Bone & Joint Open最新文献

{"title":"Management and outcomes of acute hand and wrist infections in low- and middle-income countries : a systematic review and meta-analysis.","authors":"Abigail V Shaw, Abhishek Saha, Kian Daneshi, Monique I Andersson, Simon M Graham, David J Beard, Justin C R Wormald","doi":"10.1302/2633-1462.74.BJO-2025-0389.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0389.R1","url":null,"abstract":"<p><strong>Aims: </strong>Acute hand and wrist infections can be devastating, with a substantial burden in low- and middle-income countries (LMICs) compared with high-income countries. Access to treatment, particularly surgery, can be limited. This study aimed to determine the management and outcomes of hand and wrist infections in LMICs.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review and meta-analysis was conducted (Prospective Register of Systematic Reviews (PROSPERO) CRD420250631145) within MEDLINE, EMBASE, Global Health, Global Index Medicus, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science from database inception to December 2024. Studies of acute bacterial hand and wrist infections managed in LMICs, reporting at least one outcome, were included. Primary outcomes were risk of amputation and mortality.</p><p><strong>Results: </strong>Of 18,208 abstracts screened, 39 full-text studies with 4,130 patients were included. These were mostly retrospective case series, from Africa and Asia. Mean age was 45.0 years (SD 9.3), with a male preponderance (63.3%, n = 1,804). Over half of studies (n = 22) focused on diabetic hand and wrist infections. Deep space infections were the most common infection. Mean delay to presentation was 11.8 days (SD 6.1) and surgery was required for source control in 89.4% of patients (n = 3,693). Mean length of stay for admitted patients was 12.2 days (SD 14.1). Meta-analysis demonstrated a 26.1% (95% CI 16.8 to 36.4) risk of amputation (31 studies), rising to 32.7% (95% CI 21.3 to 45.0) in studies of diabetic patients. Mortality risk was 2.8% (95% CI 1.0 to 5.3; 18 studies). Functional and socioeconomic outcomes were rarely reported. Risk of bias was assessed as moderate or high in 85% of studies (n = 33).</p><p><strong>Conclusion: </strong>Hand and wrist infections in LMICs often present late and have high rates of amputation and death, particularly among diabetic patients. Future research is needed to mitigate delayed presentation and develop interventions focused on saving life and limb.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"519-530"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647065","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":"Patient-specific Ti-6Al-4V lattice implants for critical-sized, weightbearing limb reconstruction: average 45-month surgical, oncological, and functional follow-up.","authors":"Amit Benady, Netanel Sharabi, Eran Golden, Ortal Segal, Omri Merose, Amir Sternheim, Solomon Dadia, Yair Gortzak","doi":"10.1302/2633-1462.74.BJO-2026-0026.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2026-0026.R1","url":null,"abstract":"<p><strong>Aims: </strong>Patient-specific Ti-6Al-4V lattice implants present a new era for reconstruction of weightbearing segmental defects; however, robust clinical data from larger cohorts with longer follow-up remain limited. Building on our previous study that detailed the engineering, design, and surgical workflow of these implants, this study focuses on clinical outcomes. Specifically, we aimed to: 1) characterize surgical complications and limb-salvage rates; 2) report resection margins and oncological status at the latest follow-up; and 3) describe functional outcomes.</p><p><strong>Methods: </strong>This retrospective single-centre study includes 29 patients treated between January 2016 and December 2024 with long-bone tumour resection (n = 28) or post-traumatic nonunion (n = 1) of the femur or tibia. Resections were guided by intraoperative 3D-printed osteotomy patient-specific instruments followed by reconstruction with customized Ti-6Al-4V lattice implants. Minimum follow-up was 12 months. Surgical complications, reoperations, resection margins, metastasis, and local recurrence were recorded. Musculoskeletal Tumor Society (MSTS) scores were obtained at latest follow-up.</p><p><strong>Results: </strong>The mean age was 26.2 years (SD 18.0); anatomical sites were tibia (15/29, 52%) and femur (14/29, 48%). Early complications occurred in 3/29 (10.3%; one haematoma, two deep infections); late complications occurred in 4/29 (13.7%; one deep infection requiring staged revision with implant removal and fibular grafting, one mechanical failure revised to a megaprosthesis at four months, one subtalar fusion for symptomatic nonunion, and one component loosening and subluxation). Limb salvage was achieved in 27/29 patients (93.1%). At latest follow-up, 23 patients were with no evidence of disease, two alive with evidence of disease, and three dead of disease; metastasis occurred in seven patients and local recurrence in four patients. The median MSTS at latest follow-up was 80% (IQR 60% to 87%).</p><p><strong>Conclusion: </strong>In this heterogeneous cohort, patient-specific Ti-6Al-4V lattice implants achieved reliable reconstruction with acceptable complication rates, high limb salvage, and oncological control, with high functional outcomes, supporting this approach as a practical and effective solution for critical-sized, weightbearing defects reconstruction.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"507-518"},"PeriodicalIF":3.1,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646035","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":"WaSTE: a multicentre audit of waste segregation practices in elective knee and hip arthroplasty.","authors":"Rohan Prakash, Alan J Hilley, William Fishley, Ahmed A H H Nasser, Deborah M Eastwood, Mike R Reed, Yuvraj Agrawal, Shivan Marya, Rohit Singhal, Weng Chee Ho, Benjamin Smith, Jim Holland, Stuart Irvine, Rajesh Nanda, Peter Logan, Mohammad Iqbal, Chandra Rao, Nizar Ismail, Arijit Ghosh, Edward Hayter, Oliver Pearce, Mohamed Abdalla, Jason Auld, Ian Crowther, Ashita Paul, Paul Banaszkiewicz, Mohamed Yassin, Tom Banks, Rajpal Nandra, Simon Federer, Eleanor van der Zanden, Chris Wakeling","doi":"10.1302/2633-1462.74.BJO-2025-0404.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0404.R1","url":null,"abstract":"<p><strong>Aims: </strong>Arthroplasty generates the most waste among the sub-specialties of orthopaedic surgery. Infectious waste generates ten times more CO2 than recycled waste, and over 90% of it is misallocated. This multicentre study aimed to quantify waste from primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) across UK NHS trusts, guiding strategies for waste reduction and improved segregation.</p><p><strong>Methods: </strong>Data were collected prospectively from ten UK centres over six months between October 2023 and April 2024, covering at least ten arthroplasty cases per centre. Waste was categorized and weighed across six streams (infectious, offensive, recycling, general, sharps, and linen). Data on scrubbed personnel, drapes, implant brand, and intraoperative complications were also collected.</p><p><strong>Results: </strong>Data from 222 procedures (92 THAs, 130 TKAs) revealed significant differences in total waste production across centres (p < 0.001). THAs produced a mean of 14.8 kg waste, while TKAs generated 13.6 kg. Only 5/10 trusts utilized the offensive waste stream. Implant brand, number of scrubbed personnel, and reusable drapes were predictors of increased waste production on unadjusted univariate analysis; multivariable linear regression analysis showed local centre practice was the only significant predictor of waste production.</p><p><strong>Conclusion: </strong>Local waste management practices were the strongest predictors of waste production, underscoring need for standardization, education, and adherence to best practices. The use of offensive waste streams eliminated infectious waste, supporting a shift towards less carbon-intensive disposal. Adherence to established national guidelines is required to reduce the quantity of infectious waste and reduce the carbon footprint of arthroplasty surgery. Implementing offensive waste streams can reduce carbon intensity significantly. Addressing centre-specific policies, adhering to national guidance, and industry collaboration are essential for minimizing arthroplasty waste.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"499-506"},"PeriodicalIF":3.1,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13061576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639720","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":"Optimal clinical management of tenosynovial giant cell tumours: a UK perspective.","authors":"Sydney Stern, Robert Ashford, Will Aston, C R Chandrasekar, Sam Hackett, Nadina Hood, Vasilios Karavasilis, Robin L Jones, Ahmed Mahbubl, Guy Morris, Jonathan Perera, Sarah Pratap, Beatrice M Seddon, Daniel Stark, Jonathan Stevenson, Elaine Richardson, Sara Rothschild","doi":"10.1302/2633-1462.74.BJO-2025-0365.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2025-0365.R1","url":null,"abstract":"<p><strong>Aims: </strong>Tenosynovial giant cell tumour (TGCT) management is variable across the UK. Our aim was to examine these differences in clinical practice and develop consensus statements regarding the management of TGCTs.</p><p><strong>Methods: </strong>A three-stage modified Delphi technique was conducted with surgical, clinical, and medical oncology experts from across the UK. Key areas of controversy were identified in a virtual meeting on 23 January 2025. This was followed by an online questionnaire that was iteratively refined, and a virtual consensus meeting on 2 September 2025, to discuss topics where agreement had not yet been reached.</p><p><strong>Results: </strong>This consensus developed a definition for unresectable TGCT and criteria for patient referral from TGCT local management to multidisciplinary team (MDT) review with access to current appropriate treatment options and further defined unresectable TGCT. Diffuse, recurrent, and/or unresectable TGCT, or those requiring complex procedures should be reviewed through a centralized MDT case review at a sarcoma centre, given the complex multidisciplinary nature of TGCT management.</p><p><strong>Conclusion: </strong>The clarification of classification of localized and diffuse TGCTs, and the definition of unresectable TGCTs, as well as standardizing the criteria for referral to a sarcoma MDT, will facilitate the improved management of TGCTs across the UK and address regional resource challenges.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"482-490"},"PeriodicalIF":3.1,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610145","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":"3D topographic acquisitions to predict spinal curvature in adolescent idiopathic scoliosis : a prospective validation study.","authors":"Emma B Nadler, David E Lebel, Dorothy J Kim, Mark Camp, Jennifer A Dermott","doi":"10.1302/2633-1462.74.BJO-2026-0029.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2026-0029.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to determine the reliability, accuracy, and usability of a new health application that uses AI to estimate major coronal curve magnitude in patients with adolescent idiopathic scoliosis (AIS) from 3D surface topography (ST) captured on a smartphone video scan.</p><p><strong>Methods: </strong>This is a prospective validation study. AIS patients, aged ten to 18 years, with coronal curve magnitudes ≤ 45° were recruited at a tertiary care spine clinic. A single trained researcher performed scans twice, six months apart, during participants' routine clinical and radiological assessment. Participants were asked to complete a scan once a month between clinic visits, starting the day of recruitment. Agreement was calculated by comparing scan curve magnitude predictions to the reference standard: a three-foot standing spine radiograph measured by blinded spine clinicians. Inter-rater reliability was assessed by comparing in-clinic to home scan predictions. Measures of diagnostic accuracy to determine the app's ability to screen for coronal deformity > 25° and its ability to detect progression > 5° over a six-month period were determined. Successful compared with failed scans were recorded.</p><p><strong>Results: </strong>Among participants (n = 63), 59 patients (94%) had at least one successful in-clinic scan and 32 patients (51%) had at least one successful home scan. Agreement with the reference standard was moderate for in-clinic scans (intraclass correlation coefficient (ICC) 0.535) and poor for home scans (ICC 0.402). Inter-rater reliability between in-clinic and home scans was poor (ICC 0.168). The app had an accuracy of 70% when discriminating between curve magnitudes ± 25° and detecting curve progression > 5°. A larger proportion of scans failed at-home (30%) compared with in-clinic (16%).</p><p><strong>Conclusion: </strong>Conceptually, the app shows potential as an accessible screening tool for scoliosis. However, the accuracy and reliability suggest it is not yet a reasonable replacement for radiographs and in-person clinical evaluation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"473-481"},"PeriodicalIF":3.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13043243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595269","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":"Anterior cruciate ligament injury prevention: who is responsible for implementation and what are the challenges?","authors":"Jonathan T Super, Tim Spalding, Kate Jackson, William Jackson, Mark Bowditch, Morgan Bailey, Robert F LaPrade, Fares S Haddad, Iain R Murray","doi":"10.1302/2633-1462.74.BJO-2026-0019","DOIUrl":"10.1302/2633-1462.74.BJO-2026-0019","url":null,"abstract":"<p><p>The incidence of anterior cruciate ligament (ACL) injuries is increasing in the UK, with a particularly sharp increase among young female athletes participating in sport. ACL injuries result in significant morbidity, with a profound impact on the physical, mental and social health of individuals, alongside lengthy rehabilitation. Therefore, primary prevention of ACL injuries is desirable. The intrinsic and extrinsic risk factors associated with ACL injury, such as deficits in neuromuscular control, impaired movement quality, fatigue, strength imbalances, and suboptimal load management, are shared with a spectrum of other lower-limb musculoskeletal injuries. This overlap supports the concept that ACL injury prevention may not be best considered a condition-specific endeavour, but rather as a component of a comprehensive lower-limb injury prevention strategy. ACL prevention interventions typically include multi-component training methods designed to improve neuromuscular control, functional performance, balance, strength and power. while often framed around ACL injury reduction, their effects extend beyond the knee, conveying protection against other lower-limb injuries and improving overall performance. Despite a growing body of evidence demonstrating the efficacy of neuromuscular injury prevention programmes, their translation into routine practice has been inconsistent. This annotation outlines the current best evidence relating to ACL injury epidemiology and the effectiveness of injury prevention strategies, supporting a transition to integrate ACL injury prevention into wider, sport-specific lower-limb injury prevention programmes. In doing so, it highlights key stakeholders and barriers relevant to large-scale implementation of injury prevention programmes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"491-498"},"PeriodicalIF":3.1,"publicationDate":"2026-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13044835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595267","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":"Radiological stability of a quadrangular uncemented femoral component compared with its shortened version in primary total hip arthroplasty : a prospective randomized controlled trial.","authors":"Florian Kruse, Alix Addi, Philippe Anract, David Biau","doi":"10.1302/2633-1462.74.BJO-2026-0006.R1","DOIUrl":"10.1302/2633-1462.74.BJO-2026-0006.R1","url":null,"abstract":"<p><strong>Aims: </strong>Cementless femoral fixation is widely used in total hip arthroplasty (THA), with increasing interest in shorter femoral component designs. These femoral components aim to preserve proximal bone, promote physiological load transfer, and facilitate minimally invasive approaches. Among these, 'shortened' femoral components, derived from conventional stems and retaining a diaphyseal extension, may offer advantages in terms of implant positioning. However, clinical evidence regarding their mechanical reliability remains limited. This study aimed to compare the two-year radiological stability of a shortened uncemented quadrangular femoral component with that of its conventional-length counterpart in patients undergoing THA for osteoarthritis.</p><p><strong>Methods: </strong>We conducted a prospective, single-blind, randomized, noninferiority trial between January 2018 and December 2021. Patients undergoing primary THA were randomly assigned to receive either the conventional-length quadrangular femoral component or its shortened version. The primary outcome was femoral component migration at two years, assessed with Ein Bild Roentgen analyze - femoral component analysis (EBRA-FCA). Secondary outcomes included intraoperative and postoperative complication rates, as well as the 12-item Oxford Hip Score (OHS) at 12 months.</p><p><strong>Results: </strong>A total of 143 hips were randomized, with 139 (70 conventional-length, 69 shortened) included in the clinical analysis. Per-protocol radiological analysis was carried out on 98 hips (49 hips per group). At two years, mean femoral component migration was 0.94 mm (SD 0.49) in the shortened-femoral component group and 0.86 mm (SD 0.52) in the conventional-length group. The upper bound of the 90% CI (-0.09 to 0.25) was below the prespecified noninferiority margin of 1 mm. No significant differences were observed in complication rates or functional outcomes (p > 0.05).</p><p><strong>Conclusion: </strong>At two years, radiological outcomes of the shortened quadrangular femoral component were consistent with noninferiority compared with the conventional-length version. Although the planned sample size was not fully reached, the findings remained within the prespecified noninferiority margin.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 4","pages":"465-472"},"PeriodicalIF":3.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13038370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595208","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":"Musculoskeletal injury research in sub-Saharan Africa : a ten-year bibliometric analysis of research outputs from Malawi, South Africa, and Tanzania.","authors":"Robyn Waters, Shahd Osman, Maritz Laubscher, Sithombo Maqungo, Nyengo Mkandawire, Billy Haonga, George Njambilo, Matthew L Costa, Linda Chokotho, Simon Matthew Graham, Vincent Mkochi, Chiku Mpanga, Marc Henrion, Chipiliro Moffat, Bruce M Biccard, Richard Matzopoulos, Tracey Smythe, Nosipho Mncwabe, Kirsty Berry, Bibi Mumba, Wonderful Khumalo, Patrick Ngunyale, Obedi Emmanuel, Juma Mfinanga, John Mbanga, Dorkasi L Mwakawanga, David G Lalloo, William J Harrison, Jonathan Cook, Stavros Petrou, Daniel C Perry, Sarah Drew, Duncan Appelbe, Juul Achten, Molly Glaze, Abigail Shaw, Claude Martin, David Shearer, Grace Drury, James Masters, Saima Sheikh, Annabel Morley, Jimmy Olomi, Nathaniel Scherer, Sumayyah Rashan, Chantelle Mbugua, Lacey Smith, Madeline Mackechnie","doi":"10.1302/2633-1462.73.BJO-2025-0289.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0289.R1","url":null,"abstract":"<p><strong>Aims: </strong>Musculoskeletal (MSK) injuries pose a significant health burden across sub-Saharan Africa (SSA). Despite this, regional research output is limited, constrained by insufficient infrastructure, limited funding, and underdeveloped research capacity. This bibliometric analysis examined research outputs and collaboration patterns in MSK injury research across three SSA countries, representing a spectrum of income levels: low, lower-middle, and upper-middle income.</p><p><strong>Methods: </strong>MSK injury research articles from Malawi (MLW), South Africa (SA), and Tanzania (TZN), published between January 2014 and April 2024, were identified using Web of Science and Scopus databases, and cross-referenced with ResearchGate. Data were analyzed descriptively in Excel, and institutional coauthorship and collaboration networks were mapped using VOSviewer.</p><p><strong>Results: </strong>A total of 329 articles were published across MLW (n = 98), SA (n = 141), and TZN (n = 90) between January 2014 and April 2024. We report a steady increase in the number of publications from 2014, with a research focus on fracture management, outcomes, and lower limb injuries. Most of the research was published in partnership with high-income countries (HICs) (SA: 51%, MLW: 98%, TZN: 87%), with high-income country (HIC) institutions dominating first and last authorship in MLW (68% and 61%) and TZN (59% and 69%) publications. Most studies were descriptive and based on secondary records. Institutional networks showed strong regional collaboration in SA, international focus in MLW, and limited connectivity in TZN.</p><p><strong>Conclusion: </strong>MSK injury research is increasing across MLW, SA, and TZN, but remains largely HIC-led and descriptive, particularly in lower-income countries. Strengthening local leadership, regional collaboration, and research capacity is essential for more sustainable and context-specific evidence generation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"455-464"},"PeriodicalIF":3.1,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13022721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522028","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":"Reoperation and complication rates in acute lower limb amputations due to trauma.","authors":"Alex J Trompeter, Charlotte Brookes, Sara Dardak, Edward Allen, Billy Cho, Jonathan Lohn, Vijay Kolli","doi":"10.1302/2633-1462.73.BJO-2025-0307.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0307.R1","url":null,"abstract":"<p><strong>Aims: </strong>Lower limb amputation is associated with significant morbidity and mortality. Reflecting the predominance of vascular or diabetic disease as a cause for lower limb amputation, much of the available literature excludes lower limb amputation secondary to trauma in the reporting of complication rates. This paucity of literature represents a research gap in describing the incidence of complications in lower limb amputations due to trauma, which we aim to address.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken of a prospectively collected database of lower limb amputations secondary to trauma from a regional multidisciplinary amputee service in London. Clinical records were consulted for evidence of reoperation, infection, phantom limb pain, neuroma, and contralateral limb arthritis. A multivariable regression model was created to establish risk factors for reoperation. A total of 213 amputations (200 patients) were included in the final analysis.</p><p><strong>Results: </strong>Mean age at amputation was 33 years (1 to 90), with a mean follow-up of 230 months (2 to 734). Overall, 35.2% of patients (n = 75) underwent reoperation, and 27.7% (n = 59) had at least one episode of infection. Of those who underwent reoperation, 44% (n = 33) had evidence of infection. Phantom limb pain and neuroma were reported in 39.9% (n = 85) and 10.8% (n = 23), respectively. Contralateral limb osteoarthritis was documented in 7%. Presence of infection is a statistically significant risk factor, conferring a 3.9 times increased risk of reoperation.</p><p><strong>Conclusion: </strong>Lower limb amputations secondary to trauma exhibit higher rates of reoperation and infection compared to vascular or diabetic amputees. This is the first and largest study to provide high-quality data describing the incidence of complications in patients with lower limb amputations due to trauma in the UK.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"442-447"},"PeriodicalIF":3.1,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515218","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":"Planned amputations after lower limb trauma : indications and long-term complication rates.","authors":"Charlotte Brookes, Alice Rose, Moatisim Qayyum-Bin-Asim, Vijay Kolli, Jonathan Lohn, Alex J Trompeter","doi":"10.1302/2633-1462.73.BJO-2025-0308.R1","DOIUrl":"10.1302/2633-1462.73.BJO-2025-0308.R1","url":null,"abstract":"<p><strong>Aims: </strong>The decision to proceed to planned lower limb amputation in the context of previous trauma is a complex one. Much of the existing literature with regard to decision for amputation, and outcomes, focuses on a different patient demographic (older patients with diabetes or vascular disease) and therefore is unlikely to be applicable to young patients. In this study, we aim to identify the reasons for proceeding to a planned lower limb amputation in patients with previous lower limb trauma. We report on postoperative amputation complication rates, including reoperation, infection, phantom limb pain, and neuroma. The data were derived from one of the largest amputee multidisciplinary rehabilitation units in the UK.</p><p><strong>Methods: </strong>A retrospective analysis was undertaken of a prospectively collected database of all lower limb amputations secondary to trauma from a regional multidisciplinary amputee service in London. Clinical records were consulted for date and mechanism of injury of index trauma, date of amputation, evidence of reoperation, infection (superficial or deep), phantom limb pain, and neuroma. Amputations were deemed planned if occurring > six weeks post-traumatic injury.</p><p><strong>Results: </strong>A total of 69 amputations in 66 patients were analyzed. Mean age at index trauma was 38 years (10 to 77), and mean age at time of amputation was 45 years (12 to 80). The most prevalent mechanism of injury was road traffic accident (41%), followed by fall from a height (28%). Mean time from index trauma to amputation was 77 months (3 to 508). Chronic pain and infection were the leading causes in proceeding to a planned amputation (32% and 29%, respectively); nonunion accounted for 23%. Post-amputation rates of phantom limb pain, reoperation, and neuroma were 52.17%, 18.84%, and 8.70%, respectively. Infection was reported at a rate of 33%. Mean follow-up from time of amputation was 128 months.</p><p><strong>Conclusion: </strong>Chronic pain and infection are the most common reasons for proceeding to planned amputation of a previously traumatized lower limb. The rates of reoperation, neuroma, and phantom limb pain following planned amputation due to trauma are in keeping with those published for amputations secondary to diabetes or vascular disease. However, we report a higher rate of infection, likely attributable to chronic infection as a leading cause for planned amputation. Our data can assist clinicians and patients in making the complex, informed decision of whether to proceed to amputation. This is the first study describing the incidence of complications in patients with planned lower limb amputations due to trauma in the UK.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 3","pages":"448-454"},"PeriodicalIF":3.1,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515211","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}