Orthopedic Surgery

Durable function after insertional reattachment for acute Achilles sleeve avulsion

Fifty adults with acute Achilles sleeve avulsion underwent insertional reattachment; 39 had minimum 2- and 5-year follow-up. Patients were predominantly middle-aged men with mostly high-energy injuries and mean BMI in the overweight range. PROs (VAS, AOFAS Ankle-Hindfoot, FFI, Tegner) improved and remained satisfactory at both 2 and 5 years. These data support insertional reattachment as a durable option with sustained function and sports participation in appropriately selected patients. 1

Scapular spike sign helps flag extraarticular fractures meeting surgical criteria

Among 268 AO/OTA 14B extraarticular scapula fractures, 133 met at least one established surgical indication. The scapular spike sign, measured as lateral border displacement beyond the glenoid edge on AP radiographs, correlated with these indications. A displacement threshold yielded clinically useful sensitivity, specificity, and predictive values for identifying fractures needing surgery. Interobserver and intraobserver reliability were acceptable, making the spike sign a pragmatic screening tool to prompt CT and specialist referral. 2

Nomogram estimates local recurrence risk after curettage for extremity GCTB

In 325 patients treated with curettage for extremity GCTB, local recurrence-free survival was 83% at 2 years and 77% at 5 years. A multivariable Cox-based nomogram included age, Campanacci stage, site, pathologic fracture, denosumab, prior surgery, filler, and local adjuvants. The optimism-corrected C-index was 0.69 with good calibration for 2- and 5-year predictions, indicating moderate discrimination. A web-based application allows individualized recurrence-risk estimates to guide surveillance intensity and consideration of more aggressive surgery. 3