Trauma and orthopaedics

Rotating Hinge Knee Versus Constrained Condylar Knee Revision: A Single Centre, Retrospective Comparative Study (2026)

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Type of publication:

Journal article

Author(s):

*Bishi, Habeeb; Afzal, Irrum; Wang, Chao; Stammers, John; Madanipour, Suroosh; Radha, Sarkhell; Field, Richard; Mitchell, Philip; Alazzawi, Sulaiman.

Citation:

Cureus. 18(7):e112443, 2026 Jul.

Abstract:

Introduction In revision total knee arthroplasty, rotating hinge implants (RHK) have been presumed to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). This study aimed to compare patient-reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high-volume elective orthopaedic centre with a previously validated bespoke database. Methods Patients (n=108) who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EuroQol Five Dimensions (EQ5D), EuroQol Five Dimensions (EQ5D)-Health State and Oxford Knee Scores were collected pre-operatively and at one year post-operatively. Complication data was collected at six weeks, six months and one year post-operatively. National Joint Registry (NJR) data were interrogated, in addition to our orthopaedic database, to investigate implant survival with a maximum follow-up of 12 years. Results There was no statistical significant difference between RHK and CCK in implant survival at two to 12 years of follow up. In addition, we observed no statistical significant difference in the PROMs scores and complication rates of the two implants. Conclusion This study shows that both the RHK and CCK remain viable options in revision arthroplasty; the implant survival and complication rates were comparable. We recommend future research through prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty.

DOI: 10.7759/cureus.112443

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Infection following foot and ankle surgery : a subanalysis of data captured from the UK Foot and Ankle Thromboembolism (FATE) audit (2026)

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Type of publication:

Journal article

Author(s):

Shepherd, Jenna; Mason, Lyndon; Houchen-Wolloff, Linzy; Malhotra, Karan; Mangwani, Jitendra; Ahmad, Irfan; Zeb, Junaid; Ishaq, Usman; Thomas, Jija; Jain, Kowshik; Goff, Thomas; Bagshaw, Oliver; Slade, Henry; Andrzejowski, Paul; Gomati, Ayoub; Drake, Chris; Akram, Nimra; Lowdon, Hamish; Sherif, AhmedKamel-; Jones, Anette; Best, Alistair; Zabaglo, Mate; Masunda, Stanley; Federer, Simon; Ahmad, Faheem; Lashin, Ahmed; Kaddah, Ahmed; Oladeji, Emmanuel; Dawe, Ed; Akram, Nimra; Al-Hubeshy, Zahra; Patel, Bhavi; Hussein, Mohamed; Clark, Callum; Giddie, Jasdeep; Dega, Raman; Islam, Amirul; Molloy, Andy; Nusir, Ben; Chapman, James; Holmes, David; Mamoowala, Neville; Almond, Kieran; Wright, Claire; Loveday, David; Bawa, Akshdeep; Gilmore, Rebecca; Schankat, Kerstin; Koc, Togay; Morcos, Zeid; Robertson, Gregory; Holmes, Natal; Tribe, Howard; Pearkes, Tim; Soliman, Ahmed; Valente, Lucia; Ajis, Adam; Ghani, Yaser; Chandrashekhar, Suresh; Millan, Ravi Kant; Elhassan, Yahya; Adeniyi, Adebowale; Aspinall, Will; Matthews, Hannah; Shiers-Gelalis, Fleur; Ting, Jason; Place, Stuart; Budgen, Adam; Stanley, James; Jowett, Charlie; Welck, Matthew; Patel, Shelain; Sykes, Adam; Thibbaiah, Mahesh Mamballi; Hadi, Hosain; Haldar, Anil; Ardakani, Amir Gahanbani; Jani, Priyanka; Prasanna, Anil; Blomfield, Mark; Craven, Joanna; Malhotra, Anubhav; Toner, Aileen; Jackson, Gillian; Render, Luke; Ashley, Connor; Limb, Richard; Ayyaswamy, Brijesh; Prasad, Pradeepsyam; Anand, Mr; Sunilraj, Dr; Lane, Suzanne; Prathap, Swetha; Limaye, Rajiv; Johnson-Lynn, Sarah; Sethi, Mohit; *Zahra, Wajiha; *Heaver, Catriona; Duffy, Sean; Harries, William; Riddick, Andrew; Ghobra, Amro; Kinsey, Harry; Marsh, Luke; Corin, Nicole; Walls, Andrew; Robinson, Peter; Winson, Ian; Lines, Steve; Morriss, Felix; Pwint, Zalatt; Ghandour, Omar; Hepple, Steve; Smith, Robert; Hughes, Luke; Mohamed, Muyed; Fraser, Debbie; Elhalawany, Ahmed; Beastall, James; Cousins, Gerard; Nunag, Perrico; Deol, Rupinderbir; Faroug, Rad; Johal, Karan; Mordecai, Simon; Argyropouos, Miltiadis; Chawla, Amit; Ibrahim, Mohamed; Pereira, Marta; McIntyre, Joshua; Blacklock, Calum; Middleton, Scott; Clayton, Robert; Tong, Aureola; Joyner, Claire; Dean, Mike; Hughes, Adrian; Shuttlewood, Kimberley; Little, Zoe; Saleem, Jawaad; Jolly, Lewis; Jain, Aman; Qadri, Ansar; Alvi, Farhan; Jacob, Jagan; Reddy, Raji; Sateesh, Vaishnav; Hrycaiczuk, Alex; Thornhill, Christopher; Jeyakumar, Gowsikan; Vaithilingam, Delani; Potter, Kate; Jamal, Bilal; Chan, Pete; Barton, Tristan; Robinson, Derek; Graham, Selina; Zeolla, Julian; Kapoor, Smriti; Bailey, James; Mukhopadhyay, Ishani; Rana, Sarina; Tarig, Hamza; Qualaghassi, Mahdi; Seewoonarian, Sheena; Rose, Barry; Makwana, Nilesh; Kaisi, Kahlan Al; Al-Musabi, Musab; Crate, Georgina; Abbott, Sarah; Fenner, Christopher; Geleit, Ryan; Yousaf, Sohail; Flanagan, George; Uddin, Akram; Reilly, Ian; Pillai, Anand; Madhi, Imad; Alsalihy, Mazin; Elamin, Khadija; Yip, Chee Rong; Tew, Lucy; Dahiya, Rohan; Sayani, Junaid; Kyaw, Olive; Khin, Chan; Ali, Ramla; Shaik, Yousufuddin; Hossain, Natasha; Guha, Abhijit; Pereira, Melwyn; Ayoub, Atif; Paraoan, Vlad; Hali, Nayeem; Baird, Charles; Kugan, Raj; Abdallatif, Ahmad; Bashir, Muhammad Amer; Saini, Jigyasa; Atkinson, Henry; Lever, Caroline; Bansod, Vaibhav; Iyengar, Kartik; Wadood, Abdul; McMillan, Lara; Toh, Eugene; Rymaruk, Sophy; Igbagiri, Kueni; Gaukroger, Andrew; Solan, Matthew; Peacock, Christian; Fan, Ka Siu; Lau, Benjamin; Naik, Arjun; Tung, Eleanor; Murhekar, Siddhartha; Ray, Mr Robbie; Lyle, Miss Shirley; Shaikh, Rabia; Alfred, Wilam; Okhifun, Imobhio; Cinar, Ece; Bua, Nelson; Vemulapalli, Krishna; Acharya, Ashok; Teoh, Kar; Kamat, Sanil; Bajracharya, Abhijit; Ngwayi, James Reeves Mbori; Imtiaz, Galal; Blackmore, Noah; Clark, Andrew; Rahman, Kashed; Sykes, Mark; Joseph, Vinay; Day, Miriam; Kulkarni, Avadhut; Garabadi, Mohanrao; Akhtar, Meraj; Hossain, Munier; Yunus, Shamael; Saleem, Maleeha; Fong, Joanna; Simons, Michiel; Hodgson, Paul; Thomas, Rhys; Stevens, Sam; Dasari, Kishore; Nandhara, Gurbinder; Kumar, Pritesh; Gupta, Prateek; Poole, Hope; Zace, Pamela; Gadd, Richard; Money-Taylor, John; Kantharaju, Rohit; Bhosale, Abhijit; Bahri, Suchita; Broadbent, Rosie; Kutuzov, Vladislav; Gibbons, James; Trussler, Daniel; Hawley, Eve; Akhtar, Sabeen; Caruana, Ethan; Watson, Thomas; Allison, Georgia; Barr, Lynne; Julies, Elda; Hill, Francesca; Butler, Katherine; Kendal, Adrian; Bugeja, Mark; Mooteeram, Justin; Saedi, Farid; Azhar, Muhammad Saad; Sturdee, Simon; Hussain, Halima; Sonde, Sarah; Luqman, Muhammad Qais; Farooq, Rahy; Wells, Gareth; Shenolikar, Aneil; Rajan, Praveen; Patil, Vijay; Amer, Omer; Malik, Kalim; Pavanerathan, Pranavan; Mallick, Arijit; Seferiadis, Ilias; Hind, Jamie; Morgan, Rebecca; Khalaf, Ahmed; Ditta, Adeel; Ramasamy, Arul; Khan, Shahrukh; Balasubramanian, Satishkumar; Fawcett, Nicholas; Fraig, Hossam; Hamad, Farouk; Marsland, Daniel; Elliot, Robin; Nolan, Ciaran; El-Bayouk, Khalil; Dhukaram, Vivek; Chapman, Anna; Mckenzie, James; Budair, Basil; Prem, Hari; Elmajee, Mohammed; Rajgor, Harshadkumar Dhirajlal; Thurston, Daniel; Pond, Erika; Brooks, Margaret; Everett, Samuel; Iqbal, Mohammad; Gourbault, Lysander; Singh, Shashwat; Tang, Cary; Tarhini, Mariam; Kankate, Mr Raghubir; Aktselis, Mr Ioannis; Davda, Mr Kinner; Vijapur, Mr Arvind; Tayyem, Mr Mohammed; Chau, Ms Jackie; Alzaranky, Muhammed; Elhassan, Osman; Chhantyal, Kishor; Arora, Abhishek; Abiddin, Zain; Kucharski, Robert; Gledhill, Andrea; Craven, James; Cichero, Matt; Yates, Ben; Newton, Ayla; Grice, John; Beddard, Laura; Thomas, Alex; Garg, Vipul; Taylor, Heath; Kelsall, Nikki; Roslee, Charline; Elsenosy, Adelfatah; Martin, Miss Rebecca; Pujol-Nichol, Miss Andrea; Carroll, Miss Natalie; Boucher, Alexander; Alward, Mustafa; Myint, Yuland; Currall, Verity; Sadasivan, Preetha; Kumar, Sunil; RezaSanjani, Shahrukh; Ciaccio, Maria; Jeyaseelan, Lucky; Drummond, Isabella; Jones, Neil; Shah, Savan; Ravindrarjah, Thuwarahan; Yasen, Zaid; Singh, Kunjshri; Al-Habsi, Ruqaiya; Jeyaseelan, Lucky; Habbiba, Abdullah; Walker, Thomas; Dewhurst, Maximilian; Glasgow, Nisha; Eze, Dominic; Carter, Gary.

Citation:

Bone & Joint Journal. 108-B(6):781-786, 2026 Jun 01.

Abstract:

Aims: The UK Foot and Ankle Thromboembolism (UK-FATE) Collaborative evaluated incidence of venous thromboembolism (VTE) in foot and ankle surgery and Achilles tendon (AT) rupture. As part of the data collection, infection within 90 days was a secondary outcome. This study aimed to evaluate overall rate of superficial and deep infection following foot and ankle surgery in trauma, elective, and acute diabetic surgery.

Methods: Data were collected prospectively across 68 centres in the UK for all patients who underwent foot and ankle surgery between 1 June and 30 November 2022. Over 500,000 data points were collected, including development of superficial and deep infection within 90 days of procedure and presence of comorbidities.

Results: UK-FATE captured 90-day infection data for a total of 9,723 cases. When nonoperatively managed AT ruptures were excluded, infection data were available for 9,591 trauma, elective, and acute diabetic procedures. Overall superficial and deep infection rates in all procedures were 4.1% (n = 397/9,591) and 1.4% (n = 133/9,591), respectively. Both superficial (7.4% (n = 29); p < 0.001) and deep infection (8.7% (n = 34); p < 0.001) rates were highest in acute diabetic procedures. Deep infection differed between trauma (1.4% (n = 65/4,351)) and elective (0.7% (n = 34/4,785)) procedures (p < 0.001), but superficial infection rates were similar (3.9% (n = 171/4,245) and 4.1% (n = 197/4,588), respectively (p = 0.638)). On multivariate regression analysis, peripheral vascular disease (OR (odds ratio) 2.86 (95% CI 1.74 to 4.56); p < 0.001), smoking (OR 1.54 (95% CI 1.18 to 2.00); p = 0.001), diabetes (OR 1.83 (95% CI 1.35 to 2.44); p < 0.001), American Society of Anesthesiologists grade III to IV (OR 1.94 (95% CI 1.37 to 2.73); p < 0.001), and chemical VTE prophylaxis (OR 1.38 (95% CI 1.03 to 1.85); p = 0.031) were independent predictors for developing infection.

Conclusion: Rates of superficial and deep infection were significantly higher in patients with acute diabetic surgery. Deep infection rates were higher in trauma than in elective surgery, but superficial infection rates were similar. Comorbidities and smoking affected infection rate in foot and ankle surgery, and should be optimized preoperatively and considered in postoperative monitoring.

DOI: 10.1302/0301-620X.108B6.BJJ-2025-1345.R1

Incidence, reason for treatment delay and patient-reported outcome of patients affected by a chronic Achilles tendon rupture in a Swedish population (2026)

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Type of publication:

Journal article

Author(s):

Nilsson, Niklas; Larsson, Elin; Dyrehag, Emma; *Carmont, Michael; Brorsson, Annelie; Nilsson Helander, Katarina.

Citation:

BMC Musculoskeletal Disorders. 27(1), 2026 May 01.

Abstract:

BACKGROUND: As the incidence of ATR is increasing the risk of ruptures being missed escalates and more injuries are suspected to become chronic. This study aimed to assess the incidence and causes of delayed diagnosis in chronic ATR. Additionally, the patient-reported outcome of surgical versus non-surgical treatment following delayed presentation was evaluated.

METHODS: The study is of patients with chronic ATR treated at the Sahlgrenska University Hospital between 2015 and 2020. Patients were identified using specific International Classification of Diseases (ICD) codes for ATR and included all patients in whom the treatment had been delayed for more than 14 days. The patients who accepted to participate in the study completed the Achilles tendon Total Rupture Score (ATRS) and a questionnaire regarding recovery rate in percentage.

RESULTS: Out of the 958 patients with ATR, 102 were identified as chronic, comprising 11% of the overall dataset. A total of 75 patients were included. Patients with chronic injury exhibited higher age, BMI, and comorbidity rates compared with patients with acute ruptures. Fifty-two (84%) patients delayed seeking medical attention. The rates of patients initially receiving an incorrect diagnosis was low, with 10 (1%) directly associated with trauma and 28 (3%) during later medical visits. Patients that were surgically treated (n = 57) for their chronic Achilles tendon rupture yielded significantly higher median (IQR) ATRS scores; 77 (50 ; 92) vs. 34 (23 ; 82) and recovery rates; 85% (70 ; 95) vs. 40% (20 ; 78) compared with patients treated with a non-surgical approach (n = 18).

CONCLUSIONS: This study reveals that chronic ATRs constitute a significant portion of all ATR. These were primarily due to "patient's delay" rather than the relatively rare misdiagnosis. Patient-reported outcomes, such as ATRS scores and self-reported recovery, exhibit considerable variability. Surgical intervention gave superior patient reported outcome compared with non-surgical treatment for patients affected by a chronic Achilles tendon rupture.

DOI: 10.1186/s12891-026-09890-y

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Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

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Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

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An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2026)

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Type of publication:

Journal article

Author(s):

Kondi, Suresh; *Murugesan, Thivagar; Postans, Neil; Thumri, Paavana; Kantamaneni, Ketan; Ansari, Shahbaz; Pickard, Simon.

Citation:

Cureus. 18(1):e101255, 2026 Jan.

Abstract:

BACKGROUND: Forearm pronation and supination are fundamental movements essential for daily activities and clinical applications. While supinator and biceps brachii contribute to supination, and pronator quadratus and pronator teres facilitate pronation, the precise activation patterns and torque-dependent recruitment strategies of these muscles remain incompletely understood. Conflicting evidence exists regarding muscle contribution at varying load conditions, with implications for rehabilitation protocols, surgical planning, and prosthetic design.

PURPOSE: This study aimed to quantify and compare the electromyographic (EMG) activity of forearm rotator muscles during isometric contraction under progressively increasing torque loads during both supination and pronation movements.

METHODS: Four healthy right-handed subjects (3 males, 1 female; mean age 32.5 years) underwent simultaneous EMG and motion capture recording. Surface electrodes captured activity from biceps brachii, triceps, pronator teres, and pronator quadratus, while fine-wire electrodes measured supinator muscle activity. Participants maintained a neutral forearm position against applied loads of 1 kilogram positioned at increasing distances (10-35 cm) from the supination axis, creating progressively higher torques. EMG signals were filtered, rectified, normalized, and analyzed using root mean square values across three trials per loading condition.

RESULTS: During supination resistance, the supinator demonstrated higher activation at lower torques compared to the biceps brachii. As applied torque increased, the biceps brachii activity increased proportionally more than the supinator, indicating load-dependent recruitment. Triceps showed increased co-activation for joint stability. During pronation resistance, the pronator quadratus exhibited greater activity at lower torques relative to the pronator teres. With increasing torque, the pronator teres demonstrated relatively greater activation increases than the pronator quadratus. Both movement patterns demonstrated progressive recruitment of multi-joint muscles as torque demands increased.

CONCLUSIONS: This pilot EMG study (n=4) provides preliminary descriptive evidence suggesting that supinator and pronator quadratus primarily govern low-torque forearm rotation, while biceps brachii and pronator teres become increasingly dominant during high-torque demands. These observed patterns are consistent with a hierarchical muscle recruitment strategy optimized for mechanical efficiency and joint stability. Understanding these activation patterns may have potential clinical applications for rehabilitation protocol design following nerve injury or tendon rupture, surgical planning for nerve transfer procedures, and development of myoelectric prosthetic control algorithms.

DOI: 10.7759/cureus.101255

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A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 34(4):1452-1463, 2026 Apr.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

Criteria for Return to Running After Surgical Repair of Acute Achilles Tendon Rupture: A Modified Delphi Consensus Study (2026)

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Type of publication:

Journal article

Author(s):

Gaspar, Maxime; Maffulli, Nicola; Memain, Geoffrey; *Carmont, Michael R; Hardy, Alexandre; Arnaud, Choplin.

Citation:

Sports Medicine. 2026 Jul 26.

Abstract:

BACKGROUND: The annual incidence of Achilles tendon ruptures has increased by almost 3%. Despite the large amount of data available on post-injury treatment, there is a lack of evidence-based criteria to guide return to running after surgery.

OBJECTIVE: The aim of this study was to reach a consensus among experts on the criteria for resuming running following surgery for Achilles tendon rupture.

METHODS: Thirty-five international Achilles tendon experts were invited to participate in this modified Delphi study. The study was conducted in three rounds, with a threshold of 75% agreement (or disagreement) required for an item to achieve consensus. Sixteen clinical criteria were submitted to the expert panel. A five-point Likert scale was used. The study was conducted between January and June 2025.

RESULTS: Eight criteria achieved consensus after three rounds: seven criteria reached consensus for inclusion, and one criterion reached consensus for exclusion (calf circumference symmetry). The seven criteria were (1) the absence of pain in daily life; (2) the absence of pain during and after rehabilitation sessions; (3) walking without limping; (4) the ability to walk on tiptoes; (5) the ability to perform ten single-leg heel rises; (6) good single-leg balance; and (7) the patient feeling psychologically ready to resume running.

CONCLUSION: An expert consensus on the criteria to return to running after surgery for Achilles tendon rupture has been developed. These criteria, agreed by experts, may inform clinical decision making regarding return to running, but they require prospective validation before they can be used as decision rules. Further studies are needed to refine these criteria and evaluate their impact on functional outcomes during the return-to-running phase.

DOI: 10.1007/s40279-026-02506-4

Trochanteric Buttress Plate Augmentation of the Proximal Femoral Nail for Unstable Intertrochanteric Fractures: A Randomized Controlled Trial (2026)

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Type of publication:

Randomised controlled trial

Author(s):

*Abdelaty Shalaby, Mohamed H; *Khafagy, Doaa G; Hosny, Mohamed M; Eltantawy, Ahmed E; Omran, Ali M.

Citation:

Cureus. 18(2):e104235, 2026 Feb.

Abstract:

BACKGROUND: Unstable intertrochanteric (IT) fractures pose a significant challenge in orthopedic surgery.

OBJECTIVE: To investigate the effectiveness of combining a trochanteric buttress plate (TBP) with a proximal femoral nail (PFN) for managing unstable IT fractures.

METHODS: This randomized controlled open-label study was performed on 90 patients with recent unstable IT fractures (Evans types 1c, 1d, 1e, or 2). Patients were randomly divided into two groups: Group A was treated with standard PFN fixation. Group B was treated with PFN integrated with TBP augmentation. Assessments were conducted at two weeks and monthly for six months. Functional outcomes were assessed using the modified Harris Hip Score (mHHS).

RESULTS: Operative time and blood loss were significantly higher in Group B (PFN+TBP) than in Group A (standard PFN) (P = 0.005 and 0.006, respectively). Postoperative mHHS was significantly higher in Group B at all follow-up intervals from two weeks to six months (P < 0.05).

CONCLUSIONS: The integration of the TBP with PFN for unstable IT fractures significantly improves functional outcomes without increasing major complications, despite a modest increase in operative time and blood loss.

DOI: 10.7759/cureus.104235

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One-Stage or Two-Stage Revision for Infected Shoulder Arthroplasty: A Head-to-Head Meta-Analysis of Comparative Studies (2026)

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Type of publication:

Systematic review

Author(s):

Selim, Amr; *Ibrahim, Abdelrahman; Abbas, Azhar; Sadiq, Salman; Farhan-Alanie, Muhamed M; *Ahmed, Mohammed Lyeeq; Rhee, Jae.

Citation:

JBJS Reviews. 14(7), 2026 Jul 01.

Abstract:

BACKGROUND: Periprosthetic joint infection (PJI) following shoulder arthroplasty is a devastating complication associated with substantial morbidity and revision burden. While 2-stage revision has traditionally been regarded as the gold standard for chronic shoulder PJI, single-stage revision has emerged as a potential alternative. The aim of this systematic review was to directly compare infection-related outcomes and complications between single-stage and 2-stage revision arthroplasties for shoulder PJI.

METHODS: This systematic review was prospectively registered with PROSPERO (CRD420251159566) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE, and Web of Science were searched up to September 22, 2025. Comparative observational studies and randomized controlled trials (RCTs) evaluating single-stage vs. 2-stage revision for shoulder PJI in adults were eligible; no RCTs were identified. Primary outcomes were reinfection and infection control success; overall complications were secondary. Odds ratios (ORs) were calculated within each study and pooled using a random-effects model. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment,
Development and Evaluation.

RESULTS: Thirteen retrospective comparative studies involving 260 patients (127 single-stage and 133 two-stage) were included. Compared with 2-stage revision, single-stage revision showed a lower, but not statistically significant, odds of reinfection (OR 0.46, 95% confidence interval [CI] 0.21-1.04; p = 0.06; I2 = 0%) and overall complications (OR 0.52, 95% CI 0.18-1.53; p = 0.24; I2 = 0%) and a higher, but nonsignificant, odds of infection control success (OR 1.57, 95% CI 0.45-5.40; p = 0.48; I2 = 17%).

CONCLUSION: Single-stage revision demonstrated infection control and complication rates comparable with 2-stage revision for shoulder PJI. Although no statistically significant differences were observed, trends favored single-stage revision. Given that the certainty of the evidence was graded as low, these findings should be interpreted with caution, and high-quality RCTs are required to define optimal patient selection and surgical strategy.

LEVEL OF EVIDENCE: Therapeutic Level III.

DOI: 10.2106/JBJS.RVW.26.00055

A Prospective Study of the Operative Treatment of Clavicular Fractures (2026)

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Type of publication:

Journal article

Author(s):

Bhakar, Ranj; Chakrapani, Arjun S; Shaik, Arfaz; Alexander, Aaron; *Murugesan, Thivagar; Anbazhagan, Prasanna Kumar; Ghent, Dan.

Citation:

Cureus. 18(1):e102481, 2026 Jan.

Abstract:

Objective This study aimed to evaluate the functional and radiological outcomes associated with the operative management of displaced midshaft clavicular fractures using pre-contoured locking compression plates (LCPs), specifically in cases that met surgical indications such as fracture displacement, shortening, or comminution. Methodology In this prospective study, 30 adult patients with displaced midshaft or lateral clavicular fractures underwent open reduction and internal fixation (ORIF) with pre-contoured LCPs at a tertiary care center. Patients were followed clinically for six months postoperatively. Functional outcomes were assessed using the Constant-Murley Score (CMS), and radiological union was evaluated through serial radiographs. Data were analyzed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY), and results were reported as mean +/- standard deviation (SD). Results The mean age of the patients was 36.4 +/- 10.2 years, with 21 patients (70%) being male. The mean time to radiographic union was 12.8 +/- 2.3 weeks. At the final follow-up, the mean Constant-Murley Score (CMS) was 91.2 +/- 6.4, with 24 patients (80%) demonstrating excellent shoulder function. Complications were limited to two patients (6.7%), while three patients (10%) experienced superficial infections or implant-related irritation. There were no observed cases of nonunion or implant failure. Conclusions Operative fixation of displaced clavicular fractures using pre-contoured LCPs provides stable fixation, facilitates early mobilization, and results in excellent functional recovery with minimal complications. Surgical management may be considered in active adults with displaced fractures to help optimize outcomes.

DOI: 10.7759/cureus.102481

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