Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Assessing tibial slope measurements: A study of methodological consistency and correlation with ACL rupture.","authors":"Luca Tanel, Thais Dutra Vieira, Martin Ecki, Thomas Cucurulo, Jean-Marie Fayard, Bertrand Sonnery-Cottet, Mathieu Thaunat","doi":"10.1016/j.otsr.2025.104330","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104330","url":null,"abstract":"<p><strong>Background: </strong>The tibial slope has emerged as a significant risk factor for anterior cruciate ligament (ACL) injuries and ACL graft failure. The lack of uniformity tibial slope measurement methods complicates clinical applications and research comparisons. This study aims to evaluate the correlation and reproducibility of different tibial slope measurement methods and their association with ACL rupture.</p><p><strong>Hypothesis: </strong>We hypothesized that the four tibial slope measurement methods (ACTS, PCTS, PTS, and MTS) would show strong correlations with each other and that patients with ACL injuries would exhibit significantly higher tibial slopes compared to controls, regardless of the measurement technique.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 100 patients, divided into two groups: 50 with ACL injuries and 50 with intact ACL. Tibial slope was measured on conventional lateral X-ray using four methods: Anterior Cortical Tibial Slope (ACTS), Posterior Cortical Tibial Slope (PCTS), Proximal Tibial Slope (PTS), and Mechanical Tibial Slope (MTS). A correlation analysis, including a correlation matrix and linear regression analysis was performed to evaluate the correlation between the measurement methods. Additionally, tibial slope values between the ACL-injured group and the intact ACL group were compared using statistical tests such as Student's t-test and Z-test. Intra- and inter-observer reliability were assessed using the intraclass correlation coefficient (ICC).</p><p><strong>Results: </strong>The mean tibial slope varied depending on the measurement method, with the ACTS showing the highest values and PCTS the lowest. High correlation coefficients (R > 0.80) were observed between all methods, with the strongest correlation found between PTS and MTS (R = 0.933) and the lowest between ACTS and PCTS (R = 0.809), the linear regression analysis showed a strong linear relationship between all methods. Intra- and inter-observer reliability was excellent (ICC > 0.9422). Comparative analysis between the ACL-injured group and the intact ACL group revealed a statistically significant increase in tibial slope in the ACL-injured group, regardless of the measurement method.</p><p><strong>Conclusion: </strong>The tibial slope measurements across the four measurements methods (anterior cortex, proximal tibial slope, posterior cortex and mechanical axis) are significantly correlated. The largest discrepancies are observed in measurements based on the anterior cortex. The reproducibility is satisfactory both intra- and inter-observer. A statistically significant increase in tibial slope is observed in the knees with an ACL injury, regardless of the measurement method used, reinforcing its role as a crucial risk factor in ACL rupture.</p><p><strong>Level of evidence: </strong>III; Retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104330"},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621226","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":"Does the restoration of the hindfoot alignment correlate with good clinical and functional outcomes in displaced intra-articular calcaneal fractures treated with Calcanail®?","authors":"Adrien Rossetti, Julien Maximen, Robin Delacroix, Christophe Szymanski, Mickael Ropars, Louis Rony","doi":"10.1016/j.otsr.2025.104329","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104329","url":null,"abstract":"<p><strong>Introduction: </strong>Calcaneal fractures are quite common and can lead to serious functional consequences. Minimally invasive percutaneous techniques have reduced the incidence of wound and sepsis complications associated with open reduction and internal fixation. The use of intraosseous internal fixation, such as percutaneous intramedullary nailing, has decreased these complications and yielded good functional outcomes. The aim of this study was to assess the correlation between functional outcomes and the restoration of hindfoot alignment according to the long axial view in calcaneal joint fractures treated with percutaneous intramedullary nailing.</p><p><strong>Hypothesis: </strong>Internal fixation using percutaneous intramedullary nailing restores hindfoot alignment associated with good functional outcomes.</p><p><strong>Materials and methods: </strong>This was a retrospective single-center, multi-surgeon study involving 20 cases of displaced intra-articular calcaneal fractures treated with a percutaneous nail device (Calcanail®) between 2018 and 2022, with a minimum follow-up of one year. Among these, 11 were classified as Sanders-II and nine as Sanders-III fractures. The primary endpoint was clinical evaluation using the AOFAS scale (/100) and the investigation of a correlation with the radiographic hindfoot alignment according to the long axial view. NRS pain scores, EFAS functional scores (/24), SF-12 scores, and all complications were recorded. Clinical and radiographic follow-up data were analyzed in comparison to the healthy contralateral side at the final follow-up.</p><p><strong>Results: </strong>The mean follow-up time was 40.1 months ± 14.0 (13-62). A correlation was found between hindfoot alignment and the AOFAS score (r_s = -0.494, p = 0.026). The NRS at the last follow-up was 1.3 ± 1.9 (0.0-6.0). The mean AOFAS score was 81.8 ± 9.6 (57.0-92.0), and the EFAS score was 17.3 ± 3.7 (4.0-21.0).</p><p><strong>Discussion: </strong>In our study, the use of internal fixation with percutaneous intramedullary nailing achieved acceptable functional and clinical outcomes, along with the restoration of hindfoot alignment, which correlated with the AOFAS functional score.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104329"},"PeriodicalIF":2.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621227","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":"Orthoplastic approach for the management of open tibial fractures: Should Orthopedic surgeons be trained to perform pedicled flaps?","authors":"Léonard Vezole, Laurent Mathieu, Paul-Henri Bauwens, Frédéric Rongiéras, Antoine Bertani, Etienne Massardier","doi":"10.1016/j.otsr.2025.104328","DOIUrl":"10.1016/j.otsr.2025.104328","url":null,"abstract":"<p><strong>Introduction: </strong>The management of open tibial fractures has greatly benefited from the development of the orthoplastic approach. Despite advances in soft tissue reconstruction techniques, the use of simple pedicled flaps performed by orthopedic surgeons remains a relevant option.</p><p><strong>Hypothesis: </strong>In the context of orthoplastic reconstruction of tibial fractures, the use of pedicled flaps performed by orthopedic surgeons can optimize soft tissue coverage strategies.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 63 patients treated for open tibial fractures requiring soft tissue reconstruction between July 1, 2012, and July 1, 2021. Two groups were compared: Group 1 included patients operated on before July 1, 2018, when flaps were performed exclusively by plastic surgeons; Group 2 included patients operated on after July 1, 2018, when flaps were performed by either plastic or orthopedic surgeons. Demographic and injury-related data, type of flaps used, and the 1-month flap failure rate were analyzed. Time to coverage, time to soft tissue healing, and time to secondary internal fixation were recorded and compared between groups.</p><p><strong>Results: </strong>In Group 1, 28 out of 45 patients (62%) underwent soft tissue coverage using flaps, of which 30 out of 31 flaps (97%) were performed by plastic surgeons. The free-to-pedicled flap ratio was 16:15. In Group 2, all 18 patients (100%) underwent flap coverage, of which 18 out of 20 flaps (90%) were performed by orthopedic surgeons. The free-to-pedicled flap ratio in this group was 2:18. The median time to coverage was significantly reduced in Group 2, from 28 days to 7 days (p < 0.05). Healing times were shortened. Flap failure rates were not significantly different between groups.</p><p><strong>Conclusion: </strong>When the injury pattern allows, the use of pedicled flaps by orthopedic surgeons appears to reduce the time to coverage in open tibial fractures, thereby optimizing the orthoplastic reconstruction strategy. Training orthopedic surgeons in these simple, reliable, and reproducible reconstruction techniques is therefore recommended.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104328"},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576929","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":"Frequent location and severity of sports-related fractures in children in a tertiary care-center. A retrospective observational cohort study.","authors":"Theo Cordonnier, Victor Germon, Cyril Lemé, Jean Luc Jouve, Franck Launay, Sébastien Pesenti","doi":"10.1016/j.otsr.2025.104327","DOIUrl":"10.1016/j.otsr.2025.104327","url":null,"abstract":"<p><strong>Introduction: </strong>Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe METHODS: We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of injury and fracture location were collected. Contexts were divided into five categories: domestic, sport-related, motor vehicle accident, school-based, other. In addition, treatment modality was collected and categorized as simple (cast immobilization), reduction and surgery (osteosynthesis).</p><p><strong>Results: </strong>A total of 4761 patients were included (mean age 8.9 years ± 4.3). There were 3326 patients in the domestic fractures group (mean age 7.8 years +/- 4.3) and 1435 patients in the sport-related fractures group (mean age 11.4 years +/- 3.0 (p < 0.001)). Surgical treatment was more frequent in sport-related fractures (13% vs 8%, p < 0.001). Horse-riding was the sport leading the most frequently to surgical treatment (47%). When taking domestic fractures as reference, we found that surgical treatment was significantly more frequent in most of sport-related fractures. The most at-risk sports were horse-riding (OR = 14.5, p < 0.001) and athletics (OR = 5.7, p < 0.001).</p><p><strong>Conclusions: </strong>Even though physical activity must be promoted in children regarding their beneficial effects, sport-related fractures require more often a surgical treatment. Horse-riding is particularly at-risk, and children and families must be properly informed on risks, security measures and protection equipment.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104327"},"PeriodicalIF":2.3,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576928","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":"Outcomes of ORIF or revision arthroplasty for periprosthetic knee fractures in older patients with implant loosening: Is internal fixation alone a reasonable treatment strategy?","authors":"Marie Le Baron, Alessandra Cipolla, Thibaut Battut, Thierry Bégué, Xavier Flecher, Matthieu Ehlinger","doi":"10.1016/j.otsr.2025.104326","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104326","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Periprosthetic fractures around the knee (TKAPF) often occur in old patients with concomitant diseases. Like any other fragility fracture, the aim of TKAPF management should be a patient-specific strategy considering clinical factors and associated comorbidities. The aim of the present study was to analyse if, in selected groups of unfit patients, osteosynthesis alone without revision even in cases of implant loosening (SOFCOT type 2 and 3) could be a good compromise to avoid invasive surgery and to reduce the mortality rate with reasonable results. The hypothesis was that for TKAPF SOFCOT type 2 and 3 there was no difference in survival rate between a group of patients treated by open reduction and internal fixation only compared to a group treated by revision of existing implant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 62 patients with a TKAPF and a loose implant classified as SOFCOT type 2 or 3 who have been surgical treated were included. The mean age of the population was 81.1 ± 10.3 years. Female rate was 92% (n = 57). The majority of patients had an ASA 2 or 3 score (n = 52, 83.9%). The pre-operative Parker score was 6.1 ± 2.5. Two groups were created to be compared in terms of results and complications: a group of 18 patients operated by open reduction and internal fixation (ORIF group) with a plate and a group of 44 patients operated by total knee arthroplasty revision (revision group) with or without plate osteosynthesis associated. Mortality and re-operations for mechanical complications were examined as the primary endpoint. Time to full weight-bearing (in weeks), time to bone union (in weeks) other complications such as infection and haematoma rate were collected as secondary endpoint.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The median duration of follow-up was 2 years. The re-revision rates were respectively 15,9% in revision group, 22,2% in ORIF group. No statistically significant differences were found between the groups for mechanical complications or re-revision. The survival endpoint at 2 years follow up was 88.9% (95% CI: 78.1-94.5) without differences between the groups (p = 0.64). Time to bone union was significantly longer (15.9 weeks) in the ORIF group compared to 8.6 weeks for the revision group but with a higher bone union rate in the ORIF group (p = 0.003) as well as the time to full weight-bearing (ORIF group 8.9 weeks compared to 1.7 weeks for the revision group P &lt; 0.001). More infections were reported in the ORIF group and a higher risk of haematoma and bleeding in the revision group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Despite longer time to bone union and time to full weight-bearing, open reduction and internal fixation with plate for TKAPF with a loose component in selected older and unfit patients does not increase the risk of re-operation or mortality compared to a more invasive revision arthroplasty strategy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level of evidence: &lt;/strong&gt;III, comparative retrospective st","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104326"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562047","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":"Learning curve of robotic assisted total knee arthroplasty within a surgical team: A prospective study of 115 cases","authors":"Julien Druel ,&nbsp;Santiago Claudel ,&nbsp;Maxime Fabre-Aubrespy ,&nbsp;Matthieu Ollivier ,&nbsp;Sebastien Parratte ,&nbsp;Christophe Jacquet ,&nbsp;Jean-Noel Argenson","doi":"10.1016/j.otsr.2025.104325","DOIUrl":"10.1016/j.otsr.2025.104325","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Over the last decade, robotic assistance has been highlighted to improve the accuracy of TKA&lt;/div&gt;&lt;div&gt;alignment. Despite growing adoption of robotic-assisted total knee arthroplasty (raTKA), little is known about the learning curve required to achieve consistent outcomes with personalized alignment techniques. The aim of this research was to assess the learning curve of robotic-assisted total knee arthroplasty (TKA) using the anatomic-functional implant positioning (AFIP) method by examining factors such as operative time, alignment accuracy, ability to restore the Coronal Plane Alignment of the Knee (CPAK) phenotype, postoperative ligament balance, and complication rate. This study addressed the following four specific research questions: (1) How many cases are necessary to improve operative time? (2) Does surgical experience affect implant positioning accuracy? (3) Does experience influence ligament balance and CPAK phenotype restoration? (4) Does increased experience improve patient-reported outcomes?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;Our hypothesis was that with increased experience using raTKA, operative time would improve, while maintaining high accuracy of implant positioning. We further hypothesized that personalized alignment targets, as defined by the AFIP protocol, including joint line obliquity and CPAK phenotype restoration, could be consistently achieved from the early cases, without being compromised during the learning phase.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;In total, 115 patients undergoing primary TKA with the ROSA robotic tool were prospectively included between February 2023 and February 2024. The AFIP technique was planned for each patient, and surgeries were performed by 4 experienced knee arthroplasty surgeons but with no prior experience in robotics. The following data were analyzed: (1) Preoperative and postoperative CPAK classification on full weight-bearing views. (2) Pre- and postoperative ligament balance, including the evaluation of medial and lateral femoro-tibial gaps in both flexion and extension. (3) The precision of postoperative frontal alignment (ΔHip Knee Angle (HKA)) was determined by calculating the discrepancy between the intended preoperative correction and the achieved postoperative adjustment. In addition complications and patient‐reported outcome measures (PROMs) were recorded for each patient. Cumulative summation (CUSUM) analysis was employed to evaluate the progression of learning curves.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The implementation of raTKA required a learning period of 11 cases to achieve optimal operative time, with an average duration of 108 min.&lt;/div&gt;&lt;div&gt;&lt;span&gt;Postoperative alignment remained stable throughout the series (ΔHKA = 2.0 ° ± 1.0 °), with no impact from surgical experience. Balanced medial-lateral gaps (defined as &lt;2 mm difference) were achieved in 105 of 115 cases (91%). The CPAK phenotype was restored in 51 of 115 ","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 5","pages":"Article 104325"},"PeriodicalIF":2.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555799","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":"Basal resection arthroplasty in TarsoMetatarsal arthritis, a new approach (BATMAN Technique): Technical note and outcomes.","authors":"Naveen Nara, Marion Dias, Julien Lucas Y Hernandez, Olivier Laffenêtre","doi":"10.1016/j.otsr.2025.104324","DOIUrl":"10.1016/j.otsr.2025.104324","url":null,"abstract":"<p><strong>Background: </strong>Tarsometatarsal arthritis is a significant cause of disability and is commonly treated with arthrodesis, which has limitations such as hardware-related complications and adjacent joint stress. Metatarsal base resection-arthroplasty offers a novel, mobility-preserving alternative.</p><p><strong>Technique and results: </strong>A total of 24 feet were operated on with the BATMAN Technique. Resection consisted of a wedge-shaped resection of the base and dorsal part of the metatarsal, starting approximately 1 cm distal to the joint line with an angle of approximately 45 ° and preserving the plantar hinge. The resection involved the 2nd and 3rd metatarsals in 15/24 feet (62%). Mean follow-up was 51 ± 25.8 months, with favorable outcomes. Complications were limited to metatarsalgia and clinical progression of osteoarthritis on adjacent rays in 4 patients.</p><p><strong>Discussion: </strong>Metatarsal base resection-arthroplasty seemed to be a safe and feasible technique for managing tarsometatarsal arthritis. Further studies are needed to confirm its efficacy and refine its indications.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104324"},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555798","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":"Rotational or vertical instability? An analysis of 144 pelvic ring injury patients with unilateral sacrum and pubic rami fractures.","authors":"Youh-Hua Lo, Chih-Yang Lai, I-Jung Chen, Yung-Heng Hsu, Ying-Chao Chou, Yi-Hsun Yu","doi":"10.1016/j.otsr.2025.104321","DOIUrl":"10.1016/j.otsr.2025.104321","url":null,"abstract":"<p><strong>Background: </strong>Pelvic ring injuries (PRIs) involving the unilateral sacrum and pubic rami fractures often appear radiographically similar but differ biomechanically in their stability profiles. Consequently, accurate early differentiation between Arbeitsgemeinschaft für Osteosynthesefragen (AO) type B2.1 (rotationally unstable) and C1.3 (vertically unstable) is critical for determining appropriate surgical intervention.</p><p><strong>Hypothesis: </strong>We hypothesized that specific preoperative clinical and radiological factors could help differentiate between AO B2.1 and C1.3 fracture patterns, enabling more accurate diagnosis and optimized treatment planning.</p><p><strong>Patients and methods: </strong>This retrospective study included 144 adult patients with unilateral sacrum and pubic rami fractures treated surgically between 2014 and 2021. Clinical data, including mechanism of injury, injury and new injury severity scores (ISS/NISS), and associated injuries, were collected. Radiological assessments focused on L5 transverse process (TP) fractures, sacral fracture completeness, and vertical displacement. Logistic regression and receiver operating characteristic analysis were used to identify predictors of C1.3 injuries.</p><p><strong>Results: </strong>Of the 144 patients, 60 (41.7%) had AO B2.1 fractures, while 84 (58.3%) had AO C1.3 fractures. C1.3 injuries were significantly associated with male sex, high-energy mechanisms (e.g., fall from height), higher ISS/NISS, concomitant abdominal and urogenital injuries, and longer hospital/ICU stays (P < 0.05). Additionally, L5 TP fractures and vertical sacral displacement were radiologically more common in C1.3 cases than in B2.1 cases. Logistic regression identified NISS > 19 (OR: 1.17) and L5 TP fracture (OR: 9.02) as independent predictors of vertical instability.</p><p><strong>Discussion: </strong>In the emergency setting, the presence of L5 TP fractures and a NISS > 19 can help clinicians anticipate vertical instability in patients with sacrum and pubic rami fractures. Furthermore, identifying these indicators preoperatively may facilitate more accurate classification and selection of appropriate fixation strategies, thereby improving outcomes in patients with pelvic ring injuries.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104321"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340648","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":"A comparison of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the management of tibial pilon fractures: A prospective randomized study.","authors":"Roger Erivan, Thomas Caputo, Shirin Monadjemi, Bruno Pereira, Stéphane Descamps, Stéphane Boisgard, Guillaume Villatte","doi":"10.1016/j.otsr.2025.104323","DOIUrl":"10.1016/j.otsr.2025.104323","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to compare two surgical procedures for the treatment of tibial pilon fractures, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), in terms of wound healing time, ankle swelling, change in pain, functional outcomes and complications.</p><p><strong>Hypothesis: </strong>We hypothesized that MIPO treatment would induce a faster healing process and lower complications rates.</p><p><strong>Patients and methods: </strong>This monocentric, comparative, prospective and randomized study was based on the enrollment of 54 patients between November 2017 and May 2023. Patients hospitalized for a tibial pilon fracture with closed or open fracture (Cauchoix or Gustilo type I) received randomly ORIF or MIPO treatment using distal tibial locking compression plates of 3.5 mm. Data collection included demographics, wound dressing wear time, ankle circumference ratio, pain scores, AOFAS, FADI and MAZUR functional scores, and complications. Data were monitored from the intervention day until 12 months of follow-up, with different intermediate follow-up visits. They were then compared between minimally invasive and open surgery groups.</p><p><strong>Results: </strong>We found similar dressing wear times in both groups with a mean of 21.55 ± 14.91 days in the ORIF group and 18.0 ± 6.44 days in the MIPO group (p = 0.312). VAS pain scores and ankle circumference ratio did not reveal a significant difference between the two techniques. The infection rate was identical in both groups (15.4%; 4/26). Wound complication rates in the ORIF group (11.5%; 3/26) and the MIPO group (7.7%; 2/26) were not statistically different (p = 0.334). The analysis of the functional scores showed ameliorated results in the ORIF group at 3 months follow-up with higher AOFAS, FADI and MAZUR scores, but at further monitoring visits there was no evidence of the superiority of one technique over another.</p><p><strong>Conclusion: </strong>The MIPO technique was not distinctively superior to ORIF method in the treatment of tibial pilon fractures.</p><p><strong>Level of evidence: </strong>I, prospective randomized controlled trial.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104323"},"PeriodicalIF":2.3,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340593","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":"Open-access in spine surgery education: Developing and validating a free Transforaminal Lumbar Interbody Fusion (TLIF) virtual simulator.","authors":"Léonard Swann Chatelain, Antonia Blanié, Dan Benhamou, Pierre Guigui, Emmanuelle Ferrero","doi":"10.1016/j.otsr.2025.104316","DOIUrl":"10.1016/j.otsr.2025.104316","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal Lumbar Interbody Fusion (TLIF) is a common but technically demanding procedure requiring extensive training. Existing simulators are costly and inaccessible, with no free online alternative. The goal of this study was to develop and validate the first free, online, computer-based interactive simulator for TLIF to teach surgical steps to residents.</p><p><strong>Hypothesis: </strong>The hypothesis was that this computer simulator would perform better than a traditional PDF-based operative technique.</p><p><strong>Patients and methods: </strong>A randomized controlled trial was conducted, including 42 orthopedic surgery residents from three academic centers, randomized into two groups: 21 trained using the computer-based TLIF simulator and 21 trained using the traditional PDF-based operative technique. They subsequently performed a TLIF procedure on a sawbone model. Performance was assessed using a specific TLIF checklist (primary outcome) and the Objective Structured Assessment of Technical Skills (OSATS) score (secondary outcome). Subspecialty, number of TLIF observed before the study and the sawbone model procedure time were recorded. Satisfaction was evaluated using a post-training questionnaire.</p><p><strong>Results: </strong>Residents in the simulator group performed better on the checklist scores (mean 32.7/38.0 vs. 28.8/38.0; p = 0.01). OSATS score was slightly higher in the simulation group but without reaching significant difference (mean 26.7/35.0 vs. 23.3/35.0; p = 0.17). The simulator proved particularly beneficial for residents with less TLIF experience (N < 15), showing greater relative improvement compared to PDF traditional technique (with relative score differences of +16.5% for N < 5, +15.0% for 5 ≤ N < 15, and +6.3% for N ≥ 15). Participants rated the simulator highly for ease of use (mean 8.1/10 ± 1.6) and overall satisfaction (mean 8.7/10 ± 1.9).</p><p><strong>Discussion: </strong>This new TLIF simulator provides a valuable tool for teaching procedural steps of a complex spinal surgery, especially for residents with limited experience or outside the spine specialty. Its free and accessible design eliminates barriers to surgical education, making it well-suited for use at home for daily training.</p><p><strong>Level of evidence: </strong>II; Prospective, randomized, controlled educational study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104316"},"PeriodicalIF":2.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310766","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}