Orthopaedics
Hip fracture surgery delayed only by theatre capacity was linked to higher mortality, most in frail patients
A UK cohort that excluded delays for medical optimisation found waiting beyond 36 hours for lack of theatre space was tied to more deaths. An adductor canal block showed no added benefit over local infiltration after ACL reconstruction, and surgeon and hospital, more than patient risk, explained dual-mobility hip use.
Non-hamstring ACL grafts were linked to higher scores, and an MCL injury did not clearly change that
A French registry associated non-hamstring grafts with better patient-reported outcome across medial injury patterns; a hip-preservation series set thresholds for a worthwhile result after periacetabular osteotomy; and exercise was linked to better forearm bone in women, on very low-certainty evidence.
Robotic knee replacement adds operating time, not function, across 24 randomised trials
A trials-only meta-analysis finds no functional or pain benefit from robotic TKA; an articulating spacer keeps 89% of infected hips reinfection-free at five years; and AI assistance lifts fracture detection most for junior doctors.
About one in ten patients with spinal metastases lives five years — plan the operation for them too
A 926-patient registry puts a long-term number on spinal metastatic disease, a JBJS review makes periprosthetic fracture prevention part of every hip replacement, and joint replacement under 25 works but carries more revisions.
A distal radius fracture after 65 is a window for osteoporosis treatment most patients miss; WAIT-Free sets out immediate weight-bearing after hip fracture for Asia
A Japanese cohort of 47,000 older adults finds wrist fractures mark fragile bones in still-active people, an international consensus maps immediate weight-bearing after hip fracture into low-adoption regions including South Asia, and registry studies flag Equinoxe anatomic shoulders and quadriceps-tendon ACL grafts.
Locking plates beat tension-band wiring for displaced patellar fractures
A blinded Danish trial meets its superiority bar on patient-reported knee function; robotic UKA improves early recovery but not two-year scores; linked records find a third of arthroplasty VTE outside hospital data; and Cochrane finds the fracture evidence in men remarkably thin.
An eight-point score picked out which young femoral neck fractures went on to osteonecrosis: 4% at the low end, 42% at the high
A Chinese multicentre score for osteonecrosis after screw fixation, an ACL cohort showing that tibial slope matters most in the young, ten-year data on bicruciate-retaining knees, a proximal humerus study on pain, and an ibuprofen suspension recall.
Brisk walking, at the right dose, is the bone prescription with evidence behind it
A 124-trial network meta-analysis puts numbers on the exercise advice every clinic gives: about 600 METs-minutes a week, walking or jogging, with mixed aerobic work the only modality showing a fracture signal. Plus why cementless versus cemented robotic knees remains an open question.
Waiting for a theatre, not for a medical workup, is what kills hip fracture patients
Delay past 36 hours purely for capacity carried a 37% higher one-year mortality; plus which cement and mixing order gets vancomycin out of a spacer, what vitamin D is worth in stress fractures, and a block you can stop doing after ACL reconstruction.
The fragility fractures you cannot see on the radiograph are the ones killing people
Two JBJS reviews land together on the same problem from opposite ends: vertebral and pelvic insufficiency fractures that go undiagnosed, and a global care gap that is a health-system failure rather than an evidence one. Plus inflammatory markers and fracture risk, and digital rehabilitation that is finally ready for knee osteoarthritis.
Fracture detection: 73% to 87% with a second reader that never tires
A meta-analysis of 17 studies puts numbers on what AI adds to fracture reading — and on who gains, which is mostly the junior in the emergency department at 3am. Plus a network comparison of distal tibial fixation, what psychiatric comorbidity does to hip arthroscopy at ten years, and a spacer finding that should change your bearing choice.
Stopping denosumab without a bisphosphonate to follow carries a 71% higher vertebral fracture risk
Pooled data on sequential bisphosphonate after denosumab, the AAOS position that biomarkers must not drive the fasciotomy decision, and a review finding robotic arthroplasty more precise but no better for patients.
A consensus sets out how to make immediate weight-bearing after hip fracture surgery routine in South Asia and other low-adoption regions
The WAIT-Free consensus closes the edition. Before it: higher revision with one recalled anatomic shoulder system, prior arthroscopy and arthroplasty infection, robotic hip replacement, and reoperation after quadriceps tendon ACL grafts.
Locking plates beat tension-band wiring for displaced patellar fractures in a blinded randomised trial
A 122-patient multicentre trial favours plate fixation on symptoms, sport and quality of life; a wrist fracture proves a missed window for osteoporosis treatment; and Cochrane finds the evidence for fracture prevention drugs in men is very uncertain.
The same slope, a very different knee: age decides how much tibial slope matters
A 581-patient cohort turns posterior tibial slope from a relative risk into an absolute one — 36.6% rerupture at 18, 3.9% at 45 for the same 15 degrees. Plus a knee osteoarthritis add-on trial that reports the wrong numbers, and a 1,100-patient trial of antibiotic-loaded bone graft.
Two to three hours of brisk walking a week, and the bone responds
A 124-trial network meta-analysis puts a dose on exercise for bone density; an eight-nerve block matched infiltration on pain but halved nothing except opioids and bed days; and the cemented-versus-cementless question in robotic knees remains unanswered.
The osteosarcoma gap opens before the diagnosis
Patients from the most deprived areas carried symptoms for 13 weeks against six, and arrived through emergency care twice as often - but once diagnosed, their treatment ran to the same timetable as everyone else's. Plus slope-reducing osteotomy in elite athletes, two tendon measurements for patellofemoral instability, and bioabsorbable screws that behaved themselves for two years.
Compliance with partial weight-bearing was 21% until the crutches started talking
Fifty years of periprosthetic joint infection management reviewed; manipulation beats mobilisation for neck pain by less than a point; quadriceps grafts outperform bone-patellar-tendon-bone on the bench; and a small randomised pilot exposes how little partial weight-bearing instruction achieves on its own.
Which implant, which injection, and one block you can stop doing
A 288,584-knee registry names the implant systems that fail international survivorship benchmarks; a 24-expert Delphi draws the line around orthobiologics; and a double-blind trial finds the adductor canal block adds nothing to local infiltration in ACL reconstruction.
The robot did not win: RACER-Knee finds no patient benefit and higher cost
A masked, ten-centre randomised trial with sham incisions puts robotic-arm total knee replacement 1.5 points behind conventional instruments on the Forgotten Joint Score at a year; a UK cohort isolates capacity delay from medical delay in hip fracture and finds a 37 per cent higher one-year mortality; and pooled data support a bisphosphonate after stopping denosumab.
Who holds the drill explains dual-mobility use better than who is on the table
A 238,000-hip registry analysis finds surgeon and institution account for more than half the variation in dual-mobility implant choice while patient factors explain a tenth; a network meta-analysis ranks five fixation strategies for distal tibial fractures; and psychiatric comorbidity quadruples failure a decade after hip arthroscopy.
One in ten patients with spinal metastases now reaches five years
A modern registry puts five-year survival in spinal metastatic disease at 8.9% — enough to change how durable a construct needs to be. Also: the pooled risk factors for infection after knee replacement, and why a previous arthroscopy matters at the knee and shoulder but not the hip.
The quadriceps graft is being reoperated on twice as often
Across 5653 primary anterior cruciate ligament reconstructions, quadriceps tendon autografts came back to theatre for extension deficit or pain at 11.9% against 5.5% for hamstring; a slope of 15 degrees means a 37% rerupture risk at 18 and 4% at 45; and physician-scored shoulders read 14 points better than the patient's own verdict.
Locking plates beat tension-band wiring for displaced patellar fractures
A blinded multicentre randomised trial found clinically meaningful gains on three KOOS sub-scales at twelve months with fewer reoperations and less hardware removal, while a randomised comparison of robotic and conventional unicompartmental knee replacement found better accuracy and recovery but no difference on the main outcome scores.
Locking plates beat tension-band wiring for displaced patellar fractures
A multicentre blinded randomised trial in 122 adults found locking plate fixation superior on three KOOS sub-scales at 12 months, with less hardware removal, fixation failure and reoperation. Plus a dose-response curve for resistance exercise in knee osteoarthritis, and lateral extra-articular procedures cut ACL graft failure.