European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Comparative clinical outcomes of monotherapy and combined conservative treatment strategies in lateral epicondylitis: a retrospective cohort study of 420 patients.","authors":"Volkan Kizilkaya, Sefa Erdem Karapinar, Ali Levent, Ertan Gocer, Mehmet Melih Asoglu, Mustafa Cukurlu","doi":"10.1007/s00590-026-04978-6","DOIUrl":"10.1007/s00590-026-04978-6","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral epicondylitis is a common degenerative tendinopathy of the elbow that can significantly impair pain, functional capacity, and grip strength. Although various conservative treatment options are available, evidence comparing different conservative treatment combinations remains limited. This study aimed to compare the clinical outcomes of different conservative treatment strategies in patients with lateral epicondylitis.</p><p><strong>Study design: </strong>Retrospective cohort study; Level of Evidence: III.</p><p><strong>Materials and methods: </strong>A total of 420 patients with lateral epicondylitis were retrospectively reviewed. Patients were categorized according to the conservative treatment strategy received during routine clinical practice: NSAID therapy alone, NSAID combined with orthotic support, NSAID combined with injection therapy (corticosteroid or platelet-rich plasma [PRP]), and NSAID combined with both orthotic support and injection therapy. Injection therapy in this study included only corticosteroid and PRP injections. Pain, functional outcomes, and grip strength were assessed using the Visual Analog Scale (VAS), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and a Jamar hydraulic hand dynamometer at baseline and at the 6-month follow-up.</p><p><strong>Results: </strong>Significant improvements were observed in all groups for VAS, PRTEE, and grip strength scores at 6 months (all p<0.001). However, the magnitude of improvement differed significantly among treatment groups (all p<0.001). The greatest reductions in pain (ΔVAS 4.84 ± 2.02) and PRTEE scores (ΔPRTEE 26.31 ± 9.70), as well as the largest increase in grip strength (ΔGrip 14.88 ± 4.12 kgf), were observed in patients treated with combined NSAID, orthotic support, and injection therapy. In contrast, the NSAID-only group demonstrated the smallest improvements across all outcome measures.</p><p><strong>Conclusion: </strong>In this retrospective single-center cohort, combined conservative treatment strategies were associated with greater short-term improvements in pain, functional outcomes, and grip strength at the 6-month follow-up. Because treatment allocation was non-randomized and treatment groups included heterogeneous orthotic and injection modalities, these findings should be interpreted as observational associations rather than evidence of treatment superiority. Prospective randomized studies with standardized treatment protocols are warranted to determine the optimal conservative treatment strategy for lateral epicondylitis.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031932","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":"The effect of gap and step-off displacement of infratectal T-type acetabular fractures on contact pressures of the acetabulum: a biomechanical analysis.","authors":"Adam Schlauch, Bo He, Abhinav Nalluri, Ishan Shah, John Duldner, Tien Tran, Maria Caicedo, Oluwatodimu Richard Raji, Brian Farrell","doi":"10.1007/s00590-026-04961-1","DOIUrl":"10.1007/s00590-026-04961-1","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the effect of gap and step-off displacement of infratectal T-type acetabular fractures in a biomechanical model and understand the effects of displacement on acetabular joint pressures when the fracture lies outside of the weight-bearing dome.</p><p><strong>Methods: </strong>Infratectal T-type acetabular fractures were created with osteotomies in cadaveric acetabuli and the hip joints were assembled in a servohydraulic test frame. Intra-articular pressure sensors were used to measure contact area, contact pressure, and peak forces through increasing gap and step-off displacement during simulated positions of standing, walking, and stair climbing.</p><p><strong>Results: </strong>With 0 mm articular step-off and increasing gap from 0 mm to 5 mm, there was no significant change in contact area, contact pressure, or peak force throughout most testing conditions. With a 2 mm step-off, contact area (-5.9 ± 1.8cm², -23.9% ± 7.3%, p = 0.002) and contact pressures (10.9 ± 4.2 N/cm², 43.5% ± 15.8%, p = 0.004) changed significantly once a 5 mm gap was reached.</p><p><strong>Conclusion: </strong>This biomechanical study suggests that hip conditions are not significantly altered in T-type acetabular fractures outside the weight-bearing dome when there is an articular gap but no step-off and when there is an articular step-off and a gap of 2 mm or less. Infratectal T-type acetabular fractures with a combination of 2 mm articular step-off and gap greater than 5 mm may benefit from surgical reduction as malunion may lead to increased contact pressures within the joint.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984008","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":"Letter to the Editor regarding \"Risk of surgical site infection associated with intraoperative smartphone use in a sterile cover during total knee arthroplasty\".","authors":"Tahir Burak Sarıtaş","doi":"10.1007/s00590-026-04963-z","DOIUrl":"10.1007/s00590-026-04963-z","url":null,"abstract":"<p><strong>Purpose: </strong>To critically examine the interpretation of the reported association between intraoperative smartphone use in a sterile cover and surgical site infection after total knee arthroplasty.</p><p><strong>Methods: </strong>We appraised the study's infection definition and surveillance period, statistical precision, interpretation of nonsignificant findings, and reporting of the institutional infection-prevention bundle.</p><p><strong>Results: </strong>Defining the outcome as periprosthetic joint infection within one year may capture events less plausibly attributable to intraoperative contamination. Reporting infections separately at 30 and 90 days would strengthen temporal and causal interpretation. The small number of events and wide confidence interval do not establish equivalence or non-inferiority in the absence of a prespecified margin and adequate statistical power. In addition, incomplete reporting of antimicrobial prophylaxis, decolonisation, skin preparation, perioperative glucose control, and operating-theatre conditions limits external validity.</p><p><strong>Conclusion: </strong>The findings are best interpreted as showing no detected increase in infection risk under a single institution's protocol rather than demonstrating the safety of intraoperative smartphone use. Future multicentre, protocolised non-inferiority studies should use a prespecified margin, adequately powered samples, standardised 90-day surveillance, and transparent reporting of co-interventions.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984000","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":"5-Factor Modified Frailty Index predicts 30-day complications after amputation for open lower-extremity fracture: an American College of Surgeons Trauma Quality Improvement Program database study.","authors":"Tsunagu Ichikawa, Maxwell Ruffner, Jared Sasaki, Jackson Bright, Ambika Singh, Victor Koltenyuk, Ethan Rich, Jack Weick","doi":"10.1007/s00590-026-04958-w","DOIUrl":"10.1007/s00590-026-04958-w","url":null,"abstract":"<p><strong>Purpose: </strong>Open lower-extremity fractures are high-energy injuries, with severe cases necessitating amputation. While frailty predicts adverse surgical outcomes, its role in postoperative risk among patients undergoing amputation for open lower-extremity fractures has not been defined. This study aimed to determine whether frailty, measured by the 5-Item Modified Frailty Index (mFI-5), predicts 30-day postoperative complications following surgical amputation for open lower-extremity fractures.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program database (2017-2021). Adults (≥ 18 years) with open lower-extremity fractures undergoing surgical amputation were identified using ICD-10 codes. Frailty was assessed using the mFI-5 (score range 0-5). The primary outcome was surgical site infection; secondary outcomes included cardiopulmonary complications, thromboembolic events, pressure ulcer development, and ICU admission. Multivariable logistic regression adjusted for age, sex, Injury Severity Score (ISS), insurance status, Gustilo-Anderson fracture type, smoking status, and vascular injury determined the association between mFI-5 and 30-day complications.</p><p><strong>Results: </strong>Among 1122 patients (mean age 46.7 years, 78.5% male), the mean mFI-5 score was 0.46 (SD 0.81) and mean ISS was 18.55 (SD 10.95). After adjustment, each one-point increase in mFI-5 was independently associated with significantly increased odds of surgical site infection (OR 1.36), cerebrovascular accident (OR 2.93), reintubation (OR 2.17), ICU admission (OR 1.56), and pressure ulcer development (OR 1.68).</p><p><strong>Conclusion: </strong>The mFI-5 independently predicts major 30-day postoperative complications following amputation for open lower-extremity fractures, including cerebrovascular, respiratory, and wound-related complications. Routine mFI-5 screening may enhance preoperative risk stratification, inform perioperative optimization, and facilitate shared decision-making in this vulnerable population.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984033","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":"The use of the Neviaser portal for antegrade intramedullary nailing in humerus fractures: a scoping review.","authors":"Brandon Lim, Gennie Lim, Junren Zhang","doi":"10.1007/s00590-026-04957-x","DOIUrl":"10.1007/s00590-026-04957-x","url":null,"abstract":"<p><strong>Purpose: </strong>Proximal humerus and humeral shaft fractures are common orthopaedic injuries that can be managed using antegrade intramedullary nailing. The Neviaser portal allows a more medial start point at the apex of the humeral head. The published literature on humeral intramedullary nailing through the Neviaser portal is limited and heterogeneous. This scoping review aims to map the existing literature on the use of the Neviaser portal for antegrade intramedullary nailing of humeral fractures, summarise reported indications, surgical techniques, radiographic and functional outcomes, complications, and identify gaps in the current evidence.</p><p><strong>Methods: </strong>Five electronic databases (PubMed, Embase, Scopus, Web of Science, the Cochrane Library) and two grey-literature sources (Google Scholar, ClinicalTrials.gov) were searched. This scoping review was conducted according to the Arksey and O'Malley framework and Joanna Briggs Institute (JBI) guidelines, with reporting in accordance with PRISMA-ScR recommendations.</p><p><strong>Results: </strong>Ten studies were included. Across the clinical studies, 103 patients underwent nailing through the Neviaser portal, although approach-specific outcomes were reported for fewer patients. Indications for its use included both anatomical factors, such as distorted shoulder anatomy or increased soft tissue bulk, and fracture-related factors, including varus deformity and posterior tilt of the humeral head. One comparative study reported statistically significant differences in functional outcomes, while a second descriptively reported shorter operative time and lower radiation exposure. Both studies were small, non-randomised, and conducted at single centres. Cadaveric studies showed that the Neviaser portal traverses the muscular portion of the supraspinatus while maintaining safe distances from adjacent neurovascular structures, supporting its anatomical feasibility.</p><p><strong>Conclusion: </strong>Evidence for the Neviaser portal in antegrade intramedullary nailing of humeral fractures remains limited and heterogeneous. Although the available literature supports its anatomical feasibility and potential technical advantages, further high-quality comparative studies are required to define its clinical role.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984079","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":"Impact of operative timing for proximal humerus fracture dislocations on development of neurologic injury.","authors":"Alex Demers, Maria Bozoghlian, Natalie Glass, Brendan Patterson, James Nepola, Matthew Hogue, Michael Willey, Matthew Karam, J Lawrence Marsh, Joseph Galvin","doi":"10.1007/s00590-026-04956-y","DOIUrl":"10.1007/s00590-026-04956-y","url":null,"abstract":"<p><strong>Purpose: </strong>Operative management of proximal humerus fractures with glenohumeral dislocation is often delayed until a shoulder specialist is available. This study aims to assess whether time from presentation to operative intervention impacts incidence of neurologic injury in the preoperative waiting period.</p><p><strong>Methods: </strong>Retrospective review was performed for patients undergoing operative management of a proximal humerus fracture dislocation at a level 1 trauma center. Patient charts were reviewed for patient factors, injury characteristics, neurologic status, and postoperative complications. Statistical analysis comparing patients undergoing operative intervention ≤ 5 and > 5 days from injury was performed (α ≤ 0.05).</p><p><strong>Results: </strong>Of 52 proximal humerus fracture dislocations, 14% had a neurologic deficit at presentation, and 1.9% had a change in neurologic status prior to operative intervention. 32 injuries (61.5%) underwent operative intervention ≤ 5 days from presentation and 20 (38.5%) > 5 days. There was no difference in neurologic deficit at time of presentation (18.8% vs. 10.0%, p =.077), incidence of preoperative neurologic exam change (0% vs. 5.0%, p =.38), or residual neurologic deficit at final follow-up (9.4% vs. 5.0%, p = 1.0) for the ≤ 5 or > 5 day cohorts, respectively.</p><p><strong>Conclusion: </strong>Through this exploratory retrospective study, no differences were identified for rates of neurologic injury development in the preoperative waiting period between patients undergoing operative intervention ≤ 5 days or > 5 days from presentation for proximal humerus fractures with glenohumeral dislocation, however, this is limited by only 1 patient experiencing a preoperative neurologic change in the > 5 days group. Given the rarity of neurologic injury in the preoperative waiting period and low power of this study, future larger prospective studies are needed to better define the impact of waiting for operative intervention for these injuries.</p><p><strong>Level of evidence: </strong>Level IV Case Series.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957097","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":"Mid-term outcomes after corticosteroid injection for adhesive capsulitis in patients with type-2 diabetes: a retrospective cohort study.","authors":"Eve R Glenn, Alexander R Zhu, James H Padley, Henry M Fox, Edward G McFarland","doi":"10.1007/s00590-026-04953-1","DOIUrl":"10.1007/s00590-026-04953-1","url":null,"abstract":"<p><strong>Aims: </strong>The mid-term clinical course after intra-articular corticosteroid injection for adhesive capsulitis (\"frozen shoulder\") in patients with type-2 diabetes mellitus (T2DM) remains unclear. Therefore, we evaluated coded shoulder-related outcomes and selected coded complications after such injections in patients with T2DM.</p><p><strong>Methods: </strong>This retrospective TriNetX Research Network study identified patients with T2DM and first-time adhesive capsulitis (2004-2024). Patients receiving a coded intra-articular corticosteroid injection within 6 months after diagnosis were compared with patients without a coded injection during that period (3,820 vs. 55,234). After propensity matching, 3,819 patients remained per group. Outcomes from 6 to 12 months after diagnosis included subsequent shoulder procedures, infection, pain, stiffness, and neurologic complications (P<.05).</p><p><strong>Results: </strong>The injection cohort had a higher incidence of new shoulder pain within 6-12 months after diagnosis (11%) compared with the no-injection cohort (5%) (relative risk [RR] 2.4, P<.0001). The incidence of subsequent arthrocentesis, aspiration, or injection procedures was also higher in the injection cohort (12%) than in the no-injection cohort (5%) (RR 2.4, P<.0001). The injection cohort had a higher incidence of shoulder arthroscopy (2%) than the no-injection cohort (1%) (RR 2.2, P=.0001). Despite these higher intervention rates, no differences were observed in coded infection rates, persistent shoulder stiffness, or neurologic complications.</p><p><strong>Conclusion: </strong>In patients with T2DM and adhesive capsulitis, receipt of a coded intra-articular corticosteroid injection within 6 months after diagnosis was associated with higher incidence of subsequent shoulder procedures and persistent joint pain at mid-term follow-up. These findings may reflect confounding by indication and a more complex disease course among patients selected for injection rather than a direct adverse effect of corticosteroid therapy. Tailored treatment strategies for adhesive capsulitis in patients with T2DM should account for distinct metabolic and inflammatory factors that may influence treatment response and recovery.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957092","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":"Ultrasound and radiographic outcomes of the Coxaflex brace in the treatment of developmental dysplasia of the hip (DDH): a multicentre prospective study.","authors":"Maria Rizzo, Michela Saracco, Clara De Negri, Valerio Verdoliva, Francesco Maria Lotito, Antonio Colella, Maria Paola Miolla, Daniela Dibello, Massimo Mariconda","doi":"10.1007/s00590-026-04942-4","DOIUrl":"10.1007/s00590-026-04942-4","url":null,"abstract":"<p><strong>Purpose: </strong>Early diagnosis is essential for the treatment of developmental dysplasia of the hip (DDH), and the use of abduction bracing is considered the gold standard for patients < 6 months of age. The aim of this study is to report an analysis of the results of using the Coxaflex abduction brace.</p><p><strong>Methods: </strong>This multicentre prospective study included 44 hips in infants younger than 6 months with unilateral or bilateral reducible (Barlow-positive) developmental dysplasia of the hip, treated with the Coxaflex brace. DDH was diagnosed by clinical examination and ultrasound during outpatient screening. Serial ultrasound examinations were performed throughout treatment, while pelvic radiographs were obtained at the end of treatment to assess the acetabular index (AI) and the appearance of the proximal femoral ossification nucleus.</p><p><strong>Results: </strong>The mean age at the start of treatment was 46 days (range, 4-150 days). The first follow-up (T1) was performed at 42 ± 13 days of treatment, a second follow-up (T2) at 91 ± 21 days, and a third follow-up (T3) at 134 ± 22 days. Ultrasound examinations were performed at each follow-up, which revealed a mean α angle of 47°±4° at the start of treatment. At the T1 follow-up, the mean α angle was 57°±7°, while on T2 and T3 they measured 63°±5° and 64°±5°, respectively. The angular increase on T1 and T2 was statistically significant (p < 0.001). The X-ray examination was performed at an average of 162 ± 40 days and showed an AI of 23°±5° (range 14°-38°). Treatment was successful in all 44 hips. Three hips showed residual acetabular dysplasia at the time of ultrasonographic normalization and required prolonged brace treatment; all achieved radiographic normalization during follow-up. No patient required surgical treatment or conversion to another orthosis.</p><p><strong>Conclusions: </strong>The Coxaflex brace appears to be an effective and well-tolerated treatment option for infants younger than 6 months with reducible (Barlow-positive) DDH. Since fixed or irreducible hip dislocations were not included in this study, these findings should not be generalized to those patients.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931879","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":"Perioperative shingles diagnosis does not influence prosthetic joint infection rates after shoulder arthroplasty.","authors":"Erik R Nakken, Alex Mamonov, Daniel G Whitney, William R Aibinder","doi":"10.1007/s00590-026-04954-0","DOIUrl":"10.1007/s00590-026-04954-0","url":null,"abstract":"<p><strong>Purpose: </strong>Shoulder arthroplasty (SA) utilization has increased substantially, with a corresponding rise in revision procedures, many driven by periprosthetic joint infection (PJI). Herpes zoster (HZ), or shingles, is increasingly prevalent among older and immunocompromised patients and shares overlapping risk factors with PJI. However, the association between shingles and postoperative complications following SA is unknown. This study evaluated the relationship between peri-operative shingles and postoperative complications after SA.</p><p><strong>Methods: </strong>Patient-level claims from adults ≥ 18 years undergoing SA between 2016 and 2022 from a 20% Medicare fee-for-service sample and the IBM^® MarketScan^® Commercial Database were retrospectively collected. Shingles diagnoses from one year preoperatively through one year postoperatively were identified. For postoperative shingles, the diagnosis date was required to precede the earliest censoring event (outcome occurrence, loss to follow-up, end of follow-up) to maintain appropriate temporality of events. Outcomes within one year included revision arthroplasty, irrigation and debridement (I&D), implant removal, or shoulder PJI. Incidence rates (IRs) per 100 person-years and incidence rate ratios (IRRs) were calculated for a composite primary outcome. Associations between shingles and outcomes were evaluated using three Cox regression approaches with covariate adjustment.</p><p><strong>Results: </strong>Among 26,543 patients, 1.4% had shingles preoperatively and 1.0% developed shingles on or after surgery. The IR of the primary outcome was lower in patients with (IR 3.78; 95% CI 2.20-5.36) than without shingles (IR 5.06; 95% CI 4.77-5.35), but without statistical significance (IRR 0.75; 95% CI 0.49-1.14). No analytic approach showed a significant association, and no effect modification was observed.</p><p><strong>Conclusions: </strong>Shingles diagnosed within one year before or after shoulder arthroplasty was not associated with increased risk of revision surgery, I&D, implant removal, or PJI within one year postoperatively.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921572","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":"Smart crutch tips^TM real-time feedback improves adherence to partial weight-bearing protocols following lower extremity fracture surgery: a pilot study.","authors":"Michael Coons, Fiona Cherry, Sophia Miller, Nina Fisher, Kenneth Egol","doi":"10.1007/s00590-026-04879-8","DOIUrl":"10.1007/s00590-026-04879-8","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effectiveness of Smart Crutch Tips™ in promoting adherence to prescribed early partial weight-bearing (PWB) protocols and to assess patient experience with real-time weight-bearing feedback during home rehabilitation.</p><p><strong>Methods: </strong>Twenty patients with lower extremity fractures prescribed partial weight-bearing (PWB) were randomized into two groups utilizing real-time feedback crutch tips (RFC). The Intervention group (n = 10) used Smart Crutch Tips™ (ComeBack Mobility Inc., Kiev, Ukraine), which provided real-time feedback on weight-bearing compliance. The Control group (n = 10) also used crutches equipped with Smart Crutch Tips™, but notifications were disabled, allowing passive data collection without patient feedback. Weight-bearing compliance was defined as the percentage of steps within ± 10% of the prescribed target. Secondary outcomes included patient satisfaction and device usability assessed using the System Usability Scale (SUS) throughout the home rehabilitation period.</p><p><strong>Results: </strong>The Intervention group demonstrated significantly greater PWB compliance compared with the Control group (73.6% vs. 21.1%, p < 0.01). The Intervention group reported a mean SUS score of 84.25, indicating excellent usability. No device-related complications or adverse events were observed. Patient satisfaction, assessed through video interviews, was high, with participants in the Intervention group expressing a strong willingness to recommend the device to others with similar injuries and rating it 10 out of 10.</p><p><strong>Conclusion: </strong>Smart Crutch Tips™ significantly improved adherence to prescribed partial weight-bearing protocols following lower extremity fracture surgery. The RFC device demonstrated high usability, excellent patient satisfaction, and no device-related complications during home rehabilitation throughout the study period.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914345","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}