Journal Of Orthopaedics And Traumatology[JOURNAL]
Sun
200 papers
Risk factors for the development of heterotopic ossification of the elbow in children with untreated chronic Monteggia fractures: a radiographic review of 274 cases.
Wang W, Mei Q, Zhao C … +7 more , Andreacchio A, Tang S, Liu H, Chen S, Xiong Z, Canavese F, He S
J Orthop Traumatol · 2025 Apr · PMID 40285966 · Full text
BACKGROUND: The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to eva...
BACKGROUND: The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to evaluate the radiographic data from paediatric patients with UCMFs and to identify the risk factors for HO formation and their radiographic characteristics. MATERIALS AND METHODS: We retrospectively reviewed 274 patients (mean age at injury: 5.82 ± 2.62 years) with UCMFs with all types of anterior (group A) and non-anterior (group B) radial head (RH) dislocations. Radiographs were used to assess the presence, size and bone density of HO. The risk factors evaluated included age at injury, sex, laterality, interval from injury to diagnosis, presence of radial or median nerve injury, immobilization of the fractured ulna after injury, direction of RH dislocation and distance of RH dislocation (DD-RH). The results were compared with 76 patient demographics-matched paediatric acute Monteggia fractures (PAMFs) undergoing surgery within 48 h after injury. RESULTS: The HO rate (13.1%) in children with UCMFs was significantly higher than that (0%) in children with PAMFs (P = 0.001). The incidence of HO (14.5%) in group A was significantly higher than that (0%) in group B (P = 0.032). Age at injury and DD-RH were confirmed as risk factors for HO in patients with UCMFs by both univariate and logistic regression analyses (P < 0.05). Receiver operating characteristic curve analysis and chi-squared analysis indicated that age at injury > 6.78 years and DD-RH < 1.59-fold of the narrowest radial neck width were the cut-off values for an increased HO rate in patients with UCMFs (P < 0.05). Increased age at injury (P = 0.041) and interval from injury to diagnosis (P = 0.006) were associated with high-bone density HO. CONCLUSIONS: Patients with UCMFs with anterior RH dislocations, age at injury > 6.78 years, and DD-RH < 1.59-fold of the narrowest radial neck width were more likely to develop HO. The bone density of HO increases with age at injury and interval from injury to diagnosis. Timely RH reduction after acute injury may prevent HO. LEVEL OF EVIDENCE: III.
Feasibility of non-radical resection combined with internal fixation for adolescents with lower limb fibrous dysplasia: a single-center retrospective study with a small sample size.
Li Y, Sun D, Zhou Z … +3 more , Zhang X, Li A, Chen J
J Orthop Traumatol · 2025 Apr · PMID 40279018 · Full text
BACKGROUND: The management of osteofibrous dysplasia (OFD) is controversial, with limited reports on combining non-radical resection with internal fixation. This study evaluates optimal treatments for patients with OFD a...
BACKGROUND: The management of osteofibrous dysplasia (OFD) is controversial, with limited reports on combining non-radical resection with internal fixation. This study evaluates optimal treatments for patients with OFD aged < 15 years, with attention to the limitations of the small sample size. MATERIALS AND METHODS: This retrospective analysis included 28 patients (30 extremity) with severe pain, pathological fractures, angular deformities, or extensive cortical bone involvement. On the basis of the surgical approach, patients were divided into four groups: group 1, curettage, allograft, and plate fixation for six patients (six extremity); group 2, elastic stable intramedullary nailing fixation for six patients (six extremity); group 3, Fassier-Duval telescopic system fixation for eight patients (nine extremity); and group 4, interlocking intramedullary nail for eight patients (nine extremity). RESULTS: All patients achieved bony union and pain alleviation with no recurrence of deformities. The refracture rate during the follow-up was zero cases (0%; group 1) versus one (16.7%; group 2) versus zero (0%; group 3) versus zero cases (0% group 4) (p > 0.05). Instances of internal fixation loosening were zero cases (0%; group 1) versus zero (0%; group 2) versus five (55.6%; group 3) versus zero cases (0%; group 4) (p < 0.05). The musculoskeletal tumor society (MSTS) scores of the four groups were 27.5 (group 1) versus 27.7 (group 2) versus 26.3 (group 3) versus 28.7 (group 4) (p < 0.05). CONCLUSIONS: Selecting different treatment strategies for patients of various ages and locations with OFD is vital. Surgical intervention for patients with persistent pain, pathological fractures, extensive cortical bone involvement, or significant tibial deformities can significantly improve their quality of life. The encouraging MSTS scores also support this conclusion. However, given the study's single-center design and small sample size, further research with larger, multicenter studies is necessary. LEVEL OF EVIDENCE: Level IV.
The application of antibiotic-loaded bone cement in preventing periprosthetic joint infection: an umbrella review.
Cao Y, Tang P, Chai H … +9 more , Ma W, Lin B, Zhu Y, Abdirahman A, Xiao W, Zhang J, Li Y, Liu S, Wen T
J Orthop Traumatol · 2025 Apr · PMID 40249535 · Full text
OBJECTIVES: The purpose of this study was to provide thorough, understandable and precise evidence for the clinical use of antibiotic-loaded bone cement (ALBC) in preventing periprosthetic joint infection (PJI). METHODS:...
OBJECTIVES: The purpose of this study was to provide thorough, understandable and precise evidence for the clinical use of antibiotic-loaded bone cement (ALBC) in preventing periprosthetic joint infection (PJI). METHODS: We evaluated the effectiveness of ALBC in preventing PJI by conducting an umbrella review of existing meta-analysis. Four databases, PubMed/MEDLINE, Cochrane Library, Embase and Web of Science, were searched until May 2024. Two reviewers were reviewers for literature screening, and data were extracted independently. AMSTAR 2 guideline and GRADE were also used for quality evaluation. The clinical outcomes were evaluated for effectiveness by several indicators, including surface infection rate (SIR), deep infection rate (DIR), total infection rate (TIR), unadjusted/adjusted all-cause revision rate, and revision rate for PJI. RESULTS: We synthesized the results of ten meta-analyses. Two meta-analyses had high AMSTAR 2 scores, two had moderate AMSTAR 2 ratings, three had critically low AMSTAR 2 scores, and the remaining meta-analyses had low AMSTAR 2 ratings. In terms of postoperative surgical site infection and revision rate, SIR (OR 1.50, 95% CI 1.14, 1.99, P = 0.004, I = 0%), unadjusted all-cause revision rate (RR 1.44, 95% CI 1.08, 1.90, P = 0.011, I = 91.8%) and adjusted all-cause revision rate (HR 1.21, 95% CI 1.12, 1.31, P < 0.001, I = 0%) in ALBC group were significantly higher than those in non-antibiotic-loaded bone cement (NALBC) group. ALBC group was significantly lower than NALBC group in DIR (OR 0.53, 95% CI 0.39, 0.70, P < 0.0001, I = 57%), (RR 0.506, 95% CI 0.341, 0.751, P = 0.001, I = 0%) and revision for PJI (RR 0.721, 95% CI 0.628, 0.828, P = 0, I = 53%). There was no statistical difference in total infection rate (TIR) between the ALBC group and the NALBC group (OR 0.81, 95% CI 0.51, 1.28, P = 0.37, I = 73%). CONCLUSIONS: On the basis of the results of our analysis, we do not believe that ALBC is more effective than NALBC in preventing PJI after primary total joint arthroplasty (PTJA). No statistically significant difference was found on TIR between the two groups, although it was lower in the ALBC group. In addition, the DIR and revision for PJI are significantly lower in the ALBC group, but the results are of low quality, which calls for high-quality and large-sample studies in the future.
Double plating versus nail-plate construct in AO 33C distal femur fractures: treatment choice affects knee alignment, clinical outcomes, and quality of life-a multicenter study.
De Mauro D, Smakaj A, Casiraghi A … +12 more , Galante C, Bove F, Arduini M, Vicenti G, Addevico F, Fratus A, Macellari N, Caredda M, Buono C, Maccauro G, Rovere G, Liuzza F
J Orthop Traumatol · 2025 Apr · PMID 40175637 · Full text
BACKGROUND: Distal femur fractures present a significant challenge for orthopedic surgeons, accounting for approximately 5% of all femoral fractures. Among the most commonly reported combined techniques in the literature...
BACKGROUND: Distal femur fractures present a significant challenge for orthopedic surgeons, accounting for approximately 5% of all femoral fractures. Among the most commonly reported combined techniques in the literature are the double-plate technique and the retrograde nailing plus lateral plating, the nail-plate construct (NPC). The aim of our study is to compare surgical data, quality of life, and functional outcomes in 33-C fractures treated with either double-plate constructs or a retrograde nailing plus lateral plate. MATERIALS AND METHODS: A multicenter retrospective observational study was conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Diagnoses were made on the basis of the AO classification, utilizing traditional radiological assessments. Patients were categorized into two groups on the basis of the surgical treatment they received: The NPC group comprised patients who underwent surgery with nail-plate construct, while the Plate group consisted of those who had surgery with double plating. RESULTS: A total of 42 patients were included in the study. The NPC group comprised 26 patients with a mean age of 58.4 ± 18.8 years, while the Plate group consisted of 16 patients with a mean age of 61.3 ± 16.4 years. Significant differences were observed in knee extension recovery (p = 0.010) and lateral distal femur angle (LDFA) (p < 0.001). Linear regression showed a significant influence from treatment choice on all the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, as well as in all domains of the European Quality of Life Five Dimensions Five-Level Version (EQ-5D-5L), except for the Daily Self-Care domain. CONCLUSIONS: Nail-plate constructs seems to lead to significantly better outcomes in AO type C distal femur fractures, compared with double plating, in terms of knee function and quality of life. Significant differences are shown also in anatomical outcomes, especially in extension gap, and LDFA. LEVEL OF EVIDENCE: III.
It is not waste if it is therapy: cellular, secretory and functional properties of reamer-irrigator-aspirator (RIA)-derived autologous bone grafts.
Häusner S, Kolb A, Übelmesser K … +8 more , Hölscher-Doht S, Jordan MC, Jauković A, Berberich-Siebelt F, Spasovski DV, Groll J, Blunk T, Herrmann M
J Orthop Traumatol · 2025 Mar · PMID 40140186 · Full text
BACKGROUND: Large bone defects resulting from trauma, disease, or resection often exceed the intrinsic capacity of bones to heal. The current gold standard addressing these defects is autologous bone grafting (ABG). Proc...
BACKGROUND: Large bone defects resulting from trauma, disease, or resection often exceed the intrinsic capacity of bones to heal. The current gold standard addressing these defects is autologous bone grafting (ABG). Procedures such as reamer-irrigator-aspirator (RIA) and conventional bone grafting from the iliac crest are widely recognized as highly effective interventions for critical-size bone defects. The early phase of fracture healing is particularly crucial, as it can determine whether a complete bony union occurs, or if delayed healing or non-unions develop. The initial composition of the bone marrow (BM)-rich ABG transplant, with its unique cellular (e.g., leukocytes, monocytes, and granulocytes) and acellular (e.g., growth factors and extracellular proteins) components, plays a key role in this process. However, despite many successful case reports, the role of ABG cells, growth factors, and their precise contributions to bone healing remain largely elusive. MATERIALS AND METHODS: We characterized the native cellularity of both solid and liquid RIA-derived ABG by analyzing primary, minimally manipulated populations of monocytes, macrophages, and T cells, as well as hematopoietic, endothelial, and mesenchymal progenitor cells by flow cytometry. Growth factor and cytokine contents were assessed through antibody arrays. Possible functional and immunomodulatory properties of RIA liquid were evaluated in functional in vitro assays. RESULTS: Growth factor and protein arrays revealed a plethora of soluble factors that can be linked to specific immunomodulatory and angiogenic properties, which were evaluated for their potency using functional in vitro assays. We could demonstrate a strong M2-macrophage phenotype inducing the effect of RIA liquid on macrophages. Additionally, we observed an increase in anti-inflammatory T cell subsets generated from peripheral blood mononuclear cells and BM mononuclear cells upon stimulation with RIA liquid . Finally, in vitro endothelial tube formation assays revealed highly significant angiogenic properties of RIA liquid, even at further dilutions. CONCLUSION: The cytokine and protein content of RIA liquid exhibits potent immunomodulatory and angiogenic properties. These findings suggest significant therapeutic potential for RIA liquid in modulating immune responses and promoting angiogenesis. Anti-inflammatory and angiogenic properties demonstrated in this study might also help to further define and understand its particular mode of action while also providing explanations to the excellent bone-healing properties of ABG in general. LEVEL OF EVIDENCE: Case-series (Level 4).
Ultra-distal tibial fractures: a retrospective comparison of distal plate versus nail fixation.
Wang F, Zhu X, Dai X … +4 more , Wang L, Zhong C, Qin J, Yuan T
J Orthop Traumatol · 2025 Mar · PMID 40111574 · Full text
BACKGROUND: Current literature on ultra-distal tibial fractures (UDTF) is relatively limited, particularly regarding the outcomes and complications of different treatment strategies, with data being notably scarce. This...
BACKGROUND: Current literature on ultra-distal tibial fractures (UDTF) is relatively limited, particularly regarding the outcomes and complications of different treatment strategies, with data being notably scarce. This study aimed to compare the clinical outcomes of intramedullary nailing (IMN) and distal tibial plate (DTP) fixation in the treatment of UDTF. METHODS: A total of 48 eligible patients were retrospectively reviewed and divided into two matched groups based on age, gender, injury severity score, and fracture type. The IMN group comprised 21 patients, and the DTP group included 27 patients. All patients were followed up to assess both clinical and radiological outcomes. RESULTS: The IMN group demonstrated significantly shorter surgery time (P = 0.043) and fracture healing time (P = 0.002) compared with the DTP group. However, no significant differences were found between the two groups in terms of time from fracture to admission (P = 0.740), preoperative hospital stay (P = 0.310), postoperative hospital stay (P = 0.379), infection rates (P = 1.000), or rates of nonunion (P = 0.822). Postoperative malalignment occurred in three patients in the IMN group and one patient in the DTP group (P = 0.430). The mean postoperative angulation in both groups was similar in the coronal plane (P = 0.101) and sagittal plane (P = 0.334). The mean Olerud-Molander Ankle Score (OMAS) was 88.62 ± 5.24 in the IMN group and 85.85 ± 8.39 in the DTP group (P = 0.169). CONCLUSION: Both implants are effective in treating UDTF. However, IMN offers advantages in reducing surgical time, accelerating fracture healing, and promoting early recovery. Therefore, IMN may represent a superior surgical option for managing UDTF.
Nomogram to predict periprosthetic joint infection after total hip arthroplasty using laboratory tests.
Lang J, Dong Z, Shi B … +7 more , Wang D, Yuan J, Chen L, Gao J, Sun A, Huang J, Xue Z
J Orthop Traumatol · 2025 Mar · PMID 40108055 · Full text
BACKGROUND: Periprosthetic joint infection (PJI) is a catastrophic complication after joint arthroplasty. This study aimed to analyze the relationship between laboratory tests and PJI and establish a nomogram for predict...
BACKGROUND: Periprosthetic joint infection (PJI) is a catastrophic complication after joint arthroplasty. This study aimed to analyze the relationship between laboratory tests and PJI and establish a nomogram for predicting risks of PJI after total hip arthroplasty (THA). MATERIALS AND METHODS: The clinical data of patients who underwent THA from January 2015 to December 2020 were retrospectively analyzed. Demographic and relevant clinical information of patients was collected; independent risk factors associated with PJI were determined by univariate and multivariate logistic regression analysis, and receiver operating characteristics (ROC) were drawn to analyze the specificity and sensitivity of each risk factor. Risk factors are included in the nomogram. Calibration curve and decision curve analysis were used to evaluate the predictive accuracy and discriminability of the model. RESULTS: A total of 589 patients were enrolled in the study, of whom 87 were eventually diagnosed with PJI. Multivariate logistic regression analysis showed that serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count were independent risk factors for PJI after THA. The ROC curve analysis model of multivariate combined diagnosis had good diagnostic value, sensitivity was 77.01%, and specificity was 75.51%. The calibration curve shows good agreement between the prediction of the line graph and the actual observed results. The decision curve shows that the nomogram has a net clinical benefit. CONCLUSIONS: The changes in serum C-reactive protein, erythrocyte sedimentation rate, polymorphonuclear neutrophils, D-dimer, and platelet count are related to the occurrence of PJI after hip arthroplasty. The nomogram prediction model established in this study is promising for the screening of PJI after hip arthroplasty. LEVEL OF EVIDENCE: Level III evidence. Non-randomized controlled cohort/follow-up study.
Fibular head osteotomy: A new technique for better exposure of postero-lateral tibial plateau fracture.
Yang S, Lian Y, Yang L … +8 more , Ma S, Ding C, Huang F, Liu Y, Li H, Mutan Z, Zhong H, Chen H
J Orthop Traumatol · 2025 Mar · PMID 40108047 · Full text
OBJECTIVE: Various osteotomy techniques have been explored for exposing the posterolateral tibial plateau in previous studies. However, these methods are often complex, cause significant damage to normal anatomical struc...
OBJECTIVE: Various osteotomy techniques have been explored for exposing the posterolateral tibial plateau in previous studies. However, these methods are often complex, cause significant damage to normal anatomical structures, compromise knee joint stability, and pose risks to knee function, thus limiting their clinical application. This study proposes a new fibular head osteotomy technique for treating posterolateral tibial plateau fractures, aiming to achieve favorable surgical outcomes. METHODS: Thirteen patients who underwent surgical treatment for posterolateral tibial plateau fractures between March 2020 and August 2023 at our hospital were included in this study. The study was approved by the clinical ethics committee of our institution. All patients provided informed consent before participation. Surgeries were performed through a modified Frosch approach combined with partial fibular head osteotomy, while preserving part of the biceps femoris tendon attachment to the fibula. Postoperative fracture reduction quality was assessed using X-rays and computed tomography (CT) scans, in accordance with the Rasmussen radiology scoring system. Knee joint function was evaluated at the final follow-up using the Hospital for Special Surgery (HSS) scoring system. The healing of the fibular head osteotomy site and the presence of any complications were also assessed. RESULTS: All 13 patients were followed up with for an average of 12.2 months (range: 9-17 months). All fractures, collapse, and deformities were corrected. The mean Rasmussen radiological score was 15.5 ± 2.5 (range: 10-18), with four cases rated as excellent, eight as good, and one as fair. The mean Hospital for Special Surgery (HSS) score was 89.8 ± 6.4 (range: 78-98), with 10 cases rated as excellent and 3 as good. No posterolateral knee instability was observed during physical examination at the final follow-up. There were no complications such as surgical site infection or common peroneal nerve injury. CONCLUSIONS: Partial fibular head osteotomy combined with preservation of the biceps femoris tendon attachment is an effective technique for treating posterolateral tibial plateau fractures. This method allows for successful fracture reduction and fixation without compromising knee joint function.
Female patients report comparable results to males after the implantation of an aragonite-based scaffold for the treatment of knee chondral and osteochondral defects: a gender-based analysis of a RCT at 4 years' follow-up.
Kon E, De Caro F, Dasa V … +6 more , M Scopp J, Di Matteo B, Flanigan D, Shabshin N, Strickland S, Altschuler N
J Orthop Traumatol · 2025 Mar · PMID 40080289 · Full text
BACKGROUND: The aim of the study was to provide a gender-based analysis of the results of a large, multi-centre randomized controlled trial (RCT) comparing a novel cell-free aragonite-based scaffold with the standard of...
BACKGROUND: The aim of the study was to provide a gender-based analysis of the results of a large, multi-centre randomized controlled trial (RCT) comparing a novel cell-free aragonite-based scaffold with the standard of care (i.e. debridement/microfractures) for the treatment of chondral/osteochondral defects in knees with or without concurrent osteoarthritis. MATERIALS AND METHODS: A total of 251 patients were included: 167 patients in the scaffold group and 84 in the control. In the scaffold group, there were 105 males and 59 females, whereas the control group consisted of 51 males and 32 females. Patients were evaluated up to 48 months after the treatment. The primary endpoint was the change from baseline to 48 months in the KOOS overall score. Treatment failures were defined as any secondary invasive intervention, including intra-articular injection or any surgery in the treated joint. All patients underwent magnetic resonance imaging (MRI) at 12 and 24 months to assess the percentage of defect fill after surgery. RESULTS: Both males and females in the scaffold group achieved significantly better results than controls in any KOOS subscale, as well as in KOOS overall, up to the final 48 months follow-up. Outcomes reported by females were non-inferior to those of males in the implant group. At 24 months' MRI evaluation, 86.2% of male patients in the scaffold group presented at least 75% defect fill compared with 32.6% in the control group. In the scaffold group, 87.6% of female patients presented at least 75% defect fill, compared with 28% in the control group (p < 0.0001 in both cases). Responders' rate and failure rate were also significantly better in the scaffold group for both males and females. CONCLUSION: The aragonite scaffold outperformed the control group at 48 months' evaluation. The gender-based analysis proved that males and females in the scaffold group presented comparable clinical and radiographical results, both significantly better than their counterparts treated by debridement/microfractures. LEVEL OF EVIDENCE: I-Randomized controlled trial. TRIAL REGISTRATION: Clinicaltrial.gov ID: NCT03299959 (registered on 14 September 2017).
Endoscopic-assisted percutaneous fixation for displaced anterior inferior iliac spine avulsion fractures: a prospective cohort study.
Audisio A, Aprato A, Reinaudo V … +3 more , Sinatra G, Lucchino L, Massè A
J Orthop Traumatol · 2025 Mar · PMID 40057584 · Full text
INTRODUCTION: Anterior inferior iliac spine (AIIS) avulsion fractures commonly occur in adolescent patients during sports activities. To systematically evaluate fracture severity and guide management, an adaptation of th...
INTRODUCTION: Anterior inferior iliac spine (AIIS) avulsion fractures commonly occur in adolescent patients during sports activities. To systematically evaluate fracture severity and guide management, an adaptation of the Hetsroni classification system was used to categorize fractures on the basis of their displacement relative to the acetabular rim. Traditional open reduction and internal fixation reported satisfactory consolidation rates but complications such as lateral femoral cutaneous nerve (LFCN) neuropathies, heterotopic ossifications (HO), and subspine impingement. The objectives of this work are to (1) report short- and mid-term radiographic and clinical outcomes and (2) propose an adapted classification system based on the risk of subsequent subspine impingement. MATERIALS AND METHODS: A prospective cohort study was conducted on patients with AIIS avulsion fracture with ≥ 1.5 cm displacement who underwent surgery between 2021 and 2024. Patients with follow-up < 6 months, displacement < 1.5 cm, comminuted fractures, or chronic fractures were excluded. Clinical outcomes, including the subspine impingement test, the modified Harris Hip Score (mHHS), and the University of California Los Angeles Score (UCLA), were evaluated at last follow-up. Postoperative complications, such as LFCN neurapraxia, HO (classified by Brooker), and surgical revisions, are reported. RESULTS: Eleven male patients with mean age of 14.1 years (range 12.8-15.0 years) were included. Fractures were classified as type I in two patients (18.2%), type II in four patients (36.4%), and type III in five patients (45.4%). The mean surgical duration was 71.4 min (SD 17.1 min), and the average time from injury to surgery was 4.2 days (range 1-11 days). The mean fracture displacement was 18.3 mm (range 15-25 mm). Postoperative scores averaged 89.7 for mHHS (SD 3.1) and 9.7 for UCLA (SD 0.6). Patients were followed for 20.0 months (range 6-47 months, SD 13.3 months). One patient underwent open surgical revision and subsequently experienced temporary LFCN neurapraxia, HO (Brooker 1), and symptoms of subspine impingement. CONCLUSIONS: Endoscopic-assisted percutaneous fixation is an effective technique for treating displaced AIIS avulsion fractures. Preliminary results suggest that this approach offers noninferior results, satisfactory outcomes, and limited complications. Further studies with long-term follow-up are needed to confirm these findings.
Effects of intra-articular tranexamic acid injection with different acting times after anterior cruciate ligament reconstruction: a cohort study with historical controls.
Lee KH, Chen KH, Ma HH … +3 more , Huang TJ, Ma HL, Chiang ER
J Orthop Traumatol · 2025 Mar · PMID 40056278 · Full text
BACKGROUND: Intra-articular tranexamic acid (TXA) has been proven effective in reducing postoperative bleeding in anterior cruciate ligament reconstruction (ACLR). We aimed to evaluate the effect of intra-articular injec...
BACKGROUND: Intra-articular tranexamic acid (TXA) has been proven effective in reducing postoperative bleeding in anterior cruciate ligament reconstruction (ACLR). We aimed to evaluate the effect of intra-articular injection of TXA with different acting times after an ACLR procedure. PATIENTS AND METHODS: Patients receiving ACLR and intra-articular injection of TXA between September 2023 and January 2024 were randomly divided into two groups, with drainage clamped for 4 h (TXA 4 h group) or 8 h (TXA 8 h group). Postoperative drainage output was the primary outcome. The secondary outcomes included the visual analog scale (VAS), grade of hemarthrosis, and International Knee Documentation Committee (IKDC) functional score. The data of another two groups of patients (TXA 2 h group and placebo group) were retrieved from a previous study as historical control groups for subsequent analysis. RESULTS: 121 patients were included. There were no significant differences in drainage output between TXA 4 h and TXA 8 h groups. On postoperative day 3, significantly decreased grades of hemarthrosis were noted in the TXA 8 h group (P = 0.030). There were no significant differences in the VAS at different postoperative time points or in the IKDC scores. Comparison with the placebo and TXA 2 h groups revealed significant reduction in postoperative drainage among the TXA 4 h and 8 h groups. The IKDC scores were significantly worse in the TXA 8 h group compared with the TXA 2 h (P < 0.001) and placebo (P = 0.009) groups. CONCLUSIONS: A 4 h clamping time for intra-articular TXA administration after ACLR may be considered in current practice, as it effectively reduces drainage and pain without negatively impacting functional outcomes. LEVEL OF EVIDENCE: Level III, cohort study.
Can we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial.
Cohen A, Reijman M, Kraan GA … +4 more , Baart SJ, Verhaar JAN, Colaris JW, SUSPECT study group
J Orthop Traumatol · 2025 Mar · PMID 40044935 · Full text
BACKGROUND: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead o...
BACKGROUND: In suspected scaphoid fractures with normal initial radiographs, the usual care is casting, but only 10% of patients have scaphoid fractures. To reduce overtreatment, we evaluated whether bandaging, instead of casting, resulted in noninferior functional outcomes. PATIENTS AND METHODS: We included adults with suspected scaphoid fractures and normal initial radiographs at the emergency department in our multicenter randomized controlled trial. Patients were randomized to 3-day bandaging or 2-week casting. Questionnaires, physical examination, and radiographs were performed at 2 weeks and 1 year. Additional questionnaires were sent after inclusion, 6 weeks, and 3 months. Our primary outcome was the adjusted estimated difference between groups of the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) score at 3 months (natural logarithm of the margin of noninferiority = 2.0). Secondary outcomes included the QDASH score, Patient-Rated Hand/Wrist Evaluation Score, visual analog scale pain, wrist range of motion, patient satisfaction, and complications during follow-up. RESULTS: Of the 180 patients (91 bandaging and 89 casting), 16 had scaphoid fractures and there were no scaphoid nonunions. Functional outcome in the bandaging group was noninferior at 3 months compared with the casting group [adjusted estimated difference QDASH score 0.30 (95% CI 0.02-0.62)]. All other patient-reported function and pain scores were not significantly different between groups. Range of motion at 2 weeks was better in the bandaging group, and they were more satisfied with the treatment than the casting group. CONCLUSIONS: Casting for suspected scaphoid fractures but normal initial radiographs can be avoided because bandaging seems to be an alternative treatment option when patients are reevaluated after 2 weeks. Level of evidence Level II. Trial registration Trial registered at the Trialregister on 2018-02-28 on www.trialregister.nl , NTR7164.
Intra-operative blood transfusions raise the risk of postoperative delirium and impede functional recovery in elderly hip fracture patients: a propensity score-matched study.
Li Y, Wang T, Zhang J … +3 more , Wang Z, Guo J, Zhang Q
J Orthop Traumatol · 2025 Feb · PMID 40021592 · Full text
BACKGROUND: This retrospective analysis was performed to investigate the potential influence of intra-operative blood transfusion (IBT) in patients aged 65 years or older with intertrochanteric fractures (IF) who underwe...
BACKGROUND: This retrospective analysis was performed to investigate the potential influence of intra-operative blood transfusion (IBT) in patients aged 65 years or older with intertrochanteric fractures (IF) who underwent intramedullary fixation. METHODS: The outcomes of interest included the incidence of postoperative delirium (POD), pain score at discharge, length of hospital stay (LOS), functional outcomes, and mortality. The study included all surgically treated patients with IF between Jan. 2018 and Dec. 2021. Data on patient demographics, injury-related factors, surgical procedures, intraoperative details, in-hospital information, and postoperative outcomes were collected. In order to mitigate potential confounding and selection bias, the researchers employed the propensity score matching (PSM) technique using a 1:1 ratio via the caliper matching method. Following PSM, the association between IBT and outcome analyses was assessed using McNemar's Chi-square tests. Additionally, the Spearman correlations between IBT, POD and postoperative functional outcomes were computed. RESULTS: Out of the initial 2159 consecutive patients screened, a final sample of 1681 individuals was included, consisting of 1278 in the non-IBT group and 403 in the IBT group. After PSM, each group comprised 298 participants. The disparities in POD rate and functional outcomes became significant after employing propensity score-based matching (P < 0.001 and 0.029, respectively), despite their lack of significance prior to matching. There were no notable distinctions observed in other operation-related data, LOS, and crude mortality rates at 30-day, 90-day, and 12-month intervals before and after PSM. Furthermore, incidence of POD (P = 0.006) and functional outcomes (P = 0.013) were significantly associated with IBT. CONCLUSION: In conclusion, IBT significantly increases the incidence of POD and hinders postoperative functional recovery in elderly patients with hip fracture.
Comparing two autologous bone grafting techniques to treat clavicular midshaft atrophic nonunion: a retrospective study.
Ma T, Huang Q, Wang C … +6 more , Ren C, Xu Y, Lin H, Zhang K, Zhang C, Li Z
J Orthop Traumatol · 2025 Feb · PMID 40021545 · Full text
BACKGROUND: Open reduction, superior plate (SP) fixation, and autologous cancellous granular bone grafting (ACGBG) are common strategies for treating clavicular midshaft atrophic nonunion (CMAN). We aimed to compare the...
BACKGROUND: Open reduction, superior plate (SP) fixation, and autologous cancellous granular bone grafting (ACGBG) are common strategies for treating clavicular midshaft atrophic nonunion (CMAN). We aimed to compare the radiological findings and clinical effects of two autologous cancellous bone grafts (ACBGs) and those of single SP fixation, to treat CMAN. METHODS: This retrospective study comprised 62 patients admitted to our hospital with CMAN (ACGBG with single SP fixation between March 2012 and October 2017, 32 patients; autologous cancellous structured bone grafting [ACSBG] with single SP fixation between November 2017 and May 2021, 30 patients). Patient visual analog scale (VAS) scores for pain and disability of the arm, shoulder, and hand (DASH) scores, obtained preoperatively and at final follow-up, were recorded and analyzed. Statistical differences between the ACGBG and ACSBG groups were assessed using Fisher's exact and two-sample independent t tests. RESULTS: No statistically significant differences were observed between the two groups in terms of patient demographics or the incidence of complications. VAS and DASH scores decreased significantly from the preoperative day to 9 months postoperatively in both groups, but this difference was not statistically significant at final follow-up. However, at 3 and 6 months postoperatively, compared with mean VAS and DASH scores in the ACGBG group, the ACSBG group showed lower pain and dysfunction scores (p < 0.05). The mean fracture healing times were 15.2 (range, 12-20) and 18.6 (range, 12-32) weeks in the ACSBG and ACGBG groups, respectively (p = 0.01). One case of plate breakage occurred in the ACGBG group at 5 months postoperatively, with recovery following ACSBG revision with single SP fixation. CONCLUSIONS: ACSBG combined with single SP fixation is a promising and effective alternative technique for promoting bone union and postoperative early functional rehabilitation in treating CMAN. LEVEL OF EVIDENCE: Level 3.
Radiological outcomes of surgical techniques for spastic hip in cerebral palsy: a systematic review and meta-analysis.
Menbari Oskouie I, Hakiminejad A, Yazdanmehr A … +8 more , Mostafavi K, Mafhoumi A, Sajedi AH, Roosta A, Arvin A, Presedo A, Nabian MH, Kasaeian A
J Orthop Traumatol · 2025 Feb · PMID 40021534 · Full text
BACKGROUND: In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFP...
BACKGROUND: In patients with cerebral palsy (CP), spastic hip is a prevalent complication. Various surgical approaches,, including pelvic osteotomy (PO), femoral osteotomy (FO), combined femoral and pelvic osteotomy (CFPO), and soft tissue surgery (STS), have been used to address this problem. This systematic review and meta-analysis was designed to compare the radiologic outcomes of these interventions for spastic hip in patients with CP. METHODS: To identify relevant studies, databases were searched using specific keywords. Initially, duplicates were removed, then the titles and abstracts were screened, followed by a comprehensive full-text review. Data extraction took place from the studies that met the inclusion criteria. Subsequently, a meta-analysis was conducted. RESULTS: The analysis of 6116 hips from 4546 patients across 81 studies demonstrated that PO significantly enhanced the center-edge angle (CEA), reduced the acetabular index (AI) and migration percentage (MP), and improved the Sharp and Tönnis angles. FO led to a substantial decrease in AI and MP, though CEA did not show a significant change, while CFPO resulted in significant improvements across AI, MP, neck-shaft angle (NSA), CEA, Sharp angle, and Tönnis angle. STS did not show significant changes in AI or CEA, but MP was notably reduced. Tone-decreasing procedures, such as selective dorsal rhizotomy and botulinum toxin injections, did not significantly alter MP, whereas guided growth techniques showed a significant reduction. MP improvements in FO decreased over time, with other radiologic parameters remaining relatively stable as follow-up increased. Age-specific trends indicated that children under 6 years primarily underwent tone-decreasing procedures and STS, while those around 7 years favored FO and guided growth, and older children (over 9 years) more commonly underwent PO, CFPO, or percutaneous osteotomy. Comparative analysis showed PO and percutaneous osteotomy were particularly more effective in reducing MP, with PO also being superior for AI improvement; whereas CFPO provided better outcomes for enhancing CEA. No significant differences were found among surgical methods for improving NSA. CONCLUSIONS: This systematic review and meta-analysis underscores the superior efficacy of PO and CFPO in correcting spastic hip deformity in children with CP. Radiological outcomes demonstrate significant improvements following these procedures. The findings suggest that these approaches are particularly effective for complex cases where procedures such as FO, STS, or TDS may fall short. Future studies should focus on refining surgical protocols and exploring the long-term functional outcomes of these interventions.
Do all anatomic stems perform equally at long-term survival? A regional registry-based study on 12,010 total hip arthroplasty implants according to stem length and neck modularity.
Di Martino A, Rossomando V, Bordini B … +3 more , Brunello M, Ferri R, Faldini C
J Orthop Traumatol · 2025 Feb · PMID 39984816 · Full text
BACKGROUND: Anatomic stems for total hip arthroplasty (THA) have been developed to achieve a precise geometric fit between the implant and the surrounding femoral bone, aiming at the improvement of primary stability of c...
BACKGROUND: Anatomic stems for total hip arthroplasty (THA) have been developed to achieve a precise geometric fit between the implant and the surrounding femoral bone, aiming at the improvement of primary stability of cementless implants until osteointegration occurs. The aim of the current study is to go over the regional Registry of Orthopaedic Prosthetic Implants (RIPO) to analyze survivorship of THA implants when anatomic stems are used; moreover, separate analysis for modular and nonmodular stems, and in standard and short implants, is presented. MATERIALS AND METHODS: This retrospective registry study involved the analysis of data collected by the RIPO registry between 2000 and 2019. The study focused on THAs performed for primary hip osteoarthritis (OA) between 2000 and 2019. All patients treated by THA within this time frame and officially registered in the RIPO registry were included in the study. Exclusion criteria were: revision THAs, cemented implants, hemiarthroplasties, resurfacing procedures, megaprostheses for neoplastic and non-neoplastic conditions, and THAs performed on patients residing outside the region. RESULTS: A total of 12,010 cementless primary THAs using curved anatomic stems were performed in Emilia-Romagna between 2000 and 2019 and formally registered in the RIPO registry. The overall survival rate for anatomic standard stems was 96.7% at 10 years (96.1-97.3%); at 15 from the surgery, the survival rate dropped to 95.1% (93.9-96.1%). A total of 473 out of 12,010 recorded THA with anatomic stems (3.93%) experienced failure requiring revision surgery. The fixed standard stem showed the lowest failure rate (0.6%), while modular short stems had the highest (7.4%) at long-term follow-up. The most common stem-related complication was periprosthetic fracture (PF) in short stems (2.0% of cases) while in standard stems it was implant breakage (0.9% of cases); PFs were significantly more frequent in female patients (p = 0.0082), with a relative risk (RR) of 1.59 compared with male patients. Implant breakage demonstrated the highest rate of incidence among standard-modular stems (1.1% of cases). CONCLUSIONS: This registry-based study highlights that stem length and modularity significantly affect the long-term survival of anatomic femoral stems in THA. Fixed standard stems had the lowest failure rates, while modular short stems showed the highest failure rates and complications.
Higher nonunion rates with locking plates compared to dynamic compression plates in forearm diaphyseal fractures: a multicenter study.
Tseng TH, Hung CC, Yen HK … +4 more , Chen HM, Wang CY, Tzeng SC, Fu SH
J Orthop Traumatol · 2025 Feb · PMID 39984810 · Full text
BACKGROUND: Dynamic compression plate (DCP) osteosynthesis is the gold standard for treating forearm diaphyseal fractures, providing stability and promoting healing. Locking plates (LPs) are increasingly used in modern f...
BACKGROUND: Dynamic compression plate (DCP) osteosynthesis is the gold standard for treating forearm diaphyseal fractures, providing stability and promoting healing. Locking plates (LPs) are increasingly used in modern fracture management but may increase the risk of nonunion if applied with excessive rigidity and without proper fracture site compression. The purpose of this study is to compare the nonunion rate between LPs and DCPs. MATERIALS AND METHODS: We conducted a retrospective study by reviewing the medical records and radiographs of 515 patients diagnosed with radial and/or ulnar shaft fractures at three trauma centers between 2014 and 2019. Inclusion criteria were patients treated with locking plates (LPs), locking compression plates (LCPs), or dynamic compression plates (DCPs) who had at least 9 months of outpatient follow-up and imaging assessments. Exclusion criteria included treatment with other methods, hospitalization for pathological fractures or implant removal, or incomplete surgical records. Data on patient demographics, injury details, and surgical outcomes were collected to compare nonunion rates, as well as early and late complications, between the LP and DCP groups. RESULTS: A total of 368 patients were included in the analysis. Among them, 132 (35.9%) had isolated radial shaft fractures, 116 (31.5%) had isolated ulnar shaft fractures, and 120 (32.6%) had both-bone fractures. Of these, 124 patients received LP implants, 98 were treated with LCPs, and 146 were treated with DCPs. Early complications were comparable among the groups; however, the nonunion rate was significantly higher in the LP group (18.5% versus 11.2% versus 6.2%, p < 0.007). Logistic regression identified LP use [odds ratio (OR): 3.05, 95% confidence interval (CI) 1.24-7.53] as a significant predictor of nonunion. Notably, LPs lacking dynamic compression functionality were associated with markedly higher odds of nonunion in radial shaft fractures (OR: 26.94, 95% CI 3.52-206.15). These findings collectively indicate that LPs increase the nonunion rate in forearm fractures. CONCLUSIONS: Using LPs without compression functionality to treat forearm diaphyseal fractures increases the nonunion rate, particularly in radial shaft fractures. Therefore, we recommend using LCPs or DCPs for forearm diaphyseal fractures to ensure adequate compression at the fracture site during fixation, thereby promoting optimal bone healing rates. LEVEL OF EVIDENCE: Level III: retrospective comparative therapeutic study.
Osteoperiosteal versus osteochondral for autologous transplantation in the treatment of large cystic osteochondral lesions of the talus.
Liu L, Jin J, Pan J … +4 more , Guo H, Li S, Li J, Zhang Z
J Orthop Traumatol · 2025 Feb · PMID 39918724 · Full text
BACKGROUND: Osteochondral lesions of the talus (OLTs) with a large subchondral cyst have been shown to have inferior clinical outcomes after reparative techniques. Replacement techniques such as autologous osteoperiostea...
BACKGROUND: Osteochondral lesions of the talus (OLTs) with a large subchondral cyst have been shown to have inferior clinical outcomes after reparative techniques. Replacement techniques such as autologous osteoperiosteal transplantation (AOPT) and autologous osteochondral transplantation (AOCT) are indicated for large lesions. The aim of the study was to compare the short-term clinical and radiographic outcomes between patients undergoing AOPT and those undergoing AOCT for large cystic OLTs. METHODS: Patients who underwent AOPT or AOCT for medial large cystic OLTs between May 2019 and June 2023 were retrospectively evaluated. According to their characteristics, 1:1 propensity-score matching was performed, and 65 pairs of patients with ages ranging from 18 to 60 years old were recruited. Clinical outcomes were compared between both groups with the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS). The Ankle Activity Score (AAS), time to return to sports activity (RTA), rate of return to sports level, complications, and results of a subjective evaluation were also collected. The integrity of subchondral bone and the quality of repaired cartilage were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score 12 months postoperatively. Second-look arthroscopy was performed 12 months postoperatively, and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society (ICRS). RESULTS: The within-group comparison showed significant improvements in pain severity and function in both groups post-treatment compared with pre-treatment. Between-group analysis, however, showed no significant statistical difference between groups in any of the variables for clinical and radiographic outcomes, except for donor-site morbidity of the AOPT group, which showed a better outcome compared to the AOCT group. CONCLUSIONS: In the treatment of large cystic OLTs, for patients with a chondral lesion of the patellofemoral joint that is unsuitable for AOCT, AOPT may be a safe and effective choice, with lower donor-site morbidity of the normal knee joint.
Is the treatment of ankle osteoarthritis changing over time in Italy? Analysis of temporal trends for fusion and arthroplasty in a population-based study from 2001 to 2022 on the National Hospital Discharge Record database.
Cuccu A, Samaila EM, Ciminello E … +5 more , Alfieri Montrasio U, Cortese F, Ceccarelli S, Falcone T, Torre M
J Orthop Traumatol · 2025 Jan · PMID 39881112 · Full text
BACKGROUND: Treatment of ankle osteoarthritis by total ankle replacement (TAR) is increasing worldwide. The aim of the study was to present the overall temporal trends of TAR throughout 22 years (2001-2022) in Italy, ana...
BACKGROUND: Treatment of ankle osteoarthritis by total ankle replacement (TAR) is increasing worldwide. The aim of the study was to present the overall temporal trends of TAR throughout 22 years (2001-2022) in Italy, analyzing the distributions of hospitals by volume of activity and patients by age and sex, drawing on the National Hospital Discharge Record database. Furthermore, as a secondary aim, we compared these trends with those of ankle fusions. MATERIALS AND METHODS: International Classification of Diseases, 9th Revision, Clinical Modification (ICD9-CM) codes of interest were identified to browse the Italian National Hospital Discharge Record database. Surgical volumes, trends over time, classes of hospital activity volume, sex and age of patients, and population incidence rates were described. The statistical significance of time series trends was assessed by the Cox-Stuart test with randomness as a null hypothesis. RESULTS: 20,248 ankle procedures (total ankle replacements 8853 and ankle fusions 11,395) were extracted from 231,601,523 admissions registered nationally from 2001 to 2022. The yearly total number of TARs significantly increased almost tenfold from 96 to 996 (p < 0.05), while the number of fusions exhibited a stationary behavior (p > 0.05). The increased trend in TAR procedures was concentrated mostly in the North of Italy, with predominantly males between 55 and 64 years of age. The analysis of the number of procedures performed on inhabitants by region and that performed by all the hospitals in the region showed a different pattern across Italy. CONCLUSIONS: The substantial increase in TARs may be owing to improved implant designs and innovative surgical technologies, which allow the treatment of more severe cases and deformities, previously untreated or treated by a fusion. This trend highlights the need to invest in implementing high quality registries by promoting surgeons' participation in data collection. LEVEL OF EVIDENCE: population based study, level 1 evidence.
Anterior cervical discectomy and fusion with self-locking standalone cage for the treatment of cervical degenerative disc disease in patients over 80 years.
Zhou J, Hu A, Zhou X … +1 more , Dong J
J Orthop Traumatol · 2025 Jan · PMID 39881082 · Full text
BACKGROUND: The need for anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease (CDDD) will probably grow dramatically in the geriatric population. However, ACDF with self-locking standalon...
BACKGROUND: The need for anterior cervical discectomy and fusion (ACDF) for cervical degenerative disc disease (CDDD) will probably grow dramatically in the geriatric population. However, ACDF with self-locking standalone cages in patients over 80 years has not yet been investigated. This study aimed to assess the clinical and radiographic results in patients over 80 years treated by ACDF with self-locking standalone cages. METHODS: Between January 2018 and December 2019, patients with CDDD treated with ACDF were retrospectively stratified into two groups: the older group (≥ 80 years) and the younger group (< 65 years). The data collected included the demographics, preoperative comorbidities, intraoperative parameters, length of hospital stay, complications, clinical scores, and radiological parameters. RESULTS: A total of 123 patients were included in the study. The mean follow-up duration was 28.3 ± 2.4 months. The hospital stay was 5.3 ± 0.6 days and 3.8 ± 0.4 days, respectively, for the older and younger groups. Postoperative complication rate was found higher in the older group than that of the young group without significance. All the patient-reported outcome parameters had significant improvement at the final follow-up. The two groups had no significant differences in terms of the excellent and reasonable rates, fusion rate, and the C2-C7 Cobb angle. CONCLUSIONS: Although a slightly higher incidence of complications, poorer recovery rate, and more extended hospital stay were found, without significant differences, satisfactory clinical and radiographic results were obtained in the older patients. The self-locking standalone cage is a safe and viable option for patients over 80 years who suffer from CDDD. Level of evidence Level IV.
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