of ambulatory assistive devices, and ability to ambulate.

RESULTS: The mean VR-12 PCS was slightly higher (better) for IF (24.8) than for EF (22.6) at 3 months (mean difference, 2.2 [95% confidence interval (CI): 0.2, 4.3]; p = 0.03) and trended higher for IF (27.0) compared with EF (25.3) at 6 months (mean difference, 1.8 [95% CI: -0.9, 4.4]; p = 0.19). However, there was no difference between the groups at 12 months. There were no clinically important or significant differences in SMFA Dysfunction and Bother scores between the treatment groups at any time point. EF was associated with a higher risk of using any ambulatory assistive device at 6 months (relative risk, 1.5 [95% CI: 1.21, 1.82]; p < 0.0001). The absolute percentage of patients using any ambulatory device was 37.6% for IF and 45.4% for EF at 1 year. There was no difference in ambulatory status between the treatment groups at any time point.

CONCLUSIONS: We found no difference in physical function between patients with severe tibial fractures treated with IF versus EF. There was a high rate of impairment overall. Assistive devices for walking were more often utilized in the EF group at 6 months, and both treatment groups demonstrated similar overall impairment.

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

PMID:39977529 | DOI:10.2106/JBJS.24.00888

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00044. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to determine the incidence of postoperative ileus (POI) after spine surgery and to identify risk factors for its development.

METHODS: A retrospective database study was performed between 2019 and 2021. A database of all patients who underwent spine surgery was searched, and patients who developed clinical and radiographic evidence of POI were identified. Demographic characteristics, perioperative data including opioid consumption, ambulation through postoperative day 1, surgical positioning, medical history, and surgical history were obtained and compared to examine risk factors for developing POI.

RESULTS: A total of 10,666 consecutive patients were identified who underwent cervical, thoracic, thoracolumbar, lumbar, or lumbosacral surgery with or without fusion. No patients were excluded from this study. The overall incidence of POI after spine surgery was 1.63%. POI was associated with a significantly greater mean length of stay of 7.6 ± 5.0 days compared with 2.9 ± 2.9 days in the overall cohort (p < 0.001). A history of ileus (odds ratio [OR], 21.13; p < 0.001) and a history of constipation (OR, 33.19; p < 0.001) were also associated with an increased rate of POI compared with patients without these conditions. Postoperatively, patients who developed POI had decreased early ambulation distance through postoperative day 1 at 14.8 m compared with patients who did not develop POI at 31.4 m (p < 0.001). Total postoperative opioid consumption was significantly higher (p < 0.001) in the POI group (330.3 morphine equivalent dose [MED]) than in the group without POI (174.5 MED). Lastly, patients who underwent fusion (p < 0.001), were positioned in a supine or lateral position (p = 0.03) (indicators of anterior or lateral approaches), had thoracolumbar or lumbar surgery (p = 0.01), or had multiple positions during the surgical procedure (p < 0.001) had a significantly higher risk of POI than those who did not.

CONCLUSIONS: The overall incidence of POI after all spine surgery is low. Several nonmodifiable predictors of POI include prior ileus, constipation, hepatitis, and prostatectomy. Multiple surgical factors increased the risk of POI, including supine positioning, surgery with the patient in multiple positions, and fusion. POI was associated with decreased early ambulation and increased opioid usage. Strategies should be implemented to maximize early ambulation and decrease opioid usage perioperatively.

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

PMID:39977528 | DOI:10.2106/JBJS.24.00044

J Bone Joint Surg Am. 2025 Feb 20. doi: 10.2106/JBJS.24.00313. Online ahead of print.

ABSTRACT

BACKGROUND: The late diagnosis rate of developmental dysplasia of the hip (DDH) with universal ultrasound screening is 0.2 per 1,000 children according to a recent meta-analysis, which is the same as in Japan where selective ultrasound screening is used. We hypothesized that Finland's current program of universal clinical screening complemented with targeted ultrasound is noninferior to universal and selective ultrasound screening programs.

METHODS: For this retrospective cohort study, we collected the number of children <15 years of age who were diagnosed with DDH (International Classification of Diseases, Tenth Revision [ICD-10] codes Q65.0-Q65.6 and Ninth Revision [ICD-9] code 7543) as their primary diagnosis after ≥3 visits to a physician. These data were obtained from the Finnish Care Register for Health Care, which collects the ICD-10 and ICD-9 codes from every medical appointment. We calculated the annual incidence of DDH diagnoses per 1,000 newborns between 2002 and 2021. Late diagnosis of DDH was defined as a finding of DDH in children aged 6 months through <15 years at the initial diagnosis who had undergone treatment under anesthesia (closed reduction and casting or surgery). We also registered the geographic, age, and sex distributions of the DDH diagnoses.

RESULTS: During the 20-year study period, 1,103,269 babies were born (median per year, 57,214 babies; range per year, 45,346 to 60,694 babies). A total of 6,421 children had a diagnosis of DDH (mean per year, 321 children; range per year, 193 to 405 children), with a mean calculated incidence of 5.8 per 1,000 newborns (95% confidence interval [CI], 5.7 to 6.0). Altogether, 120 children aged 6 months through <15 years were treated for DDH, with little annual variation (median, 6.5 children; range, 2 to 9 children). The mean national incidence of late-diagnosed cases was 0.11 per 1,000 newborns (95% CI, 0.09 to 0.13).

CONCLUSIONS: Finland's current DDH screening program, which includes universal clinical screening with targeted ultrasound, is noninferior when compared with other screening programs.

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

PMID:39977488 | DOI:10.2106/JBJS.24.00313

Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06457-9. Online ahead of print.

ABSTRACT

PURPOSE: Muscle mass and fatty infiltration can be assessed on computed tomography (CT) images using the cross-sectional area (CSA) and computed tomography attenuation value (CTV). Femoral head collapse in osteonecrosis of the femoral head (ONFH) may affect both values. We investigated factors influencing the CSA and CTV of the periarticular muscles in patients with ONFH.

METHODS: Overall, 101 patients with ONFH with unilateral hip pain (stage 2, 24 patients; stage 3 A, 49 patients; and stage 3B, 28 patients) were included. The CSA and mean CTV of the bilateral gluteus maximus (Gmax), gluteus medius (Gmed), gluteus minimus (Gmin), and iliopsoas (IP) muscles were measured using CT cross-sections. Bilateral comparisons and associations with Japanese Investigation Committee (JIC) stage were analysed. Multiple regression analysis was used to evaluate factors associated with the CSA and CTV.

RESULTS: On the symptomatic side, the CSA was significantly lower for the Gmax, Gmed, and IP, whereas the CTV was significantly lower for all tested muscles (all p < 0.01). The CTV, but not the CSA, of the Gmax, Gmed, and Gmin was significantly associated with the JIC stage severity bilaterally (all p < 0.01). Multiple regression analysis showed significant associations of the CTV with age, sex, and JIC stage (all p < 0.01).

CONCLUSION: Symptomatic ONFH leads to decreased muscle mass and increased fatty infiltration. Femoral head collapse progression is associated with a decrease in the CTV. Periarticular muscle assessment, including on the contralateral side, is important in patients with ONFH, particularly in older women.

PMID:39976738 | DOI:10.1007/s00264-025-06457-9