Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Partial triceps tendon transfer for dynamic stabilization in posterolateral rotatory instability of the elbow: a biomechanical study","authors":"Christoph-Johannes Pucher,&nbsp;Fabian Lanzerath,&nbsp;Stephanie Lucina Kahmann,&nbsp;Michael Hackl,&nbsp;Lars Peter Müller,&nbsp;Tim Leschinger","doi":"10.1007/s00402-026-06520-z","DOIUrl":"10.1007/s00402-026-06520-z","url":null,"abstract":"<div><h3>Purpose</h3><p>Posterolateral rotatory instability (PLRI) of the elbow results from lateral collateral ligament complex (LCLC) insufficiency. In the setting of failed conventional ligament reconstruction, no established salvage procedure is available. This study biomechanically evaluated partial triceps tendon transfer to the supinator crest as a dynamic stabilization concept for PLRI.</p><h3>Methods</h3><p>Nine fresh-frozen human elbow specimens underwent cyclic external rotational loading of 0.5 Nm. Specimens were tested sequentially in the native state, an LCLC/common extensor origin-deficient unstable state, after transosseous LCLC repair, and after partial triceps tendon transfer to the supinator crest with the LCLC detached. Testing was performed under combined biceps/triceps loading conditions with external forearm rotation relative to the humerus as the primary outcome. A two-factor repeated-measures analysis of variance (RM-ANOVA) compared unstable, repaired, and tendon-transfer conditions across loading conditions. The native state was assessed unloaded and reported separately in a one-factor RM-ANOVA.</p><h3>Results</h3><p>Intervention significantly affected external rotation (F(2,16) = 33.31, <i>p</i> &lt; 0.001, η²_p = 0.81). Across loading conditions, partial triceps transfer significantly reduced external rotation compared to the unstable state (mean difference [MD]=-3.38°, <i>p</i> = 0.005), while LCLC repair showed lower external rotation than triceps tendon transfer (MD=-3.13°, <i>p</i> = 0.012). External rotation also differed significantly across the combined biceps/triceps loading conditions (Greenhouse–Geisser corrected F(1.26,10.11) = 77.00, <i>p</i> &lt; 0.001, η²_p = 0.91), decreasing from 13.37° at 0 kg biceps/0 kg triceps to 2.42° at 0.5 kg biceps/4.0 kg triceps.</p><h3>Conclusion</h3><p>Partial triceps tendon transfer improved dynamic elbow stabilization and significantly reduced PLRI in a LCLC‑deficient in vitro model. However, it did not fully restore joint stability, supporting its role as a potential adjunct or salvage option rather than a primary procedure. The findings highlight the importance of dynamic muscle tension in lateral elbow stability, while the time‑zero, in vitro design limits direct clinical translation and warrants further in vivo investigations.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103499","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":"The perforator-based axial adipofascial turnover flap combined with juncturae tendinum grafting for complex dorsal phalangeal defects","authors":"Kadri Ozer","doi":"10.1007/s00402-026-06425-x","DOIUrl":"10.1007/s00402-026-06425-x","url":null,"abstract":"<div><h3>Introduction</h3><p>Complex dorsal finger soft tissue defects remain a challenging reconstructive problem, particularly when associated with exposure of bone and extensor apparataus. Advances in the anatomical understanding of the dorsal cutaneous vascular system of the digits have allowed adipofascial flaps in this region to evolve from random-pattern to axial-pattern designs, improving vascular reliability. However, a structured and comprehensive approach for managing these combined defects has not been clearly defined in the literature. This study aims to present a holistic loco-regional strategy that optimizes the reconstructive ladder while minimizing donor-site morbidity and technical complexity.</p><h3>Materials and methods</h3><p>This clinical series includes seven fingers with complex soft tissue defects involving the dorsal aspect of the middle and distal phalanges. All cases were managed using an ipsilateral loco-regional protocol consisting of three components: (1) an extended axial adipofascial turnover flap for soft tissue coverage, (2) tendon reconstruction using juncturae tendinum harvested from the fourth intermetacarpal space, and (3) full-thickness skin grafting from the wrist. Patients were followed for a minimum of six months. Functional outcomes were evaluated by range of motion and complication rates.</p><h3>Results</h3><p>Complete flap survival was achieved in all cases. All fingers demonstrated satisfactory functional outcomes with acceptable flexion and extension ranges of motion at follow-up. No major complications, including infection, osteomyelitis, or significant donor-site morbidity, were observed.</p><h3>Conclusions</h3><p>The perforator-based axial adipofascial turnover flap combined with juncturae tendinum grafting provides reliable single-stage reconstruction of complex dorsal finger defects without the need for microsurgical anastomosis. This structured loco-regional approach enables immediate reconstruction without the need for microsurgical equipment or advanced microvascular expertise, offering a practical and reproducible alternative within the reconstructive ladder.</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":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103712","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":"Correction: Recovery of gait after ankle fracture surgery following early mobilization and weight-bearing","authors":"Leandra Bauer,&nbsp;Anne Sophie Schlegel,&nbsp;Anne Scheuer,&nbsp;Wolfgang Böcker,&nbsp;Hans Polzer,&nbsp;Sebastian Felix Baumbach","doi":"10.1007/s00402-026-06513-y","DOIUrl":"10.1007/s00402-026-06513-y","url":null,"abstract":"","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103414","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":"Factors associated with long-term patient-reported outcomes after periacetabular osteotomy","authors":"Takeshi Shoji,&nbsp;Shinichi Ueki,&nbsp;Hiroki Kaneta,&nbsp;Hiroyuki Morita,&nbsp;Yosuke Kozuma,&nbsp;Nobuo Adachi","doi":"10.1007/s00402-026-06522-x","DOIUrl":"10.1007/s00402-026-06522-x","url":null,"abstract":"<div><h3>Introduction</h3><p>Long-term survivorship and patient-reported outcomes after periacetabular osteotomy (PAO) have been reported; however, the relationships of long-term PROMs with preoperative cartilage degeneration and postoperative three-dimensional hip morphology remain incompletely understood. This study evaluated long-term PROMs and examined their associations with preoperative cartilage T2 values and postoperative hip morphology after PAO.</p><h3>Materials and methods</h3><p>This retrospective study included 42 hips in 42 patients with early-stage osteoarthritis who underwent PAO for developmental dysplasia of the hip and were followed for more than 10 years. Clinical outcomes were assessed preoperatively and at final follow-up, whereas the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) was assessed at final follow-up. Hip morphology was evaluated using computed tomography (CT), and cartilage degeneration was assessed using preoperative T2 mapping magnetic resonance imaging. Associations with final JHEQ scores were analyzed using correlation analyses and multivariable linear regression with JHEQ scores treated as continuous outcomes.</p><h3>Results</h3><p>The mean final total JHEQ score was 56.4 ± 19.6 points. In the multivariable linear regression model for total JHEQ (adjusted <span>({R}^{2}=0.311,P&lt;0.001)</span>), higher preoperative acetabular T2 values (<span>(B=-1.915)</span>, 95% CI <span>(-2.913)</span> to <span>(-0.917)</span>; <span>(P&lt;0.001)</span>) and a larger postoperative combined angle (<span>(B=-0.298)</span>, 95% CI <span>(-0.588)</span> to <span>(-0.008)</span>; <span>(P=0.045)</span>) were independently associated with a lower total score. For the JHEQ pain subscale (adjusted <span>({R}^{2}=0.301,P&lt;0.001)</span>), higher acetabular T2 values remained independently associated with worse pain (<span>(B=-0.748)</span>, 95% CI <span>(-1.199)</span> to <span>(-0.297)</span>; <span>(P=0.002)</span>), whereas femoral anteversion was not independently significant (<span>(B=-0.206)</span>, 95% CI <span>(-0.462)</span> to <span>(0.049)</span>; <span>(P=0.111)</span>).</p><h3>Conclusions</h3><p>Greater preoperative acetabular cartilage T2 values and postoperative combined sagittal/coronal coverage were associated with worse long-term patient-reported outcomes after PAO. These findings suggest that quantitative preoperative cartilage assessment and careful postoperative morphological correction may be relevant to long-term outcomes.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103491","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":"Operative treatment of high-grade medial collateral ligament injury and chronic medial knee instability: a systematic review","authors":"Yayi Xia,&nbsp;Yixiang Zhao,&nbsp;Xiping Dou,&nbsp;Xiuyuan Wang,&nbsp;Haochuan You,&nbsp;Lei Chen,&nbsp;Yuzhe He,&nbsp;Jiangying Zhang,&nbsp;Yong Sun,&nbsp;Xiaoyun Sheng","doi":"10.1007/s00402-026-06517-8","DOIUrl":"10.1007/s00402-026-06517-8","url":null,"abstract":"<div><p>High-grade medial collateral ligament (MCL) injury and chronic medial knee instability can compromise both valgus and rotational control, especially in cruciate or multiligament injury. This systematic review evaluated operative treatment according to clinical phenotype rather than MCL grade alone. PubMed/MEDLINE and Web of Science Core Collection were searched from January 1, 2000, to August 10, 2026; a Cochrane CENTRAL update was completed on September 7, 2026. Eligible clinical reports included operative treatment of acute high-grade MCL/medial-complex injury or chronic symptomatic medial instability. Risk of bias was assessed with RoB 2, ROBINS-I, or the Joanna Briggs Institute case-series checklist. Thirty-five reports were included: 5 randomized or quasi-randomized trials, 9 nonrandomized comparative studies, and 21 case series. Routine acute medial surgery during ACL reconstruction was not consistently superior across heterogeneous grade III populations. In contrast, selected displaced distal or Stener-like lesions were plausible repair targets because interposition can prevent healing in apposition. Chronic symptomatic valgus and/or anteromedial rotatory insufficiency was most often treated with reconstruction, with directional improvement in objective stability and patient-reported outcomes in case series. Evidence for augmentation, the optimal reconstruction construct, and timing remains low certainty. Decisions should integrate repairability, residual valgus and rotational instability, associated ligament injury, alignment, and tissue quality. Prospective phenotype-stratified comparative studies using standardized stability, return-to-sport, complication, and long-term joint-preservation outcomes are required.</p><p><i>Level of evidence: </i>Level IV, systematic review of Level I-IV therapeutic studies</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103484","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":"The role of the plantar fascia, flexor hallucis longus, and fibro-osseous tunnel in functional hallux rigidus","authors":"Miqi Wang,&nbsp;Alexandra Hunter Aitchison,&nbsp;Adrienne M. Orriols,&nbsp;Ryan M. Ridenour,&nbsp;Mark E. Easley,&nbsp;Samuel B. Adams","doi":"10.1007/s00402-026-06489-9","DOIUrl":"10.1007/s00402-026-06489-9","url":null,"abstract":"<div><h3>Background</h3><p>Functional hallux rigidus is characterized by limited first metatarsophalangeal (MTP) dorsiflexion during weight bearing conditions, but normal motion otherwise. This phenomenon alters the biomechanics of the foot, potentially leading to first MTP pain and trauma to the MTP cartilage. The purpose of this study is to assess the role of the flexor hallucis longus (FHL), plantar fascia (PF), and fibro-osseous tunnel in functional hallux rigidus.</p><h3>Method</h3><p>Fourteen cadaveric lower limbs were analyzed. The Dananberg technique was used to dorsiflex the great toe and radiographs were taken after each of the following manipulations, measuring the dorsiflexion angle of the first MTP. The plantar fascia was transected with a Z-cut, shortened approximately 10 mm, then repaired. The fibro-osseous tunnel was released. The FHL was transected with a Z-cut then shortened approximately 7 mm.</p><h3>Results</h3><p>Average passive dorsiflexion of the first MTP is 23.8° (95% CI 19.7–27.9) prior to manipulation. Shortening the plantar fascia and FHL did not decrease the MTP dorsiflexion significantly beyond baseline (p&gt;0.05). Lengthening the plantar fascia increased the dorsiflexion by 6.7° (28.1% increase) and lengthening the FHL increased dorsiflexion by 7.0° (29.4% increase). The difference between the two methods was not significant (p&gt;0.05). Releasing the fibro-osseous tunnel alone increased the dorsiflexion 3.4° (14.4% increase) and was not significantly different from PF or FHL lengthening.</p><h3>Conclusion</h3><p>Functional hallux rigidus causes limitation of first MTP dorsiflexion when the first metatarsal head is prevented from plantarflexing. There is no difference between the contribution of the FHL versus the plantar fascia to functional hallux rigidus. The true etiology may be multifactorial and involve other structures such as the flexor hallucis brevis, first metatarsal, and gastrocnemius/soleus/achilles complex. As such, no clear surgical intervention can be recommended to improve functional hallux rigidus except in cases with clear-cut causes of stenosis. </p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068731","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":"High variability in resistance to valgus deformation among knee braces indicated for medial collateral ligament injuries: a standardized bench-model biomechanical comparison","authors":"Evmorfia Pechlivanidou,&nbsp;Monika Stacheter,&nbsp;Peter Wahl,&nbsp;Matthias Jacobi","doi":"10.1007/s00402-026-06519-6","DOIUrl":"10.1007/s00402-026-06519-6","url":null,"abstract":"<div><h3>Introduction</h3><p>To quantify valgus deformation and per-load mechanical stiffness of commercially available knee braces indicated for medial collateral ligament (MCL) injuries, and to evaluate whether mechanical performance is associated with material classification and qualitative stability assessment.</p><h3>Materials and methods</h3><p>Nine knee braces identified through a national market survey were tested on a custom lower limb mechanical surrogate under progressive valgus loading at 5.7, 11.4, and 19.4 Nm. Angular deformation was measured using video-based motion tracking, and per-load brace stiffness (Nm/°) was computed at each load level.</p><h3>Results</h3><p>At maximum applied torque (19.4 Nm), per-load stiffness ranged from 1.6 to 6.5 Nm/° across the nine devices — a fourfold difference between the stiffest and most compliant brace — with median valgus deformation of 8° (range 3–12°). In an exploratory, underpowered between-category comparison, rigid braces showed numerically higher stiffness than semi-rigid and soft devices (ε² = 0.34–0.45); this comparison is reported for hypothesis generation only. Qualitative ratings showed only moderate, inconsistent correlations with measured performance.</p><h3>Conclusions</h3><p>Commercially available knee braces indicated for MCL injuries demonstrate highly variable mechanical resistance to valgus deformation under standardized bench conditions. The present sample was insufficient to determine whether material category accounts for this variability. These findings describe device-specific mechanical performance and do not constitute evidence for or against the clinical effectiveness of MCL bracing; they underscore the need for standardized biomechanical testing.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068769","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":"Identification of patient subgroups by hierarchical cluster analysis in femoral neck fractures and surgical outcome analysis","authors":"Enver ipek,&nbsp;Yusuf Altuntaş,&nbsp;Bahadır Balkanlı,&nbsp;Mehmet Ali Bozca,&nbsp;Hüseyin Unutmaz,&nbsp;İsmail Demirkale,&nbsp;Osman Tuğrul Eren","doi":"10.1007/s00402-026-06487-x","DOIUrl":"10.1007/s00402-026-06487-x","url":null,"abstract":"<div><h3>Introduction</h3><p>Femoral neck fractures are a heterogeneous entity with wide variability in patient profiles and outcomes. Single-variable classification may not capture the multidimensional interactions that influence prognosis. This study aimed to identify clinically meaningful patient subgroups using hierarchical cluster analysis and to compare mortality, postoperative mobility, and complication rates between these subgroups.</p><h3>Materials and methods</h3><p>This retrospective cohort study included 672 patients treated for intracapsular femoral neck fractures classified as AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-B between 2009 and 2023, including 586 who underwent hemiarthroplasty (HA) and 86 who underwent total hip arthroplasty (THA). Unsupervised hierarchical clustering was performed using the Gower distance matrix and Ward’s D2 linkage method based on 20 preoperative and intraoperative clinical and surgical variables, excluding outcome measures. The optimal number of clusters was determined by silhouette analysis. Mortality predictors were assessed using Cox proportional hazards regression, and predictors of good postoperative mobility were evaluated by binary logistic regression.</p><h3>Results</h3><p>Two distinct clinical phenotypes were identified: a high-risk cluster (<i>n</i> = 607; mean age 78.3 years, American Society of Anesthesiologists [ASA] physical status III 86.2%, HA 96.4%, dementia 14.8%) and a low-risk cluster (<i>n</i> = 65; mean age 63.4 years, ASA II 81.5%, THA 98.5%, dementia 0%). Cox regression identified age (<i>p</i> &lt; 0.001), male sex (<i>p</i> &lt; 0.001), dementia (<i>p</i> = 0.029), ASA score (<i>p</i> = 0.010), and red-cell distribution width coefficient of variation (RDW-CV; <i>p</i> = 0.011) as independent mortality predictors, whereas procedure type was not significant (hazard ratio [HR] = 0.659, 95% confidence interval <b>[CI]</b>: 0.427–1.015, <i>p</i> = 0.058). In contrast, procedure type was independently associated with good postoperative mobility (odds ratio <b>[OR]</b> = 3.944, 95% CI: 1.516–10.260, <i>p</i> = 0.005).</p><h3>Conclusions</h3><p>Hierarchical cluster analysis identified two clinically distinct patient phenotypes with significantly different outcomes. Procedure type did not independently predict mortality, whereas THA was independently associated with good postoperative mobility, suggesting that the apparent survival advantage of THA may largely reflect indication-based selection bias. These findings support individualised, multidimensional risk assessment rather than single-variable decision-making. Because the identified phenotypes incorporate intraoperative variables, they characterise prognosis rather than guiding preoperative arthroplasty selection.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149068798","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":"Clinical, etiological, and microbiological differences between foot and non-foot osteomyelitis","authors":"Bugra Kundakci,&nbsp;Yaren Dalgic,&nbsp;Kaan Ali Dalkir,&nbsp;Hakki Can Olke,&nbsp;Akif Mirioglu,&nbsp;Mustafa Tekin","doi":"10.1007/s00402-026-06486-y","DOIUrl":"10.1007/s00402-026-06486-y","url":null,"abstract":"<div><h3>Introduction</h3><p>Osteomyelitis presents with heterogeneous clinical, etiological, and microbiological characteristics depending on anatomical location. While foot osteomyelitis is commonly associated with diabetic foot infections and contiguous spread, non-foot osteomyelitis often arises from post-traumatic, hematogenous, or postoperative causes. However, direct comparative analyses between these two entities remain limited.</p><h3>Materials and methods</h3><p>A retrospective analysis was conducted on 202 adult patients who underwent surgical treatment for osteomyelitis between 2011 and 2026. Patients were divided into foot (<i>n</i> = 89) and non-foot (<i>n</i> = 113) osteomyelitis groups. Clinical, etiological, microbiological, and treatment-related variables were compared. Only intraoperatively obtained deep tissue and/or bone cultures were included.</p><h3>Results</h3><p>Patients with foot osteomyelitis were older and had a significantly higher prevalence of diabetes mellitus (49.4% vs. 5.3%, <i>p</i> &lt; 0.001), which was identified as an independent predictor of foot osteomyelitis (OR 14.15, 95% CI 4.32–46.42; <i>p</i> &lt; 0.001). Infections in foot osteomyelitis predominantly developed via contiguous spread (73.0%), whereas non-foot osteomyelitis showed more heterogeneous etiologies, including post-traumatic and hematogenous causes (<i>p</i> &lt; 0.001). Microbiologically, <i>Staphylococcus aureus</i> was the most common pathogen in non-foot osteomyelitis, while foot osteomyelitis demonstrated a more diverse distribution with higher rates of polymicrobial infections. Amputation was significantly more frequent in the foot group (50.6% vs. 15.9%, <i>p</i> &lt; 0.001), whereas antibiotic-loaded cement use was more common in non-foot osteomyelitis (<i>p</i> &lt; 0.001).</p><h3>Conclusions</h3><p>Foot and non-foot osteomyelitis differ significantly in clinical, etiological, and microbiological characteristics. These findings suggest that foot and non-foot osteomyelitis differ in their clinical, etiological, and microbiological characteristics and may require different diagnostic and therapeutic approaches.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13616837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069327","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":"Mix and match strategies in revision total hip arthroplasty: a review of techniques and outcomes","authors":"Itay Ashkenazi,&nbsp;Farouk Khury,&nbsp;Sujith Konan","doi":"10.1007/s00402-026-06510-1","DOIUrl":"10.1007/s00402-026-06510-1","url":null,"abstract":"<div><h3>Purpose</h3><p>This review evaluates the clinical indications, surgical rationale, and outcomes of six targeted component-retention strategies in revision total hip arthroplasty (THA) designed to reduce operative morbidity and preserve host bone stock.</p><h3>Methods</h3><p>This is a narrative review. A structured but non-systematic search of PubMed/MEDLINE and Scopus was used to identify contemporary clinical cohorts, joint registry data, and biomechanical analyses, with the evidence organised sequentially across acetabular and femoral subsites.</p><h3>Results</h3><p>Acetabular retention of stable metal-on-metal shells with dual-mobility bearings minimizes surgical trauma and yields exceptionally low dislocation rates (0% to 4%). Cementing highly cross-linked polyethylene (XLPE) or dual-mobility liners into secure or revision cups successfully decouples biological fixation from alignment, ensuring high mid-term survivorship. On the femoral side, trunnion adapter sleeves protect the head-neck junction during isolated bearing exchanges, demonstrating reliable 10-year survivorship (85%). For unavoidable stem extractions with sound cement mantles, cement-in-cement revision offers a rapid pathway; utilizing high-fatigue-resistant cobalt-chromium alloys instead of stainless steel structurally mitigates the rare risk of cantilever stem fracture. Lastly, for uncontained bone loss or profound osteopenia, extended long cemented stems and allograft-stem composites bypass major defects to provide immediate biological and mechanical rigidity.</p><h3>Conclusion</h3><p>In appropriately selected patients, targeted component retention appears to offer a bone-preserving alternative to wholesale hardware explantation, although the supporting evidence is predominantly observational.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06510-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035320","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}