Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Biomechanical evaluation of composite reduction plates with variable positioning using the Henry and Thompson approaches for transverse radial fracture surgery.","authors":"Il Won Suh, Chan Hee Park","doi":"10.1016/j.otsr.2025.104240","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104240","url":null,"abstract":"<p><strong>Background: </strong>Radius fractures are challenging to stabilize due to complex muscle-loading conditions, requiring optimized plate positioning and material selection for effective treatment. This study addresses the biomechanical impact of plate positions (anterior, posterior, lateral) and materials in transverse radial fractures.</p><p><strong>Hypothesis: </strong>Plate positioning and material selection significantly influence stress distribution and displacement, with lateral positioning and WE43 alloy offering biomechanical advantages.</p><p><strong>Methods: </strong>Finite element analysis was used to evaluate Ti6Al4V titanium alloy and WE43 magnesium alloy bone plates positioned on the anterior, posterior, and lateral sides of the radius under a 50 N axial load. Stress distribution and displacement were analyzed.</p><p><strong>Results: </strong>Posterior reductions exhibited the highest stress and displacement, indicating potential instability, with maximum von Mises stress increasing by 32.5% compared to anterior reduction. Lateral reductions provided more uniform stress distribution and lower displacement, though von Mises stress was still 20% higher than in the anterior reduction. WE43 alloy demonstrated effective stress reduction in non-posterior positions, while Ti6Al4V exhibited greater stiffness and resistance to deformation.</p><p><strong>Discussion: </strong>Lateral and anterior plate positions demonstrated superior biomechanical stability, suggesting their preference for optimizing fracture healing and reducing complications. WE43 alloy's stress-reducing and biodegradable properties make it suitable for temporary fixation, while Ti6Al4V provides greater structural integrity for long-term support. These findings highlight the importance of plate positioning and material selection in improving clinical outcomes for transverse radial fracture fixation.</p><p><strong>Level of evidence: </strong>V; expert opinion, controlled laboratory study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104240"},"PeriodicalIF":2.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip resurfacing arthroplasty reduces dislocation and infection rates without differences in clinical outcomes compared to short and standard stems: A Network Meta-Analysis.","authors":"Lola Riché, Noémie Baccon, Julien Girard, Henri Migaud, Pierre-Alban Bouché","doi":"10.1016/j.otsr.2025.104239","DOIUrl":"10.1016/j.otsr.2025.104239","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are established treatments for hip osteoarthritis. Recent advancements have introduced short-stem THA, which offers potential advantages in terms of bone preservation and biomechanical restauration. None of previous studies compared these three surgical interventions. The aim of this network meta-analysis (NMA) is to compare HRA, short stem and standard stem in THA in terms of: (1) complications rate (global, infection and dislocation rate), (2) clinical outcomes (WOMAC, Harris Hip Score (HHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), Postel Merle Aubigné Score (PMA) and SF-36) at short- and mid-term, (3) procedure-related variables (operative time, pain at day one and length of stay).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic literature review was conducted using multiple electronic databases (Medline, Central and Embase) to identify comparative studies evaluating at least two of the three surgical interventions. Studies were included if they reported one of our outcomes. Data synthesis was performed using a Bayesian NMA. A total of 72 studies including, 793 593 patients (mean age 54.7 years), met the inclusion criteria. The most common comparison was standard-stem THA/ HRA (94,4% of the studies).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The NMA did not identify differences for the rate of global complications between short stem THA/standard-stem THA (risk ratio (RR) 1.52 [95% CI 0.41-5.96]), HRA/standard-stem THA (RR 1.17 [95% CI 0.85-1.66]) and HRA/short-stem THA (RR 0.77 [95% CI 0.20-2.95]). Regarding infection and dislocation, standard THA had a higher rate of infection (risk ratio 2.14 [95% CI 1.33-5.44]) and of dislocation (risk ratio 13.45 [95% CI 3.37-98.21]) compared to HRA. For functional outcomes at short term, no differences were observed between HRA and standard-stem THA for WOMAC (Mean Difference (MD) -0.01 [95% CI -0.51 to 0.40]), HHS (MD 0.05 [95% CI -3.26 to 3.45]), PMA (MD -0.13 [95% CI -0.94 to 0.71]) and FJS (MD -1.64 [95% CI -9.04-5.45]). For functional outcomes at mid-term, no differences were observed between HRA and standard-stem THA for WOMAC (MD -0.07 [95% CI -1.13 to 1.05]), HHS (MD -0.02 [95% CI -1.55 to 1.36]), PMA (MD -0.03 [95% CI -0.60 to 0.49]) and SF-36 (MD 0.11 [95% CI -3.37 to 3.61]). No difference was observed for comparison of short-stem THA/standard-stem THA and HRA/short-stem THA for clinical outcomes.The surgical time was shorter for HRA compared to short-stem THA (MD-34.05 [95% CI -53.25 to -13.28]) and standard-stem THA (MD -16.25 [95% CI -24.84 to -7.53]). No difference was observed between HRA and standard-stem THA for VAS at day one (MD 0.22 [95% CI -1.90 to 2.13]) and for the length of stay (MD 0.48 [95% CI -0.27 to 1.34]).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;HRA demonstrated had lower infection and dislocation rate compared to standard THA. HRA also offers a shorter operative time. However, no d","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104239"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning models based on a national-scale cohort accurately identify patients at high risk of deep vein thrombosis following primary total hip arthroplasty.","authors":"Ziwei Huang, Anirudh Buddhiraju, Tony Lin-Wei Chen, MohammadAmin RezazadehSaatlou, Shane Fei Chen, Blake M Bacevich, Pengwei Xiao, Young-Min Kwon","doi":"10.1016/j.otsr.2025.104238","DOIUrl":"10.1016/j.otsr.2025.104238","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of deep venous thrombosis (DVT) following total hip arthroplasty (THA) poses a substantial risk of morbidity and mortality, highlighting the need for preoperative risk stratification and prophylaxis initiatives. However, there exists a paucity of big-data-driven predictive models for DVT risk following elective hip arthroplasty. Therefore, this study aimed to develop and assess machine learning (ML) models in predicting DVT risk following THA using a national patient cohort.</p><p><strong>Hypothesis: </strong>We hypothesized that machine learning models would accurately predict patient-specific DVT risk in patients undergoing elective total hip arthroplasty.</p><p><strong>Patients and methods: </strong>The ACS-NSQIP national database was queried to identify 70,733 THA patients from 2013 to 2020, including 317 patients (0.45%) with DVT. Artificial neural network, random forest, histogram-based gradient boosting, k-nearest neighbor, and support vector machine algorithms were trained and utilized to predict the risk of DVT following THA. Model performance was assessed using discrimination, calibration, and potential clinical utility.</p><p><strong>Results: </strong>Histogram-based gradient boosting demonstrated the best prediction performance with an area under the receiver operating curve of 0.93 (discrimination), a slope of 0.92 (closely aligned with actual outcomes), an intercept of 0.18 (minimal prediction bias), and a Brier score of 0.010 (high accuracy). The model also demonstrated clinical utility with greater net benefit than alternative decision criteria in the decision curve analysis. Length of stay, international normalized ratio, age, and partial thromboplastin time were the strongest predictors of DVT after primary THA.</p><p><strong>Discussion: </strong>Machine learning models demonstrated excellent predictive performance in terms of discrimination, calibration, and decision curve analysis. Further research is warranted in terms of external validation to realize the potential of these algorithms as a valuable adjunct tool for risk stratification in patients undergoing THA.</p><p><strong>Level of evidence: </strong>III; Retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104238"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of intravenous tranexamic acid in total hip arthroplasty for femoral neck fracture: A propensity score-matched, real-world analysis.","authors":"Constance Pinon, Franck Verdonk, Christophe Quesnel, Alain Sautet, Philippe Nguyen","doi":"10.1016/j.otsr.2025.104237","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104237","url":null,"abstract":"<p><strong>Background: </strong>The transfusion-sparing strategy in hip prosthetic surgery (Total Hip Arthroplasty, THA) is crucial. Tranexamic Acid (TXA) is a medication whose effectiveness has been demonstrated in numerous surgical indications to reduce bleeding and prevent the risk of blood transfusion.</p><p><strong>Objective: </strong>To evaluate the impact of IV TXA on bleeding in THA for femoral neck fracture (FNF) surgery.</p><p><strong>Methods: </strong>This single-center retrospective cohort study, conducted from January 2020 to September 2021, assessed patients undergoing THA for FNF, comparing those who received 1 g of IV TXA to those who did not, using a matched population through propensity score creation. Analyses were conducted univariately and multivariately.</p><p><strong>Results: </strong>During the inclusion period, 175 patients underwent THA for FNF, with 87 receiving IV TXA and 88 not receiving TXA. After propensity score matching, the transfusion-free interval was better in the IV TXA treated group (p = 0,03). There was no difference in terms of perioperative bleeding or overall transfusion during hospitalization. There were no differences in the laboratory results at Days 1, 3, and 7.</p><p><strong>Conclusion: </strong>IV TXA delays the need for transfusion in patients undergoing THA for FNF but does not reduce perioperative bleeding or transfusion during the stay.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104237"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of the anterior tendinous portion of the supraspinatus muscle as a central point for rotator cuff repair.","authors":"Thomas Cuinet, Lucie Schnedecker, Bouchra Assabah, Nguyen Tran, François Sirveaux, Adrien Jacquot","doi":"10.1016/j.otsr.2025.104236","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104236","url":null,"abstract":"<p><strong>Introduction: </strong>Double-row repairs with knots on the medial row carry a risk of secondary lesions at the myotendinous junction. Knotless double-row repairs imply dependence between rows, sometimes resulting in a failure to properly apply the medial row, and the systematic use of 4 anchors. The anterior tendinous portion of the supraspinatus muscle appears to be a promising anatomical landmark and support point for the medial row in an optimized independent double-row technique.</p><p><strong>Hypothesis: </strong>This technique provides results equivalent to those published about rotator cuff repair and reduces the risk of medial secondary rupture and the number of implants used.</p><p><strong>Materials and methods: </strong>This study includes an initial histopathological analysis of the supraspinatus muscle, complemented by an in vivo arthroscopic observation of its anterior tendinous portion in a consecutive series of arthroscopy procedures on shoulders with intact rotator cuffs. We present a technique for independent double-row repair using 2 (or 3) anchors, with a single knot on the medial row relying on the anterior tendinous portion of the supraspinatus muscle, and lateral tension-band sutures. In this study, we report the clinical and ultrasound outcomes from a preliminary prospective series of 20 patients with distal supraspinatus tears at a 2-year follow-up.</p><p><strong>Results: </strong>The anterior tendinous portion of the supraspinatus was found in 100% of patients in our arthroscopic analysis. Regarding the surgical technique, the median number of anchors was 2. At 2-year follow-ups, the median Constant score was 84.5, and the Subjective Shoulder Value score was 93%. No complications were recorded. Tendon healing was achieved in 100% of cases (Sugaya stage I or II).</p><p><strong>Conclusion: </strong>This independent double-row repair technique relying on the anterior tendinous portion of the supraspinatus muscle provides a solid medial row fixation, minimizing the risk of secondary myotendinous injury, and an appropriate anatomical landmark, allowing for a more anatomic repair. It is a simple and reproducible technique requiring a limited number of implants and demonstrating satisfactory clinical outcomes and tendon healing rate.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104236"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do patient-specific cutting guides for pelvic and sacral tumour resection provide tumour-free bone margins?","authors":"Florian Bourbotte-Salmon, François Lataste, Etienne Massardier, Mickael Ropars, Alexandra Meurgey, Gualtar Vaz, François Gouin","doi":"10.1016/j.otsr.2025.104235","DOIUrl":"10.1016/j.otsr.2025.104235","url":null,"abstract":"<p><strong>Background: </strong>Achieving R0 margin, i.e., tumour-free margin, during conservative surgery for pelvic or sacral tumours is demanding. Small cohort studies suggest that patient-specific instrumentation (PSI) may hold promise, notably for bone margin accuracy. Objectives of this study were to determine whether PSI allowed R0 bone margins; R0 soft-tissue margins; and increased disease-free survival, without local recurrence or distant metastases, comparatively to previous studies of patients treated by free-hand or navigated surgery; and whether PSI positioning for the bone cuts was readily achieved.</p><p><strong>Hypothesis: </strong>Using PSI provides R0 bone margins in 100% patients and improves disease-free survival).</p><p><strong>Material and methods: </strong>Retrospective study including consecutively patients who underwent PSI-assisted surgical resection of a pelvic or sacral tumour between October 2011 and February 2020. Bone and soft-tissue margins were assessed according to the Union for International Cancer Control classification. Overall survival and disease-free survival were evaluated using the Kaplan-Meier method. PSI positioning was assessed by surgeons for each patient on a scale from 5 (excellent) to 1 (failed).</p><p><strong>Results: </strong>Of the 42 included patients (26 males and 16 females), 34 had primary bone malignancies, 3 had soft-tissue malignancies extended to the bone, 3 had locally aggressive benign bone tumours, and 2 had solitary bone metastases. Mean follow-up was 49 (range 4-112) mo. Bone margins were as follow: R0 in 40 (95%) patients; R1 in 1 (2.5%) and R2 in 1 (2.5%). Soft-tissue margins were as follow: R0 in 76% of patients; R1 in 21.5% of patients. At 5 years, overall disease-free survival was 63.4% (95% CI, 49.3-81.4), survival without local recurrence was 65.5% (95% CI, 47.7-90.0], and survival without distant metastases was 70.1% (95% CI, 55.4-88.5). Positioning of the 60 PSIs used was rated excellent or good in 93.3% of cases and fair or poor in 6.7% of cases; no cases of positioning failure were recorded.</p><p><strong>Discussion: </strong>PSIs provided excellent accuracy for achieving R0 bone margin. Nonetheless, local recurrence remained high similarly to free-hand surgery. This finding may be related to surgeons relying on PSI's accuracy for maximal preservation.</p><p><strong>Conclusion: </strong>PSIs are technically reliable and safe for obtaining R0 margins during conservative resection surgery to treat pelvic and sacral tumours. However, PSIs do not substantially decrease the local recurrence rate.</p><p><strong>Level of evidence: </strong>IV; retrospective observational cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104235"},"PeriodicalIF":2.3,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic trapezoid external fixation: Enhancing temporary stability in unstable pelvic ring fractures.","authors":"Dinah Bronstein, Geoffroy Dubois de Mont-Marin, Louis Rony, Guillaume David","doi":"10.1016/j.otsr.2025.104234","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104234","url":null,"abstract":"<p><strong>Background: </strong>Unstable pelvic fractures often require emergency temporary external fixation before definitive management by internal fixation. The objective of this study was to improve the stability of the posterior arc of the pelvic ring during the placement of a temporary external fixator.</p><p><strong>Hypothesis: </strong>Did a temporary pelvic external fixator with dual bars (compression and distraction) enhances posterior pelvic stability by increasing posterior compression?</p><p><strong>Materials and method: </strong>Four supracetabular fixation setups, including a \"dynamic trapezoid external fixator\" (a supra-acetabular external fixation construct featuring two connecting rods, one in compression and the other in distraction), were tested on foam pelvis models with simulated sacroiliac disjunction. Each configuration was also tested with a supra-acetabular pin partially or fully inserted into the SA corridor. Stability was assessed using a biomechanical model through reproducible cranial and lateral traction force applied to the iliac tuberosity under a 20N load to identify the most effective temporary pelvic ring stabilization method. Each measurement was repeated 10 times per configuration. Student's t-test and two-way analysis of variance (ANOVA) was used to compare the different models.</p><p><strong>Results: </strong>Sacroiliac displacement under vertical and lateral forces was measured for each configuration. Fully inserted supra-acetabular pins significantly reduced displacement compared to half insertion (p < 0.001). The \"dynamic\" construct exhibited the lowest displacement across all configurations (mean 2.9 ± 0.9 mm under lateral force; 1.8 ± 0.3 mm under vertical force). Compared to other constructs, it was significantly associated with superior stability (p < 0.005). ANOVA confirmed the effects of construct type (p < 0.0001) and SA pin length (p < 0.0001) on displacement, with the \"dynamic\" construct and full pin insertion yielding the best outcomes.</p><p><strong>Conclusion: </strong>Our study demonstrates that a dynamic trapezoidal supra-acetabular external fixator, with rods in compression and distraction, enhances resistance to vertical and horizontal displacement of SI joint compared to other construct. Though not fully replicating in vivo conditions, this model supports a streamlined approach to temporary pelvic stabilization.</p><p><strong>Level of evidence: </strong>V; In Vitro Research.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104234"},"PeriodicalIF":2.3,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes in French adolescents with idiopathic scoliosis: Responsiveness of the Scoliosis Research Society-22 Patient Questionnaire.","authors":"Federico Solla, Gerda L'Aune, Carlo M Bertoncelli, Virginie Rampal, Barbara Rocca, Marco Monticone","doi":"10.1016/j.otsr.2025.104232","DOIUrl":"10.1016/j.otsr.2025.104232","url":null,"abstract":"<p><strong>Background: </strong>The Scoliosis Research Society-22 (SRS-22) patient questionnaire is widely used to assess health-related quality of life in adolescents with idiopathic scoliosis (AIS). Its responsiveness and Minimal Important Changes (MICs) have been studied in American and Spanish samples after surgical treatment with fair responsiveness. However, these data are lacking in the French population, limiting its use in both clinical and research settings. This study aimed therefore to evaluate the responsiveness and MICs of the SRS-22 in French adolescents undergoing AIS surgery.</p><p><strong>Hypothesis: </strong>The French SRS-22 provides responsiveness with fair estimates in the majority of the domains of this questionnaire.</p><p><strong>Methods: </strong>A total of 108 adolescents (88% females, mean age 14 years) were assessed before posterior fusion for AIS and at mid-term follow-up (12-36 months, average 19). Responsiveness was evaluated by anchor-based methods using the receiver operating characteristic [ROC] curves to calculate the area under the curve (AUC) values of each domain and estimate their MICs.</p><p><strong>Results: </strong>Pain, Self-Image, and Mental Health domains had fair AUC values exceeding 0.70, while the Function domain showed poor discriminative ability (AUC = 0.61). MICs ranged from 0.15 for Function to 0.35 for Pain.</p><p><strong>Conclusion: </strong>The SRS-22 showed responsiveness with fair estimates in the majority of its domains for assessing surgical outcomes of French adolescents with AIS. Caution is advised when interpreting changes in the Function domain. MICs estimates may help clinicians and researchers to value individual treatment outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104232"},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive fixation of the greater trochanter in the intramedullary nail for unstable pertrochanteric fractures of the femur: Xander's technique.","authors":"Simone Verzellotti, Lorenzo Massimo Oldrini, Axel Gamulin, Alberto Mameli, Jochen Müller, Marco Delcogliano","doi":"10.1016/j.otsr.2025.104233","DOIUrl":"10.1016/j.otsr.2025.104233","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal femoral fractures (PFF) represent a global public health burden as more than 10 million cases per year are globally reported. Kyle 3 and 4 or AO/OTA 31.A2 pertrochanteric fractures account for 10-15% of all PFF. This specific fracture pattern is characterized by intrinsic mechanical instability as a result of the presence of a detached greater trochanter fragment and is usually treated using a cephalomedulary nail (CMN). However, the unstable greater trochanter fragment makes the insertion of the CMN guide wire challenging.</p><p><strong>Hypothesis: </strong>The aim of this surgical technical note is to describe this procedure basically allowing fracture simplification from unstable to stable, so that this complex PFF pattern can be approached in a structured manner with predictable results in terms of fracture reduction quality and implant position accuracy, even by junior surgeons.</p><p><strong>Material and methods: </strong>We used this greater trochanter stabilization technique in 34 pertrochanteric fracture fixations with a CMN. Fracture union was achieved in all cases by a minimum one-year follow-up period without surgical complications.</p><p><strong>Discussion: </strong>The authors developped a surgical technique allowing for both stable greater trochanter fragment stabilization and easier CMN guide wire insertion to avoid fracture dislocation and fragment collapse.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104233"},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double-approach synovectomy (anterior and posterior) for diffuse pigmented villonodular synovitis of the knee: Adjuvant treatment, functional and radiographic outcomes.","authors":"Florian Triscos, Dinah Bronstein, Julien Berhouet, Louis-Romée Le Nail, Ramy Samargandi","doi":"10.1016/j.otsr.2025.104231","DOIUrl":"10.1016/j.otsr.2025.104231","url":null,"abstract":"<p><strong>Introduction: </strong>Pigmented villonodular synovitis (PVNS) of the knee is a rare joint disease characterized by proliferation of the synovial membrane. This benign tumor can seriously affect patients' quality of life by causing disabling symptoms such as joint pain, limited movement, and painful effusions. Total synovectomy is considered the standard treatment to prevent local recurrences. However, the role of adjuvant treatments, such as radioisotopic synoviorthesis, remains controversial.</p><p><strong>Hypothesis: </strong>The main hypothesis is that double-approach surgical synovectomy in the context of diffuse PVNS of the knee would significantly reduce recurrences and complications while improving joint function. The secondary hypothesis is that adding a radioisotopic synoviorthesis as an adjuvant treatment could enhance the effectiveness of synovectomy alone by further reducing the risk of recurrence.</p><p><strong>Materials and methods: </strong>In this retrospective descriptive observational study, all patient records diagnosed with diffuse PVNS and who underwent a double-approach synovectomy at the CHRU of Tours between July 2007 and January 2023 were reviewed and analyzed. A total of 25 patients were included.</p><p><strong>Results: </strong>Postoperative functional outcomes showed a marked improvement in the KSS score for functional activities (increasing from 46.54 to 83; p < 0.05) and for symptoms (decreasing from 15.09 to 4.36; p < 0.05). The overall recurrence rate observed was 16%, with a slight trend towards fewer recurrences in patients who underwent synoviorthesis (5.8% versus 37.5%; p = 0.08). The complication rate was low; only 12% of cases presented complications, including deep vein thrombosis and neuropathic pain.</p><p><strong>Conclusion: </strong>Surgical treatment of diffuse PVNS of the knee through double-incision synovectomy appears to yield positive functional outcomes with a low recurrence rate in the treated cases. The possible addition of synoviorthesis could help reduce the risk of symptom recurrence; however, this hypothesis needs to be confirmed by further research, ideally randomized studies. The observed complications were relatively rare and manageable, which reinforces the reliability of this therapeutic approach.</p><p><strong>Level of evidence: </strong>IV; Retrospective observational study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104231"},"PeriodicalIF":2.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}