Orthopaedics and Trauma最新文献

{"title":"The posterior malleolus: the evolution of management","authors":"Alex Ward,&nbsp;Lauren Thomson","doi":"10.1016/j.mporth.2026.01.008","DOIUrl":"10.1016/j.mporth.2026.01.008","url":null,"abstract":"<div><div>When posterior malleolus fractures were first described during post-mortems in the 19th century, there was little understanding about their clinical significance. Following the discovery of X-rays and the start of the second world war, attempts were made to classify these injuries. Originally published in the <em>Journal of Surgery, Gynaecology and Obstetrics</em> in 1940, the following principle remained the same: fractures of less than a third of the articular surface could be managed conservatively. Even with the creation of the first CT scan in the 1970s, this dogma remained. From 2006 onwards, the creation of three classification systems by research teams led by Haraguchi, Bartoníček and Mason brought a new focus on these injuries, including suggested positioning and surgical approaches. With the introduction of the British Orthopaedic Association Standards for Trauma in 2016, focused clinical guidance has led to improved and standardized treatment of these complex fractures. In recent years, research has reinforced the use of CT and its importance in understanding the injury pattern, required fixation and approach. Further work has demonstrated that it is not only the size of the posterior malleolus fragment that affects outcome but also its morphology, and that functional outcomes are improved with the use of specifically designed locking plates over screws alone.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 112-116"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587999","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":"Answers to the CME questions on Hip Arthroplasty","authors":"","doi":"10.1016/j.mporth.2026.01.010","DOIUrl":"10.1016/j.mporth.2026.01.010","url":null,"abstract":"","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Page 127"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588002","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":"Ankle and hindfoot trauma: the benefits and pitfalls of primary fusion","authors":"Arham Qureshi,&nbsp;Vivekanandan Dhukaram","doi":"10.1016/j.mporth.2026.01.001","DOIUrl":"10.1016/j.mporth.2026.01.001","url":null,"abstract":"<div><div>Ankle and hindfoot trauma often results from high-energy mechanisms and can lead to complex injuries involving comminution, joint incongruity and soft tissue compromise. While traditional treatment emphasizes anatomic reconstruction and joint preservation, primary fusion is a viable alternative in cases where reconstruction is not feasible. Primary fusion involves immediate arthrodesis of the involved joints during the index procedure, aiming to provide early stability, facilitate weight-bearing, and reduce the risk of post-traumatic arthritis. It is particularly beneficial in elderly patients, polytrauma, open fractures, and those with non-reconstructible articular damage. Reported advantages include predictable union rates, improved pain control, and reduced need for secondary procedures. However, this approach is not without limitations. It results in permanent loss of joint motion, altered gait mechanics, and potential degeneration of adjacent joints. Furthermore, complications such as non-union, malalignment and infection remain concerns, especially in patients with co-morbidities. Careful patient selection and thorough preoperative counselling are essential to optimize outcomes. As techniques and fixation methods continue to evolve, primary fusion remains a valuable tool in the orthopaedic armamentarium for complex ankle and hindfoot injuries, though its use must be balanced against the functional demands and long-term implications for each individual patient.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 60-68"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587995","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":"Midfoot injuries: to fuse or fix?","authors":"Salman Sadiq,&nbsp;Amr Selim,&nbsp;Abdul-Rahman Gomaa,&nbsp;Thumri Paavana,&nbsp;Ashique Ali,&nbsp;Matthew Philpott","doi":"10.1016/j.mporth.2026.01.002","DOIUrl":"10.1016/j.mporth.2026.01.002","url":null,"abstract":"<div><div>Midfoot injuries are relatively rare and often caused by high-energy mechanisms but can be caused by low-energy mechanisms. These injuries can therefore be missed, meaning a high degree of suspicion is required when diagnosing a midfoot injury. Midfoot injuries can cause significant long-term problems with instability during gait and early osteoarthritis with midfoot collapse if not identified and managed early and appropriately. Midfoot injuries include a spectrum of injuries including fractures of the navicular, cuneiforms and cuboid bones but also injuries to the Lisfranc and Chopart joints. The aim of this review is to cover the osseous anatomy of the midfoot along with the clinical presentation, classifications, radiological findings and management of midfoot injuries, including the evidence behind whether to primarily fix or fuse these injuries.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 69-76"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588003","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":"Ankle and foot fracture management in patients with diabetes: an evidence-based review","authors":"Caroline E Plant,&nbsp;Arham Farukh Qureshi,&nbsp;Anna Chapman","doi":"10.1016/j.mporth.2026.01.007","DOIUrl":"10.1016/j.mporth.2026.01.007","url":null,"abstract":"<div><div>The incidence of diabetes is increasing across the UK. Foot and ankle injuries in patients with diabetes are challenging due to poor bone quality, increased risk of infection and peripheral neuropathy. Managing these patients requires a multidisciplinary approach from orthopaedic surgeons, diabetologists, podiatrists and orthotists both during the perioperative and rehabilitation phases. A thorough assessment of the limb for deformity, quality of soft tissues, vasculature and presence of neuropathy are vital. Nonoperative treatment typically involves a greater period of immobilization and more frequent reviews. Operative management requires a robust fixation utilizing approaches and techniques to minimize the impact upon the soft tissues, and more cautious weight-bearing protocols. In this review we provide guidance on how to approach the assessment and management of foot and ankle injuries in the patient with diabetes.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 105-111"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587998","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":"Pain after ankle fracture fixation: a management algorithm","authors":"Kareem Elsweify,&nbsp;Fady Kamel,&nbsp;Sami Al-Ali,&nbsp;Ravindra Kamath,&nbsp;James Carmichael","doi":"10.1016/j.mporth.2026.01.009","DOIUrl":"10.1016/j.mporth.2026.01.009","url":null,"abstract":"<div><div>Ankle fractures are a common orthopaedic pathology that are frequently treated through open reduction and internal fixation. Pain or symptoms following surgery is a surprisingly common complaint occurring in a high proportion of patients. The potential causes for persistent symptoms are varied, and an accurate assessment is vital to optimize patient outcomes. We present a review of the causes of postoperative pain and a structured algorithm to assist in the assessment of these complex patients. This systematic approach facilitates targeted investigation and management, addressing aetiologies including malunion, non-union, hardware irritation, nerve injury, complex regional pain syndrome, and intra-articular pathology. Implementation of this clinical pathway may improve diagnostic accuracy, streamline care, and enhance functional recovery for patients experiencing persistent symptoms following ankle fracture fixation.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 117-124"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588000","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":"Ankle fracture management in older people: an evidence-based review","authors":"Neil John Jones,&nbsp;Krishna Vemulapalli","doi":"10.1016/j.mporth.2026.01.004","DOIUrl":"10.1016/j.mporth.2026.01.004","url":null,"abstract":"<div><div>The incidence of ankle fractures in the elderly is increasing, and there remains no firm consensus regarding their optimal management in many cases. The importance of managing these fractures in a way that ensures firm fixation with the ability to allow early weight-bearing has been recognized recently and this has given rise to new concepts in treatment of these fractures. Traditionally fibula locking plates have been widely used in these commonly osteoporotic fractures given their greater strength, but issues have been raised with regards to allowing early weight-bearing with these constructs. Similarly, intramedullary fibula fixation has not been suggested as a method to allow this. Instead, retrograde tibiotalarcalcaneal fusion and antegrade tibiotalar fusion using intramedullary methods have been strongly advocated, the latter aiming to negate the need for subtalar joint violation and avoid the risk of stress-rise induced periprosthetic fracture in retrograde hindfoot nailing. Fibula pro-tibia fixation presents as a useful method to allow early weight-bearing for fractures in higher-demand older patients in whom intramedullary fusion could seem too aggressive. Further validation and high-level studies are now required to guide further advice.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 82-88"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587996","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":"Deep vein thrombosis prophylaxis after hindfoot trauma","authors":"Rosemary A Wall,&nbsp;Caroline E Plant,&nbsp;Carolyn M Chadwick","doi":"10.1016/j.mporth.2026.01.003","DOIUrl":"10.1016/j.mporth.2026.01.003","url":null,"abstract":"<div><div>Venous thromboembolism (VTE) in the form of deep vein thrombosis (DVT) and its potentially lethal consequence of pulmonary embolism (PE) are feared complications of any orthopaedic injury and intervention. The prevalence of VTE in hindfoot trauma is varied with some injuries in the region, such as Achilles tendon rupture, carrying significant risk regardless of which management strategy is undertaken. The optimal method to reduce the incidence of DVT after hindfoot trauma, or indeed after any subsequent surgical intervention, is less well studied than other orthopaedic surgery (such as hip and knee arthroplasty) and so practice varies greatly depending on injury sustained, intervention undertaken and local guidelines on VTE prophylaxis. Here we discuss the methods of VTE prophylaxis in use in the UK for hindfoot trauma along with pathophysiology of the condition, mechanism of action of the anticoagulants in common use and latest guidance.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 77-81"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588004","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":"Metatarsal fractures: a review of recent evidence on aetiology, classification and management strategies","authors":"Janak Parmar,&nbsp;Karan Malhotra,&nbsp;Matthew Welck","doi":"10.1016/j.mporth.2026.01.006","DOIUrl":"10.1016/j.mporth.2026.01.006","url":null,"abstract":"<div><div>Metatarsal fractures are among the most frequent foot injuries encountered in orthopedic practice, significantly affecting mobility and quality of life. This review synthesizes the latest evidence, focusing on the aetiology, classification and management of fractures involving the first through fifth metatarsals, with particular emphasis on high-quality randomized controlled trials, systematic reviews and meta-analyses. The fifth metatarsal, accounting for roughly 30% of metatarsal fractures, demands special consideration due to its unique anatomy and biomechanical role. Risk factors such as sports participation, foot morphology, prior injuries and footwear are discussed in detail, alongside the widely used Lawrence and Botte classification and the Torg radiological system. Management recommendations highlight a shift toward functional, early weight-bearing approaches for Zone 1 fractures, nuanced decision-making for Zone 2 fractures balancing operative and nonoperative strategies, and targeted surgical intervention for Zone 3 fractures in high-demand patients. Central metatarsal fractures – mainly involving the second through fourth metatarsals – are reviewed with respect to traumatic mechanisms, stress fracture risk factors including the female athlete triad and biomechanical variants, and evolving classification systems that incorporate MRI findings. Treatment paradigms favour conservative management for non-displaced fractures while advocating surgery for significant displacement, particularly in multiple metatarsal injuries, with Kirschner wire fixation gaining prominence due to its minimally invasive nature and favourable outcomes. First metatarsal fractures, though less common, necessitate robust fixation strategies due to their critical weight-bearing role. This review integrates current biomechanical insights and clinical evidence to provide an updated, evidence-based framework for optimizing patient-specific care in metatarsal fractures, aiming to guide clinicians in improving functional recovery and minimizing complications.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 98-104"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147587997","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":"Syndesmotic injuries: current evidence-based management guidelines","authors":"Maneesh Bhatia","doi":"10.1016/j.mporth.2026.01.005","DOIUrl":"10.1016/j.mporth.2026.01.005","url":null,"abstract":"<div><div>Isolated syndesmosis injury or high ankle sprain account for roughly one-fifth of all ankle sprains. These injuries can be associated with longer recovery and return to sport as compared with lateral ligament complex injury. There are several classifications, but it is important to consider syndesmosis injury as ‘stable’ or ‘unstable’. Following a good physical examination and initial radiographic screening, MRI scan should be considered for diagnostic confirmation. In trained hands arthroscopy is a valuable tool. Unstable syndesmotic injury usually requires surgical intervention. Rigid screw or flexible suture button can be used for fixation and both modalities are equally successful as per current evidence. Routine removal of syndesmotic screws should not be undertaken. Malreduction of syndesmosis is common and should be avoided. Direct visualization of articular surfaces is the most reliable technique to avoid malreduction. Currently there is no consensus regarding the optimum management of chronic syndesmotic instability.</div></div>","PeriodicalId":39547,"journal":{"name":"Orthopaedics and Trauma","volume":"40 2","pages":"Pages 89-97"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147588005","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}