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Habeeb Bishi, Joshua B V Smith, Vipin Asopa, Richard E Field, Chao Wang, and David H Sochart

  • There are advocates of both two-dimensional (2D) and three-dimensional (3D) templating methods for planning total hip replacement.

  • The aim of this study was to compare the accuracy of implant size prediction when using 2D and 3D templating methods for total hip arthroplasty, as well as to compare the inter- and intra-observer reliability in order to determine whether currently available methods are sufficiently reliable and reproducible.

  • Medline, EMBASE and PubMed were searched to identify studies that compared the accuracy of 2D and 3D templating for total hip replacement.

  • Results were screened using the PRISMA flowchart and included studies were assessed for their level of evidence using the Oxford CEBM criteria. Non-randomized trials were critically appraised using the MINORS tool, whilst randomized trials were assessed using the CASP RCT checklist.

  • A series of meta-analyses of the data for accuracy were also conducted.

  • Ten studies reported that 3D templating is an accurate and reliable method of templating for total hip replacement. Six studies compared 3D templating with 2D templating, all of which concluded that 3D templating was more accurate, with three finding a statistically significant difference.

  • The meta-analyses showed that 3D CT templating is the most accurate method.

  • This review supports the hypothesis that 3D templating is an accurate and reliable method of preoperative planning, which is more accurate than 2D templating for predicting implant size. However, further research is needed to ascertain the significance of this improved accuracy and whether it will yield any clinical benefit.

Maria Anna Smolle, Sandra Bösmüller, Paul Puchwein, Martin Ornig, Andreas Leithner, and Franz-Josef Seibert

  • The aim of this systematic review and meta-analysis was to assess risk for iatrogenic radial nerve palsy (iRNP), non-union, and post-operative infection in humeral shaft fractures.

  • A PubMed search including original articles comparing different treatments for humeral shaft fractures published since January 2000 was performed. Random effect models with relative risks (RR) and 95% CIs were calculated for treatment groups and outcomes.

  • Of the 841 results, 43 studies were included in the meta-analysis (11 level II, 5 level III, 27 level IV). Twenty-seven compared intramedullary nailing (IM) with ORIF, nine conservative with operative treatment, four ORIF with minimally invasive plate osteosynthesis (MIPO), and three anterior/anterolateral with posterior approach. iRNP risk was higher for ORIF vs IM (18 studies; RR: 1.80; P  = 0.047), ORIF vs MIPO (4 studies; RR: 5.60; P  = 0.011), and posterior vs anterior/anterolateral approach (3 studies; RR: 2.68; P  = 0.005). Non-union risk was lower for operative vs conservative therapy (six studies; RR: 0.37; P  < 0.001), but not significantly different between ORIF and IM (21 studies; RR: 1.00; P  = 0.997), or approaches (two studies; RR: 0.36; P  = 0.369). Post-operative infection risk was higher for ORIF vs IM (14 studies; RR: 1.84; P  = 0.004) but not different between approaches (2 studies; RR: 0.95; P  = 0.960).

  • Surgery appears to be the method of choice when aiming to secure bony union, albeit risk for iRNP has to be considered, particularly in case of ORIF vs IM or MIPO, and posterior approach. Due to the limited number of randomised studies, evidence on the best treatment option remains moderate, though.

Andrea Angelini, Nicolò Mosele, Elisa Pagliarini, and Pietro Ruggieri

  • Patients with Gorham–Stout disease (GSD) present progressive destruction and resorption of bone.

  • Typical bone-related symptoms include swelling, pain and functional impairment in the region involved.

  • The three aspects of GSD etiopathology are osteoclasts, angiogenesis/lymphangiogenesis and osteoblast function.

  • Multi-targeted pharmacological approach includes innovative options and represent milestones of treatment, sometimes associated with radiotherapy.

  • Surgery is mainly used to treat complications: pathologic/impending fractures, spinal instability or deformities and chylothorax.

  • In this narrative review, we highlight current standards in diagnosis, clinical management and therapeutic strategies.

Luigi Zagra, Francesco Benazzo, Dante Dallari, Francesco Falez, Giuseppe Solarino, Rocco D’Apolito, and Claudio Carlo Castelli

  • Hip, spine, and pelvis move in coordination with one another during activity, forming the lumbopelvic complex (LPC).

  • These movements are characterized by the spinopelvic parameters sacral slope, pelvic tilt, and pelvic incidence, which define a patient’s morphotype.

  • LPC kinematics may be classified by various systems, the most comprehensive of which is the Bordeaux Classification.

  • Hip–spine relationships in total hip arthroplasty (THA) may influence impingement, dislocation, and edge loading.

  • Historical ‘safe zones’ may not apply to patients with impaired spinopelvic mobility; adjustment of cup inclination and version and stem version may be necessary to achieve functional orientation and avert complications.

  • Stem design, bearing surface (including dual mobility), and head size are part of the armamentarium to treat abnormal hip–spine relationships.

  • Special attention should be directed to patients with adult spine deformity or fused spine because they are at increased risk of complications after THA.

Christof Audretsch, Alexander Trulson, Andreas Höch, Steven C Herath, Tina Histing, Markus A Küper, and Working Group on Pelvic Fractures of the German Trauma Society

  • Treatment of acetabular fractures is challenging and risky, especially when surgery is performed. Yet, stability and congruity of the hip joint need to be achieved to ensure early mobilization, painlessness, and good function. Therefore, coming up with an accurate decision, whether surgical treatment is indicated or not, is the key to successful therapy.

  • Data from the German pelvic Trauma Registry (n  = 4213) was evaluated retrospectively, especially regarding predictors for surgery. Furthermore, a logistic regression model with surgical treatment as the dependent variable was established.

  • In total, 25.8% of all registered patients suffered from an acetabular fracture and 61.9% of them underwent surgery. The fracture classification is important for the indication of surgical therapy. Anterior wall fractures were treated surgically in 10.2%, and posterior column plus posterior wall fractures were operated on in 90.2%. Also, larger fracture gaps were treated surgically more often than fractures with smaller gaps (>3 mm 84.4%, <1 mm 20%). In total, 51.4% of women and 66.0% of men underwent surgery. Apart from the injury severity score (ISS), factors that characterize the overall picture of the injury were of no importance for the indication of a surgical therapy (isolated pelvic fracture: 62.0%, polytrauma: 58.8%). The most frequent reason for non-operative treatment was ‘minimal displacement’ in 42.2%.

  • Besides fracture classification and fracture characteristics, no factors characterizing the overall injury, except for the ISS, and unexpectedly gender, are important for making a treatment decision. Further studies are needed to determine the relevance of these factors, and whether they should be used for the decision-making process, in particular surgeons with less experience in pelvic surgery, can orient themselves to.

George D Chloros, Christos D Kakos, Ioannis K Tastsidis, Vasileios P Giannoudis, Michalis Panteli, and Peter V Giannoudis

  • Even though fifth metatarsal fractures represent one of the most common injuries of the lower limb, there is no consensus regarding their classification and treatment, while the term ‘Jones’ fracture has been used inconsistently in the literature.

  • In the vast majority of patients, Zone 1 fractures are treated non-operatively with good outcomes.

  • Treatment of Zone 2 and 3 fractures remains controversial and should be individualized according to the patient’s needs and the ‘personality’ of the fracture.

  • If treated operatively, anatomic reduction and intramedullary fixation with a single screw, with or without biologic augmentation, remains the ‘gold standard’ of management; recent reports however report good outcomes with open reduction and internal fixation with specifically designed plating systems.

  • Common surgical complications include hardware failure or irritation of the soft tissues, refracture, non-union, sural nerve injury, and chronic pain.

  • Patients should be informed of the different treatment options and be part of the decision process, especially where time for recovery and returning to previous activities is of essence, such as in the case of high-performance, elite athletes.

Pierre J Hoffmeyer

Gherardo Pagliazzi, Enrico De Pieri, Michèle Kläusler, Morgan Sangeux, and Elke Viehweger

  • Overuse injuries imply the occurrence of a repetitive or an increased load on a specific anatomical segment which is unable to recover from this redundant microtrauma, thus leading to an inflammatory process of tendons, physis, bursa, or bone.

  • Even if the aetiology is controversial, the most accepted is the traumatic one.

  • Limb malalignment has been cited as one of the major risk factors implicated in the development of overuse injuries.

  • Many authors investigated correlations between anatomical deviations and overuse injuries, but results appear mainly inconclusive.

  • Establishing a causal relationship between mechanical stimuli and symptoms will remain a challenge, but 3D motion analysis, musculoskeletal, and finite element modelling may help in clarifying which are the major risk factors for overuse injuries.

Junbo He, Tingkui Wu, Chen Ding, Beiyu Wang, Ying Hong, and Hao Liu

  • Anterior cervical surgery (ACS) owes its development to various pioneering individuals whose revolutionary works form key advances and guide current medical decisions. This bibliometric study aimed to identify, analyse and visualize the main features of the most-cited papers in ACS.

  • The citation count for the top 100 most-cited articles ranged from 148 to 1,197, and citations per year ranged from 3.1 to 89.8. The articles were published from 1958 to 2016, with the 2000s being the most active decade. There was an inverse correlation between the average citations per year since publication and article age.

  • The oldest as well as most-cited two articles were both published in 1958 by Smith and Robinson, and Cloward, respectively. In their studies, the authors individually described the technique of anterior cervical discectomy with fusion (ACDF).

  • The most popular keywords were: ‘fusion’ (22), ‘spine’ (20), ‘cervical spine’ (16), ‘complications’ (15), ‘arthrodesis’ (13), ‘interbody fusion’ (13), ‘bone morphogenetic protein’ (13), and ‘radiculopathy’ (12).

  • ACDF was the most frequent surgical procedure (80%), while cervical disc arthroplasty is of gradual greater impact.

  • The surgical techniques of ACDF have remained unaltered for over 60 years. More attempts are needed to promote its development.

Cite this article: EFORT Open Rev 2021;6:1203-1213. DOI: 10.1302/2058-5241.6.210074