bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early total care and damage control orthopaedics result in partially contrasting patterns of microRNA expression at the fracture site and in the systemic circulation
Authors: Groven Rald V. M. , Mert Ümit , Greven Johannes , Horst Klemens , Joris Virginie , Bini Lara , Poeze Martijn , Blokhuis Taco J. , Huber-Lang Markus , Hildebrand Frank , van Griensven Martijn 
Published: February 2025

AimsThe aims of this study, using a porcine model of multiple trauma, were to investigate the expression of microRNAs at the fracture site, in the fracture haematoma (fxH) and in the fractured bone, compared with a remote unfractured long bone, to characterize the patterns of expression of circulating microRNAs in plasma, and identify and validate messenger RNA (mRNA) targets of the microRNAs.MethodsTwo multiple trauma treatment strategies were compared: early total care (ETC) and damage control orthopaedics (DCO). For this study, fxH, fractured bone, unfractured control bone, plasma, lung, and liver samples were harvested. MicroRNAs were analyzed using quantitative real-time polymerase chain reaction arrays, and the identified mRNA targets were validated in vivo in the bone, fxH, lung, and liver tissue.ResultsMicroRNA expression was associated with the trauma treatment strategy and differed depending on the type of sample. In the ETC group, a more advanced fracture healing response, as reflected by the expression of osteogenic microRNAs, was seen compared with the DCO group. DCO treatment resulted in a more balanced immune response in the systemic circulation as represented by significant upregulations of several anti-inflammatory microRNAs. The in vivo validation of the abundance of putative mRNA targets reflected the levels of microRNAs which were identified.ConclusionLocal and systemic microRNA patterns of expression were identified, specific for the treatment strategy in multiple trauma, which corresponded with the expression of mRNA at the fracture site and in target organs. These findings match clinical observations and offer insights into the cellular communication which may underlie the effects of using different surgical strategies in patients with multiple trauma, both locally and systemically. We also identified a systemic involvement of microRNAs in multiple trauma which may include distant cellular communication between injured tissues. Further research may further describe the temporospatial role of circulating microRNAs after multiple trauma, their potential role in communication between organs, and prospective therapeutic applications.Cite this article: Bone Joint J 2025;107-B(2):193–203.
Prevalence of complications in older adults after hip fracture surgery
Authors: Goh En L. , Khatri Amulya , Costa Alexander B. , Ting Andrew , Steiner Kat , Png May Ee , Metcalfe David , Cook Jonathan A. , Costa Matthew L. 
Published: February 2025

AimsOlder adults with hip fractures are at high risk of experiencing complications after surgery, but estimates of the rate of specific complications vary by study design and follow-up period. The aim of this systematic review was to determine the prevalence of complications in older adults after hip fracture surgery.MethodsMEDLINE, Embase, CINAHL, and CENTRAL databases were searched from inception until 30 June 2023. Studies were included if they reported prevalence data of complications in an unselected, consecutive population of older adults (aged ≥ 60 years) undergoing hip fracture surgery.ResultsA total of 95 studies representing 2,521,300 patients were included. For surgery-specific complications, the 30-day prevalence of reoperation was 2.31%, surgical site infection 1.69%, and deep surgical site infection 0.98%; the 365-day prevalence of prosthesis dislocation was 1.11%, fixation failure 1.77%, and periprosthetic or peri-implant fracture 2.23%. For general complications, the 30-day prevalence of acute kidney injury was 1.21%, blood transfusion 25.55%, cerebrovascular accident 0.79%, lower respiratory tract infection 4.08%, myocardial infarction 1.98%, urinary tract infection 7.01%, and venous thromboembolism 2.15%.ConclusionComplications are prevalent in older adults who have had surgery for a hip fracture. Studies reporting complications after hip fracture surgery varied widely in terms of quality, and we advocate for the routine monitoring of complications in registries and clinical trials to improve the quality of evidence.Cite this article: Bone Joint J 2025;107-B(2):139–148.
Two-stage revision for infection of oncological megaprostheses
Authors: Sambri Andrea , Campanacci Domenico A. , Pala Elisa , Smolle Maria A. , Donati Davide M. , van de Sande Michiel A. J. , Vyrva Oleg , Leithner Andreas , Jeys Lee , Ruggieri Pietro , De Paolis Massimiliano 
Published: February 2025

AimsThe aim of this study was to assess the incidence of reinfection in patients after two-stage revision of an infected megaprosthesis (MPR) implanted after resection of a bone tumour.MethodsA retrospective study was carried out of 186 patients from 16 bone sarcoma centres treated between January 2010 and December 2020. The median age at the time of tumour diagnosis was 26 years (IQR 17 to 33); 69 (37.1%) patients were female, and 117 (62.9%) were male.ResultsA total of 186 patients with chronic MPR infections were included. Median follow-up was 68 months (IQR 31 to 105). The most represented sites of MPR were distal femur in 93 cases (50.0%) and proximal tibia in 53 cases (28.5%). Polymicrobial infections were seen in 34 cases (18.3%). The most frequent isolated pathogens were staphylococci. Difficult-to-treat (DTT) pathogens were isolated in 50 cases (26.9%). The estimated infection recurrence (IR) rate was 39.1% at five years and 50.0% at ten years. A higher IR rate was found in DTT PJI compared to non-DTT infections (p = 0.019). Polymicrobial infections also showed a higher rate of infection recurrence (p = 0.046).ConclusionThis study suggests that an infected MPR treated by two-stage revision and ultimately reimplantation with a MPR can be successful, but the surgeon must be aware of a high recurrence rate compared to those seen with infected conventional implants.Cite this article: Bone Joint J 2025;107-B(2):253–260.
Identifying consensus and areas for future research in chondrosarcoma
Authors: Jeys Lee M. , Morris Guy V. , Kurisunkal Vineet J. , Botello Eduardo , Boyle Richard A. , Ebeid Walid , Houdek Matthew T. , Puri Ajay , Ruggieri Pietro , Brennan Bernadette , Laitinen Minna K. 
Published: February 2025

AimsThe Birmingham Orthopaedic Oncology Meeting (BOOM), held in January 2024, convened 309 delegates from 53 countries to discuss and refine 21 consensus statements on the optimal management of chondrosarcoma.MethodsWith representation from Europe (43%; n = 133), North America (17%; n = 53), South America (16%; n = 49), Asia (13%; n = 40), Australasia (5%; n = 16), the Middle East (4%; n = 12), and Africa (2%; n = 6), the combined experience of treating bone sarcomas among attendees totalled approximately 30,000 cases annually, equivalent to 66 years of experience in the UK alone. The meeting’s process began with the formation of a local organizing committee, regional leads, and a scientific committee comprising representatives from 150 specialist units across 47 countries. Supported by major orthopaedic oncology organizations, the meeting used a modified Delphi process to develop consensus statements through online questionnaires, thematic groupings, narrative reviews, and anonymous pre-meeting polling.ResultsStrong (> 80%) consensus was achieved on 19 out of 21 statements, reflecting agreement among delegates. Key areas of consensus included the role of radiology in diagnosis and surveillance, the management of locally recurrent disease, and the treatment of dedifferentiated chondrosarcoma. Notably, there was agreement that routine chemotherapy has no role in chondrosarcoma treatment, and radiological surveillance is safe for intraosseous chondrosarcomas. Despite the overall consensus, areas of controversy remain, particularly regarding the treatment of atypical cartilage tumours and surgical margins. These unresolved issues underscore the need for further research and collaboration within the orthopaedic oncology community.ConclusionBOOM represents the largest global consensus meeting in orthopaedic oncology, providing valuable guidance for clinicians managing chondrosarcoma worldwide. The consensus statements offer a reference for clinical practice, highlight key research priorities, and aim to improve patient outcomes on a global scale.Cite this article: Bone Joint J 2025;107-B(2):246–252.
Late fracture-related infections in HIV-positive patients
Authors: Graham Simon M. , Masterson Samuel , Laubscher Maritz , Ferreira Nando , Harrison William J. , Simpson A. Hamish R. W. , Maqungo Sithombo 
Published: February 2025

AimsHIV and musculoskeletal injuries both disproportionately affect individuals living in low- and middle-income countries (LMICs), leading to a significant number of fractures in HIV-positive patients. Despite this, little is known about the long-term outcomes for these patients. This prospective cohort study investigated whether HIV infection is associated with fracture-related infections (FRIs).MethodsAll adult patients between September 2017 and December 2018 who received intramedullary nail fixation of lower limb fractures in two tertiary referral hospitals in Cape Town, South Africa, were deemed eligible. In total, 358 participants were recruited for this study, 33 of whom were lost to follow-up. Of the 325 participants, 37 (11.4%) developed a total of 39 FRIs over the study period; 25 were early FRIs (64.1%) and 14 were late FRIs (35.9%). Participants were followed up for a minimum of 24 months. Throughout follow-up, participants were monitored for FRIs. These were categorized as early FRIs (< 90 days) and late FRIs (> 90 days).ResultsOverall, 71 participants (21.8%) were HIV-positive and 254 participants were HIV-negative (78.2%). In the HIV-positive population, 15 participants (21.1%) suffered 16 FRIs: seven early FRIs (9.9%) and nine late FRIs (7.0%). In the HIV-negative population, 22 participants (8.7%) experienced 23 FRIs, 18 were early FRIs (7.1%), and five participants experienced late FRIs (2.0%). On univariate and multivariate regression, being HIV-positive increased a participant’s likelihood of suffering late FRIs, and FRIs overall. HIV status made no significant difference to early FRI rates.ConclusionContrary to recent evidence, this study demonstrates an association between HIV and an increased risk of a patient developing late FRIs. However, there was no significant difference in early FRI rates.Cite this article: Bone Joint J 2025;107-B(2):221–228.
The impact of acetabular revision in revision total hip arthroplasty for a Vancouver B2 fracture requiring a change of femoral component
Authors: Popa Codrin , Le Baron Marie , Dobelle Émile , Flecher Xavier , Prost Solène , Ollivier Matthieu , Argenson Jean-Noel , Jacquet Christophe 
Published: February 2025

AimsThe aim of this study was to assess the necessity of revising the acetabular component in revision total hip arthroplasty (THA) in patients with a Vancouver type B2 periprosthetic femoral fracture (PFF) who require revision of the femoral component. The hypothesis was that revision of both the acetabular and femoral components and using a dual-mobility acetabular component would provide a lower postoperative risk of dislocation, without increasing perioperative morbidity and mortality.MethodsData were retrospectively analyzed from a continuously gathered database. We included 150 revisions, performed between January 2015 and December 2022, in 150 patients, with 81 revisions limited to only the femoral component and 69 involving revision of both components. This resulted, after surgery, in 60 patients having a simple-mobility acetabular component and 90 having a dual-mobility component. The mean age of the patients was 79.7 years (SD 10.1), and 98 were female (65.3%). The mean follow-up was 31 months (SD 2.3).ResultsThere were no significant differences between those in whom only the femoral component was revised and those in whom both components were revised with the use of a dual-mobility acetabular component for the rate of intraoperative complications, postoperative mortality, blood loss, the requirement of a blood transfusion, medical complications, dislocation (11/81 in the femoral component-only group vs 6/69 in the femoral + acetabular component revision group) or the overall need for reoperation at the final follow-up. Patients were at a significantly higher risk for dislocation when a simple-mobility component was retained (18.3% (n = 11) vs 6.7% (n = 6) for dual-mobility implants; p = 0.036). The revision rate prompted by postoperative instability was significantly higher in patients in whom a simple-mobility acetabular component was retained at revision (10% (n = 6) vs 0%; p = 0.002).ConclusionBased on these results, concurrent revision of the acetabular component was not associated with a higher rate of mortality or increased morbidity and patients in whom a dual-mobility acetabular component was used were significantly less prone to dislocation. We thus recommend routine revision of the acetabular component in favour of a dual-mobility component for patients sustaining a Vancouver B2 PFF requiring revision of the femoral component if their initial THA included a simple-mobility acetabular component.Cite this article: Bone Joint J 2025;107-B(2):164–172.
Deep learning for automated hip fracture detection and classification
Authors: Zheng Zhiqian , Ryu Byeong Y. , Kim Sung E. , Song Dae S. , Kim Seong H. , Park Jung-Wee , Ro Du H. 
Published: February 2025

AimsThe aim of this study was to develop and evaluate a deep learning-based model for classification of hip fractures to enhance diagnostic accuracy.MethodsA retrospective study used 5,168 hip anteroposterior radiographs, with 4,493 radiographs from two institutes (internal dataset) for training and 675 radiographs from another institute for validation. A convolutional neural network (CNN)-based classification model was trained on four types of hip fractures (Displaced, Valgus-impacted, Stable, and Unstable), using DAMO-YOLO for data processing and augmentation. The model’s accuracy, sensitivity, specificity, Intersection over Union (IoU), and Dice coefficient were evaluated. Orthopaedic surgeons’ diagnoses served as the reference standard, with comparisons made before and after artificial intelligence assistance.ResultsThe accuracy, sensitivity, specificity, IoU, and Dice coefficients of the model for the four fracture categories in the internal dataset were as follows: Displaced (1.0, 0.79, 1.0, 0.70, 0.82), Valgus-impacted (1.0, 0.80, 1.0, 0.70, 0.82), Stable (0.99, 0.95, 0.99, 0.83, 0.89), and Unstable (1.0, 0.98, 0.99, 0.86, 0.92), respectively. For the external validation dataset, the sensitivity and specificity were as follows: Displaced (0.83, 0.94), Valgus-impacted (0.89, 0.90), Stable (0.88, 0.95), and Unstable (0.85, 0.99), respectively. The overall means (Micro AVG and Macro AVG) for the external dataset were Micro AVG (0.83 (SD 0.05), 0.96 (SD 0.01)) and Macro AVG (0.69 (SD 0.02), 0.95 (SD 0.02)), respectively.ConclusionCompared to human diagnosis alone, our study demonstrates that the developed model significantly improves the accuracy of detecting and classifying hip fractures. Our model has shown great potential in assisting clinicians with the accurate diagnosis and classification of hip fractures.Cite this article: Bone Joint J 2025;107-B(2):213–220.
Facilitating clinical trials in hip fracture in the UK
Authors: Webster James , Goldacre Raphael , Lane Jennifer C. E. , Mafham Marion , Campbell Marion K. , Johansen Antony , Griffin Xavier L. 
Published: February 2025

AimsThe aim of this study was to evaluate the suitability, against an accepted international standard, of a linked hip fracture registry and routinely collected administrative dataset in England to embed and deliver randomized controlled trials (RCTs).MethodsFirst, a bespoke cohort of individuals sustaining hip fractures between 2011 and 2016 was generated from the National Hip Fracture Database (NHFD) and linked to individual Hospital Episode Statistics (HES) records and mortality data. Second, in order to explore the availability and distribution of outcomes available in linked HES-Office of National Statistics (ONS) data, a more contemporary cohort with incident hip fracture was identified within HES between January 2014 and December 2018. Distributions of the outcomes within the HES-ONS dataset were reported using standard statistical summaries; descriptive characteristics of the NHFD and linked HES-ONS dataset were reported in line with the Clinical Trials Transformation Initiative recommendations for registry-enabled trials.ResultsCase ascertainment of the NHFD likely exceeds 94%. The assessment of the robustness, relevance, and reliability of the datasets was favourable. Outcomes from the HES-ONS dataset were concordant with other contemporaneous prospective cohort studies with bespoke data collection frameworks.ConclusionOur findings support the feasibility of the NHFD and HES-ONS to support a registry-embedded, data-enabled RCT.Cite this article: Bone Joint J 2025;107-B(2):229–238.
Comparison of fore- and midfoot angles using 3DCT in standard weightbearing and sesamoid view position in feet with hallux valgus
Authors: Tripon Martin , Lalevee Matthieu , van Rooij Floris , Agu Chinyelum , Saffarini Mo , Beaudet Philippe 
Published: February 2025

AimsTo evaluate how fore- and midfoot coronal plane alignment differs in feet with hallux valgus (HV), using 3DCT when measured in standard weightbearing (SWB) versus sesamoid view (SV) position, and to determine whether first metatarsophalangeal (MTP) dorsiflexion affects the relationship between the first metatarsal (M1) head and the sesamoid bones.MethodsA consecutive series of 34 feet that underwent 3DCT in SWB and SV positions for symptomatic HV was assessed, of which four feet were excluded for distorted or incomplete images. Two foot and ankle clinicians independently digitized a series of points, and measured a series of angles according to a pre-defined protocol. Measurements include navicular pronation angle, M1 head (Saltzman angle), and metatarsosesamoid rotation angle (MSRA).ResultsThe mean age of the 30 patients was 57.5 years (SD 13.4). The mean navicular pronation angle was significantly smaller in the SV position (9.6° (SD 4.4°)) compared to the SWB position (16.4° (SD 5.8°); p < 0.001). There was a difference in MSRA between the SWB and SV positions, revealing an increase in MSRA in 22 patients, while there was a decrease in eight patients. In patients where the MSRA increased, the mean Saltzman angle was 2.5° (SD 5.7°) lower in the SV position versus the SWB position, while in patients where MSRA decreased, the mean Saltzman angle was 3.4° (SD 3.6°) greater in the SV position versus the SWB position.ConclusionMTP dorsiflexion causes supination of the navicular, while other first ray parameters remain unchanged, and has a greater influence on the M1 head coronal alignment than on the sesamoids. MTP dorsiflexion induces axial rotations of M1, which vary in direction and magnitude from one patient to another.Cite this article: Bone Joint Res 2025;14(2):69–76.
Primary malignant bone and soft-tissue tumours of the spine and appendicular sacrum
Authors: Schneider Eleonora , Tiefenboeck Thomas M. , Böhler Christoph , Noebauer-Huhmann Iris-Melanie , Lang Susanna , Krepler Petra , Funovics Philipp T. , Windhager Reinhard 
Published: February 2025

AimsThe aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.MethodsWe retrospectively analyzed our single-centre experience of prospectively collected data by querying our tumour registry (Medical University of Vienna). Therapeutic, pathological, and demographic variables were examined. Descriptive data are reported for the entire cohort. Kaplan-Meier analysis and multivariate Cox regression analysis were applied to evaluate survival rates and the influence of potential risk factors.ResultsA total of 119 consecutive patients (mean age 38 years (SD 37; 1 to 83), mean follow-up 66 months (SD 26; 0 to 505) were investigated. Histological entities included Ewing’s sarcoma (EWS; 33), chondrosarcoma (CSA; 20), osteosarcoma (OSA; 22), and soft-tissue sarcoma (STS; 44). Surgery was performed in 88 patients (74%). Neurological parameters improved in 18 patients (20%) after surgery. Overall, 32 patients (36%) suffered from surgical complications requiring revision. The median survival was 42 months (IQR 10 to 204). The one-, five-, and ten-year survival rates were 73%, 47%, and 39%, respectively. Corresponding five-year survival rates for EWS, CSA, OSA, and STS were 63%, 61%, 40%, and 32%, respectively. The decade of diagnosis, histological entity, surgical intervention, resection margin, and the presence of metastases had significant influence on survival. (Neo-)adjuvant therapies alone had no significant influence on overall survival.ConclusionOur study clearly demonstrates the positive impact of improved surgical techniques, as well as refined imaging methods and evolved adjuvant therapy options, on survival rate in all tumour entities. However, despite a multimodal treatment plan, the long-term mortality of these tumours remains high.Cite this article: Bone Jt Open 2025;6(2):109–118.
An Expert-Based Analysis of ESG Reporting in the context of the Circular Economy
Authors: Menichini Tamara , Salierno Gennaro , Maria Strollo Nicoletta 
Published: February 2025

Existing literature has highlighted how Environmental Social Governance (ESG) reporting enables companies to drive their Circular Economy (CE) practices. However, current approaches to ESG reporting do not specifically consider how company activities and decisions about CE contribute to sustainable development. Indeed, CE has a great potential to ensure that companies actively participate in the achievement of the United Nations 2030 Agenda Goals although a more effective way to link CE and sustainability reporting processes is necessary. The present paper recognizes the importance of developing a standardized approach that aligns ESG metrics with CE practices to enhance both transparency and accountability. To this end, taking into consideration the relevance of the GRI guidelines to make the ESG performance of companies more transparent, an expert-based analysis of the importance of GRI topics to capture the ability of CE practices to create circular value is proposed. Creating circular value through CE improves the company’s profitability and resilience while reducing costs for customers, and benefits society and the environment. The use of the fuzzy AHP (F-AHP) method ensures that the relevance of the economic, environmental, and social performance is estimated to make ESG reporting more informative about the company's commitment to a restorative and regenerative business. The findings offer guidelines for using CE reporting information to compare the companies’ contributions to SDGs

Keywords: ESG reporting, GRI standards, Circular Economy (CE), Fuzzy Analytic Hierarchy Process (F-AHP), Sustainable Development Goals (SDGs), circular value.