Journal Of Orthopaedics And Traumatology[JOURNAL]
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200 papers
Utility of computed tomography in children's ankle fractures from classification to surgical planning.
Aletto C, Marsiolo M, Florio M … +4 more , Aulisa AG, Toniolo RM, Falciglia F, Maffulli N
J Orthop Traumatol · 2025 Jul · PMID 40627225 · Full text
BACKGROUND: Ankle fractures are common in the pediatric population. Plain radiographs provide sufficient information for the diagnosis, but computed tomography (CT) can help to study the configuration of fracture and to...
BACKGROUND: Ankle fractures are common in the pediatric population. Plain radiographs provide sufficient information for the diagnosis, but computed tomography (CT) can help to study the configuration of fracture and to plan fixation. Our study aims to study pediatric population with ankle fracture, understanding whether CT scans should be extended to all ankle fractures admitted to the Orthopaedic Department after a first radiographic evaluation, independent of the pattern of physeal plate fracture. MATERIALS AND METHODS: Data about patients with ankle fractures admitted to the Orthopaedic Department were retrieved. The diagnosis and classification of ankle fractures obtained from plain radiographs were compared with those obtained from CT scans. For each patient, data about conservative or surgical management were retrieved. After collecting all the mentioned data, a survey with 61 plain radiographs of children's ankle fractures was proposed to 16 orthopedic surgeons of the department divided into three groups according to their years of experience in Paediatric Orthopaedics and Trauma. The survey consisted of five questions for each radiograph regarding Salter-Harris (SH) classification, management, indication for CT, number, and direction of screws (if needed). RESULTS: A total of 130 patients with ankle fractures satisfied the inclusion criteria and only 26 of them were classified according to the SH classification by orthopedic surgeons or radiologists after plain radiography. Almost all pediatric patients with ankle fractures admitted to the Orthopaedic Department, after evaluation of plain radiographs in the emergency department (ED), underwent CT with three-dimensional (3D) reconstruction to plan fixation or nonoperative management. CT may lead to reclassification of some fractures, showing that SHIV fractures may be more common than expected. A total of 6 orthopedic surgeons answered the survey on 61 ankle fracture plain radiographs. Independent of their experience, orthopedic surgeons tend to respond similarly to SH classification and fracture management, while they have contrasting opinions about performing CT scans. Analyzing their response to the number of screws, entry points, and directions and comparing them with postoperation radiographs, the results between responders were very discordant. CONCLUSION: In children's ankle fracture involving the physeal plate, the SH classification, fracture management planning, the identification of the entry point and the direction of the screw could be more accurate using CT compared with plain radiographs. LEVELS OF EVIDENCE: Level IV, according to the Oxford 2011 Levels of Evidence.
Association between ACL tear chronicity and ramp lesion subtypes: double longitudinal ramp lesions are predominant in chronic ACL tears.
Roh SH, Lee SS, Lee DH
J Orthop Traumatol · 2025 Jul · PMID 40616683 · Full text
BACKGROUND: Few studies have investigated the relationship between the chronicity of anterior cruciate ligament (ACL) tears and the incidence of ramp lesion subtypes. The purpose of this study was to evaluate the relatio...
BACKGROUND: Few studies have investigated the relationship between the chronicity of anterior cruciate ligament (ACL) tears and the incidence of ramp lesion subtypes. The purpose of this study was to evaluate the relationship between the chronicity of ACL tears and the new subtypes of ramp lesions for treatment selection. METHODS: Between May 2015 and April 2023, 367 patients who underwent primary ACL reconstruction were evaluated. Meniscal repair was performed in cases where a ramp lesion was identified. According to the exclusion criteria, 96 patients who underwent repair of ramp lesion were divided into three groups (PR type: pure ramp lesion, RR type: red-red ramp lesion, and DL type: double longitudinal ramp lesion), and the groups were compared for chronicity of ACL tears and time from injury (TFI). RESULTS: Of the 30 patients classified as having PR type lesions, 11 (36.7%) had chronic ACL tears. Likewise, of the 37 patients classified as having RR type lesions, 14 (37.8%) had chronic ACL tears. In contrast, among the 29 patients classified as having DL type lesions, 20 (69.0%) had chronic ACL tears, indicating a statistically significant difference (p < 0.05). This distinction was significant up to 12 months after injury. CONCLUSIONS: Pure ramp lesions accounted for only 31% of all ramp lesions in ACL tears. In addition, chronic ACL tears are more frequently accompanied by double longitudinal tears than by red-red zone longitudinal tears or pure ramp lesions of the meniscus posterior horn. STUDY DESIGN: case series, level of evidence IV.
The role of early weight bearing in the aftertreatment of unilateral displaced intraarticular calcaneal fractures: a systematic review and pooled analysis.
Verstappen C, Driessen MLS, Brandts L … +4 more , Edwards MJR, Poeze M, Hermans E, Kalmet PHS
J Orthop Traumatol · 2025 Jul · PMID 40608204 · Full text
BACKGROUND: Displaced intraarticular calcaneal fractures (DIACFs) remain a complex challenge in orthopedic practice due to their complexity and the intricate nature of surgical interventions. While surgical techniques ha...
BACKGROUND: Displaced intraarticular calcaneal fractures (DIACFs) remain a complex challenge in orthopedic practice due to their complexity and the intricate nature of surgical interventions. While surgical techniques have evolved, postoperative rehabilitation is equally crucial for achieving optimal outcomes. This systematic review evaluates the effects of early weight bearing (EWB) in surgically treated patients with unilateral DIACFs on patient-reported outcomes, health-related quality of life, postoperative pain, differences in Böhler's angle, and complication rates. METHODS: A systematic literature search was performed across PubMed, Embase, and Cochrane Library up to January 2025. Eligible studied included adults (≥ 18 years) who underwent surgery for unilateral DIACFs (Sanders type II-IV), implemented an EWB protocol, reported at least one patient-reported outcome, and were published from 2000 onward. Data extraction and quality assessment were conducted using the Newcastle-Ottawa Scale. RESULTS: From 1007 identified records, 20 studies (n = 1051 DIACFs) met the inclusion criteria. Pooled results showed a mean American Orthopedic Foot and Ankle Society (AOFAS) Score of 85.7, Maryland Foot Score of 91.1, and visual analog score of 1.9. The analysis revealed a decline of 0.4 degrees in Böhler's angle from postoperative to last follow-up. The overall complication rate was 13.9%. CONCLUSIONS: EWB protocols appear to be safe and beneficial in the postoperative management of DIACFs, yielding favorable outcomes without increased complication rates. These findings support the reconsideration of current conservative weight-bearing guidelines. Future research should focus on the development of standardized, evidence-based after-treatment guidelines. Level of evidence Level I. Trial registration PROSPERO CRD42022280985.
Exploring gender disparities: a survey among orthopedic residents.
Ravaglia R, Mazzola V, Ferrua P … +3 more , La Verde L, Formica M, Randelli PS
J Orthop Traumatol · 2025 Jul · PMID 40608188 · Full text
INTRODUCTION: The representation of women in the medical field has significantly increased in recent decades. However, their presence in surgical specialties, particularly in orthopedic surgery, remains disproportionatel...
INTRODUCTION: The representation of women in the medical field has significantly increased in recent decades. However, their presence in surgical specialties, particularly in orthopedic surgery, remains disproportionately low. This study investigates gender discrimination and disparities in Italian orthopedic residency programs, expanding on existing literature, which indicates that female surgeons worldwide face challenges such as fewer promotions, lower salaries, and higher rates of harassment. MATERIALS AND METHODS: From June to August 2024, the SIAGASCOT Junior Committee conducted a voluntary and anonymous survey among registered male and female orthopedic residents. The survey was distributed via email and social media and included 23 questions covering demographics, training opportunities, perceptions of gender discrimination, and experiences of physical or verbal harassment. Statistical analyses were performed using the Chi-squared test and Mann-Whitney U test to compare gender-based differences. RESULTS: A total of 394 residents were invited to participate in the survey, and 81 residents participated: 46 women (56.8%), 34 men (42%), and 1 respondent who preferred not to disclose his or her gender (response rate: 20.5%). While no significant gender disparities were observed in access to training opportunities, such as international experiences or professional memberships, significant gender differences emerged in perceptions of discrimination. Notably, 84.8% of female respondents reported being considered "unsuitable" for orthopedic surgery solely owing to their gender, compared with 0% of male respondents (p < 0.01). In addition, 85% of women reported experiencing verbal or physical harassment, primarily from male superiors or patients. CONCLUSIONS: This study highlights the persistence of gender disparities in orthopedic surgery, with notable differences in perceived discrimination and harassment experiences between male and female residents. Although training opportunities appear to be equally distributed, the reported gender disparities seem to arise from subjective perceptions and cultural attitudes rather than measurable differences. Addressing these disparities requires cultural shifts, mentorship programs, and institutional policies aimed at eliminating harassment and promoting equity, ultimately fostering a more inclusive and supportive environment in orthopedic surgery. LEVEL OF EVIDENCE: III.
Percutaneous clamp reduction technique using plate as a position template during minimally invasive plate osteosynthesis for the treatment of tibial shaft fractures.
Cui Y, Ren G, Wang Y … +3 more , Yuan B, Peng C, Wu D
J Orthop Traumatol · 2025 Jul · PMID 40608158 · Full text
BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) has become an effective option for tibial shaft fracture surgery owing to its protection of the osteogenic microenvironment. However, the nonexposure of the frac...
BACKGROUND: Minimally invasive plate osteosynthesis (MIPO) has become an effective option for tibial shaft fracture surgery owing to its protection of the osteogenic microenvironment. However, the nonexposure of the fracture site also makes satisfactory reduction challenging. In this study, we designed a strategy of percutaneous clamping reduction assisted by the implanted plate as a template. METHOD: A retrospective analysis of patients with tibial shaft fractures who underwent percutaneous clamping reduction using a plate as a template was performed. From March 2017 to April 2022, a total of 110 patients (mean age: 30.3 years) were included. The reduction time, intraoperative blood loss, the effect of reduction, and postoperative radiographs were recorded and evaluated. The healing time, recovery of limb function, and complications were also assessed. RESULTS: The average reduction time was 8.3 ± 5.8 min. The average intraoperative bleeding was 20.6 ± 5.9 ml. The radiographs after reduction showed most patients achieved near-perfect alignment with the average coronal varus or valgus angulation of 1.8° ± 0.7° and the average sagittal anterior/posterior angulation of 2.9° ± 0.9°, and one (0.9%) patient had malreduction due to improper plate shaping. Bone healing was achieved in all patients, with an average fracture healing time of 3.8 ± 1.4 months. Complications included one case of bone nonunion (0.9%) and one case of postoperative infection (0.9%), both of which achieved bone union after secondary treatment. Additionally, there was one patient with extensor hallucis longus tendon contracture and one patient with flexor hallucis longus tendon contracture. Both cases had minimal functional impact. Importantly, there were no neurovascular injuries or hematomas. CONCLUSIONS: By using the plate, which can perfectly match the anatomical structure, as a positional template to assist the percutaneous clamp reduction, a more accurate and reliable reduction was achieved with minimal surgical disturbance. It is a key advancement in clinical practice with promising applications for more complex fractures and diverse anatomical locations. Level of evidence Therapeutic level III.
Intensive care needs after hip and knee replacement: understanding risk profiles for severe postoperative complications.
Holzapfel DE, Kappenschneider T, Holzapfel S … +4 more , Schuster MF, Michalk K, Auer P, Schwarz T
J Orthop Traumatol · 2025 Jul · PMID 40608156 · Full text
BACKGROUND: The etiology of serious life-threatening events after total joint arthroplasty (TJA) is poorly elaborated and understood in literature. The purpose of this study was to identify independent predictors of post...
BACKGROUND: The etiology of serious life-threatening events after total joint arthroplasty (TJA) is poorly elaborated and understood in literature. The purpose of this study was to identify independent predictors of postoperative intensive care following total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to clarify the circumstances leading to these transfers. MATERIAL AND METHODS: A total of 142 patients suffering from postoperative intensive care-dependent serious adverse events (Clavien-Dindo classification Grade IV, CD°IV) after THA or TKA were matched 1:1 with non-CD°IV patients using propensity score matching for age, sex, comorbidity (Charlson Comorbidity Index, CCI), and year of treatment. Possible predictive factors for the need of postoperative intensive care were initially evaluated using univariate tests, followed by multivariate regression analyses to identify independent predictors. RESULTS: CD°IV transfers correlate with higher Hospitality Frailty Risk Score levels (HFRS) [mean 4.4 (standard deviation, SD 3.8) versus mean 3.0 (SD 3.0); p < 0.001], higher American Society of Anesthesiologists Physical Status Classification System (ASA) Scores [mean 2.5 (SD 0.6) versus mean 2.3 (SD 0.7); p = 0.02], a greater proportion of octogenarians [35.9% (n = 51) versus 23.9% (n = 34); p = 0.028] and a higher incidence of medical complications [97.9% (n = 139) versus 60.6% (n = 86); p < 0.001] compared with an adjusted control group after total joint arthroplasty (TJA). Multivariate regression analysis confirmed "Frailty" (odds ratio, OR 1.14, 95% confidence intervals, CI 1.05-1.23, p = .002), preexisting cardiological (odds ratio, OR 2.0, 95% confidence intervals, CI 1.004-4.1, p = 0.049) and gastrointestinal secondary diagnoses (OR 3.0, 95% CI 1.3-6.9, p = 0.01), and intake of anticoagulants (OR 2.7, 95% CI 1.6-4.6, p < 0.001) as independent risk factors for CD°IV intensive care unit (ICU) transfers after TJA. CONCLUSIONS: Patients with CD°IV events after THA and TKA represent a complex, vulnerable, and multimorbid patient population. There is a need for a multidisciplinary approach that integrates prehabilitation and perioperative risk assessments to reduce the occurrence of severe, life-threatening events requiring ICU care. LEVEL OF EVIDENCE: Level III-retrospective cohort study. TRIAL REGISTRATION: Retrospectively registered.
Diagnostic work-up in periprosthetic joint infections of the knee: can the albumin-to-globulin ratio be a screening tool?
De Mauro D, Ascione T, Festa E … +6 more , Marasco L, Leggieri F, Rosito S, Innocenti M, Di Pace E, Balato G
J Orthop Traumatol · 2025 Jul · PMID 40603631 · Full text
BACKGROUND: This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the propos...
BACKGROUND: This study aimed to assess the most appropriate thresholds for albumin-to-globulin ratio (AGR) in patients who had a suspected periprosthetic knee infection. Furthermore, the diagnostic accuracy of the proposed threshold was evaluated. MATERIALS AND METHODS: Between January 2020 and April 2022, patients with failed or painful knee arthroplasty who were admitted to a tertiary referral institution undergoing the standardized diagnostic protocol to identify those with a periprosthetic joint infection (PJI) were analyzed. The 2018 International Consensus Meeting (ICM) criteria were used to classify patients with PJIs and aseptic joints. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic (ROC) curve (AUC) of AGR were calculated to define the test's diagnostic accuracy. RESULTS: The ROC curve showed that the optimal cutoff value of AGR was 1.43. AGR registered a sensitivity of 95% (95% CI 91-197%), a specificity of 63% (95% CI 56-69%), a positive predictive value of 75% (95% CI 69-81%), and a negative predictive value of 91% (95% CI 86-94%). Receiver operator curve analysis demonstrated an AUC of 0.85 (95% CI 0.77-0.88). Although body mass index (BMI), uremia, glutamic-oxaloacetic transaminase (GOT), international normalized ratio (INR), and alkaline phosphatase showed significant differences between the false positive cases and those cases affected by aseptic failure with AGR higher than 1.43, indicating potential confounding effects (p < 0.05), no parameter was found to be a significant predictor of false positives cases (p > 0.05). CONCLUSIONS: For its high sensitivity, AGR showed potential as a screening tool for detecting infections in PJI diagnostics. LEVEL OF EVIDENCE: III.
Efficacy analysis of arthroscopic reduction combined with orthopedic robot-guided screw placement for Hawkins type II fractures of the talus neck.
Xu M, Li R, Shi R … +4 more , Chen G, Li L, Chen J, Wang C
J Orthop Traumatol · 2025 Jun · PMID 40542971 · Full text
PURPOSE: To investigate the effect of arthroscopic reduction combined with robot-guided screw placement on Hawkins type II fractures of the talus neck. METHODS: Clinical data from 42 patients with talus neck Hawkins type...
PURPOSE: To investigate the effect of arthroscopic reduction combined with robot-guided screw placement on Hawkins type II fractures of the talus neck. METHODS: Clinical data from 42 patients with talus neck Hawkins type II fracture treated in the institution from November 2019 to January 2021 were selected. According to the blind envelope method, 21 patients were enrolled in the study group, and 21 patients were enrolled in the control group. The patients in the study group underwent arthroscopy-assisted reduction combined with orthopedic robot navigation screw placement surgery, while those in the control group underwent open reduction surgery. RESULTS: All 42 patients were followed up. The patients in the study group were followed up for a mean of 14.76 (range, 12-17) months. No talus avascular necrosis or fracture nonunion were observed. Subtalar arthritis was reported in two cases. Patients in the control group were followed up for an average of 14.52 (ranging from 12 to 17) months, and no talus avascular necrosis or fracture nonunion was found. Incisional infection occurred in one case and subtalar arthritis in three cases. The difference between the two groups was statistically significant (P < 0.05) in the duration from injury to surgery, operation time, blood loss, incision length, and number of guide pin insertions. There was no significant difference between the two groups in ankle joint range of motion, the American Orthopedic Foot and Ankle Society ankle-hindfoot score at the last follow-up, and visual analogue scale of pain before operation and at the last follow-up (P > 0.05). CONCLUSIONS: The management of Hawkins type II fracture of the talus neck using arthroscopy-assisted reduction combined with robot navigation screw placement yields satisfactory results and represents a viable treatment alternative that warrants consideration.
Impact of systemic lupus erythematosus on adverse outcomes and readmission after total shoulder arthroplasty: a Nationwide Readmission Database analysis 2016-2020.
Chang HM, Wang TH
J Orthop Traumatol · 2025 Jun · PMID 40542928 · Full text
BACKGROUND: The impact of systemic lupus erythematosus (SLE) on total shoulder arthroplasty (TSA) outcomes is unclear. This study investigated the association between SLE and short-term TSA outcomes. METHODS: Data from t...
BACKGROUND: The impact of systemic lupus erythematosus (SLE) on total shoulder arthroplasty (TSA) outcomes is unclear. This study investigated the association between SLE and short-term TSA outcomes. METHODS: Data from the Nationwide Readmission Database (NRD) 2016-2020 of patients ≥ 20 years old who underwent primary TSA were included. SLE was identified by International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) codes. Outcomes were compared between patients with and without SLE, and propensity-score matching based on age and sex was performed. RESULTS: This study included 1960 matched TSA patients (980 with SLE and 980 without SLE). The mean patient age was 65.7 years, and 92% were female. After adjusting for covariates, SLE was significantly associated with a higher risk of surgical complications (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.13-1.93), acute postoperative hemorrhagic anemia (OR = 1.48, 95% CI 1.05-2.09), and increased 30-day (OR = 2.11, 95% CI 1.30-3.40) and 90-day (OR = 1.59, 95% CI 1.11-2.26) readmission rates. Patients with SLE with Charlson Comorbidity Index scores of 0 or > 1 had a significantly higher 90-day readmission rate (OR = 2.45 and 1.48, respectively). Additionally, patients with SLE ≥ 65 years old had a significantly higher risk of complications (OR = 1.56). Patients with SLE undergoing reverse TSA also exhibited a significantly increased 90-day readmission risk (OR = 1.71). CONCLUSIONS: SLE significantly increases the risk of postoperative complications and readmissions following TSA, especially in older patients and those undergoing reverse TSA. However, the lack of data on immunosuppressive therapy, laboratory tests, and disease activity may weaken the strength of the evidence.
What influences the surgeon's decision between anatomical and reverse total shoulder arthroplasty in primary osteoarthritis? A case-vignette study.
Boulidam D, Macken AA, Kraal T … +5 more , Alta TDW, van den Bekerom MPJ, Lafosse L, Lafosse T, Buijze GA
J Orthop Traumatol · 2025 Jun · PMID 40465104 · Full text
BACKGROUND: Historically, anatomical total shoulder arthroplasty (ATSA) has been the standard intervention for primary osteoarthritis in patients with an intact rotator cuff. However, there is an increasing trend towards...
BACKGROUND: Historically, anatomical total shoulder arthroplasty (ATSA) has been the standard intervention for primary osteoarthritis in patients with an intact rotator cuff. However, there is an increasing trend towards utilizing reverse total shoulder arthroplasty (RTSA) as an alternative in specific cases. The aim of this study is to investigate the influence of the degree of retroversion, percentage of subluxation and age on the surgeon's decision-making in the choice between ATSA and RTSA in patients with primary osteoarthritis with an intact rotator cuff. METHODS: Attendees of a large international congress on (live) shoulder surgery were requested to complete a questionnaire consisting of closed and open questions regarding shoulder arthroplasty and clinical scenarios. Participants were divided into high- and low-volume surgeons (< 30 cases per year). RESULTS: A total of 166 responses were collected. In total, 37 different nationalities from all six continents were represented among the respondents. The included participants had a median experience of 11 years (interquartile range, IQR: 6-18). In total, 56 (39%) participants were considered high-volume surgeons. The median degree of retroversion, the median percentage of posterior subluxation and the median age for which participants still considered performing ATSA rather than RTSA were respectively 20° (IQR: 10-20.75), 70% (IQR: 60-80) and 70 years (IQR: 65-75). Furthermore, a low degree of consensus was observed for the choice of treatment in the ten case vignettes with these factors combined. In case of significant disagreement, RTSA was preferred more often by high-volume surgeons compared with low-volume surgeons. CONCLUSIONS: This case-vignette study highlights that the degree of retroversion, percentage of subluxation of the humeral head and the patient's age are important factors to consider in the surgeon's decision-making between ATSA and RTSA. However, our findings indicate limited consensus among orthopaedic surgeons concerning the precise impact of these patient-specific factors. Despite the lack of consensus, some trends can be identified. Overall, participants preferred treatment with RTSA in patients with a high degree of retroversion and older age. Treatment with ATSA was preferred in patients with a younger age, without severe glenoid retroversion and a posterior subluxation of < 80%. The level of evidence is Level V, expert opinion.
Risk factors for surgical site infection following treatment of proximal femoral fracture: a matched-pair analysis.
Müller F, Zellner M, Bäuml C … +3 more , Proske A, Füchtmeier B, Wulbrand C
J Orthop Traumatol · 2025 Jun · PMID 40464828 · Full text
BACKGROUND: Surgical site infection (SSI) is a major postoperative complication following internal fixation or arthroplasty for proximal femoral fracture (PFF). Few studies have examined the potential risk factors for SS...
BACKGROUND: Surgical site infection (SSI) is a major postoperative complication following internal fixation or arthroplasty for proximal femoral fracture (PFF). Few studies have examined the potential risk factors for SSI; therefore, we conducted this matched-pair analysis. MATERIALS AND METHODS: This single-centre study was based on a retrospective database of patients treated for PFF with internal fixation or arthroplasty between 2006 and 2024. Patients with revision for SSI were enrolled and matched with an uneventfully treated group at a 1:3 ratio. Matching was performed on the basis of sex, age, body mass index, diagnosis and treatment. The primary outcomes were risk factors for SSI. The secondary outcomes were risk factors for mortality, as determined by multivariate Cox regression analysis. RESULTS: Initially, a total of 5000 patients were enrolled. The mean follow-up was 11.7 years. The total SSI rate was 2.8% (140/5,000). Ultimately, 130 patients with confirmed SSI and 390 matched patients were enrolled in this study. Most of the SSIs were Staphylococcus aureus, followed by Staphylococcus epidermidis. The factors that significantly influenced SSI were female sex, American Society of Anaesthesiologists (ASA) score of 4, dementia, atrial fibrillation, and the number of red blood transfusions (≥ 3 units). The mean survival duration of the total cohort was 4.2 years (SD ± 3.38). The 30-day, 3-month and 1-year all-cause mortality rates of patients with SSIs were 5.4%, 25.4%, and 40%, respectively. Multivariate Cox regression revealed that SSI was an independent risk factor for mortality (hazard ratio 1.59; 95% confidence interval 1.28-1.98; p < 0.001), Further risk factors for mortality were living in a retirement home, reduced mobility, anaemia at admission, elevated C-reactive protein, ASA score 3 or 4, intraoperative blood loss greater than 400 ml, Charlson comorbidity index score above ≥ 1, dementia and renal insufficiency. CONCLUSIONS: In this study, patients with SSI following surgery of PFF had a significantly shorter survival time than patients in the uneventfully treated matched-pair group. Most risk factors associated with SSI are unaffected. Fortunately, the rate of SSI was low and decreased significantly within the study period. LEVER OF EVIDENCE: III; clinical case series with matched pair controls.
Reduction and outcome of posterior pilon fractures with intercalary fragments: a retrospective cohort study comparing the transfibular and posteromedial approaches.
Ying L, Yao C, Wang B … +2 more , Liang J, Chen G
J Orthop Traumatol · 2025 May · PMID 40439944 · Full text
BACKGROUND: The transfibular fracture region (TFFR) approach can be utilized for managing posterior pilon fractures associated with intercalary fragments. However, its long-term outcomes remain unreported. This study aim...
BACKGROUND: The transfibular fracture region (TFFR) approach can be utilized for managing posterior pilon fractures associated with intercalary fragments. However, its long-term outcomes remain unreported. This study aimed to compare the long-term clinical outcomes of the TFFR approach and the posteromedial approach for posterior pilon fractures (Klammer type 2/3, Danis-Weber type B) associated with displaced intercalary fragments over an average 8 year follow-up. METHOD: From 2012 to 2018, a cohort of consecutive patients who underwent open reduction and internal fixation surgery via either the TFFR approach or the posteromedial approach for posterior pilon fracture associated with intercalary fragments were enrolled for this study. Clinical outcomes were evaluated over an average 8 year (range 5-12 years) follow-up. The surgical duration, number of intraoperative fluoroscopies, and postoperative complications were recorded. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), and Short Form-36 (SF-36) score at last follow-up. RESULTS: Seventy-nine patients were included in the final analysis, including 43 in the TFFR group and 36 in the posteromedial group. No significant differences between the two groups were observed in the FAOS (p = 0.679) or its specific components for symptoms (p = 0.264), pain (p = 0.963), activities of daily living (ADL, p = 0.102), sports (p = 0.156), or quality of life (p = 0.859). There was also no significant difference between the two groups in the FAAM-ADL (p = 0.408), FAAM-Sport (p = 0.617), and SF-36 scores (p = 0.757). Nevertheless, the surgical duration was shorter in the TFFR group (p < 0.001). CONCLUSION: The TFFR approach is not inferior to the posteromedial approach. For posterior pilon fractures with lateral malleolar fractures in the same plane, the TFFR approach may be preferred owing to its potential to reduce surgical time and the use of a single incision. Level of Evidence Level III, retrospective cohort study.
A novel augmentation technique for the repair of full thickness gluteal tendon tears: a biomechanical analysis in an ovine model.
Derksen A, Balli Z, Windhagen H … +2 more , Nebel D, Reifenrath J
J Orthop Traumatol · 2025 May · PMID 40413375 · Full text
BACKGROUND: Gluteus medius tendon tears lead to considerable functional limitations and a high level of suffering in affected patients. In cases where the symptoms are severe, surgical intervention is indicated. A range...
BACKGROUND: Gluteus medius tendon tears lead to considerable functional limitations and a high level of suffering in affected patients. In cases where the symptoms are severe, surgical intervention is indicated. A range of techniques are used to repair the tendon, with the primary aim being to achieve the highest possible primary stability in order to minimise the risk of re-rupture. This biomechanical study compares two different refixation techniques in terms of their stability in an ovine model. MATERIAL AND METHODS: The gluteal tendons of sheep hips (n = 17) were meticulously prepared and detached from the femoral insertion. To reattach these tendons at their original anatomical footprint, either the sole double-row transosseous-equivalent technique (DR) or the DR supplemented by a proximal suture insertion (augmentation) of the tendon (DR +) was used. Pull-out tests were performed until failure using a uniaxial material testing machine, with a tensile force applied along the physiological tensile direction of the hip abductors. The data obtained (force at failure, linear stiffness) were compared between the groups using the Mann-Whitney U test. RESULTS: The augmentation of the proximal tendon portion resulted in a substantial increase in force at failure, exceeding 450% (698 ± 80.3 N DR + compared with 155.9 ± 53.9 N DR technique). In addition, augmented tendons exhibited a notable enhancement in stiffness, with an average increase of 31.3 ± 15 N/mm in DR + compared with 12.4 ± 4.8 N/mm in DR. Furthermore, the DR + method resulted in a substantial reduction in the incidence of slippage of the tendon fibres out of the sutures and tendon bundles when compared with the DR suture. CONCLUSIONS: The clinical problem of suture knots becoming loose within the tendon stump, leading to the failure of the tendon sutures, could be mitigated by additional augmentation, resulting in a substantial increase in ultimate load at failure. The benefits of the double-row transosseous-equivalent technique, which facilitates the pressing of the tendon stump against the footprint, are maintained. Level of Evidence Level of Evidence 5.
Suture tape augmentation in the management of anterior cruciate ligament ruptures: a systematic review and meta-analysis.
Tang P, Cao Y, Zhu Y … +7 more , Tan H, Li H, Xiao W, Wen T, Zhang J, Li Y, Liu S
J Orthop Traumatol · 2025 May · PMID 40411631 · Full text
BACKGROUND: The employment of suture tape augmentation (SA) in surgical interventions for anterior cruciate ligament (ACL) ruptures is a subject of ongoing debate. This meta-analysis synthesizes prior research to assess...
BACKGROUND: The employment of suture tape augmentation (SA) in surgical interventions for anterior cruciate ligament (ACL) ruptures is a subject of ongoing debate. This meta-analysis synthesizes prior research to assess the effectiveness of additional SA in treating ACL tears. METHODS: A total of four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched up to September 2024. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Key data extracted include: Lysholm Knee Scoring Scale, International Knee Documentation Committee Score (IKDC), self-assessment numerical evaluation (SANE), Tegner Activity Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Marx Activity Scale, visual analog scale (VAS), KT-1000 anteroposterior knee laxity, and return to sports rate. Meta-analysis of outcome indicators was performed using Revman 5.4 software. RESULTS: A total of 17 articles were included in this meta-analysis. Pre-post operation effect analysis showed that additional SA was correlated with improved IKDC, Marx Activity Scale, KOOS, VR-12 physical, and VAS for pain. In addition, there were statistically significant differences in SANE (mean difference, MD = 3.26, 95% confidence intervals, 95%CI 0.77, 5.76, P = 0.01, I = 13%) and VAS for pain (MD = -0.17, 95%CI -0.32, -0.02, P = 0.02, I = 0%) in the group using the SA technique compared with the traditional surgery group without SA. However, in terms of KT-1000 anteroposterior knee laxity, the traditional surgery group without SA was better than the group with SA (MD = 0.31, 95%CI 0.03, 0.59, P = 0.03, I = 0%). CONCLUSIONS: On the basis of current evidence, we do not believe that, compared with isolated traditional surgical methods, additional SA can significantly improve patients' functional scores and help patients heal.
A meta-analysis of the therapeutic effect of total knee replacement after knee arthroscopic surgery.
Xu Y, Wang W
J Orthop Traumatol · 2025 May · PMID 40402175 · Full text
PURPOSE: To appraise the influence of knee arthroscopic surgery on subsequent total knee arthroplasty (TKA) through meta-analysis. METHODS: A computer search was implemented from the establishment of the database to Augu...
PURPOSE: To appraise the influence of knee arthroscopic surgery on subsequent total knee arthroplasty (TKA) through meta-analysis. METHODS: A computer search was implemented from the establishment of the database to August 2023 for literature on the influence of knee arthroscopic surgery on the efficacy of subsequent TKA in Web of Science, PubMed, CNKI, Embase, Cochrane Library, Wanfang, and other databases. Quality assessment, literature screening, and data extraction were enforced according to the exclusion and inclusion criteria, and the methodological quality of the involved literature was assessed using the risk-of-bias assessment method recommended by the Cochrane Assistance Network. RevMan 5.4 software was used to conduct a meta-analysis on the postoperative revision rate, periprosthetic infection rate, postoperative stiffness rate, postoperative venous thromboembolism (VTE) incidence rate, reoperation rate, and postoperative knee flexion range of motion after TKA. RESULTS: Seven documents were finally involved, with a total of 42,642 cases, including 3405 cases in the knee arthroscopy group and 39,237 cases in the non-knee arthroscopy group. Meta-analysis results show that in the revision rate [95% confidence interval (CI) 0.97, 44.82] and reoperation rate [95% CI 1.66, 4.23] after TKA between the knee arthroscopy surgery group and the non-knee arthroscopy surgery group, there were statistically significant differences in postoperative stiffness rate [95% CI 0.86, 10.84] and periprosthetic infection rate [95% CI 0.86, 2.07], while in postoperative VTE incidence [95% CI 0.83, 1.35] and in postoperative knee flexion range of motion [95% CI -0.35, 0.10] there was no statistically significant difference. CONCLUSIONS: Knee arthroscopic surgery hurts subsequent TKA surgery. Previous arthroscopic surgery increased the risk of postoperative stiffness, revision, periprosthetic infection, and reoperation after TKA, but there was no significant difference in the incidence of VTE and knee flexion range of motion after surgery.
Surgical timing and clinical factor predicting in-hospital mortality in older adults with hip fractures: a neuronal network analysis.
Vitiello R, Pesare E, Capece G … +5 more , Di Gialleonardo E, De Matthaeis A, Franceschi F, Maccauro G, Covino M
J Orthop Traumatol · 2025 May · PMID 40369316 · Full text
INTRODUCTION: Hip fractures in older adults are associated with a significant mortality rate, which has been reported to be around 35% within a year. Today, the incidence of these fractures is on the rise, and this trend...
INTRODUCTION: Hip fractures in older adults are associated with a significant mortality rate, which has been reported to be around 35% within a year. Today, the incidence of these fractures is on the rise, and this trend is expected to increase even more owing to the aging of the population. Treatment timing and perioperative management of these patients are typically challenging owing to the presence of multiple comorbidities that are important risk factors for mortality after surgery. This study aims to evaluate the relationship between surgical timing and in-hospital mortality, analyzing the role of both acute events and chronic preexisting comorbidities in patient outcomes. MATERIALS AND METHODS: This is a single-center, retrospective observational study (from January 2018 until June 2023). All consecutive patients ≥ 65 years with a diagnosis of proximal femur fracture were enrolled. The primary study endpoint was to evaluate risk factors associated with in-hospital mortality. The secondary endpoint was the assessment of the relationship between surgical timing and in-hospital mortality, including factors such as preexisting comorbidities, the Charlson Comorbidity Index, and the Nottingham Hip Fracture Score. The relative weight of each factor for predicting the mortality rate was also evaluated using neural network analysis, comparing patients treated within 24 h to those treated after a longer surgical delay. RESULTS: Among the 2320 patients enrolled, 1391 (60%) underwent surgery within 24 h, while 929 patients (40%) were treated after 24 h. For patients who underwent surgery within 24 h, the in-hospital mortality was 2.8%, and for those who underwent surgery after 24 h, it was 5.2% (p = 0.046; odds ratio (OR) 1.58). Age (p = 0.001; OR 1.06) and Nottingham score (p = 0.04; OR 1.32) are factors predicting mortality. Acute infections were related to a high risk of mortality (p = 0.001; OR 5.99), both in patients treated within and after 24 h. Acute events, such as atrial fibrillation and electrolyte imbalance, were related to mortality risk only in patients treated within 24 h (p = 0.001 versus p = 0.51). Neural network analysis revealed that atrial fibrillation (AF), flutter, and electrolyte imbalance had the highest relative weight for mortality in patients treated in the first 24 h; by contrast, renal failure and pneumonia were most present in patients who died that were treated after 24 h. CONCLUSIONS: Hip fracture is known to be a significant cause of morbidity and mortality in older adults. The impact of the timing of surgical treatment in those patients is crucial for postoperative outcomes. Early surgery is essential to reduce the risk of mortality. Our study has shown that, while in the case of acute and reversible conditions, waiting about 24 h to stabilize the patient with preoperative stabilization protocols, such as managing anticoagulation, optimizing hemodynamics, or addressing acute medical conditions including infection prevention, guarantees better results, in the case of sepsis or acute infection presence, the prolonged waiting to optimize patients before and after surgery does not help improve outcomes.
Early versus standard return to play following ACL reconstruction: impact on volume of play and career longevity in 180 professional European soccer players: a retrospective cohort study.
Battaglia M, Arner JW, Midtgaard KS … +9 more , Haber DB, Peebles LA, Peebles AM, Ganokroj P, Whalen RJ, Provencher MT, Torre G, Ciatti R, Mariani PP
J Orthop Traumatol · 2025 May · PMID 40353956 · Full text
BACKGROUND: Patients typically follow a 7-9-month return to play (RTP) protocol following anterior cruciate ligament reconstruction (ACLR); however, much of these data have been based on non-elite athletes. The purpose o...
BACKGROUND: Patients typically follow a 7-9-month return to play (RTP) protocol following anterior cruciate ligament reconstruction (ACLR); however, much of these data have been based on non-elite athletes. The purpose of this study is to understand whether professional soccer players returning to competition < 6-months following ACLR will have an increased risk of graft failure, play fewer seasons postoperatively, and have lower volume of play compared with those returning > 6 months. MATERIALS AND METHODS: A total of 180 male professional European soccer players were enrolled and underwent ACLR with a single surgeon between April 2008 and December 2016 and returned to sport < 6 months (early RTP group, n = 92) or > 6 months (standard RTP group, n = 88). Time from intervention to RTP (days), same season returns, total games and average minutes played in return season, seasons played after surgery, and playing status were recorded. RESULTS: The early RTP group returned to soccer sooner (142.8 ± 21.4 days) than the standard RTP group (276.2 ± 118.9) (p < 0.01), and more players returned the same season as the injury in the early RTP group (n = 55/92, 62.5%) than the standard RTP group (n = 18/88, 20.5%) (p < 0.01). The difference in average minutes per game in the first season back was not statistically significant (early RTP, 56.7 ± 22.3 min; standard RTP 49.9 ± 29.8 min, p = 0.094). The early RTP group had significantly longer careers following ACLR (5.7 ± 2.2 seasons) than the standard RTP group (4.7 ± 2.4 seasons) (p = 0.005). The early RTP group sustained more reruptures (n = 4, 4.4%) than the standard RTP group (n = 1, 1.1%). CONCLUSIONS: Professional European soccer players returning to competition < 6 months following ACLR did not have poorer outcomes than those who returned > 6 months despite the fact that there were three more failures. However, the early RTP group players were more likely to return during the same season, had longer careers after ACLR, and played a similar number of games and minutes per game, but had more graft failures. LEVEL OF EVIDENCE: Retrospective cohort study level IV. TRIAL REGISTRATION: Retrospectively registered according to prot. Professionisti_OSS_22.
Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.
Kuo YR, Ko PY, Lee CY … +4 more , Tsai TC, Chuang CH, Yao SH, Wu PT
J Orthop Traumatol · 2025 May · PMID 40353914 · Full text
BACKGROUND: The risk factors related to delayed union in humeral diaphyseal fractures (HDFs) following surgical osteosynthesis remain unclear. Therefore, this study aimed to evaluate radiological outcomes and the risk fa...
BACKGROUND: The risk factors related to delayed union in humeral diaphyseal fractures (HDFs) following surgical osteosynthesis remain unclear. Therefore, this study aimed to evaluate radiological outcomes and the risk factors associated with delayed union in a retrospective cohort of patients who underwent open reduction and plate fixation (ORPF) for acute HDFs. MATERIALS AND METHODS: Consecutive patients with AO/OTA 12-A and AO/OTA 12-B fractures who underwent ORPF using standard compression techniques between 2017 and 2020 were enrolled in the study. Demographic data, along with serial medical records and radiographs, were collected. The included patients were divided into two groups: the timely union (union occurring within 6 months postoperatively) and the delayed union group (union occurring between 6 and 12 months postoperatively). Differences between the groups were examined, and logistic regression was subsequently applied for risk factor analysis. RESULTS: Sixty-five cases were included in the study, consisting of 34 males and 31 females, with a median age of 38.9 years. Among these, 45 cases (69.2%) were classified in the timely union group, while 20 cases (30.8%) were classified in the delayed union group. Overall, 30 cases (46.2%) demonstrated secondary bony union. Significant differences were observed between groups in terms of fracture pattern, immediate postoperative fracture gap, union pattern, and complication rate (p < 0.05 for all comparisons). Multivariate logistic regression analysis revealed that the use of interfragmentary screw and the presence of postoperative complications were independent predictors of delayed union, with an adjusted odds ratio of 0.14 and 5.76, respectively. CONCLUSIONS: In ORPF for acute HSFs, 30 out of 65 cases demonstrated secondary bone union despite the use of standard compression techniques. The application of interfragmentary screws significantly reduces the risk of delayed union. Conversely, the presence of postoperative complications is associated with an increased likelihood of delayed union. LEVEL OF EVIDENCE: 3 Trial Registration All procedures were approved by the institutional review board of the authors' hospital (IRB nos. A-ER-112-395 and IRB20230089).
Surgical and radiological outcomes of giant cell tumor of the bone: prognostic value of Campanacci grading and selective use of denosumab.
Igrec J, Jernej L, Smolle MA … +5 more , Steiner J, Scheipl S, Lohberger B, Leithner A, Brcic I
J Orthop Traumatol · 2025 May · PMID 40317378 · Full text
BACKGROUND: Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical...
BACKGROUND: Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases. METHODS: We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes. RESULTS: The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition. CONCLUSIONS: Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management. LEVEL OF EVIDENCE: Level 4.
Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study.
Yang C, Ji B, Li G … +4 more , Zhang X, Xu B, Maimaitiming A, Cao L
J Orthop Traumatol · 2025 May · PMID 40316735 · Full text
BACKGROUND: Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1-2 g) to weight-based protocols (e.g., 10-20 mg/kg). This study aimed to compare postope...
BACKGROUND: Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1-2 g) to weight-based protocols (e.g., 10-20 mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA). MATERIALS AND METHODS: This retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1 g TXA before skin incision and a topical application of 1 g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20 mg/kg/h TXA intravenously and a topical application of 1 g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications. RESULTS: The weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22 g/L versus 26.09 g/L, p < 0.001) and fixed-dose TXA (18.22 g/L versus 24.69 g/L, p < 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (p < 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (p = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (p = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all p > 0.05). CONCLUSIONS: Weight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements. LEVEL OF EVIDENCE: Level 3, non-randomized observational study.
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