European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Antibiotic-loaded calcium sulphate beads in in debridement, antibiotics, and implant retention (DAIR) for acute hip and knee periprosthetic joint infection: a retrospective comparative cohort study.","authors":"Antonio Pirozzi, Francesco Raspanti, Niccolò Giabbani, Matteo Piccica, Letizia Attala, Matteo Innocenti, Marco Mugnaini, Luigi Zanna","doi":"10.1007/s00590-026-04940-6","DOIUrl":"10.1007/s00590-026-04940-6","url":null,"abstract":"<p><strong>Background: </strong>The role of antibiotic-loaded calcium sulphate (CaS) beads as an adjunct to debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) remains controversial. This study compared outcomes between standard DAIR and DAPRI (DAIR plus antibiotic-loaded CaS beads).</p><p><strong>Methods: </strong>A retrospective single-center cohort study was conducted on 51 consecutive patients treated for acute hip or knee PJI between 2022 and 2025. Thirty-three patients underwent standard DAIR and 18 underwent DAPRI. The primary endpoint was septic failure, defined as recurrent infection requiring surgical intervention. The secondary endpoints were identification of clinical and surgical predictors of failure. Univariable logistic regression analysis was performed to evaluate factors associated with septic failure following implant-retention treatment for acute PJI.</p><p><strong>Results: </strong>Overall septic failure occurred in 13/51 patients (25.5%). Failure rates were 27.3% in the DAIR group and 22.2% in the DAPRI group, a difference that did not reach statistical significance (p = 0.750). Recurrence with the same pathogen was less frequent after DAPRI (5.6% vs. 15.2%). In subgroup analyses, failure in acute hematogenous PJI was 25% with DAPRI versus 62% with DAIR (p = 0.099), and in hip arthroplasty no failures occurred with DAPRI (0/7) versus 25% with DAIR (6/24; p = 0.293). On univariable analysis, significant predictors of failure were acute hematogenous infection (OR 7.22; p = 0.008), preoperative fistula (OR 5.66; p = 0.018), and higher BMI (OR 1.15; p = 0.015). Among aseptic complication we reported 2/31 (6.5%) cases of hip dislocation.</p><p><strong>Conclusion: </strong>DAPRI was not associated with a statistically significant reduction in septic failure compared with standard DAIR (27.3% vs. 22.2%; p = 0.750) in this small, underpowered cohort. Exploratory subgroup analyses suggested a possible benefit in acute hematogenous PJI and hip arthroplasty, but these findings are hypothesis-generating and require confirmation in larger studies. Acute hematogenous infection, preoperative fistula, and higher BMI were significant univariable predictors of septic failure.</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":"148867696","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 \"Development and internal validation of a clinical prediction model for deep surgical site infection after open extremity fractures: the BIGB2OSS score\".","authors":"Tahir Burak Sarıtaş","doi":"10.1007/s00590-026-04951-3","DOIUrl":"10.1007/s00590-026-04951-3","url":null,"abstract":"<p><strong>Purpose: </strong>To critically examine the development, internal validation, calibration, and clinical interpretability of the BIGB2OSS score for predicting deep surgical site infection after open extremity fractures.</p><p><strong>Methods: </strong>A focused methodological appraisal was performed using the information reported in the original article. Candidate predictor complexity, event-to-parameter ratio, bootstrap validation, calibration assessment, model specification, and missing outcome data were evaluated against accepted prediction-model principles.</p><p><strong>Results: </strong>The model was developed from 45 deep-infection events after examining 18 candidate variables, corresponding to approximately 20 regression parameters (approximately 2.25 events per candidate parameter). Figure 3 reported an expected-to-observed ratio of 1.000, calibration-in-the-large of 0.000, and calibration slope of 1.000; however, these were apparent development-data estimates rather than optimism-corrected calibration measures. The apparent and optimism-adjusted C-statistics were both 0.76 with identical confidence intervals, while it was unclear whether the complete model-building sequence was repeated during bootstrapping. The model intercept and exact score-specific probabilities were not reported. In addition, 138 of 708 otherwise age-eligible patients (19.5%) lacked three-month outcome data.</p><p><strong>Conclusion: </strong>The BIGB2OSS score offers a clinically relevant framework for preliminary risk stratification, but its grouped probabilities should not yet be interpreted as validated individual risks. Full-process bootstrap validation, optimism-corrected calibration, transparent model specification, and sensitivity analyses for missing outcomes are required before external application.</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":"148867674","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 \"Topical antibiotic powder reduces fracture-related infections in pelvic and lower limb fractures: a systematic review and meta-analysis\": the denominator matters.","authors":"Tahir Burak Sarıtaş","doi":"10.1007/s00590-026-04950-4","DOIUrl":"10.1007/s00590-026-04950-4","url":null,"abstract":"<p><strong>Purpose: </strong>To clarify the interpretation of the reported increase in Gram-negative organisms after prophylactic topical antibiotic powder in a recent systematic review and meta-analysis.</p><p><strong>Methods: </strong>We examined the published report and its supplementary bacterial-profile forest plot, compared the denominators used for microbiological outcomes with the full treatment-cohort denominators, and evaluated the resulting estimand in light of potential index-event bias and contemporary randomized evidence.</p><p><strong>Results: </strong>Supplementary Material S3 used denominators of 56 powder recipients and 181 controls, although the seven contributing studies enrolled 999 and 1703 treated patients, respectively. In one contributing control group, the microbiological denominator also exceeded the number of reported FRIs. Therefore, the reported OR of 2.52 appears to describe the conditional distribution of Gram-negative organisms among selected breakthrough infections or isolates rather than patient-level Gram-negative FRI risk. Under the simplifying assumption that every reported Gram-negative event represented one patient, the corresponding crude proportions would be 2.1% and 2.3%. The largest included randomized trial similarly found no significant increase in Gram-negative-only infection.</p><p><strong>Conclusion: </strong>A patient-level reanalysis using all treated participants as denominators and mutually exclusive microbiological categories is warranted. Until then, the finding should be interpreted as a possible change in the composition of breakthrough infections, not evidence of increased absolute Gram-negative risk, ecological selection, or resistance.</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":"148867744","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":"Open subtrochanteric femur fractures: navigating a complex injury through principles, surgical strategies, and a treatment algorithm.","authors":"Zackariya Mohamed, Owais Ahmed, S Muthukumar, Ramesh Perumal, Devendra Agraharam, Dheenadhayalan Jayaramaraju, Shanmuganathan Rajasekaran","doi":"10.1007/s00590-026-04936-2","DOIUrl":"10.1007/s00590-026-04936-2","url":null,"abstract":"<p><strong>Purpose: </strong>In the realm of orthopaedic trauma, some fractures challenge our training, and then there are \"open-subtrochanteric-femur fractures\" that challenge our very limits. They are not just fractures; they are catastrophic events; they hit where biomechanics are at worst, where every muscle conspires to deform, displace and defy reduction. And when the skin is slit open, it becomes treacherous, transforming a surgical table into a battlefield. There are no established guidelines; considering Ganga-Hospital-Open-Injury-Scoring-System(GHOISS), a tool that brings structure to the chaos, we formulated a surgical algorithm designed to guide decision-making in these complex injuries.</p><p><strong>Methods: </strong>A-retrospective-cohort-study, at level-1 trauma-care-center, where 5112-open-injuries were analysed. 873 of them had open-femur-fracture; however, only 27 of them had open-subtrochanteric-femur-fractures, 2-patients died within 7days-of-admission, and 3-patients were lost-to-follow-up. This study represents the results of the remaining 22-patients, who were followed for at-least 1-year. Radiological and functional outcomes were analysed.</p><p><strong>Results: </strong>Proportion of open-subtrochanteric-femur-fractures was 0.5%. The mortality rate was 7%(2 of 27). The mean age of the study population was 34years(range:8-72), with males outnumbering females (M: F = 21:1). 54% of patients had polytrauma, 35% had multiple fractures. The mean GHOISS was 8. Mean fracture-union-time is 22-weeks, mean Harris-hip-score is 93.8. Delayed-union rate was 9%(2-of-22), infection-rate was 9%(2-of-22), Non-union was seen in 4.5%(1-of-22).</p><p><strong>Conclusion: </strong>In patients with hemodynamic stability and GHOISS of less than 9, primary-definitive-fixation can be done. However, in patients who are hemodynamically unstable or have GHOISS of more than 9, the most effective treatment involves proper initial debridement and stable external fixation. Followed by definitive fixation and early soft-tissue cover. In cases where multiple soft tissue procedures are required, either the external-fixator should be continued, or it should be converted to LRS.</p><p><strong>Level of evidence: </strong>Level III.</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":"148867750","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":"Anatomic reductions are rarely achieved for severely displaced pilon fractures and this portends severe osteoarthritis.","authors":"Lauren Morris, Reinaldo Colon-Morillo, Keenan Onodera, Andrew Wallace, Zachary Wuthrich, Nicholas Alfonso, Joshua A Parry","doi":"10.1007/s00590-026-04941-5","DOIUrl":"10.1007/s00590-026-04941-5","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between initial articular displacement, postoperative residual articular displacement, and the development of severe osteoarthritis in pilon fractures.</p><p><strong>Methods: </strong>A retrospective review was performed of adults with operative pilon fractures (OTA/AO 43) at a level I trauma center. Three surgeons reviewed injury, postoperative, and follow-up radiographs to grade initial articular displacement as <2 mm, 2-5 mm, or >5 mm, postoperative residual articular displacement as 0 mm, ≤2 mm, or >2 mm, and the osteoarthritis (OA) grade as 0 (none), 1 (doubtful), 2 (minimal), 3 (moderate), and 4 (severe). The associations between initial displacement, residual displacement, and the development of severe OA were evaluated.</p><p><strong>Results: </strong>There were 115 patients with pilon fractures included. Initial articular displacement on injury radiographs was associated with residual articular displacement with 100.0% (28/28) of patients with <2 mm of initial articular displacement having 0 mm of residual articular displacement, compared to 51.7% (15/29) and 17.2% (10/58) of patients with 2-5 mm and >5 mm of initial articular displacement (p<0.0001). The development of grade 4 OA was associated with both initial articular displacement (p<0.0001) and residual articular displacement (p<0.0001). All patients with an initial articular displacement <2 mm achieved anatomic reductions with no cases of grade 4 OA. In contrast, grade 4 OA developed in 66.7% (4/6) and 85.7% (18/21) of patients with an initial articular displacement of 2-5 mm and >5 mm that also had a residual articular displacement of >2 mm.</p><p><strong>Conclusions: </strong>Severely displaced articular injuries were less likely to receive anatomic reductions and more likely to develop severe OA.</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":"148867755","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":"Balancing safe resection and spinal stability in osteoblastoma and osteoid osteoma: a retrospective study.","authors":"Shrijith Murlidharan BNair, Nishank Mehta, Tejaswin Jha, Bhavuk Garg","doi":"10.1007/s00590-026-04938-0","DOIUrl":"10.1007/s00590-026-04938-0","url":null,"abstract":"<p><strong>Purpose: </strong>To report the clinical, functional and oncological outcome in patients with spinal OBL/OO (osteoblastoma/osteoid osteoma) using Enneking and WBB staging system treated at a single center.</p><p><strong>Methods: </strong>This is a retrospective observational study in which the hospital records of 20 patients with OBL and 11 patients with OO were reviewed with a minimum follow-up period of 24 months. Besides demographic information, presenting symptoms, radiological findings and operative details, the outcome measures reported were: neurological (ASIA) and non-neurological complications, patient-reported outcome score (visual analogue scale) and local recurrence after surgery.</p><p><strong>Results: </strong>The mean age at presentation was 20.2 ± 9.2 years and 17.3 ± 6.8 years, respectively for the OBL and OO patient groups, with a male predilection in either tumor. Localized pain was the most common presenting symptom. Neurological deficit at presentation was noted in 8/20 OBL patients, whereas all patients with OO were neurologically intact. Both the tumors predominantly involved posterior elements (27/31 patients) with no intradural involvement. Five patients (all with OO) underwent only decompression/curettage; 26/31 patients underwent decompression with instrumentation. 4 patients underwent Enneking inappropriate resection, with one patient having local tumor recurrence. Significant improvement in pre-existing neurological status and VAS scores was noted at final follow-up.</p><p><strong>Conclusion: </strong>Surgical treatment of OBL and OO is associated with a favourable clinical, radiological and oncological outcome. While anatomical constraints don't allow wide excisions, combined Enneking and WBB staging facilitates surgical planning and helps in doing anatomically feasible resections with structural stability.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857864","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":"Macroscopic cartilage degeneration despite partially preserved imaging appearance in chronic neurological hip dislocation: findings from surgically resected femoral head specimens.","authors":"Edoardo Costici, Rosa Russo, Sergio De Salvatore, Paolo Brigato, Laura Ruzzini, Rebecca Femia, Pier Francesco Costici","doi":"10.1007/s00590-026-04943-3","DOIUrl":"10.1007/s00590-026-04943-3","url":null,"abstract":"<p><strong>Background: </strong>Chronic neurological hip dislocation is a severe musculoskeletal complication in non-ambulatory patients with cerebral palsy. Surgical decision-making is largely based on standard radiographs, although radiography provides only indirect information on articular cartilage status. Whether preoperative radiographic findings accurately reflect macroscopic cartilage degeneration remains unclear. This study evaluated the association between standard radiographic appearance and intraoperative anatomical evidence of cartilage destruction in chronic neurological hip dislocation.</p><p><strong>Methods: </strong>This retrospective observational study included non-ambulatory patients with cerebral palsy, all classified as GMFCS level V, who underwent unilateral metaphyseal femoral resection with structured myoplasty for chronic neurological hip dislocation. Each patient contributed one surgically resected femoral head. Preoperative pelvic radiographs were assessed for femoral head morphology, residual acetabular coverage, degenerative changes, and osteophytosis. Intraoperative macroscopic cartilage degeneration was evaluated immediately after resection by two senior neuro-orthopaedic surgeons using predefined anatomical regions and a standardized data collection form. Severe cartilage degeneration was defined as complete cartilage loss in at least one femoral head region. Diagnostic performance of radiographic criteria was assessed using intraoperative macroscopic degeneration as the reference standard.</p><p><strong>Results: </strong>A total of 29 patients and 29 femoral heads were included. Cartilage abnormalities were identified in 28 femoral heads, and complete cartilage loss in at least one anatomical region was observed in 16 cases. Complete cartilage loss was most frequently observed in the superolateral and anterosuperior regions of the femoral head. Complete radiographic loss of femoral head morphology showed a sensitivity of 43.8% and diagnostic accuracy of 51.7% for severe cartilage degeneration. Severe radiographic deformity showed a sensitivity of 56.3% and diagnostic accuracy of 55.2%, whereas marked radiographic osteophytosis showed a sensitivity of 31.3% and diagnostic accuracy of 48.3%. A composite radiographic criterion increased sensitivity to 68.8%, but diagnostic accuracy remained limited at 58.6%. Radiographic underestimation of severe cartilage damage occurred across all criteria.</p><p><strong>Conclusions: </strong>Standard radiographs only partially reflect the extent of macroscopic cartilage degeneration in chronic neurological hip dislocation. Complete cartilage loss was most frequently observed in the superolateral and anterosuperior regions and could be present despite partially preserved radiographic morphology. Radiographic findings should therefore be interpreted together with clinical findings rather than as direct measures of cartilage integrity.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857878","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 \"Association between central sensitization-related symptoms and pressure pain thresholds at local and remote sites in patients with knee osteoarthritis\".","authors":"Fajar Farid, Haider Imran, Abdul Basit Munir","doi":"10.1007/s00590-026-04946-0","DOIUrl":"10.1007/s00590-026-04946-0","url":null,"abstract":"<p><p>Central sensitization (CS) is an increasingly recognized determinant of pain severity and postoperative outcomes in knee osteoarthritis, yet how best to measure it in clinical practice remains unsettled. We comment on a recent cross-sectional study of 121 patients awaiting total knee arthroplasty,which found that higher Central Sensitization Inventory (CSI) scores were independently associated with lower remote, but not local, pressure pain thresholds (PPTs), suggesting that CSI reflects widespread rather than localized pain hypersensitivity. We highlight that CSI and remote PPT are indirect, complementary measures rather than confirmatory proof of a central mechanism, and that pairing them with quantitative sensory testing could increase their clinical utility. We also note limitations affecting generalizability, including the advanced-disease cohort, cross-sectional design, and unmeasured covariates. Prospective, multicentre studies linking these measures to postoperative outcomes could translate this work into individualized perioperative pain management for patients undergoing knee arthroplasty.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857874","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":"Buttress plating versus trans-syndesmotic stabilisation for posterolateral malleolus fractures: outcomes with early weight-bearing.","authors":"Katie Hutchinson, Georgina Crate, Christopher Fenner, Alex Trompeter, Nielsen","doi":"10.1007/s00590-026-04904-w","DOIUrl":"10.1007/s00590-026-04904-w","url":null,"abstract":"<p><strong>Purpose: </strong>Posterolateral posterior malleolar fractures are commonly associated with syndesmotic instability, yet the optimal fixation strategy remains unclear. This study compared postoperative complications following direct posterior buttress plating and indirect trans-syndesmotic stabilisation, and evaluated differences in postoperative weight-bearing.</p><p><strong>Methods: </strong>A retrospective review of a prospectively maintained trauma database at a Level 1 major trauma centre (2012-2021) was performed. Patients with posterior malleolar fractures treated with buttress plating or syndesmotic stabilisation were included. Radiographs, with computed tomography where available, were used to assess fragment size. Postoperative complications and factors associated with early weight-bearing were analysed using multivariable logistic regression.</p><p><strong>Results: </strong>Of 1283 ankle fractures, 445 (34.6%) involved the posterior malleolus; 382 met the inclusion criteria. Buttress plating was performed in 184 patients and syndesmotic stabilisation in 111. Mean follow-up was 10 and 8.8 months. Overall complication rates were similar, with no significant differences in infection, loss of reduction, revision surgery, or arthrodesis. Metalwork removal was more frequent following syndesmotic stabilisation (37.8% vs 10.3%, p < 0.001). Early weight-bearing was more common after buttress plating (41.8% vs 22.9%) and remained independently associated after adjustment (OR 2.81, 95% CI 1.12-11.46).</p><p><strong>Conclusion: </strong>Both techniques demonstrate comparable safety profiles. However, direct fixation was associated with a greater likelihood of early postoperative weight-bearing. As postoperative rehabilitation protocols were not standardised, this finding should be interpreted cautiously and may reflect surgeon preference in addition to fixation strategy. In the presence of a syndesmotic injury associated with a posterior malleolar fragment of sufficient size to permit fixation, direct fixation of the posterior malleolar fragment should be considered, as it may restore stability and facilitate rehabilitation. Further prospective studies with standardised rehabilitation protocols and longer-term follow-up are required.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851144","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":"Avoiding pitfalls in percutaneous acetabular column screw placement using combined fluoroscopic check-point views: a technical note and case series.","authors":"Manuel Godinho, Margherita Serra, Antonio Jose Solano, Michele Nardi, Brandi Ann Krieg, Nicholas Jerome Tucker, Justin E Hellwinkel, Adam Schlauch, Nathaniel Elliot Schaffer, Cyril Mauffrey","doi":"10.1007/s00590-026-04935-3","DOIUrl":"10.1007/s00590-026-04935-3","url":null,"abstract":"<p><p>Standard fluoroscopic views may not detect cortical breaches during percutaneous acetabular column screw placement, creating an illusion of safe intraosseous positioning. The purpose of this study was to illustrate use of simple fluoroscopic checkpoint projections-the combined obturator oblique hyper-outlet (COOHO) view for anterior column (AC) screws and two known additional views, outlet and true lateral (TL), for posterior column (PC) screws-as a method to demonstrate extraosseous screw trajectories that might be missed by standard tangential column fluoroscopic views. Six clinical cases are presented as examples of standard orthogonal fluoroscopic views failing to detect extraosseous screw placement. The cases are supplemented by a synthetic pelvic model demonstration to define radiographic landmarks and common screw malposition. Guidewires were advanced in the pelvic model columns, either intraosseous or extraosseous, and their paths were evaluated with standard fluoroscopic views compared to COOHO and outlet and TL views. For the AC, COOHO tangentially profiles the pectineus recess and iliopsoas gutter to unmask in-out-in paths. For the PC, iliac and obturator oblique views may miss medial or posterior breach near the lesser sciatic notch and quadrilateral plate. The outlet and TL views show the vertical extent of the ilioischial line to detect medial or posterior breech and length-orientation errors. The COOHO, outlet and TL views additional projections that improve tangential visualization of high-risk cortices and detection of extraosseous trajectories.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851992","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}