Journal of orthopaedics最新文献

{"title":"A propensity matched cohort analysis: Cemented vs press fit humeral stem fixation in anatomic total shoulder arthroplasty","authors":"Amogh I. Iyer,&nbsp;Ryan M. Dopirak,&nbsp;Louis W. Barry,&nbsp;Benjamin L. Brej,&nbsp;Akshar V. Patel,&nbsp;Erryk Katayama,&nbsp;Gregory L. Cvetanovich,&nbsp;Julie Y. Bishop,&nbsp;Ryan C. Rauck","doi":"10.1016/j.jor.2025.02.003","DOIUrl":"10.1016/j.jor.2025.02.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Historically, humeral stems were cemented for anatomic shoulder arthroplasty (aTSA). However, cementless, or press-fit, fixation has been increasingly used. This study aims to compare outcomes and revision rates between cemented and press-fit humeral stems.</div></div><div><h3>Methods</h3><div>Institutional records were searched to identify all patients who underwent aTSA with cemented humeral fixation or press-fit fixation between 2009 and 2021. A 3:1 propensity match based on age, sex, pre-op forward elevation and external rotation was conducted. Mean functional measurements were compared using a 2-Sample <em>t</em>-Test, ordinal variables via Wilcoxon-Mann Whitney test, and categorical variables via the Chi-squared test.</div></div><div><h3>Results</h3><div>There were 35 cemented humeral fixation shoulders matched with 105 humeral press-fit shoulders included in the final cohort. Both groups had similar characteristics at baseline regarding age, sex, body mass index, Charlson Comorbidity Index, mean follow-up, ROM, and strength measurements. Average age at surgery was 61.88 ± 6.68 years with an average follow-up time of 5.61 ± 2.86 years. Post-operatively, press-fit fixation demonstrated significant improvement in all ROM testing: external rotation (ER), forward elevation (FE), internal rotation (IR)-and all strength testing: ER, FE, and IR. Cement fixation demonstrated significant improvement in all ROM testing but only in FE strength testing. Inter-group post-op ROM and strength testing comparisons revealed superior external rotation (p = 0.007) and forward elevation (p = 0.047) ROM in the press-fit group with similar internal rotation ROM values and similar strength testing. There were higher revision rates in the cement fixation cohort (Cement: 11.4 % vs press-fit: 3.8 %; p = 0.036).</div></div><div><h3>Conclusion</h3><div>The results of this analysis showcase that press-fit fixation is a viable option for aTSA. Press-fit fixation shoulders had better ROM in terms of external rotation and forward elevation as well a better survival time to revision compared to cement fixation.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 109-113"},"PeriodicalIF":1.5,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143436590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcome and correlation with ultrasound gap size of Achilles tendon rupture treated non-operatively with boot and wedges","authors":"Rohit Ravindran Nair ,&nbsp;Suzanne Lane,&nbsp;Brijesh Ayyaswamy,&nbsp;Pradeepsyam Prasad,&nbsp;Anoop Anand,&nbsp;Nithin Babu,&nbsp;Adersh Gopinathannair","doi":"10.1016/j.jor.2025.01.038","DOIUrl":"10.1016/j.jor.2025.01.038","url":null,"abstract":"<div><h3>Background</h3><div>The need for surgical management of Achilles tendon ruptures has been decreasing due to a better understanding of their non-operative management. The primary aim of our study was to assess the functional outcome of Achilles tendon ruptures treated with fixed angle walking boots with wedges (FAWW) and its relationship with gap size, functional scores, single leg heel raise height difference (HHD) and calf circumference difference (CCD). The secondary aim was to look at the complication rates.</div></div><div><h3>Methods</h3><div>34 patients (29 males and 5 females), who presented with acute Achilles tendon ruptures to Blackpool Teaching Hospitals NHS Foundation Trust from October 2020 to April 2022, were treated with an equinus slab for 2 weeks followed by a fixed angle boot, with wedges being sequentially removed every 2 weeks. They were reviewed at 3, 6 and 12 months. At each visit, Achilles Tendon Rupture score (ATRS), HHD and CCD were measured. Any complication, such as deep vein thrombosis (DVT) or re-rupture, was recorded.</div></div><div><h3>Results</h3><div>The mean age group of patients was 50 years (28–87 years). The average ATRS at 3, 6 and 12 months were 29.84, 61.68 and 76, respectively. The mean HHD was 8.9 centimetres (cm) at 3 months, 3.79 cm at 6 months and 2.4 cm at 12 months. The mean CCD was 1.31 cm at 3 months, 0.88 cm at 6 months and 1.07 cm at 12 months. We did not find a significant correlation between Achilles tendon gap size measured by ultrasound and ATRS, HHD and CCD in our study.</div></div><div><h3>Conclusions</h3><div>Non-operative management of Achilles tendon ruptures with boot and wedges gives a good functional outcome, which has no relationship with tendon gap size at the time of initial rupture.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 105-108"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of posterior tibial slope measurements: Accuracy and reliability of radiographs and CT","authors":"Shuhei Hiyama ,&nbsp;Reuben P. Rao ,&nbsp;Feng Xie ,&nbsp;Tsuneari Takahashi ,&nbsp;Katsushi Takeshita ,&nbsp;Hemant Pandit","doi":"10.1016/j.jor.2025.01.037","DOIUrl":"10.1016/j.jor.2025.01.037","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the accuracy and reliability of posterior tibial slope (PTS) measurements obtained from radiographs and CT. PTS, particularly its differences in medial and lateral measurements, plays a crucial role in knee alignment, and inconsistencies in measurement techniques across different imaging modalities have raised concerns about accuracy.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included data from 98 Japanese patients legs and 324 Chinese patients legs. PTS was measured on long-leg and short-leg radiographs and CT. Two independent surgeons assessed the measurements, and the inter- and intra-observer reliability were evaluated. The primary outcome was the comparison of medial and lateral PTS measurements, while the secondary aim was to assess the impact of tibial length on measurement accuracy.</div></div><div><h3>Discussion</h3><div>The study revealed that lateral PTS was consistently smaller than medial PTS, with an average difference of 1.2°–1.9°. Shorter leg radiographs tend to underestimate PTS compared to full-length tibial measurements. The correlation between measurements from short and long leg radiographs showed that PTS measurements were more prone to errors, which may be due to anatomical factors such as tibial bowing. Inter- and intra-observer reliability were good for medial PTS but poor to moderate for lateral PTS, especially when using radiographs.</div></div><div><h3>Conclusion</h3><div>For accurate measurement of both medial and lateral PTS, surgeons should consider using additional examination methods such as CT and MRI. If PTS is to be measured on radiographs, the focus should be on the medial PTS, as it tends to provide more reliable results.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 62-67"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can intraoperative opioid use in hip and knee arthroplasty be reduced further without negatively affecting pain control: A case controlled study","authors":"Adnan Asif ,&nbsp;Sam Aktas ,&nbsp;Baraniselvan Ramalingam ,&nbsp;Hasitha Pananwala ,&nbsp;Janna Maier ,&nbsp;Femi E. Ayeni ,&nbsp;Sol Qurashi S","doi":"10.1016/j.jor.2025.01.035","DOIUrl":"10.1016/j.jor.2025.01.035","url":null,"abstract":"<div><h3>Background</h3><div>Whilst forming the backbone of perioperative analgesic regimes in joint replacement surgery, the negative side effect profile of opioids is well known. Common impediments to a smooth running Enhanced Rapid Recovery model of care are often altered cognitive function and postoperative nausea and vomiting (PONV), both related to opioid use.</div><div>This study focuses on evaluating whether further reductions in intraoperative opioid use during joint arthroplasty can be safely achieved with minimal impact of such reductions on pain control and postoperative outcomes including opioid requirements and the incidence of PONV and ability to mobilise.</div></div><div><h3>Method</h3><div>Case controlled review of prospectively collected data assessing intraoperative opioid use, postoperative analgesic requirement, incidence of PONV and cognitive status as well as day 0 mobility postoperatively. 50 patients were randomized in the study and control groups.</div></div><div><h3>Results</h3><div>The study group received statistically significant lower dose of intraoperative opioids equivalent to 24.18 mg of Morphine compared to control group with equivalent to 69.58 mg of Morphine (p &lt; 0.001). There was no statistically significant increase in analgesia requirement postoperatively and no negative influence on PONV or ability to follow immediate postoperative rehabilitative protocols.</div></div><div><h3>Conclusion</h3><div>Opioid use intraoperatively can be reduced even further without any compromise of postoperative pain control and PONV and may further reduce impediments to efficiency in rapid recovery models of care.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 40-44"},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of Miller ME and Ayoub to Letter to the Editor by Schatzman and BS Miller reading article: Increased blood 1,25 dihydroxyvitamin D levels in infants with metabolic bone disease of infancy in contested cases of child abuse. Journal of orthopaedics. 2024 Oct 29;63:81","authors":"","doi":"10.1016/j.jor.2025.01.019","DOIUrl":"10.1016/j.jor.2025.01.019","url":null,"abstract":"","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 93-95"},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143418872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct anterior total hip arthroplasty after hip arthroscopy: A retrospective review","authors":"Matthew Pate ,&nbsp;Joshua Gira ,&nbsp;Carl Wierks","doi":"10.1016/j.jor.2025.01.017","DOIUrl":"10.1016/j.jor.2025.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>Limited studies have investigated outcomes of total hip arthroplasty (THA) after ipsilateral hip arthroscopy, with mixed conclusions. There is need to provide clarity on potential risks/complications associated with this sequence of operations.</div></div><div><h3>Methods</h3><div>This is a retrospective single surgeon cohort study, evaluating patients from 01/01/2012–01/01/2020 undergoing direct anterior THA for osteoarthritis, with minimum 90-day follow-up. There were two groups: previous hip arthroscopy plus THA (THA+) and isolated THA (control) without previous hip arthroscopy. All THA + patients had undergone one previous hip arthroscopy prior to THA. Quantitative variables were evaluated using the Mann-Whitney-U test or a two-tailed unpaired <em>t</em>-test. Nominal variables were evaluated using the chi-square or Fisher's Exact test. Significance was assessed at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Seventy-one patients were included, 38 patients in the THA + group, and 33 patients in the control group. Surgery duration was longer in the THA + group (74 min THA + [SD = 9.5], 60 min control [SD = 11.3], p &lt; 0.0001). The only secondary outcome with significance was average estimated blood loss (400 mL THA+, 275 mL control, p = 0.009). Only one THA + patient required postoperative transfusion (p = 1.0). There were no postoperative deep infections requiring debridement, intra-operative fractures requiring fixation, or postoperative dislocations in either group. The THA group had one post-operative fracture requiring surgery. The THA + group was younger (average) than the control group (52 THA + [SD = 9.9], 58.4 control [SD = 8.8], p = 0.0062).</div></div><div><h3>Conclusion</h3><div>This study highlights increased operative time and estimated blood loss after previous ipsilateral hip arthroscopy. Surgeons should recognize implications on time management, and assist surgeons when deciding to perform a THA at a surgery center vs hospital. These results contribute to a growing body of literature indicating no increase in major complication rate of THA after ipsilateral hip arthroscopy.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 68-71"},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of augmented reality surgical navigation reduces intraoperative fluoroscopic imaging in anterior total hip arthroplasty with equivalent accuracy for component positioning","authors":"Gloria Coden ,&nbsp;Mikhail Kuznetsov ,&nbsp;Lauren Schoeller ,&nbsp;James Patti ,&nbsp;Andrew Grant ,&nbsp;James Penn Miller ,&nbsp;Carl Talmo","doi":"10.1016/j.jor.2025.01.031","DOIUrl":"10.1016/j.jor.2025.01.031","url":null,"abstract":"<div><h3>Background</h3><div>Computer-assisted surgical navigation was designed to reduce the rates of acetabular component malpositioning, a common cause for revision following primary total hip arthroplasty (THA). We compared intraoperative measures such as radiation exposure, radiographic acetabular cup placement, and outcomes of patients who underwent a THA using computer-assisted surgical navigation with augmented reality (AR) compared to those who underwent traditional manual THA with fluoroscopic assistance (FA).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 115 hips who underwent primary direct anterior THAs using the intraoperative AR surgical navigation system between 3/30/2021 and 12/30/2022. These were compared to a matched cohort of 115 primary THAs performed with FA through a direct anterior approach during the same time period. Patients were matched based on age, gender, American Society of Anesthesiologists score (ASA), and BMI. Goal inclination and anteversion were set to 42° (°) and 22°, respectively.</div></div><div><h3>Results</h3><div>THA with AR patients had decreased intraoperative radiation exposure (mean 2.0 versus 3.2 mGy, p &lt; 0.001) and radiation time (mean 0.2 versus 0.4 min, p &lt; 0.001). Deviation from the preoperative plan was similar between AR and FA for both radiographic inclination and anteversion. There was no difference in the operative time, estimated blood loss, or reoperations, all of which were for infection (1.7 versus 0.0 %, p = 0.5).</div></div><div><h3>Conclusion</h3><div>AR surgical navigation in primary THA has similar radiographic, operative and clinical results as THA with intraoperative FA. However, AR surgical navigation is associated with decreased intraoperative fluoroscopic radiation and time. Further research is needed to evaluate accuracy of acetabular component positioning and complications.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 15-19"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of distal biceps tendon and triceps tendon injuries in National Football League players from 2009 to 2022","authors":"Ashwin R. Garlapaty ,&nbsp;Molly Jones ,&nbsp;John Baumann ,&nbsp;Christian Gunn ,&nbsp;James L. Cook ,&nbsp;Steven F. DeFroda","doi":"10.1016/j.jor.2025.01.033","DOIUrl":"10.1016/j.jor.2025.01.033","url":null,"abstract":"<div><h3>Purpose</h3><div>The purpose of this study is to determine the incidence and impact of distal biceps and triceps tendon injuries in the National Football League (NFL) from the 2009-10 to the 2022-23 seasons. This study explores the impact that player and injury characteristics have on injury risk, return-to-play, and player performance.</div></div><div><h3>Methods</h3><div>Data from the 2009-10 to the 2022-23 NFL seasons were analyzed for players with distal biceps or triceps tendon tears. Return-to-play (RTP) and performance metrics were recorded for each player during the season before and first two post-injury seasons. Data were analyzed to determine statistically significant differences in proportions using chi-square, Fisher's exact, or McNemar tests. Statistical significance was set at p &lt; 0.05.</div></div><div><h3>Results</h3><div>Fifty tendon ruptures (26 biceps, 24 triceps) were identified. Biceps injuries were more common in defensive players (73.1 %), while triceps injuries predominantly affected offensive players (58.3 %). Significant risk factors for biceps injuries included BMI ≥31 (p = 0.0008) and ≥4 seasons of experience (p = 0.031, OR = 2.7). Triceps injuries were associated with BMI ≥31 (p = 0.01), age ≥26 (p &lt; 0.0001), and ≥4 seasons of experience (p = 0.006). RTP rates were 73.1 % for biceps and 70.8 % for triceps injuries. However, only 52.6 % and 41.2 % of players with biceps and triceps injuries, respectively, returned to pre-injury performance levels. Younger players (&lt;26 years) and those with fewer years of experience (≤4 years) were more likely to achieve prior performance levels.</div></div><div><h3>Conclusion</h3><div>Distal biceps and triceps tendon injuries are typically season-ending for NFL players. Significant risk factors include BMI ≥31, ≥4 years of NFL experience, and game exposure, with age ≥26 being an additional risk factor for triceps tendon injuries. RTP rates exceed 70 %, indicating a strong potential for athletes to return to the NFL post-injury.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 20-26"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143181387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking tumor viability as prognostic factor in soft tissue sarcoma","authors":"Julien Montreuil ,&nbsp;Eric Kholodovsky ,&nbsp;Moses Markowitz ,&nbsp;Sergio Torralbas Fitz ,&nbsp;Dominic Campano ,&nbsp;J. Erik Geiger ,&nbsp;Francis Hornicek ,&nbsp;Brooke Crawford ,&nbsp;H. Thomas Temple","doi":"10.1016/j.jor.2025.01.030","DOIUrl":"10.1016/j.jor.2025.01.030","url":null,"abstract":"<div><h3>Background</h3><div>Histopathologic assessment of tumor viability has emerged as a potential predictive factor of outcomes in various cancers. This study evaluates the prognostic significance of viability in high-grade soft tissue sarcoma while accounting for different adjuvant regimens and clinical variables.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted on 147 patients surgically treated for high-grade soft tissue sarcoma between 2010 and 2021 at a single institution. Perioperative, clinical and surveillance data were collected. Tumor viability was determined through histopathologic analysis by a board-certified pathologist.</div></div><div><h3>Results</h3><div>No significant differences in clinical variables were observed between groups with ≤10 % and &gt;10 % tumor viability. Neoadjuvant treatments, tumor grade, size, and depth did not independently affect tumor viability. There was no statistically decreased risk of local recurrence in the group with ≤10 % viability compared to the group with &gt;10 % viability (HR = 1.19, 95 % CI [0.57,2.50]) (p = 0.64). Margin status was the only variable that significantly increases the risk of LR on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>This cohort suggests that neoadjuvant radiotherapy, chemotherapy, or their combination did not influence tumor viability predictably. Notably, tumors without neoadjuvant treatment exhibited a high rate of necrosis, potentially confounding the interpretation of treatment effect. Other factors such as tumor type may play a more significant role in the cause of tumor necrosis than originally thought. Pathologic tissue response continues to offer value for the management of STS, but these findings underscore the need for further investigation into tumor viability in soft tissue sarcoma, targeting specific treatments analyzed in large collaborative studies.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 7-14"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of posterior pilon fractures","authors":"Joseph Boesel ,&nbsp;Dominique DiGiacomo ,&nbsp;Brett Hoffman ,&nbsp;Jiayong Liu","doi":"10.1016/j.jor.2025.01.034","DOIUrl":"10.1016/j.jor.2025.01.034","url":null,"abstract":"<div><div>Posterior pilon fractures (PPFs) are intra-articular ankle injuries of the posterior aspect of the distal tibia, often caused by high-energy mechanisms of trauma such as falling from high heights or motor vehicular accidents. However, the definition, mechanism, classification, and surgical approach for fractures have not been thoroughly investigated. This study aims to explore current literature to expand the understanding of this fracture to help physicians achieve better treatment outcomes. Keywords such as “posterior pilon,” “surgical approach,” “fracture,” etc., were used to find relevant literature on PubMed, MEDLINE, Embase, and the Web of Science. Inclusion criteria involved studies discussing PPFs and retrospective and prospective cohort studies. Exclusion criteria included non-English-published papers, anatomical or biomechanical studies, and studies not discussing PPFs. General demographics, complications, and the American Orthopaedic Foot and Ankle Society (AOFAS) functional outcome scores were collected. A total of 18 publications were selected for data collection, most of which were retrospective studies. The articles discussed 959 (Male: 430, Female: 529) patients. PPFs are defined as distal tibia fractures involving impaction of the articular surface and proximal displacement of talus and posterior malleolus fragments. This characteristic fracture is caused by high-energy rotational and axial load. Five studies in this review describe a classification system for ankle fractures that include studies from Klammer (2013), Bartoníček (2015), Mason (2017), Zhang (2018), and Wang (2020). The posterolateral (PL) approach was used in 34.9 % of cases, followed by the posteromedial (PM) in 7.9 %, modified PM in 20.7 %, and combined PM and PL approach in 6.9 % of cases. PPFs are breaks that occur in the posterior half of the articular surface of the distal tibia, typically affecting the weight-bearing area. These fractures result from a combination of rotational and axial loads, leading to intra-articular ankle fractures that often involve a sizeable posterior fragment. Five classification systems for PPFs identify characteristics observable in X-rays, CT scans, or through morphological analysis. The posterolateral (PL) approach was used more than the posteromedial approach. Common complications included malreduction, nerve injuries, and post-operative pain.</div><div><strong>Level of Evidence</strong>: III.</div></div>","PeriodicalId":16633,"journal":{"name":"Journal of orthopaedics","volume":"68 ","pages":"Pages 34-39"},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}