SICOT J. 2025;11:30. doi: 10.1051/sicotj/2025025. Epub 2025 May 19.

ABSTRACT

BACKGROUND: Total knee arthroplasty (TKA) in patients with prior anterior cruciate ligament reconstruction (ACLR) presents unique challenges due to altered knee kinematics, residual instability, and fixation implants that may interfere with implant positioning. Image-based robotic-assisted TKA enables the functional alignment (FA) strategy that accounts for individual bony anatomy, ligamentous laxities, and anterior compartment characteristics.

SURGICAL TECHNIQUE: This technique involves a CT-based robotic workflow where femoral and tibial components are planned based on patient-specific alignment and soft tissue balance. Intraoperative assessment with a digital tensioning device guides fine-tuning of flexion and extension gaps, ensuring balanced implant positioning while minimizing soft tissue releases. Fixation implants from prior ACLR are identified using robotic navigation, allowing for targeted adjustments such as selective removal or controlled elevation of components to avoid excessive bone loss. Patellar tracking is dynamically evaluated with a probe, facilitating real-time adjustments to optimize mediolateral tracking and anterior offset.

DISCUSSION: Given the altered biomechanics in post-ACLR knees, FA may provide a physiological alignment by accommodating native laxities and reducing the risk of residual instability. Additionally, robotic guidance allows for precise management of fixation implants, ensuring optimal implant positioning and bone preservation. While further studies are needed, robotic-assisted FA represents a promising approach for enhancing outcomes in TKA for post-ACLR patients.

PMID:40391825 | PMC:PMC12091943 | DOI:10.1051/sicotj/2025025

Injury. 2025 May 12;56(7):112428. doi: 10.1016/j.injury.2025.112428. Online ahead of print.

ABSTRACT

INTRODUCTION: Fractures of the distal humerus are common in older patients with osteoporotic bone, often presenting as complex, multi-fragmentary injuries involving the articular surface. This complexity complicates the decision between open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA), as both procedures carry specific risks. Hemiarthroplasty (HA) may be a viable alternative, yet few studies have compared its outcomes with those of ORIF. In this retrospective matched-pair study, we aimed to compare primary HA versus ORIF for complex distal humerus fractures. Our hypothesis was that HA could achieve functional outcomes equivalent to ORIF when joint reconstruction is not feasible.

MATERIALS AND METHODS: We matched 10 pairs of patients who underwent HA or ORIF between 2018 and 2022. Matching criteria included age, gender, and fracture classification (Orthopaedic Trauma Association (OTA) or Dubberley classification for coronal shear fractures). Functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score and the Mayo Elbow Performance Score (MEPS). The mean follow-up was 29 months for the HA group and 33 months for the ORIF group.

RESULTS: Both treatment groups exhibited satisfactory functional outcomes. In the HA group, the median MEPS was 89.5 and a qDASH score of 21.6. Mean range of motion in extension/flexion was 105.9°. The ORIF group had a median MEPS of 81.5, a qDASH of 17 and a mean range of motion of 116.5°. No significant differences in functional outcomes were observed between the two groups CONCLUSIONS: HA can yield functional results comparable to ORIF in managing complex distal humerus fractures. When ORIF is not feasible, HA is an effective alternative, particularly for physically active patients over 60 years, as it avoids the limitations associated with linked total elbow arthroplasty, such as weight restrictions and the risk of ulnar component loosening.

LEVEL OF EVIDENCE: Level III.

PMID:40393340 | DOI:10.1016/j.injury.2025.112428

Injury. 2025 May 9:112418. doi: 10.1016/j.injury.2025.112418. Online ahead of print.

ABSTRACT

BACKGROUND: For firearm-related injuries (FRI), understanding spatial injury patterns may inform intervention strategies. This study evaluates geographic FRI patterns, emphasizing (1) proximity of home address to injury location and (2) locational social determinants of health (SDOH).

METHODS: We performed a retrospective analysis of FRI patients at a Level 1 trauma center between 01/2016-10/2022. Patient home and injury ZCTAs (ZCTA tabulation areas) were collected. SDOH indicators were calculated by ZIP codes using the Distressed Communities Index (DCI, ranges from 0-100 [most distressed]) and Social Deprivation Index (SDI, ranges from 1-100 [highest deprivation]). SDOH index variations and distances between ZCTAs were calculated.

RESULTS: Of 37,537 trauma activations, 6326 were due to FRI. ZCTAs were available in 3864 (63.12 %) patients. The cohort was 86.5 % male and 85.2 % Black. Median (IQR) age was 30 (23-39) years. Home and injury locations were the same in 37.8 % of patients, within 5 miles of each other in 57.1 %, and within 20 miles in 87.2 %. DCI and SDI were significantly higher in injury vs home addresses (average DCI: home 59.5, injury 65.7; average SDI: home 71.8, injury 79.6; p < 0.001). Twenty ZCTAs (among 182) made up 68.4 % of injury locations. On linear regression, SDI and DCI were significantly associated with FRI number within ZCTAs.

CONCLUSIONS: FRI often happens close to home, and when ZCTAs differ, injury location SDOH tend to be worse. "Hotspots" with higher-than-average distress/deprivation present opportunity to maximize the impact of violence reduction; efforts should target these regions to mitigate factors perpetuating violence.

PMID:40383685 | DOI:10.1016/j.injury.2025.112418

Injury. 2025 May 8:112419. doi: 10.1016/j.injury.2025.112419. Online ahead of print.

ABSTRACT

INTRODUCTION: Hemorrhagic shock is a life-threatening condition that requires rapid identification for timely intervention. Although shock is easily discernible in the hypotensive patient, compensated shock in the "normotensive" patient is not. This study aimed to evaluate the utility of shock index (SI) in trauma patients with compensated shock.

METHODS: Patients with SBP > 90 mmHg on arrival were identified from our trauma center registry. SI was calculated by arrival heart rate divided by arrival SBP. Patients were stratified by SI using the following thresholds: ≤ 0.7, > 0.7 to 0.9, > 0.9 to 1.1, > 1.1 to 1.3, and > 1.3. Cross tabulations were used to estimate the odds of transfusion within 1 hour of arrival for each SI category with ≤ 0.7 as the referent.

RESULTS: 5958 trauma patients were included. Blood products were transfused within 1 hour of arrival in 211 (3.5 %) patients. A main effect was observed for shock index with increased risk for required transfusion for patients with admission shock index >0.7 (P < 0.001). In comparison to shock index of ≤ 0.7, odds ratios were 2.5(1.7 - 3.8), 8.2(5.4 - 12.2), 24.9(15.1 - 41.1), 59.0(32.0 - 108.6) for each categorical increase in SI.

DISCUSSION: Among trauma patients presenting without hypotension, elevated SI was associated with an increase in odds of receiving transfusion within one hour. SI may be useful in determining the presence of compensated shock in non-hypotensive patients.

PMID:40379507 | DOI:10.1016/j.injury.2025.112419

Injury. 2025 May 10;56(7):112366. doi: 10.1016/j.injury.2025.112366. Online ahead of print.

ABSTRACT

National Mine Action Strategies (NMAS) and National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) have emerged as two frameworks with potential to improve the health and safety of millions living in vulnerable communities through coordinated and systematic planning. NMAS describe strategies for eliminating explosive ordnance (EO) and providing services and support to EO victims. NSOAPs outline a strategy to enhance surgical systems through surgical, anesthesia, and obstetric capacity building, taking broad approaches spanning from individual health providers and facilities to country-level Ministry of Health governance and financing. Though NMAS and NSOAPs originate in different sectors, they both adopt a systemic approach to complex problems with population-wide effects in low-resource settings. While seemingly disparate plans, NMAS and NSOAPs share overlapping objectives and methods to achieve them, each centered around promoting population health at national levels through complex infrastructure, human capacity, and resources development. NMAS and NSOAPs both encounter similar objectives, challenges, and implementation considerations which could benefit from improved communication and coordination between these communities. Analyzing the strengths and criticisms of current NMAS and NSOAPs in light of one another can help to mutually strengthen and support these critically important strategic plans.

PMID:40378730 | DOI:10.1016/j.injury.2025.112366

J Bone Joint Surg Am. 2025 May 16. doi: 10.2106/JBJS.24.01096. Online ahead of print.

ABSTRACT

BACKGROUND: The calcaneonavicular distance has yet to be definitively defined on the basis of morphological studies and thus remains a somewhat elusive value for orthopaedists. The purposes of the present study were to measure the calcaneonavicular distance with use of magnetic resonance imaging (MRI) in a control pediatric population and to assess whether sex and age affected this distance.

METHODS: We retrospectively reviewed 363 MRI scans of the feet of healthy controls and measured calcaneonavicular distances (i.e., the distance between the bone margins of the anterior process of the calcaneus and the navicular and the distance between the cartilaginous margins of the anterior process of the calcaneus and the navicular) in the axial and sagittal planes.

RESULTS: Interobserver and intraobserver agreements were better for the bone measurements than for the cartilaginous measurements. The mean calcaneonavicular distance was 5.6 mm for values based on bone margins and 4.5 mm for those based on cartilaginous margins. On the basis of current criteria, the distributions of these distances were such that 41% to 46% of participants presented with values that defined them as having a too-long anterior process of the calcaneus. Furthermore, age seemed to play a major role in males, with calcaneonavicular distances narrowing with bone maturation.

CONCLUSIONS: The mean physiological calcaneonavicular distances measured in healthy pediatric controls are much shorter than reported previously. In almost 50% of cases, the calcaneonavicular distance measurements between the bone margins presented values that defined them as having a too-long anterior process of the calcaneus. Age played a major role in the calcaneonavicular distances in males, and we hypothesize that the calcaneonavicular distance narrows with bone maturation. We believe that it is essential to establish normative calcaneonavicular distance values based on sex and age so that they can be used as guidelines when diagnosing and treating patients suspected of having a too-long anterior process of the calcaneus.

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

PMID:40378236 | DOI:10.2106/JBJS.24.01096

Int Orthop. 2025 May 17. doi: 10.1007/s00264-025-06557-6. Online ahead of print.

NO ABSTRACT

PMID:40379871 | DOI:10.1007/s00264-025-06557-6

Int Orthop. 2025 May 16. doi: 10.1007/s00264-025-06558-5. Online ahead of print.

ABSTRACT

PURPOSE: As an alternative to total hip arthroplasty (THA), hip resurfacing arthroplasty (HRA) has numerous advantages including low risk of dislocation, preservation of femoral bone stock, and no restrictions on high-impact sports. This study was designed to evaluate the results of HRA performed in patients under 30 years old with a long-term follow-up.

METHODS: All HRA performed in patients younger than 30 years at the time of surgery were reviewed with a minimum follow up of two years. The analysis was based on clinical data, patient-recorded outcomes measures, biological and radiological evaluation.

RESULTS: One-hundred three HRA procedures in 93 patients (77 males and 16 females) were included. Mean age at surgery was 27.7 years (18 to 29.9). The two most frequent indications were osteoarthritis in 52% (54 HRA) and developmental dysplasia of the hip in 19% (20 HRA). There were two revisions: one for femoral aseptic loosening and one for infection. No dislocation or adverse wear-related failures were found. At a mean follow-up of 10.4 years (2-17.4), the mean UCLA activity and Oxford Hip score improved from 5.4 (1 to 7) and 39.9 (25-55) preoperatively to 7.9 (3 to 10) and 15.8 (12-34) postoperatively (p < 0.001), respectively. Kaplan-Meier survival analysis, with revision for any reason as the endpoint, showed a 10.8-year survival rate of 98%.

CONCLUSION: This cohort of HRA in patients under 30 years old is the longest follow-up ever reported. Despite HRA being done in a challenging cohort of patients, it shows excellent survivorship with a low complication rate.

PMID:40377662 | DOI:10.1007/s00264-025-06558-5

Injury. 2025 May 6:112414. doi: 10.1016/j.injury.2025.112414. Online ahead of print.

ABSTRACT

PURPOSE: The Rural Trauma Team Development Course (RTTDC) was introduced in 1998 in response to a growing number of deaths in rural areas due to trauma. Current literature provides evidence of the effectiveness of the RTTDC in reducing delays in the trauma transfer process in the United States. London Health Sciences Centre (LHSC) implemented the RTTDC in August of 2017. The objective of this study was to evaluate its impact in the Canadian setting.

METHODS: A retrospective cohort study of referred trauma patients before and after delivery of the RTTDC was conducted. The primary outcome was the proportion of patients transferred within 3 h of arrival at referring hospital. Statistical analyses compared pre and post RTTDC groups. Following multiple imputation, multivariable logistic regression analysis was used to control for confounding between groups. A planned subgroup analysis included only patients who met trauma team activation criteria and/or had an ISS ≥16. Course attendee satisfaction was measured using the American College of Surgeons RTTDC 4th Edition Course Evaluation and the Southwest Regional Trauma Network RTTDC Evaluation.

RESULTS: In total 180 patients were included in the study. Patients had a mean age of 52.0 (20.4) years, were most often male (73.3 %), sustained a blunt injury (92.8 %) with a mean ISS of 15.8 (10.5). The proportion of patients who were transferred within 3 h of arrival at primary hospital was 48.9 % pre-RTTDC and 56.7 % post-RTTDC (p = 0.370). Hosting an RTTDC did not have a significant impact on the proportion of patients transferred within 3 h of primary hospital arrival (OR = 1.18 (0.63, 2.20)). Median time (hours) spent at a primary hospital was similar (3.1 (1.4, 4.2) vs 2.7 (1.7, 3.8), p = 0.702), as was median decision to transfer time (hours) (1.5 (0.6, 2.5) vs 1.6 (0.6, 2.5), p = 0.837). Results of the subgroup analyses were similar (N = 98). Attendee satisfaction with the RTTDC was exceedingly positive.

CONCLUSION: In this study, participation in a one-day RTTDC did not result in a 20 % improvement in the proportion of patients being transferred from a referring hospital within 3 h. More accessible and sustainable educational outreach strategies are required to make further improvements.

PMID:40374421 | DOI:10.1016/j.injury.2025.112414

Injury. 2025 May 14;56(7):112409. doi: 10.1016/j.injury.2025.112409. Online ahead of print.

ABSTRACT

BACKGROUND: Following multiple trauma, individuals experience significant disability and poor functioning across several health domains. Rehabilitation is a component of trauma care management, however, there is limited evidence on patient outcomes after multiple trauma and the effectiveness of rehabilitation. This study was based on a Value-Based HealthCare (VBHC) framework and aimed to evaluate the impact of multiple trauma on patients' function and quality of life, and the relationship between these outcomes and the cost of inpatient rehabilitation. It also aimed to obtain the patient perspective regarding health areas to address for future trauma research.

METHODS: This prospective, cohort study recruited 62 adult participants from a specialist inpatient rehabilitation unit following multiple trauma orthopaedic injuries. Patients health-related quality of life was measured using the 12-Item Short Form Health Survey (Version 2) (SF-12v2). The SF-12v2 was completed during inpatient rehabilitation (to capture patient recalled pre-injury quality of life) and via a telephone interview at two weeks after rehabilitation discharge. Patients also self-reported their satisfaction with the SF-12v2 and identified important health areas to address after multiple trauma. Routine inpatient rehabilitation data was collected including: the Functional Independence Measure (FIM) (assesses patients' functional independence on rehabilitation admission and discharge) and demographics.

RESULTS: The sample's mean age was 51.6 years (standard deviation: 17.8) and the majority were male (69.4 %). Between rehabilitation admission to discharge, patients' demonstrated a statistically significant increase in function (FIM scores). However, quality of life (SF-12v2 scores) significantly decreased between pre-injury to after hospital discharge. At both timepoints, an increased proportion of patients had quality of life scores that were below the population norms. Increased rehabilitation costs (i.e., longer inpatient stays) were positively and significantly associated with increased functional independence, albeit, not quality of life scores. Patients identified important health areas that related to individual outcomes (e.g., mental health, limitations, goals) and familial impacts.

CONCLUSIONS: This study reported that an individually tailored rehabilitation program was cost effective and led to significant improvements in patient function. Patients experienced significant impacts to quality of life after multiple trauma, which suggests the need for a long-term and integrated care plan including psychological medical input.

PMID:40373364 | DOI:10.1016/j.injury.2025.112409

Injury. 2025 May 7;56(7):112412. doi: 10.1016/j.injury.2025.112412. Online ahead of print.

ABSTRACT

BACKGROUND: Ferrous metal foreign bodies (FMFBs) are often the most common metallic foreign bodies for the widespread application and low price of ferrous metal, but these bodies are very tiny and with the uncertainty of the position, it is very difficult to find them and get them out without a hitch. Our aim was to evaluate the reliability of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet. In addition, we sought to analyze the outcomes of retrieval of FMFBs from limbs soft tissue aided by a permanent magnet.

METHODS: twenty-two patients with FMFBs in limbs soft tissue who underwent surgical intervention were included between September 2022 and April 2024. Preoperative X-ray localization and intraoperative magnet assistance were performed on all patients. Clinical evaluations included operation time and postoperative complications. The mean follow-up period was 10 ± 2.4 months.

RESULTS: these FMFBs have been got out successfully in all the cases without complications. The average distance between the foreign body and the body surface measured before surgery was 2.35 cm.The operation time ranged from 30 s to 45 min, with an average operation time of 13.7 min.

CONCLUSIONS: Retrieval of FMFBs from limbs soft tissue aided by a permanent magnet is an effective and reliable treatment without postoperative complications.

PMID:40373363 | DOI:10.1016/j.injury.2025.112412

Injury. 2025 May 8;56(7):112410. doi: 10.1016/j.injury.2025.112410. Online ahead of print.

ABSTRACT

BACKGROUND: Cephalomedullary nails (CMN) are widely used for fixation of unstable pertrochanteric fractures. In 2018, the Depuy Synthes Trochanteric Fixation Nail - Advanced (TFNA) implant was introduced at a level I academic trauma center. Subsequently, clinical concerns were raised about the use of the TFNA due to reports of nail breakage. The purpose of this study was to investigate the risk of nail breakage between TFNA and other nail models. Long term outcomes following nail failure were evaluated.

METHODS: A retrospective cohort study was conducted using data of 1665 patients who had undergone a CMN procedure between 2014 and 2020. Data were handpicked from patient records. The nail breakage and breakage time of the TFNA were compared to the TFN, PFNA, Gamma3, and Intertan using cox regression analysis and logistic regression analysis. Long term outcomes were evaluated by assessing Oxford Hip Scores (OHS).

RESULTS: The number of cephalomedullary nails were as follows: TFNA 754 (45.3 %), Gamma3 462 (27.7 %), PFNA 234 (14.1 %), TFN 211 (12.7 %), and Intertan 4 (0.2 %). A total of 21 (1.3 %) nails broke during the follow-up period. The TFNA broke the most often with 15 cases (2.0 %), followed by the Gamma3 with five cases (1.1 %) and the PFNA with one case (0.4 %). Overall, the mean (SD) nail breakage time was 222 (148) days. However, for the TFNA, Gamma3 and PFNA, the mean breakage times were 177 days (110), 292 (153) and 545, respectively. In logistic regression analysis we observed significant difference between TFNA and non-TFNA group. The odds ratio (OR) for nail breakage in TFNA group was 2.66 [95 % Ci, 1.01-6.99, p = 0.047]. The mean (SD) one year OHS for Total Hip Arthroplasty after nail breakage and overall OHS for re-osteosynthesis was 38.6 (9.8) and 36.3 (7.8), respectively.

CONCLUSIONS: Our study provides evidence suggesting that the TFNA may be associated with an increased risk of nail breakage compared to other nail models. It should be noted that implant breakage is a relatively infrequent complication. Long-term outcomes following secondary procedures were comparable between THA and re-osteosynthesis.

LEVEL OF EVIDENCE: Level IV.

PMID:40367833 | DOI:10.1016/j.injury.2025.112410

Int Orthop. 2025 May 15. doi: 10.1007/s00264-025-06559-4. Online ahead of print.

NO ABSTRACT

PMID:40369326 | DOI:10.1007/s00264-025-06559-4

Int Orthop. 2025 May 14. doi: 10.1007/s00264-025-06556-7. Online ahead of print.

ABSTRACT

PURPOSE: To assess the potential relationship between synchronous and metachronous occurrences of spondylodiscitis and subsequent periprosthetic joint infection (PJI), shedding light on the interplay between these two distinct yet interconnected conditions. The secondary aim was to investigate the time interval between the occurrences of spondylodiscitis and PJI in metachronous infections, and to identify potential similarities or differences in the causative pathogens between synchronous and metachronous infections.

METHODS: A retrospective single-center study was performed. Patients diagnosed with either spondylodiscitis or PJI (based on the 2018 International Consensus Meeting criteria) were included. Demographic, clinical, laboratory and microbiology patient data were retrieved.

RESULTS: The incidence of metachronous infection and synchronous infection were 86.7% and 13.3% respectively. In metachronous infections, time between spondylodiscitis and PJI was 29.1 months (SD 31.1). The most common relation between spondylodiscitis and PJI were between hip PJI and lumbar spondylodiscitis. There was a statistically significant difference in the time between spondylodiscitis and PJI in the patient who had or had not arthroplasty prior to the spondylodiscitis (p = 0.02). The spondylodiscitis and PJI concomitant infection were predominant a monobacterial infection. Staphylococcus aureus was the most frequent species isolated (47.6%). The same organism was isolated in the cultures in metachronous and in the synchronous infections between spondylodiscitis and PJI in 100% of cases.

CONCLUSION: The findings of this study suggest a potential link between spondylodiscitis and PJI; however, further research is required to understand the mechanisms underlying the potential relationship between these events, as well as to develop effective strategies for prevention, diagnosis, and treatment of these infections.

LEVEL OF EVIDENCE: Level IV, Retrospective case series.

PMID:40366414 | DOI:10.1007/s00264-025-06556-7

J Bone Joint Surg Am. 2025 May 13. doi: 10.2106/JBJS.25.00071. Online ahead of print.

NO ABSTRACT

PMID:40359264 | DOI:10.2106/JBJS.25.00071

J Bone Joint Surg Am. 2025 May 13. doi: 10.2106/JBJS.24.00871. Online ahead of print.

ABSTRACT

BACKGROUND: Osseointegration of a bone-anchored limb (BAL) establishes a direct skeletal interface for prosthesis attachment, simplifying the donning/doffing process. The Timed Up and Go (TUG) test reliably assesses mobility in individuals with lower-extremity amputation who use socket prostheses, but it does not account for the time required to don a prosthetic limb. The aim of this study was to develop and examine the reliability and validity of the Colorado Limb Donning-Timed Up and Go (COLD-TUG) test. This test combines the time required for donning a prosthesis with the time to complete the TUG test in lower-extremity amputees using a prosthesis.

METHODS: Participants with a unilateral lower-extremity amputation were enrolled in this study; participants were divided into 2 groups: socket prosthesis users (n = 15) and BAL users (n = 22). The COLD-TUG test measured the time (in seconds) required to don the prosthesis, get up from a standard chair, walk 3 m, turn around, walk back to the chair, and sit down again. Group differences as well as the intrarater reliability and concurrent validity of the test were analyzed.

RESULTS: There were no significant differences between the 2 groups in terms of baseline characteristics. The intrarater reliability of the COLD-TUG test was excellent (intraclass correlation coefficient [ICC] = 0.94; p = 0.001). The concurrent validity between the COLD-TUG test and the TUG test in BAL patients was good (r = 0.712; p = 0.006). Participants in the BAL group had a significantly shorter mean COLD-TUG time (16.6 ± 5.6 seconds) compared with participants in the socket-prosthesis group (85.3 ± 61.4 seconds) (p < 0.001).

CONCLUSIONS: The COLD-TUG test accurately measures prosthesis-donning burden in the context of functional mobility, thus providing valuable insights into functional abilities and quality of life. Use of a BAL was associated with a shorter donning time compared with use of a socket prosthesis.

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

PMID:40359258 | DOI:10.2106/JBJS.24.00871

J Bone Joint Surg Am. 2025 May 13. doi: 10.2106/JBJS.24.00744. Online ahead of print.

ABSTRACT

BACKGROUND: Conventional sonication is a recommended method in the diagnosis of periprosthetic joint infection (PJI), but the accuracy of diagnosis is still not ideal. We have applied the use of a handheld ultrasonic device and the intraoperative direct sonication of prostheses and soft tissues retrieved during surgery to improve the efficacy of the microbiological diagnosis of PJI and the incubation time of pathogens.

METHODS: This was a retrospective study of patients diagnosed with PJI or aseptic loosening who underwent revision, DAIR (debridement, antibiotics, and implant retention), or resection, and for whom either sonication method was used between July 2017 and June 2023. Starting in August 2021, the removed implants and adjacent soft tissue were directly sonicated in a small metal container, and then the sonication fluid was incubated in blood culture bottles in the operating room under laminar air flow. Conventional sonication was continued through July 2021, and included vortex mixing for 30 seconds, sonication for 5 minutes, and additional vortex mixing for 30 seconds, as described by Trampuz et al. in 2007. The sensitivity, specificity, and time to positivity (TTP) of pathogen cultures were compared between intraoperative direct sonication and conventional sonication.

RESULTS: Of the 415 included patients, 266 had PJI and 149 had aseptic loosening. Fluid from intraoperative direct sonication and conventional sonication showed sensitivities of 88% and 69% (p < 0.001) and specificities of 84% and 93% (p = 0.105), respectively. Higher sensitivity was obtained by intraoperative direct sonication of only soft tissue than by direct sonication of only the prosthesis (80% versus 75%). Culture results from intraoperative direct sonication of soft tissue and the prosthesis were inconsistent in 55 cases (soft tissue plus prosthesis: 28 cases, soft tissue only: 17 cases, and prosthesis only: 10 cases). Gram-positive organisms grew significantly faster following direct sonication (median TTP for soft-tissue, 2.12 days [interquartile range (IQR), 1.40 to 3.16 days], and median TTP for the prosthesis, 2.02 days [IQR, 1.08 to 3.04 days]) compared with conventional sonication (median TTP, 2.92 days [IQR, 1.83 to 3.96 days]) (p = 0.003 and p < 0.001, respectively).

CONCLUSIONS: Intraoperative direct sonication was more sensitive than conventional sonication for the microbiological diagnosis of PJI and slightly shortened the TTP of microorganisms.

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

PMID:40359254 | DOI:10.2106/JBJS.24.00744

SICOT J. 2025;11:29. doi: 10.1051/sicotj/2025024. Epub 2025 May 12.

ABSTRACT

Complications on the femoral side after performing proximal femoral replacement (PFR), such as stem loosening and periprosthetic fractures, are the major reasons for reoperation. Femoral reconstruction was performed using PFR with a locking plate to minimize the risk of complications. We present the case of an 85-year-old woman with stem loosening and massive proximal femoral bone loss (Paprosky type IV) 10 years after stem revision in bipolar hemiarthroplasty. Femoral reconstruction was performed using the following surgical techniques. After removing the previous implant, a PFR was inserted into the host bone of the distal femur and fixed at the junction with cement. In addition, a locking plate was used for bridging. Full weight-bearing rehabilitation was started the day after surgery. At the 5-year follow-up, the patient could walk steadily without complications. A postoperative radiograph of the femur showed no signs of a radiolucent line, implant-related issues, or bone resorption. This reconstructive technique may reduce the high torsional and compressive stresses on bone cement prostheses, which can cause complications on the femoral side. Even in the case of poor femoral host bone quality, this reconstruction method can achieve robust femoral reconstruction. Femorl reconstruction using PFR with a locking plate is a particularly beneficial reconstruction method for older patients with massive proximal femoral bone loss.

PMID:40354518 | PMC:PMC12068785 | DOI:10.1051/sicotj/2025024

SICOT J. 2025;11:28. doi: 10.1051/sicotj/2025026. Epub 2025 May 12.

ABSTRACT

INTRODUCTION: Treatment of spinal metastases is multidisciplinary, where radiotherapy (RT) and surgery have a central role. The effect of adjuvant post-operative RT versus surgery alone for metastatic spinal disease has not been previously investigated. Our aim was to analyze whether post-operative RT was associated with better functional outcome or increased incidence of local complications after surgical treatment for spinal metastatic disease.

METHODS: Information on neurologic outcome of 200 patients surgically treated for spinal metastases was retrieved from the institutional registry. The events of pre-operative and post-operative neurological function, post-operative wound complications as well as death and implant revision were available.

RESULTS: Post-operative RT was significantly associated to superior neurological recovery, evaluated both as restoration of the ambulatory capacity and absolute change in the Frankel score. At the same time, use of post-operative RT was not associated to an increased risk of wound complications. The risk for revision surgery when RT was administered was similar to surgery alone in a competing risks analysis with death as the competing event.

DISCUSSION: The results indicate that surgery with post-operative RT is associated with superior neurologic recovery than surgery alone. The results also do not indicate any significant risk for wound healing problems with administered post-operative RT.

PMID:40354517 | PMC:PMC12068786 | DOI:10.1051/sicotj/2025026

Injury. 2025 May 8;56(7):112365. doi: 10.1016/j.injury.2025.112365. Online ahead of print.

ABSTRACT

PURPOSE: Fractures in infants younger than 1 year without an obvious accidental cause raise suspicion of child abuse, warranting a skeletal survey. However, adherence to child abuse screening guidelines remains suboptimal. This study aimed to identify factors associated with skeletal survey completion in infants with fractures in the absence of a clear accidental context.

METHODS: A retrospective chart review was conducted on children younger than 1 year with at least one fracture, identified over a 6-year period (2017-2023) at a French tertiary children's hospital. Infants with fractures due to obstetric trauma or road traffic accidents were excluded. Multivariate logistic regression was used to determine factors associated with skeletal survey completion.

RESULTS: A total of 312 children were included, of whom 97 (33%) underwent a skeletal survey. Among those children, additional fractures were detected in 16 (16.5%). Skeletal surveys were more frequently performed in boys (odds ratio [OR]: 3.82, 95% confidence interval [CI]: 1.66-8.84), younger infants, and those with an inconsistent or evolving trauma explanation (OR: 17.18, 95% CI: 1.86-158.26) or no reported explanation (OR: 16.56, 95% CI: 6.30-43.54).

CONCLUSIONS: Only one-third of infants were screened for occult fractures, but the factors associated with skeletal survey completion aligned with established clinical guidelines. Long-term follow-up is necessary to assess whether the two-thirds of children who were unscreened were later identified as victims of child abuse.

PMID:40354771 | DOI:10.1016/j.injury.2025.112365