European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Cauda equina syndrome: a structured approach for the higher orthopaedic examination.","authors":"Srinath Pammi, Praveen Rajan, Himaja Narapareddy","doi":"10.1007/s00590-026-04952-2","DOIUrl":"10.1007/s00590-026-04952-2","url":null,"abstract":"<p><strong>Purpose: </strong>To provide a focused, examination-oriented review of cauda equina syndrome (CES), covering definition and classification, clinical assessment, bladder dysfunction, emergency imaging and referral, surgical timing, and postoperative rehabilitation.</p><p><strong>Methods: </strong>MEDLINE/PubMed and relevant national guidance were reviewed and updated to 22 August 2026. Priority was given to UK guidance, systematic reviews and multicentre studies, including the current Getting It Right First Time (GIRFT) national suspected CES pathway, updated in March 2026.</p><p><strong>Results: </strong>CES is a clinical syndrome of sacral nerve-root dysfunction and should not be defined by an MRI appearance or by painless retention alone. The current UK pathway recommends emergency MRI at the presenting hospital as soon as possible and within four hours of the radiology request, without prior spinal-team approval. Post-void residual (PVR) measurement is an adjunct: a value of at least 200 mL increases suspicion, but a lower value does not exclude CES. Routine digital rectal examination solely to assess resting anal tone is not required. Imaging-confirmed compression requires immediate spinal referral. Incomplete CES should be decompressed as quickly as possible; CES with retention should be treated within 24h of MRI under the current pathway.</p><p><strong>Conclusion: </strong>For both the examination and clinical practice, the priorities are early recognition of sacral symptoms, rapid MRI, avoidance of false reassurance from a single bedside test, urgent senior-led decompression when compression is confirmed, and structured bladder, bowel, sexual and psychological rehabilitation.</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":"148914400","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 social determinants of health on post hospital care following orthopaedic polytrauma.","authors":"David Dallas-Orr, Jessica Valdez, Shannon Tse, Mark A Lee, Megan R Terle, Gillian L S Soles, Ellen P Fitzpatrick, Sean T Campbell, Barton L Wise, Augustine M Saiz","doi":"10.1007/s00590-026-04939-z","DOIUrl":"10.1007/s00590-026-04939-z","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether community socioeconomic distress, measured by the Area Deprivation Index (ADI), is associated with worse short-term clinical outcomes in orthopaedic polytrauma patients treated at an academic level I trauma center.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of polytrauma patients treated for orthopaedic injuries at an academic level I trauma center (2014-2019). State ADI scores were used to classify patients as residing in a distressed community (ADI > 8; DC) versus non-distressed community (NDC). Collected variables included demographics, injury characteristics including the Injury Severity Score (ISS), insurance status, and outcomes. Primary outcomes were malunion, nonunion, and unplanned return to the operating room; secondary outcomes included disposition at discharge and follow-up duration.</p><p><strong>Results: </strong>Among 348 patients, 193 (55.5%) resided in DC. Compared with NDC, a higher proportion of DC patients identified as Black or American Indian/Pacific Islander (p < 0.002), and DC patients more frequently had a prior smoking history (57.4%) and psychiatric illness (19.7%; both p < 0.001) and carried public insurance (p = 0.003). Mechanisms of injury differed (p = 0.045). Mean ISS was similar between DC and NDC (18.8 vs. 19.8; p = 0.435), and patients from DC were less likely to be discharged home (48.9 vs. 62.0%; p = 0.021). Rates of malunion, nonunion, and reoperation were similar between groups.</p><p><strong>Conclusions: </strong>Our findings indicate that orthopaedic polytrauma patients from distressed communities are disproportionately affected by factors that complicate recovery, including smoking history, psychiatric comorbidities, and insurance status. Despite these associations, ADI was not associated with short-term outcomes in our polytrauma patient population.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914384","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":"Surgical outcomes and complications of fixation strategies for distal tibial fractures: a systematic review and network meta-analysis.","authors":"Lei Zhang, Zhihui Fang, Wei Yu, Yue Xi","doi":"10.1007/s00590-026-04776-0","DOIUrl":"10.1007/s00590-026-04776-0","url":null,"abstract":"<p><strong>Background: </strong>Multiple fixation options exist for distal tibial fractures, but the optimal approach remains controversial. Common techniques includeopen reduction and internal fixation(ORIF), minimally invasive plate osteosynthesis (MIPO), external fixation combined with limited open reduction and internal fixation (EF + LORIF), intramedullary nailing (IMN), and retrograde tibial nailing (RTN).</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and the Cochrane Library were searched through March 19, 2026. Network meta-analysis (R v4.5.1) assessed operation time, fracture healing time, malunion, delayed union/nonunion, and infection, reporting MDs or RRs with 95% CIs.</p><p><strong>Results: </strong>Eleven randomized controlled trials and 18 cohort studies (2145 patients) were included. MIPO was associated with a longer operative time and a longer time to union than IMN-IP (MD = 8.23, 95% CI 0.44-16.01; and MD = 1.02, 95% CI 0.10-1.93, respectively). For malunion, ORIF had a lower risk than MIPO (RR = 0.30, 95% CI 0.11-0.82), whereas MIPO had a higher risk than EF + LORIF (RR = 3.26, 95% CI 1.08-9.80) and IMN-SP (RR = 4.03, 95% CI 1.30-12.48). ORIF, EF + LORIF, and IMN-SP also showed lower malunion risk than IMN-IP. No significant differences were observed for delayed union and nonunion. Infection risk was generally higher with ORIF and MIPO than with several comparators, particularly EF + LORIF and intramedullary nailing-based strategies.</p><p><strong>Conclusions: </strong>No single strategy was consistently superior. Operation time and impaired union ( delayed union and nonunion) did not differ significantly among techniques. MIPO may be associated with longer time to union than IMN-IP and higher malunion risk than EF + LORIF and IMN-SP. Infection risk appeared higher with ORIF and MIPO in network estimates, although several comparisons remained uncertain. Findings should be interpreted in light of imprecision and study-level heterogeneity.</p><p><strong>Protocol registration: </strong>INPLASY2025120055.</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":"148913341","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":"Quantitative assessment of pelvic reduction using a pretensioned external fixator in unstable pelvic injuries: a retrospective study.","authors":"Queipo-de-Llano Alfonso, Mariscal Lara Jorge, Leiva Gea Antonio, Delgado Rufino Francisco de Borja","doi":"10.1007/s00590-026-04906-8","DOIUrl":"10.1007/s00590-026-04906-8","url":null,"abstract":"<p><strong>Introduction: </strong>Conventional anterior external fixation provides effective stabilization in pelvic injuries but has limited ability to reduce and control posterior pelvic ring displacement, particularly in type C fractures. Although several anterior fixation systems capable of posterior compression have been described, many remain complex and impractical in emergency settings.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of a pretensioned pelvic external fixator (PPEF) as a reduction tool in unstable pelvic fractures across different clinical scenarios.</p><p><strong>Methods: </strong>A retrospective study was conducted including 28 patients treated with PPEF between 2012 and 2024. In 24 cases, the device was used as emergency stabilization, and in 4 cases as an adjunct or intraoperative reduction tool. Pelvic reduction was assessed using pre- and postoperative CT scans. Anterior and posterior diastasis, as well as vertical displacement, were measured. Radiological outcomes were classified using Matta/Tornetta criteria. Subgroup analyses were performed according to fracture type (A/B vs C), presence of sacral or pubic fractures, and bilateral involvement.</p><p><strong>Results: </strong>Posterior diastasis decreased from 2.54 ± 2.09 cm preoperatively to 0.30 ± 0.67 cm postoperatively. Anterior diastasis improved from 2.54 ± 3.00 cm to 0.35 ± 0.51 cm. Vertical displacement was reduced from 1.18 ± 0.95 cm to 0.36 ± 0.52 cm. Excellent or good radiological outcomes were achieved in 89.3% of cases. No significant differences were observed between fracture types or injury patterns. The complication rate was low, with pin site infection in 7.1% of cases (n = 2) and no observed re-displacement.</p><p><strong>Conclusion: </strong>The pretensioned pelvic external fixator is a simple and effective technique for achieving immediate radiological reduction in unstable pelvic injuries. It provides reliable correction of displacement, including in type C fractures, and may serve as a valuable tool in both emergency management and as an adjunct to definitive fixation, particularly in resource-limited settings.</p><p><strong>Level of evidence iv: </strong>Retrospective study.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888710","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":"Letter to the Editor regarding \"Skin keratin correlates with bone and tendon collagen quality: a proof-of-concept clinical study using FTIR spectroscopy in shoulder arthroplasty patients\".","authors":"Tahir Burak Sarıtaş","doi":"10.1007/s00590-026-04949-x","DOIUrl":"10.1007/s00590-026-04949-x","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the statistical robustness and translational interpretation of reported associations between skin keratin signals and bone and tendon collagen quality in a proof-of-concept Fourier-transform infrared spectroscopy study of eight patients undergoing shoulder arthroplasty.</p><p><strong>Methods: </strong>Correlation-specific denominators and unexplained asterisks in Table 2 were examined. Pearson coefficients and p values were recalculated from the rounded tabulated values using complete cases. Fisher 95% confidence intervals and Spearman rank-based sensitivity analyses were assessed; multiplicity and measurement reliability were also appraised.</p><p><strong>Results: </strong>If the asterisks indicate unavailable measurements, the skin keratin-bone collagen analysis includes seven complete pairs. Recalculation yields r = 0.719 and p = 0.068 rather than the reported r = 0.72 and p = 0.04. Skin keratin/lipid content versus bone mineralization yields r = 0.697 and p = 0.081 rather than p = 0.053, while bone versus tendon collagen yields r = 0.897 and p = 0.006 rather than p = 0.003. The skin-tendon Pearson correlation remains r = 0.76 and p = 0.03, but its approximate 95% confidence interval is 0.11-0.95; Spearman sensitivity analysis gives ρ = 0.55 and p = 0.16. Triplicate skin spectra were obtained, although within-subject repeatability was not reported.</p><p><strong>Conclusion: </strong>Skin spectroscopy remains hypothesis-generating and cannot yet be considered a validated surrogate or predictive tool for deep-tissue quality. Clarification of missing-data handling, analytic denominators, multiplicity, and influence analyses, followed by standardized repeatability assessment and external clinical validation, is warranted.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876142","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 on: \"Management of anterior shoulder instability in patients aged 40 and older: a systematic review\".","authors":"Harun Sağlıcak","doi":"10.1007/s00590-026-04947-z","DOIUrl":"10.1007/s00590-026-04947-z","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867726","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":"Clinical outcomes of contoured dorsal mini-fragment plate fixation versus tension band wiring for transverse articular patellar fractures: a prospective observational study.","authors":"Giuliano Lattanzi, Nicolò Ferullo, Andrea Panfighi, Luca Liverani, Antonio Pompilio Gigante, Raffaele Pascarella, Simone Cerbasi","doi":"10.1007/s00590-026-04944-2","DOIUrl":"10.1007/s00590-026-04944-2","url":null,"abstract":"<p><strong>Purpose: </strong>Articular patellar fractures (AO/OTA 34-C1/C2) are commonly treated with internal fixation. This non-randomized prospective observational study aimed to compare clinical and functional outcomes between two osteosynthesis techniques: contoured dorsal mini-fragment plate and tension band wiring.</p><p><strong>Methods: </strong>All patients who underwent surgical fixation for transverse articular patellar fractures between November 2023 and January 2025 were prospectively enrolled. Patients were divided into two groups: Group A, treated with a dorsal mini-fragment plate, and Group B, treated with tension band wiring. Demographic data, failure rate, hardware removal rate, and range of motion (ROM) at 1 year postoperatively were compared between groups. In addition, functional outcomes and quality of life were assessed at a minimum follow-up of 1 year using the Kujala Anterior Knee Pain Scale (AKPS) and the 12-Item Short Form Health Survey (SF-12).</p><p><strong>Results: </strong>A total of 54 patients were included (Group A: n = 24; Group B: n = 30). Compared with Group B, Group A showed a lower failure rate (8.3% vs. 16.7%, p = 0.44; OR 0.45) and a lower rate of hardware removal (4.5% vs. 24.0%, p = 0.11; OR 0.15), although these differences did not reach statistical significance. Functional outcomes were significantly better in Group A, with a greater median postoperative range of motion (105° vs. 100°, p = 0.011) and higher median Kujala scores (84 vs. 75, p = 0.005). Median SF-12 Physical Component Summary (PCS) scores were significantly higher in Group A (45.56 vs. 42.73, p = 0.016), whereas median Mental Component Summary (MCS) scores were comparable between groups (56.56 vs. 56.30, p = 0.788).</p><p><strong>Conclusion: </strong>Contoured dorsal mini-fragment plate fixation may be associated with better functional outcomes at 1-year follow-up than tension band wiring. Lower implant failure and hardware removal rates were observed, although these differences were not statistically significant. Given the observational design, these findings should be considered hypothesis-generating.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867741","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 on: \"Tibial tubercle involvement in tibial plateau fractures is associated with nonunion, reoperation, and flexion deficits\".","authors":"Burak Olcay Güler","doi":"10.1007/s00590-026-04945-1","DOIUrl":"10.1007/s00590-026-04945-1","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867751","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":"Re: efficacy of platelet-rich plasma versus hyaluronic acid in obese individuals with knee osteoarthritis.","authors":"Habib Ahmad, Ishtiaq Ahmad, Israr Khan, Abdus Salam Afridi","doi":"10.1007/s00590-026-04948-y","DOIUrl":"10.1007/s00590-026-04948-y","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867734","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":"Scapular spine and acromion stress fractures following reverse shoulder arthroplasty have a high rate of failure following operative treatment.","authors":"Michael Coons, Estelle Strangmark, Amelia Goldstein, Abhishek Ganta, Steven Rivero, Joseph Zuckerman, Kenneth Egol","doi":"10.1007/s00590-026-04885-w","DOIUrl":"10.1007/s00590-026-04885-w","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this case series is to investigate outcomes for repair of fractures of the scapular spine and acromial process following reverse total shoulder arthroplasty (RTSA).</p><p><strong>Methods: </strong>All adult patients who were treated operatively for a stress scapular spine or acromial fracture following a RTSA at a single center between 2013 and 2024 were identified. All patients underwent operative repair with plate and screw fixation with or without adjunctive bone grafting. Data collected included patient demographics, injury characteristics, fracture classification, surgical details, radiographic findings, and clinical outcomes, which were based on chart review of follow-up visits and revision surgeries.</p><p><strong>Results: </strong>Among 2006 RTSA procedures performed during the study period, 18 patients (0.9%) developed a scapular spine or acromial stress fracture, 16 (88.9%) of which required operative fixation. Mean follow-up after fixation was 23 months. The cohort included 11 women (68.8%) and 5 men (31.2%), with a mean age of 71.9 years. All fractures were attributed to an insufficiency mechanism. Bone graft or biologic augmentation was performed in 11 patients (68.8%). Following index fracture fixation, 10 patients (62.5%) developed a postoperative complication or adverse clinical outcome, including nonunion in 6 patients (37.5%), fracture-related infection in 2 patient (12.5%), subsequent secondary acromial stress fracture in 1 patient (6.2%), and glenoid component loosening with humeral component dislocation in 1 patient (6.2%). Nine patients (56.3%) underwent at least one additional surgical procedure, including 8 patients (50.0%) who required an unplanned reoperation; hardware removal was the most common subsequent procedure (7/16, 43.8%). At final follow-up, 5 patients (31.3%) reported chronic pain, 3 patients (18.8%) had persistent nonunion, and 3 patients (18.8%) had hardware failure managed nonoperatively. The number of plates used and implant positioning did not differ significantly between patients who achieved union and those who did not (p = 0.264).</p><p><strong>Conclusion: </strong>Scapular spine and acromial stress fractures following RTSA are uncommon but clinically consequential complications of reverse total shoulder arthroplasty. Standard operative fixation demonstrated a low rate of success after a single intervention, underscoring the need for alternative treatment strategies.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867707","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}