J Bone Joint Surg Am. 2025 Mar 19;107(6):541-542. doi: 10.2106/JBJS.25.00095. Epub 2025 Mar 19.

NO ABSTRACT

PMID:40105719 | DOI:10.2106/JBJS.25.00095

Injury. 2025 Mar 7:112230. doi: 10.1016/j.injury.2025.112230. Online ahead of print.

ABSTRACT

BACKGROUND: Penetrating neck trauma poses significant risks due to critical anatomical structures. This study evaluates the impact of explosion fragment proximity to major vessels on the need for surgical exploration and outcomes, during a high-intensity urban warfare conflict.

METHODS: We conducted a retrospective review of medical records from penetrating neck trauma patients at a tertiary hospital from October 2023 to April 2024. Analyses included demographics, injury specifics, radiology, surgical interventions, and outcomes.

RESULTS: The cohort comprised 24 male soldiers, 10 of whom had vascular injuries. Those with suspected vascular injuries had notably higher rates of neck exploration (90 % vs. 21 %), ICU admissions (70 % vs. 29 %), and ICU stay duration [median 2.50 (IQR 0-55) days vs. 0 (IQR 0-10) days]. Complication rates were also higher in this group (80 % vs. 7 %), including, but not limited to, post-operative hoarseness (40 % vs. 0 %). A distance shorter than 5 mm from a fragment to a major blood vessel was correlated with the decision to undergo neck exploration (85 % vs. 9 %), ICU hospitalization (69 % vs. 18 %), to suffer from vascular injury 77 % vs. 9 %) or complications (77 % vs. 0 %).

CONCLUSIONS: Advanced imaging is crucial in managing penetrating neck trauma, with a <5 mm proximity threshold from a fragment to a major blood vessel influencing surgical and ICU decisions. Vascular injuries are associated with worse outcomes, emphasizing the need for precise diagnostics and multidisciplinary approach including head and neck surgeons, radiologists, interventional radiologists, orthopedics, ICU and Anesthesia. Future research should focus on prospective studies to refine clinical guidelines and enhance outcomes.

PMID:40102150 | DOI:10.1016/j.injury.2025.112230

Int Orthop. 2025 Mar 18. doi: 10.1007/s00264-025-06488-2. Online ahead of print.

ABSTRACT

PURPOSE: International Medical Graduates (IMGs) have lower match rates than their United States (U.S.)-trained Doctor of Allopathic Medicine (MD) and Doctor of Osteopathic Medicine (DO) peers. This study aims to more completely elucidate the research accomplishments required for IMGs to match into orthopaedic residency and to compare their academic productivity during residency to that of U.S. MD and DO graduates.

METHODS: Data from orthopaedic-related journals and ACGME-accredited residency programs were extracted in July of 2024 using Python. Variables included: residency year, publications, first-author publications, citations, journals, h-index, medical school type, and the medical school and residency program locations.

RESULTS: Prior to residency, the 56 matched IMGs had a mean of 32.8 publications, 9.8 first-author publications, and 517.1 citations. Matched U.S. MDs had an average of 3.7 publications, 1.1 first-author publications, and 61.0 citations while DO matched applicants had an average of 3.7 publications, 1.0 first-author publications, and 5.6 citations. During residency, IMG orthopaedic residents averaged 5.2 publications per year and 16.6 citations per year. U.S. MD residents averaged 1.3 publications per year and 3.6 citations per year, while DO residents averaged 0.55 publications per year and 1.1 citations per year. The h-index averaged 9.8 for IMGs, 2.2 for U.S. MDs and 0.7 for DOs. All comparisons for IMGs vs. U.S. MDs and IMGs vs. DOs yielded P < 0.0001.

CONCLUSION: These findings highlight the significant differences in research output between IMGs and their U.S.-trained counterparts in orthopaedic surgery, and show that these differences continue throughout residency.

PMID:40100391 | DOI:10.1007/s00264-025-06488-2

Int Orthop. 2025 Mar 18. doi: 10.1007/s00264-025-06497-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this scoping review is to analyze the application of artificial intelligence (AI) in ultrasound (US) imaging for diagnosing carpal tunnel syndrome (CTS), with an aim to explore the potential of AI in enhancing diagnostic accuracy, efficiency, and patient outcomes by automating tasks, providing objective measurements, and facilitating earlier detection of CTS.

METHODS: We systematically searched multiple electronic databases, including Embase, PubMed, IEEE Xplore, and Scopus, to identify relevant studies published up to January 1, 2025. Studies were included if they focused on the application of AI in US imaging for CTS diagnosis. Editorials, expert opinions, conference papers, dataset publications, and studies that did not have a clear clinical application of the AI algorithm were excluded.

RESULTS: 345 articles were identified, following abstract and full-text review by two independent reviewers, 18 manuscripts were included. Of these, thirteen studies were experimental studies, three were comparative studies, and one was a feasibility study. All eighteen studies shared the common objective of improving CTS diagnosis and/or initial assessment using AI, with shared aims ranging from median nerve segmentation (n = 12) to automated diagnosis (n = 9) and severity classification (n = 2). The majority of studies utilized deep learning approaches, particularly CNNs (n = 15), and some focused on radiomics features (n = 5) and traditional machine learning techniques.

CONCLUSION: The integration of AI in US imaging for CTS diagnosis holds significant promise for transforming clinical practice. AI has the potential to improve diagnostic accuracy, streamline the diagnostic process, reduce variability, and ultimately lead to better patient outcomes. Further research is needed to address challenges related to dataset limitations, variability in US imaging, and ethical considerations.

PMID:40100390 | DOI:10.1007/s00264-025-06497-1

J Bone Joint Surg Am. 2025 Mar 18. doi: 10.2106/JBJS.24.00680. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this study was to evaluate whether increased anteroposterior (AP) thickness of the proximal patellar tendon at preseason evaluation is predictive of symptomatic patellar tendinopathy and associated sequelae.

METHODS: Thirty-one male National Collegiate Athletic Association (NCAA) Division I basketball players voluntarily participated in this study (n = 52 tendons from 27 athletes after application of exclusion criteria, with evaluation at preseason, midseason, and postseason time points). At each time point, Victorian Institute of Sport Assessment-Patellar Tendon (VISA-P) scores, patellar tendon tenderness, patellar tendon AP thickness, and the presence of a proximal patellar tendon hypoechoic region were evaluated. Measurement of patellar tendon AP thickness and the identification of hypoechoic regions were performed using a portable ultrasound device. Outcome measures included a proximal patellar tendon hypoechoic region, a trip to the training room (TTR), time-loss symptomatic patellar tendinopathy (TLPT), and patellar tendon rupture. Covariates evaluated in the multivariable regression model included body mass index and a patient-reported history of patellar tendinopathy (α = 0.05).

RESULTS: The mean preseason tendon thickness was 4.78 ± 1.22 mm. Nine (17.3%) of the tendons were symptomatic to the point of requiring a TTR. Preseason tendon thickness was associated with increased odds of a TTR (adjusted odds ratio [aOR] = 3.68 [95% confidence interval (CI) = 1.73 to 7.81]; p < 0.01). The predicted probability of a TTR was 86.0% with a preseason tendon thickness of 8 mm versus 3.4% with a preseason tendon thickness of 4 mm. Preseason tendon thickness was also predictive of TLPT (aOR = 1.96 [95% CI = 1.03 to 3.71]; p = 0.04). Preseason VISA-P scores were not predictive of a TTR (p = 0.66) or TLPT (p = 0.60).

CONCLUSIONS: Increased patellar tendon thickness on preseason ultrasound is predictive of symptomatic patellar tendinopathy and associated sequelae during an NCAA Division I basketball season. Ultrasound identification of at-risk individuals may allow triage toward additional physical therapy and activity modification for these athletes to prevent progression to irreversible patellar tendon disease. These data support the use of ultrasound as a screening tool for elite jumping athletes.

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

PMID:40100945 | DOI:10.2106/JBJS.24.00680

J Bone Joint Surg Am. 2025 Jan 1;107(1):e3. doi: 10.2106/JBJS.24.00980. Epub 2025 Jan 1.

NO ABSTRACT

PMID:40100016 | DOI:10.2106/JBJS.24.00980

J Bone Joint Surg Am. 2025 Jan 1;107(1):e2. doi: 10.2106/JBJS.24.00887. Epub 2025 Jan 1.

NO ABSTRACT

PMID:40100015 | DOI:10.2106/JBJS.24.00887

J Bone Joint Surg Am. 2025 Jan 1;107(1):81-92. doi: 10.2106/JBJS.24.00340. Epub 2024 Nov 14.

ABSTRACT

➢ Anterior glenohumeral instability is a complex orthopaedic problem that requires a detailed history, a thorough physical examination, and a meticulous review of advanced imaging in order to make individualized treatment decisions and optimize patient outcomes.➢ Nonoperative management of primary instability events can be considered in low-demand patients, including elderly individuals or younger, recreational athletes not participating in high-risk activities, and select in-season athletes. Recurrence can result in increased severity of soft-tissue and osseous damage, further increasing the complexity of subsequent surgical management.➢ Surgical stabilization following primary anterior instability is recommended in young athletes who have additional risk factors for failure, including participation in high-risk sports, hyperlaxity, and presence of bipolar bone loss, defined as the presence of both glenoid (anteroinferior glenoid) and humeral head (Hill-Sachs deformity) bone loss.➢ Several surgical treatment options exist, including arthroscopic Bankart repair with or without additional procedures such as remplissage, open Bankart repair, and osseous restoration procedures, including the Latarjet procedure.➢ Favorable results can be expected following arthroscopic Bankart repair with minimal (<13.5%) bone loss and on-track Hill-Sachs lesions following a primary instability event. However, adjunct procedures such as remplissage should be performed for off-track lesions and should be considered in the setting of subcritical glenoid bone loss, select high-risk patients, and near-track lesions.➢ Bone-grafting of anterior glenoid defects, including autograft and allograft options, should be considered in cases with >20% glenoid bone loss.

PMID:40100014 | DOI:10.2106/JBJS.24.00340

J Bone Joint Surg Am. 2025 Jan 1;107(1):e1. doi: 10.2106/JBJS.24.00210. Epub 2024 Nov 22.

ABSTRACT

BACKGROUND: Orthopaedic surgery is one of the least gender-diverse surgical specialties, with only 7% women in practice and 20.4% in residency. There are numerous "leaks" in the talent pipeline for women orthopaedic surgeons that lead to the field as a whole falling short of a critical mass (30%) of women. For over a decade, a network of professional and nonprofit organizations, including the Ruth Jackson Orthopaedic Society, The Perry Initiative, Nth Dimensions, and others, have focused on targeted outreach and mentoring of women in the talent pipeline; they report a positive effect of these interventions on recruitment and retention of women in the field.

METHODS: In this study, we applied mathematical models to estimate the historic and future impacts of current outreach and hands-on exposure efforts to recruit more women into orthopaedic surgery. The model uses published data on program reach and impact from one of the largest and longest-running programs, The Perry Initiative, and combines it with AAMC and AAOS Census data. These data were used to forecast the percentage of women entering the profession as postgraduate year 1 (PGY1) residents and among practicing orthopaedic surgeons.

RESULTS: The results of the mathematical models suggest that the increase in women in the PGY1 population from 14.7% to 20.9% from 2008 to 2022 is at least partially attributable to current mentoring and outreach efforts by The Perry Initiative and others. Assuming continued intervention at present levels, the PGY1 residency class will reach peak diversity of 28% women in 2028, and the field as a whole will reach a steady-state composition of approximately 25% practicing women orthopaedic surgeons by 2055.

CONCLUSIONS: The results of this study indicate that outreach and exposure efforts, such as those of The Perry Initiative, are having a substantive impact on gender diversity in orthopaedic surgery. With continued intervention, the field as a whole should approach a critical mass of women within a generation. The collective efforts of the orthopaedics community over the past decade to close the gender gap serve as a guidebook for other professions seeking to diversify.

PMID:40100013 | DOI:10.2106/JBJS.24.00210

J Bone Joint Surg Am. 2025 Jan 1;107(1):73-79. doi: 10.2106/JBJS.24.00706. Epub 2024 Nov 19.

ABSTRACT

BACKGROUND: Fractures of the thoracic and lumbar spine are increasingly common. Although it is known that such fractures may elevate the risk of near-term morbidity, the natural history of patients who sustain such injuries remains poorly described. We sought to characterize the natural history of patients treated for thoracolumbar fractures and to understand clinical and sociodemographic factors associated with survival.

METHODS: Patients treated for acute thoracic or lumbar spine fractures within a large academic health-care network between 2015 and 2021 were identified. Clinical, radiographic, and mortality data were obtained from medical records and administrative charts. Survival was assessed using Kaplan-Meier curves. We used multivariable logistic regression to evaluate factors associated with survival, while adjusting for confounders. Results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS: The study included 717 patients (median age, 66 years; 59.8% male; 69% non-Hispanic White). The mortality rate was 7.0% (n = 50), 16.2% (n = 116), and 20.4% (n = 146) at 3, 12, and 24 months following injury, respectively. In adjusted analysis, patients who died within the first year following injury were more likely to be older (OR = 1.03; 95% CI = 1.01 to 1.05) and male (OR = 1.67; 95% CI = 1.05 to 2.69). A higher Injury Severity Score, lower Glasgow Coma Scale score, and higher Charlson Comorbidity Index at presentation were also influential factors. The final model explained 81% (95% CI = 81% to 83%) of the variation in survival.

CONCLUSIONS: We identified a previously underappreciated fact: thoracolumbar fractures are associated with a mortality risk comparable with that of hip fractures. The risk of mortality is greatest in elderly patients and those with multiple comorbidities. The results of our model can be used in patient and family counseling, informed decision-making, and resource allocation to mitigate the potential risk of near-term mortality in high-risk individuals.

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

PMID:40100012 | DOI:10.2106/JBJS.24.00706

J Bone Joint Surg Am. 2025 Jan 1;107(1):53-65. doi: 10.2106/JBJS.23.00735. Epub 2024 Nov 22.

ABSTRACT

BACKGROUND: In this study, we expand the supportive evidence for total disc arthroplasty (TDA) with results up to 21 years in a large patient cohort who received a semiconstrained ball-and-socket lumbar prosthesis. The objectives of the study were to compare the results for 1 versus 2-level surgeries and to evaluate whether prior surgery at the index level(s) impacts clinical outcomes.

METHODS: From 1999 to 2013, 1,187 patients with chronic lumbar degenerative disc disease (DDD) underwent lumbar TDA, of whom 772 underwent a 1-level procedure and 415 underwent a 2-level procedure. A total of 373 (31.4%) of the 1,187 patients had prior index-level surgery. Patients were evaluated preoperatively; at 3, 6, 12, 18, and 24 months postoperatively; and yearly thereafter. The follow-up duration ranged from 7 to 21 years (mean, 11 years and 8 months). Collected data included radiographic, neurological, and physical assessments, as well as self-evaluations using the Oswestry Disability Index (ODI) and visual analog scale (VAS) for back and leg pain. Perioperative data points, complication rates, and reoperation or revision rates were also assessed. Patients were divided into 4 groups: 1-level TDA with no prior surgery at the index level, 1-level TDA with prior surgery, 2-level TDA with no prior surgery, and 2-level TDA with prior surgery.

RESULTS: All groups showed dramatic reduction in the ODI at 3 months postoperatively and maintained these scores over time. Although VAS pain did not diminish to its final level as rapidly for patients with prior surgery, there was no significant difference between the groups in terms of pain reduction at 24 months postoperatively. Of 1,187 patients, 49 (4.13%) required either a new surgery at another level or revision or reoperation at the index level. Rates were too low in all groups to compare them statistically. Total TDA revision and adjacent-level surgery rates over 7 to 21 years were very low (0.67% and 1.85%, respectively).

CONCLUSIONS: This study demonstrates the robust long-term clinical success of 1 and 2-level lumbar TDA as assessed at 7 to 21 years postoperatively in one of the largest evaluated cohorts of patients with TDA. Patients had dramatic and maintained reductions in disability and pain scores over time and low rates of index-level revision or reoperation and adjacent-level surgery relative to published long-term fusion data. Additionally, patients who underwent 1-level lumbar TDA and those who underwent 2-level TDA demonstrated equivalent improvement, as did patients with prior surgery at the index level and those with no prior surgery.

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

PMID:40100011 | PMC:PMC11665976 | DOI:10.2106/JBJS.23.00735

J Bone Joint Surg Am. 2025 Jan 1;107(1):16-25. doi: 10.2106/JBJS.23.01480. Epub 2024 Nov 20.

ABSTRACT

BACKGROUND: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain.

METHODS: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain.

RESULTS: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p < 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group.

CONCLUSIONS: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay.

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

PMID:40100010 | DOI:10.2106/JBJS.23.01480

J Bone Joint Surg Am. 2025 Jan 1;107(1):9-15. doi: 10.2106/JBJS.23.01351. Epub 2024 Nov 20.

ABSTRACT

BACKGROUND: Rotator cuff repair (RCR) is a frequently performed outpatient orthopaedic surgery, with substantial financial implications for health-care systems. Time-driven activity-based costing (TDABC) is a method for nuanced cost analysis and is a valuable tool for strategic health-care decision-making. The aim of this study was to apply the TDABC methodology to RCR procedures to identify specific avenues to optimize cost-efficiency within the health-care system in 2 critical areas: (1) the reduction of variability in the episode duration, and (2) the standardization of suture anchor acquisition costs.

METHODS: Using a multicenter, retrospective design, this study incorporates data from all patients who underwent an RCR surgical procedure at 1 of 4 academic tertiary health systems across the United States. Data were extracted from Avant-Garde Health's Care Measurement platform and were analyzed utilizing TDABC methodology. Cost analysis was performed using 2 primary metrics: the opportunity costs arising from a possible reduction in episode duration variability, and the potential monetary savings achievable through the standardization of suture anchor costs.

RESULTS: In this study, 921 RCR cases performed at 4 institutions had a mean episode duration cost of $4,094 ± $1,850. There was a significant threefold cost variability between the 10th percentile ($2,282) and the 90th percentile ($6,833) (p < 0.01). The mean episode duration was registered at 7.1 hours. The largest variability in the episode duration was time spent in the post-acute care unit and the ward after the surgical procedure. By reducing the episode duration variability, it was estimated that up to 640 care-hours could be saved annually at a single hospital. Likewise, standardizing suture anchor acquisition costs could generate direct savings totaling $217,440 across the hospitals.

CONCLUSIONS: This multicenter study offers valuable insights into RCR cost as a function of care pathways and suture anchor cost. It outlines avenues for achieving cost-savings and operational efficiency. These findings can serve as a foundational basis for developing health-economics models.

LEVEL OF EVIDENCE: Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:40100009 | DOI:10.2106/JBJS.23.01351

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06492-6. Online ahead of print.

NO ABSTRACT

PMID:40095073 | DOI:10.1007/s00264-025-06492-6

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06499-z. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the clinical efficacy of endoscopic plantar fascia release through the modified dual medial deep fascia approach for the treatment of refractory plantar fasciitis.

METHODS: A retrospective study was conducted involving 34 patients with refractory plantar fasciitis treated by endoscopic plantar fascia release through the modified dual medial deep fascia approach. Among them, 25 patients had concurrent calcaneal spurs. All patients were followed for a minimum of 12 months. Functional outcomes were assessed using the Visual Analogue Scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score, while structural evaluations included the Medial Longitudinal Arch Angle (MLAA), navicular tuberosity height-to-foot length ratio (NH/FL), and the Arch Index (AI). Differences between patients with and without calcaneal spurs were also analyzed.

RESULTS: All patients completed at least 12 months of follow-up, with primary wound healing in all cases. Two patients experienced transient plantar skin numbness and small toe abduction difficulty, which resolved within three months. The VAS score decreased significantly from 6.53 ± 1.19 preoperatively to 1.18 ± 0.76 postoperatively, and the AOFAS score improved from 52.41 ± 5.23 to 93.29 ± 3.91 (both P < 0.05), indicating statistical significance. However, changes in the MLAA, NH/FL and AI were not statistically significant. Apart from age differences (49.04 ± 4.41 vs. 34.56 ± 3.13), no significant differences in other scores were observed between the calcaneal spur group and the non-calcaneal spur group at the final follow-up. Moreover, compared to the methods reported in other studies, our study demonstrated a shorter operative time and superior pain and functional outcomes.

CONCLUSION: The dual medial deep fascia approach for endoscopic plantar fascia release is a safe, quick, effective, and minimally invasive technique that yields favourable clinical outcomes. It has certain advantages compared to other techniques. The presence of calcaneal spurs does not impact postoperative outcomes.

PMID:40095072 | DOI:10.1007/s00264-025-06499-z

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06472-w. Online ahead of print.

ABSTRACT

PURPOSE: Study of the sagittal accuracy of the 'Robotic Surgical Assistant' (ROSA®), compared to conventional surgery, regarding the application of the tibial slope (TS). Study of the impact of TS on the range of motion (ROM) and patient-reported outcome measures (PROMS).

METHODS: Inclusion of patients who underwent primary Total Knee Arthroplasty (TKA) between 1/1/2021 and 15/4/2024. Divided into robotic-assisted TKA (RA-TKA) and manual TKA (M-TKA). Measurement of pre- and post-operative TS, using the posterior tibial cortex, on profile knee X-rays. 3° TS applied arbitrarily for both groups. ROM was measured pre-operatively and at three, six and 12 months post-operatively. Patient satisfaction assessed via Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS).

RESULTS: 266 patients were included in the study. The M-TKA (110) had a post-operative TS of 3.11° (± 2.12°). 81.21% were within 2° of the target and 92.87% within 3°. The RA-TKA (82) had a post-operative TS of -0.11° ± (1.93°). 36.83% were within 2° of the target and 56.63% within 3°. RA-TKA had a KOOS of 64.43 ± 12.87 and OKS of 33.05 ± 6.01. M-TKA had a KOOS of 64.18 ± 13.11 and OKS of 32.31 ± 5.97. Maximum flexion at 12 months was 118.74° ± 8.19° for M-TKA and 121.88° ± 7.43° for RA-TKA (p = 0.002).

CONCLUSION: The application of TS using ROSA® was less precise than the conventional method in achieving post-operative TS values as measured on X-rays. However, there were no clinical differences in ROM or PROMS.

PMID:40095071 | DOI:10.1007/s00264-025-06472-w

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06494-4. Online ahead of print.

ABSTRACT

BACKGROUND: understanding the concept of multiple compression neuropathy syndrome has recently evolved, leading to better clinical assessment and evaluation. However, decompression of the involved nerves might require multiple incisions. Concomitant compression neuropathy, such as Lacertus Syndrome (LS) and cubital tunnel syndrome, is not uncommon. The traditional approach for releasing both nerves encompasses two separate surgical incisions. Minimazing surgical incisions is essential for postoperative scar management and nerve gliding. In this paper we describe a single surgical incision for releasing both compressions.

SURGICAL TECHNIQUE: To release the Lacertus Fibrosis using the classical surgical incision for cubital tunnel syndrome, an incision is made between the medial epicondyle and olecranon. After reaching the brachial fascia, the skin and subcutaneous tissue are raised as a one flap off the fascia. The lacertus fibrosis, identified as a thick rectangular or trapezoid stracture attached to the brachial fascia, is then incised to expose the median nerve beneath it.

CONCLUSION: As we advance towards the concept of multiple compression neuropathy, it is crucial to minimize surgical incisions to reduce pain, wound breakdown, scar formation, traction neuropathy, neuroma formation, and unsatisfactory aesthetic outcomes.

PMID:40095070 | DOI:10.1007/s00264-025-06494-4

Injury. 2025 Feb 28;56(4):112218. doi: 10.1016/j.injury.2025.112218. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to identify the optimal position for the femoral neck system (FNS) device when fixing Pauwels III #NOF, by analyzing the mechanical stability and stress distribution of FNS at different screw placement positions for the fixation of Pauwels III femoral neck fractures.

METHODS: We employed finite element analysis to create a 3D model of a Pauwels type III femoral neck fracture. Six models were designed, each with varied FNS screw placement positions. Axial stresses of 600 N, 1200 N, and 1800 N were applied to simulate physiological loads during different activities: standing on two legs, standing on one leg, and walking. The mechanical properties of these screw placements were assessed by comparing stress distribution, displacement, and fracture stability across models under varying load conditions.

RESULTS: Model 1, with the power rod aligned along the femoral neck axis, showed the best stability, with 42.40 % lower maximum VMS and 18.49 % less femoral displacement, compared to the worst model. Displacement of the internal fixation and fracture surface decreased by 21.72 % and 19.16 %, respectively. It also had superior results for internal fixation VMS and fracture surface compressive stress. Model 2, with the head screw centered axially, demonstrated good stability but had higher stress concentrations under 1800 N load. The displacement of the fracture surface and femur in model 2 increased by 18.37 % and 17.26 %, respectively, compared to model 1. Models 5 and 6, with the FNS nail near the lateral femoral cortex, showed significant stress concentrations, with compressive and shear forces rising by about 33 %. Model 5's maximum VMS increased by 46.68 %, and model 6's maximum compressive stress of the fracture surface increased by 46.37 %, compared to model 1. Models 3 and 4, with the power rod shifted up or down, displayed moderate stability, reducing displacement in some tests.

CONCLUSION: This finite element analysis highlights that centring the FNS power rod along the femoral neck axis significantly enhances fracture stability and minimises postoperative displacement. Conversely, poor screw placement may result in mechanical stress concentration, raising the risk of nonunion or malunion. Clinicians should prioritise screw placements with more excellent mechanical stability to optimise treatment outcomes.

PMID:40088553 | DOI:10.1016/j.injury.2025.112218

Injury. 2025 Mar 7;56(4):112258. doi: 10.1016/j.injury.2025.112258. Online ahead of print.

ABSTRACT

BACKGROUND: Recovery from a traumatic injury is a complex process that precipitates difficulties and isolation for survivors. Peers can provide valuable psychosocial support rooted in lived experience. The savings associated with peer support largely outweigh the costs. Despite this, research has yet to explore the ideal components of a cross-continuum peer support program or the factors that might impact its delivery.

OBJECTIVES: Understand the barriers/facilitators to integrating peer support across the continuum of care; and (2) Identify recommendations for the design and delivery of a cross-continuum peer support program.

METHODS: Qualitative descriptive approach. Interviews were conducted with trauma survivors (n = 16), caregivers (n = 4), and healthcare providers (HCPs) (n = 16). We employed an inductive thematic analysis to identify barriers and facilitators. We also conducted a deductive analysis using a framework for peer support interventions in physical medicine and rehabilitation to identify what should be included in a cross-continuum peer support program.

RESULTS: Barriers and facilitators included: (1) individual-level issues, (2) the physical and social environment, (3) clinical practice considerations, (4) finance and resourcing, and (5) organization/system issues. Peer support programming should be introduced early in recovery and continue into community living. Peer support programming should be offered flexibly (virtually or in-person) and provide: (1) education, (2) empowerment; and (3) social support. Participants agreed that a person with lived experience should be trained and centrally involved.

CONCLUSIONS: When designing peer support programming, we must consider who would benefit from support, what support should consist of, and ideal timing and mode of support delivery.

PMID:40088552 | DOI:10.1016/j.injury.2025.112258

Injury. 2025 Mar 8;56(4):112259. doi: 10.1016/j.injury.2025.112259. Online ahead of print.

ABSTRACT

BACKGROUND: Traumatic injuries significantly impact individuals' physical and mental health and are a leading cause of disability worldwide. Trauma recovery is complex and entails patients interacting with multiple places of care before returning to the community. Despite trauma recovery being optimized when patients' psychosocial needs are addressed early on and throughout recovery, care remains overwhelmingly focused on physical and functional improvement. Peer support is a cost-effective way of providing emotionally and experientially-driven psychosocial support that complements usual patient care. Thus, we aimed to explore the experiences of trauma survivors, family caregivers, and healthcare providers (HCPs) with engaging in and facilitating peer support and to identify their priorities for a future peer support program.

METHODS: Qualitative descriptive approach. Trauma survivors, caregivers and HCPs were recruited from three major trauma centres in Ontario. We conducted one-one-one interviews with participants which were recorded and transcribed. Data was thematically analyzed by multiple analysts to reduce bias and enhance data reliability.

RESULTS: We interviewed n=16 trauma survivors, n=4 caregivers, and n=16 HCPs. We identified four themes: (1) "It's a major change": Navigating life after injury is challenging and characterized by uncertainty; "I just needed somebody just to talk to:" Peer support helps trauma survivors feel like they're not alone; (3) "You can learn off each other": Peer support is multi-faceted and facilitates recovery in ways that other supports cannot; and (4) "If other people say negative things…that makes things worse": Tensions exist between the benefits of peer support and the risk of unintended negative consequences. Overall, to meet trauma survivors' socialization needs and enhance the efficacy of interventions, it is recommended that peer support to be offered via a range of modalities.

CONCLUSIONS: Our study demonstrates that peer support is valued across stakeholders and has the potential to positively impact the psychosocial health of trauma survivors throughout recovery. Future development of a cross-continuum peer support program will consider how to connect peers early on after injury and sustain these relationships into community recovery.

PMID:40088551 | DOI:10.1016/j.injury.2025.112259