Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"A multimodal imaging approach to predict carpal tunnel syndrome after distal radius fractures","authors":"Mehmet Önüt,&nbsp;Nihat Alkol,&nbsp;Yiğit Önaloğlu,&nbsp;Mete Özer,&nbsp;Eren Apaydın,&nbsp;Mehmet Ali Talmaç","doi":"10.1007/s00402-026-06416-y","DOIUrl":"10.1007/s00402-026-06416-y","url":null,"abstract":"<div><h3>Objective</h3><p>Distal radius fractures are commonly associated with the development of carpal tunnel syndrome (CTS), yet current evidence primarily focuses on radiographic alignment parameters. The role of carpal tunnel morphology, particularly total carpal tunnel cross-sectional area (CSA) measured on computed tomography (CT), remains insufficiently investigated. This study aimed to evaluate the relationship between CSA, volar tilt, and the development of CTS in conservatively managed distal radius fractures, and to assess the predictive performance of these parameters when used in combination.</p><h3>Methods</h3><p>This retrospective case-control study included 150 patients, comprising 50 patients who developed CTS and 100 controls without CTS. CSA was measured on CT scans obtained at initial presentation, while volar tilt was assessed using standard radiographs. Additional variables, including the presence of ulna fracture and fracture type, were analyzed. Group comparisons were performed using nonparametric tests. Multivariable logistic regression analysis was conducted to identify independent predictors of CTS. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.</p><h3>Results</h3><p>Patients who developed CTS had significantly lower CSA and higher volar tilt values (both <i>p</i> &lt; 0.001). The presence of an ulna fracture was inversely associated with CTS (<i>p</i> = 0.004). Multivariable analysis identified CSA (OR = 0.748, 95% CI: 0.643–0.871, <i>p</i> &lt; 0.001), volar tilt (OR = 1.132, 95% CI: 1.051–1.219, <i>p</i> = 0.001), and ulna fracture (OR = 0.249, 95% CI: 0.076–0.817, <i>p</i> = 0.022) as independent predictors of CTS. ROC analysis showed moderate discriminative ability for CSA and volar tilt individually (AUC = 0.685 and 0.708, respectively), which improved when combined (AUC = 0.772). The highest predictive performance was achieved with the combined model including CSA, volar tilt, and ulna fracture (AUC = 0.802).</p><h3>Conclusion</h3><p>In conservatively managed distal radius fractures, carpal tunnel cross-sectional area (CSA) and volar tilt are independently associated with the development of CTS. While CSA alone demonstrates limited discriminative ability, its combination with radiographic parameters appears to improve predictive performance. These findings suggest that incorporating CT-based morphological measurements alongside conventional radiographic assessment may provide additional value in early risk stratification for CTS.</p><h3>Level of evidence</h3><p>Level III, retrospective casecontrol study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06416-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429641","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":"Unicompartmental knee arthroplasty and total knee arthroplasty in patients with 15 or more degrees of varus deformity: age- and gender-matched comparative study of radiographic and clinical outcomes","authors":"Arun Mullaji,&nbsp;Sitaram Chopperla,&nbsp;George K. George,&nbsp;Rufiat Kazi","doi":"10.1007/s00402-026-06403-3","DOIUrl":"10.1007/s00402-026-06403-3","url":null,"abstract":"<div><h3>Introduction</h3><p>To date, few studies have directly compared matched cohorts of patients with severe varus deformity undergoing UKA versus TKA. The current study seeks to address this gap. The hypothesis was that, in patients with deformity of &gt; 15°, postoperative PROMs following UKA would be inferior to those achieved with TKA.</p><h3>Methods</h3><p>Records of patients operated for UKA and TKA from January 2016 to December 2021 were evaluated, and the data for patients with deformity of ≥ 15° were selected. The UKA patients were then matched for age and gender with TKA patients. 52 matched pairs of patients were obtained. The HKA, mLDFA, MPTA were measured. OKS, SF12, and FJS were collected. The magnitude of change in the mLDFA and MPTA was assessed using the Estimated Marginal Means.</p><h3>Results</h3><p>The mean follow-up times for UKA and TKA were 3.7 years and 5.5 years, respectively. The mean deformity correction (ΔHKA) was significantly greater in TKA (16.3° ± 4.5°) than UKA (10.6° ± 3.1°) (<i>p</i> &lt; 0.001), with significant changes in mLDFA and MPTA (<i>p</i> &lt; 0.001). In UKAs, 68% of patients demonstrated a postoperative HKA between 171.2° and 175.7°, whereas in TKAs, values clustered between 174.5° and 179.8°. Mann–Whitney U test demonstrated no statistically significant differences between the UKA and TKA cohorts across all assessed PROMs, including OKS, SF-12, and FJS (<i>p</i> &gt; 0.05 in all). 98% of the UKA and 94% of the TKA cohort achieved excellent or good outcomes.</p><h3>Conclusion</h3><p>UKA performed in carefully selected patients with large varus deformities (&gt; 15°) can provide satisfactory short- to mid-term outcomes. Although no statistically significant differences were observed in postoperative PROMs between the UKA and TKA groups, the current study was not designed or sufficiently powered to establish equivalence or detect subtle clinically meaningful differences between procedures. Greater deformity correction was achieved with TKA; however, UKA also resulted in substantial correction despite persistence of some residual varus in certain patients with severe preoperative deformity. Neither the severity of preoperative deformity nor the degree of postoperative residual varus demonstrated a statistically significant correlation with postoperative outcomes in this cohort.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06403-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418241","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":"Routine intraoperative infection testing in presumed aseptic hip and knee revision: a matched cohort retrospective study","authors":"Mattia Loppini,&nbsp;Caterina Rocchi,&nbsp;Marco Di Maio,&nbsp;Katia Chiappetta,&nbsp;Alberto Bulgarelli,&nbsp;Guido Grappiolo","doi":"10.1007/s00402-026-06411-3","DOIUrl":"10.1007/s00402-026-06411-3","url":null,"abstract":"<div><h3>Introduction</h3><p> Periprosthetic joint infections (PJIs) complicate 1–2% of primary and up to 4% of revision arthroplasties, and their diagnosis remains challenging due to the lack of a diagnostic gold standard. Differentiating PJI from aseptic failure is particularly difficult in low-grade or biofilm-related infections. Routine intraoperative microbiological screening is not recommended in presumed aseptic revisions. This study aimed to evaluate the association between routine intraoperative microbiological screening and implant survival in presumed aseptic revision arthroplasty. A secondary objective was to identify preoperative predictors of unexpected PJIs. </p><h3>Methods</h3><p>Retrospectively collected data of patients undergoing presumed aseptic THA and TKA revisions between 2013 and 2019 were included. Two matched cohorts were compared: a screened group (2016–2019) undergoing routine intraoperative microbiological sampling, and an unscreened one (2013–2015) without systematic screening. Kaplan-Meier survival analysis with log-rank testing assessed overall and infection-free survival. Univariate conditional logistic regression and receiver operating characteristic (ROC) analyses evaluated potential associations between preoperative serum markers and unexpected PJI. </p><h3>Results</h3><p> A total of 559 patients were included, of whom 295 underwent screening and 264 did not. Unexpected infections occurred in 20.3% (<i>n</i> = 60) of screened patients. No significant differences in implant survival were observed between groups. Although overall and infection-free survival were numerically higher in the screened cohort, these differences were not statistically significant (<i>p</i> = 0.168 and <i>p</i> = 0.118, respectively). Stratified analyses by joint and failure mechanism showed comparable findings. C-reactive protein and erythrocyte sedimentation rate were associated with unexpected PJI (<i>p</i> = 0.004 and <i>p</i> = 0.046), but ROC analysis suggested limited discrimination of individual markers, whereas a combined serum model improved diagnostic performance (AUC = 0.833).</p><h3>Conclusions</h3><p>Routine intraoperative microbiological screening in presumed aseptic revision arthroplasty was not associated with a significant improvement in implant survival. Future studies should investigate whether selective screening improves outcomes. Level III retrospective cohort study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06411-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418218","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 novel biomechanical model for reproducing and analysing the causal mechanisms of PFNA “cut-in” phenomenon","authors":"Kumaran Rasappan,&nbsp;K. Joshua,&nbsp;Siaw Meng Chou,&nbsp;Leanne Kayla Rebecca Mei-Yi Shaw,&nbsp;Daran Huang,&nbsp;Andy Yew,&nbsp;Ernest Beng Kee Kwek","doi":"10.1007/s00402-026-06398-x","DOIUrl":"10.1007/s00402-026-06398-x","url":null,"abstract":"<div><h3>Introduction</h3><p>“Cut-in” is a rare but serious complication associated with cephalomedullary nail fixation for intertrochanteric hip fractures, particularly with Proximal Femoral Nail Antirotation (PFNA). This phenomenon involves paradoxical superomedial migration of the helical blade through the femoral head. Although increasingly recognised, the underlying mechanisms remain incompletely defined. This study aims to describe a new superolateral tensile loading set up in a bidirectional loading model, with the aim of incorporating possible mechanical deviations introduced by abductor weakness.</p><h3>Materials and methods</h3><p>This study was conducted in two stages. An initial stage with synthetic femurs (SYNBONE^® 2420) was used to calibrate the set up. Within this stage, intramedullary canal diameter was compared (12 mm vs. 18 mm). In the final stage, 5 osteoporotic synthetic femurs (Sawbones^® 3503) were used. In both stages, standardised AO/OTA 31-A1.1 intertrochanteric fracture were created in the synthetic femurs and fixed with PFNA-II implants. All femurs were subjected to cyclical bidirectional loading with a universal testing machine. Each cycle consisted of axial compression (720 N) and superolateral tensile loading (120 N) at 2 Hz. This configuration was designed to simulate altered hip biomechanics postulated with the trendelenburg gait. Testing was continued until mechanical failure, construct deformation, or specimen fracture occurred. Full cut-in was defined as complete perforation of the blade through the femoral head cortex, while partial cut-in was defined as superomedial migration of the blade without perforation of the femoral head cortex.</p><h3>Results</h3><p>The initial stage demonstrated partial cut-in more frequently in specimens with larger canal diameters (18 mm), but did not produce any full cut-in. The final stage with an 18 mm canal diameter achieved full cut-in in all five specimens.</p><h3>Conclusions</h3><p>Our bidirectional loading model with superolateral tensile loading reproduced full ‘cut-in’ in all 5 specimens of the final stage, serving as a proof-of-concept tool. Larger studies are warranted for validation.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06398-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418176","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":"Acetabular superior wall fractures: a distinct acetabular fracture entity","authors":"Axel Gänsslen,&nbsp;Dietmar Krappinger,&nbsp;Emmanouil Liodakis,&nbsp;Jan-Dierk Clausen,&nbsp;Tarek Omar-Pacha,&nbsp;Richard A. Lindtner,&nbsp;Stephan Sehmisch,&nbsp;David B. Osche","doi":"10.1007/s00402-026-06407-z","DOIUrl":"10.1007/s00402-026-06407-z","url":null,"abstract":"<div><h3>Introduction</h3><p>A transitional “grey-zone” exists between typical locations of classical trapezoidal anterior wall and large-fragment posterior wall acetabular fractures. Part of this grey zone is the superior acetabular dome, which is commonly involved in acetabular fracture patterns, especially in geriatric patients. The aim of this study was to characterize isolated acetabular superior wall fractures and to assess their relevance as a distinct fracture pattern.</p><h3>Methods</h3><p>A retrospective analysis of pelvic fracture databases from three tertiary trauma centers was performed. Acetabular fractures with superior dome involvement were screened, and cases with isolated superior articular involvement were included. Overall, seven patients were identified. Clinical and radiological data were analyzed regarding fracture morphology, associated fracture characteristics (including dislocation, comminution, marginal impaction, intra-articular fragments, and femoral head injury), concomitant pelvic ring injuries, treatment, and clinical outcomes.</p><h3>Results</h3><p>Isolated superior wall acetabular fractures occurred following both high-energy and low-energy mechanisms, including simple falls. The mean age was 48 years and four of seven patients were male. Hip dislocation or subluxation was observed in four cases (anterior-superior or purely superior). Surgical treatment was performed in six cases, predominantly using anterior approaches (mainly the iliofemoral approach) with screw and/or plate fixation. Outcomes were frequently unfavorable, with relevant joint degeneration or persistent symptoms, likely related to substantial articular damage of the superior weight-bearing zone.</p><h3>Conclusion</h3><p>Acetabular superior wall fractures present a distinct fracture pattern that differs from classical anterior and posterior wall fractures and is less commonly observed. These injuries involve the superior weight-bearing dome and are frequently associated with comminution and substantial articular damage of both the acetabulum and femoral head. Even in cases with restored joint congruence, outcomes appear inferior, underscoring the clinical relevance of this fracture entity.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06407-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418289","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":"Artificial intelligence advancements for orthopaedic clinical reasoning: longitudinal assessment of newer models (ChatGPT-5, Grok-3, Gemini 2.5 Flash) compared to clinicians","authors":"Suzen Agharia,&nbsp;Shayan Soroush,&nbsp;Daniel Ameen,&nbsp;Yushy Zhou","doi":"10.1007/s00402-026-06400-6","DOIUrl":"10.1007/s00402-026-06400-6","url":null,"abstract":"<div><h3>Introduction</h3><p>This descriptive study aimed to longitudinally evaluate the performance of contemporary large language models - ChatGPT-5, Gemini 2.5 Flash, and Grok-3 - on orthopaedic clinical multiple-choice tasks, benchmarked against pooled clinician consensus. A secondary aim was to assess whether recent advances in generative AI translated into improved alignment with clinician consensus compared with previous AI models.</p><h3>Materials and methods</h3><p>A total of 97 multiple-choice clinical cases spanning eight orthopaedic subspecialties were sourced from OrthoBullets and previously benchmarked against aggregated responses from thousands of practising clinicians. Using identical methodology to our 2023 study of ChatGPT-3.5, ChatGPT-4, and Bard, each model was prompted with standardised case stems and response options. The primary outcome was the proportion of AI responses matching the most popular clinician response; secondary analyses assessed agreement within 10% and 20% of clinician consensus, performance on ‘controversial’ (&lt; 25% margin) questions, and inter-model concordance using Cohen’s kappa coefficients.</p><h3>Results</h3><p>Gemini 2.5 Flash achieved the highest alignment with clinician consensus (69.1%), followed by Grok-3 (66.0%) and ChatGPT-5 (58.8%). None of the LLMs refused to respond to any prompts, representing a reduction from 7.2% from our 2023 study. Subspecialty analysis demonstrated that Gemini 2.5 Flash performed best in Hand and Paediatric domains, while Grok-3 excelled in Reconstruction, Trauma, and ‘controversial’ cases. Inter-model agreement was highest between Grok-3 and Gemini 2.5 Flash (κ = 0.678), indicating improved consistency compared with prior-generation systems.</p><h3>Conclusions</h3><p>Contemporary LLMs can be promising adjuncts for orthopaedic education by simulating peer reasoning and offering structured explanations in non-critical settings. Despite incremental gains in reasoning capability compared to previous AI models, contemporary LLMs remain unsuitable for independent clinical use. Future research should develop hybrid clinician–AI workflows and longitudinal benchmarks to distinguish true reasoning improvements from memorisation.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06400-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395529","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":"Trajectory of urinary incontinence symptoms following total hip arthroplasty for hip osteoarthritis","authors":"Masaru Kadowaki,&nbsp;Sayaka Fukutani,&nbsp;Kiminori Ushio,&nbsp;Yuji Uchio","doi":"10.1007/s00402-026-06410-4","DOIUrl":"10.1007/s00402-026-06410-4","url":null,"abstract":"<div><h3>Introduction</h3><p>Urinary incontinence (UI), a prevalent quality-of-life–limiting condition, frequently coexists with hip osteoarthritis, potentially through pelvic floor dysfunction related to obturator internus muscle involvement. Several reports suggest improvement after total hip arthroplasty (THA), although postoperative time-course changes remain unclear. This study aimed to clarify the temporal trends in UI after THA and examine association of postoperative UI trajectories with functional recovery.</p><h3>Materials and methods</h3><p>This retrospective study included 118 female patients who underwent THA for hip osteoarthritis between October 2021 and March 2024. UI, assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), was defined as ICIQ-SF ≥ 1 preoperatively and at 3, 6, 9, and 12 months postoperatively, and classified as stress (SUI), urge (UUI), or mixed (MUI). Hip-related patient-reported outcomes were evaluated using the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Associations with BMI, age, surgical approach (direct lateral/Bauer vs. modified Watson-Jones/OCM), and UI type were tested using Mann–Whitney U, chi-squared, and repeated-measures ANOVA tests.</p><h3>Results</h3><p>Of 118 patients (mean age at surgery, 67 years; mean BMI, 24.3 kg/m²) preoperatively, 73 (61.9%) reported UI (mean ICIQ-SF 7.88), including SUI (n = 20), UUI (n = 26), and MUI (n = 27), with a higher baseline severity in MUI than in UUI. The mean ICIQ-SF improved markedly by 3 months (3.88) with a significant time effect (p &lt; 0.001, η² = 0.39), but then plateaued through 12 months. Although most patients improved, 45/73 (61.6%) had persistent UI at 12 months. These patients had higher preoperative ICIQ-SF and significantly worse postoperative JHEQ (notably pain) across multiple time points, while BMI, approach, and UI type showed no significant group differences.</p><h3>Conclusion</h3><p>UI symptoms improved significantly within the first 3 months following THA; however, subsequent recovery was limited. Persistent UI was associated with poorer functional recovery and higher pain levels.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06410-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395571","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 grand piano ratio: an adjunctive intraoperative screening tool for detecting excessive femoral component external rotation in total knee arthroplasty","authors":"Özgür Avci,&nbsp;Alpaslan Öztürk,&nbsp;Burak Olcay Güler,&nbsp;Hünkar Çağdaş Bayrak,&nbsp;Ali Ömer Kaya,&nbsp;Yakup Doğan","doi":"10.1007/s00402-026-06412-2","DOIUrl":"10.1007/s00402-026-06412-2","url":null,"abstract":"<div><h3>Background</h3><p>Accurate femoral component rotation is essential for optimal outcomes in total knee arthroplasty (TKA), yet reliable intraoperative assessment remains challenging. The “grand piano sign” has been described as a qualitative visual cue, but its quantitative clinical value has not been clearly established. This study aimed to evaluate the diagnostic performance of the grand piano ratio as an intraoperative tool for detecting excessive femoral component external rotation using advanced postoperative imaging as a reference standard.</p><h3>Methods</h3><p>A retrospective analysis was conducted on 170 knees undergoing primary TKA. The intraoperative grand piano ratio was measured after completion of all femoral resections and before trial component implantation using the anterior femoral resection surface. Postoperative femoral component rotation was assessed using MAVRIC-sequence magnetic resonance imaging referenced to the surgical transepicondylar axis (sTEA). Excessive femoral component external rotation was defined as postoperative external rotation greater than 3° relative to the sTEA reference. Receiver operating characteristic (ROC) analysis was performed to evaluate diagnostic performance of the grand piano ratio and determine the optimal cutoff value, while multivariable logistic regression analysis was used to identify independent predictors of excessive external rotation.</p><h3>Results</h3><p>Excessive femoral component external rotation (&gt; 3°) was identified in 39 of 170 knees (22.9%). The mean grand piano ratio was significantly lower in knees with external rotation compared to those without (0.41 vs. 0.54, <i>p</i> &lt; 0.001). The grand piano ratio demonstrated moderate discriminative ability for detecting femoral component external rotation greater than 3° (AUC = 0.74, 95% CI 0.65–0.83). The optimal cutoff value was 0.44, yielding a sensitivity of 71.8% and a specificity of 74.0%. In multivariable analysis, the grand piano ratio was the only independent predictor of malrotation (<i>p</i> &lt; 0.001). At the identified threshold, the negative predictive value reached 89.9%, suggesting that excessive external rotation was unlikely when the grand piano ratio exceeded the proposed cutoff.</p><h3>Conclusion</h3><p>The grand piano ratio may serve as a simple and readily available adjunctive intraoperative screening parameter for identifying excessive femoral component external rotation in TKA. A threshold value of 0.44 demonstrated a high negative predictive value and may assist surgeons in intraoperative decision-making. However, the ratio should be considered a complementary assessment tool rather than a definitive method for determining femoral component rotation. The grand piano ratio should be viewed as a complementary intraoperative assessment tool rather than an alternative to navigation or robotic-assisted techniques.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06412-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148395584","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 shoulder stiffness scale: a validated tool for monitoring stiffness in arthroscopic rotator cuff reconstructions","authors":"Samy Bouaicha,&nbsp;Matthias Biner,&nbsp;Farah Selman,&nbsp;Karl Wieser,&nbsp;Andreas Marc Müller,&nbsp;Laurent Audigé","doi":"10.1007/s00402-026-06402-4","DOIUrl":"10.1007/s00402-026-06402-4","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative shoulder stiffness after arthroscopic rotator cuff repair is common and clinically heterogeneous. Established shoulder scores assess pain and function, but do not specifically isolate stiffness during follow-up. The aim of this study was to validate the newly developed Shoulder Stiffness Scale (SSS) as a pragmatic monitoring tool for postoperative shoulder stiffness after arthroscopic rotator cuff repair (ARCR).</p><h3>Methods</h3><p>From a cohort of 973 primary arthroscopic rotator cuff reconstructions, patients without concomitant joint pathology of the same or contralateral arm were included. The new SSS was based on three items related to shoulder pain, subjective and objective ROM ranging from 0 to 10 points. It was collected before surgery, as well as 6 and 12 months postoperatively, along with other pain level parameters, Constant Score (CS), Subjective Shoulder Value (SSV), Oxford Shoulder Score (OSS). Changes of the SSS and its subscales over time, Cronbach's alpha for internal consistency, bottom and ceiling effects were reported. Validity was investigated through SSS associations with other parameters of similar dimension, and functional scores. </p><h3>Results</h3><p>The selected cohort with 740 patients showed postoperative shoulder stiffness in 12.7 %. The SSS averaged 5.1 points (SD 2.5) preoperatively, and decreased significantly to mean 2.9 (SD 2.4) and 1.6 (SD 1.9) at 6 and 12 months, respectively (p&lt;0.001). Cronbach's alpha ranged from 0.612 to 0.740 between time points. The SSS showed significant correlation in all three subscales pain, subjective ROM and objective ROM as well as to the functional scores CS, OSS and SSV scores at baseline, 6 months and 12 months with correlation coefficients ranging from -0.302 (low) to -0.649 (moderate) at baseline and from -0.626 (moderate) to -0.719 (high) at 12 months. </p><h3>Conclusions</h3><p>The SSS demonstrated acceptable internal consistency and construct validity as a simple clinician-administered tool for monitoring postoperative shoulder stiffness after ARCR. It complemented existing scores by isolating stiffness as a distinct construct and may facilitate day-to-day clinical follow-up and patient communication.</p><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06402-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389846","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":"Osteoporosis treatment gap prior to femoral fracture and prevalence of pharmacological risk factors: a prospective observational study","authors":"Lukas Böck,&nbsp;Katharina Kerschan-Schindl,&nbsp;Martin Frossard,&nbsp;Stefan Hajdu,&nbsp;Richard Crevenna,&nbsp;Martina Anditsch,&nbsp;Gunar Stemer,&nbsp;Anna Antoni","doi":"10.1007/s00402-026-06401-5","DOIUrl":"10.1007/s00402-026-06401-5","url":null,"abstract":"<div><h3>Introduction</h3><p>Hip fractures are a major complication of osteoporosis and are associated with high morbidity, mortality, and costs. Despite clear guideline recommendations, pharmacological osteoporosis treatment remains underutilized. In addition, medications that increase fall and fracture risk further contribute to fracture occurrence. The aim of this study was to assess guideline concordance of osteoporosis therapy and to quantify the prevalence of medications associated with increased fall and fracture risk prior to the fracture in patients admitted with femoral fractures.</p><h3>Materials and methods</h3><p>In this prospective observational study, 145 patients aged ≥ 55 years admitted with femoral neck, per- and subtrochanteric, femoral shaft and distal femur fractures to a tertiary academic trauma center between April and June 2025 were included. Pre-admission medication was assessed using structured medication reconciliation. Guideline concordance of pre-fracture osteoporosis therapy was evaluated according to the current Austrian osteoporosis guideline (Dimai et al., 2024). Fall-risk-increasing drugs (FRIDs) were identified using the STOPPFall criteria, and fracture-associated medications were recorded based on Austrian osteoporosis guideline-defined drug classes.</p><h3>Results</h3><p>Among 145 included patients (mean age 80.4 years; 71% female), 117 (81%) met criteria for pharmacological osteoporosis treatment prior to the fracture, defined by a preexisting osteoporosis diagnosis or a 10-year fracture risk above the treatment intervention threshold using the FRAX^® calculator. Only 9 (7.7%) of these patients were treated in accordance with guideline recommendations. A treatment gap was observed in 78.6% of therapy-eligible patients. At least one FRID was prescribed in 70% of patients, and 57% received at least one medication associated with increased fracture risk.</p><h3>Conclusions</h3><p>Patients presenting with femoral fractures demonstrate a substantial gap in guideline-concordant osteoporosis therapy and a high prevalence of medications associated with increased fall and fracture risk. These findings highlight important opportunities for systematic primary and secondary fracture prevention and structured medication review.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06401-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374244","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}