Background Management of high-energy wartime ballistic trauma is well established, but strategies for low-energy civilian injuries remain debated. This study analyzed injury patterns and treatment approaches for low-energy ballistic limb trauma in civilian and military French trauma centers (TCs). Methods We conducted a retrospective multicenter study in five Level 1 TCs (2 civilian, 3 military), including adults treated for low-energy ballistic limb injuries between 2012 and 2022. Demographics, injury mechanism and context, injury characteristics, surgical management, and outcomes were analyzed. Results Among 178 patients with a mean age of 33.4 years, 124 (70%) were treated in civilian TCs and 54 (30%) in military TCs. Most injuries were bullet-related (98%), predominantly due to urban violence (86%). The patients totalized 196 injuries including 103 (53%) soft-tissue injuries and 93 (47%) open fractures. Early total care was applied in 137 (70%) cases, and damage control orthopedics (DCO) in 59 (30%). The mean ISS was significantly higher in the DCO group. Early infection occurred in 20 cases, with 13 septic recurrences. At 25-month mean follow-up, bone union was achieved in 83%, with four persistent bone infections. Upper limb injuries more frequently involved nerves and temporary stabilization with splint. DCO was used more often in military TCs, but bone union and infection rates were comparable between groups. Conclusions Despite variability in surgical strategies, outcomes were generally favorable. Low-energy ballistic limb injuries in civilian practice can often be managed according to standard open fracture principles; however, DCO may be warranted when patient-related factors (particularly associated injuries) or the clinical context require a staged approach. Level of evidence IV; case series.
INTRODUCTION:Complex intra-articular distal radius fractures with severe comminution or fragment rotation may be difficult to reduce using conventional fixation. We describe a dorsal salvage strategy, the Marseille Approach for Radius Salvage (MARS), enabling direct articular visualization in selected cases. HYPOTHESIS:The MARS strategy allows reliable reduction and acceptable short-term functional outcomes in fractures not amenable to standard fixation. MATERIALS AND METHODS:Single-center prospective case series (May 2021-October 2025). CT assessed reduction quality (step-off ≤ 2 mm). Functional outcomes at 1 year included motion, grip strength, pain, and QuickDASH. RESULTS:Among 252 intra-articular fractures, 12 patients were included. All achieved satisfactory reduction on CT with maintenance at 6 months. At 1 year, pronosupination was preserved with mild extension loss and satisfactory pain and QuickDASH scores. One superficial infection and one mild tendon irritation requiring plate removal occurred; no tendon ruptures or CRPS were observed. DISCUSSION:The MARS strategy enables direct articular visualization and stable reconstruction and may be useful in fracture-dislocations or markedly rotated fragments where conventional techniques are challenging. CONCLUSION:MARS strategy represents a pragmatic salvage option for highly complex intra-articular distal radius fractures when conventional strategies are insufficient. LEVEL OF EVIDENCE:III; Prospective case series.
Background Lower limb fractures with large bone defects (BDs) are uncommon and represent a major therapeutic challenge, often leading to unpredictable healing outcomes. Few studies have specifically assessed the impact of BD size on bone regeneration. The primary objective of this study was to evaluate the consolidation rate of the Masquelet technique in femoral and tibial bone defects. Secondary objectives were to analyse healing time, complications and prognostic factors. Methods We conducted a retrospective single-centre study, including 60 patients treated between January 2018 and June 2023 for femoral or tibial non-union using the Masquelet technique. Patients were divided into two groups according to defect size: <5 cm (n = 41) and ≥5 cm (n = 19). Consolidation rates, healing time, complications and reoperations were compared. Multivariate analysis was performed to assess the influence of defect size, adjusting for established local risk factors. Results Radiological consolidation was achieved in 82.9% of patients with defects <5 cm and in 68.4% of patients with defects ≥5 cm, a difference that was not statistically significant (p > 0.05). Mean healing time was 6.3 months in the <5 cm group versus 8.4 months in the ≥5 cm group. Complication and reoperation rates were comparable. Multivariate analysis identified tibial location, defects <5 cm, and segmental defects as independent predictors of successful healing. Segmental defects were associated with an 82% reduction in the risk of complications (adjusted OR = 0.18). Conclusion The Masquelet technique is a reliable option for managing non-unions with substantial bone loss. Although crude comparisons did not demonstrate a significant effect of defect size on consolidation, adjusted analyses showed that segmental tibial defects smaller than 5 cm are associated with successful healing. Larger prospective studies are needed to confirm these findings. Level of evidence III; Therapeutic studies, Retrospective comparative study
BACKGROUND:Revision total hip arthroplasty (rTHA) for major acetabular bone loss is technically demanding due to challenges in achieving stable fixation, restoring hip biomechanics, and ensuring long-term osseointegration. Modular porous acetabular systems offer intraoperative adaptability, multipoint fixation, and enhanced biological integration, yet comparative mid-term outcomes in heterogeneous Paprosky II-III defects remain limited. METHODS:We conducted a retrospective comparative study of 80 patients undergoing rTHR for Paprosky II-III acetabular defects between 2017 and 2021 at a tertiary referral center. Forty patients received one modular cementless acetabular reconstruction system (Group A) and 40 received another modular cementless cup-cage system (Group B). Implant selection was based on surgeon preference and implant availability; no pelvic discontinuities were included. Preoperative evaluation included clinical assessment, radiographs, and CT-based Paprosky classification. Surgical techniques, implant positioning, and postoperative rehabilitation were standardized. Primary outcomes were functional recovery (Merle d'Aubigné-Postel score) and radiographic stability; secondary outcomes included operative metrics and complications. Follow-up ranged from 48 to 60 months, with mean follow-up of 52 months in Group A and 50 months in Group B. RESULTS:Both groups were demographically comparable. Group B demonstrated significantly longer operative times (175 ± 45 vs 150 ± 41 min) and greater intraoperative blood loss (942 ± 262 vs 781 ± 218 mL; p < 0.01). Radiographic evaluation showed stable cup fixation in all patients, minimal non-progressive radiolucent lines, and complete osseointegration. Functional scores improved significantly in both groups, with no intergroup difference at final follow-up (Group A: 8.4 ± 1.6 → 15.8 ± 1.9; Group B: 8.1 ± 1.7 → 16.1 ± 1.7; p = 0.42). Complications were few and comparable: superficial infection 1/40 (2.5%) vs 1/40 (2.5%), deep infection 1/40 (2.5%) vs 1/40 (2.5%), intraoperative blood loss >1500 mL 0/40 (0%) vs 2/40 (5%), no dislocations or periprosthetic fractures. Re-revision-free survival at 48 months was 97.5% in both cohorts (p = 0.94). Differences in operative time and blood loss were related to defect complexity and the need for additional augments rather than to the implant category itself. CONCLUSION:Both modular acetabular systems provide reliable mid-term outcomes in complex acetabular rTHA, achieving substantial functional improvement, stable fixation, low complication rates and comparable functional and radiological outcomes. These findings support the use of either system for managing complex acetabular defects, with implant selection guided by intraoperative requirements, defect morphology, and surgeon experience. LEVEL OF EVIDENCE:III; Retrospective comparative cohort study.
BACKGROUND:Surgical planning for adolescent idiopathic scoliosis (AIS) is complex. Large language models (LLMs) like DeepSeek Reasoning Model R1 (DeepSeek-R1) offer potential for decision support, but their accuracy in determining fusion levels is unproven. HYPOTHESIS:The DeepSeek-R1 model could generate surgically reasonable fusion levels for AIS with clinically acceptable accuracy. PATIENTS AND METHODS:This study enrolled 203 consecutive AIS patients meeting surgical indications. Comprehensive clinical and radiological data, including Lenke classification, were structured into standardized prompts. DeepSeek-R1 was tasked with determining the upper and lower instrumented vertebrae (UIV, LIV) for each case. Its outputs were evaluated independently by three experienced spinal surgeons using a 5-point Likert scale (≥3 defined as reasonable). Inter-rater reliability was assessed using Intraclass Correlation Coefficient (ICC). Performance across Lenke subtypes was analyzed using Fisher's exact test with Monte Carlo simulation. RESULTS:DeepSeek-R1 generated surgically reasonable fusion levels (Likert score ≥3) in 70.9% (144/203) of cases, with excellent inter-expert agreement (ICC = 0.840, 95% CI [0.798, 0.875]). Performance varied significantly by Lenke subtype, demonstrating high reasonable rates for types 1A (87.0%), 1B (82.9%), 5C (81.1%), and 6C (87.5%). However, suboptimal performance was observed for types 1C (19.0%), 2A (42.9%), and 2C (25.0%). CONCLUSION:DeepSeek-R1 demonstrated clinically acceptable accuracy in planning AIS fusion levels overall, particularly excelling in specific Lenke curve patterns (e.g., 1A, 1B, 5C, 6C). Its performance, however, was inconsistent across all subtypes, highlighting limitations in complex curve scenarios (notably 1C, 2A, 2C). While promising as a decision-support tool, further refinement and validation are necessary before clinical implementation. LEVEL OF EVIDENCE:III.
