Int Orthop. 2025 Jan 28. doi: 10.1007/s00264-025-06413-7. Online ahead of print.

ABSTRACT

PURPOSE: This study reports the relationship between posterior cruciate ligament (PCL) retention vs resection and soft tissue laxity and balance throughout flexion using a robotically controlled ligament tensioner.

METHODS: 55 robotic-assisted TKAs (Total knee arthroplasty) were retrospectively reviewe. The robotic ligament tensioner collected laxity data both before and after PCL resection. Medial and lateral coronal laxity were compared before and after PCL resection at 10°, 45°, and 90° flexion. Gap opening was compared between pre-operative coronal hip-knee-ankle groups.

RESULTS: Lateral laxity was greater after PCL resection at 60° (12.7 ± 2 vs 11.5 ± 3 mm), 75° (13.2 ± 2 vs 11.8 ± 3 mm), and 90° (13.7 ± 2 vs 12.1 ± 3 mm). Medial laxity was significantly greater after PCL resection at 90° (10.1 ± 2 vs 9 ± 2 mm). After PCL resection, laxity in valgus knees increased more compared to neutral/varus knees laterally at 30° (1.2 ± 1 vs 0.3 ± 1 mm), 45° (1.6 ± 1 vs 0.6 ± 1 mm), and 60° (2.1 ± 2 vs 1 ± 1 mm). A similar, but non-significant trend was observed at 90° (2.7 ± 2 vs 1.5 ± 1 mm, p = 0.09).

CONCLUSION: PCL resection increases flexion laxity laterally by up to 1.6 mm and medially by 1.1 mm on average, with valgus knees increasing more than neutral/varus knees. The findings emphasize that surgeons should consider the interplay between PCL resection and coronal deformity when planning and executing TKA procedures.

PMID:39873710 | DOI:10.1007/s00264-025-06413-7

Injury. 2024 Dec 18;56(2):112045. doi: 10.1016/j.injury.2024.112045. Online ahead of print.

ABSTRACT

Frame configuration for the management of complex tibial fractures is highly variable and is dependent upon both fracture pattern and surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally larger, multi-ring-per-segment constructs have been assumed to offer optimal stability and therefore favourable conditions for fracture healing but there is little in-vivo evidence for this and the recent concept of reverse dynamisation challenges this approach. We compared the clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a stable two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The mean time in frame was 168 days for the 2-ring group and 202 days for the 3+ rings group (p = 0.003). No significant differences were found in the rate of malunion or the requirement for secondary surgical intervention to achieve union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, post-treatment alignment and presence of an open fracture. This study finds that 2-ring frame constructs are a reliable option associated with shorter duration of treatment and no increase in rates of adverse outcomes compared with larger, more complex frame configurations.

PMID:39870047 | DOI:10.1016/j.injury.2024.112045

Injury. 2025 Jan 17;56(3):112162. doi: 10.1016/j.injury.2025.112162. Online ahead of print.

ABSTRACT

INTRODUCTION: Clinical data on osseointegration (OI) for limb replacement indicates a concerning increase in mechanical complications after five years post-implantation. Since adequate bone-implant contact and proper implant alignment are critical factors for successful osseointegration, it is essential to identify the factors influencing these outcomes. This study aimed to assess the effects of residual femur length and implant sizing on bone-implant contact and implant alignment.

METHODS: Three-dimensional models of eight cadaveric femora were reconstructed from CT scans, and transfemoral amputations were simulated for each femur at three levels: short (ST: 1/3 L), medium (MD: 1/2 L), and long (LG: 2/3 L). Virtual OI surgeries were then performed using computer-aided design (CAD) models, and implant sizes were recorded. Subsequently, the effect of implant sizing was assessed by adjusting the implant size by ±1 mm. Contact length and implant alignment were compared between the groups using repeated measures analysis of variance with Bonferroni correction.

RESULTS: The contact in the ST group (65.2 ± 7.3 %) was significantly less compared to the MD (96.1 ± 4.1 %, p < 0.001) and LG (96.8 ± 3.2 %, p < 0.001) groups. Upsizing increased contact in the ST group by 7.0 ± 2.6 % (p < 0.001), though it did not reach levels comparable to the MD and LG groups (p > 0.05). Additionally, sagittal implant misalignment was larger in the ST group (10.1 ± 2.0°) than in the MD (7.9 ± 1.5°) and LG (3.5 ± 1.6°) groups (p < 0.001), while no difference was observed in coronal implant alignment.

CONCLUSION: These findings highlight the factors influencing mechanical complications of osseointegration implants and provide a basis for refined implant designs and surgical techniques for patients with short residual limbs.

PMID:39869959 | DOI:10.1016/j.injury.2025.112162

Injury. 2025 Jan 11:112149. doi: 10.1016/j.injury.2025.112149. Online ahead of print.

ABSTRACT

INTRODUCTION: Optimizing treatment strategies in polytrauma patients is a key focus in trauma research and timing of major fracture care remains one of the most actively discussed topics. Besides physiologic factors, associated injuries, and injury patterns also require consideration. For instance, the exact impact and relevance of traumatic brain injury on the timing of fracture care have not yet been fully investigated.

METHODS: In this retrospectively cohort study at a level one trauma center, patients requiring trauma team activations from 2015 to 2020 were screened. Patients with an injury severity score >16 and at least one body region requiring operative fixation were included. Patients who underwent their first definitive surgery <24 h were stratified as group SDS (Safe Definitive Surgery) and >24 h as group DFC (Delayed Fracture Care). Outcomes were early mortality (<72 h), SIRS and sepsis, timing to first definitive surgery and completed reconstruction, total number of surgeries, and factors influencing the surgical strategy (e.g., unstable physiology). Odds ratios for treatment strategies and influencing factors were calculated using the Fisher`s exact test with conditional maximum likelihood estimate.

RESULTS: From a total of 901 patients screened, 239 were included in the analyzes (Group DFC: 151, Groups SDS: 88). Groups did not significantly differ regarding early mortality, SIRS and sepsis. Group SDS had a significantly lower mean number of operations (4.3 vs. 5.3; p = 0.037) and a significantly shorter mean time until completion of reconstructive operations (10 days vs. 15 days; p = 0.013). Unstable physiology and intracranial trauma sequelae with the necessity for neurosurgical interventions (NSI) were identified as most significant factors for delaying definitive fracture care (OR: 2.85; 95 % CIs: 1.56 to 5.33 and OR: 5.59; 95 % CIs: 1.63 to 29.85), while the presence of intracranial bleeding (IB) without NSI did not have a significant influence (OR: 1.21; 95 % CIs: 0.63 to 2.34).

CONCLUSION: The necessity of NSI and unstable physiology are highly relevant factors for delaying definitive fracture care in polytrauma patients, while the presence of IB without NSI had less impact. In this cohort, early definitive fracture care in physiologically stable patients without NSI, was not associated with increased patient morbidity.

PMID:39864965 | DOI:10.1016/j.injury.2025.112149

Injury. 2025 Jan 22;56(3):112180. doi: 10.1016/j.injury.2025.112180. Online ahead of print.

ABSTRACT

INTRODUCTION: External fixators are utilized to temporarily stabilize bicondylar tibial plateau fractures. They can be prepped during definitive surgery to help maintain fracture length and alignment. However, there is a potential for increased infection by leaving the external fixator on during the surgery. We hypothesize that maintaining the external fixator during surgery will result in no difference in rates of deep infection but improve reduction quality.

METHODS: We performed a retrospective cohort study of all bicondylar tibial plateau fractures treated at an academic, level one trauma center over a 10-year period. The primary outcome analyzed was the rate of deep infection. Secondary outcomes analyzed included reduction quality by comparing the medial proximal tibia angle (MPTA) and posterior proximal tibia angle (PPTA), complication rate, and reoperation rate.

RESULTS: One hundred and thirty-nine fractures in 133 patients met the inclusion criteria. There was no difference between the external fixator removed and prepped groups in terms of baseline patient characteristics except for more motor vehicle collisions in the removed group (42 % vs 22.99 %, p = 0.0193) and more open fractures in the prepped group (6 % vs 18.39 %). Operative characteristics were also not statistically different except for more patients in the prepped group underwent preoperative skin shaving (22 % vs 48.28 %, p = 0.0023) and more patients in the removed group had fixation constructs with plate and pin site overlap (46 % vs 24.14 %, p = 0.0083). There was no difference in deep infection between the groups (16.00 % vs 8.05 %, p = 0.1511). There was no difference in reduction quality when comparing the MPTA (87.64° vs 87.40°, p = 0.6607) and PPTA (83.18° vs 83.97°, p = 0.3592). The rates of superficial infection (20 % vs 29.89 %, p = 0.2056), unplanned reoperation (30 % vs 18.39 %, p = 0.1179), complications (58 % vs 44.83 %, p = 0.1376), and nonunion (8 % vs 6.89 %, p = 0.8111) were also similar.

CONCLUSIONS: Bicondylar tibial plateau fractures are challenging injuries with a high complication profile. Our findings suggest that maintaining the external fixator is not associated with increased rates of deep infection or complications. However, maintaining the external fixator during surgery did not lead to differences in final coronal or sagittal alignment reduction quality.

PMID:39864400 | DOI:10.1016/j.injury.2025.112180

Injury. 2025 Jan 17;56(3):112163. doi: 10.1016/j.injury.2025.112163. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults make up an increasing portion of orthopedic trauma care. Proxy reports are particularly valuable when patients face difficulties formulating answers due to pre-existing or temporary cognitive impairment, and provide critical insights into patient well-being.

QUESTIONS/PURPOSES: This study examines the agreement between patient- and proxy-reported outcome measures across various health domains of older adult orthopedic trauma patients, including those with mild cognitive impairment.

PATIENTS AND METHODS: A prospective cohort study was conducted in the Orthopedic trauma clinic of two Level 1 trauma centers, involving 108 patients aged 70 years or older, with or without mild cognitive impairment, and a self-identified discernible proxy. Participants were evaluated using PROMIS measures for physical function, pain intensity, anxiety, depression, fatigue, and social roles and (instrumental) activities of daily living questionnaires. Agreement between patient and proxy assessments was analyzed using Intraclass Correlation Coefficient and Bland-Altman analyses. Subgroup comparison was made using confidence intervals.

RESULTS: Most patients were married women with a mean age of 78 years (SD 6.2), 61 % had higher education, 67 % were walking independently, and 53 % had fractures of the pelvic ring or femur. Proxies were younger (mean age 64 years, SD 15), with 41 % being children and 40 % spouses. Significant correlations were found between patient and proxy assessments in physical function (ICC 0.74, 95 % CI 0.61-0.82), pain intensity (ICC 0.83, 95 % CI 0.74-0.89), (instrumental) activities of daily living (both ICC 0.86, 95 % CI 0.80-0.91). Moderate correlations were observed in anxiety, depression, fatigue, and participation in social roles (ICCs ranging from 0.56 to 0.66). Bland-Altman analyses confirmed good agreement with none to minimal systematic bias across all these domains.

CONCLUSION: Proxy-reported outcomes are valuable for evaluating health domains in older adult orthopedic trauma patients, including those with cognitive impairments. While proxies reliably assess physical and pain-related domains, additional strategies are needed to improve accuracy in more subjective domains. Future research should explore longitudinal agreements to better understand recovery perceptions over time and mitigate bias proxy-reporting, ultimately enhancing both patient care and outcomes research in geriatric orthopedic trauma patients.

PMID:39864399 | DOI:10.1016/j.injury.2025.112163

Injury. 2025 Jan 20;56(3):112176. doi: 10.1016/j.injury.2025.112176. Online ahead of print.

ABSTRACT

BACKGROUND: Proximal femoral fractures has been associated with high mortality risk, while little is known about more distal lower extremity fractures. The aim was to report 30- and 365-days mortality in surgically treated lower extremity fractures in individuals above 65 years.

MATERIALS AND METHODS: We extracted data from the Danish National Patient Register on all surgically treated lower extremity fracture in the period 1998-2017. The primary outcome was mortality reported by fracture site defined by ICD-10 codes (femur S72*, tibia S82*, foot/ankle S92*S825-8). The secondary outcomes were mortality divided on sex, age groups (5-year span), and comorbidity. This study was conducted using descriptive statistics.

RESULTS: We identified 182,013 operatively treated lower extremity fractures of which 73 % occurred in females. The 30-day mortality was 10 % for patients with femoral fractures, 2 % for tibia and 1 % for foot/ankle. The 30-day mortality were similar in femoral fractures regardless of location in the femur (8-11 %). The 365-day mortality was 29 % for femoral fractures, 8 % for tibia and 6 % for foot/ankle. Men with a femoral fracture had higher mortality (15 % at 30 days, 37 % at 356 days) in comparison to women (8.2 % at 30 days, 26 % at 356 days). For the above 85+ year age group, the fracture location was less important for 365-day mortality.

CONCLUSION: There was an observed high risk of mortality in surgically treated femoral fractures. The mortality risks seems to rapidly decline when the fractures are below the knee.

PMID:39862495 | DOI:10.1016/j.injury.2025.112176

Injury. 2025 Jan 20;56(3):112169. doi: 10.1016/j.injury.2025.112169. Online ahead of print.

ABSTRACT

BACKGROUND: Unstable posterior pelvic-ring fractures are rare and difficult to manage. There are many injury patterns, they are associated with high morbidity and mortality, and optimal surgical management remains contentions. This study aims to compare outcomes and complications for different surgical management of these injuries.

METHODS: This was a multi-centre observational study of patients with traumatic posterior pelvic-ring injuries that underwent operative management between 1st January 2010 and 1st January 2020 at three Australian MTS. Cases were identified using internal hospital databases and the Victorian State Trauma registry. Data was retrieved from medical records and included surgeries, fixation method, length of stay, and outcomes (revision surgery, infection, hardware breakage, screw misplacement and hardware removal), time to each outcome was also recorded. The extracted data was collated and then analysed using RStudio; generalised liner models and linear regression models were developed to calculate mean differences and odd ratios.

RESULTS: There were 439 cases (309 males and 130 females) in the cohort with a median age of 39 years. The overall prevalence of revision was 7.7 %; 4.8 % for infection, 1.8 % for hardware failure and 13.2 % for removal of hardware. Bulkier, more prominent fixation methods had higher rates of metalware removal. Numbers were too small in subgroups to detect a significant difference in complication rates between fixation method. However, bilateral injuries had a significant effect on revision with a calculated prevalence of 16.7 % vs 5.6 % for unilateral injuries. Cases managed with open-reduction had a calculated infection rate of 15.6 % vs 4.6 %. Length-of-stay was increased in patients managed with temporising external fixators, who had bilateral injuries, where infection occurred or were restricted to non-weight bearing postoperatively.

CONCLUSIONS: This study highlight bilateral posterior-pelvic ring injuries as a greater management challenge than unilateral injuries. It supports the use of percutaneous fixation with closed-reduction, decreased infection risk and decreased length-of-stay. It challenges the use of external fixators and supports less restrictive post-operative restrictions. This study also serves as a descriptive analysis for the current management of pelvic fractures in an Australian setting, shedding light on complication rates and profiles.

PMID:39862494 | DOI:10.1016/j.injury.2025.112169

Injury. 2025 Jan 16;56(3):112170. doi: 10.1016/j.injury.2025.112170. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study is to determine what demographic and anatomical variables affect successful placement of a superior medullary ramus screw, and how they affect the maximal diameter of that screw.

METHODS: Design: Prognostic Level IV SETTING: Level I Trauma Center Patients/Participants: Two hundred consecutive patients underwent computed tomography (CT) of the pelvis. We included those patients aged 18 and older without osseous injury or abnormalities precluding measurement.

INTERVENTION: 3D reconstructions of the pelvis were created, and a virtual 3.5 mm cylindrical implant was placed from the pubic tubercle to the lateral cortex of the ilium. Success was defined as a bicortical virtual screw path from the ramus to the lateral ilium without cortical perforation. The cylinder was then expanded to model varying screw diameters. We then repeated this same process for unicortical retrograde screw insertion ending medial to the acetabular joint.

MAIN OUTCOME MEASURES: Successful screw placement and maximum screw diameter.

RESULTS: A 3.5 mm screw was successfully placed in 187 patients (93.5 %). One male (1/107, 0.9 %) and 12 females (12/93, 12.9 %) could not accommodate a 3.5 mm screw. All cases of perforation occurred lateral to the obturator foramen. Increasing height was associated with success, and male gender was associated with the ability to accommodate screws with a diameter 6.5 mm and larger.

CONCLUSIONS: Most patients can accommodate a 3.5 mm screw from the pubic tubercle to the ilium. Height and gender should be noted when planning medullary ramus fixation.

PMID:39862493 | DOI:10.1016/j.injury.2025.112170

Injury. 2025 Jan 23;56(3):112167. doi: 10.1016/j.injury.2025.112167. Online ahead of print.

ABSTRACT

OBJECTIVE: Our primary objective was to identify and describe demographic trends in head and neck injuries incurred while participating in horseback riding.

STUDY DESIGN: Cross-sectional analysis.

SETTING: National Database.

METHODS: Head and neck injuries related to horseback riding over a ten-year period (2014-2023) were analyzed using data from the National Electronic Injury Surveillance System (NEISS). A total of 3,177 cases were identified. Inclusion criteria encompassed injuries to the head, neck, face, mouth, or ear. Variables included age, gender, injury type, anatomical location, and patient disposition. Chi-squared analyses were employed to compare the aforementioned injury variables.

RESULTS: Among the 3,177 reported injuries of males and females, females (mean age 27.51 years, SD = 19.04) were more likely to be treated and released (83.29 %, n= 2023), while males (mean age 34.65 years, SD = 22.58) were more likely to be hospitalized. There was a significant association between gender and concussion diagnosis (p<.001), with females more likely to be diagnosed with concussions (n = 687) compared to males (n = 129). Females experienced more head and face injuries compared to males. Age distribution varied significantly across disposition categories, indicating different management practices for various age groups. The dataset indicates that the average age of females (27.51 years) is notably lower than that of males (34.65 years), suggesting a younger demographic among females overall.

CONCLUSIONS: The study highlights a significant gender disparity in horseback riding-related head and neck injuries, with females more likely to be treated and released and males more often requiring hospitalization.

PMID:39862492 | DOI:10.1016/j.injury.2025.112167

Injury. 2025 Jan 11;56(2):112161. doi: 10.1016/j.injury.2025.112161. Online ahead of print.

ABSTRACT

INTRODUCTION: The development of national registries from routinely collected health data has transformed the research landscape by improving access to large sample populations. This growing volume of data enables researchers to address critical questions but also challenges clinicians in conducting, evaluating, and applying the research. The National Trauma Data Bank (NTDB), the largest aggregate of deidentified trauma data in the world, is increasingly utilized for retrospective studies on trauma. This scoping review aimed to assess the quality of reporting of NTDB-based orthopedic trauma publications.

METHODS: We queried the Dimensions database for orthopedic studies using the NTDB. The quality of reporting was assessed by adherence to two international publication guidelines: the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the REporting of studies Conducted using Observational routinely collected data (RECORD).

RESULTS: From a total of 3,720 identified articles, 137 manuscripts were available for analysis. The median scores and interquartile ranges (IQR) for STROBE and RECORD were 19 (IQR 18-20) and 7 (IQR 7-8), respectively. For STROBE scoring, the lowest fulfilled items were handling missing data and potential sources of bias. For RECORD scoring, the lowest fulfilled items were accessibility to protocol, raw code and data, validation studies, and data cleaning. A greater proportion of high-scoring studies were published in high-impact journals versus low-impact journals and in journals that enforced guidelines versus those that did not.

CONCLUSION: This study highlights the methodological gaps in the NTDB-based orthopedic trauma publications and identifies areas for improvement, including the management of missing data, selection of the study population through data cleaning, identification of sources of bias, and transparency in data accessibility. Future work should test the reproducibility of these studies and evaluate adherence to established guidelines across a broader range of databases and disciplines.

PMID:39854810 | DOI:10.1016/j.injury.2025.112161

J Bone Joint Surg Am. 2025 Jan 24. doi: 10.2106/JBJS.24.00394. Online ahead of print.

ABSTRACT

BACKGROUND: To date, no studies have evaluated the longevity of calcaneal lengthening osteotomy (CLO) in patients with cerebral palsy (CP) and pes planovalgus. This study aimed to explore the changes in foot alignment following CLO in patients with CP, utilizing both radiographic evaluations and dynamic foot-pressure assessments.

METHODS: A retrospective study of 282 feet in 180 ambulatory patients was performed. The mean patient age at the surgical procedure was 8.9 ± 2.6 years. The mean follow-up period was 8.0 ± 4.3 years, and the mean age at the final follow-up 16.9 ± 4.4 years. Weight-bearing radiographs at 3 separate time points (before the surgical procedure, 6 months postoperatively, and at the final follow-up) were used. The feet were classified as corrected, undercorrected, or overcorrected on the basis of the radiographic parameters.

RESULTS: At the final follow-up, we classified 98 feet (34.8%) as corrected, 58 (20.6%) as undercorrected, and 126 (44.7%) as overcorrected. Foot-pressure analysis demonstrated that the undercorrected feet had higher relative vertical impulses in the medial forefoot and medial midfoot than in the other groups, whereas the overcorrected feet had higher impulse in the lateral midfoot. There were no significant differences in preoperative radiographic parameters between the 3 groups, except for the calcaneal pitch angle. At 6 months after the surgical procedure, we classified 181 feet (64.2%) as corrected, 58 (20.6%) as undercorrected, and 43 (15.2%) as overcorrected. However, 53.6% of initially corrected feet changed to being undercorrected or overcorrected during further follow-up, 43.1% of the undercorrected feet became corrected or overcorrected, and 16.3% of the overcorrected feet became corrected. A younger age at the surgical procedure and lower naviculocuboid overlap at 6 months after the surgical procedure were the risk factors for overcorrection.

CONCLUSIONS: Although CLO is an effective method for correcting planovalgus foot deformities and enhancing foot-pressure distribution, the extent of correction observed early after the surgical procedure was not necessarily sustained over the follow-up period in individuals with CP. Furthermore, our findings highlight a noticeable tendency toward the overcorrection of the deformity, as evidenced by increased pressure exerted on the lateral midfoot.

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

PMID:39854489 | DOI:10.2106/JBJS.24.00394

J Bone Joint Surg Am. 2025 Jan 24. doi: 10.2106/JBJS.24.00113. Online ahead of print.

ABSTRACT

BACKGROUND: Although delays in musculoskeletal care in low- and middle-income countries (LMICs) are well documented in the open fracture literature, the impact of surgical delays on closed fractures is not well understood. This study aimed to assess the impact of surgical delay on the risk of infection in closed long-bone fractures treated with intramedullary nailing in LMICs.

METHODS: Using the SIGN (Surgical Implant Generation Network) Surgical Database, patients ≥16 years of age who were treated with intramedullary nailing for closed diaphyseal femoral and tibial fractures from January 2018 to December 2021 were identified. Infection was diagnosed based on the assessment by the treating surgeon. A logistic regression model, adjusting for potential confounders, was used to analyze the association between delays to surgery (in weeks) and infection.

RESULTS: Of the 9,477 closed fractures that were included in this study, 58% were femoral fractures and 42% were tibial fractures. The mean age was 35 years, and 76.2% of the patients were men. The mean delay to surgery was 10.5 days, and the median delay to surgery was 6 days. The overall infection rate was 3.1%. The odds of developing an infection increased by 9.2% with each week of delayed surgical treatment (odds ratio,1.092; 95% confidence interval, 1.042 to 1.145). Increasing delays were also associated with longer surgery duration and higher rates of open reduction.

CONCLUSIONS: Surgical delays in LMICs were associated with an increased risk of infection in closed long-bone fractures. This study quantified the increased risk of infection due to delays in receiving care, highlighting the importance of timely surgery for closed fractures in LMICs.

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

PMID:39854435 | DOI:10.2106/JBJS.24.00113

J Bone Joint Surg Am. 2024 Oct 2;106(19):e43. doi: 10.2106/JBJS.24.00710. Epub 2024 Oct 2.

NO ABSTRACT

PMID:39853225 | DOI:10.2106/JBJS.24.00710

J Bone Joint Surg Am. 2024 Oct 2;106(19):e41. doi: 10.2106/JBJS.24.00586. Epub 2024 Oct 2.

NO ABSTRACT

PMID:39853224 | DOI:10.2106/JBJS.24.00586

J Bone Joint Surg Am. 2024 Oct 2;106(19):1739-1749. doi: 10.2106/JBJS.23.01390. Epub 2024 Aug 5.

ABSTRACT

BACKGROUND: Fixation of distal femoral fractures remains a challenge, and nonunions are common with standard constructs. Far cortical locking (FCL) constructs have been purported to lead to improved fracture-healing as compared with that achieved with traditional locking bridge plates. We sought to test this hypothesis in a comparative effectiveness clinical trial.

METHODS: This randomized trial was performed across 16 centers and included adult patients with an AO/OTA type 33A or 33C distal femoral fracture that was suitable for bridging fixation. We excluded patients with periprosthetic fractures. Participants were randomly assigned to either FCL fixation or standard locking plate fixation. The primary outcome was a hierarchical composite of radiographic and clinical fracture-healing at 3 months after fixation. We estimated between-group differences with use of the win ratio approach. Secondary outcomes included radiographic healing, clinical fracture-healing, complications, reoperations, and health-related quality of life (Short Form-36 Health Survey Version 2 [SF-36] Physical Component Summary and Mental Component Summary scores) at 3, 6, and 12 months after fixation.

RESULTS: We randomly assigned 193 patients to treatment with either FCL screws (96 patients) or standard screws (97 patients). The study population had a mean age of 63.4 years, consisted predominantly of women (68%), and was well-balanced between AO/OTA 33A and 33C fractures. Based on 4,355 pairwise comparisons, the calculated win ratio was 1.18 (95% confidence interval [CI], 0.77 to 1.79; p = 0.45), indicating that patients assigned to FCL screws had better outcomes in 51% of the comparisons. Radiographic healing did not differ significantly between the groups (odds ratio, 1.36; 95% CI, 0.69 to 2.72; p = 0.38), nor did Function IndeX for Trauma (FIX-IT) scores (p = 0.41). There were no significant differences between the groups in terms of SF-36 Physical Component Summary scores at 3 months or in the change in scores at 12 months after fixation.

CONCLUSIONS: In this multicenter randomized trial of adult patients with an AO/OTA type 33A or 33C distal femoral fracture, similar clinical and radiographic healing outcomes were observed in the FCL and standard fixation groups.

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

PMID:39853223 | DOI:10.2106/JBJS.23.01390

Int Orthop. 2025 Jan 24. doi: 10.1007/s00264-024-06398-9. Online ahead of print.

ABSTRACT

PURPOSE: The outcome of elective total joint arthroplasty (TJA) in patients with Parkinson's disease (PD) is controversial due to the concomitant risk profile. This study investigated postoperative complications and revision rates following total hip (THA) and knee arthroplasty (TKA) in patients with PD.

METHODS: Ninety-six patients with PD undergoing THA or TKA were matched 1:1 with non-PD patients using propensity score matching for age, sex and comorbidity (Charlson Comorbidity index, CCI). Rates of revisions, medical and surgical complications were compared. Univariate and multivariate regression analyses were calculated.

RESULTS: PD patients exhibited higher rates of revision-surgeries within 90 days (13.5% vs. 5.2%; p = 0.048), medical complications (68.8% vs. 43.8%; p < 0.001) and surgical complications (40.6% vs. 21.9%; p = 0.005). Multivariate regression analysis confirmed PD as a significant risk factor for complications and long-term revision-surgeries.

CONCLUSION: PD increases the risk of adverse outcomes following THA and TKA. Improvements in pre-operative planning and post-operative care are critical to the improvement of outcomes in this vulnerable population.

PMID:39856201 | DOI:10.1007/s00264-024-06398-9

Int Orthop. 2025 Jan 24. doi: 10.1007/s00264-025-06416-4. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to compare the release of the iliopsoas tendon at two levels: proximally at the pelvic brim and distally near the lesser trochanter.

METHODS: The study was a randomized clinical trial. It was done to check the equivalence between two parallel groups of patients with DDH of grade 2 or more who underwent open reduction operations for their hips: Group 1, division of the iliopsoas tendon at the pelvic brim, and Group 2, division of the tendon at the lesser trochanter level. All the operations were done through the anterior approach.

RESULTS: Thirty-eight patients (24 females and 14 males) with 54 hips (cases) operated, 27 cases in each group. The mean follow-up period of the cases was 2.4 years (SD 0.6). In the third month postoperatively, children of both groups had grade 2 hip flexion strength. Later, a statistically significant difference (p-value 0.007) occurred between them in the 24th month (Group 1 reached grade 5 and Group 1 to grade 4). More complications, 13 out of 27 (48.2%%), were recorded in Group 2. The complications were active bleeding due to injury to medial circumflex femoral vessels (5 cases) and avascular necrosis of the femoral epiphysis (8 cases). Group 1 had only four cases of avascular necrosis of the femoral epiphysis.

CONCLUSION: Patients who underwent a DDH operation with a division of the iliopsoas tendon proximally at the pelvic brim regained hip flexion strength earlier and achieved a better grade with fewer complications.

PMID:39853427 | DOI:10.1007/s00264-025-06416-4

Int Orthop. 2025 Jan 24. doi: 10.1007/s00264-025-06414-6. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to assess the presence of spin in abstracts of systematic reviews and meta-analyses comparing biceps tenodesis and tenotomy outcomes and to explore associations between spin and specific study characteristics.

METHODS: Using Web of Science and PubMed databases, systematic reviews and meta-analyses comparing outcomes of biceps tenodesis and tenotomy were identified. Abstracts were evaluated for the nine most severe types of spin as described by Yavchitz et al. and appraised using the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Study characteristics were extracted, including adherence to PRISMA guidelines,funding status, and impact metrics such as journal impact factor, total number of citations, and average annual citations.

RESULTS: A total of 16 studies were included, with spin detected in 81.3% of the abstracts. Type three spin was the most frequent (56.3%), followed by types six (43.8%), five (37.5%), nine (25.0%), two (12.5%), and four (6.3%). Spin types one, seven, and eight were not observed. AMSTAR 2 appraised 75% of the studies as 'low' quality, and 25% as 'critically low' quality. All studies had at least one critical flaw, with item 15 (investigation of publication bias) being the most frequent (93.8%). A strong positive correlation was found between AMSTAR 2 scores and citation counts (r = 0.821, p < 0.001). Studies with a higher number of spin incidents were significantly more likely to have an associated letter to the editor (p = 0.0043).

CONCLUSION: Severe types of spin were prevalent in the abstracts of systematic reviews and meta-analyses comparing biceps tenodesis and tenotomy. Data analysis suggests that abstracts with a higher incidence of spin tend to attract more scrutiny from the academic community. These findings highlight the need to enhance reporting standards.

PMID:39853426 | DOI:10.1007/s00264-025-06414-6

SICOT J. 2025;11:6. doi: 10.1051/sicotj/2024061. Epub 2025 Jan 23.

ABSTRACT

INTRODUCTION: Knee joint stability is influenced by force distribution and ligament structures. High Tibial Osteotomy (HTO) treats knee deformities and redistributes load, reducing further invasive procedures. High Tibial Osteotomy (HTO) is a well-established procedure for addressing knee instability, particularly in cases involving ligament deficiencies such as ACL and PCL insufficiencies. This systematic review aims to evaluate the clinical outcomes and long-term efficacy of HTO in improving knee stability and function.

METHODS: A systematic literature search was conducted using Cochrane Central, PubMed, MEDLINE, and ProQuest databases for studies published between 2000 and June 2024. Eligible studies included human subjects with at least six months of follow-up and focused on HTO for knee instability. Exclusion criteria included animal studies, non-knee joint studies, and reviews. Data on patient demographics, follow-up duration, subjective and objective outcomes, and complications were extracted.

RESULTS: Out of 536 studies identified, 11 met the inclusion criteria, encompassing 303 patients. Combining HTO with ACL or PCL reconstruction significantly improved both subjective instability and objective measures, including Lachman and Pivot Shift test grades. Patient satisfaction was high, and functional scores such as Lysholm and Tegner improved markedly. The incidence of complications was low, with minor issues such as infections and delayed union, and no reported graft failures.

CONCLUSION: HTO, particularly when combined with ligament reconstruction, effectively treats knee instability due to ACL or PCL deficiency. The procedure demonstrates strong mid- to long-term outcomes, high patient satisfaction, and a low rate of complications. It remains a viable option for patients with knee instability.

PMID:39846478 | PMC:PMC11756237 | DOI:10.1051/sicotj/2024061