Wan-Sun Choi

Background and Objectives: The surgical management of displaced scapular fractures remains controversial, particularly regarding the importance of restoring scapular alignment. This study evaluated radiologic restoration and clinical outcomes following posterior fixation of displaced scapular fractures, with a particular focus on correction of lateral border offset (LBO) and angular deformity. Materials and Methods: This retrospective case series included 20 patients who underwent posterior open reduction and internal fixation for displaced scapular fractures between 2017 and 2024 with a minimum follow-up of 12 months. Surgical indications included lateral border offset (LBO) > 20 mm, angular deformity > 30°, or displaced intra-articular fractures with step-off > 3 mm. Radiologic parameters including LBO, angular deformity, and intra-articular step-off were measured using computed tomography before and after surgery. Clinical outcomes were evaluated using shoulder range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) score, and modified American Shoulder and Elbow Surgeons (ASES) score. Results: Significant postoperative improvement was observed in all radiologic parameters. Mean LBO improved from 18.9 ± 10.7 mm (range, 0–45.5 mm) to 3.1 ± 7.1 mm (range, 0–29.9 mm), angular deformity improved from 28.7° ± 11.3° (range, 10.2–48.1°) to 0.9° ± 3.9° (range, 0–17.8°), and intra-articular step-off improved from 6.4 ± 2.0 mm (range, 3.7–9.7 mm) to 1.8 ± 0.5 mm (range, 1–2.5 mm). At final follow-up, mean forward flexion was 126° ± 34.4° (range, 10–170°) and external rotation was 62.3° ± 20.8° (range, 0–90°). Mean DASH and modified ASES scores were 27.3 ± 17.3 (range, 8.3–74.2) and 71.6 ± 15.0 (range, 25.8–89), respectively. Glenoid involvement was not associated with inferior clinical outcomes, whereas associated ipsilateral upper extremity injuries tended to be related to poorer functional results. Conclusions: Posterior fixation effectively restored scapular alignment and articular congruity in displaced scapular fractures. Restoration of LBO and correction of angular deformity may represent important surgical objectives for correction of glenoid medialization and restoration of normal scapular alignment.

Introduction: Coracoid process fractures are frequently associated with injuries to the superior suspensory shoulder complex, including the acromioclavicular (AC) joint. However, concomitant AC joint injuries may be overlooked in the acute phase, potentially limiting treatment options. This study aimed to investigate the association between coracoid process fractures and SSSC injuries and to identify imaging-based predictors of concomitant AC joint injury. Methods: A retrospective single-center cohort study including 60 patients with coracoid process fractures was conducted between February 2016 and April 2023. Coracoid fractures were classified based on anatomical location, and associated SSSC injuries were categorized according to the involved structures. These injuries were evaluated using 3D shoulder CT. Morphological deformity of the SSSC was assessed by measuring the glenoclavicular distance (GCD)—a longitudinal parameter—on final follow-up clavicle AP radiographs. In base fractures, the medial displacement gap was measured on sagittal CT. Statistical analyses included logistic regression and ROC curve analysis to identify predictors of AC joint injury. Results: Among the 60 patients, fractures were located anteriorly in 27 cases, in the middle region in 5 cases, and at the base in 28 cases. AC joint injury was identified in 15 patients, all of whom had base-type fractures. Logistic regression analysis revealed a significant association between base fractures and SSSC injuries (OR = 21.0, p < 0.001). The GCD was significantly different between affected and contralateral sides in base fracture cases (Kruskal–Wallis test, p < 0.001). Receiver operating characteristic (ROC) curve analysis indicated that a displacement gap of ≥ 5.82 mm was predictive of concurrent AC joint injury (AUC = 0.741). Conclusions: Coracoid process base fractures are significantly associated with injuries to other components of the SSSC. In particular, a displacement gap of 5.82 mm or more suggests a higher likelihood of previously unrecognized AC joint injury. Level of evidence: III, retrospective cohort study.

Background/Objectives: Rami fractures in anteroposterior compression (APC)-type pelvic ring injuries show favorable outcomes with conservative management in isolated settings; however, the necessity of direct rami fixation when posterior instability is present remains unclear. This study aimed to determine whether adding direct rami fixation to symphyseal plating improves clinical and radiologic outcomes in APC-type pelvic ring injuries. Methods: This retrospective cohort study included a final cohort of 98 patients with APC type II or III pelvic ring injuries and concomitant pubic rami fractures treated at a Level 1 trauma center (2014–2022). All patients underwent plate-based symphyseal fixation, classified into four groups by fixation strategy. Primary outcomes were rami nonunion and implant-related complications, analyzed with parsimonious multivariate logistic regression (events-per-variable ratio ≥ 10). Results: Among 98 patients (mean age 45.4 ± 16.2 years; 76.5% male), complete posterior ring injury was independently associated with rami nonunion (aOR 8.176; 95% CI 2.448–27.309; p = 0.001), implant-related complications (aOR 3.364; 95% CI 1.250–9.049; p = 0.016), and overall complications (aOR 4.292; 95% CI 1.640–11.233; p = 0.003). Female sex was an additional independent predictor of overall complications (aOR 4.226; 95% CI 1.443–12.378; p = 0.009). Direct rami fixation was not a significant predictor of any outcome but consistently increased operative time in pairwise subgroup comparisons (Group 1 vs. 2: 64.9 vs. 106.9 min, p < 0.001; Group 3 vs. 4: 95.1 vs. 153.5 min, p < 0.001). Pairwise subgroup comparisons were severely underpowered (power range 5–16%); therefore, the absence of statistically significant differences between fixation strategies should not be interpreted as evidence of equivalence. Because more complex fractures were more likely to receive additional fixation, confounding by indication further limits these comparisons. Conclusions: Complete posterior ring injury was the dominant predictor of adverse outcomes in APC-type pelvic ring injuries. In this underpowered exploratory analysis, adding direct rami fixation to symphyseal plating did not demonstrate a statistically significant reduction in complications but was associated with longer operative time. Direct rami fixation may be reserved for selected cases with marked displacement, poor indirect reduction, or compromised bone quality; larger prospective studies are needed before firm recommendations can be made.

Objective: This study aimed to investigate the incidence and potential predictors of delayed displacement in minimally displaced clavicle fractures associated with polytrauma. It was hypothesized that polytrauma-related factors may reduce the risk of delayed displacement by limiting early patient mobilization. Methods: Between 2018 and 2021, a cohort study was conducted on 79 patients with minimally displaced clavicle fractures who had an injury severity score (ISS) of 16 or greater and were initially treated conservatively. The patients underwent regular radiographic examinations and those who exhibited displacement of more than 100% during follow-up were classified as having delayed displacement and subsequently underwent surgical intervention. Univariate and multivariate logistic regression analyses were used for statistical analysis to evaluate the risk factors for delayed displacement. The factors included polytrauma-related factors, such as the ISS, accompanying upper extremity injury, scapular fracture, rib fracture, level of consciousness, traumatic central nervous system injury, intensive care unit admission, use of a ventilator, duration of intubation, and fracture-specific factors, which were the location of the fracture and the presence of comminution. Results: Overall, 31 patients (39.2%) had delayed displacement. The univariate and multivariate logistic regression analyses showed that the statistically significant risk factors for delayed displacement of clavicle fractures were the presence of comminuted fractures and fractures located in the middle third of the clavicle shaft (odds ratio = 5.954 and 4.423, respectively; P = .003 and .018, respectively), while polytrauma-related factors were not associated. Conclusion: Polytrauma-related factors were not significantly associated with delayed displacement in minimally displaced clavicle fractures accompanied by polytrauma. Instead, fracture-specific characteristics, such as midshaft location and comminution, emerged as important predictors of delayed displacement, even when the initial displacement was minimal. These findings highlight the need for regular radiographic monitoring for at least 5 weeks in patients with polytrauma, particularly when such fracture characteristics are present. Cite this article as: Lee D, Han K, Park YU, Cho W, Koh J, Choi W. Delayed displacement of minimally displaced clavicle fractures in polytrauma patients: a retrospective cohort study. Acta Orthop Traumatol Turc., 2026; 60(3), 0511, doi: 10.5152/j.aott.2026.25511.

Purpose: To evaluate the radiologic and clinical outcomes of a novel scapular anatomical plate designed for fixation of glenoid articular and periarticular fractures. Methods: This prospective case series included 14 patients with scapular fractures treated between 2020 and 2024. Indications for surgery were intra-articular step-off >3 mm, glenoid medialization >20 mm, or glenoid angulation >30°. All patients underwent open reduction and internal fixation using the newly developed anatomical plate and were followed for at least 12 months. Radiologic outcomes were assessed using computed tomography, including intra-articular step-off, lateral border offset, and glenoid angular deformity. Clinical outcomes were evaluated using shoulder range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) score, modified American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) for pain. Results: Six patients had intra-articular fractures and eight had extra-articular fractures. Mean intra-articular step-off improved from 6.3 mm to 1.9 mm, lateral border offset from 21.2 mm to 2.3 mm, and glenoid angular deformity from 30.1° to near-anatomical alignment postoperatively. No articular screw penetration was observed on postoperative CT. All fractures achieved radiographic union without loss of reduction or implant-related complications. At 12 months, mean forward flexion was 136.4°, DASH score 24.5, modified ASES score 72.9, and VAS score 3.1. Conclusion: The novel scapular anatomical plate provided stable fixation with satisfactory radiologic restoration and favorable clinical outcomes for glenoid articular and periarticular fractures.

Background and Objectives: Coracoid process (CP) fractures combined with acromioclavicular (AC) joint dislocation are extremely rare, and evidence guiding optimal surgical management remains limited. This retrospective, single-center case series study evaluated clinical and radiologic outcomes after simultaneous fixation of both lesions using a clavicular hook plate and a coracoid screw. Materials and Methods: We retrospectively reviewed 15 consecutive patients with Ogawa type I CP fractures combined with AC joint dislocation who underwent clavicular hook plate and coracoid screw fixation between March 2019 and May 2024. Clinical outcomes at final follow-up included shoulder range of motion (ROM), visual analog scale (VAS) for pain, and the Constant score. Radiologic outcomes included CP union confirmed by computed tomography (CT) and residual AC joint subluxation. Results: The cohort comprised 13 men and 2 women with a mean age of 55.2 years, and the mean final follow-up was 40.2 months. At final follow-up, mean ROM was 168° for forward elevation, 161° for abduction, and 69° for external rotation at the side, with internal rotation to L1. The mean VAS score was 0.4 and the mean Constant score was 97. CT-confirmed union of the CP fracture was achieved in all patients, and no residual AC joint subluxation was observed. All patients returned to sports and activities of daily living. Conclusions: In this series, simultaneous fixation using a clavicular hook plate and a coracoid screw provided reliable stabilization for CP fractures with AC joint dislocation, achieving consistent CP union, restoration of AC joint alignment, and favorable clinical outcomes. However, given the retrospective, non-comparative study design, these findings should be interpreted with caution, and further comparative studies are warranted.

We present the case of a 55-year-old man with an AO/OTA 43-C3 pilon fracture in whom initial uniplanar external fixation failed to relieve persistent medial skin tenting, resulting in focal ischemic necrosis. Within 72 hours, the patient developed bullae and violaceous discoloration, which progressed to full-thickness skin breakdown. Despite staged open reduction and internal fixation and fasciocutaneous flap coverage, the patient developed chronic osteomyelitis, ultimately requiring segmental bone resection to control the infection. The patient underwent serial debridement procedures and placement of antibiotic-loaded cement spacers. Definitive reconstruction was achieved with salvage tibiotalocalcaneal arthrodesis using the Expert Tibial Nail system on postoperative day 319. Twelve months after fusion and bone grafting, radiographs confirmed solid union, and the patient was ambulating independently, albeit with considerable long-term functional limitations. This case underscores the importance of early and meticulous soft tissue evaluation in high-energy pilon fractures. Prompt repositioning of fracture fragments or the use of adjunctive decompression is essential. Delayed or inadequate decompression can lead to a cascade of complications, beginning with soft tissue necrosis and progressing to deep infection and limb salvage fusion, even when standard fixation protocols are followed.

Few studies have reported the epidemiology of lateral epicondylitis (LE) and medial epicondylitis (ME) in nationwide databases. This study aimed to investigate the epidemiology of LE and ME in South Korea. We analyzed data from the nationwide database of the Korean Health Insurance Review and Assessment Service from 2013 to 2017. We investigated the incidence, prevalence, and surgical trends in patients with LE or ME. Between 2013 and 2017, we identified 2813,431 and 836,610 patients with LE and ME, respectively. LE and ME were more frequently diagnosed in women than in men. During the study period, the mean annual age-adjusted incidence rates of LE and ME were 9.7 per 1000 people and 2.9 per 1000 people, respectively. The incidence of LE did not change significantly during the study period, but the prevalence rate increased significantly. Conversely, the incidence and prevalence rates of ME have significantly increased. Furthermore, 0.8% and 1.0% of patients with LE and ME, respectively, required surgical treatment, showing an annual increase in the number of surgical treatments for LE and ME, respectively. The proportion of arthroscopic surgeries performed for LE did not significantly change during the study period. The prevalence of LE and ME has increased in South Korea. Consequently, the number of surgeries performed annually for LE and ME has increased.

Lee YS, et al. Clin Orthop Surg. 2025 Apr;17(2):308-316. https://doi.org/10.4055/cios24127

Hydrogels are known for their high water retention capacity and biocompatibility and have become essential materials in tissue engineering and drug delivery systems. This review explores recent advancements in hydrogel technology, focusing on innovative types such as self-healing, tough, smart, and hybrid hydrogels, each engineered to overcome the limitations of conventional hydrogels. Self-healing hydrogels can autonomously repair structural damage, making them well-suited for applications in dynamic biomedical environments. Tough hydrogels are designed with enhanced mechanical properties, enabling their use in load-bearing applications such as cartilage regeneration. Smart hydrogels respond to external stimuli, including changes in pH, temperature, and electromagnetic fields, making them ideal for controlled drug release tailored to specific medical needs. Hybrid hydrogels, made from both natural and synthetic polymers, combine bioactivity and mechanical resilience, which is particularly valuable in engineering complex tissues. Despite these innovations, challenges such as optimizing biocompatibility, adjusting degradation rates, and scaling up production remain. This review provides an in-depth analysis of these emerging hydrogel technologies, highlighting their transformative potential in both tissue engineering and drug delivery while outlining future directions for their development in biomedical applications.