To determine whether community socioeconomic distress, measured by the Area Deprivation Index (ADI), is associated with worse short-term clinical outcomes in orthopaedic polytrauma patients treated at an academic level I trauma center. We performed a retrospective cohort study of polytrauma patients treated for orthopaedic injuries at an academic level I trauma center (2014–2019). State ADI scores were used to classify patients as residing in a distressed community (ADI > 8; DC) versus non-distressed community (NDC). Collected variables included demographics, injury characteristics including the Injury Severity Score (ISS), insurance status, and outcomes. Primary outcomes were malunion, nonunion, and unplanned return to the operating room; secondary outcomes included disposition at discharge and follow-up duration. Among 348 patients, 193 (55.5
To provide a focused, examination-oriented review of cauda equina syndrome (CES), covering definition and classification, clinical assessment, bladder dysfunction, emergency imaging and referral, surgical timing, and postoperative rehabilitation. MEDLINE/PubMed and relevant national guidance were reviewed and updated to 22 August 2026. Priority was given to UK guidance, systematic reviews and multicentre studies, including the current Getting It Right First Time (GIRFT) national suspected CES pathway, updated in March 2026. CES is a clinical syndrome of sacral nerve-root dysfunction and should not be defined by an MRI appearance or by painless retention alone. The current UK pathway recommends emergency MRI at the presenting hospital as soon as possible and within four hours of the radiology request, without prior spinal-team approval. Post-void residual (PVR) measurement is an adjunct: a value of at least 200 mL increases suspicion, but a lower value does not exclude CES. Routine digital rectal examination solely to assess resting anal tone is not required. Imaging-confirmed compression requires immediate spinal referral. Incomplete CES should be decompressed as quickly as possible; CES with retention should be treated within 24h of MRI under the current pathway. For both the examination and clinical practice, the priorities are early recognition of sacral symptoms, rapid MRI, avoidance of false reassurance from a single bedside test, urgent senior-led decompression when compression is confirmed, and structured bladder, bowel, sexual and psychological rehabilitation.
To evaluate the effectiveness of Smart Crutch Tips™ in promoting adherence to prescribed early partial weight-bearing (PWB) protocols and to assess patient experience with real-time weight-bearing feedback during home rehabilitation. Twenty patients with lower extremity fractures prescribed partial weight-bearing (PWB) were randomized into two groups utilizing real-time feedback crutch tips (RFC). The Intervention group (n = 10) used Smart Crutch Tips™ (ComeBack Mobility Inc., Kiev, Ukraine), which provided real-time feedback on weight-bearing compliance. The Control group (n = 10) also used crutches equipped with Smart Crutch Tips™, but notifications were disabled, allowing passive data collection without patient feedback. Weight-bearing compliance was defined as the percentage of steps within ± 10
Conventional anterior external fixation provides effective stabilization in pelvic injuries but has limited ability to reduce and control posterior pelvic ring displacement, particularly in type C fractures. Although several anterior fixation systems capable of posterior compression have been described, many remain complex and impractical in emergency settings. To evaluate the effectiveness of a pretensioned pelvic external fixator (PPEF) as a reduction tool in unstable pelvic fractures across different clinical scenarios. A retrospective study was conducted including 28 patients treated with PPEF between 2012 and 2024. In 24 cases, the device was used as emergency stabilization, and in 4 cases as an adjunct or intraoperative reduction tool. Pelvic reduction was assessed using pre- and postoperative CT scans. Anterior and posterior diastasis, as well as vertical displacement, were measured. Radiological outcomes were classified using Matta/Tornetta criteria. Subgroup analyses were performed according to fracture type (A/B vs C), presence of sacral or pubic fractures, and bilateral involvement. Posterior diastasis decreased from 2.54 ± 2.09 cm preoperatively to 0.30 ± 0.67 cm postoperatively. Anterior diastasis improved from 2.54 ± 3.00 cm to 0.35 ± 0.51 cm. Vertical displacement was reduced from 1.18 ± 0.95 cm to 0.36 ± 0.52 cm. Excellent or good radiological outcomes were achieved in 89.3
To examine the statistical robustness and translational interpretation of reported associations between skin keratin signals and bone and tendon collagen quality in a proof-of-concept Fourier-transform infrared spectroscopy study of eight patients undergoing shoulder arthroplasty. Correlation-specific denominators and unexplained asterisks in Table 2 were examined. Pearson coefficients and p values were recalculated from the rounded tabulated values using complete cases. Fisher 95
The role of antibiotic-loaded calcium sulphate (CaS) beads as an adjunct to debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infection (PJI) remains controversial. This study compared outcomes between standard DAIR and DAPRI (DAIR plus antibiotic-loaded CaS beads). A retrospective single-center cohort study was conducted on 51 consecutive patients treated for acute hip or knee PJI between 2022 and 2025. Thirty-three patients underwent standard DAIR and 18 underwent DAPRI. The primary endpoint was septic failure, defined as recurrent infection requiring surgical intervention. The secondary endpoints were identification of clinical and surgical predictors of failure. Univariable logistic regression analysis was performed to evaluate factors associated with septic failure following implant-retention treatment for acute PJI. Overall septic failure occurred in 13/51 patients (25.5
To evaluate the association between initial articular displacement, postoperative residual articular displacement, and the development of severe osteoarthritis in pilon fractures. A retrospective review was performed of adults with operative pilon fractures (OTA/AO 43) at a level I trauma center. Three surgeons reviewed injury, postoperative, and follow-up radiographs to grade initial articular displacement as <2 mm, 2–5 mm, or >5 mm, postoperative residual articular displacement as 0 mm, ≤2 mm, or >2 mm, and the osteoarthritis (OA) grade as 0 (none), 1 (doubtful), 2 (minimal), 3 (moderate), and 4 (severe). The associations between initial displacement, residual displacement, and the development of severe OA were evaluated. There were 115 patients with pilon fractures included. Initial articular displacement on injury radiographs was associated with residual articular displacement with 100.0
Articular patellar fractures (AO/OTA 34-C1/C2) are commonly treated with internal fixation. This non-randomized prospective observational study aimed to compare clinical and functional outcomes between two osteosynthesis techniques: contoured dorsal mini-fragment plate and tension band wiring. All patients who underwent surgical fixation for transverse articular patellar fractures between November 2023 and January 2025 were prospectively enrolled. Patients were divided into two groups: Group A, treated with a dorsal mini-fragment plate, and Group B, treated with tension band wiring. Demographic data, failure rate, hardware removal rate, and range of motion (ROM) at 1 year postoperatively were compared between groups. In addition, functional outcomes and quality of life were assessed at a minimum follow-up of 1 year using the Kujala Anterior Knee Pain Scale (AKPS) and the 12-Item Short Form Health Survey (SF-12). A total of 54 patients were included (Group A: n = 24; Group B: n = 30). Compared with Group B, Group A showed a lower failure rate (8.3
In the realm of orthopaedic trauma, some fractures challenge our training, and then there are “open-subtrochanteric-femur fractures” that challenge our very limits. They are not just fractures; they are catastrophic events; they hit where biomechanics are at worst, where every muscle conspires to deform, displace and defy reduction. And when the skin is slit open, it becomes treacherous, transforming a surgical table into a battlefield. There are no established guidelines; considering Ganga-Hospital-Open-Injury-Scoring-System(GHOISS), a tool that brings structure to the chaos, we formulated a surgical algorithm designed to guide decision-making in these complex injuries. A-retrospective-cohort-study, at level-1 trauma-care-center, where 5112-open-injuries were analysed. 873 of them had open-femur-fracture; however, only 27 of them had open-subtrochanteric-femur-fractures, 2-patients died within 7days-of-admission, and 3-patients were lost-to-follow-up. This study represents the results of the remaining 22-patients, who were followed for at-least 1-year. Radiological and functional outcomes were analysed. Proportion of open-subtrochanteric-femur-fractures was 0.5
To critically examine the development, internal validation, calibration, and clinical interpretability of the BIGB2OSS score for predicting deep surgical site infection after open extremity fractures. A focused methodological appraisal was performed using the information reported in the original article. Candidate predictor complexity, event-to-parameter ratio, bootstrap validation, calibration assessment, model specification, and missing outcome data were evaluated against accepted prediction-model principles. The model was developed from 45 deep-infection events after examining 18 candidate variables, corresponding to approximately 20 regression parameters (approximately 2.25 events per candidate parameter). Figure 3 reported an expected-to-observed ratio of 1.000, calibration-in-the-large of 0.000, and calibration slope of 1.000; however, these were apparent development-data estimates rather than optimism-corrected calibration measures. The apparent and optimism-adjusted C-statistics were both 0.76 with identical confidence intervals, while it was unclear whether the complete model-building sequence was repeated during bootstrapping. The model intercept and exact score-specific probabilities were not reported. In addition, 138 of 708 otherwise age-eligible patients (19.5
To clarify the interpretation of the reported increase in Gram-negative organisms after prophylactic topical antibiotic powder in a recent systematic review and meta-analysis. We examined the published report and its supplementary bacterial-profile forest plot, compared the denominators used for microbiological outcomes with the full treatment-cohort denominators, and evaluated the resulting estimand in light of potential index-event bias and contemporary randomized evidence. Supplementary Material S3 used denominators of 56 powder recipients and 181 controls, although the seven contributing studies enrolled 999 and 1703 treated patients, respectively. In one contributing control group, the microbiological denominator also exceeded the number of reported FRIs. Therefore, the reported OR of 2.52 appears to describe the conditional distribution of Gram-negative organisms among selected breakthrough infections or isolates rather than patient-level Gram-negative FRI risk. Under the simplifying assumption that every reported Gram-negative event represented one patient, the corresponding crude proportions would be 2.1
The purpose of this case series is to investigate outcomes for repair of fractures of the scapular spine and acromial process following reverse total shoulder arthroplasty (RTSA). All adult patients who were treated operatively for a stress scapular spine or acromial fracture following a RTSA at a single center between 2013 and 2024 were identified. All patients underwent operative repair with plate and screw fixation with or without adjunctive bone grafting. Data collected included patient demographics, injury characteristics, fracture classification, surgical details, radiographic findings, and clinical outcomes, which were based on chart review of follow-up visits and revision surgeries. Among 2006 RTSA procedures performed during the study period, 18 patients (0.9
Chronic neurological hip dislocation is a severe musculoskeletal complication in non-ambulatory patients with cerebral palsy. Surgical decision-making is largely based on standard radiographs, although radiography provides only indirect information on articular cartilage status. Whether preoperative radiographic findings accurately reflect macroscopic cartilage degeneration remains unclear. This study evaluated the association between standard radiographic appearance and intraoperative anatomical evidence of cartilage destruction in chronic neurological hip dislocation. This retrospective observational study included non-ambulatory patients with cerebral palsy, all classified as GMFCS level V, who underwent unilateral metaphyseal femoral resection with structured myoplasty for chronic neurological hip dislocation. Each patient contributed one surgically resected femoral head. Preoperative pelvic radiographs were assessed for femoral head morphology, residual acetabular coverage, degenerative changes, and osteophytosis. Intraoperative macroscopic cartilage degeneration was evaluated immediately after resection by two senior neuro-orthopaedic surgeons using predefined anatomical regions and a standardized data collection form. Severe cartilage degeneration was defined as complete cartilage loss in at least one femoral head region. Diagnostic performance of radiographic criteria was assessed using intraoperative macroscopic degeneration as the reference standard. A total of 29 patients and 29 femoral heads were included. Cartilage abnormalities were identified in 28 femoral heads, and complete cartilage loss in at least one anatomical region was observed in 16 cases. Complete cartilage loss was most frequently observed in the superolateral and anterosuperior regions of the femoral head. Complete radiographic loss of femoral head morphology showed a sensitivity of 43.8
To report the clinical, functional and oncological outcome in patients with spinal OBL/OO (osteoblastoma/osteoid osteoma) using Enneking and WBB staging system treated at a single center. This is a retrospective observational study in which the hospital records of 20 patients with OBL and 11 patients with OO were reviewed with a minimum follow-up period of 24 months. Besides demographic information, presenting symptoms, radiological findings and operative details, the outcome measures reported were: neurological (ASIA) and non-neurological complications, patient-reported outcome score (visual analogue scale) and local recurrence after surgery. The mean age at presentation was 20.2 ± 9.2 years and 17.3 ± 6.8 years, respectively for the OBL and OO patient groups, with a male predilection in either tumor. Localized pain was the most common presenting symptom. Neurological deficit at presentation was noted in 8/20 OBL patients, whereas all patients with OO were neurologically intact. Both the tumors predominantly involved posterior elements (27/31 patients) with no intradural involvement. Five patients (all with OO) underwent only decompression/curettage; 26/31 patients underwent decompression with instrumentation. 4 patients underwent Enneking inappropriate resection, with one patient having local tumor recurrence. Significant improvement in pre-existing neurological status and VAS scores was noted at final follow-up. Surgical treatment of OBL and OO is associated with a favourable clinical, radiological and oncological outcome. While anatomical constraints don’t allow wide excisions, combined Enneking and WBB staging facilitates surgical planning and helps in doing anatomically feasible resections with structural stability.
Central sensitization (CS) is an increasingly recognized determinant of pain severity and postoperative outcomes in knee osteoarthritis, yet how best to measure it in clinical practice remains unsettled. We comment on a recent cross-sectional study of 121 patients awaiting total knee arthroplasty,which found that higher Central Sensitization Inventory (CSI) scores were independently associated with lower remote, but not local, pressure pain thresholds (PPTs), suggesting that CSI reflects widespread rather than localized pain hypersensitivity. We highlight that CSI and remote PPT are indirect, complementary measures rather than confirmatory proof of a central mechanism, and that pairing them with quantitative sensory testing could increase their clinical utility. We also note limitations affecting generalizability, including the advanced-disease cohort, cross-sectional design, and unmeasured covariates. Prospective, multicentre studies linking these measures to postoperative outcomes could translate this work into individualized perioperative pain management for patients undergoing knee arthroplasty.
Short-stem total hip arthroplasty aims to improve metaphyseal load transfer while enabling minimally invasive implantation via the direct anterior approach. Long-term migration and clinical data for these implants remain limited. This study evaluated 10-year femoral stem migration, periprosthetic radiolucency, and clinical outcomes for a cementless, metaphyseal-anchored short stem. In this single-center retrospective study, 66 hips in 57 patients underwent primary THA with the AMIStem-H (Medacta International) between 2010 and 2012. Stem subsidence was measured serially using EBRA-FCA, radiolucency was graded by Gruen zone, and clinical function was assessed with the Harris Hip Score (HHS). Median stem subsidence increased from 0.51 mm at 3 months to 1.45 mm (IQR 0.72–2.12 mm) at 10 years, with most migration occurring in the first five years; 33.3
Radial head arthroplasty is widely used for unreconstructable radial head fractures, particularly in complex elbow trauma, yet long-term outcomes remain poorly documented. This study aimed to assess implant survival and clinical outcomes after radial head arthroplasty performed for traumatic fractures. This retrospective monocentric study included patients who underwent radial head arthroplasty between 1997 and 2017 with a minimum follow-up of seven years. The primary outcome was implant survival, defined as absence of revision or implant removal. Secondary outcomes included pain (numerical rating scale), range of motion, grip strength, functional scores (MEPS, Broberg–Morrey, QuickDASH), and radiographic findings. Fifty-four patients underwent radial head arthroplasty, and 47 were included in the survival analysis. At a mean follow-up of 142.7 ± 52.5 months, implant survival was 91.5
Standard fluoroscopic views may not detect cortical breaches during percutaneous acetabular column screw placement, creating an illusion of safe intraosseous positioning. The purpose of this study was to illustrate use of simple fluoroscopic checkpoint projections—the combined obturator oblique hyper-outlet (COOHO) view for anterior column (AC) screws and two known additional views, outlet and true lateral (TL), for posterior column (PC) screws—as a method to demonstrate extraosseous screw trajectories that might be missed by standard tangential column fluoroscopic views. Six clinical cases are presented as examples of standard orthogonal fluoroscopic views failing to detect extraosseous screw placement. The cases are supplemented by a synthetic pelvic model demonstration to define radiographic landmarks and common screw malposition. Guidewires were advanced in the pelvic model columns, either intraosseous or extraosseous, and their paths were evaluated with standard fluoroscopic views compared to COOHO and outlet and TL views. For the AC, COOHO tangentially profiles the pectineus recess and iliopsoas gutter to unmask in–out–in paths. For the PC, iliac and obturator oblique views may miss medial or posterior breach near the lesser sciatic notch and quadrilateral plate. The outlet and TL views show the vertical extent of the ilioischial line to detect medial or posterior breech and length-orientation errors. The COOHO, outlet and TL views additional projections that improve tangential visualization of high-risk cortices and detection of extraosseous trajectories.
