International Orthopaedics最新文献

{"title":"What is the influence of tibial component posterior slope on clinical and radiographic outcomes following cemented medial unicompartmental fixed-bearing knee arthroplasty? A retrospective study with a minimum follow-up of five years.","authors":"Maksym Polt, Titus Thut, David Alexander Graf, Naeder Helmy, Octavian Andronic","doi":"10.1007/s00264-025-06579-0","DOIUrl":"https://doi.org/10.1007/s00264-025-06579-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate how changing the native posterior tibial slope (PTS) through implantation of a cemented medial unicompartmental knee arthroplasty (UKA) impacts clinical and radiographic outcomes, specifically whether it correlates with the occurrence of tibial periprosthetic radiolucency or tibial aseptic loosening (AL).</p><p><strong>Methods: </strong>This retrospective study analyzed 63 patients with cemented medial UKAs with a minimum follow-up of five years. Patient-reported outcomes (PROMs) included the Oxford Knee Score (OKS). Radiographic parameters assessed were: PTS, mechanical axis, prosthetic joint space height, tibial component obliquity, intraprosthetic divergence, and tibial periprosthetic radiolucency. Partial Pearson correlation and multiple linear regression analyses were used to evaluate the relationship between tibial periprosthetic radiolucency and demographic or radiographic parameters.</p><p><strong>Results: </strong>Of 63 patients (mean age 68.9 ± 7.9 years, follow-up 62.5 ± 8.8 months), 5 knees (7.9%) demonstrated tibial periprosthetic radiolucency ≥ 2 mm. The mean postoperative PTS change was 3.8 ± 2.6°, mechanical axis change: 2.5 ± 1.8°, prosthetic joint space height: 9.2 ± 3.1 mm, tibial component obliquity: 2.5° ± 3°, and intraprosthetic divergence angle: 5° ± 4°. OKS averaged 43.9 (range 22-48), with a mean knee flexion of 123.4 ± 6.8°. Statistical analysis showed no significant associations between tibial periprosthetic radiolucency and demographics, radiographic parameters, or PROMs. Changes in PTS did not correlate with a range of motion (ROM), PROMs, or radiolucency.</p><p><strong>Conclusion: </strong>In our cohort, the deviation from native PTS following implantation of the cemented tibial component did not show a significant correlation with tibial periprosthetic radiolucency, PROMs, or ROM at mid-term follow-up.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic and functional outcomes of shelf acetabuloplasty versus conservative management in legg-calvé-perthes disease: an age- and gender-matched study including healthy controls for isokinetic hip muscle strength.","authors":"Mehmet Demirel, İlhan Sulejmani, Yaşar Gökçeoğlu, Türker Şahinkaya, Yavuz Sağlam, Fuat Bilgili","doi":"10.1007/s00264-025-06588-z","DOIUrl":"https://doi.org/10.1007/s00264-025-06588-z","url":null,"abstract":"<p><strong>Introduction: </strong>Shelf acetabuloplasty, one of surgical containment methods, have been employed to preserve hip joint congruity in the management of Legg-Calvé-Perthes disease (LCPD). However, its long-term effect on radiographic and functional outcomes remains unclear due to limited evidence. Moreover, comparative studies against conservative treatment are lacking. This study aimed to (1) compare the mid- to long-term outcomes between children with advanced-stage LCPD treated with shelf acetabuloplasty and those receiving conservative management, and (2) evaluate isokinetic hip muscle strength compared to age- and gender-matched healthy controls.</p><p><strong>Materials and methods: </strong>This retrospective age- and gender-matched study included 28 children with unilateral LCPD, divided into Shelf (n = 14) and Conservative (n = 14) treatment groups. A healthy control group (n = 14) was also recruited for isokinetic comparisons. Radiographic outcomes were assessed using modified Stulberg classification and several quantitative parameters. Functional outcomes were assessed using the Harris Hip Score (HHS) and isokinetic testing of hip muscle strength.</p><p><strong>Results: </strong>The Shelf group (median follow-up: 5.5 years, IQR: 4-7) showed significantly better HHS (67.9 ± 15.9) compared to the Conservative group (median follow-up: 6 years, IQR: 5-8) (54.6 ± 13.3; p = 0.024) at the final follow-up. Shelf acetabuloplasty also resulted in significantly improved radiographic parameters, including centre-edge angle (p < 0.001) and femoral head coverage (p = 0.002). Isokinetic testing revealed that the Conservative group had significantly lower hip extension (p = 0.021), abduction (p = 0.018), and adduction (p = 0.027) torque values, as well as greater muscle fatigue (p = 0.014). In contrast, the Shelf and Control groups exhibited comparable performance in most strength and endurance parameters.</p><p><strong>Conclusions: </strong>Shelf acetabuloplasty, when applied as a salvage procedure in advanced-stage LCPD, may provide better functional outcomes and improved hip muscle performance compared to conservative treatment, despite comparable long-term femoral head morphology. Following Shelf acetabuloplasty, comparable hip flexor and extensor strength to healthy controls can be expected, although mild abductor and adductor weakness may persist.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The origins of limb lengthening and reconstruction surgery date back to 1521 when the first intervention ever reported in history was performed on St. Ignatius of Loyola.","authors":"Filippo Vandenbulcke, Beth Lineham, Emiliano Malagoli, Alexander Kirienko","doi":"10.1007/s00264-025-06591-4","DOIUrl":"https://doi.org/10.1007/s00264-025-06591-4","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the historical case of Saint Ignatius of Loyola's leg injury and subsequent surgical interventions as a potential early instance of limb lengthening and reconstruction surgery.</p><p><strong>Methods: </strong>A detailed analysis of \"A Pilgrim's Journey\" (Ignatius of Loyola's autobiography) was conducted, focusing on orthopaedic descriptions of his injury and treatments.</p><p><strong>Results: </strong>In 1521, Íñigo López de Loyola sustained a severe, comminuted open fracture of the tibia due to a cannonball wound during the siege of Pamplona. Initial attempts at reduction were unsuccessful, leading to a non-union with significant deformity and shortening. He underwent a revision surgery, a procedure described as \"carnage\" and endured without a single lament. Although the fracture eventually united, residual shortening and a prominent bone deformity persisted. Unwilling to accept this disfigurement for social reasons, Ignatius requested a second, highly painful osteotomy to remove the protruding bone followed by continuous traction for \"days and days of martyrdom\" for progressive lengthening. Crucially, after these arduous treatments, Ignatius was able to walk and even ride a horse again. The only significant residual symptom was swelling in his leg by evening.</p><p><strong>Conclusion: </strong>St. Ignatius of Loyola's case provides a compelling historical account of complex orthopaedic challenges in the early 16th century. The documented surgeries represent remarkably early attempts at managing non-union, deformity, and potentially achieving limb lengthening, predating modern reconstructive techniques by centuries. This historical narrative offers valuable insights into the nascent stages of orthopaedic surgery and highlights how a physical ordeal can profoundly shape one's life path.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor on \"Arthroscopic cystectomy and open surgery for the treatment of popliteal cysts: a retrospective clinical cohort study\".","authors":"Yudong Wang, Hao Wu","doi":"10.1007/s00264-025-06590-5","DOIUrl":"https://doi.org/10.1007/s00264-025-06590-5","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significant and lasting correction after medializing calcaneal osteotomy in collapsing flatfoot deformity: comment on the study by Farge et al.","authors":"Sitanshu Barik, Vikash RAj, Vishal Kumar","doi":"10.1007/s00264-025-06586-1","DOIUrl":"https://doi.org/10.1007/s00264-025-06586-1","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foot compartment syndrome treatment: a systematic review.","authors":"Mariana Tapia-Nañez, Humberto de Leon-Gutierrez, Neri Alejandro Alvarez-Villalobos, Jorge Gutierrez-de-la-O, Jose Felix Vilchez-Cavazos, Rodrigo Teran-Garza, Abraham Guadalupe Espinosa-Uribe, Santos Guzman-Lopez, Alejandro Quiroga-Garza, Rodrigo Enrique Elizondo-Omaña","doi":"10.1007/s00264-025-06566-5","DOIUrl":"https://doi.org/10.1007/s00264-025-06566-5","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the treatment approaches for foot compartment syndrome (FCS) and evaluate their outcomes.</p><p><strong>Methods: </strong>A systematic review was conducted in MEDLINE, EMBASE, Mayo journals via OVID Databases, Web of Science, and Scopus from each database's inception to December 2024. Two reviewers, independently working in duplicate, assessed each manuscript's title, abstract, and full text for eligibility. Study characteristics, quality of evidence, and outcomes were obtained and analyzed.</p><p><strong>Results: </strong>A total of 45 articles were included in the qualitative analysis, 38 case reports, and seven  cohort studies. Among the case reports, only two patients underwent conservative management, while all remaining cases, as well as all cohort studies, reported fasciotomy as the primary treatment. Trauma was the most frequently identified cause of FCS, and the diagnostic criterion commonly used was an intracompartmental pressure exceeding 30 mmHg. There was no consensus on the number or anatomical location of incisions. Due to the heterogeneity of the data, a meta-analysis could not be performed to assess the risk associated with different incision approaches.</p><p><strong>Conclusion: </strong>Fasciotomy remains the standard treatment for FCS. However, there is insufficient evidence to determine the optimal number and location of surgical incisions. While existing data suggest that using two or more incisions may be associated with fewer long-term sequelae, further research is needed to establish specificity of compartment decompression to enhance treatment recommendations.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical considerations, diagnosis, and treatment of medial and posterolateral elbow rotatory instability in athletes: an arthroscopic perspective and literature review.","authors":"Michail Kotsapas, Dimitrios Giotis, Frantzeska Zampeli, Vasileios Giannatos, Christos Koutserimpas, Zinon Kokkalis, Dimitrios Karadimos, Christos Koukos","doi":"10.1007/s00264-025-06485-5","DOIUrl":"10.1007/s00264-025-06485-5","url":null,"abstract":"<p><strong>Purpose: </strong>Elbow joint instability results from the disruption of one or more stabilizing anatomical structures. The two most common forms of instability are posterolateral rotatory instability (PLRI) and medial elbow instability (MEI), particularly in athletes. This review aims to explore the anatomical foundations, diagnostic methods, and therapeutic approaches for PLRI and MEI in athletes.</p><p><strong>Methods: </strong>A comprehensive literature review was performed to investigate the study objective.</p><p><strong>Results: </strong>Regarding the anatomical background, the primary stabilizing structures of the elbow joint include the humeroulnar joint (trochlea, olecranon, and coronoid process), the medial collateral ligament (MCL), and the lateral ulnar collateral ligament (LUCL). PLRI is primarily caused by LUCL insufficiency, while MEI results from MCL dysfunction. A thorough clinical evaluation, combined with advanced imaging-magnetic resonance imaging (MRI) or MR arthrography is essential for an accurate diagnosis. For high-level athletes, surgical intervention is often required, with the timing and type of surgery tailored to the athlete's specific needs, expectations, and the chronicity of the injury.</p><p><strong>Conclusion: </strong>PLRI and MEI present diagnostic and therapeutic challenges, especially in athletes. Advanced imaging and clinical evaluation are crucial for the diagnosis. Surgical intervention, particularly arthroscopy, is often required for optimal outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1439-1450"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of surgical approaches in orthopaedics.","authors":"Jan Bartoníček, Ondřej Naňka","doi":"10.1007/s00264-025-06541-0","DOIUrl":"10.1007/s00264-025-06541-0","url":null,"abstract":"<p><p>Surgical approaches in bone surgery have undergone a long evolution over more than 130 years. While a number of publications have been devoted to the history of internal fixation, surgical approaches have remained neglected from this perspective. The development of approaches in musculoskeletal surgery is inextricably linked to four personalities. Theodor Kocher, in 1892, pointed out that descriptions of surgical approaches must be an essential part of surgical textbooks of operative techniques; James Edwin Thompson, in 1918, formulated the basic requirements for the surgical approaches to the skeleton of limbs; Arnold Kirkpatrick Henry published the first textbook of surgical approaches in 1927 and presented the concept of internervous planes in 1945; in the same year, Toufick Nicola created the first comprehensive atlas of surgical approaches to bones and joints of limbs, the pelvis and spine.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":"49 6","pages":"1537-1541"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body mass index matters: morbid obese patients have different microorganism profiles in the setting of periprosthetic hip joint infections.","authors":"Maximilian Budin, Nemandra A Sandiford, Thorsten Gehrke, Mustafa Citak","doi":"10.1007/s00264-025-06513-4","DOIUrl":"10.1007/s00264-025-06513-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the relationship between BMI and microorganism profiles, with a particular focus on gut microorganisms in patients with PJI following total hip arthroplasty (THA). It also explored comorbidities, that may contribute to these variations.</p><p><strong>Methods: </strong>This study included all patients treated at our institution for a PJI of a THA between 1996 and 2021. Patients were categorized into four distinct BMI groups: <30; 30-34.9; 35-39.9; ≥ 40. Bivariate and logistic regression analysis were conducted, with presentation of odds ratio (OR) and 95% confidence interval (CI).</p><p><strong>Results: </strong>A total of 3645 hip PJI cases were recruited for the final analysis. Patients with a BMI ≥ 40 had approximately a ten fold higher risk for Streptococcus dysgalactiae (p < 0.001; OR = 9.92; 95% CI 3.87-25.44) and a seven fold higher risk for Proteus mirabilis (p < 0.001; OR = 7.43; 95% CI 3.13-17.67) and Klebsiella pneumoniae (p < 0.001; OR = 6.9; 95% CI 2.47-19.31). Furthermore, polymicrobial infections (p < 0.001; OR = 2.17; 95% CI 1.50-3.15) were found to be significantly more prevalent in patients with a BMI ≥ 40.</p><p><strong>Conclusion: </strong>Obese patients (BMI ≥ 30) displayed a distinct microorganism profile in hip PJIs, mainly dominated by Firmicutes and Proteobacteria. Comorbidities such as diabetes, hypertension, and hyperlipidaemia may contribute to a leaky gut syndrome, increasing PJI risk caused by gut microorganisms. Optimizing comorbidities may help reduce the risk of hip PJI. Further research is needed to clarify the relationship between obesity, gut microbiome alterations and hip PJI development.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1309-1317"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of femoral shaft fractures in Sub-Saharan Africa: A systematic review.","authors":"Patrick Birkenhead, Paul Joseph Birkenhead, Clara Vella, Maritz Laubscher, Sithombo Maqungo, Simon Matthew Graham","doi":"10.1007/s00264-025-06407-5","DOIUrl":"10.1007/s00264-025-06407-5","url":null,"abstract":"<p><strong>Purpose: </strong>Femoral shaft fractures are significant injuries and if not managed appropriately can result in high complication rates and long-term disability. These complex injuries occur at a higher rate across low and middle income countries and sub-Saharan Africa is thought to have a higher incidence than other regions across the world. This study aims to summarise the most up to date evidence surrounding the treatment and associated outcomes of adult femoral shaft fractures in sub-Saharan Africa - giving a clear understanding of current practices and highlighting potential areas for further research.</p><p><strong>Methods: </strong>PubMed, Google Scholar, Africa Journals Online, Cochrane, Clinicaltrial.gov were searched using Boolean search strategies. Data collected included demographics, fracture classification, interventions, union rates, time to union, patient-reported outcomes / functional outcome scores, and secondary outcomes (orthopaedic and medical complications, malunion / non-union, length of admission).</p><p><strong>Results: </strong>Twenty-three studies reporting 2,180 patients were included-73% (1592/2180) of patients were male, with a mean age of 35 years. Overall, 59% of patients were treated with intramedullary nailing (IMN), 23% with skeletal traction, and 14% with open reduction internal fixation (ORIF). There was a heterogeneity in practice in different regions, with the highest reported rates of IMN in Tanzania (99%), and lowest in Malawi (29.4%). Union rates were highest in IMN (82.4-100%) versus traction (48 - 100%) and ORIF (83.3-87%). Intramedullary nailing demonstrated a super complication profile, with better functional outcomes, shorter hospital stays and time to mobilisation.</p><p><strong>Conclusion: </strong>Intramedullary nailing demonstrated superior clinical and functional outcomes compared to other modalities for the treatment of femur shaft fractures across sub-Saharan Africa. However, there is significant sparsity of research and variable management approaches across the region. Focused research to determine the burden of injury, current healthcare resources and cost-effective and appropriate interventions to improve outcomes are now a public health priority.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"1499-1508"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}