What’s New in Orthopaedic Trauma 2025

Recent findings in orthopaedic trauma are presented in the new JBJS Guest Editorial What’s New in Orthopaedic Trauma. Here, we highlight the 5 most impactful studies, as selected by coauthor Brendan M. Patterson, MD, MBA. 

Proximal Femur

A recent JBJS study found a postoperative periprosthetic femoral fracture rate of 0.6% among 809,832 patients who underwent primary total hip arthroplasty from 2004 to 2020 in England. Patients with polished tapered slips had a 3 times greater risk of such fracture than those with cemented composite-beam stems¹. Guest Editorial authors Drs. Copp and Patterson note that, although the study has limitations, its findings suggest that “surgeons should consider not only whether to use cement or not but also the mechanics of the cemented or cementless stem that they are selecting.” 

A new study published in JBJS found that accelerated care was associated with a lower risk of mortality compared with standard care among 322 patients with a hip fracture and elevated troponin at hospital arrival². These findings call into question the practice of delayed surgical intervention in such patients and suggest “a paradigm shift to more expedited management, similar to other ‘control the trigger’ recommendations,” write Drs. Copp and Patterson. 

Distal Femur

A Level I JBJS study compared far cortical locking (FCL) fixation and standard locking plate fixation in a cohort of 193 adult patients from 16 centers. Patients had OTA/AO type-33A or 33C distal femoral fractures that were suitable for bridging. The clinical and radiographic healing outcomes were similar between the fixation groups. A potential benefit of FCL in patients with ≥4-cm medial comminution or young patients was identified as an area for further research³. 

Infection Prevention

Researchers investigated 0.7% iodine povacrylex in 74% isopropyl alcohol vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol in nearly 9,000 patients from 25 centers in the U.S. and Canada. Both open and closed fractures were included. Iodine povacrylex was associated with a significantly lower infection rate compared with chlorhexidine gluconate in patients with closed fractures (2.4% and 3.3%, respectively; p = 0.049); however, the 2 interventions performed similarly in patients with open fractures⁴. 

A randomized controlled trial by the Major Extremity Trauma Research Consortium (METRC) group evaluated oral vs. intravenous antibiotics for fracture-related infection in 233 patients across 24 U.S. centers. Oral antibiotics were noninferior to intravenous antibiotics with regard to the rates of surgical procedures required, secondary infection, treatment failure, and nonunion⁵. 

What’s New in Orthopaedic Trauma is freely available at JBJS.org. 

What’s New by Subspecialty

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the What’s New by Subspecialty collection at JBJS.org. 

Recent OrthoBuzz posts include: What’s New in Spine Surgery, What’s New in Foot and Ankle Surgery, and What’s New in Sports Medicine. 

References 

1. Lamb JN, West RM, Relton SD, Wilkinson JM, Pandit HG. The risk of postoperative periprosthetic femoral fracture after total hip arthroplasty depends more on stem design than cement use: an analysis of National Health Data from England. J Bone Joint Surg Am. 2025 Mar 5;107(5):476-87. 
2. Borges FK, Guerra-Farfan E, Bhandari M, Patel A, Slobogean G, Feibel RJ, Sancheti PK, Tiboni ME, Balaguer-Castro M, Tandon V, Tomas-Hernandez J, Sigamani A, Sigamani A, Szczeklik W, McMahon SJ, Ślęczka P, Ramokgopa MT, Adinaryanan S, Umer M, Jenkinson RJ, Lawendy A, Popova E, Nur AN, Wang CY, Vizcaychipi M, Biccard BM, Ofori S, Spence J, Duceppe E, Marcucci M, Harvey V, Balasubramanian K, Vincent J, Tonelli AC, Devereaux PJ; the HIP ATTACK Investigators. Myocardial injury in patients with hip fracture: a HIP ATTACK randomized trial substudy. J Bone Joint Surg Am. 2024 Dec 18;106(24):2303-12. 
3. Lefaivre KA, Slobogean G, O’Hara NN, O’Brien PJ; Canadian Orthopaedic Trauma Society (COTS) Investigators. Far cortical locking versus standard constructs for locked plate fixation in the treatment of acute, displaced fractures of the distal femur: a multicenter randomized trial. J Bone Joint Surg Am. 2024 Oct 2;106(19):1739-49. 
4. Sprague S, Slobogean G, Wells JL, O’Hara NN, Thabane L, Mullins CD, Harris AD, Wood A, Viskontas D, Apostle KL, O’Toole RV, Joshi M, Johal H, Al-Asiri J, Hymes RA, Gaski GE, Pilson HT, Carroll EA, Babcock S, Halvorson JJ, Romeo NM, Matson CA, Higgins TF, Marchand LS, Bergin PF, Morellato J, Van Demark RE 3rd, Potter GD, Gitajn IL, Chang G, Phelps KD, Kempton LB, Karunakar M, Jaeblon T, Demyanovich HK, Domes CM, Kuhn GR, Reilly RM, Gage MJ, Weaver MJ, von Keudell AG, Heng M, McTague MF, Alnasser A, Mehta S, Donegan DJ, Natoli RM, Szatkowski J, Scott AN, Shannon SF, Jeray KJ, Tanner SL, Marmor MT, Matityahu A, Fowler JT, Pierrie SN, Beltran MJ, Thomson CG, Lin CA, Moon CN, Scolaro JA, Amirhekmat A, Leonard J, Pogorzelski D, Bzovsky S, Heels-Ansdell D, Szasz OP, Gallant JL, Della Rocca GJ, Zura RD, Hebden JN, Patterson JT, Lee C, O’Hara LM, Marvel D, Palmer JE, Friedrich J, D’Alleyrand JG, Rivera JC, Mossuto F, Schrank GM, Guyatt G, Devereaux PJ, Bhandari M; PREP-IT Investigators; The PREP-IT Investigators. Skin antisepsis before surgical fixation of extremity fractures. N Engl J Med. 2024 Feb 1;390(5):409-20. 
5. Obremskey WT, O’Toole RV, Morshed S, Tornetta P 3rd, Murray CK, Jones CB, Scharfstein DO, Taylor TJ, Carlini AR, DeSanto JM, Castillo RC, Bosse MJ, Karunakar MA, Seymour RB, Sims SH, Weinrib DA, Churchill C, Carroll EA, Pilson HT, Goodman JB, Holden MB, Miller AN, Sietsema DL, Stahel PF, Mir H, Schmidt AH, Westberg JR, Mullis B, Shively KD, Hymes RA, Konda SR, Vallier HA, Breslin MA, Smith CS, Crickard CV, Reid JS, Baker M, Eglseder WA, LeBrun C, Manson T, Mascarenhas DC, Nascone J, Pollak AN, Schloss MG, Sciadini MF, Degani Y, Miclau T, Weiss DB, Yarboro SR, McVey ED, Firoozabadi R, Agel J, Burgos EJ, Gajari V, Rodriguez-Buitrago A, Tummuru RR, Trochez KM; Major Extremity Trauma Research Consortium (METRC). Oral vs intravenous antibiotics for fracture-related infections: the POvIV randomized clinical trial. JAMA Surg. 2025 Mar 1;160(3):276-84.