Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Visualization of the posteromedial compartment in the knee: Comparison between a posterolateral transseptal approach with a standard anterior transnotch approach when repairing posterior lesions of the medial meniscus.","authors":"Andreas Friberg, Nicolas Kloek, Fabrice Duparc, Olivier Courage, Franck Dujardin, Jonathan Curado","doi":"10.1016/j.otsr.2025.104181","DOIUrl":"10.1016/j.otsr.2025.104181","url":null,"abstract":"<p><strong>Introduction: </strong>Visualization and exposure of the medial meniscus in the posterior compartment during knee arthroscopy can be challenging. Using a posterolateral transseptal approach can help to have a better visualization to ensure a better meniscal repair in the posterior compartment.</p><p><strong>Hypothesis: </strong>The posterolateral transseptal approach allows a better visualization of the posterior segment of the medial meniscus when compared to a trans notch approach.</p><p><strong>Material and methods: </strong>A controlled laboratory study using 12 human cadaveric knees were included in this arthroscopic study. The first step was to visualize the posterior medial compartment by transnotch viewing. A posteromedial portal was then created, and a meniscal suture was positioned as medial as possible under direct visualization by an all inside technique with a suture hook. Afterwards the posterolateral transseptal portal was created and a second meniscal suture was positioned as medial as possible with the same technique. Finally, by dissection, a posterior arthrotomy was performed allowing us to directly measure the length of the medial meniscus (at its meniscocapsular junction) from its posterior root to respectively the first and second suture, representing the two different approaches. The safety was evaluated by extended dissection of the neurovascular posterior structures.</p><p><strong>Results: </strong>The mean paired difference between the first and second suture was 6.75 ± 2.56 mm (CI95% = 5.19; 8.31, P ≈ 0.001). No nerve or vascular lesion were observed during dissection.</p><p><strong>Discussion: </strong>A transseptal viewing portal offers better exposure and visualization of the medial meniscus in the posterior compartment and can be safely performed. When repairing meniscal lesions in the posterior compartment, it is commonly advised to insert a knot at least every 5 mm. Our study has demonstrated a significant difference in distance of 6.75 mm when using a transseptal approach, which provides an argument for its utilization during posterior meniscal repair enabling the operator to better repair meniscal lesion and potentially improve the healing process.</p><p><strong>Level of evidence: </strong>III; Case/Control anatomical study on cadaveric specimens.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":" ","pages":"104181"},"PeriodicalIF":2.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366757","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":"Revision for stiff knee after knee replacement","authors":"Sophie Putman ,&nbsp;Paul-Antoine André ,&nbsp;Gilles Pasquier ,&nbsp;Julien Dartus","doi":"10.1016/j.otsr.2024.104060","DOIUrl":"10.1016/j.otsr.2024.104060","url":null,"abstract":"<div><div>Stiffness following total knee replacement is defined as &gt;15° flexion contracture and/or flexion &lt;75° or, for other authors, arc of motion &lt;70° or 45° or 50°. Alternatively, it could be defined as a range of motion less than the patient needs in order to be able to do what they wish.</div><div>The first step in management is to determine the causes: preoperative (history of stiffness, patient-related risk factors, etc.), intraoperative (technical error: malpositioning, oversizing, overhanging, etc.), and postoperative (defective pain management and/or rehabilitation, etc.).</div><div>Treatment depends on the interval since replacement and on the type of stiffness (flexion or extension), and should be multidisciplinary (surgery, rehabilitation, pain management).</div><div>For intervals less than 3 months, manipulation under anesthesia gives good results for flexion. If this fails, surgery should be considered.</div><div>If there was no significant technical error, arthrolysis may be indicated, and is usually arthroscopic. It is technically difficult, but has a low rate of complications. Open arthrolysis allows greater posterior release and replacement of the insert by a thinner model.</div><div>In case of malpositioning or oversizing or of failure of other procedures, implant revision is the only option, although the risk of complications is high. After exposure, which is often difficult, the aim is to correct the technical errors and to restore joint-line height and two symmetrical, well-balanced spaces in extension and flexion. A semi-constrained or even hinged implant may be needed, although with uncertain lifetime for young patients in the latter case.</div><div>In all cases, the patient needs to accept that treatment is going to be long, with more than the intervention itself (i.e., specific pain management and rehabilitation), and that expectations have to be reasonable as results are often imperfect.</div></div><div><h3>Level of evidence</h3><div>expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104060"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696256","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":"Prediction of transfusion risk after total knee arthroplasty: use of a machine learning algorithm","authors":"Nicolas Faure ,&nbsp;Siam Knecht ,&nbsp;Pierre Tran ,&nbsp;Lyna Tamine ,&nbsp;Jean-Christophe Orban ,&nbsp;Nicolas Bronsard ,&nbsp;Jean-François Gonzalez ,&nbsp;Grégoire Micicoi","doi":"10.1016/j.otsr.2024.103985","DOIUrl":"10.1016/j.otsr.2024.103985","url":null,"abstract":"<div><h3>Introduction</h3><div>Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient's risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient's subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count.</div></div><div><h3>Hypothesis</h3><div>Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty.</div></div><div><h3>Material and methods</h3><div>This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model's performance.</div></div><div><h3>Results</h3><div>Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921–1], sensitivity of 94.4% [95% CI 91.2–97.6], and specificity of 85.4% [95% CI 80.6–90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at <span><span>https://arthrorisk.com</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusion</h3><div>The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient.</div></div><div><h3>Level of evidence</h3><div>II; diagnostic study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103985"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141816","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":"Radiologic evaluation of the healing of the greater tubercle after humeral hemiarthroplasty with Aequalis-fracture-implants for proximal humeral fracture: a retrospective cohort study in 45 shoulders","authors":"Sixtine Regnard ,&nbsp;Carlos Maynou ,&nbsp;Philippe Clavert ,&nbsp;Fabrice Duparc","doi":"10.1016/j.otsr.2024.104002","DOIUrl":"10.1016/j.otsr.2024.104002","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Development and use of specific anatomic prosthesis for shoulder’s fracture aimed to reach the best rate of consolidation of the greater tubercle, which means a cuff restitution to improve functional results. The lack of bone healing of the tubercles suggested the use of a fenestrated humeral implant with interposition of a bone graft in the metaphyseal part of the prosthesis. This characteristic of specific implant, have few reports in the literature, leading us to the current retrospective study aiming: 1) to evaluate the healing rate of the greater tubercle after implantation of fracture dedicated anatomic implant, which includes a fenestration in the prosthetic metaphysis for the addition of a cortico cancellous graft, 2) to asses on patients with proximal humerus fractures, the bone healing of the greater tubercle close to the intraprosthetic bone graft.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The specific “implant-fracture” can achieve a high rate of bone healing of the humeral greater tubercle.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Between January 2001 and December 2020, fifty-one patients were operated on by implantation of fracture dedicated implant for proximal humerus fracture. Six were excluded (2 operated for revision, 2 operated after 3 weeks, 1 died, 1 without follow-up). In total 45 patients were included in radiological analysis, clinical analysis had been performed on 23/45 patients at the longest follow up, the other 22/45 were only analyzed on radiographies. Mean-aged 66 years (range, 47 years -88 years), 25/45 (56%) of women, with 3–4-parts fractures according to Neer’s classification. The techniques of tubercle fixation were isolated cerclages of combined horizontal cerclages and vertical sutures. Position and healing of the greater tubercle was controlled through antero-posterior and lateral X-Rays views at the longest follow-up (mean 50 months, range 3–193 months). Peroperative techniques of fixation, clinical and functional outcomes were noted and correlated to the radiologic position of the greater tubercle and the graft evolution. Factors associated with healing and anatomic position had been investigated.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The rate of greater tubercle healing was 32/45 (73%). Factors significantly associated with greater tuberosity consolidation were higher age (p = 0.04) and the addition of a vertical osteosuture to the horizontal suture of the greater tubercle (p = 0.01). The rate of anatomic position of the greater tubercle was 15/45 (33%) of cases. When the fixation of the tuberosity was made with vertical suture, good position of the tuberosity was observed in 68% (17/24) at the longest follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Our results were in accordance with the literature, but the current study underlined there were two types of factors influencing tubercle healing in the literature: the technique of fixation of the tubercle and the patie","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104002"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332554","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":"Orthopaedics & traumatology: surgery & research: our ongoing quest: promoting excellence in research for our readers","authors":"Patrick Haubruck ,&nbsp;Philippe Clavert ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2024.104100","DOIUrl":"10.1016/j.otsr.2024.104100","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104100"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830885","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":"Posterior shoulder instability","authors":"Jérôme Garret ,&nbsp;Stanislas Gunst ,&nbsp;Marc Olivier Gauci","doi":"10.1016/j.otsr.2024.104061","DOIUrl":"10.1016/j.otsr.2024.104061","url":null,"abstract":"<div><div>Posterior shoulder instability (PSI) is defined by dynamic, recurrent and symptomatic partial or total loss of posterior joint contact. Anatomic risk factors comprise ligament hyperlaxity, glenoid retroversion or dysplasia, and high horizontal acromial morphology. Associated anatomic lesions comprise labrum lesions, posterior glenoid erosion and/or fracture, and anterior humeral head notching.</div><div>We distinguish two subcategories of PSI: functional and structural, respectively without and with anatomic lesions. In both categories, there may be anatomic risk factors. Clinically, functional PSI involves reproducible asymptomatic voluntary subluxation or sometimes reproducible involuntary subluxation. Functional PSI implicates impaired external-rotation rotator cuff and scapular stabilizer muscle activity. Treatment is non-operative, by rehabilitation and shoulder pace maker.</div><div>Structural shoulder instability involves anatomic lesions, often due to iterative microtrauma; pain is the most frequent symptom. It usually concerns young athletic subjects, but the clinical forms of structural and of anterior shoulder instability are not superimposable. Treatment may be surgical; arthroscopic labrum repair is effective in the absence of significant bone lesions, whereas otherwise posterior bone block is the treatment of choice. Surgical treatment of scapular features underlying structural PSI is improved by 3D preoperative planning, cutting guides and dedicated internal fixation systems.</div></div><div><h3>Level of evidence</h3><div>expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104061"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696255","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":"Periprosthetic acetabular fractures","authors":"Nicolas Reina","doi":"10.1016/j.otsr.2024.104068","DOIUrl":"10.1016/j.otsr.2024.104068","url":null,"abstract":"<div><div>Periprosthetic acetabular fractures are a major challenge in orthopedics. Proper recognition of these complex cases helps to identify and treat patients with different presentations. These fractures can occur intraoperatively and be treated immediately, or they can occur postoperatively, following trauma or in the context of chronic low bone quality or associated implant loosening. The existing classification systems categorize these fractures as a function of the acetabular cup’s stability and the context surrounding the fracture.</div><div>When a fracture is detected intraoperatively, immediately analyzing its stability is crucial for choosing between a conservative strategy, the need for additional fixation, or the need to change the cup or use of an acetabular reinforcement ring.</div><div>When the patient has symptoms such as persistent pain or instability, secondary diagnosis of a fracture requires diagnostic imaging. Its treatment depends on the cup’s stability, with options ranging from conservative treatment with functional limitations, cup revision potentially combined with stabilization of the fracture site, and also management of potential periprosthetic bone defects.</div><div>Traumatic fractures require a comprehensive assessment to determine whether the acetabular cup is still stable. The treatment may be conservative or surgical (internal fixation or cup revision).</div><div>Chronic pelvic discontinuity is associated with bone loss and implant loosening. Acute pelvic discontinuity requires treatment tailored to each patient, often with acetabular rings or custom triflange cups to restore function.</div><div>This article aims to provide an in-depth review of periprosthetic acetabular fractures, touching on their causes, classification, assessment and treatment, along with specific considerations for fractures diagnosed postoperatively and following acute trauma.</div></div><div><h3>Level of evidence</h3><div>IV; systematic review of level II-IV studies</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104068"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142711873","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":"Poorer clinical outcomes after THA in patients with a spinal scoliotic deformity: a case-control study of 268 patients assessed with PROMS","authors":"Sena Boukhelifa,&nbsp;Marie Protais,&nbsp;Clélia Thouement,&nbsp;Elhadi Sariali","doi":"10.1016/j.otsr.2024.104004","DOIUrl":"10.1016/j.otsr.2024.104004","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Spinal deformities can lead to specific complications after total hip arthroplasty (THA), such as functional leg length discrepancy due to a fixed pelvic obliquity, as well as an increased risk of prosthetic instability due to a lack of adaptive pelvic mobility, but these issues were not investigated in large comparative series. Therefore a retrospective case-control study was done aiming: 1) to analyze the impact of a preoperative scoliotic deformity on the functional outcomes of patients who underwent THA with a minimum 1-year follow-up, 2) to measure the prevalence of scoliosis in both the case and control groups 3) to screen other factors that may be correlated with poorer clinical outcomes in patients who underwent THA, including age, gender, Body Mass index (BMI), American Society of Anesthesiologists (ASA) score, primary THA etiology and postoperative complication occurrence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The presence of scoliosis would have a negative impact on THA outcomes as assessed by PROMs.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;A case-control study was conducted using prospectively collected data including 268 patients who underwent THA between January 2009 and December 2021 through a direct anterior approach by the same senior surgeon. Cases were identified based on a 1-year follow-up modified Harris Hip score (mHHS) lower than 81 while controls were defined as patients with an excellent 1-year follow-up mHHS score (equal to or higher than 81). Three controls were randomly matched with each case based on the surgery period. To assess the impact of a concurrent scoliosis on clinical outcomes, a mathematical univariate and multivariate logistic model was used, including other confounding factors (age, gender, ASA score, BMI, Complication occurrence, etiology), to calculate the adjusted odds-ratio.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;In the multivariate analysis, scoliosis was found to be a significant risk factor, with a three-fold higher adjusted odds-ratio of lower mHHS score (adjOR = 3.1; 95 CI:1.4–7, [p &lt; 0.01]). The mean mHHS score was significantly lower in the scoliosis group compared to the non-scoliosis group (77 vs. 84 [p = 0.01]) as well as the mean Oxford Hip Score (36 vs. 43 [p &lt; 0.001]). Among the other assessed risk factors, only the occurence of a postoperative complication was associated with an increased odds ratio of poorer mHHS scores (adjOR = 7.1; 95 CI: 2.78–18.24, [p &lt; 0.001]). The prevalence of scoliosis in our practice was 19%.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;: Given the prevalence of 19% found in our study, we recommend screening for scoliosis in all patients scheduled for THA. Our results indicate that patients who had scoliosis experienced lower PROMs scores compared to those who had not. Surgeons should consider delivering this information to patients who have scoliosis undergoing THA to mitigate patient dissatisfaction.&lt;/div&gt;&lt;/div&gt;&lt;di","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104004"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332553","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":"Knee ligament and meniscus injuries in children and teenagers","authors":"Philippe Gicquel","doi":"10.1016/j.otsr.2024.104073","DOIUrl":"10.1016/j.otsr.2024.104073","url":null,"abstract":"<div><div>Knee ligament and meniscus injuries in children and teenagers are becoming more numerous because of increased sports participation but also better diagnosis. Meniscus injuries occur either in a normal meniscus or due to a congenital anomaly. The diagnosis is made clinically and confirmed by MRI. Treatment depends on the findings: meniscoplasty for discoid meniscus and primary repair of meniscus tears. Meniscus preservation is the rule.</div><div>Injuries to the central pivot of the knee typically involve either the anterior cruciate ligament (ACL) or the tibial spine. Age, anatomy and the mechanism of injury determine the specific nature of the injury. The treatment of tibial spine fractures is highly standardized and typically surgical, with the aim of limiting residual laxity. ACL tears can be treated either by primary repair or non-surgically with guided rehabilitation. ACL reconstruction in skeletally immature patients is feasible as long as the growth plates are protected. The rate of residual laxity or retear is lower when anterolateral reconstruction is performed simultaneously.</div></div><div><h3>Level of evidence</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 104073"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752354","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":"Does double distal locking reduce non-union rates in intramedullary nailing for humeral shaft fracture?","authors":"Jules Levasseur ,&nbsp;Pierre Bordure ,&nbsp;Yvon Moui ,&nbsp;Guillaume David ,&nbsp;Louis Rony","doi":"10.1016/j.otsr.2024.103913","DOIUrl":"10.1016/j.otsr.2024.103913","url":null,"abstract":"<div><h3>Introduction</h3><div>Intramedullary nailing is one of the surgical treatments for humeral shaft fracture. Non-union is a common complication, with rates of 10–20%. The objective of this study was to compare non-union in humeral shaft fractures treated by intramedullary nailing with double distal locking, single distal locking or no locking.</div></div><div><h3>Hypothesis</h3><div>Nailing with double distal locking decreases non-union rates compared to single or no locking.</div></div><div><h3>Material and methods</h3><div>This single-center retrospective comparative study included 87 patients with closed humeral shaft fracture without neurologic deficit treated by anterograde intramedullary nailing: group 1 (double locking): 15 fractures; group 2 (single locking): 63 fractures; group 3 (no locking): 9 fractures. Non-union was defined as absence of radiographic callus at 6 months without clinical pain. The primary endpoint was non-union rate per group. The secondary endpoints were Constant score at 6 months, and postoperative use of non-steroidal anti-inflammatory drugs (NSAIDs).</div></div><div><h3>Results</h3><div>There were no significant differences in non-union rate: 20.0% in group 1, 20.3% in group 2, and 0% in group 3 (<em>p</em> <!-->=<!--> <!-->0.32). Constant score at 6 months was significantly different between the 3 groups (<em>p</em> <!-->=<!--> <!-->0.01). Group 2 used more NSAIDs than the other groups (39.1% vs. 20.0% in group 1 and 33.3% in group 3; <em>p</em> <!-->=<!--> <!-->0.37).</div></div><div><h3>Discussion</h3><div>Non-union rates were similar regardless of distal locking for closed humeral shaft fractures without neurologic deficit treated by intramedullary nailing. Nevertheless, patients in the double locking group had higher Constant scores at 6 months, probably related to greater stability of fixation, allowing more efficient rehabilitation.</div></div><div><h3>Level of evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 1","pages":"Article 103913"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288944","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}