Int Orthop. 2025 Feb 20. doi: 10.1007/s00264-025-06434-2. Online ahead of print.

ABSTRACT

PURPOSE: Compression neuropathy is a common problem that results in impaired axonal conduction, and with time, numbness, tingling and weakness from muscle atrophy. Supercharge reverse end-to-side (SETS) nerve transfers have emerged as a novel approach to augment function in chronic nerve compression syndromes with minimal donor site morbidity. This review answers the question, "What are the indications, surgical techniques, and nuances of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies?".

METHODS: This article reviews current literature and technical components of the use of SETS in chronic nerve compression syndromes.

RESULTS: SETS nerve transfers improve functional outcomes and reduce disability in chronic nerve compression syndromes with limited donor site morbidity. SETS nerve transfers for ulnar, axillary, and femoral compressive neuropathy improve muscle strength, as demonstrated by increased MRC scores. It has also been shown that SETS transfers decrease clawing in ulnar nerve compression and pain in axillary nerve compression. More research is needed for SETS transfers for radial nerve compression neuropathies.

CONCLUSION: SETs nerve transfers have emerged as a novel approach to restore function and reduce pain and dysfunction in chronic nerve compression syndromes. SETS nerve transfers have minimal donor site morbidity and improve the strength and function of muscles innervated by the effected "recipient" nerve. This review explores the indications and surgical techniques of SETS nerve transfers for ulnar, axillary, radial, and femoral compression neuropathies as well as their reported outcomes.

PMID:39976737 | DOI:10.1007/s00264-025-06434-2

Injury. 2025 Jan 27;56(3):112166. doi: 10.1016/j.injury.2025.112166. Online ahead of print.

ABSTRACT

Despite substantial progress in road safety, road traffic fatalities (RTFs) continue to be a persistent issue in Australia. This study aims to forecast RTFs trends up to 2050 by analyzing factors such as geographic location, age, gender, speed limits, and time of occurrence. Utilizing historical data from 1989 to 2024, fatalities were categorized by road user type, demographics, and day of the week. The Facebook Prophet time series model, incorporating categorical variables like region, age, and speed limits, was employed to predict future trends. The analysis reveals significant regional disparities in fatality reduction rates, with some areas lagging others. Gender-specific forecasts indicate a sharper decline in male fatalities compared to females, while projections highlight persistent risks for older drivers. Additionally, highways with higher speed limits are expected to see a substantial decrease in fatalities. These insights emphasize the need for targeted interventions in areas with slower reductions and high-risk demographic groups, aiding policymakers in refining safety measures, enforcing speed limits, and enhancing public awareness campaigns.

PMID:39970494 | DOI:10.1016/j.injury.2025.112166

J Bone Joint Surg Am. 2025 Feb 19. doi: 10.2106/JBJS.24.00544. Online ahead of print.

ABSTRACT

BACKGROUND: Increasing U.S. health-care costs raise concerns regarding the sustainability of the U.S. health-care system, with the potential for negative effects on the mental and physical health of patients. Orthopaedic injuries often impose considerable financial burdens on patients and hospitals, but the trends in, and drivers of, costs remain unclear. This study evaluated the total expenditure and out-of-pocket (OOP) costs of patients with a lower-extremity (LE) fracture in the non-institutionalized U.S. population from 2010 to 2021.

METHODS: A total of 3,016 participants with an LE fracture from the Medical Expenditure Panel Survey (MEPS) were propensity score matched with 15,080 MEPS participants with no LE fracture. Patients with an LE fracture were predominantly between 40 and 64 years old (43.2%), female (66.0%), and White (78.8%). Total expenditure and OOP costs were compared between the groups. A multivariable regression analysis was performed to identify factors that were associated with costs. Outcomes were adjusted on the basis of the 2022 Consumer Price Index.

RESULTS: Patients with an LE fracture had greater total expenses than the control group ($20,230 [95% confidence interval (CI), $18,916 to $21,543] versus $10,678 [95% CI, $10,302 to $11,053]; p < 0.001) as well as greater OOP costs ($1,634 [95% CI, $1,516 to $1,753] versus $1,089 [95% CI, $1,050 to $1,128]; p < 0.001). Between 2010 and 2021, total expenses increased more for patients with an LE fracture than for the control group (101.2% versus 51.4%; p < 0.001), whereas OOP costs increased to a lesser degree in both groups (61.1% versus 44.5%; p = 0.17). In the LE fracture group, total expenditure was driven by inpatient care, office-based visits, and prescription costs, whereas OOP costs were driven by office-based visits, prescription costs, and "other" sources. Femoral fracture, hospitalization, and certain comorbidities were associated with higher total expenses. Hospitalization, uninsured status, and a higher income level were associated with increased OOP costs, whereas African American or Hispanic background and a lower educational level were associated with lower OOP costs.

CONCLUSIONS: An LE fracture was associated with considerable total expenditure and OOP costs, which increased disproportionately compared with general health-care costs over the past decade. Post-hospitalization care was the biggest driver of both total expenses and OOP costs. Due to limitations inherent to the MEPS database, the impact of financial burden on not only payers but also individuals and their medical decision-making remains unclear and requires further investigation.

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

PMID:39970239 | DOI:10.2106/JBJS.24.00544

J Bone Joint Surg Am. 2025 Feb 19. doi: 10.2106/JBJS.24.00589. Online ahead of print.

ABSTRACT

BACKGROUND: Computer navigation and patient-specific instrumentation have been in use over the past 2 decades for total knee replacement (TKR). However, their effects on implant survival and patient-reported outcomes remain under debate. We aimed to investigate their influence on implant survival, outcomes of the Oxford Knee Score (OKS) and health-related quality of life (EQ-5D-3L), intraoperative complications, and postoperative mortality compared with conventional instrumentation, across a real-world population.

METHODS: This observational study used National Joint Registry (NJR) data and included adult patients who underwent primary TKR for osteoarthritis between April 1, 2003, and December 31, 2020. The primary analysis evaluated revision for all causes, and secondary analyses evaluated differences in the OKS and EQ-5D-3L at 6 months postoperatively, and mortality within 1 year postoperatively. Weights based on propensity scores were generated, accounting for several covariates. A Cox proportional hazards model was used to assess revision and mortality outcomes. Generalized linear models were used to evaluate differences in the OKS and EQ-5D-3L. Effective sample sizes were computed and represent the statistical power comparable with an unweighted sample.

RESULTS: Compared to conventional instrumentation, the hazard ratios (HRs) for all-cause revision following TKR performed using computer navigation and patient-specific instrumentation were 0.937 (95% confidence interval [CI], 0.860 to 1.021; p = 0.136; effective sample size [ESS] = 91,607) and 0.960 (95% CI, 0.735 to 1.252; p = 0.761; ESS = 13,297), respectively. No differences were observed in the OKS and EQ-5D-3L between conventional and computer-navigated TKR (OKS, -0.134 [95% CI, -0.331 to 0.063]; p = 0.183; ESS = 29,135; and EQ-5D-3L, 0.000 [95% CI, -0.005 to 0.005]; p = 0.929; ESS = 28,396) and between conventional TKR and TKR with patient-specific instrumentation (OKS, 0.363 [95% CI, -0.104 to 0.830]; p = 0.127; ESS = 4,412; and EQ-5D-3L, 0.004 [95% CI, -0.009 to 0.018]; p = 0.511; ESS = 4,285). Mortality within 1 year postoperatively was similar between conventional instrumentation and either computer navigation or patient-specific instrumentation (HR, 1.020 [95% CI, 0.989 to 1.052]; p = 0.212; ESS = 110,125).

CONCLUSIONS: On the basis of this large registry study, we conclude that computer navigation and patient-specific instrumentation have no statistically or clinically meaningful effect on the risk of revision, patient-reported outcomes, or mortality following primary TKR.

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

PMID:39970237 | DOI:10.2106/JBJS.24.00589

J Bone Joint Surg Am. 2025 Feb 19;107(4):e12. doi: 10.2106/JBJS.24.01070. Epub 2025 Feb 19.

NO ABSTRACT

PMID:39969497 | DOI:10.2106/JBJS.24.01070

J Bone Joint Surg Am. 2025 Feb 19;107(4):e11. doi: 10.2106/JBJS.24.01050. Epub 2025 Feb 19.

NO ABSTRACT

PMID:39969496 | DOI:10.2106/JBJS.24.01050

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06448-w. Online ahead of print.

ABSTRACT

BACKGROUND: Knee synovial chondromatosis (SC) is a rare joint disorder involving loose cartilaginous bodies, leading to pain, swelling, and impaired function. Arthroscopy has become a primary treatment option, but its efficacy and recurrence rates remain debated. This systematic review evaluates the effectiveness and safety of arthroscopic interventions, focusing on loose body removal, partial synovectomy, and total synovectomy.

METHODS: A systematic search of PubMed and EMBASE (1985-2024) identified studies on arthroscopic treatment of knee SC, adhering to PRISMA guidelines. Inclusion criteria targeted original studies detailing outcomes of loose body removal with or without synovectomy. Data on patient demographics, surgical techniques, and outcomes were extracted, with recurrence as the primary outcome. Qualitative synthesis was conducted due to heterogeneity among studies.

RESULTS: The review included 84 patients (median age: 36 years, range: 7-67). Loose body removal alone was performed in 57.8%, partial synovectomy in 30.9%, and total synovectomy in 13%. Median follow-up was 28 months. Recurrence occurred in 22.6%, predominantly after loose body removal alone. Complication rates were negligible, with only one reported instance unrelated to the arthroscopic procedure.

CONCLUSIONS: Arthroscopic treatment is safe and effective for knee SC. Recurrence rates underscore the importance of synovectomy in preventing disease recurrence. Total synovectomy may offer superior outcomes for advanced cases. Further research with standardized protocols and extended follow-up is needed to optimize treatment strategies.

PMID:39969591 | DOI:10.1007/s00264-025-06448-w

Int Orthop. 2025 Feb 19. doi: 10.1007/s00264-025-06424-4. Online ahead of print.

ABSTRACT

PURPOSE: Implant-associated infections are the most challenging complication in orthopaedics and trauma surgery as they often lead to long courses of illness and are a financial burden for the healthcare system. There is a need for fast, simple, and cheap identification of pathogens but the ideal detection method was not found yet. The work aims to test whether the detection of pathogens culturing the removed implant is more successful than from simultaneously taken tissue samples or punction fluid.

METHODS: Implants were removed due to infection, irritation, or loosening. Tissue samples and joint fluids were processed for bacterial growth in sterile conditions. Samples were incubated and checked for growth. Bacterial identification and antibiotic sensitivity testing were performed. Data were anonymized, and statistical analysis was done using Excel and SAS, employing tests like Shapiro-Wilk, Mann-Whitney-U, and Kruskal-Wallis. Ethical approval was obtained for this study.

RESULTS: Between February 2018 and April 2019, a total of 163 patients (175 cases) underwent orthopaedic implant removal for various reasons. 30 cases were not usable or analyzable due to missing or damaged reference material, so 145 cases could be evaluated due to study protocol. The range of detected bacteria was as expected and included low-virulent bacteria such as Micrococcus luteus and Corynebacteria. Pathogen detection by culture of the the explant´s was more sensitive (84.83%) than pathogen detection from tissue samples and punction fluid (64.14%, p<0.0001). Comorbidities did not play any role in the quality of detection but prior antibiotic treatment did influence the results of tissue diagnostics.

CONCLUSION: This study showed with a higher frequency of bacterial detection of orthopedic explant´s surface compared to tissue samples or punction fluid. This may reduce the number of samples and cost but enhances the quality of orthopaedic implant-related infection diagnostics.

PMID:39969590 | DOI:10.1007/s00264-025-06424-4

Injury. 2025 Feb 10:112214. doi: 10.1016/j.injury.2025.112214. Online ahead of print.

ABSTRACT

BACKGROUND: Houselessness is associated with increased mortality and unmet health needs. Current understanding of traumatic injury in houseless patients is limited.

METHODS: This is a retrospective matched cohort study among houseless and housed adults, admitted to an urban, safety net, level I trauma center from 1/1/2018-12/31/2021. Houseless patients were matched with their housed counterparts 1:2 based on age, sex, injury severity score (ISS) and nature of injury. The primary outcome was in-hospital adverse events. Secondary outcomes included hospital length of stay (LOS), outpatient follow-up, emergency department (ED) utilization post-injury, and readmission. Conditional multivariable regression was used to determine associations between the exposure and outcomes.

RESULTS: 1413 patients were included; 471 houseless patients and 942 matched controls. Median [IQR] age was 42 years [31-58] and median [IQR] ISS was 9 [5-13] for all patients. About 30 % of traumatic injuries were violent in nature. Median [IQR] total LOS was longer for houseless patients (4.4 days [2.0-8.3] vs. 3.1 days [1.4-6.5], p < 0.001). Houseless patients were more frequently admitted to the ICU (5 % versus 3 %, p = 0.045). The rate of any in-hospital adverse event was similar (houseless 17 % vs. housed 16 %, p = 0.537). Adjusting for age, sex, language, insurance, ISS, nature of injury, injury mechanism, ICU admission, and operative intervention, houselessness was inversely associated with outpatient follow-up (OR 0.60, 95 % CI 0.46-0.79) and positively associated with ED representation (OR 2.49, 95 % CI 1.64-3.78) and hospital readmission (OR 4.35, 95 % CI 3.19-5.92).

CONCLUSIONS: Housing status was not associated with increased in-hospital morbidity or mortality in trauma patients in a single institution cohort of trauma patients. Unhoused patients had lower odds of completing outpatient injury-specific follow-up and higher odds of utilizing the ED within 30 days of discharge. These findings highlight gaps in post-discharge care coordination and underscore opportunities to improve discharge services for this population.

PMID:39966000 | DOI:10.1016/j.injury.2025.112214

Injury. 2025 Feb 12;56(3):112213. doi: 10.1016/j.injury.2025.112213. Online ahead of print.

ABSTRACT

Foot and ankle soft tissue defects with exposed bone pose significant challenges in wound healing and patient satisfaction OBJECTIVE: The study aims to assess the impact of nursing care quality and patient satisfaction on optimizing outcomes for complex foot and ankles injuries, focusing on the timing of rh-FGF administration after reconstructive surgery METHODS: This study included eighteen patients (15 males and 3 females) with traumatic foot and ankle soft tissue defects and exposed bone wounds, treated between January 2021 and December 2022. Patients were randomly assigned to three groups, underwent reconstructive surgery, and received rh-bFGF at varying times postoperatively. Key outcomes included wound healing time, hospital stay duration, satisfaction with nursing care scale, American Orthopedic Foot and Ankle Society (AOFAS) score, and Visual Analogue Scale for pain. All patients were followed for at least three months RESULTS: The study population had an average age of 41.1 years, with a range from 16 to 74 years. Findings indicated an average hospital stay of 17 days and a corresponding wound healing time of 17 days. At three months post-operation, the average American Orthopedic Foot and Ankle Society (AOFAS) score was 88. A notable 88.9 % of patients expressed satisfaction with the attentiveness of nursing staff and the privacy afforded to them. Furthermore, 84.3 % rated the nurses' competence positively, and 83.3 % appreciated the support provided to family and friends, along with personalized care and nurses' expertise in patient management. The results demonstrated a consistent trend of improvement in all assessed outcomes across the three treatment groups. Patients in Group 1, who received rh-bFGF one day after surgery, demonstrated the most favorable outcomes. This was followed by Group 3, which received rh-bFGF until ischemic changes were noted. In contrast, Group 2, which received rh-bFGF once inflammatory granulation had subsided, exhibited the least improvement CONCLUSION: The results of this study highlight the crucial role of timing in the administration of rh-bFGF for optimizing soft tissue repair in patients with foot and ankle defects. Timely application of rh-bFGF post-surgery is essential for achieving favorable patient outcomes, improving patient satisfaction with nursing care, and facilitating faster recovery.

PMID:39965533 | DOI:10.1016/j.injury.2025.112213

J Bone Joint Surg Am. 2025 Feb 18. doi: 10.2106/JBJS.24.00433. Online ahead of print.

ABSTRACT

BACKGROUND: The impact of radiation exposure on cataracts and hand skin cancer in orthopaedic and spine surgeons remains understudied. This study aimed to investigate the prevalence of cataracts and chronic hand inflammation in orthopaedic and spine surgeons and to assess their association with radiation exposure.

METHODS: A cross-sectional analysis was conducted on orthopaedic and spine surgeons attending the 38th Annual Meeting of the Neurospinal Society of Japan or the 31st Annual Meeting of the Japanese Society for the Study of Low Back Pain. Cataractous changes were categorized into none, lens micro-opacity, or cataracts and were detailed alongside the prevalence of chronic hand inflammation, which included longitudinal melanonychia and hand eczema. Participants were divided into quartiles according to hand-exposure opportunities in the operating and fluoroscopy rooms in 2022. Prevalence ratios and 95% confidence intervals (CIs) of chronic hand inflammation in the upper quartiles relative to the first quartile were calculated using modified Poisson regression adjusted for potential confounders.

RESULTS: The median work experience of the 162 participants was 23 years, and the median number of hand-exposure opportunities was 70 (interquartile range [IQR], 20 to 123) in the operating room and 20 (IQR, 0 to 60) in the fluoroscopy room. The prevalence of cataracts was 20% (32 participants), and the prevalence of cataractous changes, including lens micro-opacity, was 40% (64 participants). Chronic hand inflammation was present in 62 participants (38%), of whom 52 had longitudinal melanonychia and 23 had hand eczema. The adjusted prevalence ratios of chronic hand inflammation relative to the lowest quartile of hand-exposure opportunities in the operating room were 0.91 (0.50, 1.66) for quartile 2, 0.72 (0.41, 1.25) for quartile 3, and 1.56 (0.97, 2.50) for quartile 4. For fluoroscopy room exposure, the adjusted prevalence ratios were 2.31 (1.16, 4.58) for quartile 2, 2.03 (1.00, 4.09) for quartile 3, and 2.94 (1.51, 5.75) for quartile 4.

CONCLUSIONS: This study highlighted substantial cataractous and chronic hand inflammatory changes in spine surgeons, indicating indirect and direct radiation exposure effects. Therefore, radiation safety and protective measures must be emphasized. Comparative studies with other populations and longitudinal observations are required to better understand the effects of radiation on health.

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

PMID:39965042 | DOI:10.2106/JBJS.24.00433

J Bone Joint Surg Am. 2025 Feb 18. doi: 10.2106/JBJS.24.00196. Online ahead of print.

ABSTRACT

BACKGROUND: Patient-reported outcome measures (PROMs) are used to evaluate the impact of musculoskeletal conditions and their treatment on patients' quality of life, but they have limitations, such as high responder burden and floor and ceiling effects. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to address these issues but needs to be further evaluated in comparison with legacy PROMs. The goals of this study were to evaluate the floor and ceiling effects of, the correlations between, and the predictive ability of PROMIS scores compared with traditional legacy measures at 10-year follow-up in a cohort who underwent revision anterior cruciate ligament (ACL) reconstruction.

METHODS: A total of 203 patients (88.7% White; 51.7% female) who underwent revision ACL reconstruction completed the PROMIS via computer adaptive tests as well as legacy PROMs at the cross-sectional, 10-year follow-up of the longitudinal MARS cohort study (MARS cohort n = 1,234). Floor and ceiling effects and Spearman rho correlations between PROMIS and legacy measures are reported. Linear regression with quadratic terms were used to develop and evaluate conversion equations to predict legacy scores from the PROMIS.

RESULTS: No floor or ceiling effects were reported for the PROMIS Physical Function (PF) domain, whereas a floor effect was found for 37.9% of the participants for the PROMIS Pain Interference (PI) domain, and a ceiling effect was found for 34.0% of the participants for the PROMIS Physical Mobility (PM) domain. PROMIS domains correlated moderately with the International Knee Documentation Committee total subjective score (absolute value of rho [|ρ|] = 0.68 to 0.74), fairly to moderately with the Knee injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index scores (|ρ| = 0.52 to 0.67), and fairly with the Marx Activity Rating Scale (|ρ| = 0.35 to 0.44). None of the legacy-measure scores were accurately predicted by the PROMIS scores.

CONCLUSIONS: The PROMIS PF domain has value in assessing patients 10 years after revision ACL reconstruction. Because of floor and ceiling effects, using the PI and PM domains may not allow for precision when measuring long-term changes in pain and mobility. Although the PROMIS measures correlated with the legacy measures, with effect sizes ranging from fair to moderate, the legacy scores were not accurately predicted by the PROMIS. The results suggest that knee-specific legacy measures should not be eliminated from long-term follow-up when the goal is to capture the specific knee-related information that they provide.

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

PMID:39965036 | DOI:10.2106/JBJS.24.00196

Int Orthop. 2025 Feb 18. doi: 10.1007/s00264-025-06443-1. Online ahead of print.

ABSTRACT

PURPOSE: To investigate the effects of adding immediate weight-bearing to tolerance into a post-operative rehabilitation program for surgically treated Tibial Plateau (TP) fractures on clinical and radiological outcomes.

METHODS: A randomized control trial. 106 Patients were recruited following open reduction internal fixation (ORIF) TP fracture, with 54 patients meeting the criteria for inclusion. Patients were assigned randomly into one of two groups: (1) the traditional group (TG) and (2) the weight-bearing group (WG). The TG was given the non-weight-bearing (NWB) rehabilitation protocol for six weeks. The WG was allowed immediate weight-bearing, and the same therapeutic exercise program was given to both groups. The dependent variables, including clinical and radiological measurements, were recorded six weeks, three months, and six months after the surgery.

RESULTS: A total of 45 patients (11 women and 34 men), with a mean age of 43 ± 14 years, completed the study. There were significant differences between groups in favor of the WG at 6-months for the total clinical Rasmussen score (p =.002) as well as for the pain (p =.005), walking capacity (p =.002), and knee ROM (p =.047). We found neither difference between groups regarding radiological CT- Scan and X-ray measures nor Rasmussen's radiological scores (p =.854). Fracture type (Schatzker I-IV) did not affect any radiological measures between the groups. Four of 45 patients had intra-articular collapse, three in TG and one in WG (p =.571).

CONCLUSION: Immediate weight-bearing as tolerated after ORIF of TP fractures (Schatzker I-IV) resulted in better clinical outcomes with no significant differences in the radiological measures.

PMID:39964437 | DOI:10.1007/s00264-025-06443-1

Injury. 2025 Feb 12;56(3):112212. doi: 10.1016/j.injury.2025.112212. Online ahead of print.

ABSTRACT

INTRODUCTION: Achilles tendon rupture (ATR) carries a high risk of venous thrombo-embolism (VTE) whether the injury is managed surgically or non-operatively. This study reports symptomatic VTE rate following ATR. The influence of patient demographics, treatment type and use of chemical thromboprophylaxis is examined.

MATERIALS AND METHODS: Observational cohort study. The data is from a multi-centre, prospective, national audit of patients from 68 participating United Kingdom centres. Data was prospectively collected from hospital records. The study was conducted between June and November 2022, with a 3-month follow up.

RESULTS: Of 11,363 participants in the National Audit, 9.5 % (n = 1084) had experienced an ATR. Management strategies included both non-surgical (74 %) and surgical (26 %). Following ATR, the VTE rate was 3.69 % (n = 40) compared to 0.57 % (n = 59) for other foot and ankle surgeries. Participants who developed symptomatic VTE after ATR were older than those who did not (mean age 54 years (95 %CI 50.5 - 54.7) vs 48 years (95 %CI 47.3 - 49.1)). There was no significant difference in VTE events due to participant sex, ethnicity or number of comorbidities. Differences in treatment regimen, such as weight-bearing status and immobilisation strategy, showed no significant difference in symptomatic VTE events between groups.

CONCLUSION: After ATR, patients are 6.5-times more likely to experience symptomatic VTE than those recovering from surgery for other foot and ankle pathology. There was no significant difference in symptomatic VTE rate after ATR with specific chemical prophylaxis or early mobilisation strategies.

PMID:39961162 | DOI:10.1016/j.injury.2025.112212

J Bone Joint Surg Am. 2025 Feb 17. doi: 10.2106/JBJS.24.00324. Online ahead of print.

ABSTRACT

BACKGROUND: Sport participation has been associated with favorable outcomes following hip arthroscopy (HA) for femoroacetabular impingement (FAI) at short- and mid-term follow-up; however, few studies have evaluated the 10-year outcomes in this population. The purpose of this study was to compare patient-reported outcome measures (PROMs), the achievement of clinically significant outcomes, and reoperation-free survivorship between patients with and without regular preoperative sport participation who underwent HA for FAI and had a minimum of 10 years of follow-up.

METHODS: Data were prospectively collected for patients who underwent primary HA for FAI between January 2012 and September 2013. Patients who participated in weekly sport participation at the time of surgery ("athletes") were matched 1:1 to patients who denied sport participation ("nonathletes"), controlling for age, sex, and body mass index (BMI). Preoperative and 10-year postoperative PROMs were collected, including the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports (HOS-Sports) subscales, the modified Harris hip score (mHHS), and the visual analog scale for pain (VAS Pain) and satisfaction (VAS Satisfaction). Patient acceptable symptom state (PASS) achievement and reoperation-free survivorship were compared between the groups.

RESULTS: Sixty-four athletes were matched to 64 nonathletes of similar age, sex, and BMI (p ≥ 0.411). In the athlete group, 85.9% were recreational-level athletes. The groups had similar preoperative PROMs, except for the HOS-ADL subscale, where the athlete group demonstrated a higher preoperative score (67.8 ± 16.7 versus 59.9 ± 21.1, p = 0.029). Both groups demonstrated a significant improvement in all PROMs (p < 0.001) at the minimum 10-year follow-up10.3 ± 0.4 years). At the time of the final follow-up, the athlete group demonstrated significantly higher scores across all of the measured PROMs (p ≤ 0.036). Athletes showed a higher cumulative PASS achievement compared with nonathletes for the HOS-ADL subscale (73% versus 50%, p = 0.033), the HOS-Sports subscale (85% versus 61%, p = 0.010), the mHHS (69% versus 43%, p = 0.013), and the VAS Pain (78% versus 51%, p = 0.006). Reoperation-free survivorship frequencies were 87.5% and 82.8%, respectively (p = 0.504).

CONCLUSIONS: Athletes who underwent contemporary HA for FAI showed superior PROMs and PASS achievement compared with nonathletes at the 10-year follow-up. Athletes and nonathletes showed reoperation-free survivorship frequencies of 87.5% and 82.8%, respectively.

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

PMID:39960979 | DOI:10.2106/JBJS.24.00324

Int Orthop. 2025 Feb 17. doi: 10.1007/s00264-025-06405-7. Online ahead of print.

ABSTRACT

PURPOSE: To examine the effectiveness of a novel bone graft reduction technique with a bone tamp impactor instrument in minimally invasive treatment of tibial plateau collapse fractures through arthroscopic and imaging evaluation.

METHODS: This is a retrospective analysis of prospectively collected data on patients with tibial plateau collapse fracture who received the novel bone graft reduction procedure with a bone tamp impactor instrument for minimally invasive treatment of tibial plateau collapse fractures in a tertiary referral university hospital from February 2021 to March 2023. Patients were classified according to a classification combined with Schatzker classification, AO classification and three-column classification. Arthroscopy evaluation and radiographs were used to measure the reduction effect.

RESULTS: A total of 196 patients were eligible and included. Compared to the preoperative values, post-ADD(c) showed a significant reduction improvement (P = 0.000-0.007), ranging from 87.9 to 96.6% for different classifications. The post-ADD (s) have decreased by 87-96.8% (P = 0.000-0.039), the post-FFG and post-TPW reduced by 87.5-100% (P = 0.000-0.026) and 34.2-63.5% (P = 0.000-0.075) respectively. Additionally, the lower limb alignment have been significantly corrected, with notable changes in post-MPTA (P = 0.000-0.081), post-PTSA (P = 0.000-0.178) and post-FTA (P = 0.000-0.069) for different types of fracture, measured one day after surgery. Arthroscopic evaluation indicated that the average articular surface depression depth was less than 4 mm, and over 60% achieved a depression depth of less than 2 mm. All patient achieved a less than 2 mm of postoperative fracture fragment gap, with over 50% achieving a gap of less than 1 mm. None of patients experienced neurovascular injury or wound infection.

CONCLUSION: The novel bone graft reduction technique utilizing a bone tamp impactor instrument can achieve effective reduction in all types of tibial plateau collapse fractures. This method may prove to be a useful option for minimally invasive treatment of tibial plateau fractures.

PMID:39960508 | DOI:10.1007/s00264-025-06405-7

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

ABSTRACT

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

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

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

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

ABSTRACT

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

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

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

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

LEVEL OF EVIDENCE: III.

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

Injury. 2025 Feb 7;56(3):112205. doi: 10.1016/j.injury.2025.112205. Online ahead of print.

ABSTRACT

OBJECTIVES: TAD > 25 mm is a risk factor for cut-out in intramedullary nailing. Less attention has been given to the risk factors for central cut-through and the possible outcomes of TAD <10 mm. Furthermore, the risk of cut-through depending on minimum depth on either anterior-posterior (AP) or lateral views has not been explored. The goal of this study is to outline the parameters that increase risk of cut-through in intertrochanteric hip fractures.

METHODS: A retrospective review of 2128 intertrochanteric hip fractures admitted to a single level 1 academic trauma center from 2014 - 2023 was conducted. Variables included patient and operative characteristics, fracture fixation device, fracture type based on OTA/AO 2018 classification, TAD, neck-shaft angle and radiographic and clinical outcomes.

RESULTS: TAD <10 millimeters carried a significantly higher risk for lag screw and blade cut-through. Cut-through risk increased significantly when either AP or lateral apex-to-center distance was <4 millimeters, including when comparing fracture reduction quality for a cohort including sliding hip screws, lag screws and blades. Cut-out complications in this cohort only occurred with a TAD >10 mm and was significantly more likely to occur with TAD >25 mm, similar to prior studies.

CONCLUSION: TAD optimization between 10 and 25 mm reduces risk of both cut-out and cut-through and maintenance of 4 mm of distance between apex-to-center distance may help decrease the risk of cut-through complications.

PMID:39954635 | DOI:10.1016/j.injury.2025.112205

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

ABSTRACT

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

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

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

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

LEVEL OF EVIDENCE: IV.

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