Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"A nine-year retrospective study of bacterial epidemiology and culture optimization in four orthopaedic surgery departments.","authors":"Sylvain Robinet, François Parisot, Arnaud Clavé","doi":"10.1016/j.otsr.2025.104193","DOIUrl":"10.1016/j.otsr.2025.104193","url":null,"abstract":"<p><strong>Background: </strong>Management of device-associated bone and joint infections combines surgical treatment and antibiotic therapy. Immediate postoperative broad-spectrum empiric treatment is often recommended pending complete microbiology results. The probabilistic antibiotics often used are not harmless, and expose the patient to the selection of resistant bacteria and changes in bacterial ecology within the healthcare units. The aim of this study was to answer the following questions: (1) Have the pathogenic bacteria isolated in osteoarticular infections and/or their antibiotic susceptibility profile changed over a 9-year period at our center, with possible implications for antibiotic therapy protocols? (2) Is there a way to optimize the incubation time for microbiological cultures while still being acceptable for slow growing pathogens?</p><p><strong>Hypothesis: </strong>Our hypothesis was that no difference in microbial epidemiology and antibiotic resistance rates would be found over this 9-year period, confirming antibiotic protocols.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study describing a nine-year bacterial epidemiology in four traumatology and orthopedic surgery departments. Bacteria identified, site of infection, and antibiotic resistance were evaluated. Antibiotics for use in probabilistic protocols and after documentation of infection were selected for follow-up. Bacterial species were isolated after a maximum incubation period of 15 days up to 2020, and 10 days from 2021 with the addition of a solid culture medium that promotes anaerobic bacterial growth.</p><p><strong>Results: </strong>Of the 648 clinical situations, 824 bacteria were identified. Gram-positive cocci accounted for 61.4% (506/824) of the strains, including 291/824 (35.3%) Staphylococcus aureus and 136/824 (16.5%) coagulase-negative staphylococci. For the latter, fluoroquinolone resistance remained stable at 7.3% (18/291 (p = 0.086)) and 22.8% (34/136 (p = 0.432)), respectively. Resistance to rifampicin was also stable for Staphylococcus aureus (1.2%,4/291 (p = 0.486)) and for coagulase-negative staphylococci (10.7%, 15/136 (p = 0.596)). Enterobacteriaceae accounted for 148/824 (18.0%) of identifications and were more resistant to piperacillin/tazobactam (15.1%, 24/148) than to cefepime (5.6%,9/148 (p = 0.006)). There was no significant difference between the 15-day and 10-day culture protocols in the proportion of anaerobic bacteria isolated from shoulder (p = 0.721), hip and knee (p = 0.530) prosthesis infections and spinal device-associated infections (p = 0.373). A microbiological diagnosis was made within five days using the 10-day culture protocol in 333/344 (96.8%) cases.</p><p><strong>Discussion: </strong>The increase in Cutibacterium acnes isolates is mainly explained by the increased number of patients recruited for shoulder arthroplasty. No change in antibiotic resistance was observed in our retrospective study","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104193"},"PeriodicalIF":2.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476934","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":"Strain analysis of intra- and extra-medullary implants for fixing the subtrochanteric femoral fractures.","authors":"Jie Wang, Hongqiang Jiang, Haomin Li, Haobo Jia, Lei Wang","doi":"10.1016/j.otsr.2025.104192","DOIUrl":"10.1016/j.otsr.2025.104192","url":null,"abstract":"<p><strong>Background: </strong>Intra or extra medullary fixation for subtrochanteric fractures (STF) is still controversial. And the strain on fracture site and implant have not been reported. The aim of our study is to evaluate the differences in strain at the medial and lateral cortex of the subtrochanteric region with PFNA, 'upside-down' LISS and PFLP fixing different types of subtrochanteric femoral fractures under static loads.</p><p><strong>Hypothesis: </strong>Our hypothesis was that the PFNA was superior than LISS and PFLP for fixation of STF. However, PFNA also had some weakness.</p><p><strong>Methods: </strong>Thirty composite femurs with PFNA, LISS or PFLP fixation were divided into three groups. Four models of implant-femur constructs were tested under axial compression load with strain recording by gauges. While finite element analysis (FEA) was performed to simulate the biomechanical test with synthetic bone and implant construct finite element model in order to measure the strain on femur and implant.</p><p><strong>Results: </strong>In model I, both of the strains recorded by gauge 2 of PFNA and LISS were significantly lower than that of PFLP (PFNA: p = 0.002; LISS: p = 0.038). In model II, both of the strains recorded by gauge 2 (PFNA: p = 0.019; LISS: p = 0.016) and 3 (PFNA: p = 0.016; LISS: p = 0.006) of PFNA and LISS were significantly lower than that of PFLP. In model III, the strain recorded by gauge 2 (p = 0.007) and 3 (p = 0.002) of PFNA were significantly lower than that of LISS. While the strain recorded by gauge 1 (p = 0.028) and 2 (p < 0.0001) of PFNA were significantly lower than that of PFLP. The strain value recorded by four gauges in each femur construct group changed from model I to IV similar to the results of FEA, except for individual gauges.</p><p><strong>Discussion: </strong>Our study demonstrated that PFNA and reverse LISS fixation were superior to PFLP for stable subtrochanteric fractures and unstable subtrochanteric fractures that have restored medial bone support. For comminuted subtrochanteric fracture, PFNA fixation was slightly superior to reverse LISS and PFLP. However, it was needed to know that the main nail of PFNA had huge compress force on the subtrochanteric medial bone area.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104192"},"PeriodicalIF":2.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473243","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":"High trans-iliac incomplete bi-cortical pelvic osteotomy vs dega osteotomy in treatment of developmental dysplasia of the hip in young children: A new technique.","authors":"Hosam El-Din Amin, Hisham Abdel-Ghani, Naguib Basha, Mahmoud Badawy, Alaa Abououf, Ahmed Darweash, Ebeed Yasin","doi":"10.1016/j.otsr.2025.104191","DOIUrl":"10.1016/j.otsr.2025.104191","url":null,"abstract":"<p><strong>Introduction: </strong>There are many controversies regarding the ideal pelvic osteotomy in managing Developmental dysplasia of the hip (DDH). We introduce a new high trans-iliac incomplete bi-cortical pelvic osteotomy (HTIBO) by starting the osteotomy at a higher point proximal to the anterior superior iliac spine and hinging on the post limb of the triradiate cartilage, comparing the results with Dega osteotomy (DO).</p><p><strong>Hypothesis: </strong>HTIBO has superior clinical outcomes to Dega osteotomy and minimizes reliance on intraoperative fluoroscopic guidance.</p><p><strong>Patients and methods: </strong>This retrospective multicenter comparative study included 72 patients (81 hips) with DDH aged between 18 and 30 months between March 2019 and March 2021. There were 34 patients (38 hips) managed by HTIBO, and 38 patients (43 hips) managed by DO, the mean follow-up was 53.74 ± 7.57 & 52.91 ± 7.59 respectively. Intra-operative fluoroscopic guidance and surgery time were recorded. Patients were evaluated clinically according to McKay criteria, limb length discrepancy, cosmetic deformity, and radiographically for acetabular index, central edge angle, Shenton line continuity, osteotomy site union, and avascular necrosis according to Kalamachi classification.</p><p><strong>Results: </strong>The HTIBO group recorded lower intra-operative x-ray exposure (P <  0.01) and post-operative cast duration (P < 0.01), and better clinical outcome (P = 0.01). The final acetabular index was 15.11 ± 3.84, 37.68 ± 7.5, and the central edge angle was 14.56 ± 2.65, 34.47 ± 6.26, in HTIBO & DO groups respectively. In both groups, we recorded no cases of limping, restricted ROM, pain, LLD, re-dislocation, graft dislodgement, non-union, infection, or cosmetic deformity.</p><p><strong>Discussion: </strong>The current osteotomy (HTIBO) is feasible, and reliable, with a satisfactory clinical and radiological outcome, and can be safely performed in young DDH children without fluoroscopic guidance.</p><p><strong>Level of evidence: </strong>III, retrospective comparative study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104191"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460756","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":"Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies.","authors":"Jaden Hardrick, Anna M Ifarraguerri, Michael S Collins, David P Trofa, James E Fleischli, Nady Hamid, Patrick N Siparsky, Bryan M Saltzman","doi":"10.1016/j.otsr.2025.104190","DOIUrl":"10.1016/j.otsr.2025.104190","url":null,"abstract":"<p><strong>Background: </strong>Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic rotator cuff repair (ARCR). ISNBs with anesthetic agents like bupivacaine are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this systematic review and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.</p><p><strong>Methods: </strong>A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.</p><p><strong>Results: </strong>Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD -3.45, 95% CI [-5.20, -1.60]; P = 0.0003 and SMD -2.39, 95% CI [-4.01, -0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD -4.66; 95% CI, -7.95 to -1.36; p = 0.006; SMD -3.77; 95% CI, -5.69 to -1.85; p = 0.0001, SMD -3.34 95% CI [-5.13, -1.56]; p = 0.0002, and SMD -3.43; 95% CI, -5.74 to -1.12; p = 0.004, respectively).</p><p><strong>Discussion: </strong>LB moderately decreased pain scores 24-72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.</p><p><strong>Level of evidence: </strong>I.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104190"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460760","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 fractures around cemented hip hemiarthroplasty: Are SOFCOT-Vancouver recommendations mandatory? A comparative study with propensity score matching.","authors":"Galdéric Roblot, Julien Demester, Benoit Brunschweiler, Antoine Gabrion, Riadh Rahab, Patrice Mertl","doi":"10.1016/j.otsr.2025.104189","DOIUrl":"10.1016/j.otsr.2025.104189","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Periprosthetic hip fracture is a serious complication associated with increased mortality and impaired autonomy. When the implant is loosened, the standard treatment involves prosthetic revision. However, recent studies suggest that these cases can be successfully treated with fixation without prosthetic exchange. This strategy seems relevant for elderly and frail patients with fractures around hemiarthroplasties but it has not yet been investigated in France. Therefore we did a retrospective comparative investigation aiming to compare postoperative complications (i.e., death within one month or reintervention) between osteosynthesis and prosthetic revision in elderly patients with Vancouver B fractures around polished tapered stem hemiarthroplasties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;We hypothesized that there would be no significant difference between osteosynthesis and prosthetic revision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In a single-university-center, all patients treated between 2005 and 2024 for periprosthetic fractures after cemented hemiarthroplasty were included in a retrospective observational study. A total of 92 patients were included, with an average age of 88.7 years (range, 77-107), mostly institutionalized (58%) and with multiple comorbidities, as indicated by a mean ASA score of 2.75 (range: 2-4) and a mean Charlson Comorbidity Index of 6.4 (range: 4-10); the average time between HHA and PPF occurrence was 2.1 years (range: 7-5679 days). The primary outcome was a composite criterion including the occurrence of a complication requiring reintervention or death within one month postoperatively. Group comparability was established using a propensity score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean follow-up was 665 days, with the longest follow-up reaching 5704 days. No significant difference was observed in the primary outcome between the osteosynthesis group (n = 19/39 patients, (48.71%)) and the revision group (n = 16/39 patients, (41.02%)) (p = 0.637). Osteosynthesis demonstrated significantly shorter operative time (96 min vs. 167 min, p &lt; 0.001), reduced blood loss (428 mL vs. 874 mL, p &lt; 0.001), shorter hospital stays (9.17 days vs. 13.39 days, p &lt; 0.001), and better autonomy preservation (loss of 1.09 Parker score points vs. 1.97 points, p &lt; 0.001) compared to revision surgery. The 1-year mortality rate was 29,3% (27/92). The reintervention rate was 27.2% (25/92). The main causes of reintervention were dislocations, accounting for 13% (12/92) of cases, (occurring in 9.4% (5/53) of patients in the osteosynthesis group and 17.9% (7/39) in the revision group. The second most common reintervention cause was infection, which accounted for 11% (10/92) of cases, (occurring in 7.5% (4/53) of patients in the osteosynthesis group and 15.4% (6/39) in the revision group).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This result supports the idea that, for HHA's PPF, the Vancouver-SOFCOT recommendation","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104189"},"PeriodicalIF":2.3,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460765","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 ankle instability severity score. A simple preoperative score to select patients for ankle ligament repair or reconstruction Surgery.","authors":"Ronny Lopes, Tomoyuki Nakasa, Pierre-Alban Bouché","doi":"10.1016/j.otsr.2025.104188","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104188","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is no established preoperative clinical tool for determining whether to opt for surgical reconstruction or repair in cases of chronic ankle instability.</p><p><strong>Hypothesis: </strong>This study aimed to develop a predictive score for the likelihood of instability recurrence after surgical repair.</p><p><strong>Patients and methods: </strong>A multicenter case-control study was conducted, comparing patients who experienced recurrence of instability after surgical repair of the lateral ankle ligament (ATFL) to those who did not experience recurrence within 2 years post-surgery. Preoperative risk factors associated with instability recurrence at the 2-year mark were identified. Utilizing these datas along with existing literature, the Ankle Instability Severity Score (AISS) for predicting the risk of recurrence after ATFL repair was formulated. Subsequently, this score was calculated for all patients in the study cohort to evaluate its predictive capability.</p><p><strong>Results: </strong>Gender (p = 0.03), age (p = 0.02), BMI (p = 0.02), and participation in pivot sports (p = 0.04) were identified as risk factors for recurrence. The 9-point AISS score was applied to the patient cohort. When the score was three or lower, the recurrence rate after ATFL repair stood at 10.6% (OR 0.11 [0.04;0.28], p < 0.001). Conversely, if the score exceeded five, the recurrence rate was substantially higher at 80.0% (OR 11.9 [1.67;237.0], p = 0.03). Using ROC analysis, a threshold value of AISS score at 3.5 (sensitivity = 77.4%, specificity = 72.8%, AUC = 0.78) was identified to develop a instability recurrence after surgical repair.</p><p><strong>Discussion: </strong>This study introduces the AISS score, which relies on straightforward preoperative criteria to assist in deciding whether patients with chronic ankle instability should undergo ligament repair surgery or explore alternative treatment options.</p><p><strong>Level of evidence: </strong>IV; retrospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104188"},"PeriodicalIF":2.3,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434388","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":"Traction-related urinary complications in hip arthroscopy using a perineal post: Prevalence, risk factors, and outcomes.","authors":"Şahan Güven, Enejd Veizi, Ömer Faruk Naldöven, Yasin Erdoğan, Ali Şahin, Halil Çağatay Mert, Ahmet Fırat","doi":"10.1016/j.otsr.2025.104187","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104187","url":null,"abstract":"<p><strong>Background: </strong>Femoroacetabular impingement syndrome (FAIS) is a leading cause of chronic hip pain in young adults, often treated with hip arthroscopy. While effective, the procedure involves traction with a perineal post that can impact the urogenital system. This study aims to evaluate urinary function changes in patients undergoing hip arthroscopy for FAIS.</p><p><strong>Hypothesis: </strong>Urinary functions of the operated patients would be affected by the surgical procedure in the short term, but the symptoms would resolve within the first year MATERIALS AND METHODS: A retrospective cohort study was conducted on patients who underwent hip arthroscopy with a perineal post for FAIS between March 2017 and May 2022. Inclusion criteria were patients aged 18-50 with consistent physical and radiological findings of FAIS, who had failed non-surgical treatments, and had complete preoperative, postoperative, and one-year follow-up data. Patients with pre-existing conditions affecting urinary function were excluded. The study included 118 patients who completed the International Incontinence Consultation Questionnaire (ICIQ). Data on demographic variables, surgical details, and urinary symptoms were collected and analyzed. Urinary functions were assessed using the Female and Male Lower Urinary Tract Symptoms Questionnaires (ICIQ-FLUTS and ICIQ-MLUTS), and clinical outcomes were measured with the modified Harris Hip Score (mHHS).</p><p><strong>Results: </strong>The study cohort had an average age of 38.1 ± 8.3 years, with 54% being female. The average operation time was 145.9 ± 17.9 min, and the average traction time was 74.6 ± 16.1 min. Pudendal nerve irritation was observed in 13 patients postoperatively, resolving within the first year. Correlation analysis revealed that filling, voiding and incontinence function scores were positively correlated with traction time (p = 0.002, p < 0.001, p = 0.004, respectively) and total operation time (p = 0.002, p < 0.001, p = 0.001, respectively). In men, significant deterioration in voiding and incontinence functions was observed at four months postoperatively, and this improved at one year. Women showed no significant changes in urinary function scores postoperatively. Higher body mass index (BMI) was associated with increased incontinence scores.</p><p><strong>Discussion: </strong>Arthroscopic surgeries for FAIS with a perineal post have been observed to have significant effects on urinary functions, especially in male patients. These findings emphasize the importance of considering urinary functions in the planning of the surgical process. Additionally, it is important to inform patients about these potential issues. Future studies will provide more information on the prevention and management of these complications.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104187"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426692","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 screw trajectory affect surgical outcomes in percutaneous fixation for subacute scaphoid fracture?","authors":"Cheungsoo Ha, Segi Kim, Chi-Hoon Oh, Junhan Kim, Soo-Hong Han","doi":"10.1016/j.otsr.2025.104186","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104186","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Scaphoid fractures are the most common fracture in carpal bone fracture. However, they are often overlooked in the acute stage, leading to delayed diagnosis. There is limited research on the treatment outcomes of subacute scaphoid fractures. While many biomechanical studies have investigated the optimal trajectory for fixing scaphoid fractures, their clinical relevance remains unclear. This study aims to explore the clinical outcomes of volar percutaneous fixation for subacute scaphoid fractures and compare potential outcomes between groups with perpendicular and non-perpendicular fracture-screw angles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;In subacute scaphoid fractures, there is no difference in clinical outcomes between the non-perpendicular group and the perpendicular group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Between 2012 and 2022, 98 patients diagnosed with subacute scaphoid fractures were treated with volar percutaneous fixation within 3 weeks to 3 months post-injury. Acutrak mini headless compression screws (Acumed Inc., USA) were uniformly used. Included patients were divided into two groups: those with a fracture-screw angle ≥ 70 degrees formed the perpendicular group, while those with a fracture-screw angle &lt; 70 degrees constituted the non-perpendicular group. Effective screw length was calculated. Clinical outcome assessment included wrist joint range of motion and Disability of the Arm, Shoulder, and Hand (DASH) scores recorded final follow-up visits. Union rate and union time were evaluated for radiologic assessment. Demographic and clinical outcomes were statistically compared between the two groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Basic demographic characteristics did not show statistically significant differences between the two groups. The fracture-screw angle differed significantly between the groups, with the perpendicular group having a mean angle of 83.5 ° (± 6.00) and the non-perpendicular group having a mean angle of 62.7 ° (± 2.40) (p &lt; 0.001). The screw length used in the perpendicular group was 21.3 mm, while it was 23.1 mm in the non-perpendicular group (p &lt; 0.001). There was no significant difference in the effective screw length between the two groups. The utilization of the trans-trapezial approach differed significantly between the groups, with 11.4% in the perpendicular group and 64.3% in the non-perpendicular group (p &lt; 0.001). The union rate was 100% in both groups, and there were no notable complications. Both groups showed satisfactory outcomes in range of motion and clinical scores.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients with subacute scaphoid fractures, volar percutaneous fixation performed with appropriate indications achieved excellent outcomes. There was no significant difference in clinical outcomes between the perpendicular and non-perpendicular groups based on the fracture-screw angle. In cases where it is difficult to insert the screw perpendicularly, usi","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104186"},"PeriodicalIF":2.3,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426730","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":"Impact of preoperative measures on postoperative results in combined anterior cruciate and medial collateral ligament injuries: an analysis from the registry of the francophone arthroscopic society.","authors":"Benjamin Freychet, Nicolas Bouguennec, Emilie Berard, Alexandre Hardy, Corentin Herce, Charles Kajetanek, Christian Lutz, Thomas Neri, Matthieu Ollivier, Etienne Cavaignac","doi":"10.1016/j.otsr.2025.104185","DOIUrl":"10.1016/j.otsr.2025.104185","url":null,"abstract":"<p><strong>Background: </strong>Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are frequent in knee trauma. Treatment approaches vary widely, including surgical and conservative methods. However, the impact of preoperative measures on postoperative outcomes remains unclear.</p><p><strong>Hypothesis: </strong>Preoperative measures influence on postoperative outcomes for cases involving combined anterior cruciate and medial collateral ligament injuries.</p><p><strong>Patients and methods: </strong>A prospective, multicenter study was conducted in 8 French surgical centers specializing in knee surgery. Data were collected on patients undergoing ACL reconstruction with concomitant MCL injury over a 12-month period. Inclusion criteria were primary ACL injury associated with MCL injury (Grade I, II or III) and requiring ACL reconstruction, patients aged ≥ 15 years. The use and type of preoperative brace, weight-bearing and the time between injury and surgery were assessed. A functional assessment of the IKDC, ACL-RSI, TEGNER and SKV scores was performed at final follow-up. Patients were evaluated with regards of iterative ACL rupture, contralateral ACL rupture and reoperation.</p><p><strong>Results: </strong>The study included 408 patients with a mean follow-up of 18.5 months. Time between injury and surgery did not significantly affect the risk of iterative rupture, contralateral rupture, or reoperation. No significant impact of preoperative brace type or weight-bearing status on postoperative outcomes was observed. However, patients with higher grade MCL injuries underwent surgery earlier (p < 0.0001) and had lower preoperative weight-bearing allowances (p < 0.05). Patients with Grade 2-3 MCL injuries had lower functional scores compared to those with Grade 1 injuries (p < 0.05).</p><p><strong>Discussion: </strong>Preoperative measures, including time between injury and surgery, showed no significant influence on postoperative outcomes in combined ACL-MCL injuries. The type of preoperative brace and weight-bearing status did not significantly impact postoperative results. A functional approach with immediate full weight-bearing/recovery of full range of motion and with the use of bracing according to pain and patient apprehension is recommended. Further research is needed to refine preoperative treatment strategies for such injuries.</p><p><strong>Level of evidence: </strong>IV; prospective study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104185"},"PeriodicalIF":2.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426688","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":"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":"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}