European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Correlation between sagittal plane deformities of the hip and spinopelvic alignment in advanced hip arthritis patients undergoing total hip arthroplasty: a prospective observational study.","authors":"Souvik Paul, Aritra Chattopadhyay, Ankit Gaurav, Siddhartha Singh, Abhishek Meena, Udit Chauhan, Quamar Azam, Roop Bhushan Kalia","doi":"10.1007/s00590-026-04994-6","DOIUrl":"https://doi.org/10.1007/s00590-026-04994-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the relationship between fixed flexion deformity (FFD), hip range of motion (ROM), and dynamic spinopelvic parameters, and explored factors associated with early postoperative sacral slope (SS) mobility in patients with advanced hip arthritis undergoing total hip arthroplasty (THA).</p><p><strong>Methods: </strong>In this prospective study, 45 patients with unilateral hip arthritis and FFD undergoing primary THA were evaluated preoperatively and at three months postoperatively. Clinical assessments included the Thomas test, hip ROM, Harris Hip Score (HHS), and Visual Analogue Scale (VAS) for pain. Radiographic measurements in standing and sitting positions included pelvic incidence, sacral slope, pelvic tilt, ante-inclination (AI), and pelvic-femoral angle. Spinopelvic mobility was defined by the change in sacral slope (ΔSS) between standing and sitting positions.</p><p><strong>Results: </strong>The mean age was 56.2 years. Mean FFD improved from 16.4° preoperatively to 0° postoperatively, while hip flexion increased from 72.5° to 114.1°. Preoperatively, 11% of patients exhibited a stiff spinopelvic pattern, 63% had normal mobility, and 26% were hypermobile. Following THA, spinopelvic mobility shifted toward a more physiological distribution. Preoperative FFD correlated positively with ΔSS (r = 0.45, p = 0.002). Exploratory multivariable regression analysis identified preoperative hip ROM (β = - 0.35, p = 0.012) and preoperative dynamic change in AI (β = 0.31, p = 0.026) as significant independent factors associated with postoperative ΔSS.</p><p><strong>Conclusion: </strong>Correction of FFD through THA improves spinopelvic mobility and promotes pelvic realignment. Preoperative hip ROM and dynamic AI were independently associated with early postoperative SS mobility in this exploratory analysis; larger studies are required to validate these associations and determine their clinical significance.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of sacral fragility fractures leading to spinopelvic dissociation: a scoping review.","authors":"Tasneem Pope, Esther Wright, Peter Taylor, Douglas Evans, Jasvinder Daurka","doi":"10.1007/s00590-026-04984-8","DOIUrl":"10.1007/s00590-026-04984-8","url":null,"abstract":"<p><strong>Purpose: </strong>Fragility fractures affecting the sacrum present an increasing challenge to orthopaedic practice, due to limited comparative data and the absence of consensus on optimal management. U-Type and Rommens Type IVb fractures may result in a bilateral pattern of spinopelvic dissociation with possible neurological injury. This scoping review aims to summarise the current principles of care, indications for surgery, and outcomes of operative versus non-operative treatment for low-energy bilateral posterior sacral fractures (BPSFs).</p><p><strong>Methods: </strong>This scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A systematic search of electronic databases identified studies including ≥ 10 patients with Bilateral Posterior Sacral Fractures (BPSFs) comparing operative and non-operative approaches. Two reviewers independently screened titles, abstracts, and full texts against predefined inclusion and exclusion criteria, resolving disagreements by consensus. Data were extracted using a standardised form and summarised narratively with reference to mobility, quality of life, and patient-reported outcome measures. From 421 studies screened, eight met inclusion criteria.</p><p><strong>Results: </strong>From 421 screened records, eight studies including 235 patients met inclusion criteria. Operative management resulted from failed non-operative care in most cases. Percutaneous screw fixation was the most common surgical technique utilised. Although one study reported improved outcomes with early fixation, considerable heterogeneity in surgical approach and timing was observed with a similar lack of consensus on non-operative regimes and their point of 'failure'.</p><p><strong>Conclusion: </strong>Operative management may enhance pain relief, mobility, and function in selected patients with BPSFs, though with notable implant-related risks. Careful patient selection remains key, and further prospective studies are needed to establish optimal non-operative management and those who would benefit from early operative intervention.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute management of pelvic ring injuries: identifying common treatment principles across institutional algorithms.","authors":"Sascha Halvachizadeh, Christian T Hübner, Roman Pfeifer, Alona Katzir, Claude Sagi, Nikolaos K Kanakaris, Peter V Giannoudis, Ishvinder Grewal, Cyril Mauffrey, Hans-Christoph Pape, Adam J Starr","doi":"10.1007/s00590-026-04993-7","DOIUrl":"10.1007/s00590-026-04993-7","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic ring injuries are associated with substantial morbidity and mortality, particularly in patients presenting with hemodynamic instability and major hemorrhage. Numerous institutions have developed management algorithms for the acute treatment of pelvic ring injuries; however, the common principles underlying these pathways remain unclear.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, and Scopus were searched on January 8, 2026, for peer-reviewed publications published from January 1, 2006, through December 31, 2025 that described algorithms, pathways, or protocols for the acute management of pelvic ring injuries. Two independent reviewers performed study selection and data extraction. Algorithm components related to mechanical stabilization, physiologic assessment, imaging, hemorrhage control, and damage control resuscitation were extracted and compared using descriptive quantitative and qualitative synthesis.</p><p><strong>Results: </strong>The search identified 328 records that underwent title and abstract screening, and 63 articles were assessed for full-text eligibility. Twenty-five studies were included in the final analysis. All included algorithms (25/25, 100%) used physiology-based decision-making. Early noninvasive mechanical stabilization was specified in 23/25 algorithms (92%); pelvic binders were specified in 17/25 (68%). Angiography with potential angioembolization was included in 19/25 algorithms (76%), exploratory laparotomy in 10/25 (40%), and resuscitative endovascular balloon occlusion of the aorta (REBOA) in 3/25 (12%). Computed tomography was incorporated into 20/25 algorithms (80%), whereas pelvic radiography was included in 18/25 (72%). Fracture morphology was used as a treatment decision point in 4/25 algorithms (16%), and pelvic packing was described in 20/25 publications (80%).</p><p><strong>Conclusion: </strong>Published algorithms for the acute management of pelvic ring injuries demonstrate substantial consistency despite institutional variation. Early mechanical stabilization, physiologic assessment, damage control resuscitation, radiologic evaluation, and structured hemorrhage-control pathways were identified as the most common components of contemporary management algorithms.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CT-based evaluation of bony Bankart lesions after arthroscopic Trillat stabilization for anterior shoulder instability.","authors":"Arnaud Gonnachon, Hélène Henriquet, Alice Bordet, Ludovic Labattut, Pierre Martz","doi":"10.1007/s00590-026-04988-4","DOIUrl":"https://doi.org/10.1007/s00590-026-04988-4","url":null,"abstract":"<p><strong>Purpose: </strong>Bony Bankart lesions are known to contribute to anterior shoulder instability, and their evolution has mainly been studied after arthroscopic repair. However, the evolution of these lesions after shoulder stabilization without any specific procedure performed on the osseous fragment remains unknown. The aim of this study was to assess the CT-based evolution of bony Bankart lesions after arthroscopic Trillat stabilization.</p><p><strong>Methods: </strong>This retrospective, single-center study included patients treated between 2013 and 2022 for chronic anterior shoulder instability with a bony Bankart lesion who underwent arthroscopic Trillat stabilization. Glenoid bone loss and fragment characteristics were assessed on CT scans by two independent observers using the best-fit circle method. Fragment size, position, consolidation, and resorption were also evaluated. Postoperative CT scans were used to assess changes in consolidation and resorption over time.</p><p><strong>Results: </strong>Twenty-eight patients were included. The mean glenoid defect size was 10.3%. The proportion of patients with complete union increased significantly from 21.4% preoperatively to 85.7% postoperatively (p < 0.01). Fragment resorption increased from 27.1% preoperatively to 40.1% postoperatively (p < 0.001). A non-significant inferior shift in fragment position was observed postoperatively. An association was observed between preoperative consolidation and the time since the last dislocation. An association was also observed between the absence of postoperative consolidation and postoperative recurrence.</p><p><strong>Conclusion: </strong>CT-based evaluation of bony Bankart lesions after arthroscopic Trillat surgery demonstrated fragment consolidation and resorption at 6 months postoperatively, without any significant change in fragment position or glenoid defect size.</p><p><strong>Level of evidence: </strong>Level IV, Retrospective case series.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and associated factors after InterTAN nailing of geriatric intertrochanteric fractures.","authors":"Serdar Toy, Mehmet Ali Uyumaz, Ali Yücesan, Bekir Karakılıç, Mehmet Ali Talmaç, Furkan Akbaş","doi":"10.1007/s00590-026-04997-3","DOIUrl":"https://doi.org/10.1007/s00590-026-04997-3","url":null,"abstract":"<p><strong>Purpose: </strong>Large single-implant series of the dual integrated-screw InterTAN nail remain scarce. This study aimed to determine the rates of cut-out, reoperation, wound complication, and death after InterTAN nailing of intertrochanteric fractures in patients aged 65 years or older, and to identify the radiographic, morphological, and perioperative factors associated with each outcome.</p><p><strong>Methods: </strong>We retrospectively reviewed 540 patients (543 hip fractures) aged 65 years or older treated with the InterTAN nail between 2021 and 2024 at a single center. Tip-apex distance (TAD) and collodiaphyseal angle (CDA) were measured by one observer. Vital status and dates of death came from national records, with follow-up censored on 30 July 2026. Firth penalized logistic regression and Cox regression were used.</p><p><strong>Results: </strong>The mean age was 80.2 years, and American Society of Anesthesiologists (ASA) class was 3 or higher in 79.6%. Cut-out occurred in 2.6%, wound complication in 2.2%, and reoperation in 3.7%. Mortality was 8.2% at 30 days and 33.1% at one year, with median survival of 34.2 months. Higher TAD and Evans-Jensen grade 4-5 were associated with cut-out and lower CDA with reoperation. Death was associated with age, ASA class, and preoperative delay (hazard ratio 1.05 per day, mean delay 8.0 days).</p><p><strong>Conclusion: </strong>Cut-out was related to TAD and fracture pattern, reoperation to CDA, and death to age, ASA class, and preoperative delay. At a mean delay of 8 days, each additional day was associated with higher mortality, a finding consistent with operating as soon as the patient is medically fit.</p><p><strong>Level of evidence: </strong>IV (retrospective observational study).</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic-loaded synthetic calcium sulfate (Stimulan) in the surgical management of fracture-related complications in a low-middle income country.","authors":"Kate V Atkinson, Ilziba Yusup, Emma Slack, Chaplin C L Chan, Lyann C Hy, Hong P Sambath, Niak Puei Koh, Saqib Noor, James G Gollogly","doi":"10.1007/s00590-026-04987-5","DOIUrl":"10.1007/s00590-026-04987-5","url":null,"abstract":"<p><strong>Purpose: </strong>The use of calcium sulfate antibiotic delivery systems are underreported in low- and middle-income countries (LMICs), despite the high burden of fracture-related infections and complications. This study evaluates the use of Stimulan in fracture-related complications in a resource-limited setting.</p><p><strong>Methods: </strong>A prospective analysis was conducted of all patients treated with Stimulan (Biocomposites Ltd., Keele, UK) for fracture-related complications, between July-September 2023 at Children's Surgical Centre, Cambodia. Patients were followed up regularly at six, nine, and 12 months post-operatively and assessed on the following outcomes: radiological union, radiological/clinical infection remission and functional outcome.</p><p><strong>Results: </strong>Five out of six patients (83.3%) treated for FRI were clinically and radiologically infection-free, and six out of eight patients (75%) achieved fracture union, at 12 months follow-up. Surgical wounds had healed with no evidence of infection in seven (87.5%) patients. Five non-unions (71.4%) had radiologically healed by 12 months. All patients were fully weightbearing at one year, with two (25%) still requiring walking aids.</p><p><strong>Conclusion: </strong>The use of Stimulan in LMICs appears to provide an effective adjunct for managing fracture-related complications, however more research is required to investigate its efficacy in the treatment of infected non-unions in a LMIC setting.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Inpatient mortality following hip fracture in the United States: an updated analysis of over one million cases\".","authors":"Janani Gopalakrishnan, Kamini Bharani, Krishna Prasanth Baalann","doi":"10.1007/s00590-026-04966-w","DOIUrl":"10.1007/s00590-026-04966-w","url":null,"abstract":"<p><p>This commentary examines the statistical and methodological limitations of a recent national analysis of inpatient hip fracture mortality using the Epic Cosmos database. Four concerns are raised. First, the reported Spearman correlation between a four-category Social Vulnerability Index and mortality lacked statistical power because it was calculated across only four aggregated data points, and collapsing a continuous index into ordinal bins discarded patient-level variation needed to detect a dose-response relationship. Second, do-not-resuscitate status, documented in over one-third of patients, was omitted from the analysis of racial mortality differences, despite its direct influence on in-hospital mortality timing and its potential to confound comparisons unrelated to surgical risk. Third, the regional analysis reported the distribution of deaths across regions rather than region-specific mortality rates, conflating hospital volume with mortality risk. These limitations should be addressed before the reported demographic and regional patterns are used to guide resource allocation or clinical practice.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle volume, CT attenuation, and bone mineral density in relation to trochanteric fragment formation in older women with intertrochanteric femur fractures.","authors":"Chuji Terada, Suguru Yokoo, Junya Kondo, Yoshito Otake, Keisuke Uemura","doi":"10.1007/s00590-026-04970-0","DOIUrl":"10.1007/s00590-026-04970-0","url":null,"abstract":"<p><strong>Purpose: </strong>Greater and lesser trochanter fragments are common in intertrochanteric femur fractures and may reflect fracture morphology and instability. Although fragment formation has been discussed in relation to the attached muscles, the associations of muscle quantity, muscle quality, bone mineral density, and anthropometric factors with trochanteric fragment formation remain unclear. This study investigated factors potentially related to trochanteric fragment formation in older women.</p><p><strong>Methods: </strong>This retrospective study included 90 women aged ≥ 65 years with intertrochanteric femur fractures. Fractures were classified using the Shoda classification and categorized by the presence of greater and lesser trochanter fragments. Volumes and CT attenuation values of the gluteus medius, gluteus minimus, piriformis, iliacus, and psoas major were measured using artificial intelligence-based CT analysis as surrogate measures of muscle morphology and composition. Contralateral total hip and femoral neck T-scores were used as BMD indices. Group comparisons and univariate and multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>No significant differences in muscle volume, CT attenuation, contralateral bone mineral density, age, height, or weight were detected between patients with and without greater or lesser trochanter fragments. Neither univariate nor multivariable logistic regression identified a statistically significant association between fragment formation and any of the analyzed factors.</p><p><strong>Conclusion: </strong>In this cohort of older women with intertrochanteric femur fractures, no statistically significant relationships were detected between trochanteric fragment formation and peri-trochanteric muscle characteristics, BMD, or anthropometric factors. Larger, adequately powered studies are needed to further investigate whether these factors are related to fragment formation.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual function after pelvic ring fractures: does injury mechanism matter?","authors":"Jean Frecaut, Louis Rony, Florian Ducellier, Clément Marc, Guillaume David","doi":"10.1007/s00590-026-04921-9","DOIUrl":"10.1007/s00590-026-04921-9","url":null,"abstract":"<p><strong>Background: </strong>Pelvic ring fractures are severe injuries frequently associated with neurological, vascular, and urogenital damage. Although sexual dysfunction represents a major determinant of long-term quality of life, its relationship with the initial injury mechanism remains poorly explored.</p><p><strong>Objective: </strong>To evaluate male sexual function after surgically treated pelvic ring fractures and to compare outcomes according to the injury mechanism defined by the Young and Burgess classification.</p><p><strong>Methods: </strong>This retrospective single-centre study (Angers University Hospital) included male patients aged 18-75 years who underwent surgical treatment for pelvic ring fractures between January 2020 and June 2024. Fractures were classified into anteroposterior compression (APC), lateral compression (LC), and vertical shear (VS) groups. Sexual function was assessed at a minimum of 9 months postoperatively using the International Index of Erectile Function (IIEF-5). Univariate analyses were conducted to explore potential confounding factors. Statistical comparisons were performed between groups.</p><p><strong>Results: </strong>Thirty-one patients were included (15 APC, 10 LC, 6 VS). The mean follow-up was 22.8 ± 11.9 months. A significant difference in IIEF-5 scores was observed among the three groups (Kruskal-Wallis test, H = 13.45, p = 0.0012), with a large non-parametric effect size (epsilon-squared, ε² = 0.41). The LC group demonstrated significantly higher scores (19.4 ± 5.8) compared with the APC (15.8 ± 4.7) and VS groups (7.2 ± 0.8). All patients in the VS group exhibited severe erectile dysfunction. No statistically significant differences in age, surgical approach, or follow-up duration were identified, although these findings should be interpreted cautiously given the limited sample size.</p><p><strong>Conclusion: </strong>These exploratory findings suggest an association between injury mechanism and sexual outcomes after pelvic ring fractures. LC fractures appear associated with better functional recovery, whereas APC and especially VS fractures may carry a higher risk of persistent sexual dysfunction. However, residual confounding related to associated urethral, neurological, vascular, psychological, or systemic trauma-related factors cannot be excluded. Given the small sample size, results should be interpreted with caution. Systematic screening and multidisciplinary management should be considered in high-risk patients.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AO type C ankle fractures with additional posterior malleolus fragment: radiological and functional results of osseous reconstruction of the tibiofibular syndesmosis.","authors":"Adriaan Laurens Franx, Floortje Huizing, Samuel Marinus Verhage, Pieta Krijnen, Inger Birgitta Schipper, Jochem Maarten Hoogendoorn","doi":"10.1007/s00590-026-04975-9","DOIUrl":"10.1007/s00590-026-04975-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study compares the syndesmosis congruity and functional outcomes after syndesmotic reconstruction by open reduction and internal fixation (ORIF) of posterior malleolar fractures (PMFs) sized  > 5% versus no fixation in type C ankle fractures.</p><p><strong>Methods: </strong>This multicenter prospective cohort study compared ORIF of PMFs (FIX) with no fixation (NO-FIX). Both groups underwent fibular and medial malleolus fixation according to AO principles, with trans-syndesmotic stabilization screws in case of instability. The primary outcome was syndesmotic alignment assessed on post-operative bilateral CT scans. The main secondary outcome measures were patient-reported functional outcome up to 1 year assessed with AAOS and OMAS questionnaires, and complications.</p><p><strong>Results: </strong>26 patients (17 FIX, 9 NO-FIX) were included, with a median PMF size of 20%. Syndesmotic stabilization with fib-tib screws was used in 6% of FIX vs 44% of NO-FIX (p = 0.03). Anatomical reduction (primary outcome) was achieved in 85% (FIX) versus 29% (NO-FIX, p = 0.02). AAOS and OMAS scores during follow-up were superior in FIX (linear mixed models, p < 0.01). The complication rate was higher in NO-FIX (55% vs. 0%, p < 0.001).</p><p><strong>Conclusion: </strong>in this study, ORIF of the PMF resulted in a higher rate of anatomically reduced syndesmosis, lesser need for syndesmotic stabilization screws, better functional outcome and fewer complications compared to no fixation. Fixation of PMFs in suprasyndesmotic fibula fractures with PMFs > 5% may be valuable, but more studies are needed to confirm this hypothesis due to study limitations.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}