Journal of Clinical Orthopaedics and Trauma最新文献

{"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}

{"title":"Diagnostic pitfalls and conservative management of acute culture-negative arthritis following total knee arthroplasty","authors":"Maria Surroca ,&nbsp;Laura Berbel-Arcobé ,&nbsp;Marti Bernaus ,&nbsp;Margarita Veloso ,&nbsp;Silvia Miguela ,&nbsp;Lluís Font-Vizcarra","doi":"10.1016/j.jcot.2026.103357","DOIUrl":"10.1016/j.jcot.2026.103357","url":null,"abstract":"<div><h3>Background</h3><div>Acute inflammatory arthritis after total knee arthroplasty (TKA) may closely mimic acute hematogenous periprosthetic joint infection (PJI), often leading to invasive surgical treatment. When microbiological cultures are negative, distinguishing between infectious and non-infectious causes remains particularly challenging.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of 11 episodes of acute arthritis in 9 patients following TKA treated between January 2012 and December 2021. Acute arthritis was defined by sudden onset of symptoms within 72 h after a previously pain-free period, regardless of time from arthroplasty. All cases had negative synovial fluid and intraoperative cultures and no documented antibiotic exposure prior to aspiration. Clinical presentation, laboratory findings, management strategies, and outcomes were analyzed.</div></div><div><h3>Results</h3><div>The median patient age was 79 years. All patients presented with abrupt knee pain and swelling. Inflammatory markers were markedly elevated (median C-reactive protein 90 mg/L), and synovial leukocyte counts were high (median 75,883 cells/mm³; median polymorphonuclear cells 88.3%), exceeding commonly accepted thresholds for PJI. Despite this, all cultures remained negative. Seven episodes were initially treated surgically with debridement and antibiotics, while four were managed conservatively. All patients achieved clinical resolution. Two patients experienced a second episode, both resolving with non-steroidal anti-inflammatory drugs. No subsequent prosthetic joint infections were observed during a median follow-up of 36 months.</div></div><div><h3>Conclusion</h3><div>Acute inflammatory arthritis following TKA can present with synovial fluid and laboratory findings indistinguishable from PJI. In clinically stable patients with persistently negative cultures, absence of systemic signs of infection, and early clinical and laboratory improvement, a conservative management strategy with close monitoring may be considered to avoid unnecessary surgical intervention.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103357"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175084","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":"EXTROS (EXtensor Repair & Transfer Outcome Score): Validation of a unified, percentage-based metric for extensor tendon repairs and transfers","authors":"J. Terrence Jose Jerome ,&nbsp;G. Surendran ,&nbsp;Kuppusamy Thirumagal","doi":"10.1016/j.jcot.2026.103358","DOIUrl":"10.1016/j.jcot.2026.103358","url":null,"abstract":"<div><h3>Background</h3><div>Outcome reporting for extensor tendon surgery is fragmented. Legacy systems—Miller for repairs and Bincaz for transfers—use different success definitions, limiting comparison. Building on the composite framework proposed by Jerome et al. (wrist arc, forearm rotation, MCP extension/flexion, first-web opening, grip/pinch; all normalized to the contralateral side), we adopted this construct as the EXTensor Repair &amp; Transfer Outcome Score (EXTROS) and validated its measurement properties across repairs and transfers.</div></div><div><h3>Methods</h3><div>EXTROS summarizes domain percentages into an overall grade: Good (&gt;75%), Fair (50–75%), Poor (&lt;50%). We evaluated 80 patients at ≥4 months (mean 6): 40 acute repairs (zones III–VII) and 40 tendon transfers (radial palsy or rheumatoid attrition). Two blinded raters scored EXTROS. We calculated Cohen's κ and ICC for reliability, Cronbach's α for internal consistency, correlations with DASH, ROM%, grip%, and pulp-to-palm for construct validity, and agreement with Miller (repairs) and Bincaz (transfers) for criterion validity.</div></div><div><h3>Results</h3><div>Mean age 36.8 ± 11.5 years; 70% male. EXTROS graded 85% as Good. Inter-rater agreement 90%; κ = 0.85 (95% CI 0.78–0.92); continuous score ICC = 0.95. Internal consistency α = 0.88. Construct validity was strong: EXTROS correlated with DASH (<em>r</em> = −0.72), ROM% (<em>r</em> = +0.80), grip% (<em>r</em> = +0.77), and pulp-to-palm (ρ = −0.65) (all p &lt; 0.001). Criterion validity was substantial: Bincaz vs EXTROS 95% agreement (κ = 0.78) and Miller vs EXTROS 90% (κ = 0.82).</div></div><div><h3>Conclusions</h3><div>EXTROS is reliable, valid, and straightforward. As a unified, percentage-based Good/Fair/Poor grade, it enables consistent reporting across repairs and transfers, supports clinical decisions, and provides a pragmatic standard for future studies of extensor tendon injuries.</div></div><div><h3>Level of evidence</h3><div>Level IV (observational validation/case series).</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103358"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175086","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":"Covariates associated with pulmonary complications including unplanned intubation after total knee arthroplasty","authors":"Pranay Gadikota ,&nbsp;Thor S. Stead ,&nbsp;Latha Ganti","doi":"10.1016/j.jcot.2026.103362","DOIUrl":"10.1016/j.jcot.2026.103362","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is widely regarded as a safe procedure. Yet pulmonary complications do occur sometimes, requiring unplanned intubation, creating difficulties with ventilator weaning, or resulting in pneumonia. Our goal was to identify which risk factors are most strongly associated with these respiratory complications after TKA using the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) database.</div></div><div><h3>Methods</h3><div>The NSQIP database is a comprehensive de-identified registry of surgical outcomes. Our analytical approach proceeded in two phases. Initially, we conducted univariate analyses to screen individual factors for associations with our three primary outcomes: unplanned intubation, failure to wean from mechanical ventilation, and the development of pneumonia.</div><div>Factors showing statistical significance in this preliminary screening then advanced to multivariate logistic regression modelling. Variables included patient demographics, such as age and sex, relevant comorbidities (such as diabetes, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF), functional status, key laboratory parameters (such as white blood cell (WBC) and platelet counts), American Society of Anesthesiologists (ASA) classification, and anesthesia approach. Statistical significance was defined as p &lt; 0.05.</div></div><div><h3>Results</h3><div>The strongest predictors across the three outcomes of unplanned intubation, failure to wean, and pneumonia, in descending order, were age, ASA classification, history of COPD, and history of CHF.</div></div><div><h3>Conclusion</h3><div>Our study found that the risk of pulmonary complications within 30 days following total knee arthroplasty was independently associated with older age, higher ASA class, and history COPD or CHF, increased operative time, and elevated preoperative WBC count.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"74 ","pages":"Article 103362"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146175471","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}