Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Nail plate combination technique for periprosthetic supracondylar femur fractures: How far have we come?","authors":"Jaclyn M. Jankowski,&nbsp;Christian G. Zapf,&nbsp;Ian S. Hong,&nbsp;Joseph G. Miceli,&nbsp;Richard S. Yoon,&nbsp;Frank A. Liporace","doi":"10.1016/j.jcot.2025.102969","DOIUrl":"10.1016/j.jcot.2025.102969","url":null,"abstract":"<div><div>Open reduction and internal fixation for periprosthetic supracondylar femur fractures (PPFx) around a stable total knee arthroplasty (TKA) remains the gold standard, with the nail plate combination (NPC) technique offering increased biomechanical stability and high union rates. Advances in implant technology, particularly the introduction of the novel lateral locking attachment washer (LAW), have increased the availability of NPC options in the treatment of these technically demanding and complex cases. In this technical paper, we discuss two cases: Case 1 – describing the traditional NPC technique utilizing a retrograde intramedullary nail and lateral distal femoral locking plate; Case 2 – describing the NPC technique utilizing a retrograde nail and a novel LAW implant, which is now the authors’ more commonly utilized technique. Managing PPFx around a TKA implant remain a challenge, however, the integration of the LAW and newer generation of retrograde intramedullary nails have marked significant progress in treating these complex fractures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102969"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619476","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":"Estimation of adductor ratio in the Indian population: Is it a reliable indicator for recreating joint line of the knee?","authors":"Yuvarajan Palanisamy,&nbsp;Abhijit Jawali,&nbsp;Arjun R. Prasad,&nbsp;David V. Rajan","doi":"10.1016/j.jcot.2025.102970","DOIUrl":"10.1016/j.jcot.2025.102970","url":null,"abstract":"<div><h3>Background</h3><div>Accurate restoration of the joint line is critical in revision total knee arthroplasty (r-TKA) to ensure proper ligament tension and optimize functional outcomes.</div></div><div><h3>Objective</h3><div>To determine the adductor ratio in the Indian population and assess its reliability for restoring the joint line in primary total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>The study consisted of two parts. In the first part, 93 young, non-arthritic individuals were evaluated radiologically to estimate the adductor ratio. In the second part, 47 patients with grade IV osteoarthritis undergoing primary TKA were included. Pre-operative radiographic and intraoperative calliper measurements of the adductor tubercle to joint line distance (ATJL) and femoral width (FW) were taken. Pearson correlation was estimated between FW and ATJL, and Bland-Altman analysis was used to assess the agreement between pre-operative and intra-operative measurements. The error in using a standard adductor ratio was estimated.</div></div><div><h3>Results</h3><div>The mean adductor ratio in the non-arthritic population was 0.542, with a strong correlation between ATJL and FW (r = 0.81, p &lt; 0.001). In the second part, the mean adductor ratio was consistent pre-operatively (0.53) and intra-operatively (0.54), with a bias of 0.001 and 95 % limits of agreement from −0.062 to 0.065. The estimated ATJL was within 5 mm of the actual measurement in 95 % of cases.</div></div><div><h3>Conclusion</h3><div>The adductor ratio of 0.54 is a reliable indicator for joint line restoration in the Indian population. Documentation of ATJL and FW during primary TKA is recommended for enhancing accuracy in joint line reconstruction in revision scenarios.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102970"},"PeriodicalIF":0.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628227","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":"Survey of management of ankle fracture blisters in Yorkshire among orthopaedic surgeons","authors":"Praise Kess Briggs ,&nbsp;Jeevith Shetty Sowkoor ,&nbsp;Adnan Abdulmajeed Faraj","doi":"10.1016/j.jcot.2025.102955","DOIUrl":"10.1016/j.jcot.2025.102955","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of ankle fracture blisters is contentious. This study aims to evaluate the management of ankle fracture blisters among orthopedic surgeons in Yorkshire and establish a consensus.</div></div><div><h3>Methods</h3><div>A questionnaire was distributed among Orthopaedic Surgeons in Yorkshire, United Kingdom, to gain insight into their management of ankle fracture blisters. Responses were processed in Excel spreadsheet, chi-squared analysis was done, comparing the responses of foot and ankle surgeons with other orthopaedic surgeons.</div></div><div><h3>Results</h3><div>There were 69 respondents (58 % of whom were consultants, 7 % associate specialists and 35 % registrars) out of 125 surgeons invited to participate (55.2 % response rate). 17 were foot and ankle surgeons. For most respondents, the type of blister (haemorrhagic or serosanguinous) does not affect decision around timing of surgery. 76 % say that blister location affects the placement of skin incision. 19 % would make their skin incisions irrespective of blister location and 5 % had variable responses to this. 43 surgeons would defer the surgical fixation of the fracture if the blister were at the incision site, while 22 (32 %) would defer surgery if blister is extensive, but not as incision site. If surgery is deferred because of the blister, 52 % will wait till skin creases return while others would wait a variable period. While waiting, 67 % would immobilize with a plaster cast if appropriate, 56 % would use an external fixator. 65 % think that blisters increase the risk of infection, however, 97 % will not prescribe any systemic antibiotics for ankle fracture blisters. The most preferred dressing for blisters is Inadine and Mepitel.</div></div><div><h3>Conclusion</h3><div>Majority of Orthopaedic Surgeons in Yorkshire consider ankle fracture blisters to be significant in determining the management of patients with ankle fractures; however significantly more foot and ankle surgeons opine that blisters should not cause delay in definitive fixation of ankle fractures.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102955"},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578556","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":"Enhancing agreement in classification and surgical approach selection for tibial plateau fractures: The role of identifying metaphyseal fracture exit. - A Cross-sectional study","authors":"Jaime A. Leal ,&nbsp;Natalia Rodríguez ,&nbsp;Stephanie Renza ,&nbsp;Georgina González ,&nbsp;Carlos A. Sanchéz","doi":"10.1016/j.jcot.2025.102954","DOIUrl":"10.1016/j.jcot.2025.102954","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine if identifying the metaphyseal exit can enhance intra- and inter-observer agreement in utilizing the Kfuri and Schatzker anatomical classification and selecting the appropriate surgical approach for tibial plateau fractures.</div></div><div><h3>Methods</h3><div>Design: Cross-sectional observational study.</div><div>Setting: Academic hospital with access to advanced imaging technologies.</div><div>Patient Selection Criteria: Tibial plateau fracture cases from January 2019 to March 2021 with complete image sets (AP and lateral knee radiographs, CT scans). Exclusion criteria included periprosthetic, neglected, or pathological fractures.</div><div>Outcome Measures and Comparisons: Primary outcome measures were intra- and inter-observer agreement in fracture classification and surgical approach selection, quantified using Cohen's and Fleiss Kappa coefficients.</div></div><div><h3>Results</h3><div>The study analyzed 63 cases. Intra-observer agreement improved from moderate to 'very good,' especially in the third evaluation phase when the metaphyseal exit was identified alongside 3D CT imaging. Inter-observer agreement was generally low but improved when comprehensive image sets were available. Notably, the most experienced evaluator demonstrated significantly higher agreement in both fracture classification and surgical approach selection.</div></div><div><h3>Conclusions</h3><div>The identification of metaphyseal exit points significantly enhances agreement in fracture classification and surgical approach selection, addressing limitations of traditional systems. While surgeon experience and imaging availability remain critical, incorporating the metaphyseal exit into the Kfuri and Schatzker classification offers a reproducible framework for guiding treatment decisions.</div></div><div><h3>Level of evidence</h3><div>III Diagnostic Study.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102954"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578555","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":"Bibliometric studies: Essential navigational tools in today's academic landscape","authors":"Raju Vaishya (Senior Consultant Orthopaedics),&nbsp;Brij Mohan Gupta (Retired Scientist)","doi":"10.1016/j.jcot.2025.102952","DOIUrl":"10.1016/j.jcot.2025.102952","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102952"},"PeriodicalIF":0.0,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of age and timing of hip orthosis on treatment outcomes in infants with developmental dysplasia of the hip: A systematic review and meta-analysis","authors":"Daniela Alessia Marletta ,&nbsp;Biagio Zampogna ,&nbsp;Gabriele Giuca ,&nbsp;Matteo Nanni ,&nbsp;Sanzarello Ilaria ,&nbsp;Danilo Leonetti","doi":"10.1016/j.jcot.2025.102944","DOIUrl":"10.1016/j.jcot.2025.102944","url":null,"abstract":"<div><h3>Background</h3><div>Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1–3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH.</div></div><div><h3>Methods</h3><div>This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing.</div></div><div><h3>Results</h3><div>Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes.</div></div><div><h3>Conclusion</h3><div>Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia.</div></div><div><h3>Level of evidence</h3><div>Level IV</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102944"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512603","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":"Outcomes of arthroscopic rotator cuff repair via single-row anchor technique versus transosseous anchorless technique: A randomized controlled trial","authors":"Mustafa Mohamed Mesriga,&nbsp;Mohamed Kamal Mesregah,&nbsp;Ahmed Abdel-Monem Dewidar,&nbsp;Hany Elsayed Saad,&nbsp;Ayman Mohamed Ebied","doi":"10.1016/j.jcot.2025.102951","DOIUrl":"10.1016/j.jcot.2025.102951","url":null,"abstract":"<div><h3>Background</h3><div>Rotator cuff tears can be addressed using various repair techniques. This study sought to compare the clinical and radiologic outcomes and costs after arthroscopic single-row anchor repair and arthroscopic transosseous repair for small to medium-sized tears.</div></div><div><h3>Methods</h3><div>The study was a prospective randomized clinical trial (registered as trial number PACTR202404475835971 in the Pan African Clinical Trial Registry, Apr 04, 2024) that included 62 patients, randomized into two equal groups. Group A: single-row anchor repair (n = 31) and Group B: transosseous repair (n = 31). Patients were clinically evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Oxford Shoulder Score (OSS), in addition to evaluation of range of motion (ROM) of forward flexion, external rotation (ER), and internal rotation (IR). Total implant costs were calculated and compared.</div></div><div><h3>Results</h3><div>In both groups, the ROM increased significantly, P &lt; 0.001. The mean differences between preoperative and postoperative forward flexion, ER, and IR were comparable in both groups, P = 0.933, 0.817, and 0.151, respectively. The mean ASES score and OSS improved significantly in both groups at last follow-up, P &lt; 0.001. The mean follow-up ASES score was 91.1 ± 3.5 in Group A and 90.8 ± 2.7 in Group B, P = 0.818. The mean follow-up OSS was 42.4 ± 2.1 in Group A and 41.5 ± 1.9 in Group B, P = 0.214. The average financial cost of operation was significantly lesser in the transosseous group than the anchors group, P &lt; 0.001.</div></div><div><h3>Conclusion</h3><div>Anchorless transosseous rotator cuff repair can achieve similar excellent functional outcomes as the single-row anchor repair, with equivalent tendon healing results. However, the transosseous technique has substantially lower costs.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102951"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512602","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":"Posterolateral corner ligament reconstruction in knee arthroscopy: Complications and complication management","authors":"Juan Bernardo Villarreal-Espinosa,&nbsp;Monique Haynes,&nbsp;Eric J. Cotter,&nbsp;Rodrigo Saad Berreta,&nbsp;Jourdan M. Cancienne,&nbsp;Nikhil N. Verma,&nbsp;Jorge Chahla","doi":"10.1016/j.jcot.2025.102948","DOIUrl":"10.1016/j.jcot.2025.102948","url":null,"abstract":"<div><div>The posterolateral corner (PLC), composed of three static stabilizers including the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, collectively provide posterolateral knee stability (varus and external rotation). Disruption of this complex typically occurs in the setting of concomitant multi-ligament knee injuries (MLKI), typically requiring surgical management for restoration of knee stability. Anatomic surgical reconstructions have been shown to outperform non-anatomic reconstructions or repairs, yet are technically challenging and are not exempt of complications. The present review will address the anatomy and biomechanics of the involved structures, detail the senior author's anatomic three ligament tibiofemoral based reconstruction technique, and provide tips and tricks for avoiding the most frequently associated intraoperative and postoperative complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102948"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512605","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":"Radiographic outcomes of dorsal spanning plate with and without volar plate fixation for comminuted intraarticular distal radius fractures","authors":"Daniel Calem,&nbsp;Matthew Weintraub,&nbsp;Michael Vosbikian,&nbsp;Irfan Ahmed","doi":"10.1016/j.jcot.2025.102949","DOIUrl":"10.1016/j.jcot.2025.102949","url":null,"abstract":"<div><h3>Purpose</h3><div>Dorsal spanning plate fixation for comminuted intra-articular distal radius fractures involves indirect reduction via ligamentotaxis, potentially resulting in suboptimal restoration of native anatomy. Displaced volar fragments may necessitate separate buttress support with a volar plate. This objective of this study was to retrospectively compare radiographic outcomes between distal radius fractures managed with dorsal spanning plate fixation alone versus dorsal spanning plate fixation with concomitant volar plating.</div></div><div><h3>Methods</h3><div>A retrospective review identified 51 distal radius fracture cases treated with dorsal spanning plate fixation, with 35 receiving isolated dorsal spanning plate fixation and 16 receiving dorsal spanning plate fixation with a concomitant volar plate. Radiographic parameters were measured at plate application and removal.</div></div><div><h3>Results</h3><div>Final radiographs for isolated dorsal spanning plate fixation vs. dorsal spanning and volar plate fixation showed similar outcomes: radial height (9.3 mm vs. 8.9 mm, p = 0.8), ulnar variance (−2.77 mm vs. −2.47 mm, p = 0.76), radial inclination (18.8° vs. 16.3°, p = 0.21), volar tilt (1.3° vs. 2.8°, p = 0.45), and teardrop angle (48.9° vs. 51.0°, p = 0.32). Little to no loss of radiographic alignment was observed between time points.</div></div><div><h3>Conclusions</h3><div>Radiographic outcomes for distal radius fractures treated with dorsal spanning plate fixation alone versus dorsal spanning plate and volar plate fixation are comparable, with suboptimal restoration of volar tilt and teardrop angle.</div></div><div><h3>Level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102949"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445556","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":"Hintegra® total ankle replacement. Five and 10 year survivorship analysis, clinical outcomes, complications and satisfaction rates","authors":"D. Protheroe ,&nbsp;A. Gadgil ,&nbsp;G. Davies","doi":"10.1016/j.jcot.2025.102950","DOIUrl":"10.1016/j.jcot.2025.102950","url":null,"abstract":"<div><h3>Background</h3><div>This study retrospectively evaluated a consecutive series of patients who underwent Total Ankle Replacement (TAR) with the third-generation mobile bearing Hintegra® prosthesis performed by a single non-designer surgeon. Few studies reporting outcomes from total ankle replacement (TAR) have been published by non-designer investigators. Clinical outcomes, complication and satisfaction rates have also been analysed.</div></div><div><h3>Method</h3><div>A consecutive series of 52 patients that received 55 TAR were reviewed between 2008 and 2016. Kaplan-Meier survival analysis was performed on all of the 55 TAR. Change in AOFAS hind foot scores from pre to post surgery and self-reported satisfaction scores were analysed.</div></div><div><h3>Results</h3><div>The 10 year survival analysis group had a minimal mean follow up of 10 years (SD 1.5, median 8.5, min 7.0. max 12.9), with a survival rate of 87 % (CI 0.74 to 0.94). Five-year survival rate was 93 % (CI 0.82 to 0.97). Six ankles (11 %) had to be revised. One having a talar component revision with polyethylene exchange and the remaining five with a conversion to arthrodesis. Only thirty-eight of the original 55 TAR were analysed for outcome measures. Seventeen patients were lost to follow up and 19 patients were deceased. In total 79 % (30) patients were satisfied with the TAR procedure with sixteen patients reporting to be extremely satisfied. Sixteen per cent (6) patients reported to be neutral and only 5 % (2) patients stated that they were not satisfied with the TAR procedure.</div></div><div><h3>Conclusions</h3><div>Our results show that the Hintegra® TAR prosthesis leads to good medium to long term survivorship and acceptable patient satisfaction rates. The results of these cases, all treated by a single non-designer surgeon in a low-volume practice, demonstrate that acceptable outcomes may be achieved outside of high-volume TAR centres.</div></div><div><h3>Level of evidence</h3><div>Retrospective analysis – Level III.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"64 ","pages":"Article 102950"},"PeriodicalIF":0.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143471477","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}