Journal Of Orthopaedics And Traumatology[JOURNAL]
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200 papers
Fibrous dysplasia: clinical and pathologic characteristics, surgical approaches, and outcomes in a large Italian cohort.
Mordenti M, Trisolino G, Moroni A … +7 more , Parisi SC, Nanni S, Staals EL, Righi A, Gambarotti M, Donati DM, Sangiorgi L
J Orthop Traumatol · 2026 Jul · PMID 42402547 · Full text
Fibrous dysplasia (FD) is a rare benign bone disease caused by postzygotic activating mutations in the GNAS gene, leading to replacement of normal bone with fibrous tissue. It may be monostotic or polyostotic, often asym...
Fibrous dysplasia (FD) is a rare benign bone disease caused by postzygotic activating mutations in the GNAS gene, leading to replacement of normal bone with fibrous tissue. It may be monostotic or polyostotic, often asymptomatic but sometimes associated with pain, deformity, or fractures. Management is mainly surgical in symptomatic or complicated cases. This retrospective study analyzes a large FD cohort to identify determinants of treatment and outcomes, with a focus on pain and its evolution. The primary aim was to assess factors influencing surgical indication, while the secondary aim was to evaluate predictors of outcome in surgically treated patients, particularly symptom persistence at follow-up. A total of 227 patients were included. Mean age at diagnosis was 35.5 years (range 2-86 years); 79.3% had monostotic and 20.7% polyostotic FD. Pain was the most common presentation (62.6% at diagnosis; 78.4% during disease course), followed by incidental findings (21.6%), fractures (11.5%), and mass (4.4%). Surgery was performed in 51.6% of patients (127 lesions). Surgical patients were younger and had larger lesions and higher Mirels' scores (all p < 0.001), although Mirels' score showed only moderate predictive accuracy for surgery (area under the curve (AUC) 0.71). At a mean follow-up of 4.5 years, persistent pain was present in 24.1% of patients, with no significant difference between surgical and nonsurgical groups. Surgery was not an independent predictor of pain resolution in multivariable analysis. Postoperative complications occurred in 17.3% of procedures, with 7.1% requiring multiple revisions; rates were higher in polyostotic disease (21.3% versus 6.7%, p = 0.004). Our findings suggest that pain alone should not be used as an indication for surgery in FD, as it was not a reliable predictor of outcome in our study. Surgical decisions for pain relief should therefore be made with caution, and patients should be informed about the risk of persistent symptoms. Conservative, multidisciplinary management-including bisphosphonates, monoclonal antibodies, and psychological support-should be considered first-line, as it may improve symptoms and quality of life.
Glycemic variability improves risk prediction and reveals a mortality threshold in orthopedic trauma patients with sepsis.
Long Z, Wang W, Wang S … +5 more , Han T, Lin F, Li F, Qin Y, Lei M
J Orthop Traumatol · 2026 Jul · PMID 42387235 · Full text
BACKGROUND: Sepsis is a life-threatening complication in patients with orthopedic trauma, associated with significant mortality. Dysregulated glucose metabolism is a hallmark of critical illness, but the specific role of...
BACKGROUND: Sepsis is a life-threatening complication in patients with orthopedic trauma, associated with significant mortality. Dysregulated glucose metabolism is a hallmark of critical illness, but the specific role of glycemic variability (GV), beyond hyperglycemia, in this high-risk population remains inadequately explored.Kindly check and confirm the author and their respective affiliations 9 and 10 are correctly identified.Some changes have been made. Please refer to the eProofing system. METHODS: This retrospective cohort study utilized 1946 patients from the Beth Israel Deaconess Medical Center between 2008 and 2022. We included adult intensive care unit (ICU) patients with a primary diagnosis of orthopedic trauma and concurrent sepsis. GV was quantified as the coefficient of variation of all blood glucose measurements during the ICU stay. The primary outcome was all-cause mortality at in-hospital, 30-day, 90-day, and 365-day. Restricted cubic spline (RCS) analysis was used to determine the detailed relationship between GV and mortality and the optimal GV threshold for dichotomization. Propensity score matching and multivariable logistic regression were employed to control for confounders. RESULTS: The study cohort experienced substantial mortality, with rates of 16.0% (in-hospital), 19.8% (30-day), 26.4% (90-day), and 33.9% (365-day). RCS analysis revealed a significant nonlinear, J-shaped relationship between GV and all mortality end points (p < 0.001), characterized by an initial modest increase in risk followed by a sharp escalation beyond a specific threshold. The optimal GV thresholds for predicting in-hospital, 30-day, 90-day, and 365-day mortality were remarkably consistent (0.218, 0.217, 0.205, and 0.210, respectively), leading to a unified average dichotomization threshold of 0.213. After propensity score matching created a well-balanced cohort, high GV remained independently associated with significantly increased risks of mortality across all time points in the fully adjusted model (adjusted odds ratio (OR) for in-hospital mortality: 1.969, 95% confidence interval (CI): 1.379-2.811, p < 0.001; 30-day mortality OR: 1.744, 95% CI: 1.245-2.442, p = 0.001; 90-day mortality OR: 1.735, 95% CI: 1.268-2.375, p < 0.001; 365-day mortality OR: 1.815, 95% CI: 1.352-2.438, p < 0.001). Furthermore, adding GV significantly improved the predictive performance of the Oxford Acute Severity of Illness Score (OASIS) (area under the receiver operating characteristic curve (AUC) increased from 0.684 to 0.699 for in-hospital mortality, p = 0.008) and Charlson Comorbidity Index scores (AUC increased from 0.681 to 0.701, p = 0.001). CONCLUSIONS: In critically ill septic patients with orthopedic trauma, elevated GV is a potent, independent predictor of short- and long-term mortality, exhibiting a J-shaped relationship with mortality risk. GV values above 21.3% are associated with significantly higher mortality risk, and this threshold may serve as a useful prognostic marker for risk stratification. Furthermore, GV provides incremental prognostic value beyond established risk scores, highlighting its potential as a key metric for risk stratification.
Fibular allograft augmentation shows potential benefits in treating medial column comminuted proximal humeral fractures with osteoporosis: a secondary analysis of a randomized controlled trial.
Chai Y, Shi T, Jiang H … +6 more , Chen Y, Xu Z, Zhu Y, Ruan Z, Chen Y, Wang Q
J Orthop Traumatol · 2026 Jun · PMID 42350837 · Full text
BACKGROUND: Fibular allograft (FA) augmentation is proposed to address the lack of medial column support in plate-fixed proximal humeral fractures; however, the role of FA augmentation in these fractures remains inadequa...
BACKGROUND: Fibular allograft (FA) augmentation is proposed to address the lack of medial column support in plate-fixed proximal humeral fractures; however, the role of FA augmentation in these fractures remains inadequately elucidated. Our previous clinical trial did not show additional benefit in inserting an FA when treating adults with medial column comminuted proximal humeral fractures. Nonetheless, it is possible that some subgroups may still derive benefits from FA. This study aimed to investigate whether there were any subgroups benefit from FA. MATERIALS AND METHODS: Our randomized controlled trial (RCT) recruited adults with a medial column comminuted proximal humeral fracture and randomly allocated them to receive a surgery fixed with a locking plate (LP group) or with an LP augmented with an FA (FA group). This study was a subsequent subgroup analysis of the previous randomized controlled trial, in which we included 72 participants who completed follow-up at the time of 12 months for the current subgroup analysis. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 12 months postoperatively. The secondary outcomes included the DASH score at other time points, changes in neck-shaft angle and humeral head height. We used generalized linear models for subgroup analysis to evaluate the effect of intervention (FA or LP) on 12-month DASH score in subgroups. RESULTS: A total of 72 participants who completed follow-up at 12 months were included: 35 were in the FA group and 37 in the LP group. In participants with proximal humeral osteoporosis, both the unadjusted mean difference (-12.8; 95% confidence interval (CI) -22.2 to -3.2; p = 0.01) and the adjusted mean difference (-11.1; 95% CI -20.0 to -2.2; p = 0.02) in the 12-month DASH score were statistically significant. Furthermore, in proximal humeral osteoporosis category, the DASH scores at other time points showed the similar trends though did not reach statistical significance. CONCLUSIONS: FA augmentation seemed to have added values in treating osteoporotic proximal humeral fractures in combination with medial column comminution. LEVEL OF EVIDENCE: Level II, therapeutic study. TRIAL REGISTRATION: ChiCTR-IOR-16008817.
Thicker polyethylene inserts for varus deformity versus thinner inserts for flexion contracture in total knee arthroplasty: a retrospective comparative study.
Lee SH, Kwon HM, Lee WS … +1 more , Park KK
J Orthop Traumatol · 2026 Jun · PMID 42342953 · Full text
BACKGROUND: The success of total knee arthroplasty (TKA) depends on achieving precise mechanical alignment and stable soft tissue balance, with the thickness of the final polyethylene (PE) insert serving as a critical co...
BACKGROUND: The success of total knee arthroplasty (TKA) depends on achieving precise mechanical alignment and stable soft tissue balance, with the thickness of the final polyethylene (PE) insert serving as a critical component. However, the impact of preoperative factors on PE thickness remains unclear. In this study, we investigated the effects of preoperative knee alignment and clinical deformities on PE thickness. MATERIALS AND METHODS: The medical records of patients who underwent primary TKA between August 2024 and July 2025 were retrospectively evaluated. Preoperative radiographic parameters, including the hip-knee-ankle (HKA) angle, medial proximal tibial angle, lateral distal femoral angle (LDFA), joint-line convergence angle, weight-bearing line ratio (WBLR), and posterior tibial slope, were measured, along with the flexion contracture (FC) as a clinical factor. Intra-observer reliability was assessed using intraclass correlation coefficients (ICC). Linear regression analyses were performed to evaluate the effects of these preoperative factors on PE thickness. RESULTS: This study included 233 knees (158 patients). The intra-observer reliability of the radiographic parameters was excellent (ICC > 0.9). Multivariable linear regression revealed that preoperative HKA angle (β = 0.033, p < 0.001), WBLR (β = -0.008, p < 0.001), and LDFA (β = 0.065, p = 0.003) were significantly associated with final PE thickness. Preoperative FC demonstrated a significant negative correlation (β = -0.027, p = 0.011). In a subgroup analysis of knees with minimal FC, the mean PE thickness increased from 10.37 mm in mild varus to 12.75 mm in extreme varus. CONCLUSIONS: Preoperative HKA angle and FC were identified as significant predictors of PE insert thickness in TKA. Specifically, greater varus deformity resulted in a thicker PE insert, whereas more severe FC led to a thinner insert. Clinically, surgeons must anticipate gap expansion after medial release in varus knees, while accommodating the tight extension space in the FC. Level of evidence Level III, retrospective comparative study.
PediLoc blade plate yields faster consolidation rates than LCP pediatric condylar plate in distal femoral osteotomies: a retrospective comparison and description of surgical technique.
Tschudi S, Delay C, Krautwurst B … +2 more , Grisch D, Dreher T
J Orthop Traumatol · 2026 Jun · PMID 42340533 · Full text
BACKGROUND: The PediLoc Locking Cannulated Blade Plate System was originally designed for proximal femoral osteotomies but has also been used for multidimensional correction of distal femoral deformities. The present stu...
BACKGROUND: The PediLoc Locking Cannulated Blade Plate System was originally designed for proximal femoral osteotomies but has also been used for multidimensional correction of distal femoral deformities. The present study delineates the surgical technique and undertakes a retrospective analysis of the consolidation rates of distal femoral osteotomies performed using the aforementioned system, comparing them with those performed using the DePuy Synthes 90° LCP Pediatric Condylar Plate. We hypothesized that the semi-rigid design of the blade plate results in faster osteotomy healing rates compared with other locking screw plate systems. MATERIALS AND METHODS: This retrospective single-centre study included patients who underwent distal femoral osteotomy with the PediLoc Blade Plate (Blade Plate) and the DePuy Synthes 90° LCP Pediatric Condylar Plate (90° LCP-PCP) at the University Children's Hospital Zurich (2020-2024). Consolidation rates were assessed using "Regenerating Bone Defects Using New Biomedical Engineering" (REBORNE), "Radiographic Union Score for Tibial Fractures" (RUST) and modified RUST (mRUST) scores at 6 weeks and 3 months postoperatively and compared using using Wilcoxon signed-rank test. For the comparison between both intervention groups, the unpaired t-test was used for normally distributed data and the Mann-Whitney U test for non-normally distributed and ordinal data. For all tests, values of p < 0.05 were considered statistically significant. Geometric planes of osteotomy were analysed, and a stepwise correction technique was described. RESULTS: A total of 111 osteotomies with complete radiographic follow-up were analysed (77 Blade Plate [69.4%], 34 90° LCP-PCP [30.6%]). At 6 weeks, early consolidation (RUST score ≥ 10) was observed in 39% of Blade Plate cases versus 6% in the 90° LCP group. By 3 months, consolidation reached 91% in the Blade Plate group and 70% in the 90° LCP-PCP group. One Blade Plate case was excluded due to an implant-associated intraoperative fracture. CONCLUSIONS: The PediLoc Blade Plate facilitates stable, multidirectional correction of distal femoral deformities and achieves earlier radiographic consolidation of osteotomies compared with the 90° LCP-PCP without increased complication rates. Since faster consolidation was observed only in the RUST scores, the clinical relevance of this finding remains to be determined through prospective randomized controlled trials. LEVEL OF EVIDENCE: Level III, retrospective comparative study. TRIAL REGISTRATION: Clinicaltrials.gov, 2025-0000, registration date 14 April 2025, retrospectively registered, https://register. CLINICALTRIALS: gov/prs/beta/records.
Thin cortical translucent area of the iliac wing: morphometric analysis and implications for surgical safety.
Yücedağ Gündoğdu H, Paslı B, Erçakmak Güneş B
J Orthop Traumatol · 2026 Jun · PMID 42313293 · Full text
BACKGROUND: The iliac wing is a frequently used fixation site in the surgical management of pelvic and acetabular fractures. Achieving safe implant placement in this region necessitates a comprehensive understanding of l...
BACKGROUND: The iliac wing is a frequently used fixation site in the surgical management of pelvic and acetabular fractures. Achieving safe implant placement in this region necessitates a comprehensive understanding of local morphology. However, the morphometric characteristics and surgical safety margins of the thin cortical translucent area (PLA) located in the central iliac wing have not been sufficiently defined. This may pose a significant challenge in evaluating the risk of cortical perforation, particularly during implant placement. This study aimed to evaluate the morphometric characteristics of the PLA and its relationship to fixation corridors. METHODS: Fifty-one unpaired dry hip bones were examined. The thin cortical translucent region was identified using photoluminescence. Photograph-based measurements were conducted utilising ImageJ software on standardised photographs. Dimensions, area, distances to reference landmarks and relationships with the iliac pillar and supraacetabular corridors were assessed. The safe angular deviation range for anterior inferior iliac spine (AIIS)-origin screw fixation was calculated. Cortical thickness was measured using a digital thickness gauge. RESULTS: The vertical and horizontal diameters and area of the PLA were 56.24 ± 16.56 mm, 59.92 ± 24.83 mm and 28.10 ± 16.47 cm, respectively. Mean distances to the anterior superior iliac spine, posterior superior iliac spine, iliac crest and acetabular roof were 62.12 ± 19.84 mm, 71.03 ± 12.17 mm, 19.88 ± 11.61 mm and 56.02 ± 9.09 mm, respectively. The safe angular deviation for AIIS-origin screw fixation was 16.94° ± 4.43°. The central cortical thickness was 2.07 ± 1.60 mm (range 0.3-5.9). CONCLUSIONS: The PLA is a clinically important region characterised by marked central cortical thinning and individual variability. Individualised morphometric assessment and preoperative imaging may help define safer zones for fixation planning and donor-site procedures. LEVEL OF EVIDENCE: Level V.
Efficacy and safety of MIPO versus ORIF in distal tibial fractures: a systematic review and meta-analysis.
Hassaan AM, Hassan AA, Abdelkhalik WS … +8 more , Saad AM, Hosny AS, Elfeky BAEH, Mandour I, Ragheb MG, Elsayyad MAEA, Khalafalla MA, Imam MA
J Orthop Traumatol · 2026 Jun · PMID 42303945 · Full text
BACKGROUND: Distal tibial fractures are challenging to manage owing to limited soft-tissue coverage and compromised blood supply. Minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (O...
BACKGROUND: Distal tibial fractures are challenging to manage owing to limited soft-tissue coverage and compromised blood supply. Minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) are among the widely used surgical options, but the optimal approach remains unclear. MIPO preserves periosteal blood flow with smaller incisions, while ORIF offers direct visualisation but increases soft-tissue damage. With growing comparative evidence, an updated evaluation of these techniques is necessary. AIM: To compare the efficacy and safety of MIPO versus ORIF in adult patients with distal tibial fractures. METHODS: Following PRISMA guidelines and the Cochrane Handbook, we searched in PubMed, Embase, Cochrane, Scopus, and Web of Science till November 2025. Randomised trials and cohort studies comparing MIPO and ORIF were included. Data extraction was performed independently by two reviewers. Risk of bias was assessed using RoB 2 for RCTs and the Newcastle-Ottawa Scale for observational studies. Random-effects models were used to estimate pooled mean differences and odds ratios, and heterogeneity was assessed using I. Sensitivity and subgroup analyses were conducted by study design. RESULTS: Nine studies involving 530 patients met our inclusion criteria. No significant differences were found between MIPO and ORIF in AOFAS scores, union time, operative duration, hospital stay, return-to-work time, or major complications. MIPO showed trends toward shorter union time, reduced blood loss, and lower infection rates. Infection analysis showed a nonsignificant odds ratio (OR 0.57; 95% CI 0.24-1.33) but a statistically significant risk difference (RD -0.06; 95% CI -0.11 to -0.01), reflecting an absolute reduction of 4.6% with MIPO. Rates of malunion, delayed union, nonunion, and wound complications were similar between groups. CONCLUSIONS: MIPO and ORIF provide comparable functional and radiological outcomes for distal tibial fractures. MIPO offers modest advantages in soft-tissue preservation and infection risk. Surgical choice should be individualized on the basis of fracture characteristics and soft-tissue condition. Further multicenter randomized trials are needed.
Comparative efficacy and safety of aspirin, low-molecular-weight heparin, and rivaroxaban for deep venous thrombosis prophylaxis after hip arthroplasty for femoral neck fracture: a single-center randomized controlled trial.
Miao S, Yue Q, Zhang X … +4 more , Lu J, Zhang Y, Lu N, Wei L
J Orthop Traumatol · 2026 Jun · PMID 42295523 · Full text
OBJECTIVE: To evaluate the efficacy and safety of aspirin, low-molecular-weight heparin (LMWH), and rivaroxaban for deep vein thrombosis (DVT) prophylaxis after total hip arthroplasty (THA) or bipolar hemiarthroplasty (B...
OBJECTIVE: To evaluate the efficacy and safety of aspirin, low-molecular-weight heparin (LMWH), and rivaroxaban for deep vein thrombosis (DVT) prophylaxis after total hip arthroplasty (THA) or bipolar hemiarthroplasty (BHA) for femoral neck fracture, with subgroup analysis stratified by surgical type. METHODS: This single-center randomized controlled trial (RCT) was conducted between June 2024 and June 2025. A total of 217 consecutive patients with femoral neck fracture undergoing hip arthroplasty were initially screened, and 161 eligible patients were finally enrolled and randomly assigned to the aspirin group, LMWH group, or rivaroxaban group at a 1:1:1 ratio. All patients received standardized intermittent pneumatic compression (IPC) and graduated compression stockings for mechanical DVT prophylaxis, as well as a unified postoperative rehabilitation protocol. The primary outcome was the incidence of lower extremity DVT within 12 weeks postoperatively, confirmed by color Doppler ultrasound. The secondary outcome was the incidence of bleeding-related complications graded by the International Society on Thrombosis and Hemostasis (ISTH) criteria. All patients were followed up at 6, 8, and 12 weeks postoperatively, with routine bilateral lower extremity ultrasound performed at 12 weeks regardless of symptoms. Subgroup analysis was performed on the basis of surgical type (THA versus BHA). RESULTS: Among the 50 patients in the aspirin group, 5 (10.00%) developed DVT and 2 (4.00%) experienced bleeding complications. In the LMWH group (n = 58), 3 (5.17%) developed DVT and 3 (5.17%) had bleeding complications. In the rivaroxaban group (n = 53), 4 (7.55%) developed DVT and 12 (22.64%) had bleeding complications. No statistically significant difference in DVT incidence was observed among the three groups in either the overall cohort or THA/BHA subgroups (all P > 0.05). However, the incidence of bleeding complications in the rivaroxaban group was significantly higher than that in the aspirin and LMWH groups in both the overall cohort and surgical subgroups (all adjusted P < 0.0167). The baseline characteristics, surgical type distribution, operative duration, intraoperative complications, and postoperative ambulation time were well balanced among the three groups (all P > 0.05). CONCLUSIONS: Aspirin, LMWH, and rivaroxaban have comparable efficacy in reducing DVT incidence after both THA and BHA for femoral neck fracture. LMWH and aspirin exhibit more favorable safety profiles with significantly lower bleeding risk, while rivaroxaban is associated with a markedly higher incidence of bleeding complications and should be used with caution in elderly patients.
Does the surgical sequence of lumbar spine fusion and total hip arthroplasty affect the dislocation and revision risk? A meta‑analysis and systematic review.
Liu F, Jia C, Wu X … +1 more , Zhou Y
J Orthop Traumatol · 2026 Jun · PMID 42283757 · Full text
BACKGROUND: Patients who underwent primary total hip arthroplasty (THA) after lumbar spine fusion (LSF) had a higher incidence of complications compared with those who had not previously undergone LSF. This study aimed t...
BACKGROUND: Patients who underwent primary total hip arthroplasty (THA) after lumbar spine fusion (LSF) had a higher incidence of complications compared with those who had not previously undergone LSF. This study aimed to determine whether the timing of THA before or after LSF impacts the incidence of THA complications. METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Web of science, Embase, and Cochrane Library from their inception until 1 October 2025. Data from all eligible published studies meeting the inclusion criteria were extracted and subsequently analyzed using a random-effects model to calculate the rates of all-cause revision, dislocation, periprosthetic joint infections, and aseptic loosening. RESULTS: Our analysis included 10 studies involving 27,605 patients who underwent THA followed by LSF and 32,002 patients who received LSF prior to THA. There are no significant differences in the rates of dislocation (odds ratio [OR] 1.19, 95% confidence interval (CI) 0.73-1.86, p = 0.45), periprosthetic joint infections (OR 0.91, 95% CI 0.52-1.62, p = 0.76), and aseptic loosening (OR 0.89, 95% CI 0.74-1.08, p = 0.23) between the two surgical sequences, while for all-cause revision, the OR was (OR 1.01, 95% CI 0.70-1.47, p = 0.94), which reached statistical significance. CONCLUSIONS: Compared with the patients undergoing THA after LSF, no significant difference for complication rates was observed in patients with LSF after THA.
Effects of anterior cruciate ligament resection and total knee arthroplasty on lower limb alignment and tibiofemoral rotation.
Fan Y, Chen S, Jiang L … +3 more , Chen Z, Wu M, Wang C
J Orthop Traumatol · 2026 Jun · PMID 42262630 · Full text
BACKGROUND: The anterior cruciate ligament (ACL) is a key structure that restricts excessive anterior translation of the tibia and maintains rotational stability. This study aims to dynamically and quantitatively assess...
BACKGROUND: The anterior cruciate ligament (ACL) is a key structure that restricts excessive anterior translation of the tibia and maintains rotational stability. This study aims to dynamically and quantitatively assess the direct effects of ACL resection and total knee arthroplasty (TKA) on lower limb alignment and tibiofemoral joint rotation under passive, unloaded conditions and in the pathological state of osteoarthritis. METHODS: This retrospective study included 110 patients with varus knee osteoarthritis who underwent Mako for robotic-assisted TKA. Dynamic intraoperative measurements of the lower limb mechanical axis (flexion angle at maximum extension; varus angle) and tibiofemoral rotation at multiple flexion angles (min to max flexion) were recorded at three intervals: pre-ACL resection, post-ACL resection and post-TKA. The variation in rotation amplitude was calculated for successive flexion intervals. RESULTS: Post-ACL resection, a significant decrease in the flexion angle at the maximum extension and varus angle (both p < 0.001) was observed, which was accompanied by increased tibial internal rotation at flexion angles of 60° and above (p < 0.05). Varus alignment was successfully corrected following TKA (p < 0.001). However, tibiofemoral rotational kinematics were significantly modified: the amplitude of internal rotation decreased in the initial flexion arc (min to 30°) but increased in flexion intervals beyond 30° (all p < 0.01). CONCLUSIONS: Under passive, unloaded osteoarthritic conditions, ACL resection immediately alters lower limb alignment and increases tibial internal rotation. Although TKA restores coronal alignment, it does not fully restore passive rotational kinematics; whether this affects active weight‑bearing function remains unknown. Accordingly, we hypothesize that rotational stability is as critical as limb alignment in TKA, pending validation with patient-reported outcome measures, functional scores and postoperative follow-up.
Comparison of Bankart repair with remplissage and Latarjet procedure for anterior shoulder instability: a systematic review and meta-analysis.
Nong K, Liu G, Jiang S … +7 more , Li Q, Kwabena BR, Yuan D, Xiao W, Zhang K, Liu S, Li Y
J Orthop Traumatol · 2026 Jun · PMID 42251610 · Full text
BACKGROUND: Anterior shoulder instability is the most common type of shoulder instability. For cases with subcritical glenoid bone loss, both Bankart repair with remplissage (BR) and the Latarjet procedure are viable sur...
BACKGROUND: Anterior shoulder instability is the most common type of shoulder instability. For cases with subcritical glenoid bone loss, both Bankart repair with remplissage (BR) and the Latarjet procedure are viable surgical options. The aim of this study was to compare the postoperative outcomes in patients undergoing BR and Latarjet procedure. METHODS: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological index for nonrandomized studies (MINORS) was used to characterize the methodological quality. A literature search was conducted using PubMed, the Cochrane Library, Embase, Web of Science, and Scopus. The analyzed outcomes included postoperative Rowe score, visual analog scale (VAS) score, the Single Assessment Numeric Evaluation (SANE) score, range of motion (ROM), return-to-sport (RTS) rate, RTS time, recurrence rate, revision rate, and complications. Subgroup analysis was performed on the basis of follow-up duration. RESULTS: Overall, 12 studies involving 1186 patients were included. The meta-analysis showed that BR was associated with a significantly lower complication rate than the Latarjet procedure. No significant differences were observed in functional outcomes, ROM, recurrence, revision, RTS, or RTS time. Subgroup analysis showed a significant interaction between follow-up duration and outcomes, particularly for VAS and Rowe scores, with a trend toward better short-term results for BR and better longer-term results for Latarjet. CONCLUSIONS: BR and the Latarjet procedure provide comparable clinical outcomes for anterior shoulder instability, with BR demonstrating a significantly lower complication rate. Follow-up duration may influence VAS and Rowe outcomes, suggesting a potential temporal shift in treatment effects. LEVEL OF EVIDENCE: Level III. TRIAL REGISTRATION: CRD42024582343.
Risk of periprosthetic joint infection within 1 year following robotic-assisted versus conventional primary total knee arthroplasty: a propensity-score-matched cohort study.
Tian S, Li Y, Mu W … +4 more , Ji B, Zhang X, Cao L, Zhao J
J Orthop Traumatol · 2026 Jun · PMID 42247101 · Full text
BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly being adopted for its ability to enhance bone-resection accuracy and component alignment. However, whether these technical gains influence the...
BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) is increasingly being adopted for its ability to enhance bone-resection accuracy and component alignment. However, whether these technical gains influence the risk of periprosthetic joint infection (PJI) remains uncertain, especially in the context of prolonged operative duration. This study aimed to compare the 1-year rate of PJI following conventional total knee arthroplasty (cTKA) and RA-TKA in a propensity-score-matched cohort. METHODS: We retrospectively reviewed 1284 consecutive patients who underwent primary TKAs at a single centre between 2021 and 2023. The patients were stratified according to surgical technique (cTKA versus RA-TKA) and subsequently matched 1:1 using propensity score analysis (age, sex, body mass index [BMI], American Society of Anesthesiologists [ASA] score, Charlson Comorbidity Index [CCI] score, CCI components and smoking), resulting in 522 pairs (1044 patients) for the final comparative analysis. Operative time and 1-year PJI were assessed using multivariable logistic regression. Infections were stratified according to timing: ≤ 90 days and from 90 days to 1 year after surgery. RESULTS: The 1-year rate of PJI was 0.77% (4/522) after RA-TKA and 0.96% (5/522) after cTKA (P = 1.000). All PJIs in patients who underwent RA-TKA occurred within 90 days, whereas PJIs in patients who underwent cTKA occurred in both time windows. Multivariable logistic regression analysis did not identify surgical modality as an independent predictor of PJI (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.22-2.90; P = 0.57). The median operative time was longer in the RA-TKA group than in the cTKA group (115 (range, 90-145) versus 85 (range, 60-105) min; P < 0.001). CONCLUSIONS: RA-TKA was associated with a longer operative time, while no statistically significant difference in 1-year PJI rates was detected compared with cTKA. Nevertheless, these findings should be interpreted cautiously given the limited number of infection events. LEVEL OF EVIDENCE: Level 3, non-randomised observational study.
Measured resection, gap balancing, and force-sensor-guided total knee arthroplasty result in different femoral and tibial rotational alignment but similar combined knee rotation and clinical outcomes: a randomized controlled trial.
Hernández-Hermoso JA, Nescolarde L, Yañez-Siller F … +3 more , Calle-García J, Pérez-Andrés R, García-Perdomo D
J Orthop Traumatol · 2026 Jun · PMID 42240919 · Full text
BACKGROUND: Different alignment philosophies and balancing methods may alter femoral and tibial component rotation in distinct ways within the same knee. This study aimed to (1) determine which of three surgical techniqu...
BACKGROUND: Different alignment philosophies and balancing methods may alter femoral and tibial component rotation in distinct ways within the same knee. This study aimed to (1) determine which of three surgical techniques-measured resection (MR), gap balancing with computer-assisted surgery (GB-CAS), or a force-sensor soft-tissue balancing device (FS-STB)-most closely reproduces native femoral, tibial, and combined rotational alignment in mechanically aligned total knee arthroplasty (TKA), and (2) assess whether differences in rotational alignment affect outcomes at 5 years postoperatively. MATERIAL AND METHODS: A total of 60 patients undergoing primary mechanical alignment TKA were randomly assigned to one of three surgical approaches (n = 20 per group): MR, GB-CAS, or FS-STB. Blinded observers assessed the Knee Society Score (KSS), Western Ontario MacMaster Universities Osteoarthritis Index (WOMAC) score, and hip-knee-ankle angle preoperatively and at the 5-year follow-up visit. Pre- and postoperative two-dimensional (2D)-computed tomography scans were used to measure femoral rotation (BFA), tibial rotation, and combined femur-tibia rotation (TE_PTCA and BC_PTCA). Statistical analyses included paired t-tests, one-way analysis of variance, and effect size calculations. RESULTS: Femoral rotation remained unchanged in the MR and GB-CAS groups, but decreased slightly (1° external rotation) in the FS-STB group (P = 0.010). Tibial rotation increased significantly in internal rotation in the GB-CAS and FS-STB groups (P < 0.001), but not in the MR group (P = 0.061). The combined TE-PTCA rotation decreased slightly across all groups (P < 0.05), with no significant intergroup differences. Combined BCPTCA rotation increased only with GB-CAS (P = 0.006), but again without significant differences between the techniques. At 5 years, functional KSS and WOMAC scores improved in the FS-STB group compared with that in the MR group, although this difference was not statistically significant (P = 0.058 and P = 0.056, respectively). CONCLUSIONS: Measured resection best preserved native knee rotation in mechanically aligned TKA. Although the individual component rotations varied by technique, the overall combined rotational alignment and functional outcomes did not differ significantly. Prosthesis design may govern the kinematics, and soft tissue adaptation may mitigate the impact of minor rotational differences in TKA procedures. More technologically assisted balancing methods may not provide meaningful functional advantages in terms of rotational alignment. LEVEL OF EVIDENCE: Level I, therapeutic study. Trial registration Retrospectively registered on the UK's Clinical Study Registry platform. REGISTRATION NUMBER: ISRCTN66642689). Date of registration: 25/10/2025.
Risser growth plate injury in unstable paediatric pelvic fractures: a multicentre retrospective study.
Oransky M, Aulisa AG, Roncoroni A … +5 more , Zoppi AR, Mata M, Rohayem MA, Falciglia F, Toniolo RM
J Orthop Traumatol · 2026 May · PMID 42216996 · Full text
INTRODUCTION: Unstable pelvic fractures in children are rare but severe injuries and are associated with high-energy trauma. Unlike adults, children have open growth plates, particularly the Risser growth plate (RGP), wh...
INTRODUCTION: Unstable pelvic fractures in children are rare but severe injuries and are associated with high-energy trauma. Unlike adults, children have open growth plates, particularly the Risser growth plate (RGP), which is vulnerable to injury. The presence of growth plates, such as the triradiate cartilage and Risser's plate, represents point of vulnerability that determines distinctive fracture patterns, similar to those seen with Salter-Harris growth plate injuries. Lateral compression fracture is the most common mechanism and results in an irreducible crushing of the sacral alae, causing a rotational deformity. Both vertical and lateral compression displaced pelvic fractures require careful evaluation of the posterior iliac apophysis-associated injury. Failure to treat Risser growth plate injury (RGPI) can lead to severe long-term problems such as limb length discrepancy and scoliosis. This study aimed to determine how commonly RGPI occurs in unstable paediatric pelvic fractures, link it to specific fracture patterns and propose a subgroup type to improve treatment. MATERIALS AND METHODS: This multicentre retrospective study included 40 children aged up to 12 years with unstable pelvic fractures (AO/OTA 61B and 61C). The patients were treated between 1987 and 2022 at trauma centres in Italy, Argentina and Venezuela. We reviewed patient demographics, injury mechanisms and computed tomography (CT) scans to classify fractures using the AO/OTA system and identify RGPI. Statistical analysis was used to explore links between RGPI and specific fracture features. RESULTS: Forty children (25 males; mean age 7.3 ± 3.6 years) were included. RGPI occurred in 26/40 patients (65%), with 19/21 cases (90.4%) in AO/OTA type C fractures. RGPI significantly correlated with complex posterior fracture-dislocations (p = 0.001) and AO/OTA type C injuries (p = 0.0007). Three RGPI types were identified: type 1 (minimally displaced), type 2 (avulsed RGP with sacroiliac [SI] joint disruption) and type 3 (bilateral lesions). In total, 11 of 13 patients (84.6%) with at least 2 years of follow-up developed deformities. DISCUSSION AND CONCLUSIONS: RGPI is a common and critical part of unstable paediatric pelvic fractures, especially severe ones. In patients below the age of 7 years old with displaced and unstable pelvic fractures, the Risser's growth plates and posterior iliac apophysis are involved in 50% of cases. The Tile/AO classification, adapted to include concurrent injuries of the growth plates, offers a useful framework for treatment planning. Although the Torode and Zeig classification remains the standard, it is incomplete because it does not consider injuries related to the Risser growth plate. Our findings suggest that unrecognised or inadequately reduced RGPI causes severe, progressive functional deformities, such as limb length discrepancy, rather than mechanical instability. Although further prospective validation is needed, we hypothesize that anatomical reduction of these specific physeal injuries should be considered to prevent severe growth arrest. Our proposed classification seeks to improve upon traditional frameworks by incorporating this critical structure. LEVEL OF EVIDENCE: Level 4 (case series).
Total femur replacement: function, quality of life, and gait: a multicentric EMSOS study.
Valentini M, Svehlik M, Leithner A … +3 more , Bergovec M, EMSOS TFR Study Group, Smolle MA
J Orthop Traumatol · 2026 May · PMID 42209906 · Full text
BACKGROUND: Total femur replacements (TFRs) involve the replacement of the whole femoral bone, reconstruction of the hip and knee joints, and soft tissue reconstruction for function and joint stability. The aim of this m...
BACKGROUND: Total femur replacements (TFRs) involve the replacement of the whole femoral bone, reconstruction of the hip and knee joints, and soft tissue reconstruction for function and joint stability. The aim of this multicentric European Musculo-Skeletal Oncology Society (EMSOS) study is to report on the functional outcome, quality of life, as well as gait analysis in patients with TFR. MATERIALS AND METHODS: Retrospective data from 12 international participating centers were collected. In total, 65 patients [median (IQR) age at surgery 40 (18-56) years, 60% male] who received a TFR owing to oncologic or nononcologic indications between 1 January 1990 and 31 March 2024 were included. Patient-related outcome measures (PROMs), range of motion (ROM) of the hip and knee, and gait videos were collected. RESULTS: At a median (IQR) follow-up of 28 (14-126) months, the median (IQR) percentage Musculoskeletal Tumor Society (MSTS) score was 63% (43-73%), 12-Item Short-Form Health Survey (SF-12) was 70% (55-79%), Harris Hip Score (HHS) was 63% (52-77%), and Oxford Knee Score (OKS) was 63% (52-79%); the median (IQR) extension-to-flexion ROM were 80° (70-97.5°, hip) and 70° (40-90°, knee). Gait videos were available for 24/65 patients (37%). The median (IQR) total Edinburgh Visual Gait Score of the operated side was 8.5 (6-13), with deviations from norm in all patients (24/24). Compensational gait pathology on the contralateral side was detected in 23/24 patients (96%). Better outcome measures significantly correlated with younger age (all PROMs), oncologic indications (MSTS and OKS), and primary TFR implantations (MSTS). CONCLUSIONS: Moderate-to-good PROM scores are to be expected after TFR, with better outcomes in younger patients undergoing primary implantations for oncologic indications. The reported results must be appraised as best-case estimates. The recurrent gait deviations observed and the compensational gait pathology on the contralateral side should be considered in TFR aftercare, remobilization, and patient counseling. LEVEL OF EVIDENCE: Level III, therapeutic study.
Vascularized versus nonvascularized free fibular grafts in reconstruction of post-traumatic critical long bone defects, a comparative study.
Fouaad AA, Massoud AH, Shaban M … +2 more , Abdel-Naby M, Abulsoud MI
J Orthop Traumatol · 2026 May · PMID 42177697 · Full text
BACKGROUND: Reconstruction of critical-sized long bone defects is a complex orthopedic challenge. Free fibular grafts, vascularized (FVFG) and nonvascularized (NVFG), are established reconstructive options, but comparati...
BACKGROUND: Reconstruction of critical-sized long bone defects is a complex orthopedic challenge. Free fibular grafts, vascularized (FVFG) and nonvascularized (NVFG), are established reconstructive options, but comparative clinical outcomes remain uncertain. PURPOSE: To compare clinical and radiological outcomes of FVFG and NVFG in patients with post-traumatic critical bone defects more than 10 cm. METHODS: A randomized controlled trial was conducted with 50 patients assigned equally to FVFG or NVFG groups. The primary outcome was time to union, while secondary outcomes included graft hypertrophy, functional scores (DASH and LEFS), complication rates, and donor site morbidity. RESULTS: The mean time to union was 5.78 months in the FVFG group and 6.17 months in the NVFG group, showing no statistically significant difference (p = 0.447). Rates of graft hypertrophy, functional recovery, and complications were comparable between the groups. CONCLUSIONS: Both FVFG and NVFG provide effective reconstruction for critical bone defects, with nearly similar healing times and functional outcomes. NVFG may represent a less complex alternative in selected cases.
Five-year outcomes of medial open-wedge high tibial osteotomy with lateral supplemental lag screw in patients with obesity.
Tian YH, Lee KH, Huang CW … +2 more , Lin SY, Yang JC
J Orthop Traumatol · 2026 May · PMID 42086951 · Full text
BACKGROUND: Obesity contributes to the accelerated progression of knee osteoarthritis. Medial open-wedge high tibial osteotomy (MOWHTO) is a joint-preserving surgical intervention for unicompartmental knee osteoarthritis...
BACKGROUND: Obesity contributes to the accelerated progression of knee osteoarthritis. Medial open-wedge high tibial osteotomy (MOWHTO) is a joint-preserving surgical intervention for unicompartmental knee osteoarthritis; however, its efficacy in patients with obesity remains controversial. This study aimed to evaluate the 5-year clinical and radiographic outcomes of MOWHTO with lateral supplemental lag screw fixation in patients with obesity. MATERIALS AND METHODS: This retrospective cohort study included patients with obesity who underwent MOWHTO between 2017 and 2020, with a minimum follow-up of 5 years. All procedures were performed by a single surgeon using three-dimensional printed, patient-specific instrumentation, locking plates, and a lateral supplemental lag screw. Clinical outcomes were assessed using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic parameters, including the weight-bearing line percentage (WBL%) and medial proximal tibial angle (MPTA), were evaluated. RESULTS: Significant improvements in VAS and WOMAC scores were observed at all postoperative time points (p < 0.001) and were accompanied by improved radiographic alignment, with WBL% shifting toward the Fujisawa point and increased MPTA values. At 5 years, mild regression in alignment was noted; however, the overall correction was maintained. The 5-year conversion rate of TKA was 3.8%. Lateral hinge fractures occurred in 3.8% of cases and healed without loss of correction. CONCLUSIONS: Medial open-wedge high tibial osteotomy is associated with satisfactory 5-year clinical and radiographic outcomes in patients with obesity. Obesity is not necessarily a contraindication for HTO, although appropriate patient selection and long-term follow-up are essential for this procedure. LEVEL OF EVIDENCE: III, Retrospective cohort study.
Outcomes of surgical fixation of osteochondral fracture: a systematic review.
Pang AS, Oviya R, Tan JJ … +3 more , Lim KSA, Hui JHP, Tan SHS
J Orthop Traumatol · 2026 May · PMID 42081062 · Full text
BACKGROUND: Dealing with knee osteochondral defects presents a substantial clinical challenge due to the variable nature of repair outcomes and intricate biomechanical complexities inherent to the knee joint. Numerous su...
BACKGROUND: Dealing with knee osteochondral defects presents a substantial clinical challenge due to the variable nature of repair outcomes and intricate biomechanical complexities inherent to the knee joint. Numerous surgical alternatives exist for addressing knee osteochondral lesions, yet there is limited evidence available for comparing their respective outcomes. METHODS: According to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines, a systematic literature search was conducted to identify publications from inception to September 2023 on PubMed, Cochrane, and Medline academic search engines with the MeSH terms "osteochondral" AND ("patella" OR "patellar" OR "patellofemoral" OR "femoral condyle lesions" OR "trochlear lesions"). Inclusion criteria were clinical human studies, English language, subjects who underwent surgical management (fixation, reconstruction, or debridement) for knee osteochondral lesions with reported treatment outcomes, and a minimum sample size of ten patients. The methodological index for non-randomized studies (MINORS) was used to evaluate the non-randomized studies' methodological quality. Main outcome measurements Pediatric International Knee Documentation Committee (Pedi IKDC) scale, Tegner-Lysholm Scoring Scale, Tegner Activity Score, Visual Analog Scale, Knee Society Score (KSS) Score, Kujala Score, and Fulkerson score were collected. RESULTS: In all, 25 studies were included with 1093 patients in total. The analysis revealed that patellar lesions had similar outcomes to femoral lesions. Surgical fixation demonstrated superior outcomes compared with debridement, with improvements observed across multiple validated outcome measures. Both fixation and reconstruction resulted in significant improvement in outcomes. Osteochondral fragment size, age, and sex did not influence postoperative outcomes. CONCLUSIONS: While surgical management of knee osteochondral defects consistently yields significant functional improvement, the current evidence favors anatomic restoration via fixation or reconstruction over debridement. Despite the variability in patient demographics and reported outcomes, these findings suggest that treatment selection should be prioritized on the basis of lesion characteristics and specific surgical technique rather than age alone. However, given the significant heterogeneity, wide age range, and missing demographic data across the literature, these findings should be interpreted as observed associations rather than definitive evidence of clinical superiority. They underscore the need for tailored treatment strategies and highlight the requirement for high-level, standardized research with consistent use of validated outcome measures and established minimal clinically important difference (MCID) thresholds to further clarify optimal surgical interventions. TRIAL REGISTRATION: The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) international prospective register of systematic reviews database (CRD42024596365).
Do modular tapered long stems differ in stability and function? A prospective comparison of two stems in complex femoral revision THA.
Fahmy M, Shawky MA
J Orthop Traumatol · 2026 May · PMID 42081054 · Full text
BACKGROUND: Revision total hip arthroplasty (rTHA) in the setting of substantial proximal femoral bone loss is technically challenging. Modular tapered fluted stems provide predictable diaphyseal fixation while allowing...
BACKGROUND: Revision total hip arthroplasty (rTHA) in the setting of substantial proximal femoral bone loss is technically challenging. Modular tapered fluted stems provide predictable diaphyseal fixation while allowing independent adjustment of version, offset, and limb length. Among these, two commonly used systems-modular tapered fluted stem Type A (Revitan) and Type B (LIMA Modulus)-have limited direct comparative evidence. This study aimed to prospectively compare radiographic stem subsidence (primary outcome), as well as functional outcomes, complications, survivorship, and secondary outcomes, between Type A and Type B modular long stems in femoral rTHA. METHODS: In this single-center randomized prospective study, 110 patients undergoing femoral revision rTHA were randomly assigned to receive either Type A (n = 55) or Type B (n = 55) stems. All procedures were performed by experienced revision surgeons under standardized perioperative and rehabilitation protocols. Radiographs were analyzed for stem subsidence, osseointegration, and limb-length restoration. Functional outcomes were assessed using the Harris Hip Score (HHS), Oxford Hip Score (OHS), and European Quality of Life Visual Analogue Scale (EQ-VAS) at baseline and final follow-up (mean 61.4 months). Complications and stem survivorship were recorded prospectively. Statistical analysis included paired and unpaired comparisons, correlation, regression, and Kaplan-Meier survival estimates. RESULTS: Baseline demographics and femoral defect severity were comparable. Both groups achieved high radiological stability, with mean distal subsidence of 1.3 ± 0.7 mm (Type A) and 1.5 ± 0.9 mm (Type B; p = 0.24), and osseointegration in > 92% of cases. Limb-length and offset restoration were similar. HHS improved significantly in both groups (Type A: 44.7 → 88.1; Type B: 45.1 → 87.3; p < 0.001), with > 80% achieving good-to-excellent outcomes. Complication rates were low and comparable. Five-year stem survivorship was 98.2% (Type A) and 97.6% (Type B). Early full weight-bearing and lower Paprosky defect grades independently predicted superior functional outcomes, whereas stem type did not. CONCLUSIONS: Both Type A and Type B modular tapered fluted stems demonstrated durable fixation, minimal subsidence, low complication rates, and excellent mid-term functional recovery. Radiographic stem subsidence did not differ between groups, indicating that design variations do not significantly affect clinical outcomes. These findings support the use of modular tapered fluted stems as reliable solutions in complex femoral rTHA.
Clinical comparison of single posterolateral plate with medial-cannulated-screw fixation and double-plate fixation for extra-articular distal humerus fractures.
Jung HS, Chu MS, Lee JS
J Orthop Traumatol · 2026 May · PMID 42065830 · Full text
BACKGROUND: Double-plate fixation is the gold standard for extra-articular distal humerus fractures, but it carries a substantial risk of postoperative ulnar neuropathy. Fixation using a single posterolateral plate with...
BACKGROUND: Double-plate fixation is the gold standard for extra-articular distal humerus fractures, but it carries a substantial risk of postoperative ulnar neuropathy. Fixation using a single posterolateral plate with a medial cannulated screw may reduce ulnar neuropathy while maintaining fracture stability. This study aimed to compare the clinical outcomes of single-plate-with-medial-screw fixation versus double-plate fixation for extra-articular distal humerus fractures. MATERIALS AND METHODS: Fifty-six patients who underwent surgery for extra-articular distal humerus fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] classification A2 or A3) between January 2018 and August 2024 were divided into a double-plate group and a single-plate-with-medial-screw group. We conducted a retrospective, nonrandomized comparative study. The double-plate fixation was used in 30 patients from January 2018 to October 2021, while the single-plate fixation with a medial screw was used in 26 patients from November 2021 to August 2024. All surgeries were performed using a posterior paratricipital approach. Bony union, radiographic healing, and loss of reduction were evaluated. Postoperative pain scores (visual analog scale at 2 days after the operation), operative time (minutes), elbow range of motion, elbow function (Mayo Elbow Performance Score [MEPS]), and the presence of postoperative ulnar neuropathy were compared between the two groups. RESULTS: The double-plate fixation and single-plate fixation with a medial screw were performed in 30 and 26 patients, respectively. The mean age was 54.8 ± 19 (range, 17-85) years, and the mean follow-up duration was 18.2 ± 6.5 (range, 12-38) months. All fractures achieved solid osseous union at final follow-up. No significant differences were observed between the groups in terms of postoperative pain score, range of motion, and MEPS (all p > 0.05). However, the operative time was shorter for the single-plate-with-medial-screw group than that for the double-plate group (112.5 ± 25.7 versus 172.2 ± 35.2 min, p < 0.05), and the operative time was significantly associated with the fixation method (p < 0.05). In addition, postoperative ulnar neuropathy occurred less frequently with the single-plate-with-medial-screw group than with the double-plate group (8% versus 37%, p = 0.013). CONCLUSIONS: Both double-plate and single-plate-with-medial-screw fixation showed comparable union rates and functional outcomes in extra-articular distal humerus fractures. However, single-plate fixation with a medial screw required a shorter operative time and was associated with a lower incidence of postoperative ulnar neuropathy than double-plate fixation. Level of evidence Level III, retrospective comparative study.
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