European Journal of Orthopaedic Surgery and Traumatology最新文献

{"title":"Early complications after surgery for periprosthetic femoral fractures: incidence, risk factors, and clinical implications.","authors":"Nicolas Blum, Lise Chevassut, Grégoire Leclerc, Pauline Sergent, Alizé Dabert, Guillaume Marillier, Zouhair Aouzal, Laurent Obert, Thomas Fradin","doi":"10.1007/s00590-026-04905-9","DOIUrl":"10.1007/s00590-026-04905-9","url":null,"abstract":"<p><strong>Purpose: </strong>Periprosthetic femoral fractures (PFF) are the second cause of revision surgery after total hip arthroplasty and occur predominantly in elderly, fragile patients. Despite high associated morbidity and mortality, data specifically focusing on early postoperative complications remain scarce.</p><p><strong>Methods: </strong>A single-center retrospective study was conducted on 192 patients who underwent surgery for PFF between January 2010 and April 2023. Patients were treated by open reduction and internal fixation (ORIF, n = 75) or revision surgery (n = 117). All complications occurring within the first postoperative month were recorded and categorized as general, mechanical, or septic. Univariate and multivariate logistic regression analyses were performed to identify factors associated with their occurrence.</p><p><strong>Results: </strong>The mean age was 82.1 years. 126 complications were observed in 70 patients (36.5%) within the first month. General complications were the most frequent (75.4%), predominantly pulmonary and urinary infections, leading to a 7.3% early mortality rate. Mechanical complications occurred in 5 patients (2.6%) and periprosthetic joint infection (PJI) in 12 patients (6.3%), with S. aureus responsible for 66.7% of infections. In multivariate analysis, preoperative infection was independently associated with early mortality (OR = 3.47; p = 0.01) and early PJI (OR = 2.40; p < 0.001) in the ORIF group, while alcoholism was correlated with early mortality (OR = 1.70; p = 0.02). Weight-bearing restrictions were significantly associated with mechanical complications in the revision group (OR = 2.87; p < 0.01).</p><p><strong>Conclusion: </strong>Early complications following PFF surgery are frequent and severe, reflecting the extreme frailty of this patient population. Preoperative infection control and an individualized approach to postoperative weight-bearing appear as key modifiable factors to improve early outcomes. A multidisciplinary, patient-centered management strategy is essential in this complex surgical setting.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702745","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":"Pseudomyogenic hemangioendothelioma (involving skin, bone and soft tissue): a case report with long-term follow-up and review of literature.","authors":"Maysam Moghaddam Amin, Ákos Sükösd, Imre Antal, Zoltán Sápi, Zsuzsanna Pápai, Miklós Szendrői","doi":"10.1007/s00590-026-04917-5","DOIUrl":"10.1007/s00590-026-04917-5","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudomyogenic hemangioendothelioma is rare, usually indolent vascular tumor characterized immunohistochemically by SERPINE1-FOSB fusion, presenting as multiple bone and soft tissue lesions, affecting males in their 3rd-4th decades.</p><p><strong>Case presentation: </strong>We present the case of a 28-years-old male patient with the history of pain in the left lower extremity hindering him in the daily activities. Radiological examinations showed well-defined lytic lesions of the femur, patella, tibia, fibula, talus and calcaneus with low metabolic activity on PET-scan. MR revealed multiple soft tissue involvements of the affected extremity. Multiple skin lesions were located on the extensor surface of the leg. Molecular analysis confirmed the pathognomonic gene fusion. Patient was treated with epirubicin as an eight-cycle locoregional intraarterial monotherapy, achieving clinical control of the disease and substantial improvement in complaints for over 10 years. The patient's complaints decreased substantially, his bony lesions, however, are persisting for over ten years of his follow-up.</p><p><strong>Discussion: </strong>The molecular characteristics and differential diagnostics of the disease is well known, however, due to the rarity of the disease, the wide array of treatment methods and short-term follow-up intervals, there is still no consensus over the most efficient treatment plan. Many chemotherapeutic agents and treatment regimens were utilized throughout the literature, with acceptable outcomes as far as reported but self-limiting character and spontaneous regression of the disease have also been described according to our experience during the very long follow-up period of our patient.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698172","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 clinical and radiographic outcomes at minimum five-year follow-up after stemless reverse shoulder arthroplasty.","authors":"Stephanie Geyer, Cedric Oettle, Larissa Eckl, Christian Schoch","doi":"10.1007/s00590-026-04880-1","DOIUrl":"10.1007/s00590-026-04880-1","url":null,"abstract":"<p><strong>Background: </strong>Stemless reverse total shoulder arthroplasty (rTSA) was developed to preserve humeral bone stock and facilitate revision surgery. While short-term outcomes are promising, mid-term data beyond five years remain limited. The purpose of this study was to evaluate clinical and radiographic outcomes at a minimum follow-up of five years after implantation of a stemless reverse shoulder prosthesis. We hypothesized that metaphyseal fixation would demonstrate sustained clinical function and stable radiographic integration at mid-term follow-up.</p><p><strong>Methods: </strong>This retrospective case series included 44 consecutive patients who underwent stemless rTSA. At minimum five-year follow-up, 35 patients were available for clinical and radiographic evaluation (follow-up rate 79.5%). Clinical assessment included the Constant Score (CS), age-adjusted Constant Score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and Visual Analog Scale (VAS) for pain. Radiographic evaluation was performed using standardized two-plane radiographs and assessed for humeral and glenoid radiolucency, implant subsidence, loosening, and scapular notching.</p><p><strong>Results: </strong>At a median follow-up of 69 months, patients demonstrated sustained functional outcomes with a median Constant Score of 74 (IQR 71-78), ASES score of 85 (IQR 80-95), SST score of 9.1 ± 2.0, and VAS pain score of 1 (IQR 0-2). The absolute Constant Score decreased slightly between the two- and five-year follow-up; however, this difference was not statistically significant (p = 0.264). Incomplete humeral radiolucent lines < 1 mm were observed in 3 patients (10.7%) and glenoid radiolucent lines in 2 patients (7.1%). No progressive loosening or implant migration was detected.</p><p><strong>Conclusion: </strong>Stemless reverse shoulder arthroplasty demonstrated favorable clinical outcomes and stable radiographic metaphyseal fixation at a minimum follow-up of five years. No progressive radiographic changes or implant-related complications were observed beyond the initial two postoperative years. While these findings support the mid-term performance of this implant concept, further studies with larger patient cohorts are warranted to confirm these results.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698191","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 arrow and the target-description of the \"Robin Hood\" technique for fixation of tibial spine avulsion fractures: a technical note.","authors":"Karl-Heinz Frosch, Robinson Esteves Pires, Harm Hoekstra, Gustavo Waldolato Silva, Rafael Chagas Silva, Danilo Taype Zamboni, Vincenzo Giordano","doi":"10.1007/s00590-026-04915-7","DOIUrl":"10.1007/s00590-026-04915-7","url":null,"abstract":"<p><p>Avulsion fractures of the tibial spine, also known as the tibial eminence, are predominantly described in the pediatric population and uncommon in adults. In the presence of a tibial spine fracture associated with a fracture of the proximal meta-epiphyseal tibia, management of the spine fragment remains controversial. The objective of this technical note is to describe the Frosch technique termed the \"Robin Hood technique\", which consists of fixation of the tibial spine fracture with screws inserted in a retrograde fashion in cases of combined fractures of the tibial spine (due to avulsion of the anterior cruciate ligament) and fractures of the proximal meta-epiphyseal area of the tibia.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698232","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 management of severely displaced IPRF: operative technique, indications, and preliminary clinical outcomes.","authors":"Chao Liu, Houlin Ji, Xuchu Meng, Jitao Wang, Qingrong Xu, Jinxi Hu, Xiaoxiao Zhou, Liyun Xiao","doi":"10.1007/s00590-026-04909-5","DOIUrl":"10.1007/s00590-026-04909-5","url":null,"abstract":"<p><strong>Background: </strong>Standardized surgical protocols for severely displaced inferior pubic ramus fractures (IPRF) remain scarcely reported. This study presents the operative technique and preliminary clinical outcomes of open reduction and internal fixation (ORIF) via the trans-inferior pubic ramus approach.</p><p><strong>Methods: </strong>This retrospective case series included 6 patients with severely displaced IPRF (fracture separation ≥ 1.5 cm) treated with ORIF between 2016 and 2022. Fractures were categorized using a 3-zone anatomical system, Type I/II morphological typing, and conventional Tile/AO classifications to guide implant selection. Fracture union was confirmed by pelvic radiographs and CT, and functional outcomes were assessed using the 1-year Majeed Pelvic Score (MPS).</p><p><strong>Results: </strong>The cohort comprised 4 males and 2 females (mean age 48.3 ± 13.4 years; mean follow-up 15.5 ± 3.2 months). Five fractures involved Zones II and III, and one extended across all three zones; 4 were Type I simple fractures and 2 Type II comminuted fractures, including 3 Tile/AO A2.2 and 3 Tile B injuries. Mean fracture displacement was 3.1 ± 0.9 cm. Mean operative time was 48.3 ± 17.2 min, with a mean intraoperative blood loss of 53.3 ± 25.0 mL; half of the patients underwent second-stage supplementary fixation. All fractures achieved bony union within 3-6 months. Five patients had excellent MPS (100 points), and one had fair function (65 points). No major perioperative complications occurred.</p><p><strong>Conclusion: </strong>Severely displaced IPRF requiring surgery is rare, accounting for the small 6-case sample. The trans-inferior pubic ramus approach achieves low perioperative morbidity, reliable union, and satisfactory short-term function for operatively indicated cases. The 1.5 cm displacement threshold serves as an exploratory reference and requires prospective validation. All conclusions are limited by the small sample and warrant verification in large multicenter studies.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686523","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":"Construct length rather than interbody spacer material is associated with reoperation after anterior cervical discectomy and fusion.","authors":"Hershil Patel, Sapan Patel, Karli Funk, Matthew O'Hara, Evan Honig, Usman Zareef, Ryan Curto, Husni Alasadi, Ryan Smith, Tyler Pease, Phelan Shea, Joshua Olexa, Alexander Padovano, Daniel Cavanaugh, Eugene Koh, Charles Sansur, Steven Ludwig, Julio Jauregui","doi":"10.1007/s00590-026-04916-6","DOIUrl":"10.1007/s00590-026-04916-6","url":null,"abstract":"<p><strong>Objective: </strong>We compared reoperation after primary anterior cervical discectomy and fusion (ACDF) performed with structural allograft versus synthetic interbody cage, and we characterized the indications for revision in each group. Comparative data on interbody spacer selection derive largely from series with approximately one year of observation in which radiographic nonunion, rather than reoperation, is the endpoint. Whether spacer material alters the need for revision over a longer horizon remains unresolved.</p><p><strong>Methods: </strong>We identified all consecutive patients undergoing primary ACDF for degenerative disease at a single academic center between January 2016 and July 2021, requiring a minimum of 24 months of follow-up. Pseudarthrosis and adjacent segment disease were defined as symptomatic failure requiring reoperation and were abstracted from operative reports by two independent reviewers. The primary analysis was a multivariable Cox proportional hazards model adjusting for age, Charlson Comorbidity Index (CCI), and number of fused levels. Propensity score matching was retained as a sensitivity analysis.</p><p><strong>Results: </strong>Of 588 procedures screened, 248 patients met criteria (211 allograft, 37 cage). Mean age was 55.1 ± 10.2 years and 39.9% were male, with a median follow-up of 44.5 months (IQR 33.3-55.9). Revision was performed in 32 of 211 allograft patients (15.2%) and 4 of 37 cage patients (10.8%, P = 0.618). Estimated freedom from revision at two years was 90.9% and 91.9% (log-rank P = 0.619). Cage was not associated with revision after adjustment (hazard ratio 0.90, 95% CI 0.30-2.65). Three-level fusion was associated with revision relative to single-level fusion (hazard ratio 2.96, 95% CI 1.13-7.76, P = 0.028). Adjacent segment disease was the leading indication in both groups. Anterior plate fixation was used in 99.5% of allograft constructs but in only 33.3% of cage constructs with documented plate status.</p><p><strong>Conclusions: </strong>Interbody spacer material was not associated with reoperation in this cohort, whereas construct length was. With 36 events and a confidence interval extending to a 2.2-fold higher hazard, these data represent a null result under limited power rather than evidence of equivalence. Construct length warrants explicit discussion during preoperative counseling. Spacer material and construct configuration travelled together in this cohort, which has implications for how the existing comparative literature should be read.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686449","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":"Pain and functional outcomes following open surgical treatment of Haglund syndrome using suture anchor-based Achilles repair: a prospective cohort study.","authors":"Sagar Jaiswal, Sarang Deore, Parag Kulkarni, Do Kyung Lee, Girish Motwani, Chirag Patel","doi":"10.1007/s00590-026-04903-x","DOIUrl":"10.1007/s00590-026-04903-x","url":null,"abstract":"<p><strong>Background: </strong>Haglund syndrome is a multifactorial condition characterized by posterosuperior calcaneal prominence, retrocalcaneal bursitis, and varying degrees of Achilles tendon involvement. While both open and endoscopic surgical techniques have been described, the optimal approach for cases with associated tendon pathology remains debated.</p><p><strong>Purpose: </strong>To evaluate pain and functional outcomes following open surgical management of Haglund syndrome using deformity excision, retrocalcaneal bursa excision, and suture anchor-based Achilles tendon repair.</p><p><strong>Study design: </strong>Analytical observational Prospective cohort study.</p><p><strong>Methods: </strong>This study included 30 patients treated between 2022 and 2024 with clinically and radiographically diagnosed Haglund syndrome refractory to conservative management. All patients underwent open surgical excision of the Haglund deformity and retrocalcaneal bursa, along with Achilles tendon debridement and repair (tenodesis) using a double-loaded 5 mm titanium suture anchor. Outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score preoperatively and at 1-year follow-up. Pre- and postoperative outcomes were compared using paired statistical analysis.</p><p><strong>Results: </strong>The mean VAS pain score improved significantly from 6.63 ± 1.33 preoperatively to 1.40 ± 1.04 at final follow-up (p < 0.001). The mean reduction in VAS pain scores was 5.23 (95% CI 4.66-5.80), demonstrating a large clinical effect (Cohen's d = 3.43). The mean AOFAS score improved from 60.93 ± 13.13 to 83.13 ± 6.98 (p < 0.001). The mean functional improvement was 25.27 points (95% CI 22.22-28.31), also revealing a large effect size (Cohen's d = 3.10).Two patients (6.7%) developed superficial wound complications, which resolved with conservative management. No cases of deep infection, tendon re-rupture, or implant failure were observed.</p><p><strong>Conclusion: </strong>Open surgical management with suture anchor-based Achilles tendon repair appears to provide significant improvement in pain and function in patients with refractory Haglund syndrome. However, given the absence of a control group and limited objective outcome measures, further comparative studies are required.</p><p><strong>Level of evidence: </strong>Level II, prospective cohort study.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680985","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":"Correction to: Repurposing traditional cerclage and suture techniques for the reduction of comminuted patellar fractures.","authors":"Yuan Pan, Tao Wang, Min An, Yingying Deng, Chao Feng","doi":"10.1007/s00590-026-04874-z","DOIUrl":"https://doi.org/10.1007/s00590-026-04874-z","url":null,"abstract":"","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680996","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":"Topical antibiotic powder reduces fracture-related infections in pelvic and lower limb fractures: a systematic review and meta-analysis.","authors":"João Pedro Campos Lima, Ilana Moreira Araujo, Steven Patricio Valarezo-Brazales, Daniela Ramos Bueno Rivas, Igors Terjajevs, Vincenzo Giordano","doi":"10.1007/s00590-026-04882-z","DOIUrl":"10.1007/s00590-026-04882-z","url":null,"abstract":"<p><strong>Aims: </strong>Fracture-related infection (FRI) remains a significant public health issue. Intrawound vancomycin and tobramycin powder achieve high local antibiotic concentrations, yet their efficacy and safety remain uncertain. We aimed to evaluate the effect of prophylactic topical antibiotic powder in patients undergoing operative treatment for pelvic and lower-limb fractures.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) and observational studies comparing intrawound antibiotic powder (vancomycin and/or tobramycin) with standard systemic prophylaxis in operatively treated pelvic and lower limb fractures. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models, and the certainty of evidence was assessed with the GRADE approach.</p><p><strong>Results: </strong>Fourteen studies (three RCTs and 11 observational studies) comprising 4906 patients were included, of whom 1779 received topical antibiotic powder. Topical antibiotic powder reduced the odds of FRI (OR 0.63; 95% CI 0.45 to 0.87), with the greatest effect in high-risk and open fractures (OR 0.54 and 0.49, respectively). No significant effect was observed on superficial surgical site infection (OR 0.79; 95% CI 0.51 to 1.21) or nonunion (OR 1.03; 95% CI 0.64 to 1.66). Gram-negative organisms were more frequent in the intervention group (OR 2.52; 95% CI 1.24 to 5.14), whereas the trend for Gram-positive organisms favored the intervention (OR 0.42; 95% CI 0.16 to 1.08). No significant difference was found for acute kidney injury (AKI) (OR 0.94; 95% CI 0.44 to 2.02) or length of hospital stay (MD - 1.72 days; 95% CI - 4.05 to 0.61).</p><p><strong>Conclusion: </strong>Moderate-certainty evidence, derived predominantly from observational studies, indicates that intrawound antibiotic powder is associated with a 37% reduction in FRI without an increase in nonunion or AKI. However, the safety outcomes were informed by a few studies with low to very low certainty and should be interpreted with caution; the observed shift toward Gram-negative infections warrants further investigation.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680988","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":"Differential complication risks in diabetic and non-diabetic geriatric patients following distal femur fracture surgery.","authors":"Sri Tummala, Mehul M Mittal, Senthil N Sambandam, Ashoke Sathy, Dane K Wukich","doi":"10.1007/s00590-026-04899-4","DOIUrl":"10.1007/s00590-026-04899-4","url":null,"abstract":"<p><strong>Background: </strong>Current literature is limited regarding the impact of diabetes mellitus (DM) on short- and long-term postoperative complications following distal femur (DF) fracture surgery in geriatric patients. Although DM is a known risk factor for adverse outcomes following hip fracture and lower-extremity arthroplasty, large-scale data specific to DF fractures, which pose distinct fixation, weight-bearing, and healing challenges, remain limited. This study evaluates short- and long-term postoperative complication rates among geriatric patients undergoing operative treatment for DF fractures, comparing those with and without DM.</p><p><strong>Methods: </strong>Using a nationally representative multi-institutional database, we conducted a retrospective analysis of patients aged ≥ 65 years who underwent DF fracture surgery between January 2012 and January 2022. Patients were categorized as having DM or not, and propensity score matching controlled for demographic and comorbidity differences. A subgroup analysis stratified diabetic patients into complicated and uncomplicated DM to assess whether disease severity modified risk. Follow-up periods were 6 months, 1 year, and 3 years.</p><p><strong>Results: </strong>A total of 9390 patients were matched into each cohort. Patients with DM had significantly higher risks of myocardial infarction, transfusion, acute kidney failure, glomerular disease, pneumonia, mortality, cardiac arrest, and wound dehiscence across all follow-up intervals. Surgical site infection was more frequent in the DM cohort at 6-month and 1-year follow-up but did not reach statistical significance at 3 years. No significant differences were observed in deep vein thrombosis, pulmonary embolism, hematoma, DF nonunion, or DF malunion. In the subgroup analysis, patients with complicated DM showed higher rates of major complications, including acute kidney failure and myocardial infarction, compared with matched patients with uncomplicated DM.</p><p><strong>Conclusions: </strong>Geriatric patients with DM were observed to have significantly higher rates of medical and infectious complications following distal femur fracture surgery compared with matched non-diabetic patients. These findings identify DM, and particularly complicated DM, as an important risk marker and may warrant consideration of enhanced perioperative co-management. Because this is a retrospective observational study, findings represent associations rather than causal relationships; prospective and interventional studies are needed to clarify modifiable factors in geriatric patients with DM undergoing DF fracture surgery.</p>","PeriodicalId":50484,"journal":{"name":"European Journal of Orthopaedic Surgery and Traumatology","volume":"36 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671134","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}