Injury. 2025 Aug 15;56(10):112684. doi: 10.1016/j.injury.2025.112684. Online ahead of print.

ABSTRACT

BACKGROUND: Humeral shaft fractures are common in young adults following high-energy trauma. While open fractures often result in infections, infections in closed fractures are rare, making such cases particularly challenging to manage when they occur.

CASE PRESENTATION: We report a unique case of a 25-year-old pregnant female who sustained a closed humeral shaft fracture after a high-energy injury. Although there was no initial open wound, a purulent infection was discovered at the fracture site during surgery a few days after the injury. Cultures identified Haemophilus influenzae as the causative organism. This report details the management of the fracture and associated infection, highlighting the diagnostic challenges and therapeutic steps taken to address this acute osteomyelitis-like infection in a closed fracture.

DISCUSSION: This case represents the first documented instance of an acute Haemophilus influenzae infection in a closed adult humeral fracture, a pathogen traditionally associated with pediatric respiratory infections. Contributing factors may have included the patient's complex medical and social background, including pregnancy, polysubstance abuse, homelessness, and the use of immunomodulatory medications. This case highlights the importance of heightened vigilance, the need for modifications in surgical decision-making, and possibly revised empirical antibiotic protocols in the management of closed fractures in immunocompromised patients.

CONCLUSION: Acute infections in closed humeral fractures, though rare, pose significant diagnostic and therapeutic challenges, particularly in immunocompromised individuals. This case prompts a reconsideration of management strategies in similar contexts, advocating for a broad differential diagnosis and tailored antimicrobial strategies to address atypical pathogens in complex clinical scenarios.

PMID:40848688 | DOI:10.1016/j.injury.2025.112684

Injury. 2025 Aug 10;56(10):112680. doi: 10.1016/j.injury.2025.112680. Online ahead of print.

ABSTRACT

Hip fractures in the older persons are associated with high morbidity and mortality rates, with a growing incidence due to an aging population. Early readmission increases dependence and healthcare costs, and identifying the factors associated with readmission could improve care. This study aims to identify factors associated with 30-day readmission following hip fracture in patients aged 75 and older, as well as to explore the relationship between various clinical variables. A multicentric, retrospective observational study was conducted using data from the National Hip Fracture Registry (NHFR) involving 57,544 patients admitted from January 1, 2017, to December 31, 2022. Patients were excluded if they had died during acute hospitalization or were lost to follow-up. Key demographic, clinical, and surgical variables were collected and analysed. Statistical analyses were performed using RStudio, employing both univariate and multivariate regression models to identify predictors of 30-day readmission. The study revealed a 30-day readmission rate of 5.18 %. Factors significantly protective against readmission included female gender (OR 0.84 p < 0.001), intertrochanteric (OR 0.81 p < 0.008) and subtrochanteric (OR 0.74 p < 0.007) fracture type, neuraxial anaesthesia (OR 0.82 p < 0.015), and increased length of stay (OR 0.98 p < 0.001). Conversely, ASA IV (OR 1.93 p < 0.05), ASA V (OR 5.59 p < 0.05) and discharge to residential care were associated with increased readmission risk. Notably, patients discharged home showed a reduced risk of readmission compared to those transferred to other care facilities such as residential care (OR 1.26 p < 0.001), acute hospitalization (OR 35.46 p < 0.001) and long-term care hospital(OR 2.36 p < 0.001). The readmission rate observed was lower than the reported by comparable registries. Identifying patients at high risk of early readmission following hip fracture is critical for enhancing patient care, and specific variables can serve as effective predictors, enabling targeted interventions to reduce readmission rates.

PMID:40848687 | DOI:10.1016/j.injury.2025.112680

Injury. 2025 Aug 12;56(10):112667. doi: 10.1016/j.injury.2025.112667. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.

METHODS: We performed a single centre retrospective matched cohort study in consecutive Indigenous and non-Indigenous Australian patients who received a CT scan of the pelvis between January and March 2024 at our institution. Patients were excluded if they were under the age of 18 at the time of the scan or had a history of pelvic fractures or fixation. CT scans were assessed for both qualitative and quantitative features of sacral dysmorphism. The primary outcome of interest was the prevalence and severity of sacral dysmorphism in Indigenous and non-Indigenous Australian populations.

RESULTS: 120 patients were included in the study - 60 Indigenous and 60 non-Indigenous Australians. All patients exhibited at least one characteristic of sacral dysmorphism. There was no difference in the prevalence of qualitative sacral dysmorphism between the two groups. Compared to their non-Indigenous counterpart, Indigenous patients demonstrated a lower S1 transsacral corridor coronal diameter (20.50 vs. 21.85 mm, p = 0.005), S1 oblique corridor axial diameter (17.90 vs. 19.60 mm, p = 0.028), S1 pelvic width (144.85 vs. 158.70 mm, p < 0.001), S2 transsacral corridor coronal diameter (13.70 vs. 14.95 mm, p = 0.013), S2 transsacral corridor axial diameter (10.60 vs. 11.55 mm, p = 0.013), and S2 pelvic width (126.60 vs 136.00 mm, p < 0.001). Additionally, in Indigenous patients, S1 and S2 transsacral and oblique S1 iliosacral fixation lengths were shorter. Where an S1 trans-sacral osseous corridor was not present, the S2 corridor was significantly larger in coronal, axial measurements across both groups (p < 0.001).

CONCLUSIONS: Indigenous Australian patients exhibited more severe forms of sacral dysmorphism when compared to their non-Indigenous counterparts. Additionally the overall prevalence of sacral dysmorphism across this Australian population was amongst the highest reported in the literature. This may present significant technical challenges and warrants consideration when performing percutaneous iliosacral screw fixation.

PMID:40848686 | DOI:10.1016/j.injury.2025.112667

Int Orthop. 2025 Aug 23. doi: 10.1007/s00264-025-06621-1. Online ahead of print.

ABSTRACT

This editorial explores the marginalization of women in medieval French surgical practice through a prosopographical analysis of guild records, tax rolls, and legal texts. While women were present in various medical roles-such as barbers and "miresses"-their visibility declined as surgery became a formalized and male-dominated profession. By examining documents like the Livre de la Taille and Livre des Métiers, as well as royal ordinances, the study highlights how linguistic shifts and guild regulations gradually excluded women from professional recognition. The trial of Perette la Pétone in 1410 serves as a case study of this exclusion, marking the transition from informal acceptance to institutional rejection. Although some women maintained workshop privileges, especially as widows, the broader trend reflects a tightening of gender boundaries in the medical field. This study underscores how prosopography can illuminate structural changes in professional identity and reveal the gendered dynamics underlying medieval medical history.

PMID:40847223 | DOI:10.1007/s00264-025-06621-1

Injury. 2025 Aug 7;56(10):112650. doi: 10.1016/j.injury.2025.112650. Online ahead of print.

ABSTRACT

OBJECTIVES: In acknowledgement of the ongoing transition of surgical education from a time-based approach to competency-based curricula, this study aimed to identify key parameters for assessing the performance of surgical trainees in open reduction and internal fixation (ORIF) of a simple ulnar shaft fracture (AO/OTA classification 2U2A3.B).

METHODS: A 4-round Delphi process regarding seven different orthopedic osteosynthesis surgeries was conducted with an international panel of orthopedic surgeons involved in surgical education. This manuscript focuses on compression plating of isolated ulna fractures. Round 1 focused on item generation, round 2 on importance rating, round 3 on defining optimal intervals and borderline error values for a specific fracture model (not reported in this manuscript), and round 4 on assigning weights to each parameter. Data collection was carried out online.

RESULTS: Ninety-eight surgeons agreed to participate in the study. Round 1 generated 30 assessment parameters. In round 2 and 3, these were reduced to 26 parameters. In round 4, parameters received an overall mean weight of 8.27 out of 10 (SD 0.66) with a range of individual parameter mean weights from 6.7 to 9.4. The assessment parameters that achieved the highest weights were anatomical fracture reduction and assessment of forearm range of motion after fixation. In the final list of parameters, five were related to fracture reduction, three to hardware choice, five to plate placement, nine to screw placement, and four to concluding the procedure.

CONCLUSIONS: Utilizing a Delphi process, expert consensus was reached generating a comprehensive list of 26 assessment parameters that can be used to assess surgeon performance in open reduction and internal fixation of an isolated adult ulnar shaft fracture. This will allow educators to provide standardized feedback (formative assessment) to trainees and use a mastery-learning training approach (summative assessment).

PMID:40845526 | DOI:10.1016/j.injury.2025.112650

J Bone Joint Surg Am. 2025 Aug 22. doi: 10.2106/JBJS.24.01236. Online ahead of print.

ABSTRACT

BACKGROUND: Tranexamic acid (TXA) and absorbable hemostat (AH) are widely used to reduce perioperative blood loss in total knee arthroplasty (TKA). However, the efficacy of single-method hemostatic strategies is increasingly insufficient for meeting clinical demands. This study tested the efficacy and safety of TXA combined with AH for perioperative blood management in TKA.

METHODS: Hemostatic efficacy was preliminarily evaluated through in vitro dynamic coagulation assays, lactate dehydrogenase activity measurements, and scanning electron microscopy, as well as in vivo using a rabbit liver bleeding model. The in vivo biocompatibility was also measured. Subsequently, the efficacy and safety of TXA combined with AH were further evaluated in a prospective, blinded study involving 149 individuals who were randomized to receive TXA, AH, or TXA+AH during TKA. The primary outcomes were perioperative blood loss, blood transfusion, hemoglobin and hematocrit levels, maximum hemoglobin change, anemia, and postoperative complications. Secondary outcomes included perioperative inflammation, coagulation function, and knee joint function.

RESULTS: Coagulation assays and the liver hemostasis model demonstrated that TXA combined with AH effectively promoted coagulation, with satisfactory biocompatibility. The clinical results of 114 Han Chinese (East Asian) patients indicated that the combination significantly reduced perioperative blood loss in TKA (564.51 ± 136.26 mL in the TXA+AH group, 879.35 ± 85.62 mL in the TXA group, and 692.70 ± 96.06 mL in the AH group; p < 0.001) without an increase in thromboembolic events or wound-related complications. Additionally, the combination accelerated early postoperative knee function recovery without significantly affecting pain scores or inflammatory markers.

CONCLUSIONS: The combination of TXA and AH effectively reduced perioperative blood loss in TKA, accelerated early patient recovery, and did not increase the rate of complications.

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

PMID:40845176 | DOI:10.2106/JBJS.24.01236

J Bone Joint Surg Am. 2025 Aug 22. doi: 10.2106/JBJS.25.00090. Online ahead of print.

ABSTRACT

BACKGROUND: Glycation stress has been implicated in frozen shoulder, potentially inducing oxidative stress through advanced glycation end products (AGEs) and their receptor (RAGE). As the role of oxidative stress in frozen shoulder remains undetermined, this study examined the expression of related genes: NOX, SOD, and PRDX.

METHODS: Thirty-eight participants 35 to 70 years old (23 men and 15 women; all ethnic Japanese) were included; 16 had frozen shoulder, and 22 had a rotator cuff tear without range-of-motion limitations. Tissue samples were collected from the rotator interval capsule and the middle glenohumeral ligament during surgical procedures. Oxidative stress was evaluated by quantifying dihydroethidium (DHE) fluorescence intensity and protein carbonyl levels. Expression levels of genes associated with oxidative stress (SOD1, SOD2, SOD3, PRDX5, NOX1, NOX4), matrix turnover and remodeling (COL1, COL3, MMP1, MMP3, MMP13), and glycation stress (RAGE, RELA) were measured using real-time polymerase chain reaction. Superoxide dismutase (SOD) activity was also evaluated.

RESULTS: In the frozen shoulder group, oxidative stress was indicated by elevated DHE fluorescence and protein carbonyl levels in tissue samples from both the rotator interval capsule and the middle glenohumeral ligament. NOX4, RELA, and MMP13 were significantly upregulated, while SOD1 was significantly downregulated, in the rotator interval capsule and middle glenohumeral ligament in the frozen shoulder group compared with the rotator cuff tear controls. PRDX5, RAGE, and COL1 were significantly upregulated and SOD2 was significantly downregulated in the rotator interval capsule in the frozen shoulder group. SOD activity was significantly downregulated in the rotator interval capsule and middle glenohumeral ligament in the frozen shoulder group.

CONCLUSIONS: The frozen shoulder group showed increased expression of glycation stress genes and NOX along with decreased SOD expression and activity, indicative of oxidative stress. Oxidative stress, in addition to glycation stress, could be involved in the pathogenesis of frozen shoulder.

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

PMID:40845125 | DOI:10.2106/JBJS.25.00090

Injury. 2025 Aug 8;56(10):112658. doi: 10.1016/j.injury.2025.112658. Online ahead of print.

ABSTRACT

INTRODUCTION: Open pelvic fractures, though rare, are associated with high morbidity and mortality due to severe soft tissue damage, hemorrhage, and associated injuries. This retrospective study aimed to assess injury patterns, management strategies, complications, and outcomes of open pelvic fractures at a Level 1 trauma center MATERIALS AND METHODS: A retrospective analysis of 30 patients with open pelvic fractures treated between 2014 and 2021 was conducted. Data included demographics, injury mechanism, fracture pattern (Jones-Powell classification), soft tissue injury (Faringer classification), hemodynamic status, transfusion requirements, associated injuries, surgical interventions, and functional outcomes (Merle de Au Binge score) RESULTS: The mean age was 35.7 years, with a male predominance (28 males, 2 females). Road traffic accidents were the most common injury mechanism. Most patients (n = 28) sustained multiple injuries. Fracture patterns were: Class 1 (n = 2), Class 2 (n = 7), and Class 3 (n = 21). Faringer classification revealed 22 Zone 1, 4 Zone 2, and 4 Zone 3 injuries. The mean transfusion requirement was 5.63 units within 24 h. Emergency external fixation was performed in 15 patients. Definitive fixation (internal or external) was performed at a mean of 11.27 days post-injury. Complications included urinary incontinence (n = 5), rectal incontinence (n = 2), and infections. The mortality rate was 20 % (n = 6). Functional outcomes showed 3 excellent, 8 good, 8 fair, and 5 poor results CONCLUSION: Open pelvic fractures are complex injuries requiring multidisciplinary management. Early haemorrhage control, aggressive soft tissue management, and appropriate fracture stabilization are crucial for improving outcomes. Delayed internal fixation after thorough debridement and soft tissue healing may reduce infection risk. High transfusion requirements and unstable fractures were associated with increased mortality.

LEVEL OF EVIDENCE: III.

PMID:40840317 | DOI:10.1016/j.injury.2025.112658

Injury. 2025 Aug 6;56(10):112662. doi: 10.1016/j.injury.2025.112662. Online ahead of print.

ABSTRACT

INTRODUCTION: The primary objective was to analyze the trends in hemiarthroplasty (HA) and total hip arthroplasty (THA) for adult patients with fractures (FNFs), with a focus on geriatric population, over the past two decades. The secondary objectives were to compare outcomes between HA and THA and evaluate its association with patient- and surgeon- specific factors.

METHODS AND MATERIALS: Design: Retrospective cohort.

SETTING: Two Level 1 Trauma Centers. Patient Selection Criteria: Adult patients with FNFs between 2001 and 2023.

RESULTS: A total of 3180 cases of FNF treated with arthroplasty were included in the study, comprising 2497 patients who received HA and 683 patients who received THA. There was an overall increase in both THA and HA performed for geriatric FNFs with THA increasing at a faster rate (223 % vs. 172 %, respectively). Patients receiving THA were younger (70.8 vs. 81.4 years, p < 0.001) and more likely to be female (70.9 % vs. 65.1 %, p = 0.006). Patients receiving HA had lower BMI (24.6 vs. 25.4kg/m2, p = 0.002), higher Charlson Comorbidity Index (7.5 vs. 4.6, p < 0.001), and higher rates of dementia (29.9 % vs. 7.8 %, p < 0.001).Factors associated with selection of THA over HA included arthroplasty fellowship training (21.5 % vs. 10.4 %, p < 0.001) and greater surgical experience, as measured by years in practice (15.1 vs. 12.5 years, p < 0.001).. Patients receiving THA had shorter hospitalizations (6.3 vs. 7.9 days, p < 0.001) and were more likely to be discharged home (24.3 % vs. 5.5 %, p < 0.001). Despite similar reoperation rates (4.5 % vs. 5.1 %, p = 0.58), THA resulted in a higher complication rate (9.2 % vs. 6.1 %, p = 0.006). HA had higher 90-day (11.1 % vs. 1.6 %, p < 0.001) and 1 year (21.1 % vs. 3.8 %, p < 0.001) mortality rates.

CONCLUSIONS: There has been a rising trend in THA for the treatment of FNFs over the past two decades, and factors affecting treatment decision are both patient and surgeon driven.

PMID:40840316 | DOI:10.1016/j.injury.2025.112662

Injury. 2025 Aug 13;56(10):112681. doi: 10.1016/j.injury.2025.112681. Online ahead of print.

NO ABSTRACT

PMID:40840315 | DOI:10.1016/j.injury.2025.112681

J Bone Joint Surg Am. 2025 Aug 21. doi: 10.2106/JBJS.24.00821. Online ahead of print.

ABSTRACT

BACKGROUND: Predicting anterior cruciate ligament reconstruction (ACLR) revision risk using machine learning (ML) regression analyses of large-scale registry data offers an evidence-based approach for clinical decision-making and management at a patient-specific level. We examined the performance of an enhanced ML-Cox regression analysis of the Danish Knee Ligament Reconstruction Registry (DKRR) for predicting ACLR revision risk.

METHODS: We analyzed surgical and patient-reported outcome measure data from 18,753 patients in the DKRR who underwent primary ACLR between 2005 and 2023. Enhanced ML-Cox regression analyses, using the least absolute shrinkage and selection operator (LASSO) and stable iterative variable selection (SIVS) approaches, were applied to predict the risk of ACLR revision (i.e., the risk of repeat surgery to reconstruct the ACL). The SIVS procedure identified key variables, including age at the time of primary ACLR and several Knee injury and Osteoarthritis Outcome Score (KOOS) items from 12-month follow-up surveys, as inputs for the best-performing regression models for predicting ACLR revision risk. The resultant Cox regression models for the prediction of ACLR revision risk, therefore, did not involve an analysis of patients with incomplete 12-month follow-up survey data, including patients with graft ruptures within 12 months after the primary surgery.

RESULTS: The best-performing Cox regression model for predicting ACLR revision risk incorporated age at the time of primary ACLR and 3 KOOS items (Pain P1 and Quality of Life Q2 and Q3) from the 12-month postoperative follow-up assessment. This model demonstrated good prediction accuracy 1, 2, and 5 years after the 12-month follow-up assessment (C-index [and standard error], 0.73 [0.03], 0.73 [0.02], and 0.74 [0.02], respectively). This 4-variable Cox regression model was well-calibrated across these time points. An online clinical point-of-care tool, the Danish KOOS3 Risk Monitoring Tool (DK3), was developed for predicting ACLR revision risk.

CONCLUSIONS: Enhanced ML-Cox regression, incorporating patient age and 3 KOOS items obtained 12 months postoperatively, provided good prediction accuracy for ACLR revision risk from 1 to 5 years after the 12-month follow-up assessment, a period that has been associated with the vast majority of ACLR revisions. The newly developed DK3 point-of-care tool offers a direct-input method to predict and monitor the risk of ACLR revision.

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

PMID:40839712 | DOI:10.2106/JBJS.24.00821

Injury. 2025 Aug 7;56(10):112654. doi: 10.1016/j.injury.2025.112654. Online ahead of print.

ABSTRACT

BACKGROUND: Determine whether native acetabular anteversion angle increased the risk of ipsilateral limb injuries in patients with traumatic hip dislocations.

METHODS: Retrospective clinical series completed at a large, tertiary health care system between February 2016-November 2021. Patients with a native traumatic hip dislocation requiring a closed reduction in the operating room or open reduction internal fixation (ORIF) of an associated fracture were included, identified using current provider terminology (CPT) codes 27,250 and 27,252. Standard acetabular version angles were measured on CT images.

RESULTS: 121 cases were included in the analysis. The average age of our population was 37.5 years and 72 % were male. The median acetabular version was 14.7° (2-27°). Of the 121 cases of dislocations, 28 experienced a knee injury (23 %, p = 0.89) and 40 had a femoral head injury (33 %, p = 0.88). The most common knee injuries were patellar fractures (29 %, n = 8), tibial plateau fractures (29 %, n = 8), meniscal injuries (25 %, n = 7) and ligamentous knee injuries 21 %, n = 6). Median version angle was not associated with an increase in predisposition to femoral head injury or knee injury for patients with a native hip dislocation (p = 0.13).

CONCLUSION: These findings demonstrate that native acetabular anteversion does not predispose, nor protect, patients from experiencing an ipsilateral limb injury in the setting of a traumatic hip dislocation. Future studies should investigate other factors that may influence the occurrence of ipsilateral limb injuries in these settings.

LEVEL OF EVIDENCE: Level IV - Therapeutic (Retrospective Clinical Series).

PMID:40834614 | DOI:10.1016/j.injury.2025.112654

J Bone Joint Surg Am. 2025 Jun 19;107(16):1818-1824. doi: 10.2106/JBJS.24.01225.

ABSTRACT

BACKGROUND: Implant-associated infections (IAIs) require aggressive debridement to eliminate microbial bioburden. The use of irrigants may improve microbial killing during debridement. This study compared the efficacy of surgical irrigants in vitro against Staphylococcus aureus alone and in combination with Candida albicans, in both planktonic and biofilm states.

METHODS: Full-strength Dakin's solution, 0.35% povidone-iodine (PI), 10% PI, 3% hydrogen peroxide (HP), a 1:1 combination of 10% PI and 3% HP (PI + HP), Irrisept, XPERIENCE, Bactisure, and normal saline solution were tested. For planktonic testing, 1 × 106 colony-forming units (CFUs) of S. aureus and C. albicans were utilized, and biofilms were grown in these conditions on 0.8 × 10-mm titanium alloy Kirschner wires for 48 hours. Killing assays were performed using 5-minute dwell times. Success was defined by complete eradication of planktonic or biofilm CFUs.

RESULTS: PI + HP and Bactisure were the only irrigants to eradicate S. aureus in both planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states.

CONCLUSIONS: PI + HP and Bactisure were superior irrigants against S. aureus, eliminating it in planktonic and biofilm states. PI + HP was the only irrigant to eradicate polymicrobial S. aureus + C. albicans bioburden in both states. In vivo studies are needed to evaluate the clinical effectiveness.

CLINICAL RELEVANCE: Surgical irrigants have variable efficacy in eradicating microbes depending on their state of existence (planktonic versus biofilm). In this study, the most effective eradication of polymicrobial S. aureus + C. albicans bioburden was a 1:1 combination of 10% PI and 3% HP, which is of nominal cost.

PMID:40833422 | PMC:PMC12356552 | DOI:10.2106/JBJS.24.01225

J Bone Joint Surg Am. 2025 Jul 10;107(16):1879-1886. doi: 10.2106/JBJS.24.01287.

ABSTRACT

➢ Glucagon-like peptide-1 (GLP-1) receptor agonists are a promising tool for preoperative weight loss in the patient who is undergoing orthopaedic surgery and has concomitant obesity and type-2 diabetes mellitus.➢ With regard to the perioperative management of GLP-1 receptor agonists for the orthopaedic surgeon, the American Society of Anesthesiologists (ASA) recommends withholding daily-dose GLP-1 therapy on the day of the elective surgical procedure and withholding weekly-dose therapy for the week prior to the procedure.➢ The ASA recommends postponing surgery or proceeding with "full stomach precautions" if the patient undergoing an orthopaedic procedure and taking GLP-1 therapy exhibits gastrointestinal symptoms on the day of the elective procedure.➢ In the trauma setting, patients taking GLP-1 therapy should proceed with the surgical procedure at the discretion of the surgeon with full stomach precautions or a preoperative point-of-care gastric ultrasound.➢ GLP-1 receptor agonists show the potential for disease modification in osteoarthritis and osteoporosis.

PMID:40833394 | PMC:PMC12356572 | DOI:10.2106/JBJS.24.01287

J Bone Joint Surg Am. 2025 Aug 20. doi: 10.2106/JBJS.24.01411. Online ahead of print.

ABSTRACT

BACKGROUND: The effect of home call on the sleep of orthopaedic residents and attending surgeons remains unquantified, despite known negative impacts of poor sleep on cognition, fine motor skills, and decision-making. We prospectively measured the impact of home call on orthopaedic surgery residents' and attending surgeons' sleep patterns (total sleep, slow-wave sleep [SWS], and rapid eye movement [REM] sleep), as well as on heart rate variability (HRV). We hypothesized that orthopaedic home call would negatively impact all phases of sleep and suppress post-call HRV.

METHODS: Sixteen orthopaedic attending surgeons and 14 orthopaedic surgery residents taking home call at multiple Level-I trauma centers in a single program wore WHOOP 3.0 Straps. The WHOOP Strap objectively measures and quantifies total sleep, SWS, and REM sleep. Over a 13-month period, home call nights were prospectively recorded and matched with physiological data to compare on-call, post-call night 1 (PCN 1), and PCN 2 metrics. Fixed-effects regression models were used for statistical analysis.

RESULTS: Over 13 months, we observed 4,574 recorded nights of residents' sleep and 3,573 recorded nights of attending surgeons' sleep. The mean baseline (non-call night) sleep parameters were highly varied among individuals. Overall, the mean sleep time was significantly shorter (p < 0.001) for attending surgeons (6.0 hours) than for residents (6.7 hours). When on home call, residents' total sleep decreased by 20% from baseline (p < 0.001), REM sleep decreased by 12% (p < 0.001), and SWS decreased by 12% (p < 0.001). For attending surgeons, total sleep on call decreased by 10% from baseline (p < 0.001), REM sleep decreased by 7% (p < 0.001), and SWS decreased by 4% (p < 0.01).

CONCLUSIONS: Orthopaedic surgery residents and attending surgeons exhibited low baseline sleep, and taking home call reduced this further. This suggests that there is a previously unmeasured toll of home call on orthopaedic surgeons, upon which further research is required to ensure excellent patient care, maximize educational environments, and develop strategies for resilience.

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

PMID:40834105 | DOI:10.2106/JBJS.24.01411

J Bone Joint Surg Am. 2025 Aug 20;107(16):e81. doi: 10.2106/JBJS.24.01633.

NO ABSTRACT

PMID:40833424 | DOI:10.2106/JBJS.24.01633

J Bone Joint Surg Am. 2025 Aug 20;107(16):e80. doi: 10.2106/JBJS.25.00526.

NO ABSTRACT

PMID:40833398 | DOI:10.2106/JBJS.25.00526

J Bone Joint Surg Am. 2025 Aug 20;107(16):e79. doi: 10.2106/JBJS.25.00583.

NO ABSTRACT

PMID:40833396 | DOI:10.2106/JBJS.25.00583

J Bone Joint Surg Am. 2025 Jul 10;107(16):1841-1847. doi: 10.2106/JBJS.24.01304.

ABSTRACT

BACKGROUND: Researchers employ murine fracture models to study bone healing, but the temporal relationship between mouse and human fracture healing is poorly understood. The hypothesis of this study was that it was possible to quantify specific post-fracture time frames corresponding to the stages of endochondral ossification in both mice and humans.

METHODS: Radiographs of mice and human femoral fractures treated with intramedullary stabilization were reviewed. The study included 330 human femoral fractures (OTA/AO 32A, B, or C injuries) that ultimately healed without complications in patients aged 18 to 55 years and 309 surgically created midshaft femoral fractures in 3-month-old C57BL6/J mice. Multiple orthopaedic surgeons assessed the radiographs using the Modified Radiographic Union Score for Tibia (mRUST). A 4-parameter log-logistic curve was fit to describe fracture healing over time, with 3 parameters allowed to vary: Y∞ (mRUST score at time = ∞), k (healing rate in [1/log(time)]), and X0.5 (time to half-healing).

RESULTS: The values (and 95% confidence interval) for the mice were Y∞ = 14.70 (14.54 to 14.87), k = 4.54/log(days) (4.30 to 4.77), and X0.5 = 11.77 days (11.56 to 11.98). For the humans, the values were Y∞ = 16.78 (16.21 to 17.36), k = 1.37/log(days) (1.28 to 1.45), and X0.5 = 91 days (83 to 99). All parameters differed significantly between the mice and humans (p < 0.05).

CONCLUSIONS: Using mRUST scoring and mathematical modeling, we were able to quantify and compare the temporal progression of fracture healing in mice and humans.

CLINICAL RELEVANCE: These data are relevant for designing and/or interpreting fracture healing studies of mice and humans to promote rational translation of fracture research between species.

PMID:40833385 | PMC:PMC12344732 | DOI:10.2106/JBJS.24.01304

J Bone Joint Surg Am. 2025 Aug 20;107(16):e82. doi: 10.2106/JBJS.ER.23.01346.

NO ABSTRACT

PMID:40833379 | DOI:10.2106/JBJS.ER.23.01346