Trauma and orthopaedics

The description, measurement with inter- and intra-observer reliability of calcaneal tunnel placement for tendon transfer in Achilles tendon reconstruction (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; Andresen, Tor Kristian; *Morgan, Fraser; Nilsson-Helander, Katarina; Husebye, Elisabeth Ellingsen.

Citation:

Journal of Experimental Orthopaedics. 12(2):e70223, 2025 Apr.

Abstract:

Purpose: A tendon transfer is a common method of treating ankle plantar flexion weakness and tendon end non-union following chronic Achilles tendon rupture and delayed representation following Achilles tendon re-rupture. Commonly, the transferred tendon is fixed into a bone tunnel on the postero-superior surface of the calcaneum close to the distal Achilles tendon insertion. To date, there is no standardised description or measurement of calcaneal tunnel position. The aim of this study is to describe the anatomic location for calcaneal tunnel placement and to determine the reliability of a method of measuring tunnel position and direction within the calcaneum.

Methods: The routine post-operative lateral ankle radiographs from 40 patients (40 ft) following Achilles tendon reconstruction using tendon transfer into the calcaneum: calcaneal tunnel zone (CTZ), calcaneal tunnel ratio (CTR) and calcaneal tunnel angle (CTA) were tested for reliability using test-retest between three observers. Additionally, CTR and CTA were compared in cases where a calcaneoplasty was performed or not.

Results: The intraclass correlation coefficient (ICC) of the CTR and CTA was found to be 0.86-0.95 (95% confidence interval [CI]: 0.75-0.98) and 0.95-0.99 (95% CI: 0.92-0.99), respectively, indicating good and excellent reliability. Patients who received a calcaneoplasty had a significantly greater CTR of 0.74 (0.1) and a lower CTA of 76.1degree (10.8) compared to those who did not have a CTR of 0.61 (0.1) and 100.9 (12.4), Diff 95% CI: 0.13 (0.08-0.18) and -25 (-32 to -17), respectively, both p < 0.001.

Conclusions: The CTR and CTA were reliable measures for the calcaneal tunnel following Achilles tendon reconstruction using tendon transfer within the limitations of the sagittal radiographic view. When a
calcaneoplasty was performed, it resulted in a significantly greater CTR. These measurements should be used to describe calcaneal tunnels rather than a description of tunnel placement to optimise predictive factors following Achilles tendon reconstruction.

Level of Evidence: Level III.

DOI: 10.1002/jeo2.70223

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Iliopsoas Impingement After Total Hip Arthroplasty: A Review of Diagnosis and Management (2025)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Ravi, Balu; *Abdullah, Faliq; Al-Naseri, Ahmed; Bitar, Khaldoun.

Citation:

Cureus. 17(5):e83391, 2025 May.

Abstract:

Iliopsoas impingement is a growingly acknowledged yet frequently overlooked cause of persistent groin pain after total hip arthroplasty (THA), occurring in a small percentage of patients undergoing the
procedure. It typically results from mechanical irritation of the iliopsoas tendon by anterior acetabular component overhang, retained cement, long screws, or other prosthetic hardware. Clinically, patients
report pain that worsens with active hip flexion, stair climbing, and transitioning from sitting to standing. Diagnosis involves a combination of clinical assessment, imaging techniques such as radiographs, CT scans, or ultrasound, and confirmatory image-guided diagnostic injections. Conservative management, including physiotherapy and corticosteroid injections, may offer temporary relief but is often insufficient for long-term resolution. Surgical options, particularly iliopsoas tenotomy or acetabular component revision, are indicated in refractory cases and have demonstrated high success rates with improved functional outcomes. Early recognition and appropriate intervention are critical for optimizing
postoperative recovery and improving the quality of life in affected patients.

DOI: 10.7759/cureus.83391

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Endoscopically Assisted Reconstruction of the Achilles Tendon Using Semitendinosus Graft (2025)

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Type of publication:

Journal article

Author(s):

*Carmont, Michael R; *Saha, Arunansu; *Rhind, John-Henry; Nilsson, Niklas; Karlsson, Jon; Nilsson-Helander, Katarina.

Citation:

Video Journal of Sports Medicine. 1(5):26350254211021859, 2021 Sep-Oct.

Abstract:

Background: Chronic ruptures of the Achilles tendon may lead to symptomatic weakness, despite rehabilitation. Open reconstruction yields good outcome but has a high complication rate, notably wound problems. Endoscopically assisted free semitendinosus transfer restores ankle and preserves first metatarsophalangeal joint (MTPJ) function.

Indications: The main indication for the procedure is symptomatic chronic rupture of the Achilles tendon with a palpable tendon gap.

Technique Description: The procedure can be split into 4 stages: graft harvest, calcaneum and tunnel preparation, proximal graft attachment, and finally graft passage and screw insertion.

Discussion/Conclusion: Following reconstruction, patients use a cast in full plantar flexion for 2 weeks, then a graduated walker for full weight-bearing.

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Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair (2025)

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Type of publication:

Journal article

Author(s):

Lopes, Ronny; Freiha, Kinan; *Carmont, Michael R; Valentin, Eugenie; Alvino, Kylian; Mousa, Mohamed; Rauline, Gauthier; Fourchet, Francois; Picot, Brice; Hardy, Alexandre.

Citation:

American Journal of Sports Medicine. 2025 Apr 22.[epub ahead of print]

Abstract:

BACKGROUND: The Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.

PURPOSE/HYPOTHESIS: The main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: This was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.

RESULTS: A total of 50 patients (24 women and 26 men), with a mean age of 38.3 +/- 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 +/- 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.

CONCLUSION: The Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient's psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.

Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review (2025)

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Type of publication:

Systematic Review

Author(s):

*Patel, Ravi; Khan, Muhammad Murtaza; Gibson, William; Banerjee, Robin; Pardiwala, Asif.

Citation:

Chinese Journal of Traumatology.  2025 Feb 19. [epub ahead of print]

Abstract:

PURPOSE: Surgical management of the lateral end of clavicle fractures hasbeen a challenge for orthopedic surgeons considering the high rate ofnon-union. There has been no right and wrong answer to these types of fractures and many methods discussed in the literature, but the 2 most used bony procedures are hook plate and locking plate with or without the use of supplementary soft tissue procedures. The available evidence, in this case, is scarce with questionable reliability. The idea of this systemic review is to promote evidence-based practice when choosing between the 2 implants for this fracture. This study aims to review the results by performing a systemic review of the literature comparing the results of locking plate vs. hook plate for the lateral end of clavicle fracture fixation with an emphasis on outcome and associated complications.

METHODS: A search of the literature was made with the keyword "clavicle" in PubMed/Ovid Medline/Embase and University of Edinburgh online library "discover Ed". A total of 4063 articles were identified including case series (with at least 3 cases) and review articles focusing on locking plate alone, comparisons of locking plate and hook plate, or hook plate alone. Articles were excluded if they were not published in English, focused on pediatric studies, or consisted only of book chapters. Studies examining tension band wiring, soft tissue procedures for fracture fixation, arthroscopic-assisted procedures, additional soft tissue procedures along with plate fixation, and fracture dislocation of the lateral end of the clavicle were also excluded. The search was then narrowed down to 21 articles after consideration of inclusion and exclusion criteria. A detailed review of the surgical methodology further excluded additional soft tissue procedures, resulting in a final selection of 15 studies. The quality of the studies was assessed using the Modified Coleman Score by the authors.

RESULTS: A total of 15 studies related to Neer type II fracture met the inclusion criteria. However, 2 other studies also included type V fracture as well. The mean age of patients in these studies was 32 years. The mean follow-up period was 24.3 months (ranging from 6 to 65 months). The time of radiological union was documented from 2 to 4.5 months. Constant and disabilities of arm, shoulder, and hand scores were most used as the criteria for patient outcomes. The size of the lateral fragment that can accommodate/provide bicortical fracture was documented in only 3 studies. The mean incidence of removal of hook plate was 86.9%. In contrast, the mean incidence of removal of locking plate was 27.0%. Superficial wound infection was documented in 5 studies and deep wound infection was seen in 1 study. The mean union rate for hook plate was 97.0% compared to 100% for locking plate. Complications associated with hook plate have been documented in 11 studies. The most commonly reported incidence of complication was acromial osteolysis. The quality of studies was assessed using modified Coleman score. Other than 2 studies that were considered for the study that met the "fair" standard all of them were considered "poor" based on the modified Coleman score.

CONCLUSION: Both hook plate and locking plate provide acceptable operative treatment options for the lateral end of clavicle fracture. However, a consideration of surgeons' experience, the likelihood of a second operation, and the size of the lateral fragment should be considered when choosing between the 2 types of implants.

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The changing landscape of traumatic brain injuries at a district general hospital in a trauma network (2025)

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Type of publication:

Journal article

Author(s):

Abualsaud, Suhaib; Elmahdi, Ahmed; *Youssef, Mohamed; Jayakumar, Nithish; Lahart, Ian; Ashwood, Neil.

Citation:

British Journal of Neurosurgery. 1-6, 2025 Feb 22.

Abstract:

BACKGROUND: Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced. We compare outcomes of TBI patients pre- (2008-2012) and post-MTC (2013-2021) network implementation.

METHODS: We conducted a retrospective analysis of TBI patients admitted to a 500-bedded DGH, before and after the introduction of a trauma network. We compared the characteristics of patients, including age, mechanism of injury, imaging findings, and length of stay. All statistical analyses were carried out in SPSS v29 (IBM).

RESULTS: Overall, 876 patients (males = 56.1%; median age 67 years) were included. Mean yearly cases pre-MTC was 76 compared to 55 in the post-MTC period. Mean age was significantly higher, and patients had more co-morbidities, in the post-MTC period (p < 0.001). Mean GCS at presentation was not significantly different between the pre- and post-MTC periods (13.7 vs 13.8, respectively). Referrals to the regional neurosurgical centre were significantly higher in the post-MTC period. The overall mortality rate was 33.7%. Increasing age (OR = 1.072), higher comorbidities (OR = 1.243) and intracerebral haematoma (OR = 6.269) were associated with a higher risk of death. The post-MTC period was associated with a lower risk of death (OR = 0.501).

CONCLUSIONS: Fewer patients with less severe mechanisms of injury, and a more elderly population are now being managed at our DGH in the post-MTC period. Mortality was similar to published literature but the introduction of the trauma system was associated with lower risk of death. Although fewer TBIs help to optimise service delivery by maintaining orthopaedic bed capacity, the reduced exposure to these patients may lead to lowered expertise in managing these complex cases.

Doctor when can I drive? A systematic review and meta-analysis of brake reaction time in patients returning to driving after hip arthroscopy for femoroacetabular impingement (FAI) (2025)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; Sokhal, Balamrit Singh; Fenton, Carl; Omonbude, Daniel; Banerjee, Robin; Nandra, Rajpal.

Citation:

Hip International, 2025 Feb 24.[epub ahead of print]

Abstract:

BACKGROUND: A common question from patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is when they may return to driving.

PURPOSE: We aimed to perform a formal systematic review and meta-analysis to address this issue.

METHODS: A systematic review and meta-analysis followed PRISMA guidelines. Databases searched included OVID, EMBASE, and COCHRANE through July 2024 for articles with keywords and MeSH terms like "Hip arthroscopy," "Femoroacetabular Impingement," "total brake response time," and "reaction time" related to driving. Titles and full articles were reviewed for quality and relevance. Statistical analysis was done using Review Manager Version 5.4.A total of 39 articles were reviewed, with 5 meeting inclusion criteria. All selected articles used brake reaction time (BRT) as an outcome measure. A meta-analysis compared pre- and postoperative BRT values. Data were analysed for the right and left hips combined, followed by a subgroup analysis by laterality. BRT values were divided into preoperative and 2, 4, 6, and 8 weeks postoperative periods.

RESULTS: The studies assessed 160 patients, with 142 undergoing hip arthroscopy for FAI. The mean age was 32.75 +/- 9.4 years, with a male-to-female ratio of 73:69. The right hip was affected in 68% of
patients. Preoperative BRT ranged from 566 to 1960 milliseconds, while postoperative BRT ranged from 567 to 1860 milliseconds between week 2 and week 12.

CONCLUSIONS: BRTs returned to baseline or control values and continued to improve 4 weeks post-surgery for FAI. It is safe to recommend a return to driving at 4 weeks after hip arthroscopy for FAI.

Assessing SPECT/CT for the identification of cartilage lesions in the knee joint: A systematic review (2025)

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Type of publication:

Systematic review

Author(s):

Rix L.; *Tushingham S.; Wright K.; Snow M.;

Citation:

Osteoarthritis and Cartilage Open. 7(1) (no pagination), 2025. Article Number: 100577. Date of Publication: 01 Mar 2025.

Abstract:

Background: Single-photon emission computerised tomography with conventional computer tomography (SPECT/CT) is an emerging technology which may hold clinical value for the identification of cartilage lesions in the knee joint. The intensity and distribution of SPECT/CT uptake tracer may identify physiological and structural information in the absence of structural change on other imaging modalities.

Objective(s): To systematically assess the utility of SPECT/CT in the detection of chondral lesions within the knee joint, in patients presenting with knee pain, with or without structural change.

Result(s): PubMed, Science Direct, Web of Knowledge, and NHS databases were searched for English language articles focusing on the diagnostic value of SPECT/CT for knee chondral lesions and knee pain. Animal studies, cadaver studies, comparator radiological technique other than SPECT/CT or patients with a pathology other than knee chondral lesions were excluded. From the search, 11,982 manuscripts were identified, and screened for relevance. Seven studies were identified and scored low on QUADAS-2 bias review. SPECT/CT correlated with lesions found on other imaging modalities and during intraoperative assessment. Furthermore, in some cases, SPECT/CT out-performed other modalities in the detection of cartilage lesions.

Conclusion(s): Evidence suggests SPECT/CT may be a useful tool for the detection and localisation of cartilage lesions, particularly in discrepant cases when there is an absence of lesions on other imaging modalities, or a lack of correlation with patients' symptoms. Further studies are required to confirm the conclusions of this review.

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Base of Thumb Fractures: A Review of Anatomy, Classification, and Management (2025)

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Type of publication:

Journal article

Author(s):

Younis, Zubair; Hamid, Muhammad A; Devasia, Thomas; *Khan, Muhammad Murtaza; *Abdullah, Faliq; *Singh, Rohit; Simons, Adrian William.

Citation:

Cureus. 17(1):e76729, 2025 Jan.

Abstract:

Fractures of the thumb metacarpal base are uncommon but significant due to their critical role in hand functionality and hand grip strength. These fractures exhibit diverse patterns, including extra-articular, Bennett, Rolando, and highly comminuted fractures, each with unique implications for management and outcomes. Each type presents unique challenges in achieving anatomical reduction, stability, and favorable long-term outcomes. This review explores the anatomy of the trapeziometacarpal joint, classification systems, clinical presentation, imaging techniques, and management strategies for these fractures. Stable extra-articular fractures often respond well to closed reduction and casting, while displaced intra-articular fractures generally require surgical intervention. Bennett fractures are typically treated using closed reduction and percutaneous pinning or open reduction and internal fixation. Rolando and comminuted fractures pose greater challenges due to their inherent instability and often necessitate advanced techniques such as locking plates, external fixation, or arthroscopic-assisted procedures. Achieving anatomical reduction is paramount to prevent complications such as joint incongruity, instability, and post-traumatic arthritis. Optimal treatment approaches depend on fracture patterns, stability, and patient-specific factors, with surgical techniques tailored to preserve thumb function and minimize long-term morbidity.

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Bilateral corneal endothelial decompensation following airbag-induced trauma (2025)

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Type of publication:

Journal article

Author(s):

*Khaliq, Tayyib; *Pummiram, Srivarshini; *Iqbal, Naeem; *Jenyon, Tom.

Citation:

BMJ Case Reports. 18(1), 2025 Jan 27.

Abstract:

Approximately 3% of individuals in road traffic accidents suffer ocular injuries. We present a case of a man in his late 80s who presented with bilateral corneal decompensation following airbag deployment during a road traffic accident. Ocular examination revealed multilevel ocular injury with severe bilateral corneal oedema. This was managed with topical steroids, mydriatics and antibiotic therapy. At 1-month follow-up, the left eye had persistent corneal oedema. Specular microscopy was performed which confirmed endothelial cell loss making the patient a candidate for a corneal endothelial graft. We observed blunt trauma from airbag deployment causing endothelial cell loss and subsequent corneal decompensation. Our findings suggest that patients presenting to the emergency department with facial trauma from airbag injury should be referred for comprehensive ophthalmological assessment and that the reviewing ophthalmologist should have endothelial cell loss in mind during examination.

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