Musculoskeletal Surgery[JOURNAL]
Sun
200 papers
Comprehensive management of the adolescent athlete with osgood-schlatter disease: a multidimensional approach.
Colmenares-Bonilla D, Solis-Pena J
Musculoskelet Surg · 2026 Jul · PMID 42402080 · Publisher ↗
Osgood-Schlatter disease (OSD), also known as tibial tubercle apophysitis, is a traction apophysitis of the tibial tuberosity that disproportionately affects adolescents during periods of rapid skeletal growth (1). First...
Osgood-Schlatter disease (OSD), also known as tibial tubercle apophysitis, is a traction apophysitis of the tibial tuberosity that disproportionately affects adolescents during periods of rapid skeletal growth (1). First described independently by Robert Osgood and Carl Schlatter in 1903, this condition represents the most prevalent cause of knee pain in the skeletally immature athletic population (3). Despite its self-limiting nature, OSD can result in prolonged symptoms lasting up to 24 months, with approximately 10% of affected individuals experiencing persistent pain into adulthood, particularly with activities such as kneeling. However, conservative management achieves successful outcomes in over 90% of pediatric cases (4). The burden of OSD extends beyond immediate symptomatology. Recent epidemiological data indicate that lower extremity apophysitis can result in pain lasting between 1 and 45 weeks, with potential consequences for physical activity participation during critical developmental periods (7). This is particularly concerning given the established relationship between childhood physical activity and long-term health outcomes. Furthermore, the condition's propensity to affect athletes during peak competitive years raises important considerations for talent development, psychological well-being, and long-term athletic participation. Historically, OSD management has relied heavily on activity modification and symptomatic treatment. However, advances in our understanding of its pathophysiology-particularly the identification of specific biomechanical risk factors and critical developmental windows-have enabled a more nuanced, multidimensional approach to care.
Comparison between early versus delayed (staged) plate fixation in the treatment of pilon (tibial plafond) fractures: a systematic review and meta-analysis.
Siddig MM, Amin MHJ, Eldouma MYM … +5 more , Elomeiri L, Kumari S, Amin JHJ, Eltayeb MA, Kanwal A
Musculoskelet Surg · 2026 Jul · PMID 42390660 · Publisher ↗
The optimal timing of definitive fixation for tibial plafond (pilon) fractures remains controversial. While staged protocols aim to reduce soft-tissue complications, early definitive fixation may reduce morbidity associa...
The optimal timing of definitive fixation for tibial plafond (pilon) fractures remains controversial. While staged protocols aim to reduce soft-tissue complications, early definitive fixation may reduce morbidity associated with prolonged external fixation. This systematic review and meta-analysis evaluated whether early fixation is associated with different complication rates compared with delayed or staged management. A systematic search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted from inception to December 2025. Comparative studies evaluating early versus delayed or staged surgical management of adult pilon fractures were included. Early management was defined as definitive plate fixation performed within 48-72 h after injury, while delayed or staged management involved initial external fixation followed by delayed definitive surgery. Primary outcomes were infection or wound complications and reoperation. Secondary outcomes included malunion and nonunion. Random-effects meta-analyses were performed using risk ratios (RR) with 95% confidence intervals (CI). Risk of bias was assessed using validated tools, and certainty of evidence was graded using GRADE. Reporting followed PRISMA 2020 guidelines. This review was not prospectively registered. Seven studies involving 543 patients were included. There was no significant difference in infection or wound complications between early and delayed or staged fixation (RR 0.83; 95% CI 0.41-1.69). No significant reduction in reoperation was observed with early fixation (RR 0.60; 95% CI 0.36-1.00). No significant differences were found for malunion (RR 0.92; 95% CI 0.24-3.54) or nonunion (RR 0.79; 95% CI 0.49-1.28). Overall certainty of evidence ranged from low to very low. Early definitive plate fixation appears to have comparable complication rates to delayed or staged protocols, with a possible reduction in reoperation. Selective early fixation may be safe in appropriately chosen patients.
Lessons from the learning curve of the direct anterior approach in total hip arthroplasty: a systematic review.
Corradi N, Trimarchi A, Manca F … +3 more , Martini I, Colombelli A, Belluati A
Musculoskelet Surg · 2026 Jul · PMID 42384145 · Publisher ↗
The direct anterior approach (DAA) in total hip arthroplasty (THA) offers advantages in muscle preservation and early recovery but is challenged by a steep learning curve that may affect outcomes. This systematic review...
The direct anterior approach (DAA) in total hip arthroplasty (THA) offers advantages in muscle preservation and early recovery but is challenged by a steep learning curve that may affect outcomes. This systematic review analyzed complication and reoperation rates during the learning phase of DAA in primary THA. A comprehensive search of PubMed, Cochrane Library, and Web of Science, was performed according to PRISMA guidelines. Studies reporting complications and reoperations during the DAA learning curve were included. Data on demographics, surgical volume, and adverse events were extracted. The primary outcomes were complication and reoperation prevalence with 95% confidence intervals (CI). Thirty-five studies encompassing 96,605 primary THAs met inclusion criteria. The overall complication prevalence during the learning curve was 2.75% (2,653/96,605; 95% CI: 2.65%-2.85%). The most frequent complications were aseptic loosening (22%), periprosthetic fracture (14%), dislocation (10%), and prosthetic joint infection (9%). The reoperation prevalence was 1.81% (1,743/96,605; 95% CI: 1.72%-1.90%), mainly due to aseptic loosening, infection, and fracture. Heterogeneity in surgeon experience and reporting limited comparability across studies. The adoption of DAA in THA is associated with a measurable learning curve characterized by increased complication and reoperation rates during early experience. Awareness of these risks, along with structured training and careful patient selection, is essential to mitigate early failures. Further prospective studies are needed to better define the learning curve threshold and standardize outcome reporting.
Gait analysis after TKA: Do different alignment strategies lead to different outcomes? A systematic review.
Bulzaki Bogucki BD, Digennaro V, Panciera A … +4 more , Cecchin D, Ferri R, Benvenuti L, Faldini C
Musculoskelet Surg · 2026 Jun · PMID 42265439 · Publisher ↗
BACKGROUND: Total knee arthroplasty (TKA) provides reliable pain relief and implant survival; however, a clinically relevant proportion of patients still report residual symptoms, functional limitations, or an unnatural...
BACKGROUND: Total knee arthroplasty (TKA) provides reliable pain relief and implant survival; however, a clinically relevant proportion of patients still report residual symptoms, functional limitations, or an unnatural joint perception. Instrumented gait analysis may objectively assess postoperative function and clarify whether alignment strategies influence gait recovery. METHODS: This systematic review followed PRISMA 2020 recommendations. PubMed/MEDLINE and the Cochrane Library were searched from January 1990 to November 2024. Eligible studies reported instrumented gait-analysis outcomes after primary fixed-bearing TKA performed with mechanical, kinematic, anatomical, functional, inverse kinematic, restricted kinematic, or other personalized alignment techniques, with at least 12 months of follow-up. Revision TKA, unicompartmental knee arthroplasty, case reports, reviews, and studies without an appropriate comparison group were excluded. RESULTS: Six studies met the inclusion criteria, underscoring the limited available evidence. The studies were heterogeneous in design, alignment strategy, gait-analysis protocol, and reported outcomes. Four studies compared kinematic and mechanical alignment, one inverse kinematic and adjusted mechanical alignment, and one gap-balanced TKA with healthy controls. No consistent gait advantage of one alignment strategy was demonstrated. Some studies reported lower knee adduction moment or gait patterns closer to healthy controls after kinematic or inverse kinematic alignment, but findings were inconsistent. CONCLUSION: Evidence on gait analysis after TKA with different alignment strategies remains limited and heterogeneous. Current data do not allow firm conclusions regarding the superiority of any alignment strategy. Larger prospective studies using standardized gait-analysis protocols are needed.
Total knee arthroplasty alignment strategies and their impact on ankle and hindfoot: a systematic review.
Bogucki BDB, Digennaro V, Panciera A … +4 more , Cecchin D, Ferri R, Benvenuti L, Faldini C
Musculoskelet Surg · 2026 Jun · PMID 42258121 · Publisher ↗
Multiple alignment strategies have been proposed in total knee arthroplasty (TKA), ranging from systematic approaches such as mechanical alignment and anatomical alignment to personalized techniques including kinematic,...
Multiple alignment strategies have been proposed in total knee arthroplasty (TKA), ranging from systematic approaches such as mechanical alignment and anatomical alignment to personalized techniques including kinematic, restricted kinematic, inverse kinematic, and functional alignment. Although previous studies and reviews have evaluated the relationship between TKA and distal alignment, the influence of different knee alignment strategies on ankle and hindfoot alignment remains less clearly defined. The aim of this systematic review was to evaluate the impact of TKA alignment strategies on postoperative ankle and hindfoot alignment. A systematic review was conducted according to PRISMA guidelines. Medline (PubMed) and the Cochrane Library were searched for studies evaluating preoperative and postoperative ankle and/or hindfoot alignment following TKA. Eligible studies included clinical investigations reporting radiographic measurements of the ankle or hindfoot and clearly defining the TKA alignment strategy adopted. Study design, level of evidence, patient demographics, alignment technique, radiographic parameters, and functional outcomes were extracted and analyzed. Twenty-two studies were included, most of which provided level III evidence. Sixteen studies evaluated mechanically aligned TKA only, five compared mechanical alignment with personalized or alternative alignment strategies, and one investigated a personalized alignment strategy without direct comparison. Mechanical alignment consistently corrected coronal knee malalignment, particularly varus knee deformity, but distal ankle and hindfoot adaptations were variable. These changes appeared to be influenced by the severity of preoperative varus deformity, subtalar joint flexibility, and the presence of ankle osteoarthritis. Residual hindfoot valgus and incomplete distal compensation were frequently reported, especially in patients with severe preoperative varus knee deformity. Mechanical alignment reliably corrects coronal knee alignment, but ankle and hindfoot responses are variable and may remain incomplete in patients with severe varus deformity, ankle osteoarthritis, or limited subtalar compensation. Selected studies suggest that personalized alignment strategies may reduce compensatory distal changes, but the available evidence is limited and heterogeneous. Further comparative studies with standardized ankle and hindfoot assessment are needed before firm conclusions can be drawn.
Retrograde insertion of full-length ramus screws for the treatment of pelvic and/or acetabular fracture.
Zheng L, Hu CJ, Shen X … +5 more , Hao J, Yu L, Zeng G, Yang G, Pan Y
Musculoskelet Surg · 2026 May · PMID 42098568 · Publisher ↗
PURPOSE: To assess the feasibility, safety, and effectiveness of a retrograde technique for inserting a full-length ramus screw through an osseous starting site (OSS) at the anteromedial corner of the para-symphyseal bon...
PURPOSE: To assess the feasibility, safety, and effectiveness of a retrograde technique for inserting a full-length ramus screw through an osseous starting site (OSS) at the anteromedial corner of the para-symphyseal bone, and to analyze the position and parameters of the ramus osseous fixation pathway (OFP) based on screw placement. METHODS: From August 2020 to December 2021, patients with fractures of the anterior acetabular column or the superior pubic ramus treated with a retrograde superior ramus screw were included in this study. The OSS was located at the anteromedial corner of the para-symphyseal bone. Perioperative and postoperative complications were recorded. The position and the parameters of the ramus OFP were established based on the postoperative CT images of the inserted full-length screws. RESULTS: Twenty-three (23/25) full-length large-diameter (≥ 7 mm) ramus screws were successfully inserted in 19 (19/20) cases. Postoperative CT images showed that all full-length screws were positioned within a bony corridor, located anteriorly and cranially to the acetabular dome. The OFP measures 119.9 ± 7.6 mm in length, with angle projection of 16.9 ± 6.3 degrees to the coronal plane and 38.6 ± 3.9 degrees to the horizontal plane. During follow-up, bone union was achieved in all cases, with no instances of bone delayed union or screw breakage observed. CONCLUSIONS: Via the OSS at the anteromedial corner of the para-symphyseal bone, the inserted full-length large ramus screws were situated anteriorly and cranially to the acetabular dome. This retrograde technique has been demonstrated to be a feasible, safe, and effective surgical procedure.
Surveillance of postoperative respiratory complications in Japanese patients with hip fractures using ARISCAT score.
Ishimaru N, Waki T, Shimokawa T … +5 more , Mizuki S, Kanzawa Y, Nakajima T, Yano T, Ito K
Musculoskelet Surg · 2026 May · PMID 42086844 · Publisher ↗
PURPOSE: The ARISCAT score can reportedly be used to detect perioperative respiratory complications when they are not predictable by routine pulmonary function tests, blood gas tests, or chest radiography. However, its v...
PURPOSE: The ARISCAT score can reportedly be used to detect perioperative respiratory complications when they are not predictable by routine pulmonary function tests, blood gas tests, or chest radiography. However, its validity in Japanese patients with hip fractures is unverified. Here, we aim to determine the sensitivity and specificity of the ARISCAT score for the prevalence of respiratory complications in Japanese patients with hip fractures. METHODS: This study retrospective cohort analysis included patients that underwent surgery for hip fracture at our hospital between July 2020 and March 2022. The primary outcome was the rate of postoperative respiratory issues (pneumothorax, aspiration pneumonia, respiratory infection, bronchospasm, respiratory failure, atelectasis, and pleural effusion). RESULTS: Respiratory complications occurred in 17 of 389 patients with hip fractures, with an incidence rate [95% CI] of 4.4% (2.3, 6.4). The mean age was 83.7 [8.7] years, 27.8% were men, and 232 of them (59.6%) had femoral neck fractures. The discriminative power of the ARISCAT score model for the occurrence of respiratory complications was C-statistic 0.71 [0.57,0.83]. Sensitivity and specificity were 52.9% [29.2, 76.7] and 76.8% [72.6, 81.2], respectively, for a score of ≥ 26, and 42.9% [6.2, 79.5] and 96.5% [94.6, 98.4], respectively, for a score of ≥ 45. CONCLUSION: The ARISCAT score had low sensitivity for detecting respiratory complications in Japanese patients with hip fractures. Surveillance of postoperative respiratory complications in Japan should be via regionally validated tools.
Correction: Systematic review of injections for acute ankle sprains.
Frey C, Shukla A, Adydan EC … +1 more , Strasser N
Musculoskelet Surg · 2026 Apr · PMID 42047957 · Publisher ↗
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Transcatheter arterial microembolization (TAME) in foot and ankle pathologies: current indications and future perspectives.
Mazzotti A, Facchini G, D'Antonio G … +7 more , Langone L, Sgubbi F, Peta G, Quarchioni S, Di Carlo M, Miceli M, Faldini C
Musculoskelet Surg · 2026 Apr · PMID 41973173 · Publisher ↗
Transcatheter arterial microembolization (TAME) is a minimally invasive endovascular procedure initially developed for bleeding control and later applied to the treatment of chronic musculoskeletal conditions characteriz...
Transcatheter arterial microembolization (TAME) is a minimally invasive endovascular procedure initially developed for bleeding control and later applied to the treatment of chronic musculoskeletal conditions characterized by pathological hypervascularization, to inhibit or reduce the release of inflammatory mediators. First introduced in anatomical districts such as the knee, TAME has more recently been proposed as a therapeutic option for chronic inflammatory foot and ankle disorders refractory to conservative treatment. A narrative review of the literature was conducted by searching PubMed using the keywords "microembolization," "transcatheter arterial microembolization," "TAME," "foot," and "ankle." The most recent and relevant studies, including case reports, case series, and retrospective studies, were analyzed, along with the reference lists of selected articles. Clinical indications, procedural techniques, embolic materials, clinical outcomes, and complications were evaluated. The main indications for TAME in foot and ankle pathology were Achilles tendinopathy, plantar fasciopathy, and, in a single reported case, non-union of a fifth metatarsal fracture. The procedure was predominantly performed using temporary embolic agents, most commonly imipenem/cilastatin sodium. All studies reported a technical success rate of 100%, with significant pain reduction and functional improvement in most patients. Reported complications were minor and transient, with no major adverse events documented.TAME represents a promising minimally invasive therapeutic option for chronic inflammatory foot and ankle conditions refractory to conservative management, particularly Achilles tendinopathy and plantar fasciopathy. Although preliminary clinical results are encouraging, the current evidence is limited by small sample sizes and low methodological quality, underscoring the need for larger, well-designed prospective studies.
Assessing predictive accuracy of 2D digital templating in fluoroscopy-guided direct anterior approach total hip arthroplasty.
Liu J, Gilreath N, Nassar JE … +6 more , Daher M, Okewunmi J, Peresuh SJ, Molino J, Antoci V, Jenkins D
Musculoskelet Surg · 2026 Apr · PMID 41951897 · Publisher ↗
INTRODUCTION: Preoperative 2D digital templating aids surgical planning in total hip arthroplasty (THA). We evaluated template accuracy by comparing preoperative templated measurements with postoperative findings and fin...
INTRODUCTION: Preoperative 2D digital templating aids surgical planning in total hip arthroplasty (THA). We evaluated template accuracy by comparing preoperative templated measurements with postoperative findings and final implant sizes. METHODS: We retrospectively reviewed a consecutive series of 100 patients who underwent fluoroscopy-guided direct anterior approach (DAA) THA by a single surgeon from November 2022 to September 2024. All patients received an Emphasys femoral stem with a Pinnacle acetabular cup. A single arthroplasty surgeon used Traumacad™ software for preoperative templating, which was compared to postoperative measurements and implants. RESULTS: Preoperative template averages were: cup size (55.1 mm), femur size (5.8), head size (36 mm), and inclination (41.0°). Delta values (difference between postoperative and templated measurements) were: neck cut length (5.6 mm), neck cut angle (2.8°), LLD (0.1 mm), cup size (1.3 mm), femur size (0.7), head size (0 mm), and inclination (2.9°). Cup size was perfectly predicted in 56% of cases, 95% within two sizes; femur size was perfect in 52% of cases, 88% within one size, and 95% within two sizes. Stem offset was 94% accurate. Regression analysis found that higher BMI and male gender were associated with less accurate predictions for neck angle and cup size, respectively. CONCLUSION: While variables such as higher BMI and male gender may influence the accuracy of templating, our findings suggest that 2D templating for DAA THA offers reliable predictions within a narrow range for final implant sizes, neck cut, and planned leg length changes.
Systematic review of injections for acute ankle sprains.
Frey C, Shukla A, Adydan E … +1 more , Strasser N
Musculoskelet Surg · 2026 Mar · PMID 41843366 · Publisher ↗
Lateral ankle sprains are a common injury that can result in morbidity in terms of pain and time away from work or sport. Although it is typically self-resolving, treatments to expedite or enhance healing may be benefici...
Lateral ankle sprains are a common injury that can result in morbidity in terms of pain and time away from work or sport. Although it is typically self-resolving, treatments to expedite or enhance healing may be beneficial. One modality utilized by health care practitioners is the injection of therapeutic compounds. The purpose of this study is to determine the impact of injections of local anesthetics, platelet-rich plasma (PRP), and hyaluronic acid (HA) on patients with lateral ankle sprains. Systematic Review; Level of evidence 3. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library on December 17th, 2024, by the Health Sciences Research Librarian. A total of 10 studies were included. 5 pertained to local anesthetic injections and demonstrated a favorable impact on recovery time. 3 manuscripts used PRP with 2 of the 3 finding improvements in the intervention group relative to the control up to 24 weeks from the injury. 2 manuscripts pertained to hyaluronic acid injections and one of the studies found relative improvements compared to the control in terms of pain control. Injections of PRP, hyaluronic acid, and local anesthetics may be able to improve recovery time and pain control for lateral ankle sprains; however, there remains a need for high-quality research to make recommendations for clinical practice.
Medial tibial stress syndrome.
Mazzotti A, Di Paola G, Arceri A … +5 more , Sgubbi F, Langone L, Zielli SO, Gemini G, Faldini C
Musculoskelet Surg · 2026 Mar · PMID 41831134 · Publisher ↗
Medial Tibial Stress Syndrome (MTSS) is an overuse pathological condition, characterized by pain and tenderness along the posteromedial border of the tibia. The duration and severity of symptoms, in some cases, may lead...
Medial Tibial Stress Syndrome (MTSS) is an overuse pathological condition, characterized by pain and tenderness along the posteromedial border of the tibia. The duration and severity of symptoms, in some cases, may lead to marked functional impairment and undermine athletic performance.There is a lack of consensus across literature regarding several aspects of MTSS. The purpose of this narrative review is to synthesize current evidence and highlight key elements related to MTSS.Findings indicate that MTSS is a multifactorial condition involving periosteal traction, bone overload and impaired remodeling. Epidemiological data are heterogeneous, but MTSS remains prevalent among athletes and military personnel. Multiple intrinsic and extrinsic risk factors contribute to its onset. Diagnosis is primarily clinical, supported by imaging. Conservative management, consisting of rest, anti-inflammatory medications and physiotherapy, remains the cornerstone, while the evidence for surgical intervention is limited and methodologically weak.
A comparative study between two commonly used robotic systems on the accuracy of the intraoperative cuts in total knee arthroplasty.
Liong SS, Lee WC, Khoo SKM … +2 more , Chee BRK, Kunnasegaran R
Musculoskelet Surg · 2026 Mar · PMID 41796279 · Publisher ↗
PURPOSE: We aimed to compare the accuracy of robotic Total Knee Arthroplasty (TKA) intraoperative cuts between Computed Tomography image-based MAKO and imageless ROSA. METHODS: We retrospectively analysed registry data f...
PURPOSE: We aimed to compare the accuracy of robotic Total Knee Arthroplasty (TKA) intraoperative cuts between Computed Tomography image-based MAKO and imageless ROSA. METHODS: We retrospectively analysed registry data for patients who underwent imaged-based MAKO and imageless ROSA robotic TKA. Two reviewers independently radiographically measured the coronal alignment of the implants in relation to the mechanical axis at 3 months post-operation. These were compared to the planned intraoperative robotic cuts. RESULTS: One hundred sixty-one patients underwent MAKO and 110 ROSA TKA. Intraclass correlation for radiographic readings was 0.88 to 0.96. When comparing the variability between intraoperative planned alignment and 3 months postoperative, MAKO femur showed no statistically significant difference (- 0.1° ± 0.8° vs. - 0.1° ± 1.2°, p = 0.12) and likewise no difference for tibia (- 0.9° ± 1.2° vs. - 0.6° ± 1.3°, p = 0.60). However, for ROSA, its femur showed statistically significant difference (- 1.2° ± 1.0° vs. - 0.7° ± 1.3°, p < 0.01), likewise for tibia (- 0.4° ± 0.9° vs. - 0.2° ± 1.4°, p < 0.01). The variability from intraoperation to 3 months postoperative was significantly different between MAKO and ROSA for femur (0.0° ± 1.0° vs. 0.4° ± 1.1°, p < 0.01), but was not statistically significant for tibia (0.3° ± 0.1° and 0.1° ± 1.1°, p = 0.26). There was a significant difference with a larger proportion of femur implant that deviated < 1º from intraoperative plan in MAKO compared to ROSA (62.1% and 37.2% respectively, p < 0.01). At the tibia component, there was no statistically significant difference in the proportion of the extent of deviation (p = 0.73). CONCLUSION: There was statistically significant variability in coronal alignment between intraoperative plan and postoperative 3 months in the imageless robotic system at both femur and tibia components. The extent of variability between the imageless and CT-image based systems in femur was also statistically significant. There was also a larger proportion of implant deviation of > 1º in the femur component in imageless robotic system. Nevertheless, the overall extent of the deviation between the intraoperative plan and the postoperative position was < 0.5º. Future studies may be performed to determine whether this would translate into any clinical significance.
Are elderly patients undergoing blood transfusion during hip fracture surgery at risk of postoperative delirium: a retrospective observational study.
Laudisio A, Zampogna B, Papalia GF … +5 more , Iuorio MS, Vorini F, Catania P, Rizzello G, Papalia R
Musculoskelet Surg · 2026 Mar · PMID 41787021 · Publisher ↗
PURPOSE: Delirium is common following hip fracture surgery. Red blood cell transfusion (RBCT), which is frequently needed in this population, has been inconsistently associated with incident delirium in previous studies....
PURPOSE: Delirium is common following hip fracture surgery. Red blood cell transfusion (RBCT), which is frequently needed in this population, has been inconsistently associated with incident delirium in previous studies. This study aims to investigate whether RBCT in patients undergoing hip fracture surgery is associated with increased risk of post-operative delirium, and to identify potential risk factors that might influence this association. MATERIALS AND METHODS: We conducted a retrospective observational study of all hip fracture patients who underwent surgery between November 1 2020 and February 28 2022. Delirium was diagnosed based on DSM V criteria, and assessed daily. The need of perioperative RBCT, and the number of units transfused, were recorded. RESULTS: A total of 364 participants with a mean age of 84 years were included. Delirium was recorded in 49 (14%) patients, while 88 (24%) required RBCT. In logistic regression, RBCT was associated with delirium (OR = 3.88, 95% CI = 1.23-12.24), after adjusting. An increasing number of RB units transfused was associated with increased probability of delirium (P for linear trend = .013). CONCLUSIONS: Clinicians should carefully consider the indications for RBCT in hip fracture patients. Further studies are needed to confirm these results, and to investigate the potential mechanisms underlying this association.
Surgical fixation reduces scapular dyskinesis and mal-union rates in midshaft clavicle fractures: a retrospective comparative analysis.
Oldrini LM, Previtali D, Tamborini S … +2 more , Filardo G, Candrian C
Musculoskelet Surg · 2026 Feb · PMID 41644830 · Publisher ↗
BACKGROUNDS: Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at lon...
BACKGROUNDS: Clavicle fractures are a common injury, with lesions of the middle third accounting for 80% of all clavicle fractures. The most suitable approach to address these fractures remains debated, especially at long term. The aim of this study was to compare surgical and conservative treatments of displaced midshaft clavicle fractures at long-term follow-up. MATERIALS AND METHODS: A total of 123 patients (≥18 years) with a displaced midshaft clavicle fracture, treated surgically with plate fixation (68 patients) or conservatively (55 patients) and evaluated at a mean follow-up 6.7±2.6 years, were included in this study. Shoulder function was evaluated with the Constant-Murley score (CMS) and disabilities of the arm, shoulder, and hand (DASH) score. Aesthetic satisfaction, scapular dyskinesia, radiological outcomes, and overall patient satisfaction were documented as well. A sub-analysis was performed to evaluate the influence of the radiological outcome on the functional outcome. RESULTS: The mean CMS was 94.1±10.6 points in the surgical group and 88.5±16.8 points in the conservative group (p=0.03). The DASH score was 5.1±11.3 in the surgical, 6.7±13.1 in the conservative group (n.s). The incidence of scapular dyskinesis was significantly lower (p<0.001) in the surgical group. Radiological follow-up documented a lower rate of non-unions (p<0.001) and mal-unions (p<0.001) in the surgical group. Regarding patient satisfaction, there was no difference in terms of aesthetic satisfaction, while the overall satisfaction favored the surgical treatment (p=0.02). Patient with a non-union or a mal-union showed a worse outcome regarding CMS, overall and aesthetic satisfaction, and incidence of scapular dyskinesis. CONCLUSIONS: These findings support surgical fixation in patients at risk of malalignment or with high activity demands, as it significantly improves long-term function, biomechanics, and patient satisfaction compared to non-operative management. LEVEL OF EVIDENCE: III.
Durability of posterior column fixation through the anterior-only approach: a prospective study for assessment of reduction loss.
Fahmy M, Shawky MA
Musculoskelet Surg · 2026 Feb · PMID 41622384 · Publisher ↗
PURPOSE: Durability of anterior-only fixation for posterior column acetabular fractures remains debated, particularly regarding potential loss of reduction over time. This study prospectively evaluated radiographic stabi...
PURPOSE: Durability of anterior-only fixation for posterior column acetabular fractures remains debated, particularly regarding potential loss of reduction over time. This study prospectively evaluated radiographic stability and functional outcomes following fixation performed exclusively through the anterior approach. METHODS: Between 2019 and 2023, forty-five consecutive patients with displaced acetabular fractures requiring posterior column fixation were enrolled. All underwent reduction and fixation via the anterior approach in the supine position. Patients with old fractures (> 3 weeks), pathological fractures, or prior hip surgery were excluded. Standardized radiological assessments measured posterior column height and displacement immediately postoperatively and at 12-month follow-up (mean 15.6 ± 1.2 months). Reduction loss was defined as ≥ 2 mm displacement. Functional recovery was evaluated using the Harris Hip Score (HHS). Complications were prospectively recorded. RESULTS: Mean age was 49.3 years. Radiological assessment showed minimal change between immediate postoperative and final follow-up: mean posterior column height increased 0.4 mm and posterior displacement 0.7 mm. No patient demonstrated displacement ≥ 2 mm. Functional outcomes were excellent, with mean HHS of 92.7 ± 6.4. Subgroup analysis revealed slightly lower scores in cases requiring posterior column fixation with infrapectineal buttressing (mean HHS 89.4 ± 5.1 vs. 94.1 ± 4.2, p < 0.05). One deep infection occurred (2.2% complication rate), managed successfully with debridement. No reoperation for fixation failure or nonunion was required. CONCLUSION: Anterior-only fixation of posterior column acetabular fractures provided durable radiographic stability and excellent short-term functional outcomes at one year, with a low complication rate. While exclusion of irreducible fragments limits generalizability, these findings support the anterior intrapelvic approach as a reliable option in appropriately selected patients. Longer-term follow-up and comparative studies are warranted to determine its role relative to combined or posterior approaches.
Neglected pelvic ring injuries: prospective evaluation of radiological, functional, and predictive factors for optimal reconstruction.
Fahmy M, Abo-Elsoud M, Shawky MA
Musculoskelet Surg · 2026 Jan · PMID 41587014 · Publisher ↗
PURPOSE: Neglected pelvic ring injuries are rare but pose significant reconstructive challenges due to chronic deformity, soft-tissue contracture, and pelvic instability. Evidence on prognostic factors and optimal fixati...
PURPOSE: Neglected pelvic ring injuries are rare but pose significant reconstructive challenges due to chronic deformity, soft-tissue contracture, and pelvic instability. Evidence on prognostic factors and optimal fixation strategies is limited. This prospective study evaluates radiological and functional outcomes after delayed reconstruction, identifies predictors of reduction quality and complications, and compares minimally invasive INFIX versus open anterior plating. METHODS: Twenty patients presenting ≥ 6 weeks post-injury with pelvic malunion or nonunion underwent individualized staged reconstruction between 2019 and 2022. Posterior stabilization was performed first, followed by anterior fixation using either open plating or INFIX. Radiological alignment was graded by Matta's criteria, and functional recovery was assessed with the Majeed Pelvic Score. Correlation and multivariable analyses identified independent predictors of outcomes. RESULTS: At a mean follow-up of 13.2 months, bone union was achieved in 95% of cases, and anatomical or satisfactory reduction in 90%. Mean Majeed scores improved from 48.7 ± 12.4 to 82.5 ± 9.7 (p < 0.001). Multivariable analysis identified surgical delay > 12 weeks and type C morphology as independent predictors of suboptimal reduction, while minimally invasive INFIX fixation reduced wound complications, providing an evidence-based framework for decision-making. Overall complications occurred in 20% of cases, and the predictive model showed good discriminative power (AUC = 0.81). CONCLUSION: Delayed reconstruction of neglected pelvic fractures can achieve high union rates and meaningful functional recovery when guided by meticulous planning, staged fixation, and anatomical reduction. Reduction quality and surgical timing are key determinants of outcome, and INFIX constructs reduce wound complications. Neglected pelvic fractures are uncommon, representing fewer than 5% of all pelvic injuries; despite the small cohort, this study is among the largest prospective series reported, offering novel predictive data to inform timing, technique, and functional expectations in delayed reconstruction.
Tailor's bunion (bunionette): current concepts and outcomes of open versus minimally invasive surgery.
Colò G, Fusini F, Marcolli D … +3 more , Testa A, Leigheb M, Surace MF
Musculoskelet Surg · 2026 Jan · PMID 41587013 · Publisher ↗
BACKGROUND: Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfor...
BACKGROUND: Bunionette deformity (BD), also referred to as Tailor's bunion, is characterized by a lateral prominence of the fifth metatarsal head, frequently associated with pain, inflammation, and shoe-related discomfort. This narrative review synthesizes current knowledge on the pathogenesis and clinical presentation of BD, while placing particular emphasis on recent developments in minimally invasive surgery (MIS) techniques compared with traditional open approaches. METHODS: A narrative review of the literature was conducted using PubMed, Scopus, and Embase databases up to July 2025, focusing on the etiology, clinical presentation, and treatment strategies for BD. Both conservative and surgical approaches, including open and MIS techniques, were critically analyzed. RESULTS: Conservative management, including footwear modification and orthoses, is recommended as first-line treatment. However, no long-term studies have demonstrated sustained symptom relief with non-operative modalities. Surgical options include exostectomy and a range of metatarsal osteotomies (distal, diaphyseal, and proximal), performed via open or MIS techniques. Complication rates in open surgery are reported as highest in proximal (22%) and diaphyseal (21%) osteotomies, followed by distal osteotomies (11%). Revision surgery is more frequent in diaphyseal osteotomies (n = 5; 2%). MIS techniques demonstrate complication rates ranging from 0% to 21.4%, with nonunion rates between 0% and 5.6%. MIS appears to reduce wound-related and hardware complications compared to open techniques; however, direct comparative studies are lacking. CONCLUSION: While MIS techniques demonstrate favorable complication and recovery profiles in retrospective studies, the lack of high-quality prospective trials prevents definitive conclusions. Future research should prioritize randomized comparative designs to establish clear treatment guidelines.
Meta-analytic evaluation of complications and longevity of bone-anchored prostheses in lower extremity amputees: does design matter?
Milchem H, Khair YJ, Adra M … +8 more , Sivanathan SS, Suresh S, Vankayalapati DK, Haroon AM, Than CA, Tarazi N, Nakanishi H, Smitham PJ
Musculoskelet Surg · 2026 Jan · PMID 41533204 · Publisher ↗
Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free surviva...
Bone-anchored prostheses (BAPs) are an alternative option for lower-limb amputees with problematic suspended socket prostheses (SSPs). We sought to meta-analytically quantify complication burden and revision-free survival for BAPs, whilst investigating possible differences in complication rates between common screw-fit (OPRA) and press-fit (ILP/OPL) designs. A multi-database search of PubMed, EMBASE, CiNAHL, Cochrane Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and Web of Science from inception to September 2025 was conducted. Proportions were pooled using a random-effects model. This review was registered in PROPSPERO (ID: CRD42024507070). A total of 22 studies reporting 979 patients were included. An overall complication rate of 65% (95% CI: 0.53-0.75, I = 69%) was found. The most common complication was breakage of the abutment or dual-cone adaptor (DCA) (0.38, 95% CI: 0.19-0.62, I = 97%), which constituted 94% of all mechanical failures (95% CI: 0.87-0.98, I = 51%). Second was infection (0.36, 95% CI: 0.25-0.50, I = 92%) with 72% of infections being grade I (95% CI: 0.57-0.83, I = 72%). Estimated revision-free survival was 89% (95% CI: 0.84-0.93, I = 0%) at five years and 77% (95% CI: 0.70-0.82, I = 0%) at ten years. The largest difference between implant designs was for overall proportion of mechanical failure, OPRA at 68% (95% CI: 0.34-0.90, I = 98%), ILP/OPL at 19% (0.09-0.36, I = 85%). BAPs do carry appreciable risks for superficial infection and mechanical (abutment/DCA) breakage, with screw-fit designs appearing to have a higher mechanical failure rate. However, the revision-free survival rate overall remains acceptable up to 10 years demonstrating the viability of BAPs in lower-limb amputees.
Efficacy of blood flow restriction (BFR) rehabilitation treatment in patients undergoing primary total and partial knee arthroplasty: a single-center case-control study.
Giusti S, Zampogna B, Alfonsi V … +3 more , Cerulli S, Papalia R, Adriani E
Musculoskelet Surg · 2026 Jan · PMID 41520087 · Publisher ↗
BACKGROUND: Blood flow restriction (BFR) therapy has emerged as a promising rehabilitation modality to enhance post-operative recovery following knee arthroplasty. This study evaluates the efficacy of BFR rehabilitation...
BACKGROUND: Blood flow restriction (BFR) therapy has emerged as a promising rehabilitation modality to enhance post-operative recovery following knee arthroplasty. This study evaluates the efficacy of BFR rehabilitation in patients undergoing primary total and partial knee arthroplasty compared to standard physiotherapy protocols. METHODS: A single-center, case-control study was conducted on patients undergoing knee arthroplasty. Participants were divided into two groups: one receiving conventional physiotherapy and the other incorporating BFR rehabilitation. Outcome measures included postoperative range of motion (ROM), quadriceps strength, functional mobility (assessed via the Timed Up and Go test), and patientreported pain and satisfaction scores. RESULTS: Patients in the BFR group demonstrated significantly greater improvements in quadriceps strength (p 0.05) and functional mobility compared to the control group. ROM and pain scores also showed favorable trends in the BFR group, indicating enhanced postoperative recovery. No significant adverse effects were reported. CONCLUSIONS: BFR rehabilitation appears to be an effective adjunct to conventional physiotherapy in enhancing functional recovery after knee arthroplasty. Further large-scale studies are warranted to validate these findings and optimize rehabilitation protocols.
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