Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Robot-assistance in revision thoracolumbar fusion surgeries – Prospective study of 64 patients","authors":"Balamurugan Thirugnanam ,&nbsp;Vidyadhara Srinivasa ,&nbsp;Abhishek Soni ,&nbsp;Akhil Xavier Joseph ,&nbsp;R Dinesh Iyer","doi":"10.1016/j.jcot.2025.103247","DOIUrl":"10.1016/j.jcot.2025.103247","url":null,"abstract":"<div><h3>Background</h3><div>Robot-assisted spine surgery is currently gaining popularity in thoracolumbar spine instrumentation because of enhanced precision and safety. Revision spine surgeries present unique challenges by virtue of abnormal anatomical bony landmarks, broken implants/bone cement in-situ and loose implant tracts, posing difficulties in re-implantation of screws. We evaluated the usefulness of Robot-assistance in Revision Spine Surgeries for varied pathologies.</div></div><div><h3>Methods</h3><div>We prospectively analysed 64 consecutive patients undergoing Revision Thoracolumbar Spine Instrumented Fusion Surgeries over one-year. The causes of revision surgery were broken implants (20), adjacent segment disease (19), revision deformity surgeries (12), surgical site infection with implant loosing (8) and failed back syndrome secondary to cement augmentation (5). The O-arm time, cut to close time, radiation dose, robot time, time per screw, operative time, blood loss, screw accuracy, and intraoperative complications were noted.</div></div><div><h3>Results</h3><div>Robot-assisted revision pedicle screw placement was successfully performed for 388 screws in 64 patients. The mean O-arm time was 10.3 ± 2.2 min, cut to close time was 157.9 ± 45.8 min, and radiation dose was 16.6 ± 3.7 mGy, robot time was 18.2 ± 3.7 min, time per screw was 3.1 ± 1.3 min, and blood loss was 538.8 ± 156.9 mL. No intraoperative complications were reported. Two out of 388 revised screws was misplaced without clinical implications</div></div><div><h3>Conclusions</h3><div>Robot-assisted revision thoracolumbar spine surgery offers alternate safe bony corridors for placement of screws in revision spine surgeries with loose/broken implants/bone cement with accuracy and safety. It demonstrated acceptable operative time, blood loss, and radiation exposure with high screw placement accuracy and no intraoperative complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103247"},"PeriodicalIF":0.0,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417750","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":"Machine-learning prediction of 90-day readmission following primary TKA: Insights from 2,123 cases in the Michigan arthroplasty registry","authors":"Usher Khan ,&nbsp;Zachary Crespi ,&nbsp;Fong Nham ,&nbsp;Chaoyang Chen ,&nbsp;Bryan Little ,&nbsp;Hussein Darwiche","doi":"10.1016/j.jcot.2025.103250","DOIUrl":"10.1016/j.jcot.2025.103250","url":null,"abstract":"<div><h3>Background</h3><div>Despite peri-operative advances, unplanned 90-day readmission after total knee arthroplasty (TKA) remains a costly quality metric. We leveraged statewide registry data and machine-learning analytics to quantify contemporary risk and uncover modifiable drivers.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed all primary TKAs performed between 2016 and 2024 at a MARCQI-participating academic hospital. Demographics, comorbidities, peri-operative factors, and medication use were compared between patients with and without 90-day readmission. A multilayer perceptron neural network (MPNN) incorporating 10 routinely collected variables (age, sex, race, marital status, length of stay [LOS], smoking, alcohol, bleeding disorder, prior DVT/PE, ASA class) was trained (70 %) and validated (30 %) to predict readmission; model performance was assessed by accuracy, AUC, and variable importance.</div></div><div><h3>Results</h3><div>Among 2123 TKAs, 86 patients (4.1 %) were readmitted. Compared with non-readmitted patients, those readmitted had higher ASA scores (2.92 ± 0.49 vs 2.72 ± 0.48), longer LOS (2.97 ± 1.43 vs 2.32 ± 1.30 days), more prior DVT/PE (11.9 % vs 5.8 %), and greater pre-operative opioid use (5.0 % vs 3.2 %) (all p ≤ .036). LOS (ρ = 0.10) ranked highest on correlation analysis, while home/self-care discharge correlated negatively (ρ = −0.06). The MPNN achieved 96.0 % accuracy and AUC 0.704; LOS was the strongest predictor (importance 100 %), followed by ASA class, race, prior DVT/PE, and bleeding disorders.</div></div><div><h3>Conclusions</h3><div>Although uncommon, 90-day readmission after primary TKA is chiefly associated with prolonged LOS, elevated ASA status, prior thromboembolism, opioid exposure, and non-home discharge. Targeted enhancements -- aggressive VTE prophylaxis, opioid-sparing analgesia, and streamlined discharge pathways promoting safe home return -- may further curb readmissions and related costs.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103250"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417749","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":"Precision of preoperative planning in medial opening wedge high tibial osteotomy: A retrospective study","authors":"Ana Suarez-Quintero ,&nbsp;Javier Olmedo Palma ,&nbsp;Ramon Alvarez de Manzaneda","doi":"10.1016/j.jcot.2025.103254","DOIUrl":"10.1016/j.jcot.2025.103254","url":null,"abstract":"<div><h3>Background</h3><div>Medial opening wedge high tibial osteotomy (HTO) is a valid treatment for unicompartmental osteoarthritis due to varus alignment. This study aimed to examine the relationships between preoperative planning, intraoperative opening, and postoperative measurements, focusing on the correction of the mechanical axis.</div></div><div><h3>Methods</h3><div>Radiological measurements, including HKA, mPTA, mLDFA, JLCA, and %WBL, were compared in 21 patients before and after surgery. The osteotomy size was calculated manually using the Miniaci method. A regression analysis determined which variables influenced successful correction (%WBL postoperative 45–55 %).</div></div><div><h3>Results</h3><div>The mean age was 40 years. The difference between the intraoperative opening and the Miniaci-calculated size was 0.45 ± 1.05 mm (p = 0.048). Postoperative corrections were significant for HKA, mMPTA, and %WBL (p &lt; 0.001). Preoperative HKA and Miniaci values negatively predicted successful correction.</div></div><div><h3>Conclusions</h3><div>The Miniaci method tends to underestimate intraoperative opening size, but still allows for sufficient correction of the mechanical axis to the joint center.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103254"},"PeriodicalIF":0.0,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417775","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":"Predictive variables influencing intraoperative blood loss during single-stage posterior spinal fusion in severe idiopathic scoliosis: Analysis of 126 cases","authors":"Y. Mihara ,&nbsp;S.Y. Lee ,&nbsp;C.Y.W. Chan ,&nbsp;C.K. Chiu ,&nbsp;M.S. Hasan ,&nbsp;M.K. Kwan","doi":"10.1016/j.jcot.2025.103248","DOIUrl":"10.1016/j.jcot.2025.103248","url":null,"abstract":"<div><h3>Background</h3><div>Despite the clinical importance, few studies have specifically addressed intraoperative blood loss in patients with severe idiopathic scoliosis undergoing posterior spinal fusion (PSF). Therefore, this study seeks to investigate independent predictors of intraoperative bleeding during single-stage PSF in this high-risk population.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 126 patients with severe IS (defined as a major Cobb angle ≥90°) who underwent single-stage PSF without osteotomy procedures. Key parameters collected included preoperative Cobb angle (Pre Cobb), postoperative Cobb angle (Post Cobb), correction rate (CR), side-bending Cobb angle (SB Cobb), side-bending flexibility (SBF), side-bending correction index (SBCI), total number of fusion levels, number of pedicle screws utilized, and operative time (Op Time). The estimated total intraoperative blood loss (EBL) was quantified. Multiple regression analysis was employed to identify independent predictors of intraoperative blood loss.</div></div><div><h3>Results</h3><div>The mean pre Cobb was 103.0 + 12.4^° and post Cobb was 45.1 + 14.0°. The mean CR was 56.1 + 12.8 %. The mean SB Cobb and flexibility were 65.0 + 19.4^° and 37.7 + 13.7 %. Average SBCI was 1.8 + 1.2. The mean fusion levels and number of screws used were 13.3 + 1.3 and 16.3 + 1.6, respectively. The mean Op time in this study was 185.9 + 49.3 min. The mean EBL was 1493.0 + 841.0 mL, EBL/EBV ratio was 51.6 + 29.1 %, and EBL/level fused was 112.0 ± 62.0 mL. Multiple regression analysis identified Op time, gender, and pre Cobb as the independent predictors for EBL (R² 0.281; <em>p</em> &lt; 0.05). The derived predictive formula was EBL = −1747.0 + (5.6 x Op time) + (13.9 x pre Cobb) + (697.0 x G), where G = 2 for male and G = 1 for female.</div></div><div><h3>Conclusions</h3><div>Operative time, male gender, and preoperative major Cobb angle were the significant predictive factors for EBL in single-stage PSF surgery for severe IS patients.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103248"},"PeriodicalIF":0.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466683","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":"Elastic stable intramedullary nailing for pediatric forearm fractures: A review article","authors":"Esha Reddy ,&nbsp;Aakanksha Sriwastwa ,&nbsp;Saral Patel ,&nbsp;Rajul Gupta ,&nbsp;Shital N. Parikh","doi":"10.1016/j.jcot.2025.103249","DOIUrl":"10.1016/j.jcot.2025.103249","url":null,"abstract":"<div><div>Fractures of the shaft of the radius and ulna are common injuries in children and adolescents. Undisplaced fractures and fractures that are stable after closed reduction, can be treated with cast immobilization and an interosseous mold. Healing is reliable in children and remodeling would help to correct any residual malunion at the fracture site. However, in older children and adolescents, where the healing and remodeling potential is limited, and for unstable fractures, surgical intervention may be necessary. Intramedullary nailing using elastic nails, also known as elastic stable intramedullary nailing (ESIN) is the gold standard for surgical treatment of forearm fractures in children and adolescents, as it is physeal-sparing, safe, reliable and minimally invasive. There are several pearls and pitfalls related to the surgical technique of ESIN which would be discussed in this article. It does require a second surgery for removal of the nails once fracture is healed. The overall outcomes of ESIN of forearm shaft fracture are very satisfactory. Most of the complications are technique-related and can be avoided by meticulous attention to details. The aim of this narrative review article is to provide an overview of the indications, surgical techniques, clinical outcomes and potential complications of ESIN of forearm shaft fractures. It is important for orthopaedic surgeons who treat these fractures in children to master the art of ESIN.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103249"},"PeriodicalIF":0.0,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417840","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":"Oral antibiotics demonstrate superior success and fewer complications compared to parenteral antibiotics for pediatric bone and joint Infections:A systematic review and meta-analysis","authors":"Gabriella Schreiner ,&nbsp;Alexis Driscoll ,&nbsp;Jesus Mejia ,&nbsp;Stephen Fucaloro ,&nbsp;Laura Krivicich ,&nbsp;Matthew Salzler","doi":"10.1016/j.jcot.2025.103245","DOIUrl":"10.1016/j.jcot.2025.103245","url":null,"abstract":"<div><h3>Background</h3><div>Effective antimicrobial therapy for bone and joint infections (BJIs) in the pediatric population is essential to prevent serious sequelae. As literature continues to evaluate the best therapeutic route, discussions centered upon the efficacy of oral antibiotics compared to parenteral have demonstrated promising results. This study aims to provide a statistical appraisal of literature comparing oral antibiotic therapy to parenteral treatment success and complications in treating pediatric BJIs.</div></div><div><h3>Methods</h3><div>After PROSPERO registration (ID: CRD42023463451), PubMed, Embase, and Web of Science databases were queried for articles comparing oral and parenteral antibiotic therapies for pediatric BJIs. Studies were included if parenteral and oral regimens were used for the entire treatment duration, or if the parenteral control group was compared against an “early switch” group, where the therapeutic route was switched from parenteral to oral antibiotics within 11 days. Data for all included studies was collected, pooled, and analyzed using DerSimonian-Laird Random-effects modeling, with statistical significance defined as <em>p</em>-value less than 0.05.</div></div><div><h3>Results</h3><div>Meta-analysis of six early switch studies demonstrated higher odds of success for the early switch group (OR = 2.27 [1.53–3.36], <em>I</em>^<em>2</em> = 9.20 %, <em>p</em> &lt; 0.01). Five oral-only studies demonstrated higher odds of success for the oral group (OR = 2.64 [1.10–6.34], <em>I</em>^<em>2</em> = 66.22 %, <em>p</em> &lt; 0.01). Meta-analysis demonstrated significantly higher odds of uncomplicated treatment for the early switch and oral-only groups compared to parenteral groups, though heterogeneity was significant for these analyses.</div></div><div><h3>Conclusion</h3><div>The findings of this meta-analysis, limited by high heterogeneity and primarily observational data, demonstrate early switch to antibiotics had higher success rates and fewer complications compared to parenteral antibiotics. Future high-quality randomized controlled trials in specific pediatric subgroups and varied resource settings are needed.</div></div><div><h3>Level of evidence</h3><div>Level III, systematic review of one randomized controlled trial, one case-control study and six retrospective comparative studies.</div></div><div><h3>Mesh terms</h3><div>Osteomyelitis; Antibiotics; Anti-Bacterial Agents; Bone Diseases, Infectious; Septic Arthritis; Pediatrics.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103245"},"PeriodicalIF":0.0,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417774","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":"Does approach for radial head repair in Bado II Monteggia variants affect outcome?","authors":"Matthew W. Sgaglione,&nbsp;Sanjit R. Konda,&nbsp;Philipp Leucht,&nbsp;Nirmal C. Tejwani,&nbsp;Kenneth A. Egol","doi":"10.1016/j.jcot.2025.103246","DOIUrl":"10.1016/j.jcot.2025.103246","url":null,"abstract":"<div><h3>Background</h3><div>This study compares outcomes and complications of patients with Bado II Monteggia fracture-dislocations that required radial head fixation or replacement based upon approach to the radial head.</div></div><div><h3>Methods</h3><div>A retrospective review was performed of 159 consecutive patients with proximal ulna fractures and a radial head dislocation or fracture (Monteggia Variant). Injuries were classified by Bado type. Forty-one patients with Bado II Monteggia injuries treated with either a radial head replacement or fixation with complete follow up were included. Demographics, injury information, surgical details, and follow up information including elbow range of motion (ROM) and complications were collected. A trans-osseous posterior (TOP) approach working through the ulna fracture to address the radial head first was used in 19 patients, while 22 patients had their radial head treated via a separate lateral (Kocher) interval after ulnar fixation. Ulnar plate fixation was performed for all patients. Comparisons were made using independent t-tests.</div></div><div><h3>Results</h3><div>Forty-one Monteggia lesions treated through TOP (19, 46 %) or Kocher (22, 64 %) approaches underwent a radial head replacement (33, 80.5 %) or fracture repair (8, 19.5 %) with a mean final follow-up of 15.3 months. At all post-operative visits, groups displayed similar rates of functional elbow ROM. At latest follow-up rates of patient-reported pain, ultimate elbow ROM, time to radiographic healing were equivalent. No significant differences were observed in ulna non-union, joint malalignment, post-operative nerve injury, post-operative infection, heterotopic ossification, incidence of hardware failure, patient-reported pain, and rate of removal of symptomatic hardware. Sub-analysis of radial head replacement versus fixation revealed equivalent percentage of patients with full ROM at each post-operative time point.</div></div><div><h3>Conclusion</h3><div>For Bado II Monteggia fracture-dislocations, the surgical approach to the radial head—TOP versus Kocher—does not influence ultimate patient outcomes or complication rates. Radial head replacement and fixation provide comparable results.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103246"},"PeriodicalIF":0.0,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417748","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":"The effects of multiple myeloma on total knee arthroplasty outcomes: A retrospective study","authors":"Sushrruti Varatharaj,&nbsp;Senthil Sambandam,&nbsp;Sruthi Priyavadhana Ramanan,&nbsp;Clarissa Meza,&nbsp;Gatik Senthil","doi":"10.1016/j.jcot.2025.103190","DOIUrl":"10.1016/j.jcot.2025.103190","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is a common orthopedic procedure, yet outcomes in patients with multiple myeloma (MM) remain poorly understood since there are limited studies. As a result, the aim was to assess how MM affects outcomes of patients undergoing TKA.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, patients with MM who underwent TKA were identified using a TriNetX national database from 2005 to 2024. These patients were matched to controls without MM using propensity score matching based on age, sex and relevant comorbidities. Postoperative complication rates, readmission, revision surgery, and mortality were analyzed over a one-year follow-up.</div></div><div><h3>Results</h3><div>A total of 237, 007 patients who had TKR were matched to 353 patients with MM who had TKR. MM patients were older, male (mean age 70.3 vs 67 years) and had a higher incidence of comorbidities at baseline. MM patients had significantly higher rates of wound dehiscence (1.98 % vs 0.52 %, p = .003), periprosthetic infection (2.27 % vs 0.81 %, p = .009), acute renal failure (5.95 % vs 1.96 %, p &lt; .001), blood loss anemia (15.01 % vs 6.53 %, p &lt; .001),DVT (2.55 % vs 1.27 p = .049), myocardial infarction (0.85 % vs 0.21 %, p = .040), pulmonary embolism (3.12 % vs 0.84 %, p &lt; .001) and pneumonia. However, one-year mortality rates did not differ significantly between groups.</div></div><div><h3>Conclusion</h3><div>MM is associated with an increased risk of postoperative complications following TKA compared to control patients but not mortality. This study highlights multispecialty tailored perioperative care protocols for MM patients undergoing TKA to decrease complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103190"},"PeriodicalIF":0.0,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417839","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":"Outcomes of Masquelet technique combined with gentamicin-cement-coated rigid nails in the treatment of infected bone defects: A retrospective review","authors":"Germán Garabano ,&nbsp;Andres Juri ,&nbsp;Leonel Perez Alamino ,&nbsp;Joaquín Rodriguez ,&nbsp;Cesar Angel Pesciallo","doi":"10.1016/j.jcot.2025.103242","DOIUrl":"10.1016/j.jcot.2025.103242","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to describe the bone healing, infection recurrence, and failure rates in patients with infected bone defects (IBD) of the femur and tibia in whom we combined the Masquelet technique with gentamicin-cement-coated rigid nails from the first stage.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of fourteen consecutive patients with IBD treated between June 2015 and December 2022 with the Masquelet technique and a gentamicin cement-coated rigid nail. Eleven patients were male; the median age was 40.5 years. Six defects were located in the femur and eight in the tibia. We analyzed the bone healing, infection recurrence, and failure rates (nonunions, graft resorption, amputations). We used the Lower Extremity Functional Scale (LEFS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess the functional outcomes.</div></div><div><h3>Results</h3><div>One patient needed additional debridement after the first stage. The mean time between stages was 10.28 (range 6–28) weeks. The mean LEFS score before the second stage was 62.57 ± 5.66 points. The median defect length was 6.8 cm (range 3.5–12). All the patients achieved bone healing within a median of eight months. No infection recurrences or failures were recorded. At the study closure, the mean LEFS and WOMAC were 62.07 ± 4.17, and 77.92 ± 10.89, respectively. The median follow-up was 31.71 months (range 12–80).</div></div><div><h3>Conclusion</h3><div>The combination of gentamicin cement-coated rigid nails with Masquelet's technique was associated with excellent bone healing and infection control in the treatment of infected bone defects in this small series. Further research is needed to validate the effectiveness of this method.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103242"},"PeriodicalIF":0.0,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363885","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":"Monteggia fractures and the Bado CLASSIFICATION: AN urban trauma center experience","authors":"Olivia Jagiella-Lodise ,&nbsp;Anna Meyer,&nbsp;Nicholas Cantu ,&nbsp;Adam Boissonneault,&nbsp;Thomas Large","doi":"10.1016/j.jcot.2025.103244","DOIUrl":"10.1016/j.jcot.2025.103244","url":null,"abstract":"<div><h3>Background</h3><div>There are conflicting reports regarding the incidence of Monteggia fractures by Bado type and their associated risks of nerve and vascular injury and other complications.</div></div><div><h3>Methods</h3><div>A registry was queried at a level I trauma center for Monteggia fracture codes. A retrospective chart and radiographic review were then conducted to correctly identify Monteggia fractures. The primary outcome was incidence by Bado type with secondary outcomes being associated injuries.</div></div><div><h3>Results</h3><div>69 patients sustained Bado I (42), Bado II (15), Bado III (8), and Bado IV (4) injuries. 83 % had a high-energy mechanism. 7 % had vascular injuries, 32 % were open, 13 % had a radial head fracture, 10 % had neurological deficits, 0 % had compartment syndrome, 1 % required open reduction of the radiocapitellar joint, 1 % developed malunion, and 9 % developed nonunion. 61 % were Bado I injuries. However, it was more common for Bado III fractures to be open (p = 0.018), and for Bado II fractures to involve radial head fractures (p = 0.008). Neurologic deficits were seen in Bado I, II, and IV injuries with 5/7 of these injuries in Bado I patients, although not significant (p = 0.600). Three nerve injuries were transections without recovery. Five vascular injuries were seen, none required revascularization. One Bado I required open reduction of the radiocapitellar dislocation. Malunion and nonunion were significant for Bado II (p = 0.031).</div></div><div><h3>Conclusion</h3><div>Bado I are the most common type in this mostly high-energy cohort. There were no significant differences in the incidence of associated neurologic or vascular injuries between Bado types. There were significantly more nonunion/malunion and radial head fractures in Bado II and greater percentage of open injuries in Bado III. No patients developed compartment syndrome. Twelve patients had nerve or vascular injuries, 32 % were open fractures, and 6 had nonunions, underscoring that this is not a benign injury.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"71 ","pages":"Article 103244"},"PeriodicalIF":0.0,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363882","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}