Debra Marvel,Jodi L Gallant,Sarah MacRae,Sheila Sprague
{"title":"A Second Trauma: Navigating Infection After Orthopaedic Surgery.","authors":"Debra Marvel,Jodi L Gallant,Sarah MacRae,Sheila Sprague","doi":"10.2106/jbjs.25.00921","DOIUrl":"https://doi.org/10.2106/jbjs.25.00921","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"69 1","pages":"2512-2515"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Objective Ignorance: A Flaw in Our Ability to Predict Patient Outcomes.","authors":"Frederick A Matsen","doi":"10.2106/jbjs.25.00638","DOIUrl":"https://doi.org/10.2106/jbjs.25.00638","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"107 1","pages":"2508-2511"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Open Fractures: Still Risky After All These Years: Commentary on an article by Roman M. Natoli, MD, PhD, et al.: \"Infection and Nonunion Rates in Open Fractures. Description of 6,042 Fractures from the FLOW and PREP-IT Trials\".","authors":"Thomas A DeCoster","doi":"10.2106/jbjs.25.00175","DOIUrl":"https://doi.org/10.2106/jbjs.25.00175","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"31 1","pages":"2488-2489"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicolas S Piuzzi,Irene K Sigmund,Pablo A Slullitel,Nicolaas Budhiparama,Laurens Manning,Anabelle Visperas,Javad Parvizi
➢ The rate of periprosthetic joint infection (PJI) is rising globally, with substantial regional variability, and PJI has 5-year mortality rates of 15% to 25%, which exceed those of early-stage breast and prostate cancer and rival those of colorectal and hematologic malignancies.➢ Diagnostic criteria, including synovial fluid analysis, novel culture techniques, and molecular techniques, have improved in accuracy. However, infections caused by fastidious, biofilm-forming microorganisms continue to pose a major diagnostic challenge worldwide.➢ While patient selection remains critical for successful outcomes, the use of DAIR (debridement, antibiotics, and implant retention), 1-stage, 2-stage, and 1.5-stage procedures varies across regions and is often influenced by logistical constraints, resource availability, and clinical expertise. In parallel, discordant definitions of treatment success in the literature hinder comparative research and outcome benchmarking. A tiered framework-encompassing infection eradication, surgical burden, joint function, and patient-reported outcomes-offers a path toward standardized and clinically meaningful reporting.➢ Advances in immunogenetics, artificial intelligence-driven risk modeling, and precision medicine, alongside the emergence of research consortia and global collaborations, are opening new frontiers in treatment strategies and creating opportunities for innovative, individualized approaches to PJI management.
{"title":"Global Perspectives on the Management of Periprosthetic Joint Infection.","authors":"Nicolas S Piuzzi,Irene K Sigmund,Pablo A Slullitel,Nicolaas Budhiparama,Laurens Manning,Anabelle Visperas,Javad Parvizi","doi":"10.2106/jbjs.25.00775","DOIUrl":"https://doi.org/10.2106/jbjs.25.00775","url":null,"abstract":"➢ The rate of periprosthetic joint infection (PJI) is rising globally, with substantial regional variability, and PJI has 5-year mortality rates of 15% to 25%, which exceed those of early-stage breast and prostate cancer and rival those of colorectal and hematologic malignancies.➢ Diagnostic criteria, including synovial fluid analysis, novel culture techniques, and molecular techniques, have improved in accuracy. However, infections caused by fastidious, biofilm-forming microorganisms continue to pose a major diagnostic challenge worldwide.➢ While patient selection remains critical for successful outcomes, the use of DAIR (debridement, antibiotics, and implant retention), 1-stage, 2-stage, and 1.5-stage procedures varies across regions and is often influenced by logistical constraints, resource availability, and clinical expertise. In parallel, discordant definitions of treatment success in the literature hinder comparative research and outcome benchmarking. A tiered framework-encompassing infection eradication, surgical burden, joint function, and patient-reported outcomes-offers a path toward standardized and clinically meaningful reporting.➢ Advances in immunogenetics, artificial intelligence-driven risk modeling, and precision medicine, alongside the emergence of research consortia and global collaborations, are opening new frontiers in treatment strategies and creating opportunities for innovative, individualized approaches to PJI management.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"10 1","pages":"2521-2528"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Consensus Recommendations and Insights on Infection: Commentary on an article by the International Consensus Meeting Executive Committee: \"International Consensus Meeting on Infection. Top 10 Evidence-Backed Recommendations and Insights\".","authors":"Emil H Schemitsch","doi":"10.2106/jbjs.25.01070","DOIUrl":"https://doi.org/10.2106/jbjs.25.01070","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"71 1","pages":"2486-2487"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDIntravenous corticosteroids have been used to manage pain following total knee arthroplasty (TKA). Oral dexamethasone has good bioavailability and is suitable for ambulatory TKA. This study investigated the efficacy and dose-response relationship of oral dexamethasone in pain control after TKA.METHODSIn this randomized controlled trial, 120 Thai patients (mean, 68 ± 8 years; 86% female) undergoing primary TKA were allocated to 1 of 3 groups: 16 mg of oral dexamethasone (DEX-16), 8 mg of oral dexamethasone (DEX-8), or placebo. Dexamethasone or placebo was administered once daily, in the morning before surgery and the morning of the first 4 postoperative days. The primary outcome was pain at rest and during motion, measured over time. Linear mixed-effects modeling was used to compare outcomes between groups.RESULTSBoth DEX-8 and DEX-16 significantly reduced pain at rest within 48 hours postoperatively compared with placebo (p < 0.05). However, only DEX-16 significantly reduced pain during motion (p < 0.05). At 48 hours postoperatively, the DEX-16 group showed approximately 50% reductions in pain at rest (p < 0.001) and during motion (p = 0.006) relative to placebo.CONCLUSIONSOral dexamethasone was effective in reducing pain after TKA, with a 16-mg dose providing superior pain relief during motion, compared with an 8-mg dose, within the first 48 hours. These findings support the use of oral dexamethasone as part of multimodal pain management, particularly in an ambulatory TKA setting.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Oral Corticosteroids Reduce Pain After Total Knee Arthroplasty: A Higher Dose of Dexamethasone Effectively Controlled Pain During Motion: A Dose-Response Randomized Placebo-Controlled Trial.","authors":"Supakit Kanitnate,Yot Tanariyakul,Pattaranatcha Charnwichai,Pimjai Anthanont,Sudsayam Manuwong,Nattapol Tammachote","doi":"10.2106/jbjs.25.00642","DOIUrl":"https://doi.org/10.2106/jbjs.25.00642","url":null,"abstract":"BACKGROUNDIntravenous corticosteroids have been used to manage pain following total knee arthroplasty (TKA). Oral dexamethasone has good bioavailability and is suitable for ambulatory TKA. This study investigated the efficacy and dose-response relationship of oral dexamethasone in pain control after TKA.METHODSIn this randomized controlled trial, 120 Thai patients (mean, 68 ± 8 years; 86% female) undergoing primary TKA were allocated to 1 of 3 groups: 16 mg of oral dexamethasone (DEX-16), 8 mg of oral dexamethasone (DEX-8), or placebo. Dexamethasone or placebo was administered once daily, in the morning before surgery and the morning of the first 4 postoperative days. The primary outcome was pain at rest and during motion, measured over time. Linear mixed-effects modeling was used to compare outcomes between groups.RESULTSBoth DEX-8 and DEX-16 significantly reduced pain at rest within 48 hours postoperatively compared with placebo (p < 0.05). However, only DEX-16 significantly reduced pain during motion (p < 0.05). At 48 hours postoperatively, the DEX-16 group showed approximately 50% reductions in pain at rest (p < 0.001) and during motion (p = 0.006) relative to placebo.CONCLUSIONSOral dexamethasone was effective in reducing pain after TKA, with a 16-mg dose providing superior pain relief during motion, compared with an 8-mg dose, within the first 48 hours. These findings support the use of oral dexamethasone as part of multimodal pain management, particularly in an ambulatory TKA setting.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDCapitellar osteochondritis dissecans (OCD) is common in adolescent throwing athletes. Surgical treatment yields favorable clinical outcomes. However, the relationship between bone density and clinical outcomes following OCD treatment is not well understood. We hypothesized that surgery normalizes subchondral bone density distribution and that clinical outcome improvements correlate with the bone density changes. This study quantitatively analyzed these changes and compared different surgical techniques.METHODSFifty-one male ethnic Japanese patients with capitellar OCD treated surgically (mean age at surgery: 14.0 ± 1.6 years) were enrolled, with a mean follow-up of 6.7 ± 3.1 years (mean age at final evaluation: 20.7 ± 3.5 years). Subchondral bone density was measured in Hounsfield units using computed tomography preoperatively and postoperatively, as well as in the contralateral elbow. Relative bone densities, expressed as proportions, in the distal humerus, radial head, and proximal ulna were compared among the preoperative, postoperative, and contralateral elbows within their respective anatomical subregions. Subgroups with reconstruction procedures and with preservation procedures were also analyzed separately. Functional outcome changes using Timmerman-Andrews scores were correlated with bone density changes.RESULTSIn the distal humerus, subchondral bone density at the OCD lesion was significantly lower preoperatively (0.99 ± 0.17) than postoperatively (1.19 ± 0.17, p < 0.001) and in the contralateral elbow (1.17 ± 0.13, p < 0.001), whereas the density of the surrounding sclerotic bone was higher preoperatively (1.24 ± 0.10) than postoperatively (1.14 ± 0.10, p < 0.001) and in the contralateral elbow (1.07 ± 0.08, p < 0.001). The regions within and outside the site of the OCD lesion exhibited similar density distribution patterns postoperatively and in the contralateral elbow. In the radial head, the highest density was in the radial-volar quadrant preoperatively (1.14 ± 0.14) but shifted to the ulnar-volar quadrant postoperatively (1.06 ± 0.12, p = 0.020) and matched the contralateral value (1.02 ± 0.10, p < 0.001). Patterns in subchondral bone density in the regions were comparable between the reconstruction and preservation groups across all conditions. Improvements in Timmerman-Andrews scores correlated moderately with bone density normalization at the lesion site (R = 0.49, p = 0.003) and surrounding sclerotic bone (R = 0.43, p = 0.010).CONCLUSIONSSurgical treatment of capitellar OCD effectively restored the subchondral bone density distribution to normal patterns, regardless of the surgical technique. These bone density changes moderately correlated with improvements in functional outcome, providing quantitative evidence supporting the efficacy of surgical intervention for advanced lesions.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Normalization of Subchondral Bone Density Patterns After Surgical Treatment for Capitellar Osteochondritis Dissecans: A Quantitative Analysis.","authors":"Satoshi Miyamura,Ko Temporin,Yuji Miyoshi,Ryoya Shiode,Toru Iwahashi,Seiji Okada,Kunihiro Oka,Hiroyuki Tanaka,Tsuyoshi Murase,Kozo Shimada","doi":"10.2106/jbjs.25.00212","DOIUrl":"https://doi.org/10.2106/jbjs.25.00212","url":null,"abstract":"BACKGROUNDCapitellar osteochondritis dissecans (OCD) is common in adolescent throwing athletes. Surgical treatment yields favorable clinical outcomes. However, the relationship between bone density and clinical outcomes following OCD treatment is not well understood. We hypothesized that surgery normalizes subchondral bone density distribution and that clinical outcome improvements correlate with the bone density changes. This study quantitatively analyzed these changes and compared different surgical techniques.METHODSFifty-one male ethnic Japanese patients with capitellar OCD treated surgically (mean age at surgery: 14.0 ± 1.6 years) were enrolled, with a mean follow-up of 6.7 ± 3.1 years (mean age at final evaluation: 20.7 ± 3.5 years). Subchondral bone density was measured in Hounsfield units using computed tomography preoperatively and postoperatively, as well as in the contralateral elbow. Relative bone densities, expressed as proportions, in the distal humerus, radial head, and proximal ulna were compared among the preoperative, postoperative, and contralateral elbows within their respective anatomical subregions. Subgroups with reconstruction procedures and with preservation procedures were also analyzed separately. Functional outcome changes using Timmerman-Andrews scores were correlated with bone density changes.RESULTSIn the distal humerus, subchondral bone density at the OCD lesion was significantly lower preoperatively (0.99 ± 0.17) than postoperatively (1.19 ± 0.17, p < 0.001) and in the contralateral elbow (1.17 ± 0.13, p < 0.001), whereas the density of the surrounding sclerotic bone was higher preoperatively (1.24 ± 0.10) than postoperatively (1.14 ± 0.10, p < 0.001) and in the contralateral elbow (1.07 ± 0.08, p < 0.001). The regions within and outside the site of the OCD lesion exhibited similar density distribution patterns postoperatively and in the contralateral elbow. In the radial head, the highest density was in the radial-volar quadrant preoperatively (1.14 ± 0.14) but shifted to the ulnar-volar quadrant postoperatively (1.06 ± 0.12, p = 0.020) and matched the contralateral value (1.02 ± 0.10, p < 0.001). Patterns in subchondral bone density in the regions were comparable between the reconstruction and preservation groups across all conditions. Improvements in Timmerman-Andrews scores correlated moderately with bone density normalization at the lesion site (R = 0.49, p = 0.003) and surrounding sclerotic bone (R = 0.43, p = 0.010).CONCLUSIONSSurgical treatment of capitellar OCD effectively restored the subchondral bone density distribution to normal patterns, regardless of the surgical technique. These bone density changes moderately correlated with improvements in functional outcome, providing quantitative evidence supporting the efficacy of surgical intervention for advanced lesions.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Weight Loss After Joint Replacement: Fact or Fiction?: Commentary on an article by Daniel Karczewski, MD, et al.: \"Mean Body Mass Index Does Not Increase or Decrease at 10 Years After Primary Total Hip or Knee Arthroplasty\".","authors":"Lisa C Howard","doi":"10.2106/jbjs.25.01006","DOIUrl":"https://doi.org/10.2106/jbjs.25.01006","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"123 1","pages":"e99"},"PeriodicalIF":0.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kanu Okike,Richard N Chang,Andrew S Fang,Cameron Sadeghi,Ronald A Navarro,Bobby Dezfuli,Kathryn E Royse,Brian H Fasig,Elizabeth W Paxton
BACKGROUNDWhile some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics.METHODSThis retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients ≥60 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk.RESULTSThe study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of ≥3). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of ≥3 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex.CONCLUSIONSIn this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
虽然一些先前的研究表明，在股骨粗隆间骨折的头髓内钉治疗中，螺旋刀片比拉力螺钉有更高的固定失败和切断的风险，但其他研究并没有显示任何这样的差异。本研究的目的是比较采用头髓内钉治疗老年髋部骨折患者的螺旋刀片和拉力螺钉固定的效果，并确定这两种固定方法的相对效果是否会因患者的特点而有所不同。方法：本回顾性队列研究利用综合医疗保健系统的髋部骨折登记，识别2009年至2023年期间接受螺旋刀片或螺钉头髓内钉治疗的≥60岁患者。使用倾向评分加权Cox比例风险回归来评估无菌翻修的风险（主要结局指标）和特定原因翻修的风险（次要结局指标），死亡率被认为是一个竞争风险。结果共纳入22308例患者，其中螺旋刀11877例，螺钉10431例，平均年龄81.7岁，女性占71.5%，白人占73.3%，美国麻醉医师学会（ASA）分级≥3级者占71.8%。螺旋刀组10年累积无菌翻修发生率为1.69% (n = 194)，螺钉组为1.88% (n = 182)（校正风险比[HR] 0.87； 95%可信区间[CI] 0.69 ~ 1.11; p = 0.27）。有证据表明，ASA分级对疗效有改善作用，在ASA为1 ~ 2的患者中，螺旋刀片优于螺钉（无菌改良发生率1.74%比2.56%；校正HR 0.65; 95% CI 0.43 ~ 0.98; p = 0.04），而在ASA≥3的患者中则没有效果（无菌改良发生率1.72%比1.64%；校正HR 1.03; 95% CI 0.78 ~ 1.35; p = 0.85）。没有证据表明年龄或性别对效果有影响。结论：在本研究中，采用头髓内钉治疗的老年髋部骨折患者，螺旋刀片和拉力螺钉固定的总体效果相似。我们发现螺旋刀片固定在健康（ASA 1 - 2）的老年患者中可能表现更好，这是有趣的，值得进一步研究。证据水平：治疗性三级。有关证据水平的完整描述，请参见作者说明。
{"title":"Helical Blade Versus Lag Screw Fixation in the Cephalomedullary Nailing of Geriatric Hip Fractures.","authors":"Kanu Okike,Richard N Chang,Andrew S Fang,Cameron Sadeghi,Ronald A Navarro,Bobby Dezfuli,Kathryn E Royse,Brian H Fasig,Elizabeth W Paxton","doi":"10.2106/jbjs.25.00294","DOIUrl":"https://doi.org/10.2106/jbjs.25.00294","url":null,"abstract":"BACKGROUNDWhile some prior research has shown helical blades to have higher risks of fixation failure and cut-out than lag screws in the cephalomedullary nailing of intertrochanteric femoral fractures, other studies have not demonstrated any such differences. The purpose of this study was to compare the performance of helical blade and lag screw fixation among older patients with a hip fracture treated with cephalomedullary nailing and to determine whether the relative performance of these 2 fixation methods varies on the basis of patient characteristics.METHODSThis retrospective cohort study utilized the hip fracture registry of an integrated health-care system to identify patients ≥60 years old who underwent cephalomedullary nailing with a helical blade or lag screw from 2009 to 2023. Propensity score-weighted Cox proportional hazards regression was used to evaluate the risk of aseptic revision (the primary outcome measure) and the risks of revision for specific reasons (the secondary outcome measures), with mortality considered as a competing risk.RESULTSThe study sample included 22,308 cases (11,877 with a helical blade and 10,431 with a lag screw; mean patient age, 81.7 years; 71.5% female; 73.3% White; 71.8% with an American Society of Anesthesiologists [ASA] classification of ≥3). The 10-year cumulative incidence of aseptic revision was 1.69% (n = 194) in the helical blade group and 1.88% (n = 182) in the lag screw group (adjusted hazard ratio [HR], 0.87; 95% confidence interval [CI], 0.69 to 1.11; p = 0.27). There was evidence of effect modification by ASA classification, with the helical blade outperforming the lag screw in patients with an ASA of 1 to 2 (aseptic revision incidence, 1.74% versus 2.56%; adjusted HR, 0.65; 95% CI, 0.43 to 0.98; p = 0.04) but not in those with an ASA of ≥3 (aseptic revision incidence, 1.72% versus 1.64%; adjusted HR, 1.03; 95% CI, 0.78 to 1.35; p = 0.85). There was no evidence of effect modification by age or sex.CONCLUSIONSIn this study of geriatric patients with a hip fracture treated with cephalomedullary nailing, helical blade and lag screw fixation performed similarly overall. Our finding that helical blade fixation may perform better in healthier (ASA 1 to 2) geriatric patients is interesting and deserves further investigation.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eve R Glenn,Brienna K Buchanan,Grace Q Chen,Ysa Le,Samalya Thenuwara,Dawn M LaPorte,Richard A Schaefer
{"title":"Appreciating the Role of Narrative Medicine in Orthopaedic Surgery.","authors":"Eve R Glenn,Brienna K Buchanan,Grace Q Chen,Ysa Le,Samalya Thenuwara,Dawn M LaPorte,Richard A Schaefer","doi":"10.2106/jbjs.25.00486","DOIUrl":"https://doi.org/10.2106/jbjs.25.00486","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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