Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Cosmetic appearance in adolescent idiopathic scoliosis: Predictive factors and evaluation of the TAPS and SRS-22 self-image subdomains before and after posterior spinal fusion.","authors":"Alice Baroncini, Melissa Bou Jaoude, Louis Boissière, Anouar Bourghli, Ahmet Alanay, Ferran Pellisé, Frank Kleinstueck, Javier Pizones, Uchenna Ajoku, Cecile Roscop, Daniel Larrieu, Ibrahim Obeid","doi":"10.1016/j.otsr.2025.104244","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104244","url":null,"abstract":"<p><strong>Background: </strong>Despite being one of the main drivers of patients' satisfaction, the cosmetic appearance after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) has not yet been thoroughly investigated. This study evaluated the self-perceived cosmetic outcomes following posterior spinal fusion in patients with AIS using the SRS-22 and Trunk Appearance Perception Scale (TAPS).</p><p><strong>Hypothesis: </strong>It is possible to highlight outcome differences before and after surgery, and to determine correlations between these self-image assessments and radiographic as well as implant-related parameters.</p><p><strong>Patients and methods: </strong>A multicenter retrospective analysis on data prospectively collected between February 2011 and November 2021. AIS patients requiring surgery and with a 1-year follow-up were included. Pre- and postoperative radiographic data, including Cobb angle, clavicle angle, pelvic and sacral obliquity, and thoracic kyphosis, were compared with patient-reported outcomes. Statistical analyses evaluated correlations between self-image subdomains and surgical outcomes.</p><p><strong>Results: </strong>Data from 123 patients were available (101 females, 22 males). Considerable improvements in cosmetic self-perception were observed postoperatively, with both TAPS and SRS-22r scores increasing one year after surgery. Coronal parameters such as major Cobb angle and clavicle angle were the primary drivers of preoperative self-image perception. In particular, the Cobb angle increased from 41.06 ± 33.29 ° in patients who did not perceive a back deformity to 65.86 ± 12.46 ° in patients who perceived a severe deformity (p = 0.009). Similarly, the clavicle angle increased from 0.31 ± 0.53 ° to 2.8 ± 2.49 ° (p = 0.02). Postoperative cosmetic appearance was correlated to implant density and thoracic kyphosis (T2-T5). Implant density decreased from 1.65 ± 0.3 to 1.47 ± 0.13 in patients with no perceived deformation and slight deformation of the back, respectively (p = 0.03); and from 1.65 ± 0.27 to 1.51 ± 0.15 in patients with no perceived deformation and slight deformation of the front, respectively (p = 0.04). The T2 - T5 kyphosis increased from 17.25 ± 9.36 ° to 38.72 ° (p = 0.05) in patients with poorer forward bending perception, and decreased from 26.61 ° to 19.9 ± 10.15 ° (p = 0.04) in patients with better cosmetic appearance in the SRS Q6.</p><p><strong>Discussion: </strong>Posterior fusion significantly enhances self-perceived trunk appearance in AIS patients. The coronal alignment has a more marked influence on preoperative cosmetic appearance, whereas postoperative sagittal alignment and implant density play a more critical roles in the postoperative self-image assessment.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104244"},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip-resection arthroplasty: A valuable treatment for complex hip prosthetic joint infection?","authors":"Lou Macaux, Benjamin Levavasseur, Younes Kerroumi, Thomas Aubert, Maiwenn Prunel, Beate Heym, Simon Marmor, Valérie Zeller","doi":"10.1016/j.otsr.2025.104243","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104243","url":null,"abstract":"<p><strong>Introduction: </strong>Management of recurrent hip prosthetic joint infection (PJI) is challenging. Hip-resection arthroplasty is a last-choice rescue strategy for complex PJI. The main objective was to assess prospectively the mid-term infectious and functional PJI outcomes of patients managed with hip-resection arthroplasty.</p><p><strong>Hypothesis: </strong>In complex multi-operated PJI, hip-resection arthroplasty may cure the infection without any major impact on hip function, which is often already very limited.</p><p><strong>Material and methods: </strong>This prospective cohort study conducted in a French Referral Center for bone-and-joint infections included all hip PJIs treated with hip-resection arthroplasty from 2004 to 2019. Patients were followed for at least 2 years, with recording of the following events: reinfection, including relapse or new infection, and PJI-related death. Hip functional status was assessed with the modified Merle d'Aubigné-Postel (mMAP) score. The primary outcome was 2-year event-free survival (EFS). The secondary outcomes were the 4- and 6-year EFS rates and hip functional status at 2 years.</p><p><strong>Results: </strong>We included 30 patients: median age, 65 years; 39% women. Median [IQR] PJI duration was 15 [4-39] months and patients underwent a median of 5 surgical procedures before resection arthroplasty. The 2-year reinfection free-survival was 89.2% (95% CI: 70.2-96.4). After a median follow-up of 70 [32-103] months, we observed: 1 relapse, 4 new infections, 7 revisions for mechanical reasons and 1 PJI-related death. Median mMAP score 2 years postsurgery was 12, versus 7 before; pain reduction was the main benefit of resection arthroplasty.</p><p><strong>Discussion: </strong>Hip-resection arthroplasty achieves sepsis and pain control, and can be a valuable last-line rescue strategy for patients with complex or recurrent hip PJIs.</p><p><strong>Level of evidence: </strong>II; monocentric prospective cohort.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104243"},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041044","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":"Is there a cardiovascular risk associated with the use of fluoroquinolones for the treatment of osteoarticular infections? Analysis of a retrospective cohort of 817 patients from a surgical and infectious disease referral center (CRIOAC).","authors":"Malo Buisson, Philippe-Alexandre Faure, Barthelemy Lafon Desmurs, Caroline Loiez, Benjamin Valentin, Henri Migaud, Eric Senneville","doi":"10.1016/j.otsr.2025.104242","DOIUrl":"https://doi.org/10.1016/j.otsr.2025.104242","url":null,"abstract":"<p><strong>Introduction: </strong>Bone joint infection is a rare but serious complication, the treatment of which most often requires intervention combined with prolonged high-dose antibiotic therapy. Fluoroquinolones are among the standard antibiotics for the treatment of these infections, particularly in combination with rifampicin for staphylococcal infections and as monotherapy for Gram-negative bacilli infections. However, recent studies, confirmed by several meta-analyses, have highlighted an increased cardiovascular risk such as aortic aneurysm and mitro-aortic regurgitation occurring early following fluoroquinolone use, leading to recommendations for caution from health agencies. These meta-analyses are often based on limited series with numerous indication biases (variable treatment durations) and low doses. We therefore conducted a single-center, single-prescriber, real-life study of a continuous series of osteo-articular infections. The objectives were to determine the rate of cardiovascular events (aortic aneurysm, mitro-aortic regurgitation) at 60 days, the mortality rate at 60 days, and at the final follow-up.</p><p><strong>Hypothesis: </strong>Our hypothesis was that despite long-term, high-dose treatments, there was no increased cardiovascular risk in patients treated for osteo-articular infections with fluoroquinolones.</p><p><strong>Materials and methods: </strong>Between 2017 and 2019, 817 patients were treated at the CRIOAC (Referral Center for Complex Osteo-Articular Infections) Lille-Tourcoing (332/817 patients received treatment with fluoroquinolones). This retrospective cohort study assessed the onset or worsening of cardiovascular events (such as aortic aneurysms and mitro-aortic regurgitation) and death at 2 months using a propensity score.</p><p><strong>Results: </strong>After propensity score weighting, there was no significant difference in the risk of aortic aneurysm and mitro-aortic regurgitation at 60 days (Odds ratio (OR) 0.921 [0.317; 2.673], p = 0.879) or in the risk of death at 60 days (OR 1.252 [0.502; 3.118]; p = 0.630). There was also no significant difference in the risk of death at last follow-up after propensity score weighting (OR 1.011 [0.646; 1.582], p = 0.962).</p><p><strong>Discussion: </strong>The results of this study suggest that the use of fluoroquinolones in patients treated for osteoarticular infections does not pose a significant increased risk of aortic aneurysm, mitro-aortic regurgitation, or death within two months. We believe it is reasonable to continue prescribing fluoroquinolones for osteoarticular infections while maintaining surveillance for these events.</p><p><strong>Level of evidence: </strong>III; case-control study with propensity score.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104242"},"PeriodicalIF":2.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063297","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":"Biomechanical evaluation of composite reduction plates with variable positioning using the Henry and Thompson approaches for transverse radial fracture surgery.","authors":"Il Won Suh, Chan Hee Park","doi":"10.1016/j.otsr.2025.104240","DOIUrl":"10.1016/j.otsr.2025.104240","url":null,"abstract":"<p><strong>Background: </strong>Radius fractures are challenging to stabilize due to complex muscle-loading conditions, requiring optimized plate positioning and material selection for effective treatment. This study addresses the biomechanical impact of plate positions (anterior, posterior, lateral) and materials in transverse radial fractures.</p><p><strong>Hypothesis: </strong>Plate positioning and material selection significantly influence stress distribution and displacement, with lateral positioning and WE43 alloy offering biomechanical advantages.</p><p><strong>Methods: </strong>Finite element analysis was used to evaluate Ti6Al4V titanium alloy and WE43 magnesium alloy bone plates positioned on the anterior, posterior, and lateral sides of the radius under a 50 N axial load. Stress distribution and displacement were analyzed.</p><p><strong>Results: </strong>Posterior reductions exhibited the highest stress and displacement, indicating potential instability, with maximum von Mises stress increasing by 32.5% compared to anterior reduction. Lateral reductions provided more uniform stress distribution and lower displacement, though von Mises stress was still 20% higher than in the anterior reduction. WE43 alloy demonstrated effective stress reduction in non-posterior positions, while Ti6Al4V exhibited greater stiffness and resistance to deformation.</p><p><strong>Discussion: </strong>Lateral and anterior plate positions demonstrated superior biomechanical stability, suggesting their preference for optimizing fracture healing and reducing complications. WE43 alloy's stress-reducing and biodegradable properties make it suitable for temporary fixation, while Ti6Al4V provides greater structural integrity for long-term support. These findings highlight the importance of plate positioning and material selection in improving clinical outcomes for transverse radial fracture fixation.</p><p><strong>Level of evidence: </strong>V; expert opinion, controlled laboratory study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104240"},"PeriodicalIF":2.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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

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

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

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

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