ORIF is associated with lower early morbidity but greater long-term revision risk compared with acute THA for acetabular fractures in the elderly.

To Fix or Replace? A Systematic Review and Meta-Analysis on Surgical Management of Acetabular Fractures in the Elderly.

Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.

Functional outcomes, arthrofibrosis and residual laxity following arthroscopic and open reduction and internal fixation of tibial spine fractures: A systematic review and meta-analysis.

This systematic review and meta-analysis compares open reduction and internal fixation (ORIF) versus distal femoral replacement (DFR) for periprosthetic distal femur fractures (PDFF), focusing on patient-reported outcomes, perioperative measures, functional results, and complications. Following PRISMA guidelines, PubMed, Embase, Scopus, and ScienceDirect were searched from January 2010 through November 2024 using keywords and MeSH strategies. Studies were eligible if they compared outcomes of ORIF and DFR for PDFFs and included ≥10 patients. Exclusion criteria included noncomparative studies, primary arthroplasty indications, and nonperiprosthetic fractures. Two independent reviewers extracted data on demographics, interventions, patient-reported outcomes, functional outcomes, and complications. Quality was assessed using the Newcastle-Ottawa Scale. Discrepancies were resolved by a third author. Random-effects meta-analyses were used to calculate pooled incidence rates and risk ratios with 95% confidence intervals. Heterogeneity was assessed via I2 and Cochran Q. Thirteen retrospective cohort studies (n = 881; ORIF: 554, DFR: 327) were included. Knee Society Functional Scores were significantly better for ORIF vs DFR in the 2 studies reporting this metric (53 vs 39, P = 0.012; 52 vs 37, P = 0.027). There was no significant difference in Oxford Knee Scores (MD = -0.11, 95% confidence intervals: [-1.74, 1.52], P = 0.85). Mean time to weight bearing was shorter for DFR vs ORIF (2 vs 78 days, respectively; P = 0.04), although risk ratios for returning to preoperative mobility and achieving unassisted ambulation were statistically insignificant. The rate of reoperation was significantly higher for ORIF versus DFR (12% vs 7%, respectively; P = 0.048). ORIF may offer advantages in patient-reported functional outcomes compared with DFR. Although DFR allows for immediate weight bearing, this advantage may not imply superior long-term mobility. Level III.

To compare postoperative outcomes and complications between closed reduction and open reduction and internal fixation (ORIF) of condylar and subcondylar fractures. This is a multicenter, retrospective database study utilizing data from 64 healthcare organizations in the United States from January 1, 2010 to July 31, 2025. The TriNetX database was used to identify adult patients ages 18 years or older with a history of condylar or subcondylar fractures. These patients were either treated with closed reduction or ORIF. The relative risks (RRs) with 95% confidence intervals (CIs) for outcomes and complications were assessed within 1 year postoperatively. Infection at or around the surgical site was more common with ORIF (RR: 0.64 [0.47-0.88]), while jaw pain and malocclusion were more frequent after closed reduction (RR: 1.73 [1.29-2.33]; 1.61 [1.21-2.15]). Malunion/nonunion and wound disruption rates were similar between groups (RR: 0.95 [0.61-1.48]; 1.33 [0.69-2.59]), and there were no facial nerve injuries. Patients treated with closed reduction had higher 30- and 90-day emergency department visit rates (RR: 1.90 [1.55-2.33]; 1.73 [1.44-2.09]). Closed reduction is associated with a higher rate of jaw pain, malocclusion, and visits to the emergency department when compared to ORIF, but associated with an increased risk of infection. There was no risk of facial nerve injury or osteomyelitis with either treatment options. 3.

Early versus delayed weight-bearing after open reduction and internal fixation for vancouver type-B periprosthetic femoral fractures: A multicenter retrospective study.

The impact of fracture fragment displacement on sensory function recovery of the inferior alveolar nerve in mandibular angle fractures.

Nail plate combination for Su type III periprosthetic distal femur fractures results in early ambulation and favorable clinical outcomes: A comparative case series and technical points.

To study the biomechanical effects of tilting titanium cages on internal fixation devices in TES surgery. We used finite element analysis to simulate lumbar total en bloc spondylectomy (TES). Five models were constructed:(a) the intact model (L1-S); (b) the TES model after L3 removal; and the TES model with a titanium cage tilted at (c) 5°, (d) 10°, or (e) 15° in the sagittal plane. The sacrum was fixed to simulate the stress during lumbar flexion, extension, lateral bending to the left and right, and rotation to the left and right, and measured the biomechanical response of the internal fixation system. The range of motion (ROM) in segments L1-5 of the TES surgical model was significantly reduced compared to the intact model, with a decrease of 66.87-96.49%. The maximum von Mises stress (VMS) in the pedicle screw system occurred during left lateral bending, reaching 283.9MPa, while the minimum VMS occurred during flexion, at 114.7MPa; during rotation, the maximum endplate stress was observed at L2 and L4, with values of 30.8MPa and 22.7MPa, respectively. When comparing the tilted cage models c-e to the neutral cage model b , the ROM of the lumbar spine most notably increased during left and right rotations, with an increase of 166.5%-227.6%. The VMS in the pedicle screw-rod system significantly increased during rotation, with a peak value of 421.3MPa, and the VMS in the titanium cage also showed a marked increase, with a maximum value of 733.5MPa. The VMS of the lower endplate at L2 increased to a range of 21.6MPa to 113.0MPa, and the VMS of the upper endplate at L4 increased to a range of 12.0MPa to 66.9MPa. After the titanium cage is tilted, the pedicle screw-rod system, the titanium cage, and the upper and lower endplates of the adjacent vertebrae all experience an increase in stress. This stress elevation is most critical during rotational movements. Although the stress values fluctuated across different tilt angles (5°, 10°, 15°), no consistent dose-response relationship was observed in this model. This suggests that the presence of sagittal tilt itself may be a more critical factor influencing stress than the exact degree of tilt within the 5°-15° range.

Femoral diaphysis malunion: An overview.

From 2D to 3D: Evolution of evaluation methods for femoral neck fracture reduction quality.

Biomechanical comparison of four internal fixation approaches for Pauwels type Ⅲ femoral neck fractures using finite element analysis.

Orbital fractures are common after craniofacial trauma. A rare but severe complication is retrobulbar hematoma (RBH), potentially causing increased intraorbital pressure, optic nerve compression, and irreversible vision loss. Prompt diagnosis and emergency decompression, typically via lateral canthotomy, are critical. Despite its low incidence, the relationship between fracture morphology and RBH remains insufficiently understood. This study investigates the association between orbital floor fracture characteristics and RBH occurrence. In this retrospective single-center study, we analyzed all patients who presented to our department between 2015 and 2025 with CT-confirmed RBH and elevated intraocular pressure (IOP) following orbital trauma. CT-based fracture morphology was assessed and classified by size, fragmentation, and wall involvement. Findings were correlated with clinical parameters, including IOP, initial and postoperative visual acuity, and the need for surgical intervention. Statistical analyses evaluated associations between fracture features and clinical severity. We analyzed 27 patients with RBH following orbital trauma, mainly involving the orbital floor, typically caused by falls or assault. Ipsilateral visual acuity was initially reduced (0.15 (0.00-0.80)), improving after decompression; IOP also decreased significantly. Functional outcomes were associated with fracture pattern and, to a lesser extent, anticoagulation. Several Association of the Study of Internal Fixation (AO) fracture types correlated with clinical outcomes. Receiver operating characteristic analysis showed that orbital floor displacement predicted preoperative visual acuity (AUC=0.75, cut-off 4.7mm), while medial wall displacement poorly predicted IOP or vision initially. Postoperatively, medial wall displacement showed excellent discrimination for IOP normalization (AUC=0.944); however, neither wall predicted visual outcome reliably. The extent and displacement of orbital fractures, along with intraocular pressure, strongly correlated with functional outcomes. Our findings highlight the prognostic value of CT-based fracture assessment in addition to urgent clinical evaluation and suggest that trauma mechanism and patient profile further influence risk and recovery.

Computational biomechanical comparison of conventional and novel fixation techniques for Pauwels type III femoral neck fractures.

Geriatric hip fractures, particularly unstable intertrochanteric fractures, pose a significant global health challenge with high morbidity and mortality. The optimal surgical management remains debated, with both Closed Reduction and Internal Fixation (CRIF) and Bipolar Hemiarthroplasty (BHA) being widely accepted treatment options. However, there is a conspicuous paucity of objective, quantitative data comparing the longitudinal gait recovery trajectories following these two distinct surgical approaches. This study aimed to leverage validated wearable inertial sensors to systematically characterize and compare the spatiotemporal gait recovery patterns of elderly patients undergoing CRIF versus BHA for unstable intertrochanteric fractures. This prospective cohort study enrolled 48 patients aged > 70 years with unstable intertrochanteric fractures (AO/OTA 31-A2/A3). Patients were allocated to Group A (CRIF with PFNA, n = 21) or Group B (BHA, n = 27) based on surgeon preference and patient factors. Baseline frailty was assessed using the modified Frailty Index (mFI) and it was comparable between 2 groups. A comprehensive battery of spatiotemporal gait parameters was objectively quantified using validated Gait Up Physilog® 5 wearable inertial sensors at 2 weeks, 1 month, 3 months, and 6 months postoperatively. At 3 months postoperatively, the BHA group demonstrated markedly superior gait parameters compared to the CRIF group, including significantly higher cadence (82.9 ± 27.3 vs. 51.7 ± 22.3 steps/min; p = 0.025) and shorter gait cycle time (1.6 ± 0.5 s vs. 2.7 ± 1.0 s; p = 0.028), reflecting a more confident and fluid gait pattern in the BHA cohort. However, this functional advantage attenuated by 6 months, as the CRIF group exhibited a compensatory "catch-up" phenomenon, achieving comparable gait parameters (p > 0.05) once fracture consolidation was established. No postoperative complications were observed in either group during the study period. While both BHA and CRIF are effective treatments for unstable intertrochanteric fractures, BHA offers a clinically meaningful advantage in early-to-mid-term gait recovery. The immediate intrinsic stability provided by arthroplasty facilitates earlier return to confident ambulation, which is of paramount importance for frail geriatric patients with limited physiological reserve. For select high-risk patients, BHA may be preferred to mitigate risks of prolonged immobility and optimize functional recovery. Level III, Therapeutic Study.

To compare the effectiveness of Holosight robot-assisted percutaneous reduction and internal fixation versus reduction and internal fixation via sinus tarsi approach in treatment of calcaneal fractures. A retrospective analysis was conducted on 46 cases (46 feet) of closed intra-articular calcaneal fractures classified as Sanders type Ⅱ or Ⅲ, admitted between June 2022 and June 2025. Among them, 20 patients were treated with Holosight robot-assisted percutaneous reduction and internal fixation (RA group), and 26 with open reduction and internal fixation via sinus tarsi approach (control group). There was no significant difference between groups ( P>0.05) in age, gender, affected side, fracture classification, the interval between fracture and operation, and preoperative visual analogue scale (VAS) score for pain, American Orthopedic Foot and Ankle Association (AOFAS) score, calcaneal morphological parameters (length, width, height, Böhler angle, Gissane angle). The two groups were compared in terms of operation time, intraoperative blood loss, fluoroscopy frequency, screw (guide wire) adjustment times, initial screw (guide wire) implantation success rate, incidence of complications, and the differences in calcaneal morphological parameters, pain and functional outcomes (VAS and AOFAS scores) between pre- and post-operation. Compared with the control group, the RA group had significantly less intraoperative blood loss, fewer fluoroscopy frequency, fewer screw (guide wire) adjustments, higher initial screw (guide wire) implantation success rate, and shorter operation time and hospital stay ( P<0.05). No postoperative complication occurred in RA group, whereas 1 case of superficial incision infection was observed in control group; however, there was no significant difference in the incidence of complications between groups ( P>0.05). All patients were followed up 6-7 months (mean, 6.5 months). X-ray film at last follow-up showed that all fractures healed. At 6 months after operation, the calcaneal morphological parameters and pain and functional indicators all significantly improved when compared with the preoperative values in the two groups ( P<0.05). The changes in VAS score and AOFAS score differed significantly between the two groups ( P<0.05), whereas no significant difference was found in the changes of the other indicators ( P>0.05). Compared with the operation via sinus tarsi approach, Holosight robot-assisted percutaneous reduction and internal fixation for calcaneal fractures demonstrates superior safety and effectiveness, as evidenced by shortened operation and hospital stay, reduced intraoperative blood loss and the fluoroscopy frequency, improved screw placement accuracy, enhanced postoperative functional recovery.

The recent escalation of conflict in Gaza has resulted in a substantial burden of trauma-related injuries, particularly orthopedic trauma, with a total of 362 patients included in this study. This study presents a retrospective descriptive analysis of epidemiology, injury patterns, and clinical management of encountered orthopedic trauma cases during the conflict. This study aimed to characterize the mechanisms, patterns, and outcomes of orthopedic injuries sustained during the ongoing war in Gaza, with the goal of informing surgical response, resource allocation, and emergency preparedness in conflict settings. Data were retrospectively collected from the paper medical records of 362 patients with both direct conflict-related trauma and indirect conflict-affected orthopedic conditions, treated at the Jordanian Military Field Hospital – Southern Gaza (Khan Younis), between June 22 and October 2, 2024. Variables included demographic data, injury mechanisms, anatomical and injury types, surgical interventions, anesthesia modalities, perioperative care, and outcomes. Descriptive statistics were used to report frequencies, percentages, and means. The study included predominantly male patients (78.5%) with a mean age of 29.6 years. Blast injuries (48.3%) and gunshot wounds (31.2%) were the leading causes of trauma. The most common injuries were femur fractures (36.5%) and acute open fractures (36.2%). Frequent procedures included open reduction and internal fixation (34.8%) and fixation device removal (29.0%). General anesthesia (32.3%) and spinal anesthesia (29.8%) were commonly used, and all patients received antibiotics (100.0%). Anticoagulants were administered to 47.5% of patients, and 92.3% received physiotherapy. Surgical complications were low (4.4%), with no recorded venous thromboembolism events or deaths within 9 months. Orthopedic trauma during the Gaza conflict was primarily characterized by blast and gunshot injuries, with femur fractures being most prevalent. These findings underscore the importance of targeted trauma care protocols and resource planning in conflict zones. Despite relatively low short-term complications, only 30.1% of patients regained independent ambulation at 3 months, underscoring a substantial early disability burden. The high incidence of complex injuries, incomplete follow-up, and cohort heterogeneity limit definitive conclusions, but the findings point to an urgent need for sustained international support for trauma care and rehabilitation systems in Gaza.

To compare the short-term effectiveness of functional double-bundle anterior cruciate ligament reconstruction with internal brace (F-DBACLR+IB) by helical continuous suture fixation versus anatomical single-bundle anterior cruciate ligament reconstruction (A-SBACLR). A retrospective analysis was performed on the clinical data of 66 patients who underwent anterior cruciate ligament reconstruction between January 2023 and December 2024 and met the selection criteria. Patients were divided into the A-SBACLR group ( n=34) and the F-DBACLR+IB group ( n=32) according to the surgical procedure. No significant intergroup difference was observed in baseline data, including gender, age, body mass index, injured side, preoperative meniscal injury status, or preoperative Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) score, KT-1000 measurement, and pivot shift test grade ( P>0.05). Intraoperative data including operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Functional outcomes were evaluated preoperatively and postoperatively using the Tegner score, IKDC score, Lysholm score, KT-1000 measurement, and pivot shift test grade. There was no significant difference in operation time, intraoperative blood loss, and graft complex diameter between the two groups ( P>0.05). All patients were followed up, the follow-up duration was (22.94±4.55) months in the A-SBACLR group and (21.25±4.25) months in the F-DBACLR+IB group, with no significant difference ( t=1.558, P=0.852). All incisions healed by first intention, and no complication such as knee stiffness/fibrosis or deep joint infection occurred in either group. No revision surgery was performed due to postoperative graft re-rupture in either group. Medial knee pain was reported in 7 patients in the A-SBACLR group and 6 patients in the F-DBACLR+IB group, and peripatellar numbness occurred in 6 and 5 patients, respectively; the incidences showed no significant intergroup differences ( P>0.05). At last follow-up, the F-DBACLR+IB group exhibited significantly greater improvements in the Tegner score, IKDC score when compared with the A-SBACLR group ( P<0.05); no significant difference was found in changes of Lysholm score, KT-1000 measurement, or pivot shift test grade between the two groups ( P>0.05). Compared with A-SBACLR, F-DBACLR+IB yields superior early postoperative recovery of sporting and effectiveness. The helical continuous suture technique provides reliable internal brace fixation for F-DBACLR.

This study aimed to investigate risk factors for poor functional recovery at 6 months after open reduction and internal fixation for ankle fracture, develop a predictive nomogram, and perform internal validation to support early identification of high-risk patients and formulation of individualized postoperative rehabilitation strategies. A retrospective cohort study was conducted including 582 patients with ankle fracture treated between January 2022 and December 2024. The primary outcome was poor functional recovery, defined as an AOFAS ankle-hindfoot score < 80 at 6 months postoperatively. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors and construct a nomogram prediction model. Model discrimination was assessed using receiver operating characteristic curves and area under the curve (AUC). Calibration was evaluated using the Hosmer–Lemeshow test. Two internal validation approaches were applied: bootstrapping with 1000 iterations and 10-fold cross-validation; no independent external validation was performed. The events-per-variable ratio was 21.6 (108 events, 5 predictors), ensuring low overfitting risk. Sensitivity and specificity were calculated at the optimal threshold determined by the Youden index. Calibration curves and decision curve analysis were used to evaluate clinical utility. Overall, 153 (26.29%) patients exhibited poor functional recovery. Independent risk factors included age ≥ 65 years, postoperative VAS score ≥ 5, weight-bearing duration ≥ 4 weeks, posterior malleolus involvement, and ankle range of motion < 20°. The nomogram showed good discrimination with AUC of 0.842 in the modeling cohort and 0.802 in the validation cohort. After internal validation, the AUC was 0.822, with a sensitivity of 82.6% and specificity of 83.4%. The model was well-calibrated and achieved favorable net benefit in decision curve analysis. This internally validated nomogram based on a retrospective cohort demonstrates reliable efficacy in predicting poor 6-month functional recovery after ankle fracture surgery. It provides quantitative evidence for early risk stratification, precise intervention, and individualized postoperative rehabilitation management to improve functional outcomes.