Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Clinical and patient-reported outcomes of a novel robotic system in total knee arthroplasty","authors":"Farouk Khury,&nbsp;Ittai Shichman,&nbsp;Sophia Antonioli,&nbsp;Joshua Rozell,&nbsp;Morteza Meftah,&nbsp;Ran Schwarzkopf","doi":"10.1007/s00402-025-05932-7","DOIUrl":"10.1007/s00402-025-05932-7","url":null,"abstract":"<div><h3>Background</h3><p>Robotic assistance (RA) is increasingly used in total knee arthroplasty (TKA) for more accurate bony resection and balancing. However, the impact of robotic TKA (RATKA) on clinical outcomes and patient-reported measures (PROMs) remains unclear. This study aims to compare RATKA and conventional TKA (CTKA) using a novel robotic system.</p><h3>Methods</h3><p>A retrospective review was conducted on 10,031 patients who underwent TKA from February 2021 to October 2024. 289 RATKAs were performed with a hand-held robotic system. These RATKA cases were 1:1 propensity-score matched to CTKA for patient demographics, surgeon, implant system, and articulation design. Postoperative and clinical outcomes including surgical time, length of stay (LOS), discharge disposition, 90-day emergency department (ED) visits, manipulation under anesthesia (MUA), debridement, reoperations and revisions were collected and analyzed. Patient-reported outcomes measures (PROMs) included Knee Injury and Osteoarthritis Outcome Scores (KOOS, JR) and Patient Reported Outcome Measurement Information System (PROMIS) scores.</p><h3>Results</h3><p>RATKA demonstrated significantly shorter LOS (30.04 vs. 51.91 hours, <i>p</i> &lt; 0.001, respectively) compared to CTKA. There was no difference in surgical time (107.18 vs. 106.22 minutes, <i>p</i> = 0.349). Although there was no statistical difference in 90-day ED visits, the majority of the CTKA revisits were due to surgery-related causes when compared to the RATKAs (1.38% vs. 0.34%, <i>p</i> = 0.239). While RATKAs had higher incidence of MUAs (2.07% vs. 0.34%, <i>p</i> = 0.201), CTKAs had more reoperations (1 vs. 0, <i>p</i> = 0.369) and more revisions than the RATKAs (6 vs. 0, <i>p</i> = 0.117). In terms of PROMs, both RATKAs and CTKAs showed similar improvements in KOOS, JR and PROMIS pain scores following TKA, with no significant differences in the magnitude of improvement at early postoperative timepoints. However, at the one-year follow-up, RATKA demonstrated significantly greater reduction in PROMIS pain intensity (Δ-9.12, <i>p</i> = 0.032) compared to CTKAs.</p><h3>Conclusions</h3><p>This retrospective analysis showed that the novel RATKA resulted in reduced length of stay, fewer reoperations, and greater reduction in one-year PROMIS pain intensity compared to CTKAs, despite having a higher incidence of MUA rates. Further research is needed to clarify these differences clinically and enhance patient outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The accuracy of MRI diagnosis of thumb ulnar collateral ligament injuries over physical examination in clinical decision-making for surgery","authors":"Nicolas Orbenes,&nbsp;Philipp Moog,&nbsp;Klaus Woertler,&nbsp;Jan Neumann,&nbsp;Hans-Guenther Machens,&nbsp;Haydar Kükrek","doi":"10.1007/s00402-025-05923-8","DOIUrl":"10.1007/s00402-025-05923-8","url":null,"abstract":"<div><h3>Purpose</h3><p>This retrospective study assessed whether magnetic resonance imaging (MRI) confers a diagnostic or therapeutic advantage over clinical examination in managing thumb ulnar collateral ligament (UCL) injuries and evaluated its accuracy in lesion characterization.</p><h3>Materials and methods</h3><p>We reviewed 96 patients undergoing surgical repair over a ten-year period, 43 of whom had preoperative MRI and 53 who did not.</p><h3>Results</h3><p>While MRI exhibited high sensitivity (97%) and specificity (80%) for detecting UCL pathology, its accuracy for differentiating lesion subtypes was only moderate (72–84%). No appreciable difference was noted between MRI and non-MRI cohorts in the proportion of indication-appropriate (57% vs. 45%) or surgeries potentially amenable to conservative treatment (43% vs. 55%).</p><h3>Conclusions</h3><p>Thus, MRI did not influence the indication for surgery beyond what was determined by a meticulous physical examination. A thorough clinical assessment remains the mainstay, reserving MRI for diagnostically challenging scenarios or when detailed anatomical visualization is necessary.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05923-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131496","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":"Blood transfusion risk factors in patients with osteoporotic hip fracture","authors":"Julián Carlos Segura-Nuez,&nbsp;Pilar Herranz-Andrés,&nbsp;Marta Infantes-Morales,&nbsp;Juan Segura-Nuez,&nbsp;Carlos Martín-Hernández,&nbsp;Adrián Roche-Albero","doi":"10.1007/s00402-025-05930-9","DOIUrl":"10.1007/s00402-025-05930-9","url":null,"abstract":"<div><h3>Purpose</h3><p>This study analyzes the perioperative factors influencing the risk of transfusion in patients with osteoporotic hip fractures and their relationship with 30-day mortality.</p><h3>Methods</h3><p>This is a retrospective analytical study that included patients over 65 years old diagnosed with hip fracture admitted to our hospital from March to October, 2023. They were treated according to the hospital’s osteoporotic hip fracture management protocol. Data collected included admission day, age, sex, type of fracture, anticoagulant or antiplatelet treatment, time to surgery, and 30-day mortality.</p><h3>Results</h3><p>A total of 348 patients (77.3% women) with a mean age of 85.3 (SD 7.51) years were included. The mean hemoglobin level at admission was 12.6 (SD 1.66) mg/dl. The mean time to surgery was 2.51 (SD 1.45) days. The proportion of patients transfused was 42%, and the 30-day post-discharge mortality rate was 4.6%. Multivariate analysis showed that age, type of fracture, hemoglobin level at admission, and surgery within the first 48 h were associated with a higher transfusion rate (<i>p</i> &lt; 0.05). No differences were found regarding sex and prior anticoagulant or antiplatelet treatment. The 30-day mortality was higher in the transfused group.</p><h3>Conclusions</h3><p>Age; hemoglobin level at admission; subtrochanteric, pertrochanteric, and basicervical fractures compared to subcapital fractures; and surgery within the first 48 h were associated with a higher transfusion rate. Multidisciplinary perioperative management of patients who cannot be operated on within the first 48 h is crucial to prevent complications and improve survival.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125634","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 revision of Monteggia-variant fractures","authors":"Valentin Rausch,&nbsp;Thomas Rosteius,&nbsp;Matthias Königshausen,&nbsp;Thomas A. Schildhauer,&nbsp;Dominik Seybold,&nbsp;Jan Geßmann","doi":"10.1007/s00402-025-05895-9","DOIUrl":"10.1007/s00402-025-05895-9","url":null,"abstract":"<div><h3>Purpose</h3><p>Monteggia-variant fractures involve a fracture of the proximal ulna combined with a radiocapitellar dislocation and/or additional injuries to the radial head. These injuries are associated with severe outcomes, high complication rates, and frequent need for revision surgery. This study aimed to investigate strategies for early revision following failed operative treatment of these injuries.</p><h3>Methods</h3><p>We retrospectively included all patients over 18 years of age who underwent revision surgery within the first 3 months after failed initial treatment of a Monteggia-variant fracture due to persistent instability or mechanical failure between October 2013 and December 2018 at our institution. We reviewed the reasons for revision, the operative strategies used, and the clinical and radiological outcomes of these patients.</p><h3>Results</h3><p>Twenty-seven patients, with a mean age of 57.9 ± 17 years (range: 21–94 years), were included in the study. Nineteen patients (70.4%) underwent revision due to instability, and 10 patients (37%) underwent revision due to failed osteosynthesis. For the revisions, the collateral ligaments were reconstructed in 63% (<i>n</i> = 17), a radial head prosthesis was implanted in 51.9% (<i>n</i> = 14), and re-osteosynthesis of the ulna and additional osteosynthesis were performed in 40.7% (<i>n</i> = 11) and 29.6% (<i>n</i> = 8), respectively. The coronoid was reconstructed in 22.2% (<i>n</i> = 6), and a radial head resection was performed in 14.8% (<i>n</i> = 4). In three cases, total elbow arthroplasty was performed, and in six cases, an additional external fixator was applied. All reconstructive procedures successfully stabilized the elbow. The mean functional arc for extension-flexion at final follow-up was 79 ± 29° (range: 20–115°).</p><h3>Conclusions</h3><p>Common reasons for revision surgery in Monteggia-variant fractures include ulnohumeral or radiohumeral instability, often due to missed coronoid fractures, collateral ligament injuries, or absence of the radial head.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125657","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":"No difference in reoperation rates or aseptic loosening following cemented total knee arthroplasty with or without a tourniquet","authors":"Aaron Gazendam,&nbsp;Hassaan Abdel Khalik,&nbsp;Mansi Patel,&nbsp;Seper Ekhtiari,&nbsp;Isabelle Tate,&nbsp;Thomas J Wood","doi":"10.1007/s00402-025-05933-6","DOIUrl":"10.1007/s00402-025-05933-6","url":null,"abstract":"<div><h3>Introduction</h3><p>The objective of the current study was to evaluate the reoperation rate among patients undergoing cemented total knee arthroplasty (TKA) with or without an intraoperative tourniquet.</p><h3>Materials and methods</h3><p>A retrospective cohort study of consecutive patients who received a primary, cemented TKA at a high volume academic orthopaedic center. Eligible patients underwent primary, cemented TKA either with or without the use of a tourniquet throughout the entirety of the care. The causes and timing of reoperations were recorded. Survivorship analysis was conducted using Kaplan-Meier curves. Cox proportional hazards models were utilized to evaluate independent predictors of reoperation.</p><h3>Results</h3><p>There were 2276 (58%) cases in which a tourniquet was used and 1663 (42%) cases with no tourniquet use. Mean time from the primary TKA was 14.7 years. The cumulative survival at final follow-up for the no tourniquet group and tourniquet group were 92.2% and 96.5%, respectively. Only younger age was an independent predictor of both all cause revision and aseptic loosening.</p><h3>Conclusions</h3><p>Adjusting for confounders, the presence of a tourniquet did not affect the rates of long-term all-cause revision rates or aseptic loosening. Younger patients have a higher risk of all-cause reoperation and reoperation due to aseptic loosening.</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":2.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144125655","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":"TOUCH® duo-mobile prosthesis in TMC osteoarthritis: two-year results and practical insights regarding key surgical steps and complication management","authors":"Pia-Elena Frey,&nbsp;Simeon C. Daeschler,&nbsp;Yusuf Naseri,&nbsp;Maximilian Franzen,&nbsp;Jan Sommer,&nbsp;Leila Harhaus,&nbsp;Benjamin Panzram","doi":"10.1007/s00402-025-05926-5","DOIUrl":"10.1007/s00402-025-05926-5","url":null,"abstract":"<div><h3>Introduction</h3><p>The Touch® dual-mobility prosthesis is a well-established treatment for advanced trapeziometacarpal (TMC) joint osteoarthritis, offering an alternative to resection arthroplasty. Short-term studies suggest dual-mobility designs reduce dislocation and loosening compared to single-mobility prostheses. This retrospective study presents clinical outcomes after a mean follow-up of 24 months, focusing on revision surgery and providing insights about key surgical steps and the management of adverse events.</p><h3>Materials and methods</h3><p>A total of 78 patients (88 prostheses) with TMC osteoarthritis underwent surgery between August 2019 and December 2023, performed by a single surgeon in a monocentric setting. Preoperative assessments and follow-ups were conducted at 6 weeks, 6 months, 12 months, and annually. Outcome measures included radiographic analysis, range of motion, grip/pinch strength, pain (NRS 1–10), and functional scores (qDASH, briefMHQ). Complications and revisions were recorded.</p><h3>Results</h3><p>At a mean follow-up of 24 months (range 6–61 months), significant improvements in hand function, pain, and mobility were observed. Preoperative thumb MCP hyperextension (&gt; 15° in 23 thumbs) was corrected to 6° on average, and thumb length was restored. Four patients (4.5%) required implant revision: two due to secondary cup dislocation after misplacement, two due to impingement. Seven secondary surgeries addressed wound healing disorders (<i>n</i> = 2) and secondary De Quervain tenosynovitis (<i>n</i> = 5). Kaplan-Meier analysis showed a 96% prosthesis survival rate at two years.</p><h3>Conclusions</h3><p>The Touch® dual-mobility prosthesis demonstrates high effectiveness in improving pain, function, and thumb stability, with low revision rates. Restoration of thumb length and correction of hyperextension support its use as a reliable surgical option. These findings are consistent with existing literature suggesting superior long-term stability compared to single mobility implants. Identified surgical challenges highlight factors contributing to complications and emphasize intraoperative strategies to prevent revision.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05926-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108423","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":"Evaluation of surgeon demographics and association with postoperative complication rates after total hip arthroplasty at the United States News and World Report top-ranked orthopaedic hospitals","authors":"Adam M. Gordon,&nbsp;Rushabh Vakharia,&nbsp;Michael A. Mont","doi":"10.1007/s00402-025-05925-6","DOIUrl":"10.1007/s00402-025-05925-6","url":null,"abstract":"<div><h3>Introduction</h3><p>The rankings provided by the <i>U.S. News &amp; World Report</i> (USNWR) are widely consulted to identify leading hospitals. This study aimed to (1) investigate the demographic characteristics of surgeons practicing at USNWR Top-Ranked Orthopaedic hospitals and (2) evaluate if any were associated with complication rates following total hip arthroplasty (THA).</p><h3>Methods</h3><p>The 2009 to 2013 USNWR ‘Orthopaedic’ hospital rankings were curated. Surgeons performing THA and their adjusted postoperative complication rates were compiled using publicly available data from the Centers for Medicare and Medicaid Services (2009 to 2013). Demographic information for each surgeon, including fellowship training, years of practice, age, sex, practice setting, medical degree, residency reputation, case volume, and geographic region, was collected using an internet search algorithm. Logistic regression analyses were conducted to evaluate the association between surgeon demographics and complication rates, with a significance level set at <i>P</i> &lt; 0.008.</p><h3>Results</h3><p>Between 2009 and 2013, a total of 659 orthopaedic surgeons conducted THA procedures at 80 USNWR-top-ranked hospitals. The average case volume for THA was 171 (range: 20 to 1,122), and the average age of surgeons was 50.7 years (range: 32 to 75). A majority of surgeons (56.4%) had completed an orthopaedic surgery fellowship. The mean adjusted 30-day complication rate was 2.2% (range: 1.1 to 4.4%). Surgeon age ≤ 42 years (odds ratio (OR) 3.1; <i>P</i> = 0.006) and lower case volumes (≤ 100 cases) (OR 2.5; <i>P</i> &lt; 0.0001) were associated with higher complication rates. However, sex, geographic region, completion of fellowship, medical degree type, and residency reputation did not show significant associations.</p><h3>Discussion</h3><p>Surgeon-related factors may be associated with complication rates following THA conducted at USNWR Top-Ranked Orthopaedic Hospitals, which could be informative for patients and hospitals assessing quality of care.</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":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108662","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":"Trends in open tibia fracture antibiotic prophylaxis","authors":"Andrew D. Marten,&nbsp;Elizabeth Cho,&nbsp;Patrick Mazza,&nbsp;Carlo Eikani,&nbsp;Ashley E. Levack","doi":"10.1007/s00402-025-05921-w","DOIUrl":"10.1007/s00402-025-05921-w","url":null,"abstract":"<div><h3>Purpose</h3><p>Prophylactic antibiotics are an effective intervention in reducing fracture related infection (FRI) in open fractures after orthopaedic trauma. Despite routine antibiotic use, the rate of FRI in Gustilo Anderson (GA) type III open fractures remains high; henceforth, we investigated the rate of open tibia fractures and trends in prophylactic antibiotic usage at our institution.</p><h3>Methods</h3><p>This was a retrospective study of 133 type III open tibia fractures treated at an academic tertiary level I trauma center over a 15-year period (2007–2021). We collected information on administered prophylactic antibiotics, local antibiotics, soft tissue coverage, and FRI. Chi-squared tests analyzed trends in antibiotic utilization and FRI. Multivariable logistic regression was performed to evaluate association between GA type, prophylactic antibiotics, local antibiotics, and flap coverage with FRI outcomes.</p><h3>Results</h3><p>Analysis revealed a higher percentage of 1st/2nd generation cephalosporin use among type IIIA compared to IIIB/IIIC fractures (<i>p</i> &lt; 0.001), an increase in utilization of 3rd generation cephalosporins over the 15-year period (<i>p</i> = 0.018), and decline in 1st/2nd generation cephalosporins. FRIs occurred in 24.8% (<i>n</i> = 26) of type III open tibia fractures. On multivariable logistic regression analysis, when controlling for GA type, prophylactic antibiotic regimen, and flap coverage: local antibiotic use was the only independent predictor of FRI (OR 9.3, 95% CI = 3.0-28.7, <i>p</i> &lt; 0.001). When evaluating patients with adequate follow-up, local antibiotics remained the only independent predictor of FRI (OR 9.4, 95% CI 2.9–30.1, <i>p</i> &lt; 0.001).</p><h3>Conclusion</h3><p>Institutional protocols for orthopaedic care and hospital-wide education may be beneficial to improve recognition and appropriate prophylactic treatment of high-risk open fractures.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108663","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":"Femoral stem subsidence after uncemented total or hemiarthroplasty for femoral neck fractures does not correlate with local femoral bone quality evaluated by Dorr and cortical thickness index","authors":"Rahel Badoux,&nbsp;Manuel Waltenspül,&nbsp;Michael Dietrich,&nbsp;Method Kabelitz","doi":"10.1007/s00402-025-05928-3","DOIUrl":"10.1007/s00402-025-05928-3","url":null,"abstract":"<div><h3>Introduction</h3><p>The increase in femoral neck fractures in elderly individuals is primarily attributable to reduced bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA), has been demonstrated to be a reliable bone mineral density (BMD) estimate. Femoral cortical thickness index (CTI), and Dorr classification are reliable assessment methods of the femoral cortical thickness. Patients with low BMD, low CTI or Dorr C who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). Dual-energy X-ray absorptiometry (DEXA), femoral cortical thickness index (CTI), and Dorr classification have been demonstrated to be reliable bone mineral density (BMD) estimates. Patients with low BMD who undergo uncemented total hip arthroplasty (THA) or hemiarthroplasty (HA) are at an increased risk of early femoral stem subsidence (FSS). The objective of this study was to investigate the relationship between CTI, Dorr classification, and early FSS, hypothesizing that these indicators can predict stem subsidence.</p><h3>Material and methods</h3><p>A retrospective analysis was conducted on patients with femoral neck fractures treated by uncemented THA or HA using the direct anterior approach (DAA). Preoperative radiographs were utilized to assess CTI and Dorr classification. Postoperative FSS was the primary outcome measure, with follow-up X-rays averaging 403 days (range 38–3371). The canal fill ratio (CFR) was observed at four levels postoperatively. A subsequent statistical analysis was conducted to examine the correlation between CTI, Dorr classification, CFR, BMI, age, and FSS.</p><h3>Results</h3><p>The study’s sample population included 64 patients (20 male, 44 female) with a mean age of 73 ± 9 years, who were treated between June 2020 and February 2024. The mean femoral CTI was 0.51 ± 0.08 on the fractured side and 0.54 ± 0.06 on the contralateral unaffected side. The mean FSS was 1.02 ± 1.49 mm. A subsidence of at least 5 mm was identified in a mere two patients, both of whom were classified as Dorr B. A modest correlation (r = 0.27) was noted between FSS and CRF 2.</p><h3>Conclusion</h3><p>Neither decreased BMD nor cortical thickness correlated with femoral stem subsidence.</p><h3>Level of evidence</h3><p>Level III, Therapeutic study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The myth of 2.5 cm symphyseal diastasis","authors":"Axel Gänsslen,&nbsp;Jan Lindahl,&nbsp;Dietmar Krappinger,&nbsp;Richard A. Lindtner,&nbsp;Mario Staresinic","doi":"10.1007/s00402-025-05904-x","DOIUrl":"10.1007/s00402-025-05904-x","url":null,"abstract":"<div><p>Detection of disruption of the pubic symphysis and resulting anterior pelvic ring instability primarily depends on the symphyseal widening on standard anterior–posterior X-rays. Based on biomechanical and clinical analyses from the 80 to 90’s, a cut-off value of 2.5 cm widening distinguished between stable and unstable lesions. A relevant debate developed concerning minor (&lt; 2.5 cm displacement), moderate (&gt; 2.5 cm displacement) and severe disruptions (&gt; 2.5 cm displacement + posterior complete pelvic ring instability) of the pubic symphysis. Analysis of anatomic, biomechanical, physiological and clinical literature showed, that an exact value does not allow this differentiation. Thus, symphyseal posttraumatic disruptions with displacements &gt; 10 mm should be treated surgically, while in minor displacements (5–10 mm) stress examination can guide adequate treatment.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-025-05904-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100331","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}