Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"The impacts of surgically treated acetabular and pelvic fractures on return to work and to sports","authors":"Juliette Tremblay ,&nbsp;Alexis Dufour ,&nbsp;Rami Ayoubi ,&nbsp;Étienne L. Belzile ,&nbsp;Julien Dartus ,&nbsp;Stéphane Pelet","doi":"10.1016/j.otsr.2025.104449","DOIUrl":"10.1016/j.otsr.2025.104449","url":null,"abstract":"<div><h3>Background</h3><div>Literature exploring impacts and quality of life limitations of pelvic ring and acetabular fracture is limited. The aim of the study is to evaluate the impact of pelvic ring and acetabular fracture on the return to work (RTW) and sports (RTS) and identify factors associated with difficulties to resume their previous activities.</div></div><div><h3>Hypothesis</h3><div>Patients with pelvic ring and acetabular fractures will experience difficulties to return to their previous occupation and physical activities.</div></div><div><h3>Patients and methods</h3><div>This is a retrospective cohort study reviewing the medical and radiological charts under IRB approbation. The patients were contacted for a final questionnaire assessing the RTW and the RTS at a minimum of two years follow-up. All patients admitted for a surgically treated pelvic ring and/or acetabulum fracture between 2009 and 2022 at a level 1 trauma center were included. For RTW, collected information covered an overview of the patients' employment situation and classifying it by level of occupational activity. Global physical activity level was assessed with the UCLA Hip Activity Scale. Other variables of interest included: concomitant injury, trauma type, pelvic ring fracture type, delay for final fracture stabilization, and complications. Initial analysis was carried out based on the ability to resume activities at the level before the trauma (success or failure). Uni- and multivariate analyzes were conducted to identify factors associated with a failed return to their activities.</div></div><div><h3>Results</h3><div>One hundred and thirteen patients completed the final questionnaire (73% men, average age 51 ± 16.7 years). Among 88 patients still employed at the time of the trauma, 57 patients had a difficult RTW (65%). Forty-eight patients had a difficult RTS (43%). Thirty-four patients (39%) never returned to work and 30 patients (27%) did not return to sports. The presence of other fractures within the initial trauma (OR 3.17; 95%CI 1.24–8.10; p = 0.014) and a concomitant traumatic brain injury (OR 3.78; 95%CI 1.27–11.27; p = 0.013) are significantly associated with a difficult RTW. The presence of marginal impaction on the acetabulum (OR = 7.3; p = 0.014, CI95% 1.44–37.16) is associated with a difficult RTS.</div></div><div><h3>Discussion</h3><div>Most patients with a surgically treated pelvic and acetabular fracture have a difficult RTW and RTS. Among the factors identified, few are modifiable. The study does not show influence of quality reduction on RTW and RTS.</div></div><div><h3>Level of evidence</h3><div>III; Retrospective cohort study</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104449"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260176","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 a Collar Reduce Revision Rates and Periprosthetic Fractures in Femoral Neck Fractures? A Comparative Cohort Study of 5,189 Stems","authors":"Ceyran Hamoudi ,&nbsp;Fatos Ramadani ,&nbsp;Jean-Francois Fischer ,&nbsp;Laurent Mustaki ,&nbsp;Olivier Husmann ,&nbsp;Lada Eberlova ,&nbsp;Alexandre Lunebourg","doi":"10.1016/j.otsr.2025.104545","DOIUrl":"10.1016/j.otsr.2025.104545","url":null,"abstract":"<div><h3>Background</h3><div>Cemented stems are currently recommended for the treatment of displaced femoral neck fractures (FNFs) due to their reduced risk of revision and periprosthetic fractures (PPF). However, cementless stems with a collar may enhance implant stability. This study assessed the effect of collar addition on revision rates and implant survival in conventional total hip arthroplasty (THA), double mobility THA (THA DM) or hemiarthroplasty (HA) for FNFs.</div></div><div><h3>Hypothesis</h3><div>We hypothesized that the presence of a collar on cementless stems could play a protective role against both all-cause and periprosthetic fracture revision risk in FNFs.</div></div><div><h3>Methods</h3><div>A total of 5,189 hip procedures for FNFs, recorded by the Swiss National Joint Registry between 2012 and 2023, were included. Patients received Corail<em>™</em> collarless cementless (n = 900), collared cementless (n = 2,028), and cemented stems (n = 2,261). Cumulative percent revision (CPR) was calculated for all-cause revision and revision for PPF. Hazard ratios (HRs) with 95% confidence interval were estimated with adjustment for age, gender, BMI, ASA scores, approach, and size of stems to compare revision risk among the three groups. Subgroup analyses were performed among implant types: HA, THA DM, and THA.</div></div><div><h3>Results</h3><div>Cemented stems had a lower all-cause revision rate than collarless stems (3.2 versus 6.9%, p &lt; .001) and for PPF (0.5 versus 2.9%, p &lt; .001). However, no statistical difference was found when cemented stems were compared with collared stems. After adjustment, collarless stems showed a significantly higher risk of all-cause revision (HR: 1.91 (1.30–2.79], p &lt; .001) and PPF (HR: 5.82 (2.68–12.67], p &lt; .001) compared with cemented stems. No significant difference was found between collared and cemented stems. Increased ASA, BMI 30–34.9, and posterior approach also predicted higher revision risk. In subgroup analyses, cemented and collared stems were consistently associated with a lower or equivalent risk of all-cause revision compared to collarless cementless stems regardless of the implant type.</div></div><div><h3>Conclusion</h3><div>Collared and cemented stems demonstrated equivalent and superior implant survival compared to collarless stems for both all-cause and PPF revisions. Collared stems appear to be a viable alternative to cemented stems when treating FNFs.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104545"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145432977","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":"Ankle and foot tendon transfer (excluding paralytic foot and toe deformity)","authors":"Marion Di Schino ,&nbsp;Linda Ferraz ,&nbsp;Hachem Mahjoub","doi":"10.1016/j.otsr.2025.104391","DOIUrl":"10.1016/j.otsr.2025.104391","url":null,"abstract":"<div><div>It is essential to master the techniques of tendon transfer and to know the indications, so as to be able to treat tendinopathy, tendon tear or static deformity in the foot and ankle. The type of transfer depends on the pathology, with the aim of reconstructing or supplementing the affected muscle. Complete clinical and paraclinical assessment is needed to determine feasibility and draw up the preoperative plan according to axial deformity and associated retraction. Success depends on several factors: rigorous technique, fixation method, tension adjustment, immobilization, and rehabilitation. Stability is ensured by transosseous fixation with interference screw, or tenodesis. Tendon tension is crucial, but consensus is lacking; the general rule is to maximize tension according to the targeted effect. Postoperative immobilization is generally recommended, for 4–6 weeks, depending on associated procedures, indications and type of fixation. Rehabilitation is systematic, to reprogram gait with an altered motor schema. Muscle exercises against resistance should not be started before month 3. Once surgery has been indicated, the choice of transfer is made on a case-by-case basis.</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 104391"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006902","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 forearm fracture in children in 2025","authors":"Céline Klein","doi":"10.1016/j.otsr.2025.104439","DOIUrl":"10.1016/j.otsr.2025.104439","url":null,"abstract":"<div><div>Orthopedic surgeons frequently have to deal with diaphyseal fractures of the two forearm bones. The present update aims to answer five questions: (1) Have the epidemiology and trauma mechanisms of forearm fractures changed over the last two decades? (2) What displacements are acceptable, at what age? (3) Is there any real debate about treatment for diaphyseal fracture of the two forearm bones? (4) What other types of forearm fracture are found in children? (5) What therapeutic strategies should be proposed in the event of complications and sequelae of fracture of the two forearm bones? And how can rates be limited?</div><div>Fractures of the forearm have increased in incidence over the last 2 decades. Trampolines are greatly implicated. Displacement is acceptable when remodeling is sufficient to restore the anatomical and functional framework of the forearm; non-operative treatment may therefore be proposed up to the age of 10 for &lt;15 ° sagittal displacement and &lt;10 ° frontal displacement with &lt;50% translation. The surgical treatment of choice is elastic stable intramedullary nailing, which may be considered in school-age children. Compartment syndrome is rare, but not exceptional in fracture of both forearm bones in children, particularly in case of crushing, direct impact or numerous reduction maneuvers. To prevent secondary displacement and re-fracture, immobilization may be prolonged, for up to 3 months, with material removal only once the medullary canal is completely permeable. Forearm fractures in children have a very good prognosis.</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 104439"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180017","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":"The use of the anterior tendinous portion of the supraspinatus muscle as a central point for rotator cuff repair","authors":"Thomas Cuinet ,&nbsp;Lucie Schnedecker ,&nbsp;Bouchra Assabah ,&nbsp;Nguyen Tran ,&nbsp;François Sirveaux ,&nbsp;Adrien Jacquot","doi":"10.1016/j.otsr.2025.104236","DOIUrl":"10.1016/j.otsr.2025.104236","url":null,"abstract":"<div><h3>Introduction</h3><div>Double-row repairs with knots on the medial row carry a risk of secondary lesions at the myotendinous junction. Knotless double-row repairs imply dependence between rows, sometimes resulting in a failure to properly apply the medial row, and the systematic use of 4 anchors. The anterior tendinous portion of the supraspinatus muscle appears to be a promising anatomical landmark and support point for the medial row in an optimized independent double-row technique.</div></div><div><h3>Hypothesis</h3><div>This technique provides results equivalent to those published about rotator cuff repair and reduces the risk of medial secondary rupture and the number of implants used.</div></div><div><h3>Materials and methods</h3><div><span>This study includes an initial histopathological analysis of the supraspinatus muscle, complemented by an in vivo arthroscopic observation of its anterior tendinous portion in a consecutive series of arthroscopy procedures on shoulders with intact rotator cuffs. We present a technique for independent double-row repair using 2 (or 3) anchors, with a single knot on the medial row relying on the anterior tendinous portion of the supraspinatus muscle, and lateral tension-band </span>sutures. In this study, we report the clinical and ultrasound outcomes from a preliminary prospective series of 20 patients with distal supraspinatus tears at a 2-year follow-up.</div></div><div><h3>Results</h3><div>The anterior tendinous portion of the supraspinatus was found in 100% of patients in our arthroscopic analysis. Regarding the surgical technique, the median number of anchors was 2. At 2-year follow-ups, the median Constant score was 84.5, and the Subjective Shoulder Value score was 93%. No complications were recorded. Tendon healing was achieved in 100% of cases (Sugaya stage I or II).</div></div><div><h3>Conclusion</h3><div>This independent double-row repair technique relying on the anterior tendinous portion of the supraspinatus muscle provides a solid medial row fixation, minimizing the risk of secondary myotendinous injury, and an appropriate anatomical landmark, allowing for a more anatomic repair. It is a simple and reproducible technique requiring a limited number of implants and demonstrating satisfactory clinical outcomes and tendon healing rate.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104236"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782054","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":"Effect of intramedullary platelet-rich plasma on fracture healing in elderly intertrochanteric fractures: A randomized controlled trial","authors":"Saran Tantavisut ,&nbsp;Sanzhar Artykbay ,&nbsp;Chavarin Amarase ,&nbsp;Siripong Tantanarat ,&nbsp;Sinsuda Dechsupa ,&nbsp;Sittisak Honsawek","doi":"10.1016/j.otsr.2025.104457","DOIUrl":"10.1016/j.otsr.2025.104457","url":null,"abstract":"<div><h3>Background</h3><div>Intertrochanteric fractures in the elderly present challenges due to poor bone healing and high complication rates. Platelet-rich plasma (PRP) may promote early bone regeneration, but clinical evidence, especially for osteoporotic fractures, is limited. Unlike extramedullary injections, intramedullary PRP specifically targets the vascular marrow at the fracture site. This randomized controlled trial aimed to evaluate the effect of intramedullary PRP application on fracture healing and clinical outcomes in elderly patients undergoing surgical fixation for intertrochanteric fractures.</div></div><div><h3>Hypothesis</h3><div>We hypothesized that intramedullary PRP would accelerate early bone healing and improve postoperative functional recovery compared to placebo.</div></div><div><h3>Patients and methods</h3><div>This single-center, double-blind, parallel-group trial was conducted from November 2020 to December 2024. Patients aged ≥60 years with isolated low-energy intertrochanteric femoral fractures were randomized to receive either 5 mL of autologous PRP or 5 mL of normal saline intraoperatively. All patients underwent fixation with a short cephalomedullary nail. Follow-up assessments were performed at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively.</div></div><div><h3>Results</h3><div>Eighty-four patients were randomized (40 to the PRP group, 44 to the control group), with no significant differences in baseline characteristics. At 2 weeks, the PRP group showed a significantly higher Radiographic Union Score for Hip (RUSH) than the control group (12.0 vs. 10.5; <em>P</em> &lt; 0.001); however, no significant differences were observed at 6 weeks, 3 months, or 6 months. Postoperative bone turnover markers (P1NP, osteocalcin, ALP, Beta-Crosslaps, and bone-specific ALP) were comparable between groups. Functional outcomes, assessed by the Harris Hip Score, Barthel Index, and De Morton Mobility Index at 6 weeks and 6 months, did not differ significantly.</div></div><div><h3>Discussion</h3><div>Intramedullary PRP did not improve mid- to long-term fracture healing or functional outcomes in elderly patients with intertrochanteric fractures. Although early radiographic healing was enhanced at 2 weeks, this benefit was not sustained over time. Functional recovery also showed no significant difference. PRP may offer limited clinical benefit in this population, and further research is needed to assess its role in selected subgroups or with modified protocols.</div></div><div><h3>Level of evidence</h3><div>I.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104457"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276770","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":"Liposomal bupivacaine after arthroscopic rotator cuff repair moderately decreases early postoperative pain and demonstrates equivocal opioid consumption compared to traditional interscalene nerve blocks: A systematic review and meta-analysis of level 1 studies","authors":"Jaden Hardrick ,&nbsp;Anna M. Ifarraguerri ,&nbsp;Michael S. Collins ,&nbsp;David P. Trofa ,&nbsp;James E. Fleischli ,&nbsp;Nady Hamid ,&nbsp;Patrick N. Siparsky ,&nbsp;Bryan M. Saltzman","doi":"10.1016/j.otsr.2025.104190","DOIUrl":"10.1016/j.otsr.2025.104190","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span>Interscalene nerve blocks (ISNBs) reduce length of stay, postoperative pain, and opioid consumption following arthroscopic </span>rotator cuff repair (ARCR). ISNBs with anesthetic agents like </span>bupivacaine<span> are associated with intense rebound pain, while liposomal bupivacaine (LB) can potentially extend pain relief up to 72 h and reduce opioid consumption. The purpose of this </span></span>systematic review<span> and meta-analysis is to compare the efficacy of LB versus traditional ISNB for postoperative pain management and opioid consumption following ARCR.</span></div></div><div><h3>Methods</h3><div>A systematic review following PRISMA guidelines was performed from inception through March 2024. Randomized controlled trials comparing LB and traditional ISNB for postoperative pain management and opioid consumption following ARCR were included. The meta-analysis on each outcome measure was outlined in a forest plot detailing the standard mean difference (SMD) for continuous variables.</div></div><div><h3>Results</h3><div>Data was extracted from 5 articles on 362 patients who underwent ARCR, 196 of whom received LB and 166 with a control non-LB ISNB. LB interventions had significantly lower pain scores than controls on postoperative day (POD) 1 and POD 2 (SMD −3.45, 95% CI [−5.20, −1.60]; P = 0.0003 and SMD −2.39, 95% CI [−4.01, −0.77]; P = 0.004, respectively). There was a significantly lower oral morphine equivalent dosage consumption in the LB cohort than controls on POD 0, POD 1, POD 2, and POD 3 (SMD −4.66; 95% CI, −7.95 to −1.36; <em>p = 0.006</em>; SMD −3.77; 95% CI, −5.69 to −1.85; <em>p = 0.0001</em>, SMD -3.34 95% CI [−5.13, −1.56]; <em>p = 0.0002</em>, and SMD -3.43; 95% CI, −5.74 to −1.12; <em>p = 0.004</em>, respectively).</div></div><div><h3>Discussion</h3><div>LB moderately decreased pain scores 24–72 h postoperatively and reduced opioid consumption for up to 96 h following ARCR compared to a control ISNB cohort. However, the clinical difference in opioid usage may not translate to patient benefits or justify the increased cost.</div></div><div><h3>Level of evidence</h3><div>I.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104190"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460760","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":"Techniques for correcting major lower limb deformities. Corrections of lower limb deformities","authors":"Franck Launay","doi":"10.1016/j.otsr.2025.104417","DOIUrl":"10.1016/j.otsr.2025.104417","url":null,"abstract":"<div><div>Lower limb deformities can be simple when there is only one deformity but can be complex when there are up to four deformities in different planes (angulation, rotation, translation, length). The time frame must be considered because the deformities can be progressive in nature or can recur after the first correction attempt. No single strategy is best for a patient. Several strategies can be proposed to achieve the optimal result. However, strict technical specifications must be followed to achieve the desired correction:</div><div><ul><li><span>•</span><span><div>Know how to precisely analyze the deformities.</div></span></li><li><span>•</span><span><div>Know which pathology is responsible for the deformity and its progressive nature.</div></span></li><li><span>•</span><span><div>Know how to correct a complex deformity without creating secondary deformities.</div></span></li><li><span>•</span><span><div>Know the potential complications of each technique and how to deal with them.</div></span></li><li><span>•</span><span><div>Know how to present the various options to the family in order to commit to a logical strategy, which will be shared by everyone. This strategy can be one where all the deformities are corrected in a single surgery, or one that combines several successive and more simple techniques.</div></span></li></ul></div><div>The end goal is optimal correction with the fewest inconveniences for the patient. If the technical specifications cannot be followed, one should propose the use of orthotics or refer the patient to a team having more experience with these deformities.</div></div><div><h3>Level of evidence</h3><div>&gt;V.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"112 1","pages":"Article 104417"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042471","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":"Orthopedic complications of sickle-cell disease in children","authors":"Anne-Laure Simon,&nbsp;Lucrezia Montanari,&nbsp;Cindy Mallet,&nbsp;Brice Ilharreborde","doi":"10.1016/j.otsr.2025.104416","DOIUrl":"10.1016/j.otsr.2025.104416","url":null,"abstract":"<div><div>Sickle cell disease is the most common serious genetic disease in the world. It is a systemic disease, characterized by vaso-occlusive phenomena, especially in the bone capillary network. Orthopedic complications are thus the most common, with a strong impact on quality of life. In children, these complications mainly comprise bone infarction, epiphyseal aseptic osteonecrosis, and bone and joint infection: acute or chronic osteomyelitis, osteoarthritis and septic arthritis. Aseptic osteonecrosis mainly involves the proximal extremities of the femur and humerus. It may be completely asymptomatic in childhood, but almost systematically deteriorates during the 3rd decade without early management, while in childhood there are opportunities for revascularization and remodeling. Prognosis is more severe in sickle-cell-related than community-based childhood bone and joint infection, as treatment is often delayed by diagnostic difficulties due to the absence of specific clinical and paraclinical signs differentiating it from an acute vaso-occlusive crisis. The most common pathogens are minor Salmonella and <em>Staphylococcus aureus</em>. Due to high rates of iterative surgery and sequelae, systematic radio-clinical monitoring is required. Any surgery in children with sickle-cell disease requires special precautions, based primarily on preventive measures to avoid dehydration, hypoxia, hypothermia, acute anemia and pain that can trigger a life-threatening vaso-occlusive crisis. All orthopedic complications should be managed in a specialized reference center with experienced multidisciplinary medical-surgical teams.</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 104416"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145034692","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":"Childhood fibrous dysplasia","authors":"Clémence Pfirrmann ,&nbsp;Pierre Journeau ,&nbsp;Franck Chotel ,&nbsp;Roland Chapurlat","doi":"10.1016/j.otsr.2025.104440","DOIUrl":"10.1016/j.otsr.2025.104440","url":null,"abstract":"<div><div>Fibrous dysplasia is a rare, non-malignant bone disorder in which diagnosis may be easy (polyostotic forms) or more difficult (monostotic forms). Complementary radiological examinations (standard X-ray, CT, scintigraphy) are essential to pinpoint the location or locations of bone involvement. In case of diagnostic doubt, bone biopsy screens for GNAS gene mutation. Fibrous dysplasia may be isolated or part of McCune-Albright syndrome. In case of extraosseous involvement, it is essential to investigate the physiology of the various affected tissues (e.g., for phosphate diabetes). International guidelines were issued in 2019, for diagnosis of fibrous dysplasia and McCune-Albright syndrome and for patient management. There is no specific medical treatment for fibrous dysplasia, but appropriate analgesics and biphosphonates can improve quality of life. In fibrous dysplasia, the bone may be fragile, particularly in the femoral neck, leading to limping, bone deformities and pathological fractures. Orthopedic management ranges from simple monitoring for small monostotic lesions in non-weight-bearing areas to invasive surgery with axial correction and preventive osteosynthesis. In children, fibrous dysplasia lesions can be found at birth on histology, but appear progressively until puberty on X-ray. The impact of skeletal growth, with asymmetric growth due to fibrous dysplasia lesions, lower limb length discrepancy and epiphysiodesis, make surgical management complex. Intramedullary nailing is the surgical technique of choice.</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 104440"},"PeriodicalIF":2.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151981","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}