Weekly Digest

Key Takeaway: The 155°-distalized stem configuration produced a 4-fold lower risk of greater tuberosity nonhealing compared to the 135°-lateralized stem (8% vs. 32%, RR 4.0, 95% CI 1.23–13.05) in reverse TSA for proximal humerus fractures.

Key Takeaway: Pediatric lower extremity above-ankle fractures present with mean serum 25-OH vitamin D of 18.9 ng/mL versus 25.7 ng/mL in upper extremity fractures, with 58% meeting deficiency criteria (<20 ng/mL) compared to 30% in upper extremity and ankle/foot groups.

Key Takeaway: Open Bankart plus inferior capsular shift reduced recurrence to 2.5% versus 17.5% with isolated arthroscopic Bankart repair in collision athletes after a first dislocation (p=0.031), with equivalent functional scores, ROM, and return-to-sport rates at 5 years.

Key Takeaway: A PHOS-based prognostic model predicts surgical curve progression in unbraced AIS patients with a c-statistic of 0.89 and NPV of 0.94, performing equivalently to a Risser-based model.

Key Takeaway: At 12-year follow-up after lumbar stenosis surgery, 26% of patients required revision, and the revision cohort demonstrated clinically worse PI-LL mismatch (16° vs 10°) and lumbar lordosis (41° vs 47°) compared to non-revision patients.

Key Takeaway: In a combined biomechanical study and NMA, the 2-divergent-lateral-plus-1-medial-pin configuration (L2DM1) ranked highest across varus stiffness (SUCRA 99.7%), valgus stiffness (92.9%), and torsional failure torque (SUCRA 100%) for pediatric supracondylar humerus fracture fixation.

Key Takeaway: Among 2,685,041 DRF patients, preexisting upper-limb nerve injury carries the highest CRPS risk (OR 3.20), while overall CRPS incidence was only 0.18%.

Key Takeaway: BPTB autograft produces higher anterior knee pain prevalence at 6 months (26% vs. 6%) but this pain is mild, resolves by 1 year, and does not translate into differences in KOOS, WOMAC, IKDC, Marx scores, or return-to-play rates at 5 years.

Key Takeaway: Across 35 studies, preoperative GLP-1 RA use was associated with similar or lower 90-day complications in arthroplasty—including reduced PJI rates—while spine surgery showed mixed signals including increased pneumonia, AKI, and pseudarthrosis with prolonged semaglutide exposure.

Key Takeaway: Pediatric ACL tear patients demonstrated significantly greater valgus alignment than matched controls, with each 1° increase in HKA valgus increasing ACL tear odds by 14% (OR 1.14, 95% CI 1.02–1.27).

Key Takeaway: ACS-NSQIP predicted a 1.85% 'any' complication rate for distal radius ORIF, but observed long-term hand-related complications reached 27.72%—a 15-fold underestimation.

Key Takeaway: After national centralization of pediatric bone sarcoma surgery in the Netherlands, R0 margins were achieved in 94% of 99 patients, with 22% experiencing a 30-day complication and only 7% experiencing chemotherapy delay beyond 28 days.

Key Takeaway: In complex pediatric tibial fractures (AO 42B-C and 43A2-A3), MIPO achieved radiographic union 5.2 weeks faster than ESIN (10.6 vs. 15.8 weeks, P<0.001) and eliminated unplanned reoperations (0% vs. 24%).

Key Takeaway: In revision reverse TSA, short cementless stems achieved Constant score improvement of 23.5 points versus 3.5 points for long stems (P=.018), with a 0% humeral stem re-revision rate at minimum 2-year follow-up.

Key Takeaway: 36-mm femoral heads carry a 14% higher all-cause revision hazard versus 32-mm heads (HR 1.14, 95% CI 1.08–1.20) in primary THA, driven by increased fracture (HR 1.30) and loosening (HR 1.21) revisions that outweigh the dislocation benefit.

Key Takeaway: Aseptic glenoid baseplate loosening occurred in 5.7% of Aramis rTSA cases at mean 4.2 years, independently predicted by intraoperative glenoid fracture (OR 15) and excessive lateral component positioning (OR 1.07 per degree).

Key Takeaway: In morbidly obese patients (BMI >40) undergoing primary THA, dual mobility implants achieved 100% five-year survivorship free from revision versus 96.8% for fixed-bearing constructs, with instability rates of 1.4% versus 0.6%.

Key Takeaway: Stereotactic navigation in posterior thoracic/lumbar fusion and PLIF was independently associated with higher odds of superficial SSI and overall postoperative infection at 30 days after controlling for operative time, frailty, and revision status in 115,570 patients.

Key Takeaway: 89.2% of shoulder arthroplasty patients returned to sport with 80.2% reporting maintained or improved performance, and rTSA demonstrated superior sport performance stability versus aTSA in matched GHOA patients (87.9% vs 78.9%, P=0.039).

Key Takeaway: Anatomic femoral stems carry the highest overall revision rate (3.9%) in primary THA, while single-wedge stems demonstrate the lowest relative revision risk (RR 0.31) and periprosthetic fracture risk (RR 0.21) compared to anatomic designs.

Key Takeaway: Baseplate failure occurred in 1.6% of 5,049 rTSA cases, with revision surgery (OR 4.57), bone graft use (OR 2.81), and increased lateral offset (OR 1.08 per mm) as independent predictors, while central screw fixation was protective (OR 0.55).

Key Takeaway: At 50 months, cementless medial mobile-bearing UKA for osteonecrosis achieved 97.7% survival free from aseptic loosening versus 100% for cemented fixation, with no statistically significant difference (P=0.35).

Key Takeaway: LTO nonunion occurred in 33.4% of aTSA patients, with younger age as the only significant predictor (OR 0.98 per year, p=0.037), yet only 2.7% of nonunions required revision surgery.

Key Takeaway: Adding convex posterior intervertebral release (PIVR) to SRS Grade 2 osteotomy achieved 14% greater coronal curve correction (70% vs. 56%) and tripled the odds of reaching MCID for self-image (OR 3.0) in severe rigid adult idiopathic scoliosis without increasing operative time or blood loss.

Key Takeaway: Anterior graft placement (supraspinatus footprint) in arthroscopy-assisted lower trapezius transfer yielded significantly greater postoperative forward elevation (160.2° vs. 150.4°), forward elevation strength (27.4 vs. 24.4 N·m), and AHD MCID achievement (68.2% vs. 45.6%) compared to posterior placement.

Key Takeaway: Prior heterotopic ossification after index fixation confers a 3x increased risk of HO after conversion THA, with an overall HO incidence of 33.3% in this cohort.

Key Takeaway: Facet resection ≥50% during posterior cervical foraminotomy produced equivalent VAS and NDI improvements to <50% resection at 2 years, though bone bridge formation was significantly higher (66.7% vs 26.3%, p=0.002).

Key Takeaway: Preoperative shear wave elastography Δ shear modulus of the LHBT proximal to the bicipital groove correlates strongly with arthroscopic lesion severity (ρ = 0.750), with a diagnostic threshold >14 distinguishing normal from frayed tendon.

Key Takeaway: Multifidus atrophy and fat infiltration are independent risk factors for postoperative sagittal imbalance after multilevel PLIF, while psoas and erector spinae metrics are not, in a cohort of 213 patients with minimum 2-year follow-up.

Key Takeaway: Adult reconstruction fellowship-trained surgeons performing UKA had a 31% lower 5-year revision-to-TKA rate (OR 0.69) and 61% lower implant failure rate (OR 0.52) compared to non-fellowship-trained surgeons.

Key Takeaway: Delayed ACL reconstruction (>120 days post-injury) increases odds of medial meniscus tears by 80% (aOR 1.80) and combined medial+lateral tears by 47% (aOR 1.47) across all age groups.

Key Takeaway: A two-step deep learning pipeline detected radial head dislocation in pediatric Monteggia fractures with 95–97.5% accuracy and ulnar fracture detection AUC of 0.923, exceeding reported expert interpretation performance.

Key Takeaway: Glenoid wear after ream-and-run arthroplasty averages 0.3 mm/year and plateaus after 4 years, with 81% of patients experiencing ≤5 mm medialization at mean 6.7-year follow-up.

Key Takeaway: In adolescents with TT-TG ≥20 mm, adding TTO to MPFL reconstruction produced no difference in recurrent instability, Kujala scores (91.4 vs. 88.5), or SANE scores (84.3 vs. 86.8) at mean 5.7-year follow-up.

Key Takeaway: Primary malignant spine tumors carry a 5-year disease-specific survival of 47.5%, with advanced TNM stage (IVA+IVB) conferring a 7.6-fold increased hazard of death compared to localized disease.

Key Takeaway: The Persona PS Knee System achieved 95.7% implant survival at mean 11.1-year follow-up with a mean FJS-12 of 69.52, indicating substantial but incomplete joint awareness reduction.

Key Takeaway: A novel bilateral shoulder DXA protocol in 224 rotator cuff repair patients identifies a proximal humerus osteoporosis threshold of 0.478 g/cm² (corresponding to femoral neck T-score of -2.17), with significant BMD reduction in the medial humeral head (R2, p<0.001) that progresses from periarticular to diffuse with advancing fatty infiltration grade.

Key Takeaway: DRF patients undergoing ORIF with same-day carpal tunnel release had a 1-year CRPS incidence of 1.44% and 4.60-fold higher odds versus non-operative management, compared to 1.84-fold for ORIF alone.

Key Takeaway: Extra-long (≥XL) femoral heads in primary THA are associated with a 7.2% vs. 4.5% cumulative 9-year revision rate compared to standard heads, with use inversely correlated with hospital volume (5.4% low-volume vs. 3.0% high-volume centers).

Key Takeaway: Preoperative GLP-1 RA use in non-obese TSA patients (n=845 matched pairs) was not associated with increased 90-day or 1-year medical or surgical complications compared to controls.

Key Takeaway: In patients aged 81 years with loose implants (SOFCOT type 2/3 periprosthetic knee fractures), ORIF alone yielded a 2-year survival of 88.9% and re-revision rate of 22.2%, not significantly different from revision arthroplasty (88.9% survival, 15.9% re-revision; p=0.64).

Key Takeaway: External fixation and RSA yield equivalent Constant-Murley Scores (58.4 vs. 55.2, p=0.42) for Neer 2- and 3-part proximal humerus fractures in patients aged 65-80, but EF produces superior external rotation (60.9° vs. 46.5°, p<0.01) with shorter operative time (48.2 vs. 92.4 min) and zero transfusion requirement.

Key Takeaway: Septic arthritis after ACLR treated with arthroscopic lavage and graft retention yields equivalent 7-year functional scores to uncomplicated ACLR (Lysholm 89.1 vs 92.1, p=0.32), but delays return to sport by 2.1 months (10.2 vs 8.1 months, p=0.01).

Key Takeaway: Periacetabular allograft-prosthesis composite reconstruction achieved 88% graft retention at 15 years with a mean MSTS score of 23/30 at mean 10-year follow-up in 49 patients with primary or secondary pelvic bone tumors.

Key Takeaway: Pre-bending flexible nails prior to ESIN of pediatric both-bone forearm fractures produced no significant difference in radial bow magnitude (4.9% vs. 5.3%), time to union (44 vs. 42 days), or forearm rotation recovery (100 vs. 81 days) compared to unbent nails.

Key Takeaway: Surgical management of complex proximal ulna fractures yielded mean MEPI of 100 and QuickDASH of 6.8 at mean 28 months, but 37% developed radiographic arthrosis and patients with concomitant coronoid or radial head fractures had significantly worse outcomes.

Key Takeaway: Third-generation flexible metaphyseal cones in revision TKA achieved 100% survivorship free from aseptic loosening at mean 3-year follow-up with a 0.5% cone-related intraoperative fracture rate across 241 cones.

Key Takeaway: Calcium phosphate/calcium sulfate bone substitute achieved complete graft resorption in 88% of pediatric benign bone tumor patients by 1 year, with a 13% local recurrence rate at mean 32-month follow-up.

Key Takeaway: Two-stage knee arthrodesis using a modular intramedullary system achieved 87.2% Kaplan-Meier survival at 17.3 years with 100% limb salvage but a 19% reinfection rate across 29 patients.

Key Takeaway: ACL-R + LET in high-risk adolescents (n=42) yielded 0% graft rupture and 89.7% return to preinjury or higher sport level at mean 41-month follow-up.

Key Takeaway: Electron beam-radiated, melt-annealed HXLPE in THA demonstrates 93.5% all-cause survivorship and 98.6% osteolysis-free survivorship at 20 years, with a mean linear wear rate of 0.06 mm/year.

Key Takeaway: In 27 pediatric neglected Monteggia fractures, a preoperative maximum ulnar bow ≥3.45 mm predicted the need for ulnar osteotomy, and delayed surgery (median 73 days, range 51–220.5) did not worsen outcomes, with 22/27 patients achieving excellent MEPI scores.

Key Takeaway: Revision rotator cuff repair augmented with a bioinductive collagen patch (REGENETEN) achieved a 71.4% structural integrity rate at 12 months MRI (Sugaya I–III) with significant functional improvement (Constant score 44→63, ASES 20→59.2) in 21 patients.

Key Takeaway: Combined tibial tubercle periosteal sleeve transfer with MPFC reconstruction achieved Pedi-IKDC 90.9, Lysholm 96.9, and Kujala 92.7 at mean 46.7-month follow-up with one physeal arrest in 30 skeletally immature knees.

Key Takeaway: In 16 rTSA patients, pectoralis major, teres minor, and latissimus dorsi overactivation negatively correlated with functional internal rotation (hand-to-back), while posterior deltoid, upper/lower trapezius, and teres major activation characterized high-fIR performers.

Key Takeaway: Arthroscopic shoulder stabilization in skeletally immature patients yields a 34.7% recurrence rate and 10% revision rate at mean 5.1-year follow-up, with younger age as the primary risk factor.

Key Takeaway: Suprapatellar rigid intramedullary nailing in skeletally immature adolescents (mean age 15.9 years) achieved union in all 24 patients at mean 14.3 weeks with zero cases of physeal growth disturbance or angular deformity at final follow-up.

Key Takeaway: Ligamentum teres intraosseous ligamentodesis ('Teretization') as an adjunct to open reduction in IHDI grade ≥III DDH achieved 0% redislocation and 10.5% asymptomatic AVN at median 23-month follow-up in 19 hips.

Key Takeaway: Insufficient metaphyseal fixation at or near the modular junction—not patient weight or implant duration—is the primary driver of metal fatigue fracture in revision TKA, identified in 8 fractured components versus 489 stemmed controls.

Key Takeaway: CT detected volar plate impingement in 76% of patients (16/21) after volar locking plate fixation of scaphoid waist nonunion, while plain radiographs identified only 2 of those 16 cases.

Key Takeaway: A 30° angled distal tibial allograft restored glenohumeral contact forces to 86.6% of intact (62.17 N vs. 71.81 N) and distraction forces to 98.5% of intact, significantly outperforming flat graft placement in a 20% anterior glenoid defect model.

Key Takeaway: Standard rTSA polyethylene liners vary in constraint ratio from 40% to 62% across U.S. manufacturers, with retentive liners ranging from 47% to 71%, demonstrating no consistent definition of either category.

Key Takeaway: Subacromial microclip impingement in mice peaks tenocyte apoptosis at 4 weeks (TUNEL index 16.72%), driven by concurrent mitochondrial cristae loss and rough ER cisternae expansion.

Key Takeaway: Among 104 Knee Society members, cemented fixation dominates at 72.9% average use, while patellar resurfacing rates vary from 0–100% with no consensus, and 40% of surgeons changed their resurfacing indications within the past 5 years.

Key Takeaway: SAB-preserved rotator cuff repair achieved 2.1× higher ultimate load to failure at 3 weeks compared to SAB-resected repair (6.8 N vs. 3.3 N, P=.0004) in a rat supraspinatus transection model.

Key Takeaway: The Neviaser portal allows third-generation IMN insertion through the supraspinatus muscular portion in 100% of specimens, with nail entry point 4 mm from the myotendinous junction and 39 mm from the RC footprint.

Key Takeaway: Stemless humeral components showed significantly greater micromotion at 820 N and reduced torsional stability versus stemmed implants (p<0.001), but lesser tuberosity osteotomy did not increase micromotion regardless of implant type; BMD was the dominant predictor of instability across all constructs.

Key Takeaway: The Knee+ AR navigation device achieved mean coronal plane errors of 1.23° (LDFA) and 1.22° (MPTA), but tibial slope error averaged 2.15° with 21% of cases exceeding 3° error in the sagittal plane.

Key Takeaway: A single low-dose local TNF-α application (20 µL of 50 ng/mL) at the fusion site reduced posterolateral fusion rates from 4/5 to 0/5 by manual palpation at 4 weeks in a rat model.

Key Takeaway: FE-based preoperative planning for Schatzker IV tibial plateau fractures doubled load to failure (1050 N vs. 442 N, p=0.041) and cycles to failure (10,100 vs. 4,100, p=0.046) compared to conventional CT planning, though significance was lost after anatomical variation adjustment.

Key Takeaway: Double screw fixation requires 78.3 N more force to achieve 2.0 mm displacement in bending and generates 60.6–65.6 N·mm greater maximum torque than single screw plus bone graft constructs in an unstable scaphoid waist fracture model.

Key Takeaway: Sonication of cerclage wires exchanged at second-stage revision THA for PJI revealed bacterial contamination in only 1 of 26 cases (3.8%) and zero cases of true bacterial colonization.

Key Takeaway: Surgeon likelihood of recommending volar plate fixation decreased and cast/K-wire fixation increased when patients reported financial insecurity, independent of fracture pattern in 162 surveyed surgeons.

Key Takeaway: 3D virtual planning integrating kinematic analysis, ligament tension modeling, and patient-specific instrumentation improves precision of forearm deformity correction beyond what standard anatomic reduction alone achieves, though no comparative outcome numbers are reported.

Key Takeaway: AO Spine recommends CT/MRI as gold standard for subaxial cervical fracture workup, conditional surgical treatment for floating lateral mass or large fragment unilateral facet fractures, posterior augmentation for stand-alone ACDF when PLL is injured or bilateral facet dislocation is present, and anterior fixation for unilateral facet injuries without cord injury.