Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Two-year outcomes of non-conservative treatment of the long head of the biceps tendon in the repair of small supraspinatus tears: A multicenter prospective study","authors":"Aimery Sabelle ,&nbsp;Benjamin Sallé ,&nbsp;Christophe Charousset ,&nbsp;Adrien Jacquot ,&nbsp;François Gadéa ,&nbsp;Jacques Guery ,&nbsp;Thierry Joudet ,&nbsp;Nicolas Bonnevialle ,&nbsp;Xavier Ohl ,&nbsp;Lionel Neyton ,&nbsp;Nicolas Gasse ,&nbsp;Ramy Samargandi ,&nbsp;Johannes Barth ,&nbsp;Maxime Antoni ,&nbsp;Franck Dordain ,&nbsp;David Gallinet ,&nbsp;Julien Berhouet","doi":"10.1016/j.otsr.2025.104451","DOIUrl":"10.1016/j.otsr.2025.104451","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of the long head of the biceps tendon (LHBT) is well established in case of massive, irreparable rotator cuff tears (RCTs). However, its treatment in the context of small RCTs, especially those involving the supraspinatus tendon remain controversial, with ongoing debate over whether tenotomy, tenodesis, or simple preservation is the most appropriate approach. This study hypothesized that a non-conservative treatment (either isolated tenotomy or tenodesis) would yield equivalent functional outcomes, regardless of the macroscopic intraoperative appearance of the biceps tendon.</div></div><div><h3>Materials and methods</h3><div>In this prospective multicenter study, 210 patients underwent rotator cuff repair for a tear primarily affecting the supraspinatus tendon. A tenotomy or a tenodesis of the LHBT was systematically performed, regardless of its intraoperative appearance (normal or pathologic). Functional outcomes at two years (VAS, Constant score, SSV, ASES score) were collected and compared according to the macroscopic aspect of the tendon. To account for potential confounding factors, a 1:1 propensity score matching was performed. Outcomes were also compared between tenotomy and tenodesis groups. Cuff healing was assessed by ultrasound at the last follow-up.</div></div><div><h3>Results</h3><div>At the two-year follow-up, after propensity-score matching, no statistically significant differences were found between groups in any of the tested score (Constant score, <em>p</em> = 0.96; VAS, <em>p</em> = 0.33; ASES score, <em>p</em> = 0.50).</div><div>Before matching, functional scores were significantly better in patients who underwent tenotomy or tenodesis in combination with cuff repair when the LHBT appeared macroscopically normal during surgery: Constant score (87 ± 8 vs. 83 ± 11, p = 0.003), ASES score (91 ± 19 vs. 85 ± 22, p = 0.002), and SSV (95 ± 9 vs. 79 ± 31, p &lt; 0.001). No statistically significant difference was found in Constant score improvement.</div><div>Tenodesis was associated with better flexion strength, but no statistical differences were observed for other outcomes, including the Popeye deformity. At two years, cuff healing rates were similar between the two groups.</div></div><div><h3>Conclusion</h3><div>After controlling for confounding factors, the macroscopic appearance of the LHBT did not significantly influence clinical outcomes at two years after rotator cuff repair and tenotomy or tenodesis.</div></div><div><h3>Level of evidence</h3><div>III; Prospective non-randomized study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104451"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socio-professional impact of the hip spica cast for femoral shaft fracture management in children under six","authors":"Edouard de Charnace ,&nbsp;Iseut Line Bunetel ,&nbsp;Margaux Haas ,&nbsp;Charles Senah ,&nbsp;Mohammed Belouadah ,&nbsp;Mohamed Mehrez Kilani ,&nbsp;Delphine Tuton ,&nbsp;Sophie Bourelle","doi":"10.1016/j.otsr.2025.104556","DOIUrl":"10.1016/j.otsr.2025.104556","url":null,"abstract":"<div><h3>Background</h3><div>The treatment of a femoral shaft fracture in children under the age of 6 years old consists in a closed reduction followed by a hip spica cast, which can have a major impact on the family. The aim of this study is to assess the socio-professional impact of the hip spica cast (HSC) on families.</div></div><div><h3>Materials and methods</h3><div>Families of 114 children under 6 years of age treated with a hip spica cast for a femoral shaft fracture were surveyed using a questionnaire created for this study. Additional clinical data were collected on treatment, hospitalization and duration of immobilization.</div></div><div><h3>Results</h3><div>Within the 114 patients included, the mean age was 2.7 years, and the mean duration of immobilisation was 6.6 weeks. The difficulties encountered by the parents in managing the cast were evaluated at 7 out of 10 scale (from 0 very easy to 10 very difficult). Difficulties were significantly greater in relation to the duration of immobilisation and the age of the child (p &lt; 0.05). In 47% of cases, one or both parents had to take time off work. Taking time off work was not correlated with the duration of immobilisation or the age of the child. Families with both parents working (or single parents working) were out of work more often and for longer periods than those with at least one parent at home (p &lt; 0.05). After removal of the immobilisation, 71% of the children had returned to walking within a month.</div></div><div><h3>Conclusions</h3><div>The treatment with hip spica cast has a major socio-economic impact, particularly in terms of parental time off work. However, it is the reference treatment for femoral shaft fractures in children under 6 years of age, with very good results.</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 104556"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of patients on long-term oral anticoagulant therapy during primary total hip or knee replacement arthroplasty: A prospective non-interventional comparative study","authors":"David Biau ,&nbsp;Anne Godier ,&nbsp;Anthony Viste ,&nbsp;Didier Hannouche ,&nbsp;Jean-Yves Jenny ,&nbsp;Marie Le Baron ,&nbsp;Simon Marmor ,&nbsp;Pierre-Yves Petit ,&nbsp;Pablo Rodriguez ,&nbsp;Pierre Bentzinger ,&nbsp;David Delahaye ,&nbsp;Wiem Braham ,&nbsp;Maxime Coré ,&nbsp;Xavier Flecher ,&nbsp;Moussa Hamadouche","doi":"10.1016/j.otsr.2025.104561","DOIUrl":"10.1016/j.otsr.2025.104561","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Patients scheduled for primary hip or knee replacement are frequently treated with long-term curative oral anticoagulants (LT-COA), vitamin K antagonists (VKA) or direct oral anticoagulants (DOA). We conducted a prospective, controlled study comparing patients treated with LT-COA undergoing total hip replacement (THR) or total knee replacement (TKR) with patients not treated with LT-COA undergoing the same procedure, in order to estimate the adjusted and unadjusted risks of postoperative haemorrhagic or thrombotic complications associated with LT-COA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;The rate of post-operative complications was higher in the group treated with LT-COA.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;This was a prospective, comparative, non-interventional study comparing patients undergoing primary THR or TKR arthroplasty who were treated with LT-COA with those who were not treated with curative-dose oral anticoagulants (control group). A total of 325 patients were assessed at 3 months, 215 (66%) in the control group, 123 with THR and 92 with TKR, and 110 (34%) in the LT-COA group, 68 with THR and 42 with TKR. Patients in the control group were more likely to be female, and were also slightly younger and in better pre-operative health. In the LT-COA group, 55 (50%) patients were treated with VKA and 55 (50%) with DOA. The surgical technique, implants and management of perioperative anticoagulants were left to the discretion of the practitioners. The primary endpoint was the occurrence of a HTR (haemorrhagic or thrombotic complications, or revision surgery) complication within 3 months of surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 325 patients analysed, 77 (24%) had a HTR complication, 50 (23%) in the control group and 27 (25%) in the LT-COA group (OR = 0.93; 95% CI: 0.54–1.59 (p = 0.80)). In multivariable analysis, the risk of a HTR complication was not significantly different between the groups (adjusted OR = 0.85; 95% CI: 0.45–1.61 (p = 0.62)). Age (p = 0.99) and sex (p = 0.97) were not associated with the occurrence of a HTR complication. In contrast, ASA score (p = 0.017), and type of surgery (THR or TKR, p = 0.019) were significantly associated with the occurrence of a HTR complication in the multivariable analyses.&lt;/div&gt;&lt;div&gt;In the LT-COA group, the rate of HTR complications during hospitalisation was significantly higher (p = 0.0076) for patients who had undergone preoperative relay (discontinuation of anticoagulants and initiation of LMWH (Low Molecular Weight Heparin)) (n = 15 out of 41 patients, 37%) compared with those who had not (n = 9 out of 69 patients, 13%). Similarly, HTR complications during hospitalisation were significantly more frequent (p = 0.0363, Fisher's exact test) for patients treated with VKA (n = 19 out of 55 patients, 35%) compared with those treated with DOA (n = 8 out of 55 patients, 15%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;The rate of HTR complica","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104561"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dislocation after anterior-approach THA: High prevalence of spinopelvic risk factors","authors":"Camille Vorimore,&nbsp;Vincent Le Strat,&nbsp;Simon Marmor,&nbsp;Wilfrid Graff,&nbsp;Antoine Mouton,&nbsp;Thomas Aubert","doi":"10.1016/j.otsr.2025.104315","DOIUrl":"10.1016/j.otsr.2025.104315","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Hip dislocation remains one of the most frequent complications of &lt;/span&gt;total hip arthroplasty (THA). To minimize the risk of dislocation, cup placement has traditionally been guided by a defined \"safe zone\". However, dislocations still occur even when the implant components are positioned within this zone, which may be due to the influence of spinopelvic motion on THA stability. This study aimed to (1) compare spinopelvic risk factors for dislocation between patients who experienced dislocations and those who did not after anterior-approach surgery and (2) analyze the risk factors associated with anterior versus posterior dislocations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;Our hypothesis was that patients with dislocation of a total hip arthroplasty after the anterior approach had a higher rate of risk factors for adverse spinopelvic mobility and that implant versions, as well as hip lengths and offsets, play an important role in anterior and posterior dislocations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and methods&lt;/h3&gt;&lt;div&gt;Patient with dislocation were prospectively collected from August 2018 to August 2022. Out of a total of 6,166 THAs, 35 dislocations were recorded, and 7 patients were excluded. This single-center study included a prospective cohort of 28patients who experienced dislocations (19 anterior, 9 posterior) compared with a consecutive control cohort of 278 patients who did not, all of whom underwent primary THA via the anterior approach. Preoperative spinopelvic parameters such as lumbar flexion (LF), spinopelvic tilt (SPT), pelvic incidence (PI), and pelvic mobility (change in SPT [ΔSPT]) were analyzed in the control group using pelvic-femoral computed tomography and lateral X-rays. Patients who experienced dislocation underwent advanced postoperative functional analysis, in which spinopelvic parameters, implant version, hip length discrepancy, and femoral offset were assessed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The prevalence of spinopelvic risk factors was greater in the dislocation cohort than in the control cohort [SPT≤−10°: 42.5% vs. 10.5% (p &lt; 0.001); LF ≤ 35°: 46.1% vs. 11.9% (p &lt; 0.001); PI–lumbar lordosis (LL) ≥ 10°: 33.9% vs. 14.8% (p = 0.003); ΔSPT ≥ 20 ° from standing to seated: 50% vs. 8.3% (p &lt; 0.001); and ΔSPT ≤−13 ° from supine to standing: 21.4% vs. 6.7% (p = 0.012)]. The mean combined anteversion (CA) was 35 ° (7°–53 °) in the anterior dislocation group and 24 ° (15°–30 °) in the posterior dislocation group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Patients with dislocations presented a high prevalence of spinopelvic risk factors. Anterior dislocations were linked to spinopelvic abnormalities rather than excessive CA. In contrast, posterior dislocations occurred in patients with low CA, especially at the expense of stem version and spinopelvic risk factors. Therefore, in patients undergoing anterior-approach THA, restricting implant anteversion may not be the primary factor","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104315"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to driving after surgical treatment of proximal humerus fractures","authors":"Vinh Le Thai ,&nbsp;Maxime Antoni ,&nbsp;Philippe Clavert","doi":"10.1016/j.otsr.2025.104346","DOIUrl":"10.1016/j.otsr.2025.104346","url":null,"abstract":"<div><h3>Introduction</h3><div>There are few data available about how patients resume car driving after proximal humerus fracture. The aim of this study was to evaluate return to car driving after surgical treatment of proximal humerus fracture. Secondary aims were to identify factors associated with return to driving.</div></div><div><h3>Methods</h3><div>This retrospective monocentric study included 155 patients (mean age 64.3 ± 11.7 years), operated on for a traumatic proximal humerus fracture. Among them, 59% were treated by ORIF by nail, 18% by ORIF by plate and 23% by a reverse shoulder arthroplasty. All patients had a driver’s license and used to drive a car preoperatively, on a regular basis. Modalities for resuming driving after surgery were collected retrospectively. Primary endpoint was the postoperative time to return to car driving. Secondary endpoints were: return to driving rates at 3, 6, 12, 24 months, the time to be back to driving with a shoulder free of pain. Influence of different potential factors on the primary endpoint was evaluated with multivariate analysis. A p-value of less than 0.05 was considered significant.</div></div><div><h3>Results</h3><div>The 3 groups were comparable with regard to gender, age, medical history, side affected, frequency of pre-operative driving. Postoperative time to return to driving was 15.9 ±11.3 weeks and time to be back to driving with a shoulder free of pain was 31.9 ±13.8 weeks. At 2 years follow-up, 71% of patients had resumed car driving. In multivariate analysis, the following factors were associated with a delayed return to driving: Neer 4 fracture (delayed by 10.2 weeks, <em>p</em> = 0.001); reverse shoulder arthroplasty (delayed by 8.0 weeks, <em>p</em> = 0.02); occurence of a postoperative complication (delayed by 8.9 weeks, <em>p</em> = 0.013). A high SSV score at 3 months was associated with a shortened delay to return to driving (<em>p</em> = 0.035). We did not find any statistical correlation between delay to return to driving and the other potential factors evaluated.</div></div><div><h3>Conclusion</h3><div>After surgical treatment of proximal humerus fracture, 71% of patients were able to resume car driving, at 2 years follow-up. Mean postoperative time to resume car driving was 15.9 weeks.</div></div><div><h3>Level of evidence</h3><div>III; retrospective case-control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104346"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should Ceramic-on-Ceramic or Ceramic-on-Polyethylene Bearings Be Preferred in Revision Total Hip Arthroplasty After Ceramic Head or Liner Fracture? A Retrospective Multicenter Case-Control Study of 33 Cases","authors":"Robin Oger ,&nbsp;Christophe Hulet ,&nbsp;Martin Tripon ,&nbsp;Julien Dunet ,&nbsp;Philippe-Alexandre Faure ,&nbsp;Julien Dartus ,&nbsp;Gaelle Maroteau ,&nbsp;Henri Migaud","doi":"10.1016/j.otsr.2025.104426","DOIUrl":"10.1016/j.otsr.2025.104426","url":null,"abstract":"<div><h3>Introduction</h3><div>Fracture of ceramic components in total hip arthroplasty (THA), although rare, remains a major concern. The optimal bearing choice in revision surgery following such fractures is still debated. Few studies have specifically compared ceramic-on-polyethylene (CoP) to ceramic-on-ceramic (CoC) in this context. Therefore we built up a retrospective comparative study aiming to compare the two bearing surfaces regarding: (1) complication rates, (2) implant survival, and (3) functional outcomes.</div></div><div><h3>Hypothesis</h3><div>The use of CoP with a monoblock (single-mobility) design is associated with fewer complications than CoC bearings in revision THA for ceramic component fracture.</div></div><div><h3>Materials and methods</h3><div>A retrospective multicenter analysis was conducted on 33 patients treated for ceramic component fractures (17 femoral heads, 16 liners), which occurred at a mean of 6 years and 8 months (range, 2 months to 25 years) after the index procedure. Sixteen patients received CoC bearings and 17 received CoP bearings. Patients were assessed at a mean follow-up of 8 years and 10 months (range, 1–21 years).</div></div><div><h3>Results</h3><div>At a mean follow-up of 8.9 years, the CoC group (mean follow-up 9.1 years) experienced significantly more complications than the CoP group (mean follow-up 8.7 years): 10/16 cases (62.5%) in the CoC group versus 3/17 cases (17.6%) in the CoP group (p = 0.013). Complications in the CoC group included: 5 dislocations (31%), 2 cases of squeaking (13%), 2 recurrent ceramic head fractures (13%), and 1 infection (6%). In the CoP group, complications included 2 dislocations (12%) and 1 aseptic loosening (6%). Mean Oxford Hip Scores at final follow-up were 21.7/60 (range, 12–47) for the CoP group and 23.1/60 (range, 12–45) for the CoC group, with no significant difference (p = 0.5).</div></div><div><h3>Discussion</h3><div>The strength of this study lies in the direct comparison of CoC and CoP bearing surfaces, with a significantly lower complication rate observed in the CoP group. However, these results should be confirmed in larger cohorts to help standardize current practices, which are often guided by expert opinion rather than scientific evidence. CoC bearings did not prevent dislocations, squeaking, or recurrent fractures. CoP monoblock constructs may offer both durability and a reduced complication profile in these high-risk revision scenarios.</div></div><div><h3>Level of evidence</h3><div>III; Retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104426"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does tendon healing after isolated supraspinatus tendon repair influence clinical outcomes?","authors":"Charles Thery,&nbsp;Maxime Antoni,&nbsp;Florent Baldairon,&nbsp;Thomas Mereb,&nbsp;Philippe Clavert","doi":"10.1016/j.otsr.2025.104566","DOIUrl":"10.1016/j.otsr.2025.104566","url":null,"abstract":"<div><h3>Introduction</h3><div>Many factors intrinsic and extrinsic are known to influence the clinical result after rotator cuff repair. Achieving tendon healing is one of the objectives in surgical repair of the rotator cuff, and many factors could influence this healing. After one-year post-op, assessment of tendon healing can guide management if clinical examination reveals persistent pain or unsatisfactory mobility. Despite non-healing being known to be associated with poorer outcome in massive tear, it has not been clearly established that tendon healing has influence on the clinical outcome in the case of isolated distal ruptures. Therefore we performed a retrospective study aiming to determine whether if there is difference in clinical outcomes between healed and non-healed patients at one year follow up after isolated supraspinatus distal repair?</div></div><div><h3>Hypothesis</h3><div>We hypothesized that tendon healing status at one year has no impact on clinical outcomes.</div></div><div><h3>Materials and methods</h3><div>A retrospective comparative study was conducted in 203 patients who undergo repair of isolated distal supraspinatus tendon tear. Healing was assessed at 1 year on MRI using the Sugaya classification. Stages I, II and III counting as “healed”. Two groups were compared between 186 “healed” (107 females, 79 males) and 17 “non-healed” patients (9 females, 8 males). We analyzed evolution of Constant score and its subscores (pain, activities of daily living, motion and strength components), anterior elevation and lateral rotation at 6 weeks, 3 months, 6 months and results at one year follow up.</div></div><div><h3>Results</h3><div>There were no significant between the two groups in demographic data and surgical procedures. We found no significative differences during evolution at one year of follow up in global Constant score (healed, 73.7 ± 17.6; non-healed, 72.4 ± 15.6 (p = 0.72)) or its components: pain (11.3 vs 10.9 (p = 0.78)), activities of daily living (8.2 vs 8.3 (p = 0.85)), motion (35.4 vs 32.2 (p = 0.09)), strength (10.8 vs 10.1 (p = 0.59)), and anterior elevation (165.6 ° vs 163.2 ° (p = 0.65)) or lateral rotation (58.6 ° vs 58.7 ° (p = 0.98)).</div></div><div><h3>Discussion</h3><div>Healing showed no clinical impact in isolated distal supraspinatus tendon repair at one year follow up in Constant score analysis and in pain, activities of daily living, strength or motion. Factors which could influence healing, and the absence of result are not clear. Even so, tendon healing is a prime objective, as it has been shown to prevent lesion extension and long-term clinical deterioration. Many studies have sought to improve intra- or post-operative healing, by improve surgical technique of repair and biological supplements. Further studies are needed to improve these results.</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 104566"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal endoscopy: Techniques, indications and limitations","authors":"Benjamin Bouyer ,&nbsp;Henri d'Astorg","doi":"10.1016/j.otsr.2025.104458","DOIUrl":"10.1016/j.otsr.2025.104458","url":null,"abstract":"<div><div>Spinal endoscopy is a major advance in spinal surgery, offering a minimally invasive alternative to traditional techniques. Since the first attempts at indirect visualization of the spinal canal in the 20th century, numerous technological advances have extended the applications of endoscopy, from treating herniated discs to lumbar fusion. Two main techniques are used: uniportal, with a single incision for instruments and endoscope, and biportal, inspired by arthroscopy, using two separate incisions. Uniportal techniques are precise and allow minimal approaches, ideal for simple procedures, while biportal techniques offer better maneuverability for more complex procedures. Spinal endoscopy has proven effective in treating compressive lumbar pathologies: herniated discs, canal or foraminal stenosis, and medullary compression in cervical and thoracic pathologies. It considerably reduces postoperative morbidity and ensures rapid recovery, less pain and fewer infectious complications. However, the learning curve for these techniques is a significant challenge, requiring experience and specialized training. Among other limitations, there is an increased risk of hematoma, transient dysesthesia and accidental durotomy. The high cost of specialized equipment is also a barrier to widespread adoption, although savings are achieved via shorter hospital stay. Despite these challenges, spinal endoscopy is becoming increasingly well-established, with future prospects linked to technological improvements and surgeon training.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104458"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention and treatment of post-irradiation fractures and other complications","authors":"Eric Mascard ,&nbsp;Gualter Vaz ,&nbsp;Valentine Martin","doi":"10.1016/j.otsr.2025.104441","DOIUrl":"10.1016/j.otsr.2025.104441","url":null,"abstract":"<div><div>Bone may be irradiated either as a target volume in the treatment of metastases or primary bone tumors, or as an organ at risk in soft tissue sarcomas (STS) and other cancers. This review aims to answer 5 key questions: 1. What are the causes, mechanisms, and locations of post-irradiation fractures (PIF)? Radiotherapy affects bone metabolism and surrounding soft tissues, contributing to fractures and complicating their treatment. In STS, periosteal stripping and radiation doses exceeding 50 Gy increase the risk of PIF, especially in the femur, which is the most frequently affected site. Fractures of the tibia, fibula, metatarsals, and upper limb are less common. PIF can also occur in the mandible (head and neck cancers), ribs or spine (lung and breast cancers), upper humerus, or pelvis. Osteoradionecrosis (ORN) is mostly associated with head and neck or maxillofacial sites but can affect other parts of the skeleton and pose significant therapeutic challenges. 2. How can post-irradiation fractures be prevented? Prevention of PIF mainly involves reducing skeletal radiation exposure and correcting any pre-existing osteopenia. Antioxidants and hyperbaric oxygen therapy are effective in preventing ORN. Preventive femoral nailing is recommended when general and especially local risk factors are present, such as during resection of STS of the thigh. Skeletal coverage with a flap can prevent complications caused by the sacrifice of soft tissue during resection of the primary tumor. 3. How is a post-irradiation fracture diagnosed? Some PIFs are easy to diagnose, while others are discovered fortuitously. It is important to differentiate PIFs from other lesions (metastasis, tumor progression, radiation-induced sarcoma, osteonecrosis), which may require a biopsy. 4. How are post-irradiation fractures treated? PIF treatment is associated with high rates of non-union and infection. Autologous bone grafts, and especially vascularized grafts, are recommended. Intra-medullary nailing is the preferred internal fixation technique. In certain cases, prosthetic replacement or even amputation may be necessary. 5. What are the specific features of radiotherapy in children and adolescents? Prevention and treatment of PIF in pediatric populations require a multidisciplinary approach, coordinated with the treatment of the underlying tumor, which remains the top priority.</div></div><div><h3>Level of evidence &gt; V</h3><div>Expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104441"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ceramic head and liner fractures in total hip arthroplasty","authors":"Jean-Marie Philippeau","doi":"10.1016/j.otsr.2025.104525","DOIUrl":"10.1016/j.otsr.2025.104525","url":null,"abstract":"<div><div>The ceramic-on-ceramic (CoC) bearing is preferred in total hip arthroplasty (THA) in young patients since it has virtually no wear or peri-prosthetic osteolysis. However, it exposes patients to a rare but serious risk of head or liner fracture. These fractures are multifactorial in origin and involve parameters related to the material, implant geometry, interface characteristics (angle and length of the taper junction), surgical technique (impaction, positioning), joint kinematics, and to a lesser extent, patient factors. According to registries and manufacturers, the head fracture rate has significantly decreased between the 3rd (2 per 1000) and 4th (2 per 100,000) generations of ceramics. However, the liner fracture rate remained stable at around 2–3 per 10,000. These fractures occur suddenly through high-speed propagation of an intragranular crack. The diagnosis may be obvious on standard radiographs or more difficult, requiring CT imaging or even joint aspiration. Reoperation is not urgent but must be planned rapidly and performed meticulously. After retrieving the surgical data on the current implants, synovectomy and lavage must be performed with removal of ceramic fragments that could cause third-body wear in the subsequent arthroplasty. The revision modalities depend on the fractured component (femoral head and/or liner) and the condition and position of the implants. The preferred new bearing is CoC with a revision head diameter of 36 mm if possible, to reduce the risk of instability. Alternatively, the ceramic-on-polyethylene (CoPE) bearing may be used. This revision carries significant risks of instability and re-revision. However, a well-defined surgical strategy has contributed to improving the prognosis of this rare but formidable complication.</div></div><div><h3>Level of evidence</h3><div>&gt; V: expert opinion.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104525"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598155","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}