Coronal hamate body fractures are rare injuries, and studies regarding their morphology and management are limited. This study analyzed fracture patterns, injury mechanisms, associated injuries, surgical strategy, and clinical outcomes in patients with coronal hamate body fractures involving more than one-third of the articular surface and concomitant carpometacarpal (CMC) joint instability.

Fifty-eight male patients were retrospectively reviewed. Fractures were classified as dorsal oblique or coronal splitting types based on computed tomography findings. Surgical treatment involved open reduction and multiple screw fixation of the hamate using a K-wire-guided technique, with supplementary Kirschner wire stabilization for associated metacarpal base fractures or CMC joint instability. Radiographic and functional outcomes were evaluated after a minimum follow-up of 6 months.

Dorsal oblique fractures (63.8%) occurred more frequently than coronal splitting fractures (36.2%) and were most commonly associated with punching (OR, 4.9; p = 0.01), whereas falls from height were more common in coronal splitting types. Concomitant fractures occurred in 82.8% of cases, most frequently involving the fourth metacarpal base. Among 35 patients with a minimum 6-month follow-up, 34 achieved successful healing. In the 33 patients with functional outcome data, the mean DASH score was 3.0, and mean grip strength was 94.1% of the contralateral side. One patient treated 45 days post-injury showed recurrent subluxation and poorer outcome. No differences in functional outcomes were observed between fracture types.

Coronal hamate body fractures with CMC instability frequently presented as dorsal oblique patterns following punching injuries and were commonly associated with fourth metacarpal base fractures. Open reduction with multiple small-diameter screw fixation through K-wire tracts, combined with supplementary K-wire stabilization, was feasible and provided favorable clinical outcomes. Favorable outcomes were generally observed when anatomical reduction was achieved within 3 weeks after injury, and fracture morphology was not associated with significant differences in clinical outcomes.

IV.

in locked dislocation of the shoulder, instead of reducing back to the glenoid, the humeral head remains incarcerated on the glenoid in a locked fashion. This clinical situation is fairly uncommon. It is essential to conduct an individual evaluation of each patient to determine the appropriate treatment.

the aim of this study was to evaluate the functional outcomes of reverse total shoulder arthroplasty (rTSA) in the treatment of locked shoulder dislocation.

patients with locked shoulder dislocation who underwent reverse shoulder prosthesis surgery and were admitted to our center between 2007 and 2023 were reviewed. The primary outcome was the Constant score. Secondary outcomes included the adjusted Constant, UCLA and DASH scores. Additionally, any signs of radiologic loosening were also documented.

the series consisted of 10 patients, six men and four women, with a mean age of 68.0 years. The average time from the traumatic injury to surgery was 7.5 months. All patients showed improved Constant, Adapted Constant, UCLA, and DASH scores compared to their preoperative values. When comparing the outcomes of chronic posterior and anterior dislocations, no differences in functional outcomes or shoulder motion were observed after rTSA implantation. There were no complications during or after surgery.

The results of the present study have shown that patients with locked shoulder dislocation can achieve reliable short-term functional results when treated with rTSA. This proceduredecreases pain, improves functionality and enhances patient satisfaction. Level evidence: IV.

Lumbar fusion alters spinal–pelvic biomechanics and may influence degenerative changes in the lower extremities. This study investigated whether fusion length is associated with radiographic progression of hip and knee osteoarthritis.

In this retrospective, single-center cohort study, patients aged 40–65 years who underwent lumbar surgery between 2010 and 2021 were grouped as no fusion (N), short fusion (S; ≤3 levels), or long fusion (L; ≥4 levels). Hip joint space width was assessed using minimum joint space (MJS) and superointermediate joint space (SJS), including femoral head–standardized measures (sMJS and sSJS). Knee medial joint space width (KMJS) was measured when available. Spinopelvic parameters (LL, PI, PT, SS, PI–LL) and functional outcomes (ODI, HHS, WOMAC) were recorded. Multivariable linear and logistic regression analyses were performed to identify independent predictors of joint space narrowing and osteoarthritis risk.

Hip joint space narrowing differed significantly among groups, with the highest annual narrowing rates in the long-fusion group, followed by the short-fusion group, and the lowest in the no-fusion group (p < 0.001). In contrast, knee KL grade change and annual KMJS narrowing did not differ significantly between groups (p > 0.05). In logistic regression, each additional fused level increased the odds of postoperative MJS ≤ 2.0 mm by 16–19%, and higher CEA was also associated with increased risk.

Long-segment lumbar fusion (≥ 4 levels) was associated with greater hip joint space narrowing and greater radiographic progression of hip osteoarthritis, whereas knee degeneration did not differ by fusion status. Patients undergoing extensive fusion may benefit from closer hip surveillance to facilitate earlier recognition of degeneration.

Surgical stabilization of Pauwels Type III femoral neck fractures remains a significant challenge due to high vertical shear forces. While the medial buttress plate is a recognized solution, it requires extensive deep dissection. This study aims to compare the biomechanical performance of various screw configurations combined with either a medial buttress or anteromedial support plate.

Twenty-five third-generation synthetic femurs were used to create a standardized 70-degree (Pauwels III) fracture model. Specimens were divided into five groups (n = 5): (A) Inverted triangle (IT) screws with a Pauwels screw, (B) Inverted triangle (IT) with medial buttress plate (MBP), (C) Inverted triangle with anteromedial support plate (ASP), (D) L-configuration with medial buttress plate (MBP), and (E) L-configuration with anteromedial support plate (ASP). Axial loading was applied at 2 mm/min until construct failure, defined objectively by the real-time force-distance curve.

Although no statistically significant difference was found between groups (p = 0.102), a large effect size was observed (η² = 0.309). Group C (IT + ASP) demonstrated the highest mean failure load (1695 ± 494.6 N). Conversely, Group E (L-configuration + ASP) exhibited the lowest stability (977.2 ± 195.4 N) with a remarkably narrow standard deviation. The majority of failures occurred as transverse subtrochanteric fractures distal to the implants.

The combination of an inverted triangle screw arrangement with an anteromedial support plate demonstrated comparable biomechanical stability to the medial buttress plate, while offering a potentially safer surgical corridor. Conversely, pairing L-shaped screw configurations with anteromedial support plates resulted in the lowest mean ultimate load-to-failure among the tested constructs, likely due to potential stress riser effects.

Shoulder hemiarthroplasty (HA) is a well-established treatment for various humeral-side pathologies. Overstuffing should be avoided because it is associated with glenoid wear; however, specific radiological reconstruction targets remain unclear. This study assessed the association between radiological joint restoration in stemmed and stemless HA and long-term functional outcomes.

Patients who underwent stemmed or stemless HA between 2001 and 2011 were included in a long-term follow-up. Cases with incomplete or non-calibratable digital radiographs or concomitant glenoid procedures were excluded. Clinical outcomes were evaluated using the Constant-Murley Score (CMS) and satisfaction questionnaires. Radiographic parameters—lateral glenohumeral offset (LGHO), lateral humeral offset (LHO), and center of rotation (COR)—were measured on standardized anteroposterior radiographs pre- and postoperatively by two independent observers. Differences from baseline to final follow-up (ΔLHO, ΔLGHO, ΔCOR) were calculated. Interobserver reliability was determined using the intraclass correlation coefficient (ICC). Associations between radiological measures and clinical outcomes were analyzed using linear regression; intergroup comparisons used unpaired t-tests (p < 0.05).

Forty-eight patients (12 stemmed, 36 stemless HA) were examined after a mean follow-up of 16.6 ± 2.5 years. CMS did not differ between groups (stemmed 50.5 ± 20.8 vs. stemless 54.1 ± 20.4, p = 0.603). Complete radiographic data were available for 25 patients. Interobserver agreement was excellent for LHO (ICC = 0.93) and very good for LGHO (ICC = 0.85). Mean reconstruction values were close to zero for LHO (ΔLHO = − 0.3 ± 5.1 mm), slightly underreconstructed for LGHO (ΔLGHO = − 6.3 ± 12.9 mm), and slightly medialized for COR (ΔCOR = − 3.5 ± 8.5 mm). Linear regression revealed a significant negative association between ΔLHO and CMS (R² = 0.45; coefficient = − 4.9; p = 0.02).

Both stemmed and stemless HA achieve satisfactory long-term outcomes after over 16 years. Accurate reconstruction of the lateral humeral offset correlates with improved functional results.

Vancouver B2 and B3 periprosthetic femur fractures (PPFF) have posed significant treatment challenges due to stem instability and lack of adequate femoral bone stock. This study investigated subsidence, survivorship, and outcomes of Vancouver B2 and B3 fractures, based on the order in which revision stem placement and fracture reduction occurred during revision total hip arthroplasty (rTHA).

This retrospective, cohort study included 46 rTHAs between June 2011 and April 2023. Included patients underwent rTHA for Vancouver B2 or B3 PPFF with minimum one-year radiographic and two-year clinical follow-up. All patients were treated with diaphyseal-engaging tapered fluted titanium stems and stem modularity decisions were based on surgeon preference. Cohorts were separated based on if stem placement (SF, n = 19), or fracture reduction (RF, n = 27) occurred first. Patient demographics, intraoperative information, and clinical and radiographic outcomes were collected.

The SF and RF cohort showed no statistically significant differences in rate of subsidence ≥5 mm [26.3%[SF], 22.2%[RF], P = 0.749), rate of subsidence ≥ 10 mm (15.8%[SF], 14.8%[RF], P = 0.928), nor average subsidence (4.1 mm[SF], 4.4 mm[RF], P = 0.861). We found no statistically significant differences in surgery-related clinical outcomes or all-cause revision rates within a two-year follow-up period. The groups demonstrated comparable rates of procedure-related 90-day emergency department visits(P = 0.370) and readmissions(P = 0.712). The SF group underwent four revisions for three PJIs and one acetabular component aseptic loosening. The RF cohort underwent four revisions for one acetabular component aseptic loosening, one dislocation, one PPFF, and one PJI. Rates of all-cause revision were comparable(P = 0.583). There was one case within the RF cohort to explant the trochanteric plate with no revision of arthroplasty components.

The present analysis suggests the order in which intraoperative femoral stem implantation and fracture reduction occurs does not affect short-term clinical and radiographic outcomes. This intraoperative decision should be based upon patient anatomy, fracture patterns, and surgeon discretion.

The aim of this study was to evaluate the procedural time and safety of an infraclavicular approach to the subclavian vessels for damage control of major upper extremity vascular injuries. The study specifically focused on the performance of non-thoracic surgeons using a cadaveric model.

A sample of 100 orthopedic trauma surgeons (residents, specialists, and attendings) was recruited from an AO cadaveric dissection course. Emergency infraclavicular access was performed on 50 cadavers over two consecutive days. The procedural time, successful vessel clamping, participant self-assessment, and the resulting learning curve were analyzed.

On day one, 27% (9/33) of participants who successfully achieved correct clamping of both subclavian vessels reported feeling confident. By day two, this proportion increased to 71% (55/77). Comparing day 1 to day 2 we found an improvement of 35% (subclavian artery) and 37% (subclavian vein) in the correct identification of subclavian vessels in our sample. The evaluations of this study show that there is no correlation between surgical experience and successful emergency access.

Anatomic dissection is of paramount importance for teaching rare and demanding surgical techniques. This study demonstrates that anatomical workshops significantly improve procedural safety and self-assessment when accessing subclavian vessels during emergencies.

Hand injuries are common traumatic conditions that often require specialized surgical care. Differences in hospital structures and levels of specialization may influence the timeliness and complexity of treatment. This study evaluates quality of care across different hospital types, focusing on time-to-skin-incision and surgical management of finger and hand injuries.

This retrospective multicenter study is based on data from the HandTraumaRegister of the German Society for Hand Surgery (HTR DGH). A total of 16,726 surgically treated cases with documented finger or hand injuries recorded between 2018 and 2023 were analyzed. Hospitals were categorized as non-replantation centers, replantation centers, or FESSH-accredited replantation centers. Demographic characteristics, injury-patterns, treatment modalities, and time-related parameters were assessed. Statistical analysis included descriptive statistics, group comparisons, and multivariate regression models to evaluate factors associated with time-to-skin-incision.

The study population consisted predominantly of male patients (75.79%), and 91.6% were right-handed. Soft tissue injuries without fractures or amputations accounted for 46.57% of cases. Non-replantation centers demonstrated the longest time-to-skin-incision (median 13 h), whereas replantation centers (median 3.75 h) and FESSH-accredited centers (median 4 h) showed significantly shorter times. Treatment strategies differed significantly between center types (p < 0.001), with non-replantation centers performing more secondary procedures. Replantations or revascularizations were performed in 3.96% of cases, with the highest proportion observed in FESSH-accredited centers (4.64%). Operative durations were significantly longer in replantation centers, particularly for complex and amputation injuries (p < 0.001).

Specialized replantation centers are associated with shorter access times to surgical care compared to non-replantation centers. Longer operative times observed in highly specialized and FESSH-accredited centers may reflect greater injury complexity as well as the technical demands of advanced microsurgical procedures, rather than indicating differences in care quality. These findings highlight the potential relevance of specialized care structures in the management of severe finger injuries.

This study aimed to analyze to what extent a novel intraoperative navigation platform (Next-AR, Medacta) for total knee arthroplasty (TKA) allows to restore the native knee joint kinematics and strains in the medial collateral ligament (MCL) and lateral collateral ligament (LCL) throughout a squatting motion.

Computed tomography (CT) scans of 6 native cadaver legs were used to design patient-specific guides. Bony landmarks and virtual single-line collateral ligaments were identified to acquire real-time intraoperative feedback on bone resection, implant alignment, tibiofemoral kinematics, and collateral ligament elongations using the Next-AR system. The specimens were subjected to squatting (35°-100°) motion using a physiological ex vivo knee simulator while maintaining a constant vertical ankle load of 110 N through active quadriceps and bilateral hamstring controls. Subsequently, each knee underwent a medially-stabilized TKA (Medacta) with mechanical alignment technique and was retested under the same conditions as in their native state. The tibiofemoral and patellofemoral kinematics, along with collateral ligament strains, were computed from 3D marker trajectories using a six-camera optical system (Vicon). MCL and LCL insertions—ant, mid, and post bundles—were identified in relation to bone-pin markers using a wand.

Both native and post-operative conditions exhibited similar tibial valgus orientation (Root Mean Square Error (RMSE = 1.7°), patellar flexion (RMSE = 1.2°), abduction (RMSE = 0.5°), and rotation (RMSE = 0.4°) during squatting (p > 0.13). However, a significant difference was observed in tibial internal rotation between 35° and 62° (p < 0.048, RMSE = 3.2°). MCL strains in anterior (RMSE = 1.5%), middle (RMSE = 0.7%), and posterior (RMSE = 0.8%) were closely matching in both conditions, showing no statistical differences (p > 0.05). Contrary, LCL strain in all bundles (RMSE < 4.6%) differed significantly from mid to deep flexion in both conditions (p < 0.048).

The novel intraoperative Next-AR system not only targets planned knee alignment but also aids in restoring native knee kinematics and elongation of the collateral ligaments through real-time feedback.

Distal radius fractures may affect the median nerve through trauma-related and treatment-related mechanisms. While overt neurological deficits are uncommon, subclinical median nerve alterations may occur following both conservative and surgical treatment.

To determine whether treatment modality influences subclinical median nerve behavior using combined dynamic ultrasonographic and electrophysiological assessment.

This retrospective observational study included 42 patients with unilateral distal radius fractures. 18 patients were treated conservatively with circular casting, and 24 patients underwent volar plate fixation. Ultrasonographic assessment of the median nerve was performed at the distal radius level in neutral wrist position, as well as during wrist flexion and extension, using a dynamic ultrasonographic approach, and was combined with electrophysiological evaluation including sensory and motor nerve conduction studies. In the surgically treated group, only patients with Soong type 1 or type 2 plate positioning were included.

Clinical functional outcome scores were comparable between groups, despite a higher frequency of mild clinical signs such as positive Tinel test and night pain in the plate group. However, ultrasonographic evaluation demonstrated significantly greater position-dependent median nerve enlargement and flattening in the volar plate group, particularly during wrist flexion and extension (p < 0.05). Electrophysiological assessment revealed a significant reduction in sensory nerve conduction velocity on the affected side in surgically treated patients compared with the cast group (p < 0.05), while motor conduction parameters remained preserved. These differences were observed despite comparable clinical functional outcomes between groups.

Patients treated with volar plate fixation demonstrated more pronounced subclinical ultrasonographic and electrophysiological median nerve alterations compared with those treated conservatively with cast immobilization. However, given the retrospective and non-randomized design, these findings should be interpreted as associative rather than causal. Combined ultrasonographic and electrophysiological assessment may be useful for detecting early median nerve involvement and guiding follow-up evaluation, even in the absence of clinically overt symptoms.

To compare the clinical and functional outcomes of open reduction and internal fixation (ORIF) and reverse shoulder arthroplasty (RSA) in patients aged ≥ 65 years with complex proximal humeral fractures (PHFs).

A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Web of Science, ScienceDirect, EBSCO, and the Cochrane Library were searched for randomized controlled trials (RCTs) and cohort studies published in English without date restrictions. Eligible studies compared RSA and ORIF in elderly patients with PHFs and reported functional, radiographic, or complication outcomes. Pooled data were analyzed using a random-effects model.

Twenty-two studies involving > 34,000 patients were included. RSA was associated with greater forward flexion and a trend toward improved abduction, whereas internal rotation favored ORIF without reaching significance. No significant differences were observed in external rotation. The functional scores (Constant-Murley, Oxford Shoulder Score) were similar, and the complication and reoperation rates did not differ significantly between the groups.

RSA offers modest advantages in forward flexion compared with ORIF but does not consistently improve overall functional scores or reduce complications. RSA may be preferred in elderly patients with poor bone stock or rotator cuff pathology, whereas ORIF remains appropriate for patients in whom joint preservation is feasible. High-quality RCTs with standardized outcome reporting are needed to clarify the optimal surgical management.

The impact of attention deficit, impulsivity, and anger on various types of injuries is a subject of ongoing research. Hand tendon injuries are frequently encountered clinical conditions; however, their potential relationships with the aforementioned factors have not been previously investigated. This study aimed to examine the mechanisms of hand tendon injuries from certain psychiatric perspectives.

32 patients presenting to the physical therapy and rehabilitation outpatient clinic with hand tendon injuries and 32 healthy controls were evaluated. The assessment included sociodemographic data, causes of injury, Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) and Visual Analog Scale (VAS) scores, as well as the physical and functional consequences of the injury. Patients and controls were assessed for attention deficit, impulsivity, and anger using the Adult ADHD Self-Report Scale (ASRS), Barratt Impulsivity Scale-11 (BIS-11), and State-Trait Anger Expression Inventory self-report scales. Statistical analyses of the results were performed.

Patients with tendon injuries were found to have significantly higher scores in ASRS attention and BIS-11 Motor impulsivity compared to the control group (p = 0.048, p = 0.040). Individuals with hand tendon injuries resulting from work accidents demonstrated significantly lower ASRS total, ASRS hyperactivity and impulsivity scores, and VAS rest scores compared to those with tendon injuries resulting from other causes (p = 0.049, p = 0.045, p = 0.038).

Hand tendon injuries are associated with elevated impulsivity and inattention, suggesting that psychiatric screening could guide injury prevention and rehabilitation strategies. In contrast, the finding that work-related accidents are characterized by lower impulsivity indicates that prevention in this subgroup should prioritize environmental safety and occupational regulations over individual behavioral interventions.

NCT07126899.

Coracoid process fractures are frequently associated with injuries to the superior suspensory shoulder complex, including the acromioclavicular (AC) joint. However, concomitant AC joint injuries may be overlooked in the acute phase, potentially limiting treatment options. This study aimed to investigate the association between coracoid process fractures and SSSC injuries and to identify imaging-based predictors of concomitant AC joint injury.

A retrospective single-center cohort study including 60 patients with coracoid process fractures was conducted between February 2016 and April 2023. Coracoid fractures were classified based on anatomical location, and associated SSSC injuries were categorized according to the involved structures. These injuries were evaluated using 3D shoulder CT. Morphological deformity of the SSSC was assessed by measuring the glenoclavicular distance (GCD)—a longitudinal parameter—on final follow-up clavicle AP radiographs. In base fractures, the medial displacement gap was measured on sagittal CT. Statistical analyses included logistic regression and ROC curve analysis to identify predictors of AC joint injury.

Among the 60 patients, fractures were located anteriorly in 27 cases, in the middle region in 5 cases, and at the base in 28 cases. AC joint injury was identified in 15 patients, all of whom had base-type fractures. Logistic regression analysis revealed a significant association between base fractures and SSSC injuries (OR = 21.0, p < 0.001). The GCD was significantly different between affected and contralateral sides in base fracture cases (Kruskal–Wallis test, p < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that a displacement gap of ≥ 5.82 mm was predictive of concurrent AC joint injury (AUC = 0.741).

Coracoid process base fractures are significantly associated with injuries to other components of the SSSC. In particular, a displacement gap of 5.82 mm or more suggests a higher likelihood of previously unrecognized AC joint injury.

III, retrospective cohort study.

The number of patients with mild traumatic brain injury (TBI) receiving oral anticoagulation is increasing. Up-to-date diagnostic and treatment algorithms are missing in Austria. The aim of this survey is to collect and analyse Austria-wide data on the care of this patient group.

The survey was carried out using “Jotform” between 27 November 2023 and 31 January 2024, asking questions relating to the diagnosis and treatment of patients with mild TBI receiving antithrombotic therapy. Patient groups comprising individuals with alcohol addiction and hemophilia were incorporated as well with a view to the paucity of available literature on these groups. The survey was sent to all orthopedic-traumatological and neurosurgical departments in Austria.

39 of 67 (58.2%) orthopedics & traumatology departments and 4 of 10 (40%) neurosurgery departments participated in the survey. The share of departments reporting routine submission of different patient groups to cranial computed tomography (CCT) was 38 (95%) for patients taking antiplatelet agents, 39 (97.5%) departments for patients taking vitamin K antagonists (VKAs), 39 (97.5%) for patients taking direct oral anticoagulants (DOACs), 11 (27.5%) for patients with alcohol addiction, and 28 (70%) for patients with known hemophilia. Considering the separate groups of patients not living in a nursing facility vs. those living in a nursing facility, inpatient admission occurred for 63% vs. 44% of patients taking antiplatelet agents, for 78% vs. 61% of patients taking VKAs, 80.5% vs. 63.4% of patients taking DOACs, 17.1% vs. 17% of patients with alcohol addiction, and 51.2% vs. 43.9% of patients with hemophilia. Statistically significant regional differences in inpatient admission were found in the group with hemophilia (living and not living in a nursing facility) as well as in the group with DOAC intake (living in a nursing facility).

Regional differences in the treatment of the studied patient groups exist within Austria, particularly regarding in-house admission of patients. An up-to-date guideline would be desirable to enable the best possible patient care while taking the increasing resource scarcity into account.

The long head of the biceps tendon is a frequent source of anterior shoulder pain, often treated with tenodesis. While anchor tenodesis is well established, it carries risks of implant-related complications. This study evaluates an implant-free “loop tenodesis” technique as a potentially safer and cost-effective alternative.

In this prospective, double-blinded, randomized exploratory study, 48 patients undergoing arthroscopic biceps tenodesis were randomized to either loop (n = 24) or anchor (n = 24) tenodesis. Clinical outcomes were assessed using ASES, Constant, and DASH scores, as well as range of motion, supination strength, satisfaction, aesthetic appearance, and return-to-sport. Statistical analysis was performed using the Mann-Whitney U and Wilcoxon signed-rank tests to compare non-parametric data.

Both groups showed significant improvements with similar gains in functional scores. Supination strength recovery was greater in the loop group (103% vs. 93%). There were no significant differences in range of motion or complications. Notably, only the anchor group showed cases of Popeye deformity (2 patients). Return to sport was achieved in 95.3% of patients, typically within 3 months. No revision or implant-related issues occurred.

Loop tenodesis offers equivalent clinical outcomes to anchor-based techniques, with fewer aesthetic concerns and no implant-associated risks, making it a safe, reliable, and cost-effective alternative for biceps tenodesis.

Conventional open reduction and internal fixation (ORIF) remains the standard approach for midshaft clavicle fractures, yet its traumatic nature has driven the need for minimally invasive techniques. Locking minimally invasive plate osteosynthesis (MIPO) demonstrates clinical potential through biomechanical superiority and tissue-preserving characteristics.

To compare the clinical efficacy and safety of MIPO versus ORIF for midshaft clavicular fractures.

A retrospective cohort study included 203 patients (MIPO group:101 cases; ORIF group:102 cases) treated between 2022 and 2024. Baseline characteristics, functional outcomes (DASH and Constant-Murley scores), and complications were analyzed using Mann-Whitney U and chi-square tests.

No baseline differences were observed (P > 0.05). Functional outcomes were equivalent between groups (DASH score: P = 0.906; Constant-murley score: P = 0.646). The overall complication rate was significantly lower in the MIPO group than in the ORIF group (7.92% vs. 36.27%, P < 0.001), particularly in nonunion (0% vs. 5.88%, P = 0.039) and sensory disturbance (6.93% vs. 27.45%, P < 0.001). This advantage is also evident in the subgroup of patients with AO type 2 C fractures, where MIPO similarly demonstrates a significantly lower incidence of these two complications.

MIPO achieves comparable functional recovery to ORIF while reducing postoperative complications, supporting its prioritization in midshaft clavicular fracture management.

The increasing incidence of fractures and cases of delayed union or nonunion has encouraged the search for non-invasive therapies. Extracorporeal shockwave therapy (ESWT) has been proposed as a strategy to stimulate bone regeneration and improve fracture healing.

A systematic review was conducted following PRISMA guidelines, with searches performed in PubMed, Scopus, Web of Science, and Embase (2005–2025). Clinical studies evaluating ESWT for fracture treatment with radiographic assessment of bone healing and the presence of a control group were included.

A total of 834 studies were initially identified, of which 7 were included in the final analysis. Most studies demonstrated positive effects of ESWT, including improved bone healing, pain reduction, and functional recovery. However, there was considerable heterogeneity in treatment protocols and relatively small sample sizes.

ESWT shows potential as a non-invasive therapy to stimulate fracture healing, particularly in cases of delayed union or nonunion. However, further controlled clinical trials and standardized protocols are needed to confirm its clinical effectiveness.

Stage II scapholunate advanced collapse (SLAC) and Scaphoid non-union advanced collapse (SNAC) wrists are currently treated either by scaphoidectomy and Four Corner Fusion or by Proximal Row Carpectomy. In our retrospective study, isolated scaphoidectomy demonstrated clinical non-inferiority when compared to standard procedures and could be supplemented by a Four Corner Fusion only at a later time if needed.

Between 2006 and 2011, 13 patients / 14 wrists (mostly males, manual workers) underwent the surgical procedure. 8 patients were affected by SNAC and 5 by SLAC. The average age was 56,5. All patients were manual workers. The mean follow-up was 15 years. These patients were reviewed a first time in 2012 and once again in 2024. Subjective outcome, DASH score, return to work, ROM and grip strength were evaluated. Radiographic assessment was done in all 14 wrists at the first follow-up and in 6 at the last long-time review. Statistical analysis was conducted using the SPSS software.

12 patients had resumed the same work at a mean of 3 months after surgery. Only one patient required a Four Corner Fusion after 2 years. 11 of the 13 enrolled patients declared their satisfaction for the procedure at the longest follow-ups. Clinical results remained stable over time. Radiological deterioration was seen in 6/13 wrists at the first follow-up and in all the 6 patients that could be investigated with an X-ray at the second long term follow-up. Lunate-Capitate arthrosis and Lunate DISI pattern were the radiological features observed without carpal collapse.

Isolated scaphoidectomy for type II SLAC and SNAC wrist is a reliable and simple surgical procedure which could be proposed only after careful patient selection. This procedure has maintained a high level of satisfaction at long-term follow-up despite the radiological deterioration. It is far less invasive and requires a shorter time of functional recovery than Four Corner Fusion and Proximal Row Carpectomy in elderly or low-demanding patients with good pain relief. In case of failure, isolated Scaphoidectomy can be supplemented by a Four Corner Fusion at a later time if needed.

Split hamate fractures, which most often are a complicating part of fracture dislocations of the 5th or 5th and 4th carpometacarpal joints, are rare and challenging injuries that can severely affect hand function. The injury usually requires surgical treatment. However, both short- and long-term data on the effectiveness of these interventions are limited. The objective of this study is to advance understanding of this rare hand surgical condition by investigating its epidemiology, etiopathogenesis, subsequent complications, and functional outcomes.

Between 2010 and 2024, a total of 29 patients with a split hamate fracture were treated at a level-1 trauma center, of which 12 patients are included in this study. Using patient surveys (DASH, SF-36, PRWE), along with clinical and radiological examinations, the hand function of a total of 12 patients with split hamate fractures is evaluated.

Twelve male patients with a split hamate fracture were included, with a mean age of 28.1 years at the time of surgery. In 10 patients (83%) the dominant right hand was affected, most involving, the injuries resulted from direct trauma or a fall; surgery was performed on average of 12 days after injury. Functional outcomes were favourable, with a mean DASH score of 14.1 and PRWE score of 14.8, indicating minimal residual reduction of function in most cases. Radiological follow-up showed complete fracture consolidation in 92% of patients, while degenerative changes and implant-related findings were observed in 58% and 42% of cases, respectively.

This case series demonstrates that split hamate fracture can achieve excellent functional and radiological outcomes with surgical treatment, while also highlighting specific challenges in surgical approach and osteosynthesis.

Mix and Match is considered a viable option for minimizing morbidity in total hip arthroplasty (THA). However in reverse total shoulder arthroplasty (rTSA) this strategy remains comparatively new. This study provides an overview of currently available implant systems and the potential combinations of glenoid and humeral components.

A review of commercially available shoulder arthroplasty systems was performed. Nineteen manufacturers were contacted and asked to provide detailed information on glenoid and humeral component sizes for their rTSA systems. The reported component sizes were compiled and analyzed for possible combinations.

Thirteen manufacturers (68%) consented to the publication of their component size data. Two manufacturers (11%) do not produce rTSA systems, and four (21%) did not respond to repeated inquiries. A total of 21 implant systems were reported, comprising 10 distinct implant sizes. Glenosphere and humeral inlay diameters ranged from 32 mm to 48 mm, with 36 mm being the most commonly available size (16 of 21 systems, 76%).

Mix-and-match implantation in rTSA is likely employed more frequently than documented, yet remains poorly investigated. This study demonstrates that numerous systems can theoretically be combined during revision surgery, although the biomechanical implications are not yet understood. Early clinical reports appear promising. The potential advantages for patients undergoing this procedure include reduced operative time, less invasive surgery with lower risk of perioperative complications.

Level V.