Trauma and orthopaedics

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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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. 2026 Feb 06.

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

An Electromyographic Study Comparing Muscle Function During Supination and Pronation of the Forearm (2025)

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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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Short-Term Functional Outcomes in Patients Undergoing Primary Total Knee Arthroplasty According to Their Body Mass Index (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):e101269, 2026 Jan.

Abstract:

OBJECTIVE: This study aimed to evaluate the association between body mass index (BMI) and short-term outcomes following primary unilateral total knee arthroplasty (TKA), including functional improvement, perioperative variables, and postoperative complications.

METHODOLOGY: A retrospective case-control study was conducted at a tertiary orthopedic center on 525 consecutive patients who underwent primary unilateral TKA for osteoarthritis between January 2019 and December 2023. Patients were classified according to World Health Organization (WHO) BMI criteria: normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (>=30.0 kg/m2). Collected data included demographics, American Society of Anesthesiologists (ASA) grade, Charlson Comorbidity Index (CCI), glycated hemoglobin (HbA1c), operative time, length of hospital stay, change in Knee Society Score (DELTAKSS) at 12 months, patient-reported outcome measures, satisfaction, revision surgery, and postoperative complications. Between-group comparisons were performed using one-way analysis of variance (ANOVA) for continuous variables and chi-square or Fisher's exact tests for categorical variables, with significance set at p < 0.05.

RESULTS: Baseline characteristics were comparable across BMI groups, except for higher ASA scores and HbA1c levels in obese patients (p < 0.05). Obese patients had significantly longer operative times (95.9 +/- 16.8 minutes) and hospital stays (4.8 +/- 1.2 days) than normal-weight patients (83.6 +/- 14.1 minutes; 3.9 +/- 1.0 days, p < 0.01). All BMI groups demonstrated significant improvement in DELTAKSS at 12 months, although the gain was lowest in obese patients (34.7 +/- 10.5 vs. 41.2 +/- 9.6; p = 0.012). Overall complications were highest in the obese group with 16 patients (9.1%), followed by nine patients (5.1%) in the overweight group and seven patients (4.0%) in the normal-weight group, with wound-related issues being the most common. Revision surgery occurred in one (0.6%) obese patient, and no mortality was reported.

CONCLUSION: Higher BMI was associated with longer operative times, prolonged hospital stays, increased wound complications, and slightly reduced functional improvement and satisfaction at 12 months after primary TKA. These findings highlight the importance of optimizing metabolic status before surgery and emphasize the need for individualized perioperative risk assessment in patients undergoing knee arthroplasty.

DOI: 10.7759/cureus.101269

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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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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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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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