Journal of Orthopaedics and Traumatology最新文献

{"title":"Reduction and outcome of posterior pilon fractures with intercalary fragments: a retrospective cohort study comparing the transfibular and posteromedial approaches.","authors":"Li Ying, Can Yao, Bin Wang, Junbo Liang, Guofu Chen","doi":"10.1186/s10195-025-00851-0","DOIUrl":"https://doi.org/10.1186/s10195-025-00851-0","url":null,"abstract":"<p><strong>Background: </strong>The transfibular fracture region (TFFR) approach can be utilized for managing posterior pilon fractures associated with intercalary fragments. However, its long-term outcomes remain unreported. This study aimed to compare the long-term clinical outcomes of the TFFR approach and the posteromedial approach for posterior pilon fractures (Klammer type 2/3, Danis-Weber type B) associated with displaced intercalary fragments over an average 8 year follow-up.</p><p><strong>Method: </strong>From 2012 to 2018, a cohort of consecutive patients who underwent open reduction and internal fixation surgery via either the TFFR approach or the posteromedial approach for posterior pilon fracture associated with intercalary fragments were enrolled for this study. Clinical outcomes were evaluated over an average 8 year (range 5-12 years) follow-up. The surgical duration, number of intraoperative fluoroscopies, and postoperative complications were recorded. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), and Short Form-36 (SF-36) score at last follow-up.</p><p><strong>Results: </strong>Seventy-nine patients were included in the final analysis, including 43 in the TFFR group and 36 in the posteromedial group. No significant differences between the two groups were observed in the FAOS (p = 0.679) or its specific components for symptoms (p = 0.264), pain (p = 0.963), activities of daily living (ADL, p = 0.102), sports (p = 0.156), or quality of life (p = 0.859). There was also no significant difference between the two groups in the FAAM-ADL (p = 0.408), FAAM-Sport (p = 0.617), and SF-36 scores (p = 0.757). Nevertheless, the surgical duration was shorter in the TFFR group (p < 0.001).</p><p><strong>Conclusion: </strong>The TFFR approach is not inferior to the posteromedial approach. For posterior pilon fractures with lateral malleolar fractures in the same plane, the TFFR approach may be preferred owing to its potential to reduce surgical time and the use of a single incision. Level of Evidence Level III, retrospective cohort study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"34"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel augmentation technique for the repair of full thickness gluteal tendon tears: a biomechanical analysis in an ovine model.","authors":"Alexander Derksen, Zarife Balli, Henning Windhagen, Dennis Nebel, Janin Reifenrath","doi":"10.1186/s10195-025-00850-1","DOIUrl":"10.1186/s10195-025-00850-1","url":null,"abstract":"<p><strong>Background: </strong>Gluteus medius tendon tears lead to considerable functional limitations and a high level of suffering in affected patients. In cases where the symptoms are severe, surgical intervention is indicated. A range of techniques are used to repair the tendon, with the primary aim being to achieve the highest possible primary stability in order to minimise the risk of re-rupture. This biomechanical study compares two different refixation techniques in terms of their stability in an ovine model.</p><p><strong>Material and methods: </strong>The gluteal tendons of sheep hips (n = 17) were meticulously prepared and detached from the femoral insertion. To reattach these tendons at their original anatomical footprint, either the sole double-row transosseous-equivalent technique (DR) or the DR supplemented by a proximal suture insertion (augmentation) of the tendon (DR +) was used. Pull-out tests were performed until failure using a uniaxial material testing machine, with a tensile force applied along the physiological tensile direction of the hip abductors. The data obtained (force at failure, linear stiffness) were compared between the groups using the Mann-Whitney U test.</p><p><strong>Results: </strong>The augmentation of the proximal tendon portion resulted in a substantial increase in force at failure, exceeding 450% (698 ± 80.3 N DR + compared with 155.9 ± 53.9 N DR technique). In addition, augmented tendons exhibited a notable enhancement in stiffness, with an average increase of 31.3 ± 15 N/mm in DR + compared with 12.4 ± 4.8 N/mm in DR. Furthermore, the DR + method resulted in a substantial reduction in the incidence of slippage of the tendon fibres out of the sutures and tendon bundles when compared with the DR suture.</p><p><strong>Conclusions: </strong>The clinical problem of suture knots becoming loose within the tendon stump, leading to the failure of the tendon sutures, could be mitigated by additional augmentation, resulting in a substantial increase in ultimate load at failure. The benefits of the double-row transosseous-equivalent technique, which facilitates the pressing of the tendon stump against the footprint, are maintained. Level of Evidence Level of Evidence 5.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"33"},"PeriodicalIF":3.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suture tape augmentation in the management of anterior cruciate ligament ruptures: a systematic review and meta-analysis.","authors":"Peiyuan Tang, Yangbin Cao, Ying Zhu, Han Tan, Haoxuan Li, Wenfeng Xiao, Ting Wen, Jun Zhang, Yusheng Li, Shuguang Liu","doi":"10.1186/s10195-025-00845-y","DOIUrl":"10.1186/s10195-025-00845-y","url":null,"abstract":"<p><strong>Background: </strong>The employment of suture tape augmentation (SA) in surgical interventions for anterior cruciate ligament (ACL) ruptures is a subject of ongoing debate. This meta-analysis synthesizes prior research to assess the effectiveness of additional SA in treating ACL tears.</p><p><strong>Methods: </strong>A total of four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched up to September 2024. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Key data extracted include: Lysholm Knee Scoring Scale, International Knee Documentation Committee Score (IKDC), self-assessment numerical evaluation (SANE), Tegner Activity Score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Marx Activity Scale, visual analog scale (VAS), KT-1000 anteroposterior knee laxity, and return to sports rate. Meta-analysis of outcome indicators was performed using Revman 5.4 software.</p><p><strong>Results: </strong>A total of 17 articles were included in this meta-analysis. Pre-post operation effect analysis showed that additional SA was correlated with improved IKDC, Marx Activity Scale, KOOS, VR-12 physical, and VAS for pain. In addition, there were statistically significant differences in SANE (mean difference, MD = 3.26, 95% confidence intervals, 95%CI 0.77, 5.76, P = 0.01, I² = 13%) and VAS for pain (MD = -0.17, 95%CI -0.32, -0.02, P = 0.02, I² = 0%) in the group using the SA technique compared with the traditional surgery group without SA. However, in terms of KT-1000 anteroposterior knee laxity, the traditional surgery group without SA was better than the group with SA (MD = 0.31, 95%CI 0.03, 0.59, P = 0.03, I² = 0%).</p><p><strong>Conclusions: </strong>On the basis of current evidence, we do not believe that, compared with isolated traditional surgical methods, additional SA can significantly improve patients' functional scores and help patients heal.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"32"},"PeriodicalIF":3.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12103404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A meta-analysis of the therapeutic effect of total knee replacement after knee arthroscopic surgery.","authors":"Yunwei Xu, Weidong Wang","doi":"10.1186/s10195-025-00848-9","DOIUrl":"10.1186/s10195-025-00848-9","url":null,"abstract":"<p><strong>Purpose: </strong>To appraise the influence of knee arthroscopic surgery on subsequent total knee arthroplasty (TKA) through meta-analysis.</p><p><strong>Methods: </strong>A computer search was implemented from the establishment of the database to August 2023 for literature on the influence of knee arthroscopic surgery on the efficacy of subsequent TKA in Web of Science, PubMed, CNKI, Embase, Cochrane Library, Wanfang, and other databases. Quality assessment, literature screening, and data extraction were enforced according to the exclusion and inclusion criteria, and the methodological quality of the involved literature was assessed using the risk-of-bias assessment method recommended by the Cochrane Assistance Network. RevMan 5.4 software was used to conduct a meta-analysis on the postoperative revision rate, periprosthetic infection rate, postoperative stiffness rate, postoperative venous thromboembolism (VTE) incidence rate, reoperation rate, and postoperative knee flexion range of motion after TKA.</p><p><strong>Results: </strong>Seven documents were finally involved, with a total of 42,642 cases, including 3405 cases in the knee arthroscopy group and 39,237 cases in the non-knee arthroscopy group. Meta-analysis results show that in the revision rate [95% confidence interval (CI) 0.97, 44.82] and reoperation rate [95% CI 1.66, 4.23] after TKA between the knee arthroscopy surgery group and the non-knee arthroscopy surgery group, there were statistically significant differences in postoperative stiffness rate [95% CI 0.86, 10.84] and periprosthetic infection rate [95% CI 0.86, 2.07], while in postoperative VTE incidence [95% CI 0.83, 1.35] and in postoperative knee flexion range of motion [95% CI -0.35, 0.10] there was no statistically significant difference.</p><p><strong>Conclusions: </strong>Knee arthroscopic surgery hurts subsequent TKA surgery. Previous arthroscopic surgery increased the risk of postoperative stiffness, revision, periprosthetic infection, and reoperation after TKA, but there was no significant difference in the incidence of VTE and knee flexion range of motion after surgery.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"31"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12098253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical timing and clinical factor predicting in-hospital mortality in older adults with hip fractures: a neuronal network analysis.","authors":"Raffaele Vitiello, Elisa Pesare, Giacomo Capece, Emidio Di Gialleonardo, Andrea De Matthaeis, Francesco Franceschi, Giulio Maccauro, Marcello Covino","doi":"10.1186/s10195-025-00846-x","DOIUrl":"https://doi.org/10.1186/s10195-025-00846-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Hip fractures in older adults are associated with a significant mortality rate, which has been reported to be around 35% within a year. Today, the incidence of these fractures is on the rise, and this trend is expected to increase even more owing to the aging of the population. Treatment timing and perioperative management of these patients are typically challenging owing to the presence of multiple comorbidities that are important risk factors for mortality after surgery. This study aims to evaluate the relationship between surgical timing and in-hospital mortality, analyzing the role of both acute events and chronic preexisting comorbidities in patient outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This is a single-center, retrospective observational study (from January 2018 until June 2023). All consecutive patients ≥ 65 years with a diagnosis of proximal femur fracture were enrolled. The primary study endpoint was to evaluate risk factors associated with in-hospital mortality. The secondary endpoint was the assessment of the relationship between surgical timing and in-hospital mortality, including factors such as preexisting comorbidities, the Charlson Comorbidity Index, and the Nottingham Hip Fracture Score. The relative weight of each factor for predicting the mortality rate was also evaluated using neural network analysis, comparing patients treated within 24 h to those treated after a longer surgical delay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 2320 patients enrolled, 1391 (60%) underwent surgery within 24 h, while 929 patients (40%) were treated after 24 h. For patients who underwent surgery within 24 h, the in-hospital mortality was 2.8%, and for those who underwent surgery after 24 h, it was 5.2% (p = 0.046; odds ratio (OR) 1.58). Age (p = 0.001; OR 1.06) and Nottingham score (p = 0.04; OR 1.32) are factors predicting mortality. Acute infections were related to a high risk of mortality (p = 0.001; OR 5.99), both in patients treated within and after 24 h. Acute events, such as atrial fibrillation and electrolyte imbalance, were related to mortality risk only in patients treated within 24 h (p = 0.001 versus p = 0.51). Neural network analysis revealed that atrial fibrillation (AF), flutter, and electrolyte imbalance had the highest relative weight for mortality in patients treated in the first 24 h; by contrast, renal failure and pneumonia were most present in patients who died that were treated after 24 h.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hip fracture is known to be a significant cause of morbidity and mortality in older adults. The impact of the timing of surgical treatment in those patients is crucial for postoperative outcomes. Early surgery is essential to reduce the risk of mortality. Our study has shown that, while in the case of acute and reversible conditions, waiting about 24 h to stabilize the patient with preoperative stabilization protocols, such as managing anticoagulation, ","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"30"},"PeriodicalIF":3.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early versus standard return to play following ACL reconstruction: impact on volume of play and career longevity in 180 professional European soccer players: a retrospective cohort study.","authors":"Michael Battaglia, Justin W Arner, Kaare S Midtgaard, Daniel B Haber, Liam A Peebles, Annalise M Peebles, Phob Ganokroj, Ryan J Whalen, Matthew T Provencher, Guglielmo Torre, Riccardo Ciatti, Pier Paolo Mariani","doi":"10.1186/s10195-025-00837-y","DOIUrl":"10.1186/s10195-025-00837-y","url":null,"abstract":"<p><strong>Background: </strong>Patients typically follow a 7-9-month return to play (RTP) protocol following anterior cruciate ligament reconstruction (ACLR); however, much of these data have been based on non-elite athletes. The purpose of this study is to understand whether professional soccer players returning to competition < 6-months following ACLR will have an increased risk of graft failure, play fewer seasons postoperatively, and have lower volume of play compared with those returning > 6 months.</p><p><strong>Materials and methods: </strong>A total of 180 male professional European soccer players were enrolled and underwent ACLR with a single surgeon between April 2008 and December 2016 and returned to sport < 6 months (early RTP group, n = 92) or > 6 months (standard RTP group, n = 88). Time from intervention to RTP (days), same season returns, total games and average minutes played in return season, seasons played after surgery, and playing status were recorded.</p><p><strong>Results: </strong>The early RTP group returned to soccer sooner (142.8 ± 21.4 days) than the standard RTP group (276.2 ± 118.9) (p < 0.01), and more players returned the same season as the injury in the early RTP group (n = 55/92, 62.5%) than the standard RTP group (n = 18/88, 20.5%) (p < 0.01). The difference in average minutes per game in the first season back was not statistically significant (early RTP, 56.7 ± 22.3 min; standard RTP 49.9 ± 29.8 min, p = 0.094). The early RTP group had significantly longer careers following ACLR (5.7 ± 2.2 seasons) than the standard RTP group (4.7 ± 2.4 seasons) (p = 0.005). The early RTP group sustained more reruptures (n = 4, 4.4%) than the standard RTP group (n = 1, 1.1%).</p><p><strong>Conclusions: </strong>Professional European soccer players returning to competition < 6 months following ACLR did not have poorer outcomes than those who returned > 6 months despite the fact that there were three more failures. However, the early RTP group players were more likely to return during the same season, had longer careers after ACLR, and played a similar number of games and minutes per game, but had more graft failures.</p><p><strong>Level of evidence: </strong>Retrospective cohort study level IV.</p><p><strong>Trial registration: </strong>Retrospectively registered according to prot. Professionisti_OSS_22.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"29"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors associated with delayed union after open reduction and plate fixation for humeral diaphyseal fractures.","authors":"Yuh-Ruey Kuo, Po-Yen Ko, Chun-Yi Lee, Ting-Chien Tsai, Chang-Han Chuang, Shu-Hsin Yao, Po-Ting Wu","doi":"10.1186/s10195-025-00843-0","DOIUrl":"10.1186/s10195-025-00843-0","url":null,"abstract":"<p><strong>Background: </strong>The risk factors related to delayed union in humeral diaphyseal fractures (HDFs) following surgical osteosynthesis remain unclear. Therefore, this study aimed to evaluate radiological outcomes and the risk factors associated with delayed union in a retrospective cohort of patients who underwent open reduction and plate fixation (ORPF) for acute HDFs.</p><p><strong>Materials and methods: </strong>Consecutive patients with AO/OTA 12-A and AO/OTA 12-B fractures who underwent ORPF using standard compression techniques between 2017 and 2020 were enrolled in the study. Demographic data, along with serial medical records and radiographs, were collected. The included patients were divided into two groups: the timely union (union occurring within 6 months postoperatively) and the delayed union group (union occurring between 6 and 12 months postoperatively). Differences between the groups were examined, and logistic regression was subsequently applied for risk factor analysis.</p><p><strong>Results: </strong>Sixty-five cases were included in the study, consisting of 34 males and 31 females, with a median age of 38.9 years. Among these, 45 cases (69.2%) were classified in the timely union group, while 20 cases (30.8%) were classified in the delayed union group. Overall, 30 cases (46.2%) demonstrated secondary bony union. Significant differences were observed between groups in terms of fracture pattern, immediate postoperative fracture gap, union pattern, and complication rate (p < 0.05 for all comparisons). Multivariate logistic regression analysis revealed that the use of interfragmentary screw and the presence of postoperative complications were independent predictors of delayed union, with an adjusted odds ratio of 0.14 and 5.76, respectively.</p><p><strong>Conclusions: </strong>In ORPF for acute HSFs, 30 out of 65 cases demonstrated secondary bone union despite the use of standard compression techniques. The application of interfragmentary screws significantly reduces the risk of delayed union. Conversely, the presence of postoperative complications is associated with an increased likelihood of delayed union.</p><p><strong>Level of evidence: </strong>3 Trial Registration All procedures were approved by the institutional review board of the authors' hospital (IRB nos. A-ER-112-395 and IRB20230089).</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"28"},"PeriodicalIF":3.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and radiological outcomes of giant cell tumor of the bone: prognostic value of Campanacci grading and selective use of denosumab.","authors":"Jasminka Igrec, Lisa Jernej, Maria Anna Smolle, Jakob Steiner, Susanne Scheipl, Birgit Lohberger, Andreas Leithner, Iva Brcic","doi":"10.1186/s10195-025-00841-2","DOIUrl":"https://doi.org/10.1186/s10195-025-00841-2","url":null,"abstract":"<p><strong>Background: </strong>Advancements in diagnostic and therapeutic modalities for giant cell tumors of bone (GCTB) have introduced molecular and radiological tools that refine clinical decision-making. H3.3 G34W immunohistochemical staining has become a routine diagnostic marker, while H3F3A mutational analysis enhances prognostic insights. Treatment primarily involves surgical methods such as curettage or en bloc resection, with denosumab serving as an adjunct in high-risk or inoperable cases.</p><p><strong>Methods: </strong>We retrospectively analyzed 55 patients with GCTB, focusing on clinicopathologic and radiological findings. Tumors were evaluated using the Campanacci grading system. Immunohistochemical analysis with H3.3 G34W antibody and next-generation sequencing (NGS) were performed to detect H3F3A mutations. A subgroup of nine patients treated with denosumab was further analyzed for clinical outcomes and histological changes.</p><p><strong>Results: </strong>The cohort had a mean age of 37.7 years, with tumors most commonly affecting the knee joint (55%). All tested tumors demonstrated positive H3.3 G34W staining, with eight exhibiting H3F3A G34W mutations. Recurrence rates were 32% following curettage and 18% after en bloc resection. Denosumab treatment, administered for an average of 14.6 months, facilitated tumor downsizing and new bone formation without major side effects. Histologically, treated tumors showed a depletion of giant cells and increased bone matrix deposition.</p><p><strong>Conclusions: </strong>Surgery remains the cornerstone of GCTB treatment, with curettage or resection tailored to tumor characteristics. Denosumab offers a valuable adjunct in high-risk cases, enhancing surgical feasibility and promoting joint preservation. The Campanacci grading system continues to be a crucial tool for prognostication and treatment planning, particularly when complemented by molecular and radiological diagnostics. Future research should focus on integrating advanced imaging and artificial intelligence for personalized GCTB management.</p><p><strong>Level of evidence: </strong>Level 4.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"27"},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight-based tranexamic acid lowers the risk of postoperative blood loss and transfusion requirements compared with fixed-dose regimen in revision knee arthroplasty: a comparative study.","authors":"Chenchen Yang, Baochao Ji, Guoqing Li, Xiaogang Zhang, Boyong Xu, Askar Maimaitiming, Li Cao","doi":"10.1186/s10195-025-00844-z","DOIUrl":"https://doi.org/10.1186/s10195-025-00844-z","url":null,"abstract":"<p><strong>Background: </strong>Intravenous tranexamic acid (TXA) dosing regimens differ substantially across studies, varying from fixed doses (e.g., 1-2 g) to weight-based protocols (e.g., 10-20 mg/kg). This study aimed to compare postoperative blood loss, transfusion rates, in-hospital mortality, and complications between fixed-dose and weight-based TXA regimens in revision total knee arthroplasty (rTKA).</p><p><strong>Materials and methods: </strong>This retrospective comparative study included 298 patients who underwent rTKA between June 2004 and May 2024. Patients were divided into three groups: (1) the no TXA group; (2) the fixed-dose TXA group, in which patients received an intravenous infusion of 1 g TXA before skin incision and a topical application of 1 g; and (3) the weight-based TXA group, in which patients received a weight-adjusted dose of 20 mg/kg/h TXA intravenously and a topical application of 1 g. We analyzed the maximum decrease in hemoglobin (Hb) levels, postoperative transfusion rate, and the incidence of in-hospital mortality and complications.</p><p><strong>Results: </strong>The weight-based TXA group demonstrated a lower maximal decrease in Hb compared with both the no TXA (18.22 g/L versus 26.09 g/L, p < 0.001) and fixed-dose TXA (18.22 g/L versus 24.69 g/L, p < 0.001) groups. Both the fixed-dose TXA and weight-based TXA groups exhibited lower postoperative transfusion rates compared with the no TXA group (p < 0.001). The weight-based TXA group showed a lower postoperative transfusion rate compared with the fixed-dose TXA group (p = 0.022). Although the incidence of deep vein thrombosis (DVT) among the three groups was statistically significant (p = 0.038), pairwise comparisons between groups did not reveal statistically significant differences (all p > 0.05).</p><p><strong>Conclusions: </strong>Weight-based dosage of TXA significantly reduced postoperative blood loss and transfusion requirements in rTKA compared with fixed-dose TXA regimen. A weight-based TXA regimen should be considered to effectively minimize postoperative blood loss and decrease transfusion requirements.</p><p><strong>Level of evidence: </strong>Level 3, non-randomized observational study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"26"},"PeriodicalIF":3.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the development of heterotopic ossification of the elbow in children with untreated chronic Monteggia fractures: a radiographic review of 274 cases.","authors":"WenTao Wang, QianQian Mei, ChongZhi Zhao, Antonio Andreacchio, ShengPing Tang, Hang Liu, ShunYou Chen, Zhu Xiong, Federico Canavese, ShengHua He","doi":"10.1186/s10195-025-00842-1","DOIUrl":"https://doi.org/10.1186/s10195-025-00842-1","url":null,"abstract":"<p><strong>Background: </strong>The factors predicting the development of heterotopic ossification (HO) of the elbow in children with untreated chronic Monteggia fractures (UCMFs) remained unclear. This multicentre study was designed to evaluate the radiographic data from paediatric patients with UCMFs and to identify the risk factors for HO formation and their radiographic characteristics.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 274 patients (mean age at injury: 5.82 ± 2.62 years) with UCMFs with all types of anterior (group A) and non-anterior (group B) radial head (RH) dislocations. Radiographs were used to assess the presence, size and bone density of HO. The risk factors evaluated included age at injury, sex, laterality, interval from injury to diagnosis, presence of radial or median nerve injury, immobilization of the fractured ulna after injury, direction of RH dislocation and distance of RH dislocation (DD-RH). The results were compared with 76 patient demographics-matched paediatric acute Monteggia fractures (PAMFs) undergoing surgery within 48 h after injury.</p><p><strong>Results: </strong>The HO rate (13.1%) in children with UCMFs was significantly higher than that (0%) in children with PAMFs (P = 0.001). The incidence of HO (14.5%) in group A was significantly higher than that (0%) in group B (P = 0.032). Age at injury and DD-RH were confirmed as risk factors for HO in patients with UCMFs by both univariate and logistic regression analyses (P < 0.05). Receiver operating characteristic curve analysis and chi-squared analysis indicated that age at injury > 6.78 years and DD-RH < 1.59-fold of the narrowest radial neck width were the cut-off values for an increased HO rate in patients with UCMFs (P < 0.05). Increased age at injury (P = 0.041) and interval from injury to diagnosis (P = 0.006) were associated with high-bone density HO.</p><p><strong>Conclusions: </strong>Patients with UCMFs with anterior RH dislocations, age at injury > 6.78 years, and DD-RH < 1.59-fold of the narrowest radial neck width were more likely to develop HO. The bone density of HO increases with age at injury and interval from injury to diagnosis. Timely RH reduction after acute injury may prevent HO.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"25"},"PeriodicalIF":3.0,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12033129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}