Bone & Joint Journal最新文献

{"title":"Cost-effectiveness of treatment strategies for non-displaced osteoporotic femoral neck fractures in older adults in Ontario, Canada.","authors":"Pakpoom Ruangsomboon, Yu Qing Huang, Onlak Ruangsomboon, Davis Tam, Michael Zywiel, Bheeshma Ravi, David M J Naimark","doi":"10.1302/0301-620X.108B5.BJJ-2025-0673.R1","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0673.R1","url":null,"abstract":"<p><strong>Aims: </strong>This economic evaluation study assessed the cost-effectiveness of six treatment strategies for non-displaced osteoporotic femoral neck fractures (NDFNFs) in older adults using a Markov cohort model from the Ontario, Canada, public payer perspective.</p><p><strong>Methods: </strong>A probabilistic Markov chain Monte Carlo decision analysis model was developed to compare six strategies: 1) cemented femoral fixation total hip arthroplasty (THA; hybrid, cemented femoral component/uncemented cup - 'cemented THA'); 2) cementless THA; 3) cemented hip hemiarthroplasty (HHA); 4) cementless HHA; 5) internal fixation (IF); and 6) conservative treatment. The base case cohort consisted of Canadian patients presenting with a NDFNF aged 65 years, modelled with a lifetime horizon. Outcomes included quality-adjusted life-months (QALMs), lifetime costs (discounted at 1.5% annually), net monetary benefits (NMBs), and incremental cost-effectiveness ratios (ICERs). All costs are presented in Canadian dollars (CAD, $). The cost-effectiveness threshold (λ) was $4,166.67 per QALM. The primary outcome measure was expected NMBs, and the preferred strategy was the one with the highest expected NMBs over the lifetime horizon.</p><p><strong>Results: </strong>The estimated mean costs were $6,054 (IF), $11,995 (cemented THA), $11,011 (cemented HHA), $11,854 (cementless HHA), $15,405 (cementless THA), and $7,617 (conservative treatment). Cemented THA yielded the highest QALMs (192.7). Cemented THA had the highest NMB ($790,784). Cementless THA, cementless HHA, and conservative treatment were absolutely dominated while cemented HHA was extendedly dominated. After excluding dominated strategies, the ICER for cemented THA compared with IF was $127.5 per QALM, indicating that cemented THA is cost-effective relative to IF. At a λ of $4,166.67 per QALM, cemented THA was the most cost-effective strategy in 48.7% of simulations, followed by cemented HHA (31.2%) and IF (17.9%).</p><p><strong>Conclusion: </strong>Cemented femoral fixation THA is the most preferred strategy (highest expected NMB at λ) for NDFNFs in 65-year-old patients. When evaluated against a λ of $4,166.67 per QALM, cemented THA outperforms cementless THA, HHA, IF, and conservative treatment.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"688-697"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and symptom severity as predictors of outcomes following shockwave therapy in Achilles tendinopathy : a single-centre observational study.","authors":"Anne-Marie Hutchison, Paul Williams, Claire J Topliss, Owen Bodger, Rhys Whelan, David J Beard","doi":"10.1302/0301-620X.108B5.BJJ-2025-0706.R2","DOIUrl":"10.1302/0301-620X.108B5.BJJ-2025-0706.R2","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to determine the factors associated with positive outcomes from extracorporeal shockwave therapy (ESWT) in patients with chronic Achilles tendinopathy, and to develop and evaluate a simple predictive model for clinical use.</p><p><strong>Methods: </strong>An observational study was carried out on patients with chronic Achilles tendinopathy, managed through the therapist-led Tendo Achilles Pathway (TAP), who did not respond to physiotherapy and podiatry. Logistic regression was used with potential predictors including age, sex, symptom duration, athletic status, type of onset, use of insoles, bilateral symptoms, body side and symptom location, neovessel presence, and severity measurements (Victoria Institute of Sport Assessment-Achilles (VISA-A) and visual analogue scale (VAS)).</p><p><strong>Results: </strong>The sample (n = 183) were mostly female (60%, 110/182), had a median age of 53 years (IQR 24 to 86), and had experienced symptoms from three months to 14 years, with pain most commonly reported in the tendon body (58%, 105/181). Overall, 30% (19/63) were athletes, 55% (54/99) wore insoles, and 89% (54/61) had insidious onset. The mean baseline VAS and VISA-A scores were 57 (SD 23) and 33 (SD 17), respectively. ESWT led to positive outcomes in 46% and only milder initial symptoms and older age were associated with better outcomes (p < 0.05).</p><p><strong>Conclusion: </strong>This study presents an analysis of the rate and determinants of positive outcome at three months following ESWT in patients with Achilles tendinopathy. Age and symptom severity emerged as significant predictors of positive treatment success. Furthermore, we developed a very simple predictive model with potential clinical utility.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 5","pages":"650-656"},"PeriodicalIF":4.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone cements: strengthening oversight.","authors":"Sayf Faraj, James Li, Warran Wignadasan, Andreas Fontalis, Fares S Haddad","doi":"10.1302/0301-620X.108B.BJJ-2026-0346","DOIUrl":"10.1302/0301-620X.108B.BJJ-2026-0346","url":null,"abstract":"","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B ","pages":"735-738"},"PeriodicalIF":4.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Suspected Cauda Equina Syndrome Score (SuCESS) : development and validation of a clinical triage tool.","authors":"Elie Najjar, Shahbaz Khan, Rawan Masarwa, Michael P Grevitt","doi":"10.1302/0301-620X.108B3.BJJ-2025-0986.R2","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0986.R2","url":null,"abstract":"<p><strong>Aims: </strong>Cauda equina syndrome (CES) is a rare but critical spinal emergency. However, over 80% of urgent MRIs for suspected CES show no cauda equina compression. This diagnostic uncertainty places strain on imaging services and delays care. We aimed to develop and validate a clinical triage tool, the Suspected Cauda Equina Syndrome Score (SuCESS), to safely exclude CES and improve the accuracy of triage.</p><p><strong>Methods: </strong>We retrospectively developed the SuCESS score using the records of 259 patients who had been referred to a UK tertiary spinal unit between 2016 and 2018. Six clinical variables - saddle anaesthesia, reduced perianal sensation, motor weakness, bilateral sciatica, bladder post-void residual volume (PVR), and urethral catheterization - were identified using multivariable logistic regression, random forest, and XGBoost, and combined into an eight-point scoring system. Penalized regression was applied to minimize overfitting. External validation was undertaken using two temporally independent cohorts from 2020 and 2023 (n = 444). Primary outcomes were sensitivity and negative predictive value (NPV) for surgically confirmed CES. Model performance was assessed using area under the curve (AUC), Brier scores, calibration plots, and decision curve analysis.</p><p><strong>Results: </strong>At a threshold of ≥ 3.0, SuCESS achieved 100% sensitivity and 100% negative predictive value across all cohorts, correctly identifying all 64 cases of confirmed CES. Specificity increased from 37% in the development cohort to 54% after validation. AUC improved from 0.70 to 0.85, and Brier scores improved from 0.26 to 0.13. Use of the score might have safely deferred 38.7% of urgent MRIs, based solely on bedside clinical data.</p><p><strong>Conclusion: </strong>SuCESS is the first validated triage tool for CES to show perfect sensitivity. It offers a pragmatic and safe framework for reducing unnecessary MRI requests and for improving diagnostic accuracy in urgent spinal referrals.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"416-424"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of early compared with late weightbearing on the outcomes of subtalar joint arthrodesis : a systematic review and meta-analysis of single proportions.","authors":"Gareth Chan, Rachel Gregg, Panagiotis Christidis, Paul Halliwell, Anthony Sakellariou, Matthew Solan, Edward Dawe","doi":"10.1302/0301-620X.108B3.BJJ-2025-0461.R1","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0461.R1","url":null,"abstract":"<p><strong>Aims: </strong>Although end-stage osteoarthritis (OA) of the subtalar joint is routinely managed surgically with arthrodesis, postoperative weightbearing regimens vary widely from immediate weightbearing through to prolonged (≥ six weeks) non-weightbearing. It has been assumed that immediate weightbearing may compromise the rate of union and be associated with an increased rate of complications, but these concerns have not been substantiated. This systematic review and meta-analysis of single proportions aimed to assess the effect of early compared with late weightbearing regimens on the outcomes after isolated elective subtalar arthrodesis.</p><p><strong>Methods: </strong>All studies reporting on isolated elective subtalar arthrodesis for primary OA, post-traumatic arthritis, inflammatory arthritis, coalition, or planovalgus/cavovarus deformity correction were identified from MEDLINE, Embase, or Cochrane CENTRAL databases from inception to July 2024. Risk of bias was assessed with the MINORS tool. No direct comparative studies comparing weightbearing regimens were identified. A meta-analysis of single proportions was performed to generate a pooled proportion of the outcomes of interest, with early (≤ two weeks), intermediate (two to six weeks), and late (≥ six weeks) weightbearing regimens used to stratify the results.</p><p><strong>Results: </strong>A total of 32 studies reporting on 1,629 subtalar arthrodeses were included; four studies had early weightbearing regimens, three were intermediate weightbearing, and 25 reported outcomes from delayed weightbearing regimens. The overall rates of union were 95% (95% CI 92 to 97) with no difference between the regimens. Rates of wound complications, infection, and removal of metalwork were also not grossly different between the weightbearing regimens.</p><p><strong>Conclusion: </strong>Early weightbearing (≤ two weeks after isolated primary subtalar arthrodesis) is not associated with any deleterious effects on union, infection rates, or wound complications. This study also identified that there is a paucity of evidence regarding the impact of early compared with late weightbearing on outcomes after subtalar arthrodesis, and is limited by the quality of the studies available for this meta-analysis of single proportions.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"399-406"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic arm-assisted versus conventional jig-based unicompartmental knee arthroplasty achieves better soft-tissue balance : a unicompartmental pressure sensor study.","authors":"Tiejian Li, Xiangpeng Kong, Minzhi Yang, Zheng Cao, Xiang Li, Haifeng Li, Shaokui Nan, Wei Chai","doi":"10.1302/0301-620X.108B3.BJJ-2025-0090.R3","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0090.R3","url":null,"abstract":"<p><strong>Aims: </strong>We developed a novel unicompartmental pressure sensor to measure intraoperative medial compartment pressureduring robotic arm-assisted unicompartmental knee arthroplasty (UKA) and conventional jig-based UKA in order to assess the effect and impact of soft-tissue balance.</p><p><strong>Methods: </strong>This retrospective study evaluated 80 patients who underwent medial compartment UKA at our institution between November 2022 and June 2023, including 40 patients in conventional jig-based (mobile bearing) UKA and 40 patients in robotic arm-assisted (fixed bearing) UKA. After intraoperative soft-tissue balancing, the medial compartment pressure at 10°, 45°, and 90° of knee flexion was measured using a new unicompartmental pressure sensor. The knee range of motion (ROM), Numerical Rating Scale, and American Knee Society scores were recorded at three months and one year of follow-up.</p><p><strong>Results: </strong>Conventional jig-based UKA did not achieve consistent medial compartment pressures at 10°, 45°, and 90° of knee flexion (p < 0.001), whereas robotic arm-assisted UKA achieved more balanced pressures at these angles (p-values between 10° vs 45°, 10° vs 90°, and 45° vs 90° were 0.132, 0.378, and > 0.999, respectively). In addition, robotic arm-assisted UKA showed better outcome scores and ROM at three months, but no significant clinical differences at the one-year follow-up.</p><p><strong>Conclusion: </strong>Intraoperative pressure measurements using the novel unicompartmental pressure sensor showed that robotic arm-assisted UKA was able to achieve more consistent pressure in the medial compartment than conventional jig-based UKA, which may improve early postoperative rehabilitation.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"302-309"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total hip arthroplasty with dual-mobility components : a retrospective series of 25,545 primary cases.","authors":"Pierre-Alban Bouché, Christian Brand, Sophie Putman, Christian Delaunay, Antoine Poichotte, Alexandre Poignard, Stéphane Boisgard","doi":"10.1302/0301-620X.108B3.BJJ-2025-0766.R1","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0766.R1","url":null,"abstract":"<p><strong>Aims: </strong>This registry-based study aimed to evaluate the long-term survivorship of dual-mobility components (DMCs) compared to conventional components (CCs) in primary total hip arthroplasty (THA), and to assess potential adverse effects, particularly in younger patients (aged < 75 years).</p><p><strong>Methods: </strong>Data from 58,314 primary THAs recorded between January 2006 and December 2023 in the French national SOFCOT/RENACOT registry were analyzed, including 25,545 DMCs (46%). The primary outcome was revision for any cause. Kaplan-Meier survival curves and Cox proportional hazards models were used to compare implant survivorship, adjusting for age, sex, primary diagnosis, and fixation method.</p><p><strong>Results: </strong>Among the 25,545 primary THAs performed with a DMC, 284 revisions (1.1%) were recorded. In adjusted Cox regression analysis, DMC use was not significantly associated with an increased risk of revision compared to CCs (hazard ratio 0.83 (95% CI 0.66 to 1.04); p = 0.118). Periprosthetic fracture was the leading cause of revision in the DMC group (98/284, 34.5%), occurring significantly more frequently than in the CC group (77/493, 15.6%; p < 0.001), while dislocation-related revisions were less common with DMCs. Overall, the combined proportion of revisions due to dislocation or fracture was lower in the DMC group (112/284, 39.4%) than in the CC group (254/493, 51.5%). No risk factors for implant failure were identified in multivariable Cox regression analysis.</p><p><strong>Conclusion: </strong>DMCs provide excellent long-term survivorship and effectively reduce the risk of dislocation in primary THA. Although a higher incidence of periprosthetic fractures was observed with DMCs, the overall outcomes support their safe and effective use. Nevertheless, ongoing surveillance remains important to monitor these risks.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"294-301"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervised versus self-managed rehabilitation for patients with an acute first-time or recurrent patellar dislocation: the Physiotherapy Rehabilitation Post Patellar Dislocation (PRePPeD) external pilot randomized controlled trial and embedded qualitative study.","authors":"Colin P Forde, Elizabeth Tutton, Matthew L Costa, Jonathan A Cook, Marloes Franssen, Duncan Appelbe, Rupert Barker, David J Keene, Georgina Taylor, Mark Deakin, Aran Horrell, Crispin Mortimer, Joy Edwards, Teswaree Sewdin, Lisa Irving, Alexander Herring, Andrew Waton, Genevieve Simpson, Paul Minty, Niall Maher, Sanjeev Anand","doi":"10.1302/0301-620X.108B3.BJJ-2025-0403.R1","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0403.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to determine the feasibility of a full-scale randomized controlled trial (RCT) comparing two exercise-based rehabilitation interventions for patients with an acute patellar dislocation.</p><p><strong>Methods: </strong>A two-group external pilot RCT and embedded qualitative study was conducted in five English NHS hospitals. Patients were aged ≥ 14 years with an acute (recruited ≤ 21 days of injury) first-time or recurrent patellar dislocation. Randomization was 1:1 to supervised rehabilitation (between four and six physiotherapy sessions of tailored advice and prescribed home exercises) or self-managed rehabilitation (one physiotherapy session of advice, exercise instruction, and the provision of materials to guide self-management). Quantitative feasibility objectives were: patients' willingness to be randomized; patient recruitment; adherence to the intervention (overall proportion of supervised rehabilitation patients who attended at least four physiotherapy sessions and self-managed rehabilitation patients who attended at least one session); and retention. Follow-up was at three, six, and nine months after randomization. There was no blinding. Semistructured interviews aimed to understand patients' experience of recovery, and the acceptability to them of the interventions and the methods of follow-up.</p><p><strong>Results: </strong>A total of 50 of 88 eligible patients (57% (95% CI 46 to 67)) were willing to be randomized. Sites recruited a mean of 1.4 patients per month (95% CI 0.6 to 1.8), the rate of adherence to the intervention was 72% (95% CI 58 to 83), and the rate of retention at nine months was 62% (95% CI 48 to 74). During follow-up, three patients redislocated the index patella and another underwent patellar stabilization surgery. Interviews with nine patients showed that the experience of recovery was conveyed through the themes 'coming to terms with the initial injury' and 'regaining my former self'. Interviews also indicated that the interventions and methods of follow-up were generally acceptable to patients.</p><p><strong>Conclusion: </strong>A full-scale RCT comparing two exercise-based rehabilitation interventions for patients with an acute patellar dislocation is feasible with minor modifications. Modifications should prioritize improving retention and attendance at physiotherapy sessions.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"310-321"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopaedic care pathway for diabetic foot disease : experience from a UK rural district general hospital.","authors":"Nijil Vasukutty, Girish Gopinath","doi":"10.1302/0301-620X.108B3.BJJ-2025-0480.R1","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0480.R1","url":null,"abstract":"<p><strong>Aims: </strong>The diabetic foot is the major cause of non-traumatic amputations of the lower limb in the UK. There are well-established guidelines and pathways for the management of these patients in tertiary centres, but their management in district general hospitals (DGHs) remains inconsistent. The aim of this study was to describe a dedicated orthopaedic pathway, set up and managed by a multidisciplinary foot team in a DGH.</p><p><strong>Methods: </strong>Patients are managed on either an emergency, urgent, or elective pathway. We describe how these pathways have worked in our DGH: a total of 104 patients were managed in this way between August 2019 and September 2023. Patients who were initially on the emergency pathway for a foot attack or an acute episode were moved to the urgent or elective pathway for a specialist reconstructive procedure.</p><p><strong>Results: </strong>A total of 29 patients were managed as an emergency, 75 as urgent, and 12 were treated on an elective pathway. Ten patients were moved from the emergency to the urgent pathway, and two from the urgent to the elective pathway. A total of 150 bony and soft-tissue reconstructive procedures were undertaken. The mean follow-up was 30 months (17 to 65), during which time ten patients died and three moved away. There were six major amputations. The rate of limb salvage was thus 93.4% (85 of 91). A total of 77 patients (84.6%) had complete resolution of their infection and wound healing, and 67 (73%) were independently mobile.</p><p><strong>Conclusion: </strong>We demonstrate how an orthopaedic care pathway can be run effectively in a DGH in the UK for the management of patients with diabetic foot disease, achieving an excellent rate of limb salvage and an acceptable rate of complications.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"331-338"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary subtalar arthrodesis is a viable option for selected patients with a calcaneal fracture.","authors":"Robin Eelsing, Jens A Halm, Tim Schepers","doi":"10.1302/0301-620X.108B3.BJJ-2025-0489.R1","DOIUrl":"10.1302/0301-620X.108B3.BJJ-2025-0489.R1","url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to describe the surgical and functional outcome and quality of life after open reduction and internal fixation (ORIF) combined with subtalar arthrodesis (primary subtalar arthrodesis) for displaced intra-articular calcaneal fractures, using the sinus tarsi surgical approach. We also compared these results with those of an earlier study which we undertook regarding ORIF and delayed subtalar arthrodesis for these fractures. An overall aim was to provide new insights and guidance regarding the indications for the use of primary subtalar arthrodesis in these patients.</p><p><strong>Methods: </strong>This was a retrospective study of 62 patients with 64 displaced intra-articular fractures of the calcaneum, who underwent primary subtalar arthrodesis between August 2012 and January 2024. Surgical outcomes and patient-reported outcome measures (PROMs), including the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, Foot Function Index (FFI) score, and EuroQoL five-dimension questionnaire (EQ-5D) index/visual analogue scale (VAS) score, were recorded at many timepoints. Finally, potential predictors of outcome were analyzed.</p><p><strong>Results: </strong>The median follow-up of the surveys was 2.5 years (IQR 1.6 to 6.2). The median Böhler angle postoperatively was 29.5° (IQR 25.0° to 32.8°). Subtalar union was achieved in 59 cases (92.2%) with four successful revision arthrodeses. One patient died of unrelated causes. There was deep surgical site infection in four (6.3%), and screws were required to be removed in ten (15.6%). The median AOFAS and FFI scores were 80.0 (IQR 59.0 to 90.0) and 18.0 (IQR 5.3 to 39.5). The median EQ-5D index score was 0.843 (IQR 0.762 to 0.904) and the median EQ-5D VAS score was 81.0 (IQR 70.0 to 90.0).</p><p><strong>Conclusion: </strong>ORIF combined with subtalar arthrodesis provided good rates of subtalar union and good functional outcomes. These results were similar or better than those following ORIF alone or delayed arthrodesis. These findings support the use of this procedure in selected patients, using predefined criteria, potentially reducing the need for secondary surgery and improving the overall outcome.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":"108-B 3","pages":"355-360"},"PeriodicalIF":4.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}