Orthopedic Surgery

Reverse TSA maintains good function and radiographic stability at 15 years, with nontrivial complication and reoperation rates

This prospective series analyzed 258 reverse TSAs with ≥15-year follow-up, including detailed clinical and radiographic evaluation in 52 shoulders. Complication-free survival was about 80% at 10 years and 76% at 15 years, with reoperation-free survival around 84% at 15 years. Most functional gains at two years were maintained through 10 and 15 years, with Constant scores and SSV remaining in the good range. Pain relief, abduction, rotation, and strength were stable long term, although forward flexion declined modestly over time. Younger age, female sex, and revision indication were independent predictors of complications, informing patient selection and counseling for reverse TSA. 1

Revision Latarjet with malleolar screws after failed suture cerclage provides noninferior primary stability

This cadaveric study evaluated coracoid graft stability after revising failed all-suture cerclage Latarjet to two malleolar screws. Specimens were cyclically loaded up to 300 N with static conjoint tendon tension, and graft displacement was compared to primary screw fixation. There were no significant differences in graft displacement at any load level between revision and primary screw groups. Revision constructs showed slightly higher displacement at low loads but superior stability at higher loads versus primary screw fixation. One intraoperative graft fracture occurred during revision without affecting construct stability, supporting screw-based revision as a biomechanically viable salvage option. 2

Residual displacement and malalignment after tibial plateau ORIF correlate with KOOS-based recovery

This multicenter study related radiographic measures of tibial plateau fracture displacement and alignment to long-term KOOS outcomes after surgery. Over 1100 surgically treated patients were identified, with more than half completing KOOS questionnaires at a mean seven-year follow-up. Preoperative CT gaps and stepoffs and postoperative residual incongruity, condylar widening, and tibial alignment were independently measured. Patients were classified as fully recovered when KOOS scores were within the MCID range of population-based normative values. Results linked specific degrees of residual articular incongruity and alignment deviations with lower likelihood of KOOS-defined full recovery, informing reduction and alignment targets. 3

IM nailing and locking plates have equivalent outcomes for displaced proximal humerus fractures

This systematic review and meta-analysis included 12 studies with 1039 adults undergoing intramedullary nailing or locking plate fixation for displaced proximal humerus fractures. DASH, ASES, and Constant-Murley scores at six months showed no significant differences between nails and plates. Pain scores, range of motion, complication rates, and reoperation rates were similar between techniques, including in 2-part and 3-part subgroups. Some individual studies suggested small early advantages for one method, but none reached thresholds for clinical relevance. Given comparable outcomes, implant selection can prioritize soft-tissue handling, operative time, cost, and surgeon experience. 4