Trauma and orthopaedics

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

Posted on by

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

Link to full-text [open access - no password required]

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)

Posted on by

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

Link to full-text [open access - no password required]

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

Posted on by

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

Link to full-text [open access - no password required]

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)

Posted on by

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

Link to full-text [open access - no password required]

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

Posted on by

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

Link to full-text [open access - no password required]

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

Posted on by

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

Link to full-text [open access - no password required]

Evaluation of practice patellofemoral instability collaborative (EPPIC) (2025)

Posted on by

Type of publication:

Journal article

Author(s):

Kosy J.; Thomas W.; Higgin R.; Thomas J.; Odeh A.; Archer J.; Bache C.E.; Gaffey A.; Buddhdev P.; Bosman H.; Tun Ngu A.W.; Stringfellow T.; Lebe M.; Parikh S.; Sanalla A.; Khan W.; Tennyson M.; Hislop S.; Lenihan J.; Ahmed Almustafa M.A.; Baskaran D.; To K.; Hughes W.; Butt M.M.; Venkatesh R.; Dawood L.; Archer D.; Jamjoom A.; Reddy G.; Anand S.; Rajput V.; Akrawi H.; Loeffler M.; AL-Sukaini A.; Ramasamy A.; Syed S.; Khan M.; Thonse R.; Paramasivan A.; Morton R.; Mahmood A.; Luo W.; Umer H.M.; Haslam P.; Hancock G.; Servant C.; Gill J.; Karssiens T.; Wood R.; Bowditch M.; Deo H.; Barwell J.; Hourston G.; Wyatt D.; Chen A.; Williams J.; Sivaprakasam M.; Young J.; Khwaja M.; Sleiman S.; Bowman N.; Napier R.J.; Finlayson G.; Jones K.; Blyth M.J.; Hopper G.P.; Wheelwright B.; Dalgleish S.; Davies P.S.E.; Sinnerton R.J.H.; Banziger C.; Abell A.; McNamara I.; Hasan R.; Liew I.; Archunan M.; Watts D.; Subhash S.; Negus O.; Muller S.; Irvine S.; Bottomley N.; Woods A.; Bretherton C.; Myatt R.; Paul C.; Gacaferi H.; Smith J.; Newman J.; Cohen A.; Cruickshank J.; Kahn R.; Matheron G.; Patel J.; Crane E.; *Roach R.; *Kabariti R.; *Khaleeq T.; Rushbrook J.; Morcos Z.; Thiruchandran G.; Barrett-Lee J.; Bailey L.; Subramanian S.; Britton J.; Tindall A.; Cheema K.; Oluku J.; Saleh A.; Chahal J.; Fernandes A.; Papadopoulus D.; Dellis S.; El-Raheb K.; Akintade A.; Saraglis G.; Mitchell S.; Leow J.M.; Mandalia V.; Skinner E.; Middleton S.; Schranz P.; Gillespie G.; Howard J.; White T.; Makaram N.; Simpson C.; Johnstone P.; Akhtar K.; Karam E.; Ferguson D.; Cuthbert R.; Wickramarachchi L.; Liang K.; Bhutta A.; Havenhand T.; Hoggett L.; Rogers G.; Waugh C.; Cowie J.; Ashraf T.; Sweed T.; Mussa M.; Dong H.; Ashraf Y.; Stoddard J.; Jayasuriya R.; George H.; Craik J.; Rose L.; Wei R.; Clark D.; Donovan R.; Shiels S.; Tilston T.; Johnson D.; Baigent T.; Iqbal K.; Mughal E.; Dewan V.; Chauhan G.; Habeebullah A.; Bleibleh S.; Kaur J.; Thanikachalam P.; Metcalfe A.; Weiyun W.N.; Krishnan H.; Eldridge J.; Beaumont O.; Sheath P.C.; Stoneham A.; Morley W.; Gibson C.; Fraig H.; Bowen D.; Hossain F.; Sur H.; Sherbaz S.; Osman K.; Khadabadi N.; Saleemi A.; Arif M.; Moores T.; Nicolai P.; Sibbel J.; Nabulyato W.; Pathan A.; Mcgarvey C.; Ahmed M.; Logishetty K.; Al-Hourani K.; Baileyi M.; Hingi C.

Citation:

Knee. 57 (pp 325-334), 2025. Date of Publication: 01 Dec 2025.

Abstract:

Background: The management of patellofemoral instability in the United Kingdom remains poorly standardised. Through the British Association for Surgery of the Knee trainee collaborative, we aimed to identify which procedures (and in which combination) were being used to surgically manage this common condition across the UK. Method(s): A retrospective national audit was conducted via a trainee collaborative analysing local trust data between 1st January 2014 and 31st December 2019. Data from institutions registered for the EPPIC audit was compiled and analysed for degree of compliance against more recently published national guidelines. Result(s): Fifty (n = 50) sites submitted data, totalling 3189 skeletally mature patients. The median age was 26.7 (SD 0.5) years and 63.3 % were female. An isolated lateral release was performed in 8 %, an isolated medial patellofemoral ligament reconstruction (MPFLR) was performed in 37 % of patients and proximal realignment surgery was conducted in 8 % of patients. Trochleoplasty was required in 11 % of patients, with combined MPFLR and tibial tubercle osteotomy (TTO) being undertaken in 22 % of patients. Combined MPFLR, TTO and trochleoplasty was undertaken in 3 % of patients. Conclusion(s): This audit highlights the national variation in surgical treatment of a common orthopaedic presentation. Despite the lack of evidence, an isolated lateral release is still being performed. There remains a lack of standardisation within the UK in the management of recurrent patellar instability, highlighting the need for national consensus of appropriate surgical interventions.

DOI: 10.1016/j.knee.2025.06.015

Epidemiology of metatarsal fractures in Shropshire 2020-2023 (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Garton, Mark; *Rowlands, Jenni; *Roach, Richard.

Citation:

Archives of Osteoporosis. 20(1):126, 2025 Sep 18

Abstract:

The epidemiology of metatarsal fractures remains poorly understood. We identified retrospectively all adults with >= 1 radiologically confirmed metatarsal fracture, over 3 years. Young men and women had similar fracture rates, but overall risks were significantly higher for women (RR 1.99, 95% CI 1.76-2.26), driven by age-related falls in male fracture incidence.

PURPOSE: Metatarsal fractures are clinically and economically important and may reflect trauma, insufficiency or fatigue. However, their epidemiology remains poorly understood. We evaluated radiologically confirmed metatarsal fractures identified within Shropshire over a 3-year period.

METHODS: Radiology reports were searched for all patients aged >= 18 years between 2020 and 2023, using the terms 'metatarsal' AND 'fracture', to identify patients with >= 1 confirmed metatarsal fracture. Age at fracture, sex, fracture description and mechanism were recorded, and population fracture rates estimated, using local census data.

RESULTS: A total of 1121 (758 female) individual patients aged 50.7 (18.9) years, fractured 1370 metatarsals, usually the fifth in isolation, with fewer individuals fracturing two, three or four metatarsals.
Fractures were located at the metatarsal base (59%), shaft (26%), neck (12%) or head (3%); were mostly oblique, transverse or comminuted; and were usually caused by low-energy inversion injuries or falls. Fracture rates per 100,000 were 105 for women aged 18-29 years, rising to 153 and 142 in the sixth and ninth decades, with comparative male rates of 102, 40 and 31. Overall, women had more metatarsal fractures than men (RR 1.99, 95% CI 1.76-2.26), the sex difference being highest for metatarsal head fractures (RR 2.98 95% CI 1.34-6.60) and lowest for shaft fractures (RR 1.67, 95% CI 1.32-2.12).

CONCLUSION: Most metatarsal fractures are isolated low-energy injuries of the fifth metatarsal. Overall, women suffer twice as many fractures as men, driven by sustained high fracture rates in older women and a steep age-related decline among men. The underlying reasons for this pronounced sex difference are unclear and require further study.

DOI: 10.1007/s11657-025-01603-7

Surgical Treatment of Wrist and Hand Deformity in Children with Cerebral Palsy (2025)

Posted on by

Type of publication:

Journal article

Author(s):

*Patel, Ravi; *Khan, Muhammad Murtaza; *Gurukiran, Gurukiran; Carsi, Maria Belen; Singh, Rohit Amol.

Citation:

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 92(4):210-217, 2025 Aug.

Abstract:

Cerebral palsy (CP) is a complex disorder resulting from injury to developing brain. It involves multimodal and multidisciplinary approach that involves various disciplines of medical science. The entire focus of this approach is to provide patients with this disorder the best quality of life. Although CP can affect both upper and lower limbs, the functional expectation of upper limb is much higher and complex. This implies particularly to hand and wrist based on complex functional movements expected of them. This puts orthopaedic surgeons in a unique position in managing these patients. It is worth mentioning here that it is not about offering them a surgical intervention the emphasis should lie on the entire process of selection, evaluation, and intervention. All these steps need to be considered very thoroughly so that the best outcome is achieved based on patients' expectation at present and keeping the future consideration in mind as well. This paper focuses only on children with hand and wrist deformity. Although children have a great healing potential, but they have high functional demand and longer-life expectancy in general so getting things right for the first time should be of paramount importance. This paper tries to address this issue by reviewing the literature to help orthopaedic surgeons in developing an algorithm in their mind when offering intervention. The consideration of inclusion and exclusion criteria along with review of literature has been considered with this background in mind. This paper primarily addresses the surgical aspect of disease and steps that are critical in this regard. Follow up planning, long-term outcome, rehabilitation planning, use of conservative treatment has not been considered in this review.

DOI: 10.55095/achot2025/011

Link to full-text [no password required]