Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Minimally invasive stabilisation of anterior pelvic ring injuries through anterior infix versus percutaneous anterior retrograde pubic screw: a prospective comparative cohort study","authors":"Ahmed Goda El-Hamalawy,&nbsp;Mohamed Abdelmoneim,&nbsp;Mohamed Al-Sayed,&nbsp;Mohamed Youness,&nbsp;Fouad Sadek,&nbsp;Elsayed Kassem","doi":"10.1007/s00402-026-06380-7","DOIUrl":"10.1007/s00402-026-06380-7","url":null,"abstract":"<div><h3>Background</h3><p>Management of unstable anterior pelvic ring fractures has shifted toward minimally invasive fixation techniques. This prospective randomized cohort study compares anterior subcutaneous internal fixator with percutaneous retrograde pubic ramus screw fixation, evaluating radiological outcomes, functional scores, complications, and peri-operative parameters.</p><h3>Methods</h3><p>Fifty adult patients with unstable anterior pelvic ring injuries (Tile B &amp; C; Young–Burgess lateral compression and vertical shear mechanisms) were enrolled between 2023 and 2025 and randomized into two equal groups: group 1 (internal fixator) and group 2 (retrograde pubic screw). Both groups underwent individualized posterior ring fixation as required. Outcomes assessed included operative time, blood loss, fluoroscopy time, union rate, Matta radiological score at 6 months, Majeed and Pelvic Outcome Scores at 12 months, and post-operative complications.</p><h3>Results</h3><p>Management of anterior pelvic injury showed that retrograde screw fixation demonstrated significantly shorter operative time (32.0 ± 9.2 vs. 50.3 ± 8.4 min, <i>p</i> &lt; 0.001) and less intraoperative blood loss (68.3 ± 16.2 vs. 122.3 ± 31.8 ml, <i>p</i> &lt; 0.001). Radiological outcomes were comparable: excellent Matta score in 68% vs. 64% (<i>p</i> = 0.834). Union time showed no significant difference (14.1 ± 2.4 vs. 15.1 ± 1.5 weeks, <i>p</i> = 0.076). Functional outcomes at 12 months showed no significant difference in Majeed score (<i>p</i> = 0.517), while Pelvic Outcome Score favored the retrograde screw group (32.3 ± 3.5 vs. 30.0 ± 3.3, <i>p</i> = 0.023). Internal fixator had a higher rate of lateral femoral cutaneous nerve injury (28%), while retrograde screw fixation showed fewer reoperations and lower implant removal rate.</p><h3>Conclusion</h3><p>Upon reviewing study cases and relevant literature, both minimally invasive techniques can provide reliable fixation and comparable radiological and functional outcomes for unstable anterior pelvic ring fractures. Retrograde pubic ramus screw fixation offers advantages of reduced blood loss and lower neurovascular complications. Internal fixator offers slightly reduced fluoroscopy exposure but carries a higher risk of lateral femoral cutaneous nerve irritation.</p><h3>Level of evidence</h3><p>Level 4.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06380-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315229","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":"Compensatory activation of the deltoid and remaining rotator cuff muscles in patients with rotator cuff tears using real-time tissue elastography","authors":"Kyosuke Hoshikawa,&nbsp;Ryuta Oishi,&nbsp;Takuma Yuri,&nbsp;Tomohiro Uno,&nbsp;Jun Nagai,&nbsp;Hugo Giambini,&nbsp;Nariyuki Mura","doi":"10.1007/s00402-026-06386-1","DOIUrl":"10.1007/s00402-026-06386-1","url":null,"abstract":"<div><h3>Introduction</h3><p>Rotator cuff (RC) tears are a prevalent condition leading to dysfunction and shoulder pain. Spatial changes in the behavior of the deltoid and remaining RC muscles during arm elevation in patients with RC tears have not been investigated. The purpose of this study was twofold: (1) to investigate factors related to the changes in the deltoid muscle behavior during scapular plane abduction (scaption) in patients with RC tears, and (2) to examine the functional relationship between the deltoid and remaining RC muscles, particularly remaining infraspinatus (ISP) and teres minor (TMin) muscles, in these patients using ultrasound elastography.</p><h3>Methods</h3><p>Twenty-four patients (mean age, 66 ± 6 years) with RC tears (mean antero-posterior diameter, 17.4 ± 8.3 mm) were evaluated. Antero-posterior and medio-lateral diameters of the posterosuperior RC and Subscapularis (SSC) tears were measured intra-operatively. Muscle elasticity was evaluated at passive and active states, as a proxy for muscle activation, at 30°, 60°, and 90° during scaption for the deltoid, ISP, and TMin muscles using real-time tissue elastography. Based on the deltoid muscle activity ratio at 30° and 90° scaption, patients were divided into normal and abnormal activation groups.</p><h3>Results</h3><p>Activity of the deltoid muscle in the abnormal activation group exhibited consistently high activity across various elevation angles, significantly higher compared to that of the normal activation group at 30° scaption (<i>p</i> = 0.037). Although there was no statistically significant between-group difference in TMin muscle activity at 30° scaption, TMin muscle activity in the normal activation group was highest at 30° and significantly higher than at 90° scaption (<i>p</i> = 0.032). Abnormal activation group had a higher incidence of SSC tears combined with posterosuperior RC tears (<i>p</i> = 0.009).</p><h3>Conclusions</h3><p>SSC tears combined with posterosuperior RC tears may be associated with compensatory activation of the deltoid muscle in the early phase of arm elevation, while relatively greater TMin muscle activity in the initial range of elevation may reflect a compensatory contribution of the remaining posterior RC muscles.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06386-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306529","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":"Impact of cannabis use and tobacco smoking on outcomes of open carpal tunnel release surgery: a nationwide study in the United States","authors":"Amir Human Hoveidaei,&nbsp;Sina Esmaeili,&nbsp;Ruby Gilmor,&nbsp;Zhongming Chen,&nbsp;Janet D. Conway,&nbsp;John V. Ingari","doi":"10.1007/s00402-026-06391-4","DOIUrl":"10.1007/s00402-026-06391-4","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the impact of cannabis use, tobacco smoking, and their concurrent use on postoperative complications following open carpal tunnel release (CTR) using a nationwide database.</p><h3>Methods</h3><p>A retrospective cohort study was conducted using the PearlDiver database (2010–2022) to identify adult patients who underwent open CTR. Patients were categorized into four groups: cannabis-only users (<i>n</i> = 800), tobacco-only users (<i>n</i> = 167,803), concurrent users (<i>n</i> = 3529), and non-users (<i>n</i> = 167,803 matched controls). Postoperative complications, surgical site infection, wound disruption, joint stiffness, and complex regional pain syndrome, were assessed at 6 weeks and 3 months postoperatively.</p><h3>Results</h3><p>At 6 weeks and 3 months, surgical site infection was more common among concurrent cannabis and tobacco users, cannabis-only users, and tobacco-only users. Wound disruption occurred more frequently in concurrent users and tobacco-only users, but not in cannabis-only users. Complex regional pain syndrome was associated only with tobacco use. No association was found between any substance use and joint stiffness.</p><h3>Conclusion</h3><p>Cannabis use, tobacco smoking, and especially concurrent use increase the risk of surgical site infection and wound disruption following open CTR. Tobacco use is independently associated with complex regional pain syndrome, while cannabis may have a protective effect. These findings emphasize the need for preoperative screening and patient education.</p><h3>Type of study/level of evidence</h3><p>Retrospective cohort study/level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06391-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306622","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":"Pin orthosis extension block pinning versus conservative treatment for doyle type 4B mallet fractures","authors":"Kemal Arda Col,&nbsp;Onur Demirsu,&nbsp;Mahmud Aydın,&nbsp;Serkan Surucu,&nbsp;Murat Yilmaz,&nbsp;Dogan Atlihan","doi":"10.1007/s00402-026-06342-z","DOIUrl":"10.1007/s00402-026-06342-z","url":null,"abstract":"<div><h3>Introduction</h3><p>Although numerous treatment options have been reported for mallet fractures, a universally accepted gold-standard approach has not yet been established. The purpose of this study was to compare the clinical and radiographic outcomes of the pin-orthosis extension-block pinning technique (PO-EBPT) with those of conventional conservative treatment in patients with Doyle type 4B mallet fractures.</p><h3>Materials and methods</h3><p>This study included 62 patients with Doyle type 4B mallet fractures involving 20–50% of the distal interphalangeal (DIP) joint articular surface, treated between March 2022 and April 2024. Patients were randomized into two groups: Group 1 (<i>n</i> = 33) underwent PO-EBPT, whereas Group 2 (<i>n</i> = 29) received conservative treatment with splint immobilization. Outcome measures included DIP joint extension lag, range of motion, fracture union, complication rates and functional outcomes according to the Crawford criteria. Follow-up evaluations were performed at 2, 4 and 6 weeks and at 3, 6 and 12 months.</p><h3>Results</h3><p>A total of 62 patients were analyzed (33 PO-EBPT; 29 conservative). No statistically significant differences were observed between the groups with respect to sex, affected side, injured finger, or complication rates (<i>p</i> = 0.461, <i>p</i> = 0.658, <i>p</i> = 0.763 and <i>p</i> = 0.165, respectively). However, the PO-EBPT group demonstrated significantly improved DIP joint extension lag (4.5 ± 7.8° vs. 12.2 ± 10.4°, <i>p</i> = 0.002) and flexion range (88.5 ± 4.4° vs. 86.0 ± 5.7°, <i>p</i> = 0.039). According to the Crawford criteria, functional outcomes were also significantly superior in the PO-EBPT group (<i>p</i> = 0.02).</p><h3>Conclusion</h3><p>PO-EBPT yielded superior functional outcomes compared with conservative treatment in patients with Doyle type 4B mallet fractures, as demonstrated by reduced extension lag, improved DIP joint flexion and higher rates of excellent Crawford scores.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06342-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306539","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":"Timing and microbiological profile influence long-term outcomes after debridement, antibiotics, and implant retention (DAIR) in acute hip periprosthetic joint infection","authors":"Ernesto Muñoz-Mahamud,&nbsp;Juan Carlos Perdomo-Lizarraga,&nbsp;Andrés Combalia,&nbsp;Alfonso Alías,&nbsp;Adrià Serra,&nbsp;Jenaro Ángel Fernández-Valencia,&nbsp;Miguel Ángel Verdejo,&nbsp;Álex Soriano","doi":"10.1007/s00402-026-06385-2","DOIUrl":"10.1007/s00402-026-06385-2","url":null,"abstract":"<div><h3>Introduction</h3><p>The strategy of debridement, antibiotics, and implant retention (DAIR) represents one of the main therapeutic modalities for acute periprosthetic joint infection (PJI). However, reported outcomes remain highly variable, with success rates ranging from 16 to 92%. This study aimed to evaluate long-term treatment failure-free survival and identify risk factors for treatment failure in patients with acute hip PJI treated with DAIR using time-to-event analytical methods.</p><h3>Material and methods</h3><p>This retrospective study evaluated the treatment failure rate in 115 patients treated with the DAIR strategy for acute PJI following primary or aseptic revision hip arthroplasty between 1999 and 2018. Potential predictors of treatment failure-free survival, including patient characteristics, infection microbiology, and surgical timing, were analyzed using univariate tests, Cox proportional hazards regression (hazard ratio [HR]), and Kaplan–Meier survival estimates.</p><h3>Results</h3><p>Among the 115 patients included, 56 were women and 59 were men; 48 were aged 75 years or younger and 67 were older than 75 years. In 88 cases, the infection occurred after primary arthroplasty, whereas 27 followed aseptic revision surgery. The mean follow-up was 7.1 years (SD 4.4). At five years, treatment failure occurred in 30.4% of cases. Procedures performed within seven days of diagnosis showed lower failure rates than those after the first week following diagnosis (27.5% vs 53.8%, p = 0.05; HR = 2.09, 95% CI 0.91–4.79). Failure was more frequent after revision arthroplasty compared with primary arthroplasty (48.1% vs 25%, p = 0.02; HR = 2.15, 95% CI 1.08–4.27) and in polymicrobial infections compared with monomicrobial infections (47.8% vs 24.5%, p = 0.04; HR = 2.32, 95% CI 1.13–4.77). No other variables showed a significant association with failure risk.</p><h3>Conclusion</h3><p>Revision arthroplasty and polymicrobial infections were associated with higher failure rates after DAIR. Lower failure rates were observed among patients treated within seven days of diagnosis, although this finding should be interpreted with caution and warrants further investigation.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06385-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306548","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":"Validity and prognostic value of a novel intraoperative assessment tool for reduction in trimalleolar fractures: the SGSC checklist approach","authors":"Hua Gao,&nbsp;Guoqiang Xu,&nbsp;Ji Ma,&nbsp;Yijun Wang,&nbsp;Jiatian Wang,&nbsp;Rubing Zhou,&nbsp;Zhenyu Liu,&nbsp;Baojun Wang","doi":"10.1007/s00402-026-06390-5","DOIUrl":"10.1007/s00402-026-06390-5","url":null,"abstract":"<div><h3>Background</h3><p>Trimalleolar fractures present substantial surgical challenges, and the quality of fracture reduction significantly influences patient outcomes. Current intraoperative assessment methods, including fluoroscopy and arthroscopy, each possess inherent limitations when used independently. This study aimed to validate the effectiveness of a novel intraoperative evaluation tool, the SGSC (Step, Gap, Syndesmosis, Congruity) “traffic light” checklist, that integrates arthroscopic and fluoroscopic assessment, and to evaluate its predictive value for clinical prognosis.</p><h3>Methods</h3><p>This single-center retrospective cohort study enrolled 36 patients who underwent surgical treatment for trimalleolar fractures. Validation proceeded in two stages: first, we calculated inter-rater reliability (Kappa statistic) and concordance with postoperative CT as the reference standard to establish the reliability and validity of the SGSC checklist (accuracy validation); second, patients were stratified into “All-Green” and “Non-All-Green” groups based on intraoperative SGSC assessment, and we compared AOFAS scores and early radiographic degenerative changes at final follow-up (prognostic validation).</p><h3>Results</h3><p>For accuracy validation, inter-rater agreement between the two assessors demonstrated excellent reliability (Kappa = 0.827; 95% CI: 0.644-1.000). The overall concordance between SGSC checklist assessments and postoperative CT findings was 91.67%. Regarding prognostic value, the All-Green group (<i>n</i> = 25) achieved a mean AOFAS score of 88.9 ± 3.0, significantly exceeding the 78.4 ± 4.4 observed in the Non-All-Green group (<i>n</i> = 11) (t = 8.32, <i>P</i> &lt; 0.001). Furthermore, early radiographic degenerative changes (Kellgren-Lawrence grade ≥ 2) developed in only 8% (2/25) of the All-Green group compared with 45.5% (5/11) in the Non-All-Green group (<i>P</i> = 0.012).</p><h3>Conclusions</h3><p>The SGSC checklist represents a valid and reliable intraoperative assessment instrument. Achieving “All-Green” status effectively predicts superior short-term functional outcomes and a lower incidence of early degenerative changes. However, these preliminary findings are limited by small sample size and retrospective design. Prospective studies are needed to confirm clinical utility.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06390-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275918","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":"Preoperative NarxCare overdose risk scores greater than 100 are associated with worse PROMs improvements and dissatisfaction after primary THA","authors":"Shujaa T. Khan,&nbsp;Ahmed K. Emara,&nbsp;Shlok V. Patel,&nbsp;Khaled A. Elmenawi,&nbsp;Alvaro Ibaseta,&nbsp;Ignacio Pasqualini,&nbsp;Chao Zhang,&nbsp;Nicolas S. Piuzzi","doi":"10.1007/s00402-026-06372-7","DOIUrl":"10.1007/s00402-026-06372-7","url":null,"abstract":"<div><h3>Introduction</h3><p>The NarxCare Overdose Risk Score (ORS) is a weighted measure of patient-specific prescription drug use. In patients undergoing primary total hip arthroplasty (THA), this study aimed to evaluate (1) the trend of the ORS from preoperative to 1-year postoperatively, and (2) the association of preoperative ORS with achievement of clinically meaningful improvements in patient reported outcome measures (PROMs), and satisfaction at 1-year.</p><h3>Methods</h3><p>All patients who underwent primary unilateral elective THA at a USA tertiary healthcare system from January 2016-December 2022 were eligible. Patients with incomplete PROMs or missing baseline NarxCare ORS were excluded, leading to the inclusion of 5,424 patients. Multivariable regression models were used to assess the association between ORS and 1-year PROMs, including achievement of the minimum clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the Hip Disability and Osteoarthritis Outcome Score (HOOS) subdomain scores, as well as satisfaction.</p><h3>Results</h3><p>Preoperatively, 46.1% (<i>n</i> = 2501) had a NarxCare ORS of 0, 24.6% (<i>n</i> = 1336) had scores between 100 and 199, and 16.2% (<i>n</i> = 876) in the 200–299 range. After adjusting for confounding variables, a preoperative ORS of 100–199 was associated with failure to achieve MCID in HOOS Pain (OR 1.91;CI 1.32–2.77;<i>p</i> = 0.001), and HOOS JR (OR 1.54;1.10–2.15;<i>p</i> = 0.012). Preoperative ORS of 100–199 was also associated with failure to reach PASS threshold in HOOS Pain (OR 1.45;1.23–1.71;<i>p</i> &lt; 0.001), PS (OR 1.47;1.22–1.75;<i>p</i> &lt; 0.001) and JR (OR 1.26;1.08–1.49;<i>p</i> = 0.004), with the odds of failure continually increasing as the ORS increases. Patients with a preoperative ORS of 100–199 were 58% more likely to be dissatisfied at 1-year (OR 1.58;1.26–1.99;<i>p</i> &lt; 0.001) compared to prescription drug use naïve patients.</p><h3>Conclusions</h3><p>Increasing preoperative NarxCare ORS, a measure of prescription drug use, is inversely associated with patient perceived improvement after THA. An ORS of just 100 may significantly decrease the chances of clinically meaningful improvements in hip pain and function, as well as satisfaction at 1-year. A multidisciplinary approach is warranted to mitigate the detrimental effects of sedatives, opioids, or stimulant drug use and surgeons may use this easily accessible score to guide a patient centered discussion regarding postoperative improvements.</p><h3>Level of evidence</h3><p>III. </p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06372-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275830","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":"Surgical treatment of varus unicompartmental knee osteoarthritis: indications, trends, and outcomes—a narrative review","authors":"Carmelo Burgio,&nbsp;Francesco Bosco,&nbsp;Claudio Cobisi,&nbsp;Karlos Zepeda,&nbsp;Fortunato Giustra,&nbsp;Marcello Capella,&nbsp;David Mayman,&nbsp;Eytan Debbi,&nbsp;Jonathan Vigdorchik","doi":"10.1007/s00402-026-06388-z","DOIUrl":"10.1007/s00402-026-06388-z","url":null,"abstract":"<div><h3>Introduction</h3><p>Varus unicompartmental knee osteoarthritis (UC-KOA) is a frequent and heterogeneous clinical condition characterized by compartment-specific cartilage degeneration and frequently associated with lower-limb malalignment. The progressive understanding of knee biomechanics and alignment has led to the development of surgical strategies specifically tailored to address isolated compartment disease. The purpose of this narrative review is to evaluate indications, current trends, and clinical outcomes of the main surgical options for varus UC-KOA, with particular focus on realignment osteotomies and unicompartmental knee arthroplasty (UKA).</p><h3>Materials and methods</h3><p>A narrative review of the literature was conducted using major biomedical databases. Evidence related to biomechanics, alignment correction, osteotomy techniques, UKA indications, implant evolution, complication profiles, and comparative outcomes was analyzed and synthesized thematically.</p><h3>Results</h3><p>Biomechanical and clinical evidence consistently identifies malalignment as a key driver of isolated compartment degeneration. Corrective osteotomies effectively restore physiological load distribution and provide durable outcomes in selected patients with extra-articular deformity. Advances in implant design and surgical techniques have substantially improved UKA survivorship, allowing broader patient selection without compromising clinical outcomes. Comparative studies indicate that osteotomy and UKA serve complementary roles, with specific advantages depending on patient age, activity level, deformity origin, and joint status.</p><h3>Conclusions</h3><p>Current evidence supports an individualized, alignment-based, compartment-specific approach to the surgical management of varus UC-KOA, emphasizing patient-specific decision-making grounded in biomechanical principles.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06388-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275846","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":"Non-tobacco nicotine dependence is associated with increased complications following clavicle open reduction internal fixation","authors":"Akin A. Adio,&nbsp;Rahul K. Goyal,&nbsp;Abby Skiena,&nbsp;Mohammad Daher,&nbsp;John G. Horneff,&nbsp;Hafiz F. Kassam,&nbsp;Brian W. Hill,&nbsp;Joseph A. Abboud","doi":"10.1007/s00402-026-06377-2","DOIUrl":"10.1007/s00402-026-06377-2","url":null,"abstract":"<div><h3>Background</h3><p>Tobacco dependence is well established to impair bone healing and increase postoperative complications. However, the independent effects of nicotine, separate from combustion-related factors, remain unclear. This study aimed to evaluate the impact of non-tobacco nicotine dependence (NTND) following open reduction and internal fixation (ORIF) of clavicle fractures, including midshaft and lateral fracture subtypes.</p><h3>Methods</h3><p>A retrospective cohort study was performed using a large national database. Patients undergoing ORIF of clavicle fractures were identified using procedural and diagnostic codes. Patients with non-tobacco nicotine dependence (e.g., vaping, patches, or gum) were identified and propensity score matched to (1) patients without nicotine exposure and (2) patients with tobacco nicotine dependence. In a secondary analysis, patients were stratified by fracture type (midshaft and lateral), and outcomes were compared between nicotine exposure and no nicotine exposure within each subgroup. Outcomes were assessed at 90 days and 1 year and included medical complications, number of opioid prescriptions, and implant-related outcomes. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, with <i>p</i> &lt; 0.05 considered significant.</p><h3>Results</h3><p>After matching, 936 non-tobacco nicotine users were identified. Non-tobacco nicotine dependence was associated with increased implant removal at 90 days (RR 2.50) and higher opioid prescriptions (<i>p</i> &lt; 0.05). At 1-year, non-tobacco nicotine use was associated with increased implant removal (RR 1.74), infection (RR 1.73), and nonunion (RR 1.78) (<i>p</i> &lt; 0.05). In direct comparisons between non-tobacco nicotine and tobacco nicotine users (<i>n</i> = 897), there were no significant differences in postoperative complications or implant-related outcomes (all <i>p</i> &gt; 0.05). In fracture-specific analyses, nicotine use was associated with increased infection (RR 2.17), nonunion (RR 1.42), and implant removal (RR 1.24) in midshaft fractures (<i>p</i> &lt; 0.05), with no significant differences observed in lateral fractures.</p><h3>Conclusion</h3><p>Non-tobacco nicotine dependence was associated with increased risks of infection, opioid utilization, implant removal, and nonunion following clavicle fracture fixation. These associations were observed predominantly in midshaft fractures, with no significant differences in lateral fractures. These findings suggest that non-tobacco nicotine dependence may carry a risk profile similar to that of tobacco use.</p><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06377-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275920","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":"Simulated tears of antero-posterior rotator cuff force-couple and reduced glenoid concavity decrease anterior glenohumeral stability: a robot-assisted biomechanical analysis of a load and shift sequence","authors":"Mats Jonas Karlsfeld,&nbsp;Jens Wermers,&nbsp;Stefanie Tänzler,&nbsp;Julia Sußiek,&nbsp;Elmar Herbst,&nbsp;J. Christoph Katthagen","doi":"10.1007/s00402-026-06383-4","DOIUrl":"10.1007/s00402-026-06383-4","url":null,"abstract":"<div><h3>Backround</h3><p>The glenoid concavity and the compression applied by the rotator cuff (RC) are essential for glenohumeral stability (GHS). This study aimed to determine how different simulated rotator cuff tears (RCT) and the glenoid depth influence GHS.</p><h3>Methods</h3><p>A Load and Shift sequence was performed with eight fresh-frozen cadaveric shoulders in a robotic-assisted setup. Differently configured static loading of the reinforced RC and deltoid muscle (DLT) simulated intact RC and anterior, superior, anterosuperior, posterosuperior, mass, and complete RC plus DLT tears. Anterior dislocation forces and their changes were determined as indicators of stability. The glenoid depth and Bony shoulder stability ratio (BSSR) were defined as indicators of concavity. To assess GHS, the maximal force (<i>F</i>_<i>avg</i>), the maximal force increase (<i>dF</i>_<i>avg</i>), and their mean deviations (<i>ΔF</i>_<i>max</i>, <i>ΔdF</i>_<i>max</i>) to the intact configuration during the sequence were evaluated.</p><h3>Results</h3><p>Simulated tears of the subscapularis tendon (SCP) (<i>ΔF</i>_<i>max</i> = 7.90 N, <i>ΔdF</i>_<i>max</i> = 1.54 N/mm) and simulated tears of the infraspinatus (ISP) + teres minor (TM) tendons (<i>ΔF</i>_<i>max</i> = 7.19 N, <i>ΔdF</i>_<i>max</i> = 1.48 N/mm) resulted in greater differences to the intact shoulder than simulated tears of the supraspinatus tendon (<i>ΔF</i>_<i>max</i> = 3.82 N, <i>ΔdF</i>_<i>max</i> = 1.16 N/mm). High correlations were observed between maximal force concerning glenoid depth (<i>r</i> = 0.81) and BSSR (<i>r</i> = 0.79).</p><h3>Conclusion</h3><p>Simulated tears of the SCP or ISP + TM significantly affect the anterior GHS in this model. These findings highlight the importance of careful evaluation regarding the indication for surgical reconstruction in such configurations. Decreased glenoid concavity reduces the anterior GHS and should be considered in treatment algorithms for shoulder instability.</p><h3>Study design</h3><p>Controlled Laboratory Study.</p><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06383-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275848","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}