Orthopaedics & Traumatology-Surgery & Research最新文献

{"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":"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}

{"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":"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":"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":"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":"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":"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}