Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"Elective arthroplasty on “high-risk” calendar dates: no evidence for worse outcomes in 43,000 procedures","authors":"Nike Walter,&nbsp;David W. Lowenberg,&nbsp;Christian Heiss,&nbsp;Edmund C. Lau,&nbsp;Markus Rupp","doi":"10.1007/s00402-026-06405-1","DOIUrl":"10.1007/s00402-026-06405-1","url":null,"abstract":"<div><h3>Background</h3><p>Concerns regarding the timing of elective surgery remain common among patients and may influence surgical scheduling. Superstition-associated calendar dates such as Friday the 13th are frequently perceived as “high-risk” time points, yet evidence regarding their impact on arthroplasty outcomes is lacking. This study investigated whether primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed on these dates are associated with differences in revision risk, mortality, or procedure frequency.</p><h3>Methods</h3><p>A nationwide retrospective cohort study was conducted using Medicare physician service records (2009–2019). Primary THA and TKA procedures were identified in a 5% sample of Medicare beneficiaries aged ≥ 65 years. Outcomes included aseptic revision, septic revision, and mortality. Competing-risk survival analyses (Fine–Gray) and multivariable Cox regression models adjusted for demographic, clinical, and socioeconomic covariates were applied. Procedure volumes were compared between superstition-associated and control dates.</p><h3>Results</h3><p>A total of 945 arthroplasties were performed on Fridays falling on the 13th. No significant differences were observed in aseptic revision, septic revision, or mortality compared with control dates. For Friday the 13th, hazard ratios were 0.80 (95% CI 0.44–1.47) for aseptic revision, 0.83 (95% CI 0.31–2.25) for septic revision, and 1.00 (95% CI 0.83–1.19) for mortality. Procedure volumes did not differ significantly between superstition-associated and control dates.</p><h3>Conclusion</h3><p>In this large registry-based study, the timing of elective total joint arthroplasty on superstition-associated calendar dates was not associated with increased complication risk, mortality, or changes in procedure volume. These findings may support evidence-based patient counselling and surgical scheduling in elective arthroplasty</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787546","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":"Postoperative periprosthetic fractures associated with compressive osseointegration: a systematic review of the Zimmer Biomet Compress® device","authors":"Kazuhiko Hashimoto,&nbsp;Shunji Nishimura,&nbsp;Koji Goto","doi":"10.1007/s00402-026-06477-z","DOIUrl":"10.1007/s00402-026-06477-z","url":null,"abstract":"&lt;div&gt;&lt;p&gt;The Zimmer Biomet Compress&lt;sup&gt;®&lt;/sup&gt; Compliant Pre-Stress (CPS) device uses a compressive osseointegration technique for endoprosthetic fixation and provides an alternative to stemed implants. Despite having benefits, such as bone stock retention, periprosthetic fractures continue to remain a concern. Therefore, this systematic review presents the prevalence, risk factors, and outcomes of the CPS device and periprosthetic fractures after treatment. Medical databases (PubMed, Embase, and Google Scholar) were searched to identify studies reporting complications related to the CPS device. Peer-reviewed studies with at least 2 years of follow-up for fracture rates, revision results, and implant survivorship were included. The primary data collected were fracture incidence and timing of complications, and the CPS device was compared with the traditional cemented stem. This review highlights important studies, including a cohort of 221 patients and pediatric data from 36 patients. Adult populations showed a periprosthetic fracture rate of 2.7–3.9%. A distinct temporal pattern emerged: the frequency of fractures was most pronounced within the first 2 years after surgery. In the pediatric context, spindle survivorship was 86.3% at 5–10 years, despite higher rates of mechanical complications. Notably, for most fracture cases, the bone–implant interface was radiographically stable, providing easier revision with significantly less bone loss with the CPS device than with the traditional cemented stem. The CPS device showed a periprosthetic fracture rate similar to or lower than that of the traditional cemented stem and an early onset temporal profile with distinct features. The stability of the bone–implant interface despite fracture and its ability to be modified after implantation highlight its suitability for limb salvage surgery. To reduce the fracture risk, strict postoperative weight-bearing protocols are recommended during the early osseointegration period. This review highlights important studies, including a cohort of 221 patients and pediatric data from 36 patients. Adult populations showed a periprosthetic fracture rate of 2.7–3.9%. A distinct temporal pattern was observed, with fractures occurring most frequently within the first 2 years after surgery. In pediatric populations, spindle survivorship was 86.3% at 5 years and 66.2% at 10 years, despite higher rates of mechanical complications. Notably, for most fracture cases, the bone–implant interface remained radiographically stable, providing easier revision with significantly less bone loss than with traditional cemented stems. The CPS device showed low reported adult periprosthetic fracture rates and an early-onset temporal profile with distinct features. The stability of the bone–implant interface despite fracture occurrence, together with the ability to modify the implant after implantation, highlight its suitability for limb salvage surgery. To reduce fracture risk, strict postop","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a novel strap fixation method for biomechanical testing of sheep Achilles tendons","authors":"Onur Basci,&nbsp;Selahaddin Aydemir,&nbsp;Resit Bugra Husemoglu,&nbsp;Mustafa Çeltik","doi":"10.1007/s00402-026-06478-y","DOIUrl":"10.1007/s00402-026-06478-y","url":null,"abstract":"<div><h3>Background</h3><p>Reliable fixation of tendon specimens is a major challenge in biomechanical testing, as slippage and tissue damage can reduce accuracy and reproducibility. Although various clamp- and suture-based fixation methods have been reported, there is still no widely accepted, practical, low-cost technique that preserves tendon integrity during testing. This study aimed to compare commonly used fixation techniques and to evaluate whether a novel strap-based fixation method provides a more stable and tissue-preserving alternative for biomechanical testing of sheep Achilles tendons.</p><h3>Methods</h3><p>Forty fresh-frozen cadaveric sheep Achilles tendons obtained from a local butcher were used, and the specimens were stored at − 20 °C until testing. After controlled thawing at room temperature, all tendons were repaired using the Bunnell suture technique with No. 0 Vicryl. Four different proximal fixation methods were evaluated: (1) sutured fixation with strap, (2) direct clamp fixation, (3) Kocher clamp fixation, and (4) Krackow suture fixation. All specimens were mounted on a universal testing machine and subjected to a load-to-failure protocol at a constant loading rate of 10 mm/s. Maximum force (N), displacement at failure (mm), and mechanical failure mechanisms were recorded for each sample. Data were analyzed using the Kruskal–Wallis test with Bonferroni-corrected Mann–Whitney U tests for pairwise comparisons (p &lt; 0.0083).</p><h3>Results</h3><p>The strap method demonstrated the highest numerical load-carrying capacity [114.58 N (73.59–135.00)] with relatively controlled displacement [16.96 mm (8.79–26.52)]. Its maximum load was significantly higher than that of the direct clamp and Kocher clamp methods; however, the difference compared with the Krackow suture method did not remain statistically significant after Bonferroni correction. Tendons fixed directly by clamp (Group 2) exhibited tissue damage due to clamp pressure and showed lower load capacity [75.41 N (58.28–110.78)] with greater displacement [28.01 mm (17.63–51.93)]. The Kocher clamp method (Group 3) provided the lowest mechanical strength, and most specimens slipped at the onset of loading [38.35 N (26.41–49.53); 15.55 mm (10.92–17.54)]. The Krackow suture method (Group 4) showed intermediate performance [82.95 N (65.62–148.50); 27.00 mm (19.49–30.75)].</p><h3>Conclusion</h3><p>The strap fixation method provided stable fixation, no visible slippage, and the highest numerical load-to-failure values among the tested techniques. It was significantly stronger than the direct clamp and Kocher clamp methods; however, it was not statistically superior to the Krackow suture method after Bonferroni correction. The strap method may therefore be considered a practical and tissue-preserving alternative for further biomechanical tendon testing.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787609","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":"Hip resurfacing arthroplasty at a minimum of 14 years: revision is concentrated among female patients with dysplasia and small components","authors":"Yu-Chih Lin,&nbsp;Chih-Hsiang Chang,&nbsp;Pang-Hsin Hsieh,&nbsp;Yu-Yi Huang,&nbsp;Dave W. Chen,&nbsp;Ngi-Chiong Lau","doi":"10.1007/s00402-026-06481-3","DOIUrl":"10.1007/s00402-026-06481-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Hip resurfacing arthroplasty (HRA) is a bone-preserving option for young, active patients. The influence of the underlying diagnosis on long-term outcome remains unclear, particularly the distinction between primary osteoarthritis (OA), developmental dysplasia of the hip (DDH) and non-OA conditions.</p><h3>Materials and methods</h3><p>We retrospectively reviewed 104 consecutive metal-on-metal HRAs in 101 patients (three bilateral) performed by one surgeon between 2006 and 2011, stratified into Primary OA (<i>n</i> = 50), DDH (<i>n</i> = 29) and Non-OA (<i>n</i> = 25: avascular necrosis [AVN] <i>n</i> = 15, inflammatory arthritis <i>n</i> = 5, post-traumatic arthritis <i>n</i> = 3, Legg-Calvé-Perthes disease <i>n</i> = 2). AVN was analysed additionally as an independent group, and exploratory analyses restricted to female patients and to cups ≤ 50 mm addressed the collinearity of dysplasia, sex and size. Survivorship used Kaplan-Meier estimation with revision as the endpoint.</p><h3>Results</h3><p>Implant status was known for all 104 hips; the 91 unrevised assessed hips had a mean follow-up of 16.2 ± 1.5 years. Overall 15-year survivorship was 95.2%. Primary OA, Non-OA and AVN each showed 100%; DDH 82.8% (versus Primary OA <i>p</i> = 0.002, versus Non-OA <i>p</i> = 0.031). All five revisions occurred in female DDH patients with a cup ≤ 50 mm; DDH survivorship remained lower within female patients (<i>p</i> = 0.025) and within small cups (<i>p</i> = 0.006), with no event in any comparator arm. Final HHS was lower in DDH (89.5 ± 8.5) than in Primary OA (93.9 ± 6.8) or Non-OA (95.0 ± 4.9; <i>p</i> = 0.012), a difference below the minimal clinically important improvement threshold of 15.9 to 18 points. The Co/Cr ratio did not differ between groups (<i>p</i> = 0.37).</p><h3>Conclusions</h3><p>HRA achieved 100% 15-year survivorship in primary OA and in non-OA diagnoses including AVN. Dysplasia may be associated with an increased risk of revision, but dysplasia, female sex and small component size were too collinear, with no revision outside the dysplastic group, for their independent contributions to be separated.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787567","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":"Union outcomes and associated factors in adolescent scaphoid fractures","authors":"Ömer Torun,&nbsp;Ahmet Berkay Girgin,&nbsp;Merve Kaşıkçı,&nbsp;Ahmet Acar,&nbsp;Hüseyin Bilgehan Çevik","doi":"10.1007/s00402-026-06480-4","DOIUrl":"10.1007/s00402-026-06480-4","url":null,"abstract":"<div><h3>Purpose</h3><p>Scaphoid fractures (SF) in adolescents differ from adult fractures in fracture pattern, healing capacity, and skeletal maturity. Limited data exist on factors affecting union and healing time in this population. This study evaluated clinical, radiological, and treatment-related factors associated with union and healing time in adolescent SF.</p><h3>Methods</h3><p>This study included 77 adolescents (aged 10–18 years) treated for SF. Chronological age, bone age, fracture characteristics, treatment modality, union status, and healing time were recorded. Fractures were classified by anatomical location, displacement, and time to diagnosis (&lt; 6 weeks or ≥ 6 weeks). CT-based morphometric measurements, including scaphoid height, lateral intrascaphoid angle, and dorsal cortical angle, were obtained from initial computed tomography images. Functional outcomes were assessed using the QuickDASH and patient-rated wrist evaluation (PRWE) scores.</p><h3>Results</h3><p>Union was achieved in 63 patients (81.8%), with a median union time of 8 weeks (range, 6–10 weeks). Union rates were highest in distal pole fractures (100%) and lowest in proximal pole fractures (33.3%). Non-displaced fractures had higher union rates than displaced fractures (92.5% vs. 56.5%), and fractures diagnosed within 6 weeks demonstrated better union outcomes. Surgical treatment, performed in 16.9% of patients, was associated with lower union rates and longer healing times. Younger chronological and bone age correlated with higher union rates, shorter immobilization, and improved functional scores. Increased scaphoid height, lateral intrascaphoid angle, and dorsal cortical angle were associated with prolonged healing time and reduced union rates.</p><h3>Conclusion</h3><p>Healing of SF in adolescents is influenced by fracture characteristics, skeletal maturity, and scaphoid morphology. Younger age and favorable morphometric parameters are associated with improved healing outcomes. Scaphoid morphometric measurements may offer additional prognostic value in adolescents and should be further evaluated in larger prospective studies.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06480-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783189","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":"Relationship of foot anthropometry with Modified Pirani score during Ponseti correction of idiopathic congenital talipes equinovarus: a prospective observational study","authors":"Meera Suresh,&nbsp;Deepak John Victor Pinto,&nbsp;Pranav Rajasekharan","doi":"10.1007/s00402-026-06467-1","DOIUrl":"10.1007/s00402-026-06467-1","url":null,"abstract":"<div><h3>Background</h3><p>The Ponseti method is the gold standard treatment for idiopathic congenital talipes equinovarus (CTEV). Clinical monitoring during correction primarily relies on the Modified Pirani score, which evaluates deformity severity based on clinical findings. However, objective quantitative assessment of morphological foot changes during treatment remains limited. This study aimed to evaluate the relationship between serial foot anthropometric measurements and Modified Pirani scores during Ponseti correction of idiopathic clubfoot.</p><h3>Methods</h3><p>A prospective observational cohort study was conducted in 30 children with idiopathic unilateral CTEV undergoing Ponseti correction at a tertiary care center between June 2024 and February 2026. Five anthropometric parameters were measured weekly for eight weeks: great toe to midheel distance (GT-MH), little toe to midheel distance (LT-MH), second toe to midheel distance (ST-MH), medial malleolus to midheel distance (MM-MH), and lateral malleolus to midheel distance (LM-MH). Modified Pirani scores were assessed simultaneously by two independent observers. Pearson correlation analysis and inter-observer reliability testing were performed.</p><h3>Results</h3><p>Significant improvement was observed in all anthropometric parameters and Pirani scores over the study period (p &lt; 0.001). Mean GT-MH increased from 80.73 ± 3.36 mm to 87.56 ± 3.41 mm, LT-MH from 65.36 ± 2.04 mm to 70.22 ± 2.05 mm, and MM-MH from 26.19 ± 0.79 mm to 30.85 ± 0.78 mm. LM-MH decreased from 28.40 ± 0.56 mm to 25.25 ± 0.51 mm, reflecting correction of hindfoot varus. Pirani score improved from 5.33 ± 0.24 to 0.03 ± 0.18. Strong inverse correlations were observed between Pirani score and GT-MH (r = -0.56), LT-MH (r = -0.61), ST-MH (r = -0.71), and MM-MH (r = -0.88), while LM-MH demonstrated a positive correlation (r = 0.71). Inter-observer reliability was excellent, with ICC values ranging from 0.9956 to 1.000. Percutaneous Achilles tenotomy was required in 80% of patients.</p><h3>Conclusions</h3><p>Serial anthropometric assessment demonstrates significant correlation with Modified Pirani scoring during Ponseti correction of idiopathic clubfoot. Anthropometric measurements provide objective and reproducible quantitative data that complement clinical scoring and may improve monitoring of deformity correction during treatment.</p><h3>Trial registration</h3><p>Institutional Ethics Committee approval was obtained prior to commencement of the study.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06467-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782683","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 effect of surgeon volume on outcomes after total hip arthroplasty: a systematic review and meta-analysis","authors":"Nils Meissner,&nbsp;Katharina Ortwig,&nbsp;Sonia Ramos-Pascual,&nbsp;Chinyelum Agu,&nbsp;Johannes Stoeve,&nbsp;Daniel Schrednitzki,&nbsp;Tim Rolvien,&nbsp;Andreas M. Halder","doi":"10.1007/s00402-026-06434-w","DOIUrl":"10.1007/s00402-026-06434-w","url":null,"abstract":"<div><h3>Purpose</h3><p>To synthesize, critically appraise and systematically review studies comparing outcomes after primary total hip arthroplasty (THA) performed by low- vs. high-volume surgeons, and to propose evidence-based threshold definitions for these categories.</p><h3>Methods</h3><p>This review followed the PRISMA guidelines and was registered in PROSPERO. Medline and Embase were searched on March 24, 2025. Prospective and retrospective clinical studies were included if they reported THA thresholds for low- and high-volume surgeons. Articles not written in English or German were excluded. Outcomes were pooled and presented in forest plots. Methodological quality was assessed.</p><h3>Results</h3><p>Of 872 identified articles, 18 were included, reporting on 796,061 patients undergoing THA. Methodological quality was high in all studies (&gt;6 of 7 points). Thresholds used to define high- vs. low-volume were determined using arbitrary values (n = 11), tertiles (n = 1), quartiles (n = 3), percentiles (n = 2), or receiver operating characteristic curves (n = 1). High-volume surgeons had significantly lower 1-month readmission rates [odds ratio (OR) = 1.6; <i>p</i> = 0.033] and 3-month mortality rates (OR = 1.8; <i>p</i> = 0.008). In contrast, there were no significant differences between high- and low-volume surgeons for 3-month revision rates (OR = 2.0; <i>p</i> = 0.228), 12-month revision rates (OR = 1.8; <i>p</i> = 0.228), and 3-month readmission rates (OR = 1.3; <i>p</i> = 0.337).</p><h3>Conclusions</h3><p>The included studies demonstrated considerable variability in the definitions of surgeon volume. However, there remains a trend suggesting that higher-volume surgeons experience fewer revisions, complications, readmissions, and mortality; although these differences were largely not statistically significant. Nonetheless, surgeon volume may not be the only factor influencing outcomes, as hospital and patient characteristics may influence short- to long-term outcomes following primary THA.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06434-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782576","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":"Implementation and early results of same-day hip and knee replacement in a public hospital without prior same-day surgical experience, a feasibility study","authors":"Christoffer C. Jørgensen,&nbsp;Thor-Magnus Sveen,&nbsp;Brita Johansen,&nbsp;Marlene Sander,&nbsp;Christian Steen-Hansen,&nbsp;Mikkel S. Sundstrup,&nbsp;Christian Rothe,&nbsp;Kai HW. Lange","doi":"10.1007/s00402-026-06468-0","DOIUrl":"10.1007/s00402-026-06468-0","url":null,"abstract":"<div><h3>Background</h3><p>Hip and knee replacements are increasingly performed as same-day surgery (SDS). However, the feasibility of SDS pathways in departments without prior experience is unknown. We report on the implementation process, feasibility and early results of implementing a SDS protocol in a department without prior experience with same-day hip and knee replacement.</p><h3>Methods</h3><p>The study design was based on Bowens feasibility study framework on implementation processes. Data were collected prospectively through patient reported questionnaires and medical records during, and from the local Department of Digitalisation and Analytics after implementation. Outcome data included discharge on day of surgery, 30-days primary-care contacts, 90-days readmissions and patient satisfaction.</p><h3>Results</h3><p>Implementation was initiated as a dedicated fellowship from September 2023 to October 2024. Patients were admitted and discharged through a dedicated day-surgical department with transfer to the regular ward in case of admission. The first SDS patient underwent surgery the 4th of September 2023. By October 2024, 150 of 713 operated patients (21.0% CI:18.2–24.2) had SDS. Of these, same-day discharge was achieved in 125 (83.3% CI:76.6–88.5) patients of which 6 (4.0% CI:0.9–7.1) were readmitted within 90-days. From October 2024 to October 2025, 178 of 800 patients were planned for SDS (22.3% CI:19.5–25.3), of which 131 (73.6% CI: 66.7–80.1) achieved same-day discharge despite less restrictive inclusion criteria.</p><h3>Conclusion</h3><p>Implementation of a protocolled SDS framework was feasible within 1 year despite no prior SDS experience. SDS utilisation and success remained stable the 12 following months, confirming adaptation into standard of care.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06468-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782575","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":"Hexapod-assisted limb salvage after talectomy: outcomes of tibiocalcaneal arthrodesis using the TL-hex system","authors":"José Antonio Guerrero Serrano,&nbsp;Enrique Sánchez Morata,&nbsp;José María García López,&nbsp;Sergio Mencía González,&nbsp;Jesús Vilá y Rico","doi":"10.1007/s00402-026-06379-0","DOIUrl":"10.1007/s00402-026-06379-0","url":null,"abstract":"<div><h3>Background</h3><p>Severe talar destruction due to infection, trauma, avascular necrosis, or neuroarthropathy represents a major reconstructive challenge. Talectomy followed by tibiocalcaneal arthrodesis (TCA) is a limb-salvage option in selected high-risk patients, although optimal fixation remains controversial. Modern hexapod external fixators offer computer-assisted multiplanar control that may improve alignment and fusion after talectomy. The aim of this study was to evaluate the clinical and radiographic outcomes of talectomy followed by TCA using the TL-HEX system in a series of high-risk patients.</p><h3>Methods</h3><p>A retrospective observational study was conducted between January 2020 and January 2024 including all patients who underwent total talectomy followed by TCA using a TL-HEX circular external fixator. Indications included talar destruction secondary to infection, avascular necrosis, post-traumatic collapse, Charcot neuroarthropathy, and aseptic loosening of total ankle arthroplasty. Primary outcomes were radiographic fusion and hindfoot alignment. Secondary outcomes included time to union, functional scores (AOFAS, EFAS), pain (VAS), complications, and patient satisfaction. Preoperative and final follow-up outcomes were compared using paired statistical tests, with significance set at <i>p</i> &lt; 0.05.</p><h3>Results</h3><p>Thirteen patients (mean age 57 years) were included with a mean follow-up of 24 months. Radiographic fusion was achieved in 11 of 13 patients (84.6%) using the TL-HEX alone, with a mean time to union of 22.1 ± 3.1 weeks. Two patients required conversion to intramedullary fixation, both achieving final consolidation. Mean AOFAS score improved from 39.2 ± 10.8 to 74.1 ± 9.7 (<i>p</i> &lt; 0.001), VAS pain score from 5.1 ± 1.2 to 1.4 ± 1.1 (<i>p</i> &lt; 0.001), EFAS score from 3.2 ± 1.8 to 14.3 ± 3.8 (<i>p</i> &lt; 0.001), and SF-36 PCS from 23.4 ± 2.6 to 38.6 ± 3.5 (<i>p</i> &lt; 0.001). Mean final hindfoot alignment was 6.5° of valgus, and all fused patients obtained a stable, plantigrade foot without bracing. No postoperative strut adjustments were required in any patient. Patient satisfaction was high (84.6% satisfied, 15.4% partially satisfied, none dissatisfied). No deep infections, amputations, or neurovascular complications occurred.</p><h3>Conclusion</h3><p>Tibiocalcaneal arthrodesis using a TL-HEX hexapod fixator appears to be a feasible limb-salvage strategy after talectomy in selected high-risk patients, achieving satisfactory fusion, alignment, and functional improvement in our cohort.</p><h3>Level of clinical evidence</h3><p>IV.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06379-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782375","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":"Coronal shear fractures of the distal humerus in children and adolescents: proposal for a modified classification","authors":"Justus Lieber,&nbsp;Michael Esser,&nbsp;Francisco F Fernandez,&nbsp;Peter P Schmittenbecher,&nbsp;Dorien Schneidmueller,&nbsp;Peter Strohm,&nbsp;Martin M Kaiser,&nbsp;Ralf Kraus","doi":"10.1007/s00402-026-06461-7","DOIUrl":"10.1007/s00402-026-06461-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Coronal shear fractures (CSF) of the capitulum and trochlea humeri are rare injuries during growth age. No systematic, prospective analysis of the classification, procedure, and outcome has yet been found in the literature.</p><h3>Materials and methods</h3><p>Based on the results of a multicentre study of CSF in growing patients, we propose a redesign of the AO Paediatric Comprehensive Classification of Long-Bone Fractures (PCCF) for children and adolescents. We also assessed inter-rater agreement consistency with the modified classification and calculated the intra-class correlation coefficient (ICC) and its 95% confident interval (CI).</p><h3>Results</h3><p>A detailed classification has been proposed that refers to the location of the fragment, the extent to which the trochlea is involved, and the distinction between single and multiple fracture injuries. This modified AO classification distinguishes between five types of injury (13-E/3.1I – 13-E/3.1IV and 13-E/3.2), replacing the current code 13r-E/8.1. Inter-rater reliability using this modified classification was moderate (ICC 0.452 (95% CI 0,284; 0,661). This is more accurate than all previous classifications tested for CSF.</p><h3>Conclusion</h3><p>A revised classification of coronal shear fractures of the distal humerus in children and adolescents is required. Our proposed classification considers the various types of this injury and their implications for treatment. Cross-sectional imaging is necessary for any classification to be applied successfully, since plain radiographs do not provide sufficiently precise information.</p></div>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"146 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00402-026-06461-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782373","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}