Orthopedics[JOURNAL]
Sun
200 papers
Preoperative Copper-to-Zinc Ratio and Postoperative Delirium After Hip Fracture Surgery: A Propensity Score-matched Cohort Study.
Lee C, Ahn YJ, Lee K … +1 more , Kim J
Orthopedics · 2026 Jun · PMID 42347850 · Publisher ↗
BACKGROUND: Postoperative delirium (POD) is frequent after hip fracture surgery, yet objective biomarkers that improve risk stratification beyond age, dementia, and frailty are limited. The serum copper-to-zinc (Cu/Zn) r...
BACKGROUND: Postoperative delirium (POD) is frequent after hip fracture surgery, yet objective biomarkers that improve risk stratification beyond age, dementia, and frailty are limited. The serum copper-to-zinc (Cu/Zn) ratio reflects combined inflammatory and nutritional vulnerability, but its association with POD after hip fracture surgery is uncertain. MATERIALS AND METHODS: We performed a single-center retrospective cohort study of 420 consecutive patients aged ≥65 years undergoing surgery for low-energy hip fracture. The preoperative Cu/Zn ratio, measured within 48 hours before surgery, was the exposure (prespecified high ratio >2.0). The primary outcome was POD within 7 postoperative days or before discharge. Secondary outcomes were numeric rating scale pain scores, 24-hour morphine-equivalent opioid consumption, and hospital length of stay (LOS). RESULTS: In the matched cohort, POD occurred in 23/124 (18.5%) patients with low Cu/Zn ratios and 56/124 (45.2%) with high ratios (odds ratio [OR], 3.62; 95% confidence interval [CI], 2.04-6.42; < .001). In the full cohort, high Cu/Zn remained associated with POD after adjustment (adjusted OR, 3.35; 95% CI, 2.00-5.59; < .001). After matching, early postoperative pain and 24-hour opioid consumption were not significantly different, whereas LOS was modestly longer in the high Cu/Zn group (mean difference = 1.0 day). CONCLUSION: A high preoperative Cu/Zn ratio (>2.0) was independently associated with increased odds of POD and slightly longer hospital LOS after hip fracture surgery in older adults, with minimal impact on early pain-related outcomes.
Supracondylar Distal Femur Fracture Fixation: Early Experiences Comparing the Retrograde Nail With Locking Attachment Washer (LAW) Plate to Traditional Fixation Techniques.
Bishara P, Bishara E, Perez S … +3 more , Hill S, Samanta D, Duvall NM
Orthopedics · 2026 Jun · PMID 42347849 · Publisher ↗
BACKGROUND: The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures...
BACKGROUND: The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate. MATERIALS AND METHODS: A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications. RESULTS: Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group ( = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance. CONCLUSION: The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.
Intra-Articular Vancomycin Powder in Primary Total Knee Arthroplasty: A Retrospective Observational Study.
Şibar K, Biçici V, Şibar EG … +4 more , Erdoğan Y, Akgün E, Uzar H, Firat A
Orthopedics · 2026 Jun · PMID 42347848 · Publisher ↗
BACKGROUND: Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). Vancomycin powder has been proposed as a low-cost adjunct to reduce infection by providin...
BACKGROUND: Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). Vancomycin powder has been proposed as a low-cost adjunct to reduce infection by providing high local antibiotic concentrations with minimal systemic exposure; however, clinical evidence remains inconsistent. This study aimed to evaluate the effect of intra-articular vancomycin powder on PJI, aseptic wound complications, and renal function in primary TKA. MATERIALS AND METHODS: Patients who underwent primary TKA between 2022 and 2024 with at least 1 year of follow-up were retrospectively analyzed. A total of 661 patients were included: 247 received 1 g intra-articular vancomycin powder and 414 served as controls. All procedures were performed with standardized perioperative protocols. Demographics, comorbidities, and high-risk status were recorded. Outcomes included PJI, aseptic wound complications, and acute kidney injury. RESULTS: PJI occurred in 7 patients (1.1%): 6 in the control group (1.4%) and 1 in the vancomycin group (0.4%), with no significant difference ( = .266). Aseptic wound complications were observed in 28 patients (4.2%), including 20 control patients (4.8%) and 8 vancomycin patients (3.2%) ( = .326). Acute kidney injury occurred in 12 patients (1.8%), with comparable rates between groups ( = 1.000). CONCLUSION: Intra-articular vancomycin powder did not result in a statistically significant reduction in PJI rates, while demonstrating a favorable safety profile. Although safe, routine use may not provide additional measurable benefit in optimized surgical settings with low baseline infection rates. Larger, well-designed randomized trials are required to identify patient subgroups who may benefit from selective application.
Limb Salvage Versus Amputation for the Management of Primary Bone Tumors of the Upper Extremity: A Systematic Review.
Zouhbi AE, Wanna TE, El Abiad JM … +3 more , Fatfat A, Yassine I, Haidar R
Orthopedics · 2026 · PMID 42206844 · Publisher ↗
Primary bone tumors are rare yet present a significant burden to patients, with surgery being the mainstay of treatment. We reviewed outcomes of limb salvage (LS) and amputation for management of upper extremity tumors....
Primary bone tumors are rare yet present a significant burden to patients, with surgery being the mainstay of treatment. We reviewed outcomes of limb salvage (LS) and amputation for management of upper extremity tumors. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. A total of 2,886 studies were screened, and 5 studies were included (n = 187 patients; LS = 101, Amputation = 86). Commonly reported outcomes included local recurrence, metastasis at follow-up, and survival. Metastasis and local recurrence rates were in favor of LS surgery, with some studies reporting no differences. Survival was consistently reported to be statistically significantly in favor of LS.
A Modified Keshishyan Index Demonstrates Three-dimensional Assessment of Asymmetry in Pediatric Pelvic Fractures.
Krajewski KT, Hornfeck M, Sanders JS
Orthopedics · 2026 · PMID 42206843 · Publisher ↗
BACKGROUND: Orthopedic surgeons use a combination of plain radiographs and computed tomography (CT) to diagnose and manage pelvic ring injuries. Historically, pelvic ring asymmetry has been calculated using the Keshishya...
BACKGROUND: Orthopedic surgeons use a combination of plain radiographs and computed tomography (CT) to diagnose and manage pelvic ring injuries. Historically, pelvic ring asymmetry has been calculated using the Keshishyan index (KI) measured in 2 dimensions. Three-dimensional (3D) CT modeling may assess deformity more comprehensively, aiding in treatment decisions. This study aimed to evaluate the accuracy and reliability of a modified KI (MKI) derived from 3D models of pediatric patients with pelvic fractures. MATERIALS AND METHODS: Two separate raters identified landmarks 3 separate times on 29 generated models. Traditional KI (TKI) was calculated using the contralateral distance between the most anterior portion of the sacroiliac joint (SAAS) and the deepest point of the acetabulum. The MKI used the contralateral distance between the SAAS and pubic tubercle. KI was calculated on correlating radiographs (RxKI). Bland-Altman analyses and intra-/interclass correlation coefficients (ICC) were used to evaluate agreement between measurement methods and reliability. RESULTS: RxKI and TKI measurements exhibited similar agreement with a mean bias (MB) of -0.0205. RxKI and MKI had a MB of 0.0012, and TKI and MKI had a MB of 0.0210. TKI reliability ranged from good to excellent (Intra = 0.923, 95% confidence interval [CI], 0.892-0.947; Inter = 0.897, 95% CI, 0.852-0.928), and MKI reliability was excellent (Intra = 0.938, 95% CI, 0.911-0.959; Inter = 0.912, 95% CI, 0.876-0.937). CONCLUSION: All methods exhibited excellent reliability, with MKI having the highest ICCs. MKI provided similar, reproducible values compared with RxKI, suggesting that clinicians can compare pelvic asymmetry values between CT and radiograph images.
Planned Versus Intraoperative Vascular Surgery Consultations in Orthopedic Oncology.
Riley DJ, Butler ZR, Alfonsi S … +3 more , Kupietzky K, Richard M, Blank AT
Orthopedics · 2026 · PMID 42206842 · Publisher ↗
BACKGROUND AND OBJECTIVE: Orthopedic oncology surgeries frequently involve complex resections where critical neurovascular structures are at risk, and vascular injury can result in severe complications, including functio...
BACKGROUND AND OBJECTIVE: Orthopedic oncology surgeries frequently involve complex resections where critical neurovascular structures are at risk, and vascular injury can result in severe complications, including functional loss and mortality. Although multidisciplinary vascular collaboration is increasingly recognized as beneficial in oncologic surgery, limited evidence exists regarding optimal timing of vascular surgery consultation in orthopedic oncology. This study evaluated whether preoperative planned consultations improve intraoperative and postoperative outcomes compared to intraoperative consultations. MATERIALS AND METHODS: A retrospective review identified 30 patients who underwent orthopedic oncology surgery requiring vascular surgery involvement between 2015 and 2025 at a single academic institution. Patients were categorized into planned vascular consultations (n = 18) and intraoperative consultations (n = 12). Data collection included demographics, operative details, estimated blood loss (EBL), complications, and type of vascular intervention. RESULTS: The intra-operative consultation group experienced significantly higher median EBL (1,225 mL vs 325 mL, = .015). Additionally, intraoperative consultations demonstrated trends toward longer operative times (307 vs 185.5 minutes) and higher postoperative complication rates. Infections occurred in 42% of intraoperative cases compared to 17% of planned cases. One intraoperative patient also experienced cardiac arrest, and another developed deep vein thrombosis. CONCLUSION: Planned vascular surgery consultations are associated with significantly reduced intraoperative blood loss and trend toward improved operative efficiency and fewer postoperative complications. This is the first study directly comparing outcomes between planned and intraoperative vascular consultations in orthopedic oncology. Early vascular involvement enables better anticipation of vascular challenges and supports proactive multidisciplinary collaboration to enhance patient safety and optimize resource use.
Alteon HA Femoral Stem vs Origin Stem in Total Hip Arthroplasty: A Retrospective Cohort Study.
Christensen CP, Hendricks CB, Muehlmann AM
Orthopedics · 2026 · PMID 42206841 · Publisher ↗
BACKGROUND AND OBJECTIVE: Standard-length hydroxyapatite (HA)-coated femoral stems have demonstrated strong performance and survivorship in total hip arthroplasty. However, limited data exist comparing these outcomes to...
BACKGROUND AND OBJECTIVE: Standard-length hydroxyapatite (HA)-coated femoral stems have demonstrated strong performance and survivorship in total hip arthroplasty. However, limited data exist comparing these outcomes to those of newer, shortened HA-coated stems. MATERIALS AND METHODS: This retrospective cohort study evaluated intraoperative and postoperative outcomes in patients who underwent total hip arthroplasty using either the standard-length Origin Stem or the shortened Alteon HA Femoral Stem. RESULTS: A total of 479 patients were included (151 Origin, 328 Alteon HA). The Origin group showed higher rates of calcar fracture (3.3% vs 2.1%), distal femur reaming (2.0% vs 0.3%), and revision (1.3% vs 0.3%), though not statistically significant. Osseointegration was achieved in the majority of cases (Origin: 96.8%; Alteon HA: 95.0%). Both groups experienced significant improvements in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and EQ-5D scores ( < .0001), as well as having comparable Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scores. Leg length discrepancy occurred significantly more frequently in the Origin group compared to the Alteon HA group (2.6% vs 0.3%). The Alteon HA group demonstrated a 2-year survivorship rate of 98.2%. CONCLUSION: Both the standard-length Origin and shortened Alteon HA stems showed excellent short-term results, with 96% of patients in each group experiencing meaningful functional improvement. Both implants showed high osseointegration with low complication and revision rates. The Origin stem required more distal reaming and had an increased leg length discrepancy risk, whereas the shorter Alteon HA stem provided greater intraoperative flexibility with equally strong early results.
Small Femoral Nails and the Development of a Nonunion: A Case-Control Study.
Brand J, Hughes M, Turner KE … +7 more , Lawrence JE, Kovvur M, Gage MJ, Nascone JW, Sciadini MF, O'Hara NN, O'Toole RV
Orthopedics · 2026 · PMID 42206840 · Publisher ↗
BACKGROUND AND OBJECTIVE: Locked intramedullary (IM) nails are the primary treatment modality for femoral shaft fractures. This study aimed to determine the risk of developing a femur nonunion as a function of nail-to-bo...
BACKGROUND AND OBJECTIVE: Locked intramedullary (IM) nails are the primary treatment modality for femoral shaft fractures. This study aimed to determine the risk of developing a femur nonunion as a function of nail-to-bone diameter mismatch. MATERIALS AND METHODS: A retrospective case-control study was performed at a Level I trauma center. Adult patients with femoral shaft fractures (AO/OTA 32 classification) treated with IM nail fixation from 2016 to 2022 were identified from the institutional database. Cases required nonunion surgery. Controls were randomly selected in a 3:1 ratio and included only if fractures healed at final follow-up based on the modified Radiographic Union Score of the femur (mRUSF). The primary outcome was nonunion. The study compared the association of nonunion with nail diameter (range, 9 mm to 13 mm) relative to femur width (range, 12 mm to 36 mm) and adjusted for smoking status, open fracture, and the degree of comminution. RESULTS: In total, 203 patients were included: 50 cases and 153 controls. Patients with a femur anterior-to-posterior diameter >22 mm at the level of the lesser trochanter (11% of this sample) were at increased odds for nonunion when treated with a small diameter IM nail (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7; = .01). In patients with narrower femur diameters, the nail diameter was not associated with increased odds of nonunion surgery. CONCLUSION: Larger IM nails (≥11 mm) might have protected against nonunion in patients with wide femoral canals (≥22 mm) but likely conferred no significant benefit in patients with narrower femoral canals.
Aspirin Versus Direct Oral Anticoagulants for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty: A 10-year Retrospective Cohort Study.
Chi R, Fox K, Ewing B … +2 more , Nakla A, Rajaee S
Orthopedics · 2026 · PMID 42206839 · Publisher ↗
BACKGROUND: Although venous thromboembolism (VTE) prophylaxis has been widely studied, comparative data evaluating aspirin versus direct oral anticoagulants (DOACs) following primary total knee arthroplasty (TKA) remain...
BACKGROUND: Although venous thromboembolism (VTE) prophylaxis has been widely studied, comparative data evaluating aspirin versus direct oral anticoagulants (DOACs) following primary total knee arthroplasty (TKA) remain limited. The study evaluated deep vein thrombosis (DVT) and pulmonary embolism (PE) incidence in patients prescribed aspirin or DOACs. MATERIALS AND METHODS: We retrospectively examined patients undergoing primary TKA at a single academic medical center over a 10-year period. There were 2,232 patients in the aspirin group and 1,638 in the DOAC group. Primary outcome measures include incidence of DVT and PE. A logistic regression model adjusted for differences across groups in relation to the primary outcome measures. RESULTS: The incidence of PEs (0.4% vs 0.6%, = .486) and DVTs (1.3% vs 1.4%, = .780) at 90 days were similar between the aspirin and DOAC groups, respectively. After adjusting for significant covariates in the logistic regression model, there remained no differences in the rate of PE and DVT between groups. The incidence of re-operation (0.4% vs 1.0%) was statistically different ( = .009) between the aspirin and DOAC groups at 90 days, respectively. CONCLUSION: Our study revealed no significant differences in the incidence of PE and DVT among patients receiving either DOACs or aspirin following primary TKA. While the rate of reoperation at 90 days was higher in the DOAC group, no differences were observed at 1 year. This study adds to the growing body of evidence demonstrating the safety and efficacy of aspirin for VTE prophylaxis in TKA.
A Comparative Analysis of Suture-Button and InternalBrace Fixation for Purely Ligamentous Lisfranc Injuries.
Lee S, Chun DI, Cho J … +3 more , Won SH, Lee SH, Yi Y
Orthopedics · 2026 · PMID 42017628 · Publisher ↗
BACKGROUND: Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal...
BACKGROUND: Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries. MATERIALS AND METHODS: A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications. RESULTS: Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up ( < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; = .58) or VAS scores (1.5 vs 1.2, respectively; = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis ( = .75) and no clinically significant loss of reduction at final follow-up. CONCLUSION: SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.
Effect of Socioeconomic Disadvantage on Patient-reported Outcomes After Orthopedic Trauma: A Study Using the Area Deprivation Index.
Puckett HD, Borgida JS, Kleinsmith RM … +7 more , Doxey SA, Swenson R, Rivard RL, Vang S, Shapiro LM, Nguyen MP, Cunningham BP
Orthopedics · 2026 · PMID 42017627 · Publisher ↗
BACKGROUND: Socioeconomic status (SES) is increasingly recognized as a key factor influencing outcomes after orthopedic procedures. The objective of this study was to determine the effect of socioeconomic disadvantage on...
BACKGROUND: Socioeconomic status (SES) is increasingly recognized as a key factor influencing outcomes after orthopedic procedures. The objective of this study was to determine the effect of socioeconomic disadvantage on patient-reported outcomes (PROs) after orthopedic trauma. MATERIALS AND METHODS: A retrospective review of PROs was performed for orthopedic trauma patients from 2018 to 2023. The Area Deprivation Index (ADI) was used as a surrogate for socioeconomic disadvantage. Outcomes included Patient-Reported Outcomes Measurement Information System Global Physical Health and Global Mental Health 10-item short forms (PROMIS 10 GPH and GMH) at 6 weeks, 3 months, 6 months, and 1 year postoperatively. A mixed-model analysis was performed to compare outcomes among ADI cohorts. RESULTS: In total, 844 patients were included. Of these, 313 (37.1%) were in the least socioeconomically disadvantaged group. There was a significant difference in the distributions of age, marital status, smoking status, and self-reported race among the five ADI cohorts ( < .002). Patients with an ADI of 1 or 2 (low disadvantage) had significantly higher PROMIS 10 GPH scores compared with their counterparts in ADI Groups 3/4, 5/6, and 9/10, although all groups saw a similar significant improvement from the 6-week to 1-year follow-up. CONCLUSION: Socioeconomic disadvantage has a significant effect on PROMIS 10 GPH and GMH scores following orthopedic trauma procedures. However, patients in all ADI cohorts saw improvements in PROMIS 10 GPH up to 1 year postoperatively. It is important to identify patients in socioeconomically disadvantaged areas and create care pathways to better optimize their improvements postoperatively.
Endobutton Combined With Medial Plate Fixation for the Treatment of Lisfranc Injuries.
Xiao K, Huang R, Qiu X
Orthopedics · 2026 · PMID 42017626 · Publisher ↗
BACKGROUND: The purpose of this study was to demonstrate the clinical efficacy of the Endobutton in combination with medial plate fixation for the treatment of Lisfranc injuries. MATERIALS AND METHODS: We analyzed clinic...
BACKGROUND: The purpose of this study was to demonstrate the clinical efficacy of the Endobutton in combination with medial plate fixation for the treatment of Lisfranc injuries. MATERIALS AND METHODS: We analyzed clinical data from 30 patients with Lisfranc injuries between February 2021 and October 2024 to assess foot function using Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale score, plantar pressure assessment, and weight-bearing imaging. We evaluated patients' postoperative pain and foot function, examined the appearance of the foot for any obvious deformities, assessed plantar pressure distribution, and conducted weight-bearing imaging to evaluate the gaps in patients' joints. RESULTS: All 30 patients received effective follow-up for a duration of 12 to 14 months (mean ± standard deviation, 12.92 ± 1.129 months). At the final follow-up, no clinically significant foot deformities were observed, and weight-bearing radiographs demonstrated stable tarsometatarsal alignment without evidence of progressive joint subluxation or displacement. The differences in the first and second tarsometatarsal joints gap distances and VAS and AOFAS scores at 3 months postoperatively and at the final follow-up were statistically significant ( < .05) when compared to the preoperative period. The difference in the results of the plantar pressure test between the injured foot and the contralateral foot was not statistically significant ( > .05). CONCLUSION: For low-energy and crush Lisfranc injuries, Endobutton combined with medial plate fixation yielded favorable early clinical outcomes and reliable short-term surgical results in this single-center retrospective study. Although the clinical benefits of this combined technique are promising, its efficacy compared with conventional fixation methods requires further validation in well-designed prospective controlled trials.
Impact of Varied Severity of Chronic Kidney Disease Stage on Surgical Outcomes Following Distal Radius Fracture Operative Fixation.
Sanchez JG, Zehner KM, Salib A … +4 more , Donnelly CA, Diatta FH, Wilson FP, Grauer JN
Orthopedics · 2026 · PMID 41944657 · Publisher ↗
BACKGROUND: Chronic kidney disease (CKD) alters bone metabolism, immune function, and vascular health, potentially increasing postoperative risk following distal radius fracture (DRF) operative fixation (ie, open reducti...
BACKGROUND: Chronic kidney disease (CKD) alters bone metabolism, immune function, and vascular health, potentially increasing postoperative risk following distal radius fracture (DRF) operative fixation (ie, open reduction and internal fixation, percutaneous pinning). However, data stratifying risk by CKD severity remain limited. This study evaluated the association between CKD stage and 90-day complications and 1-year orthopedic-related events following DRF operative fixation. MATERIALS AND METHODS: Adults aged 18 to 65 undergoing isolated DRF operative fixation were identified in the PearlDiver M170 database. Patients were stratified by CKD status: none, stage 1 to 2, stage 3 to 4, and stage 5 or end-stage renal disease (ESRD). Ninety-day medical complications and 1-year orthopedic-related events were assessed using univariable and multivariable logistic regression controlling for age and sex, with and without adjustment for Elixhauser Comorbidity Index (ECI). Bonferroni correction was significant at ≤ .001. RESULTS: Among 29,009 patients, 28,411 (97.9%) had no CKD history, 101 (0.3%) had stage 1 to 2 CKD, 336 (1.2%) had stage 3 to 4, and 161 (0.6%) had stage 5/ESRD. Complication risk increased stepwise with CKD severity. Adjusting for age and sex, odds ratios (OR) for any 90-day complication were 5.62, 15.07, and 30.63 for stages 1 to 2, 3 to 4, and 5/ESRD, respectively (all < .001). After ECI adjustment, associations remained significant, although attenuated (OR = 2.23, 5.93, and 11.04, respectively). No differences were observed in 1-year orthopedic-related events, including hardware removal or malunion/nonunion. CONCLUSION: CKD independently and incrementally increased short-term complication risk following DRF operative fixation, even after accounting for comorbidity burden. These findings support stage-based perioperative counseling and multidisciplinary optimization in patients with CKD.
Canopy Flap: A Specially Shaped Flap for the Repair of Complex Hand Defects.
Chen LF, Wang ZZ, Li WX
Orthopedics · 2026 · PMID 41944656 · Publisher ↗
BACKGROUND: Traditional flap transplantation for complex hand defect repair faces challenges like insufficient blood supply and scar contracture. This study aimed to explore the clinical value of the "canopy flap" with t...
BACKGROUND: Traditional flap transplantation for complex hand defect repair faces challenges like insufficient blood supply and scar contracture. This study aimed to explore the clinical value of the "canopy flap" with three-dimensional shaping in such repairs. MATERIALS AND METHODS: A retrospective analysis was conducted on 13 patients with irregular single wounds and complex tissue defects (accompanied by deep tissue exposure and nerve injury) treated with canopy flaps from June 2021 to March 2025. The technique included preoperative wound contour tracing, flap design based on a single perforator vessel, harvesting under tourniquet control, tension-dispersed transfer, microvascular anastomosis, and standardized postoperative management. Follow-up assessments used the British Medical Research Council sensory grading scale and hand function evaluation. RESULTS: Of the 13 flaps, 12 survived completely with primary healing; 1 developed postoperative venous crisis that was successfully salvaged. Follow-up showed flap appearance/texture similar to surrounding skin and no significant scar contracture. Sensory recovery reached S4 (4 cases), S3 (7 cases), and S2 (2 case). Approximately 70% of patients achieved excellent/good hand function, with all donor sites healing without functional impairment. CONCLUSION: The canopy flap has high survival rate, good three-dimensional conformability, and reduces complications. It achieves favorable sensory and functional recovery, providing a valuable option for complex hand defect repair.
Three Cases of Ipsilateral Limb Swelling Secondary to Iliopsoas Bursitis Following Total Hip Arthroplasty.
Na X, Ren C, Chen T … +1 more , Wu H
Orthopedics · 2026 · PMID 41944655 · Publisher ↗
This article reports three cases of ipsilateral limb swelling following total hip arthroplasty secondary to vascular compression from iliopsoas bursitis. The etiology was attributed to insufficient acetabular component a...
This article reports three cases of ipsilateral limb swelling following total hip arthroplasty secondary to vascular compression from iliopsoas bursitis. The etiology was attributed to insufficient acetabular component anteversion, leading to polyethylene liner wear and iliopsoas impingement. Two patients underwent revision surgery and achieved symptom resolution. In contrast, the third patient opted for conservative management, resulting in recurrent limb swelling and the development of deep vein thrombosis. The patient required interventional treatment by the vascular surgery service and ultimately showed clinical improvement.
Variations in Laxity After Total Knee Arthroplasty Do Not Affect Prosthesis-generated Noise.
Cozzarelli NF, Hohmann AL, Khan IA … +2 more , Zaid MB, Lonner JH
Orthopedics · 2026 · PMID 41885517 · Publisher ↗
BACKGROUND: Prosthesis-generated noise following total knee arthroplasty (TKA) may affect patient satisfaction and function. The advent of robotic-assisted TKA (RA-TKA) allows for objective knee laxity measurements. The...
BACKGROUND: Prosthesis-generated noise following total knee arthroplasty (TKA) may affect patient satisfaction and function. The advent of robotic-assisted TKA (RA-TKA) allows for objective knee laxity measurements. The purpose of this study was to compare knee laxity measurements in RATKA patients with and without reported noise generation. MATERIALS AND METHODS: This was a single-institution, retrospective study of 133 patients who underwent primary unilateral RA-TKA from 2018 to 2021. Patients completed a survey consisting of four Likert scale questions related to prosthesis noise, the Forgotten Joint Score (FJS), and the Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS, JR). Intraoperative laxity measures were obtained from the robotic system and compared between patients who did and did not report noise generation. RESULTS: Of the patients, 57.9% did not report noise and 42.1% did report noise. There were no significant differences in medial extension laxity (1.7 mm vs 1.8 mm; = .454), lateral extension laxity (1.9 mm vs 2.0 mm; = .567), medial flexion laxity (2.2 mm vs 2.0 mm; = .419), and lateral flexion laxity (2.7 mm vs 2.9 mm; = .307). Compared to patients who reported noise, those who did not had significantly higher satisfaction (94.8% vs 37.5%; < .001), postoperative KOOS, JR scores (79.2% vs 69.7%; = .005), and FJSs (60.3 vs 44.2; = .002). Patients who felt noise also had higher satisfaction (90.0% vs 41.5%, < .001). CONCLUSION: While prosthesis-generated noise symptoms affect satisfaction following TKA, variability in knee laxities does not seem to significantly affect whether a patient will experience noise following TKA.
Impact of Stroke History and Interval on Outcomes of Total Hip Arthroplasty: A Retrospective Cohort Study.
Botolin P, Robles R, Keshishian C … +3 more , Bains SS, Delanois RE, Patel NK
Orthopedics · 2026 · PMID 41885516 · Publisher ↗
BACKGROUND: There is limited data on perioperative management of patients with prior stroke undergoing total hip arthroplasty (THA). This study evaluates timing for THA following stroke. We assessed (1) complications at...
BACKGROUND: There is limited data on perioperative management of patients with prior stroke undergoing total hip arthroplasty (THA). This study evaluates timing for THA following stroke. We assessed (1) complications at 90 days, 1 year, and 2 years; (2) timing of stroke and THA; and (3) risk factors for periprosthetic joint infection (PJI). MATERIALS AND METHODS: We retrospectively analyzed a national database to identify 35,496 THA patients. Cohorts were stratified by time from stroke to surgery: no stroke (n = 20,000), stroke within 6 months (n = 5,535), 12 months (n = 3,165), 18 months (n = 2,614), 24 months (n = 2,168), and 30 months (n = 2,014). Complication rates were compared at 90 days, 1 year, and 2 years, and multivariate analysis identified risk for PJI. RESULTS: Stroke within 6 months of THA was associated with higher PJI revision rates at 90 days and 2 years (all < .046). Stroke within 18 months increased PJI revision risk across all time points (all < .047). Several risk factors were associated with this complication, including hypertension, obesity, and tobacco use. Stroke 6 to 18 months before THA was associated with higher rates of 90-day complications, including deep vein thrombosis, cardiac arrest, and surgical site infections. Patients with stroke prior to THA had significant risks of revision for PJI and aseptic revisions at 1 and 2 years, with risks depending on time between stroke and THA (all < .002). CONCLUSION: A history of stroke increases postoperative complications after THA, particularly PJI. We recommend patients defer THA for at least 18 months following a stroke to minimize risks.
Pulmonary Squamous Cell Carcinoma Presenting as Glenoid Bone Metastasis: A Case Report.
Zouhbi AE, Daaboul M, El Abiad JM … +4 more , Zakleet S, Shebly A, Saghieh S, Nassereddine M
Orthopedics · 2026 · PMID 41885515 · Publisher ↗
We present the case of a 64-year-old male patient who reported right shoulder radiculopathy, right-hand weakness, and 3 kg weight loss. Physical examination revealed restricted active shoulder mobility. Magnetic resonanc...
We present the case of a 64-year-old male patient who reported right shoulder radiculopathy, right-hand weakness, and 3 kg weight loss. Physical examination revealed restricted active shoulder mobility. Magnetic resonance imaging showed a massive septated lesion in the glenoid that infiltrated adjacent tissues, indicating sarcoma. Core needle biopsy revealed metastatic poorly differentiated squamous cell cancer. Positron emission tomography scan results showed a primary lung tumor (stage IVB) with metastases to the left adrenal gland and a large mass in the right glenoid. This case describes the first documented case of metastatic lung squamous cell carcinoma to the shoulder glenoid, an uncommon metastatic location.
A Novel Technique for Midshaft Clavicle Fracture With Ipsilateral Acromioclavicular Dislocation: Titanium Elastic Nail Combined With Coracoclavicular Ligament Reconstruction and Joint Capsule Suture.
Zeng LL, Wu HL, Li YH … +3 more , Fu H, Jiang YW, Zeng LQ
Orthopedics · 2026 · PMID 41885514 · Publisher ↗
BACKGROUND: Midshaft clavicle fracture (MSCF) combined with ipsilateral acromioclavicular joint dislocations (ACJD) are rare injuries with no consensus on optimal management. This study evaluated a novel technique using...
BACKGROUND: Midshaft clavicle fracture (MSCF) combined with ipsilateral acromioclavicular joint dislocations (ACJD) are rare injuries with no consensus on optimal management. This study evaluated a novel technique using a titanium elastic nail (TEN) for MSCF fixation combined with coracoclavicular (CC) ligament reconstruction and acromioclavicular (AC) joint capsule repair for ACJD stabilization. MATERIALS AND METHODS: This retrospective study included 7 patients with MSCF and ipsilateral ACJD who were treated between November 2017 and February 2024. Surgical procedures involved TEN fixation for the MSCF and CC ligament reconstruction with No. 5 Ethibond sutures, augmented with AC joint capsule suturing using No. 2 Ethibond sutures. Clinical assessments included the Constant-Murley score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), range of motion, radiographs, and complications. RESULTS: Mean follow-up was 24.9 months. All fractures healed at a mean of 10.9 weeks. The mean CMS was 95.9 points (range, 92-100 points), the mean DASH was 5.0 points (range, 2-9 points), and the mean VAS was 0.4 points (range, 0-2 points). The mean active forward flexion, abduction, external rotation, and internal rotation (level) were 175°, 169°, 56°, and T9, respectively. One patient required nail removal for persistent skin irritation. No major complications occurred, including nonunion, implant failure, AC joint arthritis, or recurrent dislocation. CONCLUSIONS: The simple, combined technique of TEN fixation with CC ligament and AC joint capsule reconstruction provided reliable stability and satisfactory short-term radiographic and functional outcomes for MSCF with ipsilateral ACJD, representing a viable, minimally invasive alternative.
Accuracy of Orthopedic Surgeons Versus Electronic Health Record in Prediction of Operating Room Times.
Melemai VK, Blake RJ, Fitzpatrick BM … +2 more , Neumann E, Grant DR
Orthopedics · 2026 · PMID 41885513 · Publisher ↗
BACKGROUND: Despite integration of machine learning in electronic health record (EHR) systems, accurate prediction of case time continues to present variable outcomes. This study compared the accuracy of the EHR versus s...
BACKGROUND: Despite integration of machine learning in electronic health record (EHR) systems, accurate prediction of case time continues to present variable outcomes. This study compared the accuracy of the EHR versus surgeons in predicting operating room (OR) times. MATERIALS AND METHODS: A retrospective chart review examining orthopedic case times was conducted at a level 1 trauma center. OR durations were calculated, and the difference between predicted and actual times were compared between the EHR system and surgeons. A prediction within 30% of the actual case duration was considered correct. T test and analysis of variance (ANOVA) were used to compare prediction accuracy. RESULTS: The EHR-predicted OR time demonstrated a 77.9% accuracy, whereas surgeon-prediction demonstrated a 48.2% accuracy. EHR-predicted OR time resulted in a sum discrepancy of a 1,007-minute underestimation with an absolute difference of 9,941 minutes; surgeon-predicted OR time resulted in a sum discrepancy of 13,014-minute underestimation with an absolute difference of 15,850. minutes. ANOVA and t tests between surgeon-predicted case time and EHR-predicted time stratified by subspecialty demonstrated significant differences between spine-joint and spine-trauma. T tests comparing differences between single-procedure cases and multi-procedure cases for both EHR- and surgeon-predicted times demonstrated significantly increased discrepancies in multi-procedure cases. CONCLUSION: Although performance varied, the EHR appears to more accurately predict operating time compared to surgeons. Notably, surgeons tend to underestimate operating time. These findings support the use of the EHR when scheduling cases to improve efficiency and maximize OR use.
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