Mechanical failure remains an important complication after Fassier-Duval telescopic nailing in pediatric osteogenesis imperfecta. Although adequate epiphyseal fixation is considered technically important, the association between thread engagement across the physis and construct survival has not been well characterized, particularly after accounting for local anatomy and changes in risk over time. We conducted a single-center retrospective cohort study of pediatric patients with osteogenesis imperfecta treated with Fassier-Duval telescopic nails. The primary outcome was documented mechanical telescopic failure. Thread count, physeal diameter, and nail diameter were independently assessed by two observers. Time to documented failure or censoring was analyzed using Cox regression with robust standard errors clustered by patient. Because the proportional-hazards assumption was violated for thread count, the primary model incorporated a time-varying thread coefficient using an interaction with log-transformed follow-up time. Piecewise Cox models and OI- and observer-specific sensitivity analyses were performed. Fifty-six patients contributed 107 operated segments; 106 segments from 55 patients were available for time-to-event analysis, with 54 documented failure events. Interobserver reliability was excellent for physeal diameter [ICC(A,1) = 0.998], nail diameter [ICC(A,1) = 1.000], and thread count (weighted κ = 0.998). Physeal diameter was positively correlated with thread count (Spearman ρ = 0.347; p < 0.001), confirming anatomical constraint on achievable engagement. After adjustment for physeal diameter, nail diameter, age, operated bone, and OI-related heterogeneity, each additional thread was associated with a lower hazard of failure at 1 year (HR 0.457, 95
Predicting survival using readily available blood parameters are necessary for guiding surgical decision-making in patients undergoing intramedullary nailing for bone metastases. This study aimed to evaluate the prognostic value of preoperative systemic inflammatory and nutritional indices—specifically the global ımmuno-nutritional ındex (GINI), prognostic nutritional ındex (PNI), and systemic ımmune-ınflammation ındex (SII)—for overall survival (OS) in patients treated with intramedullary nailing (IMN) for long-bone metastases. In this retrospective, multicenter study, 203 patients (2010–2024) who underwent intramedullary nailing for long-bone metastases were analyzed. Preoperative blood markers were used to calculate GINI, PNI, and SII. Survival was assessed using Kaplan–Meier curves, diagnostic validity was assessed using ROC analysis, and independent risk factors were identified using Cox regression. The median overall survival time in this study was 10.3 months. GINI displayed greater diagnostic accuracy (AUC: 0.722) than both SII and PNI. The median survival time for patients with a low GINI score was found to be more than three times longer than that of the higher group (22.1/6.2 months, respectively; p < 0.001). Multivariate analysis identified ECOG performance status (3–4), hypercalcemia, and rapidly growing tumors as independent risk factors for mortality. Solitary metastasis was protective. Although GINI is not an independent predictor in multivariate analysis, it demonstrates significant prognostic value in receiver operating characteristic (ROC) and univariate analyses, indicating its practical utility.
Orthopaedic infection is usually approached as a local problem: eradicate the infection, retain or remove the implant, achieve union, salvage the limb, restore function. A proportion of these infections also kill, either during the acute illness or in the years after apparent cure. The threat to life arises from the interaction of four familiar domains: the pathogen, the host, the infection itself and the intervention required to control it. A focussed search was conducted on PubMed from inception to 31 August 2026 using four conceptual blocks covering mortality in orthopaedic infection, host vulnerability, fulminant bone and soft-tissue infection, and source control in sepsis. Records were screened against pre-specified eligibility criteria and reference lists hand-searched. The resulting synthesis is narrative and is combined with the authors’ experience of managing severe osteoarticular infection in a tertiary referral practice. Mortality clusters around a small number of recognisable situations: dissemination from Staphylococcus aureus bacteraemia, rapidly progressive necrotising infection, resistant or unsuspected organisms, and infection of any severity in a host with little physiological reserve. Source control remains the principal surgical contribution to survival and should proceed alongside rather than before or after antimicrobial therapy and physiological support; its extent and timing must be matched to what the patient can tolerate. Survivors carry an excessive risk of mortality that persists for years. In life-threatening orthopaedic infection, the immediate objective shifts from the limb to life. Recognising that shift early, and acting on it, is what changes the outcomes.
This prospective study aimed to examine the changes in pedobarographic parameters along with foot and ankle functional outcomes based on the pre-operative knee varus deformity in patients undergoing simultaneous bilateral total knee arthroplasty (TKA). This study included 124 knees in 62 patients. Patients underwent pedobarographic analysis pre-operatively and at 1 year of follow-up. Maximum pressures at the first metatarsal head (M1), fifth metatarsal head (M5), and the average of maximum pressure at the lateral and medial aspects of the heel were recorded while standing and walking. The knees were divided into two subgroups based on the pre-operative varus deformity for analysis: Group 1 with ≤ 10° varus deformity, and Group 2 with > 10° varus deformity. Group 1 consisted of 46 knees, and Group 2 consisted of 78 knees. In Group 1, there was a significant decrease in the static M5 pressure at the final follow-up (p = 0.026). In Group 2, dynamic M5 pressure decreased significantly (p = 0.023) at the final follow-up. There was also a significant increase in the static M1 pressure (p = 0.04) and static heel pressure (p = 0.001) at the final follow-up in Group 2. Both groups showed significant improvement in the foot and ankle functional outcomes. In patients with osteoarthritic varus knees and supple foot and ankle joints, altered foot loading pressure distribution can be corrected, in both the static and dynamic context, by just realigning the limb by TKA surgery. TKA surgery in such patients also leads to improved foot and ankle functional outcomes.
