Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Joint line elevation after TKA is higher in patients with metaphyseal deformity: a prospective study","authors":"Süleyman Albayrak,&nbsp;İsmail Demirkale,&nbsp;Mehmet Özer,&nbsp;Alparslan Kiliç,&nbsp;Hakan Şeşen,&nbsp;Murat Altay","doi":"10.1007/s00402-025-06054-w","DOIUrl":"10.1007/s00402-025-06054-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Joint level restoration is crucial for the success of total knee arthroplasty. The aim of this study was to evaluate joint line estimation methods between two patient groups with mild to moderate or advanced varus deformities.</p><h3>Material and Methods</h3><p>Patients were classified according to the Parvizi Classification as Type IA or Type M. Measurements were taken of distances from the fibular head, medial and lateral epicondyles, and adductor tubercle to the joint line, and the adductor ratio (AR) was calculated. Joint line elevation was measured postoperatively. Two years after surgery, the Hospital for Special Surgery (HSS) scores were recorded at the end of 2 years postoperatively.</p><h3>Results</h3><p>Evaluation was made of 68 patients, comprising 58 (85.3%) females and 10 (14.7%) males with a median age of 65 years (IQR: 25–75; 62–69). Although preoperative AR values were significantly lower in the Type M group (p &lt; 0.001), no significant intraoperative AR difference was found (p = 0.829). The medial epicondyle to joint line and lateral epicondyle to joint line distances showed consistency between measurements in all groups. Joint elevation was significantly higher in the Type M group (3.5 mm (IQR 3.1–3.8) than the Type IA group (2.1 mm (IQR 1.6–2.6) (p &lt; 0.001). Preoperative and postoperative HSS were found to be similar in both groups (p = 0.995 and p = 0.374, respectively).</p><h3>Conclusions</h3><p>While Type IA gonarthrosis did not significantly affect joint line estimation and the Adductor Ratio (AR) showed inconsistency in Type M gonarthrosis, a key finding was the significantly higher joint line elevation observed in Type M compared to Type IA patients. Importantly, this increased elevation did not result in a significant impact on HSS functional scores at two years post-surgery.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145073693","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":"Assessing the correlation between vastus medialis obliquus cross-sectional area and patellofemoral instability: a comparative magnetic resonance imaging study","authors":"Connor James Holmes,&nbsp;Diego Agustín Abelleyra Lastoria,&nbsp;Tobias Roberts,&nbsp;Vivian Ejindu,&nbsp;Claire Robertson,&nbsp;Caroline Hing","doi":"10.1007/s00402-025-06059-5","DOIUrl":"10.1007/s00402-025-06059-5","url":null,"abstract":"<div><h3>Background</h3><p>This study investigated the relationship between the vastus medialis obliquus (VMO) cross-sectional area (CSA) and patellofemoral instability (PFI) in both primary and recurrent lateral patellar dislocations (LPD). Our secondary objective was to examine associations between VMO CSA and trochlear dysplasia, tibial tuberosity position, and patellar height in patients with PFI.</p><h3>Methods</h3><p>Magnetic resonance imaging (MRI) radiographs were retrospectively analysed for 90 patients with primary acute LPD, 90 patients with recurrent LPD, and 56 patients without LPD (control). Measurements of the CSA ratio of the VMO to the whole thigh in three transverse slices were performed to calculate a mean ratio per patient. Additionally, tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt angle (PTA), trochlear sulcus angle (TSA), and Insall-Salvati ratio (ISR) were measured as part of the Dejour Protocol.</p><h3>Results</h3><p>The median CSA ratios in primary (0.04, standard deviation [SD]: 0.02) and recurrent (0.04, SD: 0.02) LPD patients were significantly lower than those in the control group (0.07, SD: 0.02) (<i>P</i> &lt; 0.05). Compared with the primary LPD group, the recurrent LPD group presented significantly greater TT-TG distances (16.0, SD: 4.77 mm vs. 13.0, SD: 4.73 mm; <i>p</i> = 0.0101) and PTA (25, SD: 9.79 degrees vs. 19, SD: 15.76 degrees; <i>p</i> = 0.0071). There was no statistically significant correlation between any parameters of the Dejour Protocol and the VMO CSA ratio in patients with primary or recurrent dislocations (<i>P</i> &gt; 0.05).</p><h3>Conclusion</h3><p>Patients with both primary and recurrent LPD demonstrated smaller VMO bulk relative to the rest of the thigh compared with controls. These findings indicate an association between reduced VMO size and patellar dislocation; however, causality cannot be inferred from this cross-sectional analysis.</p><h3>Level of evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06059-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062223","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":"Flexible intramedullary nailing versus Kirschner wire fixation in the treatment of paediatric radial neck fractures: a minimum 2-year follow-up study","authors":"Kun Jiang,&nbsp;Wenyu Feng,&nbsp;Lei Geng,&nbsp;Bufeng Zheng","doi":"10.1007/s00402-025-06066-6","DOIUrl":"10.1007/s00402-025-06066-6","url":null,"abstract":"<div><h3>Introduction</h3><p>The aims of this study were to compare the clinical outcomes of flexible intramedullary nailing (FIN) and Kirschner wire (KW) fixation in the surgical treatment of paediatric radial neck fractures to provide evidence-based guidance for optimising therapeutic strategies.</p><h3>Methods</h3><p>In this retrospective comparative study, the cases of 68 paediatric patients with Judet III–IV radial neck fractures between February 2018 and March 2023 were analysed; 37 patients underwent FIN, and 31 KW. Comparative parameters included operative time, time to implant removal, complications, and functional recovery, which were evaluated using forearm rotation loss, the Mayo Elbow Performance Score (MEPS), and the Métaizeau radiographic classification.</p><h3>Results</h3><p>All patients were followed for a minimum of 24 months postoperatively. Baseline characteristics were comparable between the groups. No significant difference in operative time was observed between the two groups. The time to implant removal was significantly longer in the FIN group (262.05 ± 49.16 days) than in the KW group (32.06 ± 3.63 days; <i>P</i> &lt; 0.05). Functional outcomes, as assessed by the MEPS, were significantly better in the FIN group, with 97.3% of patients achieving excellent or good results, compared to 83.9% in the KW group (<i>P</i> &lt; 0.05). Additionally, the FIN group exhibited significantly less forearm rotation loss (6.03 ± 8.44° vs. 17.06 ± 19.04°, <i>P</i> &lt; 0.05). Although complication rates were generally low, the KW group had a slightly higher incidence, primarily due to pin tract infections.</p><h3>Conclusions</h3><p>FIN fixation offers superior functional outcomes, less forearm rotation loss, and a lower risk of superficial infection compared to KW fixation for paediatric radial neck fractures. While KW allows for earlier implant removal, it is associated with a greater risk of infection. Therefore, FIN is recommended as the preferred surgical option in clinical practice.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145062222","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 postoperative three-phase Technetium-99 m bone scanning predicts traumatic osteonecrosis in patients with femoral neck fractures: a 2- to 6-year follow-up study","authors":"Guangmin Yang,&nbsp;Shiye Huang,&nbsp;Deqing Liu,&nbsp;Ye Yuan,&nbsp;Yangyang Yu,&nbsp;Yan Li,&nbsp;Zuoxiang He,&nbsp;Yongwei Pan,&nbsp;Zhe Zhao","doi":"10.1007/s00402-025-06064-8","DOIUrl":"10.1007/s00402-025-06064-8","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aimed to explore the predictive value of early postoperative TPBS on post-traumatic osteonecrosis of the femoral head (ONFH) in femoral neck fracture (FNF) patients after internal fixation.</p><h3>Materials and methods</h3><p>This study retrospectively reviewed the FNF patients who underwent TPBS within 72 h after internal fixation from January 2017 to December 2020 in our institution. All Patients were divided into ONFH and non-ONFH groups during the follow-up, and diagnostic analysis was used to assess the predictive value of TPBS on ONFH occurrence.</p><h3>Results</h3><p>Fifty-one patients (51 hips) were included, with a mean follow-up of 4.7 years, ranging from 2.3 to 6.7 years. Twenty-one out of 51 patients showed femoral head perfusion defects on the postoperative TPBS, and 15 of the 21 patients developed ONFH in the follow-up. The sensitivity, specificity, positive predictive value, and negative predictive value of TPBS are 93.75%, 83.33%, 71.43%, and 96.77%, respectively. The semi-quantitative analyses showed that the tracer uptake in the lateral and medial pillars of the femoral head in the ONFH group was significantly reduced compared with the contralateral side. In contrast, the uptake in the medial, central, and lateral columns of the fracture side in the non-ONFH group was significantly higher than those on the contralateral side.</p><h3>Conclusions</h3><p>The present results found that early postoperative TPBS showed high sensitivity and specificity in predicting posttraumatic ONFH for the FNF patients after internal fixation and has considerable value in estimating the future risk of ONFH.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037368","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":"Comparison of conventional MRI and CT scans for assessing bony parameters and classifying On- and Off-Track lesions in anterior shoulder dislocations","authors":"Philipp Zehnder,&nbsp;Max Kersten,&nbsp;Markus Schwarz,&nbsp;Peter Biberthaler,&nbsp;Chlodwig Kirchhoff,&nbsp;Lukas Willinger","doi":"10.1007/s00402-025-06062-w","DOIUrl":"10.1007/s00402-025-06062-w","url":null,"abstract":"<div><h3>Background</h3><p>Shoulder dislocation is the most common major joint dislocation, with anterior dislocations accounting for 95% of cases. Accurate assessment of bony lesions, such as glenoid bone loss (GBL) and Hill-Sachs lesions, is critical for treatment planning. While computed tomography (CT) is the gold standard for evaluating bony parameters, magnetic resonance imaging (MRI) may serve as a viable alternative, offering no radiation exposure. This study aims to compare the reliability of conventional 2D (two- Dimensional)-MRI with 2D-CT in measuring bony parameters and classifying lesions as on- or off-track. It was hypothesized that there is no difference in evaluation between MRI and conventional CT scans.</p><h3>Methods</h3><p>A retrospective case-control study was conducted on 61 patients (mean age 45 ± 19 years) with anterior shoulder dislocations who underwent both CT and MRI imaging. Radiographic measurements, including glenoid diameter, glenoid defect (in width), Hill-Sachs lesion and bony bridge, were obtained independently from CT and MRI scans. Patients were categorized as on- or off-track based on the glenoid track and Hill-Sachs index. Statistical analyses included correlation tests, Bland-Altman plots, interrater agreement (intraclass correlation coefficient), and sensitivity and specificity analyses for lesion classification.</p><h3>Results</h3><p>MRI showed good agreement with CT across most parameters, with mean differences of less than 1 mm for glenoid defect, glenoid diameter, and Hill-Sachs lesions. Correlation coefficients ranged from 0.62 (bony bridge) to 0.93 (glenoid defect). Bland-Altman plots revealed good agreement for glenoid parameters but higher variance for the Hill-Sachs lesion and bony bridge. MRI correctly classified 89% of on-track lesions (sensitivity) and 76% of off-track lesions (specificity). Interrater agreement was excellent for glenoid defect measurements (ICC = 0.962) and lower for the bony bridge (ICC = 0.848).</p><h3>Conclusion</h3><p>Conventional MRI demonstrates high reliability in measuring bony parameters and good accuracy in classifying on- and off-track lesions compared to CT. MRI is a viable alternative for preoperative evaluation, particularly in cases with minor bony defects. However, in indeterminate defects, a CT scan is recommended to ensure accurate measurements, classification and treatment planning.</p><h3>Level of evidence</h3><p>Level III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06062-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145037222","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":"Long-term outcome of dorsal digital defect reconstruction using reverse-cross-finger flaps","authors":"Mohamed Esam Yasmin,&nbsp;Adrian Sebald,&nbsp;Andreas Arkudas,&nbsp;Raymund E. Horch","doi":"10.1007/s00402-025-06038-w","DOIUrl":"10.1007/s00402-025-06038-w","url":null,"abstract":"<div><h3>Purpose</h3><p>Despite advances in microsurgical reconstruction, the reverse cross-finger flap (RCF) remains a reliable technique for dorsal finger defects. However, long-term outcome data are limited. This study evaluates the clinical and subjective long-term outcomes of patients treated with RCF reconstruction.</p><h3>Methods</h3><p>A retrospective single-center cohort study was conducted on patients who underwent RCF for dorsal finger defects between 2003 and 2022. Nineteen patients (mean age 59.0 ± 20.1 years) were included in the follow-up (mean duration: 12.6 ± 6.1 years). Functional outcomes were assessed via range of motion (ROM), two-point discrimination, and cold intolerance. Subjective satisfaction and functional limitations were evaluated using the Quick-DASH and a custom survey. Complications and aesthetic results were also recorded.</p><h3>Results</h3><p>All flaps fully integrated. Complications were: 2 infections, 1 hematoma, and 1 partial flap necrosis requiring revision. Mean two-point discrimination was 7.6 mm (vs. 5.8 mm contralaterally; <i>p</i> &lt; 0.05), and cold intolerance occurred in 9 cases. ROM showed no significant differences compared to the contralateral hand. Mild activity-related pain was reported by 6 patients, with no resting pain. Mean satisfaction scores were 8.1 (functional) and 7.7 (aesthetic). The mean Quick-DASH score was 5.1.</p><h3>Conclusion</h3><p>The RCF remains a safe, effective, and durable option for dorsal finger reconstruction. It offers reliable functional and aesthetic outcomes with low donor site morbidity and complication rates, supporting its continued role in modern hand surgery, particularly where microsurgical resources are limited.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028368","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 superiority of novel dynamic tape over standard tape suture in distal triceps tendon repair: a human cadaveric study testing an intense early rehabilitation protocol","authors":"Moritz Kraus,&nbsp;Bogdan Bocea,&nbsp;Nicolas Ion,&nbsp;Mehar Dhillon,&nbsp;Ivan Zderic,&nbsp;Luise Puls,&nbsp;Boyko Gueorguiev,&nbsp;R Geoff Richards,&nbsp;Hans-Christoph Pape,&nbsp;Tatjana Pastor,&nbsp;Torsten Pastor","doi":"10.1007/s00402-025-06040-2","DOIUrl":"10.1007/s00402-025-06040-2","url":null,"abstract":"<div><h3>Background</h3><p>Distal triceps tendon rupture is related to high complication rates with up to 25% failures. Elbow stiffness is another severe complication, as the traditional approach considers prolonged immobilization to ensure tendon healing. Recently, a dynamic tape was designed, implementing a silicone-infused core for braid shortening and preventing repair elongation during mobilization, thus maintaining constant tissue approximation. The aim of this study was to compare biomechanically the novel dynamic tape versus conventional tape in a human cadaveric distal triceps tendon repair model.</p><h3>Methods</h3><p>Sixteen paired arms from eight donors were split to two groups. Distal triceps tendon tenotomies and repairs were performed via the crossed transosseous locking Krackow stitch technique for anatomic footprint repair. Either conventional (SutureTape) or the novel dynamic tape (DYNATape) were used. A postoperative protocol mimicking intense early rehabilitation was simulated by a 9-day, 300-cycle daily mobilization under 150 N load followed by a final destructive test.</p><h3>Results</h3><p>Significant differences were identified between the groups regarding the displacement over time at the distal, intermediate, and proximal tendon aspects, <i>p</i> &lt; 0.001. DYNATape demonstrated significantly less displacement compared to SutureTape (4.6 ± 1.2 mm versus 7.8 ± 2.1 mm) and higher load to failure (637 ± 113 N versus 341 ± 230 N), <i>p</i> ≤ 0.037. DYNATape retracted 0.95 ± 1.95 mm after each 24-hour period and withstood the whole cyclic loading sequence without failure. In contrast, SutureTape failed early in three specimens.</p><h3>Conclusion</h3><p>DYNATape demonstrated improved biomechanical competence compared to SutureTape in a distal triceps tendon repair model, with significantly lower maximal displacement and higher load to failure. These findings indicate that DYNATape may offer a more stable construct under controlled laboratory conditions. Knot slippage and bone-related complications observed in both groups underscore the technical challenges associated with this repair technique and highlight the importance of precise surgical execution.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06040-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028251","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":"Comparison of antirotation proximal femoral nail and talon locking nail systems in the treatment of intertrochanteric fractures: functional and cost-effectiveness outcomes","authors":"İsmail Güzel,&nbsp;İbrahim Ulusoy,&nbsp;Mehmet Fırat Tantekin,&nbsp;Mehmet Yılmaz,&nbsp;Aybars Kıvrak","doi":"10.1007/s00402-025-06065-7","DOIUrl":"10.1007/s00402-025-06065-7","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to compare the clinical outcomes and cost-effectiveness of two widely used intramedullary fixation systems—the Proximal Femoral Nail Antirotation (PFNA) and the Proximal Femoral Nail with Talon Locking System (PFN-TLS)—in the treatment of intertrochanteric femur fractures (ITFF).</p><h3>Methods</h3><p>A retrospective cohort study was conducted on 118 patients aged 65–90 years who underwent surgical treatment for ITFF using either PFNA (<i>n</i> = 53) or PFN-TLS (<i>n</i> = 65). All patients were followed for a minimum of 24 months. Preoperative functional evaluation was unavailable; outcomes were assessed at 24 months postoperatively. Surgical parameters, complication and revision rates, functional outcomes (Harris Hip Score [HHS], Visual Analog Scale [VAS], and SF-36), and health-economic indicators (Quality-Adjusted Life Years [QALY], Incremental Cost-Effectiveness Ratio [ICER]) were evaluated. Binary logistic regression analysis was performed to determine independent predictors of favorable functional outcomes.</p><h3>Results</h3><p>The PFN-TLS group demonstrated significantly shorter surgical duration, reduced incision length, and lower fluoroscopy exposure (<i>p</i> &lt; 0.05). At the 24-month follow-up, HHS was significantly higher in the PFN-TLS group (82.7 ± 7.4) compared to the PFNA group (76.4 ± 8.1; <i>p</i> = 0.001). VAS and SF-36 scores were also higher, although not statistically significant. Revision rates showed a non-significant trend favoring PFN-TLS. QALY gains were slightly higher in the PFN-TLS group (0.530 vs. 0.449), with a lower cost per QALY ($1,637.93 vs. $1,863.22). PFN-TLS use was independently associated with favorable functional outcomes (OR: 2.62; 95% CI 1.23–5.58; <i>p</i> = 0.013).</p><h3>Conclusion</h3><p>Both PFNA and PFN-TLS are effective options for the management of ITFF. However, PFN-TLS may offer additional clinical and economic benefits, including improved functional outcomes and greater cost-efficiency. Findings should be interpreted with caution due to the retrospective design. Prospective, randomized studies are needed to validate these results and guide implant selection in clinical practice.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028252","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":"Poor fracture alignment equals poor outcome? Analysis of conservatively managed distal radius fractures","authors":"Julian Diepold,&nbsp;Sebastian Filipp,&nbsp;Florian Dussing,&nbsp;Gernot Steiner,&nbsp;Christian Deininger,&nbsp;Tobias Gotterbarm,&nbsp;Florian Wichlas","doi":"10.1007/s00402-025-06047-9","DOIUrl":"10.1007/s00402-025-06047-9","url":null,"abstract":"<div><h3>Purpose</h3><p>The NOM (non-operative management) of distal radius fractures (DRF) is influenced by various factors. This study seeks to determine whether poor fracture alignment correlates with poor outcome.</p><h3>Methods</h3><p>Over a period of three years, a study was conducted on conservatively treated DRF involving 127 patients, 104 women (81.9%) and 23 men (18.1%). The average age was 70.6 years (SD ± 19.1; range 21 to 102 years). The patient population is categorized into two groups according to radiological healing outcomes: Group I and Group II. The classification threshold was established as (1) &gt; 10° dorsal/volar tilt of the lateral articular surface angle. (2) Radial tilt of the anteroposterior joint surface angle exceeds 10 degrees. (3) The loss in radial height surpasses 4 mm. Patients were categorized into group II if they met two or more criteria for DRFs, while those with one or fewer criteria were placed in group I.</p><h3>Results</h3><p>Group I exhibited superior mobility across all planes, except in radial abduction. There was also a significant improvement in the clinical scores (QuickDASH, PRWE). Patients over 70 years with anatomically healed distal radius fractures (Group I) had superior range of motion in all planes, with the exception of radial abduction. Group II exhibited significantly higher scores (QuickDASH, PRWE).</p><h3>Conclusion</h3><p>Thus, the ultimate goal—both in younger and older patients—should remain to achieve the best possible anatomical reduction. And especially in geriatric people, anatomical repositioning demonstrates enhanced ROM and significantly improvement in patient’s satisfaction and daily functioning.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-06047-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028248","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":"Significant differences in the rate of periprosthetic joint infections in revision hip and knee arthroplasty depending on the applied definition","authors":"Laura Elisa Streck,&nbsp;Christian Manuel Sterneder,&nbsp;Lyubomir Haralambiev,&nbsp;Marco Brenneis,&nbsp;Yu-Fen Chiu,&nbsp;Friedrich Boettner","doi":"10.1007/s00402-025-05994-7","DOIUrl":"10.1007/s00402-025-05994-7","url":null,"abstract":"<div><h3>Background</h3><p>Differentiating periprosthetic joint infections (PJI) from aseptic failure is challenging in total joint arthroplasty. To date, there is no consensus about the most accurate criteria to diagnose PJI. The current study compares common diagnostic PJI criteria.</p><h3>Methods</h3><p>256 total hip and knee arthroplasties that underwent revision surgery between 2017 and 2022 were retrospectively classified as PJI or non PJI according to the following definitions: 2011 Musculoskeletal Infections Society (MSIS), 2013 Infectious Disease Society of America (IDSA), 2018 updated MSIS-criteria (MSIS-18), 2018 International Consensus Meeting on Periprosthetic Joint Infections (ICM), 2021 European Bone and Joint Infections Society (EBJIS), Pro-Implant Foundation, and the surgeons’ assessment at the time of surgery. Accuracy, sensitivity, specificity, and predictive values were calculated with reference to (1) microbiological culture results, (2) MSIS-criteria, and (3) the surgeons’ diagnosis. Results were compared between hip- and knee arthroplasties using Fisher’s Exact- or Chi-square test, outcomes were compared between two criteria using Pearson correlation.</p><h3>Results</h3><p>PJI was diagnosed in 47.7% of cases applying MSIS-criteria, 49.2% for IDSA-criteria, 52.3% for MSIS-18 criteria, 55.5% for ICM-criteria, 62.1% for EBJIS-criteria, 67.2% for Pro-Implant-criteria, and 55.1% according to the surgeons’ judgment. Pro-Implant-criteria showed the lowest concordance with microbiological cultures and a rate of 35.5% culture negative infections. ICM- and MSIS-18-criteria showed best concordance with the surgeons’ diagnosis.</p><h3>Conclusion</h3><p>The current study showed that the diagnosis of PJI is highly dependent on the applied diagnostic criteria. EBJIS- and Pro-Implant-criteria classified more cases as PJI compared to other diagnostic criteria. Care should be taken to avoid overdiagnosis and overtreatment, especially if low synovial white blood cell thresholds are applied as definite criteria to diagnose PJI.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011962","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}