Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"The influence of preoperative methylprednisolone bolus on edema in lower leg fractures: A prospective randomized controlled trial.","authors":"Guillaume Fassot, Guillaume Villatte, Stéphane Descamps, Shirin Monadjemi, Myriam Galvin, Bruno Pereira, Stéphane Boisgard, Roger Erivan","doi":"10.1016/j.otsr.2025.104304","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104304","url":null,"abstract":"<p><strong>Introduction: </strong>Lower limb fractures are often associated with significant soft tissue damage, leading to edema and unfavorable conditions for wound healing. This study investigates the efficacy of a preoperative bolus of methylprednisolone (MP) in reducing edema and improving postoperative function in patients undergoing ankle or tibial fracture surgery.</p><p><strong>Hypothesis: </strong>We hypothesized that the cohort receiving the steroid would experience faster edema reduction and improved functional outcomes.</p><p><strong>Material and methods: </strong>A monocentric, prospective, randomized, double-blind, controlled trial was conducted from May 2019 to June 2023, including 104 patients. The experimental group (n = 51) received a 2 mg/kg bolus of MP in 100 ml of saline, while the control group (n = 51) received 100 ml of saline prior to surgery. Data were collected on the intervention day and postoperatively at days 2, 7, 15, 45, and at 3 and 6 months. Leg circumference ratio, pain intensity, wound healing, complications, LEFS scores, and work and sport resumption were recorded.</p><p><strong>Results: </strong>There were no significant differences in edema reduction between the two groups, except on day 15, where the MP group showed a significantly lower leg circumference ratio compared to the placebo group (P = 0.015). No differences were found in pain scores, functional recovery, or return to work. Both groups had comparable complication rates, with no evidence of adverse effects associated with the steroid treatment.</p><p><strong>Conclusion: </strong>The injection of a bolus of MP had a slight positive impact on lower leg edema without apparent risk of adverse event. The long-term monitoring (6 months) and the low rate of lost to follow-up let us affirm that a single 2 mg/kg MP bolus does not impede wound healing or functional recovery.</p><p><strong>Level of evidence: </strong>II; prospective randomized controlled trial.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104304"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144310","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":"Complex articular fractures of the distal radius in patients over 65 years old: A comparison of functional outcomes after locked anterior plate osteosynthesis versus orthopedic treatment, with an average follow-up of 40 months.","authors":"Mohamed Boudari, Mostafa Ibrahim, Christophe Chantelot, Marc Saab","doi":"10.1016/j.otsr.2025.104306","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104306","url":null,"abstract":"<p><strong>Introduction: </strong>Distal radius fractures are among the most common traumatic injuries in patients over 65 years old, but there is no consensus on their management. Our aim was to compare the functional outcome between surgical treatment with an anterior locking plate and orthopedic treatment.</p><p><strong>Hypothesis: </strong>There was no difference in functional outcomes between orthopedic and surgical treatment by osteosynthesis with volar locking plates in patients older than 65 years old.</p><p><strong>Patients and method: </strong>A retrospective, non-randomized, multicenter study between 2017 and 2022 compared the functional outcome, after osteosynthesis with anterior locked plate versus orthopedic treatment of AO type C distal radius fractures in patients over 65 years old with a minimum follow-up of 6 months. One hundred and fourteen patients were included, 68 received surgical treatment and 46 had orthopedic treatment. The mean follow-up was 40 months (6-74 months). The main endpoint was to evaluate the PRWE score at the last follow. Secondary endpoints included: assessment of wrist motion, radiological parameters of the distal radius (radial inclination, radial shortening, ulnar variance, and radial tilt) at last follow-up, and complication rate.</p><p><strong>Results: </strong>The mean PRWE score was 14.3 (± 10.9) for the surgical group and 15.8 (± 8.6) for the orthopedic group, with no significant difference (p = 0.27). There was no clinical difference in wrist motion. Radiological parameters at final follow-up were better in terms of anatomical reduction after surgery (p < 0.01). The complication rate was 17% (n = 12) after surgery and 7% (n = 4) after orthopedic treatment (p = 0.03).</p><p><strong>Discussion: </strong>This study found no significant difference in the PRWE score at final follow-up between osteosynthesis by volar locking plate and orthopedic treatment after an AO type C distal radius fracture in patients aged over 65. Orthopedic treatment thus remained a valid and satisfactory treatment option for this population.</p><p><strong>Level of evidence: </strong>III; Retrospective, comparative, non-randomized, multicenter study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104306"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144293","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":"Normative ranges of horizontal gaze parameters and their correlations with cervical sagittal parameters.","authors":"Hamza Karabag, Ahmet Celal Iplikcioglu","doi":"10.1016/j.otsr.2025.104305","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104305","url":null,"abstract":"<p><strong>Background: </strong>Maintaining a horizontal gaze is crucial for humans to interact with their surroundings and perform daily tasks. This gaze is evaluated using horizontal gaze parameters, including the chin-brow vertical angle (CBVA), McGregor slope (MGS), and slope of the line of sight (SLS). However, the normative ranges for SLS and CBVA, as well as their associations with cervical sagittal parameters, remain unclear. This study aimed to determine the normal ranges of horizontal gaze parameters based on their relationships with cervical sagittal parameters.</p><p><strong>Hypothesis: </strong>The normal ranges of horizontal gaze parameters can be established by analyzing their correlations with cervical sagittal parameters.</p><p><strong>Patients and methods: </strong>In 50 asymptomatic individuals, horizontal gaze parameters and cervical sagittal parameters were assessed using standing lateral cervical radiographs that included the skull. Pearson's correlation coefficient was used to analyze the relationships between these parameters. Additionally, predictive formulas were derived through linear regression analysis of significantly correlated parameters to define the normative ranges of horizontal gaze parameters.</p><p><strong>Results: </strong>Horizontal gaze parameters demonstrated significant correlations with the C2 slope (C2S) (T1 slope [T1S] minus cervical lordosis [CL]) and the C2-7 sagittal vertical axis (C2-7 SVA). They also showed significant but relatively weaker correlations with CL (p < 0.05). Based on the normal CL range (-8° to -29.5°), the estimated ranges for CBVA, MGS, and SLS were -10.8° to 7.83°, -6° to 14°, and -15.5° to 8°, respectively.</p><p><strong>Discussion: </strong>The significant correlations between horizontal gaze parameters and C2S as well as C2-7 SVA allow for the identification of kyphotic thresholds. Furthermore, kyphotic and lordotic thresholds can be determined based on their relationship with CL. However, larger studies are necessary to refine predictive formulas further.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104305"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144304","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":"Cast-rod construct for gradual correction of fixed knee flexion deformities in young children with arthrogryposis: Technical note and preliminary results.","authors":"Mohamed Yahya Hassanein, Almeldeen Khalf, Mohamed Khaled, Abdel Khalek Hafez Ibrahim, Nariman Abol Oyoun","doi":"10.1016/j.otsr.2025.104303","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104303","url":null,"abstract":"<p><strong>Introduction: </strong>Fixed knee flexion deformities (FKFDs) are common in children with arthrogryposis, yet their management in younger children is underreported.</p><p><strong>Material and method: </strong>This study describes a non-invasive cast-rod construct for the gradual correction of FKFDs secondary to arthrogryposis.</p><p><strong>Results: </strong>This study presents preliminary results from 18 knees in 12 patients under four years old (median age at 30 mo, 18-48). The median knee flexion contracture angle improved from 54.5 degrees (27-90) to 10 degrees (0-30) after cast removal, (p < 0.05). Treatment lasted for a median of 32 days (21-68). At a median eight months follow up (3-47), the angle increased to a median of 28 degrees (10-35), which remained significantly lower than the initial angle, (p < 0.05).</p><p><strong>Conclusion: </strong>The cast-rod construct appears to be an effective tool for improving FKFDs in young children with arthrogryposis: however, further research with extended follow-up is needed to assess the long-term durability of these outcomes.</p><p><strong>Level of evidence: </strong>IV; Case series.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104303"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144286","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":"Inside-out repair of bucket-handle meniscal tears in young patients: Long-term effectiveness in a high-risk population.","authors":"François Fauré, Jeanne Commeureuc, Robin Fauconnet, Antoine Josse, Franck Chotel","doi":"10.1016/j.otsr.2025.104301","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104301","url":null,"abstract":"<p><strong>Objective: </strong>Bucket-handle meniscal tears (BHMT) represent a severe tear and are challenging to preserve. This study focused on BHMT repair with mainly inside-out vertical sutures using non-absorbable materials in stable knees (no associated anterior cruciate ligament tear) in patients under 18 years old, evaluating survival rates and clinical outcomes. We hypothesized that this technique could result in a low failure rate in this presumed at-risk population.</p><p><strong>Methods: </strong>This retrospective study included 31 patients (31 knees) with a mean age of 13.7 years old at time of arthroscopic meniscal repair for BHMT (19 lateral and 12 medial) between 2010 and 2019.</p><p><strong>Results: </strong>After a mean follow-up of 8.25 ± 2.9 years, seven clinical healing failures (22%) were observed, with 5-year survival rates of 77.4% for all lesions, 75% for medial menisci, and 78.9% for lateral menisci. The mean recurrence interval was 26.4 ± 18.8 mo. Clinical outcomes included mean pedi-IKDC scores of 83.7 ± 12.2 mean Kujala scores of 86.7 ± 10.9, Simple Value Test subjective functional scores of 82.5 ± 13.3, and Tegner scores of 6.4 ± 2.1.</p><p><strong>Conclusion: </strong>This study demonstrates that sutured repair of bucket-handle meniscal tears in stable knees of patients under 18 years of age is associated with a relatively low failure rate, supporting the hypothesis that this technique is effective in a population traditionally considered at risk.</p><p><strong>Level of evidence: </strong>IV; Retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104301"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133132","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":"Evolving strategies for both-column fractures: From ilioinguinal to pararectus approach with anatomical quadrilateral plate fixation.","authors":"Pablo Froidefond, Marie Castoldi, Nicolas Bronsard, Jean-François Gonzalez, Régis Bernard de Dompsure","doi":"10.1016/j.otsr.2025.104299","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104299","url":null,"abstract":"<p><strong>Background: </strong>The pararectus approach has emerged as an alternative to the traditional ilioinguinal approach for complex both-column (BC) fractures of the acetabulum. Concurrently, suprapectineal plates have evolved to enhance anatomical fixation of the quadrilateral surface (QLS) and restore joint congruency. This study aimed to answer the following questions: Does the pararectus approach provide comparable articular reduction to the ilioinguinal approach in BC fractures? Does it reduce operative time and blood loss? Are mid-term functional outcomes similar? We hypothesized that the pararectus approach, combined with anatomical QLS plating, would yield similar reduction quality and functional outcomes while decreasing surgical time and blood loss compared to the ilioinguinal approach.</p><p><strong>Patients and methods: </strong>This retrospective, single-center study included 43 patients with BC fractures treated between 2009 and 2022. Patients were divided into two groups: ilioinguinal approach with conventional suprapectineal plate (II, n = 15) and Pararectus approach with anatomical QLS plate (PR, n = 28). Pre- and postoperative CT scans assessed axial, coronal, and sagittal residual gap, step and femoral head displacement. Operative time, blood loss, transfusion needs, and complications were recorded. Functional outcomes were assessed at two years using the Harris Hip Score (HHS) and PMA score.</p><p><strong>Results: </strong>Articular gap reduction was similar: axial (II: 5.0 ± 2.9 mm vs. PR: 4.6 ± 5.1 mm, p = 0.3), coronal (II: 5.7 ± 2.4 mm vs. PR: 5.6 ± 5.5 mm, p = 0.2), sagittal (II: 5.6 ± 2.8 mm vs. PR: 6.4 ± 6.5 mm, p = 0.6). Residual coronal step was lower in PR (1.9 ± 2.0 mm vs. 3.6 ± 1.9 mm, p = 0.01). Anterior femoral head displacement improved in PR (-1.7 mm vs. + 5.6 mm, p < 0.001). Medial (5.9 mm vs. 3.98 mm, p = 0.4) and proximal displacement (1.1 mm vs. 1.2 mm, p = 0.46) were comparable. Operative time (PR: 125.1 ± 37.9 min vs. II: 309 ± 85.5 min, p < 0.001) and postoperative transfusions (p = 0.01) were significantly reduced in PR. Functional outcomes were comparable (HHS and PMA good-to-excellent: II: 70% vs. PR: 70%, p = 0.9).</p><p><strong>Conclusion: </strong>The shift from the ilioinguinal to the pararectus approach with QLS plate fixation appears to offer at least equivalent reduction quality while reducing surgical time, transfusion needs, and complications. These findings support evolving strategies in BC fracture management and highlight the key role of implant design. Further prospective studies are needed to confirm these results over the long term.</p><p><strong>Level of evidence: </strong>Level III: comparative cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104299"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133122","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 hip spine complex: Have we made real progress or just stacked piles of data?","authors":"Pascal Kouyoumdjian, Jean-Charles Le Huec, Jean-Yves Lazennec, Benjamin Blondel","doi":"10.1016/j.otsr.2025.104297","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104297","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104297"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133133","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":"Influence of the antero-posterior position of a pin on the risk of a medial hinge fracture during a lateral opening wedge distal femoral varus osteotomy. A biomechanical study.","authors":"Anthony Risser, Samuel Berthe, Mekki Tamir, Alexia Samier, Karl Boulos, François Bonnomet, Nadia Bahlouli, Henri Favreau, Matthieu Ehlinger","doi":"10.1016/j.otsr.2025.104300","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104300","url":null,"abstract":"<p><strong>Introduction: </strong>Lateral opening wedge distal femoral varus osteotomy (LOWDFO) is indicated for early isolated lateral compartment osteoarthritis in young patients with genu valgum due to an isolated distal femoral metaphyseal deformity. A medial hinge fracture is considered a poor prognostic factor for radio-clinical outcomes, hence its prevention is crucial. The protective role of a temporary pin has been demonstrated in the literature. The primary objective of this study was to evaluate the influence of the antero-posterior position of this pin on hinge protection.</p><p><strong>Hypothesis: </strong>The main hypothesis was that a centrally positioned pin offers the best resistance to breakage compared to anterior and posterior positions.</p><p><strong>Materials and methods: </strong>The experimental model was a 3D model of a distal femur, fabricated and printed from the pre-operative CT scan of a patient who underwent a LOWDFO. ABS polymer was chosen for printing these models due to its fracture characteristics similar to bone. Fifteen specimens were printed. Three different cutting guides were also printed, each corresponding to one of the three pin protection positions, the use of these cutting guides ensure the reproducibility of pin positioning. Three pin positions were defined: 25% anterior and 75% posterior junction (anterior group) on a horizontal plane of the distal femur, 50%-50% junction (central group), and 75% anterior and 25% posterior junction (posterior group). The tests were conducted on a single-column traction-compression machine 3345® (Instron™, Norwood, MA, USA). The protocol involved opening the osteotomy until breakage, defined by the appearance of the first fissure at the hinge. The primary outcome measure was the maximum force at breakage, and secondary outcomes were displacement before breakage and stiffness.</p><p><strong>Results: </strong>The \"Central group\" showed, in absolute terms (mean of 130.9 N), the greatest breaking force. This difference was statistically significant (SS) only compared to the \"Anterior group\" (mean of 85.09 N). The \"Central group\" also demonstrated the highest stiffness (mean of 15.70 N/mm) with a SS difference compared to the other two groups (9.06 N/mm for the anterior group and 11.98 N/mm for the posterior group).</p><p><strong>Discussion: </strong>These results confirm the working hypothesis: a centrally positioned pin provides increased protection of the medial hinge during a LOWDFO. Although this in vitro study can only approximate actual in vivo conditions, it provides valuable insights into the optimal position of the pin for hinge protection. However clinical studies are needed.</p><p><strong>Level of evidence: </strong>IV; Experimental study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104300"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133131","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":"Three dimensional scapholunate distance assessment from biplanar radiographs: A feasibility study in clinical practice.","authors":"François Loisel, Thomas Fradin, Laurent Gajny, Laurent Obert, Sébastien Laporte, Wafa Skalli","doi":"10.1016/j.otsr.2025.104298","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104298","url":null,"abstract":"<p><strong>Introduction: </strong>Wrist ligament injuries present a significant challenge in orthopedic surgery. They primarily affect a young and active population. When left undiagnosed, they can lead to chronic pain, arthritic degeneration, and professional disabilities. The lack of objective pre- and postoperative tools limits effective patient follow-up. The aim of this study is to apply a 3D reconstruction method based on biplane radiographs of the hand and wrist to diagnose and monitor these ligament injuries.</p><p><strong>Hypothesis: </strong>A personalized hand and wrist reconstruction created from biplane radiographs could enable the objective diagnosis and follow-up of carpal ligament pathologies.</p><p><strong>Materials and methods: </strong>We included 30 healthy volunteers, and 12 patients suspected of having ligament injuries. Data acquisition was performed using a low-dose biplane radiography system (EOS). Bone reconstruction was conducted, and scapholunate (SL) distances were calculated between the neutral and clenched fist positions by determining bone centroids. The variations in SL distances in patients, both pre- and postoperatively, were compared to the values of the healthy volonteers cohort.</p><p><strong>Results: </strong>In healthy volunteers, variations in SL distances between the neutral and clenched fist positions were significantly different depending on sex (0.1 mm in males, 0.5 mm in females) and lunate morphology. No statistically significant difference was observed between the healthy and preoperative groups (p = 0.165). However, a significant difference was found between preoperative and postoperative patients (p = 0.014).</p><p><strong>Discussion: </strong>This study highlights the utility of personalized reconstruction in objectively assessing biomechanical alterations of the wrist and monitoring patients. However, the routine clinical application of this method requires technical improvements in terms of precision and automation.</p><p><strong>Level of evidence: </strong>III; case-control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104298"},"PeriodicalIF":2.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133136","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":"Third fragment femoral shaft fracture: A retrospective analysis of complications and predictive factors for non-union and delayed union.","authors":"Edoardo Gambuti, Antonio Caldaria, Elisa Spadoni, Nicolò Biagi, Danila Azzolina, Achille Saracco, Maria Vittoria Guerzoni, Leo Massari, Gaetano Caruso","doi":"10.1016/j.otsr.2025.104295","DOIUrl":"10.1016/j.otsr.2025.104295","url":null,"abstract":"<p><strong>Introduction: </strong>Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures. The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach. The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union.</p><p><strong>Material and methods: </strong>This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up.</p><p><strong>Results: </strong>Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not. Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor.</p><p><strong>Conclusion: </strong>The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104295"},"PeriodicalIF":2.3,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129087","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}