Weekly Digest

Key Takeaway: Aspirin alone (81 mg daily) was noninferior to rivaroxaban-then-aspirin for symptomatic VTE prevention after THA/TKA, with VTE rates of 0.48% vs. 0.45% (risk difference 0.02 percentage points).

Key Takeaway: At 10-year follow-up, primary arthrodesis for unstable Lisfranc injuries produced superior AOFAS scores (88 vs. 76, p<0.05) and lower reoperation rates compared to temporary bridge plating.

Key Takeaway: BHA via direct lateral approach and TKA reached AQI 'Unhealthy' thresholds in 80% and 71% of cases respectively by 25% of normalized surgical time, with median maximum PM2.5 of 129.50 and 118.80 µg/m³ versus 6.14 µg/m³ for anterior-approach THA.

Key Takeaway: Abstract not available — see the original article for details.

Key Takeaway: Combined training produced the largest reduction in 24-hour systolic BP (-6.18 mmHg) among hypertensive adults, but no exercise modality demonstrated superiority over another in head-to-head comparisons.

Key Takeaway: Tourniquet use in cemented primary TKA reduced all-cause revision (RR 1.38 without TQ, 95% CI 1.18–1.61) but did not reduce aseptic loosening rates or improve RSA migration at 12–24 months.

Key Takeaway: Extension deficit >3° at 2 months post-ACLR is associated with 10.21% greater T2 increase in anterior medial femoral condyle cartilage and 6.14% greater increase in the weightbearing zone at 6 months.

Key Takeaway: At 5-year follow-up, PSI showed a numerically higher but non-significant revision rate versus conventional instrumentation in UKA (14.3% vs. 5.1%, p=0.094), with no difference in any PROM.

Key Takeaway: ACL reconstruction produces persistent posterior displacement of the tibiofemoral contact pressure center (medial 5.29 mm, lateral 4.73 mm) that spatially corresponds to 9–21% focal cartilage thinning on the tibial plateau at 3 years.

Key Takeaway: WBCT-derived cut-off values for PCFD classes A–D achieve AUCs of 73–85%, with HMA ≥13.9 mm, TNCA ≥38.7°, FAA ≤8.7°, and sinus tarsi coverage ≥25.7% as the strongest independent predictors of symptomatic PCFD.

Key Takeaway: A smartphone game-based nerve examination protocol reduced postoperative neurological assessment time to 12.2 ± 2.4 minutes versus a longer classical-method time in pediatric supracondylar humerus fractures (n=102).

Key Takeaway: STVO and shelf acetabuloplasty produced equivalent clinical outcomes (81.2% good in each group) in Waldenström stage II LCPD, but STVO caused clinically significant LLD (>1.5 cm) in 43.8% of patients versus 0% in the shelf group.

Key Takeaway: Fracture-related infection (OR 11.17) and absence of medial column fixation (OR 0.41) are the strongest independent predictors of revision surgery to promote bone healing in 13.8% of surgically treated pilon fractures.

Key Takeaway: Structured-trained APPs achieved lower rates of loss of reduction (p<0.001) and subsequent surgery (p=0.005) compared to PGY-2 residents during their first 5 independent pediatric distal radial fracture reductions.

Key Takeaway: At a single tertiary care center, low COI was not associated with later presentation age (29.2 vs 31.2 days, P=0.66), worse Graf alpha angle (54.1° vs 53.6°, P=0.54), or higher surgical intervention rate (10% vs 9%) compared to high COI in 287 DDH patients treated with Pavlik harness.

Key Takeaway: Perioperative VEGFi use carries an OR of 4.12 for wound complications after spinal metastasis surgery, and reinitiation within 40 days postoperatively is associated with significantly higher complication rates than reinitiation after 40 days.

Key Takeaway: Prophylactic antibiotics reduced superficial infection rate from 2.0% to 0.2% in pediatric closed reduction percutaneous pinning of hand fractures across 734 patients.

Key Takeaway: Preoperative sepsis within 2 years of THA increases 2-year PJI risk (OR 1.4), mortality (OR 1.5), and dislocation (OR 1.3), with PJI and mortality risk persisting up to 1 year post-sepsis.

Key Takeaway: Liposomal bupivacaine with dexamethasone (no PCA) reduced cumulative inpatient opioid consumption by 86% compared to intrathecal morphine (0.56 vs. 4.13 MME/kg) in AIS patients undergoing posterior spinal fusion.

Key Takeaway: Extending denosumab dosing intervals beyond 90 days was associated with a 2.50-fold higher risk of surgically treated skeletal-related events (cs-aHR 2.50, 95% CI 1.35–4.66), while intervals ≤90 days maintained SRE protection with reduced ONJ risk (cs-aHR 0.54).

Key Takeaway: Obese AIS patients undergoing PSF with liposomal bupivacaine consumed significantly less total inpatient opioid (β=-0.50, P=0.0001) than healthy-weight peers, with increasing BMI percentile negatively correlated with total MME/kg (ρ=-0.182, P=0.012).

Key Takeaway: AKI occurred in only 6.6% of patients after first-stage very high-dose antibiotic-loaded spacer insertion (≥8g antibiotics/40g cement), with 86% of cases resolving within one month.

Key Takeaway: En bloc resection for primary malignant mobile spine tumors achieves 67% 5-year overall survival, but intralesional margin confers an 11.3-fold higher hazard of death and prior intralesional procedure nearly triples local recurrence risk.

Key Takeaway: In 699 CSM surgical patients, higher baseline quality of life (OR=4.0), anterior approach (OR=2.3), UE weakness as presenting symptom (OR=2.5), and symptom duration under 12 months (OR=1.6) were the strongest independent predictors of maximum postoperative satisfaction at 24 months.

Key Takeaway: Flexion-type supracondylar humerus fractures had an 80% open reduction rate, and Gartland Type IV instability carried an OR of 5.21 for failed closed reduction in a cohort of 318 children.

Key Takeaway: Among 5,387 primary ACLRs, concomitant meniscal repair carried an 11.3% subsequent meniscal procedure rate versus 4.8% for resection, but successful repair achieved treatment failure rates (8.9%) comparable to isolated ACLR (5.4%).

Key Takeaway: Concomitant CTR at the time of DRF fixation did not reduce subsequent CTR rates at 2 years (2.24% vs 1.79%; HR 1.306, 95% CI 0.992–1.721) and was associated with higher rates of revision DRF surgery (3.32% vs 2.36%) and malunion/nonunion surgery (0.98% vs 0.63%).

Key Takeaway: AMI at 30 days post-TKA is the dominant predictor of persistent AMI at 60 days (OR 15.6, p<0.001), with pre-operative AMI independently predicting both 30-day (OR 6.08) and 60-day (OR 4.41) inhibition.

Key Takeaway: Preoperative clinical dorsiflexion was the only independent predictor of postoperative dorsiflexion after TAA, with 63.4% of patients failing to achieve ≥20° at mean 3.3 years.

Key Takeaway: Edema-enhanced CT (EECT) derived from dual-energy CT achieved the highest sensitivity, specificity, and inter/intraobserver reliability for sacral fragility fracture detection and localization, eliminating the experience-related performance gap seen with standard CT.

Key Takeaway: Lateral wedge osteotomy at the first metatarsal base (M-method) resects a mean >50% of the peroneus longus insertion, while the cuneiform-based osteotomy (C-method) resects significantly less (p<0.001), with an IMA cutoff of 21.4° identifying feet at highest risk.

Key Takeaway: Parkinson's disease patients undergoing THA face a 2.86-fold increased mortality risk, 1.97-fold increased dislocation risk, and 2.42-fold increased revision risk compared to non-PD controls across 10 comparative studies.

Key Takeaway: Multimodal IONM achieves 76% sensitivity and 94% specificity (AUC 0.91) for detecting intraoperative neural injury in DCM surgery, yet pooled data from 5 comparative studies show no significant reduction in postoperative neurological deficits (RR ≈ 0.6, p = 0.23).

Key Takeaway: Intraoperative smartphone use in a sterile cover during primary TKA was not associated with increased SSI risk (0.7% vs 0.9%; OR 0.80, 95% CI 0.08–4.92).

Key Takeaway: A machine learning-derived predictive formula for UBE portal placement reduced operative time and intraoperative radiation exposure, with greatest benefit in patients with BMI >28 or BMI <18.5, though the specific magnitude of time reduction is not reported in the abstract.

Key Takeaway: Preoperative gluteus medius/minimus attenuation below 41.6 HU on CT is associated with early THA dislocation (AUC 0.794, 75% sensitivity, 89% specificity) despite cups within the Lewinnek safe zone.

Key Takeaway: In OPLL patients, lumbar OLF (OR 6.49) and lumbar IVD gas (OR 5.75) are independent CT predictors of requiring lumbar surgery, with 39.3% of the cohort ultimately undergoing lumbar intervention.

Key Takeaway: Scapulothoracic arthrodesis achieved 82.3% overall fusion success at final follow-up (mean 38.4 months), with the 7th rib demonstrating the poorest outcomes including 13.33% definite non-union and 8.89% fracture rate.

Key Takeaway: Mendelian randomization identifies slow walking pace as a genetically predicted risk factor for 10 spinal disorders, and higher posterior thigh muscle fat infiltration increases odds of spinal stenosis, spondylolisthesis/spondylolysis, and spondylosis.

Key Takeaway: A multimodal deep learning model trained on radiograph-text paired data classified pediatric femoral neck fractures with 96.5% AP accuracy, significantly outperforming senior pediatric orthopaedic surgeons (p<0.05) and a unimodal image-only model (90.1%).

Key Takeaway: ALAD grade (HR 2.59) and Tönnis grade (HR 2.13) were the dominant independent predictors of THA conversion after hip arthroscopy, and era-level improvements in 5-year THA-free survival (83.3% Era II → 95.9% Era IV) were fully explained by stricter patient selection rather than technical advances.

Key Takeaway: CUSUM analysis identified initial proficiency for imageless navigation THA at 15–17 cases and sustained proficiency at 38–43 cases, with overall surgery time improving 8.2% (86.0 vs 78.9 min, p<0.001) after the sustained proficiency threshold.

Key Takeaway: Stand-alone 3D-printed porous titanium cages achieved 88.4% fusion versus 92.3% for anchored PEEK cages (non-significant) with 27-minute shorter operative time in single- and two-level ACDF.

Key Takeaway: Strength recovery after arthroscopic rotator cuff repair reaches only 49.2% of its 12-month value at 3 months, significantly lagging behind ROM recovery (69.5–79.2%) at the same timepoint.

Key Takeaway: In 52 age- and gender-matched pairs with ≥15° varus deformity, UKA and TKA produced equivalent OKS, SF-12, and FJS scores at mean 3.7 and 5.5 years respectively, with 98% vs 94% achieving good-to-excellent outcomes despite UKA correcting 5.7° less deformity (ΔHKA 10.6° vs 16.3°, p<0.001).

Key Takeaway: A higher nail-to-medullary canal ratio (NMR) independently reduces proximal femoral shortening after Gamma3 nailing of osteoporotic pertrochanteric fractures, with mean PFS of 5.02 mm and severe shortening (≥10 mm) occurring in 17.2% of patients.

Key Takeaway: A RadImageNet-pretrained ResNet-50 classifier achieved 76.2% overall accuracy and AUROC 0.766–0.853 across three scoliosis severity classes on adult biplanar radiographs, with highest F1 of 0.85 for the mild scoliosis category.

Key Takeaway: Routine intraoperative microbiological screening in presumed aseptic revision arthroplasty revealed unexpected PJI in 20.3% of screened patients but did not produce a statistically significant improvement in implant survival compared to unscreened controls (p=0.168).

Key Takeaway: In conservatively treated AIS, ΔATR ≤ -1.5° identifies radiographic improvement and ΔATR ≥ +0.5° identifies worsening (AUC ~0.78 for both), with brace-plus-exercise patients requiring a larger improvement threshold (-4.5°) than exercise-only patients (-1.5°).

Key Takeaway: ORIF with distal radius cancellous autograft achieved 100% union in adolescent scaphoid nonunion at a mean of 3.3 months, with 94% returning to activities by 9.6 months.

Key Takeaway: Intraoperative fractures during DAA THA require approach-specific decision frameworks distinguishing stable constructs (observation or supplemental fixation) from unstable implants (revision techniques or extensile exposure), though no aggregate incidence rate is reported in this review.

Key Takeaway: OAT achieves return-to-sport rates >85% within 6 months for focal femoral condyle lesions 1–4 cm², with outcomes declining significantly once defect size exceeds 3 cm².

Key Takeaway: Concomitant cartilage restoration during MPFL reconstruction provided no consistent additional clinical benefit over MPFL reconstruction alone across KOOS Pain (+24.5 vs +26.2), Kujala (+32.0 vs +30.4), and IKDC (+25.0 vs +32.7) scores in 1,632 patients.

Key Takeaway: The Instituto Ottolenghi at Hospital Italiano de Buenos Aires produced 500+ indexed publications in the last 10 years and trained 340 residents and fellows over 25 years, establishing it as a globally recognized orthopaedic center originating outside North America or Europe.

Key Takeaway: Transphyseal ACLR in skeletally immature patients produced angular deviations ≥5° in 37.5% of cases at 5 years, but maximum deviation was only 6° and no premature physeal closure occurred.

Key Takeaway: Anterior open-wedge HTO correcting posterior tibial slope by a mean of 9.2° improved Lysholm scores from 59 to 83 points (p=0.0002) in 11 patients with chronic PCL insufficiency, with no patient requiring secondary PCL reconstruction at mean 3.6-year follow-up.

Key Takeaway: pNGF-loaded nanosphere-hydrogel composites increased tendon-bone interface maximum load to 32.7 N versus 21.6 N in repair-alone controls at 8 weeks in a rat rotator cuff model.

Key Takeaway: Kyphotic (type C) scapular posture increases posterior deltoid force by 35 N and scapular spine zone 3B strain by 150% during forward flexion compared with upright (type A) alignment.

Key Takeaway: Return to downhill skiing after UKA ranges from 0% to 37.5% across five studies, with a consistent trend toward reduced participation despite improved functional outcomes.

Key Takeaway: Opioid-free peripheral nerve block without sedation achieved a 99% single-attempt success rate in 71 procedures across 58 pediatric patients (ages 8–16) undergoing lower extremity surgery.

Key Takeaway: An interfragmentary gap ≥12–13 mm after intramedullary nailing of femoral shaft fractures independently predicts complications (OR 1.10) and nonunion (OR 1.08), with a 5.2% nonunion rate in this 190-patient cohort.

Key Takeaway: Single-stage tibiotalocalcaneal arthrodesis with retrograde IMN plus external fixation improved AOFAS from 36.1 to 75.7 and VAS from 7.7 to 2.5 at one year in 34 patients with distal tibial nonunion and concurrent hindfoot arthritis.

Key Takeaway: For AORI Type 2A uncontained medial tibial bone loss, structural allograft achieved 97.0% 10-year tibial implant survival versus 83.6% with thick metal augments (≥10 mm), a statistically significant difference (P=0.015).

Key Takeaway: Shoulder arthrodesis with vascularized fibular graft after proximal humeral tumor resection achieves final union in 8/12 patients and a mean MSTS score of 25.5/30, but pseudarthrosis occurred in 5/12 and 100% of survivors reported cosmetic dissatisfaction.

Key Takeaway: Stemless TESS anatomic shoulder arthroplasty achieved a mean Constant-Murley score improvement from 29 to 72 points at mean 134-month follow-up with zero humeral component loosening despite frequent peripheral radiolucent lines in zones 1 and 5.

Key Takeaway: C2 nerve root sectioning during C1-C2 arthrodesis (Harms technique) produced zero C2 sensory deficits, vascular injuries, or neurological complications in 31 consecutive patients.

Key Takeaway: 83% of DAA THA patients achieved full ADL recovery within 3 months, with male sex (OR 1.93) but not early postoperative pain independently predicting recovery.

Key Takeaway: Isolated acetabular superior wall fractures, identified in 7 patients across three tertiary centers, represent a distinct fracture entity involving the superior weight-bearing dome with unfavorable outcomes in the majority despite surgical restoration of joint congruence.

Key Takeaway: PSI improved guidewire entry point (p=0.0006) and inclination (p=0.011) overall, but provided no significant benefit over freehand technique for Walch A1, A2, C, Favard E0/E4, or glenoid retroversion <10°.

Key Takeaway: Vertebral-spinal endometriosis (n=14 cases, 1968–2025) presents most commonly with radicular pain (71.4%) and lumbar involvement (78.5%), with 57.1% achieving near-complete symptom resolution regardless of treatment modality.

Key Takeaway: A bidirectional loading model combining axial compression (720 N) and superolateral tensile loading (120 N) reproduced full PFNA helical blade cut-in in 100% of osteoporotic synthetic femurs (n=5) with 18 mm canal diameter.

Key Takeaway: CMOS (Combination Metatarsal Osteotomies for Shortening) achieves MTP joint preservation in RA forefoot deformity with maintained correction at long-term follow-up, contrasting with the functional sacrifice of resection arthroplasty.

Key Takeaway: Immediate office-based vergence/accommodative therapy (OBVAM) after concussion-related convergence insufficiency produced 4.7–5.1 D gains in accommodative amplitude versus 1.0 D with watchful waiting (p<0.001), with 86% vs. 28% resolution of accommodative insufficiency at 6 weeks.

Key Takeaway: Adding intra-articular corticosteroid to MUA significantly improves external rotation recovery (MD=6.90°, 95% CI 5.05–8.75°) but confers no significant benefit in pain, forward flexion, abduction, or internal rotation in the overall pooled analysis.

Key Takeaway: Abstract not available — see the original article for details.