Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"From load-bearing to load-sharing: contact-driven transitions in locked plate constructs.","authors":"Marianne Hollensteiner, Martina Schindler, Markus Greinwald, Mischa Mühling, Dirk Baumeister, Peter Augat","doi":"10.1007/s00402-026-06494-y","DOIUrl":"10.1007/s00402-026-06494-y","url":null,"abstract":"<p><p>Locked plate osteosynthesis functions as an internal fixator, yet load-induced plate-bone and fragment-fragment contacts - key transitions from load-bearing to load-sharing - remain poorly characterized. This study quantified their effects on construct stiffness, plate strain, and interfragmentary motion under axial loading. Twenty-seven configurations were tested using epoxy-glass surrogate bone fixed with titanium LCP plates, varying fracture gap (3-9 mm), working length (49-121 mm), and plate-bone distance (0-3 mm). Digital image correlation measured strain and motion. Contact events were identified manually from characteristic transitions in the force-displacement response, supported by corresponding changes in plate-surface strain progression. Geometric parameters dominated initial stiffness (125-442 N/mm), decreasing with plate elevation and working length in elevated setups. Within the investigated load range up to 600 N, 16/27 configurations showed non-linear transitions associated with contact events: fragment-fragment contact caused pronounced stiffness increases and strain stagnation at the fracture gap, whereas plate-bone contact was associated with local plate-surface strain stagnation at the location overlying the contact while strain at the fracture gap continued to increase. Interfragmentary motion stagnated after contact, confirming contact-dependent shifts in load transfer. Response surface regression explained 81.9% of the variance in initial stiffness and 89.6% of the variance in axial interfragmentary motion, identifying outcome-specific associations with geometric parameters and selected interaction terms. In conclusion, load-dependent contact events were associated with distinct transitions in construct stiffness, plate-surface strain progression, and interfragmentary motion, complementing the observed associations between geometric parameters and initial mechanical behavior.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890874","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":"Factors associated with periprosthetic joint infection following total knee arthroplasty: an updated systematic review and meta-analysis.","authors":"Haoyue Gao, Yajie Deng, Yuling Ma, Xun Li, Fengdi Zhang, Yingxue Mei","doi":"10.1007/s00402-026-06492-0","DOIUrl":"10.1007/s00402-026-06492-0","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to systematically evaluate factors associated with periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), and thereby to provide evidence-based references for clinical prevention and perioperative risk stratification.</p><p><strong>Methods: </strong>Computerized searches were conducted in the following databases from their inception until May 26, 2025: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Two researchers independently screened the literature, extracted data, and assessed study quality. The methodological quality was assessed using the Newcastle-Ottawa Scale. Quantitative synthesis was performed when at least two studies reported comparable exposure definitions and sufficient comparator information; otherwise, narrative synthesis was used. Review Manager 5.4 software was used for the primary analysis. This study is registered on PROSPERO (CRD420251079339).</p><p><strong>Results: </strong>A total of 25 observational studies were included in the qualitative synthesis, of which 24 contributed to the primary quantitative synthesis. Quantitatively pooled factors associated with PJI included male sex (OR = 1.39, 95% CI 1.27-1.51), BMI ≥30 kg/m² (OR = 5.72, 95% CI 2.65-12.36), prolonged operative time, type 2 diabetes mellitus (OR = 2.09, 95% CI 1.45-3.01), rheumatoid arthritis (OR = 2.64, 95% CI 1.38-5.02), smoking (OR = 1.65, 95% CI 1.34-2.04), blood transfusion (OR = 2.27, 95% CI 1.59-3.25), American Society of Anesthesiologists score ≥3 (OR = 2.73, 95% CI 1.02-7.32), history of hormone therapy (OR = 4.88, 95% CI 2.90-8.22), postoperative urinary tract infection (OR = 3.59, 95% CI 1.15-11.21), intraoperative blood loss >200 ml (OR = 1.51, 95% CI 1.03-2.22), postoperative drainage tube placement duration ≥24 h (OR = 2.23, 95% CI 1.50-3.32), preoperative anemia (OR = 1.82, 95% CI 1.67-1.99), and combined pulmonary disease (OR = 5.54, 95% CI 1.93-15.96). Age was narratively summarized because its classification differed substantially across studies.</p><p><strong>Conclusion: </strong>Multiple demographic, comorbidity-related, and perioperative factors were associated with PJI after TKA. However, because the included studies were observational and clinically heterogeneous, these findings should be interpreted as associations rather than causal effects. Optimization of modifiable factors may help reduce the burden of PJI, but further prospective studies using standardized PJI definitions and adjusted effect estimates are required.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgery of trochanteric femoral fractures in patients on direct oral anticoagulants (DOACs) reduces the length of stay (LOS) and the 1-year mortality rates without increasing the risk for revision surgery: a matched-pair analysis.","authors":"Valerie Weihs, Roberta Laggner, Michael Humenberger, Andreas Duma, Martin Frossard, Stefan Hajdu","doi":"10.1007/s00402-026-06490-2","DOIUrl":"10.1007/s00402-026-06490-2","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear whether early surgical fixation of trochanteric femoral fractures in patients with direct oral anticoagulation (DOAC) therapy has an impact on the long-term outcome.</p><p><strong>Methods: </strong>A retrospective cohort study on patients with trochanteric femoral fractures and DOAC therapy between 2016 and 2024 was conducted. Patients were divided into two groups according to their time to surgery and matched with age and ASA score as covariates. The primary outcome of interest was the impact of early surgery on the long-term outcome.</p><p><strong>Results: </strong>Of 233 included patients, 102 patients were assigned in each group after propensity score matching. Patients with early surgery had lower in-hospital complication rates (16.0% vs. 26.3%; p = 0.077) and a significantly shorter median length of stay (LOS) (11.5 days (IQR 6) vs. 15 days (IQR 6); p < 0.001). No difference in the rates of revision surgery (9.8% vs. 5.9%; p = 0.298) was observed. Kaplan-Meier curves revealed a significant difference in the mortality rates during the follow-up period (p = 0.0057) with lower in-hospital (2.0% vs. 6.9%; p = 0.088), 30-day (3.9% vs. 9.8%; p = 0.097) and 1-year mortality rates (20.6% vs. 31.4%; p = 0.079).</p><p><strong>Conclusion: </strong>Early surgical fixation of trochanteric femoral fractures in patients on DOAC therapy leads to a significant reduction in the LOS without increasing the risk for peri- and postoperative complications or the risk for revision surgery. Furthermore, early surgery may positively influence the long-term outcome in this specific cohort of patients.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platform-specific learning curve and early tibial radiographic agreement of ROSA^®-assisted medial unicompartmental knee arthroplasty in an experienced high-volume surgeon: a consecutive case series.","authors":"Stefano Petrillo, Damiano Ardiri, Matteo Marullo, Sergio Romagnoli","doi":"10.1007/s00402-026-06497-9","DOIUrl":"10.1007/s00402-026-06497-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the platform-specific learning curve and early tibial radiographic agreement of imageless ROSA^®-assisted medial unicompartmental knee arthroplasty (UKA), with short-term clinical findings assessed exploratorily.</p><p><strong>Methods: </strong>This retrospective consecutive case series included 30 patients who underwent ROSA^®-assisted medial UKA with the Persona^® Partial Knee implant between January and April 2026 at a high-volume arthroplasty referral centre. A continuous learning-curve cumulative summation (LC-CUSUM) analysis of total surgical duration was performed against an independently defined surgeon-specific historical benchmark derived from institutional operative-register skin-to-skin times for manual UKA performed by the same surgeon (20 ± 4 min). Adequate performance was defined as a mean duration of 25 min, inadequate performance as 30 min, and the reference standard deviation as 4 min. Type I and type II error targets were 0.05 and 0.10, respectively; the decision boundary was calibrated by Monte Carlo simulation over a 30-case monitoring horizon. Robotic time and a supportive comparison of cases 1-5 versus 6-30 were secondary efficiency analyses. Postoperative radiographic measurements were performed by an observer blinded to the planned and robot-validated ROSA^® values. Agreement was quantified using Bland-Altman bias and 95% limits of agreement.</p><p><strong>Results: </strong>Mean robotic time was 14.5 ± 2.4 min, mean non-robotic time was 8.9 ± 3.1 min (range, 4.1-15.6), and mean total surgical duration was 23.4 ± 2.3 min. The continuous LC-CUSUM score crossed the calibrated decision boundary (h = 4.5895) at case 6. Robotic time was 16.0 ± 3.8 min in cases 1-5 and 14.2 ± 2.0 min in cases 6-30 (p = 0.787); corresponding total durations were 24.8 ± 3.8 and 23.1 ± 1.9 min (p = 0.385). Bland-Altman bias for postoperative minus planned measurements was + 0.13° for tibial coronal alignment and + 0.10° for tibial slope; bias for postoperative minus robot-validated HKA was + 0.34°. All 30 postoperative radiographic measurements were within ± 2° of the planned target for both tibial coronal alignment and slope (100%; exact 95% CI, 88.43%-100%).</p><p><strong>Conclusions: </strong>The predefined platform-specific temporal-performance standard was reached after six cases by an experienced high-volume UKA surgeon. Tibial planned-to-postoperative deviations were small in this consecutive series, while the findings remain conditional on the specified benchmark and require external validation.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cartilage disruption patterns associated with percutaneous intramedullary screw fixation for metatarsal fractures: a cadaveric study.","authors":"Bailey Keith, Joseph Burke, Kelly Hynes, James Baker, Jeannie Huh","doi":"10.1007/s00402-026-06457-3","DOIUrl":"10.1007/s00402-026-06457-3","url":null,"abstract":"<p><strong>Purpose: </strong>Intramedullary screw fixation is an emerging technique for operative metatarsal fractures, yet the extent and location of articular cartilage disruption from retrograde screw insertion remain undefined. This study quantifies cartilage surface disruption and maps injury locations in the metatarsal head following screw placement.</p><p><strong>Methods: </strong>Fourteen fresh-frozen cadaveric feet (56 lesser metatarsals) underwent standardized retrograde intramedullary screw fixation using 3.6 mm screws. Following dissection, the total articular surface area and cartilage defect were measured to calculate the percentage of disruption. The cartilage surface was divided into quadrants (dorsal-to-plantar) and thirds (medial-to-lateral) to determine screw trajectory.</p><p><strong>Results: </strong>Mean cartilage disruption increased progressively from the 2nd to 5th metatarsals: 10.17%, 11.2%, 14.93%, and 17.43%, respectively. All screws were located within the middle third in the medial-to-lateral plane. In the dorsal-to-plantar plane, the majority of screws were positioned in the 2nd and 3rd quadrants. No screws were placed in the medial or lateral thirds.</p><p><strong>Conclusion: </strong>Retrograde intramedullary screw fixation results in measurable cartilage disruption, with a tendency for screw placement in the middle third in the medial-to-lateral plane and 2nd and 3rd dorsal-to-plantar quadrants. While the relative cartilage surface disruption ranges from approximately 10% to 17%, increasing in more lateral metatarsals, the clinical implications remain unknown. These findings define the articular disruption of intramedullary screws in metatarsal fractures and highlight the need for future studies on the clinical outcomes after undergoing this fixation construct.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locking plate fixation for proximal humerus fractures: are four proximal screws adequate? A clinical and radiological analysis of 105 consecutive cases.","authors":"Christian Michelitsch, Philipp Florian Stillhard, Christoph Zindel, Christoph Sommer, Yves Pascal Acklin","doi":"10.1007/s00402-026-06417-x","DOIUrl":"10.1007/s00402-026-06417-x","url":null,"abstract":"<p><strong>Introduction: </strong>Proximal humerus fractures are common injuries, and achieving stable fixation is essential to prevent complications such as varus collapse and screw perforation. While optimal screw positioning has been emphasized biomechanically, clinical evidence regarding the required number of screws in the humeral head, particularly when minimally invasive aiming devices limit placement to four screws, remains limited. This study evaluated whether fixation with four cranial screws provides adequate clinical and radiological stability.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted including 105 patients with displaced proximal humerus fractures treated with plate osteosynthesis. Patients were grouped according to the number of proximal screws used: four screws (n = 58) or more than four screws (n = 47). The primary outcome was the Constant-Murley Score. Secondary outcomes included secondary screw perforation, head-shaft angle maintenance, restoration of medial cortical support, and avascular necrosis. Mean follow-up was 18 ± 6 months.</p><p><strong>Results: </strong>Functional outcomes were comparable between groups, with Constant-Murley Scores of 78 ± 7 in the four-screw group and 73 ± 13 in the multi-screw group (p = 0.23). Rates of screw perforation (8.6% vs. 10.6%; p = 0.72) and postoperative head-shaft angles were likewise similar, and no significant alignment change occurred during follow-up. Medial cortical support was restored more frequently in the multi-screw group (82% vs. 63%; p = 0.001), but this did not translate into superior clinical or radiographic outcomes. Avascular necrosis occurred in 3 and 13% of patients, respectively.</p><p><strong>Conclusion: </strong>When fracture reduction/alignment is adequately restored, the use of four cranial screws appears sufficient to maintain alignment and prevent mechanical complications in minimally invasive plate osteosynthesis of proximal humerus fractures. Further prospective studies with longer follow-up are required to validate these findings.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13526713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nighttime intramedullary nailing of femoral fractures is not associated with worse outcomes: a 13-year Level I trauma center cohort","authors":"Artsiom Abialevich,&nbsp;Vadim Benkovich,&nbsp;Vladislav Osinsky,&nbsp;Yosef Adiniaev,&nbsp;Ilan Tzaytlin,&nbsp;Yotam Heinemann,&nbsp;Asaf Acker","doi":"10.1007/s00402-026-06484-0","DOIUrl":"10.1007/s00402-026-06484-0","url":null,"abstract":"<div><h3>Background</h3><p>Whether nighttime orthopedic trauma surgery adversely affects outcomes remains controversial. Evidence specifically addressing intramedullary fixation across femoral fracture locations remains limited. This study evaluated whether nighttime surgery was associated with a higher rate of recorded postoperative complications than daytime surgery.</p><h3>Methods</h3><p>This retrospective observational cohort included adult patients with nonperiprosthetic femoral fractures treated with intramedullary fixation between January 2010 and January 2023 at a single Level I trauma center. Of 311 screened records, 23 were excluded because the patient was younger than 18 years (<i>n</i> = 17) or the fracture was periprosthetic (<i>n</i> = 6), leaving 288 procedures (242 daytime and 46 nighttime). The primary outcome was any recorded postoperative complication during available follow-up. Secondary outcomes included radiographic abnormality, delayed union (&gt; 24 weeks), nonunion, revision surgery, and mortality. Surgeon experience was categorized as senior surgeon or resident. Exploratory fracture-location subgroup analyses and multivariable logistic regression were performed.</p><h3>Results</h3><p>Nighttime patients were younger (35.1 ± 19.1 vs. 46.6 ± 24.6 years, <i>p</i> &lt; 0.001), more frequently male (82.6% vs. 64.0%, <i>p</i> = 0.014), more often injured by a high-energy mechanism (80.4% vs. 56.6%, <i>p</i> = 0.002), and underwent surgery sooner after trauma (4.0 [2.0–10.0] vs. 18.0 [7.0–48.0] hours, <i>p</i> &lt; 0.001). Residents were the recorded primary surgeon in 54.3% of nighttime and 39.3% of daytime procedures (<i>p</i> = 0.057). After adjustment for demographic, injury, fracture-location, time-to-surgery, and surgeon-experience variables, nighttime surgery was not associated with the primary outcome (adjusted odds ratio 0.45, 95% confidence interval 0.15–1.38; <i>p</i> = 0.163). Delayed union (28.3% vs. 19.4%, <i>p</i> = 0.233) and revision surgery (4.3% vs. 12.4%, <i>p</i> = 0.130) did not differ significantly.</p><h3>Conclusions</h3><p>In this single-center cohort, nighttime intramedullary fixation of femoral fractures was not associated with higher observed rates of postoperative complications, impaired fracture healing, or revision surgery compared with daytime fixation. These findings suggest that operative timing alone may not be a major determinant of outcome within an organized Level I trauma system. Nevertheless, the small nighttime cohort, unequal group sizes, fracture heterogeneity, and limited statistical precision require cautious interpretation and preclude definitive conclusions regarding equivalence or subgroup-specific safety. Larger multicenter studies with standardized assessment of surgeon experience, staffing, fatigue, and fracture-specific outcomes are warranted.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06484-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcomes after lateral unicompartmental and total knee arthroplasty: a propensity score-matched cohort study","authors":"Mustafa Hariri,&nbsp;Reza Sorbi,&nbsp;Babak Moradi,&nbsp;Johannes Weishorn,&nbsp;Raphael Trefzer,&nbsp;Tobias Reiner,&nbsp;Tilman Walker,&nbsp;Timo Albert Nees","doi":"10.1007/s00402-026-06491-1","DOIUrl":"10.1007/s00402-026-06491-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Comparative evidence on patient-reported outcomes (PROs) after lateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) remains limited. We compared PROs between cohorts matched for demographic characteristics and baseline knee function.</p><h3>Materials and methods</h3><p>Prospectively collected single-center data were retrospectively analyzed. Lateral UKA was performed for isolated lateral-compartment osteoarthritis and TKA predominantly for multicompartmental disease. One-to-one propensity score matching incorporated age and body mass index, exact matching on sex, and restrictions on age and preoperative Oxford Knee Score (OKS), yielding 31 pairs. Postoperative OKS was the primary outcome. Secondary outcomes included OKS improvement, Forgotten Joint Score (FJS), University of California, Los Angeles (UCLA) activity score, OKS minimal clinically important difference (MCID) achievement, and FJS patient acceptable symptom state (PASS) attainment.</p><h3>Results</h3><p>All matching covariates achieved acceptable balance (absolute standardized mean differences &lt; 0.20). Postoperative OKS did not differ significantly (UKA, 38.9 ± 7.0; TKA, 39.8 ± 7.5; mean paired difference [TKA minus UKA], 0.94; 95% confidence interval [CI], − 2.57 to 4.44; <i>p</i> = 0.590). No significant differences were detected for OKS improvement (difference, 0.77; 95% CI, − 2.62 to 4.17; <i>p</i> = 0.644) or FJS (difference, 0.83; 95% CI, − 12.53 to 14.19; <i>p</i> = 0.900). UCLA scores were higher after TKA (difference, 0.93; 95% CI, 0.26 to 1.60; <i>p</i> = 0.008). MCID achievement (UKA, 90.3%; TKA, 93.5%; <i>p</i> = 1.000) and PASS attainment (UKA, 67.7%; TKA, 77.4%; <i>p</i> = 0.774) did not differ significantly.</p><h3>Conclusions</h3><p>No significant differences in postoperative OKS, OKS improvement, or FJS were detected, whereas UCLA scores were higher after TKA. Given differing indications and limited sample size, these findings do not establish equivalence or comparative effectiveness between procedures.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06491-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre- and postoperative 4D CT analysis of thumb CMC joint kinematics after first metacarpal extension osteotomy","authors":"Alissa Guebeli,&nbsp;Philipp Honigmann,&nbsp;Johannes G. G. Dobbe,&nbsp;Marco Keller","doi":"10.1007/s00402-026-06455-5","DOIUrl":"10.1007/s00402-026-06455-5","url":null,"abstract":"<div><h3>Introduction</h3><p>First metacarpal extension (Wilson) osteotomy combined with modified Brunelli ligamentoplasty is performed for early thumb carpometacarpal (CMC1) osteoarthritis to improve pain and function. The purpose of this study was to quantify in vivo changes in CMC1 joint contact distribution and kinematics after this combined procedure and to determine whether postoperative patterns resemble those of healthy volunteers. We hypothesized that the procedure would reduce cumulative palmar contact during opposition–retroposition.</p><h3>Materials and methods</h3><p>In a prospective single-center observational cohort study, six adults with early CMC1 osteoarthritis (Eaton–Littler I–II) underwent standardized preoperative and 6-month postoperative four-dimensional computed tomography (4D CT) of the CMC1 joint during active opposition–retroposition. Five healthy volunteers served as reference with a single 4D CT scan. First metacarpal–trapezium motion was registered across frames. Joint contact was estimated using a 2.0 mm proximity surrogate on the trapezial surface. The primary outcome was change in cumulative palmar contact area. Secondary outcomes included change in dorsoradial contact, temporal variability of contact curves, and contact-centroid path length and mean position. Within-subject pre- versus postoperative comparisons were performed; healthy scans provided reference patterns.</p><h3>Results</h3><p>Healthy volunteers showed reproducible patterns with increasing palmar contact toward terminal opposition and near-mirror symmetry on retroposition. Preoperatively, patients demonstrated elevated palmar contact persisting into retroposition and loss of symmetry. Postoperatively, the procedure did not consistently reduce cumulative palmar contact. Instead, most patients exhibited increased palmar contact, flattening of contact-versus-time curves, and a shorter contact-centroid path with a palmar–ulnar shift in mean position. These changes suggest a stabilizing effect more consistent with functional partial arthrodesis than selective palmar unloading.</p><h3>Conclusion</h3><p>Wilson osteotomy with modified Brunelli ligamentoplasty did not produce the anticipated palmar unloading during functional thumb motion. The dominant postoperative effect was palmar loading with reduced dynamic variability. These findings refine the biomechanical rationale for this joint-preserving procedure and support future studies isolating the osteotomy from ligamentoplasty using load-standardized tasks.</p><h3>Level of evidence</h3><p>Therapeutic, IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06455-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148837978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimal kyphotic progression following pediatric vertebral fractures: implications for reduced radiographic surveillance","authors":"Sebastian Wegmann,&nbsp;Maximilian Lenz,&nbsp;Tamara Babasiz,&nbsp;Peer Eysel,&nbsp;Lars Peter Mueller,&nbsp;Maximilian Weber","doi":"10.1007/s00402-026-06482-2","DOIUrl":"10.1007/s00402-026-06482-2","url":null,"abstract":"<div><h3>Introduction</h3><p>Pediatric spinal fractures are rare injuries (14.24 per 100,000 per year), representing only 0.6–3% of all spinal injuries. While most stable compression fractures are managed conservatively, concerns exist regarding progressive vertebral collapse and kyphotic deformity. Unlike extensive adult literature, pediatric-specific data on radiographic progression following conservative management remain limited, creating uncertainty about the clinical utility of routine follow-up imaging in this radiosensitive population.</p><h3>Materials and methods</h3><p>Retrospective single-centre cohort study of 54 pediatric patients (mean age 12.3 years) with traumatic vertebral body fractures diagnosed between 2012 and 2024. Kyphosis angles were measured using Cobb methodology at baseline and follow-up intervals (1, 3, and 6 weeks). The primary outcome was the change in kyphotic angle; secondary outcomes included the identification of predictors of progression. Paired t-tests and multivariable linear regression analysis were performed.</p><h3>Results</h3><p>Kyphosis angles remained essentially unchanged across all follow-up intervals (ΔFU1 + 0.19°, ΔFU2 + 1.27°, ΔFU3 − 0.14°), with no statistically significant differences detected (<i>p</i> &gt; 0.05 at all timepoints). No clinical or radiographic factors predicted progression of kyphosis. Only three patients (5.6%) required treatment escalation. Subgroup analyses revealed no significant differences across fracture types, treatment modality, or injury characteristics.</p><h3>Conclusion</h3><p>Pediatric patients with stable compression fractures demonstrate minimal kyphotic progression regardless of treatment approach. Routine radiographic surveillance provides little clinical value and exposes children to unnecessary ionising radiation. The present study suggests that routine radiographic follow-up may not be necessary in carefully selected patients with stable vertebral compression fractures who remain clinically asymptomatic. Nevertheless, these findings should be interpreted in light of the retrospective study design and the limited sample size. Confirmation in larger prospective studies is needed before changes to routine follow-up protocols can be recommended.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06482-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}