Acetabular fractures are becoming more common, especially in the elderly population. Standard goals of management include restoring stability and articular congruity to the hip joint in an effort to minimize the risk of posttraumatic arthritis. This is most commonly achieved through open reduction and internal fixation, from which outcomes are generally positive. However, several preoperative risk factors have been identified that correlate with poor outcomes, such as severe acetabular impaction, femoral-sided lesions, and older age. Furthermore, goals of management in the increasingly encountered elderly acetabular fracture may predominantly consist of postoperative mobilization and minimizing revision surgery. In the select patient with identifiable risk factors, acute total hip arthroplasty with or without concurrent fracture fixation may be able to improve outcomes. Specifically, acute total hip arthroplasty appears to reduce the risk of revision surgery in comparison to fracture fixation alone and may improve complication profiles in comparison to conversion arthroplasty after failed fixation, albeit at the expense of an increased surgical insult at the initial surgery. However, given the heterogeneity and short-term nature of the available data, more robust and long-term data will be required before definitive conclusions can be drawn.

Coronal shear fracture (CSF) of the distal humerus is rare, accounting for approximately 1% of elbow fractures; cases combined with olecranon fracture are even rarer. This study aimed to clarify the relationship between surgical methods and clinical outcomes in this uncommon injury. Between 2017 and 2025, we retrospectively reviewed 8 patients (8 elbows) with CSF associated with olecranon fracture who underwent open reduction and internal fixation in a multicenter case series and were followed for more than 6 months. Patient demographics, fracture classifications, surgical methods, postoperative complications, additional surgeries, elbow range of motion, and Mayo Elbow Performance Score at the final follow-up were analyzed descriptively. The mean age was 64 years (range, 51-79 years), and the mean follow-up was 27 months (range, 10-96 months). Dubberley classification was type 2A in 2 cases, type 3A in 2, and type 3B in 4. A posterolateral extended approach was used in 6 patients and a combined lateral-posterior approach in 2. Postoperative complications included elbow release in 2 cases and ulnar neuropathy in 2. At final follow-up, the mean Mayo Elbow Performance Score was 92.5 (range, 75-100), and the mean range of motion was -21°/121.3°. Outcomes of CSF with concomitant olecranon fracture appeared to depend on CSF severity, and complications were more frequent than in isolated CSF. Given the small sample size and observational design, these findings should be regarded as preliminary and hypothesis-generating rather than definitive evidence favoring any particular method.

The optimal duration of occupational therapy after distal radius fracture remains uncertain. Occupational therapy practitioners focus on objective indicators such as range of motion and grip strength, whereas patients prioritize subjective daily activity difficulties. To identify objective and subjective factors influencing decisions to continue occupational therapy from therapists' and patients' perspectives. Prospective observational cohort study. Multicenter. Patients (N = 143) who underwent open reduction and internal fixation for distal radius fracture were enrolled. The number of participants analyzed at Postoperative Weeks 4, 8, 12, and 24 was 143, 138, 114, and 82, respectively, because of attrition and incomplete data. Objective assessments included range of motion and grip strength, whereas patient-reported outcomes were assessed using the Hand20 questionnaire. Therapists and patients evaluated the necessity for continued occupational therapy. Statistical analyses included Cohen's κ for agreement, Lasso regression for variable selection, and generalized linear models for significance testing. Therapists prioritized objective measures (range of motion, grip strength), whereas patients emphasized subjective difficulties with daily activities. At Postoperative Week 8, Hand20 scores significantly affected the decisions of both groups, more closely aligning with perceptions. By Postoperative Week 12, therapists reverted to objective measures, renewing discrepancies. Discrepancies exist between therapists' objective assessments and patients' subjective recovery requirements regarding therapy continuation. With limited evidence supporting therapy beyond 12 wk, integrating patient-reported outcomes into shared decision-making may enhance functional recovery and satisfaction, particularly during the first 8 wk postoperation. Plain-Language Summary: This study investigated how patients and occupational therapists decide whether to continue or discontinue therapy after a wrist fracture. Therapists focus on movement and strength, whereas patients care more about how their hand feels during daily activities. Early after surgery, their views were different; however, by 8 weeks, similarities were observed. Subsequently, differences reemerged. The results suggest that listening to patients' experiences, especially during the first 8 weeks, may improve therapy plans and recovery outcomes.

Suture tension band fixation of olecranon fractures: description and early outcomes of a novel technique.

Glenoid defects in revision shoulder arthroplasty may be treated with coracoid autograft with reliable short-term results.

In this meta-analysis, we systematically compared the efficacy of the Allgöwer-Donati suture technique versus the interrupted vertical mattress suture technique in preventing postoperative incision complications following calcaneal fracture surgery. A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from their inceptions up to May 2025. This study included randomized-controlled trials (RCTs) involving adults (18-80 years) with closed calcaneal fractures who underwent open reduction and internal fixation (ORIF) via a lateral incision. The primary outcomes were surgical suture time, wound suture time, drainage tube removal time, and the incidence of postoperative complications. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using fixed-effect or random-effects models based on heterogeneity (I2 statistic). Eight RCTs comprising 640 patients were included. The Allgöwer-Donati technique significantly reduced surgical suture time (SMD = 0.81, 95% CI 0.22 to 1.39, p = 0.007; I2 = 47%), drainage tube removal time (SMD = 4.94, 95% CI 4.42-5.47, p < 0.00001; I2 = 65%), and wound suture time (SMD = -3.36, 95% CI -3.90 to -2.81, p < 0.00001; I2 = 34%) compared to the interrupted vertical mattress technique. However, there was no significant difference in the overall rate of postoperative complications between the two techniques (OR = 1.32, 95% CI 0.95-1.82, p = 0.10; I2 = 0%). The Allgöwer-Donati suture technique offers significant advantages in operative efficiency by reducing suture times and drainage duration without increasing the risk of postoperative complications compared to the interrupted vertical mattress technique. It represents a promising suturing option for calcaneal fracture surgery, particularly in settings valuing procedural efficiency.

Proximal clavicular physeal fracture-separation is an extremely rare injury in adolescents and young adults. It involves a fracture-disruption between the clavicle and its ossification center, often mimicking a sternoclavicular dislocation. The authors report a case of proximal clavicular physeal fracture-separation in a 17-year-old male, with no associated neurovascular injury. A CT scan was essential for accurate diagnosis. Surgical management consisted of open reduction of the fracture-separation followed by stabilization using two Kirschner wires (K-wires).The clinical and radiological outcome was excellent at the 6-month follow-up.

To compare the clinical outcomes and complication profiles of open reduction and internal fixation with plate (ORIF-P) versus reduction and internal fixation with threaded Kirschner wire (ORIF-TKW) for midshaft clavicular fractures (MCFs). A retrospective analysis was conducted on patients with MCFs who underwent either ORIF-P or ORIF-TKW between January 2012 and October 2023. Based on the surgical technique, patients were divided into ORIF-P and ORIF-TKW groups. The two groups were compared in terms of intraoperative blood loss, operative duration, radiographic union duration, shoulder function (Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), complication rates, and implant removal characteristics. Of 128 eligible patients, 85 received ORIF-P and 43 received ORIF-TKW. The ORIF-TKW group demonstrated more favorable peri‑operative metrics: shorter operative time (51.5 ± 6.4 vs. 63.6 ± 5.7min, p < 0.001), less blood loss (38.7 ± 5.6 vs. 56.2 ± 10.1ml, p < 0.001), and smaller incision length (3.9 ± 0.7 vs. 8.8 ± 0.9cm, p < 0.001). Radiographic union occurred earlier in ORIF-TKW (median 5.0 vs. 6.0months, p < 0.001). All 43 patients in the ORIF‑TKW group underwent planned implant removal, with minimal operative time and blood loss, whereas in the ORIF‑P group, only 50 patients (58.8%) underwent removal, exclusively for symptomatic reasons or patient request, with significantly more invasive removal procedures (p < 0.001). Functional outcomes at 6months were equivalent. Complication rates did not differ significantly between groups. Two refractures in the ORIF P cohort were successfully revised using ORIF TKW. In this single-center retrospective study, ORIF-TKW was associated with superior peri-operative outcomes, earlier radiographic union, and a less invasive planned removal procedure compared with ORIF-P, while functional recovery was similar. A post-hoc analysis demonstrated statistical comparability in fracture complexity within the 2B subgroup, partially mitigating concerns regarding selection bias. However, these findings remain hypothesis-generating and subject to residual confounding; prospective randomized trials with stratification based on fracture morphology are required before any change in routine practice can be recommended. The limited revision experience (2 cases) is insufficient to endorse threaded K-wire fixation as a routine salvage strategy.

Neglected volar dislocation of the thumb metacarpophalangeal joint: A case report with review of literature.

Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries. A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications. Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up (P < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; P = .58) or VAS scores (1.5 vs 1.2, respectively; P = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis (P = .75) and no clinically significant loss of reduction at final follow-up. SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.

Introduction: Patellar fractures constitute about 1% of all skeletal injuries and disproportionately affect elderly women because of osteoporosis and low-energy falls. Displaced transverse fractures disrupt the knee extensor mechanism and, if unaddressed, predispose to non-union and permanent disability. In many low- and middle-income settings, initial referral to traditional bone-setters remains common and frequently delays definitive care. Case presentation: A 66-year-old woman presented one month after a simple fall with a displaced transverse fracture of the left patella and Kellgren–Lawrence grade II osteoarthritis of the same knee. Prior care was limited to traditional bone-setting without improvement. On admission, she had a palpable patellar gap and an inability to actively extend the knee. Radiographs confirmed displacement of 10 mm. Single-stage open reduction and internal fixation with a modified tension band wire construct reinforced by circumferential cerclage was performed. Active-assisted flexion began on postoperative day 14; by four weeks, she had 30° of pain-free flexion, full active extension, and primary wound healing, and was discharged for structured outpatient physiotherapy. Conclusion: A combined tension band wire plus circumferential cerclage construct provided reliable fixation and an encouraging early functional result despite a one-month delay and prior bone-setter manipulation. Prompt referral and structured rehabilitation remain pivotal for minimising non-union, hardware failure, and long-term disability in geriatric patellar fractures.

Peripheral artery disease (PAD) has been associated with an increased risk of wound complications and surgical site infection following open reduction and internal fixation (ORIF) for ankle fractures. However, longer-term outcomes, including fracture healing, remain poorly characterized. This study evaluates the association between PAD and short- and long-term postoperative complications following ankle ORIF. The TriNetX Research Network was queried to identify patients who underwent isolated unimalleolar, bimalleolar, trimalleolar, or syndesmotic ORIF for ankle fractures. Patients were classified as having PAD if they had a documented diagnosis within 6 months before surgery, whereas patients without PAD served as controls. PAD and non-PAD cohorts were 1:1 propensity score matched for demographics and medical comorbidities. Postoperative complications were assessed at 90 days and 2 years. After propensity matching, 2,159 patients were included in each cohort. At 90 days, patients with PAD had markedly higher rates of surgical site infection (5.5% vs 2.0%), wound disruption (10.2% vs 3.9%), lower extremity cellulitis (7.6% vs 2.1%), and acute osteomyelitis of the ankle or foot (3.1% vs 0.6%) (all P < 0.001). At 2 years, PAD was associated with increased risks of nonunion (RR 3.07, 95% CI, 1.69 to 5.60), chronic osteomyelitis (RR 8.42, 95% CI, 4.64 to 15.27), implant infection (RR 3.19, 95% CI, 2.47 to 4.11), implant removal (RR 1.54, 95% CI, 1.32 to 1.81), and below-knee amputation (RR 10.5, 95% CI, 5.50 to 20.03) (all P ≤ 0.0001). PAD is associated with markedly increased short- and long-term complications following ankle ORIF, including a sustained risk of impaired fracture healing. These findings underscore the importance of long-term risk stratification in patients with PAD undergoing ankle fracture fixation.

Distal humerus fractures (DHF) in the elderly pose a challenge due to osteoporotic bone, comminution, and potential for poor functional recovery. Surgical management typically involves open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA). However, inconsistent findings across studies have led to uncertainty regarding which intervention optimizes outcomes, underscoring the need for a rigorous meta-analysis to guide clinical decision making. A systematic literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar for studies published up to October 28, 2025. Randomized controlled trials and comparative studies evaluating ORIF vs. TEA in patients older than 65 years with DHF were included. Seven studies (1,347 patients aged ≥65 years) met inclusion criteria. Key outcome measures included the DASH score, flexion-extension arc, hospital stay, surgical time, complication rate, infection rate, revision surgery rate, and Mayo Elbow Performance Score. Pooled analysis demonstrated that TEA was associated with a statistically significant improvement in elbow flexion-extension range of motion compared with ORIF (mean difference: -9°, 95% confidence interval, -14.72 to -3.28; P = 0.002). No statistically significant differences were observed between TEA and ORIF about surgical time, hospital length of stay, Mayo Elbow Performance Score, overall complication rates, infection rates, or revision surgery rates (all P > 0.05). In elderly patients with intra-articular DHF, TEA provides a modest but statistically significant improvement in elbow range of motion compared with ORIF, although this difference is below commonly reported thresholds for minimal clinically important difference. These findings support an individualized treatment approach, favoring ORIF when durable fixation is achievable, while reserving TEA for carefully selected low-demand or frail patients with fracture patterns unlikely to permit stable reconstruction. Long-term implications of implant-related failure should be considered in surgical decision making. Meta-analysis, Level II.

Combined hip procedure (CHP) involving open reduction and internal fixation and acute total hip arthroplasty (THA) for elderly acetabular fractures: a comparative analysis to THA for femoral neck fractures and hip osteoarthritis.

Managing Vancouver B2 periprosthetic femoral fractures: is open reduction and internal fixation superior to stem revision? : A comparative analysis with a minimum 5-year follow-up.

Bilateral clavicle fractures represent one of the rarest patterns of shoulder girdle trauma, occurring predominantly after high-energy mechanisms and posing unique challenges in diagnosis and management. Their simultaneous disruption compromises both clavicular struts, resulting in impaired shoulder biomechanics and necessitating timely stabilization for optimal functional recovery. A 25-year-old male sustained high-velocity trauma following a motorcycle accident and presented with severe bilateral shoulder pain, deformity, swelling, and markedly restricted arm elevation. Neurological and distal vascular examinations were normal. Radiographs demonstrated displaced bilateral midshaft clavicle fractures (Allman Group I), with no associated thoracic or systemic injuries. Due to significant displacement and bilateral involvement, open reduction and internal fixation was performed using 8-hole titanium anatomical locking plates on both sides through an anterior approach. Stable fixation was confirmed intraoperatively. Early pendulum exercises were initiated, followed by progressive passive and active range-of-motion rehabilitation. Postoperative recovery was uneventful. At 1 month, the patient achieved shoulder abduction of 110° on the right and 100° on the left, with full muscle strength bilaterally. Serial imaging demonstrated progressive fracture consolidation with maintained anatomical alignment. Bilateral displaced midshaft clavicle fractures, though rare, can be effectively managed with anatomical locking plate fixation, providing stable reconstruction and permitting early mobilization. This case reinforces the value of operative intervention in high-energy bilateral clavicular injuries, contributing to the limited but growing evidence guiding treatment of this uncommon trauma pattern.

Tibial plateau fractures account for approximately 1% of all fractures and are clinically significant due to their intra-articular features, which may compromise the long-term functionality, symmetry, and rigidity of the knee. Evaluation of the results of tibial plateau fractures treated with open reduction and internal fixation (ORIF) using plate osteosynthesis was the goal of this prospective observational study. Forty patients with closed tibial plateau fractures, aged 18 to 70, participated in a systematic prospective study conducted at Chettinad Hospital. All patients had ORIF with plate osteosynthesis. Individuals were monitored at 1, 3, and 6 months, and functional results were evaluated using the Modified Rasmussen Score. In the present investigation of 40 tibial plateau fracture individuals, 87.5% were male, and the average age was 40.15 years. The most common causes (77.5%) were automobile accidents. Schatzker type VI (22.5%) and type V (20%) fractures were most common. The average surgery time was 75.9 minutes, and the average union time was 15.9 weeks. Modified Rasmussen Scores improved from 13.95 preoperatively to 25.85 after six months. Ninety-five per cent of those treated achieved satisfactory to outstanding results at final follow-up. Implant discomfort or infection occurred in 7.5% of cases. Success required restoring joint congruity, positioning, and rigidity. Tibial-plateau fractures, a complex category of intra-articular fractures, present substantial problems owing to their complex nature and capacity for functional problems. Located in the proximal end of the tibia, these fractures represent a minor proportion of overall fractures. However, they have a disproportionately large impact, particularly in the elderly population, where they are responsible for a large number of fractures. Effective treatment of these fractures is essential to reducing long-term functional deficits and enhancing patient well-being. In summary, tibial plateau fractures can be effectively treated with ORIF with plates, which encourages quick healing and reduces the risk of long-term impairment.</p>.

This paper describes a pelvic procedure that is technically simpler, quicker to perform, and equally effective as all existing pelvic osteotomies. It is used alongside hip open reduction for the treatment of the associated acetabular dysplasia. It is a minimal additional procedure that is intended to ignite the growth of the dysplastic acetabulum. A total of 167 hips (in 154 infants) treated with open reduction and growth-stimulating minimal acetabuloplasty, all with follow-up between 4 and 16 years postoperatively, are reported. The surgical technique is described. Sequential radiographs were analyzed through to final follow-up, which for 21% is to skeletal maturity. Patient demographics, preoperative and sequential postoperative indices, and outcomes are recorded. Preoperative IHDI position was grade IV dislocation in 77% and grade III in 33%. Mean starting acetabular index (AI) was 41.3 degrees (range 30 to 54 degrees) and median age at operation was 13 months (range from 1 to 2.5years). At final follow-up, 98.2% of hips have a Severin 1 (excellent) or 2 (good) outcome, with the AI normalized. These are all IHDI grade 1 and have a mean center-edge-angle of 35.7 degrees. Only 6 of these (3.6%) have warranted a subsequent pelvic osteotomy for residual acetabular dysplasia. The growth-stimulating minimal acetabular procedure is technically straightforward. It is simpler than standard existing pelvic osteotomies, yet it is shown to be at least as effective. With up to 16 years follow-up, we can highly commend its routine use alongside hip open reduction in infants aged 1 to 2.5 years old. Level III-case-control study.

Highly Porous Metal Revision Cup with a Cemented Dual Mobility Bearing Reduces Instability Following Complex Acetabular Reconstructions: A Minimum Two-Year Follow-Up.

Background: Despite the frequent occurrence of ankle injuries, there is no consensus among orthopedic surgeons regarding the diagnosis and treatment of syndesmotic injuries. This study evaluates the clinical and radiological outcomes of three-cortex syndesmotic fixation in Weber type B/C lateral malleolus fractures (with or without medial malleolus involvement) associated with syndesmotic injury. Material and Method: This study analyzed thirty-six (36) patients with Weber type B/C lateral malleolus fractures treated between 2011 and 2022. All underwent open reduction and fixation with plates and screws for malleolar fractures, along with a 3.5 mm cortical syndesmosis fixation using three cortical engagements. Preoperative and postoperative radiological findings and final functional ankle assessments were reviewed. Intraclass correlation coefficients (ICC) were used to assess inter- and intra-observer agreement for tibiofibular clear space (TFCS), tibiofibular overlap (TFO), medial clear space (MCS), and anterior tibiofibular ratio (ATFR) measurements. The functional status of the ankle has been assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale. Results: The mean age of the patients was 50.56 ± 16.23 years, and the mean follow-up duration was 20.89 ± 24.93 months. Postoperative AOFAS scores averaged 91.08 ± 9.90. The inter-observer agreement for preoperative assessments was excellent across all parameters (ICC > 0.9). However, in the postoperative period, inter-observer agreement for ATFR measurement was poor (ICC < 0.5), while agreement for all other parameters remained excellent (ICC > 0.9). Intra-observer comparisons of preoperative (pre-op) and postoperative (post-op) measurements were poor across all parameters (ICC < 0.5); this can be attributed to the success of reduction, reflecting the positive directional change on all parameters. After an average follow-up of 20 months, four radiological parameters showed significant differences, indicating enhanced stability and reduced diastasis. Conclusions: Three-cortex syndesmotic screw fixation in Weber type B/C lateral malleolus fractures with syndesmotic injuries yielded excellent mid-term radiological and functional outcomes.