Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Comparative efficacy of advanced and traditional wound dressings in post-operative orthopaedic care for hip and knee surgeries: A randomized controlled trial","authors":"Nidhi Srivastava ,&nbsp;Manisha ,&nbsp;Amresh Ghai ,&nbsp;Meenu Goyal ,&nbsp;Manoj Kumar ,&nbsp;Manoj Kumar","doi":"10.1016/j.jcot.2025.102933","DOIUrl":"10.1016/j.jcot.2025.102933","url":null,"abstract":"<div><h3>Background</h3><div>This randomized controlled study aimed to evaluate the efficacy of three advanced dressings (Aquacel Ag®, Opsite® Post-Op, and Mepilex Border Post-Op®) versus traditional dressings in post-operative care for patients undergoing orthopaedic hip or knee surgeries.</div></div><div><h3>Methods</h3><div>Conducted between August and December 2022 at a tertiary care orthopaedic centre, 314 patients were randomized into four groups. Group A received Aquacel Ag®, Group B received Opsite® Post-Op, Group C received Mepilex Border Post-Op®, and Group D received traditional dressings. The primary outcomes measured were pain levels during dressing changes, exudate management, patient comfort, nurses’ ease of application and removal of the dressing, and surgical site complications. Multivariate analysis, including logistic regression, was performed to adjust for potential confounders (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID NCT06540040).</div></div><div><h3>Results</h3><div>Mepilex Border Post-Op® (Group C) significantly outperformed other dressings in key areas. Pain levels during dressing changes were consistently lower in this group on Day 3 (3.5 ± 0.8 vs. 6.0 ± 1.1 in the traditional dressing group, p = 0.002) and at day 7 &amp; 14 as well. Exudate management was effective with Mepilex Border Post-Op®. Group C patients reported the highest comfort and mobility scores on a Likert scale with easy application and removal. Surgical site complications were minimal, with only 1.2 % of Group C patients affected by Day 14 compared to 9.8 % in Group D (p = 0.003). Multivariate analysis confirmed that Mepilex Border Post-Op® significantly reduced surgical site complications and improved patient comfort, with adjusted odds ratios favouring this dressing over traditional options.</div></div><div><h3>Conclusion</h3><div>Mepilex Border Post-Op® (a 4-layer hydrophilic foam dressing) demonstrated benefits in post-operative care, reducing pain and complications while improving patient comfort. Single centre design with a limited sample size of the present study limits the generalizability of our findings. Further research is warranted to confirm these findings in broader clinical settings.</div></div><div><h3>Trial registration number</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> ID NCT06540040.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"63 ","pages":"Article 102933"},"PeriodicalIF":0.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454995","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":"Hand in hand with healthcare: A nationwide analysis of emergency department encounters for hand ailments","authors":"Heather A. Peluso ,&nbsp;Sajni S. Parikh ,&nbsp;Marwan S. Abougergi ,&nbsp;Adam C. Walchak","doi":"10.1016/j.jcot.2025.102943","DOIUrl":"10.1016/j.jcot.2025.102943","url":null,"abstract":"<div><h3>Background</h3><div>Hand ailments are frequent reasons for emergency department (ED) visits in the United States. This study analyzed the incidence, causes, outcomes, predictors of hospitalization, and healthcare utilization patterns nationwide.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized data from the Nationwide Emergency Department Sample and National Readmission Database from 2016 to 2021. It included patients with a principal diagnosis of hand or wrist complaints.</div></div><div><h3>Results</h3><div>The study included 29,109,534 ED visits for hand ailments. The mean patient age was 36 years. Most patients were Caucasian (61 %), healthy (89 % Charlson Comorbidity score of 0), male (57 %), and from lower income brackets (60 %). Most injuries were unintentional (71 %), with hand lacerations being the most common reason for presentation, followed by closed distal radius fractures. Most patients were discharged home (96 %). Predictors of admission included older age (adjusted odds ratio (aOR) per decade: 1.03; 95 % Confidence Interval (CI): 1.02–1.03; p &lt; 0.01), higher Charlson index (aOR:1.69; CI:1.65–1.73; p &lt; 0.01), Medicaid insurance or uninsured (aOR:1.26; CI:1.18–1.36, aOR:1.25; CI:1.16–1.36; p &lt; 0.01, respectively), and presentation at level I metropolitan trauma teaching hospitals (aOR:3.48; CI:2.98–4.07; p &lt; 0.01). Admission rates increased by 21 % in 2020 compared to 2016. Healthcare expenditure was a staggering $105 billion in total ED and inpatient hospitalization charges. Expenditure increased significantly, surpassing inflation-adjusted rates.</div></div><div><h3>Conclusions</h3><div>Our analysis of 29 million patients highlights the healthcare burden posed by hand ailments, with lacerations being the most prevalent concern in emergency settings. Admission and readmission rates were influenced by age, comorbidities, socioeconomic status, insurance type, and hospital characteristics. This study provides a basis for targeted interventions in patient outcome enhancement and resource allocation. Limitations include the reliance on ICD-10-CM coding in the absence of clinical data, which may impact the accuracy of case identification and classification.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"63 ","pages":"Article 102943"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454996","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":"Treating insertional Achilles tendinitis with bio inductive collagen scaffold - Does it improve outcomes? A case series","authors":"Gil Genuth ,&nbsp;Lukas D. Iselin","doi":"10.1016/j.jcot.2025.102931","DOIUrl":"10.1016/j.jcot.2025.102931","url":null,"abstract":"<div><h3>Background</h3><div>Achilles tendinopathy is a prevalent musculoskeletal condition, affecting approximately 6% of the population at some point in their lives. Insertional Achilles tendinopathy (IAT) is often associated with Haglund deformity (HD), and several surgical interventions exist to address this pathology. Bio-inductive Collagen Scaffolds (REGENETEN™ Smith &amp; Nephew) is a novel bio-inductive scaffold that supports the body's intrinsic healing processes, promoting the growth of new tendon-like tissue. The application of Bio-inductive Collagen Scaffolds in the treatment of IAT and Haglund syndrome represents a relatively recent advancement. This study aims to present our experiences with the use of Bio-inductive Collagen Scaffolds (REGENETEN™) for treating IAT.</div></div><div><h3>Materials and methods</h3><div>This investigation is a retrospective case series involving a single surgeon's experience with eight patients diagnosed with IAT and HD who underwent surgery utilizing Bio-inductive Collagen Scaffolds as an adjunct to standard treatment modalities between 2022 and 2023. The study was classified as a service evaluation by the local ethics committee. Data collected included age, comorbidities, complications, and AOFAS hindfoot scores pre-operatively and at six months postoperatively. Pre-operative and six-month postoperative MRI scans were similarly analysed.</div></div><div><h3>Results</h3><div>The mean age of participants was 52.6 years (range: 43–65), with 50% of the cohort being female. The average follow-up duration was 10 months (range: 8–14 months). The AOFAS (Ankle-Hindfoot) score improved from 62.3 (range: 57–70) prior to surgery to 89.6 (range: 82–94) at six months post-surgery (p &lt; 0.05). All MRI evaluations indicated complete healing by six months post-operation. All patients regained full preoperative function, averaging nine months after surgery (range: 6–11 months). No wound-related complications or other adverse events were noted during the follow-up period.</div></div><div><h3>Conclusions</h3><div>The application of Bio-inductive Collagen Scaffolds appears to enhance patient outcomes without increasing complication rates. Future research is warranted to more comprehensively assess the benefits of Bio-inductive Collagen Scaffolds in the management of IAT and HD.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"63 ","pages":"Article 102931"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395602","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":"Chronic reactive synovitis in patients undergoing ACL reconstruction and augmentation with tape-type sutures","authors":"Anant Joshi ,&nbsp;Aashiket Sable ,&nbsp;Sajeer Usman ,&nbsp;Bhushan Sabnis ,&nbsp;Vaibhav Bagaria","doi":"10.1016/j.jcot.2024.102884","DOIUrl":"10.1016/j.jcot.2024.102884","url":null,"abstract":"<div><h3>Introduction</h3><div>Arthroscopic Anterior Cruciate Ligament Reconstruction (ACLR) with internal bracing and augmentation using tape-type sutures (TTS) has gained popularity due to its biomechanical advantages. However, concerns have emerged regarding chronic reactive synovitis, which can lead to graft failure and the need for revision surgery. The purpose of this research is to determine the prevalence of chronic reactive synovitis after TTS-reinforced ACLR.</div></div><div><h3>Materials and methods</h3><div>A retrospective review was conducted on a series of 84 patients who underwent arthroscopic ACL reconstruction with FiberTape or SutureTape augmentation, performed by a single surgeon in the year 2019.</div></div><div><h3>Results</h3><div>Of the 84 patients analyzed, 17 presented with at least two or more symptoms, including persistent instability, knee pain, swelling, stiffness, and local rise in temperature, within 3–45 months post-surgery. All required secondary surgery, either for synovectomy, and tape removal (8 cases) or revision ACLR (9 cases). Intraoperative histopathological analysis confirmed the diagnosis of reactive synovitis due to foreign body reaction. One year after the secondary surgery, all 17 knees showed satisfactory results. None of the patients experienced the pain, swelling, or instability that they had before the secondary surgery.</div></div><div><h3>Conclusion</h3><div>Foreign body synovitis was found in 17 symptomatic patients out of 84 (20.2 %) who underwent ACLR with TTS reinforcement one year. While this study does not establish a direct causal link between tape-type sutures and the development of synovitis, it emphasizes the significance of remaining vigilant for impending reactive synovitis as a complication, given the potential exposure of the knee to foreign body material.</div></div><div><h3>Level of evidence</h3><div>Level IV (Retrospective case series without a comparison group)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102884"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016250","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":"Cementless fixation in total joint arthroplasty: Factors impacting osseointegration","authors":"Sravya P. Vajapey ,&nbsp;Vivek M. Shah ,&nbsp;Mengnai Li ,&nbsp;Daniel M. Estok II","doi":"10.1016/j.jcot.2024.102871","DOIUrl":"10.1016/j.jcot.2024.102871","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>The success of cementless fixation in TJA depends on a multitude of factors including biological, mechanical, implant, surgical, and material properties.</div></span></li><li><span>•</span><span><div>Biologic fixation has become the primary mode of fixation for the majority of primary total hip arthroplasty (THA) surgeries done today in the United States (US) due to its low complication rate and superior longevity compared to cemented fixation.</div></span></li><li><span>•</span><span><div>Cementless fixation has yet to gain wider acceptance in total knee arthroplasty (TKA) and hip hemiarthroplasty due to several factors including host bone quality, implant design, and surgical technique.</div></span></li><li><span>•</span><span><div>Understanding a) the properties of the different biomaterials, b) the bone-implant interface characteristics of the different ingrowth and ongrowth surfaces, and c) the various factors that affect osseointegration can lead to:<ul><li><span>i)</span><span><div>appropriate choice of implants for individual patients with consequent increase in revision-free survival, and</div></span></li><li><span>ii)</span><span><div>the development of new techniques that can reduce the risk of aseptic loosening.</div></span></li></ul></div></span></li></ul></div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102871"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016267","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":"Public perceptions of meniscus tears: Evaluating knowledge gaps and the role of education","authors":"Beshoy A. William ,&nbsp;Claudia Davidson ,&nbsp;Eric N. Bowman","doi":"10.1016/j.jcot.2024.102853","DOIUrl":"10.1016/j.jcot.2024.102853","url":null,"abstract":"<div><h3>Background</h3><div>Meniscus tears are common, occurring acutely during sports or as degenerative tears with aging. Limited information exists about the public’s understanding of these injuries and their management.</div></div><div><h3>Hypothesis/Purpose</h3><div>This study aimed to evaluate the public’s baseline understanding of meniscus tear management and assess the effectiveness of an educational intervention to improve their understanding.</div></div><div><h3>Study design</h3><div>Level III, Cross-Sectional Study.</div></div><div><h3>Methods</h3><div>A 33-question survey on meniscus anatomy, injury risk, diagnosis, treatment, and surgical expectations was distributed online to adults aged 18+ over 5 months from the beginning of July. An educational video and handout were provided to improve baseline knowledge. Data analysis included descriptive statistics, ANOVA, McNemar’s test, and a paired <em>t</em>-test to measure pre- and post-intervention changes.</div></div><div><h3>Results</h3><div>Baseline surveys from 245 participants showed 66.9% were women, 69.4% were aged 18–29, and 63.7% were white. 46.1% held a bachelor’s degree, and 90.2% had limited knowledge of meniscus tears. 76% believed surgery was necessary, 84% thought degenerative tears were repairable, and 65% didn’t understand the link to osteoarthritis. Most expected over 3 months for recovery. Higher scores were associated with male gender, healthcare experience, and prior knowledge (p &lt; 0.05). Post-intervention, correct responses rose from 45.3% to 75% (p &lt; 0.001) among 118 participants.</div></div><div><h3>Conclusion</h3><div>Significant misconceptions about meniscus tears were identified. An educational intervention notably improved knowledge of meniscus anatomy, its link to osteoarthritis, and treatment options. This underscores the importance of education in aligning patient expectations with current medical practices to enhance care quality.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102853"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016392","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 survey of Scottish Committee for Orthopaedics and Trauma members on lower limb joint replacement practices in morbidly obese patients","authors":"Alexis Panzures ,&nbsp;Nick D. Clement ,&nbsp;Paul Jenkins ,&nbsp;Muhammad Adeel Akhtar","doi":"10.1016/j.jcot.2024.102855","DOIUrl":"10.1016/j.jcot.2024.102855","url":null,"abstract":"<div><h3>Background</h3><div>Scotland has one of the highest rates of obesity in the developed world which increases risk of lower limb osteoarthritis resulting in total joint arthroplasty (TJA). This paper aimed to investigate (1) current practice of orthopaedic consultants in Scotland in managing end-stage hip and knee osteoarthritis in obese patients, (2) adherence to National guidelines, and (3) understanding of complication risks in lower limb TJA for BMI≥40.</div></div><div><h3>Methods</h3><div>A 15-question online survey was sent to all active members of Scottish Committee for Orthopaedics and Trauma (SCOT) between February and March 2023 to understand the current practices for managing obese patients with lower limb arthritis requiring joint replacement surgery.</div></div><div><h3>Results</h3><div>The survey received 62 responses from members of SCOT. The experience ranges from 1 to 44 years (mean 15 years) at consultant level. 61 % of respondents were aware of the SCOT National Guidelines for lower limb TJA in obese patients. 72 % would offer TJA to patients with a BMI&gt;40.35 % would get a second opinion and 22 % discuss these cases in a multidisciplinary team meeting. 71 % were aware of the local weight management guidelines. 77 % quoted risk of deep infection to be between 1 and 30 %, and 40 % quoted risk of amputation between .002 % and 10 % in morbidly obese patients.</div></div><div><h3>Conclusion</h3><div>Surgical management of obese patients with lower limb osteoarthritis in Scotland is variable. A standardised approach would be beneficial in obtaining informed consent.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102855"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016263","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":"AI in scientific publishing: Revolutionizing research with caution","authors":"Madhan Jeyaraman ,&nbsp;Vijay Kumar Jain","doi":"10.1016/j.jcot.2024.102904","DOIUrl":"10.1016/j.jcot.2024.102904","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102904"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069486","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 use of three-dimensional printing and virtual reality technologies in orthopaedics-with a focus on orthopaedic trauma","authors":"Thomas J. Policicchio ,&nbsp;Kishore Konar ,&nbsp;Devon T. Brameier ,&nbsp;Patrick Sadoghi ,&nbsp;Nishant Suneja ,&nbsp;Derek Stenquist ,&nbsp;Michael J. Weaver ,&nbsp;Arvind von Keudell","doi":"10.1016/j.jcot.2025.102930","DOIUrl":"10.1016/j.jcot.2025.102930","url":null,"abstract":"<div><div>Although the use of three-dimensional printing in orthopaedics is relatively new, many benefits of this technology to both patients and providers have already been observed. Printing models of fractured bone based upon segmented CT imaging allows for improved surgical planning as surgeons are able to view and physically manipulate accurate representations of fracture patterns prior to surgery, increasing both speed and accuracy of fixation in the operating room. The use of three-dimensional models by surgeons prior to surgery has been shown to reduce blood loss, intraoperative time, and fluoroscopy use. These models also have incredible potential in orthopaedic resident and patient education. Among residents, these models significantly improve recognition of fracture patterns, while patients benefit from the use of these models through increased trust and satisfaction with their surgeon's care, as well as decreased anxiety about their injury. Currently, the imaging segmentation and model generation process are prohibitively costly both in terms of time and money; however, in the future, three-dimensional printing may become a point-of-care technology in the orthopaedic field as technology improves and costs decrease. This article aims to illustrate the value of three-dimensional printing and virtual reality technologies in preoperative planning and intraoperative precision, resident education, and patient understanding and satisfaction. The benefits and challenges of the technologies are discussed, as well as current limitations.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"63 ","pages":"Article 102930"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349604","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":"Midfoot fractures: Patterns of injury and predictors of stability","authors":"Serena Patel,&nbsp;Danielle Piper,&nbsp;Paul Fenton","doi":"10.1016/j.jcot.2024.102874","DOIUrl":"10.1016/j.jcot.2024.102874","url":null,"abstract":"<div><h3>Background</h3><div>Lisfranc injuries describe a spectrum of midfoot and tarsometatarsal joint (TMTJ) trauma ranging from purely ligamentous to multiple fracture-dislocations. Lisfranc injuries represent 0.2 % of all fractures and are seen predictably, with mechanisms involving a fall from height, crushing, or torsion. Diagnosis can be challenging, with approximately 20 % of cases being missed, and relies upon clinical acumen and proficient image interpretation. Whilst multiple classification systems have described Lisfranc injuries using a 3-column concept, these add zero prognostic value and are therefore rarely used clinically. Furthermore, existing literature on diagnosis and management is limited to retrospective small series.</div></div><div><h3>Methods</h3><div>We present a review of 161 midfoot injuries, with the aim of highlighting characteristics of radiological instability and indication for operative management. CT scans and weight-bearing and non-weight-bearing X-rays were reviewed for features of joint instability. These features included metatarsal base, cuneiform and cuboid fractures, tarsometatarsal joint subluxation or dislocation and C1-MT2 diastasis. The subsequent “stable” and “unstable” injury groups were then compared to identify statistically significant indicators for instability.</div></div><div><h3>Results</h3><div>Avulsion and intra-articular fractures of the medial, middle, or lateral column were all suggestive of instability. Although these appeared in multiple combinations, 95 % involved the middle column. Concomitant inter-cuneiform and cuboid fractures were additional indicators of instability. In cases of uncertain midfoot instability, weight-bearing radiographs were of value with 14.2 % demonstrating a diastasis of C1-MT2 &gt;2 mm.</div></div><div><h3>Conclusion</h3><div>We propose the need for a new classification of midfoot injuries which emphasises the diagnosis of instability and guides surgical management. We propose that, based on non-weight-bearing X-ray and CT scans, these injuries can be initially classified as “stable”, “unstable”, or “stability uncertain”. Weight-bearing X-rays are a safe and reliable method of detecting instability in the “stability uncertain” group. Fractures of the medial column and cuneiform on initial imaging were suggestive of midfoot instability.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"61 ","pages":"Article 102874"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016303","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}