J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.01142. Online ahead of print.

NO ABSTRACT

PMID:40153484 | DOI:10.2106/JBJS.24.01142

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.00220. Online ahead of print.

ABSTRACT

BACKGROUND: Osteochondritis dissecans of the knee (KOCD) may be a source of pain in active, skeletally immature patients. An association between the condylar lesion location and lower-extremity coronal plane malalignment has been established, but clinical implications have been poorly understood. This study aimed to confirm the high rate of malalignment in KOCD and variation in demographic characteristics, presentation features, and disease severity between those with and without malalignment.

METHODS: Prospectively collected clinical, demographic, and radiographic data were obtained, and standard standing alignment measurements were evaluated from an institutional KOCD cohort. Alignment was defined as whether the mechanical axis passed between the condyles (neutral), the lateral femoral condyle (valgus), or the medial femoral condyle (varus). Comparative analysis was performed between KOCD lesions in each condyle presenting with or without malalignment. The Fisher exact test or chi-square test was used to analyze categorical variables, and the t test or Mann-Whitney U test was used to analyze continuous variables.

RESULTS: This study examined 187 knees (156 patients, with a mean age of 12.9 years, 36.4% female); 66.3% had medial femoral condyle (MFC) lesions. Malalignment was found in 47.6% of all KOCD cases and 45.9% of skeletally immature cases. Twenty-nine (23.4%) of 124 MFC KOCD cases were in varus knees, and 42 (66.7%) of 63 lateral femoral condyle (LFC) KOCD cases were in valgus knees. MFC KOCD cases that presented in varus knees were more likely in Black or African American patients (p = 0.008) and had a larger lesion size, with a coronal width of 16.6 mm compared with MFC KOCD cases not in varus knees at 14.1 mm (p = 0.008). Similar differences were found in LFC KOCD cases presenting in valgus knees, which represented nearly all LFC KOCD cases in Black or African American patients (91.7%; p = 0.05) and had a larger lesion size, with a sagittal width of 20.8 mm compared with 16.4 mm for LFC KOCD cases not in valgus knees (p = 0.006).

CONCLUSIONS: Nearly one-half of knees with KOCD in skeletally immature patients may be in coronal malalignment and, thus, candidates for guided growth. Malalignment corresponding to the involved compartment was common and was present in two-thirds of lateral lesions. When malalignment placed the weight-bearing axis within the involved compartment, lesions were larger and more advanced. Thus, consideration should be given to addressing malalignment found during evaluations.

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

PMID:40153481 | DOI:10.2106/JBJS.24.00220

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.01134. Online ahead of print.

ABSTRACT

BACKGROUND: The scarcity of women in academic orthopaedics has persisted for decades despite general interest in promoting diversity. Therefore, we aimed to understand what aspects of workplace culture enhance or detract from building an inclusive workplace for women surgeons in academic orthopaedics.

METHODS: Women orthopaedic surgeons in the United States with a range of training backgrounds, races/ethnicities, academic institutions, subspecialties, and geographic locations were recruited using purposive sampling techniques until thematic saturation was achieved. All women currently hold or previously held an academic position in orthopaedics. Forty-minute virtual semistructured interviews were conducted from December 2023 to April 2024. Data were analyzed using grounded theory methodology to develop a conceptual model of inclusive culture.

RESULTS: Of the 35 women approached for participation, 26 (74%) participated. Eighty-one percent were currently in academia, and 19% had left academia; 12% identified as Asian, and 23% identified as Underrepresented in Medicine (URiM). Our model of inclusive workplace culture is built on 2 interrelated pillars: "supportive structures" and "social inclusion." The first pillar, supportive structures, is primarily under the direction of department leaders and includes themes of intentional career development, valuing diverse contributions, transparent policies, and building department cohesiveness. The second pillar, social inclusion, relies on all members of an organization. Themes within social inclusion are respect for women, male allyship, women supporting women, and true integration of women surgeons.

CONCLUSIONS: With intentional effort, orthopaedic departments can create the structures of support necessary to foster women's career success, as well as the social inclusion to encourage their longevity in academia.

CLINICAL RELEVANCE: TK.

PMID:40153480 | DOI:10.2106/JBJS.24.01134

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.00781. Online ahead of print.

ABSTRACT

BACKGROUND: While the Femoral Neck System (FNS) is increasingly utilized for the fixation of femoral neck fractures in elderly patients, studies comparing the device to the historical standard (that is, multiple cannulated screws) are lacking. The purpose of this study was to determine the risk of all-cause revision following fixation with the FNS device compared with multiple cannulated screws in patients ≥60 years of age with a femoral neck fracture.

METHODS: Patients ≥60 years of age who underwent fixation of a femoral neck fracture with the FNS or 3 cannulated screws (2017 to 2022) were identified using the Kaiser Permanente Hip Fracture Registry. Exclusion criteria were polytrauma, pathologic fracture, open fracture, additional surgeries at other sites during the same hospital stay, and prior procedures on the affected hip. The primary outcome measure was all-cause revision surgery, and the secondary outcome measures were mortality, emergency department visits, and readmissions. Multivariable Cox proportional hazards or logistic regression was performed, controlling for a wide range of potential confounders.

RESULTS: A total of 352 FNS and 1,686 cannulated-screw repairs were included. The overall incidence of revision at 2 years was 4.0% and 4.8% for the FNS and cannulated-screw constructs, respectively. Mortality at 2 years was 23.6% and 25.2%, respectively. In the adjusted analysis, no difference in all-cause revision risk was observed when comparing the FNS to cannulated screws (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.50 to 1.71; p = 0.79). A subgroup analysis of procedures performed by surgeons who used both devices also did not demonstrate a difference in revision rates (HR = 0.91; 95% CI = 0.39 to 2.17; p = 0.84).

CONCLUSIONS: In this study of patients ≥60 years of age with a femoral neck fracture, the rates of all-cause revision and mortality were found to be similar between the FNS and multiple cannulated screws.

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

PMID:40153479 | DOI:10.2106/JBJS.24.00781

J Bone Joint Surg Am. 2025 Mar 28. doi: 10.2106/JBJS.24.00773. Online ahead of print.

ABSTRACT

BACKGROUND: Acupoint stimulation has been shown to reduce the risk of postoperative nausea and vomiting (PONV) after various types of surgeries involving general anesthesia, but whether the same is true after orthopaedic surgery involving spinal anesthesia is unclear. The purpose of this study was to compare PONV rates and the quality of recovery between patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under spinal anesthesia receiving conventional antiemetics alone and those receiving antiemetics combined with use of a transcutaneous electrical acupoint stimulation bracelet (EmeTerm; WAT Medical Enterprise).

METHODS: Patients at moderate or high risk for PONV, including 195 patients undergoing THA and 153 patients undergoing TKA, were randomized to receive routine antiemetics (dexamethasone and ondansetron) alone or with use of the EmeTerm bracelet. The primary outcome was the PONV incidence within 24 hours postoperatively; secondary outcomes included the rates of severe PONV, antiemetic rescue, adverse events, and Quality of Recovery scores.

RESULTS: Combining antiemetics with the EmeTerm bracelet significantly reduced PONV (16.0% compared with 31.2%; p = 0.001), severe PONV (1.1% compared with 8.1%; p = 0.002), and antiemetic rescue (3.4% compared with 13.9%; p = 0.001). Use of the bracelet reduced the risk of PONV within 24 hours by 61% (adjusted hazard ratio, 0.39; 95% confidence interval [CI], 0.24 to 0.63), and its benefit became significant at 0 to 3 and 3 to 6-hour intervals after surgery. The complete response rate was higher for the bracelet + antiemetics group compared with the group with antiemetics alone (84.0% compared with 68.8%; p = 0.001), with better Quality of Recovery scores at 24 hours in the bracelet + antiemetics group.

CONCLUSIONS: The EmeTerm bracelet enhanced the efficacy of antiemetics in reducing PONV after THA and TKA under spinal anesthesia and may improve short-term recovery.

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

PMID:40153477 | DOI:10.2106/JBJS.24.00773

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06505-4. Online ahead of print.

NO ABSTRACT

PMID:40152988 | DOI:10.1007/s00264-025-06505-4

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06506-3. Online ahead of print.

ABSTRACT

PURPOSE: Firearm-related injuries in children and adolescents have increased over the past decade. The standard of care for ballistic fractures in children is complex, resulting in a burden of healthcare follow-up that many families find challenging. Consistent follow-up is crucial, especially in orthopaedic trauma and firearm cases, to prevent complications. This study aims to identify demographic and clinical variables associated with loss to follow-up (LTFU) in paediatric patients with ballistic fractures.

METHODS: This is a retrospective registry study at a Level I trauma centre for patients aged zero to 21 who presented with a ballistic-induced fracture. Patients with isolated skull, facial, or rib fractures were excluded. Follow-up was dichotomized at the median number of follow-up days for analysis. Logistic regression analysis was used to identify predictors of LTFU.

RESULTS: The study included 144 patients with a median age of 18 years. The majority were male (89%) and White (72%). Most patients had government insurance (44%) or were uninsured (33%). The mechanism of injury was primarily assault (71%). Operative intervention occurred in 55% of cases. Key factors increasing follow-up adherence included male sex (p = 0.011), higher injury severity scores (p = 0.009), requiring operative intervention (p < 0.001), air transportation (p < 0.001), or injury at a private residence (p = 0.040). Uninsured status (p = 0.007), opioid use (p = 0.047), and greater distance from the hospital (p = 0.002) were associated with low follow-up.

CONCLUSIONS: This study identifies key factors influencing follow-up adherence in pediatric patients with ballistic fractures. Identifying these factors allows for tailoring future interventions to improve follow-up adherence for this vulnerable population.

PMID:40152987 | DOI:10.1007/s00264-025-06506-3

SICOT J. 2025;11:21. doi: 10.1051/sicotj/2025014. Epub 2025 Mar 27.

ABSTRACT

INTRODUCTION: The understanding of the influence of posterior tibial slope (PTS) on knee kinematics has increased. However, the PTS influence on clinical outcomes remains unclear. The study aimed to evaluate whether a significant change between the native and the prosthetic tibial plateau PTS influences functional results and the risk of complications following total knee arthroplasty (TKA).

METHODS: This was a retrospective, monocentric comparative study. Clinical and radiological data from 793 knees were collected from a prospective surgical database. Inclusion criteria were patients operated with a posterior-stabilized TKA (PS-TKA) for primary tibiofemoral osteoarthritis, with or without associated patellofemoral osteoarthritis, or osteonecrosis of the femoral condyle or tibial plateau, with a minimum follow-up of 5 years. Range of motion and International Knee Society (IKS) score as well as radiological measurements were collected preoperatively and postoperatively at each follow-up visit. Two groups were composed according to the change in PTS between pre- and post-op (Group 1: ≤10°, n = 703; Group 2: >10°, n = 90).

RESULTS: The mean follow-up was 75.5 months ± 9.1. The mean change in PTS from preoperative was 4.96° ± 3.24 in group 1 and 12.7° ± 1.87 in group 2. There was no significant difference in the mean IKS Knee subscore (89.5 ± 10.7 and 89.7 ± 10.2, p = 0.89) and mean IKS Function subscore (88.2 ± 15.7 and 86.3 ± 16.6, p = 0.33) in groups 1 and 2, respectively. Postoperative maximum flexion was very satisfactory in both groups with no clinically relevant difference (120.0 ± 11.9 and 123.0 ± 8.3, p = 0.026). The complication rate was 5.0% (n = 40) (5.5% in group 1; 1.1% in group 2; p = 0.07) while the most common complication requiring further procedure was deep infection (n = 9, 1.1%) and the second most common was stiffness (n = 6, 0.8%).

DISCUSSION: PTS did not influence postoperative maximum flexion or clinical scores and was not associated with a higher complication rate at a minimum 5-year follow-up after PS-TKA.

PMID:40145786 | PMC:PMC11948999 | DOI:10.1051/sicotj/2025014

SICOT J. 2025;11:20. doi: 10.1051/sicotj/2025017. Epub 2025 Mar 27.

ABSTRACT

Total knee arthroplasty (TKA) in valgus knee deformities presents unique challenges, including alignment, soft tissue balance, and implant positioning. The lateral approach offers advantages over the traditional medial approach by improving direct access, patellar tracking, and soft tissue preservation. Robotic-assisted TKA enhances precision, ligament balancing, and patient-specific alignment strategies, such as functional knee positioning (FKP). This study describes a surgical technique integrating the lateral approach with robotic-assisted TKA using FKP principles. The technique is based on an image-based robotic system, ensuring accurate preoperative planning, intraoperative adjustments, and optimized prosthetic placement. Key intraoperative steps, including bone resection strategies, soft tissue balancing, and trial component evaluations, are detailed. The lateral robotic approach with FKP was found to be effective and reproducible, allowing for precise implant alignment and optimized soft tissue balance in valgus knees. This method minimizes the need for extensive lateral releases, preserves vascularity, and ensures postoperative stability. The combination of the lateral approach, robotic-assisted TKA, and FKP represents a promising strategy for valgus knee deformities. Further long-term studies are needed to validate the durability and functional benefits of this technique.

PMID:40145785 | PMC:PMC11948998 | DOI:10.1051/sicotj/2025017

Injury. 2025 Mar 24:112285. doi: 10.1016/j.injury.2025.112285. Online ahead of print.

NO ABSTRACT

PMID:40148146 | DOI:10.1016/j.injury.2025.112285

Injury. 2025 Mar 22;56(4):112297. doi: 10.1016/j.injury.2025.112297. Online ahead of print.

ABSTRACT

INTRODUCTION: ChatGPT, a widely accessible AI program, has demonstrated potential in various healthcare applications, including emergency department (ED) triage, differential diagnosis, and patient education. However, its potential in providing recommendations to emergency department providers with orthopedic consultations has not been evaluated yet.

METHODS: This study compared the performance of four board certified orthopedic surgeons, two attendings and two trauma fellows who take independent call at the same institution and ChatGPT-4 in responding to clinical scenarios commonly encountered in emergency departments. Five common orthopedic ED scenarios were developed (lateral malleolar ankle fractures, distal radius fractures, septic arthritis of the knee, shoulder dislocations, and Achilles tendon ruptures), each with four questions related to diagnosis, management, surgical indication, and patient counseling, totaling 20 questions. Responses were anonymized, coded, and evaluated by independent reviewers including emergency medicine physicians using a five-point Likert scale across five criteria: accuracy, completeness, helpfulness, specificity, and overall quality.

RESULTS: When comparing the ratings of AI answers to non-AI responders, the AI answers were shown to be superior in completeness, helpfulness, specificity, and overall quality with no difference in regards to accuracy (p < 0.05). When considering question subtypes including diagnosis, management, treatment, and patient counseling, AI was shown to have superior scores in helpfulness, and specificity in diagnostic questions(p < 0.05). In addition, AI responses were superior in all the assessed categories when looking at the patient counseling questions (p < 0.05). When considering different clinical scenarios, AI outperformed non-AI groups in completeness in the distal radius fracture scenario. Furthermore, AI outperformed non-AI groups in helpfulness in the lateral malleolus fracture scenario. In the shoulder dislocation scenario, AI responses were more complete, helpful, and had a better overall quality. AI responses were non-inferior in the remaining categories of the different scenarios.

CONCLUSION: Artificial intelligence exhibited non-inferior and often superior performance in common orthopedic-ED consultations compared to board certified orthopedic surgeons While current AI models are limited in their ability to integrate specific images and patient scenarios, our findings suggest AI can provide high quality recommendations for generic orthopedic consultations and with further development, will likely have an increasing role in the future.

PMID:40147063 | DOI:10.1016/j.injury.2025.112297

J Bone Joint Surg Am. 2025 Mar 27. doi: 10.2106/JBJS.24.01014. Online ahead of print.

ABSTRACT

BACKGROUND: Fractures are common in children, but knowledge about refractures has been limited. This study aimed to determine the rate of radiographically confirmed refractures within 2 years of the primary fracture in children and to analyze the association between fracture stability and refracture risk.

METHODS: All patients who were <16 years of age and had at least 2 fractures in the same bone between 2014 and 2023 were reviewed from the Helsinki University Hospitals' electronic pediatric treatment register, KIDS Fracture Tool. Patients' radiographs and records were evaluated. Patients with subsequent fractures in different parts of the bone than the primary fracture, patients with pathological fractures, and patients with a systemic condition predisposing to fractures were excluded.

RESULTS: Of 20,749 fractures, 163 consecutive fractures in the same bone within 2 years were identified. After exclusions, 100 cases (0.48% of all fractures) remained, with 83 occurring within 1 year and 17 occurring in the second year after the primary fracture. Refracture rates were highest in diaphyseal both-bone forearm fractures (3.76% [43 of 1,144]), diaphyseal tibial fractures (1.01% [7 of 693]), distal forearm fractures (0.55% [27 of 4,949]), and distal humeral fractures (0.49% [11 of 2,227]). The median time to refracture was 73 days (interquartile range [IQR], 56 to 131 days) for the distal forearm, 109 days (IQR, 79 to 169 days) for the diaphyseal tibia, 124 days (IQR, 80 to 178 days) for the diaphyseal forearm, and 426 days (IQR, 243 to 660 days) for the distal humerus. Displaced fractures requiring closed reduction had a significantly higher refracture risk compared with other fractures: relative risk (RR), 8.0 (95% confidence interval [CI], 4.5 to 14) compared with stable fractures; RR, 5.0 (95% CI, 2.9 to 8.7) compared with fractures that had acceptable position but might be unstable and required follow-up; and RR, 3.2 (95% CI, 1.8 to 5.7) compared with fractures requiring fixation and follow-up.

CONCLUSIONS: The overall refracture rate in children was approximately 0.5%, with the highest rates in both-bone diaphyseal forearm fractures. The median time to refracture varied significantly by anatomic location, and displaced fractures treated with closed reduction were associated with a higher refracture risk.

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

PMID:40146814 | DOI:10.2106/JBJS.24.01014

J Bone Joint Surg Am. 2025 Mar 27. doi: 10.2106/JBJS.24.00997. Online ahead of print.

ABSTRACT

➢ Musculoskeletal injuries constitute a substantial proportion of worldwide disease, with access limited to many due to the availability and cost of devices. A multifaceted approach is needed to improve system-level access to care.➢ Although a number of procurement policies are utilized, providers in low and middle-income countries often struggle with inconsistent supply chains, leading to delays in care or less desirable management strategies.➢ Partnerships between governments, academic institutions, and nongovernmental agencies are needed to improve access to devices by providing funds for patients and creating regulatory bodies to ensure product quality and availability.➢ There should be a focus on local and regional manufacturing as well as job creation within low and middle-income countries to achieve sustainable access to orthopaedic devices.➢ High-quality research initiatives are needed to provide evidence-based solutions. This includes a focus on outcomes-based studies to determine best management practices within the low and middle-income countries' context and operations research to optimize systems for device procurement.

PMID:40146811 | DOI:10.2106/JBJS.24.00997

J Bone Joint Surg Am. 2025 Mar 27. doi: 10.2106/JBJS.24.01177. Online ahead of print.

ABSTRACT

BACKGROUND: It is unclear when a patient can return to driving after total knee arthroplasty (TKA). Currently, most surgeons simply restrict all patients from driving for 4 to 6 weeks after TKA despite variability in patient age, general health, and physical capabilities. The primary objective of this study was to create novel clinical prediction calculators to estimate the return-to-driving time following primary TKA.

METHODS: In this study, 167 patients who were undergoing a primary TKA were prospectively enrolled. Subjects received text message surveys every third day postoperatively to determine when they returned to driving. Subjects completed 8 physical performance maneuvers at their 2, 6, and 12-week postoperative clinical appointments. Additionally, subjects completed return-to-driving surveys and a structured interview. Data on demographic characteristics, operative factors, patient-reported outcomes, and patient factors were collected. Cox proportional hazard and parametric survival models were utilized to create 2 novel calculators for predicting return-to-driving time.

RESULTS: There were 156 patients (mean age, 67.7 years [range, 39 to 83 years]) who completed the study. The median return-to-driving time was 18 days (interquartile range [IQR], 12 to 27 days). Univariate analysis demonstrated that male patients returned to driving sooner (18 days) than female patients (25.3 days) (p < 0.001) and that patients who underwent left-sided surgery returned to driving sooner (20.1 days) than patients who underwent right-sided surgery (24.4 days) (p = 0.021). For preoperative factors, age, sex, laterality, and preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) had an effect on return-to-driving time and therefore were included in the novel preoperative clinical prediction calculator. For postoperative factors, age, sex, laterality, preoperative KOOS, and 6 metrics from the physical performance maneuvers had an effect on return-to-driving time and therefore were included in the novel postoperative physical performance-based instrument.

CONCLUSIONS: Overall, patients undergoing primary TKA returned to driving considerably earlier than previously reported. Patient-related factors and postoperative physical performance significantly affect return-to-driving time. Using the novel preoperative clinical prediction tool, individual patients can be advised when to expect to return to driving. After surgery, the novel postoperative physical performance-based instrument can inform patients when they may be ready to return to driving.

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

PMID:40146809 | DOI:10.2106/JBJS.24.01177

J Bone Joint Surg Am. 2025 Mar 27. doi: 10.2106/JBJS.24.00779. Online ahead of print.

ABSTRACT

BACKGROUND: Age-related osteoporosis complicates rotator cuff tear (RCT) treatment, undermining the integrity of surgical anchor fixation during rotator cuff repair (RCR). This study aimed to investigate whether supplementation with glutamine, an intrinsic amino acid crucial in cell metabolism, can enhance rotator cuff healing by ameliorating age-associated osteoporosis.

METHODS: Forty-eight female Sprague-Dawley rats were divided into 4 groups: (1) young control (sham surgery), (2) aged control (sham surgery), (3) aged-RCT (RCR with fibrin), and (4) aged-RCT-Gln (RCR with glutamine-enriched fibrin). RCR was performed bilaterally on rats in the RCT groups, with subsequent application of the respective fibrin gel at the tendon-bone interface. Evaluations included micro-computed tomography (CT) for bone quality, histology and immunohistochemistry for tissue integrity, and biomechanical testing for tendon-bone complex strength.

RESULTS: Micro-CT revealed worse bone quality at the proximal humerus in the aged rats compared with the young rats, confirming spontaneous osteoporosis occurring with age. Glutamine supplementation improved bone quality in the aged-RCT-Gln group compared with the aged-RCT group, with significantly higher mean bone volume/total volume fraction (BV/TV) (28.69% ± 3.1% compared with 21.13% ± 3.9%), trabecular number (Tb.N) (1.88 ± 0.18 compared with 1.55 ± 0.21 mm-1), and trabecular thickness (Tb.th) (0.15 ± 0.03 compared with 0.12 ± 0.02 mm) and lower trabecular separation (Tb.sp) (0.19 ± 0.03 compared with 0.22 ± 0.03 mm). Histological and immunohistological analysis demonstrated enhanced bone regeneration and a more organized tendon-cartilage-bone interface in the aged-RCT-Gln group. Biomechanical analysis also revealed a more resilient tendon-bone complex after glutamine supplementation.

CONCLUSIONS: Osteoporosis occurred spontaneously at the proximal humerus with age. Glutamine supplementation effectively mitigated age-related osteoporosis and enhanced RCR in elderly rats. These findings support the potential of glutamine, the most abundant amino acid in the body, as a valuable therapeutic intervention for improving RCT outcomes in the aging population, warranting further investigation in clinical settings.

CLINICAL RELEVANCE: Glutamine supplementation may be a novel therapeutic strategy to enhance RCR in elderly patients with osteoporosis.

PMID:40146808 | DOI:10.2106/JBJS.24.00779

J Bone Joint Surg Am. 2025 Mar 27. doi: 10.2106/JBJS.24.00867. Online ahead of print.

ABSTRACT

BACKGROUND: Idiopathic scoliosis (IS) is the most common spinal deformity and is often accompanied by abnormal respiratory function.

METHODS: This study investigated the correlations among radiographic parameters, pulmonary function tests, and sleep-breathing monitoring in patients with IS. The clinical data of patients with IS admitted to our hospital for scoliosis surgery between January 2020 and March 2022 were retrospectively collected. Radiographic measurements, including scoliosis and thoracic malformation parameters, were performed. Pulmonary function measurements and sleep-breathing monitoring results were collected for correlation analysis.

RESULTS: Overall, 19.8% of the 81 participants were diagnosed with obstructive sleep apnea. The sleep-breathing monitoring results showed a significant correlation between the main thoracic curvature and the lowest oxygen saturation (SpO2) (r = -0.233; p = 0.036). The degree of thoracic kyphosis significantly correlated with FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) and FEV1. FEV1 was significantly correlated with the oxygen desaturation index (ODI) (r = -0.242; p = 0.03), as was FVC.

CONCLUSIONS: In this study, 19.8% of the patients with thoracic IS had obstructive sleep apnea. In patients with IS, the severity of pulmonary function decline and SpO2 during sleep-breathing correlated with the severity of thoracic scoliosis, whereas the decline in pulmonary function correlated with the ODI during sleep-breathing.

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

PMID:40146806 | DOI:10.2106/JBJS.24.00867

Int Orthop. 2025 Mar 26. doi: 10.1007/s00264-025-06512-5. Online ahead of print.

ABSTRACT

PURPOSE: The direct anterior approach (DAA) in total hip arthroplasty (THA) has a risk of lateral femoral cutaneous nerve (LFCN) injury. Long-term outcomes and therapeutic options for such injuries are poorly investigated. This study evaluates the impact of iatrogenic LFCN lesions on long-term outcomes and investigates treatments like ultrasound-guided nerve infiltration or neurolysis.

METHODS: Our institutional database of primary THAs (2014-2022) was searched for patients with iatrogenic LFCN lesions after DAA, confirmed via ultrasound or electroneurography. First, retrospective analysis of the effects of ultrasound-guided nerve infiltration and neurolysis. Second, clinical-radiological assessment of pain, function, incision, and affected skin area. Patient-reported outcomes (OHS, COMI Hip, UCLA) were compared to a matched non-LFCN injury control group.

RESULTS: Of 8136 patients, 29 (0.36%) met inclusion criteria, with 22 undergoing ultrasound diagnostics. Eighteen received nerve infiltration (improvement after one (n = 7), two (n = 3) or three (n = 1) infiltrations), and two had neurolysis. After a mean follow-up of 4.95 years, 13 patients were assessed. Common symptoms included hypesthaesia (11), dysesthesia (6), and tingling (3), with a mean affected area of 253cm2 ± 64.8. 24-months questionnaires for the LFCN group (OHS 39.2 ± 8.6, COMI Hip 2.4 ± 2.7, UCLA 6.5 ± 1.6) were worse than the control group (OHS 46.2 ± 2.3, COMI Hip 0.6 ± 0.8, UCLA 7.2 ± 1.5), though differences were not statistically significant.

CONCLUSION: Instrumentally proven LFCN lesions after DAA THA are rare but lead to worse long-term outcomes. Ultrasound-guided nerve infiltration shows favorable results for symptom management.

PMID:40140107 | DOI:10.1007/s00264-025-06512-5

Injury. 2025 Mar 24;56(4):112298. doi: 10.1016/j.injury.2025.112298. Online ahead of print.

ABSTRACT

BACKGROUND: With Australia's aging population, the incidence of falls is expected to rise. The proportion of adults aged ≥65 years is projected to increase from 15 % in 2017 to 22 % by 2057, highlighting the growing need for effective fall prevention measures. Therefore, this study aimed to assess fall trends and determinants using repeated follow-up data from a population-based study.

METHODS: This study utilized data from the Geelong Osteoporosis Study (GOS) to analyse fall trends in men and women. Men's data were collected at baseline (2001-2006; n = 1533), 5 years (2006-2011; n = 968), and 15 years (2016-2021; n = 627), while women's data were from 6 years (2001-2003; n = 1014), 10 years (2004-2008; n = 1098), and 15 years (2011-2014; n = 844). Falls data, self-reported for the past 12 months, were age-standardised to the Australian population. Data included self-reported prior fractures, medications, comorbidities, alcohol use, and smoking, along with measured anthropometrics, muscle strength, biochemical tests, and imaging. A multivariable Generalised Estimating Equation model identified fall determinants, reporting adjusted odds ratios (AORs) and 95 % confidence intervals.

RESULTS: In men, the age-adjusted prevalence of falls declined over time, while in women, it initially dropped by 4.2 % before a slight 0.6 % increase. After adjusting for confounders, each additional year of age raised the fall risk by 1 % (AOR = 1.01, 95 % CI: 1.00-1.02). Women had a 52 % higher likelihood of falling than men (AOR = 1.52, 95 % CI: 1.22-1.88). Diabetes increased the risk by 69 % (AOR = 1.69, 95 % CI: 1.23-2.31), while a 1 N/kg increase in hip flexion strength lowered the risk by 3 % (AOR = 0.97, 95 % CI: 0.95-0.99).

CONCLUSION: Men experienced a steady decrease in fall prevalence over time, whereas women displayed a more intricate trend, with falls initially declining before subsequently rising, following a polynomial pattern. The key predictors of falls included age, sex, diabetes and hip flexion strength. Policies should prioritize tailored fall prevention, strength training, and diabetes care integration.

PMID:40139100 | DOI:10.1016/j.injury.2025.112298

Injury. 2025 Mar 22;56(4):112299. doi: 10.1016/j.injury.2025.112299. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric farm-related injuries, while less common than other pediatric injuries, are often more severe. Agricultural youth injuries can require costly treatment and have higher hospitalization rates, often resulting from industrial hazards, unsafe worksites, or agricultural recreational activities. Injuries in rural areas often necessitate travel to larger hospitals for specialized treatment, delaying care.

OBJECTIVE: This study aims to evaluate trends in farm-related injuries among youth presenting to emergency departments (EDs) in the United States (US).

METHODS: The National Electronic Injury Surveillance System (NEISS), a publicly available database representing approximately 100 US EDs, was queried for all injuries among individuals aged 0-18 occurring in farms (land, pasture, farm, barn, outbuildings). Queries were restricted to injuries from 2014 to 2023.

RESULTS: From 2014 to 2023, a total of 750 ED visits from farm-related injuries were identified, resulting in a national estimate (NE) of 33,664 cases. Injury rates decreased significantly across the study period (P=0.012). The most common diagnosis was fracture (NE 7337, 21.8 % of all injuries), with males accounting for 52.1 % and females for 47.9 %. In an age-specific analysis, 12-year-olds experienced more farm-related injuries than any other age group (NE 3185, 9.5 %), followed by 11-year-olds (NE 2769, 8.2 %), who also sustained the highest number of head injuries (NE 711, 13.2 % of all head injuries). The most commonly affected body part across ages was the head (NE 5384, 16 % of all injuries). The most common mechanism of injury was horseback riding (NE 10,691, 31.8 % of all injuries). The overall rate of hospitalization was 13.5 %.

CONCLUSION: The incidence of farm-related injuries in young people has decreased over time. Most injuries are caused by horseback riding, with a majority involving the head and relatively high hospitalization rates. 11-12-year-olds are the most affected, highlighting the importance of continued targeted prevention efforts. Although occupational hazards are a concern, this study demonstrates that younger patients are also frequently affected by farm injuries, emphasizing the need for increased focus on child access and safety in agricultural recreational activities.

PMID:40139099 | DOI:10.1016/j.injury.2025.112299

J Bone Joint Surg Am. 2025 Mar 26. doi: 10.2106/JBJS.24.00423. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study was to determine whether preserving a normal-appearing long head of the biceps (LHB) tendon leads to better Constant-Murley scores (CMS) than releasing it in patients undergoing arthroscopic repair of an isolated stage-1 supraspinatus tendon tear.

METHODS: Patients (40 to 70 years old) who were undergoing arthroscopic repair of a minor supraspinatus tendon tear and who had a macroscopically normal LHB were randomized to LHB preservation or LHB release during a prospective clinical trial. The surgeon was free to choose whether to perform tenodesis in patients undergoing LHB release. The primary outcome was the involved shoulder's function based on the absolute CMS score at 6 and 24 months. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) shoulder score and Subjective Shoulder Value (SSV). A post-hoc analysis of prospectively collected data was done using 1:1 propensity score matching without replacement. This resulted in 2 age- and sex-matched groups of 95 patients each. Race and ethnicity data were not collected.

RESULTS: At 24 months, the mean CMS was significantly better in the LHB release group (mean and standard deviation, 86.8 ± 8.3) than in the LHB preservation group (82.9 ± 10.0) (p = 0.003), 97% of the patients in the LHB release group and 88% in the LHB preservation group had more than the minimal clinically important difference (MCID) for the CMS in rotator cuff repair (p = 0.048), 15% in the LHB preservation group and 3% in the LHB release group (p = 0.01) had an absolute CMS below 70, and the ASES was significantly higher in the LHB release group (91.4 ± 19.2) than in the LHB preservation group (83.6 ± 25.0) (p = 0.02). There were 4 reoperations in the LHB preservation group and no reoperations in the LHB release group.

CONCLUSIONS: Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.

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

PMID:40138461 | DOI:10.2106/JBJS.24.00423