The edition · Orthopaedics
A five-item score separated 4% from 42% osteonecrosis risk after femoral neck fixation
The FNF-ON8 score outdid the Garden classification for predicting osteonecrosis in adults under 65. Plus bicruciate-retaining knees at ten years, the pelvic fragility fractures nobody sees on a radiograph, and what a perineal post does to the pudendal nerve.
The edition in brief
A retrospective three-centre Chinese study of 1,012 adults aged 18 to 65 fixed with three cannulated screws derived an eight-point score for femoral head osteonecrosis. Five variables were retained: displaced fracture (OR 7.9, 3 points), superior subcapital fracture line (OR 3.5, 2 points), inferior subcapital line (OR 3.0, 1 point), comminution (OR 2.4, 1 point) and age 45 or over (OR 2.1, 1 point). Osteonecrosis developed in 4% of patients scoring 0 to 3 and 42% of those scoring 6 to 8. Discrimination beat the Garden classification (AUC 0.80 vs 0.70). It is not yet externally validated. Ten-year follow-up of a randomised radiostereometric trial of 50 knees found no difference in tibial component migration between bicruciate-retaining and cruciate-retaining total knee arthroplasty (maximum total point motion 0.88 vs 0.64 mm, difference -0.23 mm, 95% CI -0.57 to 0.10), and no difference in Oxford Knee Score or Forgotten Joint Score trajectories. Two revisions occurred in the bicruciate-retaining group and none in the comparator. A review of pelvic and vertebral fragility fractures notes that many patients are asymptomatic or have symptoms attributed elsewhere, that pelvic and sacral fractures are hard to see radiographically, that non-operative care suits most patients, and that secondary fracture prevention is critical. A propensity-matched comparison of 258 hip arthroscopies found interportal and T-type capsulotomy gave comparable outcomes and 98% reoperation-free survivorship at two years. In 93 hip arthroscopies with a perineal post, 83% had pudendal nerve symptoms acutely, 14% beyond six months and none at a year; each extra 10 minutes of traction raised the odds by 1.59.
A five-item score predicted osteonecrosis better than the Garden classification
Score displacement, fracture line position, comminution and age preoperatively to give a young patient a real number for osteonecrosis risk — 4% at the low end, about 42% at the high.
Bicruciate-retaining knees at ten years: no fixation gain, two revisions
Ten years on, bicruciate-retaining knees showed no fixation or outcome advantage over cruciate-retaining ones, with two revisions against none — not a reason to switch.
Pelvic and vertebral fragility fractures: the diagnosis is the hard part
Treat an unexplained pelvic or back pain after a low-energy fall as an occult fragility fracture until imaged, manage most non-operatively, and start secondary prevention during the same episode.
Interportal and T-type capsulotomy came out the same at two years
With capsular closure, interportal and T-type capsulotomy gave comparable outcomes and survivorship at two years — choose on the exposure the case needs.
Compartment syndrome is diagnosed on the trend, not on a pulse
Watch the analgesic trend and passive stretch pain rather than the pulse, repeat the examination, and measure pressures in anyone who cannot report pain.
Pudendal symptoms after hip arthroscopy were the rule, and traction time predicted them
Put pudendal symptoms into the consent conversation, then record and minimise traction time and force — each extra 10 minutes raised the odds by about 60%.
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