Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Pelvic injuries in elderly trauma patients: epidemiology, injury characteristics, in-hospital care and factors influencing mortality","authors":"Anders Enocson,&nbsp;Andrea Lundin,&nbsp;Mathias Granqvist","doi":"10.1007/s00402-026-06506-x","DOIUrl":"10.1007/s00402-026-06506-x","url":null,"abstract":"<div><h3>Background</h3><p>Pelvic and acetabular fractures are increasing in incidence in elderly patients. Whether the fracture contributes independently to mortality, or merely accompanies the factors that drive it, remains contested, and large national data on elderly trauma patients are limited. The primary aim of this study was to determine factors influencing 30-day mortality in elderly trauma patients, with particular focus on pelvic injuries. Secondary aims included to analyse the influence of these injuries on in-hospital care and discharge destination.</p><h3>Methods</h3><p>All patients aged ≥ 60 years admitted as trauma alerts in Sweden between 1 January 2022 and 31 December 2024 were identified through the Swedish Trauma Registry (SweTrau). The primary outcome was 30-day mortality. The association between pelvic injury (pelvic or acetabular fracture) and 30-day mortality was assessed using multivariable logistic regression, adjusting for gender, ASA class, NISS, and head injury.</p><h3>Results</h3><p>Of 11,624 patients (median age 76 years, 39.7% males), 776 (6.7%) sustained a pelvic injury. Patients with pelvic injury more frequently sustained high-energy trauma, had a higher median NISS (17 vs. 11), longer hospital length of stay (6 vs. 3 days), higher ICU admission rate (30.9% vs. 20.0%), and was less frequent discharged direct home (34.0% vs. 55.8%; all <i>p</i> &lt; 0.001). Crude 30-day mortality was 16.1% vs. 12.5% (<i>p</i> = 0.002) for patients with and without pelvic injury respectively. After adjustment for gender, ASA class, NISS, and head injury, pelvic injury remained independently associated with 30-day mortality (adjusted OR 1.28, 95% CI 1.03–1.57, <i>p</i> = 0.025).</p><h3>Conclusion</h3><p>In a national cohort of elderly trauma patients, pelvic injury was independently associated with increased 30-day mortality, greater in-hospital resource use and greater need for in-patient rehab after discharge, and should be considered a distinct prognostic factor in early risk stratification.</p><p>Keywords: pelvic injury, trauma, elderly, mortality, retrospective</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06506-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148927072","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":"Bioabsorbable vs. titanium screws in first metatarsophalangeal joint arthrodesis: a pilot randomized controlled trial with 2-year follow-up","authors":"Nikke Partio,&nbsp;Ville Mattila,&nbsp;Ville Waris,&nbsp;Heikki Mäenpää","doi":"10.1007/s00402-026-06501-2","DOIUrl":"10.1007/s00402-026-06501-2","url":null,"abstract":"<div><h3>Introduction</h3><p>To assess the feasibility and preliminary clinical outcomes of bioabsorbable screw fixation in first metatarsophalangeal joint arthrodesis compared to conventional titanium screw fixation. Methods: In this prospective pilot randomized controlled trial, 30 patients were allocated 1:1 to bioabsorbable or titanium cannulated lag screw fixation. Arthrodesis was performed using a cup-and-cone technique at two Finnish hospitals. Full weight-bearing in an orthopaedic shoe was allowed after six weeks. Outcomes included AOFAS and VA-FAS FA-VAS scores, union rates, and complications assessed at 3, 6, 12, and 24 months.</p><h3>Results</h3><p>Both groups showed significant functional improvement with no between-group differences. At 24 months, mean AOFAS scores were 89.1 (SD 2.7) in the titanium group and 90.0 (SD 0.0) in the bioabsorbable group (p = 0.23). Mean FA-VAS total scores (sum of pain, function, and complaints subscales) were 1948 (SE 59.4) in the titanium group and 1914 (SE 61.4) in the bioabsorbable group (p = 0.655). Union rate was 90% overall; nonunion occurred in one titanium and two bioabsorbable patients, all requiring revision. No implant-related complications or hardware removal surgeries were recorded. Degradation of bioabsorbable screws caused no adverse clinical or radiographic reactions.</p><h3>Conclusions</h3><p>Bioabsorbable screws appear safe and feasible in first metatarsophalangeal joint arthrodesis, with preliminary outcomes comparable to titanium fixation. These findings support the conduct of a larger confirmatory trial.</p><h3>Trial registration</h3><p>ClinicalTrials.gov, NCT03133039, registered 28 April 2017. https://clinicaltrials.gov/ct2/show/NCT03133039</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06501-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918167","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":"Intraoperative patellofemoral load varies between total knee replacement and patellofemoral joint resurfacing, and across TKR implant systems","authors":"Louis Phillipson,&nbsp;John Naybour,&nbsp;Annabel Watson,&nbsp;Nick London,&nbsp;David Barrett","doi":"10.1007/s00402-026-06500-3","DOIUrl":"10.1007/s00402-026-06500-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Patellofemoral joint loading is influenced by implant design and surgical execution during knee replacement. Altered patellofemoral mechanics have been implicated in postoperative symptoms, yet the magnitude and variability of intraoperative load changes across different replacement procedures and implant systems remain incompletely characterised. The aim of this registry study was to describe and quantify intraoperative patellofemoral joint load changes following total knee replacement (TKR) and patellofemoral joint resurfacing (PFJR), focusing on cumulative and compartment-specific load redistribution.</p><h3>Materials and methods</h3><p>This observational registry study analysed prospectively collected intraoperative patellofemoral joint load measurements from 291 knee replacement procedures. Load was recorded in medial, lateral, superior, and inferior compartments before and after trial component implantation. Absolute and percentage changes in compartmental and cumulative load were calculated. Descriptive analyses examined the distribution and variability of load change across procedure type and implant system, with implant comparisons restricted to TKR procedures. No formal hypothesis testing was pre-specified, and no adjustment for potential confounding variables was undertaken.</p><h3>Results</h3><p>Cumulative patellofemoral load change demonstrated substantial inter-individual variability. While most cases clustered around small percentage changes, a distinct subset of patients exhibited large cumulative load increases exceeding + 70%. TKR procedures demonstrated a broader distribution and higher observed frequency of large cumulative load increases compared with PFJR. Implant-specific analysis of TKR procedures revealed descriptive differences in cumulative load distributions between implant cohorts, with certain implant systems showing a higher observed frequency of large load increases within this dataset. Compartmental magnitude analysis demonstrated that lateral and superior compartments accounted for most of the load redistribution, whereas medial and inferior compartments contributed minimally.</p><h3>Conclusions</h3><p>Intraoperative patellofemoral load redistribution following knee replacement is highly variable and was observed to differ descriptively between procedure types and implant systems. Load changes were predominantly observed in the lateral and superior compartments, with a meaningful subset of patients experiencing large cumulative increases. Registry-based intraoperative load measurement allows detailed characterisation of patellofemoral biomechanics beyond cumulative metrics alone and may inform future investigations into implant design and surgical optimisation. Given the observational registry design and absence of confounder adjustment, these findings should be interpreted as descriptive associations rather than causal relationships.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06500-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918303","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":"Pain, quality of life, and functional outcomes of total hip arthroplasty in female patients with crowe type III–IV developmental dysplasia of hip: retrospective cohort study","authors":"Nizamettin Güzel,&nbsp;Ahmet Serhat Genç,&nbsp;Nevin Esra Gümüş,&nbsp;Orhan Taşkın,&nbsp;Aybars Güzel","doi":"10.1007/s00402-026-06504-z","DOIUrl":"10.1007/s00402-026-06504-z","url":null,"abstract":"<div><h3>Introduction</h3><p>The aim of this study was to investigate physical and psychosocial recovery including pain and quality of life measures, as well as lower limb functional out-comes in patients with Crowe type III–IV developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty (THA) with subtrochanteric shortening osteotomy.</p><h3>Materials and methods</h3><p>This study was conducted with a total of 45 female patients aged 32–65 with Crowe type III–IV DDH. Pre-op 30-second chair-stand Test (30-s CST), 6-minute walk test (6MWT) and Visual Analogue Scale (VAS) were assessed clinically, whereas Harris Hip Score (HHS), EuroQol 5-Dimension 5-Level (EQ-5D-5 L) scale, Forgotten Joint Score-12 (FJS-12), Hip disability and Osteoarthritis Outcome Score (HOOS), and SF-36 Quality of Life Scale (SF-36) scores were measured and recorded based on patient self reports. At least two years after the surgery, the same measurements were repeated in the patients. </p><h3>Results</h3><p>At the mid-term follow-up, a significant increase was observed in the 30-s CST and 6MWT distance compared with the pre-op period (<i>p</i> &lt; 0.01). Furthermore, statistically significant differences were observed in the VAS, HHS, EQ-5D-5 L, FJS-12, HOOS and SF-36 scores (<i>p</i> &lt; 0.01).</p><h3>Conclusions</h3><p>An evaluation after THA with subtrochanteric shortening osteotomy in female patients revealed a significant improvement in functional performance and clinical scores. Also, it is an effective factor in improving joint function and quality of life in cases of severe DDH. Prospective studies are needed to understand the potential long-term effects of the procedure.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06504-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918273","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":"Cortical hypertrophies in cementless short stem total hip arthroplasty in young patients under 60 years and elderly patients over 75 years—analysis of outcome and risk factors for cortical hypertrophies","authors":"Paul Michael Schwarz,&nbsp;Samuel Stützle,&nbsp;Christian Stadler,&nbsp;Matthias Holzbauer,&nbsp;Lorenz Pisecky,&nbsp;Tobias Gotterbarm,&nbsp;Matthias Luger","doi":"10.1007/s00402-026-06450-w","DOIUrl":"10.1007/s00402-026-06450-w","url":null,"abstract":"<div><h3>Background</h3><p>Cortical hypertrophy (CH) is a common radiological finding associated with short-stem total hip arthroplasty (THA), but its clinical significance remains unclear. This study evaluates differences in outcomes between young patients under 60 years of age and elderly patients over 75 years of age who underwent cementless short stem THA. The aim was to evaluate if there are differences in these patients depending on the presence of CH.</p><h3>Methods</h3><p>A retrospective analysis of 208 short-stem THAs performed between 2014 and 2017 was conducted. Patients were divided into younger (&lt; 60 years, <i>n</i> = 119) and older (&gt; 75 years, <i>n</i> = 89) groups. Clinical outcomes, including Harris Hip Scores (HHS) and Oxford Hip Scores (OHS), were compared between patients with and without CH. Multivariate regression analysis was performed to identify risk factors for CH, focusing on delta hip offset, canal fill index, and stem alignment.</p><h3>Results</h3><p>Younger patients with CH demonstrated significantly better HHS (96.1 ± 7 vs. 90.8 ± 14.3, <i>p</i> = 0.010) and OHS (45.8 ± 5.2 vs. 42.9 ± 8.8, <i>p</i> = 0.028) compared to those without CH. In older patients, the presence of CH did not significantly impact outcomes. Regression analysis identified younger age (<i>p</i> = 0.012), higher Canal Fill Index III (<i>p</i> = 0.047), and stem alignment (<i>p</i> = 0.049) as significant predictors of CH.</p><h3>Conclusion</h3><p>Cortical hypertrophy is associated with non-inferior functional outcomes in younger patients but shows limited clinical relevance in older patients. Implant positioning and patients demographics significantly influence the development of CH. These findings support the interpretation of CH as an adaptive response in younger, active patients rather than a pathological condition.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904997","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 effectiveness of single-stage versus two-stage revision for hip prosthetic joint infection: emulation of the INFORM target trial using electronic health record data","authors":"Changqing Zhang,&nbsp;Yusheng Li,&nbsp;Chi Su,&nbsp;Yun Shen,&nbsp;Shengdi Lu","doi":"10.1007/s00402-026-06503-0","DOIUrl":"10.1007/s00402-026-06503-0","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;To estimate the comparative effectiveness of single-stage versus two-stage revision for hip prosthetic joint infection (PJI) in Chinese tertiary hospitals by emulating the INFORM randomized trial using the target trial emulation framework.&lt;/p&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;p&gt;Retrospective cohort study emulating a target trial, reported per the TARGET guideline. The protocol and analysis plan were written before analysis but were not prospectively registered.&lt;/p&gt;&lt;h3&gt;Setting&lt;/h3&gt;&lt;p&gt;Three tertiary hospitals in China. Index revision surgeries were performed between 1 January 2018 and 30 June 2022, with follow-up data locked on 31 December 2023, ensuring a minimum potential follow-up of 18 months for every patient.&lt;/p&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;p&gt;754 adults with confirmed hip PJI undergoing revision surgery (280 single-stage; 474 two-stage), identified from electronic health records and confirmed by manual chart review. Treatment groups reflected the intended surgical strategy documented before or at the index operation.&lt;/p&gt;&lt;h3&gt;Main outcome measures&lt;/h3&gt;&lt;p&gt;Primary outcome: Harris Hip Score (HHS) at 18 months. Secondary outcomes: surgically treated reinfection, reoperation, mortality, and complications. The primary analysis used inverse probability of treatment weighting (IPTW) on the full cohort with multiple imputation of missing covariate and outcome data; 1:1 propensity score (PS) matching (280 pairs) was confirmatory. Patients who died before an assessment were excluded from the functional analysis at that assessment rather than having a score imputed, so the functional estimand is restricted to survivors (727 of 754 at 18 months). No a priori sample size calculation was performed because all eligible patients were included; precision is reported in place of retrospective power.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Mean age was 60.6 (SD 14.4) years; 511 of 754 patients (67.8%) were male. Avascular necrosis was the leading indication for the primary arthroplasty (390/754, 51.7%). The adjusted mean difference in HHS at 18 months was 1.68 points (95% confidence interval [CI] − 0.12 to 3.48; &lt;i&gt;P&lt;/i&gt; = 0.07), favoring single-stage but not reaching statistical significance; the interval is small relative to the within-person minimal clinically important improvement (MCII) for the HHS reported after primary hip arthroplasty (approximately 16 to 18 points), but that threshold describes improvement within an individual patient rather than a difference between groups, and no minimal important between-group difference has been established for this instrument in revision surgery, so we do not claim to have excluded a clinically important difference. At 3 months, single-stage was associated with a higher HHS (mean difference 5.82, 95% CI 1.43 to 10.21; &lt;i&gt;P&lt;/i&gt; = 0.01); this early difference is attributable in part to many two-stage patients not yet having undergone reimplantation. Surgically treated reinfection was similar in frequency (13.2% v 11.8%; risk ratio [RR]","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900057","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":"Cemented dual mobility component in newly implanted porous tantalum shells for severe acetabular defects: medium-term outcomes from a high-volume single-surgeon series","authors":"Mattia Loppini,&nbsp;Vincenzo Di Matteo,&nbsp;Alberto Bulgarelli,&nbsp;Francesco La Camera,&nbsp;Katia Chiappetta,&nbsp;Emanuela Morenghi,&nbsp;Guido Grappiolo","doi":"10.1007/s00402-026-06498-8","DOIUrl":"10.1007/s00402-026-06498-8","url":null,"abstract":"<div><h3>Background</h3><p>The management of severe acetabular bone defects remains challengin due to extensive bone loss and poor soft tissue quality during revision total hip arthroplasty (rTHA). The aim of this study was to assess clinical and radiological outcomes of the use of dual mobility components (DMC) cemented into a newly implanted porous tantalum (PT) acetabular shell during acetabular rTHA.</p><h3>Methods</h3><p>Patients who underwent cementation of a DMC into a newly implanted PT cup between 2014 and 2020 were included. Bone defects were classified according to the Paprosky classification. The primary outcome was to determine the reintervention-free survival rate. The secondary outcome was clinical and radiographic assessment at last follow-up.</p><h3>Results</h3><p>Thirty-six patients (36 hips), with an average age of 67.9 years (range, 46–90) were included. Paprosky type III defects (61.1%) were more common than type II defects (38.9%), with type IIIa (36.1%) and IIIb (25.0%) predominating. Median follow-up was 67.3 months (range; 17–109). The dislocation rate was 8.3% (<i>n</i> = 3). Four (11.1%) of 36 hips underwent acetabular component revision: 2 (5.5%) for infections, 1 (2.7%) for aseptic loosening, and 1 (2.7%) for dislocation. Cup survival rate was 89.08% (CI 69.54% to 96.38%) at 60 months. The Harris hip score (HHS) improved from 31.8 ± 12.0 to 87.0 ± 14.2 points (<i>p</i> &lt; 0.001). The vertical and horizontal position of the hip center of rotation (COR) improved from 19.4 ± 14.9 mm to 3.8 ± 3.4 mm and from 12.4 ± 9.9 mm to 3.8 ± 3.5 mm, respectively (both <i>p</i> &lt; 0.001). Limb length discrepancy improved from − 7.8 ± 20.6 mm to -1.7 ± 5.6 mm (<i>p</i> = 0.056).</p><h3>Conclusions</h3><p>DMCs cemented into PT shells could be considered an effective management of severe acetabular bone defects without pelvic discontinuity providing excellent clinical and radiographic results in the mid-term.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900017","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":"From load-bearing to load-sharing: contact-driven transitions in locked plate constructs","authors":"Marianne Hollensteiner,&nbsp;Martina Schindler,&nbsp;Markus Greinwald,&nbsp;Mischa Mühling,&nbsp;Dirk Baumeister,&nbsp;Peter Augat","doi":"10.1007/s00402-026-06494-y","DOIUrl":"10.1007/s00402-026-06494-y","url":null,"abstract":"<div><p>Locked plate osteosynthesis functions as an internal fixator, yet load-induced plate–bone and fragment–fragment contacts – key transitions from load-bearing to load-sharing – remain poorly characterized. This study quantified their effects on construct stiffness, plate strain, and interfragmentary motion under axial loading. Twenty-seven configurations were tested using epoxy-glass surrogate bone fixed with titanium LCP plates, varying fracture gap (3–9 mm), working length (49–121 mm), and plate–bone distance (0–3 mm). Digital image correlation measured strain and motion. Contact events were identified manually from characteristic transitions in the force–displacement response, supported by corresponding changes in plate-surface strain progression. Geometric parameters dominated initial stiffness (125–442 N/mm), decreasing with plate elevation and working length in elevated setups. Within the investigated load range up to 600 N, 16/27 configurations showed non-linear transitions associated with contact events: fragment–fragment contact caused pronounced stiffness increases and strain stagnation at the fracture gap, whereas plate–bone contact was associated with local plate-surface strain stagnation at the location overlying the contact while strain at the fracture gap continued to increase. Interfragmentary motion stagnated after contact, confirming contact-dependent shifts in load transfer. Response surface regression explained 81.9% of the variance in initial stiffness and 89.6% of the variance in axial interfragmentary motion, identifying outcome-specific associations with geometric parameters and selected interaction terms. In conclusion, load-dependent contact events were associated with distinct transitions in construct stiffness, plate-surface strain progression, and interfragmentary motion, complementing the observed associations between geometric parameters and initial mechanical behavior.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890874","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 periprosthetic joint infection following total knee arthroplasty: an updated systematic review and meta-analysis","authors":"Haoyue Gao,&nbsp;Yajie Deng,&nbsp;Yuling Ma,&nbsp;Xun Li,&nbsp;Fengdi Zhang,&nbsp;Yingxue Mei","doi":"10.1007/s00402-026-06492-0","DOIUrl":"10.1007/s00402-026-06492-0","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to systematically evaluate factors associated with periprosthetic joint infection (PJI) following total knee arthroplasty (TKA), and thereby to provide evidence-based references for clinical prevention and perioperative risk stratification.</p><h3>Methods</h3><p>Computerized searches were conducted in the following databases from their inception until May 26, 2025: PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, and Chinese Biomedical Literature Database. Two researchers independently screened the literature, extracted data, and assessed study quality. The methodological quality was assessed using the Newcastle–Ottawa Scale. Quantitative synthesis was performed when at least two studies reported comparable exposure definitions and sufficient comparator information; otherwise, narrative synthesis was used. Review Manager 5.4 software was used for the primary analysis. This study is registered on PROSPERO (CRD420251079339).</p><h3>Results</h3><p>A total of 25 observational studies were included in the qualitative synthesis, of which 24 contributed to the primary quantitative synthesis. Quantitatively pooled factors associated with PJI included male sex (OR = 1.39, 95% CI 1.27–1.51), BMI ≥30 kg/m² (OR = 5.72, 95% CI 2.65–12.36), prolonged operative time, type 2 diabetes mellitus (OR = 2.09, 95% CI 1.45–3.01), rheumatoid arthritis (OR = 2.64, 95% CI 1.38–5.02), smoking (OR = 1.65, 95% CI 1.34–2.04), blood transfusion (OR = 2.27, 95% CI 1.59–3.25), American Society of Anesthesiologists score ≥3 (OR = 2.73, 95% CI 1.02–7.32), history of hormone therapy (OR = 4.88, 95% CI 2.90–8.22), postoperative urinary tract infection (OR = 3.59, 95% CI 1.15–11.21), intraoperative blood loss &gt;200 ml (OR = 1.51, 95% CI 1.03–2.22), postoperative drainage tube placement duration ≥24 h (OR = 2.23, 95% CI 1.50–3.32), preoperative anemia (OR = 1.82, 95% CI 1.67–1.99), and combined pulmonary disease (OR = 5.54, 95% CI 1.93–15.96). Age was narratively summarized because its classification differed substantially across studies.</p><h3>Conclusion</h3><p>Multiple demographic, comorbidity-related, and perioperative factors were associated with PJI after TKA. However, because the included studies were observational and clinically heterogeneous, these findings should be interpreted as associations rather than causal effects. Optimization of modifiable factors may help reduce the burden of PJI, but further prospective studies using standardized PJI definitions and adjusted effect estimates are required.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890896","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":"Early surgery of trochanteric femoral fractures in patients on direct oral anticoagulants (DOACs) reduces the length of stay (LOS) and the 1-year mortality rates without increasing the risk for revision surgery: a matched-pair analysis","authors":"Valerie Weihs,&nbsp;Roberta Laggner,&nbsp;Michael Humenberger,&nbsp;Andreas Duma,&nbsp;Martin Frossard,&nbsp;Stefan Hajdu","doi":"10.1007/s00402-026-06490-2","DOIUrl":"10.1007/s00402-026-06490-2","url":null,"abstract":"<div><h3>Background</h3><p>It remains unclear whether early surgical fixation of trochanteric femoral fractures in patients with direct oral anticoagulation (DOAC) therapy has an impact on the long-term outcome.</p><h3>Methods</h3><p>A retrospective cohort study on patients with trochanteric femoral fractures and DOAC therapy between 2016 and 2024 was conducted. Patients were divided into two groups according to their time to surgery and matched with age and ASA score as covariates. The primary outcome of interest was the impact of early surgery on the long-term outcome.</p><h3>Results</h3><p>Of 233 included patients, 102 patients were assigned in each group after propensity score matching. Patients with early surgery had lower in-hospital complication rates (16.0% vs. 26.3%; <i>p</i> = 0.077) and a significantly shorter median length of stay (LOS) (11.5 days (IQR 6) vs. 15 days (IQR 6); <i>p</i> &lt; 0.001). No difference in the rates of revision surgery (9.8% vs. 5.9%; <i>p</i> = 0.298) was observed. Kaplan-Meier curves revealed a significant difference in the mortality rates during the follow-up period (<i>p</i> = 0.0057) with lower in-hospital (2.0% vs. 6.9%; <i>p</i> = 0.088), 30-day (3.9% vs. 9.8%; <i>p</i> = 0.097) and 1-year mortality rates (20.6% vs. 31.4%; <i>p</i> = 0.079).</p><h3>Conclusion</h3><p>Early surgical fixation of trochanteric femoral fractures in patients on DOAC therapy leads to a significant reduction in the LOS without increasing the risk for peri- and postoperative complications or the risk for revision surgery. Furthermore, early surgery may positively influence the long-term outcome in this specific cohort of patients.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886246","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}