Orthopedic Surgery

Fracture rTSA: modular diaphyseal stems improve ASES; metaphyseal stems improve rotation

In 99 rTSAs for acute three- or four-part proximal humerus fractures, modular diaphyseal (n=66) and nonmodular metaphyseal (n=33) stems had similar complications and revisions. Modular diaphyseal stems produced higher postoperative ASES scores than metaphyseal stems (76.35 vs 65.58; p=0.015). Metaphyseal stems yielded greater abduction (74.55° vs 57.93°; p=0.0267) and substantially better external rotation (32.12° vs 14.79°; p<0.0001). VAS pain and revision rates were comparable, though operative time and follow-up were longer with diaphyseal stems. 1

Anterior shoulder pain affects one in eight patients after rTSA and links to design choices

Among 1,401 rTSAs with at least 12 months’ follow-up, 12.4% developed documented anterior shoulder pain. Pain localized to anterior structures such as the conjoint tendon region, biceps tenodesis site, subscapularis repair, and anterior deltoid. Anterior shoulder pain was associated with rotator cuff deficiency, lower weight, an inlay humeral component in 20° retroversion, and greater total glenoid lateralization. Onlay humeral design in 30° retroversion and less lateralization correlated with lower anterior pain prevalence. 2

Younger and female patients have higher odds of poor outcome after radial head replacement

This study of 134 patients undergoing radial head replacement for acute complex elbow instability used the Oxford Elbow Score (OES) to define outliers. Patients in the lowest OES quartile (<35) were younger, had more high-energy trauma, and more terrible triad or Essex-Lopresti injuries than higher scorers. Low-OES patients had worse motion, more pain, lower satisfaction, inferior MEPS and DASH scores, and all implant removals occurred in this group. Multivariate analysis found younger age and female sex independently increased the odds of being in the lowest OES quartile. 3

Bioinspired mineralized collagen scaffold markedly enhances enthesis healing in multiple animal models

A mineralized collagen scaffold with 33% inorganic content was engineered to mimic native fibrocartilage enthesis mineral architecture. Across mouse, rat, rabbit, and goat models, this scaffold consistently improved fibrocartilage healing at the tendon–bone interface. In rabbits, it produced 82% fibrocartilage width recovery, more than double that achieved with comparator biomaterials. Scaffold treatment increased maximum load to failure and restored normal walking in rats and rabbits, with goats showing improved jumping ability. 4