Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104571
Corentin Petitpas , Sarah Barlomiejczyk , Boualem Frendi , Khalid Alomar , Florence Muller , Pierre Journeau
Background
Supracondylar humerus fractures are common injuries, representing more than half of pediatric elbow fractures. Given the limited growth potential around the elbow, achieving an anatomic reduction has traditionally been emphasized. However, the extent to which residual postoperative frontal or sagittal translation can be tolerated without cosmetic or functional consequences remains unclear.
Hypothesis
We hypothesized that an initial reduction defect, particularly translational, would not result in functional impairment at skeletal maturity due to growth-related remodeling, whereas angular deformities would persist.
Material and methods
We included 97 children who underwent surgical fixation for a supracondylar humerus fracture between 2004 and 2017 and had reached skeletal maturity at final follow-up. Baumann’s angle, percentages of frontal and sagittal translation, and the position of the anterior humeral line were assessed postoperatively, at the time of hardware removal, and at skeletal maturity.
Results
Overall, 55% of patients demonstrated an initial reduction defect, regardless of the parameter considered. Frontal translation underwent complete remodeling with growth, whereas a mean residual sagittal translation of 7% persisted but had no clinical impact. In contrast, only 6% of patients with an abnormal postoperative Baumann’s angle showed normalization over time. Clinical evaluation at maturity revealed no significant functional differences compared with the contralateral elbow.
Discussion
This study underscores the excellent remodeling potential of translational deformities and confirms progressive correction of sagittal deviations. Although Baumann’s angle demonstrates poor remodeling capacity, the absence of functional impairment precludes defining corrective thresholds that would mandate surgical revision.
{"title":"Bone Remodeling after Supracondylar Fractures in Children: myth or reality? A review of 97 Cases","authors":"Corentin Petitpas , Sarah Barlomiejczyk , Boualem Frendi , Khalid Alomar , Florence Muller , Pierre Journeau","doi":"10.1016/j.otsr.2025.104571","DOIUrl":"10.1016/j.otsr.2025.104571","url":null,"abstract":"<div><h3>Background</h3><div>Supracondylar humerus fractures are common injuries, representing more than half of pediatric elbow fractures. Given the limited growth potential around the elbow, achieving an anatomic reduction has traditionally been emphasized. However, the extent to which residual postoperative frontal or sagittal translation can be tolerated without cosmetic or functional consequences remains unclear.</div></div><div><h3>Hypothesis</h3><div>We hypothesized that an initial reduction defect, particularly translational, would not result in functional impairment at skeletal maturity due to growth-related remodeling, whereas angular deformities would persist.</div></div><div><h3>Material and methods</h3><div>We included 97 children who underwent surgical fixation for a supracondylar humerus fracture between 2004 and 2017 and had reached skeletal maturity at final follow-up. Baumann’s angle, percentages of frontal and sagittal translation, and the position of the anterior humeral line were assessed postoperatively, at the time of hardware removal, and at skeletal maturity.</div></div><div><h3>Results</h3><div>Overall, 55% of patients demonstrated an initial reduction defect, regardless of the parameter considered. Frontal translation underwent complete remodeling with growth, whereas a mean residual sagittal translation of 7% persisted but had no clinical impact. In contrast, only 6% of patients with an abnormal postoperative Baumann’s angle showed normalization over time. Clinical evaluation at maturity revealed no significant functional differences compared with the contralateral elbow.</div></div><div><h3>Discussion</h3><div>This study underscores the excellent remodeling potential of translational deformities and confirms progressive correction of sagittal deviations. Although Baumann’s angle demonstrates poor remodeling capacity, the absence of functional impairment precludes defining corrective thresholds that would mandate surgical revision.</div></div><div><h3>Level of evidence</h3><div>IV; Retrospective observational study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104571"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145812188","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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104228
Ewen Lataste , Nicolas Bigorre
Background
Carpal tunnel syndrome (CTS) surgery is one of the most frequent procedures performed in hand surgery and has long been shown to be effective. However, there are still no recommendations concerning the return to driving after the operation. The aim of this study was to determine the average time to return to driving after CTS surgery, and to identify the factors influencing this time.
Hypothesis
Providing appropriate information on this issue could help to anticipate patients’ post-operative needs, facilitating the post-operative process.
Patients and methods
Patients who underwent surgery for CTS between 16 November 2022 and 14 November 2023, and who answered a simplified questionnaire at the follow-up visit were included retrospectively and monocentrically. Demographic characteristics, pre- and post-operative parameters and results of additional examinations were analyzed.
Results
One hundred and seven patients were included in this study. The mean time to return to driving was 16 days. This time was significantly longer in female patients (p = 0.035), in patients who had had their medical discharge postponed (p < 0.01), and in those with a perception of work distress (p < 0.01). Patients who were not working returned to driving sooner (p = 0.018), as those with a higher nerve conduction velocity on the preoperative electroneuromyography (p = 0.022).
Discussion
Sex, professional activity, perception of difficulty at work and preoperative nerve conduction velocity seems to be influencing the time taken to resume driving.
{"title":"Return to driving after carpal tunnel syndrome surgery","authors":"Ewen Lataste , Nicolas Bigorre","doi":"10.1016/j.otsr.2025.104228","DOIUrl":"10.1016/j.otsr.2025.104228","url":null,"abstract":"<div><h3>Background</h3><div>Carpal tunnel syndrome (CTS) surgery is one of the most frequent procedures performed in hand surgery and has long been shown to be effective. However, there are still no recommendations concerning the return to driving after the operation. The aim of this study was to determine the average time to return to driving after CTS surgery, and to identify the factors influencing this time.</div></div><div><h3>Hypothesis</h3><div>Providing appropriate information on this issue could help to anticipate patients’ post-operative needs, facilitating the post-operative process.</div></div><div><h3>Patients and methods</h3><div>Patients who underwent surgery for CTS between 16 November 2022 and 14 November 2023, and who answered a simplified questionnaire at the follow-up visit were included retrospectively and monocentrically. Demographic characteristics, pre- and post-operative parameters and results of additional examinations were analyzed.</div></div><div><h3>Results</h3><div>One hundred and seven patients were included in this study. The mean time to return to driving was 16 days. This time was significantly longer in female patients (p = 0.035), in patients who had had their medical discharge postponed (p < 0.01), and in those with a perception of work distress (p < 0.01). Patients who were not working returned to driving sooner (p = 0.018), as those with a higher nerve conduction velocity on the preoperative electroneuromyography (p = 0.022).</div></div><div><h3>Discussion</h3><div>Sex, professional activity, perception of difficulty at work and preoperative nerve conduction velocity seems to be influencing the time taken to resume driving.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104228"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634971","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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104555
Matthew Arnold , Patrick Nicholas , Conor Rankin , Cameron Simpson , Christopher Thornhill , Rohan Ramasubbu , Matthew Kennedy , Donald Hansom
Background
Downhill skiing is a popular sport globally and increasing number of patients undergoing total knee arthroplasty (TKA) seek to return to the sport. While skiing provides physical and psychological benefits, it also poses potential biomechanical risks such as torsional stress, high impact loading and possible implant compromise. Despite advances in implant design and rehabilitation, there is no consensus on the safety or functional outcomes of skiing following TKA. This systematic review aims to evaluate the current literature to assess postoperative outcomes, risks, and expert opinion on skiing after TKA.
Methods
A systematic review was conducted following PRISMA guidelines and registered prospectively with the PROSPERO database. Literature was searched in Medline, Embase, Cochrane, PubMed, and Scopus databases up to October 2025 using combinations of terms including “total knee arthroplasty,” “TKA,” “skiing,” and “winter sports.” Studies were included if they reported outcomes specific to skiing following TKA. Data was extracted on study type, sample size, follow-up duration, outcome measures and key findings.
Results
From 572 identified studies, 21 were included. Most studies came from a single research group which conducted prospective cohort studies on post TKA skiing biomechanics, tendon morphology, and functional outcomes. Return to skiing rates following TKA was 47–51%. These studies found no increase in radiographic loosening or pain, and reported improvements in tendon stiffness, gait symmetry, and muscle strength after skiing. Patient-reported outcomes were favourable, with average Oxford Knee Scores >45 and Tegner activity levels indicating moderate to high activity. Survey studies showed mixed surgeon opinions, though most favoured a return to skiing for experienced patients with adequate strength and range of motion.
Conclusion
Current evidence supports that skiing after TKA can be safe and functionally beneficial for selected patients. Experienced skiers with good rehabilitation outcomes may return to the sport without increased risk of implant-related complications. Larger, long term and multicentre prospective studies are needed to provide definitive guidelines for patients and surgeons post operatively.
{"title":"Downhill Skiing After Total Knee Arthroplasty: A Systematic Review","authors":"Matthew Arnold , Patrick Nicholas , Conor Rankin , Cameron Simpson , Christopher Thornhill , Rohan Ramasubbu , Matthew Kennedy , Donald Hansom","doi":"10.1016/j.otsr.2025.104555","DOIUrl":"10.1016/j.otsr.2025.104555","url":null,"abstract":"<div><h3>Background</h3><div>Downhill skiing is a popular sport globally and increasing number of patients undergoing total knee arthroplasty (TKA) seek to return to the sport. While skiing provides physical and psychological benefits, it also poses potential biomechanical risks such as torsional stress, high impact loading and possible implant compromise. Despite advances in implant design and rehabilitation, there is no consensus on the safety or functional outcomes of skiing following TKA. This systematic review aims to evaluate the current literature to assess postoperative outcomes, risks, and expert opinion on skiing after TKA.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines and registered prospectively with the PROSPERO database. Literature was searched in Medline, Embase, Cochrane, PubMed, and Scopus databases up to October 2025 using combinations of terms including “total knee arthroplasty,” “TKA,” “skiing,” and “winter sports.” Studies were included if they reported outcomes specific to skiing following TKA. Data was extracted on study type, sample size, follow-up duration, outcome measures and key findings.</div></div><div><h3>Results</h3><div>From 572 identified studies, 21 were included. Most studies came from a single research group which conducted prospective cohort studies on post TKA skiing biomechanics, tendon morphology, and functional outcomes. Return to skiing rates following TKA was 47–51%. These studies found no increase in radiographic loosening or pain, and reported improvements in tendon stiffness, gait symmetry, and muscle strength after skiing. Patient-reported outcomes were favourable, with average Oxford Knee Scores >45 and Tegner activity levels indicating moderate to high activity. Survey studies showed mixed surgeon opinions, though most favoured a return to skiing for experienced patients with adequate strength and range of motion.</div></div><div><h3>Conclusion</h3><div>Current evidence supports that skiing after TKA can be safe and functionally beneficial for selected patients. Experienced skiers with good rehabilitation outcomes may return to the sport without increased risk of implant-related complications. Larger, long term and multicentre prospective studies are needed to provide definitive guidelines for patients and surgeons post operatively.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104555"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642734","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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104437
Raphaël Vialle
Skeletal syndromes and dysplasias include more than 150 entities, most often of genetic origin. Some of them cause abnormalities in the cervical spine, with or without instability, distortion or compression of the spinal cord. These abnormalities must be detected and treated if necessary because they can have serious consequences such as quadriplegia. Up to 30% of patients with Down syndrome are affected by occipitocervical or atlantoaxial instability. Dynamic cervical spine radiographs are the most common screening tool. Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases that result in the accumulation of glycosaminoglycans sometimes responsible for craniocervical instability and cervical spinal canal stenosis. Their monitoring requires an MRI every two years. Neurofibromatosis type 1 and syndromes with connective tissue abnormalities (Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) can cause severe and unstable cervical spine deformities that may remain asymptomatic for a long time. Cervical X-rays should therefore be performed if there is the slightest doubt. Some rare chondrodysplasias (punctate chondrodysplasia, Larsen syndrome, Metatropic dysplasia) or segmentation anomalies (Klippel Feil syndrome, Sprengel's disease) have cervical spine abnormalities that should be looked for. In case of progression of a deformity (usually kyphosis) or stenosis of the cervical spine, it is important to consider surgical treatment with correction and stabilization. Sometimes preceded by a period of Halo traction, the instrumentation must have "wide” limits and exceed the anatomical limits of the spinal deformity by at least 2–3 levels to prevent the development of an adjacent deformity. The increasing use of surgical navigation techniques allows for greater corrections and more efficient stabilizations, including severe cervical spinal deformities. Vigilance and the detection of these abnormalities remain the key to early and preventive treatment of the complications of these spinal anomalies on often difficult terrain.
{"title":"Pathologies of the cervical spine in skeletal syndromes and dysplasias","authors":"Raphaël Vialle","doi":"10.1016/j.otsr.2025.104437","DOIUrl":"10.1016/j.otsr.2025.104437","url":null,"abstract":"<div><div>Skeletal syndromes and dysplasias include more than 150 entities, most often of genetic origin. Some of them cause abnormalities in the cervical spine, with or without instability, distortion or compression of the spinal cord. These abnormalities must be detected and treated if necessary because they can have serious consequences such as quadriplegia. Up to 30% of patients with Down syndrome are affected by occipitocervical or atlantoaxial instability. Dynamic cervical spine radiographs are the most common screening tool. Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases that result in the accumulation of glycosaminoglycans sometimes responsible for craniocervical instability and cervical spinal canal stenosis. Their monitoring requires an MRI every two years. Neurofibromatosis type 1 and syndromes with connective tissue abnormalities (Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome) can cause severe and unstable cervical spine deformities that may remain asymptomatic for a long time. Cervical X-rays should therefore be performed if there is the slightest doubt. Some rare chondrodysplasias (punctate chondrodysplasia, Larsen syndrome, Metatropic dysplasia) or segmentation anomalies (Klippel Feil syndrome, Sprengel's disease) have cervical spine abnormalities that should be looked for. In case of progression of a deformity (usually kyphosis) or stenosis of the cervical spine, it is important to consider surgical treatment with correction and stabilization. Sometimes preceded by a period of Halo traction, the instrumentation must have \"wide” limits and exceed the anatomical limits of the spinal deformity by at least 2–3 levels to prevent the development of an adjacent deformity. The increasing use of surgical navigation techniques allows for greater corrections and more efficient stabilizations, including severe cervical spinal deformities. Vigilance and the detection of these abnormalities remain the key to early and preventive treatment of the complications of these spinal anomalies on often difficult terrain.</div></div><div><h3>Level of evidence</h3><div>>V (expert opinion).</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104437"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114807","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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104414
Matthieu Ollivier , Sébastien Parratte , Matthieu Ehlinger , Kristian Kley , Antoine Piercecchi
Correction of frontal knee deformities by high tibial osteotomy (HTO) is a well-established surgical procedure used to correct specific lower limb deformities. This study aims to clarify, through six key questions, the indications, deformity analysis, surgical planning, technical execution, complication prevention, and postoperative management associated with HTO.
•
HTO is indicated for significant extra-articular deformities but is contraindicated in cases of advanced osteoarthritis, except as a salvage procedure.
•
Deformity analysis requires measuring several angles between the mechanical and anatomical axes. It is essential to identify whether the deformity originates from the femur, tibia, and/or joint line to understand the overall alignment, confirm the indication, and determine the optimal site for correction. The Joint Line Convergence Angle (JLCA), defined by the tangents to the femoral and tibial condyles, helps assess intra-articular conditions, while mechanical axis deviation guides the required degree of correction.
•
Surgical planning is based on full-length, weight-bearing radiographs of the lower limbs to evaluate alignment and localize the deformity. The use of calibrated digital images and the Miniaci method allows for accurate calculation of the correction angle and thorough preoperative planning.
•
The surgical technique varies depending on whether a medial opening wedge or lateral closing wedge osteotomy is performed, each approach having specific advantages and limitations. Proper patient positioning and execution of biplanar osteotomies are crucial for maintaining stability and avoiding unintended changes in tibial slope. Protection of the posterior neurovascular structures and prevention of hinge fractures are fundamental to minimizing intraoperative risk.
•
The most common complications include lateral hinge fractures and surgical site infections.
•
Postoperative management involves progressive weight-bearing and serial radiographic evaluations. Return to sports is generally allowed once bone consolidation is achieved.
HTO remains an effective treatment for frontal plane knee deformities, providing symptom relief and delaying osteoarthritis progression. Optimal outcomes depend on careful preoperative assessment, precise surgical execution, and vigilant postoperative follow-up.
{"title":"Proximal tibial osteotomy for frontal plane deformities correction","authors":"Matthieu Ollivier , Sébastien Parratte , Matthieu Ehlinger , Kristian Kley , Antoine Piercecchi","doi":"10.1016/j.otsr.2025.104414","DOIUrl":"10.1016/j.otsr.2025.104414","url":null,"abstract":"<div><div>Correction of frontal knee deformities by high tibial osteotomy (HTO) is a well-established surgical procedure used to correct specific lower limb deformities. This study aims to clarify, through six key questions, the indications, deformity analysis, surgical planning, technical execution, complication prevention, and postoperative management associated with HTO.</div><div><ul><li><span>•</span><span><div>HTO is indicated for significant extra-articular deformities but is contraindicated in cases of advanced osteoarthritis, except as a salvage procedure.</div></span></li><li><span>•</span><span><div>Deformity analysis requires measuring several angles between the mechanical and anatomical axes. It is essential to identify whether the deformity originates from the femur, tibia, and/or joint line to understand the overall alignment, confirm the indication, and determine the optimal site for correction. The Joint Line Convergence Angle (JLCA), defined by the tangents to the femoral and tibial condyles, helps assess intra-articular conditions, while mechanical axis deviation guides the required degree of correction.</div></span></li><li><span>•</span><span><div>Surgical planning is based on full-length, weight-bearing radiographs of the lower limbs to evaluate alignment and localize the deformity. The use of calibrated digital images and the Miniaci method allows for accurate calculation of the correction angle and thorough preoperative planning.</div></span></li><li><span>•</span><span><div>The surgical technique varies depending on whether a medial opening wedge or lateral closing wedge osteotomy is performed, each approach having specific advantages and limitations. Proper patient positioning and execution of biplanar osteotomies are crucial for maintaining stability and avoiding unintended changes in tibial slope. Protection of the posterior neurovascular structures and prevention of hinge fractures are fundamental to minimizing intraoperative risk.</div></span></li><li><span>•</span><span><div>The most common complications include lateral hinge fractures and surgical site infections.</div></span></li><li><span>•</span><span><div>Postoperative management involves progressive weight-bearing and serial radiographic evaluations. Return to sports is generally allowed once bone consolidation is achieved.</div></span></li></ul></div><div>HTO remains an effective treatment for frontal plane knee deformities, providing symptom relief and delaying osteoarthritis progression. Optimal outcomes depend on careful preoperative assessment, precise surgical execution, and vigilant postoperative follow-up.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104414"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042508","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}
<div><h3>Background</h3><div>Neonatal separation of the distal humeral epiphysis (NSDHE) is a very rare injury. On one hand, anatomical reduction is usually required in pediatric elbow fractures due to limited remodeling potential at the distal humerus. But on the other hand, neonatal fractures often show favorable evolution without reduction, even in cases of severe displacement. NSDHE, often associated with traumatic deliveries, remains underreported, controversial, and its management lacks standardized protocols. Furthermore, its diagnosis can be difficult on X-rays as the distal humeral epiphysis is not ossified at birth.</div><div>The study questions are: Can non-reduction orthopedic treatment of distal humeral epiphyseal separation yield good clinical and radiological outcomes? Are there risk factors for distal humeral epiphyseal separation? What relevant additional examinations should be performed?</div></div><div><h3>Hypothesis</h3><div>Orthopedic treatment without reduction may yield satisfactory clinical and radiological outcomes in NSDHE.</div></div><div><h3>Patients and methods</h3><div>This multicenter retrospective study included patients with NSDHE with at least two years of follow-up from four university hospitals. Data on delivery, diagnostic methods, and treatment types were collected. At the last follow-up, joint range of motion, clinical outcomes, and elbow radiographs were evaluated.</div></div><div><h3>Results</h3><div>Fifteen patients were included, with a mean age of 8,8 years at the last follow-up (ranging from 2 years to 29 years). All patients underwent an initial elbow radiograph, which was misinterpreted as an elbow dislocation in two cases. Two radiographs were initially deemed normal, necessitating further examinations (ultrasound, arthrography, Magnetic Resonance Imaging). Twelve patients were treated by immobilization without reduction, while two underwent surgical treatment with reduction under general anesthesia and percutaneous pinning. The non-operated patients had complete and symmetrical range of motion without complications, except for one case of resolving cubitus varus. One of the operated patients developed osteitis that required reoperation and also presented with resolving cubitus varus at 4 years old.</div></div><div><h3>Discussion</h3><div>Orthopedic treatment through immobilization without reduction appears to be a viable option for neonatal epiphyseal separation of the distal humeral, which are frequently mistaken for elbow dislocations on initial radiographs. Complementary examinations, such as ultrasound, can be useful to confirm the diagnosis. This series yields promising results, although the sample size remains limited.</div></div><div><h3>Conclusion</h3><div>Neonatal separation of the distal humeral epiphysis may represent an exception among displaced elbow fractures, as conservative management without reduction can lead to good clinical and radiological outcomes.</div></div><div><h3>Level of
{"title":"Neonatal separation of the distal humeral epiphysis can be treated orthopedically without reduction","authors":"Malek Brichni , Marine De Tienda , Manon Bachy , Gauthier Caillard , Emeline Bourgeois , Clément Jeandel , Stéphanie Pannier , Marion Delpont","doi":"10.1016/j.otsr.2025.104382","DOIUrl":"10.1016/j.otsr.2025.104382","url":null,"abstract":"<div><h3>Background</h3><div>Neonatal separation of the distal humeral epiphysis (NSDHE) is a very rare injury. On one hand, anatomical reduction is usually required in pediatric elbow fractures due to limited remodeling potential at the distal humerus. But on the other hand, neonatal fractures often show favorable evolution without reduction, even in cases of severe displacement. NSDHE, often associated with traumatic deliveries, remains underreported, controversial, and its management lacks standardized protocols. Furthermore, its diagnosis can be difficult on X-rays as the distal humeral epiphysis is not ossified at birth.</div><div>The study questions are: Can non-reduction orthopedic treatment of distal humeral epiphyseal separation yield good clinical and radiological outcomes? Are there risk factors for distal humeral epiphyseal separation? What relevant additional examinations should be performed?</div></div><div><h3>Hypothesis</h3><div>Orthopedic treatment without reduction may yield satisfactory clinical and radiological outcomes in NSDHE.</div></div><div><h3>Patients and methods</h3><div>This multicenter retrospective study included patients with NSDHE with at least two years of follow-up from four university hospitals. Data on delivery, diagnostic methods, and treatment types were collected. At the last follow-up, joint range of motion, clinical outcomes, and elbow radiographs were evaluated.</div></div><div><h3>Results</h3><div>Fifteen patients were included, with a mean age of 8,8 years at the last follow-up (ranging from 2 years to 29 years). All patients underwent an initial elbow radiograph, which was misinterpreted as an elbow dislocation in two cases. Two radiographs were initially deemed normal, necessitating further examinations (ultrasound, arthrography, Magnetic Resonance Imaging). Twelve patients were treated by immobilization without reduction, while two underwent surgical treatment with reduction under general anesthesia and percutaneous pinning. The non-operated patients had complete and symmetrical range of motion without complications, except for one case of resolving cubitus varus. One of the operated patients developed osteitis that required reoperation and also presented with resolving cubitus varus at 4 years old.</div></div><div><h3>Discussion</h3><div>Orthopedic treatment through immobilization without reduction appears to be a viable option for neonatal epiphyseal separation of the distal humeral, which are frequently mistaken for elbow dislocations on initial radiographs. Complementary examinations, such as ultrasound, can be useful to confirm the diagnosis. This series yields promising results, although the sample size remains limited.</div></div><div><h3>Conclusion</h3><div>Neonatal separation of the distal humeral epiphysis may represent an exception among displaced elbow fractures, as conservative management without reduction can lead to good clinical and radiological outcomes.</div></div><div><h3>Level of","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104382"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979233","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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104423
Frédéric Sailhan , Pierre-Jean Garnier , Christian Delaunay
<div><h3>Introduction</h3><div>With an increasing number of surgical procedures, particularly due to the aging population, we are facing an increase in the number of total hip arthroplasty (THA) revisions and, consequently, conflicts between surgeons and patients. There are very little data specifically dedicated to THA revisions in the international literature. Therefore, we conducted a retrospective study to identify the most common causes of lawsuits following THA revision in France.</div></div><div><h3>Materials and methods</h3><div>We reviewed 263 consecutive complaint files following a THA first revision between 2010 and 2023 from the Cabinet Branchet (CB) database. Collected data included: nature of the pathology leading to the revision, time between revision and complaint, American Society of Anesthestiologists (ASA) score, age and sex of patients, any complications following the revision, nature of the procedure, attribution of responsibilities, and amount of poured compensation.</div></div><div><h3>Results</h3><div>These 263 procedures involved 256 patients, 144 men (56.2%) and 112 women (43.7%), with an average age of 61.4 years (27–92) and an average ASA score of 2. The clinical situations leading to THA revision, that eventually resulted in a patient complaint, were: aseptic loosening (70/263, 26.6%), Surgical Site Infection (SSI, 46, 17.5%), dislocation (32, 12.2%), or implant fracture (23, 8.7%). However, in 160 cases (61%), these are the complications following the revision surgery that led to the patient’s complaint. These complications were: SSI in 52.5% of cases (93/177), neurological deficit in 12.4% of cases (22/177), death (17 patients, 9.6%), persistent pain (12, 6.7%), and leg length discrepancy (LLD, 11, 6.2%). The 263 final legal proceedings were distributed as follow: 137 in French Commission for Conciliation and Compensation for Medical Accidents (CCI, 52%), 97 in judicial court (36.9%), 26 amicable settlements (9.9%), and 3 others. In 192 cases (73%), the surgeon’s legal responsibility was not retained. The average compensation amount was €60,000, and >€100,000 in 6 cases (2.3%).</div></div><div><h3>Discussion</h3><div>French orthopaedic surgeons are frequently sued. CB data indicates a frequency of one implication every 27 months, excluding the field of spine surgery. Some causes of revision seem to be less well tolerated by patients than others, such as implant fractures or LLD. Nevertheless, our study shows that SSIs are the main cause of litigation, accounting for 52.9% of cases (139/263), either as the primary cause or as secondary cause following complications after first revision surgery.</div></div><div><h3>Conclusion</h3><div>Aseptic loosening, surgical site infection, recurrent dislocation, and implant fractures are the primary causes of complaints leading to a lawsuit after THA revision in France. These data must be communicated to orthopaedic surgeons to better guide preoperative inform consent discussi
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Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104549
Elie Saliba , Clement Munoz , Aren Joe Bizdikian , Yan Lefevre
Elastic Stable Intramedullary Nailing (ESIN) is the treatment of choice for forearm fractures in children. However, fractures occurring at the distal metaphyseal-diaphyseal junction (DMDJ) of the radius are notoriously difficult to treat. This paper presents a modified ESIN method to treat these fractures.
Surgical intervention was considered for fractures with angulation >10 ° in the coronal plane, 20 ° in the sagittal plane, >1 cm of bayoneting, and instability after reduction. A radial approach is used. Once the nail is at the biceps tuberosity, it is retracted by 4 cm and at bent 90 °, and reinserted so that the nail lies against the medial cortex, thereby stabilizing the fracture.
Twenty-seven patients were treated, all showing <5° of coronal and sagittal tilt as well as <5 mm of coronal translation and <5° of difference in pronation-supination. This new ESIN method is an effective technique for the treatment of DMDJ fractures on the radius in children.
{"title":"Modified Elastic Stable Intramedullary Nailing: A New Approach for Metaphyseal-Diaphyseal Fractures of the Forearm in Children","authors":"Elie Saliba , Clement Munoz , Aren Joe Bizdikian , Yan Lefevre","doi":"10.1016/j.otsr.2025.104549","DOIUrl":"10.1016/j.otsr.2025.104549","url":null,"abstract":"<div><div>Elastic Stable Intramedullary Nailing (ESIN) is the treatment of choice for forearm fractures in children. However, fractures occurring at the distal metaphyseal-diaphyseal junction (DMDJ) of the radius are notoriously difficult to treat. This paper presents a modified ESIN method to treat these fractures.</div><div>Surgical intervention was considered for fractures with angulation >10 ° in the coronal plane, 20 ° in the sagittal plane, >1 cm of bayoneting, and instability after reduction. A radial approach is used. Once the nail is at the biceps tuberosity, it is retracted by 4 cm and at bent 90 °, and reinserted so that the nail lies against the medial cortex, thereby stabilizing the fracture.</div><div>Twenty-seven patients were treated, all showing <5° of coronal and sagittal tilt as well as <5 mm of coronal translation and <5° of difference in pronation-supination. This new ESIN method is an effective technique for the treatment of DMDJ fractures on the radius in children.</div></div><div><h3>Level of evidence</h3><div>IV; Technical note and case series</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104549"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472325","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}
Proximal femoral nail antirotation (PFNA) fixation for intertrochanteric fractures often results in nail or blade protrusion, particularly in Asian populations, and is associated with postoperative lateral hip pain. However, not all patients with protrusion experience pain. The specific lengths and locations causing clinically significant pain remain unclear. This study aims to determine the cut-off values and locations of PFNA nail and blade protrusions that predict lateral hip pain and to evaluate their relationship with functional outcomes.
Hypothesis
Protrusion of the PFNA-II nail and blade beyond specific radiographic cut-off values is associated with increased lateral hip pain after intertrochanteric fracture fixation.
Methods
In this comparative observational study, 226 patients with intertrochanteric fractures treated with PFNA-II fixation were recruited from August 2021 to December 2023. Inclusion criteria included age ≥60 years, ≥6 months post-fixation, and radiographic fracture union. Lateral hip pain was evaluated using the Visual Analog Scale (VAS, 0–10) at two sites: the nail tip (greater trochanter) and the end of the blade. The patients were divided into four groups according to VAS scores: Group A (nail tip pain, VAS < 4), Group B (nail tip pain, VAS ≥ 4), Group C (blade end pain, VAS < 4), and Group D (blade end pain, VAS ≥ 4). Protrusion lengths (medial/lateral nail, superior/inferior blade) were measured radiographically. The Receiver Operating Characteristics (ROC) analysis determined the cut-off values, and multivariate logistic regression evaluated the risk factors. The Harris Hip Score (HHS) was used to evaluate functional outcomes.
Results
Medial nail protrusion ≥3.775 mm (sensitivity 91%, specificity 61%) and lateral nail protrusion ≥8.015 mm (sensitivity 85%, specificity 65%) predicted nail tip pain. The superior blade protrusion ≥10.95 mm (sensitivity 56%, specificity 70%) and the inferior blade protrusion ≥3.265 mm (sensitivity 60%, specificity 66%) predicted blade end pain. Medial nail protrusion increased pain risk (odds ratio 17.17, 95% CI 7.68–38.39). HHS did not show a significant correlation with protrusion, except for a weak negative correlation with inferior blade protrusion (r = −0.39, p = 0.032).
Conclusion
Distinct radiographic cut-off values of PFNA-II protrusion predict postoperative lateral hip pain. While pain is mainly associated with medial nail and superior blade protrusion, excessive inferior blade protrusion may slightly impair hip function. The refinement of the PFNA II design and surgical technique to minimize protrusion could further improve postoperative outcomes in Asian patients.
Level of evidence
II.
背景：股骨近端钉防旋转（PFNA）固定治疗股骨粗隆间骨折常导致钉或钢板突出，特别是在亚洲人群中，并与术后髋外侧疼痛相关。然而，并非所有的突出症患者都会感到疼痛。引起临床显著疼痛的具体长度和位置尚不清楚。本研究旨在确定预测髋关节外侧疼痛的PFNA钉和刀片突出的截止值和位置，并评估其与功能预后的关系。假设：股骨粗隆间骨折固定后，PFNA-II钉和刀片的突出超过特定的x线截值与髋外侧疼痛增加有关。方法：在这项比较观察研究中，从2021年8月至2023年12月招募了226例经PFNA-II固定治疗的转子间骨折患者。纳入标准为年龄≥60岁，固定后≥6个月，x线骨折愈合。采用视觉模拟评分（VAS, 0-10）在两个部位评估髋外侧疼痛：甲尖（大转子）和刀片末端。根据VAS评分将患者分为4组：A组（甲尖疼痛），VAS结果：内侧甲突≥3.775 mm（敏感性91%，特异性61%）和外侧甲突≥8.015 mm（敏感性85%，特异性65%）预测甲尖疼痛。叶片上突≥10.95 mm（敏感性56%，特异性70%）和下突≥3.265 mm（敏感性60%，特异性66%）预测叶片末端疼痛。内侧指甲突出增加疼痛风险（优势比17.17,95% CI 7.68-38.39）。HHS与下叶突出无显著相关，与下叶突出呈弱负相关（r = -0.39, p = 0.032）。结论：PFNA-II型髋关节突出的x线截值可预测术后髋外侧疼痛。虽然疼痛主要与内侧钉和上刀片突出有关，但过度的下刀片突出可能会轻微损害髋关节功能。改良PFNA II设计和手术技术以减少突出可以进一步改善亚洲患者的术后结果。证据水平：II。
{"title":"Cut-Off values for PFNA nail and blade protrusion predicting postoperative pain in intertrochanteric fractures","authors":"Saran Tantavisut , Chavarin Amarase , Napol Ratanasermsub , Sanzhar Artykbay , Sorn Banpapong","doi":"10.1016/j.otsr.2025.104552","DOIUrl":"10.1016/j.otsr.2025.104552","url":null,"abstract":"<div><h3>Background</h3><div>Proximal femoral nail antirotation (PFNA) fixation for intertrochanteric fractures often results in nail or blade protrusion, particularly in Asian populations, and is associated with postoperative lateral hip pain. However, not all patients with protrusion experience pain. The specific lengths and locations causing clinically significant pain remain unclear. This study aims to determine the cut-off values and locations of PFNA nail and blade protrusions that predict lateral hip pain and to evaluate their relationship with functional outcomes.</div></div><div><h3>Hypothesis</h3><div>Protrusion of the PFNA-II nail and blade beyond specific radiographic cut-off values is associated with increased lateral hip pain after intertrochanteric fracture fixation.</div></div><div><h3>Methods</h3><div>In this comparative observational study, 226 patients with intertrochanteric fractures treated with PFNA-II fixation were recruited from August 2021 to December 2023. Inclusion criteria included age ≥60 years, ≥6 months post-fixation, and radiographic fracture union. Lateral hip pain was evaluated using the Visual Analog Scale (VAS, 0–10) at two sites: the nail tip (greater trochanter) and the end of the blade. The patients were divided into four groups according to VAS scores: Group A (nail tip pain, VAS < 4), Group B (nail tip pain, VAS ≥ 4), Group C (blade end pain, VAS < 4), and Group D (blade end pain, VAS ≥ 4). Protrusion lengths (medial/lateral nail, superior/inferior blade) were measured radiographically. The Receiver Operating Characteristics (ROC) analysis determined the cut-off values, and multivariate logistic regression evaluated the risk factors. The Harris Hip Score (HHS) was used to evaluate functional outcomes.</div></div><div><h3>Results</h3><div>Medial nail protrusion ≥3.775 mm (sensitivity 91%, specificity 61%) and lateral nail protrusion ≥8.015 mm (sensitivity 85%, specificity 65%) predicted nail tip pain. The superior blade protrusion ≥10.95 mm (sensitivity 56%, specificity 70%) and the inferior blade protrusion ≥3.265 mm (sensitivity 60%, specificity 66%) predicted blade end pain. Medial nail protrusion increased pain risk (odds ratio 17.17, 95% CI 7.68–38.39). HHS did not show a significant correlation with protrusion, except for a weak negative correlation with inferior blade protrusion (<em>r</em> = −0.39, <em>p</em> = 0.032).</div></div><div><h3>Conclusion</h3><div>Distinct radiographic cut-off values of PFNA-II protrusion predict postoperative lateral hip pain. While pain is mainly associated with medial nail and superior blade protrusion, excessive inferior blade protrusion may slightly impair hip function. The refinement of the PFNA II design and surgical technique to minimize protrusion could further improve postoperative outcomes in Asian patients.</div></div><div><h3>Level of evidence</h3><div>II.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104552"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589900","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}
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