Injury. 2025 Jan 12;56(2):112145. doi: 10.1016/j.injury.2025.112145. Online ahead of print.

ABSTRACT

The term "fragility fractures of the pelvis" refers to the disruptions of the pelvic ring that are caused by low energy injuries (such as low-level falls or falls from the standing position) in the elderly population (age over 65 years) in the absence of metastatic bone disease. These fractures are increasing in numbers, due to the aging population, particularly in the developed countries, causing significant morbidity and mortality [1]. Although some fracture patterns are stable enough requiring only conservative treatment, other fracture types can cause significant pelvic instability, demanding a more insistent management protocol.

PMID:39847824 | DOI:10.1016/j.injury.2025.112145

J Bone Joint Surg Am. 2025 Jan 23. doi: 10.2106/JBJS.24.00689. Online ahead of print.

ABSTRACT

BACKGROUND: Periprosthetic joint infections (PJIs) are a major complication of total joint replacement surgeries. This study investigated the enhancement of mechanical properties and antibiotic release in ultra-high molecular weight polyethylene (UHMWPE) through the encapsulation of submicron gentamicin sulfate (GS) particles, addressing the critical need for improved implant materials in orthopaedic surgery, particularly in managing PJIs.

METHODS: The present study involved embedding submicron GS particles into UHMWPE flakes at concentrations of 2% to 10% by weight. These particles were prepared and blended with UHMWPE flakes using a dual asymmetric centrifugal mixer, and the blends were consolidated. The present study compared the mechanical properties and antibiotic release rate of UHMWPE containing submicron, medium (as-received), and large (resolidified) GS particles.

RESULTS: UHMWPE samples with submicron GS particles exhibited superior mechanical properties, including higher ultimate tensile and Izod impact strengths, compared with samples with larger particles. Additionally, the submicron GS UHMWPE blends demonstrated a markedly higher and more sustained antibiotic release rate.

CONCLUSIONS: This study highlights the potential of incorporating submicron GS particles into UHMWPE to drastically improve the feasibility of using these therapeutic and functional spacer implants in expanded indications.

CLINICAL RELEVANCE: By offering improved mechanical strength and effective, prolonged antibiotic release, this innovative material could be used as a spacer implant to reduce the considerably high morbidity and mortality associated with PJIs. This material has the potential to prevent PJIs not only in high-risk revision cases but also in primary total joint arthroplasty procedures.

PMID:39847614 | DOI:10.2106/JBJS.24.00689

Int Orthop. 2024 Nov 28. doi: 10.1007/s00264-024-06382-3. Online ahead of print.

ABSTRACT

PURPOSE: To compare the efficacy of an internal brace and the arthroscopic Broström-Gould procedure for chronic lateral ankle instability (CLAI).

METHODS: The clinical data of 71 patients who were diagnosed with chronic lateral ankle instability between May 2020 and May 2022 were retrospectively analyzed. The American Orthopedic Foot and Ankle Society (AOFAS) scale, Foot and Ankle Ability Measure (FAAM), and Visual Analogue Scale (VAS) were used to assess clinical outcomes.

RESULTS: A total of 59 patients were followed up for a mean of 21 months (range, 16-24 months). Thirty-seven patients underwent the modified Broström-Gould (IB) procedure, and twenty-two patients underwent the arthroscopic Broström-Gould (ABG) procedure. The mean postoperative VAS score (P = 0.790), AOFAS score (P = 0.252), FAAM daily activity score (P = 0.983), and FAAM for sports activity score (P = 0.379) were not significantly different between the ABG and IB groups at the final follow-up. However, the FAAM sports score was better in the internal brace group than in the arthroscopy group at the 1-year postoperative follow-up (P = 0.025).

CONCLUSION: Patients treated with an internal brace recovered faster than those who underwent the arthroscopic ABG procedure. However, no other significant differences were observed between the two methods.

LEVEL OF EVIDENCE: Level IV, retrospective case series.

PMID:39847081 | DOI:10.1007/s00264-024-06382-3

Injury. 2025 Jan 17;56(3):112175. doi: 10.1016/j.injury.2025.112175. Online ahead of print.

ABSTRACT

BACKGROUND: Indications for, and usage of, anticoagulant (AC) and antiplatelet (AP) agents is increasing. In this context, it is important to understand the evidence base of the effect of pre-injury AC/AP agents on patient outcomes in the context of traumatic solid organ injury (SOI) to inform management protocols.

METHODS: A scoping review of the literature was undertaken with a systematic search strategy within the PubMed and Scopus databases. Study characteristics, clinical outcomes and outcome measures including mortality, hospital length of stay, admission to intensive care units, length of stay in intensive care and management details were extracted from included studies.

RESULTS: The search identified six eligible studies reporting results from a total of 26,960 patients. Patients on AC/AP are more likely to fail non-operative management (NOM) than their non-AC/AP counterparts; at the same time, they are less likely to be operated on as a first line of management. Clinical outcome measures (mortality, length of stay, admission to intensive care units, and length of intensive care unit stay) were heterogeneous across studies, but it is likely that AC/AP patients have poorer outcomes in SOI. Results on transfusion requirements were inconclusive.

CONCLUSION: Few studies have examined the effect of pre-injury anticoagulation on outcomes in trauma patients sustaining solid organ injuries. Future studies should more closely examine solid organ trauma within the elderly group, as well as the effect of newer AC/AP agents in current use.

PMID:39842106 | DOI:10.1016/j.injury.2025.112175

J Bone Joint Surg Am. 2025 Jan 22. doi: 10.2106/JBJS.24.00261. Online ahead of print.

ABSTRACT

BACKGROUND: Limb-salvage surgery for malignant bone tumors can be associated with considerable perioperative blood loss. The aim of this randomized controlled trial was to assess the safety and efficacy of the intraoperative infusion of tranexamic acid (TXA) in children and adolescents undergoing limb-salvage surgery.

METHODS: All participants were <18 years of age at the time of surgery and diagnosed with a malignant bone tumor of the femur that was treated with resection and reconstruction with a megaprosthesis. Exclusion criteria included anatomic locations other than the femur, reconstruction with a vascularized fibular graft, and a previous history of deep venous thrombosis, coagulopathy, or renal dysfunction. Participants were randomly allocated to either the TXA group (a preoperative loading dose infusion of 10 mg/kg of TXA followed by a continuous infusion of 5 mg/kg/hr until the end of surgery) or the placebo group (the same dosage but with TXA substituted with an infusion of normal saline solution). Intraoperative and perioperative blood loss were calculated with use of the hemoglobin balance method. Perioperative blood loss at postoperative day 1 and at discharge from the hospital were calculated. The total volumes of blood transfused intraoperatively and postoperatively were recorded. A statistical comparison between the groups was performed for blood loss and blood transfusion as well as for possible independent variables other than TXA, including age, body mass index, histopathologic diagnosis, tumor volume, preoperative hemoglobin level, type of resection, and the duration of surgery.

RESULTS: A total of 48 participants, with a mean age of 12.5 ± 3.44 years (range, 5 to 18 years) and a male-to-female ratio of 1.18, were included. All participants were Egyptians by race and ethnicity. There were no minor or major drug-related adverse events. There was no significant difference between the groups with respect to intraoperative blood loss (p = 0.0616) or transfusion requirements (p = 0.812), but there was a significant difference in perioperative blood loss at postoperative day 1 (p = 0.0144) and at discharge from the hospital (p = 0.0106) and in perioperative blood transfusion (p = 0.023).

CONCLUSIONS: TXA can be safely infused intraoperatively in children and adolescents undergoing limb-salvage surgery, and it contributes significantly to the reduction of perioperative blood loss and transfusion requirements.

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

PMID:39841811 | DOI:10.2106/JBJS.24.00261

J Bone Joint Surg Am. 2025 Jan 22. doi: 10.2106/JBJS.22.01273. Online ahead of print.

ABSTRACT

BACKGROUND: Comorbidity indices are used to help to estimate patients' length of hospital stay, care costs, outcomes, and mortality. Increasingly, they are considered in reimbursement models. The applicability of comorbidity indices to patients undergoing orthopaedic oncology surgery has not been studied. The purpose of this study was to determine the predominant comorbidities in patients undergoing orthopaedic oncology surgery and to evaluate the predictive value of these indices.

METHODS: Patient demographic characteristics, diagnoses, and preoperative comorbidities were collected retrospectively on 300 patients undergoing orthopaedic oncology surgery between January 2014 and March 2023. In this study, 3 subsets of 100 patients each with malignant primary bone tumors, malignant primary soft-tissue tumors, or osseous metastatic disease were randomly selected. Comorbidities were tabulated and weighted according to the guidelines of the Charlson Comorbidity Index (CCI), the National Institute on Aging/National Cancer Institute (NIA/NCI) index, the van Walraven Index, and the Agency for Healthcare Research and Quality (AHRQ) Index. Two-tailed bivariate Pearson correlations were performed to assess the relationship between the indices and between each index and patient outcomes. Comorbidities in our patient population were compared with those published in other studies.

RESULTS: The predominant comorbidities in patients undergoing orthopaedic oncology surgery were hypertension, deficiency anemias, metastatic disease, recent unintended weight loss or being underweight, and fluid or electrolyte disorders. The percentage of patients with certain comorbidities exceeded those reported in other cancer, orthopaedic, and inpatient populations. The 4 comorbidity indices had variable correlation when assessing our patient population. The number of comorbidities and the weighted scores from all indices demonstrated little to no correlation with length of stay and survival in our patient sample.

CONCLUSIONS: The prevalence of many comorbidities in patients undergoing orthopaedic oncology surgery is greater than those reported in other patient populations. Commonly utilized indices demonstrate variable correlation with one another. With these tools, there was little to no correlation between comorbidities and patient outcomes in our patient population. The comorbidities deemed protective in these tools may underestimate the true assessment of the comorbidities in patients undergoing orthopaedic oncology surgery. This highlights the importance of developing tools to properly assess the comorbidities in defined patient populations, especially as these models are used to set benchmarks for measuring patient outcomes; assessing quality, efficiency, and safety; and determining reimbursement criteria.

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

PMID:39841810 | DOI:10.2106/JBJS.22.01273

J Bone Joint Surg Am. 2025 Jan 22. doi: 10.2106/JBJS.24.01427. Online ahead of print.

NO ABSTRACT

PMID:39841804 | DOI:10.2106/JBJS.24.01427

SICOT J. 2025;11:5. doi: 10.1051/sicotj/2024060. Epub 2025 Jan 20.

ABSTRACT

BACKGROUND: Hinge fracture on the lateral part of the tibia (LHF) is a common complication of medial Open Wedge High Tibial Osteotomy (OWHTO). Many factors have been described as risks for these fractures, but no study has compared an osteotome or an oscillating saw to prevent LHF following OWHTO.

METHODS: This "propensity-score-matched" (PSM) study was conducted from data obtained in the literature from 1974 to November 2024. A total of 10,368 knees with OWHTO were identified. After 1:1 matching based on correction amount, posterior slope change, surgeon's experience, the osteotome and oscillating groups comprised 2760 knees each.

RESULTS: Among the 5520 knees of the PSM population, the prevalence of LHF was 6.1% in the osteotome alone group (168 cases), and 22% in the oscillating saw group (607 cases). The osteotome group had a significant lower prevalence of hinge fracture than the oscillating saw group (OR, 0.23; 95% CI, 0.19 to 0.27; p < 0.0001) and a lower rate of clinically relevant hinge fractures with revision (OR, 0.34; 95% CI, 0.25 to 0.45; p < 0.001.

DISCUSSION: The osteotome may be an appropriate method for preventing hinge fractures following OWHTO.

PMID:39835708 | PMC:PMC11748527 | DOI:10.1051/sicotj/2024060

SICOT J. 2025;11:3. doi: 10.1051/sicotj/2024054. Epub 2025 Jan 20.

ABSTRACT

INTRODUCTION: Revision Total Knee Arthroplasty (RTKA) is complex, and induced bone loss might endanger implant fixation and joint stability. Intramedullary stems improve fixation throughout stress redistribution. The current study aims to compare the performance of short tibial stems with long tibial stems, investigating their intermediate-term radiographic and survival outcomes in RTKA. The main hypothesis is that the two types of tibial stems would exhibit similar complication and revision rates in mid-term follow-up.

METHODS: Patients who underwent RTKA for all causes in a specialized arthroplasty center from 2010 to 2022 with minimum 2-year follow-up were included in this study. Patients receiving mega prosthesis or implants associated with sleeves or cones were excluded. The final groups consisted of 234 knees: 110 patients with short stems (SS) and 124 with long stems (LS). The mean age at surgery was 65.96 ± 8.73 years in SS and 67.07 ± 8.64 years in LS. The mean Body Mass Index (BMI) was 28.95 is SS and 30.88 in LS (p < 0.05). The average follow-up for SS group was 4.24 years and for LS 5.16 years (p < 0.05).

RESULTS: Complications and re-revisions did not differ significantly between two groups (p > 0.05). Pathological radiolucency was present in 20.91% in SS group and 33.87% in LS group (p < 0.02). Time-to-re-revision was shorter in SS group and occurred at a mean of 3.1 years, while LS failed at a mean of 5.1 years (p < 0.001).

CONCLUSIONS: The SS and LS may be comparable in terms of complications and re-revision. SS significantly fails almost 2 years earlier than long stem (p < 0.001). Additionally, there is a higher tendency for re-revision due to loosening in patients who present pathological radiolucency in SS group. To obtain the benefits of short stem and improve the longevity of the construct; adjuvant zone II (metaphyseal) fixation might be the clue.

PMID:39835707 | PMC:PMC11748526 | DOI:10.1051/sicotj/2024054

Injury. 2025 Jan 10;56(2):112157. doi: 10.1016/j.injury.2025.112157. Online ahead of print.

ABSTRACT

INTRODUCTION: Studies have demonstrated successful outcomes with early weightbearing following open reduction internal fixation (ORIF) of specific ankle fractures. The external validity of an early weightbearing protocol and its effects on patient-reported outcome information scores (PROMIS) has yet to be investigated. This study aimed to investigate the effects of an early weightbearing protocol for all operatively treated ankle fractures and its impact on clinical outcomes and complications.

METHODS: This retrospective cohort study included 229 patients (≥ 16 years) with OTA/AO 44 A-C fractures who underwent open reduction and internal fixation (ORIF). Patients were divided into groups based on early (2-3 weeks postoperative) or delayed (>6 weeks postoperative) weightbearing protocols. Primary outcomes included PROMIS score subsets including physical function, depression, and pain interference and ankle range of motion (ROM) at each follow up visit. Secondary outcomes included complications such as implant removal for pain, prominence, or surgical site infection, revision surgery for failure of fixation or loss of reduction, and post-operative sensory or motor deficits.

RESULTS: There were 96 patients in the early weightbearing cohort and 133 patients in the delayed weightbearing cohort. The median follow-up time of the early weightbearing cohort was 471.47 ± 389.69 days while the delayed cohort was 459.82 ± 358.21 days. Demographics and comorbidities were distributed equally between both groups, except the presence of peripheral neuropathy which was observed more frequently in the delayed weightbearing cohort (8 versus 0, p = 0.022). Results indicated no statistically significant differences in PROMIS scores at final follow up, ankle ROM, or post-operative complications between the early and delayed weightbearing cohorts. Multivariable regression analysis identified smoking as a factor associated with worse ankle ROM at final follow-up.

CONCLUSIONS: This study found that early weightbearing after ORIF of unstable ankle fractures leads to similar PROMIS scores and ankle ROM without increased complications. In addition, smokers were found to have worse ankle ROM when compared to nonsmokers at final follow-up.

PMID:39837099 | DOI:10.1016/j.injury.2025.112157

J Bone Joint Surg Am. 2025 Jan 21. doi: 10.2106/JBJS.23.01397. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to develop an accurate and clinically relevant prediction model for 30-day mortality following hip fracture surgery.

METHODS: A previous study protocol was utilized as a guideline for data collection and as the standard for the hip fracture treatment. Two prospective, detailed hip fracture databases of 2 different hospitals (hospital A, training cohort; hospital B, testing cohort) were utilized to obtain data. On the basis of the literature, the results of a univariable analysis, and expert opinion, 26 candidate predictors of 30-day mortality were selected. Subsequently, the training of the model, including variable selection, was performed on the training cohort (hospital A) with use of adaptive least absolute shrinkage and selection operator (LASSO) logistic regression. External validation was performed on the testing cohort (hospital B).

RESULTS: A total of 3,523 patients were analyzed, of whom 302 (8.6%) died within 30 days after surgery. After the LASSO analysis, 7 of the 26 variables were included in the prediction model: age, gender, an American Society of Anesthesiologists score of 4, dementia, albumin level, Katz Index of Independence in Activities of Daily Living total score, and residence in a nursing home. The area under the receiver operating characteristic curve of the prediction model was 0.789 in the training cohort and 0.775 in the testing cohort. The calibration curve showed good consistency between observed and predicted 30-day mortality.

CONCLUSIONS: The Rotterdam Hip Fracture Mortality Prediction-30 Days (RHMP-30) was developed and externally validated, and showed adequate performance in predicting 30-day mortality following hip fracture surgery. The RHMP-30 will be helpful for shared decision-making with patients regarding hip fracture treatment.

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

PMID:39836737 | DOI:10.2106/JBJS.23.01397

J Bone Joint Surg Am. 2025 Jan 21. doi: 10.2106/JBJS.24.00946. Online ahead of print.

ABSTRACT

BACKGROUND: Joint arthroplasty effectively treats osteoarthritis, providing pain relief and improving function, but postoperative venous thromboembolism (VTE) remains a common complication. This study therefore assessed the effectiveness and safety of aspirin compared with oral anticoagulants (OACs) for VTE prophylaxis after joint arthroplasty.

METHODS: A systematic review and meta-analysis was performed by searching PubMed, Embase, the Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) up to May 14, 2024, that compared the effect of aspirin versus OACs on VTE prophylaxis in adults undergoing joint arthroplasty. Data extraction followed the PRISMA guidelines. Two independent researchers conducted the literature searches and data extraction. A random-effects model was used to estimate effects. The primary outcome was the incidence of VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE); secondary outcomes included bleeding, wound complications, and mortality.

RESULTS: The meta-analysis included 11 RCTs with a total of 4,717 participants (55.1% female) from several continents. The relative risk (RR) of VTE following joint arthroplasty was 1.11 (95% confidence interval [CI], 0.93 to 1.32) for aspirin compared with OACs. Similar results were observed for DVT (RR, 1.12; 95% CI, 0.90 to 1.40) and PE (RR, 1.18; 95% CI, 0.51 to 2.71). There were no significant differences in the risks of bleeding, wound complications, or mortality between patients receiving aspirin and those receiving OACs. Subgroup analyses considering factors such as study region, type of joint surgery, type of VTE detection, year of publication, use of mechanical VTE prophylaxis, aspirin dose, type of OAC comparator, study quality, and funding also found no significant differences in VTE incidence between aspirin and OACs. The overall quality of evidence for VTE and DVT outcomes was high.

CONCLUSIONS: Based on high-quality evidence from RCTs, aspirin is as effective and safe as OACs in preventing VTE, including DVT and PE, after joint arthroplasty, without increasing complications.

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

PMID:39836735 | DOI:10.2106/JBJS.24.00946

J Bone Joint Surg Am. 2025 Jan 21. doi: 10.2106/JBJS.24.00593. Online ahead of print.

ABSTRACT

The Centers for Medicare & Medicaid Services (CMS) recently introduced mandatory reporting of patient-reported outcomes (PROs) following primary, elective total joint arthroplasty (TJA) procedures. This article explores the implications and implementation challenges of this policy shift in the field of orthopaedic surgery. With a review of the existing literature, we analyze the potential benefits and limitations of PROs, discuss the role of CMS in health-care quality improvement initiatives, explain the predicted difficulties in the successful implementation of this new mandate, and provide recommendations for the successful integration of the reporting of PROs in clinical practice.

PMID:39836727 | DOI:10.2106/JBJS.24.00593

SICOT J. 2025;11:4. doi: 10.1051/sicotj/2024053. Epub 2025 Jan 20.

ABSTRACT

PURPOSE: The primary aim of this study is to determine the rectus abdominis tendon (RAT) insertional anatomy and consequently clarify the extension of secure mobilization of the tendon from the pubic bone in the setting of anterior approaches in pelvic and acetabular reconstruction surgery.

MATERIALS AND METHODS: Eleven fresh frozen cadaveric pelvises were dissected by two fellowship-trained orthopaedic trauma surgeons utilizing the anterior intrapelvic approach (AIP). The RAT at the pubic body was dissected, and its footprint on the pubic bone was defined, marked, and measured.

RESULTS: Nineteen (19) RAT insertions were analyzed. The average total medial vertical length was 33 mm (range 26-42 mm), and the average total lateral vertical length was 36.5 mm (range 26-46 mm). The total width of the proximal insertion on both sides was measured at an average of 20.42 mm (range 14-24 mm). The average width of the tendon at the transition area between the cranial and caudal areas of the pubic bone was 16.45 mm (range 12-22 mm). The average distal insertion width of the RAT was less than the proximal and middle widths, measuring 10.45 mm (range 8-13 mm).

CONCLUSION: The tendon can be safely mobilized up to an average total medial vertical length of 33 mm (and in no case more than 42 mm) and to an average total lateral vertical length of 36.5 mm (and in no case more than 46 mm). This piece of anatomical information will equip orthopaedic surgeons with a better understanding of the insertional anatomy of the RAT and subsequent safer surgical release when performing anterior approaches to the pelvic ring.

PMID:39831723 | PMC:PMC11744990 | DOI:10.1051/sicotj/2024053

Injury. 2025 Jan 16;56(2):112171. doi: 10.1016/j.injury.2025.112171. Online ahead of print.

ABSTRACT

BACKGROUND: Fragility fractures of the pelvis are becoming increasingly important in an ageing society. However, they are under-represented in the current research literature. In particular, unstable bilateral fragility fractures of the sacrum (FFP IVb) benefit from surgical treatment, but individual fracture patterns need to be considered in the surgical decision. This study describes the sacral anatomy in patients with FFP IVb pelvic fractures, with particular emphasis on the identification and evaluation of possible trans-sacral screw corridors, with particular emphasis on the transverse fracture components.

METHODS: Design: Retrospective clinical study.

SETTING: Level 1 trauma center. Patient Selection Criteria: The study reviewed 100 patients admitted for bilateral FFP with a transverse fracture between 01 / 2013 and 11 / 2023 that had a preoperative computed tomography (CT) of the pelvis including the fifth vertebra, treated with FFP IVb using preoperative multiplanar CT scans to analyze sacral anatomy. Outcome Measures and Comparisons: Sacral types and transitional abnormalities were classified, and corridor dimensions for S1 and S2 were measured, including estimated bone density using Hounsfield units. Bone corridors ≥ 8 mm were considered adequate. In addition, possible trans-sacral screw corridors were evaluated, taking into account the transverse fracture component.

RESULTS: While large trans-sacral screw corridors (≥ 8 mm) for S1 and S2 were identifiable in most cases, the actual feasibility for screw placement was limited due to the transverse fracture component's location, resulting in meaningful corridors in only 80 % for S1 and 47 % for S2. Additionally, in 4 % of patients without an S1 corridor, trans-sacral screw fixation was deemed inadequate due to the fracture line passing through S2.

CONCLUSIONS: These results indicate that not all FFP IVb fractures can be effectively stabilized using trans-sacral screw or bar fixation, necessitating alternative techniques for some cases. Furthermore, precise preoperative planning is essential for the management of these fractures due to complexity of anatomy. To identify the most suitable treatment approaches, further clinical studies are required.

LEVEL OF EVIDENCE: III.

PMID:39827531 | DOI:10.1016/j.injury.2025.112171

Injury. 2025 Jan 9;56(2):112152. doi: 10.1016/j.injury.2025.112152. Online ahead of print.

ABSTRACT

INTRODUCTION: Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care.

OBJECTIVE: Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks.

METHODS: A multicentre retrospective cohort study was conducted.

INCLUSION CRITERIA: aged ≥ 18 and an Injury Severity Score (ISS) > 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures.

RESULTS: Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P25-P75 1-6 vs. 5, P25-P75 2-9, p = 0.002), depression (2, P25-P75 1-5 vs. 5, P25-P75 2-9, p < 0.001), and post-traumatic stress (6, P25-P75 0-15 vs. 13, P25-P75 3-33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P25-P75 1-6 vs. 4, P25-P75 2-10, p = 0.030) and post-traumatic stress (7, P25-P75 0-18 vs. 15, P25-P75 4-34, p < 0.001).

CONCLUSIONS: Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.

PMID:39827530 | DOI:10.1016/j.injury.2025.112152

Injury. 2025 Jan 12;56(2):112160. doi: 10.1016/j.injury.2025.112160. Online ahead of print.

ABSTRACT

BACKGROUND: Femoral neck fractures, particularly Pauwels type II and III, pose significant challenges due to their vertical instability and susceptibility to complications such as non-union and avascular necrosis (AVN). Medial buttress plates (MBPs) have emerged as a promising adjunct in fixation, offering biomechanical advantages by neutralizing shearing forces and enhancing stability. However, the clinical efficacy of MBPs across different fixation techniques, plate configurations, and positioning remains unclear.

PURPOSE: This study aimed to (1) analyse outcomes of femoral neck fracture fixations augmented with MBPs, focusing on Pauwels type 2 and 3 fractures, and (2) analyse the impact of plate size, positioning, and the use of MBPs in different fixation techniques.

STUDY DESIGN: Systematic review; Level of evidence, 4.

METHODS: Two independent reviewers performed a literature search based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using PubMed, MEDLINE, EMBASE, and Cochrane databases. Studies published from 2010 onwards, focusing on MBPs in Pauwels type II and III femoral neck fractures, were included. Clinical outcomes and plate details were recorded.

RESULTS: Data from 21 studies, including 11 derived from meta-analyses, encompassing 642 patients were analysed. MBP-augmented fixations demonstrated a non-union rate of 6 %, an AVN rate of 4 %, and an overall failure rate of 17.3 %. The mean time to union was 3.9 ± 1.2 months, and the average HHS was 89.5 ± 5.5 at the final follow-up. Multiple cannulated screws (MCS) combined with a MBP showed a lower failure rate (14.6 %) compared to dynamic hip screw combined with a MBP (26.8 %), though not statistically significant (p = 0.164). Medial or anteromedial plate positioning yielded better outcomes, while anterior placement was associated with high failure rates. No studies examined the outcomes of femoral neck system fixation combined with a MBP.

CONCLUSION: MBPs are a valuable adjunct in managing Pauwels type II and III femoral neck fractures, providing favourable outcomes with low rates of failure and complications. The combination of MBPs with various fixation techniques has shown promising results, highlighting the potential for improved stability and outcomes. Further research is needed to optimize plate size, screw type, positioning, and the role of MBPs in augmenting fixation techniques for these challenging fractures.

PMID:39827529 | DOI:10.1016/j.injury.2025.112160

Injury. 2025 Jan 12;56(2):112158. doi: 10.1016/j.injury.2025.112158. Online ahead of print.

ABSTRACT

The repair of critical-sized bone defects represents significant clinical challenge. An alternative approach is the use of 3D composite scaffolds to support bone regeneration. Hydroxyapatite (HA) and tri-calcium phosphate (β-TCP), combined with polycaprolactone (PCL), offer promising mechanical resistance and biocompatibility. Bioelectrical stimulation (ES) at physiological levels is proposed to reestablishes tissue bioeletrocity and modulates cell signaling communication, such as the BMP/TGF-β and the RANK/RANK-L/OPG pathways. This study aimed to evaluate the use HA/TCP scaffolds and ES therapy for bone regeneration and their impact on the TGF-β/BMP pathway, alongside their relationship with the RANK/RANKL/OPG pathway in critical bone defects. The scaffolds were implanted at the bone defect in animal model (calvarial bone) and the area was subjected to ES application twice a week at 10 µA intensity of current for 5 min each session. Samples were collected for histomorphometry, immunohistochemistry, and molecular analysis. The TGF-β/BMP pathway study showed the HA/TCP+ES group increased BMP-7 gene expression at 30 and 60 days, and also greater endothelial vascular formation. Moreover, the HA/TCP and HA/TCP+ES groups exhibited a bone remodeling profile, indicated by RANKL/OPG ratio. HA/TCP scaffolds with ES enhanced vascular formation and mineralization initially, while modulation of the BMP/TGF pathway maintained bone homeostasis, controlling resorption via ES with HA/TCP.

PMID:39826405 | DOI:10.1016/j.injury.2025.112158

Int Orthop. 2025 Jan 18. doi: 10.1007/s00264-025-06406-6. Online ahead of print.

ABSTRACT

PURPOSE: Previous studies have shown that subtrochanteric femoral fractures treated with intramedullary nails might lead to varus-procurvatum malalignment. Similar results have been reported when using antegrade intramedullary lengthening nails (ILNs). The purpose of our study is to examine if antegrade telescoping intramedullary lengthening nails lead to varus-procurvatum malalignment of the proximal femur and what are possible predictors of that shift.

METHODS: In this retrospective, single centre study, five surgeons performed 537 femoral ILN. 347 antegrade PRECICE nails were selected after applying exclusion criteria. The following exclusion criteria were applied, intentional angular deformity correction, retrograde femoral lengthening and concomitant tibial lengthening. After further exclusion criteria were applied, we retrospectively inspected 201 PRECICE nails inserted in 158 paediatric and adult patients (average age 19.9 years) that underwent IM nail limb lengthening. Follow-up was at least one year by which time all osteotomies were healed.

RESULTS: Mean lengthening was 4.7 cm per lengthening surgery with some patients needing multiple lengthening for large discrepancies. Of the 201 nails, trochanteric entry was used in 127 procedures and piriformis entry was used in 74 of them. With pre-op Osteotomy Level Coefficient (OLC) of 0.3. The preoperative neck shaft angle (NSA) was significantly reduced from 130.6 to 127.4 degrees at the end of lengthening (P < 0.05). There was no discernible correlation between the OLC and change in NSA. The trochanteric entry point was associated with a greater tendency to reduce the NSA (Mdif = -4.1, SD = 6.5) as compared to the piriformis entry point (Mdif = -3, SD 6.4) (P < 0.05). No significant change in anatomic medial proximal femoral angle (aMPFA) was noted between pre- and postoperative time points, nor between trochanteric and piriformis entry groups.

CONCLUSION: Our study investigated the risk of iatrogenic varus deformity of the proximal femur following intramedullary limb lengthening procedures. We identified the osteotomy site as the most significant risk factor for developing iatrogenic varus, while the nail insertion point did not significantly predict this complication, showing comparable results for both trochanteric and piriformis entry points. Additionally, our study is the first to identify a correlation between the level of osteotomy and coxa-valga correction. We hypothesize that a higher osteotomy level might be beneficial for patients undergoing limb lengthening who also present with coxa-valga deformity.

LEVEL OF EVIDENCE: IV.

PMID:39825909 | DOI:10.1007/s00264-025-06406-6

Injury. 2025 Jan 13;56(2):112154. doi: 10.1016/j.injury.2025.112154. Online ahead of print.

ABSTRACT

BACKGROUND: Boxing is a sport well-known for the risk of injury. However, the epidemiology of boxing-associated fractures has not been well studied. This study aims to report the characteristics of boxing fractures that lead to presentation to the emergency room and evaluate the demographics and practices of the patients to prevent these injuries.

METHODS: This cross-sectional study analyzed boxing-associated fractures over a decade (2013-2022) using the National Electronic Injury Surveillance System (NEISS) database. Patients presenting to U.S. emergency departments with boxing-related injuries were categorized by age, gender, and injury location. Descriptive statistics, chi-square tests, and ANOVA were employed to assess temporal trends and associations between injury occurrence and demographic variables.

RESULTS: Analysis of 959 boxing-associated fractures (BAFs) showed that hand fractures were most common (53.64%), followed by phalanx (12.73%) and facial fractures (10.91%). Significant differences were observed across body parts (χ2 = 9.74, P < .001). Associated soft tissue injuries included lacerations, contusions, sprains, strains, and hematomas, with no significant differences among these categories (χ2 = 1.47, P = 0.832). Males experienced more BAFs than females overall, but females had a significant increase over time (F(1,9) = 4.308, p = 0.032). Most fractures occurred in recreational or sports settings (34.5%), followed by home (19.1%) and school (13.24%). The highest BAF incidence was in individuals aged 21-30 (32.18%), while the lowest was in those aged 41-50 (5.47%). From 2020 to 2022, BAFs decreased in recreational settings and increased at home during 2020-2022.

CONCLUSION: Hand fractures were the most common type of BAF. Males had significantly more BAFs, although the incidence of BAFs in females increased significantly since 2013. Fractures mainly occurred in recreational places, but from 2020-2022, most occurred at home. This shift coincided with the COVID-19 pandemic, suggesting increased home sparring. These findings emphasize the need for further research into protective measures and injury prevention in boxing.

PMID:39823921 | DOI:10.1016/j.injury.2025.112154