Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Functional and radiological outcomes of percutaneous wiring for two and three part fractures of the proximal humerus","authors":"Sanjay Sanatkumar Desai ,&nbsp;Rachit Vipul Shah ,&nbsp;Vishwesh Devendrasinh Chudasama","doi":"10.1016/j.jcot.2025.103044","DOIUrl":"10.1016/j.jcot.2025.103044","url":null,"abstract":"<div><h3>Background</h3><div>Proximal humerus fractures are common, with minimally displaced types often managed non-surgically. However, displaced fractures present a challenge due to complex patterns and numerous treatment options. While there is a general agreement on managing displaced four-part fractures in the elderly, two- and three-part fractures can be treated using various surgical methods, including open reduction and internal fixation (ORIF) with plate, ORIF with intramedullary nail, external fixation, screw fixation, arthroplasty, and percutaneous wiring. This study aims to evaluate the functional and radiological outcomes of treating two- and three-part proximal humerus fractures using closed percutaneous wire fixation.</div></div><div><h3>Methods</h3><div>39 patients, with a mean age of 67 years, treated with percutaneous wiring for displaced two and three-part proximal humerus fractures were prospectively evaluated. Radiological evaluation comprised of anteroposterior and axillary radiographs to look for union while functional evaluation was done using the Constant-Murley (CM) and American Shoulder and Elbow Society (ASES) scoring systems.</div></div><div><h3>Results</h3><div>Union was seen in all the cases and 92.3 % patients had satisfactory result with a mean CM score of 72.7 and mean ASES score of 74.2, at an average follow up of 14 months (12–32 months). Three patients (7.69 %) had unsatisfactory results. One patient had malunion secondary to infection. Two patients had low functional scores secondary to systemic illnesses. None of the patients underwent revision surgery.</div></div><div><h3>Conclusion</h3><div>Percutaneous wiring for displaced two- and three-part fractures of proximal humerus is a reliable, minimally invasive method of fixation. The procedure has predictable outcomes with low complication rate and can be performed under regional block.</div></div><div><h3>Level of Evidence</h3><div>Level IV; Case series; Treatment Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103044"},"PeriodicalIF":0.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143947963","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 additional value of radiology reports in the follow-up of extremity fractures: a retrospective study in an academic hospital","authors":"Mare M.H. Walraven ,&nbsp;Pieta Krijnen ,&nbsp;David A. Vuijk ,&nbsp;Monique Reijnierse ,&nbsp;Inger B. Schipper ,&nbsp;Marco F. Termaat","doi":"10.1016/j.jcot.2025.103043","DOIUrl":"10.1016/j.jcot.2025.103043","url":null,"abstract":"<div><h3>Background</h3><div>Radiology reports on radiographic findings during follow-up (FU) after extremity fractures are generally not yet available when the patient is seen by the treating orthopedic trauma surgeon and may therefore be redundant. The aim of this study was to explore the inter-observer agreement on the reported findings of the FU radiograph between orthopedic trauma surgeons and radiologists.</div></div><div><h3>Method</h3><div>This retrospective cohort study included all FU radiographs of adult patients with an extremity fracture, treated in a Dutch university hospital between January 2022 and July 2023. The radiologist's and orthopedic trauma surgeon's assessments of unacceptable alignment, delayed/non-union and abnormalities associated with osteosynthesis material (OSM) on the FU radiographs were collected from the medical files. Fracture healing was considered normal in the absence of these findings. The interobserver agreement of the radiographic parameters between surgeon and radiologist was determined using Cohens' Kappa (κ). Additionally, incidental findings and their clinical relevance were explored.</div></div><div><h3>Results</h3><div>953 FU radiographs of 569 patients were included. The interobserver agreement was close to perfect for normal fracture healing (κ = 0.82, 95 % CI 0.77–0.88) and delayed/non-union (κ = 0.94, 95 % CI 0.89–0.99). The inter-observer agreement was substantial for unacceptable alignment of the fracture (κ = 0.80, 95 % CI 0.72–0.88) and abnormalities associated with the OSM (κ = 0.77, 95 % CI 0.65–0.89). Twenty-one incidental findings were diagnosed in the FU by the radiologist of which two were also independently described by the surgeon. Three of the findings that were missed or not described by the surgeon could have clinical significance, however the missing of these findings did not lead complications or additional hospital visits. These included two missed rib fractures and one osteochondral defect, which led to prolonged immobilization due to pain.</div></div><div><h3>Conclusion</h3><div>Radiographic reports in the FU of extremity fractures have limited additional value for clinical care and probably lacks cost-effectiveness or efficiency.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103043"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916096","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":"Single-incision anatomic technique yields good outcomes in acute and chronic distal biceps avulsions alike","authors":"D. Bodansky ,&nbsp;V. Gandbhir ,&nbsp;N. Modi ,&nbsp;J. Brookes ,&nbsp;M. Rathinam ,&nbsp;M. Pullagura","doi":"10.1016/j.jcot.2025.103042","DOIUrl":"10.1016/j.jcot.2025.103042","url":null,"abstract":"<div><h3>Background</h3><div>Distal biceps tendon ruptures can be treated with a single incision intervention, fixed with a combination of devices. Shorter time to surgery is expected to yield better results. Our hypothesis was that the timing of surgery whether within 4 weeks or beyond does not affect return to full work, post-operative range of motion or outcome scores.</div></div><div><h3>Methods</h3><div>The retrospective cohort consisted of consecutive adult patients referred to a U.K. hospital from 2012 to 2019 and received single incision anatomic repair for distal biceps rupture. Patients were stratified into two groups: an acute group, that received operation within 4 weeks and chronic group, beyond 4 weeks.</div></div><div><h3>Results</h3><div>52 patients were included, with 37 acute and 15 chronic. All participants were male, with a mean age of 43.5 (±8.01 SD). Patients underwent surgery at median of 6 days (Range 0–26) in acute group compared to median of 47 days (Range 29–147) in chronic group (p &lt; 0.00001). No significant differences were found as regards post-operative range of motion, QuickDASH scores and return to full work.</div></div><div><h3>Conclusion</h3><div>The timing of surgery whether within 4 weeks or beyond does not affect return to full work, functional outcome or post-operative range of motion.</div></div><div><h3>Level of evidence</h3><div>Level II.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103042"},"PeriodicalIF":0.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924619","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":"Management of open femur fractures with massive bone loss using two-stage vascularized fibula grafting and synthetic calcium sulfate: A report of two cases","authors":"Ajayakumar Thankappan,&nbsp;Nizaj Nasimudeen,&nbsp;Aadithya Rangarajan","doi":"10.1016/j.jcot.2025.103037","DOIUrl":"10.1016/j.jcot.2025.103037","url":null,"abstract":"<div><div>Type III Gustilo-Anderson fractures with massive bone loss present significant treatment challenges due to the extensive bony and soft tissue damage they entail. Poor management can lead to complications such as osteomyelitis, non-union, limb length discrepancies, or even amputation. We present two cases of 52- and 56-year-old adults who had complex intra-articular distal femur open fractures with massive bone loss of 21 cm and 18 cm, respectively, successfully managed using synthetic calcium sulfate beads and vascularized fibula grafting.</div><div>The use of calcium sulfate offers several advantages over polymethylmethacrylate (PMMA) beads, including more effective antibiotic delivery, greater osteogenicity, and reduced systemic toxicity of antibiotics. We recommend the use of calcium sulfate over PMMA in managing complex cases with bone defects.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103037"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143937724","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":"Comparing early functional outcomes between the midvastus and medial parapatellar approach for total knee arthroplasty: A prospective cohort study in an Asian population","authors":"Emrick Sen Hui Quah ,&nbsp;Brian Rui Kye Chee ,&nbsp;Lynn Thwin,&nbsp;Michael Gui Jie Yam","doi":"10.1016/j.jcot.2025.103033","DOIUrl":"10.1016/j.jcot.2025.103033","url":null,"abstract":"<div><h3>Background</h3><div>The medial parapatellar approach is the most prevalent approach for total knee arthroplasty. However, recent studies have suggested that the midvastus approach may confer benefits of better functional outcomes in the early post-operative period. This study aims to explore the differences in early functional outcomes between the two approaches.</div></div><div><h3>Methods</h3><div>This is a prospective cohort study of 72 total knee arthroplasties performed in a single tertiary institution. Baseline demographics and functional status were collected. Patients were followed up at the following time points - post-operative day 0, 1, 2, day of discharge and at first follow up 4–6 weeks post-surgery. The primary outcomes were range of motion, ambulatory distance, use of mobility aids, ability to straight leg raise and quadriceps strength – adjuncts to approximate functional recovery. Secondary outcomes include pain scores, operative time, length of stay, presence of any peri-operative complications, and patient discharge destination.</div></div><div><h3>Results</h3><div>Patients in the midvastus group achieved a greater ambulatory distance on post-operative day 1 compared to those in the medial parapatellar group (median ambulation distance 30m versus 18m, p &lt; 0.001). The time to straight leg raise was also shorter in the midvastus group (median duration 0 days vs 1 day, p = 0.016). There was no significant difference in length of stay, operative time or incidence of peri-operative complications.</div></div><div><h3>Conclusion</h3><div>The midvastus approach showed non inferior outcomes when compared to the classic medial parapatellar approach and may confer additional functional benefits in the form of shorter time to straight leg raise and longer ambulatory distances on post-operative day 1. Clinicians need to balance the purported benefits of the midvastus approach with the intraoperative technicalities of the midvastus approach, before deciding if it is suitable to be a standard approach to the knee in total knee arthroplasties.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103033"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924620","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":"Orthogonal soft tissue reconstruction for acute acromioclavicular joint dislocations: ‘A novel technique ensures predictable outcome’","authors":"Vikas Kulshrestha ,&nbsp;Anjan Prabhakara ,&nbsp;Soma Kulshrestha ,&nbsp;Munish Sood ,&nbsp;Manu Mohan ,&nbsp;Ibrahim Maishan","doi":"10.1016/j.jcot.2025.103032","DOIUrl":"10.1016/j.jcot.2025.103032","url":null,"abstract":"<div><h3>Background</h3><div>Acromioclavicular joint (ACJ) injuries are common in young active populations. Various surgical procedures have been described but each has had limited success. We have described a novel technique of open reduction of AC joint, and coracoclavicular fixation using synthetic tape followed by reconstruction of coracoclavicular and AC joint ligaments using hamstring graft to ensure healing and predictable outcome.</div></div><div><h3>Methods</h3><div>Twenty-five adults with severe ACJ dislocation were taken up for the open reduction of ACJ &amp; coracoclavicular fixation with fibretape tied and cinched over dog bone buttons through tunnels in the clavicle and base of the coracoid. This was followed by an autologous semitendinosus graft looped around the coracoid and clavicle in a figure-of-eight fashion. Patients were followed up over two years to look for maintained ACJ reduction and recovery of shoulder function using subjective and objective outcome assessment scores.</div></div><div><h3>Results</h3><div>Twenty-five patients with ACJ dislocation with a mean age of 30 years were operated using our technique. 84 % of them were active adult male patients. At a mean follow-up of 28 months (range 24–36), the mean Constant Score was 94.12 ± 6.2 (range 80–100) and was close to pre-injury level. The quick DASH score improved to 6.8 ± 7.18 from the baseline of 66.84 ± 14.18. The average European quality of life 5 Dimensions index improved from a baseline of 0.52 ± 0.05 to 0.92 ± 0.03. Only in two cases (8 %) there was loss of reduction with subluxation of AC joint.</div></div><div><h3>Conclusion</h3><div>Primary open reduction and fixation of ACJ after severe ACJ dislocation, when augmented with the biological reconstruction of coracoclavicular and acromioclavicular ligaments, promises predictable outcomes allowing return to preinjury level of activity in young adults.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103032"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900024","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":"Firearm violence and policy in the United States: A survey study on the perspectives of hand surgeons","authors":"Michael M. Vosbikian,&nbsp;Kiauntee Murray,&nbsp;Dominick V. Congiusta,&nbsp;Irfan H. Ahmed","doi":"10.1016/j.jcot.2024.102878","DOIUrl":"10.1016/j.jcot.2024.102878","url":null,"abstract":"<div><h3>Purpose</h3><div>Firearm ownership and gun control are subjects of great contention. As healthcare professionals responsible for treating firearm-related injuries, the opinions of hand surgeons are particularly relevant. The aim of this study is to determine the association between exposure to gun violence and opinions regarding gun control or the role of the surgeon in the gun control debate and if gun ownership status correlates with these opinions.</div></div><div><h3>Methods</h3><div>A survey comprised of 24 multiple-choice and free text questions was distributed to the email database of the ASSH. The survey identified factors related to surgeon's practices, such as practice setting, location, and training background. Questions regarding surgeons' experiences with firearms and opinions on the responsibility of surgeons to take part in policymaking were assessed. Chi square, Kendall, binary logistic, and ordinal regression analyses were conducted as appropriate.</div></div><div><h3>Results</h3><div>A total of 578 responses were received. Approximately 17 % of respondents reported treating firearm injuries frequently (several times per month). The majority of respondents report feeling comfortable with treating such injuries.</div><div>Disagreement with current gun policies was found in half of respondents. The majority of surgeons feel that they do not have a responsibility to be involved in the gun control debate. Firearm ownership was positively associated with belief in the second amendment as a basic right, acceptable recreational gun use, the belief that guns create a safer home, and the belief that adequate resources are available. Years of practice and comfort in treating firearm-related injuries were not associated with any response.</div></div><div><h3>Conclusions</h3><div>These objective findings may better inform on the opinions of healthcare professionals directly involved in the treatment of firearm injuries. Awareness of the origins of opinions on both sides of the debate are critical to fostering productive conversations.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 102878"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898864","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":"A Narrative review of advancements in knee Arthroplasty: Analyzing diverse prosthetic materials and their implications","authors":"Shahzad Waqas Munazzam ,&nbsp;Vikramaditya Rai ,&nbsp;Shaista Nousheen ,&nbsp;Basharat Ullah ,&nbsp;Sajjal Sharif ,&nbsp;Cara Mohammed","doi":"10.1016/j.jcot.2025.103034","DOIUrl":"10.1016/j.jcot.2025.103034","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Knee arthroplasty (KA) represents a transformative milestone in the management of degenerative knee conditions, significantly improving patient mobility and quality of life. Over the decades, material innovations have driven advancements in implant design, addressing challenges such as wear, biocompatibility, and longevity. This review provides a comprehensive evaluation of traditional and cutting-edge materials used in KA, analyzing their properties, clinical outcomes, and economic implications while identifying future research directions.&lt;/div&gt;&lt;div&gt;Traditional materials, including cobalt-chromium and titanium alloys, ultra-high-molecular-weight polyethylene (UHMWPE), and ceramics, have been the cornerstone of knee implant technology. These materials offer durability, wear resistance, and compatibility with biological tissues, but long-term complications, such as polyethylene wear and aseptic loosening, have necessitated further advancements. Recent developments, such as highly cross-linked polyethylene (HXLPE) and vitamin E-infused polyethylene, have improved wear resistance and oxidative stability, thereby reducing revision rates. Similarly, ceramic materials, including zirconia-toughened alumina and silicon nitride, have emerged as promising alternatives due to their exceptional wear resistance and biocompatibility, although brittleness and higher manufacturing costs remain barriers to widespread use.&lt;/div&gt;&lt;div&gt;Advancements in metallic alloys, such as oxidized zirconium and porous tantalum, have further refined KA implants. These materials exhibit superior osseointegration, reduced stress shielding, and improved implant fixation, enhancing patient outcomes. Additionally, the adoption of bioactive coatings like hydroxyapatite and the utilization of 3D-printed personalized implants have revolutionized the fabrication process, offering patient-specific solutions and improved bone integration. Innovations in smart technologies, including self-healing materials, antibacterial surfaces, and sensor-integrated implants, present exciting opportunities for real-time monitoring, infection prevention, and adaptive design.&lt;/div&gt;&lt;div&gt;The biomechanical properties of these materials significantly influence joint kinematics, wear patterns, and implant survival rates. Materials with lower elastic moduli, mimicking the properties of natural bone, minimize stress shielding and improve load distribution. Advanced ceramics and polyethylene composites reduce debris generation and osteolysis, contributing to extended implant longevity. Biological responses, including reduced hypersensitivity and enhanced osteoblast differentiation, further underline the importance of material selection in KA.&lt;/div&gt;&lt;div&gt;Clinical studies consistently demonstrate the efficacy of advanced materials in reducing revision rates and improving patient-reported outcomes. For instance, oxidized zirconium implants and ceramic-on-HXLPE bearings show superior long-term performance compa","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103034"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143900115","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":"Comparative morbidity and mortality following primary total shoulder arthroplasty in octogenarians with and without diabetes in the United States","authors":"Theodore Quan ,&nbsp;Jeffrey Y. Wang ,&nbsp;Philip M. Parel ,&nbsp;Joseph E. Manzi ,&nbsp;Benjamin J. Farley ,&nbsp;Sean A. Tabaie ,&nbsp;Zachary R. Zimmer","doi":"10.1016/j.jcot.2025.103027","DOIUrl":"10.1016/j.jcot.2025.103027","url":null,"abstract":"<div><h3>Background</h3><div>Diabetic patients face higher risks of postoperative medical complications and surgical issues in various orthopedic surgeries. It is essential to understand if these risks differ in the older geriatric population. Therefore, this study sought to assess whether diabetic octogenarians exhibit elevated thirty-day morbidity and mortality risks in comparison to non-diabetic octogenarians after primary total shoulder arthroplasty (TSA).</div></div><div><h3>Methods</h3><div>Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Octogenarians who received primary TSA from 2006 to 2019 were categorized into diabetic and non-diabetic groups. Demographic information, additional medical conditions, and postoperative complications were gathered and analyzed between the two groups using both univariate statistics and multivariate logistic regression.</div></div><div><h3>Results</h3><div>After adjusting for multiple variables, diabetic octogenarians exhibited a higher risk of bleeding requiring blood transfusions (OR 1.52; p = 0.032) and prolonged hospital stays (OR 1.41; p = 0.001) compared to their non-diabetic counterparts. No significant difference in mortality rates was observed between the two cohorts (p = 0.173).</div></div><div><h3>Conclusion</h3><div>Primary TSA appears to be a generally safe procedure for diabetic octogenarians, though these patients demonstrate increased risks for blood transfusions and prolonged hospital stays compared to non-diabetes.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103027"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906190","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":"Ascending the reconstructive ladder – Our experience and outcomes with free anterolateral thigh flap in upper limb trauma","authors":"Prakash Chandra Kala,&nbsp;R. Saradha,&nbsp;Deepti Katrolia,&nbsp;Shilpi Karmakar","doi":"10.1016/j.jcot.2025.103030","DOIUrl":"10.1016/j.jcot.2025.103030","url":null,"abstract":"<div><h3>Background</h3><div>Reconstructive surgeons face a unique challenge while reconstructing post-traumatic complex upper limb defects, as the goal is not merely to resurface the defect but also to restore motor and sensory function as well as aesthetics. Free tissue transfer offers a single-stage, comprehensive reconstruction in such a setting. This study describes our experience in the use of the free Anterolateral Thigh (ALT) flap to reconstruct complex upper limb defects and its postoperative outcomes.</div></div><div><h3>Methods</h3><div>A cohort of 17 patients who underwent free ALT flap for upper limb reconstruction was assessed postoperatively at 3 and 6 months for aesthetic, functional and sensory outcomes.</div></div><div><h3>Results</h3><div>Key findings include a high overall success rate (94.1 %) with acceptable patient and observer-reported aesthetic scores, a good functional recovery at 6 months, a mean disability score of 11.51 %, and a mean grip strength of 90.38 % compared to the contralateral limb.</div></div><div><h3>Conclusion</h3><div>The study highlights the effectiveness of free ALT flap in providing reliable, high-quality soft tissue coverage with minimal donor site morbidity. The study also reinforces its preference for the reconstruction of complex upper limb trauma, supporting excellent functional recovery, thereby ensuring an early return to work and a better quality of life.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103030"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924711","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}