Int Orthop. 2025 Feb 15. doi: 10.1007/s00264-025-06446-y. Online ahead of print.

ABSTRACT

PURPOSE: Symphyseal diastasis accounts for 13-16% of pelvic ring injuries. Symphyseal plating via a Pfannenstiel approach was the standard method of fixation for symphysis diastasis. Recently, percutaneous reduction and fixation of pelvic fractures have been employed to treat various pelvic ring and acetabulum injuries. The current study aims to compare the clinical and radiological results of treatment of symphysis pubis diastasis using symphyseal plating and percutaneous symphyseal screws.

METHODS: It is a retrospective study conducted at a trauma centre at academic level I. One hundred and ten patients were identified in our records. Sixty patients were excluded according to our exclusion criteria. Fifty patients were included in this study. Among which were 26 patients treated with anterior symphyseal plating (Group A) and 24 patients treated with percutaneous symphyseal screws (Group B). Posterior pelvic injury was fixated according to the existing pathology. In both groups, we recorded operation time, intraoperative blood loss, length of the incision, number of x-ray shots, changes in symphysis distance (preoperative, immediate postoperative, and in the last follow-up), and time for union. At the last follow-up, the clinical evaluation was conducted using the Visual Analogue Scale (VAS), and the functional evaluation was conducted using the Majeed scoring method for both groups.

RESULTS: All patients have followed up for at least two years. According to the Majeed Score, group A's functional classification was excellent for fourteen patients, good for seven, fair for two, and poor for three cases. Group B's functional classification was excellent for seventeen patients, good for six, and poor for one. The operative time and intraoperative time were significantly different between both groups, while the symphysis diastasis at the last follow-up was insignificant. Five patients in group A showed metal failure in the form of plate breakage, screw loosening, and screw backing out. In Group B, one case showed implant failure and loss of reduction in the form of screw backing out and widening of the symphysis pubis. Two patients in group A had infections at the incision site, which were treated with antibiotics and daily dressings and resolved adequately. No recorded cases of infection in group B.

CONCLUSION: Both techniques showed favourable results. The group with symphyseal plating showed a higher failure rate than the group with percutaneous screw fixation. The symphyseal screw group had shorter operative time, smaller incision, and less intraoperative blood loss than the symphyseal plating group but more radiation exposure. The symphyseal screw technique is a technically demanding technique and requires a high learning curve. It involves more radiation exposure, especially in inexperienced surgeons.

PMID:39954052 | DOI:10.1007/s00264-025-06446-y

Injury. 2025 Feb 9;56(3):112211. doi: 10.1016/j.injury.2025.112211. Online ahead of print.

ABSTRACT

INTRODUCTION: Muscle weakness is among the most common motor deficits in individuals with spinal cord injury (SCI). Acute intermittent hypoxia (AIH) has been used to improve motor function by facilitating neuroplasticity. The purpose of this systematic review is to explore the impacts of AIH on muscle strength in individuals with SCI, identify who would most likely respond well to the intervention, and determine the optimal therapeutic protocol.

METHODS: Relevant literature was explored in "PubMed, MEDLINE, The Cochrane Library, Scopus, PEDro, and Web of Science" databases until October 2024. Randomized trials that involved SCI patients who underwent AIH, compared with controls, and assessed muscle strength were included in this review. The methodological quality was assessed using the "Physiotherapy Evidence Database (PEDro)" scale. The effect sizes were calculated using Cohen's d.

RESULTS: Of 502 studies, seven studies met the eligibility criteria, and the sample sizes ranged from 12 to 28 participants across the included studies. In total, 146 SCI patients (mean age 46.76 years; 88 % male) were included in this systematic review. The PEDro scores of the studies included varied between 5 and 8, with a median score of 8.

CONCLUSIONS: AIH is a promising therapeutic modality for enhancing muscle strength post-SCI, specifically in patients with motor-incomplete injuries. Based on good quality studies, delivering AIH independently or in combination with other treatments for 15 short (60-90 s) episodes of hypoxic exposure (Oxygen = 9 %) alternating with 15 (60-90 s) normoxic episodes (Oxygen = 21 %), across one or more sessions, could yield meaningful outcomes. Nevertheless, the evidence is limited by treatment protocol variations, small sample sizes, and a lack of standardization in combining AIH with other treatments. Therefore, further studies with larger sample sizes, more diverse populations, and standardized treatment protocols are strongly needed to verify our findings. Future studies should also address the potential bias, examine the long-term effects, and investigate underlying mechanisms to provide more generalized evidence.

PMID:39951963 | DOI:10.1016/j.injury.2025.112211

Injury. 2025 Feb 8;56(3):112209. doi: 10.1016/j.injury.2025.112209. Online ahead of print.

ABSTRACT

INTRODUCTION: High-energy pelvic ring injuries (PRI) are severe, life-threatening trauma conditions which might require complex surgical management. One of the major complications associated with these injuries is the development of surgical site infections (SSI) which significantly impact patient outcomes. This study aimed to evaluate the rate of SSI in patients undergoing surgical fixation of high-energy blunt PRI and identify the key predisposing factors.

METHODS: A retrospective review of patients treated for high-energy blunt PRI was conducted using the prospectively filled institutional Severely Injured Patients' Registry, focusing on the rate of SSI following surgical fixation. The multifactorial nature of infection risk was analyzed, with particular attention to the type of injury, surgical technique, external fixation devices' usage and the germs encountered.

RESULTS: A SSI rate of 10,5 % (12 out of 114 patients) was encountered among the study population. The primary SSI risk factor was PRI complexity; 83.3 % of patients with SSI had an AO/OTA type C fracture and 16.7 % a type B fracture, while 43.1 % of patients without SSI had a type C fracture and 56.9 % a type B fracture (p = 0.008). Additionally, SSI patients had a trend to have higher extremities/pelvis AIS and higher ISS, and to have been more often treated with a transient pelvic fixation device including supra-acetabular external fixator.

CONCLUSION: These findings emphasize the need for a comprehensive infection prevention strategy in high-energy PRI patients, especially in complex cases. A multidisciplinary approach is of outmost importance and should include surgical techniques with meticulous soft tissue handling, proper implant selection and aggressive post-operative wound care. Despite external fixation devices being related to certain cases of SSI, their life-saving potential during the initial management phase should be carefully weighed against this risk.

PMID:39951962 | DOI:10.1016/j.injury.2025.112209

J Bone Joint Surg Am. 2025 Feb 14. doi: 10.2106/JBJS.24.00164. Online ahead of print.

ABSTRACT

BACKGROUND: Delayed-onset neurologic changes (DONCs) following spinal deformity surgery are poorly understood and are often devastating.

METHODS: A retrospective review of cases from 12 hospitals was performed. The clinical and radiographic parameters of patients who experienced a new DONC after spinal deformity correction were evaluated.

RESULTS: Eighteen patients, with a mean preoperative major Cobb angle of 75° ± 24°, were included. The mean age at surgery was 13 ± 2 years, and 6 patients (33%) were male. Seven patients had temporary intraoperative neuromonitoring changes. Fourteen patients (78%) had neurologic changes within 24 hours postoperatively (range, 3 to 24 hours). Of 16 patients with blood pressure data, 8 (50%) had at least 1 documented episode of hypotension surrounding the change in neurologic status. No misaligned implants were seen on axial imaging. Fourteen patients (78%) were treated with vasopressors. Sixteen patients (89%) returned to the operating room, and 11 patients (61%) underwent implant removal. Seven patients (39%) sustained a spinal cord infarct, with only 1 (6%) experiencing recovery beyond an ASIA (American Spinal Injury Association Impairment Scale) score of B. Ten (91%) of the 11 patients without an infarct demonstrated recovery (5 patients with an ASIA score of D and 5 with a score of E).

CONCLUSIONS: A DONC is a rare complication of spinal deformity surgery. This study represents the largest documented series of DONCs and highlights the multifactorial and still poorly understood nature of this condition. The primary modifiable risk factor may be hypotension in the postoperative period: 50% of patients had a mean arterial pressure below the 5th percentile for their height, as documented around the time of the neurologic change. Eighty-six percent of patients with a spinal cord infarct had minimal neurologic recovery, whereas nearly all of the patients without an infarct did recover function. The management of this condition may include elevation of blood pressure with temporary implant removal.

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

PMID:39951514 | DOI:10.2106/JBJS.24.00164

J Bone Joint Surg Am. 2025 Feb 14. doi: 10.2106/JBJS.24.00582. Online ahead of print.

ABSTRACT

BACKGROUND: Tungsten carbide rings are increasingly popular modern jewelry items. Tungsten carbide is an extremely dense, hard metal. Previously described methods to remove tungsten carbide rings include using locking pliers to compress the ring or cutting the ring with a high-speed dental drill.

METHODS: A universal mechanical testing system (MTS) machine was used to diametrically compress tungsten carbide rings 9 mm in length and 2.4 mm in thickness with a 23.4-mm outer diameter and a 21.0-mm inner diameter while measuring the force required to fracture the rings. A computer numerical control (CNC) machine was used to cut tungsten carbide rings with a diamond grinding bit with and without a flow of normal saline solution. An infrared thermal camera was used to record the temperature at the site of contact between the ring and the grinding bit and at a site one-quarter of the circumference along the ring.

RESULTS: A mean force with 95% confidence interval of 3.7 ± 1.2 kN was required to fracture the tungsten carbide rings via diametral compression (p = 0.05). The rings failed at a mean displacement with 95% confidence interval of 0.32 ± 0.13 mm (p = 0.05). The maximum temperature observed at the site of contact between the ring and grinding bit averaged 160.2°C including cases with and without coolant. The time to reach maximum temperature and the duration of maximum temperature differed significantly between the cases with and without coolant (p = 0.0007 and p = 0.0108, respectively).

CONCLUSIONS: Tungsten carbide rings fractured with minimal displacement using a small amount of force via diametral compression. The brittle fracture pattern of the rings produced minimal comminution. Tungsten carbide rings reached extreme temperatures when cut with a high-speed diamond grinding bit despite cooling with normal saline solution.

CLINICAL RELEVANCE: Previously documented methods to remove a tungsten carbide ring include breaking the ring by compressing it with pliers or cutting it off with a high-speed dental drill. Clinicians should be aware of potential complications of current methods to remove tungsten carbide rings.

PMID:39951513 | DOI:10.2106/JBJS.24.00582

J Bone Joint Surg Am. 2025 Feb 14. doi: 10.2106/JBJS.24.00766. Online ahead of print.

ABSTRACT

BACKGROUND: Osteoporosis continues to be underdiagnosed and inadequately treated in older hip-fracture patients. Our aim was to improve the rate of osteoporosis treatment with IV bisphosphonate therapy in eligible patients admitted for hip-fracture surgery.

METHODS: The present study was designed as a quality improvement initiative using Plan-Do-Study-Act (PDSA) cycles at an academic medical center in Portland, Oregon, over 2.5 years. A protocol was developed (1) to administer IV zoledronate on postoperative day 2 to inpatients aged ≥50 years who underwent surgery for a low-energy hip fracture and (2) to formally diagnose osteoporosis during admission. The protocol was introduced across 3 care settings in a stepped-wedge manner. Outcome measures were the percentage of inpatient zoledronate administered to eligible patients and formal documented diagnosis of osteoporosis. Balance measures included fever after administration and hospital length of stay (LOS). Measures were assessed through quarterly chart review and tracked via control charts.

RESULTS: The rate of zoledronate administration significantly increased from 34.5% (29 of 84) to 74.6% (53 of 71) following the second PDSA cycle (p < 0.001). Documented osteoporosis diagnosis also significantly improved from 51.0% (53 of 104) to 85.7% (96 of 112) following the second PDSA cycle (p < 0.001). No significant differences were shown for hospital LOS, and 1 of 82 patients had medical work-up for post-infusion acute phase reaction after administration.

CONCLUSIONS: This initiative was effective at improving osteoporosis diagnosis and treatment among older hip-fracture patients at our institution. Protocol development for administrating inpatient zoledronate after hip fracture is a reliable way to predictably offer bone health care and secondary-fracture prevention to hip-fracture patients and can be adapted and implemented at other institutions.

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

PMID:39951512 | DOI:10.2106/JBJS.24.00766

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06411-9. Online ahead of print.

ABSTRACT

PURPOSE: Post-operative LLD is a major concern after THA. The anterior approach on a standard table allows surgeons for a direct control of the leg length. Intra-operative radiography (IR) helps in assessment of hip biomechanics and anatomic parameters. The aim of this study is to evaluate the LLD after THA through anterior approach with or without a position table and with or without the use of intra-operative radiographs. The hypothesis is that leg length may be better control when IR and a standard table are used.

METHODS: This is a single-centre retrospective comparative cohort study of three matched groups of 80 patients receiving anterior approach THA with three different techniques (Group A: positioning table with IR; Group B: standard table with IR; Group C: standard table without IR). Pre-operative and post-operative LLD was calculated. Age, sex, BMI, acetabular cup and femoral stem size, operative time, and blood loss were recorded.

RESULTS: In Group A, 15 patients (19%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group B, 20 patients (25%) had a LLD greater than 5 mm, and two patients (2,5%) had a LLD greater than 10 mm. In Group C, 16 patients (20%) had a LLD greater than 5 mm, and three patients (3,7%) had a LLD greater than 10 mm. No statistically significant differences were found for LLD > 5 mm, for LLD > 10 mm, nor for the mean LLD between the three groups (p > 0.05). Mean operative time was statistically longer in Group B (p < 0.05).

CONCLUSION: Neither the use of a standard/positioning table neither the use of IR seemed to be superior in restoring leg length after anterior approach THA. Together with the contradictory results in literature, findings of the current study indicate that no technique is clearly superior to one other and surgeons' experience may play the most relevant role.

PMID:39951054 | DOI:10.1007/s00264-025-06411-9

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06432-4. Online ahead of print.

ABSTRACT

PURPOSE: Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained significant attention since its introduction in 2005. Over 343 publications since 2013 highlight its increasing use in nerve decompression surgeries. WALANT is known for its safety benefits, cost-effectivenes and improved patient experience compared to traditional sedation and tourniquet-based methods. This review examines the advantages of WALANT in nerve decompression surgery, emphasizing its growing adoption and benefits.

METHODS: A comprehensive review of the WALANT technique is provided, focusing on injection strategies, including buffered lidocaine with epinephrine, proper needle placement and generous volume of tumescent anesthesia. Specific injection protocols and surgical approaches are discussed for various nerve decompression procedures such as carpal tunnel, lacertus, cubital tunnel, radial tunnel and lateral intermuscular septum releases.

RESULTS: WALANT eliminates sedation-related risks such as nausea, aspiration pneumonia and thromboembolism, making it suitable for high-risk patients (ASA 4). It reduces healthcare costs by decreasing the need for post-anesthesia care units and operating in minor procedure rooms. The technique fosters greater surgeon-patient interaction, reduces hospital stays and avoids preoperative fasting and testing. WALANT has demonstrated positive outcomes across multiple nerve decompression procedures.

CONCLUSION: WALANT provides a transformative approach in nerve decompression surgery, offering enhanced safety, cost-effectiveness and improved patient-centered care. It significantly contributes to positive surgical outcomes, making it a valuable technique for both patients and healthcare providers.

PMID:39951053 | DOI:10.1007/s00264-025-06432-4

Int Orthop. 2025 Feb 14. doi: 10.1007/s00264-025-06422-6. Online ahead of print.

ABSTRACT

PURPOSE: Debridement, Antibiotic Treatment, and Implant Retention (DAIR) is considered the first-line treatment for early acute Prosthetic Joint Infection (PJI). This study aims to evaluate the five year success rates of early acute PJI managed with DAIR taking into consideration the time from the index surgery.

MATERIALS AND METHODS: A retrospective analysis of medical charts for 291 consecutive patients with acute PJI occurring within the first three months after primary or revision arthroplasty was conducted. Patients were stratified into two groups based on DAIR timing: Group (A) patients who underwent DAIR within the first four weeks post-arthroplasty; Group (B) patients who underwent DAIR between five and 12 weeks post- arthroplasty. Success rate was defined as implant in place, without signs of infection and not under suppressive antibiotic treatment.

RESULTS: The overall five year success rate for the entire cohort at five years was 62.2%. The mortality rate during the study period was 8.2%. The five year success rate was 64.4% (141 of 219) for Group A and 55.6% (40 of 72) for Group B (p = 0.21). Including deceased patients without signs of infection and retained implants as successful cases, the five year success rates increased to 69.9% for Group A (153 out of 219) and 69.4% for Group B (50 out of 72). The implant survival rate at five years was 73% for Group A and 71% for Group B.

CONCLUSION: Our findings indicate that there are no significant differences between patients who undergo a DAIR procedure within four weeks from those performed between week five and 12. Importantly, the overall success rate decreased from 75.6 to 62.2% in the last three years of follow-up.

PMID:39951052 | DOI:10.1007/s00264-025-06422-6

Injury. 2025 Feb 4;56(3):112208. doi: 10.1016/j.injury.2025.112208. Online ahead of print.

ABSTRACT

AIM: The Aim of the study is to retrospectively analyse intraoperative complications in acetabular fractures treated via the Stoppa approach, identify their frequency and nature, and define potential risk factors, in addition to evaluating clinical outcomes.

METHODS: This retrospective cohort study included a total of 136 acetabulum fracture cases (aged 16 to 82 years) that were managed using Stoppa approach. Records related with age, sex, mode of injury, body mass index, history and type of associated injury and time gap between injury and surgery were noted. Intraoperative records for complications, viz., vascular injury, nerve injury, peritoneum, bowel and bladder injury were retrieved. Data was analysed using SPSS 24.0 software. Chi-square and Independent samples 't'-tests were used for comparison.

RESULTS: Mean age of patients was 40.14±14.95 years. Majority (74.3 %) of patients were males and had road traffic accident (83.8 %) as the cause of injury. Mean BMI of patients was 22.4 ± 2.43 kg/m2. ACPHT (41.2 %) and ACF (27.9 %) were the most common diagnoses. A total of 16 (11.8 %) had associated injuries. Mean time gap between injury and surgery was 6.35±4.25 days. Intraoperative complication rate was 8.8 % (3.7 % peritoneum tear, 2.9 % superior iliac vein injury and 2.2 % external iliac vein injury). Intraoperative complications had a significant association with time gap between injury and surgery (p = 0.015).

CONCLUSION: Stoppa technique was a safe approach for management of acetabulum fractures with a low incidence of intraoperative complications. Early intervention could help to reduce rate of complications further.

PMID:39947007 | DOI:10.1016/j.injury.2025.112208

Injury. 2025 Feb 8;56(3):112210. doi: 10.1016/j.injury.2025.112210. Online ahead of print.

ABSTRACT

BACKGROUND: Long bone fracture is one of the most common concomitant injuries in pediatric traumatic brain injury (TBI) patients, requiring surgical intervention in the form of intramedullary nailing (IMN), open reduction and internal fixation (ORIF), or temporary external fixation, otherwise known as damage control orthopedics (DCO), for transient stabilization before definitive repair. There are no definitive guidelines for femur fracture management in polytrauma TBI pediatric patients. This study investigates the outcomes of patients with TBI and femur fractures who underwent DCO versus early total care (ETC), hypothesizing that delayed fracture fixation is associated with worse outcomes.

METHODS: Pediatric patients admitted with TBI who underwent femur fracture repair between 2016 and 2020 were investigated using the National Inpatient Sample database. Clinical outcomes, healthcare utilization data, baseline demographics, and comorbidities were collected. All Patient Refined Diagnosis Related Groups (APR-DRG) severity was defined for each case. The injury severity scale (ISS) was developed using ICD-10-CM codes for injury. High ISS was defined as greater than 75th percentile. DCO patients were compared with ETC patients. Inpatient death, prolonged LOS, and high total charges were the primary outcomes evaluated. Multivariate binary logistic regression analysis was used to evaluate for independent predictors of primary outcomes.

RESULTS: A total of 6,775 pediatric TBI patients under the age of 21 who underwent repair of femur fracture were identified. The average age was 15.5 years (range: 0-21 years) and there were 2,065 (30.5 %) females. DCO to treat femur fractures was employed in 1,010 (14.9 % of patients). Patients undergoing DCO were significantly more likely to have extreme illness severity (OR = 3.049), early trauma complications (OR = 2.273), and respiratory complications (OR = 2.255). DCO was independently associated with prolonged length of stay (LOS) (OR = 1.263), high total charges (OR = 1.786), and inpatient death (OR = 2.796).

CONCLUSION: This study found that DCO is associated with worse outcomes, likely secondary to injury severity and underlying neurologic injury of patients undergoing DCO. These findings suggest it is time to definitively outline the timing and modality of femur fracture repair for the polytrauma pediatric patient with TBI.

LEVEL OF EVIDENCE: III.

PMID:39947006 | DOI:10.1016/j.injury.2025.112210

Injury. 2025 Feb 6;56(3):112197. doi: 10.1016/j.injury.2025.112197. Online ahead of print.

ABSTRACT

OBJECTIVE: Traumatic native hip dislocations require immediate orthopaedic attention and have been associated with significant long-term morbidity. Previous studies have reported radiographic outcomes and clinical complication rates, however; evidence evaluating the effect of these injuries on patient-reported outcomes (PROs) is limited. The purpose of our study was to evaluate PRO scores among patients with native hip dislocations.

METHODS: Adult patients with native hip dislocations between 2005 and 2020 at a single academic Level 1 trauma center were retrospectively reviewed. Radiographs and medical records were reviewed for patient demographics and comorbidities, injury characteristics, details of treatment including time to reduction, and complications. Patients were given the PROMIS Physical Function (PROMIS PF) and Short Form-36 (SF-36) via HIPAA compliant electronic data capture. Outcomes were analyzed using Student t-tests and Mann-Whitney U comparisons of means/medians. Floor and ceiling effects were also characterized for the various outcomes scores.

RESULTS: A total of 168 patients with native hip dislocation were identified, 78 (46.4 %) of whom completed all PROs measures. Among responders, mean age was 36.2 years (SD 14.5), mean BMI was 29.2 (SD 6.7), and mean dislocation duration was 8.9 h (SD 5.1). On univariable regression, older age was associated with worse SF-36 Physical scores (p = 0.007). PROMIS PF showed an estimated 2.18 decrease for every one grade increase in Kellgren-Lawrence score (p = 0.01). There were no ceiling or floor effects seen with PROMIS PF, SF-36 Physical Summary, or SF-36 Mental Summary Scores.

CONCLUSIONS: Patients of older age and higher Kellgren-Lawrence score exhibited worse SF-36 Physical Function and PROMIS PF scores, respectively, highlighting the functional impact that native hip dislocations may have. PROMIS PF, SF-36 Physical and Mental Summary Scores were without floor or ceiling effects, rendering this an important tool in the evaluation of patients with traumatic native hip dislocation.

PMID:39947005 | DOI:10.1016/j.injury.2025.112197

J Bone Joint Surg Am. 2025 Feb 13. doi: 10.2106/JBJS.24.00880. Online ahead of print.

NO ABSTRACT

PMID:39946500 | DOI:10.2106/JBJS.24.00880

J Bone Joint Surg Am. 2025 Feb 13. doi: 10.2106/JBJS.24.00657. Online ahead of print.

ABSTRACT

BACKGROUND: Total hip arthroplasty (THA) is rarely performed in pediatric patients and can be challenging in children because of smaller-sized joints, pathomorphological changes around the hip, residual growth, and higher physical demands. Literature on THA outcomes in this unique population is scarce. We aimed to describe characteristics of pediatric patients who underwent THA, 5- and 10-year implant survival, risk factors for revision, and results of patient-reported outcome measures (PROMs) in a large national cohort.

METHODS: Primary THAs (from 2007 through 2022) in pediatric patients (11 to 18 years of age) for non-oncological indications were extracted from the Dutch Arthroplasty Register (LROI). Implant survival was assessed using Kaplan-Meier survival analyses. Functional, quality-of-life, and pain-related PROM scores were described preoperatively and at 3 and 12 months postoperatively and compared using paired t tests.

RESULTS: We included 283 THAs (161 [57%] in female patients) performed in 253 patients. The mean age at surgery (and standard deviation) was 16 ± 1.6 years. The most common indications were osteonecrosis (90 [32%] of the THA procedures), dysplasia (82 [29%]), and osteoarthritis (54 [19%]). The median follow-up was 7 years (range, 2 to 16 years). Fourteen (6% of 234) THAs were revised. The 5- and 10-year cumulative survival rates were 95% (95% confidence interval [CI], 91% to 97%) and 91% (95% CI, 84% to 95%), respectively. There was an insufficient number of events to allow for statistical analyses of potential risk factors for revision. All PROMs had improved significantly at 12 months postoperatively versus preoperatively (p < 0.001).

CONCLUSIONS: This study, the largest to date on THA in children (≤18 years of age), showed good short- and mid-term THA survival, approaching that among adults. Combined with the positive PROM results, THA appears to be an effective and satisfactory intervention in cases of debilitating pediatric hip disease. Further studies should focus on long-term survival and risk factors for implant failure.

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

PMID:39946439 | DOI:10.2106/JBJS.24.00657

Int Orthop. 2025 Feb 13. doi: 10.1007/s00264-025-06447-x. Online ahead of print.

ABSTRACT

PURPOSE: The aim of the present study was to describe our experience with French Elbow Connection (FEC) (i.e. elbow reduction and triple ligamentoplasty) for patients with chronic elbow dislocation (CED).

MATERIALS AND METHODS: We performed a retrospective review of 12 patients in two departments of orthopaedic surgery undergoing the FEC procedure for CED between 2019 and 2024. The median follow-up was 1.80 years (IQR 1.00; 1.97). Range of motion, mean Mayo Elbow Performance score (MEPS), visual analog scale (VAS), elbow stability, and radiographic outcome were recorded.

RESULTS: Median MEPS and VAS were 90.00 points (IQR 75.60; 100.00) and 0 (IQR 0; 1.50), respectively. Eight (66%) patients reported no pain. The median active flexion-extension and prono-supination arcs were 145°(IQR 102.60; 150.00), and 170°(IQR 155.03; 170.00) respectively. Persistent valgus or varus instability was identified in 2 (17%), and 1 (8%) patient respectively. Size patients (50%) were diagnosed with osteoarthritis (OA) and 1 patient experienced worsening postop OA (from grade 1(preop) to 3(postop)).

CONCLUSION: CED is a complex condition that presents elbow surgeons with unique challenges. The FEC procedure allows for immediate active ROM and yielded satisfactory short-term outcomes in our hands. Larger, longer-term studies will be necessary to assess reproducibility and confirm results can be maintained over time.

LEVEL OF EVIDENCE: level IV; therapeutic study (case series [no, or historical, control group]).

PMID:39945805 | DOI:10.1007/s00264-025-06447-x

Int Orthop. 2025 Feb 13. doi: 10.1007/s00264-025-06427-1. Online ahead of print.

ABSTRACT

PURPOSE: This is a preliminary study with short-term follow up to determine the safety and efficacy of the S-design osteotomy and internal fixation for acute varus and rotational correction technique in infantile Blount's disease.

METHODS: We performed a retrospective series in our institutional hospital. An S-design osteotomy for multiplanar, acute correction followed by internal fixation was performed for Blount's disease patients. Effectiveness was measured by comparing pre-and post-operative tibiofemoral angle (TFA) and metaphyseal-diaphyseal angle (MDA). Safety was determined by the number of neurological deficits and compartment syndromes occurred post operatively. Functional outcome was assessed using the Lower Extremity Functional Scale (LEFS). All patients underwent a one-year follow-up after surgery.

RESULTS: Nineteen patients (total of 31 extremities) were included in this study and classified into TFA less than 40 degree (group A) and more than 40 degree (group B). No neurological deficits nor compartment syndrome occured in either group. Regardless the severity of pre-operative deformity, both groups achieved significant corrections. Post operatively there was no significant difference in TFA in Group A and Group B (1.70 and 3.00 respectively, with p value of 0.147) and MDA (4,60 and 6,0 respectively, with p value of 0.327). This indicated there was no correlation between preoperative deformity and postoperative results. LEFS score of group A (73.85 ± 2.73) and Group B (73.85 ± 2.73) showed equally good results in both groups (p = 0.293).

CONCLUSION: This preliminary study with short-term follow up suggested that the S-design osteotomy effectively corrected internal rotation and varus while aiding limb length. The correction of internal rotation is accomodated by performing box osteotomy between the two horizontal (proximal and distal) lines of osteotomy, with safe and effective results. Acute correction is a safe and effective strategy for severe Blount's disease. Longer-term follow-up is awaited.

LEVEL OF EVIDENCE: V.

PMID:39945804 | DOI:10.1007/s00264-025-06427-1

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06437-z. Online ahead of print.

ABSTRACT

PURPOSE: We aimed to compare the long-term outcomes of small-head (28 mm) metal-on-metal (MoM) total hip arthroplasty (THA) to ceramic-on-polyethylene (CoP) THA using the same cup.

METHODS: All primary elective MoM and CoP THAs performed 1998-2011 were prospectively included in a local registry. Patients were followed until 31 December 2022. Outcomes were all-cause revision, complications and mortality. The uncemented Morscher 28 mm monobloc press-fit cup was used in all THAs.

RESULTS: Overall, 3257 THAs were included, 864 MoM (mean age 63) and 2393 CoP THAs (mean age 72). Mean follow-up of the cohort was 12.9 years (maximum 26.8 years). Revision for any cause was performed in 85 MoM and 79 CoP THAs. Cumulative incidence of all-cause revision at 20 years was 13.2% (95% CI 10.6 to 16.3) in MoM and 6.3% (95% CI 4.8 to 8.3) in CoP group. Adjusted hazard ratio for all-cause revision was 1.88 (95% CI 1.34 to 2.65) comparing MoM vs. CoP. Diagnoses at revision were mainly aseptic loosening (33%) and adverse local tissue reactions (33%) in MoM and aseptic loosening in CoP group (44%). The smoothed hazard function revealed the largest difference in instantaneous revision rate between three and 14 years postoperative. After that period no difference was observed.

CONCLUSION: Overall, the cumulative risk of all-cause revision was almost twice as high in patients with a small head MoM as compared to a CoP THA over the 20-year period. However, most of the excess in revisions among MoM patients occurred between three and 14 years postoperative.

PMID:39937240 | DOI:10.1007/s00264-025-06437-z

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06439-x. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is the preferred treatment for end-stage knee osteoarthritis, but challenges arise with severe angular deformities and associated tibial bone loss. The cement screw construct has emerged as a promising technique for managing these defects, offering advantages such as cost-effectiveness, accessibility, and ease of implementation. This research evaluated the clinical, functional and radiological outcome of screw-cement construct for the tibial defects in TKA.

METHOD: This retrospective study aimed to evaluate the long-term functional outcomes and success rate of the cement screw construct in patients with significant tibial defects. Sixty-five patients (104 knees) undergoing TKA were divided into two groups: conventional TKA (Group A) and TKA with screw-cement construct (Group B). Demographic, clinical, and radiological data were collected, with a follow-up duration of at least eight years.

RESULTS: The study revealed comparable demographic characteristics between groups. Both cohorts exhibited significant postoperative improvements in knee morphology and clinical outcomes. Group B demonstrated a higher incidence of radiolucency around the tibial tray, although no progressive complications were observed. Implant survival rates were similar between groups, with complications such as aseptic loosening and infections occurring in both without significant difference.

CONCLUSIONS: This study emphasised the viability of the screw-cement construct for managing uncontained tibial defects during TKA, providing evidence of its efficacy, and cost-effectiveness and suggesting its potential as a standard approach for tibial defects till 20 mm.

PMID:39937239 | DOI:10.1007/s00264-025-06439-x

Int Orthop. 2025 Feb 12. doi: 10.1007/s00264-025-06440-4. Online ahead of print.

ABSTRACT

Neuropathic pain is a complex and challenging condition that arises from abnormal processing of somatosensory information, often following nerve injury or dysfunction. Its diagnosis involves a detailed clinical history, sensory examination, and diagnostic tests such as electromyography, nerve conduction studies, and MRI to identify nerve damage or structural causes. In athletes, neuropathic pain can result from nerve entrapment syndromes, post-surgical complications, or peripheral nerve injuries, with unique challenges in pain assessment due to psychological factors and exercise-induced changes. Pharmacological management primarily includes anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., tricyclics, SNRIs), tailored to minimize side effects that could impair athletic performance. Effective treatment requires a careful balance to manage pain while maintaining physical capabilities. When treating athletes for neuropathic pain, healthcare providers must ensure prescribed medications comply with World Anti-Doping Agency (WADA) regulations. Narcotics (opioids) and cannabinoids are prohibited in-competition. Glucocorticoids are also banned in-competition if administered via injection, orally, or rectally, and elevated levels in urine may lead to sanctions.

PMID:39937238 | DOI:10.1007/s00264-025-06440-4

Injury. 2025 Feb 5:112200. doi: 10.1016/j.injury.2025.112200. Online ahead of print.

NO ABSTRACT

PMID:39933980 | DOI:10.1016/j.injury.2025.112200