Journal of Orthopaedics and Traumatology最新文献

{"title":"In-hospital deep vein thrombosis after tibial plateau fractures: incidence, laterality/anatomy, and risk factors in a multicenter retrospective cohort of 3366 patients.","authors":"Shuo Yang, Guoqiang Li, Yiran Li, Yubin Long, Jiaqi Zhang, Lingfeng Liu, Zihang Zhao, Changsheng Sun, Lin Liu, Lin Jin, Tao Wang, Zhiyong Hou","doi":"10.1186/s10195-026-00916-8","DOIUrl":"10.1186/s10195-026-00916-8","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine the cumulative in-hospital incidence, anatomic distribution, and predictors of duplex ultrasonography-detected lower-extremity deep vein thrombosis (DVT) in patients hospitalized with tibial plateau fractures under routine thromboprophylaxis and protocolized surveillance.</p><p><strong>Methods: </strong> We retrospectively analyzed consecutive adults (≥ 18 years) admitted to two level-I trauma centers (November 2014-January 2024). Bilateral duplex ultrasonography was performed on admission/preoperatively (as soon as feasible after arrival and prior to surgery) and repeated serially during hospitalization (approximately every 5-7 days and when clinically suspected). The primary outcome was cumulative in-hospital DVT from admission to discharge; isolated intermuscular calf-muscle vein thrombosis (soleal/gastrocnemius) was recorded descriptively but excluded from the primary endpoint. Multiple injuries (polytrauma) were defined as ≥ 1 additional acute traumatic lesion beyond the index tibial plateau fracture documented on admission. Pulmonary embolism (PE) was assessed only when clinically suspected and confirmed by computed tomography pulmonary angiography (CTPA). Multivariable logistic regression identified independent predictors; receiver operating characteristic (ROC) analysis evaluated discrimination for key continuous predictors.</p><p><strong>Results: </strong>Among 3366 patients, 675 developed in-hospital DVT (20.0%). First detection occurred preoperatively in 432 (64.0%) patients and postoperatively in 243 (36.0%). Most events were distal (584/675, 86.5%) and ipsilateral (617/675, 91.4%); proximal DVT occurred in 91 patients (2.7% of the cohort). Independent predictors included age, multiple injuries, anemia, alcohol use, and inverse associations with activated partial thromboplastin time and serum sodium. ROC analysis of age showed modest discrimination (area under the curve [AUC] 0.593) with a cohort-derived Youden threshold of 42 years (age ≥ 42 years). Symptomatic PE occurred in five patients (0.15% of the cohort) and was confirmed by CTPA.</p><p><strong>Conclusions: </strong> Under protocolized inpatient duplex surveillance, patients with tibial plateau fracture had a substantial in-hospital burden of predominantly distal and ipsilateral DVT. Increasing age was independently associated with DVT; however, age alone showed limited discriminatory ability (AUC 0.593), with a cohort-derived Youden threshold of 42 years (age ≥ 42 years). Multiple injuries, anemia, alcohol use, shorter activated partial thromboplastin time (APTT), and lower serum sodium were independently associated with DVT, while the discrimination of age alone was modest. These findings may help inform risk stratification and the consideration of systematic or risk-adapted surveillance and individualized perioperative management; prospective studies are needed to determine whether risk-tailored strategies improve clinic","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522518","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":"Retained articulating spacers (1.5 stage) in chronic knee periprosthetic joint infections: an analysis of associate factors and outcomes in a single center cohort of patients.","authors":"Giovanni Balato, Tiziana Ascione, Enrico Festa, Domenico De Mauro, Donato Di Gennaro, Donato Rosa, Massimo Mariconda","doi":"10.1186/s10195-026-00915-9","DOIUrl":"10.1186/s10195-026-00915-9","url":null,"abstract":"<p><strong>Background: </strong>Two-stage revision remains the gold standard for chronic periprosthetic joint infection (PJI), but it can significantly impact patients' quality of life and functional recovery. The 1.5-stage revision, involving indefinite spacer retention, has emerged as a potential alternative in selected high-risk patients. Our questions were: (1) What are the early functional outcomes, including their infection-free survival? (2) Which pre- and perioperative factors are associated with spacer retention? and (3) What is the mechanical survivorship of retained spacers?</p><p><strong>Materials and methods: </strong>This was a retrospective observational study including 108 consecutive patients with chronic PJI between 2016 and 2020 who were followed prospectively for clinical outcomes. Functional status and quality of life were assessed using the EuroQol-5-Dimension-5-Level (EQ-5D-5L), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS) before spacer placement and prior to scheduled reimplantation. Infection-free status was defined as the absence of clinical, radiographic, and laboratory signs of infection recurrence over a 24-month follow-up. Univariate and multivariate logistic regression were used to identify factors associated with spacer retention.</p><p><strong>Results: </strong>All patients initially underwent articulating spacer implantation as part of a planned two-stage protocol. Subsequently, after shared decision-making, the spacer was retained indefinitely (\"retained articulating spacer,\" commonly referred to as \"1.5-stage\") in 43 patients (39.8%), while 65 patients proceeded to reimplantation (two-stage revision). The KSS, WOMAC, and quality of life (QoL) scores, before scheduling the revision, were better than preoperative ones (p < 0.001). An age over 75 years (odds ratio [OR] 4.216, p = 0.001), a lower postoperative WOMAC score (OR 0.972, p = 0.013), and a history of re-revision (OR 1.102, p = 0.027) were independently associated with 1.5-stage candidacy. Infection-free status was achieved in 91.7% of the overall cohort, with 87.6% success in the two-stage group and 97.7% in the 1.5-stage group. Kaplan-Meier survival analysis showed spacer survivorship of 100% at 24 months, 88.8% at 30 months, and 73.3% at 36 months.</p><p><strong>Conclusions: </strong>Older age, better early functional outcomes, and a history of multiple surgeries at the same site were associated with spacer retention. These associations may inform patient counseling and surgical decision-making. Level of evidence IV, retrospective cohort study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516042","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":"Moderate leg length discrepancy: a long-term risk factor for hip osteoarthritis?","authors":"Alessandro Aprato, Andrea Donis, Riccardo Giai Via, Andrea Scandurra, Francesco Tuè, Andrea Audisio, Federico Fusini, Alessandro Massè","doi":"10.1186/s10195-026-00909-7","DOIUrl":"10.1186/s10195-026-00909-7","url":null,"abstract":"<p><strong>Background: </strong>Leg length discrepancy (LLD) has been implicated as a biomechanical factor contributing to hip osteoarthritis (OA), yet the extent of its influence remains unclear. This study examines the correlation between moderate LLD (≥ 10 mm) and hip OA progression, focusing on asymmetrical OA distribution in patients over 65 years old.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted from a database of 1672 full-length standing X-rays. Patients under 65 years, with deformities, unilateral limb issues, or prosthetics, were excluded; therefore, the study group was composed of 220 patients. Tibial and femoral lengths were measured bilaterally, and hip OA severity was assessed using the Tönnis classification. Statistical analyses included Pearson's Chi-squared test and linear regression to explore correlations between LLD and OA distribution.</p><p><strong>Results: </strong>Among the sample, 18% showed an LLD ≥ 10 mm. A significant correlation was found between LLD and the asymmetrical distribution of hip OA (p = 0.002), with higher OA severity observed in the hypometric limb. Linear regression analysis suggested that each millimeter of LLD corresponded to a 0.74-unit change in OA severity difference between hips.</p><p><strong>Conclusions: </strong>This study highlights a significant association between moderate LLD and contralateral hip OA in the elderly, emphasizing the biomechanical impact of asymmetrical joint loading. Findings suggest the need for early identification and targeted management of LLD to mitigate OA progression.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505302","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":"Authorship, titles and open access as drivers of citation performance in orthopaedics: a scientometric analysis.","authors":"Filippo Migliorini, Raju Vaishya, Fabrizio Rivera, Jörg Eschweiler, Philipp Kobbe, Marcel Betsch, Francesco Oliva, Nicola Maffulli","doi":"10.1186/s10195-026-00911-z","DOIUrl":"10.1186/s10195-026-00911-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p &lt; 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p &lt; 0.001), whereas title length in words showed a negative association (β = -0.183 per word, p &lt; 0.001). The presence of a colon (+0.314 citations/year, p &lt; 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (-0.476, p &lt; 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p &lt; 0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more criti","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491949","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":"Interpreting nonsignificant findings: Reassessing the safety of self-locking standalone cages in octogenarian patients undergoing ACDF.","authors":"Audai Abudayeh, Iakiv Fishchenko","doi":"10.1186/s10195-026-00907-9","DOIUrl":"10.1186/s10195-026-00907-9","url":null,"abstract":"","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"27 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13003036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147487785","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 novel, simple, and affordable technique for arthroscopic soft-tissue tenodesis of the long head of the biceps tendon.","authors":"Chiara Fossati, Attilio Ioppoli, Rossella Ravaglia, Faizan Vaja, Alessandra Menon, Pietro Simone Randelli","doi":"10.1186/s10195-026-00913-x","DOIUrl":"https://doi.org/10.1186/s10195-026-00913-x","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to describe a novel, simple, and implant-free arthroscopic soft-tissue tenodesis technique of the long head of the biceps tendon (LHBT) to the rotator cuff using an absorbable monofilament suture and to evaluate its clinical and functional outcomes at a minimum 1-year follow-up.</p><p><strong>Methods: </strong>A retrospective case series of 23 patients (mean age 58.0 ± 7.8 years) who underwent arthroscopic rotator cuff repair with concomitant LHBT soft-tissue tenodesis between June 2021 and June 2023 was analyzed. Functional outcomes were assessed using Constant-Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and the Long Head of Biceps (LHB) score. Supination strength was measured with a handheld dynamometer and compared with the contralateral side. Incidence of Popeye deformity and tenderness over the bicipital groove were recorded.</p><p><strong>Results: </strong>Objective Popeye deformity was observed in 13% of patients, with subjective concern reported by only 4.3%. Supination strength and LHB scores were similar to the contralateral side (means of 104.65 versus 104.64 N; LHB 93.7 versus 94.6 points). The mean CMS and ASES scores were 90.3 ± 12.4 and 89.6 ± 15.9 points, respectively. The SANE score averaged 87.4 ± 20.9, and the VAS for pain was low (1.65 ± 2.59 cm).</p><p><strong>Conclusions: </strong>This implant-free, arthroscopic LHBT soft-tissue tenodesis technique is technically simple, cost-effective, and yields excellent clinical and functional outcomes with minimal cosmetic concerns. It represents a reliable option for patients undergoing rotator cuff repair with concurrent LHBT pathology.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475865","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":"ORIF of three- and four-part proximal humeral fractures: a retrospective study of long-term clinical and complication outcomes of two-plate fixation methods.","authors":"Jacopo Conteduca, Elena Gasbarra, Igor Rausa, Alberto Casto, Luigi Valentino, Giuseppe Solarino, Luigi Meccariello, Giuseppe Rollo","doi":"10.1186/s10195-026-00914-w","DOIUrl":"10.1186/s10195-026-00914-w","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to compare clinical outcomes and complication rates during long-term follow-up (≥ 6 years) after treatment for three- and four-part proximal humeral fractures using two different types of locking plates.</p><p><strong>Materials and methods: </strong>A total of 113 patients with three- and four-part proximal humeral fractures who underwent surgery between September 2012 and January 2019 were enrolled retrospectively. Data for 49 patients [ 9 males, 40 females; mean age [standard deviation] (SD ) 68.9 (5.8) years} treated with a PGR (intrauma) plate (group A) and 51 patients [10 males, 41 females; mean age (SD): 66.0 (7.5) years] treated with a PHILOS humeral plate (PHP, group B) were available at the last follow-up. The mean follow-up periods in groups A and B were 10.8 and 10.2 years, respectively, with a minimum follow-up of 6 years. At the final follow-up evaluation, functional outcomes were assessed using the Oxford Shoulder Scale (OSS), Simple Shoulder Test (SST), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. X-ray evaluation was also performed, and complications were recorded.</p><p><strong>Results: </strong>The mean OSS score in the PGR and PHP groups at follow-up was 42.9 and 39.1, respectively (p > 0.05). The SST score (PGR: 7.5 ± 2.0; PHP: 7.3 ± 4.0) and DASH score (PGR: 22.1 ± 5.5; PHP: 20.5 ± 4.0) were similar in both groups (p > 0.05). In our series, 6% of patients had complications; these included avascular necrosis of the humeral head (two cases in the PGR group and three in the PHF group) and one case of periplate fracture in the PGR group.</p><p><strong>Conclusions: </strong>Among patients with three- and four-part proximal humeral fractures, both PGR plate and PHP treatment achieved comparable functional outcomes and demonstrated similarly low complication profiles. These results reinforce the appropriate clinical utility of either implant for fixation in the treatment of this fracture pattern.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464025","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":"Incidence rates and treatment of the transcervical fracture of the neck of femur in Italy: is total hip arthroplasty an increasingly preferred approach? A population study on trends between 2001 and 2023 based on 1,120,770 hospital discharge records.","authors":"Enrico Ciminello, Emilio Romanini, Michele Venosa, Gianpiero Cazzato, Gabriele Tucci, Filippo Boniforti, Luca Carpanese, Adriano Cuccu, Tiziana Falcone, Paola Ciccarelli, Stefania Ceccarelli, Marina Torre","doi":"10.1186/s10195-026-00912-y","DOIUrl":"10.1186/s10195-026-00912-y","url":null,"abstract":"<p><strong>Introduction: </strong>Transcervical femoral neck fractures (TFNFs) are among the most devastating fragility fractures in the elderly. TFNF are associated with excess 1-year mortality rates ranging from 15% to 30%. Treatments include conservative methods, internal fixation, and arthroplasty (partial or total hip arthroplasty). This study aims to analyze the changes in incidences of TFNF in the Italian population between 2001 and 2023 and the evolution of the choices of treatment.</p><p><strong>Materials and methods: </strong>Using hospital discharge record (HDR) data from 2001 to 2023, records with ICD9-CM codes for femoral neck fractures (820.0 and 820.1) among diagnoses were selected and categorized into four treatment groups: total arthroplasty, partial arthroplasty, fixation, and conservative. Time series were analyzed with stratification by sex and age.</p><p><strong>Results: </strong>The extracted data included 1,120,724 records of TFNFs, with 871,161 cases treated surgically (total or partial arthroplasty or internal fixation) and 249,563 treated conservatively; the average patient age was 79.1 years, with a higher proportion of women (72.8%). Partial hip arthroplasty was the preferred treatment overall. For younger patients, in the age classes < 45 and 45-54 years, fixation was the most chosen treatment. Over time, the use of the conservative treatment decreased from 27.5% in 2001 to 14.6% of cases in 2023. The use of partial and total hip arthroplasty increased from 40% and 13.3% in 2001 to 44.5% and 24.3% in 2023, respectively.</p><p><strong>Conclusions: </strong>Over the past two decades, Italy experienced declining age-adjusted incidence rates of TFNF despite persistent crude numbers (approximately 50,000 cases per year) owing to demographic aging. Partial hip arthroplasty (PHA) remained the preferred treatment, while total hip arthroplasty (THA) went from being the least used to the second-most performed treatment through the 23 observed years. Level of evidence level 1, population-based study.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13103184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460695","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":"Does latissimus dorsi tendon transfer provide a normal scapular rhythm and external rotation strength in posterosuperior massive irreparable rotator cuff tears? A kinematic analysis in a retrospective cohort.","authors":"Cristobal Calvo, Gabriele Fiumana, Alberto Brigo, Elena Dora Ruggiero, Rocco Bonfatti, Alessandro Donà, Gian Mario Micheloni, Andrea Giorgini, Luigi Tarallo, Giuseppe Porcellini","doi":"10.1186/s10195-026-00910-0","DOIUrl":"10.1186/s10195-026-00910-0","url":null,"abstract":"<p><strong>Background: </strong>Posterosuperior massive irreparable rotator cuff tears (PMIRT) are rare and disabling conditions. When conservative treatment fails, latissimus dorsi tendon transfer (LDTT) is a viable surgical option for symptom relief in carefully selected patients. However, its effectiveness in restoring glenohumeral function and its influence on scapulothoracic rhythm remain subjects of ongoing debate.</p><p><strong>Purpose: </strong>The purpose of this study was to evaluate the clinical outcomes of LDTT and assess its impact on scapulothoracic rhythm using kinematic and electromyographic analysis.</p><p><strong>Material and methods: </strong>A total of 18 patients with PMIRT underwent LDTT. Functional scores consisted of Constant-Murley score (CMS), America Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Electromyography (EMG) activity of the latissimus dorsi muscle was evaluated in conjunction with three-dimensional (3D) kinematic tracking system. Differences in external rotation strength were compared with and without active adduction.</p><p><strong>Results: </strong>The mean age was 55.9 years (range 40-69 years), with a mean follow-up of 20.4 months (range 6-39 months). At final follow-up, the mean CMS was 68.2 (95% CI 64.9-71.5), ASES was 76.9 (95% CI 66.1-87.6), and QuickDASH was 17.6 (95% CI 9.5-25.6). A significant difference in external rotation strength was observed with and without active adduction (p < .0005). EMG confirmed latissimus dorsi activation in all patients, with no significant differences between rotation conditions (p > .05). Kinematic analysis showed an overall normal scapulothoracic rhythm, with significant differences only in scapular tilting during elevation and external rotation with the shoulder in adduction (p = 0.044 and p = 0.023, respectively).</p><p><strong>Conclusions: </strong>LDTT provides satisfactory clinical outcomes in patients with PMIRT, enhancing external rotation strength when the latissimus dorsi is actively recruited and contributing to near-normal scapulothoracic rhythm restoration. A structured, targeted postoperative rehabilitation protocol is essential to optimize outcomes.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13069093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357221","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":"Is there a need for exploration in pulseless supracondylar fractures of the humerus? A systematic review and individual patient data meta-analysis.","authors":"Chen Haoyang, Junye George Chen, Haoxing Lai, Andrew Kean Seng Lim, Si Heng Sharon Tan, James Hoi Po Hui","doi":"10.1186/s10195-026-00908-8","DOIUrl":"10.1186/s10195-026-00908-8","url":null,"abstract":"<p><strong>Background: </strong>Different approaches have been proposed to treat patients with pulseless supracondylar humeral fractures (SHF). We aim to analyze the current outcomes of patients who have undergone different treatment options for pulseless SHF, namely watchful waiting versus urgent surgical exploration.</p><p><strong>Methods: </strong>Electronic databases including PubMed, Embase, and Cochrane Library were explored. Our study included patients from all age groups but only included English-language articles. Single case reports and case studies with adequate description of patient population, injury, and outcomes were included. An individual patient data meta-analysis was done to evaluate key outcomes of surgical exploration versus no surgical exploration in pulseless patients with SHF.</p><p><strong>Results: </strong>Overall, the data for 1070 individual patients from a total of 48 studies were included. Patients with pulseless SHF with open fractures have a higher probability of requiring vascular intervention (p < 0.001) as they are more likely to have disrupted arteries (p = 0.050) and more likely to require vascular repairs (p < 0.001) than patients with closed fractures. Similarly, patients with pulseless SHF with pucker sign (p = 0.003) and ecchymosis (p = 0.002) were more likely to undergo surgical exploration. However, the neurological status had no relation to them undergoing surgical exploration (p = 0.382), and also does not affect complication outcomes (p = 0.326) nor the need for vascular intervention (p = 1.00). However, patients with pale pulseless SHFs were more likely to undergo surgical exploration (p < 0.001), were more likely to have disrupted arteries (p < 0.001), required more vascular intervention (p < 0.001), and had a higher likelihood of complications (p < 0.001). Notably, there is no significant difference in overall complications between those who underwent exploration of arteries and those who did not among patients with pink pulseless SHF (p = 0.230).</p><p><strong>Conclusions: </strong>Significant predictors for arterial injury requiring intervention include a pale pulseless limb, open fracture, pucker sign, and ecchymosis; expedient surgical exploration is recommended in these scenarios. However, for patients with pink pulseless SHF, watchful waiting is a viable strategy. Our meta-analysis found no significant difference in overall complication rates between patients with pink pulseless who underwent exploration and those who did not.</p><p><strong>Level of evidence: </strong>Level II.</p><p><strong>Registration: </strong>The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines CRD.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13009295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195809","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}