Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) Reconstruction: A Systematic Review and Meta-Analysis.","authors":"Yao-Tung Tsai, Chia-Chun Wu, Ru-Yu Pan, Pei-Hung Shen","doi":"10.1016/j.otsr.2025.104184","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104184","url":null,"abstract":"<p><strong>Background: </strong>Thromboembolism (VTE) is an uncommon, but potentially serious complication in patients who undergo anterior cruciate ligament (ACL) reconstruction.</p><p><strong>Patients and methods: </strong>PubMed, EMBASE, and Cochrane databases were searched for relevant studies published until July 16, 2023. Eligible studies were those investigating patients who were undergoing ACL reconstruction, with the primary focus on factors associated with VTE including age, sex, body mass index (BMI), hypertension, smoking, type of surgical setting (outpatient vs. inpatient), and tourniquet time.</p><p><strong>Results: </strong>Six studies consisted of a total of 47,886 patients underwent ACL reconstruction were included. The VTE rate ranged between 0.4% and 11.0%, and the mean patient age ranged from 26.8 to 33.25 years. The meta-analysis revealed no significant association between VTE risk and sex (pooled adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.88-1.85). Furthermore, the meta-analysis showed a significantly higher risk of VTE in smokers compared to non-smokers, favoring non-smokers (pooled aOR = 1.71, 95% CI: 1.16-2.54). The systematic review identified several other potential factors, including older age, BMI, hypertension, smoking, surgical setting, and tourniquet time, which were documented in at least 2 included studies. However, while some of these factors showed reported significance, the number of studies was insufficient to generate a pooled result.</p><p><strong>Discussion: </strong>According to our meta-analysis, sex does not appear to be a significant risk factor for VTE in patients undergoing ACL reconstruction. However, more evidence is needed to determine whether factors such as older age, BMI, hypertension, outpatient vs. inpatient surgery, and tourniquet time are associated with increased VTE risk. Caution is still advised when managing patients with these risk factors in the context of ACL reconstruction. A future meta-analysis is warranted once a sufficient number of studies are available to draw more definitive conclusions.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104184"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374954","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":"Early Tibiotalar Arthrodesis via Posterior Approach Using an Inverted Humeral Plate in Tibial Pilon Fractures: Functional and Radiological Outcomes.","authors":"Ramy Samargandi, Maxime Saad, Geoffroy Dubois de Mont-Marin, Louis-RoméeLe Nail, Julien Berhouet","doi":"10.1016/j.otsr.2025.104183","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104183","url":null,"abstract":"<p><strong>Introduction: </strong>Communitive tibial pilon fractures are complex fractures in which management is controversial and technically challenging, often leading to a high rate of complications and unsatisfactory outcomes.</p><p><strong>Objective: </strong>The primary objective of this study was to evaluate the union rate of early tibiotalar arthrodesis using an inverted PHILOS® plate via a posterior approach following a severe comminuted tibial pilon fracture.</p><p><strong>Materials and methods: </strong>A retrospective study including 9 patients who underwent early tibiotalar arthrodesis between January 2015 and August 2020 following severe comminuted tibial pilon fractures. The procedure was performed via a posterior approach and stabilized using a reversed PHILOS® plate after initial temporary stabilization with an external fixator. The minimum follow-up period was 12 months. The study evaluated the union rate of the arthrodesis and associated fracture, as well as the rate of postoperative complications. Functional outcomes were also assessed using the AOFAS score and the Maryland Foot Score (MFS).</p><p><strong>Results: </strong>At the latest follow-up, eight patients demonstrated consolidation of both the fracture and the tibiotalar arthrodesis. One patient developed an aseptic non-union, requiring revision surgery. No wound or infectious complications were reported. Two patients showed signs of subtalar arthritis. The mean AOFAS score was 66 points (range 51-82), and the MFS averaged 71 points (range 53-84).</p><p><strong>Conclusion: </strong>Early tibio-talar arthrodesis via the posterior approach appears to be a reliable technique for achieving consolidation in complex comminuted pilon fractures. The alternative use of an inverted PHILOS® humeral plate also represents a mechanically reliable material option compared to other existing fixation systems LEVEL OF EVIDENCE: IV; case series study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104183"},"PeriodicalIF":2.3,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374813","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":"Evaluating the Transfer of Surgical Skills from Simulation on Synthetic Bone to Cadaveric Bone Osteosynthesis.","authors":"Jimmy Pecheur, Guy Piétu, Christophe Nich, Cyrille Decante, Antoine Hamel, Louis Rony, Jérôme Rigaud, Hervé Thomazeau, Vincent Crenn","doi":"10.1016/j.otsr.2025.104182","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104182","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical simulation in traumatology requires validation to evaluate the technical skills acquired on synthetic bones. This study aimed to evaluate the impact of simulation-based training using synthetic bones on learners' technical skills and radiographic outcomes.</p><p><strong>Hypothesis: </strong>It was hypothesized that learners trained using simulation on synthetic bones would perform better than those without such training.</p><p><strong>Method: </strong>Sixteen learners (10 residents and 6 medical students) were randomized into two groups: Simulation and Control. The Simulation group received training on synthetic bones through modules focusing on \"Olecranon\" and \"Humerus\" osteosynthesis. Technical skills were evaluated on cadaveric specimens by blinded assessors using the OSATS (Objective Structured Assessment of Technical Skill) score and a dedicated radiological score.</p><p><strong>Results: </strong>For the \"Olecranon\" module, the Simulation group achieved a median OSATS score of 88, compared to 74 in the Control group (p = 0.313). In the resident subgroup, the OSATS score was significantly higher than in the Simulation group (90 vs. 77.6; p = 0.017). The median radiological score was also significantly higher in the Simulation group (76 vs. 56; p = 0.038). For the \"Humerus\" module, no significant differences were observed between the groups for the OSATS score (82.7 vs 63.4; p = 0.216) or the radiological score (55.5 vs. 52.8; p = 0.058).</p><p><strong>Conclusion: </strong>Simulation-based training on synthetic bones improved technical skills for olecranon osteosynthesis in residents but did not demonstrate similar efficacy for humeral diaphysis osteosynthesis, which may require more advanced simulation models incorporating soft tissues.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104182"},"PeriodicalIF":2.3,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374950","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":"Visualization of the posteromedial compartment in the knee: Comparison between a posterolateral transseptal approach with a standard anterior transnotch approach when repairing posterior lesions of the medial meniscus.","authors":"Andreas Friberg, Nicolas Kloek, Fabrice Duparc, Olivier Courage, Franck Dujardin, Jonathan Curado","doi":"10.1016/j.otsr.2025.104181","DOIUrl":"10.1016/j.otsr.2025.104181","url":null,"abstract":"<p><strong>Introduction: </strong>Visualization and exposure of the medial meniscus in the posterior compartment during knee arthroscopy can be challenging. Using a posterolateral transseptal approach can help to have a better visualization to ensure a better meniscal repair in the posterior compartment.</p><p><strong>Hypothesis: </strong>The posterolateral transseptal approach allows a better visualization of the posterior segment of the medial meniscus when compared to a trans notch approach.</p><p><strong>Material and methods: </strong>A controlled laboratory study using 12 human cadaveric knees were included in this arthroscopic study. The first step was to visualize the posterior medial compartment by transnotch viewing. A posteromedial portal was then created, and a meniscal suture was positioned as medial as possible under direct visualization by an all inside technique with a suture hook. Afterwards the posterolateral transseptal portal was created and a second meniscal suture was positioned as medial as possible with the same technique. Finally, by dissection, a posterior arthrotomy was performed allowing us to directly measure the length of the medial meniscus (at its meniscocapsular junction) from its posterior root to respectively the first and second suture, representing the two different approaches. The safety was evaluated by extended dissection of the neurovascular posterior structures.</p><p><strong>Results: </strong>The mean paired difference between the first and second suture was 6.75 ± 2.56 mm (CI95% = 5.19; 8.31, P ≈ 0.001). No nerve or vascular lesion were observed during dissection.</p><p><strong>Discussion: </strong>A transseptal viewing portal offers better exposure and visualization of the medial meniscus in the posterior compartment and can be safely performed. When repairing meniscal lesions in the posterior compartment, it is commonly advised to insert a knot at least every 5 mm. Our study has demonstrated a significant difference in distance of 6.75 mm when using a transseptal approach, which provides an argument for its utilization during posterior meniscal repair enabling the operator to better repair meniscal lesion and potentially improve the healing process.</p><p><strong>Level of evidence: </strong>III; Case/Control anatomical study on cadaveric specimens.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104181"},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366757","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":"Revision for stiff knee after knee replacement","authors":"Sophie Putman ,&nbsp;Paul-Antoine André ,&nbsp;Gilles Pasquier ,&nbsp;Julien Dartus","doi":"10.1016/j.otsr.2024.104060","DOIUrl":"10.1016/j.otsr.2024.104060","url":null,"abstract":"<div><div>Stiffness following total knee replacement is defined as &gt;15° flexion contracture and/or flexion &lt;75° or, for other authors, arc of motion &lt;70° or 45° or 50°. Alternatively, it could be defined as a range of motion less than the patient needs in order to be able to do what they wish.</div><div>The first step in management is to determine the causes: preoperative (history of stiffness, patient-related risk factors, etc.), intraoperative (technical error: malpositioning, oversizing, overhanging, etc.), and postoperative (defective pain management and/or rehabilitation, etc.).</div><div>Treatment depends on the interval since replacement and on the type of stiffness (flexion or extension), and should be multidisciplinary (surgery, rehabilitation, pain management).</div><div>For intervals less than 3 months, manipulation under anesthesia gives good results for flexion. If this fails, surgery should be considered.</div><div>If there was no significant technical error, arthrolysis may be indicated, and is usually arthroscopic. It is technically difficult, but has a low rate of complications. Open arthrolysis allows greater posterior release and replacement of the insert by a thinner model.</div><div>In case of malpositioning or oversizing or of failure of other procedures, implant revision is the only option, although the risk of complications is high. After exposure, which is often difficult, the aim is to correct the technical errors and to restore joint-line height and two symmetrical, well-balanced spaces in extension and flexion. A semi-constrained or even hinged implant may be needed, although with uncertain lifetime for young patients in the latter case.</div><div>In all cases, the patient needs to accept that treatment is going to be long, with more than the intervention itself (i.e., specific pain management and rehabilitation), and that expectations have to be reasonable as results are often imperfect.</div></div><div><h3>Level of evidence</h3><div>expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104060"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696256","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":"Prediction of transfusion risk after total knee arthroplasty: use of a machine learning algorithm","authors":"Nicolas Faure ,&nbsp;Siam Knecht ,&nbsp;Pierre Tran ,&nbsp;Lyna Tamine ,&nbsp;Jean-Christophe Orban ,&nbsp;Nicolas Bronsard ,&nbsp;Jean-François Gonzalez ,&nbsp;Grégoire Micicoi","doi":"10.1016/j.otsr.2024.103985","DOIUrl":"10.1016/j.otsr.2024.103985","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count.</div></div><div><h3>Hypothesis</h3><div>Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty.</div></div><div><h3>Material and methods</h3><div>This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance.</div></div><div><h3>Results</h3><div>Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921–1], sensitivity of 94.4% [95% CI 91.2–97.6], and specificity of 85.4% [95% CI 80.6–90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at <span><span>https://arthrorisk.com</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient.</div></div><div><h3>Level of evidence</h3><div>II; diagnostic study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103985"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141816","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":"Radiologic evaluation of the healing of the greater tubercle after humeral hemiarthroplasty with Aequalis-fracture-implants for proximal humeral fracture: a retrospective cohort study in 45 shoulders","authors":"Sixtine Regnard ,&nbsp;Carlos Maynou ,&nbsp;Philippe Clavert ,&nbsp;Fabrice Duparc","doi":"10.1016/j.otsr.2024.104002","DOIUrl":"10.1016/j.otsr.2024.104002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Development and use of specific anatomic prosthesis for shoulder’s fracture aimed to reach the best rate of consolidation of the greater tubercle, which means a cuff restitution to improve functional results. The lack of bone healing of the tubercles suggested the use of a fenestrated humeral implant with interposition of a bone graft in the metaphyseal part of the prosthesis. This characteristic of specific implant, have few reports in the literature, leading us to the current retrospective study aiming: 1) to evaluate the healing rate of the greater tubercle after implantation of fracture dedicated anatomic implant, which includes a fenestration in the prosthetic metaphysis for the addition of a cortico cancellous graft, 2) to asses on patients with proximal humerus fractures, the bone healing of the greater tubercle close to the intraprosthetic bone graft.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The specific “implant-fracture” can achieve a high rate of bone healing of the humeral greater tubercle.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Between January 2001 and December 2020, fifty-one patients were operated on by implantation of fracture dedicated implant for proximal humerus fracture. Six were excluded (2 operated for revision, 2 operated after 3 weeks, 1 died, 1 without follow-up). In total 45 patients were included in radiological analysis, clinical analysis had been performed on 23/45 patients at the longest follow up, the other 22/45 were only analyzed on radiographies. Mean-aged 66 years (range, 47 years -88 years), 25/45 (56%) of women, with 3–4-parts fractures according to Neer’s classification. The techniques of tubercle fixation were isolated cerclages of combined horizontal cerclages and vertical sutures. Position and healing of the greater tubercle was controlled through antero-posterior and lateral X-Rays views at the longest follow-up (mean 50 months, range 3–193 months). Peroperative techniques of fixation, clinical and functional outcomes were noted and correlated to the radiologic position of the greater tubercle and the graft evolution. Factors associated with healing and anatomic position had been investigated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The rate of greater tubercle healing was 32/45 (73%). Factors significantly associated with greater tuberosity consolidation were higher age (p = 0.04) and the addition of a vertical osteosuture to the horizontal suture of the greater tubercle (p = 0.01). The rate of anatomic position of the greater tubercle was 15/45 (33%) of cases. When the fixation of the tuberosity was made with vertical suture, good position of the tuberosity was observed in 68% (17/24) at the longest follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Our results were in accordance with the literature, but the current study underlined there were two types of factors influencing tubercle healing in the literature: the technique of fixation of the tubercle and the patie","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104002"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332554","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":"Orthopaedics & traumatology: surgery & research: our ongoing quest: promoting excellence in research for our readers","authors":"Patrick Haubruck ,&nbsp;Philippe Clavert ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2024.104100","DOIUrl":"10.1016/j.otsr.2024.104100","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830885","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":"Posterior shoulder instability","authors":"Jérôme Garret ,&nbsp;Stanislas Gunst ,&nbsp;Marc Olivier Gauci","doi":"10.1016/j.otsr.2024.104061","DOIUrl":"10.1016/j.otsr.2024.104061","url":null,"abstract":"<div><div>Posterior shoulder instability (PSI) is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact. Anatomic risk factors comprise ligament hyperlaxity, glenoid retroversion or dysplasia, and high horizontal acromial morphology. Associated anatomic lesions comprise labrum lesions, posterior glenoid erosion and/or fracture, and anterior humeral head notching.</div><div>We distinguish two subcategories of PSI: functional and structural, respectively without and with anatomic lesions. In both categories, there may be anatomic risk factors. Clinically, functional PSI involves reproducible asymptomatic voluntary subluxation or sometimes reproducible involuntary subluxation. Functional PSI implicates impaired external-rotation rotator cuff and scapular stabilizer muscle activity. Treatment is non-operative, by rehabilitation and shoulder pace maker.</div><div>Structural shoulder instability involves anatomic lesions, often due to iterative microtrauma; pain is the most frequent symptom. It usually concerns young athletic subjects, but the clinical forms of structural and of anterior shoulder instability are not superimposable. Treatment may be surgical; arthroscopic labrum repair is effective in the absence of significant bone lesions, whereas otherwise posterior bone block is the treatment of choice. Surgical treatment of scapular features underlying structural PSI is improved by 3D preoperative planning, cutting guides and dedicated internal fixation systems.</div></div><div><h3>Level of evidence</h3><div>expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104061"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696255","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":"Periprosthetic acetabular fractures","authors":"Nicolas Reina","doi":"10.1016/j.otsr.2024.104068","DOIUrl":"10.1016/j.otsr.2024.104068","url":null,"abstract":"<div><div>Periprosthetic acetabular fractures are a major challenge in orthopedics. Proper recognition of these complex cases helps to identify and treat patients with different presentations. These fractures can occur intraoperatively and be treated immediately, or they can occur postoperatively, following trauma or in the context of chronic low bone quality or associated implant loosening. The existing classification systems categorize these fractures as a function of the acetabular cup’s stability and the context surrounding the fracture.</div><div>When a fracture is detected intraoperatively, immediately analyzing its stability is crucial for choosing between a conservative strategy, the need for additional fixation, or the need to change the cup or use of an acetabular reinforcement ring.</div><div>When the patient has symptoms such as persistent pain or instability, secondary diagnosis of a fracture requires diagnostic imaging. Its treatment depends on the cup’s stability, with options ranging from conservative treatment with functional limitations, cup revision potentially combined with stabilization of the fracture site, and also management of potential periprosthetic bone defects.</div><div>Traumatic fractures require a comprehensive assessment to determine whether the acetabular cup is still stable. The treatment may be conservative or surgical (internal fixation or cup revision).</div><div>Chronic pelvic discontinuity is associated with bone loss and implant loosening. Acute pelvic discontinuity requires treatment tailored to each patient, often with acetabular rings or custom triflange cups to restore function.</div><div>This article aims to provide an in-depth review of periprosthetic acetabular fractures, touching on their causes, classification, assessment and treatment, along with specific considerations for fractures diagnosed postoperatively and following acute trauma.</div></div><div><h3>Level of evidence</h3><div>IV; systematic review of level II-IV studies</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104068"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}