European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Flap coverage within 8 days does not increase fracture-related infection risk: results of a protocol implementation in a developing country.","authors":"Álvaro I Zamorano, Matías A Vaccia, Carlos F Albarrán, Rodrigo I Parra, Tomás Turner, Ignacio A Rivera, Tomás Errázuriz, Andrés S A Oyarzún, Osvaldo A Garrido, Pablo F Suárez, Pierluca Zecchetto, Luis A Bahamonde","doi":"10.1007/s00590-025-04225-4","DOIUrl":"https://doi.org/10.1007/s00590-025-04225-4","url":null,"abstract":"<p><strong>Introduction: </strong>Open tibia fractures that require a soft tissue flap for adequate coverage (Gustilo- Anderson IIIB) are a significant challenge for trauma units. The incidence of fracture-related infection (FRI) has been reported to range between 10% and 52%. Early antibiotic therapy, followed by surgical debridement and early soft tissue coverage, is considered a safe and effective treatment. Typically, the gold standard is the \"fix and flap\" approach. However, local circumstances can impact the feasibility of early flap coverage. This study aims to determine whether there is a safe window for soft tissue coverage when an immediate ortho-plastic approach is not available.</p><p><strong>Materials and methods: </strong>In this retrospective analysis of a prospective cohort of 803 patients who sustained a tibia fracture and were treated in a level I trauma centre in a developing country, we describe a local protocol of management. Of all the patients, 61 met the inclusion criteria and were followed for at least 12 months after flap coverage. The primary outcome was the development of FRI.</p><p><strong>Results: </strong>Patients who underwent flap surgery within 8 days of the fracture, following the local protocol, had a 12.5% infection rate.</p><p><strong>Conclusions: </strong>Utilizing a standardized management protocol followed by soft tissue flap coverage performed within 8 days is safe and effective in reducing the risk of developing FRI in open tibia fractures GA IIIB.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"121"},"PeriodicalIF":1.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651777","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":"Surgical treatment of acetabular fractures: a comparative cohort study comparing orthogonal double plating to suprapectineal quadrilateral surface (QLS) plate osteosynthesis.","authors":"Felix Kordes, Emre Yilmaz, Matthias Königshausen, Thomas A Schildhauer, Martin F Hoffmann","doi":"10.1007/s00590-025-04251-2","DOIUrl":"https://doi.org/10.1007/s00590-025-04251-2","url":null,"abstract":"<p><strong>Background: </strong>Acetabular fractures often require stabilization. Fractures involving the quadrilateral plate (QP) remain challenging due to complex anatomy and minimal bone stock. Treatment options include orthogonal double plate fixation or anatomically preformed suprapectineal quadrilateral surface (QLS) plates. The purpose of this study was to evaluate a series of buttress plating of acetabular fractures (OTA/AO 62) comparing orthogonal double plate and QLS plate osteosynthesis regarding surgical procedure, complications, and outcome.</p><p><strong>Methods: </strong>At one level I trauma center, 109 patients underwent internal fixation either by orthogonal double plate osteosynthesis or by preshaped QLS plate. Surgical approach was performed via the first and third windows of the ilioinguinal approach. Reduction quality and osteosynthesis material were checked using CT. Groups were retrospectively evaluated regarding demographic factors, classification, and trauma mechanism. Clinical outcome was assessed utilizing the modified Harris Hip Score (mHHS). Follow-up was 25 months.</p><p><strong>Results: </strong>Fractures were stabilized using orthogonal double plate osteosynthesis (56%) and QLS plates (44%). Following OTA/AO classification, 16 type A (14.7%), 69 type B (63.3%), and 24 type C (22.0%) fractures underwent treatment. Groups did not differ regarding fracture types, age, or BMI. The majority was male (75%). High-energy trauma accounted for 39.4%. Surgery averaged 187.43 min for orthogonal double plates and 163.13 min for the QLS plate (p = 0.012). No differences were found regarding hospital stay or complications. Neither postoperative osteoarthritis nor mHHS was related to plate type. Patients with high-energy trauma had better mHHS outcomes. Preexisting osteoarthritis resulted in reduced outcome.</p><p><strong>Discussion: </strong>Acetabular fracture stabilization is challenging due to extensive approaches, minimal bone stock of the QP, and difficult plate placement. Our analysis confirms that orthogonal double plate fixation and QLS plates provide secure stabilization for acetabular fractures. According to our findings, utilization of the QLS plate may result in reduced OR time due to its anatomically tailored shape.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"118"},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651778","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":"Variables associated with loss of reduction after plate fixation of pubic symphysis injuries.","authors":"Benjamin Pesante, Tom Pollard, Keenan Onodera, Nicholas Tucker, Raveesh Richard, Cyril Mauffrey, Joshua Parry","doi":"10.1007/s00590-025-04240-5","DOIUrl":"https://doi.org/10.1007/s00590-025-04240-5","url":null,"abstract":"<p><strong>Purpose: </strong>To determine what variables are associated with loss of reduction of pubic symphysis injuries after plate fixation.</p><p><strong>Methods: </strong>A retrospective review of patients treated with plate fixation of symphysis injuries was performed. Symphysis diastasis on injury, postoperative, and follow-up radiographs was measured. Associations between patient, fracture, and fixation characteristics and a loss of reduction ≥10 mm were analyzed.</p><p><strong>Results: </strong>Fifty patients were included. The median age was 38.5 years (IQR 27.7 to 48.5), and a majority were male (80.0%, n=40). A loss of reduction ≥10 mm occurred in 18% (n=9), and revision fixation occurred in 6.0% (n=3). On univariate analysis, patients with a loss of reduction, compared to patients without, had a greater BMI (32.2 vs. 26.5, p=0.001), increased symphysis diastasis on injury radiographs (46.0 vs. 24.0 mm, p=0.0001), and more anterior pelvic space infections (55.6% vs. 14.6%, p=0.01). There were no associations between loss of reduction and age, AO/OTA classification, Young Burgess classification, 4-screw vs. >4-screw plate fixation, number of posterior screws, or residual post-fixation symphyseal diastasis (p>0.05). On multivariate analysis, initial symphysis diastasis was the only variable associated with loss of reduction ≥10 mm (p=0.03). A symphysis diastasis of ≥35.0 mm was found to maximize the sensitivity (88.9%) and specificity (75.7%) for identifying patients who had a loss of reduction.</p><p><strong>Conclusions: </strong>The severity of initial symphysis diastasis was associated with loss of reduction. A threshold of 35.0 mm of symphysis diastasis maximized the sensitivity and specificity for identifying patients who experienced a loss of reduction.</p><p><strong>Level of evidence: </strong>Retrospective comparative study, Level III evidence.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"120"},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651780","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":"Total knee arthroplasty after prior high tibial osteotomy results in comparable survival and clinical outcomes but significantly higher complication rates compared to primary total knee arthroplasty: a systematic review and meta-analysis of 550,000 patients.","authors":"Ryan Wai Keong Loke, Barry Wei Loong Tan, Erel Yun En Kane Tan, James H P Hui","doi":"10.1007/s00590-025-04237-0","DOIUrl":"https://doi.org/10.1007/s00590-025-04237-0","url":null,"abstract":"<p><strong>Background: </strong>High Tibial Osteotomy (HTO) is an effective surgical option in managing medial compartment knee osteoarthritis in the relatively younger population group but most will eventually require conversion to Total Knee Arthroplasty (TKA). TKA post-HTO is considered more complex than a primary TKA, given the numerous factors that increase the difficulty of the surgery-skin and soft tissue scarring, patella baja, limited knee motion, anatomical deformity or bony distortion of the proximal tibial metaphysis after HTO.</p><p><strong>Methods: </strong>A random-effects meta-analysis of comparative studies between TKA post-HTO and primary TKA was performed. We searched MEDLINE, EMBASE, Cochrane Library and SCOPUS from inception to August 1, 2024. Survivorship outcomes in terms of revision rates were analyzed. Where possible, further subgrouping to assess the impact of different techniques was performed. Secondarily, associated complications, surgical duration and clinical outcomes (Hospital for Special Surgery (HSS) Scores and Knee Society Scores (KSS) (Knee & Function)) were pooled.</p><p><strong>Results: </strong>At short-term follow-up, pooled revision rate for TKA post-HTO was 2.9% (95%CI 1.7-5.1) while that for primary TKA was 1.9% (95%CI 1.2-2.9). At mid-term follow-up, the pooled revision rate was 4.8% (95%CI 2.8-8.2) compared to 3.0% (95%CI 1.9-4.8) in primary TKA. At long-term follow-up, the pooled revision rate for TKA post-HTO was 7.2% (95%CI 1.3-30.9), while that of primary TKA was 4.1% (95%CI 1.6-10.2). No significant differences were noted between both groups at each follow-up. Pooled complication rate for TKA post-HTO was 15.8% (95%CI 12.3-20.0%), while that for primary TKA group was 6.1% (95%CI3.5-10.4). TKA post-HTO had significantly greater complication rates than in primary TKA (WMD: 2.6, 95%CI 2.2-3.1, p < 0.01). Pooled mean postoperative HSS scores were 83.5 (95% CI 80.1-86.8) in the TKA post-HTO group, compared to 86.1 (95% CI 82.3-90.0) in the primary TKA group. Pooled mean postoperative KSS (Knee) scores were 85.9 (95% CI 83.6-88.2) in the TKA post-HTO group, and 88.1 (95% CI 84.4-91.7) in the primary TKA group. Pooled mean postoperative KSS (Function) scores were 77.1 (95% CI 72.1-82.1) in the TKA post-HTO group and 78.4 (95% CI 74.5-82.5) in the primary TKA group. No significant differences were noted between both groups.</p><p><strong>Conclusion: </strong>TKA post-HTO has comparable survival but significantly higher complication rates than primary TKA.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"119"},"PeriodicalIF":1.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651779","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":"Functional outcomes of patients presenting with traumatic hip dislocations at a tertiary care center: a descriptive observational study.","authors":"Nitesh Raj Pandey, Rajan Bhusal, Ansul Rajbhandari, Kiran Pradhan Shrestha, Rajendra Aryal, Ashok Kumar Banskota, Bibek Banskota","doi":"10.1007/s00590-025-04243-2","DOIUrl":"https://doi.org/10.1007/s00590-025-04243-2","url":null,"abstract":"<p><strong>Introduction: </strong>Traumatic hip dislocations (THD) often result from high-energy trauma and are frequently associated with fractures of the femoral head, shaft, or acetabulum. Effective management, including timely hip relocation, is essential for favorable outcomes. However, limited literature exists on the functional outcomes of THD, especially in resource-limited settings like Nepal. This study aimed to evaluate the functional outcomes of patients with complex THDs treated at a tertiary care centre in Nepal.</p><p><strong>Methods: </strong>This descriptive observational study included 80 patients with complex THDs treated between October 2012 and July 2023. Eligible patients had follow-ups ranging from 6 months to over five years. Data on patient demographics, injury characteristics, treatment details, and functional outcomes were collected. The Harris Hip Score (HHS) was used to assess functional outcomes, with scores categorized as \"good\" (≥ 80) or \"poor\" (< 80). Statistical analysis used logistic regression to identify factors associated with better functional outcomes.</p><p><strong>Results: </strong>In this study of 80 patients with traumatic hip dislocations (THD), the majority were male (82.5%) and aged under 40 years (53.8%), with road traffic accidents being the predominant cause (73.8%). Most injuries involved posterior dislocations (87.5%), and 76.3% had associated acetabular fractures. Good functional outcomes, defined as a Harris Hip Score (HHS) ≥ 80, were achieved in 83.8% of cases, while 16.3% had poor outcomes. Logistic regression analysis revealed several significant factors associated with better outcomes: a hospital stays of less than three weeks (OR 4.67, 95% CI 1.08-20.21, p = 0.04), anterior dislocation (OR 12.17, 95% CI 1.12-131.70, p = 0.04), and follow-up duration of less than five years (OR 0.07, 95% CI 0.01-0.43, p = 0.00). However, acetabular fractures had a significantly lower likelihood of good outcomes (OR 0.28, 95% CI 0.08-0.96, p = 0.04).</p><p><strong>Conclusion: </strong>Timely management of traumatic hip dislocations, such as early discharge and treatment of associated fractures, is vital for achieving favorable functional outcomes, as reflected in the Harris Hip Score. These findings offer valuable insights for optimizing care in resource-limited settings and highlight the necessity for long-term follow-up, especially for patients with more complex injuries.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"116"},"PeriodicalIF":1.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634934","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":"Should the lumbar or femoral neck young adult mean percentage be measured in patients with distal radius fractures? A case-control study.","authors":"Shunpei Hama, Haato Kimura, Kiyohito Takamatsu, Hiroaki Nakamura","doi":"10.1007/s00590-025-04248-x","DOIUrl":"https://doi.org/10.1007/s00590-025-04248-x","url":null,"abstract":"<p><strong>Background: </strong>In the 2015 guidelines for the prevention and treatment of osteoporosis in Japan, the young adult mean percentage (%YAM) of the lumbar spine or femoral neck is required to diagnose osteoporosis in patients with distal radius fracture (DRF). When the %YAM of multiple locations is measured, the lower %YAM is adopted for the diagnosis. If the area with a lower %YAM is known, bone mineral densitometry tests may only need to be performed at one site. This study aimed to compare the lumbar and femoral neck %YAMs of patients with DRFs to find out the lower %YAM site.</p><p><strong>Methods: </strong>We retrospectively compared the %YAM of the lumbar and femoral neck of patients with DRFs who underwent open reduction and internal fixation (ORIF) between April 2018 and March 2023. We also measured the lumbar and femoral neck %YAM of patients with hip fractures (HFs) treated by ORIF, bipolar hemiarthroplasty, or total hip arthroplasty.</p><p><strong>Results: </strong>The %YAM of the femoral neck was significantly lower than that of the lumbar region in the DRF group. In the HF group, the lumbar %YAM was significantly higher than that of the femoral neck.</p><p><strong>Conclusions: </strong>In patients with DRFs, the %YAM of the femoral neck was significantly lower than the lumbar %YAM. The lumbar %YAM appears to be less reliable than the %YAM of the femoral neck because of the lumbar degenerative changes. Therefore, we believe that the %YAM of the femoral neck should be measured first if osteoporosis is suspected in patients with DRF.</p><p><strong>Level of evidence iii: </strong>Case-control study.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"117"},"PeriodicalIF":1.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634935","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":"Exploring the relationship between frailty and nonunion fractures in upper extremity injuries: insights from the national inpatient sample.","authors":"Cyrus Luczkow, Victor Koltenyuk, Ethan Parisier, Audrey Huang, Omri Ayalon","doi":"10.1007/s00590-025-04247-y","DOIUrl":"10.1007/s00590-025-04247-y","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty, a physiological decline in functional capacity, may influence nonunion risk. This study aimed to investigate the association between frailty, as measured by the modified Frailty Index-5 (mFI-5), and the likelihood of nonunion fractures of the upper extremity.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the national inpatient sample (NIS) from 2015 to 2019. Patients aged 18 and older with upper extremity fractures, identified by ICD-10-CM codes, were included. Patients were categorized into routine healing and nonunion groups. Frailty was assessed using the mFI-5, classifying patients as robust, prefrail, frail, or severely frail. Multivariate logistic regression, controlling for age, sex, and Injury Severity Score (ISS), was performed to determine the association between frailty and nonunion.</p><p><strong>Results: </strong>The study included 21,618 patients, with 3782 presenting with nonunion fractures. The median age was 69 years, and 60.5% were female. The most common fracture types in the routine healing group were forearm (40.1%), clavicle (18.4%), and humerus (16.9%), while in the nonunion group, humerus (30.4%) and scapula (32.1%) were most common. Multivariate logistic regression showed that frail and severely frail patients had a decreased risk of nonunion (OR 0.751 and 0.705, respectively, p < 0.001). Each unit increase in mFI-5 score was associated with a decreased risk of nonunion (OR 0.868, p < 0.001). Sub-analysis revealed a decreased risk of nonunion with increasing frailty for humerus, clavicle, scapula, and phalanx fractures, but no significant association for wrist, forearm, or metacarpal fractures.</p><p><strong>Conclusion: </strong>Contrary to expectations, increasing frailty, as measured by the mFI-5, was associated with a decreased risk of nonunion fractures in the upper extremity. This paradoxical finding may be due to closer medical supervision and improved treatment compliance in frail patients. Further prospective studies are needed to explore the complex interplay between frailty, treatment adherence, and fracture healing.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"115"},"PeriodicalIF":1.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630930","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":"Will patient data collection methods change after a pandemic? A systematic review of the strengths, challenges and opportunities of this new scenario.","authors":"Rafael Dos Reis Guilherme, William Dias Belangero, Robinson Esteves Santos Pires, Vincenzo Giordano","doi":"10.1007/s00590-025-04223-6","DOIUrl":"https://doi.org/10.1007/s00590-025-04223-6","url":null,"abstract":"<p><strong>Purpose: </strong>The evolution of survey methods in clinical research has been significantly shaped by technological advances and the global upheaval caused by the Coronavirus Disease 2019 (Covid-19) pandemic. The use of traditional face-to-face interviews has been augmented, and in some cases replaced, by a range of remote interviewing techniques. This shift requires a comprehensive examination of the unique advantages, limitations, and future applications of these methods.</p><p><strong>Methods: </strong>This study employs a systematic literature review, guided by PRISMA and Pati's criteria, to examine the nuances of face-to-face, remote, and mixed method interviewing.</p><p><strong>Results: </strong>From an initial corpus of 2802 articles, 2632 were deemed relevant after applying specific inclusion and exclusion criteria. The selection was then refined to 44 articles, which were then subjected to careful analysis. The results are presented as Social Visual Analysis graphs to explicit the relationship between methodologies (each interview technique) and its characteristics.</p><p><strong>Conclusion: </strong>The findings reveal the unique advantages and challenges associated with each interview technique, underscoring the complexity of selecting the most appropriate data collection method for clinical research. In particular, remote interviews are praised for their convenience and high acceptance rates, although they occasionally exhibit lower data quality and potential biases. Mixed-media approaches are emerging as a versatile solution, combining the benefits of different methods to provide a more flexible and comprehensive data collection process.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"113"},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626647","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":"What imaging characteristics are suggestive of malignancy in patients with femoral neck fractures? A look at calcar impaction lesions.","authors":"Mayank Kumar, Deepak Menon, Karolina Mazur, Holly Clarke, Musaab Abdelrahim, Sandra Bonczeck, Peyman Bakhshayesh, Mohammad Al-Ashqar","doi":"10.1007/s00590-025-04218-3","DOIUrl":"https://doi.org/10.1007/s00590-025-04218-3","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral heads are often sent for histological analysis when malignancy is suspected following a neck of femur (NOF) fracture. Anecdotally, a commonly seen lytic appearance on plain radiographs prompts suspicion of malignancy but does not correlate with histology results.</p><p><strong>Aim: </strong>To evaluate the radiographic patterns of NOF fractures deemed suspicious for malignancy, and correlate those patterns with their subsequent histology results.</p><p><strong>Methods: </strong>We performed a retrospective study of all NOF fracture patients who had femoral head histopathological analysis (N =376), across five hospitals in Yorkshire, over three years (2017-2019). Included were patients whose radiographs were deemed suspicious for malignancy by their clinicians (N = 79). All radiographs were evaluated, and their patterns categorized. Chi-Square test was used to analyse the relationship between each radiographic pattern and histology outcome (benign vs malignant disease). A p - value < 0.05 was deemed statistically significant.</p><p><strong>Results: </strong>79 eligible patients were identified, comprising 51 females and 28 males, with a mean age of 77 years. Radiographic patterns most associated with malignancy were 'multiple sclerotic lesions' (9 patients, 7 malignant, p < 0.01), and 'single lytic central neck lesion' (8 patients, 6 malignant, p = 0.01). 26 patients had an eccentric lesion with lytic appearance in the superolateral aspect of the femoral head/neck, all of which were benign (p < 0.01).</p><p><strong>Conclusion: </strong>Being familiar with radiographic patterns of disease will help clinicians decide when to investigate a femoral head for malignancy. We identified a discrete pseudopathological pattern that commonly prompts clinicians to investigate for malignancy. We named this the 'calcar impaction lesion' as we posit that this 'lytic' appearance is due to mechanical impaction of osteoporotic bone during injury. Recognizing this pattern can save time and resources by avoiding unnecessary investigations.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"114"},"PeriodicalIF":1.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626643","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":"Posterior lumbar interbody fusion for degenerative spondylolisthesis; slippage reduction can be a risk factor for adjacent segment disease.","authors":"Sosuke Saito, Kazuyoshi Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masashi Oshima, Hiroshi Uei, Kentaro Sato, Satoshi Suzuki, Tomohiro Furuya, Yuya Miyanaga","doi":"10.1007/s00590-025-04207-6","DOIUrl":"https://doi.org/10.1007/s00590-025-04207-6","url":null,"abstract":"<p><strong>Purpose: </strong>Several risk factors for adjacent segment disease (ASD) after posterior lumbar interbody fusion (PLIF) have been reported. High pelvic incidence (PI) has been identified as risk factors for L4 anterior slip in cases of lumbar degenerative spondylolisthesis. Correcting the slip with L4-L5 fixation merely restores the lumbar alignment, but the PI itself remains unchanged. We hypothesized that the fused L4 vertebral body might continue to be subject to the slip-inducing force, even after fixation, and that slip correction might be a cause of ASD. The purpose of this study is to identify the risk factors for adjacent ASD following single-segment PLIF in patients with L4 spondylolisthesis, with a particular focus on the reduction of vertebral body slippage.</p><p><strong>Methods: </strong>Fifty-two patients who underwent posterior lumbar interbody fusion at the L4-L5 level for L4 degenerative spondylolisthesis were investigated. Patients were divided into two groups: the ASD group (n = 12) and the non-ASD group (n = 40). %Slip before surgery and at follow-up, Δ%Slip (Δ%Slip = %Slip before surgery-%Slip at follow-up), L4-L5 interbody height, and L4-L5 lordosis angle were evaluated.</p><p><strong>Results: </strong>Stepwise multivariate regression analysis revealed Δ%Slip to be a risk factor for ASD (odds ratio: 1.22, 95% confidence interval: 1.04-1.43, p = 0.015). In the receiver operating characteristic analysis, the cutoff value for Δ%Slip was 7.3% (sensitivity: 75.0%, specificity: 67.5%, and area under the curve = 0.725).</p><p><strong>Conclusions: </strong>Our findings suggest that the reduction of L4 slippage may contribute to the development of ASD in patients with L4 spondylolisthesis.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"35 1","pages":"110"},"PeriodicalIF":1.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617380","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}