International Orthopaedics最新文献

Background: Femoroacetabular impingement affects 14%-17% of young adults; nonoperative physiotherapy has demonstrated outcomes comparable to surgery in selected cohorts. However, age-specific treatment responses remain poorly defined, impeding evidence-based management across age cohorts.

Methods: We conducted a prospective observational cohort study of 120 participants with femoroacetabular impingement at three specialized centres. Participants were stratified into adolescent (≤ 18 years; n = 60) and adult (19-45 years; n = 60) cohorts, each receiving standardized physiotherapy over six months. The primary outcome was a change in the International Hip Outcome Tool-33 score at six months. Secondary outcomes included Hip Outcome Score subscales, biomechanical measures, and return-to-sport rates assessed at six and 12 months. Statistical analysis employed two-sample t-tests and chi-square tests with a two-sided α = 0.025 for primary outcomes.

Results: At six months, adolescents achieved significantly higher International Hip Outcome Tool-33 scores (72.4 ± 18.3 vs. 61.8 ± 19.7; difference, 10.6 points (95% CI, 3.2-18.0); p = 0.006 and faster time to clinically meaningful improvement (8.2 ± 4.1 vs. 10.7 ± 5.3 weeks; p = 0.012). Adolescents demonstrated superior Hip Outcome Score Activities of Daily Living (88.3 ± 14.2 vs. 82.1 ± 16.8; p = 0.037), modified Harris Hip Scores (85.7 ± 12.8 vs. 79.3 ± 15.2; p = 0.007), and hip range of motion. Return-to-sport rates favored adolescents at 12 months (89.6% vs. 77.6%). Advantages persisted throughout the 12-month follow-up.

Conclusions: Adolescent femoroacetabular impingement patients demonstrate superior functional recovery trajectories compared to adults following nonoperative physiotherapy management. These findings support age-stratified treatment algorithms and suggest more favorable prognoses for younger patients pursuing conservative management.

Background: Essex-Lopresti injuries, defined by a combination of radial head fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) disruption, result in forearm longitudinal instability, ulnar-positive variance, pain, and loss of rotation. Although radial head replacement (RHR) is commonly performed, the biomechanical contribution of IOM reconstruction remains controversial. This study quantified the relationship between sequential disruption of forearm stabilizers and resultant longitudinal and rotational instability, and evaluated the extent to which RHR with IOM reconstruction restores forearm stability.

Methods: Ten fresh-frozen cadaveric forearms underwent sequential sectioning of the proximal radioulnar joint (PRUJ), DRUJ, partial and complete IOM, and radial head, followed by anatomic, overstuffed, and understuffed RHR with IOM reconstruction. Rotational motion was assessed using a custom jig and goniometer, while longitudinal displacement under axial load was measured using a materials testing machine. Data were analyzed with paired t-tests and repeated-measures ANOVA.

Results: Sequential sectioning significantly increased both rotation and longitudinal translation. Total forearm rotation expanded from 84° (intact) to 171° (complete injury; p < 0.001), primarily due to increased supination. Longitudinal displacement rose by ~ 30% after PRUJ/DRUJ injury, 100% after partial IOM sectioning, 200% after complete IOM disruption, and 435% following radial head removal (p < 0.001). RHR with IOM reconstruction restored near-normal rotation (90°, p = 0.518 vs. intact) and axial displacement (neutral, 4.37 mm; supination, 6.34 mm; p = 1.000 vs. intact). Overstuffed RHR restricted rotation, while understuffed RHR showed no significant difference from intact.

Conclusions: RHR combined with IOM reconstruction effectively restores forearm rotational and longitudinal stability in Essex-Lopresti injuries.

Purpose: To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

Methods: Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

Results: All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

Conclusion: Two-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise.

Registry: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.

Purpose: The goal of surgery for pelvic metastasis is pain-free reconstruction that enables daily activity without complications for the patient's remaining life. The purpose of our study was to assess complications, reoperations, functional outcomes, and survival in patients with pelvic metastasis treated with standard or dual mobility total hip arthroplasty (THA) and antiprotrusio cage.

Methods: We prospectively analyzed 36 patients with pelvic metastasis who underwent reconstruction with standard (n = 20) or dual mobility (n = 16) bearing THA and antiprotrusio cage between 2015 and 2024 at a single institution. We evaluated complications, reoperations, functional outcomes and survival.

Results: Infection occurred in five of 36 patients (14%): three patients required surgical debridement and two were managed with antibiotics. No dislocations were observed in both standard and dual mobility bearing groups. Local disease progression developed in seven of 36 patients (19%), with only one patient requiring acetabular revision at 63 months postoperatively. Survival of implant was 85.8% (95% CI 74.9%-98.2%) at one year after reconstruction. Median MSTS scores were 22.5 and 20.0 in the standard and dual mobility bearing groups, respectively (p = 0.564), with no difference in ambulation status. Patient survival was 77.7% (95% CI 65.2%-92.6%) at one year and 12.8% (95% CI 4.5%-36.1%) at five years.

Conclusion: Patients with pelvic metastasis treated with standard or dual mobility bearing THA with antiprotrusio cage may effectively restore painless function. Despite high risk of infection and local disease progression, no dislocation occurred, supporting this reconstruction as an acceptable surgical option for patients with pelvis metastasis who need surgical treatment.

Aim: Our primary aim was to describe the microbiology of long-bone non-unions after open fracture. Then, we sought to determine the clinical and biological factors associated with the risk of positive intraoperative tissue cultures and the outcome after non-union surgery.

Methods: We retrospectively selected patients > 18 years, who had a primary planned surgical treatment of long-bone non-union after diaphyseal open fracture, with no previous history of infection. Infection was confirmed when growth of the same micro-organism was observed from at least two bone/tissue samples obtained at the time of non-union surgery.

Results: From 2005 to 2021, 85 patients (64 males, 21 females) were included, with a mean age of 38.5 ± 15 years (18-75 years) at the time of non-union surgery. Anatomic regions included the tibia (58 cases), femur (21 cases), and humerus (6 cases). Cultures were positive in 29 cases (34%), including nine polymicrobial infections (31%), with coagulase-negative Staphylococcus species (n = 10) and Staphylococcus aureus (n = 9) being the most prevalent bacteria, followed by Cutibacterium acnes (n = 5), and Pseudomonas aeruginosa (n = 2). The risk of infection correlated with diabetes mellitus (p = 0.0017), the presence of a fistula (p = 0.001), and the type of index wound according to Cauchoix-Duparc (p = 0.03). The risk of postoperative complications and the need for additional surgery, notably for persistent non-union, were higher in patients with an infected non-union.

Conclusions: An underlying low-grade indolent infection was found in a third of cases of presumed aseptic long-bone non-union following an open fracture. The risk of infection was associated with diabetes mellitus, the presence of a fistula, and greater severity of the initial wound. In these cases, the risk of septic failure was almost three times higher as compared to patients with negative cultures.

Level of evidence: Retrospective study, Level III.

Purpose: This study quantifies the reproducibility of soft tissue laxity and gap measurements under manual stress, and implant positioning planning using the imageless ROSA^® robotic system, by comparing a senior high-volume surgeon with a low-volume resident.

Methods: In this single-centre prospective study, 17 patients undergoing robotic-assisted total knee arthroplasty were evaluated. Intra- and inter-operator variability was assessed by recording intraoperative measurements and planning outcomes using a standardized protocol for functional alignment (FA).

Results: Both intra and inter-operator analyses demonstrated good to excellent reproducibility (ICC > 0.75-0.9) for soft tissue and gap assessments. Minor variability was observed in planning parameters (ICC < 0.60), specifically stylus height, femoral flexion, and distal femoral resection, likely reflecting subjective adjustments by the high-volume surgeon.

Conclusion: High reproducibility in soft tissue measurements and surgical planning across surgeons with different experience levels is shown by the ROSA^® robotic system, while flexibility for individualized surgical strategies is retained.

This letter provides a critical commentary on the recent article by Hachadorian et al. entitled "Assessing glenoid orientation on the axillary view: a novel technique using the posterolateral acromion-to-coracoid line." The authors introduced the posterolateral acromion-to-coracoid (PLAC) line as a reproducible reference for assessing glenoid version on axillary radiographs, demonstrating excellent reliability and strong correlation with 3D CT measurements. We highlight the clinical significance of this technique as a cost-effective and radiation-sparing alternative for postoperative evaluation of glenoid orientation. Furthermore, we suggest extending validation to postoperative cases, quantifying projection-related errors, and exploring AI-assisted automation for landmark detection. This work represents a valuable step toward standardized radiographic assessment following shoulder arthroplasty.

Background: It remains unclear whether altered bone density may be a stability issue in stemless reverse shoulder arthroplasty (RSA).

Methods: This was a retrospective multicentric study. Patients with stemless RSA with two-year postoperative shoulder X-ray and clinical data were included. Measurement of proximal humeral cortical bone thickness (CBT avg) on postoperative radiography was used to assess bone density.

Results: 68 patients (mean age, 67.0 years) were included. CBT avg < 6 mm (osteoporosis) at two years was reported in 22.2% (2/9) of patients with humeral loosening and 35.6% (21/59) without humeral loosening (p = 0.7073). After adjustment for age and body mass index (BMI), CBT avg < 6 mm was not significantly associated with humeral loosening at two years (OR 0.37; 95% CI 0.04-2.21). Factors associated with humeral loosening vs. no humeral loosening at two years were BMI (24.2 vs. 27.9 kg/m²; p = 0.0131), cervico-diaphyseal angle < 140° at two years (66.7% vs. 16.9%; p = 0.0039) and lateralization of polyethylene (100% vs. 59.3%; p = 0.0217).

Conclusions: These results suggest that radiological evaluation of bone density does not predict early migration of stemless RSA implants. Some clinical factors such as BMI or implant configuration were associated to early implant migration, but never led to implant removal.

Purpose: To compare the clinical and functional outcomes of Ilizarov external fixation versus open reduction and internal fixation in the management of complex tibial plateau fractures.

Methods: A prospective, randomised comparative clinical study was conducted at two trauma centres including 40 adult patients with Schatzker types IV-VI tibial plateau fractures. Patients were randomly assigned to internal fixation (n = 20) or Ilizarov external fixation (n = 20).

Results: Patients in the external fixation group (Group B) started partial weight-bearing significantly earlier (mean 6.6 weeks) compared to the internal fixation group (Group A; mean 9.6 weeks; p = 0.002). Full weight-bearing was also achieved significantly sooner in Group B (mean 11 weeks) compared to Group A (mean 17.65 weeks; p < 0.001). Healing time, Knee Society Scores, pain, and range of motion were comparable.

Conclusion: Ilizarov external fixation facilitates earlier partial and full weight-bearing compared to internal fixation, with similar healing times and functional outcomes, suggesting its efficacy as an alternative to internal fixation for complex tibial plateau fractures.