Trauma and orthopaedics

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

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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)

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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

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

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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

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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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