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Functional and Radiological Outcomes Following Volar Locking Plate Fixation for Distal Radius Fractures: A Prospective Analytical Study (2025)

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Type of publication:

Journal article

Author(s):

Mohankumar, Mahesh; *Murugesan, Thivagar; Balamurugan, P; Venkadesh, A; Vishal, M; Muralikrishnan, R.

Citation:

Journal of Orthopaedic Case Reports. 15(12):421-429, 2025 Dec.

Abstract:

Introduction: Most frequent injuries of the Upper limb are a distal radius fracture (DRF). If they aren't handled well, they might cause problems for a long time. There are several techniques to treat this issue, but volar locking plate fixation has become increasingly prevalent since it may restore anatomical alignment, provide stable fixation, and allow for early movement. This study aimed to evaluate the functional and radiological results of distal end radius fractures treated with volar locking plate
fixation.

Materials and Methods: In this prospective analytical investigation, 60 patients with DRFs, ranging in age from 18 to 80 years, were enrolled. Patients were treated with open reduction and internal fixation using volar locking devices. Functional results are evaluated using the Gartland and Werley Demerit Point System and goniometry. Radial length, radial inclination, palmar tilt, and articular step-off were employed to quantify radiological outcomes. Follow-up evaluations were conducted at 2, 4, and 6 weeks, in addition to 6 months. We used the Statistical Package for the Social Sciences version 20 to analyze the data and discovered that P < 0.05 was significant.

Results: Patients exhibited substantial improvement in wrist function across all planes of motion, with plantar flexion rising from 31.6degree at 2 weeks to 67.8degree at 6 months, and dorsiflexion from 31.7degree to 66.4degree. Supination and pronation also became a lot better, becoming close to normal levels after 6 months. The radiographic restoration was good, with a mean radial length of 8.8 mm, an inclination of 17.6degree, and a palmar tilt of 8.9degree. There were very few complications (6.7% arthritis, 6.7% malunion).

Discussion: Our results support previous research showing volar plating offers robust fixation, restores anatomical alignment, and facilitates early mobility. Correlation study revealed that palmar tilt and articular congruity substantially impacted functional recovery, emphasizing the need of meticulous surgical reduction.

Conclusion: Volar locking plate fixation is an effective treatment for DRFs, characterized by low complication rates and excellent functional and radiological outcomes.

DOI: 10.13107/jocr.2025.v15.i12.6578

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Root causes of surgical never-events: a systematic review (2026)

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Type of publication:

Systematic Review

Author(s):

Parmar, Dilen; *Patel, Neil; Kenneth-Ogah, Catherine; Yazdouni, Sadat; Desai, Chaitya; Raveshia, Dimit; Patel, Ravi.

Citation:

Patient Safety in Surgery [Electronic Resource]. 2026 Jan 08.

Abstract:

Background
Never-events represent serious and preventable patient safety incidents within surgical practice, despite increasing national and international efforts to reduce them. Persistent concerns regarding wrong site surgery, retained surgical items, and incorrect implants highlight the need to understand contributory human factors and system-level weaknesses.

Methods
A systematic search of PubMed/Medline, Google Scholar, and the Cochrane Library was conducted. Evidence published between 2014 and 2024 was screened according to predefined eligibility criteria to identify contemporary data relating to surgical never-events. Studies were assessed using standardised selection methods and relevant findings were extracted and synthesised.

Results
Thirty-seven studies met inclusion criteria. Across international literature, recurring contributory factors included communication breakdowns, reduced situational awareness, fatigue, inadequate staffing, inconsistent team composition, and increasing surgical caseloads. Despite advances in safety practices, these factors continued to contribute to adverse surgical outcomes.

Conclusion
Never-events remain a persistent challenge in surgical care. Strengthening safety management systems, improving awareness of human factors, and prioritising non-technical skills training may help reduce the risk of these events. Ongoing evaluation of interventions and further UK-based research are required to support improvement in patient safety outcomes.

Data availability
All data generated or analysed in this study are derived from published articles and are included within this manuscript and its supplementary materials.

DOI: 10.1186/s13037-025-00474-8

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RESECT: A Randomised Controlled Trial of Audit and Feedback in Non-muscle-invasive Bladder Cancer Surgery (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gallagher K.; MacLennan S.; Bhatt N.; Clement K.; Zimmermann E.; Khadhouri S.; Kulkarni M.; Gaba MPhil F.; Anbarasan T.; Asif A.; Light A.; Ng A.; Chan V.W.-S.; Nathan A.; Cooper D.; Aucott L.; Sakthivel D.; Akand M.; Piazza P.; Marcq G.; O'Brien T.; Nielsen M.; Giudice F.D.; Simpson K.; Orecchia L.; Teixeira B.; Geisenhoff A.; Hill G.; Fukuokaya W.; Hidalgo B.G.; El-Hajj A.; Elgamal M.; Fanshawe J.; Wang B.; Lee T.; Manecksha R.; Rivas J.G.; Arda E.; Elhadi M.; Rossi S.; Teoh J.Y.-C.; Kasivisvanathan V.; Hussein I.; Longshaw A.; Kostakopoulos N.; Khadhouri S.A.S.; Kruczynska A.E.; Dimitropoulos K.K.D.; McPhee A.; Gilanliogullari K.P.; Natalie S.; Rutigliani L.; Shallcross O.R.; Dokubo I.I.; Lamb B.W.; Jimie J.H.; Hussein B.; O'Neill C.; Nelson A.R.; MacLeod A.; Arumainayagam N.; Maqboul F.; Agrawal S.; Burns H.; Bekarma H.J.; Mohammad S.; Misurati M.O.; Raslan M.Y.; Anwar A.; Gkikas C.; Alexander C.; Warren H.; Byrnes K.; Edison M.; Croghan S.; Oo E.; Beder D.; Thurtle D.R.; Janebdar H.; Reeves F.; Chua C.U.; Mcalindon J.; Hasan H.; Ng P.Y.; Mayor N.; Attar H.A.; Delacave H.S.T.; Atiyah A.; Atiyah Z.; Jelski J.E.R.; Peacock J.; Davenport K.; Shipstone D.; Malla R.A.; Krishna K.K.I.; Nizov A.; Somov P.; Ahmed Z.; McCann C.; Glackin A.J.; Asaad W.; Bain A.J.; Bordenave M.G.; Ray E.R.; Ghonaimy A.S.; Madaan S.; Fontaine C.L.L.; Daggamseh A.M.K.; Pascoe J.J.; Horn C.; Fuge O.; Laoye A.; Deytrikh A.; Thomas A.G.; Ravishankar K.; Clark M.C.; Panayi Z.; Shillito S.H.; Srirangam S.J.; Bradley C.; Lee X.W.J.W.J.; Mcilhenny C.; Leask J.; sarkar S.; chetwood A.S.A.; Paramore L.; Ali A.S.A.; Odey J.; Sheweita M.S.S.; Ekwueme K.C.; Yogeswaran C.; Mohamed Y.; Trimboli M.; Shafii M.; Duffy S.A.; Morton S.; Bandeira de Mello K.L.; Harris A.; Bruce A.; Fanshawe J.R.; Tan N.J.; Mensah E.; Walters U.; Lami M.; Omar M.A.; Kadhim H.; Gami M.N.; Hawizy A.A.M.H.; Devadoss B.J.; Breish M.; Pina I.; Cresswell J.; Simoes A.; Papadopolous G.G.; Thomas M.M.T.; Ahmed I.I.A.; Sekhon N.C.; Alleemudder A.; Okwuchi D.D.; Willmott S.V.; Majumdar P.; Coyle M.; Simson N.; Egbe A.; Nair A.; Nair M.A.N.; Kailavasan M.; Douglas-Moore J.L.; Elajnaf M.R.; Jackson B.L.; Hamami H.; Hemmant J.; Siraj M.; Craciun M.E.; Lyttle M.; Shendy M.S.; Abdalla A.; Mukherjee R.; Mihuna A.; Kantartzi A.; Atkins C.R.M.; Uddin J.; Motiwala F.; Fanshawe J.B.; Mxxxensah E.; Chan K.H.Y.; Vasdev N.N.V.; Hassan M.M.; Pushkaran A.K.; Salik M.; Barrass B.J.R.; Jones A.; Shakir J.; Waterhouse R.H.; Tan S.; Shah S.; Simpson R.G.; Mohee A.R.; Smith P.M.; Middela S.G.; Gunendran T.; Bhat T.; Mehmood S.M.; Masood S.; Karna S.; Ibiok I.A.; Ollandini G.; Yarwood A.; Hill G.T.; Kanda Swamy G.V.; Healy R.; Faek Halaseh S.A.; Lee S.-M.; Hughes C.M.; Ali O.H.; Boaz R.J.; Gabriel M.M.; Finch W.; Hammad O.O.; Heba S.T.; Yun J.W.; Pandian S.K.; Oliver R.L.; Almpanis S.S.A.; Boxall N.E.; Adamu-Biu F.I.; Pushpa-Rajah J.A.; Miakhil I.; Mera Z.; Sultana A.; Potter J.J.; Coombs L.; Laghari S.; Khan I.A.; Warner R.M.; Olaitan O.; Akman J.; Green W.J.F.; Dooldeniya M.D.; Turo R.K.; Kabia A.A.; Onowa V.E.; Anand C.V.; Tanasescu G.G.T.; Sells L.A.; Acyatan M.G.; Smith T.G.; Lokman U.U.L.; Ramachandra M.; Hodgson D.J.; *Sid Ahmed M.A.M.B.; *Moghe D.; *Ong K.K.; *Tasleem A.M.; Blick C.; Toia B.B.T.; Maduwe Gedara S.R.K.R.K.; Mohsin H.; Bleakley C.; McGrath M.J.; Ng M.G.; Parsons B.; Lindsay J.S.; Volanis D.; Wijayasuriya D.S.C.R.; Wilkinson J.; White A.; Cox A.; Calmuc A.; Fung C.; Taktak S.; Lazarowicz H.P.; Starmer B.; Chippagiri A.S.; Gallegos C.; Kerr E.; Penny N.M.; Green E.A.; Jones C.M.; Colvin H.V.; David R.; Davies M.; Qamar B.Q.; Humayun-Zakaria N.K.; Hussain A.; Dhanasekaran A.K.; Mangera A.F.; Pereca J.L.P.; Akinjise-Ferdinand O.; Rosario D.J.; *Dhother J.; *Mohamed G.; *Jenny Bo Y.N.; *Chin Chin Y.F.Y.F.; *Varma R.K.; *Elves A.; Elmansouri A.J.N.V.; Edris F.F.E.; Voss J.; Parfitt C.M.; Buckland G.R.E.; Antoniou V.; Sinha M.M.; Douglas J.; Campbell J.M.; Bondad J.; Khuoge S.; Gipson C.; Dawam D.; Lecoyte A.; Waley L.G.; Hawthorne R.; Ridgway A.; Warren K.S.; Maniarasu S.; Mistry R.; Stroman L.; Hassan M.; Ayres B.; Pinkney R.T.M.; El-Taji O.; McCabe J.; Oliyide A.E.; Chibuzo I.N.C.; Vaggers S.N.; Dyer J.E.; MacKenzie K.R.; Miller A.; Tait C.D.; Thorman H.E.; Ippoliti S.; Ilie P.C.; Babawale O.D.; Mitchell V.; O'Rourke S.; Ross A.; O'Halloran R.; Hayes J.; Gray S.B.; Day E.K.; Shirwac H.; jaibaji R.; Tang S.C.; Kennedy C.; Szabados B.; Baldini C.; Nowers J.; Sarmah P.P.B.; Williams K.G.; Tan L.J.; Boden A.K.; Simpkins S.J.; Clement K.D.; Khan R.S.S.; Ravindraanandan M.; Lango A.; Kitchen M.; Gommersall L.M.; Thomas M.; Al-Mitwalli A.; Featherstone J.M.; Catto J.; Chari N.; Nikolinakos P.; Ellis D.S.J.; Papadopoulos D.I.; Charitopoulos K.; Carey M.M.; Gordon E.M.; Lau D.H.W.H.; El-Koubani O.; Ayers J.R.S.; Hina S.; Gartner T.; James J.E.G.; Simpson K.R.S.; Mariappan P.; Ibrahim M.E.; Dallash M.H.; Jallad S.; Bencatova Z.; Karanjia R.N.; Whiting D.; Frymann R.J.; Farag S.S.F.; Whitburn J.A.S.; Miah S.; Khattab H.; Kondylis F.; Amin Alsayed Alkhawalka M.A.

Citation:

European Urology. (no pagination), 2025. Date of Publication: 2025.

Abstract:

Background and objective We aimed to determine whether audit, feedback, and education improves surgical performance after transurethral resection of bladder tumour surgery for non-muscle-invasive bladder cancer and as a secondary aim if it reduced recurrence rates. Methods This cluster randomised controlled trial compared audit and feedback plus peer comparison and education, with audit alone for four coprimary outcomes: (1) Single-instillation chemotherapy, (2) detrusor muscle sampling, (3) documentation of tumour features, and (4) resection completeness. Early recurrence was a secondary outcome. Key findings and limitations A total of 100 sites were randomised to intervention and 101 to control. In total, 14 915 patients were included. Intervention sites significantly improved documentation of tumour features (adjusted mean difference [95% confidence interval {CI}]: 6.0 [1.8, 10], p = 0.005) and of resection completeness (adjusted mean difference [95% CI]: 5.5 [1.5, 9.5], p = 0.007). There was no statistically significant difference in chemotherapy use (adjusted mean difference [95% CI]: 0.3 [-4.7, 5.3], p = 0.9) or detrusor muscle sampling (adjusted mean difference [95% CI]: 2.6 [-1.3, 6.4], p = 0.2). There was no statistically significant difference in early recurrence rate between arms (adjusted odds ratio [95% CI]: 1.02 [0.8, 1.4], p = 0.9); however, in the control arm, the early recurrence rate reduced compared with baseline (adjusted odds ratio [95% CI]: 0.7 [0.6, 0.9]). Conclusions and clinical implications Audit and feedback with education improved the documentation of important surgical findings that influence clinical management, but not the performance of detrusor muscle sampling, adjuvant chemotherapy use, or early recurrence rates. Improvements observed in the control arm may explain a lack of effect of the intervention in some outcomes.

DOI: 10.1016/j.eururo.2025.09.4174

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The Profound Impact of the COVID-19 Pandemic on the Epidemiology of Quadriceps and Patellar Tendon Ruptures: Insights From a Single Trust in the United Kingdom (2025)

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Type of publication:

Journal article

Author(s):

*Murugesan, Thivagar; *Abdullmalek, Hidayatul Rasyidah Syida; *Kondi, Suresh; *Rehman, Hamood Ur; *Carmont, Mike; *Heaver, Catriona; *Okoro, Tosan.

Citation:

Cureus. 17(11):e98022, 2025 Nov.

Abstract:

Introduction Quadriceps and patellar tendon ruptures are uncommon but disabling injuries that require surgical repair. Changes in physical activity patterns during and after the COVID-19 pandemic may have influenced their occurrence. This study compares the incidence, demographics, and seasonal distribution of these injuries before and after the pandemic within a single UK NHS trust. Methods A retrospective review was performed of all patients undergoing primary repair of quadriceps or patellar tendon ruptures at the Shrewsbury and Telford NHS Trust from January 2014 to December 2024. The pre-COVID period (2014-2019) was compared with the post-COVID period (2021-2024), with 2020 excluded due to major service disruption and atypical clinical pathways during the first pandemic year. Annual incidence rates were calculated as cases per 100,000 population, using year-specific catchment population estimates from the Office for National Statistics (ONS). Demographic variables, injury characteristics, and seasonal patterns were extracted from electronic records. Between-period comparisons used the Mann-Whitney U test. No adjustment for age, BMI, or comorbidities was performed. Results A total of 203 patients were identified, including 95 pre-COVID and 108 post-COVID. The median age was 63 years (range 15-90), with a male-to-female ratio of 7.8:1. Injuries occurred most frequently in autumn (28%). The median annual incidence increased from 4.6 per 100,000 pre-COVID to 8.3 per 100,000 post-COVID (incidence rate ratio 1.8, p = 0.0073). The median number of cases per year rose from 16 to 27 between periods. Conclusion The incidence of surgically treated quadriceps and patellar tendon ruptures increased in the post-COVID period. Although the study does not adjust for potential confounders, the findings suggest an association between the post-pandemic era and higher injury rates. Further research with multivariable analysis is needed to clarify contributing factors.

DOI: 10.7759/cureus.98022

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Shoulder Injury Related to Vaccine Administration (SIRVA) After COVID-19 Vaccination: A Retrospective Study (2025)

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Type of publication:

Journal article

Author(s):

*Manoharan, Gopikanthan; *Murugesan, Thivagar; Winton, Jo; Smith, Matthew; Brownson, Peter.

Citation:

Cureus. 17(11):e98023, 2025 Nov.

Abstract:

BACKGROUND: The global administration of billions of COVID-19 vaccine doses has raised concerns about potential adverse effects, contributing to vaccine hesitancy. While transient mild discomfort is common after intramuscular vaccination, persistent and severe post-vaccination shoulder pain has led to recognition of Shoulder Injury Related to Vaccine Administration (SIRVA). SIRVA is characterised by shoulder pain and restricted range of motion typically occurring within 48 hours of inoculation, thought to result from inadvertent vaccine delivery into the subdeltoid bursa. In addition to its clinical definition, SIRVA is also viewed as a medicolegal construct, particularly in the context of vaccine injury compensation frameworks. This study aimed to describe our experience with patients presenting with SIRVA-like symptoms following COVID-19 vaccination, compare these findings with published literature, and assess clinical outcomes.

METHODS: A retrospective study was conducted at a major trauma centre. All patients presenting to the orthopaedics department with atypical shoulder symptoms following COVID-19 vaccination between January and December 2021, with at least six months of follow-up, were reviewed. Only patients meeting the Health Resources and Services Administration (HRSA) Vaccine Injury Table diagnostic criteria for SIRVA were included. Data on demographics, vaccine type, clinical findings, investigations, treatment, and outcomes were collected.

RESULTS: Of the 31 patients presenting with post-vaccination shoulder symptoms, 16 (52%) met the HRSA criteria for SIRVA. The mean age was 54 years, and 63% were female. All patients presented with shoulder pain and reduced range of motion. The mean follow-up duration was 12 months. Most patients (94%) were treated non-operatively with analgesia, nonsteroidal anti-inflammatory drugs (NSAIDs), and physiotherapy. At one-year follow-up, 44% achieved complete or near-complete recovery, while 31% (n =5) reported no improvement and required specialist referral.

CONCLUSION: SIRVA is a rare complication following COVID-19 vaccination and is best considered a medicolegal term rather than a definitive diagnosis. Strict adherence to diagnostic criteria is essential, as overdiagnosis may occur among patients with coincidental post-vaccination shoulder pain. While most cases resolve with conservative management, a subset may experience persistent symptoms. Evidence suggests that SIRVA is more likely related to improper injection technique rather than the vaccine itself.

DOI: 10.7759/cureus.98023

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A Comparison of 1.5-Stage and Two-Stage Revisions for Prosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Meta-Analysis of Outcomes (2025)

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Type of publication:

Systematic Review

Author(s):

*Ibrahim, Abdelrahman; Khamdan, Khadija; Sadiq, Salman; *Lyeeq, Ahmed; Narayanswamy, Nikhil; Saeed, Abu.

Citation:

Cureus. 17(11):e98180, 2025 Nov.

Abstract:

Prosthetic joint infection (PJI) is a devastating complication of total hip and knee arthroplasty. Whilst two-stage revision has long been considered the gold standard treatment, the 1.5-stage revision has emerged as a viable alternative. However, the optimal surgical strategy remains a subject of debate. The aim of this meta-analysis was to evaluate the comparative outcomes of 1.5-stage versus two-stage revision for PJI. A
systematic search of electronic data sources and bibliographic reference lists was conducted. All studies reporting comparative outcomes of 1.5-stage versus two-stage revision were included, and their risk of bias was assessed. Reinfection, failure of infection eradication, aseptic loosening, overall complications, readmission, and periprosthetic fracture were the evaluated outcome parameters. All comparative studies reporting on patients who underwent either a 1.5-stage or a two-stage revision were included in the final analysis. The 1.5-stage revision was associated with a significantly lower rate of reinfection (odds ratio (OR): 0.62; 95% confidence interval (CI) 0.40-0.96, p = 0.03) but a significantly higher rate of aseptic loosening (OR: 6.12; 95% CI 1.09-34.22, p = 0.04) when compared with the two-stage revision. No significant difference was found in the rates of infection eradication (OR: 1.35; 95% CI 0.80-2.27, p =
0.26), overall complications, readmission, dislocations, or periprosthetic fracture between the two groups. A subgroup analysis for knee PJI was consistent with the main analysis for reinfection. The meta-analysis of the best available evidence indicates that a 1.5-stage revision for PJI is associated with a lower rate of reinfection but a higher risk of aseptic loosening. High-quality randomized controlled trials are needed to
definitively establish the optimal surgical strategy for managing PJI.

DOI: 10.7759/cureus.98180

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Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials. (2025)

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Type of publication:

Systematic Review

Author(s):

Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; *Khalid, Saad Muhammad; Hasan, Ali; Majeed, Salman; Shahzad, Muhammad Aamir; Shahzad, Maryam; Ahmed, Mushood; Ahmed, Raheel; Gardezi, Syed Anjum.

Citation:

International Journal of Colorectal Disease. 2025 Dec 30.

Abstract:

BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

DOI: 10.1007/s00384-025-05014-5

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Intravenous fluid mismanagement: time for national stewardship and quality improvement (2025)

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Type of publication:

Journal article

Author(s):

Breen, Andrew; *Miller, Ashley; Timmins, Alan; Barton, Greg; Kirk-Bayley, Justin; Peck, Marcus John Edwards; Davis, Huw John; Wilkinson, Jonathan.

Citation:

BMJ Open Quality. 14(4), 2025 Dec 14.

DOI: 10.1136/bmjoq-2025-003503

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The Impact of Smoking on Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Systematic Review

Author(s):

*Ibrahim, Abdelrahman; Al-Musabi, Musab; Kabariti, Rakan; Kempe-Gowda, Swarna; Wade, Roger.

Citation:

Cureus. 17(11):e96765, 2025 Nov.

Abstract:

The influence of smoking on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction is a topic of ongoing scientific discussion and uncertainty. We aimed to conduct a systematic review and meta-analysis to compare the outcomes between smokers and non-smokers undergoing this procedure. We conducted a systematic search of electronic information sources, including MEDLINE, EMBASE, CINAHL, CENTRAL, ClinicalTrials.gov, and bibliographic reference lists. We applied a combination of free-text search and controlled vocabulary search adapted to thesaurus headings, search operators, and limits in each of the above-mentioned databases. Primary outcome parameters included surgical site infections, ACL graft rupture, revision rates, and patient-reported outcome measures (PROMs). We identified 24 comparative studies, including a total of 672,241 patients, of whom 69,113 were in the smoker group and 603,128 were in the non-smoker group. The analysis revealed that smoking was associated with a significantly higher risk of surgical site infections (OR 1.40, P=0.01). Smokers also reported significantly worse PROMs on the International Knee Documentation Committee (IKDC) score (MD -5.38, P<0.00001) and multiple Knee Injury and Osteoarthritis Outcome
Score (KOOS) subscales. There was no statistically significant difference between the two cohorts for ACL graft rupture or all-cause revision rates. Smoking appears to be associated with a higher risk of surgical site infections following ACL reconstruction and is linked to significantly poorer functional PROMs.

DOI: 10.7759/cureus.96765

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Mortality from tibial shaft fractures in the elderly (MTFE)-a multicentre study of management outcomes (2025)

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Type of publication:

Journal article

Author(s):

Azhar M.S.; Selim A.; Daoub A.; Farhan-Alanie M.M.; Shah R.

Citation:

Injury. 56(12) (no pagination), 2025. Article Number: 112806. Date of Publication: 01 Dec 2025.

Abstract:

Introduction The mortality rate for tibial shaft fractures in the elderly is comparable to that of hip fractures, yet there is considerable variation in their management. Operative treatment allows for earlier weight-bearing and reduces potential complications of prolonged immobilization; however, it carries risks for this comorbid cohort. The main objective of this study was to assess the difference in 1-year mortality between operative and non-operative management. Methods A multicentre study was conducted across six trusts in England, including eight acute hospitals: three major trauma centres and five district general hospitals (DGHs). Data were collected retrospectively, covering a 5-year period from January 2017 to December 2021. The study included all patients aged 65 and over with diaphyseal tibial fractures (AO42). Patients with non-acute (>3 weeks), periprosthetic, pathological, or multiple lower limb fractures were excluded. Results A total of 171 patients were identified, comprising 38 % males and 62 % females. Of these, 59.6 % were managed operatively, while 40.4 % were managed non-operatively. The median length of stay was similar between groups (8 days non-operative vs. 8.5 days operative, p = 0.87). Non-union (21.7 % vs. 6.3 %, p < 0.001) and malunion rates (27.7 % vs. 4.6 %, p = 0.001) were significantly higher in the non-operative group. One-year mortality was also higher in the non-operative group (38.3 % vs. 12.1 %, p < 0.001). Univariate and multivariate analyses showed an odds ratio of 4.5 and 4.7 for one-year mortality with non-operative treatment, with p -values of <0.001 and 0.005, respectively. Conclusion This study demonstrated that non-operatively treated tibial shaft fractures in the elderly are associated with significantly higher rates of non-union, malunion, and 1-year mortality. Therefore, we recommend an expedited multi-disciplinary approach to managing these patients, including surgical treatment and unrestricted weight bearing where possible, to optimize outcomes. Level of Evidence Level III.

DOI: 10.1016/j.injury.2025.112806

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