Ortho&Trauma with Dr. Polotrauma

This review evaluates the clinical utility of patient-specific instrumentation, custom implants, and additively manufactured components in unicompartmental knee arthroplasty. A meta-analysis of multiple studies comprising 444 knees did not reduce alignment outliers, and patient-specific guides required conversion to standard instruments in 13% of cases. Conversely, an analysis of consecutive cementless components demonstrated a survivorship of 93.6% for any revision and 94.9% for mechanical failure. Surgeons should reserve custom guides for specific anatomic mismatches rather than adopting them routinely.

Three dimensional printing in unicompartmental knee arthroplasty: current evidence and future directions Dinh Nhat Vu
evidence c, directions f · 2026
https://doi.org/10.1007/s00264-026-06842-y

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Robotic-arm unicompartmental knee arthroplasty aims to improve precision, but comparative data on adverse events remains limited. This retrospective analysis found that the rate of adverse events was lower for the robotic patient group (3.7%) than for those who underwent conventional surgery (13.2%). Specifically, the robotic approach was associated with the odds ratio of 0.08 for implant malposition or failure. However, there were No significant differences in total hospital costs, length of stay, or readmission rates between the groups. Surgeons should weigh these safety benefits against initial access costs when planning partial knee replacements.

Short-term outcomes of robotic versus conventional unicompartmental knee arthroplasty: evidence from a national database
Shih C, et al. · Journal of Orthopaedics and Traumatology, 2025
https://doi.org/10.1186/s10195-025-00896-1

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

This systematic review asked which treatments actually help patients with complex regional pain syndrome (CRPS) after trauma or orthopaedic surgery. Because study designs varied so widely, findings could not be pooled and are reported per individual study. Diclofenac lowered pain scores to 4.9 in neuropathic pain patients, and continuous lidocaine infusion brought meaningful pain reduction in 76% of refractory patients, with a further study of IV lidocaine showing thermal pain reduction of 62.5% in subjects. Sympathetic and nerve blockade approaches were also effective: Four patients given nerve block plus pamidronate had full resolution, 61% of patients had good relief with phentolamine block, and early sympathectomy after injury gave permanent relief in 100% of patients, with sympathectomy overall curing 91% of cases. Bisphosphonates also showed benefit, with a clinical response in 71.5% of CRPS-I patients treated intravenously. Clinicians should pursue early multidisciplinary management, combining physiotherapy with targeted pharmacological and interventional options rather than delaying treatment.

Management of complex regional pain syndrome in trauma and orthopaedic surgery, a systematic review
Saed A, et al. · British Medical Bulletin, 2023
https://doi.org/10.1093/bmb/ldac034

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

This multi-centric cohort asked whether dual mobility cups perform as well in overweight and obese patients undergoing primary total hip arthroplasty as in normal weight patients. Included patients underwent surgery at a mean age of mean 70 ± 13.19 years and were followed for a mean follow-up period of mean nine ± 6.2 years. Functional scores were excellent across groups, with the obese subgroup reaching a mean 89.24 ± 4.40 on the modified Harris Hip Score. In the overweight and obese subgroups combined, Three traumatic dislocations occurred, and Two obesity patients needed additional surgery for a septic adverse event. Radiographs showed only 4 cases of non-progressive, asymptomatic osteolysis, and heterotopic ossification was seen in 15 asymptomatic patients, with Three patients sustaining a traumatic periprosthetic fracture overall. These findings suggest functional outcomes and adverse event rates with dual mobility cups are comparable between overweight, obese and normal weight patients undergoing primary hip arthroplasty.

Outcomes of primary total hip arthroplasty using dual mobility cups across body mass index categories: a multi-centric cohort study
Assi C, et al. · International Orthopaedics, 2026
https://doi.org/10.1007/s00264-026-06862-8

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

This retrospective study compared 20 patients with acetabular fractures against those with pelvic ring fractures, asking whether fracture type and surgical approach affect return to sport. Mean follow-up in the acetabular group was mean 1074.22 ± 402.31 days. Total HOS score among acetabular fracture patients averaged mean 72.22 ± 5.32, with average HSAS of mean 3.50 ± 0.48, while pelvic ring patients showed a higher total MAQ score of mean 131.8 ± 36.93, driven mainly by work-related items rather than sport-related activity. No statistically significant differences emerged between groups, suggesting that both fracture types carry comparable challenges for returning to amateur sport. Clinicians should counsel patients realistically about recovery expectations regardless of fracture location, and larger prospective studies with standardized return-to-sport scores are needed.

Return to sport after acetabular and pelvic ring fractures in amateur athletes: A retrospective study
Rovere G, et al. · Journal of Orthopaedics and Traumatology, 2025
https://doi.org/10.1186/s10195-025-00876-5

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

This multicenter study asked how reliable the reverse sural artery flap (RSAF) really is for reconstructing distal lower extremity defects, and how outcomes vary by anatomical site. Among RSAF patients, 96.7% overall flap survival was achieved, with a mean healing time of mean 21.5 days for patients. Venous congestion occurred in 83.3% of cases, and persistent congestion led to necrosis in 10% of cases. Site mattered: ankle and lower leg RSAFs maintained 100% long-term survival, while heel flaps later declined to 70.8% survival. For clinicians, this supports closer long-term surveillance and consideration of vascular augmentation for heel-based reconstructions, plus attention to modifiable risk factors like smoking and BMI during preoperative planning.

Reverse sural artery flap for lower extremity reconstruction: a multicenter retrospective analysis of success and failure patterns
Abualhaj S, et al. · Journal of Orthopaedics and Traumatology, 2025
https://doi.org/10.1186/s10195-025-00860-z

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Trauma-related necrotizing fasciitis is a rare but devastating infection, and surgeons must decide fast whether a limb can be saved. This episode unpacks a ten-year cohort of one hundred thirty-four patients that found a sixteen point four percent major amputation rate and pinned down which limbs are most at risk. We walk through the two strongest early signals, admission lactate dehydrogenase and pre-hospital delay, alongside the roles of open fractures, diabetes, multiple injuries, and septic shock. The authors turn these findings into a practical early-warning approach: draw the labs at admission, shorten the time to specialist debridement, and watch diabetic and poly-trauma limbs most closely, so the highest-risk limbs reach surgery while there is still a chance to save them.

Predicting limb amputation in trauma-related necrotizing fasciitis of the extremities: insights from a 10-year cohort
Yang S, Ren Z, Li Y, Zhao Z, Sun C, Liu L, Jin L, Hou Z · European Journal of Trauma and Emergency Surgery, 2026
https://doi.org/10.1007/s00068-026-03220-6

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Opioids have classically been the mainstay of pain control on the trauma ward, but they offer only moderate efficacy while carrying serious risks, including addiction and adverse events that raise mortality and length of stay. This episode reviews the non-opioid alternatives for both simple limb trauma and complex poly-trauma. We walk through the evidence on topical agents, acetaminophen, anti-inflammatory drugs, gabapentinoids, intravenous lidocaine, ketamine, dexmedetomidine, peripheral nerve blocks, and the newer fascial plane blocks. The classic efficacy data is striking: ibuprofen outperforms oxycodone on number needed to treat, and pairing an anti-inflammatory with acetaminophen roughly doubles the opioid-sparing effect. The authors close with a practical, stepwise algorithm separating first-line and second-line analgesics, tailored to each patient, so opioids become the rescue rather than the foundation.

Pain management in the orthopaedic trauma patient: Non-opioid solutions
Gessner DM, Horn JL, Lowenberg DW · Injury, Int. J. Care Injured, 2020
https://doi.org/10.1016/j.injury.2019.04.008

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Is Germany running out of orthopaedic and trauma surgeons? In this episode we break down a nationwide survey of 185 hospital departments, conducted at the end of 2022 by the German Society for Orthopaedics and Trauma Surgery. The numbers are sobering: 55% of clinics reported vacant doctor positions, with a median of 2.7 unfilled roles each. Junior doctor posts were hardest to fill at 89%, while consultants and specialists were missing in 47% and 33% of affected clinics. University hospitals were least affected, yet far from immune. Beyond the empty posts, department heads described a steady decline in applicant numbers, qualifications, and motivation for scientific work, and 70% now rely on doctors who are not native German speakers. We discuss why interest in surgery collapses during medical school, what drives doctors away, and the authors' two-pronged fix: better working conditions and more inspiring teaching. A must-listen for anyone thinking about the future of musculoskeletal care.

Orthopaedics and Trauma Surgery in Germany in 2023 – Will We Have Sufficient Doctors in the Future?
Ruchholtz S, Blätzinger M, Schädel-Höpfner M, Böcker W, Kladny B, Pennig D, Rudert M · Zeitschrift für Orthopädie und Unfallchirurgie, 2024
https://doi.org/10.1055/a-2110-3752

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma

Surgical simulation is changing how orthopaedic trainees learn fracture surgery. In this episode, we break down a review by Marchand and colleagues, published in the Journal of the American Academy of Orthopaedic Surgeons in 2020, on simulation training in fracture surgery. We start with why the traditional apprenticeship model is under pressure from work hour limits and cost constraints. Then we walk through the four main simulation modalities: composite bone models, virtual reality, cognitive task analysis, and cadaver specimens. We look at the evidence that simulator practice improves proficiency and transfers to real surgery, most clearly for hip fracture fixation with the dynamic hip screw. We cover the barriers too, including that twenty five percent of US programs lack simulation facilities and eighty seven percent of directors cite funding. Finally, we discuss why simulation must sit inside a formal curriculum alongside didactic teaching, never as a replacement for mentorship.

Simulation Training in Fracture Surgery
Marchand LS, Sciadini MF · Journal of the American Academy of Orthopaedic Surgeons, 2020
https://doi.org/10.5435/JAAOS-D-20-00076

Want our summary slides for every paper? Follow us on Instagram: @dr.polotrauma