Weekly Digest

Key Takeaway: Enoxaparin costs $234 more per patient than aspirin while yielding only 0.0004 additional QALYs, producing an ICER of $635,340/QALY—far exceeding the $150,000 willingness-to-pay threshold.

Key Takeaway: For length-unstable pediatric femoral shaft fractures, SBP reduced operative time by 15.7 minutes and fluoroscopy time by 22.2 seconds versus FIMN/EF, with superior knee flexion at final follow-up (108.1° vs. 100.6°).

Key Takeaway: Functional alignment restored the preoperative CPAK phenotype in 42.9% of cases versus 10.3% with mechanical alignment, and in the MA group, greater deviation from native JLO was negatively correlated with Forgotten Joint Score.

Key Takeaway: Supported implementation (in-person workshops + site visits) increased weekly Prep-to-Play programme use from 13.1% to 29.7% (OR 3.7, 95% CI 2.4–5.7) in women's/girls' Australian Football, and each unit increase in adherence was associated with a 5% reduction in total injury incidence (IRR 0.95).

Key Takeaway: A nanotechnology-based wearable device reduced 24-hour postoperative opioid consumption by 26% (25.6 vs 34.4 mg MME, P=0.015) and shortened hospital LOS by 19% (20.8 vs 25.7 hours, P=0.006) compared to sham in primary TKA.

Key Takeaway: Occult non-atherosclerotic vascular abnormalities were detected by CTA in 11.5% of high-energy tibial plateau fractures, but none required vascular intervention and abnormalities did not correlate with wound complications (p=0.47).

Key Takeaway: Flexed-seated radiographs classified 52.6% of THA patients as spinally stiff versus only 14.2% with relaxed-seated imaging, with reclassification in 39.5% of cases.

Key Takeaway: Screw fixation for pediatric lateral condyle fractures achieves radiographic union 1.5 days faster and reduces cast immobilization by 8 days compared to pin fixation, with no significant difference in complications or final range of motion.

Key Takeaway: Day 7 CRP ≥79 mg/L predicted SSI after posterior lumbar interbody fusion with AUC 0.813 and NPV 95.2%, while intrawound vancomycin powder did not alter CRP kinetics at any postoperative time point.

Key Takeaway: A short collared metaphyseal-filling stem via robotic-arm assisted DAA THA achieved 98.1% survivorship and HOOS-JR improvement from 54.5 to 94.4 at mean 2.6-year follow-up.

Key Takeaway: Both optical and ultrasonic imaging correlated strongly with radiographic Cobb angle (r=0.873 and r=0.902, respectively) with mean absolute differences of ~4.2–4.3°, supporting their use as non-invasive screening tools.

Key Takeaway: Preoperative DECT-derived coronal HU of the distal femur correlates with measured bone strength (r=0.67) and identifies cementless TKA candidates with AUC=0.82 at a cutoff of 72 HU.

Key Takeaway: Surgical treatment of flexible AAFD (Myerson Grade II) yields a mean SEFAS improvement of 11 points at 1 year, with no significant difference between calcaneal osteotomy and hindfoot arthrodesis (adjusted mean difference 2.7, 95% CI -1.2 to 6.5).

Key Takeaway: Robotic-assisted TKA required soft tissue releases in only 23.3% of cases versus 51.5% with conventional TKA (p<0.0001), but produced equivalent OKS, FJS-12, and overall satisfaction at 12 months.

Key Takeaway: Preoperative fulcrum flexibility >79.8% predicts clinical success (final curve <30°, no revision) after VBT with AUC 0.760, while mean immediate postoperative coronal correction reached 64.6% and was maintained at 62.1% at 2 years.

Key Takeaway: 62.5% of patients undergoing two-stage revision TKA for PJI experienced AORI bone loss progression between stages, with the longest reimplantation interval (mean 147 days) seen in patients progressing from AORI 1 to AORI 3.

Key Takeaway: At mean 17.5-year follow-up, HXLPE and conventional polyethylene in CR-Flex TKA showed equivalent survivorship (98.0% vs 97.8%) with zero osteolysis in either group.

Key Takeaway: Of 1,751 screened studies, only 15 met inclusion criteria for BGS in non-spinal arthrodesis, with AUGMENT (PDGF-BB) as the sole agent earning a Grade A recommendation.

Key Takeaway: GLP-1 receptor agonists reduced 90-day hospital readmissions by 29–47% and PJI rates by 30–44% in some studies, but no consistent benefit was demonstrated at 2-year follow-up across 8 retrospective studies totaling 100,421 patients.

Key Takeaway: Systematic MRI identified concomitant osteomyelitis in 43% of pediatric septic hip cases, compared to only 16% detection by radiograph, yet osteomyelitis presence did not worsen outcomes.

Key Takeaway: ORIF of Vancouver B1 periprosthetic femoral fractures achieves 96% radiographic union but carries 24% two-year mortality and a 14% five-year revision rate.

Key Takeaway: Black and Hispanic AIS patients had 61% and 68% lower adjusted odds of receiving VBT versus PSF compared to White patients, with Medicaid insurance and lowest-income ZIP code each independently reducing VBT odds by ~50%.

Key Takeaway: Hip arthroscopy for FAIS with concomitant low back pain and/or lumbar spine pathology achieves equivalent Harris Hip Score improvement, PASS rates (~89%), and reoperation-free survivorship compared to isolated FAIS at minimum 5-year follow-up.

Key Takeaway: Ketorolac use in operatively treated pediatric femoral shaft fractures was not associated with increased nonunion risk (0.8% vs. 4.8%, P=0.27) and reduced cumulative inpatient opioid consumption by 89% (0.44 vs. 3.98 MME/kg).

Key Takeaway: Nontobacco nicotine dependence (NTND) is associated with a 5.8-fold increased odds of repeat rotator cuff repair at 2 years (OR 5.836) and nearly 4-fold increased odds of perioperative MI (OR 3.817) compared to non-nicotine controls.

Key Takeaway: In 852 adolescent pelvic and hip avulsion fractures, both operative and nonoperative management achieved return to sport in nearly all cases, but no validated displacement threshold was identified at which surgical outcomes reliably exceed nonoperative outcomes.

Key Takeaway: THA patients achieved a pain plateau at 58 days with a 0.9-point lower mean plateau VAS score than TKA patients, who plateaued at 77 days postoperatively.

Key Takeaway: Preoperative PPI use was associated with a 71% increased risk of nonunion (RR 1.71, 95% CI 1.10–2.65) and 66% increased risk of revision surgery (RR 1.66, 95% CI 1.27–2.15) at 2 years following pelvic fracture fixation.

Key Takeaway: 28% of pediatric femoral neck fractures occurred in children with ASD or neurodevelopmental disorders, a prevalence far exceeding population norms, with higher rates of vitamin D deficiency and home-related injury mechanisms in this subgroup.

Key Takeaway: Femoral collar overhang ≥3 mm is associated with more than double the odds of iliopsoas impingement after direct anterior THA (OR 2.2, p=0.024), with IPI occurring in 4.8% of 985 hips.

Key Takeaway: MMPR repair in knees with ≥5° varus alignment carries an 88.5% MRI repair failure rate and 2.37-fold higher odds of OA progression compared to knees with <5° varus.

Key Takeaway: Retrograde nail plus lateral locked plate achieved 0% nonunion versus 14% nonunion with lateral locked plate alone (p=0.03) for Vancouver C periprosthetic femur fractures.

Key Takeaway: TKA without patellar resurfacing in inflammatory arthritis produced no difference in reoperation (5.7% vs 3.7%), revision (0.6% vs 0.6%), or anterior knee pain (4.9% vs 7.8%) compared to OA, while the resurfaced IA group had significantly higher aseptic reoperation (13.2% vs 3.4%, p=0.02) and revision rates (13.2% vs 0.6%, p<0.01).

Key Takeaway: After-hours CRPP for pediatric supracondylar humerus fractures produced comparable operative times, nerve injury rates, and open reduction rates versus daytime surgery, but alignment-related complications were significantly higher after-hours (P=0.04) across 913 patients.

Key Takeaway: The 12 o'clock glenoid labrum position is at least 5.0 mm deeper, 4.3 mm thicker, and 8.4 mm taller than any other clockface location, and the labrum contributes 60.1% of total glenoid depth in healthy young adults.

Key Takeaway: Among 553 pediatric ESIN forearm fracture patients, 0 of 362 asymptomatic patients at 4-week follow-up had relevant radiologic findings, supporting elimination of routine radiographs in this subgroup.

Key Takeaway: A standardized 3° posterior tibial slope target would deviate >4° from native medial PTS in 51% and native lateral PTS in 71% of primary TKA patients.

Key Takeaway: At minimum 2-year follow-up, surgically and nonsurgically treated pediatric medial epicondyle fractures showed no significant difference in QuickDASH (P=0.649) or PROMIS Pediatric Upper Extremity scores (P=0.963).

Key Takeaway: Fluoroscopic navigation predicted leg length within ±5 mm in 86.0% of cases but femoral offset within ±5 mm in only 64.9% of cases, with navigation systematically underestimating leg length change (mean 2.5 vs 4.1 mm actual) and overestimating offset change (mean 3.4 vs 1.7 mm actual).

Key Takeaway: Personalized 3D kinematic modeling classified clinically relevant pronation and supination limitations in diaphyseal forearm malunions with 91% and 82% accuracy (AUC 0.97 and 0.93, respectively), outperforming angulation-based thresholds.

Key Takeaway: Concomitant NSAID use in anticoagulated THA patients was associated with a 4.57-point reduction in 6-week pain scores (95% CI -7.82 to -1.31) without increasing VTE, wound complications, readmission, or reoperation rates.

Key Takeaway: Human dermal allograft patch augmentation in partially repairable large-to-massive rotator cuff tears reduced retear rates from 33.3% to 8.3% at final follow-up (P=.009) compared with incomplete repair alone.

Key Takeaway: Non-tobacco nicotine dependence in adolescents and young adults is associated with a two-fold increased fracture risk at 5 years (RR 2.1, 95% CI 1.5–2.9) compared to propensity-matched controls.

Key Takeaway: Children ≤10 years undergoing discoid lateral meniscus surgery have 2.67 times the odds of postoperative stiffness compared to those >10 years (95% CI: 1.12–5.86).

Key Takeaway: In 186 HMO forearms, a proportional ulnar length (PUL) threshold of ≤0.89 predicted radial head dislocation with 36% overall prevalence, forming the basis of a new 3-tier risk classification.

Key Takeaway: All long bone fractures in adults ≥65 carry significantly elevated one-year mortality versus matched controls (baseline 2.77%), ranging from 5.6% for distal humerus (RR 1.63) to 27.9% for hip fractures (RR 4.86).

Key Takeaway: DCM patients scored significantly lower on MoCA (20.61 ± 3.76) and MMSE (26.23 ± 2.84) than both CSR patients and healthy controls, with MSCC negatively correlated with cognitive scores (MoCA r = -0.218, MMSE r = -0.237 in single-level disease).

Key Takeaway: Across 170,150 primary hip and knee arthroplasties in the Netherlands, PROM differences between private and public hospitals were statistically significant on only a subset of measures but all absolute differences were ≤1.3 points—well below any established minimal clinically important difference.

Key Takeaway: Biceps augmentation added to scope-assisted lower trapezius tendon transfer (SALTT) for posterosuperior irreparable rotator cuff tears did not improve clinical outcomes and was associated with a significantly higher biceps rupture rate (p=0.019).

Key Takeaway: Global pain score was the strongest predictor of 1-year satisfaction after both THA (OR 2.80) and TKA (OR 3.61), with pain during walking and stair climbing consistently dominant across both cohorts.

Key Takeaway: Carotid atherosclerotic plaque was present in 58.8% of DCM surgical patients, and a four-variable nomogram (age, BMI, vertigo, cervical lordosis) predicted plaque with an AUC of 0.863 in development and 0.892 in temporal validation, supporting selective rather than universal preoperative carotid ultrasound screening.

Key Takeaway: Robotic-assisted UKA was associated with 25% lower adjusted odds of prolonged hospitalization (aOR 0.750) versus conventional UKA, with no significant difference in high-charge admission (aOR 1.007) in a national inpatient sample of 7,154 cases.

Key Takeaway: Two-screw fixation of scaphoid fractures showed no significant difference in nonunion rate, time to union, or hardware complications compared to single-screw fixation in a propensity-matched cohort of 92 patients.

Key Takeaway: A substitution-based antithrombotic protocol in 189 elderly ACDF patients produced zero major hemorrhagic or thromboembolic events and equivalent perioperative outcomes across three antithrombotic management groups.

Key Takeaway: Cadaveric simulation carries the highest carbon footprint at 244.0 ± 48.8 kg CO₂e per use, approximately 3,500-fold greater than a single VR simulation session (0.07 ± 0.01 kg CO₂e).

Key Takeaway: Preoperative SIRI independently predicts early deep SSI after instrumented lumbar fusion (adjusted OR 1.93), with an optimal cutoff of 1.29 yielding 63% sensitivity and 68% specificity (AUC 0.66).

Key Takeaway: The SFA score achieves 100% sensitivity and 100% NPV at a threshold ≤4 for ruling out ACL rupture in the emergency department, with an AUC of 0.759 for ACL injury and 0.82 for all severe intra-articular lesions.

Key Takeaway: Custom ultra-porous 3D-printed hemipelvis components achieved 100% iliac osseointegration and implant retention at mean 4-year follow-up in 7 salvage cases, with ischial flange ingrowth failure in 57% (4/7).

Key Takeaway: PAO in patients aged 8–13 with open triradiate cartilage achieved a mean 21-degree LCEA improvement maintained at 3.8-year follow-up, but caused premature triradiate closure in 38.5% of cases.

Key Takeaway: THA for LCPD achieves 99% aseptic revision-free survivorship at 15 years, but carries a 5% sciatic neuropraxia rate despite mean limb lengthening of only 15mm.

Key Takeaway: 10.7% of mothers (6/56) presenting to a clubfoot clinic met the EPDS clinical cutoff (≥10) for postpartum depression, with 50% endorsing difficulty coping and 50% endorsing anxiety symptoms.

Key Takeaway: Arthroscopic treatment of native glenohumeral septic arthritis showed reinfection rates ranging 7.46–75.0% versus 12.6–22.2% for open treatment across 10,352 patients, with lower 30-day complication rates arthroscopically but insufficient evidence to declare superiority of either approach.

Key Takeaway: Robotic-assisted RSA has entered early clinical use with the stated goal of reducing component malposition outliers, but no clinical outcome data yet exist to validate this benefit.

Key Takeaway: Chronic musculoskeletal pain affects 82.5% of surveyed spine surgeons, a prevalence up to four times higher than the general adult population, with only 2.5% of respondents reporting institutional ergonomic improvements.

Key Takeaway: Acute posterior SCJ dislocations treated with prompt reduction and ligament reconstruction yield reliable outcomes, while chronic locked posterior dislocations carry substantially higher surgical complexity and complication risk.

Key Takeaway: Preoperative cervical flexion <22.8° and total cervical ROM <48.2° are independent risk factors for symptomatic proximal junction kyphosis/failure after adult spinal deformity correction with UIV in the upper thoracic spine.

Key Takeaway: Spinal stiffness increased impingement in 43% of ADL scenarios, and altering pelvic tilt changed impingement risk in 65% of 40 simulated scenarios across 12 dynamic activities.

Key Takeaway: Adding axial CT to radiographs increased surgeons' posterior tilt estimates by 6° and shifted treatment preference 20% toward arthroplasty for minimally displaced femoral neck fractures.

Key Takeaway: Graft-derived skeletal stem and progenitor cells (SSPCs), not transplanted mature osteoblasts, survive iliac crest bone graft transplantation and drive spinal fusion via endochondral ossification, with donor-derived chondrocytes appearing at 2 weeks transitioning to osteocytes by 6 weeks.

Key Takeaway: Anterolateral rafting fixation for anterior impaction pilon fractures achieved 100% union, mean AOFAS 91.6, and maintained talar reduction (mean ΔLTS 0.5 mm at one year) in 23 patients.

Key Takeaway: AR-assisted MIS-TLIF in 22 consecutive patients achieved mean operative time of 129 minutes, fluoroscopy time of 41 seconds, EBL of 51 mL, and LOS of 1.9 days with a 9% reoperation rate at mean 163-day follow-up.

Key Takeaway: PMMA-gentamicin cement backfill of periprosthetic TAR cysts resulted in 0% secondary arthrodesis versus 55% (6/11) in the bone graft/calcium-phosphate group at mean 7.1-year follow-up.

Key Takeaway: Flexion-varus tibial plateau fractures carry significantly higher rates of combined ligamentous and meniscal injury and greater risk of TKA conversion compared to flexion-valgus injuries, demanding distinct surgical strategies.

Key Takeaway: Combined cartilaginous and bony endplate defects (I-TEPS ≥ 4) trigger a nonlinear 'mechanical tipping point' with sharply elevated stress across nucleus pulposus, annulus fibrosus, and subchondral bone at L4-L5.

Key Takeaway: Cervical ribs, aberrant scalene attachments, and variant plexus branching may lower the injury threshold for brachial plexus birth injury (BPBI), potentially explaining why some neonates sustain injury under normal obstetric forces while others do not.