EFORT Open Rev. 2025 Jun 2;10(6):352-360. doi: 10.1530/EOR-2025-0058.

ABSTRACT

Surgical decompression of carpal tunnel syndrome is usually successful, and failure is rare. Diagnosis of persistent or recurrent carpal tunnel syndrome is based on thorough anamnesis and clinical examination, defining underlying comorbidities, nerve conduction studies and distinguish recurrent, persistent or new complaints. Management of failed carpal tunnel release may require revision surgery, which includes redo release of the transversal carpal ligament, external neurolysis and flaps. A hypothenar fat pad flap or other local, regional or distant flaps may be added to a redo release of the carpal tunnel. Currently, convincing evidence to superiority of additional flap surgery is lacking. Postoperative care is evolving toward early motion rather than immobilization, with nerve gliding exercises to prevent adhesions and promote nerve recovery. Virtual reality was recently added to postoperative protocol options.

PMID:40459165 | PMC:PMC12139599 | DOI:10.1530/EOR-2025-0058

EFORT Open Rev. 2025 Jun 2;10(6):431-438. doi: 10.1530/EOR-2025-0054.

ABSTRACT

Psychological consequences of trauma: Acute stress reactions and post-traumatic stress disorder are common psychological conditions that affect the healing process. Early interventions: Psychological first aid and psychoeducation are evidence-based approaches aimed at mitigating post-traumatic symptoms. Social support: It plays a central role in psychological stabilisation and promotion of functional recovery. Multidisciplinary approaches: Cooperation between orthopaedists, psychologists and social workers is crucial for optimal treatment results. Challenges in clinical practice: Limited time, stigmatisation of mental illness and inadequate resources are common barriers to effective care.

PMID:40459162 | PMC:PMC12139708 | DOI:10.1530/EOR-2025-0054

EFORT Open Rev. 2025 Jun 2;10(6):361-368. doi: 10.1530/EOR-2025-0053.

ABSTRACT

The French paradox cementing technique encompasses a canal filling highly polished stem with a thin (<1 mm) cement mantle. The technique has been developed by Pr Marcel Kerboull in the late 1960s after he observed the patterns of debonding of the original Charnley stem. The key point of the technique is based upon removal of the metaphyseal cancellous bone (with hollow reamers or aggressive broaches) especially at the supero-medial region. Only two stems have been validated with this technique: the Charnley-Kerboull (CK) and the Ceraver Osteal stem, both of which are collared. This technique is neither a taper slip (the stem does not subside at long-term follow-up) nor a composite beam (a highly polished stem is used). A 12% shortened stem CK has shown similar results to the standard-length stem, including the absence of stem subsidence. Combined with the Hueter anterior approach, this technique has demonstrated one of the lowest femoral PPF rate in elderly patients in the literature.

PMID:40459160 | PMC:PMC12139596 | DOI:10.1530/EOR-2025-0053

EFORT Open Rev. 2025 Jun 2;10(6):378-387. doi: 10.1530/EOR-2025-0051.

ABSTRACT

Patellar dislocations present predominantly during adolescence, with a higher incidence observed among female patients. Patellofemoral joint stability depends critically on both osseous anatomy and soft tissue structures. Patellofemoral pathology can be classified into three major groups: objective patellar instability OPI, potential patellar instability and painful patellar syndrome. Three primary risk factors predispose individuals to patellar dislocation: trochlear dysplasia, patella alta and increased tibial tuberosity-trochlear groove (TT-TG) distance. Three secondary risk factors should be considered: femoral and tibial rotational abnormalities and valgus deformity. MRI has become the imaging modality of choice, enabling precise quantification of OPI risk factors in a single imaging examination. The 'menu à la carte' approach guides the treatment of OPI by addressing the most relevant anatomical risk factors for each patient using statistical thresholds.

PMID:40459157 | PMC:PMC12139600 | DOI:10.1530/EOR-2025-0051

EFORT Open Rev. 2025 Jun 2;10(6):403-415. doi: 10.1530/EOR-2025-0070.

ABSTRACT

BACKGROUND: Despite the growing burden of degenerative cervical myelopathy (DCM), consensus on the optimal timing of surgical intervention remains lacking, especially for patients with mild symptoms or asymptomatic cord compression or in the context of recent trauma. Different scores, such as the mJOA, Nurick scale and NDI are commonly used to classify disease severity, but guidelines for managing these patients do not provide a clear framework for intervention timing.

MATERIALS AND METHODS: We conducted a narrative review of the literature on the optimal timing of surgical intervention for DCM, using PubMed to identify relevant studies. The search was focused on surgical and non-operative management, clinical and radiological assessments, biomarkers and emerging technologies. The selected papers were reviewed for relevance and quality, with guidance from a senior author.

RESULTS: The initial search identified 6,705 articles, which were narrowed down to 136 relevant studies after applying filters for study type and clinical focus. A final selection of 87 papers was categorized by topics and the findings were synthesized to highlight trends, challenges and knowledge gaps in surgical timing for DCM.

FOCUS OF THE STUDY: This review article examines strategies for determining the optimal timing for surgery in DCM. It explores how radiological signs, clinical indicators and other markers may help identify patients at risk of rapid neurological deterioration, particularly in the 'grey-zone' population (mild symptoms or asymptomatic disease), enabling clinicians to assess correctly different clinical scenarios and to indicate timely surgical intervention.

PMID:40459154 | PMC:PMC12139713 | DOI:10.1530/EOR-2025-0070

EFORT Open Rev. 2025 Jun 2;10(6):416-423. doi: 10.1530/EOR-2025-0037.

ABSTRACT

Posterolateral tibial plateau fractures are complex injuries requiring a thorough understanding of the anatomical structures involved, including the popliteus tendon, lateral collateral ligament and posterior horn of the lateral meniscus. Standard anterolateral or midline approaches provide limited access to the posterolateral corner, often necessitating specific surgical techniques to achieve optimal fracture reduction and joint stability. This review explores the main surgical approaches used for these fractures outlining their indications, advantages and limitations. Each section provides a step-by-step guide for an effective surgical technique, based on experience from a high-volume trauma center, to optimize exposure, reduction and fixation. Understanding the biomechanical and anatomical aspects of these fractures is crucial for selecting the most appropriate surgical strategy, minimizing complications and improving patient outcomes.

PMID:40459152 | PMC:PMC12139710 | DOI:10.1530/EOR-2025-0037

EFORT Open Rev. 2025 Jun 2;10(6):336-344. doi: 10.1530/EOR-2025-0050.

ABSTRACT

Current non-surgical managements of osteoarthritis (OA) do not change the clinical course or arrest the progression of the disease, while joint replacement is indicated for end-stage disease. Given these limitations, there is an unmet clinical demand for new treatment modalities that can improve the pain and quality of life of patients suffering from OA without surgery. The recent surge of interest in regenerative medicine (RM) for OA is based on these circumstances. Unlike traditional medicine, RM products may be accompanied by many uncertainties and long-term consequences. Considering that OA directly affects quality of life rather than life and death, the 'first do no harm' principle is more important when applying RM technology to the disease. Presently, culture-expanded mesenchymal stromal cells (MSCs) and orthobiologics, including bone marrow aspirate concentrate, stromal vascular fraction from adipose tissue and platelet-rich plasma have been applied to patients in clinical trials. Results of randomized clinical trials using MSCs have demonstrated that structural improvement and reversal of the pathologic process in OA are not definitely shown, while symptomatic relief is apparent. Orthobiologics seem to have efficiency comparable to those of culture-expanded MSCs. With the advantage of avoiding the approval process from regulation agencies, orthobiologics might provide a less expensive and handier option to culture-expanded MSCs. High-quality data from a large number of patients and head-to-head comparisons of several RM products will be necessary to define the place of culture-expanded MSCs or orthobiologics for OA treatment and resolve the reimbursement issue.

PMID:40459150 | PMC:PMC12139601 | DOI:10.1530/EOR-2025-0050

EFORT Open Rev. 2025 Jun 2;10(6):327-335. doi: 10.1530/EOR-2025-0057.

ABSTRACT

Charcot neuroarthropathy is the most severe complication of the diabetic foot. Its diagnosis is difficult and often overlooked, delaying management, with sometimes disastrous consequences. Its incidence is increasing due to the rapid global rise in the number of people with diabetes. Its pathophysiology remains unclear, although the activation of the RANK/RANK-L system appears to be involved, triggered either by neurotraumatic or neurovascular mechanisms, leading to the differentiation of monocytes into osteoclasts. Diagnosis relies on clinical and radiological arguments, particularly MRI. There are different types of Charcot foot depending on the evolution, according to Eichenholtz's classification and based on location according to Sanders and Brodsky's classifications. Treatment involves a multidisciplinary approach with diabetes management and addressing other general complications. Medical treatment is indicated as the first line, with offloading and immobilisation using a 'total contact cast'. In case of failure of this method, or if there is immediate deformity, surgical intervention is indicated, and techniques are evolving rapidly. Depending on the deformity, minimally invasive or arthroscopic procedures may be performed. In cases of significant deformity, foot reconstruction may be proposed, using the so-called 'super construct' technique if necessary. Infection will be treated concurrently or initially, depending on severity. Many complications are reported, but increasingly early and aggressive surgery improves patients' quality of life and reduces amputation rates.

PMID:40459148 | PMC:PMC12139603 | DOI:10.1530/EOR-2025-0057

J Bone Joint Surg Am. 2025 Jun 3. doi: 10.2106/JBJS.24.01629. Online ahead of print.

ABSTRACT

BACKGROUND: While the morbidity associated with revision total hip arthroplasty (THA) or periprosthetic infection (PJI) has been well characterized, less is known about the risk of mortality. With this study, we aimed to determine the long-term mortality associated with revision THA for PJI and associated risk factors.

METHODS: Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were used to study mortality associated with THA procedures for osteoarthritis and subsequent revisions from September 1999 through December 2022. Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables were used to summarize the overall survival following the primary and first revision THA. Risk factors associated with mortality were identified using Cox proportional hazards models, adjusted for age and gender.

RESULTS: There were 548,061 primary THA procedures for osteoarthritis; 4,651 first revision procedures for infection and 15,891 first revisions for reasons other than infection and fracture were recorded. At 5, 10, and 15 years, the cumulative mortality rate for revision for PJI was 14.5%, 34.7%, and 57.5%, respectively. Patients who underwent revision for PJI had higher mortality rates than expected compared with the general population, and the corresponding SMR (1.31; 95% confidence interval [CI]: 1.24 to 1.39) was greater than that for patients undergoing primary THA (0.81; 95% CI: 0.81 to 0.82) or aseptic revision (0.95; 95% CI: 0.92 to 0.99). A higher SMR following revision for PJI was observed in patients <65 years of age and in female patients, and continued to increase beyond 15 years. There were no differences in mortality rates according to whether a major or minor revision was performed to manage PJI.

CONCLUSIONS: Patients revised for infection had increased mortality rates compared with the general population and those undergoing primary THA or aseptic revision. This excess risk persisted beyond 15 years, especially in younger patients.

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

PMID:40460198 | DOI:10.2106/JBJS.24.01629

Int Orthop. 2025 Jun 4. doi: 10.1007/s00264-025-06566-5. Online ahead of print.

ABSTRACT

PURPOSE: To compare the treatment approaches for foot compartment syndrome (FCS) and evaluate their outcomes.

METHODS: A systematic review was conducted in MEDLINE, EMBASE, Mayo journals via OVID Databases, Web of Science, and Scopus from each database's inception to December 2024. Two reviewers, independently working in duplicate, assessed each manuscript's title, abstract, and full text for eligibility. Study characteristics, quality of evidence, and outcomes were obtained and analyzed.

RESULTS: A total of 45 articles were included in the qualitative analysis, 38 case reports, and seven cohort studies. Among the case reports, only two patients underwent conservative management, while all remaining cases, as well as all cohort studies, reported fasciotomy as the primary treatment. Trauma was the most frequently identified cause of FCS, and the diagnostic criterion commonly used was an intracompartmental pressure exceeding 30 mmHg. There was no consensus on the number or anatomical location of incisions. Due to the heterogeneity of the data, a meta-analysis could not be performed to assess the risk associated with different incision approaches.

CONCLUSION: Fasciotomy remains the standard treatment for FCS. However, there is insufficient evidence to determine the optimal number and location of surgical incisions. While existing data suggest that using two or more incisions may be associated with fewer long-term sequelae, further research is needed to establish specificity of compartment decompression to enhance treatment recommendations.

PMID:40461896 | DOI:10.1007/s00264-025-06566-5

J Bone Joint Surg Am. 2025 Jun 2. doi: 10.2106/JBJS.24.01210. Online ahead of print.

ABSTRACT

BACKGROUND: There has been minimal literature evaluating how a prior myocardial infraction (MI) influences outcomes after total knee arthroplasty (TKA). Thus, the purpose of this study was to evaluate how the timing, type, and treatment of MI prior to TKA affect postoperative cardiac complications, general medical complications, and surgical complications.

METHODS: A retrospective comparative study was conducted using a large insurance database. Patients undergoing primary TKA for osteoarthritis were included. Patients who had experienced MI within 2 years before TKA were identified and were matched 1:4 with patients who had not had such an MI on the basis of demographic variables and comorbidities. Patients who had a prior MI were stratified into 4 groups based on the timing of the MI: 0 to <6 months, 6 to <12 months, 12 to <18 months, and 18 to 24 months before TKA. The rates of postoperative cardiac, general medical, and surgical complications were compared between groups. Subanalyses on the prior MI type, treatment, and location were performed.

RESULTS: Prior MI was associated with increased risks of postoperative MI (odds ratio [OR], 3.97 [95% confidence interval (CI), 3.20 to 4.93]), heart failure (OR, 1.45 [95% CI, 1.24 to 1.75]), and 90-day mortality (OR, 2.15 [95% CI, 1.41 to 3.28]). The risk of postoperative MI was highest for those with MI within 6 months before TKA (OR, 6.86 [95% CI, 5.34 to 8.82]). Type-1 MI, ST-elevation MI (STEMI), non-ST-elevation MI (NSTEMI), and anterior and inferior MIs were linked to elevated postoperative MI and/or mortality risks, with timing closer to surgery further amplifying the risk. Percutaneous coronary intervention within 6 months before TKA also increased postoperative risks. Type-2 MI within 6 months before TKA was associated with an increased risk of periprosthetic joint infection compared with controls (OR, 4.23 [95% CI, 1.67 to 10.67]).

CONCLUSIONS: Patients who had a prior MI, particularly within 6 months before TKA, had significantly elevated risks of postoperative MI, heart failure, and mortality. Outcomes varied by MI type, treatment, and location, with type-1 MIs and STEMIs increasing the postoperative mortality risk.

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

PMID:40455939 | DOI:10.2106/JBJS.24.01210

Int Orthop. 2025 Jun 2. doi: 10.1007/s00264-025-06552-x. Online ahead of print.

ABSTRACT

PURPOSE: This study documented changes in cartilage lesions in the arthritic medial knee compartment after medial opening wedge high tibial osteotomy (MOWHTO), their impact on clinical outcomes and possible factors influencing this improvement.

METHODS: Forty-nine patients indicated for MOWHTO (per ISAKOS criteria) underwent arthroscopy at osteotomy and implant removal (mean interval: 22.2 months). Cartilage lesions (medial femoral condyle [MFC], medial tibial plateau [MTP]) and clinical scores (Lysholm score and KOOS) were documented. No cartilage restoration procedures were performed.

RESULTS: The mean age was 47.5 years and most were females (n = 32). Arthroscopically, cartilage improvement occurred in 32 (65.3%) MFC and 25 (51%) MTP lesions. MOWHTO significantly improved the mechanical tibiofemoral angle (TFA) (7.88 ± 3.66 vs. - 2.71 ± 1.98 (°); P < 0.001). Lysholm knee score (77 ± 16.2 vs. 48.4 ± 16.3, p < 0.001) and KOOS (64.1 ± 13.6 vs. 43.8 ± 12.5, p < 0.001) significantly improved after osteotomy. On the femoral side, cartilage repair was documented in patients who achieved relatively more valgus correction, with a mean final TFA of 3.32 ± 1.7, compared with 1.57 ± 2 in the no improvement group (P = 0.001). For the MTP, no factor of statistical significance could be detected.

CONCLUSIONS: MOWHTO can improve articular cartilage lesions as a standalone procedure. A greater incidence of cartilage repair is expected with more valgus correction of the mechanical axis of the limb. This cartilage infill is associated with slightly better clinical outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov (ID NCT04541342) registered on 9.9.2020, https://clinicaltrials.gov/study/NCT04541342 .

PMID:40455268 | DOI:10.1007/s00264-025-06552-x

Injury. 2025 May 23:112438. doi: 10.1016/j.injury.2025.112438. Online ahead of print.

NO ABSTRACT

PMID:40451656 | DOI:10.1016/j.injury.2025.112438

Injury. 2025 May 24;56(8):112455. doi: 10.1016/j.injury.2025.112455. Online ahead of print.

ABSTRACT

OBJECTIVE: Surgical treatment of scaphoid nonunion after failed screw fixation is a unique challenge for hand surgeons. This retrospective study evaluated the clinical results of revisional reconstruction by a hand trauma plate system with bone grafting for this situation.

METHODS: From 2019 to 2022, 12 patients with scaphoid nonunion after failed closed or open reduction and internal fixation surgery were treated with revisional surgery using a 1.7-mm nonlocking hand trauma plate system. Pure cancellous bone was harvested from the iliac crest or olecranon of the patient to fill the bony defect between the proximal and distal segments of the fracture. Visual analog scale scores and functional outcomes were assessed after at least 2 years of follow-up.

RESULTS: We used computed tomography (CT) to assess the union, and all fractures healed. The mean interval between primary and definitive surgery was 14.4 (range, 6-36) months. The mean follow-up period was 43.4 (range, 27-72) months. The mean union time was 11 (range, 8-16) weeks. The clinical outcomes included active wrist range of motion (67.2 % ± 16.4 % vs. 82.9 % ± 12.0 %, P = 0.002), visual analog scale score (5.0 ± 1.3 vs. 2.3 ± 1.2, P < 0.001), grip strength (69.4 % ± 11.3 % vs. 88.5 % ± 16.6 %, P < 0.001), and modified Mayo wrist score (51.7 ± 16.1 vs. 71.7 ± 8.9, P < 0.001). Three patients complained of clicking at the volar part of the wrist joint, which was resolved by plate removal.

CONCLUSION: A hand trauma plate system can be used to stabilize the scaphoid fracture nonunion in the treatment of failed screw fixation for scaphoid waist fractures. Hardware removal may be considered if impingement symptoms persist after fracture healing.

PMID:40450785 | DOI:10.1016/j.injury.2025.112455

Injury. 2025 May 26;56(8):112457. doi: 10.1016/j.injury.2025.112457. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to systematically compare the clinical efficacy and safety of different surgical approaches in the treatment of posterolateral tibial plateau fractures. Specifically, it evaluated operative time, intraoperative blood loss, fracture healing time, postoperative knee function, and complication rates, to provide evidence-based guidance for clinical surgical approach selection.

METHODS: A comprehensive literature search was conducted in seven major databases-CNKI, PubMed, Web of Science, Cochrane Library, Scopus, VIP, and EMBASE-from their inception to May 2025. Controlled studies comparing different surgical approaches for posterolateral tibial plateau fractures were included. Primary outcomes were operative time, intraoperative blood loss, fracture healing time, postoperative Hospital for Special Surgery (HSS) knee scores, and incidence of postoperative complications. A network meta-analysis was performed using Stata 16.0. A network diagram and league table were generated to present both direct and indirect comparisons among surgical approaches. Surface Under the Cumulative Ranking curve (SUCRA) values were used to rank the interventions. Study quality was assessed using the MINORS scale. Inconsistency testing and publication bias analysis were also conducted to ensure robustness of the results.

RESULTS: A total of 26 studies involving 1864 patients and seven surgical approaches were included. The network meta-analysis showed that the Modified Extended Anterolateral Approach (MEALA) ranked highest across all primary outcomes: operative time (SUCRA: 97.8 %), intraoperative blood loss (94.9 %), fracture healing time (95.0 %), postoperative HSS score (98.2 %), and complication rate (78.5 %). Additionally, the Transfibular Head Approach (TFHA) demonstrated advantages in minimizing intraoperative blood loss and controlling complications. No significant inconsistency or publication bias was detected based on node-splitting analysis and funnel plot assessment, indicating robust results.

CONCLUSION: The Modified Extended Anterolateral Approach demonstrates superior overall performance in the treatment of posterolateral tibial plateau fractures, particularly in reducing operative time, minimizing intraoperative trauma, and enhancing postoperative functional recovery. The Transfibular Head Approach also shows potential benefits in complication management. Surgical approach selection should be individualized based on fracture morphology and surgeon experience. Further high-quality randomized controlled trials are warranted to validate these findings.

PMID:40449183 | DOI:10.1016/j.injury.2025.112457

Injury. 2025 May 24;56(8):112454. doi: 10.1016/j.injury.2025.112454. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal radius fractures (DRFs) are common, with an increasing incidence, particularly among the elderly. Rupture of the extensor pollicis longus (EPL) tendon, essential for thumb extension, is a notable complication, especially in non-displaced DRFs. Several mechanisms, such as local adhesion, ischemic atrophy, and tendon laceration, are associated with EPL tendon rupture. This multicenter retrospective study aims to identify risk factors for EPL tendon rupture in non-displaced DRFs.

MATERIALS AND METHODS: The study reviewed 20 cases of EPL tendon rupture and 52 control cases from 2005 to 2022, excluding those who underwent surgery or had incomplete computed tomography (CT) data. We investigated age, sex, location of fracture line, and the morphology of Lister's tubercle as variables. Logistic regression and decision tree analyses were employed to determine the risk factors for EPL tendon rupture based on these variables.

RESULTS: Fracture lines distal to Lister's tubercle and specific shapes of Lister's tubercle, characterized by shallow peak height and a higher radial peak than the ulnar peak, increased the risk of EPL tendon rupture. Decision tree analysis confirmed them as major risk factors. There was a significant difference in the predicted probability rate of tendon rupture between the case with these factors and those without them (P < 0.001). Conversely, the location and size of Lister's tubercle did not affect the incidence of EPL tendon rupture.

CONCLUSION: The location of fracture line and the shape of Lister's tubercle are key factors influencing EPL tendon rupture in non-displaced DRFs. Understanding these factors can help orthopedic surgeons predict and prevent EPL tendon ruptures, improving patient outcomes following these fractures.

PMID:40449182 | DOI:10.1016/j.injury.2025.112454

Int Orthop. 2025 May 30. doi: 10.1007/s00264-025-06565-6. Online ahead of print.

NO ABSTRACT

PMID:40445355 | DOI:10.1007/s00264-025-06565-6

Injury. 2025 May 29;56(8):112442. doi: 10.1016/j.injury.2025.112442. Online ahead of print.

ABSTRACT

INTRODUCTION: Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.

PATIENTS AND METHODS: This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2-3, 33C1-2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed "nailable." Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.

RESULTS: We identified 107 patients treated with either the RFNA (n = 45) or LLP (n = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, P = 0.12) or coronal malalignment (2.2 % versus 0 %, P = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (P = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (n = 5) or the operating room (n = 2).

DISCUSSION AND CONCLUSIONS: This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.

LEVEL OF EVIDENCE: Level III.

PMID:40446568 | DOI:10.1016/j.injury.2025.112442

Injury. 2025 May 21;56(8):112450. doi: 10.1016/j.injury.2025.112450. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to evaluate the safety and efficacy of Pelnac artificial skin one-stage surgical direct repair of significant toenail flap donor area defects.

METHODS: From March 2020 to May 2023, a total of 56 patients with traumatic finger injuries underwent reconstruction using a great toenail flap combined with iliac bone grafting, along with one-stage artificial skin repair of the great toenail flap. These patients were followed prospectively, and their clinical outcomes were systematically evaluated.

RESULTS: The average follow-up was 13.4 months (3 to 30 months). The visual analog scale for pain was 0.23±0.6, and the Vancouver scar scale (VAS) was 2.82±1.06. Among 56 patients, only one case developed postoperative infections. The aesthetic satisfaction of the donor area of the patient's foot was 87.10±5.48 points (out of 100 points). Regarding the sensory recovery, the response "normal or near normal" was obtained in 44 patients (78.6 %). The maximum active mobility of the first metatarsophalangeal joint and the distal interphalangeal joint in the donor area was 66.51±7.38°and 43.21±4.62°, respectively.

CONCLUSIONS: Given its low donor-site morbidity and favorable cosmetic and functional outcomes, one-stage reconstruction of donor site defects using artificial dermis represents an effective and clinically viable treatment option.

PMID:40446567 | DOI:10.1016/j.injury.2025.112450

Injury. 2025 May 22;56(8):112453. doi: 10.1016/j.injury.2025.112453. Online ahead of print.

NO ABSTRACT

PMID:40446566 | DOI:10.1016/j.injury.2025.112453