<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
{"title":"Reasons for malpractice claims after first revision of total hip arthroplasty in France: Insurance data from 263 consecutive claims from 2010 to 2023","authors":"Frédéric Sailhan , Pierre-Jean Garnier , Christian Delaunay","doi":"10.1016/j.otsr.2025.104423","DOIUrl":"10.1016/j.otsr.2025.104423","url":null,"abstract":"<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","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104423"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056319","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.2025.104549
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}
Pub Date : 2026-02-01DOI: 10.1016/j.otsr.2025.104438
Guillaume Villatte , Maxime Antoni , Mathieu Girard , Pierre-Sylvain Marcheix
Scapular fracture is varied but rare, and studies have only low levels of evidence. Surgical indications are increasingly numerous, but non-operative treatment with early rehabilitation is the gold-standard in the majority of cases, showing good results. Surgery is indicated according to the patient’s functional demand, on certain anatomic criteria evaluated on CT: glenopolar angle <20 °, >10 mm frontal displacement (medialization) and sagittal angulation >40 ° for fractures of the scapular neck and body, and >4 mm joint displacement, involvement of more than 30% of the joint surface and persistent subluxation for glenoid fractures. Surgery provides good functional results but is technically difficult, with high rates of complications. Acromion fracture, and particularly stress fracture following reverse total arthroplasty, is difficult to treat and incurs frequent sequelae of pain and non-union. Conservative treatment is recommended only in non-displaced lateral fracture (Levy 1). In more medial fracture, osteosynthesis with one or two plates should be considered. Prosthetic revision is indicated in fewer than 10% of cases, for instability or glenoid loosening. The superior shoulder suspensory complex must be analyzed in the bone (scapular neck and clavicle) and ligaments (acromioclavicular and coracoclavicular). The extent of neck fracture displacement dictates surgical management, either (most frequently) by fixation of the clavicle alone or by double clavicular and scapular fixation.
{"title":"Articular and extra-articular scapula fracture","authors":"Guillaume Villatte , Maxime Antoni , Mathieu Girard , Pierre-Sylvain Marcheix","doi":"10.1016/j.otsr.2025.104438","DOIUrl":"10.1016/j.otsr.2025.104438","url":null,"abstract":"<div><div>Scapular fracture is varied but rare, and studies have only low levels of evidence. Surgical indications are increasingly numerous, but non-operative treatment with early rehabilitation is the gold-standard in the majority of cases, showing good results. Surgery is indicated according to the patient’s functional demand, on certain anatomic criteria evaluated on CT: glenopolar angle <20 °, >10 mm frontal displacement (medialization) and sagittal angulation >40 ° for fractures of the scapular neck and body, and >4 mm joint displacement, involvement of more than 30% of the joint surface and persistent subluxation for glenoid fractures. Surgery provides good functional results but is technically difficult, with high rates of complications. Acromion fracture, and particularly stress fracture following reverse total arthroplasty, is difficult to treat and incurs frequent sequelae of pain and non-union. Conservative treatment is recommended only in non-displaced lateral fracture (Levy 1). In more medial fracture, osteosynthesis with one or two plates should be considered. Prosthetic revision is indicated in fewer than 10% of cases, for instability or glenoid loosening. The superior shoulder suspensory complex must be analyzed in the bone (scapular neck and clavicle) and ligaments (acromioclavicular and coracoclavicular). The extent of neck fracture displacement dictates surgical management, either (most frequently) by fixation of the clavicle alone or by double clavicular and scapular fixation.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104438"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151940","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.2025.104527
Valérie Dumaine
Initially indicated for tumor surgery only, the reliability and modularity of megaprostheses of the knee, and in particular of the distal femur, have broadened indications for revision of standard knee prostheses with significant bone destruction and for trauma surgery, particularly in elderly patients. In oncologic surgery, implant survival is 80% at 5 years, but almost half will be revised by 15 years, sometimes with multiple revision. Complications are numerous; infection is the most common and the main cause of amputation. Mechanical stress is significant and, despite technological progress, no ideal implant exists. Although design is simple, the technique is demanding, to limit risk of loosening, fracture and patellar complications. Managing these complications requires good knowledge of knee prostheses in general and of techniques specific to megaprostheses.
{"title":"Complications of distal femur megaprostheses","authors":"Valérie Dumaine","doi":"10.1016/j.otsr.2025.104527","DOIUrl":"10.1016/j.otsr.2025.104527","url":null,"abstract":"<div><div>Initially indicated for tumor surgery only, the reliability and modularity of megaprostheses of the knee, and in particular of the distal femur, have broadened indications for revision of standard knee prostheses with significant bone destruction and for trauma surgery, particularly in elderly patients. In oncologic surgery, implant survival is 80% at 5 years, but almost half will be revised by 15 years, sometimes with multiple revision. Complications are numerous; infection is the most common and the main cause of amputation. Mechanical stress is significant and, despite technological progress, no ideal implant exists. Although design is simple, the technique is demanding, to limit risk of loosening, fracture and patellar complications. Managing these complications requires good knowledge of knee prostheses in general and of techniques specific to megaprostheses.</div><div>Level of evidence: V; expert opinion</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104527"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145423459","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}
Soft tissue infections are common in the upper limb, particularly in the hand, which is exposed to the environment. They include entities that are diverse in their severity, their progression, and their frequency. However, what they have in common – if not managed correctly – is that they can have a major functional impact, amputation risk, or be life-threatening. The bacteria involved in upper limb infections are mainly Gram-positive cocci, but Gram-negative bacilli colonize bite wounds, which are common in the upper limb. From the most frequent and benign to the most serious, we distinguish: paronychia, infections without fluid collection such as bacterial dermohypodermitis (BDH), suppurative collections (abscesses) including pyogenic flexor tenosynovitis, and necrotizing soft tissue infections–necrotizing fasciitis (NSTI-NF). The clinical diagnosis is based on the presence of erythema, swelling, pain, and local heat. Lymphangitis or adenopathy are signs of regional spread. The appearance of skin necrosis or septic shock is suggestive of BNDH-FN. Laboratory tests will show elevated WBC, an increase in C-reactive protein for invasive infections, or even disturbances in the liver or kidney function, elevated lactate, which are signs of severity. Imaging examinations are mainly X-rays in the case of a wound, ultrasound or CT scan. Treatment of soft tissue infections of the upper limb is medical and surgical. Antibiotic therapy is sufficient in the case of BDH. Surgery is essential to drain any suppuration (pyogenic flexor tenosynovitis, abscess), or to widely excise the invaded tissues in NSTI-NF, in addition to antibiotic therapy that is subsequently adapted to microbiological findings. After the initial objective of eradicating the infection, the final objective is to allow the functional rehabilitation of the limb. The treatment of soft tissue infections in the upper limb is therefore often multidisciplinary, involving surgeons, and sometimes intensivists, infectiologists, and physiotherapists.
{"title":"Diagnosis and management of upper limb soft tissue infections","authors":"Isabelle Auquit-Auckbur , Roberto Beccari , Dorothée Coquerel-Beghin , Carlos-Marcelo Garcia-Doldan","doi":"10.1016/j.otsr.2025.104528","DOIUrl":"10.1016/j.otsr.2025.104528","url":null,"abstract":"<div><div>Soft tissue infections are common in the upper limb, particularly in the hand, which is exposed to the environment. They include entities that are diverse in their severity, their progression, and their frequency. However, what they have in common – if not managed correctly – is that they can have a major functional impact, amputation risk, or be life-threatening. The bacteria involved in upper limb infections are mainly Gram-positive cocci, but Gram-negative bacilli colonize bite wounds, which are common in the upper limb. From the most frequent and benign to the most serious, we distinguish: paronychia, infections without fluid collection such as bacterial dermohypodermitis (BDH), suppurative collections (abscesses) including pyogenic flexor tenosynovitis, and necrotizing soft tissue infections–necrotizing fasciitis (NSTI-NF). The clinical diagnosis is based on the presence of erythema, swelling, pain, and local heat. Lymphangitis or adenopathy are signs of regional spread. The appearance of skin necrosis or septic shock is suggestive of BNDH-FN. Laboratory tests will show elevated WBC, an increase in C-reactive protein for invasive infections, or even disturbances in the liver or kidney function, elevated lactate, which are signs of severity. Imaging examinations are mainly X-rays in the case of a wound, ultrasound or CT scan. Treatment of soft tissue infections of the upper limb is medical and surgical. Antibiotic therapy is sufficient in the case of BDH. Surgery is essential to drain any suppuration (pyogenic flexor tenosynovitis, abscess), or to widely excise the invaded tissues in NSTI-NF, in addition to antibiotic therapy that is subsequently adapted to microbiological findings. After the initial objective of eradicating the infection, the final objective is to allow the functional rehabilitation of the limb. The treatment of soft tissue infections in the upper limb is therefore often multidisciplinary, involving surgeons, and sometimes intensivists, infectiologists, and physiotherapists.</div><div>Level of evidence >V: expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104528"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432966","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.2025.104392
Mehdi Boudissa, Gael Kerschbaumer, Jérôme Tonetti
Percutaneous pelvic screwing (PPS) enables fixation of traumatic or atraumatic fractures with little or no displacement, or displaced but reduced fractures, and preventive fixation of primary or secondary tumoral lesions. It is a relatively recent technique, and indications are evolving with progress in pre- and intra-operative imaging. Morbidity is lower than with open surgery. PPS is classically performed under fluoroscopy; computer-assisted surgery is of great interest, enabling analysis of safe bone corridors. Planning is based on image processing tools included in CT DICOM viewer packages.
The aim of the present study was to review PPS.
What are the indications for PPS? All pelvic ring fractures are in principle concerned if the reduction allows passage of a K-wire and then a screw. A distinction is to be made between, on the one hand, young patients, able to support a variable period of non-weight-bearing, in whom PPS stabilizes an unstable fracture, relieves pain on motion and prevents non-union, and, on the other hand, older patients for whom PPS enables optimally early resumption of weight-bearing.
How to plan posterior PPS? The principal procedures are iliosacral screwing (ISS), trans-sacral screwing (TSS) and supra-acetabular screwing (SAS).
How to plan anterior PPS? The principal procedures are anterior column/superior pubic ramus (AC/SPR) screwing, iliac wing screwing (IWS) and gluteal pillar screwing.
How to plan percutaneous acetabular screwing (PAS)? The principal procedures are transverse acetabular screwing (TAS) and retrograde posterior column screwing (RPCS) or “butt screw”. Fixation is demanding. PPS requires rigorous preoperative planning using CT DICOM viewer software. The principle consists in multiplane reconstruction of bone corridors, to assess the feasibility of PPS and analyze implant diameters, tracing lines to measure implant trajectory and length, and 3D reconstruction using the measurements, to assess entry and exit points and forecast intraoperative fluoroscopic views.
What results, what complications, what innovations? Results are comparable to those of open surgery, with significantly less morbidity. The main complications are implant malpositioning and fixation failure, with secondary displacement of the fracture and/or implants. 3D printing, navigation and, recently, robotic surgery constitute the future of PPS.
How PPS can go wrong? Difficulties or errors in planning, errors in patient positioning or errors in reading fluoroscopy are the main pitfalls. When available, intraoperative 3D imaging, associated to navigation or not, improves safety.
{"title":"Computer-assisted surgery and planning in percutaneous pelvic screw fixation","authors":"Mehdi Boudissa, Gael Kerschbaumer, Jérôme Tonetti","doi":"10.1016/j.otsr.2025.104392","DOIUrl":"10.1016/j.otsr.2025.104392","url":null,"abstract":"<div><div>Percutaneous pelvic screwing (PPS) enables fixation of traumatic or atraumatic fractures with little or no displacement, or displaced but reduced fractures, and preventive fixation of primary or secondary tumoral lesions. It is a relatively recent technique, and indications are evolving with progress in pre- and intra-operative imaging. Morbidity is lower than with open surgery. PPS is classically performed under fluoroscopy; computer-assisted surgery is of great interest, enabling analysis of safe bone corridors. Planning is based on image processing tools included in CT DICOM viewer packages.</div><div>The aim of the present study was to review PPS.</div><div>What are the indications for PPS? All pelvic ring fractures are in principle concerned if the reduction allows passage of a K-wire and then a screw. A distinction is to be made between, on the one hand, young patients, able to support a variable period of non-weight-bearing, in whom PPS stabilizes an unstable fracture, relieves pain on motion and prevents non-union, and, on the other hand, older patients for whom PPS enables optimally early resumption of weight-bearing.</div><div>How to plan posterior PPS? The principal procedures are iliosacral screwing (ISS), trans-sacral screwing (TSS) and supra-acetabular screwing (SAS).</div><div>How to plan anterior PPS? The principal procedures are anterior column/superior pubic ramus (AC/SPR) screwing, iliac wing screwing (IWS) and gluteal pillar screwing.</div><div>How to plan percutaneous acetabular screwing (PAS)? The principal procedures are transverse acetabular screwing (TAS) and retrograde posterior column screwing (RPCS) or “butt screw”. Fixation is demanding. PPS requires rigorous preoperative planning using CT DICOM viewer software. The principle consists in multiplane reconstruction of bone corridors, to assess the feasibility of PPS and analyze implant diameters, tracing lines to measure implant trajectory and length, and 3D reconstruction using the measurements, to assess entry and exit points and forecast intraoperative fluoroscopic views.</div><div>What results, what complications, what innovations? Results are comparable to those of open surgery, with significantly less morbidity. The main complications are implant malpositioning and fixation failure, with secondary displacement of the fracture and/or implants. 3D printing, navigation and, recently, robotic surgery constitute the future of PPS.</div><div>How PPS can go wrong? Difficulties or errors in planning, errors in patient positioning or errors in reading fluoroscopy are the main pitfalls. When available, intraoperative 3D imaging, associated to navigation or not, improves safety.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104392"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008554","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.2025.104415
Matthieu Lalevée , Louis Dagneaux , François Lintz , Cesar de Cesar Netto
Adult acquired flatfoot deformity, recently renamed Progressive Collapsing Foot Deformity (PCFD), is challenging to diagnose and treat due to the still poorly understood nature of its pathogenesis, which involves a complex interaction between soft tissues and bony structures. Long regarded as being primarily linked to posterior tibial tendon dysfunction, PCFD is now considered a multifactorial deformity (osseous dysplasia, joint malposition, tendon muscle imbalance, etc.), with many aspects yet to be explored. This study aims to provide an update on this pathology by addressing the following five key questions: (1) Is flatfoot truly a problem? A stable congenital flatfoot is generally asymptomatic. However, a sagging foot, regardless of its flatness, characterized by a progressive arch collapse (PCFD), is painful. (2) What role do soft tissues play in its pathogenesis? The previously central role attributed to the posterior tibial tendon and its rupture, which was thought to trigger a chronological cascade of deformations, is now being reconsidered. (3) How should we classify a flatfoot? The Progressive Collapsing Foot Deformity (PCFD) classification distinguishes five types of deformities: hindfoot valgus, midfoot abduction, forefoot varus, peritalar subluxation, and tibiotalar valgus. These deformities can occur in isolation or in combination, without a predetermined chronological order, and each of them can be either flexible or rigid. (4) What is the contribution of modern imaging? Weightbearing Cone Beam CT enables the early identification of subluxations and joint impingements, clarifying the distinction between a stable flatfoot and PCFD while revealing complex deformities that conventional methods may not detect. (5) What are the current perspectives and future directions? Research aims to differentiate stable congenital flatfeet from PCFD in order to better identify risk factors for symptomatic progression. Dynamic imaging techniques, such as biplanar fluoroscopy, offer real time analysis of bone motions, while computational simulations, integrating both soft tissues and bony structures, contribute to a deeper understanding of the onset and progression of deformities.
{"title":"Flatfoot: New diagnostic modalities","authors":"Matthieu Lalevée , Louis Dagneaux , François Lintz , Cesar de Cesar Netto","doi":"10.1016/j.otsr.2025.104415","DOIUrl":"10.1016/j.otsr.2025.104415","url":null,"abstract":"<div><div>Adult acquired flatfoot deformity, recently renamed Progressive Collapsing Foot Deformity (PCFD), is challenging to diagnose and treat due to the still poorly understood nature of its pathogenesis, which involves a complex interaction between soft tissues and bony structures. Long regarded as being primarily linked to posterior tibial tendon dysfunction, PCFD is now considered a multifactorial deformity (osseous dysplasia, joint malposition, tendon muscle imbalance, etc.), with many aspects yet to be explored. This study aims to provide an update on this pathology by addressing the following five key questions: (1) Is flatfoot truly a problem? A stable congenital flatfoot is generally asymptomatic. However, a sagging foot, regardless of its flatness, characterized by a progressive arch collapse (PCFD), is painful. (2) What role do soft tissues play in its pathogenesis? The previously central role attributed to the posterior tibial tendon and its rupture, which was thought to trigger a chronological cascade of deformations, is now being reconsidered. (3) How should we classify a flatfoot? The Progressive Collapsing Foot Deformity (PCFD) classification distinguishes five types of deformities: hindfoot valgus, midfoot abduction, forefoot varus, peritalar subluxation, and tibiotalar valgus. These deformities can occur in isolation or in combination, without a predetermined chronological order, and each of them can be either flexible or rigid. (4) What is the contribution of modern imaging? Weightbearing Cone Beam CT enables the early identification of subluxations and joint impingements, clarifying the distinction between a stable flatfoot and PCFD while revealing complex deformities that conventional methods may not detect. (5) What are the current perspectives and future directions? Research aims to differentiate stable congenital flatfeet from PCFD in order to better identify risk factors for symptomatic progression. Dynamic imaging techniques, such as biplanar fluoroscopy, offer real time analysis of bone motions, while computational simulations, integrating both soft tissues and bony structures, contribute to a deeper understanding of the onset and progression of deformities.</div></div><div><h3>Level of evidence</h3><div>>V.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104415"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042493","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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