Journal of Clinical Orthopaedics and Trauma最新文献

{"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":"Outcomes of posterior wall acetabular fractures with marginal impaction using greater trochanter autografting: A prospective cohort study","authors":"Dharmendra Kumar,&nbsp;Pranav Raghuwanshi,&nbsp;Ankit Sriwastava,&nbsp;Ravindra Mohan,&nbsp;Arpit Singh,&nbsp;Ashish Kumar","doi":"10.1016/j.jcot.2025.103029","DOIUrl":"10.1016/j.jcot.2025.103029","url":null,"abstract":"<div><h3>Background</h3><div>Posterior wall acetabular fractures with marginal impaction pose significant challenges, mainly because of the risk of joint incongruity and the potential for developing post-traumatic arthritis. Restoration of the articular surface and stability are essential to achieve good outcomes. This study investigates the surgical outcomes of posterior wall acetabular fractures with marginal impaction using the Kocher-Langenbeck (KL) approach, buttress plating, and greater trochanter autografting.</div></div><div><h3>Methods</h3><div>This prospective cohort study was conducted on 19 patients aged 18–60 years who were treated at a tertiary care center in North India. Fractures were confirmed by radiographic imaging and CT scans. The surgical procedure included articular dis-impaction, void filling with autografts, and fixation with anatomical reconstruction using plates and screws with mean Follow-up period was (mean ± SD) 1.86 ± 0.77 (Ranges:1–3 Years) The outcome was measured using Matta's criteria for radiological evaluation, and functional outcome using the Modified Merle d'Aubigné and Postel Score. Complications were noted, including infection, avascular necrosis (AVN), myositis ossificans, and secondary surgeries.</div></div><div><h3>Results</h3><div>The mean age was 37.58 ± 9.08 years, with a male predominance of 89.5 %. The most common cause was road traffic accidents, at 94.7 %. The most common fracture pattern noted was transverse with posterior wall fracture, with marginal impaction at 47.36 %, followed by isolated posterior wall fractures with marginal impaction at 42.10 %. Anatomical reduction was achieved in 73.7 % of cases, and the radiological outcomes at one year were excellent or good in 78.9 % of cases. Functional scores were excellent or good in 73.65 %. Complications included avascular necrosis with arthritis (21.1 %), myositis ossificans (10.5 %), infection (5.3 %), and conversion to total hip replacement in 10.5 % of cases.</div></div><div><h3>Conclusion</h3><div>Correction of impaction injuries with subchondral autografting and buttress plating via the KL approach provides satisfactory radiologic and functional results. However, associated injuries, particularly head injuries, are associated with poorer recovery outcomes.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 103029"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907856","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}

{"title":"A retrospective comparison of open and arthroscopic surgery for elbow joint stiffness; a single centre pragmatic study over 15 years","authors":"Andrew P Dekker ,&nbsp;Jamie Hind ,&nbsp;Neil Ashwood","doi":"10.1016/j.jcot.2025.103031","DOIUrl":"10.1016/j.jcot.2025.103031","url":null,"abstract":"<div><h3>Background</h3><div>There is ample evidence but conflicting reports to justify decision making for open versus arthroscopic elbow debridement and release for stiffness and pain once non-surgical measures have failed. The aim of this retrospective study is to report the clinical and functional outcomes of arthroscopic and open surgery for patients presenting with elbow pain, stiffness and loss of function.</div></div><div><h3>Methods</h3><div>A consecutive series of patients who had completed a minimum of 6 months of non-surgical treatment of elbow stiffness were identified over a 15-year period between July 2008 and January 2023 from a single centre.</div></div><div><h3>Results</h3><div>96 patients were treated with arthroscopic surgery with 75 open surgery. Mean age was 51 years. Pre-operative pathology included osteoarthritis, inflammatory arthropathy and post-traumatic stiffness. Post-traumatic stiffness was more commonly treated with open surgery. The flexion-extension arc, pronosupination arc, pain score, Mayo elbow performance score (MEPS) and satisfaction scores improved in all patients (p &lt; 0.05). The arthroscopic group had a lower pain score (p &lt; 0.05), a higher satisfaction score (p &lt; 0.05), higher MEPS (p &lt; 0.05), greater flexion-extension arc (P &lt; 0.01), greater pronosupination arc (P &lt; 0.01) and fewer patients had ongoing symptoms of pain and stiffness which limited function (P &lt; 0.05) with fewer repoerations (p &gt; 0.05) than the open group.</div></div><div><h3>Conclusions</h3><div>Both arthroscopic and open surgical approaches for elbow stiffness improved elbow range of movement and function. Arthroscopic treatment was better than open surgery and may represent a more favorable approach.</div></div><div><h3>Level of evidence</h3><div>Level 4 (case series)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103031"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902547","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":"Trends in surgical stabilization of rib fractures: A contemporary literature review","authors":"Matthew Masoudi ,&nbsp;Ropafadzo Muchabaiwa ,&nbsp;Elizabeth Wake ,&nbsp;Bhavik Patel","doi":"10.1016/j.jcot.2025.103028","DOIUrl":"10.1016/j.jcot.2025.103028","url":null,"abstract":"<div><h3>Background</h3><div>Blunt chest trauma leading to rib fractures is a common injury, accounting for 20 % of thoracic trauma cases. Surgical Stabilization of Rib Fractures (SSRF) has gained popularity due to advancements in surgical techniques and multidisciplinary care, resulting in improved patient outcomes. Despite a growing body of literature on SSRF, inconsistencies in study design and outcome reporting limit the synthesis of findings and the establishment of clear clinical guidelines. This scoping review aims to provide an overview of the existing SSRF literature, identifying prevalent trends and reported outcomes.</div></div><div><h3>Methods</h3><div>A systematic scoping review was conducted following Arksey and O'Malley's framework and the Preferred Reporting Items for Scoping Reviews (PRISMA) guidelines. The study was registered with Open Science Framework (8V9KN). A comprehensive search of MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL was performed from inception to March 1, 2025. Studies were included if they reported on SSRF for blunt chest trauma in human patients. Data extraction focused on study characteristics, patient demographics, reported outcomes, and methodological rigor.</div></div><div><h3>Results</h3><div>A total of 1462 articles were screened, with 185 studies meeting the inclusion criteria. The majority (N = 162, 88 %) were published between 2015 and 2025, with the highest number in 2022. Most studies (N = 144, 78 %) employed a cohort study design, predominantly retrospective (N = 115, 80 %), while randomized controlled trials (RCTs) constituted only 8 % (N = 15). Hospital outcomes, including length of stay (N = 112) and ICU stay (N = 97), were the most frequently reported measures. Complications were documented in 124 studies, with pneumonia (N = 90) and mortality (N = 94) being the most common. Patient-reported outcomes (PROMs) were included in 60 studies (32 %), with pain (N = 46, 78 %) and quality of life (N = 23, 39 %) as key measures. Device and procedural details were reported in 70 studies (38 %), with 62 using the same device. However, variations in outcome measurement and a predominance of retrospective designs limit comparability.</div></div><div><h3>Conclusion</h3><div>SSRF literature has expanded significantly over the past decade, yet inconsistencies in study design and outcome reporting hinder the development of standardized clinical guidelines. Future research should prioritize prospective, multi-center trials with uniform reporting standards to enhance the reliability and applicability of findings.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103028"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886363","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":"Plate vs. Nail: Is there a more effective implant for extreme tibia fractures?","authors":"Abhishek Ganta ,&nbsp;Fiona K. Cherry ,&nbsp;Nirmal C. Tejwani ,&nbsp;Sanjit R. Konda ,&nbsp;Kenneth A. Egol","doi":"10.1016/j.jcot.2025.103025","DOIUrl":"10.1016/j.jcot.2025.103025","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study is to determine differences in outcomes between “extreme” tibial metaphyseal fractures treated with intramedullary nailing (IMN) or plate osteosynthesis.</div></div><div><h3>Methods</h3><div>545 prospectively collected patients were reviewed by two board-certified orthopedic trauma surgeons to identify extreme tibial shaft fractures (defined as most proximal or distal segments that involved or would have involved the area encompassed by the nail locking bolts). Fifty-one patients were identified. Twenty-five patients treated with an intramedullary nail were compared to 24 patients treated with plate and screws for similar patterns. Data collected included patient demographics, surgical details, and outcomes. Cohorts were compared using fisher's exact test, independent T tests, and multivariable linear regression.</div></div><div><h3>Results</h3><div>The mean age of all patients was 46.73 years. There were no differences in ASA, CCI, age, male/female composition, or BMI between cohorts. There were no differences in low vs. high-energy mechanism of injury between cohorts, however the IMN cohort had a greater proportion of open fractures (p = 0.018). When controlling for covariates, patients who underwent IMN were allowed earlier weight bearing on the operative extremity. There were no differences in ankle or knee range of motion at latest follow up. There was a greater incidence of total complications among IMN (p = 0.033). Single variable analysis revealed an association between IMN and nonunion (p = 0.050). IMN trended towards greater need for reoperation (p = 0.086).</div></div><div><h3>Conclusion</h3><div>Intramedullary nailing of “extreme tibia fractures” was associated with higher rates of total complications compared to plate osteosynthesis and trended with greater need for reoperation. However, it should be noted that there was a higher incidence of open fractures in this cohort. There were no differences in the rate of malalignment, range of motion, or time to healing between cohorts.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"65 ","pages":"Article 103025"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898865","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":"Sacral dysmorphism and gender-specific variations: A CT-Based approach to safe percutaneous sacral screw placement – An ambispective study","authors":"Dinesh Kale ,&nbsp;Shubham Gupta ,&nbsp;Sahil Kale ,&nbsp;Dharmendra Kumar","doi":"10.1016/j.jcot.2025.103026","DOIUrl":"10.1016/j.jcot.2025.103026","url":null,"abstract":"<div><h3>Background</h3><div>Sacral fractures are associated with high-energy trauma and pose challenging surgical conditions due to anatomical variability. The presence of sacral dysmorphism with narrow corridors, acute alar slopes, and non-circular foramina further complicates the placement of ilio-sacral and trans-sacral screws. Gender-related differences also exist in sacral morphology, which can impact surgical planning and screw trajectory.</div></div><div><h3>Methods</h3><div>We reviewed data from 1000 pelvic CT scans among 652 males and 348 females aged 18–65 years from multiple centers to measure sacral morphometry along with the safe screw placement corridors. Quantification of S1 and S2 sacral segments was done using HOROS, Radiant, Iplan software tools in terms of anteroposterior breadth, height, and width of sacral corridors. The safe screw trajectory for 6.5 mm and 7.3-mm screws was established from the vestibular concept with 2 mm of safety margin. SPSS v22.0 was used for statistical analysis.</div></div><div><h3>Results</h3><div>Sacral dysmorphism was found in 31.58 % males and 18.42 % females. Male dimensions of the sacrum were higher, more sagittal height at S1 (12.01 ± 1.83 mm vs. 10.76 ± 1.13 mm, p &lt; 0.001), and axial width (23.66 ± 3.32 mm vs. 13.3 ± 2.9 mm, p &lt; 0.001), compared to women. Measurements made at S2 were similar among genders. Safe placement of 7.3 mm S1 trans-sacral screws was possible in 84.21 % males and 47.37 % females, and 6.5 mm screws were applicable in 10.53 % of males and 26.32 % of females. For S2, 68.42 % of males and 31.58 % females were amenable to 7.3 mm screws, while 6.5 mm screws were feasible in 10.53 % of males and 23.68 % of females. Dysmorphic sacrum required a specific approach with a bias towards the use of 6.5 mm screws.</div></div><div><h3>Conclusion</h3><div>The study highlights gender variations and sacral dysmorphism impacts the safety of screw placement in Indian patients. The possibility of individualized planning before surgery by CT-based morphometry will improve safety as well as effectiveness in sacral fracture fixation.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"66 ","pages":"Article 103026"},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868635","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}