Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Comparative efficacy of acute targeted muscle reinnervation after upper vs. lower limb amputation: A retrospective, global analysis","authors":"Haad A. Arif ,&nbsp;Joaquín Sarmiento-Falen ,&nbsp;Bradley A. Carlson ,&nbsp;Fatima Z. Arif ,&nbsp;Anthony J. Archual ,&nbsp;Jan P. Szatkowski","doi":"10.1016/j.jcot.2026.103377","DOIUrl":"10.1016/j.jcot.2026.103377","url":null,"abstract":"<div><h3>Background</h3><div>While targeted muscle reinnervation (TMR) has demonstrated efficacy in reducing chronic pain and symptomatic neuroma formation following limb amputation, differences in outcomes between upper- and lower-limb TMR remain poorly defined. This study compared the efficacy of acute TMR in pain reduction following major upper-versus lower-limb amputation.</div></div><div><h3>Methods</h3><div>A retrospective cohort analysis was conducted using the TriNetX Global Network to identify adults undergoing acute TMR following upper-limb (UL cohort) and lower-limb (LL cohort) amputation. Propensity score matching was performed using demographic and comorbidity covariates. One-year outcomes included new-onset phantom limb pain (PLP), residual limb pain, symptomatic neuroma formation, opioid and neuropathic medication prescriptions, and stump complications.</div></div><div><h3>Results</h3><div>A total of 811 patients met inclusion criteria, with 182 well-matched patients in each cohort. The UL cohort experienced significantly lower rates of PLP (27.5% vs. 40.1%; RR 0.69 [95% CI 0.51–0.92]) and opioid use (59.9% vs. 74.7%; RR 0.80 [95% CI 0.69–0.93]), as well as fewer stump complications (19.8% vs. 34.1%; RR 0.58 [95% CI 0.41–0.83]). RLP (9.9% vs. 7.1%; p = 0.3478) and neuropathic medication use (56.6% vs. 66.5%; p = 0.0525) were similar between cohorts.</div></div><div><h3>Conclusions</h3><div>Acute TMR is associated with significantly lower rates of PLP, opioid use, and stump complications following UL amputation compared with LL amputation. These findings highlight differences in postoperative pain trajectories across patient populations and underscore the need for prospective studies to explore the mechanisms driving these patterns.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103377"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175468","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":"Treatment of geriatric pelvis fractures – What are the knowledge gaps?","authors":"Ulrich J. Spiegl ,&nbsp;Max Reinhold ,&nbsp;Lorin Benneker ,&nbsp;Jonathan Dalton ,&nbsp;Ashraf N. El Naga ,&nbsp;Richard Bransford ,&nbsp;Sebastian F. Bigdon ,&nbsp;Gregory Schroeder ,&nbsp;Andrei F. Joaquim ,&nbsp;Klaus John Schnake ,&nbsp;AO Spine Knowledge Forum Trauma and Infection","doi":"10.1016/j.jcot.2026.103350","DOIUrl":"10.1016/j.jcot.2026.103350","url":null,"abstract":"<div><div>The incidence of insufficiency fractures of the pelvis is rising in developed countries. The aim of this review is to summarize the current evidence regarding the classification, treatment, and surgical strategies for these fractures. Several classifications have been developed such as the AO Spine Sacral Injury Classification System, the Fragility Fractures of the Pelvis (FFP), and the OF pelvis classification. The treatment option consists of non-operative treatment, sacroplasty, ileosacral screw or rod fixation, lumbopelvic fixation and approaches to the anterior ring including fixateur externe or interne, pelvic plates or screw fixations. The advantages and disadvantages of each technique are depicted. The knowledge gap in this field is large and future directions are discussed.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103350"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175469","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":"Spectrum, management strategies, and outcomes of isolated posterior wall acetabular fractures: A retrospective study of 129 patients","authors":"Premkumar Pandiaraj,&nbsp;Ramesh Perumal,&nbsp;Muthukumar Soundararajan,&nbsp;Asif Imran,&nbsp;Dheenadhayalan Jayaramaraju","doi":"10.1016/j.jcot.2026.103363","DOIUrl":"10.1016/j.jcot.2026.103363","url":null,"abstract":"<div><h3>Background</h3><div>Posterior wall fractures are the most common acetabular fracture pattern and are associated with a wide spectrum of injury severity, hip instability, and complications. Management depends on fracture morphology and joint stability, yet factors influencing outcomes and complications remain incompletely defined.</div></div><div><h3>Methods</h3><div>This retrospective study included 129 patients with isolated posterior wall acetabular fractures treated between 2012 and 2022. Demographic data, fracture patterns, management strategies, and complications were reviewed. Radiological outcomes were assessed using Matta's criteria, and functional outcomes were evaluated using the EuroQol-5D questionnaire.</div></div><div><h3>Results</h3><div>The cohort comprised predominantly males (91%), with a mean age of 42.4 years. Fracture patterns included simple posterior wall fractures (62A1.1) in 58 patients, multifragmentary fractures (62A1.2) in 54 patients, and fractures with marginal impaction in 17 patients. Surgical management was required in 123 patients, while 6 were treated non-operatively. Complications occurred in 25 patients. Multifragmentary fractures and associated hip dislocation were significantly associated with higher rates of avascular necrosis (p = 0.023) and post-traumatic arthritis (p = 0.0137). Radiological outcomes were excellent or good in 87.6% of patients, and the majority reported no or only slight problems on the EuroQol-5D questionnaire.</div></div><div><h3>Conclusion</h3><div>Dynamic stress examination helped identify hip instability in selected posterior wall fractures, including those with less than 20% wall involvement. Fracture complexity was associated with worse outcomes and higher complication rates, particularly avascular necrosis and post-traumatic arthritis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103363"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175473","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":"Concomitant prophylactic trochanteric epiphysiodesis may not be an effective procedure for Perthes varus surgery","authors":"Anil Agarwal,&nbsp;Md Zafar Iqbal,&nbsp;Sunny Bhalla","doi":"10.1016/j.jcot.2026.103379","DOIUrl":"10.1016/j.jcot.2026.103379","url":null,"abstract":"<div><h3>Background</h3><div>Prophylactic trochanteric epiphyseodesis is commonly performed with proximal femoral varus osteotomy in Perthes disease to reduce relative trochanteric overgrowth. However, its effectiveness, particularly in children at the typical age for surgical containment, remains unclear.</div></div><div><h3>Methods</h3><div>A retrospective review (2015–2025) evaluated children with Perthes disease who underwent subtrochanteric varus osteotomy with concomitant trochanteric epiphysiodesis. Inclusion criteria were a minimum 2-year follow-up and use of a standardized surgical technique. Radiographic parameters neck shaft angle (NSA), articulo-trochanteric distance ratio (rATD), center-trochanteric distance ratio (rCTD), and abductor lever arm ratio (rLAM) were measured preoperatively and at final follow-up, normalized to the contralateral normal hip. Subgroup analysis was done in children older than 8 years and younger than 8 years<strong>.</strong></div></div><div><h3>Results</h3><div>Sixteen patients (mean age 8.1 years; mean follow-up 5.2 years) met inclusion criteria. NSA decreased significantly following varus osteotomy (p &lt; 0.001). rATD deteriorated markedly from 0.982 to 0.305 (p &lt; 0.001), indicating persistent trochanteric overgrowth despite epiphysiodesis. In contrast, rCTD and rLAM showed no significant change. Subgroup analysis revealed similar patterns across age groups: rATD worsened significantly in both older (&gt;8 years: p = 0.031) and younger children (&lt;8 years: p = 0.010), while rCTD and rLAM remained stable.</div></div><div><h3>Conclusions</h3><div>Prophylactic trochanteric epiphyseodesis performed during varus osteotomy did not prevent abnormal trochanteric development in Perthes disease. Its limited effectiveness was consistent regardless of age. Although CTD and LAM were preserved, the key parameter reflecting trochanteric overgrowth (ATD) continued to worsen. Routine use of this adjunct procedure during containment surgery may therefore be of limited benefit.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103379"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277677","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":"Erratum regarding missing peer review statement in previously published articles","authors":"","doi":"10.1016/j.jcot.2025.103314","DOIUrl":"10.1016/j.jcot.2025.103314","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103314"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147403435","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":"Erratum regarding missing peer review statement in previously published articles","authors":"","doi":"10.1016/j.jcot.2025.103313","DOIUrl":"10.1016/j.jcot.2025.103313","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103313"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394624","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":"Complication rates in patients with diabetic neuropathy undergoing total joint arthroplasty","authors":"Gabriel Furey ,&nbsp;Harrison S. Fellheimer ,&nbsp;Ryan Post ,&nbsp;Lauren O'Mara ,&nbsp;James Purtill","doi":"10.1016/j.jcot.2026.103361","DOIUrl":"10.1016/j.jcot.2026.103361","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic Neuropathy and other neurological disorders impact surgical outcomes in total joint arthroplasty (TJA). While Diabetes has been extensively studied, limited research addresses the specific effect of Diabetic Neuropathy on postoperative outcomes. This study evaluates complication rates among patients with Neuropathy, Diabetes, or both undergoing primary TJA.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 2600 patients who underwent unilateral primary total knee or hip arthroplasty at a single high-volume institution between 2001 and 2023. Patients were stratified into four cohorts: Neuropathy with Diabetes (N = 655), Neuropathy without Diabetes (N = 675), Diabetes without Neuropathy (N = 707), and other neurological disorders (N = 563). The primary outcome was 90-day postoperative medical complications. Secondary outcomes included 90-day orthopaedic complications (infection, wound issues, fracture), 90-day all-cause readmission, early revision (&lt;2 years), and non-home discharge. Statistical analysis utilized bivariate comparisons, including ANOVA, Kruskal-Wallis, and Chi-square testing. Pairwise comparisons were performed when appropriate.</div></div><div><h3>Results</h3><div>Patients with both Neuropathy and Diabetes had the highest 90-day complication rate (35.1%) compared with Diabetes without Neuropathy (23.1%), Neuropathy without diabetes (16.2%), and other neurological disorders (12.7%). Readmission was highest in the Neuropathy with Diabetes group (8.24%) versus Neuropathy without Diabetes (5.63%), Diabetes without Neuropathy (6.65%), and other neurological disorders (3.91%). Surgical site infections occurred more often in Neuropathy with Diabetes (2.75%) than in other groups (≤0.85%). Non-home discharge was most common among Diabetes without Neuropathy patients (38.5%).</div></div><div><h3>Conclusion</h3><div>Diabetic Neuropathy is associated with higher rates of postoperative complications, readmissions, and infections following TJA. These patients represent a high-risk group requiring focused preoperative optimization and postoperative care to improve outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103361"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175472","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":"Avascular osteonecrosis of the knee after multiligament reconstruction: a case report and a literature review","authors":"Pierangelo Za ,&nbsp;Biagio Zampogna ,&nbsp;Sebastiano Vasta ,&nbsp;Giuseppe Francesco Papalia ,&nbsp;Rocco Papalia","doi":"10.1016/j.jcot.2026.103360","DOIUrl":"10.1016/j.jcot.2026.103360","url":null,"abstract":"<div><div>Multiligament knee reconstruction (MLKR) is a complex surgical procedure often required to treat severe injuries involving multiple knee ligaments. A rare complication of knee ligament reconstruction is avascular osteonecrosis (AVN). To our knowledge, only 8 cases of knee osteonecrosis (ON) after ligament reconstruction were described, 7 cases after anterior cruciate ligament (ACL) reconstruction and 1 case after posterior cruciate ligament (PCL) and medial collateral ligament (MCL) reconstruction. This case report presents a rare occurrence of knee ON following MLKR for Schenck type III lesion in a 61-year-old male patient with a history of alcohol, tobacco, cannabis, and cocaine abuse. Eleven months after the MLKR surgery, the patient had a new trauma. Magnetic Resonance Imaging (MRI) scans, in addition to re-rupture of two out of three reconstructed ligaments, revealed characteristic signs of avascular ON. Despite conservative treatment, follow-up MRI did not show normalization of the necrotic areas. This case emphasizes the need for awareness of potential osteonecrosis in patients with substance use history undergoing knee reconstruction and the challenges in managing such complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103360"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175085","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":"Erratum regarding missing peer review statement in previously published articles","authors":"","doi":"10.1016/j.jcot.2025.103311","DOIUrl":"10.1016/j.jcot.2025.103311","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103311"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394625","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":"Erratum regarding missing peer review statement in previously published articles","authors":"","doi":"10.1016/j.jcot.2025.103312","DOIUrl":"10.1016/j.jcot.2025.103312","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103312"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147403436","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}