Chronic Monteggia lesions are difficult to treat when longstanding radial head dislocation results in severe radial head deformity. In such cases, corrective ulnar osteotomy with or without annular ligament repair may not achieve stable or congruent radiocapitellar reduction. This technical note describes a combined reconstructive technique using corrective ulnar osteotomy, radial head replacement, and annular ligament/lateral ligament complex repair. Through a Boyd approach, the deformed radial head is resected, and the proximal ulna is osteotomized and dorsally angulated to restore radiocapitellar alignment. The resected radial head may be used as an intercalary graft at the osteotomy site. After trial radial head replacement, the capitellum, radial head notch, and proximal ulna are contoured as needed to improve prosthetic congruity. The annular ligament, lateral ulnar collateral ligament remnant, and capsule are repaired with suture anchors to enhance stability. In chronic Monteggia lesions with severe radial head deformity, this combined technique may be useful when isolated ulnar osteotomy is unlikely to restore stable radio-capitellar articulation. A longer follow-up is needed to evaluate durability, functional outcomes, and complications.
INTRODUCTION:Total knee arthroplasty (TKA) is a well-established treatment for end-stage knee osteoarthritis. Robotic-assisted TKA (RA-TKA) has emerged over the past decade, enabling patient-specific implantation, precise bone cuts, and intraoperative control of gap balance and alignment. The HLS KneetecTM is a third condyle posterior stabilized TKA, initially designed for implantation using conventional manual instrumentation (C-TKA), and intended for use with an adjusted mechanical alignment. It can now also be implanted with robotic assistance. This pilot study aimed to evaluate the association between RA-TKA versus C-TKA and clinical outcomes in patients with bilateral knee osteoarthritis. MATERIALS AND METHODS:This was a retrospective cohort of patients operated on by primary RA-TKA in a second osteoarthritic knee after contralateral C-TKA. Twenty-two patients constituted their own control group (44 knees). Mean age was 71.9 ± 7.4 years. The mean time between the two procedures was 22 ± 19 months. Primary outcomes measured were limb alignment (hip-knee-ankle (HKA)), range of motion (ROM), and Forgotten Joint Score (FJS) at one year postoperatively. Secondary outcomes included operating time, hospital stay, incision length, blood loss, and radiographic evaluation (femoral mechanical angle (FMA), tibial mechanical angle (TMA), tibial component slope angle (TSA), patellar tilt angle (PTA), and femoral axial rotation angle (FARA)). RESULTS:RA-TKA was associated with an HKA angle significantly closer to the target (177.9° vs. 175.3°, p = 0.012), with higher flexion (+7°, p = 0.032) and a higher FJS (+13.9 points, p < 0.001). Operating time was longer in the RA-TKA group (+19.5 min, p = 0.004), while hospital stay, blood loss, and incision length did not differ significantly between groups. Radiographically, RA-TKA was associated with reduced femoral valgus (FMA -1.3°, p = 0.001), with no significant differences in TMA or TSA. Patellar tilt was similar, whereas femoral external rotation was increased with RA-TKA (+1.1°, p = 0.0006). CONCLUSION:In this pilot study, RA-TKA was associated with superior frontal alignment and better patient-reported functional outcomes compared to C-TKA. However, given the inherent temporal confounding of the bilateral sequential design and the small sample size, these findings should be interpreted with caution. Further prospective, adequately powered studies are warranted to confirm these results.
INTRODUCTION:Functional alignment (FA) has emerged as a robot-enabled, patient-specific strategy in total knee arthroplasty (TKA), aiming to individualize component positioning and knee balance within predefined safety limits. However, whether robotic FA provides clinically meaningful advantages over robotic mechanical alignment (MA) remains uncertain. This meta-analysis compared robotic FA versus robotic MA in primary TKA. METHODS:Medline, the Cochrane Library, and Google Scholar were searched from inception to December 29, 2025, for comparative studies evaluating FA versus MA in robotic primary TKA. Outcomes included additional soft-tissue release, reported knee motion, Forgotten Joint Score-12 (FJS-12), 1-year functional score improvement using Oxford Knee Score or converted Western Ontario and McMaster Universities Osteoarthritis Index scores, and operative duration. Continuous outcomes were pooled as mean differences (MDs), and dichotomous outcomes as odds ratios (ORs). RESULTS:Six studies including 645 TKAs were included. MA was associated with higher odds of requiring additional soft-tissue release compared with FA (OR = 5.38; 95% CI: 2.71 to 10.69; P < 0.00001). FA showed greater early improvement in reported knee motion at ≤6 weeks (MD = -4.64°; 95% CI: -7.07 to -2.21; P = 0.0002), but this difference was no longer significant at 6 months (MD = -1.13°; 95% CI: -8.24 to 5.98; P = 0.76). FJS-12 scores were similar at 3 months but favored FA at 6 months (MD = -10.74; 95% CI: -13.65 to -7.83; P < 0.00001), although this did not reach the established threshold for clinical importance. Functional score improvement at 1 year was similar between groups. Operative time statistically favored FA, although the difference was small. CONCLUSION:Robotic FA was associated with fewer soft-tissue releases and greater early improvement in reported knee motion, but these early advantages did not translate into superior functional improvement by 1 year. Longer-term standardized comparative studies are required.
Objective: To describe a structured technical-conceptual workflow for comprehensive biological knee reconstruction, focusing on the coordinated integration of four independent allografts – femoral osteochondral, tibial osteochondral, meniscal, and anterior cruciate ligament (ACL) – performed in a single operative setting. Background: Multicompartmental failure involving bipolar osteochondral defects, meniscal deficiency, and ligamentous instability represents one of the most challenging scenarios in joint preservation surgery. Although individual reconstructive techniques are well documented, current literature lacks a widely accepted consensus regarding their simultaneous execution. In this context, three-dimensional preoperative planning and structured sequencing logic are critical for preventing tunnel convergence and preserving the biological viability of the grafts. Methodological Framework Description: A structured reconstructive strategy is proposed to optimize surgical exposure and avoid spatial conflicts and graft interference. The workflow begins with a systematic arthroscopic mapping followed by a wide arthrotomy, adhering to a “surface restoration-to-stabilization” logic, consisting of: (1) customized femoral osteochondral shell allograft transplantation; (2) tibial osteochondral transplantation using a cylindrical plug technique; (3) medial meniscal allograft transplantation with dovetail bone fixation; and (4) anatomic ACL reconstruction using a soft tissue tendon allograft. This specific sequencing allows stabilizing elements to be adapted to the already restored articular anatomy, minimizing tunnel convergence and protecting soft-tissue grafts from aggressive osseous surgical maneuvers. Clinical Relevance: This technical-conceptual work provides a structured roadmap to support surgical decision-making in highly complex reconstructive cases. By systematizing operative sequencing and the management of technical interferences, the proposed workflow enables a reproducible biological reconstruction strategy aimed at restoring articular homeostasis in young and active patients within a single surgical procedure.
Background : The metatarsal–cuneiform joint, part of the Lisfranc complex, is essential for midfoot stability, load distribution, and gait mechanics. Injuries, often from high-energy trauma such as traffic accidents or falls, can lead to chronic instability, pain, and functional impairment. Despite accounting for only 0.2% of fractures, Lisfranc injuries are frequently missed in initial diagnosis. Surgical management typically involves internal fixation (IF) to preserve mobility or arthrodesis for permanent stability, yet evidence on their long-term effectiveness remains conflicting, highlighting the need for comparative evaluation. Methods : A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed, Scopus, Medline, and Cochrane Library were searched for studies published from January 2015 to June 2025. Ten studies met the inclusion criteria, comprising 441 patients (284 IF, 157 arthrodesis). Primary outcomes were the American Orthopaedic Foot and Ankle Society (AOFAS) score and Visual Analog Scale (VAS) pain score; secondary outcomes included recovery time and reoperation rate. Data were pooled using mean differences (MD) and percentages with corresponding p-values. Results : Arthrodesis yielded significantly higher AOFAS scores compared with IF (85.40 ± 5.51 vs 83.96 ± 5.67; MD = +1.44; p = 0.001) and lower VAS pain scores (1.31 ± 1.2 vs 2.56 ± 1.5; MD = −1.26; p = 0.038). Mean recovery time was shorter in the arthrodesis group (14.23 ± 4.76 weeks) versus IF (16.34 ± 7.81 weeks; MD = −2.11 weeks; p = 0.042). Reoperation rates were significantly lower with arthrodesis (13% vs 30.48%; p = 0.031). Conclusions : Arthrodesis offers superior functional recovery, pain relief, faster return to ambulation, and fewer reoperations than IF in posttraumatic Lisfranc injuries. Surgical choice should be individualized – arthrodesis is recommended for severe instability requiring maximal stability, while IF may be appropriate for younger or athletic patients prioritizing joint mobility. Level of Evidence : Level I, systematic review and meta-analysis.
Introduction : Posterior tibial slope (PTS) has been reported to be an important risk factor for anterior cruciate ligament (ACL) reconstruction (ACLR) failure. PTS varies between populations, and a mean value in the Emirati population has not been described. To evaluate PTS and to improve clinical decision-making regarding surgical thresholds for slope correcting osteotomy, a mean value for the Emirati population needs to be defined. Methods : This was an institutional review board-approved retrospective study of 213 consecutive Emirati patients with knee complaints visiting a single orthopedic center in 2025. Inclusion criteria were patients >18 years of age visiting the center for the first time with no previous surgery or fracture in the affected knee. Medial and lateral PTS were measured on long weight-bearing lateral tibial radiographs using the proximal and long anatomical tibial axis and mechanical tibial axis. Results : A total of 213 patients, 73 women and 140 men, were evaluated with a mean age of 46.0 years. The mean medial PTS was 12.8° ± 2.9° (range: 3.7–19.7°), and the mean lateral PTS was 11.9° ± 3.2° (range: 3.9–20.1°) using the proximal tibial axis. Using the long anatomical tibial axis, the mean medial PTS was 14.7° ± 3.3° (range: 4.8–25.5°), and the mean lateral PTS was 13.8° ± 3.7° (range: 5.1–24.8°). Using the mechanical tibial axis, the mean medial PTS was 12.7° ± 3.1° (range: 2.7–19.7°) and the mean lateral PTS was 12.2° ± 3.1° (range: 3.8–20.1°). Sex did not influence the PTS value ( p > 0.05). Discussion : In this Emirati population, the mean medial PTS was 12.7–14.7° and the mean lateral PTS was 11.9–13.8° for the differing measurement techniques. These values are higher than other reported populations and can be used as a reference when evaluating knee injuries and contribute to surgical decision-making in ACL-deficient knees.
Introduction : Restoring the offset after THA is positively correlated with good functional outcomes and patient satisfaction. Preoperative planning is now an essential tool for optimizing this restoration. Nevertheless, recent studies have focused mainly on the femoral offset, at the expense of the acetabular offset. Our hypothesis was that the variations in global offset after THA are mainly due to variations in acetabular offset relative to its initially planned value. Methods : This retrospective study involved 104 patients who had undergone primary anterior THA with two-dimensional preoperative planning between January 2023 and November 2024. The planned preoperative radiographs and the postoperative radiographs were analyzed independently by two attending orthopeadic surgeons who measured the global, acetabular, and femoral offsets. The intra-rater and inter-rater agreement was determined. The differences between the planned implant sizes and the size actually implanted were also determined. Results : In the end, 43 patients met all the pre and postoperative radiographic criteria and were included in the analysis. There was a correlation between the variation in acetabular offset and the variations in global offset ( r = 0.74, p < 0.0001) and between the variation in femoral offset and the variations in global offset ( r = 0.68, p < 0.0001). Using multiple linear regression, the coefficients of regression for the variation in the acetabular offset and femoral offset were 1.00, indicating an equal contribution (50%) to variations in global offset. Conclusion : Variations in the positioning of the acetabular cup are an important factor in the variations in global offset after THA. The postoperative variations in acetabular and femoral offsets contribute equally to changes in the global offset. Clinically, this means that practitioners should focus more on implanting the acetabular component. Registration : IRB approval N° 22727513. Level of evidence : III.
INTRODUCTION:Severe Osteogenesis Imperfecta (OI) can cause distinct proximal femoral deformities, but specific femoral neck changes remain poorly defined. This study aimed to characterize dystrophic femoral neck morphology and determine a diagnostic threshold. METHODS:We retrospectively reviewed anteroposterior pelvic radiographs from patients >8 years old with severe OI (n = 24 hips) and age-matched controls (n = 24 hips). Measurements included femoral neck length, neck diameter, head diameter, neck-shaft angle, anterior lateral proximal femoral angle (aLPFA), and acetabular protrusion. Ratios of neck length-to-diameter and neck length-to-head diameter were calculated. Statistical comparisons used t-tests; ROC analysis identified the optimal threshold for distinguishing dystrophic necks. RESULTS:OI patients had shorter femoral necks (52.7 ± 9.9 mm vs. 64.8 ± 9.6 mm, p < 0.001), smaller diameters (19.4 ± 4.7 mm vs. 32.8 ± 4.8 mm, p < 0.0001), and higher neck length-to-diameter ratios (2.82 ± 0.63 vs. 1.98 ± 0.19, p < 0.000001). A threshold of ≥2.35 (AUC = 0.90) identified dystrophic necks, associated with greater acetabular protrusion (-2.91 ± 12.33 mm vs. 4.42 ± 8.67 mm, p = 0.004). DISCUSSION:A neck length-to-diameter ratio ≥ 2.35 reliably defines dystrophic femoral necks in OI and correlates with increased acetabular protrusion. Early recognition may guide surgical planning and help preserve hip function. LEVEL OF EVIDENCE:Level IV - Retrospective comparative study.
Atypical femoral fractures are rare. They are well described in patients with prolonged bisphosphonate use. The periprosthetic form without bisphosphonate intake appears to be exceptional and may lead to mechanical complications (nonunion, secondary displacement) if the difficulties of bone healing are not anticipated. We report here two cases of atypical femoral fractures without bisphosphonate use and the resulting implications for surgical fixation.
Background: Total Knee Arthroplasty (TKA) is the standard treatment for end-stage osteoarthritis, with optimal outcomes dependent on precise mechanical alignment and accurate implant positioning. Patient-specific instrumentation (PSI), facilitated by preoperative CT imaging, has emerged as a technique to enhance surgical precision; however, the relationship between alignment and functional outcomes remains less clear. Objective: To evaluate the effectiveness of medial pivot CT-guided PSI TKA in achieving mechanical axis alignment and its correlation with functional outcomes over a 12-month period. Methods: This retrospective study analysed 389 primary medial pivot TKA procedures performed by a single surgeon between January 2015 and December 2024 using CT-guided PSI. Functional outcomes were assessed using the Oxford Knee Score (OKS) and Lysholm Knee Score (LKS) preoperatively and at three, six, and twelve months postoperatively. Mechanical alignment was evaluated using the Hip-Knee-Ankle (HKA) angle pre- and postoperatively. Descriptive statistics and paired t-tests were applied, with significance set at p < 0.05. Results: The cohort included 389 patients, 62.7% female, with a mean age of 69.6 years and mean BMI of 31.4 kg/m2. PSI significantly improved mechanical alignment, with mean HKA increasing from 172.2° preoperatively to 179.5° postoperatively. Functional outcomes also improved, with mean OKS increasing from 18.5 to 38.6 and mean LKS from 52.4 to 85.5. Patients classified as alignment outliers with severe preoperative deformities showed no significant improvement in alignment but demonstrated substantial functional gains. Conclusion: CT-guided PSI improves mechanical alignment and functional outcomes in medial pivot TKA, particularly in mild to moderate deformities. The weak correlation between alignment and functional recovery suggests other factors, including soft tissue balance, prosthesis factors and rehabilitation, to be critical in total knee arthroplasty. Further studies with larger cohorts, longer follow-up, and comparative groups are required.
Background: Anterior knee pain (AKP) is a frequent complaint after tibial intramedullary nailing (IMN), and the choice of entry approach may contribute to its occurrence. This trial compared the lateral parapatellar semi-extended (LPP) approach versus the midline transpatellar splitting (MLTP) approach for IMN of closed diaphyseal tibial fractures, focusing on AKP and knee function. Methods: In this single-blinded randomized controlled trial, 50 adults with acute closed AO/OTA 42 tibial shaft fractures were allocated 1:1 to IMN performed through either the LPP or MLTP approach. Follow-up assessments were performed at 3 and 6 months after surgery. Primary outcomes were AKP during weight-bearing, quantified using a visual analog scale (VAS), and knee function measured by the Lysholm Knee Score. Results: LPP achieved higher Lysholm scores at 3 months (82.36 ± 5.2 vs. 75.76 ± 6.1; P < 0.001) and 6 months (87.32 ± 4.8 vs. 84.20 ± 5.4; P = 0.024), indicating superior early functional recovery. VAS AKP was lower with LPP at 3 months (2.40 ± 0.9 vs. 3.60 ± 1.2; P = 0.001), but similar by 6 months (1.80 ± 0.7 vs. 1.96 ± 0.8; P = 0.122), suggesting the benefit is mainly early. Operative time favored LPP (62.1 ± 8.7 vs. 68.4 ± 10.2 min; P = 0.02) with fewer fluoroscopy shots (29.2 ± 5.4 vs. 38.5 ± 6.1; P < 0.001). All fractures united; time to union was comparable (16.8 ± 2.4 vs. 16.2 ± 2.1 weeks; P = 0.41). Complications were minor in both groups. Conclusions: LPP semi-extended tibial IMN was associated with lower early AKP, better early knee function, and improved operative efficiency without compromising union during 6-month follow-up. A Longer follow-up is required to determine whether anterior knee pain and functional outcomes converge over time.
Introduction: Floating knee involves concomitant and ipsilateral fractures of the femur and tibia, sometimes associated with a patellar fracture. Complications are common, and functional outcomes are often poor. This study aimed to evaluate bone healing and to identify factors influencing nonunion and functional results. Methods: This retrospective study included 72 knees, with a mean follow-up of 4.5 years. The primary outcome was bone union. Neurological, vascular and meniscoligamentous injuries were analyzed. Follow-up parameters were clinical, radiological and functional, including the Karlström and Olerud score. Results: At least one fracture was open in 69% of cases. Mean time to union was 10.5 months for the femur, 7.5 months for the tibia, and 4.4 months for the patella. Nonunion occurred in 68% of femoral fractures, 57% of tibial fractures, and 42% of patellar fractures. Open fractures and tibial vascular injuries were significant predictors of nonunion. Meniscoligamentous injuries were diagnosed in 32% of cases and were more frequent with increasing Ran stage (p = 0.004). Surgical site infection occurred in 30.6% of cases and was significantly associated with open fractures (p < 0.001). Functional outcomes worsened with increasing Ran stage, meniscoligamentous injuries, open fractures, and infection. Conclusion: Floating knee injuries are characterized by prolonged healing, high rates of nonunion and infection, and limited functional outcomes.
Purpose: To determine the necessity of simultaneous proximal femoral osteotomy (PFO) during open reduction (OR) and Dega acetabuloplasty (DA) in patients with developmental dysplasia of the hip (DDH) by comparing the clinical and radiographic outcomes of DDH patients who underwent OR and DA with or without PFO. Methods: We retrospectively analyzed 61 DDH patients (72 hips) who underwent OR and DA at our hospital between January 2011 and December 2015. Finally, 52 patients (59 hips) with Tönnis types I, II, and III dislocation were included. We included 28 patients (31 hips) with a median operative age of 19.0 (17.0, 25.0) months (range, 15–36 months) in the PFO group. We included 24 patients (28 hips) with a median operative age of 16.0 (16.0, 23.5) months (range, 14–32 months) in the non-PFO group. Hip joint development was compared by measuring the following indicators: acetabular index (AI), femoral epiphyseal height-to-width index (HWI), et al. In both groups, we calculated changes in AI up to the final follow-up, namely ΔAI (postoperative – final follow-up). Results: Mean follow-up durations of the PFO and non-PFO groups were 42 months (range, 24–70 months). ΔAI (postoperative – final follow-up) was 5.6° (range, −15° to 24°; SD 9.0°) and 4.7° (range, −3° to 13°; SD 4.6°), respectively (t = −0.492, P = 0.625). HWI in both groups at the final follow-up was 55.9 (range, 43–76; SD 7.1) % and 53.1 (range, 43–68; SD 6.1) %, respectively (t = −1.654, P = 0.104). Conclusion: PFO is unnecessary when OR and DA is performed in walking-age children with Tönnis type III DDH or below. Level of evidence: level III.
Background: Pediatric distal radius fractures are the most common fractures in children. Management of displaced injuries remains controversial because remodeling capacity varies with skeletal maturity, fracture stability, and fracture subtype. Metaphyseal and physeal fractures differ biologically: metaphyseal injuries are primarily threatened by redisplacement, whereas physeal injuries carry risks of growth disturbance and iatrogenic physeal injury. An evidence-based, maturity- and stability-guided framework is required. Methods: A PRISMA-compliant systematic review and Meta-analysis was performed using PubMed, Embase, Scopus, Web of Science, and the Cochrane Library (inception–2025). Randomized controlled trials and comparative observational studies of pediatric distal radius fractures (0–18 years) treated with cast or splint immobilization, with or without percutaneous Kirschner-wire fixation, were included. Primary outcomes were redisplacement and secondary intervention for metaphyseal fractures; growth disturbance and physeal complications were evaluated separately for physeal injuries. Secondary outcomes included union, functional recovery, complications, and casting quality. Results: Forty-five studies (5,340 patients) were included qualitatively; twelve comparative studies (4 RCTs, 8 observational; 1,455 patients) were analyzed quantitatively (853 cast alone; 602 cast + K-wire). In predominantly metaphyseal fractures, redisplacement occurred in 20–35% after casting versus 0–5% after K-wire fixation (pooled OR 0.10), with reduced secondary intervention (OR 0.15). Union approached 100% and long-term functional outcomes were equivalent. In children with substantial remaining growth, including those <11 years with completely displaced metaphyseal fractures, casting without reduction achieved reliable union and remodeling. For physeal injuries, restoration of physeal alignment and longitudinal growth surveillance were prioritized. Cast length and removable splints demonstrated comparable stability when molding was adequate; casting quality indices were variably predictive. Conclusions: Outcomes are excellent when treatment aligns with fracture biology and skeletal maturity. Metaphyseal and physeal injuries require distinct considerations. Nonoperative care – including acceptance of bayonet apposition in young children – is appropriate for many metaphyseal fractures, while K-wire fixation should be selectively reserved for unstable patterns. Level of evidence: Level II (Systematic review and meta-analysis of Level I–III studies).
Background: Pediatric bone and joint infections (PBJI) remain a major cause of morbidity in children, with evolving trends in epidemiology, diagnostics, and management. A comprehensive understanding of the global research landscape is essential to identify influential contributions, collaboration patterns, and thematic priorities. This study aimed to perform a bibliometric analysis of PBJI research to map productivity, impact, and knowledge structure. Methods: A systematic literature search was conducted in a major bibliographic database to retrieve PBJI-related publications from 1976 to 2025. Bibliometric indicators including total publications (TP), total citations (TC), citations per paper (CPP), relative citation index (RCI), highly cited papers (HCPs), and international collaborative papers (ICPs) were analyzed. Network analyses of keywords, authors, institutions, countries, and journals were performed using VOSviewer to assess collaboration patterns and research themes. Results: A total of 1,556 publications were identified. Journal articles dominated output (82.4%), while reviews showed higher impact (CPP 31.67; RCI 1.90). English-language papers accounted for 89.1% of publications and 97.5% of citations, including all 28 HCPs. Research output and impact were concentrated in a few high-income countries, led by the USA and the UK. Citation distribution was highly skewed, with 18.4% uncited papers and only 6.3% of publications receiving more than 50 citations. Keyword analysis revealed four major thematic clusters centered on osteomyelitis, septic arthritis, pathogens (especially Staphylococcus aureus), diagnostics, and treatment. Collaboration networks were selective and fragmented, with a small core of influential authors and institutions. Conclusion: PBJI research is a mature but uneven field, driven by a limited number of high-impact contributors and focused clinical themes. Strengthening international collaboration and improving visibility of research from underrepresented regions are critical for balanced global advancement.
Background: The SICOT-J, an open-access orthopedic journal affiliated with the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT), has been a global orthopedic research platform since 2015. This study provides a scientometric analysis of SICOT-J publications from 2015 to 2025 to evaluate research productivity, citation impact, and collaboration patterns. Methods: 542 documents published in SICOT-J and indexed in the Scopus database were analyzed using bibliometric indicators. Data on publication types, subject areas, authorship, institutional and geographic affiliations, funding disclosures, collaboration networks, and citation metrics were extracted. Microsoft Excel was used for data processing and analysis. Key indicators included citations per publication (CPP), relative citation index (RCI), and total link strength (TLS) for collaborative connections. Results: From January 1 2015, to June 30 2025, SICOT-J published 542 articles with an overall CPP of 10.29. Research articles comprised 78.6% of publications, while reviews – though fewer in number – had the highest CPP (23.38). The most frequent topics were arthroplasty (25.83%) and trauma/fractures (24.17%), with the hip and knee as the most studied anatomical regions. Only 5.17% of the articles reported external funding. Fifteen highly cited papers (≥50 citations) were mostly reviews and internationally co-authored. Conclusions: SICOT-J has demonstrated consistent publication growth and international participation, though with notable concentration in a few high-income countries. The high citation impact of reviews and collaborative works highlights the importance of strategic content development. Enhancing funding transparency, supporting underrepresented regions, and promoting emerging topics strengthen the journal’s global impact.
Background: Hahn–Steinthal fractures are rare osteochondral injuries of the humeral capitellum that primarily affect young and active patients. Although several fixation techniques have been described, most rely on metallic implants or knot-tying constructs that may increase intra-articular bulk and the risk of cartilage damage. The use of knotless suture anchor fixation for this specific fracture pattern has not yet been specifically described. To our knowledge, this study represents the first report describing knotless suture anchor fixation specifically for Hahn–Steinthal fractures of the capitellum. Methods: This study describes an open reduction and knotless suture anchor fixation technique for Hahn–Steinthal fractures of the capitellum and reports early clinical outcomes in a consecutive series of five patients treated in 2025. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, while pain intensity was evaluated using the Visual Analog Scale (VAS). Elbow range of motion (ROM) and radiographic fracture healing were also assessed during follow-up. Patients were followed for 12 weeks postoperatively. Results: The cohort consisted of five patients (three men and two women) with a mean age of 37 years (SD 3.5). All fractures achieved radiographic union without secondary displacement. In addition, computed tomography performed at 3 months postoperatively confirmed osseous union and restoration of articular congruity in the index case. The mean DASH score improved from 62 preoperatively to 43 at 2 weeks, 31 at 6 weeks, and 21 at 12 weeks postoperatively. Mean VAS scores decreased from 8 preoperatively to 5 at 2 weeks, 4 at 6 weeks, and 3 at 12 weeks. The mean flexion–extension arc improved from 48° (SD 5.5) preoperatively to 110° (SD 6.7) at final follow-up. No intraoperative or postoperative complications were observed during the 12-week follow-up period. Conclusions: Open reduction followed by knotless suture anchor fixation represents a technically feasible technique associated with encouraging early clinical and radiological outcomes in this preliminary case series. The absence of intra-articular metal hardware may reduce the risk of cartilage damage while allowing stable fixation of small osteochondral fragments and early functional recovery.
Orthopaedic surgeons across the world work within uncertainty. Decisions are often shaped not only by fracture patterns and imaging, but also by delayed presentation, limited resources, variable rehabilitation access, financial constraints, and differing patient expectations. In many global settings, especially resource-constrained environments, uncertainty is not an occasional inconvenience but a constant feature of clinical practice. This editorial argues that the capacity to recognize, tolerate, and respond constructively to uncertainty should be regarded as a core professional competency for the global orthopaedic surgeon. Rather than viewing uncertainty as a weakness or failure of knowledge, surgeons should approach it as a space that demands judgment, adaptability, humility, and ethical clarity. Training and professional discourse in orthopaedics should therefore move beyond technical mastery alone and acknowledge uncertainty management as central to sound decision-making, context sensitive care, and responsible surgical leadership.
BACKGROUND:Distal femur fractures represent a small but clinically significant proportion of femoral injuries and are associated with high rates of complications, including non-union and revision surgery. Intramedullary nailing is a commonly employed fixation strategy, with both antegrade and retrograde approaches widely used in current practice. However, controversy persists regarding the optimal nail entry technique, particularly with respect to fracture healing, revision rates, and complications. This systematic review and meta-analysis aimed to compare clinical and radiological outcomes of antegrade versus retrograde intramedullary nailing for femoral shaft and distal femur fractures. METHODS:This review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251274011). MEDLINE, EMBASE, and Cochrane databases were systematically searched for comparative studies evaluating antegrade and retrograde intramedullary nailing. Retrospective and prospective human studies reporting outcomes of union, revision, refracture, malunion, delayed union, operative time, and complications were included. Data extraction and quality assessment were independently performed, with risk of bias evaluated using the ROBINS-I tool. Meta-analysis was conducted using odds ratios (ORs) and weighted mean differences with 95% confidence intervals. RESULTS:Five studies encompassing 1,479 patients were included, of whom 894 underwent antegrade nailing, and 585 underwent retrograde nailing. Antegrade nailing demonstrated a significantly lower rate of refracture following primary fixation compared with retrograde nailing (OR 31.41; 95% CI 4.45-221.80; p < 0.001). Revision rates were also significantly lower in the antegrade group (OR 1.76; 95% CI 1.21-2.58; p = 0.003). Retrograde nailing showed a higher overall union rate, although this did not reach statistical significance (p = 0.10). Rates of malunion, delayed union, non-union, operative time, and overall complications were comparable between groups, with moderate to substantial heterogeneity observed for several outcomes. CONCLUSION:Both antegrade and retrograde intramedullary nailing provide effective fixation for femoral shaft and distal femur fractures. Antegrade nailing is associated with significantly lower rates of refracture and revision, while retrograde nailing demonstrates comparable union outcomes. These findings suggest that antegrade nailing may offer advantages in selected patient populations, particularly elderly individuals, although the surgical approach should ultimately be guided by fracture pattern, patient factors, and surgeon expertise.
Introduction: Robotic-assisted arthroplasty (RAA) is a rapidly advancing technology in orthopedic surgery. This study aims to conduct a comprehensive bibliometric analysis to map the global research landscape, identify hotspots, and trace the evolution of this field from 1992 to 2025. Methods: Literature was retrieved from the Science Citation Index Expanded (SCI-E) and Social Sciences Citation Index (SSCI) of Web of Science Core Collection. CiteSpace (6.3.R1) and VOSviewer (1.6.20) were employed to perform quantitative and visualized analyses of countries, institutions, authors, journals, co-citations, and keywords. Results: A total of 1373 publications were included. The annual publication output demonstrated exponential growth, particularly in the last five years. The USA led in productivity, while the United Kingdom had the highest average citation frequency. Mont, Michael A., Batailler, Cécile, and Lustig, Sébastien were identified as the most prolific authors. The Journal of Arthroplasty published the most papers. Keyword analysis revealed that research hotspots focused on total knee arthroplasty, alignment, accuracy, and functional alignment. Bursts and timeline analyses indicated a shift in frontiers from alignment accuracy and clinical outcomes to updates of robotic systems and new technologies. Conclusion: This bibliometric analysis maps the evolution of RAA, highlighting a shift from technical precision to patient-centered outcomes, and identifies future directions, including long-term benefit assessment and technology integration.
