J Bone Joint Surg Am. 2025 Feb 6. doi: 10.2106/JBJS.24.01192. Online ahead of print.

NO ABSTRACT

PMID:39913608 | DOI:10.2106/JBJS.24.01192

J Bone Joint Surg Am. 2025 Feb 6. doi: 10.2106/JBJS.24.01131. Online ahead of print.

ABSTRACT

The growing linguistic diversity in the United States presents substantial challenges to equitable health-care delivery. This article outlines strategies to promote health equity for orthopaedic surgery patients who speak a language other than English, including supporting the accessibility of professional interpreter services, enhancing language-specific patient educational resources, ensuring equity in the care tools that are used to improve access and engagement, strengthening the multilingual workforce in orthopaedic surgery, and standardizing the collection of language data elements for quality improvement and research. By adopting these strategies, health-care systems can better address the unique needs of non-English-speaking patients and reduce health disparities. Implementing these recommendations is crucial for advancing equity-focused value-based care in orthopaedics.

PMID:39913551 | DOI:10.2106/JBJS.24.01131

Injury. 2025 Jan 29;56(3):112199. doi: 10.1016/j.injury.2025.112199. Online ahead of print.

ABSTRACT

PURPOSE: Discharge is a critical time point in the care pathway of geriatric hospital patients, and post-acute care facilities often have less monitoring possibilities. Active medical issues such as electrolyte disturbances should be treated before transfer. We studied the impact of in-hospital hypernatremia of older hip fracture patients to mortality at 90 days.

METHODS: A retrospective study population of 2240 hip fracture patients from 2015 to 2019 was collected from the Hospital District of Southwest Finland data pool. In the present study we included patients aged ≥65 years who were transferred from the operating hospital to primary health care wards after surgery (n = 1,125). Laboratory results were collected on admission and before discharge. The main outcome was mortality at 90 days.

RESULTS: Hypernatremia, defined as serum sodium ≥144 mmol/l, was present in 6.8 % (n = 91) before discharge. For patients with hypernatremia the crude mortality at 90 days was 35.8 % (95 % CI 27.1 to 46.3) and for patients with normal serum sodium 9.6 % (95 % CI 8.0 to 11.6). The age- and sex-adjusted hazard ratio of hypernatremia compared to normal serum sodium was 3.91 (95 % CI 2.62 to 5.82).

CONCLUSION: In-hospital hypernatremia had predictive value for 90-day mortality. We recommend active screening for and prompt treatment of perioperative hypernatremia in hip fracture patients. Local guidelines and discharge checklists are recommended to secure the discharge period.

PMID:39908771 | DOI:10.1016/j.injury.2025.112199

Injury. 2025 Jan 16;56(3):112172. doi: 10.1016/j.injury.2025.112172. Online ahead of print.

ABSTRACT

OBJECTIVES: The primary aim of this study was to determine if an association exists between traumatic posterior hip dislocations and aortic injuries. Secondarily, this study assessed the incidence of chest imaging in patients with hip dislocations.

METHODS: Design: Retrospective Review of a Consecutive Case Series.

SETTING: Academic level I trauma centre. Patient Selection Criteria: Fifteen-thousand-four-hundred-thirteen consecutive traumatically injured patients with at least one orthopaedic injury were initially identified. After excluding patients without a posterior hip dislocation after blunt trauma, seven-hundred-nine patients were included. Outcome Measurements and Comparisons: The primary outcome was the coincidence of blunt traumatic aortic injury with acute posterior dislocation of a native hip. The secondary outcome was the rates of chest imaging to screen for blunt aortic injuries in patients with posterior hip dislocations.

RESULTS: The incidence of aortic injury with blunt trauma was 5.1 % in patients with a posterior hip dislocation and 1.6 % in patients without a posterior hip dislocation (OR = 3.3, CI: [2.3: 4.7], p < 0.001). Of the seven-hundred-nine patients with posterior hip dislocation, six hundred fifty-nine (93 %) received chest imaging as part of their initial workup, while thirty-four (4.8 %) never received chest imaging during hospitalization.

CONCLUSIONS: Despite improvements in automobile safety, this injury complex remains highly relevant. The findings advocate for routine chest imaging as part of the diagnostic trauma workup for patients with a native posterior hip dislocation.

PMID:39908770 | DOI:10.1016/j.injury.2025.112172

Injury. 2025 Jan 27;56(3):112184. doi: 10.1016/j.injury.2025.112184. Online ahead of print.

ABSTRACT

INTRODUCTION: Radiation Personal Protective Equipment (RPPE) is the subject of safety guidance from the British Orthopaedic Association (BOA). This pilot study aimed to examine potential performance differences in Trauma and Orthopaedic (T&O) Higher Surgical Trainees (HST) undertaking simulated Dynamic Hip Screw (DHS) surgery related to different RPPE attire.

METHODS: Fourteen Higher Surgical Trainees took part in a randomised, repeated-measures, crossover study (8 male, 6 female HSTs) performing two simulated DHS procedures wearing two RPPE attire styles (One Piece (OP) tabard 0.35 mm thickness, and Two-Piece skirt/top (TP), with a 0.5 mm thyroid guard). Primary outcome measures included continuous Heart Rate (HR) monitoring, body temperature, and Visual Analogue Scales (VAS) for comfort and fatigue before and after simulations.

RESULTS: Mean (SD) HR in OP and TP were HR OP 98.8 bpm (10.3) vs. TP 98.1 bpm (10.8, p < 0.001), Maximum HR OP 115.1 bpm (SD 12.4) vs. TP 113.4 bpm (SD 11.9) (p < 0.001). Mean change in temperature were OP 0°C and TP -0.03 °C (p < 0.001). Mean temperature VAS scores in OP were 1.9 (1.7) vs. TP 2.0 (1.4, p < 0.001). Mean Comfort VAS scores were OP 3.1 (2.4) vs. TP 1.7 (2.1, p < 0.001) and Fatigue OP 1.4 (1.9) vs. TP 0.8 (1.5, p = 0.120).

DISCUSSION: Important differences in surgeon physiological measures (HR, temperature) and self-reported measures of comfort and temperature were found related to RPPE style. Understanding the effects that specific RPPE attire has on performance should influence RPPE choice and the findings help inform future research into this important topic.

PMID:39908769 | DOI:10.1016/j.injury.2025.112184

J Bone Joint Surg Am. 2025 Feb 5. doi: 10.2106/JBJS.24.00647. Online ahead of print.

ABSTRACT

➢ The administration of antibiotics, revascularization, effective initial debridement, stabilization, and dead-space management are important time-dependent, acute actions.➢ Following the adequate resuscitation of the patient and the local soft tissues, the first stage of the Masquelet technique is performed together with the definitive coverage of the soft-tissue defect.➢ The optimal time for the second stage (grafting of the bone defect) depends on the progress of the soft-tissue reconstruction and the overall state of the patient. It is usually at 6 to 14 weeks.➢ Bone graft involves cancellous autograft; depending on the volume of the defect, it can be acquired using different donor sites and methods and can be combined with cancellous allograft, bone substitutes, bone marrow aspirate, and inductive molecules.➢ Bone healing is independent of the size of the defect, assuming that revascularization of the graft material has not been disturbed.➢ The development of signs of a fracture-related infection in the clinical setting of a severe open fracture dictates surgical treatment and pathogen-specific antibiotics, debridement of the membrane and the surrounding soft tissues, and reinitiation of the staged process of limb salvage.➢ The results of staged management of severe open fractures with bone defects are reproducible and good.

PMID:39908357 | DOI:10.2106/JBJS.24.00647

J Bone Joint Surg Am. 2025 Feb 5. doi: 10.2106/JBJS.24.00926. Online ahead of print.

ABSTRACT

BACKGROUND: We previously reported the 5-year results of the Birmingham Hip Resurfacing (BHR) implant. This study evaluates BHR survivorship as well as radiographic and clinical outcomes at long-term follow-up.

METHODS: A total of 224 patients with contemporary indications, including 179 patients from the original study, were included in this analysis. Survivorship was calculated. Metal ion levels and radiographs were updated. Patient-reported outcomes (PROs) were compared with those for matched patients who had undergone total hip arthroplasty (THA). The mean follow-up was 14 years.

RESULTS: Survivorship free from any revision and from aseptic revision was 96.0% and 97.4% at 15 years, respectively. Two patients had undergone revision since the original study. The median serum cobalt and chromium levels were 1.4 and 1.5 ppb, respectively. The PROs were similar to those for the THA cohort. Equal proportions of patients remained active; however, the BHR group trended toward more remaining highly active (p = 0.12).

CONCLUSIONS: Although activity was similar to THA at long-term follow-up, the BHR implant remains an excellent option for the treatment of osteoarthritis in younger male patients.

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

PMID:39908356 | DOI:10.2106/JBJS.24.00926

J Bone Joint Surg Am. 2025 Feb 5. doi: 10.2106/JBJS.24.00620. Online ahead of print.

ABSTRACT

While female representation within surgical specialties is increasing, the field of orthopaedic surgery remains male-dominated. Residency, fellowship, and early career coincide with the childbearing years of female surgeons. Given the overlap between these critical career stages and years of childbearing, there has been a rise in articles characterizing the experiences and perceptions around childbearing and its impact on surgeons and their careers. Multiple studies have reported the alarmingly high rates of pregnancy complications, infertility, pregnancy loss, voluntary delay in childbearing, and postpartum depression in surgeons, including those in the field of orthopaedic surgery. However, perinatal complications are not the only barriers female orthopaedic surgeons may face should they decide to start a family alongside their career. Negative perceptions and lack of support from their colleagues and institutions have also been reported as commonplace. Limited but successful support programs, policies, and resources that are designed to support female surgeons and their partners have been created in North America. Successful support programs can be used to inspire institutional policies across North America to hopefully improve the pregnancy and childbirth experiences of orthopaedic surgeons.

PMID:39908353 | DOI:10.2106/JBJS.24.00620

Int Orthop. 2025 Feb 5. doi: 10.1007/s00264-025-06428-0. Online ahead of print.

ABSTRACT

PURPOSE: In 1931, McFarland reported on medial malleolar physeal fractures and resulting deformities, which were later classified as Salter-Harris Type III and IV fractures of the medial malleolus. Ongoing controversy surrounding the factors that increase the risk for PPC in children with McFarland (MF) fracture.The retrospective study aimed to investigate the radiological and clinical outcomes of children treated surgically for MF fracture and evaluate the potential factors that increase the risk for premature physeal closure (PPC).

METHODS: We retrospectively reviewed 48 children who were surgically treated for MF fracture. Demographic data, including age at injury, gender, mechanism of injury, laterality, initial displacement, fracture type, time from injury to surgery, method of reduction, fixation method, time of hardware removal, and whether or not the patient developed PPC, were retrieved from the charts.

RESULTS: PPC occurred in 35.4% (17/48) of the patients. Our analysis revealed that patients with PPC were significantly younger than those without PPC (P < 0.001). Furthermore, our analysis revealed age and initial displacement as independent factors that increased the risk for PPC. Notably, age less than 11.5 years and initial displacement of more than 4.5 mm represented the cut-off points for an increased incidence of PPC. Overall, 11 out of 48 patients had limited ankle range of motion (ROM); mean ankle ROM in patients with PPC was lower than those without PPC (P = 0.006). Lower limb discrepancy was 2.5 cm in children, although three patients with PPC had a lower limb discrepancy measuring more than 2 cm, and five patients with PPC complained of postoperative pain.

CONCLUSIONS: Age and initial displacement are independent factors that increase the risk for PPC in children with MF fracture. Specifically, children aged under 11.5 years and those with initial displacement exceeding 4.5 mm are at a higher risk for PPC.

LEVEL OF EVIDENCE: Observational study.

PMID:39907773 | DOI:10.1007/s00264-025-06428-0

Injury. 2025 Jan 31;56(3):112201. doi: 10.1016/j.injury.2025.112201. Online ahead of print.

ABSTRACT

BACKGROUND: According to the nationally imposed standard of care in the Netherlands, severely injured patients should be brought to a Level-1 trauma center for primary treatment. If not, they are considered to be undertriaged. This study aimed to determine the incidence of undertriage among severely injured geriatric patients and to evaluate the relation between hospital-undertriage and patient outcomes in elderly.

METHODS: This retrospective cohort study used anonymized data from the regional trauma registry of 1,431 patients aged ≥70 years with an Injury Severity Score ≥16 that were admitted to hospitals within the Trauma Region West-Netherlands between 2015 and 2022. Poor patient outcome was defined as in-hospital mortality or as a Glasgow Outcome Scale (GOS) score ≤3 at hospital discharge. The association between hospital level and poor outcomes was analyzed using multivariable logistic regression analysis with adjustment for confounders after multiple imputation of missing values.

RESULTS: Seventeen percent of the severely injured geriatric patients were primarily transported to a Level-2/3 hospital. Female patients, older patients, and patients that had suffered a low-energy fall were most likely to be undertriaged. The adjusted odds ratio's for in-hospital mortality and GOS score ≤3 in Level-1 versus Level-2/3 hospitals were 1.26 (95 % confidence interval, 0.83-1.93; p = 0.28) and 0.81 (95 % confidence interval, 0.57-1.15; p = 0.24), respectively.

CONCLUSION: Undertriaged severely injured geriatric patients did not have a higher risk for poor outcomes. Level-2/3 hospitals seem to present a safe alternative for the treatment of these patients.

PMID:39904059 | DOI:10.1016/j.injury.2025.112201

Int Orthop. 2025 Feb 4. doi: 10.1007/s00264-025-06429-z. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this prospective, multi-centre study was to assess the performance and safety of a combination of osteoconductive β-tricalcium phosphate and osteoinductive native bone proteins (β-TCP - NBP) used as alternative for autograft in ankle and hindfoot arthrodesis.

METHODS: Thirty-four patients enrolled underwent ankle or hindfoot arthrodesis with β-TCP - NBP and were evaluated radiographically, clinically, and functionally up to fifty-two weeks. The primary performance endpoint was fusion rate evaluated with CT at six months. Safety was assessed based on the severity and incidence of adverse events. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and pain was recorded using the Visual Analogue Scale (VAS).

RESULTS: CT at 6 months showed that 85.3% had osseous bridging of the joint of ≥ 25%, 52.9% ≥50%, 8.8% <25% and 5.9% showed no bridging. The AOFAS score increased significantly from 60.4 ± 17.6 points at operation to 68.6 ± 17.2 points at six months and to 73.5 ± 17.7 points at 12 months. The group with fusion rate ≥25% showed significantly higher AOFAS score than that with fusion rate < 25% at 12 months. The mean VAS pain score at rest and during weight bearing decreased significantly (p < 0.0001) from operation to six and 12 months.

CONCLUSION: This study demonstrated that β-TCP - NBP is a valuable bone graft substitute for fusion of ankle and hindfoot due to debilitating osteoarthritis and offers an alternative for autograft.

LEVEL OF EVIDENCE: Level II.

PMID:39903260 | DOI:10.1007/s00264-025-06429-z

Int Orthop. 2025 Feb 4. doi: 10.1007/s00264-025-06421-7. Online ahead of print.

ABSTRACT

PURPOSE: Knowledge regarding risk factors for primary distal radioulnar joint (DRUJ) arthritis is limited. This study evaluated the association between ulnar variance (UV) and the development of primary DRUJ arthritis in a matched case-control cohort.

METHODS: Patients with symptomatic DRUJ arthritis were identified from those attending an orthopaedic outpatient clinic between January 2017 and April 2023. The control group comprised individuals without radiographic evidence of DRUJ arthritis. Propensity score matching was performed, aiming for a 1:3 ratio with an age difference limit of five years or less. UV and grade of DRUJ arthritis were assessed using a previously described method. Differences in UV between the case and control groups, and the association between ulnocarpal joint (UCJ) and DRUJ arthritis, were analysed. Receiver operating characteristic (ROC) analysis was used to determine the UV cut-off value for predicting symptomatic DRUJ arthritis.

RESULTS: The case group comprised 49 wrists from 44 patients, while the control group included 147 wrists from 132 individuals. The mean ages of the case and control groups were 69.6 and 67.5 years, respectively. UV was significantly higher in the case group (3.5 ± 2.9 vs. 1.6 ± 1.5 mm). The prevalence of UCJ arthritis increased with higher DRUJ arthritis grades. ROC curve analysis revealed a UV cut-off of 2.9 mm, with a sensitivity of 0.612 and specificity of 0.816.

CONCLUSIONS: A UV greater than 2.9 mm was associated with symptomatic primary DRUJ arthritis. Patients with more advanced DRUJ arthritis were also more likely to have concomitant UCJ arthritis.

PMID:39903259 | DOI:10.1007/s00264-025-06421-7

Int Orthop. 2025 Feb 4. doi: 10.1007/s00264-025-06412-8. Online ahead of print.

ABSTRACT

PURPOSE: Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures.

METHODS: We searched the Turkish Ministry of Health's e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures.

RESULTS: The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4-22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p < 0.001 for all).

CONCLUSIONS: This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.

PMID:39903258 | DOI:10.1007/s00264-025-06412-8

J Bone Joint Surg Am. 2025 Feb 3. doi: 10.2106/JBJS.24.00703. Online ahead of print.

ABSTRACT

BACKGROUND: The objective of this study was to determine the relationship between surgical volume and patient outcome after arthroplasty of the patellofemoral joint, to improve patient outcomes and inform future resource planning.

METHODS: All patellofemoral arthroplasty (PFA) records in the National Joint Registry from January 2003 to December 2021 were linked to the Hospital Episode Statistics database for England. The main outcome measure was revision surgery. Secondary outcome measures were serious adverse effects, patient selection characteristics, and implant designs used. Associations of early and late revision with surgical volume were examined based on surgical volume, and reasons for revision were explored.

RESULTS: Of the knee arthroplasty surgeons in the database, 858 (26%) performed ≥1 PFA during the study period; 14,615 PFA cases were available for analysis. The modal caseload was 2 per year. High-volume surgeons were defined as surgeons performing >5 PFAs per year. The hazard ratio (HR) for a high-volume surgeon was 0.98 per additional PFA per year, and the patients treated by these surgeons had a lower risk of revision than than those treated by low-volume surgeons irrespective of the patient's age. High-volume surgeons were more likely to identify and treat patients with patellar disorders than low-volume surgeons (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.09 to 1.77; p < 0.05), and their patients were less likely to have serious adverse effects as these surgeons' experience increased (OR per additional PFA per year, 0.97; 95% CI, 0.95 to 0.99; p = 0.02). Inlay implants had a higher risk of revision than onlay implants irrespective of surgical experience: for low-volume surgeons, inlays had an HR of 1.68 (95% CI, 1.23 to 2.30; p = 0.01), and for high-volume surgeons, inlays had an HR of 2.38 (95% CI, 1.83 to 3.11; p = 0.01). The most common reason for revision was progressive osteoarthritis. High-volume surgeons' patients were less likely than low-volume surgeons' patients to have an early revision (<2 years postoperatively) (OR, 0.72; 95% CI, 0.55 to 0.93; p < 0.05).

CONCLUSIONS: An association was found between surgeons performing >5 PFAs per year and a lower revision rate. This study should inform surgical planning services to improve the outcomes of PFA.

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

PMID:39899649 | DOI:10.2106/JBJS.24.00703

J Bone Joint Surg Am. 2025 Feb 3. doi: 10.2106/JBJS.24.00453. Online ahead of print.

ABSTRACT

BACKGROUND: The effects of sclerotic bone on anti-tuberculosis (anti-TB) drug distribution in the blood and in spinal tuberculosis (STB) lesions were investigated.

METHODS: Fifty-six patients with STB were prospectively enrolled from January 2020 to March 2023 and were divided into 2 groups: a group with sclerotic bone and a group without sclerotic bone, as identified on preoperative computed tomography (CT) scans. Individuals in the sclerotic bone group were further divided into fragmentary and non-fragmentary sclerotic bone groups. The patients underwent surgery, and blood was collected along with normal vertebral and STB-lesion-containing bone tissue samples. Following treatment, the samples were processed by a pharmacological laboratory in order to detect the concentrations of anti-TB drugs, including pyrazinamide, rifampicin, isoniazid, and ethambutol.

RESULTS: Twenty-seven East Asian female and 29 East Asian male patients with STB were included in this study. The levels of anti-TB drugs showed a progressive decrease with increased circulatory distance, from blood to normal vertebral tissue to TB lesions, across all patient groups. Drug concentrations in TB lesions in the sclerotic bone group were significantly lower than those in the non-sclerotic bone group, as were concentrations in TB lesions in the non-fragmentary sclerotic bone group relative to those in the fragmentary sclerotic bone group. Drug levels in the blood and in normal vertebral bone tissue did not significantly differ between the sclerotic and non-sclerotic groups, nor between the fragmentary and non-fragmentary groups. Drug levels in the blood were linearly correlated with those in TB lesions in both the non-sclerotic bone group and the fragmentary sclerotic bone group.

CONCLUSIONS: These results indicate that sclerotic bone negatively affects the dissemination of anti-TB drugs, with non-fragmentary sclerotic bone posing a greater obstacle than fragmentary sclerotic bone. In patients with STB without sclerotic bone or with fragmentary sclerotic bone, anti-TB drug levels in the blood were linearly correlated with drug levels in STB lesions.

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

PMID:39899645 | DOI:10.2106/JBJS.24.00453

Int Orthop. 2025 Feb 3. doi: 10.1007/s00264-025-06418-2. Online ahead of print.

ABSTRACT

INTRODUCTION: The development of high-frequency ultrasound technology has transformed musculoskeletal diagnostic practices, offering detailed, multi-plane visualization of superficial structures with remarkable precision and comfort. This non-invasive, pain-free modality is particularly suited for patients of all ages, including children.

PURPOSE: Ultrasound serves as a valuable adjunct to clinical evaluations by facilitating the identification of conditions such as tumours, tenosynovitis, fractures, and nerve entrapments. Portable ultrasound devices have further expanded its utility to clinical, surgical, and emergency settings. Dynamic assessments, such as nerve gliding and entrapment detection, benefit from its precision, enabling targeted therapeutic interventions with minimal risks.

METHOD: The integration of ultrasound into surgical techniques, termed ultrasonosurgery, allows for minimally invasive management of conditions like carpal tunnel syndrome and other nerve compressions. By leveraging high-resolution imaging, these procedures can be performed under local anaesthesia, minimizing traditional surgical complications.

RESULT: This innovative approach aligns with contemporary healthcare trends emphasizing wide-awake surgeries, office-based care, mini-invasive procedures, and technological advancements. Such practices not only streamline patient care but also reduce costs and improve outcomes.

PMID:39900668 | DOI:10.1007/s00264-025-06418-2

Int Orthop. 2025 Feb 3. doi: 10.1007/s00264-025-06425-3. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the outcomes of conservative treatment and locking plate osteosynthesis in displaced proximal humerus fractures in elderly patients.

METHODS: The study included patients over the age of 60 who were admitted to a tertiary trauma centre between 2020 and 2023, all diagnosed with 2-, 3-, or 4-part proximal humerus fractures. A total of 45 patients underwent either conservative management or locking plate fixation. In the older cohort, patients with Neer Type 2-4 fractures were treated conservatively using Velpeau immobilization. Displaced fractures, specifically 3- and 4-part fractures per the Neer classification, were treated surgically with locking plate fixation. Functional outcomes were evaluated using the Constant Shoulder score, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the American Shoulder and Elbow Surgeons (ASES) score, with a minimum follow-up period of one year. Radiographic assessment focused on varus collapse, medial cortex displacement, greater tubercle displacement, absence of fracture lines, and callus formation. Complications, including nonunion, malunion, and avascular necrosis, were also recorded.

RESULTS: Of the 45 patients, 22 underwent locking plate fixation (Group A), while 23 were managed conservatively (Group B). In terms of fracture type, 20 patients were classified as Neer Type 2, 23 as Neer Type 3, and 2 as Neer Type 4. The mean patient age was 73.38 years. Functional scores (DASH, ASES, and Constant) were similar between the two groups, and no significant differences were observed in radiographic parameters. However, complications were significantly more frequent in the locking plate group compared to the conservative group. Two patients who underwent surgery experienced nonunion at the humeral neck. Additionally, secondary surgery was required in one patient due to postoperative infection and in another due to screw penetration into the joint. While no correlation was found between humeral neck malunions and functional outcomes, a negative correlation was observed between tubercle malunions and functional scores.

CONCLUSION: In elderly patients with proximal humerus fractures, no significant differences in functional outcomes were observed between locking plate fixation and conservative treatment. However, locking plate fixation was associated with a higher incidence of complications and secondary surgeries. Thus, it appears that locking plate fixation does not offer superior outcomes compared to conservative management in this patient population.

PMID:39899082 | DOI:10.1007/s00264-025-06425-3

Int Orthop. 2025 Feb 3. doi: 10.1007/s00264-025-06420-8. Online ahead of print.

ABSTRACT

PURPOSE: Total knee arthroplasty (TKA) is an effective procedure for pain relief and restoration of function in patients with symptomatic end-stage knee arthritis. Kinematic problems due to conventional implant design have been postulated. The objective of this study is to determine if there was any difference in postoperative ROM and outcomes between patients undergoing MP-TKA vs PS-TKA.

METHODS: We prospectively colected the records of 600 consecutive patients with TKA performed by six senior orthopaedic surgeons between 2017 - 2021. We compared the ROM and patient-reported outcomes (Western Ontario McMaster Osteoarthritis Index WOMAC, Oxford Knee Score OKS, Knee Society Score KSS, Forgotten Joint Score FJS) between MP TKA and PS TKA.

RESULTS: There were no specific criteria for implant selection as the two groups were consecutive cohorts of patients and implant selection depended on surgeon preference. Demographics, comorbidities, diagnosis and severity of osteoarthritis were similar between MP and PS groups. The trend for OKS in our study is the same in both groups, but with higher mean values in the MP group. The trend of WOMAC pain, stiffness and disability score is the same in both groups, but with higher mean values in the PS group at one year and two years. KSS clinical and functional score is the same in both groups, but with higher mean values in the MP group. The most important score is forgetten joint score which is favourable for the MP group.

CONCLUSION: The patients who underwent the MP-TKA scored better than those who underwent the PS-TKA, particularly regarding deep knee flexion and stability of the prosthesis. This may be related to better replication of natural knee kinematics with MP-TKA.

PMID:39899081 | DOI:10.1007/s00264-025-06420-8

Injury. 2025 Jan 30;56(3):112164. doi: 10.1016/j.injury.2025.112164. Online ahead of print.

ABSTRACT

Traumatic brain injury remains a significant concern in public health, affecting millions of individuals globally and leading to long-term cognitive and physical impairments. Historically, research in this field has primarily focused on male subjects, often neglecting to consider the substantial biomechanical and anatomical differences between genders and individuals of varying ages. The present study investigates sex-specific biomechanical responses to head impacts in real-world accidents, employing an advanced female finite element head model, with a particular focus on critical brain structures such as the corpus callosum and pituitary gland. Two real-world accident scenarios were simulated: a non-fatal e-scooter collision and a fatal work-related incident involving a falling prop. A finite element analysis was conducted to determine the strain and stress distributions within the brain in response to impact conditions, assessing the potential for injury considering established failure criteria. The analysis revealed notable discrepancies in strain and stress distributions between anthropometric models. The smallest percentiles exhibited a higher risk of strain-related injury, while larger individuals demonstrated higher strain levels in key brain regions under similar impact conditions. Additionally, it was evaluated the efficacy of a safety helmet in a work-related scenario. These findings highlight the importance of subject-specific analyses in understanding TBIs and emphasise the need for continued refinement of FEHMs to improve the accuracy of injury prediction.

PMID:39893819 | DOI:10.1016/j.injury.2025.112164

Injury. 2025 Jan 17;56(3):112147. doi: 10.1016/j.injury.2025.112147. Online ahead of print.

ABSTRACT

OBJECTIVE: Metabolic bone disease (MBD, referring to osteopenia and osteoporosis) and its sequelae are associated with substantial morbidity, mortality, and healthcare costs. MBD screening and bone densitometry referral are underutilized in the general population despite published screening guidelines. Prior studies have correlated vertebral body Hounsfield unit (HU) measurements with MBD. The purpose of this study is to use this method to identify the prevalence of undiagnosed MBD in patients presenting to the hospital after high energy trauma, and to determine whether opportunistic MBD screening using this method would be valuable in this cohort.

DESIGN: Retrospective review.

SETTING: Level 1 trauma center and safety net hospital.

PATIENTS: 307 patients with a high energy femur fracture who underwent abdomen/pelvis computed tomography (CT) were identified from a trauma database.

INTERVENTION: L1 vertebral body radio density (in Hounsfield units, HU) was measured from trauma CT scans. Risk factors for MBD were identified from the medical record.

MAIN OUTCOME MEASUREMENTS: Prevalence of MBD and proportion of patients with MBD risk factors meriting further work-up.

RESULTS: The prevalence of MBD among high energy trauma patients was similar to the age-matched general population. Over half (50.5 %) of all patients had at least one risk factor for MBD. Among patients 50 to 64 years of age with any given MBD risk factor, over a third of individuals had MBD. In this population, the prevalence of MBD was highest (40.0 %) among those who used tobacco products and had a concurrent alcohol use disorder.

CONCLUSION: Opportunistic screening for MBD using a CT measurement technique can facilitate earlier diagnosis and treatment for affected individuals presenting after high energy trauma. Opportunistic screening may be particularly impactful in pre-menopausal women and in men, who frequently have MBD risk factors but who have a low referral rate for bone density testing and treatment.

LEVEL OF EVIDENCE: Diagnostic level III.

PMID:39893818 | DOI:10.1016/j.injury.2025.112147