Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Identification of biomechanical alterations associated with nonunion after tibial shaft fractures using musculoskeletal simulation based on motion capture and instrumented insole data","authors":"Tabea Wahl,&nbsp;Bergita Ganse,&nbsp;Elke Warmerdam,&nbsp;Frank Hildebrand,&nbsp;Ulf Krister Hofmann,&nbsp;Maximilian Praster","doi":"10.1007/s00402-026-06518-7","DOIUrl":"10.1007/s00402-026-06518-7","url":null,"abstract":"<div><h3>Introduction</h3><p>Musculoskeletal simulations based on gait analysis data provide access to parameters such as joint reaction forces, muscle forces, and push-off moments, which cannot directly be measured in clinical practice. Applying these methods may help evaluate weight-bearing patterns and identify mechanical risk factors associated with the development of nonunion. This study aimed to investigate differences in the longitudinal development of forces in the musculoskeletal system between cases with and without union in tibial shaft fractures.</p><h3>Materials and methods</h3><p>Longitudinal 3D marker-based motion capture and instrumented insole data of thirteen patients (8 union; 5 nonunion) with tibial shaft fractures were used to generate individualized musculoskeletal models using the AnyBody™ software.</p><h3>Results</h3><p>In a linear mixed-effects model, the fractured limb showed impaired biomechanical parameters compared with the contralateral limb, including knee joint reaction forces (KJRFs), muscle forces, and push-off moments (all <i>p</i> &lt; 0.001). During follow-up, parameters of the fractured leg increased over time, including KJRFs (<i>p</i> = 0.011), muscle forces (<i>p</i> ≤ 0.030), and ground reaction force (<i>p</i> = 0.008). The union group exhibited greater muscle forces, particularly in the soleus (<i>p</i> = 0.014) and gastrocnemius muscles (<i>p</i> = 0.049). The nonunion group exhibited significantly greater asymmetry between healthy and fractured leg than the union group in ground reaction force (β = 0.368, <i>p</i> = 0.011), KJRFs (β = 0.364, <i>p</i> = 0.028), and push-off moment (β = 0.457, <i>p</i> = 0.028). In additional time point–specific analyses no significant differences were found at 6 and 12 weeks.</p><h3>Conclusion</h3><p>Biomechanical loading patterns differed between patients with union and nonunion throughout fracture healing, with greater between-limb asymmetries in push-off moment, joint reaction forces, and plantar flexor muscle forces in the nonunion group. Larger studies are required to validate these findings using the proposed workflow.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06518-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023723","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":"Management and outcome of displaced acetabular fractures in the oldest-old: a retrospective analysis of orif and acute total hip arthroplasty","authors":"Ioannis Mamoutakis,&nbsp;Klemens Horst,&nbsp;Hatem Alabdulrahman,&nbsp;Rald V. M. Groven,&nbsp;Felix M. Bläsius,&nbsp;Frank Hildebrand,&nbsp;Till Berk,&nbsp;Eftychios Bolierakis","doi":"10.1007/s00402-026-06511-0","DOIUrl":"10.1007/s00402-026-06511-0","url":null,"abstract":"<div><h3>Purpose</h3><p>The optimal surgical management of geriatric acetabular fractures remains controversial. This study compared short-term outcomes following open reduction and internal fixation (ORIF) or acute total hip arthroplasty (THA) with or without additional osteosynthesis (THA ± ORIF) and evaluated the impact of a new treatment algorithm (standard operative procedure, SOP) that favors the use of THA in elderly and medically comorbid patients.</p><h3>Methods</h3><p>In this retrospective cohort study, patients aged ≥ 70 years with isolated trauma-associated unilateral displaced acetabular fractures who underwent surgical treatment at a single Level I trauma center between January 2016–March 2019 (old SOP) and January 2022–December 2025 (new SOP) were included. Patients underwent either ORIF or THA ± ORIF. The transitional implementation phase of the new SOP was excluded. The primary outcome was postoperative time to gait mobilization. Secondary outcomes included pain at discharge, functional mobility, complications, mortality, quality of fracture reduction, and conversion to THA following initial ORIF. Because treatment allocation followed different institutional algorithms across the study periods, the study primarily evaluates an evolving treatment strategy rather than directly comparing ORIF and THA.</p><h3>Results</h3><p>Sixty patients (median age 82 years, IQR 78–87; median Charlson Comorbidity Index 5, IQR 4–7) were included. The most common fracture pattern according to the Letournel classification was the anterior column with posterior hemitransverse fracture (<i>n</i> = 35). Thirty-five patients underwent ORIF and 25 underwent THA ± ORIF. Compared with ORIF, THA ± ORIF was associated with significantly faster remobilization (median 3 vs. 6 days, IQR 2–3 vs. 4–7; <i>p</i> &lt; 0.05), lower pain levels at discharge (VAS 1–3: 96% vs. 37.1%; <i>p</i> &lt; 0.05), and superior functional mobility at discharge. Complication rates, readmissions, length of stay, and in-hospital mortality did not differ significantly between groups. These findings remained consistent after implementation and refinement of the newly introduced SOP despite the increasing use of THA ± ORIF in older and more comorbid patients.</p><h3>Conclusion</h3><p>A structured treatment algorithm incorporating THA ± ORIF was associated with earlier remobilization and lower pain levels at discharge without increasing complication rates compared with ORIF in geriatric patients with displaced acetabular fractures. These findings support differentiated treatment allocation and the safe use of acute THA in carefully selected elderly patients.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06511-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987131","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":"A comparative study on the clinical efficacy and complications of proximal femoral nail antirotation and femoral neck system in the treatment of basicervical femoral neck fracture (AO/OTA 31-B3)","authors":"Xiaole Jiang,&nbsp;Dongze Lin,&nbsp;Yixin Huang,&nbsp;Jiajie Liu,&nbsp;Fengfei Lin","doi":"10.1007/s00402-026-06382-5","DOIUrl":"10.1007/s00402-026-06382-5","url":null,"abstract":"<div><h3>Objectives</h3><p>Basicervical femoral neck fractures (FNFs) are prone to internal fixation failure owing to their inherent biomechanical instability. This study compares the efficacy of femoral neck system (FNS) and proximal femoral nail anti-rotation (PFNA) in treating basicervical FNF.</p><h3>Materials and methods</h3><p>A retrospective analysis was conducted on 99 patients with basicervical FNF admitted to fuzhou second general hospital from January 2020 to June 2024. Patients were divided into two groups based on the internal fixation method used: the FNS group (53 cases, average age 63.83 ± 18.80 years) and the PFNA group (46 cases, average age 69.78 ± 16.65 years). Main observation indicators included reduction quality and internal fixation-related complications, while secondary indicators included tip-apex distance, surgical time, occult blood loss, wound length, postoperative hospital stay, mortality, and Harris hip score.</p><h3>Results</h3><p>The average follow-up time was 24.03 ± 9.4 months. Preoperative data were comparable between groups (<i>P</i> &gt; 0.05). The PFNA group had a significantly lower overall incidence of implant-related complications than the FNS group (2.17% vs. 16.98%, <i>P</i> = 0.035), and the distribution of implant-related complication subtypes also differed significantly between groups (<i>P</i> = 0.042). No significant differences were observed in fracture reduction quality, tip-apex distance, postoperative hospital stay, or mortality (<i>P</i> &gt; 0.05). The FNS group had significantly shorter incision length (4.60 ± 1.01 cm vs. 7.76 ± 1.32 cm, <i>P</i> &lt; 0.001), less hidden blood loss (204.91 ± 61.66 ml vs. 391.27 ± 136.71 ml, <i>P</i> &lt; 0.001), and shorter surgical time (0.62 ± 0.20 h vs. 0.70 ± 0.23 h, <i>P</i> = 0.048). In the full-cohort analysis including all patients with available HHS data, the Harris Hip Score was significantly higher in the PFNA group than in the FNS group (92.52 ± 4.15 vs. 89.28 ± 5.78, <i>P</i> = 0.002). After excluding patients with internal fixation failure, the result remained consistent, with the PFNA group showing a significantly higher HHS than the FNS group (92.78 ± 3.81 vs. 90.37 ± 4.35, <i>P</i> = 0.005).</p><h3>Conclusions</h3><p>For AO/OTA 31-B3 basicervical FNF, PFNA was associated with fewer implant-related complications and higher final follow-up HHS than FNS. The HHS result remained consistent after excluding patients with internal fixation failure. Considering the retrospective design and the small number of complication events, PFNA may be considered a favorable fixation option, but these findings should be validated in larger prospective studies.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06382-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987070","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":"Race, ethnicity, and language are underreported in hip fracture CPGs","authors":"Ashley Mulakaluri,&nbsp;Eli M. Snyder,&nbsp;Bill Young,&nbsp;Robin N. Kamal,&nbsp;Lauren M. Shapiro","doi":"10.1007/s00402-026-06496-w","DOIUrl":"10.1007/s00402-026-06496-w","url":null,"abstract":"<div><h3>Introduction</h3><p>Clinical Practice Guidelines (CPGs) are systematically developed recommendations based on peer-reviewed literature that guide patient care. Considering the impact of sociodemographic factors on patient outcomes, this study aims (1) to review the racial, ethnic, and linguistic representation of patients in literature utilized to inform the CPGs for hip fractures in older adults and (2) to assess the use of linguistically- and culturally-adapted Patient Reported Outcome Measures (PROM) in these studies.</p><h3>Materials and methods</h3><p>Publications listed under the American Academy of Orthopaedic Surgeons (AAOS) CPGs for the Management of Hip Fractures in Older Adults were identified and extracted. Variables extracted included: title, author, publication year, inclusion/exclusion criteria, country/ies of study, language of study, patient language, race and ethnicity, patient language proficiency, outcome measures utilized, translation or cultural-adaptation of outcome measures, and clinical trial registration page. The extracted variables were reported descriptively.</p><h3>Results</h3><p>Of the 196 unique articles included, 12/196 (6.12%) reported race/ethnicity data and 9/196 (4.59%) reported patient language, of which 6/9 (66.7%) reported patient language proficiency. Of the studies that reported patient language or language proficiency, 8/9 (88.9%) specified this data in their inclusion or exclusion criteria. Of the 196 articles, 134/196 (67.4%) used one or more PROMs, and of these 7/134 studies (5.2%) reported the use of one or more translated PROMs. Of these, 4/7 studies (57.1%) reported the use of one or more culturally-adapted PROMs.</p><h3>Conclusions</h3><p>This study found a paucity of reporting of patient language, race, and ethnicity in the studies utilized to inform the AAOS CPGs for hip fractures in elderly adults. Additionally, there is minimal usage of translated and/or culturally-adapted PROMs in these studies. As care outcomes are associated with sociodemographic factors, improved reporting of these factors in guideline-informing literature may enhance guideline applicability and health equity.</p><h3>Level of Evidence</h3><p>V.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06496-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987001","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":"Comparative outcomes of delta-on-delta and delta-on-highly cross-linked polyethylene bearings in total hip arthroplasty: a nationwide cohort study","authors":"Young-Kyun Lee,&nbsp;Danbee Kang,&nbsp;Hyunsoo Kim,&nbsp;Eunjee Kang,&nbsp;Juhee Cho,&nbsp;Jung-Wee Park","doi":"10.1007/s00402-026-06502-1","DOIUrl":"10.1007/s00402-026-06502-1","url":null,"abstract":"<div><h3>Introduction</h3><p>The purpose of this study was (1) to evaluate the national trends of Delta ceramic and highly crosslinked polyethylene (HXLPE) liner in total hip arthroplasty (THA), and (2) to compare survivorship of Delta ceramic versus HXLPE liner when used with a Delta ceramic head.</p><h3>Materials and methods</h3><p>Using the K-NHIS database, we identified all patients who underwent primary THA using Delta ceramic head in South Korea between 2003 and 2013 (<i>n</i> = 16,250). Cumulative incidences of dislocation, periprosthetic joint infection (PJI), and periprosthetic fracture were evaluated according to bearing type: Delta-on-Delta ceramic (DoD) and Delta-on-HXLPE (DoHXLPE). Survivorship for revisions was calculated to determine differences. Multivariable Cox proportional hazard regression models were used for comparisons, and propensity score matching was additionally performed as a sensitivity analysis.</p><h3>Results</h3><p>A total of 15,299 patients underwent THA with Delta ceramic head between 2003 and 2013. Delta liner was used in 14,255 patients (93.2%) and HXLPE in 1,044 patients (6.8%). Utilization of Delta liner has noticeably increased since 2007. The DoHXLPE group had a higher risk of PJI (aHR = 2.10, 95% CI = 1.29–3.41) compared to the DoD group within 1 year. There were no significant differences in risk of dislocation (aHR = 1.41, 95% CI = 0.97–2.05) and periprosthetic fracture (aHR = 0.90; 95% CI = 0.39, 2.07) within 1 year. After 10 years, the DoHXLPE group had a higher risk of any revision (aHR = 1.32; 95% CI = 1.03, 1.38) compared to the DoD group, despite the similar risk of cup revision and stem revision. In the propensity score–matched cohort, the increased risk of PJI remained significant, whereas the point estimate for any revision remained higher in the DoHXLPE group but was no longer statistically significant.</p><h3>Conclusion</h3><p>DoHXLPE bearings were associated with a higher risk of PJI than DoD bearings. However, the difference in the risk of any revision was not statistically significant in the propensity score–matched analysis.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06502-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987071","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":"Biomechanical comparison of innovative suture techniques for repair of Achilles tendon rupture in a porcine flexor tendon model","authors":"Lasse Weigand,&nbsp;Benjamin Liebrand,&nbsp;Sophia Scheible,&nbsp;Rainer Meffert,&nbsp;Stefanie Hoelscher-Doht","doi":"10.1007/s00402-026-06508-9","DOIUrl":"10.1007/s00402-026-06508-9","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt; In recent years, evidence-based progressive rehabilitation protocols following the surgical treatment of Achilles tendon rupture have been shown to be safe and appear superior to more restrictive treatment regimens. These protocols mainly rely on early mobilization and weight bearing. To enable this during postoperative rehabilitation, a biomechanically stable surgical treatment must be ensured. Different solutions for suturing ruptured Achilles tendons are currently favored by orthopedic surgeons and have been investigated in the past, including promising further developments of traditional approaches such as the combination of pretension and the Bunnell technique, as well as minimally invasive or percutaneous techniques using systems like the Arthrex PARS. However, the best solution in this regard remains unclear.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;We analyzed the biomechanical stability of four different suture techniques using porcine deep flexor tendons as a biomechanical model for human Achilles tendons. The tendons were harvested, prepared and sutured according to their respective group (A: Bunnell, B: Bunnell + pretension, C: PARS-to-PARS, D: PARS + anchor). The four groups (&lt;i&gt;n&lt;/i&gt; = 12) underwent progressive, cyclic, uniaxial tensile loading in the biomechanical testing machine (ZwickRoell Z020).&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Group D (PARS + anchor) showed the highest maximum force at ultimate failure, resisting statistically significant higher loads compared to all the other groups. Pretension led to a non-significant increase in maximum force in the Bunnell groups. This was the case for the force necessary to create a 5 mm gap as well, while the force necessary to create the initial gap was equal in the PARS-to-PARS and pretensioned Bunnell group, both proving superior to the Bunnell group without pretension. Group D consistently resisted statistically significant higher forces in comparison to the PARS-to-PARS group for the initial gap, the 5 mm gap and until failure. This was generally valid for the number of cycles necessary to reach the initial gap, the 5 mm gap and the point of failure, as well.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;Considering the superiority over both Bunnell techniques during the biomechanical testing in this experimental model despite its limitations in transferability, using the PARS-to-PARS technique in suturing ruptured Achilles tendons seems to be a valid alternative from a biomechanical point of view. We hypothesize that its higher resistance to tension forces found in this study could provide the potential to facilitate more progressive postoperative treatment protocols reflected by earlier weight bearing, which could enable improved rehabilitation outcomes and should be investigated in future studies. While forces acting on the human Achilles tendon during walking in an ankle foot orthosis (AFO) with a lifted heel are estimated at approximately 200 N, our results indicate resistance within a similar forc","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06508-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987130","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":"Level-dependent changes in cervical multifidus composition following anterior cervical discectomy and fusion: bridging quantitative MRI and clinical perspectives","authors":"Tom Folkerts,&nbsp;Ria Tripathi,&nbsp;Thomas Caffard,&nbsp;Bruno Verna,&nbsp;Jiaqi Zhu,&nbsp;Andrew A. Sama,&nbsp;Frank P. Cammisa,&nbsp;Alexander P. Hughes","doi":"10.1007/s00402-026-06495-x","DOIUrl":"10.1007/s00402-026-06495-x","url":null,"abstract":"<div><h3>Introduction</h3><p>Fatty infiltration (FI) of the cervical paraspinal muscles is associated with greater disease severity and less favorable outcomes in degenerative cervical spine disease. However, longitudinal data on whether muscle composition changes following anterior cervical discectomy and fusion (ACDF) are scarce. This study aimed to evaluate changes in FI and functional cross-sectional area (fCSA) of the cervical multifidus and rotatores after ACDF and to assess whether these changes differ across surgical levels.</p><h3>Materials and Methods</h3><p>This single-center retrospective study analyzed patients who underwent ACDF for degenerative cervical stenosis between 2015 and 2018. Patients were included if both preoperative and postoperative cervical spine MRI (obtained 1–5 years after surgery) were available. The multifidus and rotatores colli were segmented bilaterally on T2-weighted axial images. Measurements were categorized by position within the fusion construct as upper (most cranial fused vertebra), middle (intervening vertebrae), and lower (most caudal fused vertebra) levels. FI and fCSA were quantified using Otsu thresholding. P-values were adjusted for multiple testing using the Benjamini-Hochberg procedure.</p><h3>Results</h3><p>Thirty-five patients met inclusion criteria (median age 58 years, 40% female, 1–4 fused levels). Bilateral FI decreased significantly at the lower level (52.1 ± 15.4% vs. 45.0 ± 14.8%, adjusted p = 0.039), with no significant changes at the upper (adjusted p = 0.858) or middle level (adjusted p = 0.354). Bilateral fCSA decreased significantly at the middle level (165.2 [119.4–196.3] vs. 109.4 [92.0–171.6] mm², adjusted p = 0.018), with no significant changes at the upper (adjusted p = 0.194) or lower level (adjusted p = 0.382)</p><h3>Conclusions</h3><p>ACDF was associated with level-dependent changes in cervical multifidus composition, including a reduction in FI at the lower surgical level and a loss of fCSA at the middle level. These findings highlight that postoperative muscle remodeling varies by position within the fusion construct, which may have implications for the development of level-specific, targeted postoperative rehabilitation strategies.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06495-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981894","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":"Longer hospital stay but similar one-year mortality and readmission after combined proximal humerus and proximal femur fragility fractures: a Propensity-Score–Matched Cohort Study","authors":"Stephen Murphy,&nbsp;Clara Kellett,&nbsp;Dylan Roberts,&nbsp;Clara McGurk,&nbsp;Emer Ahern,&nbsp;Padhraig O’Loughlin","doi":"10.1007/s00402-026-06474-2","DOIUrl":"10.1007/s00402-026-06474-2","url":null,"abstract":"<div><h3>Background</h3><p>Fragility Proximal Humerus (PH) fractures are common and often associated with significant morbidity and mortality. Unlike Proximal Femur (PF) fractures, PH fractures are often omitted from established orthogeriatric multidisciplinary team (MDT) pathways. Combined Proximal Humerus and Proximal Femur fractures (PH&amp;PF) are rare. Combined injuries would be expected to result in worse outcomes compared to isolated PH fractures due to greater injury burden. This study assessed outcomes between isolated PH and combined PH&amp;PF fractures, exploring whether differences in care pathways may contribute to outcome.</p><h3>Methods</h3><p>A retrospective propensity score-matched cohort study was performed over a 2-year period identifying patients sustaining isolated fragility PH fractures and over a 5-year period identifying patients sustaining combined PH&amp;PF fractures secondary to low-energy trauma. Propensity score matching was performed using age, sex, comorbidity burden (as defined by Charlson Comorbidity Index (CCI)), mobility status, cognitive impairment and fracture pattern. Primary outcome was 1-year mortality. Secondary outcomes included 1-year readmission and length of stay (LoS). Mortality was analysed using Firth logistic regression, readmission using clustered logistic regression, and LoS using Gamma regression with cluster-robust standard errors.</p><h3>Results</h3><p>Sixty-five patients were included following matching (42 PH, 23 PH&amp;PF). Excellent covariate balance was achieved across all matched variables (all absolute standardised mean differences &lt; 0.10). One-year mortality was 7.1% in the PH group and 13.0% in the PH&amp;PF group (OR 1.93, 95% CI 0.38–9.88; <i>p</i> = 0.417). Readmission occurred in 33.3% and 26.1% of patients, respectively (OR 0.71, 95% CI 0.17–2.92; <i>p</i> = 0.615). Median hospital LoS was 4 days (IQR 0-18.3) for PH fractures and 17 days (IQR 10.5–44.5) for PH&amp;PF fractures. Gamma regression estimated a two-fold increase in hospital LoS among patients with concomitant PH&amp;PF fractures (length-of-stay ratio 2.03, 95% CI 0.98–4.22; <i>p</i> = 0.057). Sensitivity analyses incorporating calendar year yielded similar findings.</p><h3>Conclusions</h3><p>Despite a greater injury burden, patients with combined PH&amp;PF fractures demonstrated equivocal 1-year mortality and readmission rates versus those with isolated PH fractures. These findings raise the possibility that access to established orthogeriatric MDT pathways may contribute to outcomes and support further prospective investigation into dedicated multidisciplinary care models for fragility PH fractures.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06474-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981876","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":"Superior reduction quality without improved outcomes: open versus closed reduction for displaced femoral neck fractures in adults under 60 years","authors":"Jia-En Chi,&nbsp;Chang-Heng Liu,&nbsp;Youh-Hua Lo,&nbsp;Chih-Yang Lai,&nbsp;I-Jung Chen,&nbsp;Yi-Hsun Yu","doi":"10.1007/s00402-026-06475-1","DOIUrl":"10.1007/s00402-026-06475-1","url":null,"abstract":"<div><h3>Introduction</h3><p>The optimal reduction strategy for displaced femoral neck fractures (DFNFs) in non-elderly adults remains controversial. Although open reduction may improve radiographic alignment, its impact on outcomes remains unclear. </p><h3>Materials and methods</h3><p>Adults aged &lt; 60 years with DFNFs who were treated with internal fixation between 2017 and 2023 were retrospectively reviewed. Patients were categorized into closed and open reduction groups. Reduction quality was assessed using the Garden alignment index and the Haidukewych reduction criteria. Multivariate analyses were performed for the overall cohort and patients with Pauwels type III fractures. Outcomes included non-union, osteonecrosis, femoral neck shortening, and major reoperations. </p><h3>Results</h3><p>In total, 98 patients were included, among whom 83 and 15 underwent closed and open reduction, respectively. Although open reduction achieved a higher rate of excellent <i>reduction</i> (53.3% vs. 16.9%, <i>p</i> = 0.012), it was not associated with lower rates of non-union or osteonecrosis. In the overall cohort, age was associated with non-union (odds ratio [OR], 1.09; <i>p</i> = 0.024), whereas poorer reduction quality was associated with major reoperation (fair: OR 7.03, <i>p</i> = 0.012; poor: OR 47.6, <i>p</i> = 0.007). In patients with Pauwels type III fractures, poorer reduction quality predicted conversion to arthroplasty (fair: OR 9.84, <i>p</i> = 0.014), and age was associated with non-union and osteonecrosis. Femoral neck shortening of &gt; 10 mm at 3 months was associated with age and open reduction, whereas at 12 months, age and intraoperative blood loss remained significant predictors. </p><h3>Conclusions</h3><p>Open reduction achieved a higher rate of excellent reduction but did not reduce complication rates compared with closed reduction. Fracture severity, patient age, and reduction quality remained the principal determinants of outcome, supporting a fracture morphology-guided fixation strategy and realistic patient counseling.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06475-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981909","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":"Are kneeling stress radiography and the posterior sag sign associated with subjective flexion instability after posterior-stabilized total knee arthroplasty?","authors":"Mehmet Aşkın,&nbsp;Ömür Çağlar,&nbsp;Ahmet Mazhar Tokgözoğlu,&nbsp;Bülent Atilla","doi":"10.1007/s00402-026-06448-4","DOIUrl":"10.1007/s00402-026-06448-4","url":null,"abstract":"<div><h3>Introduction</h3><p> Flexion instability is a common but underdiagnosed cause of patient dissatisfaction after posterior-stabilised total knee arthroplasty (TKA). Standard clinical tests have limited reliability for this condition. We investigated whether kneeling stress radiography and selected physical examination findings can help identify it.</p><h3>Materials and methods</h3><p>We retrospectively reviewed 145 posterior-stabilised TKA knees in 119 patients, divided into two groups by the presence of subjective knee instability. The posterior sag sign, 90° anterior drawer test, and kneeling stress radiographic parameters—particularly the change in tibiofemoral translation under load (Δ-TPFA)—were compared between groups. Post-hoc analyses included ROC curve analysis, diagnostic accuracy with Wilson 95% confidence intervals, and multivariable logistic regression adjusted for age, sex, BMI, follow-up duration, implant type, and lumbar pathology.</p><h3>Results</h3><p>Thirty knees (20.7%) reported subjective instability. Mean Δ-TPFA was 1.40 ± 3.75 mm in the unstable group versus − 1.17 ± 3.28 mm in the stable group (<i>p</i> = 0.001; AUC 0.68, 95% CI 0.56–0.80) and remained an independent predictor on multivariable analysis (OR 1.30 per mm, 95% CI 1.11–1.52, <i>p</i> &lt; 0.001). The posterior sag sign had a specificity of 82.6% (95% CI 74.6–88.4%) and was independently associated with instability (OR 3.26, 95% CI 1.54–6.91, <i>p</i> = 0.002). The 90° anterior drawer test was positive in 56.7% of the unstable group and 47.0% of the stable group and did not discriminate between them (<i>p</i> = 0.41).</p><h3>Conclusions</h3><p>Patients with subjective instability also scored significantly lower on all three patient-reported outcome measures (KSS 84.8 vs. 91.6; fKSS 75.0 vs. 85.1; FJS 73.6 vs. 84.6; all <i>p</i> ≤ 0.015). On kneeling stress radiography, Δ-TPFA discriminated unstable from stable knees only modestly (AUC 0.68; Youden cut-off 0.30 mm, sensitivity 63%, specificity 73%). Kneeling stress radiography and the posterior sag sign add useful information when assessing flexion instability after posterior-stabilised TKA, although the limited discrimination of Δ-TPFA indicates it should complement rather than replace clinical assessment. The 90° anterior drawer test should be interpreted with caution in this setting.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06448-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148927385","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}