Injury. 2025 Apr 18;56(6):112352. doi: 10.1016/j.injury.2025.112352. Online ahead of print.

ABSTRACT

INTRODUCTION: Quantification of bone healing can be of interest for both clinical and research purposes. However, radiographic assessment of bone healing is challenging, especially in postoperative bone defects and non-union. Scores, such as the (modified) Radiographic Union Score for Tibial fractures ((m)RUST) are widely known. The Lane-Sandhu score, a lesser-known score for bone defects, may have benefits over the mRUST score. The aim of this study is to compare the inter- and intraobserver reliability of the Lane-Sandhu score with the mRUST in human non-unions.

METHODS: First, five postoperative radiographs were scored by five observers using both scores. Pitfalls of the scores were thereafter analyzed in a training session. Then, each observer scored ten new radiographs. The intraclass correlation coefficient was calculated to determine the intra- and interobserver reliability of the scores for each session.

RESULTS: The pilot session resulted in an interobserver reliability of 0.48 for the mRUST and -0.049 for the Lane-Sandhu score. During the training session, the interobserver reliability scores were 0.50 and 0.14 respectively. The final session resulted in a reliability score of 0.79 (95 % CI 0.60-0.91) for the mRUST and 0.76 (0.59-0.88) for the Lane-Sandhu.

CONCLUSION: Both scores are reliable scoring systems for the interpretation of postoperative bone defects and non-union. There is a slight preference for the mRUST because the reliability was less dependent on the training session. For future research, the interpretation of postoperative radiographs should be well described and a training session is recommended.

PMID:40339355 | DOI:10.1016/j.injury.2025.112352

J Bone Joint Surg Am. 2025 May 8. doi: 10.2106/JBJS.24.01090. Online ahead of print.

ABSTRACT

➢ An at-risk lunate (due to anatomic factors) subjected to a trigger event (axial load, embolism, hypercoagulability) leads to the development of lunate osteonecrosis.➢ Children, adolescents, and elderly patients with Kienböck disease respond well to nonoperative treatments, and this should be considered before any surgical intervention.➢ For disease limited to the lunate, treatment decisions should be driven by the condition of the cartilage; intact lunate cartilage can be treated with joint leveling or core decompression, whereas disrupted cartilage surfaces should be bypassed with scaphocapitate or scaphotrapeziotrapezoid arthrodesis. Newer surgical procedures such as wrist arthroscopy and the introduction of contrast-enhanced magnetic resonance imaging have expanded the treatment options for these patients.➢ Once disease extends outside of the lunate, reconstruction with proximal row carpectomy or partial or total wrist arthrodesis should be considered on the basis of which articular surfaces are affected.➢ The new unified classification system and treatment are applicable to almost all patients with Kienböck disease.

PMID:40338997 | DOI:10.2106/JBJS.24.01090

Int Orthop. 2025 May 8. doi: 10.1007/s00264-025-06554-9. Online ahead of print.

NO ABSTRACT

PMID:40338292 | DOI:10.1007/s00264-025-06554-9

Injury. 2025 May 7:112358. doi: 10.1016/j.injury.2025.112358. Online ahead of print.

NO ABSTRACT

PMID:40335386 | DOI:10.1016/j.injury.2025.112358

Injury. 2025 Apr 29;56(7):112368. doi: 10.1016/j.injury.2025.112368. Online ahead of print.

ABSTRACT

BACKGROUND: Sports-related injuries (SRIs) are a significant cause of public health concern. This study aimed to identify risk factors for spine fracture injuries in sports, focusing on sport type, injury location, and demographic patterns.

METHODS: A retrospective analysis of prospectively collected registry data from the "National Electronic Injury Surveillance System (NEISS)" database was performed for spine injuries. A total of 138,268,340 hospital emergency department records between 1/2/2011 and 12/29/2020 resulted in a weighted national estimate of 29,148 spine fracture injuries (19,791 males and 9357 females) associated with sports.

RESULTS: There were 10,530 (36 %) injuries at sports venues and 5755 (20 %) on the streets. The most prevalent sports activities leading to spine fractures were motorsports/cycling in males (60.4 %) and horseback riding in females (31.2 %). Fractures at the lumbar (40.6 %) and cervical (33.9 %) spine were the most common diagnoses. Males were more likely to have cervical fractures (40.5 % vs. 19.9 %), while females more frequently had lumbosacral injuries (66.4 % vs. 40.8 %) (all p < 0.001). Multivariate regression analysis revealed that ball sports (OR=4.2), water sports (OR=3.89), and trampoline (OR=1.88) significantly increased the risk for cervical fracture. Adults (OR=2.69), males (OR=2.31), and Asians (OR=3.66) were at higher risk for cervical spine fractures. African Americans had a greater risk of spinal cord injuries, particularly among adolescents.

CONCLUSIONS: Specific sports activities and injury locations were identified as primary risk factors for different types of spine fractures. Demographic patterns provide context for targeted prevention strategies. These findings can inform the development of sport-specific safety measures and injury prevention programs across diverse populations.

PMID:40334430 | DOI:10.1016/j.injury.2025.112368

J Bone Joint Surg Am. 2025 May 7. doi: 10.2106/JBJS.24.01234. Online ahead of print.

ABSTRACT

BACKGROUND: Orthopaedic studies frequently include subjects with bilateral conditions. Failure to account for bilateral conditions can lead to spurious associations. The performance of different methods for addressing this issue, especially in populations that include subjects with unilateral and bilateral conditions, has not been rigorously evaluated. The purpose of the present study was to test 3 different methods for analyzing bilateral data: (1) analyzing all limbs as independent subjects (naïve), (2) randomly selecting 1 limb per subject (random), and (3) accounting for correlation between limbs with use of a linear mixed model (LMM).

METHODS: We simulated a hypothetical randomized controlled trial in which Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected at a baseline and a 2-year visit. We simulated 2 scenarios: Scenario 1 (in which there was truly no difference between groups [mean difference = 0]) and Scenario 2 (in which there was truly a difference between groups [mean difference = 10]). We varied the prevalence of bilateral involvement from 10% to 100% within each scenario. We evaluated method performance on the basis of bias (difference from the simulated true effect), power (1 - type-II error), type-1 error rate, and 95% confidence interval (CI) coverage.

RESULTS: Bias (difference from simulated true effect) was similar across all methods. In Scenario 2 (true difference between groups), CI coverage was lowest with use of the naïve method (median, 87.8%; range, 85.3% to 93.5%) relative to the random method (median, 95.1%; range, 94.5% to 95.6%) and the LMM method (median, 95.1%; range, 94.5% to 95.5%). In Scenario 1 (no difference between groups), the type-1 error rate was highest for the naïve method (median, 11.3%; range, 6.7% to 14.7%) relative to the LMM method (median, 4.9%; range, 4.5% to 5.3%) and the random method (median, 5.0%; range, 4.5% to 5.2%).

CONCLUSIONS: Failure to account for bilateral conditions led to biased CIs and an increased type-1 error rate. Due to the fact that bias was similar across the methods, decreased model performance using the naïve method was likely attributable to underestimation of the standard error. Orthopaedic studies involving subjects with bilateral conditions warrant special considerations that can be addressed using simple (random) or more complex (LMM) methods.

CLINICAL RELEVANCE: Adherence to robust methodological practices is an essential but underappreciated component of the translation of evidence into clinical practice. Our work is meant to be educational, providing clinical researchers with the knowledge and skills to address a common challenge within the field.

PMID:40333952 | DOI:10.2106/JBJS.24.01234

J Bone Joint Surg Am. 2025 May 7;107(9):e47. doi: 10.2106/JBJS.24.01613. Epub 2025 Apr 30.

NO ABSTRACT

PMID:40332235 | DOI:10.2106/JBJS.24.01613

J Bone Joint Surg Am. 2025 May 7;107(9):e46. doi: 10.2106/JBJS.24.01482. Epub 2025 Apr 30.

NO ABSTRACT

PMID:40332234 | DOI:10.2106/JBJS.24.01482

J Bone Joint Surg Am. 2025 May 7;107(9):e45. doi: 10.2106/JBJS.24.01528. Epub 2025 Apr 30.

NO ABSTRACT

PMID:40332233 | DOI:10.2106/JBJS.24.01528

J Bone Joint Surg Am. 2025 May 7;107(9):e44. doi: 10.2106/JBJS.24.01576. Epub 2025 May 7.

NO ABSTRACT

PMID:40332232 | DOI:10.2106/JBJS.24.01576

J Bone Joint Surg Am. 2025 May 7;107(9):909. doi: 10.2106/JBJS.25.00306. Epub 2025 Apr 30.

NO ABSTRACT

PMID:40332231 | DOI:10.2106/JBJS.25.00306

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06550-z. Online ahead of print.

ABSTRACT

PURPOSE: To identify evidence of surgical practice in Armorica during the Roman period.

METHODS: Various sources were examined to search for potential traces of surgical activity during the Roman era. The objective was to identify archaeological artifacts that could be associated with ancient surgical instruments. Once identified, the objects of interest were examined in different archaeological repositories in Brittany by an independent observer.

RESULTS: Between March 2021 and December 2022, 995 excavation reports were analyzed. Twenty-one documents mentioned a potentially surgical object. One of the analyzed artifacts was referenced in an excavation report containing the keyword "scalpel," originating from the site of Ploufragan (22240, Côtes d'Armor, Brittany, France). Following an in-depth investigation, the artifact was successfully retrieved. The object, measuring 14 cm in length, was made of oxidized bronze. Its tapered handle had an octagonal cross-section. At one end, the handle broadened and flattened into a pointed spatula. The opposite end featured a slit containing an iron component, which was heavily corroded. According to Ralph Jackson, former curator of the British Museum and a specialist in Roman medical instrumentation, this scalpel handle is most likely from the Roman period, dating back to the first to third century CE. The presence of this scalpel suggests that relatively advanced surgical practices were performed by Armorican practitioners in Antiquity. This study provides evidence that operative medicine, as conceptualized in the Greco-Roman tradition, extended to Armorica during Antiquity.

CONCLUSION: While the study of "beautiful objects" and monumental remains gives a biased image of a given society, the analysis of everyday artifacts can yield significant insights into the habits and routines of a population. This principle also applies to the study of surgical practice in Antiquity. The examination of small objects provides crucial information on the dissemination of medical and surgical knowledge during this period. This work shows the extent to which the history of surgery cannot be conceived without interdisciplinarity.

PMID:40332583 | DOI:10.1007/s00264-025-06550-z

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06545-w. Online ahead of print.

ABSTRACT

PURPOSE: This study explores how age affects the location, extent, and progression of rotator cuff (RC) lesions in shoulder arthroscopy patients, aiming to identify age-related patterns of injury from localized damage in younger patients to more extensive degeneration in older ones, guiding age-specific diagnostic and treatment strategies.

METHODS: A prospective study of 487 shoulder arthroscopy patients (October 2019-September 2023) categorized cases into < 55 and ≥ 55 years. SLAP lesions, pulley injuries, RC tears (Lafosse and Bateman), and rotator cable damage were systematically documented. All surgeries followed standardized protocols by a single surgeon. Statistical analyses (Pearson correlation, Chi-squared tests) assessed age-related RC pathology associations, with significance set at α = 0.05.

RESULTS: Among 487 shoulder arthroscopies (mean age: 57.38 years), younger patients (< 55 years) had higher rates of medial (95.2%) and lateral (95.9%) pulley lesions, while older patients (≥ 55 years) exhibited significantly more advanced pathology, including lateral pulley lesions (100%), high-grade subscapularis tears (p < 0.0001), Bateman III-IV cuff tears (p < 0.0001), and combined cable tears (p < 0.0001). Medial pulley lesions correlated strongly with SLAP tears (r = 0.609), and age was positively associated with advanced injuries (r = 0.509) and negatively with partial subscapularis tears (r = - 0.143), indicating an age-related progression in rotator cuff degeneration.

CONCLUSION: The study suggests that lesions of the shoulder possibly arise from the biceps pulleys and extend more posteriorly. Distinct age-based patterns of RC pathology highlight the progression from localized injuries in younger patients to extensive degenerative damage in older individuals. These findings underscore the need for age-specific diagnostic and treatment strategies.

PMID:40332582 | DOI:10.1007/s00264-025-06545-w

Int Orthop. 2025 May 7. doi: 10.1007/s00264-025-06555-8. Online ahead of print.

ABSTRACT

PURPOSE: One ongoing debate in orthopaedic surgery concerns using tourniquets in sickle cell trait (SCT) patients. SCT, a heterozygous carrier state of sickle cell disease (SCD), affects an estimated 300 million individuals globally with various genetic ancestries.

METHODS: A retrospective cohort study was conducted on 940 SCT patients and 1263 matched non-SCT controls who underwent limb surgeries using tourniquets between 1978 and 2018. Patient data were gathered from hospital records, blood bank information, and postoperative haemoglobin electrophoresis. Outcomes assessed included the incidence of venous thromboembolism (VTE), pulmonary embolism (PE), phlebitis, peripheral nerve impairment, and superficial infection. Covariates included age, sex, ethnicity, and diabetes status.

RESULTS: Among SCT patients, 75% were unaware of their carrier status at surgery. VTE incidence was significantly higher in SCT patients (10%) than non-SCT controls (2%), especially after prolonged tourniquet use and in upper limb procedures without anticoagulation. PE occurred in 3% of SCT patients, versus 1% in controls. Diabetes, more prevalent in SCT individuals (9% vs. 6%), further increased the complication risk. Tourniquet inflation time did not differ significantly between groups; however, neurologic complications and phlebitis were more common in SCT patients, particularly those with Mediterranean ancestry. Notably, SCT carriers of African and Mediterranean descent experienced higher complication rates than non-carriers, though complications were not confined to any single ancestry.

CONCLUSION: SCT is associated with an increased risk of thrombotic and neurologic complications during tourniquet, particularly in patients with undiagnosed SCT or diabetes and in procedures with extended ischaemia time. These results confirm the perception of SCT as a benign condition, but call for further clinical guidelines regarding tourniquet use in SCT carriers.

PMID:40332581 | DOI:10.1007/s00264-025-06555-8

SICOT J. 2025;11:27. doi: 10.1051/sicotj/2025015. Epub 2025 May 4.

ABSTRACT

BACKGROUND: Pedicle screw fixation in the thoracolumbar spine has become more widely accepted with advancements in instrumentation and clinical efficacy have been made. The optimal way to interpret pedicle screw cortical breaches had the subject of a great deal of research. None of the previous classifications and grading systems include full neurological deficits that may result from screw misplacement and do not provide clear guidance for the management of screw violations, which is crucially needed in the literature.

OBJECTIVES: Our study aimed to evaluate the reliability and validity of the use of a new scoring system (the Meshtawy Pedicular Screw Malposition - MPSM) for evaluating pedicle screw misplacement by a detailed clinical-radiographic comprehensive scoring system (MPSM) with sharp guidance for treating injurious violations by assessing the correlation between the neurological data of patients and computed tomography (CT) findings.

PATIENTS AND METHODS: This prospective case series included 100 patients (508 pedicular screws) who underwent transpedicular fixation at Orthopedic department Al-Azhar University Hospital, Assiut branch, Egypt 255 (50.2%) screws were inserted on the right side, while 253 (49.8%) were inserted on the left side. Intra-observer reliability was examined by calculating Cronbach's alpha intraclass correlation coefficient, which compares three measurements obtained by each observer at different time points. Inter-observer reliability was also examined by calculating Cronbach's alpha intraclass correlation coefficient and comparing the average measurements obtained by each observer.

RESULTS: The MPSM demonstrated excellent (100%) intra-observer reliability for each observer regarding the violation score and total MPSM score. A strong positive and statistically significant correlation (Pearson test, P < 0.05) was found between severe neurological deficits and a greater degree of screw-pedicle violation.

CONCLUSION: MPSM scoring is a valid and reliable system for evaluating pedicular screw violations and their possible neurological consequences in the thoracic and lumbosacral spine from D7 to S1. Moreover, grades obtained from the MPSM score are helpful for making clear decisions for management.

PMID:40327785 | PMC:PMC12054976 | DOI:10.1051/sicotj/2025015

EFORT Open Rev. 2025 May 5;10(5):316-326. doi: 10.1530/EOR-2024-0184.

ABSTRACT

PURPOSE: We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods.

METHODS: PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded.

RESULTS: Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction.

CONCLUSION: The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.

PMID:40326555 | PMC:PMC12061015 | DOI:10.1530/EOR-2024-0184

EFORT Open Rev. 2025 May 5;10(5):237-249. doi: 10.1530/EOR-2024-0156.

ABSTRACT

This review highlights the role of existing spasticity treatment methods in reducing muscle tone and improving function. The surgical methods today mainly include selective dorsal rhizotomy, selective neurotomy, intrathecal baclofen treatment (ITB), etc. These techniques (except ITB) can lower patients' muscular tone in the long term and improve function to some extent. The young procedures, contralateral C7 nerve transfer and T1 neurotomy, are still under research. ITB and nonsurgical treatment methods, botulinum toxin A (BoNT-A) and extracorporeal shockwave therapy (ESWT), can reduce muscle tone in the short term, but the long-term efficacy is unsatisfactory. In addition, the effects of improving function are relatively controversial. The economic cost of these treatment methods is also heavy for patients. In addition, some studies have reported that some kinds of electrical/magnetic stimulation can improve the patients' function. They can potentially be used as an adjunctive treatment for spasticity. According to current studies and our own experience, surgery methods (except ITB) are still recommended for patients, whose spasticity has a major detrimental influence on their everyday lives, taking into account patient benefits and cost-effectiveness. There are also some problems in the current research on spasticity treatment, such as incomplete guidelines and a relative lack of high-quality studies, which is what the doctors need to strive for. Further exploration is needed to find the treatment methods that can reduce muscle tone while improving patients' function to better benefit patients.

PMID:40326554 | PMC:PMC12061021 | DOI:10.1530/EOR-2024-0156

EFORT Open Rev. 2025 May 5;10(5):258-266. doi: 10.1530/EOR-2024-0133.

ABSTRACT

PURPOSE: Controversy exists on whether a drug holiday is necessary for patients on antiresorptive medication for osteoporosis or bone metastasis and undergoing dental procedures to lower the risk of medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the effects of discontinuing different antiresorptive regimens on MRONJ in these patients.

METHODS: Publications from PubMed, EMBASE, Cochrane Library and EBSCO Open Dissertations were searched from inception to September 2023 following PRISMA guidelines, and the review was registered in PROSPERO. Eligibility criteria included clinical studies on the effects of continued and discontinued antiresorptive medications for osteoporosis or bone metastasis in patients undergoing dental procedures. The involved antiresorptive agents were oral bisphosphonates (BPs), intravenous (IV) BPs and denosumab (Dmab). Relative risk (RR) with 95% confidence interval (CI) was estimated using a random-effects model.

RESULTS: Of the 2,590 records identified, six studies (n = 717) were included. Discontinued use of oral BPs had a lower MRONJ risk than discontinuation of IV BPs (RR = 0.05; 95% CI: 0.00-0.83) and continuation of IV BPs (RR = 0.03; 95% CI: 0.00-0.46). Continuing oral BPs also resulted in a lower MRONJ risk compared to both discontinuation and continuation of IV BPs, with RR = 0.04 (95% CI: 0.00-0.67) and RR = 0.03 (95% CI: 0.00-0.37), respectively. No significant difference was found between continuation and discontinuation of oral BPs, along with other comparisons.

CONCLUSIONS: A drug holiday may not be necessary before dental procedures for oral BPs. Temporary discontinuation of IV BPs or Dmab is also unlikely to reduce MRONJ risk compared to continued medication.

PMID:40326547 | PMC:PMC12061011 | DOI:10.1530/EOR-2024-0133

EFORT Open Rev. 2025 May 5;10(5):297-308. doi: 10.1530/EOR-2024-0122.

ABSTRACT

The long head of the biceps tendon (LHBT) has recently emerged as a therapeutic option for various shoulder pathologies. Synthetic materials and allografts have not shown sufficient resistance or favorable outcomes to restore rotator cuff native tissue properties, leading to consideration of using LHBT as biological augmentation. LHBT mimics adjacent structures, such as the rotator cuff, is easily accessible during surgery, and is a good source of live autologous cells for regenerative augmentation in rotator cuff repair, as a superior capsular reconstruction in irreparable cuff tears, in subscapularis augmentation in shoulder replacement and as a stabilizer in anterior shoulder instability. This narrative review aims to collect, synthesize and critically evaluate the literature on the use of the LHBT and its current applications in the field of shoulder surgery, improving the understanding of the terminology and consolidating the concepts related to the various procedures in shoulder surgery.

PMID:40326542 | PMC:PMC12061019 | DOI:10.1530/EOR-2024-0122

EFORT Open Rev. 2025 May 5;10(5):224-236. doi: 10.1530/EOR-2024-0116.

ABSTRACT

Clinicians, scientists and regulators do not use a common set of definitions and terminology to classify and code periprosthetic tissue reactions to wear debris of arthroplasty implants and a limited granularity is present to allow early identification of associated adverse events. Adverse local tissue reactions (ALTRs) is an umbrella term, which has been used in particular for periprosthetic tissue reactions to metal wear debris. In this review, it has been extended to all implant materials and adverse reaction to metallic debris as a subset of ALTR caused by or associated with metallic particulate debris. The high variability in the terminology of ALTRs used by national arthroplasty registries, various coding systems and clinicians impedes their accurate reporting and interpretation, crucial for evaluating the reasons for implant failure and revision arthroplasty. Histopathological examination of periprosthetic soft tissue and bone uses standardized criteria for the diagnoses of reactions to wear particles, significantly contributing to their understanding and refining their interdisciplinary terminology. This review critically analyzes the current gap in coding ALTRs due to arthroplasty implants' wear in national registries and classification systems of adverse events and the use of key terms. A comprehensive unified lexicon and classification system grounded on evidence-based histopathological analyses is proposed, implementing the following findings. (a) Pseudotumor is a descriptive term for ALTR, which cannot be used for codification. (b) Metallosis is a term lacking quantitative and qualitative determination and thus not a codifiable term for ALTR. (c) Aseptic lymphocyte dominant vasculitis-associated lesion (ALVAL) should not be used due to absence of histological findings diagnostic of vasculitis. (d) Metal delayed hypersensitivity and metal allergy should be codified as separate categories of adverse events. (e) ALTR is to be classified in due consideration of definition of predominant lymphocytic or predominant macrophage infiltrate. (f) Granulomatous reaction should be reserved to sarcoid-like, immune granulomas separated from the macrophage infiltrate with/without foreign body giant cell reaction. (g) Macrophage infiltrate containing particulate wear debris with or without lymphocytic component associated with macrophage induced osteolysis/aseptic loosening should be considered as a type of ALTR.

PMID:40326541 | PMC:PMC12061016 | DOI:10.1530/EOR-2024-0116