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A comparison of minimally invasive plate osteosynthesis (MIPO) versus open reduction and internal fixation (ORIF) in the management of tibial pilon fractures: A prospective randomized study 微创钢板内固定（MIPO）与切开复位内固定（ORIF）治疗胫骨pilon骨折的比较：一项前瞻性随机研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104323

Roger Erivan , Thomas Caputo , Shirin Monadjemi , Bruno Pereira , Stéphane Descamps , Stéphane Boisgard , Guillaume Villatte

Introduction

The aim of this study was to compare two surgical procedures for the treatment of tibial pilon fractures, i.e. minimally invasive plate osteosynthesis (MIPO) vs. open reduction and internal fixation (ORIF), in terms of wound healing time, ankle swelling, change in pain, functional outcomes and complications.

Hypothesis

We hypothesized that MIPO treatment would induce a faster healing process and lower complications rates.

Patients and methods

This monocentric, comparative, prospective and randomized study was based on the enrollment of 54 patients between November 2017 and May 2023. Patients hospitalized for a tibial pilon fracture with closed or open fracture (Cauchoix or Gustilo type I) received randomly ORIF or MIPO treatment using distal tibial locking compression plates of 3.5 mm. Data collection included demographics, wound dressing wear time, ankle circumference ratio, pain scores, AOFAS, FADI and MAZUR functional scores, and complications. Data were monitored from the intervention day until 12 months of follow-up, with different intermediate follow-up visits. They were then compared between minimally invasive and open surgery groups.

Results

We found similar dressing wear times in both groups with a mean of 21.55 ± 14.91 days in the ORIF group and 18.0 ± 6.44 days in the MIPO group (p = 0.312). VAS pain scores and ankle circumference ratio did not reveal a significant difference between the two techniques. The infection rate was identical in both groups (15.4%; 4/26). Wound complication rates in the ORIF group (11.5%; 3/26) and the MIPO group (7.7%; 2/26) were not statistically different (p = 0.334). The analysis of the functional scores showed ameliorated results in the ORIF group at 3 months follow-up with higher AOFAS, FADI and MAZUR scores, but at further monitoring visits there was no evidence of the superiority of one technique over another.

Conclusion

The MIPO technique was not distinctively superior to ORIF method in the treatment of tibial pilon fractures.

Level of evidence

I, prospective randomized controlled trial.

前言：本研究的目的是比较两种治疗胫骨pilon骨折的手术方式，即微创钢板内固定（MIPO）与切开复位内固定（ORIF），在伤口愈合时间、踝关节肿胀、疼痛变化、功能结局和并发症方面的差异。假设：我们假设MIPO治疗会导致更快的愈合过程和更低的并发症发生率。患者和方法：这项单中心、比较、前瞻性和随机研究基于2017年11月至2023年5月期间入组的54例患者。因胫骨pilon骨折合并闭合性或开放性骨折（Cauchoix或Gustilo I型）住院的患者随机接受3.5 mm胫骨远端锁定加压钢板ORIF或MIPO治疗。数据收集包括人口统计学、伤口敷料磨损时间、踝围比、疼痛评分、AOFAS、FADI和MAZUR功能评分以及并发症。数据监测从干预日至12个月的随访，不同的中期随访。然后在微创手术组和开放手术组之间进行比较。结果：两组患者敷料磨损时间相近，ORIF组平均为21.55±14.91天，MIPO组平均为18.0±6.44天（p = 0.312）。VAS疼痛评分和踝围比在两种技术之间无显著差异。两组感染率相同(15.4%；4/26)。ORIF组伤口并发症发生率(11.5%；3/26)和MIPO组(7.7%；2/26)，差异无统计学意义（p = 0.334）。功能评分分析显示，在随访3个月时，ORIF组的结果有所改善，AOFAS、FADI和MAZUR评分较高，但在进一步的监测访问中，没有证据表明一种技术优于另一种技术。结论：在胫骨pilon骨折的治疗中，MIPO技术并没有明显优于ORIF方法。证据等级：I，前瞻性随机对照试验。

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引用次数: 0

Results of the AMIC® method in patients operated on for an osteochondral lesion of the talar dome (OLTD) at a mean follow-up of 34 months. A retrospective multicenter study 平均随访 34 个月的距骨穹隆骨软骨损伤 (OLTD) 手术患者的 AMIC® 方法效果。一项多中心回顾性研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2024.104020

Matthieu Peras , Émilie Bilichtin , Camille Choufani , Alexandre Caubère , Olivier Barbier

Background

Symptomatic osteochondral lesions of the talar dome (OLTD) represent a real therapeutic challenge. In the absence of appropriate treatment, these lesions can evolve into tibiotalar osteoarthritis. Stage 3 lesion of the SFA classification and resistant to medical non-operative treatment may require surgical treatment. The results of the membrane-induced chondrogenesis (AMIC®) technique in the knee have been previously reported. At the ankle, few publications exist. Our objective was to evaluate clinical results of the AMIC® technique.

Hypothesis

AMIC® technique is clinically effective for the treatment of LODT with a minimum follow-up of 12 months after surgery.

Material and method

This was a multicenter (5 centers) retrospective study including patients operated on for an OLTD stage 3 of SFA between January 2019 and March 2021 using the AMIC® technique with a ChondroGide® membrane. A functional assessment by questionnaire (AOFAS, EFAS, FFI scores), clinical (VAS) and return to sport were carried out.

Results

21 patients (10 men and 11 women), aged 16–69 years (mean age 34 years) were included. The average follow-up was 34 months (min 12 months; max 72 months). The average loss of substance was 1.83 cm² (min 0.6 cm²; max 6 cm²). The results showed a significant improvement in the AOFAS functional score which went on average from 71 [CI = 64; 77] to 90 [CI = 82; 97], EFAS which went from 15 [CI = 10; 20] to 32 [CI = 10; 20] = 26; 38], FFI which went from 28% [CI = 19%; 38%] to 10% [CI = 2%; 18%] and the EVA which decreased by 4 [CI = 3.9; 4.7] to 1 [CI = 0.5; 2.4]. 60% of patients returned to sport at the same level and 80% of patients were satisfied with the surgery.

Discussion

AMIC® method improved the functional results of patients with SFA stage 3 OLTD at an average follow-up of 34 months post-operatively.

Level of evidence

IV; retrospective observational cohort study.

背景：有症状的距骨穹隆骨软骨损伤（OLTD）是一项真正的治疗挑战。如果缺乏适当的治疗，这些病变可演变为胫骨骨关节炎。SFA分类的第3期病变和对药物非手术治疗有抵抗力的病变可能需要手术治疗。膜诱导软骨生成（AMIC®）技术在膝关节方面的效果已有报道。但关于踝关节的报道却很少。我们的目标是评估 AMIC® 技术的临床效果：假设：AMIC®技术在治疗LODT方面具有临床疗效，术后随访至少12个月：这是一项多中心（5个中心）回顾性研究，研究对象包括2019年1月至2021年3月期间使用AMIC®技术和ChondroGide®膜进行SFA OLTD 3期手术的患者。通过问卷（AOFAS、EFAS、FFI 评分）、临床（VAS）和恢复运动进行了功能评估。结果：共纳入 21 名患者（10 男 11 女），年龄在 16-69 岁之间（平均年龄 34 岁）。平均随访时间为 34 个月（最短 12 个月；最长 72 个月）。平均物质损失为 1.83 平方厘米（最小 0.6 平方厘米，最大 6 平方厘米）。结果显示，AOFAS 功能评分有了明显改善，平均从 71 [CI = 64; 77] 上升到 90 [CI = 82; 97]；EFAS 从 15 [CI = 10; 20] 上升到 32 [CI = 10; 20] = 26; 38]；FFI 从 28% [CI = 19%; 38%] 下降到 10% [CI = 2%; 18%]；EVA 从 4 [CI = 3.9; 4.7] 下降到 1 [CI = 0.5; 2.4]。60%的患者恢复了同等水平的运动，80%的患者对手术表示满意：讨论：在术后平均34个月的随访中，AMIC®方法改善了SFA 3期OLTD患者的功能效果：证据级别：IV；回顾性观察队列研究。

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引用次数: 0

Dynamic trapezoid external fixation: Enhancing temporary stability in unstable pelvic ring fractures 动态梯形外固定：增强不稳定骨盆环骨折的暂时稳定性。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104234

Dinah Bronstein , Geoffroy Dubois de Mont-Marin , Louis Rony , Guillaume David

Background

Unstable pelvic fractures often require emergency temporary external fixation before definitive management by internal fixation. The objective of this study was to improve the stability of the posterior arc of the pelvic ring during the placement of a temporary external fixator.

Hypothesis

Did a temporary pelvic external fixator with dual bars (compression and distraction) enhances posterior pelvic stability by increasing posterior compression?

Materials and method

Four supracetabular fixation setups, including a "dynamic trapezoid external fixator" (a supra-acetabular external fixation construct featuring two connecting rods, one in compression and the other in distraction), were tested on foam pelvis models with simulated sacroiliac disjunction. Each configuration was also tested with a supra-acetabular pin partially or fully inserted into the SA corridor. Stability was assessed using a biomechanical model through reproducible cranial and lateral traction force applied to the iliac tuberosity under a 20N load to identify the most effective temporary pelvic ring stabilization method. Each measurement was repeated 10 times per configuration. Student’s t-test and two-way analysis of variance (ANOVA) was used to compare the different models.

Results

Sacroiliac displacement under vertical and lateral forces was measured for each configuration. Fully inserted supra-acetabular pins significantly reduced displacement compared to half insertion (p < 0.001). The "dynamic" construct exhibited the lowest displacement across all configurations (mean 2.9 ± 0.9 mm under lateral force; 1.8 ± 0.3 mm under vertical force). Compared to other constructs, it was significantly associated with superior stability (p < 0.005). ANOVA confirmed the effects of construct type (p < 0.0001) and SA pin length (p < 0.0001) on displacement, with the "dynamic" construct and full pin insertion yielding the best outcomes.

Conclusion

Our study demonstrates that a dynamic trapezoidal supra-acetabular external fixator, with rods in compression and distraction, enhances resistance to vertical and horizontal displacement of SI joint compared to other construct. Though not fully replicating in vivo conditions, this model supports a streamlined approach to temporary pelvic stabilization.

Level of evidence

V; In Vitro Research.

背景：不稳定骨盆骨折通常需要紧急临时外固定，然后再进行最终的内固定治疗。本研究的目的是在放置临时外固定架期间改善骨盆环后弧线的稳定性。假设：双棒临时骨盆外固定架（加压和撑开）是否通过增加后压迫来增强后骨盆稳定性？材料和方法：在模拟骶髂分离的泡沫骨盆模型上测试了四种髋臼上固定装置，包括“动态梯形外固定架”（一种具有两根连接杆的髋臼上外固定装置，一根处于压迫状态，另一根处于牵引状态）。将髋臼上针部分或全部插入SA通道，对每种构型进行测试。采用生物力学模型，通过在20N载荷下对髂粗隆施加可重复颅侧牵引力来评估稳定性，以确定最有效的临时骨盆环稳定方法。每个配置重复10次测量。采用学生t检验和双向方差分析（ANOVA）对不同模型进行比较。结果：测量了骶髂关节在垂直和侧向力作用下的位移。与半置入相比，完全置入髋臼上钉可显著减少移位（p < 0.001）。“动态”结构在所有构型中表现出最低的位移（平均2.9±0.9 mm）；垂直力下1.8±0.3 mm)。与其他结构相比，它与优越的稳定性显著相关（p < 0.005）。方差分析证实了结构类型（p < 0.0001）和SA针长度（p < 0.0001）对位移的影响，其中“动态”结构和全针插入产生最佳结果。结论：我们的研究表明，与其他结构相比，带杆的动态梯形髋臼上外固定架可增强骶髂关节垂直和水平位移的抵抗能力。虽然不能完全复制体内条件，但该模型支持一种流线型的方法来暂时稳定骨盆。证据等级：V；体外研究。

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引用次数: 0

Comments on: “Assessment of chronic ankle instability: are functional scores relevant enough?” by Caubère A, Viricel C, Garcia-Jaldon F, Afonso S, Bilichtin E, Choufani C, et al., published in Orthop Traumatol Surg Res. 2025;111(4):104167. doi:10.1016/j.otsr.2025.104167 评论：《慢性踝关节不稳定的评估：功能评分是否足够相关？》，作者：caub<s:1> re A, Viricel C, Garcia-Jaldon F, Afonso S, Bilichtin E， Choufani C等，发表于2025年骨科创伤外科杂志。111(4): 104167。doi: 10.1016 / j.otsr.2025.104167。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104412

Dazhi Li

引用次数: 0

Is severe medial knee osteoarthritis a risk factor for dissatisfaction following medial open-wedge high tibial osteotomy in patients 55 years of age or younger? 对于55岁或以下的患者，严重的膝关节内侧骨关节炎是胫骨内侧开楔高位截骨术后不满意的危险因素吗？

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2024.104121

Ryu Kyoung Cho, Man Soo Kim, Keun Young Choi, Yong In

Introduction

Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge high tibial osteotomy (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years.

Material and methods

We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, articular cartilage and meniscus status, severity of varus deformity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared.

Results

At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300–9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979–15.431, p < 0.001).

Conclusion

Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO.

Level of evidence

III.

虽然先前的研究表明，严重内侧膝骨关节炎（OA）（kelgren - lawrence分级IV）是内侧开楔高位胫骨截骨术（MOWHTO）后患者不满意的危险因素，但在55岁或以下的患者中，将关节置换术作为主要手术选择并不常见。因此，我们研究的目的是评估严重的膝关节内侧OA是否是MOWHTO术后不满意的危险因素，这取决于患者年龄，以55岁为截止年龄。材料和方法：我们回顾性地回顾了270例连续接受MOWHTO的患者的资料，随访时间至少为2年。根据术后满意度将患者分为满意组（新膝关节社会评分满意度分值bbb20）和不满意组（≤20）。为了评估患者不满意的危险因素，根据年龄范围，以55岁为截止年龄进行亚组分析。比较术前人口统计学、骨性关节炎分级、关节软骨和半月板状态、内翻畸形严重程度、安大略省西部和麦克马斯特大学骨关节炎指数（WOMAC）和手术因素。结果:在手术后2年,二项逻辑回归分析表明,严重的内侧膝OA与病人不满HTO后整个队列(比值比(或)4.557,95%可信区间(CI) 2.300 - -9.030, p 55年集团是一个重要的危险因素不满MOWHTO后(或6.78,95%可信区间2.979 - -15.431,p结论:严重的内侧OA没有不满的危险因素患者接受MOWHTO 55岁或更年轻。因此，外科医生在咨询考虑MOWHTO的年轻患者时可以考虑到这一结果。证据水平：III。

{"title":"Is severe medial knee osteoarthritis a risk factor for dissatisfaction following medial open-wedge high tibial osteotomy in patients 55 years of age or younger?","authors":"Ryu Kyoung Cho, Man Soo Kim, Keun Young Choi, Yong In","doi":"10.1016/j.otsr.2024.104121","DOIUrl":"10.1016/j.otsr.2024.104121","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Although previous studies have shown that severe medial knee osteoarthritis (OA) (Kellgren-Lawrence grade IV) is a risk factor for patient dissatisfaction following medial open-wedge </span>high tibial osteotomy<span><span> (MOWHTO), it is uncommon to perform arthroplasty as a primary surgical option in patients 55 years of age or younger. Thus, the purpose of our study was to evaluate whether severe medial knee </span>OA is a risk factor for dissatisfaction following MOWHTO depending on patient age based on a cutoff of 55 years.</span></div></div><div><h3>Material and methods</h3><div><span>We retrospectively reviewed the data of 270 consecutive patients who underwent MOWHTO with a minimum of 2 years of follow up. Patients were divided into 2 groups based on satisfaction following surgery, a Satisfied group (new Knee Society Score satisfaction subscore >20) and a Dissatisfied group (≤20). In order to assess risk factors for patient dissatisfaction depending on the age range, a subgroup analysis was conducted based on a cutoff age of 55 years. Preoperative demographics, OA grade, </span>articular cartilage<span> and meniscus status, severity of varus deformity<span>, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and surgical factors were compared.</span></span></div></div><div><h3>Results</h3><div>At 2 years after surgery, binomial logistic regression analysis showed that severe medial knee OA was associated with patient dissatisfaction following HTO in the entire cohort (odds ratio [OR] 4.557, 95% confidence interval [CI] 2.300–9.030, p < 0.001). In subgroup analysis depending on age range, severe medial OA was not a risk factor for dissatisfaction in the age ≤55 years group. However, severe medial knee OA in the age >55 years group was a significant risk factor for dissatisfaction after MOWHTO (OR 6.78, 95% CI 2.979–15.431, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Severe medial OA was not a risk factor for dissatisfaction in patients age 55 years or younger who underwent MOWHTO. Therefore, surgeons can take this result into account when counseling younger patients considering MOWHTO.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104121"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883608","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}

引用次数: 0

Third fragment femoral shaft fracture: A retrospective analysis of complications and predictive factors for non-union and delayed union 股骨干第三段骨折：不愈合和延迟愈合的并发症及预测因素回顾性分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104295

Edoardo Gambuti , Antonio Caldaria , Elisa Spadoni , Nicolò Biagi , Danila Azzolina , Achille Saracco , Maria Vittoria Guerzoni , Leo Massari , Gaetano Caruso

Introduction

Diaphyseal femur fractures are relatively common, and up to 39% of these cases involve a third fragment. These types of fractures present a unique challenge due to their high risk of non-union, reported in up to 14% of cases. Despite their frequency, there is still no consensus on the optimal management of the third fragment in these fractures.

The purpose of this retrospective study was to compare the clinical and radiological outcomes of patients who underwent reduction of the third fragment with those who did not, to determine the characteristics of the third fragment that warrant reduction, and to suggest the best approach.

The hypothesis is that an open reduction of the third fragment is to be avoided as it increases the risk of non-union.

Material and methods

This retrospective monocentric study analysed clinical data from patients diagnosed with diaphyseal femur fractures at our Unit between 2010 and 2022. Radiological data encompassed the length and width of the third fragment, the fracture gap, its proximity to the proximal and distal cortex, the greatest cortex-to-cortex distance, and the orientation of the third fragment. Other factors considered included patient age, BMI, sex, type of surgery performed, fracture fixation method, occurrence of complications, specific complication types, incidence of mortality, and duration of follow-up.

Results

Seventy patients were included in the study; 24 patients underwent osteosynthesis with plates and screws, while 46 patients were treated with intramedullary nailing. Descriptive analysis revealed no statistically significant difference in the characteristics of the third fragment between patients who experienced complications and those who did not.

Surgical technique for osteosynthesis (plates and screws Vs intramedullary nailing) also showed no statistically significant differences, conversely the open reduction and synthesis of the third fragment is a statistically significant complication predictor.

Conclusion

The management of the third fragment remains a challenge. In our series of patients third fragment characteristics and type of osteosynthesis did not influence the risk of complications. However, the determining factor was found to be the open reduction of the third fragment.

Level of evidence

IV

股骨骨干骨折相对常见，其中高达39%的病例涉及第三段骨折。这些类型的骨折由于其高不愈合的风险而呈现出独特的挑战，据报道高达14%的病例。尽管发生频率较高，但对于此类骨折中第三段骨折的最佳处理方法仍未达成共识。本回顾性研究的目的是比较接受第三段复位的患者与未接受第三段复位的患者的临床和放射学结果，确定需要复位的第三段的特征，并提出最佳方法。我们的假设是避免第三段骨折切开复位，因为这会增加不愈合的风险。材料和方法：这项回顾性单中心研究分析了2010年至2022年在我们单位诊断为股骨骨干骨折的患者的临床数据。放射学资料包括第三块碎片的长度和宽度、骨折间隙、其与近端和远端皮质的接近程度、皮质到皮质的最大距离以及第三块碎片的方向。其他考虑的因素包括患者年龄、BMI、性别、手术类型、骨折固定方法、并发症的发生、特定并发症类型、死亡率和随访时间。结果：70例患者纳入研究；24例患者行钢板螺钉固定，46例患者行髓内钉固定。描述性分析显示，在经历并发症的患者和没有经历并发症的患者之间，第三段的特征没有统计学上的显著差异。植骨手术技术（钢板螺钉Vs髓内钉）也没有统计学上的显著差异，相反，切开复位和第三碎片的合成是统计学上显著的并发症预测因素。结论：第三碎片的处理仍然是一个挑战。在我们的一系列患者中，第三碎片的特征和骨结合的类型对并发症的风险没有影响。然而，决定因素被发现是开放复位的第三碎片。证据等级：四级。

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引用次数: 0

Comparison of endoscopic and open Achilles SpeedBridge techniques in the treatment of insertional Achilles tendinopathy: A prospective multicenter study of 89 patients by the Francophone Arthroscopy Society 内镜和开放跟腱速桥技术治疗插入性跟腱病的比较：一项由法语关节镜学会进行的89例患者的前瞻性多中心研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104220

Ronny Lopes , David Ancelin , Olivier Boniface , Ali Ghorbani , Thomas Amouyel , Michael Andrieu , Alexis Thiounn , The French Arthroscopy Society

Introduction

Insertional Achilles tendinopathy (IAT) is common, affecting 2% of the general population and up to 10% of runners. Despite this, medical and surgical treatments remain debated. When medical treatment fails, a procedure including open debridement, decompression, and reinsertion of the Achilles tendon is the recommended technique. However, this approach involves risks such as infection, shoe discomfort, or failure. In this context, endoscopic techniques have been developed. The primary objective of our study was to compare the outcomes of open and endoscopic surgical treatments for IAT. Our hypothesis was that endoscopic surgery would allow faster recovery (resumption of walking and sports activities) than would open surgery.

Methods

A prospective multicenter study was conducted at 10 French centers specializing in foot and ankle surgery from May 2021 to May 2023. Patients over 18 years of age with IATs resistant to medical treatment for more than 6 months and who underwent decompression/reinsertion surgery were included. Two groups were formed based on surgical approach: open or endoscopic. Demographic data were collected, and functional evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively using the EFAS (European Foot & Ankle Society) and VISA-A (Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire) scores. Postoperative complications were assessed at 1 month.

Results

Of the 89 patients included, 53 (59.5%) underwent endoscopic surgery, and 36 (40.5%) underwent open surgery. The two groups were comparable preoperatively, except for higher functional scores in the endoscopic group. At 3 months, the VISA-A (p < 0.001), EFAS daily life (p < 0.001), and EFAS sports activity (p < 0.022) scores were significantly better in the endoscopic group. At longer follow-up, all functional scores improved in both groups, with no statistically significant difference. Shoe discomfort at 6 months was reported in 2/53 (3.7%) endoscopic patients and 5/36 (13.8%) open surgery patients (p = 0.099).

Conclusion

Our prospective study reported good functional outcomes for IAT surgery. Endoscopic surgery appeared to allow faster recovery and less shoe discomfort.

Level of Evidence: III.

简介：插入性跟腱病（IAT）很常见，影响2%的普通人群和高达10%的跑步者。尽管如此，药物和手术治疗仍然存在争议。当药物治疗失败时，建议采用开放性清创、减压和重新植入跟腱的方法。然而，这种方法有感染、鞋子不适或失败等风险。在这种情况下，内窥镜技术已经发展起来。本研究的主要目的是比较开放和内镜下手术治疗IAT的结果。我们的假设是内窥镜手术可以比开放手术更快地恢复（恢复行走和体育活动）。方法：一项前瞻性多中心研究于2021年5月至2023年5月在法国10个专门从事足部和踝关节手术的中心进行。18岁以上的iat患者对药物治疗的抵抗超过6个月，并接受了减压/再插入手术。手术入路分为开放和内镜两组。收集人口统计数据，并使用EFAS（欧洲足踝协会）和VISA-A（维多利亚运动评估研究所-跟腱病问卷）评分在术前、术后3、6和12个月进行功能评估。术后1个月评估并发症。结果：89例患者中，53例（59.5%）行内镜手术，36例（40.5%）行开放手术。除了内窥镜组的功能评分较高外，两组术前具有可比性。3个月时，内镜组的VISA-A评分（p < 0.001）、EFAS日常生活评分（p < 0.001）、EFAS运动活动评分（p < 0.022）均显著优于内镜组。在更长时间的随访中，两组的所有功能评分都有所提高，但没有统计学上的显著差异。内镜患者中有2/53（3.7%）和开放手术患者中有5/36（13.8%）报告6个月时鞋子不适（p = 0.099）。结论：我们的前瞻性研究报告了IAT手术良好的功能预后。内窥镜手术似乎可以更快地恢复，减少鞋子的不适。证据水平：III。

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引用次数: 0

Frequent location and severity of sports-related fractures in children in a tertiary care-center. A retrospective observational cohort study 三级保健中心儿童运动相关骨折的常见部位和严重程度回顾性观察队列研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-11-01 DOI: 10.1016/j.otsr.2025.104327

Theo Cordonnier, Victor Germon, Cyril Lemé, Jean Luc Jouve, Franck Launay, Sébastien Pesenti

Introduction

Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe

Methods

We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of injury and fracture location were collected. Contexts were divided into five categories: domestic, sport-related, motor vehicle accident, school-based, other. In addition, treatment modality was collected and categorized as simple (cast immobilization), reduction and surgery (osteosynthesis).

Results

A total of 4761 patients were included (mean age 8.9 years ± 4.3). There were 3326 patients in the domestic fractures group (mean age 7.8 years +/− 4.3) and 1435 patients in the sport-related fractures group (mean age 11.4 years +/− 3.0 (p < 0.001)). Surgical treatment was more frequent in sport-related fractures (13% vs 8%, p < 0.001). Horse-riding was the sport leading the most frequently to surgical treatment (47%). When taking domestic fractures as reference, we found that surgical treatment was significantly more frequent in most of sport-related fractures. The most at-risk sports were horse-riding (OR = 14.5, p < 0.001) and athletics (OR = 5.7, p < 0.001).

Conclusions

Even though physical activity must be promoted in children regarding their beneficial effects, sport-related fractures require more often a surgical treatment. Horse-riding is particularly at-risk, and children and families must be properly informed on risks, security measures and protection equipment.

Level of evidence

IV.

导读：尽管对儿童有益，但据报道，体育锻炼有较高的骨折风险。我们的目的是报道儿童运动相关骨折的特点，并将其与家庭环境中持续的骨折进行比较。我们的假设是运动相关骨折更频繁地需要手术治疗，因此可以认为是更严重的。方法：我们进行了一项回顾性队列研究，包括16岁以下，在急诊科诊断为骨折的患者，不包括颅骨和面部骨折。收集了人口统计学数据、损伤背景和骨折位置。情境分为五类：家庭、运动相关、机动车事故、学校、其他。此外，治疗方式被收集和分类为简单（石膏固定），复位和手术（骨整合）。结果：共纳入4761例患者（平均年龄8.9岁±4.3岁）。国内骨折组有3326例患者（平均年龄7.8岁+/-4.3岁），运动相关骨折组有1435例患者（平均年龄11.4岁+/- 3.0岁）(p)。结论：尽管体育锻炼对儿童有益，但运动相关骨折更需要手术治疗。骑马尤其危险，必须适当告知儿童及其家庭有关风险、安全措施和保护设备的信息。证据等级：四级。

{"title":"Frequent location and severity of sports-related fractures in children in a tertiary care-center. A retrospective observational cohort study","authors":"Theo Cordonnier, Victor Germon, Cyril Lemé, Jean Luc Jouve, Franck Launay, Sébastien Pesenti","doi":"10.1016/j.otsr.2025.104327","DOIUrl":"10.1016/j.otsr.2025.104327","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite benefits in children, sport practice has been reported with higher risk of fractures. Our objective was to report the characteristics of sport-related fractures in children and to compare them to fractures sustained in a domestic context. Our hypothesis was that sports-related fractures more frequently required surgical treatment, and could therefore be considered more severe</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including patients under 16 years old, diagnosed with a fracture at the emergency department, excluding skull and face fractures. Demographic data, context of injury and fracture location were collected. Contexts were divided into five categories: domestic, sport-related, motor vehicle accident, school-based, other. In addition, treatment modality was collected and categorized as simple (cast immobilization), reduction and surgery (osteosynthesis).</div></div><div><h3>Results</h3><div>A total of 4761 patients were included (mean age 8.9 years ± 4.3). There were 3326 patients in the domestic fractures group (mean age 7.8 years +/− 4.3) and 1435 patients in the sport-related fractures group (mean age 11.4 years +/− 3.0 (<em>p</em> < 0.001)). Surgical treatment was more frequent in sport-related fractures (13% vs 8%, <em>p</em> < 0.001). Horse-riding was the sport leading the most frequently to surgical treatment (47%). When taking domestic fractures as reference, we found that surgical treatment was significantly more frequent in most of sport-related fractures. The most at-risk sports were horse-riding (OR = 14.5, <em>p <</em> 0.001) and athletics (OR = 5.7, <em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Even though physical activity must be promoted in children regarding their beneficial effects, sport-related fractures require more often a surgical treatment. Horse-riding is particularly at-risk, and children and families must be properly informed on risks, security measures and protection equipment.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 7","pages":"Article 104327"},"PeriodicalIF":2.2,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576928","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}

引用次数: 0

Does a Collar Reduce Revision Rates and Periprosthetic Fractures in Femoral Neck Fractures? A Comparative Cohort Study of 5,189 Stems. 项圈能降低股骨颈骨折的翻修率和假体周围骨折吗？5189株植物的比较队列研究。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-10-31 DOI: 10.1016/j.otsr.2025.104545

Ceyran Hamoudi, Fatos Ramadani, Jean-Francois Fischer, Laurent Mustaki, Olivier Husmann, Lada Eberlova, Alexandre Lunebourg

Background: 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.

Hypothesis: 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.

Methods: 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™ 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.

Results: Cemented stems had a lower all-cause revision rate than collarless stems (3.2 versus 6.9%, p < .001) and for PPF (0.5 versus 2.9%, p < .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 < .001) and PPF (HR: 5.82 (2.68-12.67], p < .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.

Conclusion: 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.

Level of evidence: III.

背景：骨水泥柄目前被推荐用于治疗移位性股骨颈骨折（FNFs），因为它们降低了翻修和假体周围骨折（PPF）的风险。然而，带环的无骨水泥茎可以提高种植体的稳定性。本研究评估了在fnf的常规全髋关节置换术（THA）、双活动髋关节置换术（THA DM）或半髋关节置换术（HA）中添加环对翻修率和植入物存活率的影响。假设：我们假设在无骨水泥的假体柄上安装一个环可以对fnf的全因和假体周围骨折翻修风险起到保护作用。方法：纳入2012年至2023年间瑞士国家联合登记处记录的5189例fnf髋关节手术。患者接受了Corail™无领骨水泥治疗（900例）、无领骨水泥治疗（2028例）和骨水泥治疗（2261例）。计算全因修正和PPF修正的累积百分比修正（CPR）。在校正年龄、性别、BMI、ASA评分、方法和茎的大小后，估计具有95%置信区间的风险比（hr），以比较三组间的翻修风险。对植入物类型进行亚组分析：HA、THA DM和THA。结果：骨水泥假体的全因修复率低于无环假体（3.2% vs . 6.9%）。结论：与无环假体相比，有环假体和骨水泥假体在全因修复和PPF修复方面表现出同等和更高的种植体存活率。在治疗fnf时，有圈假体似乎是骨水泥假体的可行选择。证据水平：III。

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引用次数: 0

Artificial intelligence in hip and knee surgery: a bibliometric analysis of the 50 most cited articles. 人工智能在髋关节和膝关节手术中的应用：引用次数最多的50篇文章的文献计量学分析。

IF 2.2 3区医学 Q2 ORTHOPEDICS

Orthopaedics & Traumatology-Surgery & Research

Pub Date : 2025-10-30 DOI: 10.1016/j.otsr.2025.104543

Bernard de Geofroy, Romain Léonard, Margaux Micicoi, Jonggu Shin, Jean-François Gonzalez, Peter K Sculco, Grégoire Micicoi

Background: The integration of artificial intelligence (AI) into hip and knee surgery has been evolving rapidly, with significant implications for diagnostics, surgical planning, and outcome prediction. However, there has been limited literature with comprehensive overview of AI in arthroplasty surgery. This bibliometric analysis aims to identify the 50 most cited articles on AI in hip and knee surgery, highlighting key contributors, research trends, and methodological patterns.

Hypothesis: We hypothesized that AI has generated a growing body of influential research in hip and knee surgery, with specific trends in applications, geographic distribution, and methodological approaches.

Material and methods: A systematic search was performed in the Web of Science Core Collection (WOSCC) on July 14, 2025, using predefined keywords related to AI and hip/knee surgery. Original research articles were screened and ranked by citation count. Descriptive statistics were used to analyze bibliometric variables including authorship, journal impact factor, country of origin, and AI techniques.

Results: The 50 most cited articles, published between 2016 and 2023, accumulated a total of 7,140 citations (mean: 142.8; range: 59-735). The most cited article received 735 citations. The United States was the most prolific contributor, accounting for 27 articles (54.0%) and 2,772 citations (38.8%). Deep learning was the most frequently used AI technique (29 articles, 58% of articles). Knee-related topics were predominant, addressed in 32 articles (64.0%) while hip-related studies represented 18 articles (36.0%). Thematic focus was predominantly diagnostic with 31 articles (62.0%) centered on radiographic interpretation. There was no significant correlation between journal impact factor and citation count (Pearson's r = 0.21; p = 0.28).

Discussion: This bibliometric analysis outlines the foundational literature driving AI adoption in hip and knee surgery. While the field is rapidly expanding, research remains unevenly distributed, with limited focus on hip surgery and treatment-oriented AI. Future studies should emphasize clinical validation, generalizability, and the integration of explainable AI into orthopedic practice.

Level of evidence: IV.

背景：人工智能（AI）与髋关节和膝关节手术的整合发展迅速，对诊断、手术计划和结果预测具有重要意义。然而，关于人工智能在关节置换术中的全面概述的文献有限。这项文献计量分析旨在确定人工智能在髋关节和膝关节手术中被引用最多的50篇文章，突出了主要贡献者、研究趋势和方法模式。假设：我们假设人工智能已经在髋关节和膝关节手术领域产生了越来越多的有影响力的研究，在应用、地理分布和方法方法方面有特定的趋势。材料和方法：于2025年7月14日在Web of Science Core Collection （WOSCC）中进行系统搜索，使用与AI和髋关节/膝关节手术相关的预定义关键词。对原始研究文章进行筛选，并根据引用次数进行排名。描述性统计用于分析文献计量变量，包括作者身份、期刊影响因子、原产国和人工智能技术。结果：2016 - 2023年间发表的50篇被引次数最多的文章，累计被引次数为7140次，平均142.8次，范围59-735次。被引用次数最多的文章被引用了735次。美国是最多产的贡献者，有27篇文章（54.0%）和2772次引用（38.8%）。深度学习是最常用的人工智能技术（29篇文章，占文章的58%）。膝关节相关的研究占主导地位，有32篇（64.0%），而髋关节相关的研究有18篇（36.0%）。主题焦点主要是诊断性的，有31篇文章（62.0%）集中在放射学解释上。期刊影响因子与被引次数之间无显著相关性（Pearson’s r = 0.21; p = 0.28）。讨论：本文献计量分析概述了推动人工智能在髋关节和膝关节手术中应用的基础文献。虽然该领域正在迅速扩张，但研究仍然分布不均，对髋关节手术和以治疗为导向的人工智能的关注有限。未来的研究应强调临床验证、推广，以及将可解释的人工智能整合到骨科实践中。证据等级：四级。

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引用次数: 0