Musculoskeletal Surgery[JOURNAL]
Sun
200 papers
Comparison between anterolateral standard and percutaneous antero-acromial approach in humeral intramedullary nailing (IMN). A radiological, functional, and ultrasound rotator cuff evaluation prospective study.
Pautasso A, Puricelli M, Morlacchi D … +4 more , Discalzo GA, De Falco G, Pilato G, D'Angelo F
Musculoskelet Surg · 2026 Jun · PMID 40914742 · Publisher ↗
PURPOSE: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and...
PURPOSE: The aim of this study was to evaluate the radiological-functional outcomes and rotator cuff (RC) status following humeral intramedullary nailing (IMN), comparing the anterolateral standard approach (group 1) and the percutaneous antero-acromial approach (group 2). METHODS: This observational prospective monocentric study was conducted from August 2021 to March 2023. Inclusion criteria included: two-parts proximal (surgical neck) and diaphyseal Humeral fractures treated with IMN; 12-month follow-up; age between 18 and 85 years; good performance status (excluding neurologic deficits or mental disorders). Evaluations included RC status via ultrasound, Constant, DASH, and SPADI scores, as well as fracture healing times. A T-test was used or statistical analysis. RESULTS: Sixty-one patients were enrolled during the study period (34 in group 1; 27 in group 2). The mean bone healing time resulted 2.9 ± 0.5 months in group 1 and 2.4 ± 0.7 months in group 2, with a statistically significant reduction of 17% in favor of group 2 (p < 0.05). No significant differences were found in the Constant scores at 6 and 12 months of follow-up; however, significant differences were observed in DASH and SPADI scores (p < 0.05). Supraspinatus tears were detected in both groups: 6 in Group 1 (2 full-thickness and 4 partial) localized at the footprint, and 4 in Group 2 (1 full-thickness and 3 partial) assessed medially in the musculotendinous portion. CONCLUSION: Intramedullary nailing with a percutaneous approach proved to be a minimally invasive technique with better functional outcomes and shorter fracture healing times. The impact on the RC was comparable to the standard approach.
Feasibility and outcomes of the direct anterior approach in total hip arthroplasty for obese patients: a systematic review.
Corradi N, Trimarchi A, Soldati AL … +3 more , Martini I, Colombelli A, Belluati A
Musculoskelet Surg · 2025 Sep · PMID 40913167 · Publisher ↗
Total hip arthroplasty (THA) via the direct anterior approach (DAA) is a preferred surgical technique due to its benefits, including reduced soft tissue disruption and faster recovery. However, obesity, defined as a body...
Total hip arthroplasty (THA) via the direct anterior approach (DAA) is a preferred surgical technique due to its benefits, including reduced soft tissue disruption and faster recovery. However, obesity, defined as a body mass index (BMI) ≥ 30 kg/m, poses unique challenges in DAA-THA, increasing the risk of complications and technical difficulties. This systematic review aims to assess the clinical and functional outcomes, complication rates, and reoperation rates in obese patients undergoing DAA-THA compared to non-obese patients. A systematic search was conducted in PubMed, Cochrane Library, and Web of Science for studies published between January 2000 and December 2024, following PRISMA guidelines. Inclusion criteria focused on studies reporting outcomes for obese patients undergoing DAA-THA. Data on functional outcomes, complications, and reoperations were extracted, and methodological quality was evaluated using the Modified Coleman Methodology Score (mCMS). Eleven studies involving 8,062 THAs (3,658 in obese patients, 4,386 in non-obese patients) met the inclusion criteria. Both groups showed significant postoperative improvements in functional outcomes, with similar Harris Hip Scores (HHS) (94.38 in obese vs. 93.85 in non-obese patients). Obese patients, however, had longer surgical times (82.52 vs. 68.82 min) and higher complication rates (5.5% vs. 4.88%), including increased risks of superficial wound infections, periprosthetic joint infections, and deep vein thrombosis. Reoperation rates were also higher in obese patients (1.69% vs. 0.7%). DAA-THA provides comparable functional improvements for obese and non-obese patients. However, the higher complication and reoperation rates in obese patients emphasize the need for preoperative optimization, meticulous surgical technique, and targeted perioperative care. Further high-quality studies with longer follow-up are necessary to refine strategies for optimizing outcomes in obese patients undergoing DAA-THA.
Robotic-assisted anterior and posterior cervical spine surgeries.
Pai M, Srinivasa V, Soni A … +4 more , Thirugnanam B, Kashyap A, Vidyadhara A, Rao SK
Musculoskelet Surg · 2026 Jun · PMID 40889052 · Publisher ↗
INTRODUCTION: Cervical spine surgeries pose unique challenges due to the proximity of critical structures and limited visualization with traditional techniques. Robotic assistance offers potential solutions by providing...
INTRODUCTION: Cervical spine surgeries pose unique challenges due to the proximity of critical structures and limited visualization with traditional techniques. Robotic assistance offers potential solutions by providing precise navigation and reducing radiation exposure. We present a series of 30 consecutive patients undergoing various cervical spine procedures utilizing the MazorX Stealth Edition (MXSE) robotic system with intraoperative imaging. METHODS: Anterior and posterior surgeries were performed using the MXSE system. Surgical parameters, implant placement accuracy, and patient outcomes were assessed. Data analysis included anthropometric measurements, surgical times, blood loss, radiation exposure, and patient-reported outcomes. RESULTS: Mean age was 52.43 years, with 43.33% females. Procedures included anterior cervical discectomy and fusion, corpectomy, disc replacement, and posterior decompression and fusion. Implant placements were accurate, with no neurological deficits or reoperations. Surgical parameters were comparable to standard techniques. DISCUSSION: Robotic assistance offers accurate implant placement and reduced radiation exposure. Challenges such as vertebra segmentation and surgical approach were addressed. Further research and instrument development are needed for wider adoption. CONCLUSION: Robotic navigation in cervical spine surgeries enhances precision and safety. Continued advancements in technology and technique are essential for broader implementation.
Risk factors for cephalic necrosis after plate and screw osteosynthesis of 3- and 4-part proximal humerus fractures: prospective cohort study of 121 patients.
Canton G, Zaffaroni N, Ghassempour D … +7 more , Marchetti A, Favero A, Buoite Stella A, Giraldi G, Ratti C, Trobec B, Murena L
Musculoskelet Surg · 2026 Jun · PMID 40887556 · Full text
PURPOSE: Avascular necrosis (AVN) of the humeral head is a relatively frequent complication after proximal humerus fractures (PHF), often leading to poor outcomes and reoperation. This study investigates both non-modifia...
PURPOSE: Avascular necrosis (AVN) of the humeral head is a relatively frequent complication after proximal humerus fractures (PHF), often leading to poor outcomes and reoperation. This study investigates both non-modifiable (fracture type, trauma energy, age, sex, Charlson comorbidity index) and modifiable (surgical access, bone graft use, reduction quality) risk factors for post-operative AVN in Neer 3-4-part PHFs. METHODS: Patients with Neer 3-4-part PHFs treated using angular stable plates and followed for at least 6 months were included. Clinical and radiographic elements were evaluated. Statistical analysis was performed with SPSS 26, evaluating the data by both descriptive and univariate analyses. RESULTS: Among 121 patients (mean age 63, mean follow-up 10.1 months), 8 developed AVN (6.6% incidence). Only 50% of AVN cases occurred within the first 15 months of follow-up. AVN was significantly associated with 4-part fractures (p = 0.050), medial hinge disruption (p = 0.022), tuberosity comminution (p = 0.003), failure to restore the cervico-diaphyseal angle (p = 0.022), and residual varus/valgus deformity (p = 0.01). The presence of a bone graft suggested a fourfold-increased risk of AVN (OR = 4.219). CONCLUSIONS: The present study confirms that the risk of necrosis is predicted by the type of fracture, as well as by the quality of fixation. Age, sex and CCI of the patient, varus/valgus fracture displacement, glenohumeral dislocation and energy of the trauma did not suggest the risk of AVN. These findings underscore the importance of meticulous surgical techniques to address these factors and potentially reduce the incidence of AVN. LEVEL OF EVIDENCE III: Prospective cohort study.
Efficacy of pericapsular nerve group block (PENG) compared to local infiltration analgesia (LIA) after total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
Chen J, Loke RWK, Wong EY … +1 more , Tan BWL
Musculoskelet Surg · 2026 Mar · PMID 40833559 · Publisher ↗
PURPOSE: Pain management after total hip arthroplasty (THA) is crucial for patient recovery and satisfaction. Various analgesic techniques exist, including the pericapsular nerve group (PENG) block and local infiltration...
PURPOSE: Pain management after total hip arthroplasty (THA) is crucial for patient recovery and satisfaction. Various analgesic techniques exist, including the pericapsular nerve group (PENG) block and local infiltration analgesia (LIA). This study aims to compare the efficacy of PENG and LIA in postoperative pain management following THA. METHODS: A random-effects meta-analysis of randomized controlled trials (RCTs) comparing PENG and LIA in primary THA was conducted. A systematic search of MEDLINE, Embase, Cochrane Library, and SCOPUS was performed up to October 24, 2024. Pain scores, opioid consumption, and secondary outcomes such as complications and postoperative nausea and vomiting (PONV) were analysed. RESULTS: Four RCTs were included, with 128 patients receiving PENG and 130 receiving LIA. Demographics, including age, BMI, ASA status, and surgery duration, were comparable. Pain scores at 6, 12, 24, and 48 h were higher in the PENG group but not statistically significant. At 24 h, cumulative opioid consumption was higher in the LIA group [4.23 mg (95% CI: 0.50-7.96) vs. 3.97 mg (95% CI: 0.24-7.70)] though not statistically significant (p = 0.92). At 48 h, PENG had higher cumulative opioid consumption [6.78 mg (95% CI: 1.04-12.52) vs. 6.18 mg (95% CI: 0.91-11.45)] though not statistically significant (p = 0.88). Secondary outcomes, including overall complication rates and PONV, showed no significant differences. CONCLUSIONS: PENG and LIA are comparable in terms of their effectiveness post THA. LIA is non-inferior to PENG in terms of postoperative pain scores, cumulative opioid consumption, overall complication rates and rates of PONV.
The use of short cementless femoral stems in total hip arthroplasty for femoral neck fractures: a scoping review of the literature.
Corradi N, Trimarchi A, Manca F … +3 more , Martini I, Colombelli A, Belluati A
Musculoskelet Surg · 2026 Jun · PMID 40782324 · Publisher ↗
BACKGROUND: Short cementless femoral stems, designed for bone-preserving elective THA, are increasingly used for femoral neck fractures, yet their safety and effectiveness remain unclear. OBJECTIVE: To map current eviden...
BACKGROUND: Short cementless femoral stems, designed for bone-preserving elective THA, are increasingly used for femoral neck fractures, yet their safety and effectiveness remain unclear. OBJECTIVE: To map current evidence on short cementless stems in fracture-related THA, focusing on complications, function, and revisions. METHODS: MedLine and Web of Science were searched to 30 April 2025. Studies reporting ≥ 5 THAs with short cementless stems for femoral neck fractures were included; data were charted and narratively synthesized. RESULTS: Five studies (477 short-stem, 70 standard-stem THAs; mean age 63 years; mean follow-up 65 months) met criteria. Short stems showed a 4.4% complication rate (0.6% intra-op fractures, 0.6% dislocations, 2.1% aseptic loosening) and 3.7% reoperations. Mean Harris Hip Score was 86.8-comparable to standard stems-with fewer surgical complications (4.4 vs. 15.7%). CONCLUSION: Current evidence suggests short cementless stems are a safe, effective option for selected femoral neck fracture patients, but higher-quality, long-term studies are needed.
Optimizing total knee arthroplasty recovery: the role of enhanced recovery after surgery (ERAS) protocols on clinical outcomes and patient satisfaction.
Desouza C, Shetty V
Musculoskelet Surg · 2026 Mar · PMID 40779145 · Publisher ↗
BACKGROUND: Knee osteoarthritis (OA) is a common degenerative condition that significantly affects quality of life. Total Knee Arthroplasty (TKA) is an effective treatment for end-stage OA, but recovery can be challengin...
BACKGROUND: Knee osteoarthritis (OA) is a common degenerative condition that significantly affects quality of life. Total Knee Arthroplasty (TKA) is an effective treatment for end-stage OA, but recovery can be challenging. Enhanced Recovery After Surgery (ERAS) protocols aim to optimize perioperative care and improve outcomes. METHODS: This prospective cohort study evaluated the impact of ERAS protocols on 300 patients undergoing primary TKA. Patients were divided into an ERAS group (n = 150) and a traditional care group (n = 150). ERAS included preoperative education, multimodal analgesia, early mobilization, and multidisciplinary care. Primary outcomes were postoperative pain, length of hospital stay (LOS), and complication rates. Secondary outcomes included functional recovery and patient satisfaction. RESULTS: The ERAS group had significantly shorter LOS (3 vs. 7 days, P = 0.01) and lower blood transfusion rates (21.3% vs. 36.7%, P = 0.01). Postoperative pain scores were consistently lower in the ERAS group (P = 0.01-0.04). Functional recovery, measured by Knee Society Score, and patient-reported outcomes were significantly better in the ERAS group at 3, 6, 12, and 24 months (P < 0.01). CONCLUSION: ERAS protocols significantly improve outcomes in TKA, reducing hospital stays and enhancing patient satisfaction and recovery, supporting their broader use in orthopaedic surgery.
Characterizing spinal curves: addressing variability beyond identical cobb angles.
Chehrassan M
Musculoskelet Surg · 2026 Mar · PMID 40762950 · Publisher ↗
Traditional methods for evaluating spinal curves, such as the Cobb angle, are limited in their ability to capture the full complexity of spinal deformities. This manuscript presents a novel method that builds on Cobb's p...
Traditional methods for evaluating spinal curves, such as the Cobb angle, are limited in their ability to capture the full complexity of spinal deformities. This manuscript presents a novel method that builds on Cobb's principle and Ferguson's approach to provide a more comprehensive assessment of spinal curves. The method involves identifying the centroid-based endpoints of the curve to define its "radius of curvature" and calculating the true curve length through a three-point measurement, including the apical vertebra. The curve's type and sharpness are determined using ratios of distances derived from apical and adjacent lines, enabling detailed geometric characterization.This approach allows for precise analysis of complex deformities, such as continuous kyphotic curves in ankylosing spondylitis, and facilitates improved preoperative planning by aligning surgical strategies with the geometry of the curve. Additionally, it extends to evaluating bent rods in spinal instrumentation, ensuring accurate alignment. The method's ability to integrate multiple curve characteristics addresses critical limitations of existing techniques and holds potential for enhancing outcomes in both clinical and research settings.
Management of the ulnar nerve using an adipofascial flap in elbow surgery.
Greco A, Marcovici LL, Molayem I … +2 more , Amendola C, Pagnotta A
Musculoskelet Surg · 2026 Mar · PMID 40742668 · Publisher ↗
PURPOSE: Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and per...
PURPOSE: Ulnar nerve entrapment is a common condition, with a recurrence rate after surgery reaching up to 25%. In such cases, treatment remains controversial. During elbow surgery, management of the ulnar nerve and performing neurolysis are often the initial steps, even in the absence of clear symptoms. In this study, we assessed the clinical applicability of using an adipofascial flap to cover the nerve during elbow surgery. METHODS: A retrospective study of 53 patients with elbow conditions who underwent surgery between December 2020 and December 2023 was performed. All patients received an X-ray of the elbow and electromyography (ENMG). The following scores were recorded: NRS, MEPS, and McGowan, both preoperatively and at the 1-year follow-up. RESULTS: The NRS score decreased from 7.9 ± 0.8 (range: 6-9) to 2.8 ± 1.3 (range: 0-7) at the 1-year follow-up. MEPS improved from 70.7 ± 15.9 (range: 20-100) to 96.5 ± 7.2 (range: 70-100), indicating reduced pain and improved elbow function. The McGowan scale showed improvements in 49 out of 53 cases. All patients, except one, were satisfied with the surgery, and no recurrence of ulnar nerve-related pain was observed. CONCLUSION: Preliminary results suggest that covering the ulnar nerve with an adipofascial flap following neurolysis and/or anterior transposition is an effective method for managing ulnar nerve entrapment. It appears to help prevent post-surgical complications and adhesions, which are the main causes of the high recurrence rates reported in the literature.
Correction: Returning to running after total knee arthroplasty: a systematic review and a novel multimodal protocol.
Faldini C, Traina F, Digennaro V … +6 more , Berti L, Panciera A, Cecchin D, Ferri R, Benvenuti L, Calbucci L
Musculoskelet Surg · 2025 Sep · PMID 40711724 · Publisher ↗
Abstract loading — click title to view on PubMed.
Treatment of adolescent genu valgum deformity using "wedgeless" distal femur osteotomy with K-wire fixation and cylindrical cast.
Rathod AK, Naidu AN, Jathkar A … +2 more , Akhade N, Ram SH
Musculoskelet Surg · 2026 Mar · PMID 40681946 · Publisher ↗
Abstract loading — click title to view on PubMed.
Can femoral neck-shaft angle predict timing of contralateral second hip fracture? A 7-year retrospective cohort study at a tertiary referral centre for trauma.
Abd Wahab EH, Downey C, Murphy B … +4 more , Lawlor S, O'kelly P, Shortt C, Quinlan JF
Musculoskelet Surg · 2026 Mar · PMID 40665139 · Full text
INTRODUCTION: Previously published literature from our institution found that patients with a fragility hip fracture were estimated to have a 4-10% risk of sustaining a second contralateral hip fracture. A follow-up, mul...
INTRODUCTION: Previously published literature from our institution found that patients with a fragility hip fracture were estimated to have a 4-10% risk of sustaining a second contralateral hip fracture. A follow-up, multi-centre study found that 1 in 11 (9.1%) patients sustained a contralateral hip fracture within three years of index hip fracture. Previous studies have examined the anatomic geometry of the hip joint as a risk factor for hip fractures. Our study aimed to establish a relationship between the neck-shaft angle (NSA) of the contralateral hip in patients who had already suffered a hip fragility fracture in terms of timing to second hip fracture. METHODS: A 7-year, single-institution, retrospective cohort study of patients that presented with a second contralateral fragility hip fracture from 2013 to 2019 were reviewed. Inclusion criteria were all patients 60 years old and above who suffered a second contralateral hip fracture. Exclusion criteria were all patients who were aged less than 60 years old, high-energy injuries or those who suffered peri-prosthetic fractures. The NSA was calculated by measuring the intersection of the femoral neck axis and the femoral shaft axis of the hip. Age, gender, surgery type and American Society of Anaesthesiologists Physical Status Classification (ASA) score were also examined. RESULTS: Ninety-four patients were suitable for analysis. NSA ranged from 113 to 146.5 degrees with an average of 130.2 degrees. Female patients had an average NSA of 129.7 degrees compared to 131.3 degrees in male patients. Average time to second hip fracture was 3.5 years, ranging from 0.08 years (29 days) to 20 years (7326 days). There was a 2.3:1 ratio of female-to-male presentations. Patient age ranged from 60 to 100 years old. The largest age group included patients aged 80-89 years, with 38 patients (28 females and 10 males). Correlation analysis performed showed no statistical significance between NSA and timing of second contralateral hip fracture with a p value of 0.235. There was an association between fracture type, specifically intracapsular hip fractures, and time to second hip fracture, but this was not statistically significant (p value 0.052). CONCLUSION: There is no statistically significant association between femoral NSA and time to second fragility hip fracture. As we have excluded NSA as an independent risk factor, further studies may now be carried out to look for other potential predictors of timing to second hip fracture.
Evaluating the longitudinal efficacy of platelet-rich plasma in rotator cuff surgery: a systematic review and meta-analysis.
Gill SS, Shukla A, Godhamgaonkar A … +1 more , Namireddy SR
Musculoskelet Surg · 2026 Mar · PMID 40658330 · Full text
Rotator cuff (RC) tears affect 22% of the population, increasing with age. While 48.4% are asymptomatic, 25% require surgery. Annually, over 400,000 RC repairs (RCRs) are performed in the USA, costing over $50,000 each....
Rotator cuff (RC) tears affect 22% of the population, increasing with age. While 48.4% are asymptomatic, 25% require surgery. Annually, over 400,000 RC repairs (RCRs) are performed in the USA, costing over $50,000 each. However, retear rates remain high (10-40%), with clinical outcomes stagnating since 1980. Platelet-rich plasma (PRP) has emerged as a potential adjunct to RCR, with its growth factors and regenerative properties offering promise for enhancing tendon healing and improving postoperative outcomes. A comprehensive search across four major databases selected studies utilising PRP in RCR. Out of 2709 studies initially identified, 22 were included, with 13 undergoing meta-analysis. The primary outcome measures were pain and functional scores, with secondary outcomes including patient-reported outcome measures (PROMs) and retear rates. PRP significantly reduced VAS scores, as a proxy of pain reduction at 6 months (MD = 0.34 [0.10, 0.59]) and at 12 months (MD = 0.24 [0.03, 0.44]) post-RCR. UCLA score improvements were significant at 3 months (MD = 2.98 [1.55, 4.40]), 6 months (MD = 1.96 [1.09, 2.83]) and 12 months (MD = 1.26 [0.39, 2.13]). Additionally, PRP significantly reduced retear rates at 24 months, with a mean risk reduction of 15.03%, indicating a substantial improvement in tendon healing. PRP offers substantial benefits in RCR, particularly in reducing pain and retear rates. However, further research is necessary due to observed heterogeneity and study biases. Future efforts should focus on incorporating PRP into clinical practice and guidelines.
Extensor mechanism injury/failure following spacer dislocation in periprosthetic joint infection: a case series in a single reference center.
Mei A, Scazzarriello M, Brioschi D … +2 more , Larghi M, Manzotti A
Musculoskelet Surg · 2026 Mar · PMID 40650723 · Publisher ↗
Antibiotic-loaded spacers are widely used in the two-stage revision protocol for managing periprosthetic joint infections (PJIs) of the knee, offering effective local antibiotic delivery while maintaining joint space and...
Antibiotic-loaded spacers are widely used in the two-stage revision protocol for managing periprosthetic joint infections (PJIs) of the knee, offering effective local antibiotic delivery while maintaining joint space and soft tissue tension. However, despite their clinical benefits, complications such as extensor mechanism rupture remain under-recognized and can severely compromise functional outcomes. This retrospective case series presents consecutive patients treated between 2014 and 2022 by a single orthopedic team at our institution. All patients were diagnosed with knee PJI and experienced extensor mechanism rupture following the implantation of either static or dynamic antibiotic-loaded spacers. The analysis highlights the multifactorial etiology of this complication, including factors such as severe bone loss, suboptimal spacer positioning or design, repeated debridements, and individual patient risks such as obesity and previous surgical history. Dynamic spacers, while allowing partial joint mobility, were associated with a higher risk of mechanical overload, whereas static spacers posed risks related to rigidity and stress transmission. Surgical management in all cases involved radical debridement, assessment of bone loss and femoral canal diameter, and careful selection of spacer type. Awareness of the potential for extensor mechanism injury should inform both surgical technique and postoperative care strategies.
Internal fixation through posterolateral approach versus Ilizarov external fixation for treatment of aseptic distal tibia nonunion: a comparative analysis.
Cerbasi S, Di Sante G, Rani N … +6 more , Del Piccolo N, Stagni C, Maresca A, Vitale P, Dallari D, Pascarella R
Musculoskelet Surg · 2026 Mar · PMID 40640639 · Publisher ↗
PURPOSE: Distal tibia nonunion poses a serious therapeutic challenge for orthopedic surgeons. Bone loss and soft tissue damage is relatively common. The aim of this study was to compare the healing rate and related funct...
PURPOSE: Distal tibia nonunion poses a serious therapeutic challenge for orthopedic surgeons. Bone loss and soft tissue damage is relatively common. The aim of this study was to compare the healing rate and related functional outcomes between two retrospective series of distal tibia nonunion cases treated with internal fixation via the posterolateral approach and those managed with Ilizarov external fixation. METHODS: This retrospective cohort study included 47 affected by distal tibia nonunion. The subjects had undergone internal fixation with inter-tibiofibular graft through the posterolateral approach (Group A, n = 24) and Ilizarov method associated or not with bone transport procedures and osteotomies (Group B, n = 23). Results were assessed at a minimum 24 months after surgery. Consolidation rate, radiographic healing time of nonunion, the American Orthopedic Foot and Ankle Society (AOFAS), the short form health survey (SF-12) and Visual Analog Scale (VAS) scores (pain, ability to work and treatment satisfaction) were compared between the groups. Complications and reoperations were also recorded. RESULTS: The nonunion healing rate was 75% (18/24) in the group A and 91% in the group B (21/23)(p = 0.001). Consolidation was observed, on average, 5.7 months after surgery (range, 4-9) in the group A and 10.7 months in the B group (range, 5-24) (p = 0.001). All patients recovered have had good functional outcomes with no significant differences between the groups. At final follow-up, AOFAS scores in the A group were 74 (range 52-94), while in the B group it was 79 (range 57-100). Group A showed a better perception of mental health status (SF-12-MCS 46 vs. 45, p = 0.36) and a better satisfaction with the treatment received, but a worse perception of their physical health status (SF-12-PCS 49 vs. 50, p = 0.52) with a lower mean score on working ability. CONCLUSION: Distal tibial nonunion can be successfully treated with the posterolateral approach, or external Ilizarov fixation. There are not significative outcomes differences when patients undergoing internal or external fixation. Although healing times are faster with internal fixation via the posterolateral approach, healing rates are higher with the Ilizarov method.
Modified osteodesis procedure using the mini TightRope system for the correction of hallux valgus with full weight-bearing protocol: our experience with an historical report.
Gagliardi VP, Jannelli E, Minen A … +5 more , Villafañe JH, Colò G, Samaila EM, Basile G, Leigheb M
Musculoskelet Surg · 2026 Mar · PMID 40632457 · Publisher ↗
BACKGROUND: Hallux valgus is a common pathology in the orthopedic daily practice. More than 100 techniques of surgical correction are currently described in the literature, mostly focused on osteotomies. Procedures based...
BACKGROUND: Hallux valgus is a common pathology in the orthopedic daily practice. More than 100 techniques of surgical correction are currently described in the literature, mostly focused on osteotomies. Procedures based on soft tissues balancing are actually less described. MATERIALS AND METHODS: Between May and October 2019, 20 patients, 16 females and 4 males, underwent surgery using mini TightRope® system. All were addressed to preoperative radiological and clinical assessment through the AOFAS-hallux scale and radiographs. Follow-up was performed postoperatively with weight-bearing radiographs and AOFAS-hallux score at 5 weeks, 3 months and 6 months. All patients were postoperatively allowed to immediately full weight-bear wearing a stiff sole orthopedic shoe (Donjoy, Podalux™). RESULTS: The results showed an improvement in the functional score (average AOFAS from 53.5 to 87 at 6 months) and a decrease in IMA and HVA in the direct postoperative with 9.2° and 28.3°, respectively. The reductions were maintained through 6 months and compared with the preoperative condition a reduction of 6.0° and 7.3°, respectively, were observed. CONCLUSIONS: Correction of hallux valgus with the modified osteodesis procedure with the mini TightRope system with Full Weight-Bearing can be considered effective, safe and reliable.
Orthogonal versus parallel plating in pediatric distal humeral fractures: a systematic review and meta-analysis.
Jonathan R, Kow E
Musculoskelet Surg · 2025 Dec · PMID 40418532 · Publisher ↗
INTRODUCTION: This systematic review and meta-analysis compared orthogonal and parallel plating techniques for these fractures, focusing on functional recovery, complication rates, and biomechanical stability. METHODS: A...
INTRODUCTION: This systematic review and meta-analysis compared orthogonal and parallel plating techniques for these fractures, focusing on functional recovery, complication rates, and biomechanical stability. METHODS: A comprehensive literature search was conducted on January 25, 2025, across PubMed, EMBASE, Europe PMC, and Scopus. Studies involving pediatric patients (aged 0-18 years) with distal humeral fractures treated using orthogonal or parallel plating were included. Eligible studies reported outcomes such as Mayo Elbow Performance Score (MEPS), range of motion (ROM), union time, and non-union rate. Two independent reviewers extracted data, and study quality was assessed using the Cochrane risk of bias (RoB) tool version 2.0. Statistical analyses were performed using a random-effects model in RStudio. RESULTS: From an initial pool of 659 records, five studies (three randomized controlled trials [RCTs] and two cohort studies) met the inclusion criteria. Meta-analyses revealed no significant differences between orthogonal and parallel plating in MEPS (SMD - 0.25, p = 0.07), ROM (SMD - 0.15, p = 0.27), flexion range (SMD - 0.11, p = 0.46), non-union rate (RR 1.01, p = 0.99), union time (RR 1.01, p = 0.99), or surgical duration (SMD 0.06, p = 0.74). However, orthogonal plating showed a statistically significant advantage in extension range (SMD 0.45, p = 0.005). The risk of bias was minimal, and the certainty of evidence was rated as high. CONCLUSIONS: Both orthogonal and parallel plating techniques demonstrated comparable efficacy in managing pediatric distal humeral fractures, with no significant differences in most outcomes. Orthogonal plating exhibited a slight advantage in extension range, though its clinical relevance requires further investigation.
Advancing knee diagnostics and treatment: the role of needle arthroscopy.
Compagnoni R, Pieroni A, Fedele G … +4 more , Maione A, Calanna F, Ferrua P, Randelli PS
Musculoskelet Surg · 2026 Mar · PMID 40411541 · Publisher ↗
Knee needle arthroscopy (NA) represents a minimally invasive diagnostic and therapeutic approach for managing a variety of knee joint pathologies. This innovative technique, characterized by a thin, flexible, needle-like...
Knee needle arthroscopy (NA) represents a minimally invasive diagnostic and therapeutic approach for managing a variety of knee joint pathologies. This innovative technique, characterized by a thin, flexible, needle-like device, offers a less invasive alternative to conventional arthroscopy (CA), enabling outpatient procedures with reduced postoperative pain, faster recovery, and minimal scarring. This systematic review examines the current applications, diagnostic accuracy, clinical outcomes, and patient benefits of needle arthroscopy. Studies reveal that NA demonstrates comparable diagnostic efficacy to CA and superior accuracy to MRI for intra-articular knee pathology, particularly in meniscal injuries and anterior cruciate ligament assessments. NA facilitates real-time visualization and interventions under local anesthesia, promoting cost-efficiency and patient satisfaction. Despite its advantages, there are challenges such as limited visualization and technical proficiency. While NA emerges as a promising modality in knee diagnostics and treatment, further large-scale clinical trials are essential to validate its long-term efficacy, safety, and broader applications.
Primary subtalar arthrodesis in displaced intra-articular calcaneal fracture: a systematic review.
Giuliani A, Calori S, Singlitico A … +3 more , Forconi F, Maccauro G, Vitiello R
Musculoskelet Surg · 2026 Mar · PMID 40375052 · Full text
Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for disp...
Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for displaced intra-articular calcaneal fractures (DIACFs), but it is associated with many complications. Our study aimed to review the current literature available on primary subtalar arthrodesis (PSA) as a first-line treatment for DIACFs, mostly Sanders type IV. In this study, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed, MEDLINE and the Cochrane Library. This review included articles where primary arthrodesis was performed in calcaneal fractures, with or without associated implants. Nine articles were included in the review. The total population comprised 184 patients with 192 calcaneal fractures. The mean age was 44.9 ± 6.9 years old. The mean follow-up period was 30.28 ± 15.29 months when reported. The mean time to surgery was 13.33 ± 7.02 days from injury. All studies reported a good fusion rate (between 94 and 100%) and an average fusion time of 4.05 ± 2.19 months. The mean American Orthopedic Foot & Ankle Society (AOFAS) score was 71.26 ± 8, and the mean Visual Analog Scale (VAS) score for pain was 3.26 ± 0.91. Primary arthrodesis of the subtalar joint for treating DIACFs, mostly Sanders type IV, provides good results due to the avoidance of further procedures, reduced postoperative pain, and a high rate of bony union. However, success heavily depends on factors such as patient comorbidities and addressing hindfoot deformity. Further studies with larger patient populations and more standardized protocols are necessary to draw definitive conclusions about the best management strategies for DIACFs. Systematic review, level III of evidence.
Scapular dyskinesis after breast reconstruction surgery for breast cancer: a retrospective clinical analysis on 67 patients.
Murena L, Santovito F, de Grazia A … +9 more , Libretti G, Galeazzi G, Sidoti GB, Renzi N, Trobec B, Buoite Stella A, Ramella V, Papa G, Canton G
Musculoskelet Surg · 2025 Dec · PMID 40342010 · Full text
PURPOSE: Mastectomy and breast reconstruction surgery are often associated with postoperative pain and functional limitation at the ipsilateral shoulder, potentially leading to scapular dyskinesis. However, few studies h...
PURPOSE: Mastectomy and breast reconstruction surgery are often associated with postoperative pain and functional limitation at the ipsilateral shoulder, potentially leading to scapular dyskinesis. However, few studies have determined how the type of surgery and rehabilitation might affect the development of such clinical condition. METHODS: A retrospective observational study was performed on a clinical database of females who underwent surgical and adjuvant disease control treatment against breast cancer. Data included in this analysis were: demographics and clinical history, type of surgery and duration of physiotherapy, complications, as well as scapulohumeral rhythm and shoulder soreness evaluated during the orthopedic visit. RESULTS: Based on the inclusion and exclusion criteria, 67 females (age 52 y, range 30-69) entered the statistical analysis. Static dyskinesis was present in 64.2% of the sample at the time of the visit, and it was found present bilaterally in 29.9% of the sample, whereas dynamic dyskinesis was found in 73.1% of the sample at the time of the visit. Longer physiotherapy (> 20 sessions) showed a trend for a lower risk of dynamic dyskinesis (OR 0.228, 95% CI 0.046-1.114, p = 0.072), and compared to the Subpectoral Tissue Expander, Prepectoral Implant-Based Breast Reconstruction presented a reduced risk for dynamic dyskinesis (OR 0.265, 95% CI: 0.074-0.952, p = 0.042). CONCLUSION: These preliminary findings suggest that some factors, such as the type of surgery and physiotherapy, might influence the development of scapular dyskinesis in females who undergo mastectomy and breast reconstruction.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe