Bone & Joint Open最新文献

{"title":"Slipped capital femoral epiphysis in an Indigenous Australian population.","authors":"Jonghoo Sung, Tim Cheok, Rajendra Shetty, Kanishka Williams, Jaideep Rawat","doi":"10.1302/2633-1462.68.BJO-2025-0040.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0040.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to examine the epidemiology and outcomes of slipped capital femoral epiphysis (SCFE) in Australian Indigenous populations, and risk factors of contralateral slip.</p><p><strong>Methods: </strong>This multicentre, retrospective study included 85 Australian Indigenous patients with SCFE from two Northern Territory hospitals between February 2010 and February 2024. Data such as age, posterior slope angle, and slip characteristics were collected. Risk factors for contralateral slip were identified via penalized logistic regression, and the number needed to treat (NNT) was calculated for prophylactic fixation.</p><p><strong>Results: </strong>The median age at diagnosis was 12. 1 years (IQR 11.2 to 13.0), with a high incidence of valgus slips (10.6%). In total, 73 patients (85.9%) did not have prophylactic contralateral hip pinning, of which 13 patients (17.80%) developed a contralateral slip, with younger age and elevated posterior slope angle as significant risk factors. Patients aged under 12 years with a posterior slope angle greater than 9° had a NNT of two for prophylactic fixation, suggesting targeted benefit. Prophylactic fixation showed no subsequent slip or fixation-related complications in our patient population.</p><p><strong>Conclusion: </strong>SCFE in Australian Indigenous patients presents unique challenges, with a higher proportion of valgus slips than reported in other populations. Prophylactic fixation may be beneficial in younger, high-risk patients. These findings highlight the importance of individualized care and a multidisciplinary approach, particularly in remote communities where healthcare access is limited. Tailored interventions for at-risk individuals may improve outcomes and address healthcare disparities in this vulnerable cohort.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"858-865"},"PeriodicalIF":3.1,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765594","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":"The impact of brace treatment for developmental dysplasia of the hip on caregivers and families : a thematic analysis of literature review and stakeholder survey.","authors":"Joanna Craven, Olivia O'Malley, Wesley W E S Theunissen, Daniel C Perry","doi":"10.1302/2633-1462.68.BJO-2025-0063.R1","DOIUrl":"10.1302/2633-1462.68.BJO-2025-0063.R1","url":null,"abstract":"<p><strong>Aims: </strong>To identify the effect on the family and/or caregivers when infants undergo brace treatment for developmental dysplasia of the hip (DDH) by integrating findings from a literature review and stakeholder survey.</p><p><strong>Methods: </strong>Thematic analysis combining a comprehensive literature review and data from a UK-based online survey with international involvement. Identification of key themes related to the effect of brace treatment for DDH on the family/ caregivers.</p><p><strong>Results: </strong>The literature review identified eight relevant articles for inclusion. The online survey had 131 participants. During the thematic analysis, ten key themes emerged, highlighting substantial emotional distress among parents, issues with information provision and consistency, and practical challenges related to clothing, feeding, and sleep. Additional concerns included cleanliness, equipment, child development concerns, infant discomfort, bonding, financial impact, and disruption to daily life.</p><p><strong>Conclusion: </strong>Brace treatment for DDH has a significant impact on various aspects of family life. Identifying the specific areas of family life affected by brace treatment enables recognition of key challenges, informing the development of robust support systems, clear communication strategies, and customized informational resources. While bracing remains the cornerstone of DDH management in infants, with proven effectiveness in achieving positive clinical outcomes, substantial uncertainties persist regarding critical aspects of treatment, including determining the severity of dysplasia that warrants brace treatment, the optimal duration of treatment, and the most effective approach to brace removal. Resolving these uncertainties requires well-designed randomized controlled trials to establish clear, evidence-based guidelines. Furthermore, evaluations of brace treatments should explicitly incorporate family-centred outcomes. Developing a core outcome set focused on family-relevant measures would significantly enhance the design, comparability, and quality of future DDH research.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 8","pages":"851-858"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761627","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":"The Fracture Ankle Implant Review (FAIR) study : a national multicentre retrospective review of practice in implant choice, fixation methods, and outcomes in fixation of the fibula in ankle fractures.","authors":"William G Fishley, Thomas Baldock, Alan J Hilley, Rory Morrison, Paul Baker, Dave Townshend, Mohamed Imam, Tony Antonios, Zuhaib Shahid, Joshua Luck, Jonathan Kent, Ian Crowther, Karolina Mazur, Thomas Barwick, Hashim Al-Musawi, Temitope Simon Adesina, Bal Dhinsa, Sean M A Garcia, Annis Maatough, Avadhoot P Kantak, Aayush Lal, Eltayeb Shammeseldin, N Jane Madeley, Catherine Warwick, Angus Paterson, Anthony Gould, Robyn Brown, Alexandros Stamatpoulos, Krishna Boddu, David Chrastek, Praveen Gopinath, Peter Giannoudis, Hira Rizwi, Ayobami Asaju, Maximilian Ellacott, Aabid Samaullah, Armirohammad Heidari, Adeel Ditta, Chandra Bhattia, Alex Griffiths, Luke Guiot, David Townshend, Adam Rohman, Petr Kovarik, Togay Koҫ, John Hardie, Khaled Al-Kharouf, Jagannath Chakravarthy, Chryssa Neo, Matthew Gray, Colin Shaw, Charlotte Angel, Daniel Francis, Alasdair Barrie, Owen Diamond, Catherine Gilmore, Rebekah Mercer, Stephen Aldridge, Humayoon Zaheen, Dafalla Elamin, Paul Baker, Prabha Nagalingam, Stuart Irvine, Chinedum Violet Onwuekwe, Daniel Dowen, Glen Alder, Patrick Duffy, Rory Morrison, Mohamed Elgendy, Philip Vaughan, Vidhya Chauhan, Caroline Selvakumar, Jonathan Barrow, Jack Allport, Amit Kumar Yadav","doi":"10.1302/2633-1462.67.BJO-2025-0009.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0009.R1","url":null,"abstract":"<p><strong>Aims: </strong>In fixation of the fibula in ankle fractures, the AO Foundation advocates using a lag screw and one-third tubular neutralization plate for simple patterns. Where a lag screw cannot be placed, bridging fixation is required. A local pilot service evaluation previously identified variance in use of locking plates in all patterns with significant cost implications. The Fracture Ankle Implant Review (FAIR) study aimed to evaluate current practice and implant use across the UK, and review outcomes and complication rates between different fibula fixation methods.</p><p><strong>Methods: </strong>The study was supported by CORNET, the North East orthopaedic trainee research collaborative, and the British Orthopaedic Trainee Association (BOTA). Data were collected using REDCap software from 22 centres in the UK retrospectively for a one-year period between 1 January 2019 and 31 December 2019 on injury mechanism, fracture characteristics, comorbidities, fixation, and complications. Follow-up data were collected to at least two years from surgery.</p><p><strong>Results: </strong>A total of 1,471 ankle fractures which involved fixation of the fibula were analyzed; a one-third tubular plate was used in 883 cases (59.7%), a locking plate in 470 cases (31.8%), and other methods in 118 cases (8.1%). There was significant difference between centres (p < 0.001) in terms of the implant type which was used. Other factors associated with implant type were age, diabetes, osteoporosis, open fractures, and comminuted fractures. Incidence of lateral wound breakdown and infection was higher in locking plates than one-third tubular plates (Lateral wound breakdown p = 0.008, Infection p = 0.039) in AO44B fractures. There was no significant difference in nonunion, fixation failure, or removal of metalware.</p><p><strong>Conclusion: </strong>There is significant variation in practice in the UK in implant use for fixation of the fibula in ankle fractures. If a locking plate is used unnecessarily, where a one-third tubular shows equivalent outcomes, this incurs additional cost and may increase the risk of lateral wound complications. We would encourage surgeons with high locking plate usage to evaluate their own unit's practice against these data.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"841-849"},"PeriodicalIF":2.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660518","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":"The future of precision orthopaedics: personalized data-driven practice.","authors":"Deiary F Kader, Andrew Coppola, Aditya Vijay, Andreas Fontalis, Fares S Haddad","doi":"10.1302/2633-1462.67.BJO-2025-0056.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0056.R1","url":null,"abstract":"<p><p>Advances in orthopaedic surgery have been significantly shaped by evidence-based medicine (EBM), which relies on randomized controlled trials (RCTs) to standardize care and improve outcomes. However, EBM's one-size-fits-all approach often fails to account for the heterogeneous nature of individual patients, limiting its ability to deliver personalized care. Personalized data-driven practice (PDDP), powered by AI, provides a transformative solution by integrating diverse data sources, including genetic and clinical data, imaging, and wearable device outputs, into patient-specific treatment strategies. This paper examines the complementary roles of EBM and PDDP, highlighting the capacity of AI-driven tools to enhance decision-making in orthopaedics. AI technologies, such as machine learning and Bayesian networks, enable predictive analytics, treatment personalization, and real-time data integration, fostering a shift from reactive to proactive care. However, challenges related to data quality, algorithm transparency, ethical considerations, and infrastructure development must be addressed to ensure robust and equitable implementation. By merging AI-enhanced PDDP with the established principles of EBM, orthopaedic practice can evolve into a hybrid model that enhances patient outcomes while preserving clinician oversight and ethical integrity. This integration heralds a new era of precision orthopaedics, offering a patient-centred approach in the context of big data and AI innovation.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"836-840"},"PeriodicalIF":2.8,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12266936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650757","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":"Cartilage lesions are not the main factor influencing pain and functional impairment in early knee osteoarthritis : a multivariate analysis on intra- and extra-articular factors affecting symptoms in over 200 knees.","authors":"Luca Bianco Prevot, Alessandro Bensa, Pietro S Randelli, Giuseppe Filardo","doi":"10.1302/2633-1462.67.BJO-2025-0010.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0010.R1","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the correlation between symptoms, in terms of pain and functional scores, and the extent of cartilage damage as well as other intra- and extra-articular factors in patients suffering from early knee osteoarthritis (OA).</p><p><strong>Methods: </strong>The subjects were selected from the Osteoarthritis Initiative database according to the following inclusion criteria: Kellgren-Lawrence (KL) grade 0-1-2, MRI at baseline, and availability of cartilage-denuded subchondral bone values. For each patient the following data were analyzed: demographic data, KL grade, percentage of subchondral bone denuded from cartilage, patellar quadriceps tendinitis, effusion, anserine bursa tenderness, meniscal extrusion, Hoffa body synovitis, bone marrow lesions (BML), visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, and WOMAC pain subscale.</p><p><strong>Results: </strong>A total of 204 knees were included in the analysis. The multivariate analysis showed that VAS was influenced by patellar quadriceps tendinitis (p < 0.001/η2 = 0.113), anserine bursa tenderness (p = 0.009/η2 = 0.033), and percentage of cartilage-denuded subchondral bone (p = 0.032/η2 = 0.023). WOMAC was influenced by patellar quadriceps tendinitis (p < 0.001/η2 = 0.118), anserine bursa tenderness (p < 0.001/η2 = 0.060), medial meniscus extrusion (p < 0.001/η2 = 0.066), BML of the lateral compartment (p = 0.015/η2 = 0.029), patellofemoral BML (p = 0.096/η2 = 0.014), and percentage of cartilage-denuded subchondral bone (p = 0.083/η2 = 0.015). The WOMAC pain subscale was influenced by patellar quadriceps tendinitis (p < 0.001/η2 = 0.095), anserine bursa tenderness (p = 0.001/η2 = 0.055), medial meniscal extrusion (p < 0.001/η2 = 0.071), age (p = 0.032/η2 = 0.023), total BML (p = 0.001/η2 = 0.057), and percentage cartilage-denuded subchondral bone of the tibial plateau (p = 0.044/η2 = 0.020).</p><p><strong>Conclusion: </strong>The extent of cartilage damage is not the main factor influencing pain and functional impairment in early knee OA. Other intra- and extra-articular joint OA features, including extensor mechanism tendinitis, anserine bursa tenderness, meniscal extrusion, and BMLs have greater impact in driving patient symptoms.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"828-835"},"PeriodicalIF":2.8,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643698","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":"Young Hip: an exploration into young patients' (aged < 50 years) expectations following primary total hip arthroplasty : a qualitative study.","authors":"Louise E Mew, Vanessa Heaslip, Tikki Immins, Thomas W Wainwright","doi":"10.1302/2633-1462.67.BJO-2025-0013.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0013.R1","url":null,"abstract":"<p><strong>Aims: </strong>Total hip arthroplasties (THAs) are common operations performed in orthopaedics. Though initially developed to address hip conditions in older patients, demand in younger patients is increasing. Research in older populations informs current practice, and it is unclear if outcome priorities are the same in younger patients. The study's aim was to explore the expectations and priorities of younger patients' (aged < 50 years) undergoing THA.</p><p><strong>Methods: </strong>Using interpretive phenomenological analysis (IPA) methodology, ten patients were recruited from one UK hospital. Semistructured interviews occurred at three timepoints (pre-surgery, six weeks, and six months post-surgery). This study has been reported using the COnsolidated criteria for REporting Qualitative research (COREQ).</p><p><strong>Results: </strong>Six themes were identified: 'I'm just constantly in pain', 'Giving up hope', 'Living a process that does not reflect me', 'This is not who I'm meant to be', 'My family didn't sign up for this', and 'I can't do anything'. Some themes were independent of patient age, such as pain, and experiences of healthcare. However, other findings may be more imperative to the younger patient than the older patient.</p><p><strong>Conclusion: </strong>The Young Hip study highlighted aspects currently overlooked in younger THA patients. Participants were aware that they were not the accepted patient profile for THA, and expressed having to fight to be heard. Function was considered in terms of responsibilities and roles in society, rather than traditional clinical perceptions of mobility. The findings demonstrated that current care pathways are not fully addressing the needs of younger THA patients. Further development of a personalized THA pathway, allowing for more focus on person-centred care, could address issues raised by this study, more effectively supporting younger patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"807-815"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627330","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":"From theory to practice: insights into intervention development of the NON-STOP app for children with Perthes' disease.","authors":"Adam M Galloway, Anna M Anderson, Emma Casimir, Colin Holton, David J Keene, Anthony C Redmond, Heidi J Siddle, Suzanne Richards, Daniel C Perry","doi":"10.1302/2633-1462.67.BJO-2025-0082","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0082","url":null,"abstract":"<p><p>The development of interventions in healthcare often lacks a robust theoretical basis, which may contribute to suboptimal engagement and effectiveness. This paper provides insights into and practical guidance on the development of complex interventions in healthcare, using the example of a digital self-management tool for children with Perthes' disease, called the Non-Surgical Treatment of Perthes' (NON-STOP) app. We applied the Medical Research Council framework, used psychological theory, and integrated stakeholder engagement to develop the intervention. The lessons learned and considerations for the developments of other complex interventions provide practical actions for clinicians and researchers in orthopaedics.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"822-827"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12257238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627316","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":"Outcomes of the hexapod frame in 111 'high risk' tibial fractures.","authors":"Jonathan France, Adam Tucker, Jessica Nightingale, Andrew Taylor, Simon Craxford, Benjamin Ollivere","doi":"10.1302/2633-1462.67.BJO-2025-0023.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0023.R1","url":null,"abstract":"<p><strong>Aims: </strong>The use of circular frames in the management of tibia fractures and deformity correction is well established in the literature. The Taylor Spatial Frame (TSF) is the most widely used hexapod device globally. However, the majority of published papers are small in patient numbers, contain primary and revision cases, and outcomes are therefore unclear. In this study we evaluate the clinical and radiological outcomes of patients with tibial fractures treated primarily with a TSF.</p><p><strong>Methods: </strong>Patients were identified from a prospective trauma database at a UK major trauma centre. An analysis of patient records and radiographs was performed for the study. Patient demographics, comorbidities, frame construct, time in frame, union rates, and complications of treatment were analyzed.</p><p><strong>Results: </strong>Between September 2009 and January 2020, 111 patients with tibial fractures managed primarily with a TSF were included. The majority of patients (86, 77.5%) sustained fractures to the tibial shaft, leaving nine plateau (8.1%) and 16 pilon fractures (14.4%). Of these, 55 (49.6%) were open and 56 (50.4%) were closed. Of the open fractures, seven were classified as Gustilo and Anderson grade 3A and 41 (74.5%) were classified as grade 3B. The overall union rate for primary TSF was 85%, with a mean time to union of 191 days (SD 90). A total of 15 patients (13.5%) required either open reduction and internal fixation (n = 6, 5.4%) or intramedullary nail (n = 9, 8.2%) to achieve bony union. Five patients (4.5%) developed a deep infection requiring invasive treatment. Two patients (1.8%) required an eventual amputation for an infected nonunion; both of these patients sustained an initially closed fracture. Overall limb salvage at two years was 98.2%.</p><p><strong>Conclusion: </strong>The TSF remains an established option in the surgical management of patients with complex injuries to the tibia, with good rates of limb salvage within this challenging patient subgroup.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"816-821"},"PeriodicalIF":2.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12256801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627329","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":"Efficacy of indocyanine green fluorescence-based near-infrared angiography in assessing intraoperative wound perfusion for bone and soft-tissue surgery.","authors":"Han Wang, Xiaodong Tang, Tao Ji, Dasen Li, Huayi Qu, Zhiye Du, Wei Guo","doi":"10.1302/2633-1462.67.BJO-2024-0248.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2024-0248.R1","url":null,"abstract":"<p><strong>Aims: </strong>Wound complication is common in bone and soft-tissue tumour surgery. Proper wound healing requires robust blood perfusion. However, intraoperative assessment of perfusion is difficult, and lacks methods with good accuracy. This study aimed to explore the efficacy of indocyanine green fluorescence angiography (ICGA) in intraoperatively assessing wound perfusion and predicting postoperative wound necrosis and clinical outcomes.</p><p><strong>Methods: </strong>A total of 22 patients with orthopaedic oncological diseases were enrolled in this study from August 2021 to December 2022. All patients were deemed to have high risk of postoperative necrosis but normal wound appearance during surgery. ICGA was performed intraoperatively to assess the perfusion status of the wound. A novel system, called the Fluorescence Perfusion Scale (FPS), was proposed, consisting of three types of fluorescence angiography features corresponding to different perfusion statuses. Patient- and provider-related risk factors were analyzed. The relationship between clinical outcomes and FPS types was analyzed.</p><p><strong>Results: </strong>Wound necrosis occurred in ten of 22 patients (46%). According to the FPS, seven patients (32%) showed type 1, seven patients (32%) showed type 2, and eight patients (36%) showed type 3 angiography, respectively. The uni- and multivariate analysis indicated that FPS type 1 or 2 is the only independent risk factor for wound necrosis. The necrosis rate showed a significant difference between FPS types (p＜0.001). The rate of reoperation of patients of type 1 was significantly higher than that of type 2 (85% compared 0%, p = 0.005).</p><p><strong>Conclusion: </strong>Wound perfusion in bone and soft-tissue surgery can be assessed by ICGA and graded by the FPS system, which can predict postoperative necrosis and clinical outcomes.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"796-806"},"PeriodicalIF":2.8,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609798","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":"Does weightbearing status impact mortality and other complications in hip fracture patients when accounting for frailty?","authors":"Makoa Mau, Tyler Thorne, Kai Rossbach, Eleanor H Sato, Chong Zhang, Angela P Presson, Justin M Haller","doi":"10.1302/2633-1462.67.BJO-2025-0059.R1","DOIUrl":"10.1302/2633-1462.67.BJO-2025-0059.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to analyze the risk of mortality and other postoperative complications following restricted weightbearing in geriatric patients who undergo fixation of a hip fracture, while accurately controlling for patient frailty.</p><p><strong>Methods: </strong>The National Surgical Quality Improvement Program (NSQIP) database January 2016 to December 2020 was queried for operatively treated hip fractures in patients aged ≥ 60 years using Current Procedural Terminology (CPT) codes (n = 53,959). Logistic regressions and receiver operating characteristic (ROC) curve analysis were conducted to determine the frailty measure which best predicts 30-day mortality among American Society of Anesthesiologists grade (ASA), five-factor modified Fraility Index (mFI-5), and Risk Analysis Index Recalibrated Version (RAI-Rev). The effect of weightbearing on 30-day mortality, and severe (SAE) and minor (MAE) adverse events, was assessed using logistic regressions while controlling for the selected frailty measure and other relevant patient characteristics.</p><p><strong>Results: </strong>A total of 53,959 patients met the inclusion criteria, and 36,177 patients (67%) were weightbearing as tolerated postoperatively. Under ROC curve, the only discriminatory performance was by RAI-Rev in 30-day mortality. Controlling for RAI-Rev, age, sex, BMI, functional status, and CPT, weightbearing patients had a 42% lower odds of 30-day mortality (p < 0.001), a 31% lower odds of a SAE (p < 0.001), and a 24% lower odds of a MAE (p < 0.001) in comparison to non-weightbearing patients.</p><p><strong>Conclusion: </strong>Geriatric hip fractures are prevalent in patients with varying degrees of health. RAI-Rev is a better predictor of postoperative mortality than ASA grade and mFI-5, and should be used in evaluating the risk of geriatric hip fractures. Postoperative weightbearing is associated with significant reductions in complications for geriatric hip fracture patients, even while controlling for frailty. Our findings suggest that postoperative weightbearing after surgical fixation of geriatric hip fractures should be encouraged for able patients.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"6 7","pages":"785-795"},"PeriodicalIF":2.8,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12235488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585060","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}