Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"The mix and match approach in primary total hip arthroplasty reveals comparable or lower revision rates to matched components: a systematic review.","authors":"Lukas Leitner, Magdalena Postruznik, Alexander Draschl, Amir Koutp, Andreas Leithner, Patrick Sadoghi","doi":"10.1007/s00402-025-05979-6","DOIUrl":"10.1007/s00402-025-05979-6","url":null,"abstract":"<p><strong>Introduction: </strong>The mix and match (stem and cup from different manufacturers/systems, MM) approach in primary total hip arthroplasty (THA) involves combining components from different manufacturers. Despite various configurations discussed in literature and evidence supporting the safety of MM, controversy persists regarding safety and long term outcomes compared to matched components. Our study aimed to compare the revision rates of MM versus matched components.</p><p><strong>Materials and methods: </strong>Two databases were searched for English full-text articles published until January, 2024 that evaluated revision rates after primary MM THA. Additionally, MM revision rates data was extracted from the German Arthroplasty Registry (EPRD). The Newcastle-Ottawa Scale (NOS) for cohort studies was used for quality assessment.</p><p><strong>Results: </strong>Three national and one hospital registry studies were included, of which three demonstrate MM as a common practice (19-24%). All studies found comparable revision rates for MM cohorts, or even slightly improved survival rates in MM cohorts concerning revision rate and PROMs, mostly lacking clinical relevance. These findings align with the data reported in the EPRD, with revision rates of approximately 3.6% after 6 years in both MM and matched THA.</p><p><strong>Conclusions: </strong>Employing MM in primary THA presents a feasible and safe approach, capable of providing custom fit tailored to individual patients with revision rates comparable to those of matched THA.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"381"},"PeriodicalIF":2.0,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673859","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":"Intramedullary nailing versus external ring fixation for tibial shaft fractures: an explorative analysis of muscle strength from the IMVEX trial.","authors":"Peter Larsen, Rasmus Stokholm, Jan Duedal Rölfing, Juozas Petruskevicius, Morten Kjerri Rasmussen, Steffen Skov Jensen, Rasmus Elsoe","doi":"10.1007/s00402-025-05995-6","DOIUrl":"10.1007/s00402-025-05995-6","url":null,"abstract":"<p><strong>Background: </strong>To explore the effect of intramedullary nailing versus external ring fixation for patients with tibial shaft fractures on 12-month maximal isometric muscle strength for knee extension and knee flexion. We hypothesise that patients treated with external ring fixation will show significantly better maximal isometric muscle strength for knee extension and knee flexion 12 months after surgery compared to treatment with intramedullary nailing. Moreover, we aim to explore the association between muscle strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 12 months following surgery.</p><p><strong>Methods: </strong>A pragmatic multicentre randomised, non-blinded trial with a two-group parallel design. This study is an explorative analysis of the IntraMedullary nailing Versus EXternal ring fixation Trial (IMVEX). 67 patients with a tibial shaft fracture were randomized to external ring fixation or intramedullary nailing. The primary outcome: maximal isometric muscle strength for knee extension and knee flexion. Secondary outcome was KOOS.</p><p><strong>Results: </strong>No statistically significant difference in muscle strength between treatment with intramedullary nailing and external ring fixation was observed (P < 0.31). Examination of maximal isometric muscle strength showed significant difference between the injured and the non-injured leg (knee extension: mean difference of 53N, (95%CI 33.9-72.4), knee flexion: mean difference of 35N, (95%CI 21.2-47.9)) The association between KOOS subscale scores and the relative difference in muscle strength for knee extension showed significant and moderate to high correlation (0.4-0.8) for all subscales.</p><p><strong>Conclusion: </strong>Muscle strength of knee flexion and extension was markedly decreased one year after fracture. We observed no statistically significant difference in recovery of muscle strength between treatment with intramedullary nailing and external ring fixation. Results indicate that a decrease in muscle strength is associated with worse patient-reported outcomes for all five KOOS subscales.</p><p><strong>Trial registration: </strong>NCT03945669.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"379"},"PeriodicalIF":2.1,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658236","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":"Using the Timed Up and Go test to measure mobility in non-geriatric patients after pelvic ring injury.","authors":"Simon Tiziani, Julian Scherer, Patrick Saurenmann, Sasha Halvachizadeh, Roman Pfeifer, Kai Sprengel, Hans-Christoph Pape, Georg Osterhoff","doi":"10.1007/s00402-025-05992-9","DOIUrl":"10.1007/s00402-025-05992-9","url":null,"abstract":"<p><strong>Introduction: </strong>Pelvic ring injuries are rare injuries that frequently are associated with prolonged recovery and low return-to-work rates. Since radiological outcome not always correlates with overall patient-reported outcome, the assessement of functional outcome has become a focus of follow up. The Timed-Up and Go test (TUG) would be a simple way to quantify patient mobility, but has not yet been adequately validated in a non-geriatric patient population.</p><p><strong>Methods: </strong>Consecutive patients younger than 70 years who underwent functional outcome testing as routine follow-up at 6 weeks, 12 weeks, or 6 months after pelvic ring injuries between 11/2017 and 10/2018 were included in this study. In addition to a TUG test, all patients completed a specific functional outcome score for pelvic ring injuries (Majeed-Score) and a general health score (Eq. 5D-3 L).</p><p><strong>Results: </strong>Forty patients (mean age 40 years, range 18 to 68 years, 24 female), ) of which 28 were treated operatively were included in the study. The mean Majeed-Score was 75.0 (SD 23.3, range 20 to 100) and the mean Eq. 5D-3 L-VAS was 69.9 (SD 22.5, range 5 to 100). The mean time for TUG was 7.8 s. (SD 4.1, range 2 to 22.). TUG time strongly correlated with the Majeed-Score (r= - 0.633, p = 0.0001) and with the mobility portion of the Majeed-Score (r= - 0.524, p = 0.001). For a threshold value of 10 s in the TUG test, the ROC analysis revealed a sensitivity of 91% and a specificity of 82% in predicting an impaired Majeed score of below 60 (AUC 0.935).</p><p><strong>Conclusion: </strong>The TUG correlated strongly with the Majeed score and the mobility part of the Majeed-Score indicating that achieved values reflect the subjective accounts provided by patients. The TUG can be used as a quick screening in non-geriatric patients with pelvic ring injuries to quantify mobility. A TUG longer than 10 s indicates an impaired Majeed score. For academic purposes, however, it should be accompanied by the Majeed-Score.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"378"},"PeriodicalIF":2.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12274259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658237","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":"Dynamic valgus after ACL reconstruction: quadriceps- vs. semitendinosus tendon grafts.","authors":"Fredrik Gaugg, Sebastian Bierke, Tilman Hees, Kerstin Siemßen, Bernd Wolfarth, Wolf Petersen","doi":"10.1007/s00402-025-05917-6","DOIUrl":"https://doi.org/10.1007/s00402-025-05917-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Dynamic valgus is a well-known risk factor for ACL injury. To date, there are no studies on the question of whether patients after harvesting of a semitendinosus tendon for reconstruction of the ACL are more likely to have a valgus knee movement than patients after harvesting of a quadriceps tendon graft.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis/purpose: &lt;/strong&gt;Hypothesis of the present study is that patients with a semitendinosus tendon graft land a drop jump with more in valgus than patients with a quadriceps tendon graft.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Controlled Laboratory Study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who underwent ACL reconstruction were divided into 2 groups: Group 1 received the semitendinosus tendon, and Group 2 received the quadriceps tendon with bone block as a graft. Approximately 8 months post-surgery, various jump tests and strength tests were conducted. The primary outcome was the maximum valgus during landing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the vertical drop jump, the maximal valgus angle was - 2.4° (IQR-11.3°-3.4°) in the ST group in comparison to 3.5° (IQR-9.1°-6.3°) in the QT group. This difference was statistically significant (p = 0.027). In both groups there was no significant difference in the maximal valgus angle between the operated and the contralateral side.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The results of the present study confirm our hypothesis, that patients with quadricps tendon graft land with a lower valgus angle than after harvesting the semitendinosus tendon.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;The study demonstrates for the first time that patients with a semitendinosus graft exhibit a higher valgus angle during drop jump landings compared to patients with a quadriceps tendon graft. This represents a potential increased risk factor for recurrent ACL ruptures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known about the subject: &lt;/strong&gt;Previous studies have explored the outcomes associated with quadriceps and hamstring tendons in ACL reconstruction. While both graft types have shown favorable outcomes in terms of knee stability and functional recovery, there have been discussions regarding the potential risk factors for graft failure or re-rupture between these graft types. Previous research has suggested that the hamstring tendons play an important role for the stabilization of the knee joint against valgus stress and it has been shown that the dynamic valgus is an important risk factor for ACL injury. However, the existing literature has not provided conclusive evidence regarding differences in dynamic valgus of the knee during single leg jump tasks between both graft types. Thus, the current study aims to address this gap in knowledge by directly comparing the valgus angles during drop jump landings between patients who received a semitendinosus tendon graft and those who received a quadriceps tendon graft with a bone block. By elucidating any potential differences in biomecha","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"377"},"PeriodicalIF":2.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the anatomical positions of the femoral nerve and artery in the lateral and supine positions: a multicenter retrospective study.","authors":"Ryuichiro Okuda, Tomonori Tetsunaga, Kazuki Yamada, Tomoko Tetsunaga, Takashi Koura, Tomohiro Inoue, Yasutaka Masada, Tetsuya Yamamoto, Shin Matsumoto, Hisanori Ikuma, Tadashi Komatsubara, Yuki Okazaki, Toshifumi Ozaki","doi":"10.1007/s00402-025-05968-9","DOIUrl":"10.1007/s00402-025-05968-9","url":null,"abstract":"<p><strong>Introduction: </strong>Femoral nerve palsy and femoral artery injury are serious complications of total hip arthroplasty. However, few studies have compared the anatomical positions of these structures in different patient positions. This study aimed to compare the anatomical positions of the femoral nerve and artery in the lateral and supine positions.</p><p><strong>Materials and methods: </strong>This multicenter retrospective study included 111 patients who underwent lateral and supine computed tomography (CT) from 2016 to 2023. CT images were reconstructed in the anterior pelvic plane. The horizontal distance from the anterior margin of the acetabulum to the femoral nerve (Distance N) and femoral artery (Distance A) was measured. The difference in Distance N between the two positions (ΔLateral-supine Distance N) was calculated by subtracting the supine value from the lateral value.</p><p><strong>Results: </strong>The average Distance N was 26.5 ± 5.1 mm in the lateral position and 21.1 ± 4.4 mm in the supine position, with the nerve located significantly closer to the acetabulum in the supine position (P < 0.001). Similarly, the average Distance A was 26.8 ± 5.4 mm in the lateral position and 20.4 ± 4.9 mm in the supine position (P < 0.001). Multiple regression analysis showed that Distance N in the lateral position was significantly shorter in female patients and those with low body weight. In addition, low body weight correlated with a smaller ΔLateral-supine Distance N.</p><p><strong>Conclusions: </strong>The femoral nerve and artery are located closer to the anterior margin of the acetabulum in the supine position than in the lateral position. Low body weight was an independent predictor of shorter Distance N in both positions and a smaller ΔLateral-supine Distance N. These findings underscore the importance of considering patient positioning during total hip arthroplasty, particularly in patients with low body weight, to reduce neurovascular risks.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"373"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641620","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":"No meaningful clinical differences in patient reported outcome scores for Native Hawaiian/Pacific Islanders following knee or hip arthroplasty.","authors":"Saskia Leonard, Mark Lindquist, Brent Shimoda, Rachel Pai, Rosana H Weldon, Jeanae M Kaneshiro, Cass K Nakasone","doi":"10.1007/s00402-025-05980-z","DOIUrl":"10.1007/s00402-025-05980-z","url":null,"abstract":"<p><strong>Background: </strong>Most studies investigating the influence of race on patient reported outcomes (PROs) compare Black and/or Hispanic patients to White patients. Few have examined differences in PROs between Native Hawaiian/Pacific Islander (NHPI), Asian, and White patients, which comprise most of the population of Hawai'i. The purpose of this study was to examine differences in perioperative PROs between NHPI, Asian, and White patients and discuss observed outcome disparities if present.</p><p><strong>Methods: </strong>A retrospective evaluation of Asian, White and NHPI patients undergoing elective, unilateral total hip (THA) or total knee arthroplasty (TKA) between April 2019 and April 2023 was performed. Patient demographics, Charlson Comorbidity Index (CCI), Patient-Reported Outcomes Measurement Information System (PROMIS) global physical health (GPH) and global mental health (GMH), patient satisfaction, and Hip/Knee Disability and Osteoarthritis Outcome Score for Joint replacement (H/KOOS JR) were collected. Analysis of variance and chi-square tests were performed to detect differences between racial groups.</p><p><strong>Results: </strong>NHPI patients had the highest average body mass index (BMI, kg/m²) and the largest proportion of patients classified as obese for both surgical groups. NHPI patients also reported the lowest preoperative H/KOOS JR, PROMIS GPH, and PROMIS GMH scores compared to Asian and White patients. However, by 1 year post surgery, there were no significant differences in H/KOOS JR and PROMIS GPH amongst NHPI, Asian and White patients. PROMIS GMH was not significantly different for TKA patients at 1 year post surgery, but was significantly different for THA patients, with NHPIs reporting the lowest scores.</p><p><strong>Conclusion: </strong>NHPI patients undergoing TKA and THA reported poorer preoperative scores but achieved similar outcomes as Asian and White patients following surgery. Lower preoperative scores may be due to higher levels of obesity in NHPI patients, but these factors do not seem to be predictive of poorer outcomes.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"376"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartphone-based digital templating using presentation software enhances accuracy in equalizing leg length and femoral offset during bipolar hemiarthroplasty for femoral neck fracture.","authors":"Anuwat Pongkunakorn, Siravat Teerasukakul, Siripong Tahwang, Wongsapat Prayatkul","doi":"10.1007/s00402-025-05976-9","DOIUrl":"https://doi.org/10.1007/s00402-025-05976-9","url":null,"abstract":"<p><strong>Background: </strong>Restoring femoral offset (FO) and equalizing leg lengths are essential for optimal outcomes and preventing leg length discrepancy (LLD) in bipolar hemiarthroplasty (BHA) for femoral neck fractures (FNF) in elderly patients. However, evidence on the benefits of digital templating remains limited. This study evaluates the accuracy of a smartphone-based digital templating method for equalizing leg length and FO in BHA compared to the conventional intraoperative method.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 210 patients aged ≥ 60 years with FNF who underwent BHA between June 2018 and May 2023. The templating group (n = 70) used preoperative digital templating with Keynote presentation software on an iPhone, incorporating femoral prosthesis templates. The conventional group (n = 140) relied on intraoperative visual estimation, palpation, and the shuck test. Postoperative LLD and FO differences were assessed radiographically.</p><p><strong>Results: </strong>The mean patient age was 74.9 ± 7.3 years (range: 60-95), with 180 (85.7%) women. The templating group achieved a mean LLD of 1.8 ± 3.5 mm (range: -5.6 to 10.2 mm), significantly better than 3.5 ± 5.5 mm (range: -10.9 to 18.4 mm) in the conventional group (p = 0.023). LLD within ± 6 mm was observed in 87.1% (61 cases) of the templating group versus 59.3% (83 cases) in the conventional group (p < 0.001). FO differences averaged 0.8 ± 2.6 mm (range: -7.2 to 6.1 mm) in the templating group, compared to -0.8 ± 3.7 mm (range: -9.8 to 5.7 mm) in the conventional group (p = 0.005). FO differences within ± 5 mm occurred in 92.9% (65 cases) of the templating group versus 82.1% (115 cases) in the conventional group (p = 0.038).</p><p><strong>Conclusions: </strong>The smartphone-based digital templating method using presentation software enhances the accuracy of leg length and FO equalization during BHA for elderly FNF patients, offering significant advantages over conventional techniques.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"374"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glenoid morphology in patients undergoing reverse total shoulder arthroplasty due to fracture.","authors":"Jackson S Hamersly, Mason D Tippy, James E Slaven, Yohan Jang, Lauren M Ladd, Mark T Dillon","doi":"10.1007/s00402-025-05977-8","DOIUrl":"10.1007/s00402-025-05977-8","url":null,"abstract":"<p><strong>Introduction: </strong>Glenoid morphology in patients undergoing reverse total shoulder arthroplasty (rTSA) due to arthritis has been previously studied; however, it has not been as thoroughly evaluated in fracture populations. The purpose of this study is to utilize pre-operative computed tomography (CT) scans to better understand the glenoid anatomy of those patients undergoing rTSA due to fracture.</p><p><strong>Materials and methods: </strong>Patients over the age of 18 who underwent rTSA for proximal humerus fractures from January 1, 2015 to October 31, 2023 at two university health system affiliated hospitals were included if they had a CT scan available for review and image reconstruction. Patients were excluded if a pathologic fracture was identified, surgery was performed greater than 6 weeks after the initial injury, surgery was a conversion or revision surgery, or if a glenoid fracture was present. Glenoid version and reverse shoulder arthroplasty (RSA) angles were measured by a musculoskeletal fellowship-trained radiologist and a shoulder and elbow fellowship-trained orthopaedic surgeon and averaged for final values. Glenoid morphologies were determined using the Walch and Favard classifications.</p><p><strong>Results: </strong>A total of 53 patients with a mean age of 70.4 years (range 36.6-91.2) were included in this study, 84.9% of which were female. Walch A1 glenoid morphology was noted in 92.5% of patients, and Favard E0 morphology was present in 98.1% of patients. Median glenoid version was 3° of retroversion. Median RSA angle was 19°. Of note, 37.7% of patients had a RSA angle of ≥ 20°.</p><p><strong>Conclusions: </strong>Patients undergoing rTSA for fracture may not have significant glenoid deformity from arthritic wear. However, surgeons should be aware of variations in glenoid version and RSA angle. In this study population, over one-third of patients had a RSA angle of ≥ 20°. Thus, surgeons should take these findings into account when performing rTSA for fracture.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"375"},"PeriodicalIF":2.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641621","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 biomechanical evaluation of the U-shaped lumbopelvic stabilization technique in treating unstable sacral fractures.","authors":"Dennis Nebel, Manuel Ferle, Thorben Schulz, Bastian Welke, Tilman Graulich, Sebastian Decker","doi":"10.1007/s00402-025-05988-5","DOIUrl":"10.1007/s00402-025-05988-5","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbopelvic fixation is commonly employed to stabilize unstable sacral fractures, particularly U-shaped (US) fractures, which may result in spinopelvic dissociation-leading to significant pain, deformity, and neurological deficits. Due to its superior biomechanical properties, lumbopelvic stabilization (LPS) has become the preferred method for managing such injuries. We aimed to compare the biomechanical stability of US-LPS with conventional LPS and bilateral iliosacral screw (ISS) fixation.</p><p><strong>Materials and methods: </strong>Six human cadaveric pelvic specimens were subjected to axial (750 N) and torsional (8 Nm) loading using a material testing machine (MTM). Seven configurations of LPS were evaluated. The range of motion (ROM) between three anatomical bony segments-the third lumbar vertebral body (LBV3), the first sacral vertebral body (SVB1), and the Crista Iliaca (CI)-was analyzed using an optical tracking system. Measurements included craniocaudal translation and anterior-posterior tilt under axial loading and internal-external rotation under torsional loading. Stiffness was calculated using force-displacement curves obtained via the MTM's integrated load cells and displacement transducers.</p><p><strong>Results: </strong>Both LPS and US-LPS configurations demonstrated reduced ROM and increased stiffness compared to ISS fixation under axial and torsional loading. US-LPS exhibited marginally greater stiffness than standard LPS. The use of additional cross-connectors in both LPS groups had minimal to no measurable impact on ROM or overall stability.</p><p><strong>Conclusions: </strong>US-LPS offers slightly enhanced biomechanical stability over conventional LPS in the fixation of unstable US sacral fractures. In contrast, standalone ISS fixation did not improve stability compared to the unfixed condition in this cadaveric model.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"372"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12255570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616089","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":"Extensor mechanism disruption following primary and revision total knee arthroplasty: a systematic review and meta-analysis.","authors":"Ashok Rajgopal, Kalpana Aggarwal, Saksham Tripathi","doi":"10.1007/s00402-025-05991-w","DOIUrl":"10.1007/s00402-025-05991-w","url":null,"abstract":"<p><strong>Background: </strong>Extensor mechanism disruption (EMD) following total knee arthroplasty (TKA) is a rare but debilitating complication, with an incidence ranging from 0.1 to 2.5%. This condition requires surgical management, either by direct repair or reconstruction using various graft options. Existing literature reports inconsistent outcomes and high complication rates.</p><p><strong>Methods: </strong>A comprehensive search of MEDLINE and Cochrane database (1990-2024) identified studies on EMD management. Studies of Evidence Levels I-IV with a minimum 6 months follow-up, and clear reporting of interventions for EMD were analysed. Data extraction focused on patient demographics, treatment options, and outcomes such as failure rates, complications, extensor lag, range of motion, and ambulation status. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) checklist for non-randomized studies.</p><p><strong>Results: </strong>A total of 32 studies (655 reconstruction cases, 119 repair cases) were included. Reconstruction options using allografts and synthetic mesh showed comparable failure rates (~ 32%). Direct repairs of quadriceps and patellar tendons demonstrated a failure rate of 33.9% and 63% respectively. Autograft reconstruction options reported no failures but were underrepresented. Extensor lag varied across groups, with autografts demonstrating the least extensor lag (5°). Ambulation status improved postoperatively in successful cases. Complications such as periprosthetic joint infections (PJI) were prevalent in failed cases (39-44%).</p><p><strong>Conclusion: </strong>EMD after TKA, managed with reconstruction using allografts or synthetic mesh yielded similar outcomes. Autografts and medial gastrocnemius flaps showed better outcomes in a limited cohort. Larger prospective studies, are needed to address the heterogeneity in outcomes and reporting.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"371"},"PeriodicalIF":2.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}