Weekly Digest

Key Takeaway: External ring fixation produced greater pain interference than internal fixation at 6 months (median 6.0 vs. 4.0, p=0.01), but no pain differences persisted at 12 months, with ~33% of all patients experiencing moderate-to-severe pain at both timepoints regardless of fixation type.

Key Takeaway: Preoperative IV TXA did not reduce postoperative transfusion rates versus placebo in geriatric hip fracture surgery (81% transfusion-free in both groups, p=0.97), with the trial terminated early for futility.

Key Takeaway: Ultrasound-guided tendon surface (UGTS) injection achieved 1-month complete remission in 59.2% of frozen shoulder patients versus 34.9% (MULA) and 31.0% (BTP), though remission rates converged by 24 months (p=0.216).

Key Takeaway: Across 11 RCTs and 972 patients, KA and MA yield equivalent PROMs and reoperation rates, but patients with bilateral TKA prefer their KA knee over MA knee at a 2.15:1 ratio (RR 2.15, 95% CI 1.36–3.40).

Key Takeaway: Dysphagia occurred in 70.1% of ACDF/CDR patients on POD0 and persisted in 35.8% at POD30, compared to 13.4% and 4.5% in lumbar controls, supporting its classification as a common self-limited symptom rather than a true complication.

Key Takeaway: In 1,144 strictly defined AO/OTA 31B3 basicervical fractures, implant failure rates were 6.5% for CMN, 8.1% for SHS, and 3.3% for HA, with no statistically superior fixation strategy identified.

Key Takeaway: Adding arthroscopic meniscus centralization with all-inside root repair to OWHTO reduced medial meniscus extrusion by 3.4 mm and improved healing rates (28.9% vs 13.6%) but produced no superior clinical scores and caused significantly greater knee flexion loss (36.8% vs 13.6% incidence) compared to isolated OWHTO at mean 32.9 months.

Key Takeaway: ASB carries a pooled OR of 2.41 for PJI across all arthroplasty types, but procedure-specific subgroup analyses were non-significant and antibiotic treatment of ASB conferred no protective benefit.

Key Takeaway: Leukocyte-poor PRP reduced median time to unrestricted sport by 3.3 weeks (14.5 vs 17.8 weeks, P=.042) but produced no significant difference in PROMIS Physical Function or Pain Interference scores at 6 or 12 months.

Key Takeaway: Pooled BCIS incidence is 29% in trauma (hemiarthroplasty) and 60% in oncologic cemented hip arthroplasty, with severe grades (2–3) associated with increased 30-day mortality.

Key Takeaway: Each additional year of surgeon experience reduces long-term complication odds in lumbar fusion by 17% (OR 0.83) and PCDF by 29% (OR 0.71), but confers no benefit for ACDF outcomes.

Key Takeaway: Female spine surgeons represented only 2.3% of ACDF-performing surgeons in the Medicare database from 2013–2021, increasing from 0% to 1.8% over the study period.

Key Takeaway: At median 33-year follow-up after rotationplasty, patients walked at 1.2 m/s with an energy cost of 4.4 J/kg/m—26% slower and 26% more energy-costly than controls, yet below the energy expenditure typically reported after transfemoral amputation.

Key Takeaway: High depressive burden (sustained MCS <45 perioperatively) independently predicts a 2.98-fold increased odds of revision surgery within 2 years and reduces odds of achieving MCID for 1-year ODI by 81% after lumbar fusion.

Key Takeaway: In females under 22, hamstring autograft carries 2.3× higher revision risk versus quadriceps tendon (HR 0.45) and 1.8× higher versus patellar tendon (HR 0.57) after ACL reconstruction.

Key Takeaway: External rotation stress CT (IMA protocol) with an implant-implant distance threshold of <5 mm identifies posterior THA impingement with 100% sensitivity and 89% specificity (AUC 0.98).

Key Takeaway: Combined root and body (CRAB) lateral meniscus tears occur in 10.1% of adolescent ACL reconstructions and were missed by radiologists in 74% of cases preoperatively.

Key Takeaway: Prior cervical fusion did not reduce the magnitude of functional improvement after TSA, though aTSA patients with prior fusion had lower absolute postoperative ASES scores (76.3 vs. 91.7, p=0.038) compared to matched controls.

Key Takeaway: Acute TKA for tibial plateau fracture carries a 4.8-fold higher adjusted odds of loosening-related revision compared to delayed TKA (OR 0.21 favoring delayed, p=0.045), though overall 5-year revision rates are similar at 8% vs 5%.

Key Takeaway: Cannabis use disorder before arthroscopic rotator cuff repair is associated with 17% higher early opioid use rates (42.0% vs. 35.9%) and fewer PT visits within 90 days, but no difference in 2-year complications or revision rates.

Key Takeaway: Primary hamstring autograft ACLR for irreducible tibial eminence fractures achieves equivalent Tegner, Lysholm, and IKDC scores and 85.1% patient-acceptable symptomatic state compared to suture fixation in reducible cases at mean 77-month follow-up.

Key Takeaway: At minimum 10-year follow-up, 40% of SLAP repairs failed and required revision to tenodesis, versus 0% revision rate in the primary subpectoral biceps tenodesis group.

Key Takeaway: HDA patch augmentation for large-to-massive rotator cuff tears yields a 7.7% overall retear rate at mean 39 months with no significant difference between intact anterior cable (6.1%) and disrupted anterior cable (10.3%) groups.

Key Takeaway: Hamstring autograft ACLR with graft diameter >8 mm using independent femoral tunnel drilling achieved a 3.3% revision rate at mean 5.5 years, with allograft carrying a 2.47-fold higher revision risk versus hamstring on multivariable analysis.

Key Takeaway: rTSA restores forward elevation primarily through compensatory scapulothoracic upward rotation rather than glenohumeral mechanics, with glenohumeral contribution, axial rotation, and scapulohumeral rhythm remaining reduced versus contralateral or healthy controls across all 24 included studies.

Key Takeaway: Untreated onychomycosis prior to TJA is associated with significantly increased one-year PJI risk (OR 1.57 for TKA reoperation, P=0.013), while treated onychomycosis carries no significant excess risk.

Key Takeaway: Antegrade ESIN reduced open reduction rate from 36.6% to 10.5% and achieved excellent/good forearm rotation in 92.1% vs 65.9% compared to retrograde crossed K-wires for pediatric distal radius MDJ fractures.

Key Takeaway: Patellar resurfacing in bicruciate-stabilized TKA reduced patella baja incidence from 38% to 22% and increased lateral condylar rollback by 2.6 mm compared to unresurfaced controls.

Key Takeaway: Laboratory-defined malnutrition (albumin ≤3.5 g/dL and/or leukocytes ≤1.5×10³/µL) was associated with a 2.29-fold increased risk of acute respiratory failure and 2.43-fold increased risk of osteomyelitis after femoral shaft fracture fixation in a propensity-matched cohort of 21,886 patients.

Key Takeaway: Constant-length collar (CLC) femoral stems comprised only 19.6% of collared implants but accounted for 51.7% of collar-related iliopsoas fractional lengthening procedures, with size ≤3 stems disproportionately overrepresented.

Key Takeaway: Each week of delay in weight bearing as tolerated after tibial shaft IMN independently increases nonunion odds by 7% (OR 1.07, 95% CI 1.03–1.12), with mean time to WBAT 8.3 weeks in union versus 13.7 weeks in nonunion cases.

Key Takeaway: MUA for post-TKA stiffness fails in 17.2% of cases, with ROM <96.4° at two weeks post-MUA, younger age, and cruciate-retaining implants independently predicting need for additional surgical intervention.

Key Takeaway: Dark-environment rehabilitation after ACL reconstruction reduced contralateral ACL rupture rate from 13.1% to 5.7% (p=0.01) at mean 5.8-year follow-up, with no significant difference in ipsilateral graft re-rupture (7.1% vs. 3.2%, p=0.18).

Key Takeaway: Neuraxial anesthesia was used in 80.2% of rTKA and 58.6% of rTHA cases, and on propensity-matched analysis was associated with significantly lower readmission rates (1.1% vs 15.7% for rTKA; 1.4% vs 18.6% for rTHA) compared to general anesthesia.

Key Takeaway: A new 4-type, 8-subtype classification for extra-articular distal radius fractures achieved Cohen's kappa of 0.75–0.88 across all subtypes in multicenter reliability testing.

Key Takeaway: Failed DAIR prior to two-stage exchange TKA did not significantly reduce two-stage success rates (P=0.21), though 24-month survival probability was consistently lower in the failed-DAIR group.

Key Takeaway: Vancomycin-gentamicin calcium sulfate (Stimulan) did not reduce FRI rates in tibial plateau fracture fixation (18.9% vs 18.2%, p=0.896), while Schatzker IV–VI pattern was the dominant risk factor (27.9% vs 6.9%, p<0.001).

Key Takeaway: In adult TL/L AIS patients, the 30–42 year window is the inflection point after which postoperative SRS-22 total scores remain 0.48–0.50 points lower than those achieved by patients operated on before age 40.

Key Takeaway: In 8,101 patients undergoing Lisfranc ORIF, secondary arthrodesis was required in only 2.8% at 10 years, while hardware removal drove reoperation in 19.8%.

Key Takeaway: A multinational normative cohort of 468 asymptomatic adults establishes mean cSVA of 19.1 mm and T1 slope of 23.0°, yielding the formula CSA = 25 − T1S (R²=0.45) as the basis for a four-type cervical sagittal classification system.

Key Takeaway: High-energy Galeazzi fractures yield significantly worse postoperative wrist range of motion across all planes compared to low-energy injuries, despite similar DRUJ symptom rates and nonunion rates between groups.

Key Takeaway: Iatrogenic postoperative pelvic anteversion after ASD surgery was not associated with significantly increased mechanical complications at 2 years (10.5% vs 23.9%, P=0.154), suggesting it may represent a physiological adaptation rather than a pathological outcome.

Key Takeaway: Post-brace upright radiographs in the ED showed a median 0% change in vertebral height loss across 212 thoracolumbar compression fractures, and zero patients had management changed from bracing to surgery based on these images.

Key Takeaway: UBE-assisted ULBD achieved clinical success in 92.2% vs 78.9% for microscopic decompression (P=0.012), with superior multifidus preservation and a frailty-specific outcome advantage (interaction P=0.018).

Key Takeaway: Non-pediatric trauma centers in Utah showed only 67% guideline compliance for head CT versus 87% at the primary pediatric center, with pan-scan utilization 63% higher at non-pediatric facilities (13% vs. 8%).

Key Takeaway: At mean 70.8-month follow-up, retrograde nailing produced significantly worse EQ-5D quality-of-life scores (p=0.001) and lower Lysholm functional scores (p=0.030) compared to antegrade nailing and locking plate fixation for extra-articular distal femur fractures in patients under 60.

Key Takeaway: In a nationwide Turkish cohort of 8,590 UKA cases, mobile-bearing designs had significantly higher mechanical complication rates (3.8% vs. 1.8%) and revision rates compared to fixed-bearing designs (P<0.001).

Key Takeaway: In floating fusion for ASD, mechanical complications were associated with significantly less lumbar lordosis correction (2.1° vs 9.3°, p=0.04) and less PI-LL correction (-2.1° vs -10.6°, p=0.02) compared to complication-free cases.

Key Takeaway: Implant removal combined with total wrist denervation reduced QuickDASH from 45.5 to 18.2 and VAS from 4.8 to 1.6 at 1 year in painful intra-articular distal radius malunions not amenable to osteotomy, while implant removal alone produced no significant improvement in either score.

Key Takeaway: At second-look arthroscopy after knee OCA transplantation, 32.6% of grafts met structural failure criteria (Outerbridge grade 3–4 or >2 mm peripheral delamination) at a mean of 3.17 years, and structural failure was strongly correlated with clinical failure (P < .00001).

Key Takeaway: Preoperative lateral ATS on MRI independently predicts postoperative lateral ATS (β=0.313, p<0.001), and postoperative lateral ATS correlates with residual pivot shift after anatomical ACL reconstruction.

Key Takeaway: Cemented THA with impaction bone grafting for severe acetabular defects achieved 100% survivorship free of aseptic loosening at 10 and 15 years, with zero cup revisions for loosening at mean 12.8-year follow-up in 102 hips.

Key Takeaway: Tibial osteotomy of the MCL insertion achieved 539.0 mm² of medial tibial plateau visualization—585% more than MCL split—and was equivalent to femoral epicondyle osteotomy (614.7 mm², p=0.44) while preserving proximal meniscal attachments.

Key Takeaway: MRI and CT measurements of glenoid version (3.4° vs 3.7°), glenoid depth (1.3 vs 1.4 mm), and BSSR (33.5% vs 34.8%) showed no statistically significant differences in 61 post-dislocation shoulders, with excellent-to-good interrater reliability (ICC 0.82–0.92).

Key Takeaway: Open Latarjet by a single experienced surgeon yielded a 4% minor and 0% major 90-day complication rate in 48 patients, 64% of whom were revision cases.

Key Takeaway: The trapezius aponeurosis inserts longest at the acromion (mean 28.9 mm), forms a fibrocartilaginous enthesis just posterior to the AC joint, and creates a contiguous complex with the deltoid origin and superior AC capsule that may be the anatomical basis for dynamic AC joint stabilization.

Key Takeaway: Despite MRI showing ACL fiber continuity in 85.6% of nonoperatively treated patients, KT-1000/2000 arthrometer confirmed true mechanical stability in only 54.7%, with 21.9% ultimately requiring delayed reconstruction.

Key Takeaway: Bisphosphonate use after primary TKA was associated with a 54% reduction in all-cause revision risk (1.37% vs 2.71%; OR 0.446), but evidence certainty is low due to I² = 95.5% heterogeneity.

Key Takeaway: Brachioradialis tendon-bone graft reconstruction of chronic tendinous mallet finger achieved Crawford excellent or good outcomes in all 10 patients, with mean DIP active ROM of 82° at 3–5 year follow-up.

Key Takeaway: Hip arthroscopy-assisted surgery for Pipkin I/II fractures achieved superior mHHS (97.4 vs. 94.4) and lower blood loss (50 vs. 195 mL) than the direct anterior approach, but at the cost of longer operative time (217 vs. 165 min) and a lower rate of anatomic reduction by Matta criteria.

Key Takeaway: Posterior osteochondral defects of the humeral capitellum generate significantly greater radiocapitellar contact pressure than anterior defects at 0° extension and 90° flexion under both valgus and varus stress, with lower sagittal defect location further amplifying this pressure.

Key Takeaway: The bilateral Romanian deadlift produced peak biceps femoris long head force of 1.6 BW and semimembranosus force of 1.9 BW, exceeding all other resistance training exercises and all running speeds including maximum sprinting (1.0 BW).

Key Takeaway: Septic tibial plateau nonunion required salvage procedures in 82% of patients (23/28), with only 18% achieving union and infection remission without major intervention at mean 8.1-year follow-up.

Key Takeaway: Posterior spinal fusion with pedicle screw-based constructs achieves a mean 49.5% coronal correction in OI-associated scoliosis (preoperative curves 75.5°–96°) with a 27.5% overall complication rate and 10.7% unplanned reoperation rate.

Key Takeaway: Combined ACL-ALL anatomic reconstruction in skeletally immature patients yielded a 2.6% graft failure rate and 2.6% growth disturbance rate at mean 3.6-year follow-up, with mean Pedi-IKDC and Lysholm scores of 98.2 and 98.6, respectively.

Key Takeaway: Stereotactic navigation achieved negative surgical margins in 88.3% of primary spine/pelvic tumor resections across 21 studies (n=240), with only 1% of complications attributable to navigation itself.

Key Takeaway: Lumbopelvic archetypes associated with sagittal imbalance and lumbar stiffness (A4–A7) had rates of adverse postoperative spinopelvic mobility (ΔSPT ≥20°) of 60–87.5%, with adjusted ORs of 3.2–7.5 versus lower-risk archetypes.

Key Takeaway: Chevron medial malleolar osteotomy fixed with 3 screws produced zero measurable articular displacement versus 50% step-off rate with oblique osteotomy and 2-screw fixation in a cadaveric model.

Key Takeaway: Locking plate constructs for proximal humerus fractures undergo permanent deformation beyond 3.2° of humerus rotation, with energy dissipation increasing approximately fourfold at that threshold.

Key Takeaway: Bennett fractures with >1-2 mm articular displacement and Rolando fractures with >2 mm step-off benefit from surgical fixation, while extra-articular thumb metacarpal fractures tolerate up to 30° angulation nonoperatively due to CMC compensatory motion.

Key Takeaway: Functional bracing achieves good long-term outcomes for humeral shaft fractures but carries nonunion rates up to 25%, while surgical fixation reduces nonunion risk at the cost of iatrogenic radial nerve palsy risk.

Key Takeaway: Finger biomechanical balance depends on calibrated interaction of intrinsic and extrinsic systems, with disruption producing predictable deformity patterns (clawing, boutonnière, swan-neck, bowstringing) that guide specific reconstructive strategies.

Key Takeaway: The FAMA approach using controlled sterno-clavicular joint dislocation achieved exposure of C7-T4 in a cadaveric model with no major neurovascular injuries, offering a potential alternative to sternotomy-based cervicothoracic approaches.

Key Takeaway: Flexible silicone MCP arthroplasty outperforms surface-replacement and pyrocarbon alternatives in the rheumatoid hand, with durable outcomes driven by soft-tissue balancing rather than implant design.

Key Takeaway: Sequential cadaveric sectioning demonstrates that DSTL sectioning—after prior dorsal SLIOL disruption—produces the largest biomechanical changes, converting dynamic SL instability to static DISI with marked SL diastasis and increased carpal angles.