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Tomasz Poboży

Autor: Tomasz Poboży

  • Hip Geometry and Fracture Risk — What Does It Add Beyond Bone Mineral Density?

    A meta-analysis published on 9 September 2026 suggests that proximal femoral geometry may provide information about hip-fracture risk that is not fully captured by bone mineral density alone. The most consistent signals involved hip axis length and femoral neck width. This is clinically interesting, but it does not justify new diagnostic thresholds in routine DXA practice: heterogeneity was substantial, and prediction intervals for the continuous geometric measures included no effect.

    Polish version: Geometria biodra a ryzyko złamania — co wnosi poza densytometrię?

    Why is proximal femoral geometry relevant?

    Bone mineral density remains a core component of osteoporotic fracture-risk assessment, but it does not describe the entire mechanical behaviour of the proximal femur. Two people with similar BMD may differ in femoral neck length, neck width, neck-shaft angle or hip axis length. These features can influence lever arms and the way force is transmitted during a fall.

    The clinically useful question is therefore not simply whether geometry differs between people with and without a fracture, but whether geometric measures retain an association with fracture after BMD has already been taken into account.

    Study design

    Jokar and colleagues performed a PRISMA-compliant systematic review and meta-analysis of studies assessing conventional proximal femoral geometry in people with low-trauma hip fracture and in controls, as well as studies reporting fracture risk associated with these measures.

    The analysis included 47 studies and 136,026 participants: 7,426 people with hip fracture and 128,600 controls. Measures included:

    • hip axis length (HAL),
    • femoral neck axis length (FNAL),
    • femoral neck width (FNW),
    • neck-shaft angle (NSA),
    • other conventional geometric measures obtained from DXA, radiographs or other imaging.

    Random-effects models were used, with subgroup analyses by sex, fracture type and imaging method. Models that adjusted for BMD were examined separately.

    Main results

    Compared with people without fracture, those with hip fracture had, on average, a hip axis length greater by 0.16 cm, a femoral neck axis length greater by 0.07 cm, a femoral neck width greater by 0.08 cm and a neck-shaft angle greater by 1.74°.

    The more important analysis was the one that accounted for BMD. In those models, fracture risk remained significantly associated with:

    • hip axis length: OR 1.31; 95% CI 1.20–1.42,
    • femoral neck width: OR 1.32; 95% CI 1.10–1.59.

    For femoral neck axis length and neck-shaft angle, the association after BMD adjustment was no longer convincing. Associations were more apparent in women and in analyses of femoral neck fractures.

    The odds ratios should not be converted directly into an individual’s percentage fracture risk. The included studies differed in how the geometric variables were measured and modelled, so the pooled estimates are not equivalent to a bedside risk calculator.

    Clinical interpretation for an orthopaedic surgeon

    The findings support a biologically plausible concept: hip-fracture risk reflects not only the material quality of bone but also the geometry of the structure. A longer hip axis may increase the lever arm of force during a fall, while femoral neck width may interact with load distribution and structural properties.

    From a clinical perspective, the most interesting result is that HAL and FNW remained associated with fracture in analyses adjusted for BMD. This suggests that at least some structural information is not merely a surrogate for lower bone mineral density.

    That does not mean these measurements should now be added routinely to every DXA report or used alone to make treatment decisions. The next step would be to show that adding geometric variables to existing risk models actually improves fracture prediction and leads to better clinical decisions.

    Important limitations

    • Substantial heterogeneity: populations, imaging techniques, variable definitions and statistical models differed across studies.
    • Prediction intervals included no effect: for all continuous geometric measures, indicating that the association in a new population may be considerably smaller than the pooled mean effect.
    • Observational evidence: the meta-analysis demonstrates associations rather than causation.
    • No single measurement standard: values obtained from DXA and radiography are not necessarily interchangeable, limiting the ability to define a universal clinical threshold.
    • No evidence of improved treatment decisions: the study did not test whether adding geometry to BMD or existing risk calculators improves treatment selection or reduces fractures.

    What does this change in practice?

    For now, the practical message is that BMD is not a complete description of the mechanical risk of hip fracture. Proximal femoral geometry is a reasonable candidate for future refinement of fracture-risk models, particularly when clinical risk and BMD do not tell a fully coherent story.

    The study does not show that HAL or FNW should replace BMD, does not establish a universal cutoff for either measure, and does not demonstrate that routine measurement improves outcomes. It also does not justify changing osteoporosis pharmacotherapy solely because of hip geometry. These parameters are best viewed as potentially complementary rather than standalone risk markers.

    Reference

    1. Jokar R, Sharifzadeh Y, Sarabi Javid SR, et al. Proximal femoral geometry and low-trauma hip fracture risk beyond bone mineral density: an updated and expanded systematic review and meta-analysis. BMC Musculoskelet Disord. Published 9 September 2026. DOI: 10.1186/s12891-026-10451-6.

    ← Research Updates, Literature and Evidence-Based Medicine

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Joint Aspiration — Why Is Synovial Fluid Collected?

    Joint aspiration, or arthrocentesis, is performed mainly to collect synovial fluid when the cause of an effusion needs to be clarified — particularly when infection, gout or another inflammatory process is suspected. Aspiration can also reduce pressure from a large effusion, but not every swollen joint needs to be drained. Ultrasound can confirm that fluid is present, identify the best pocket and help guide the needle safely, although it is not essential for every straightforward aspiration.

    Polish version: Punkcja stawu — po co pobiera się płyn?

    When is joint aspiration particularly important?

    The most urgent indication is suspected septic arthritis. A joint that becomes acutely very painful, swollen and hot requires prompt assessment, and infection remains possible even without a high fever. The SANJO guideline recommends aspiration as soon as septic arthritis is suspected because synovial-fluid analysis is central to confirming or excluding the diagnosis.

    Synovial fluid may also be collected when gout or calcium pyrophosphate crystal arthritis is suspected, when a large or atypical effusion appears after trauma, when the cause of an inflammatory effusion is unclear, or when fluid rapidly returns after previous aspiration.

    What is tested in synovial fluid?

    Depending on the clinical question, the sample may be assessed for the white-cell count and differential, crystals, Gram stain and bacterial culture. Additional microbiological or molecular testing can be selected when indicated.

    No single synovial-fluid white-cell threshold independently proves or excludes infection in every patient. Results must be interpreted together with symptoms, examination, blood tests, imaging when appropriate and the patient’s risk factors.

    Why is aspiration important when infection is suspected?

    Blood tests alone are not enough. A normal C-reactive protein concentration does not reliably exclude septic arthritis. In a clinically stable patient without sepsis, synovial fluid should generally be obtained for microbiology before antibiotics are started, because prior antibiotic treatment can reduce culture yield. This principle does not mean delaying urgent antimicrobial treatment in an unstable or septic patient.

    The presence of crystals does not automatically rule out a simultaneous bacterial infection. Gout or calcium pyrophosphate deposition and septic arthritis can coexist, so a crystal-positive sample still has to be interpreted in the full clinical context.

    Can the appearance of the fluid give the diagnosis?

    No. Cloudy, bloody or unusually coloured fluid may provide a clue, but visual appearance is not sufficiently reliable to establish the cause of an effusion. Laboratory analysis is needed when infection, crystal disease or another inflammatory process is a realistic possibility.

    What does ultrasound add?

    Ultrasound can confirm whether a collection is present and show where it is largest. It can help the operator avoid vessels, tendons and other sensitive structures, visualise the needle as it advances, and improve access when the effusion is small, deep or anatomically difficult. It can also be useful after a previous unsuccessful landmark-guided attempt.

    A systematic review of knee arthrocentesis found ultrasound guidance to be associated with greater procedural accuracy, less procedural pain and a larger volume of aspirated fluid compared with landmark-guided aspiration. A more recent meta-analysis in knee osteoarthritis also reported better accuracy. These findings do not mean that every uncomplicated knee aspiration requires ultrasound; the value of guidance depends on the joint, the amount and location of fluid, anatomy and operator experience.

    How is the procedure performed?

    The skin is prepared using strict aseptic technique and a needle is introduced into the joint through an appropriate route. When infection is suspected, meticulous asepsis is especially important. The needle should not be passed through an abscess and, where possible, should avoid inflamed or infected skin.

    Aspiration and injection are separate decisions. If joint infection is a realistic possibility, corticosteroid should not be injected before the situation has been clarified. Removing fluid may relieve pressure, but aspiration itself does not treat the underlying cause of the effusion.

    What about a painful joint replacement?

    A painful or swollen prosthetic joint requires a separate diagnostic pathway. Aspiration can be an important part of investigating periprosthetic joint infection, but interpretation follows dedicated criteria and should not be reduced to simply “draining fluid” from the joint.

    When does a swollen joint need urgent assessment?

    • acute severe joint pain with rapidly increasing swelling,
    • a red or hot joint, with or without fever or chills,
    • inability to bear weight or move the joint because of pain,
    • immunosuppression, diabetes, a recent procedure or another active infection together with a new effusion,
    • a prosthetic joint with sudden pain, fever, wound drainage or a marked loss of function.

    Septic arthritis can damage articular cartilage rapidly, so suspected infection should not be managed by simply waiting to see whether the swelling settles.

    Questions to discuss with an orthopaedic surgeon

    Does every knee effusion need aspiration?

    No. Aspiration is most useful when the result can clarify the diagnosis, when infection or crystal disease is suspected, or when a large effusion is causing significant symptoms. A small, clinically explainable effusion may not require aspiration.

    Does every aspiration need ultrasound?

    No. Ultrasound is especially useful when there is little fluid, anatomy is atypical, the joint is deep or access is difficult, or a previous attempt has failed. A straightforward aspiration of an obvious superficial effusion may be performed accurately without imaging by an experienced operator.

    Can the fluid be judged by colour alone?

    No. Appearance can suggest possibilities but cannot reliably distinguish infection, crystal disease and other inflammatory causes. Laboratory testing remains necessary when the diagnosis matters.

    References

    1. Ravn C, Neyt J, Benito N, et al.; SANJO guideline group. Guideline for management of septic arthritis in native joints (SANJO). J Bone Joint Infect. 2023;8:29–37. DOI: 10.5194/jbji-8-29-2023.
    2. Uson J, Rodriguez-García SC, Castellanos-Moreira R, et al. EULAR recommendations for intra-articular therapies. Ann Rheum Dis. 2021;80(10):1299–1305. DOI: 10.1136/annrheumdis-2021-220266.
    3. Wu T, Dong Y, Song HX, Fu Y, Li JH. Ultrasound-guided versus landmark in knee arthrocentesis: A systematic review. Semin Arthritis Rheum. 2016;45(5):627–632. DOI: 10.1016/j.semarthrit.2015.10.011.
    4. Deng X, Li D, Li Y. Ultrasound-guided versus blind arthrocentesis in knee osteoarthritis: A systematic review and meta-analysis. Medicine (Baltimore). 2025. DOI: 10.1097/MD.0000000000041389.

    ← Treatments and Procedures

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Proximal Humerus Fracture — Does the Type of Immobilisation Matter?

    In non-operative treatment of proximal humerus fractures, considerable attention is often paid to how restrictive the immobilisation should be. A randomized trial suggests that choosing between a Velpeau-type bandage, a standard shoulder-arm sling and a sling with additional support does not lead to meaningful differences in functional or radiographic outcomes.

    Polish version: Złamanie bliższego końca kości ramiennej — czy rodzaj unieruchomienia ma znaczenie?

    Why is this study clinically relevant?

    Immobilisation is almost routine when a proximal humerus fracture is selected for conservative management, but the exact device used is often influenced more by local practice than by strong comparative evidence. The practical question is therefore not only whether to immobilise the shoulder, but whether a more elaborate brace produces a real patient benefit.

    The study was published online on 21 August 2026 in the Journal of Shoulder and Elbow Surgery.

    Study question and methodology

    This prospective randomized study included patients with proximal humerus fractures treated non-operatively. Three immobilisation methods were compared:

    • a Velpeau-type bandage,
    • a standard shoulder-arm sling/brace,
    • a shoulder-arm sling with additional support.

    The clinical outcome analysis included 34, 39 and 32 patients in the respective groups, for a total of 105. Mean age was 60.6 years and 63.8% of participants were women. Baseline characteristics, including fracture severity according to the Neer classification, were comparable between groups.

    Outcomes included pain, range of motion and several measures of shoulder and upper-limb function: SSV, ASES, DASH and Constant score.

    Key results

    No statistically significant differences were found between the three groups in pain, range of motion or functional scores. Radiographic outcomes likewise did not show an advantage for one immobilisation method over the others.

    The authors reported nonunion in 5 of 120 patients (4.1%). Malunion was reported in 22 of 105 patients (21%), with comparable rates across the study groups.

    Clinical interpretation for an orthopaedic surgeon

    The most practical conclusion is straightforward: once a fracture has appropriately been selected for non-operative management, a more elaborate immobilisation device does not necessarily produce a better result. Choice of device may therefore reasonably take greater account of patient comfort, the ability to use the brace correctly and cost.

    This may be particularly relevant in older patients, for whom complex immobilisation devices can be harder to apply, interfere with hygiene and reduce treatment tolerance.

    Limitations

    The findings need to be interpreted within the population studied. They do not mean that every proximal humerus fracture can be treated with any sling, or that immobilisation method is irrelevant when fracture alignment is unstable, surgery is indicated, or adherence to treatment presents particular problems.

    Importantly, the absence of a statistically significant difference is not the same as formally proving equivalence between all three methods. The publicly available abstract does not indicate that the study was designed as an equivalence or non-inferiority trial.

    There is also a numerical inconsistency in the abstract: the nonunion denominator is 120 patients, whereas the analysis of the other reported outcomes includes 105. This limits full interpretation without access to the detailed data in the complete article.

    What might change in practice — and what does the study not prove?

    The trial supports moving away from the assumption that a more restrictive or more expensive immobilisation device inherently improves the outcome of conservative treatment. When fracture stability and the patient’s condition allow, a simple, well-tolerated device that can be used correctly may be a reasonable choice.

    The study does not answer which proximal humerus fractures should be treated non-operatively, when exercises should begin, or whether earlier mobilisation is better than longer immobilisation. Those are separate clinical decisions.

    Reference

    1. Sarıkas M, Kapıcıoğlu M, Şahin K, Bilsel K. Does Immobilization Method Make a Difference in Conservative Management of Proximal Humeral Fractures? A Prospective Randomized Trial. Journal of Shoulder and Elbow Surgery. 2026 Aug 21. DOI: 10.1016/j.jse.2026.08.004. PubMed PMID: 42628626.

    ← Research Updates, Literature and Evidence-Based Medicine

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Lateral Knee Pain in Runners — Could It Be Iliotibial Band Syndrome?

    Pain on the outer side of the knee that appears during running and builds as the distance increases may be caused by iliotibial band syndrome. Not every case of lateral knee pain has this explanation, however. Diagnosis is based mainly on the history and clinical examination; ultrasound or MRI are generally reserved for atypical symptoms, persistent problems despite treatment, or situations in which another condition needs to be excluded.

    Polish version: Ból po bocznej stronie kolana u biegacza — czy to pasmo biodrowo-piszczelowe?

    What does iliotibial band syndrome usually feel like?

    The pain is typically quite well localised on the lateral side of the knee, near the lateral femoral epicondyle. Early on, it may appear only after a certain amount of running and settle quickly when exercise stops. With greater overload, symptoms may begin earlier and may also occur while walking downstairs or during longer walks.

    A large knee effusion, a feeling of “fluid in the knee” or true mechanical locking are not typical. When those features dominate, another source of symptoms should be considered.

    Does the iliotibial band really “rub” over the bone?

    The condition was traditionally called iliotibial band friction syndrome. Contemporary reviews emphasise that the mechanism is more complex, and the simple concept of the band sliding back and forth and rubbing over the lateral femoral epicondyle has been questioned.

    Overload of tissues on the lateral side of the knee, control of the limb during running, hip muscle strength and coordination, and sudden changes in training load may all contribute. For that reason, simply “stretching the band” should not be regarded as a complete treatment strategy.

    What else can cause lateral knee pain?

    Similar symptoms may arise from the lateral meniscus, patellofemoral joint, lateral collateral ligament, biceps femoris tendon, proximal tibiofibular joint or bone. After trauma, ligament and intra-articular injuries also need to be considered.

    How is iliotibial band syndrome diagnosed?

    The key elements are the pain pattern, its precise location, its relationship to running and a careful examination of the limb. Assessment should not be limited to the knee: hip function, range of motion, muscle strength, lower-limb control under load and signs of another injury may all be relevant.

    There is no single test that independently confirms the diagnosis in every patient. When the clinical picture is typical, additional imaging is not always necessary.

    When can ultrasound help?

    Ultrasound can be useful when symptoms persist or recur, or when superficial structures on the lateral side of the knee need to be assessed. Reported findings may include soft-tissue oedema or fluid deep to the iliotibial band near the lateral femoral epicondyle. Thickening of the band itself is neither constant nor sufficiently specific to establish the diagnosis on its own.

    When is MRI useful?

    MRI is not routinely required for a typical presentation. It becomes more useful when the diagnosis is uncertain, intra-articular symptoms are present, pain persists despite appropriate management, or a meniscal, cartilage, bone or other structural problem needs to be excluded.

    How is it treated?

    The usual starting point is a temporary reduction in the load that provokes pain, followed by a gradual return to running. This does not normally mean several weeks of complete rest. The aim is to identify an activity level that does not perpetuate symptoms while addressing factors that may be contributing to overload.

    Exercise

    A 2024 systematic review of 13 studies involving 201 runners found that hip abductor strengthening was the most common component of rehabilitation programmes. The individual studies were highly heterogeneous and a reliable meta-analysis could not be performed. Exercise is therefore an important part of management, but there is no single proven programme that is appropriate for every runner.

    A rehabilitation plan may include strengthening of the hip and trunk muscles, improved control during single-leg loading, and progressive functional exercises that reflect the demands of running.

    Training load and running technique

    Recent changes in weekly distance, pace, hill running, downhill running and training frequency are worth reviewing. Selected changes in running mechanics may help some runners, but there is no basis for prescribing the same stride or cadence modification to everyone.

    Medication, shockwave therapy and injections

    Anti-inflammatory medication may be used briefly in selected patients when there are no contraindications, but it does not correct the cause of overload. Shockwave therapy has also been described in the literature.

    A corticosteroid injection is not a routine first-line treatment for every runner. It may be considered in selected persistent cases after the pain source has been identified. If an injection is performed, ultrasound guidance allows the needle and injectate to be placed in the intended location.

    When can you return to running?

    The decision should not be based only on the number of days since symptoms began. Return should be progressive and guided by tolerance of everyday walking and basic exercises, followed by a short easy run that does not cause escalating pain during activity or a clear deterioration the next day.

    A common mistake is to return immediately to the previous mileage, pace and downhill workload. It is safer to increase load step by step and monitor how the knee responds.

    When does lateral knee pain need earlier assessment?

    • pain began after a clear injury and makes weight bearing difficult,
    • the knee becomes rapidly and markedly swollen,
    • the joint is hot or red, particularly with fever,
    • the knee truly locks or clearly gives way,
    • there is very focal bone tenderness and pain with weight bearing, especially after a sudden increase in training,
    • pain becomes constant, occurs at night or progresses despite reducing activity.

    Key point for an orthopaedic surgeon

    Iliotibial band syndrome is a common cause of lateral knee pain in runners, but the diagnosis should come from the whole clinical picture. Typical cases are usually managed without surgery through load adjustment, exercise and a gradual return to running. Ultrasound and MRI are supporting tools, especially when the presentation is atypical or progress is not as expected.

    References

    1. Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Front Sports Act Living. 2024;6:1386456. DOI: 10.3389/fspor.2024.1386456.
    2. Bonoan M, Morales M, Liu XW, Oyeniran O, Zheng K, Palatulan E. Iliotibial Band Syndrome Current Evidence. Curr Phys Med Rehabil Rep. 2024;12:193-199. DOI: 10.1007/s40141-024-00442-w.
    3. Jiménez Díaz F, Gitto S, Sconfienza LM, Draghi F. Ultrasound of iliotibial band syndrome. J Ultrasound. 2020;23(3):379-385. DOI: 10.1007/s40477-020-00478-3.

    ← Knee Conditions

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Duloxetine After Hip or Knee Replacement — Less Opioid Use, Small Analgesic Effect

    A recent meta-analysis of 13 randomized trials suggests that duloxetine may reduce opioid consumption after total hip and knee arthroplasty. At the same time, the average reduction in pain was small and, at most time points, did not reach the threshold considered clinically important.

    Polish version: Duloksetyna po endoprotezoplastyce — mniej opioidów, mały efekt przeciwbólowy

    Why is this study clinically relevant?

    Duloxetine is a serotonin-noradrenaline reuptake inhibitor (SNRI) used, among other indications, for neuropathic pain and chronic pain syndromes. Interest in arthroplasty comes from its potential role in multimodal analgesia and opioid-sparing strategies. The clinically important question, however, is not only whether a difference is statistically significant, but whether it is large enough for patients to notice.

    Study question and methodology

    Ibrahim, Abdelnabi and Sheta analysed 13 randomized trials published between 2010 and 2024, including 1,176 patients after total hip or total knee arthroplasty. Outcomes included pain at rest and while walking, opioid consumption converted to morphine equivalents, and adverse events. Random-effects models were used when heterogeneity was substantial, with additional sensitivity analyses for selected outcomes.

    Key results

    • At 24 hours, duloxetine reduced pain at rest by an average of 5.09 mm and pain while walking by 4.55 mm on a 0–100 mm scale.
    • At 2 weeks, the corresponding differences were 6.48 mm and 8.93 mm.
    • Most of these differences were statistically significant, but remained below the 10 mm minimal clinically important difference adopted by the authors.
    • Opioid use was lower by 22.74 mg morphine equivalents at 48 hours and by 10.58 mg at 72 hours. Heterogeneity for these analyses was extremely high, however: I² 100% and 97%, respectively.
    • Nausea or vomiting occurred less often with duloxetine, while somnolence was more frequent.

    Clinical interpretation for an orthopaedic surgeon

    The most important finding is the gap between statistical significance and effect size. The results do not support the claim that duloxetine provides clearly superior pain control for the average patient after joint replacement. The opioid-sparing signal may nevertheless be clinically useful as one component of a broader multimodal analgesia protocol.

    The reductions of 22.74 mg and 10.58 mg morphine equivalents should not be treated as precise, universally expected effects. With I² values of 97–100%, the individual studies differed so markedly that the pooled estimates are better interpreted as indicating a direction of effect than as predicting a specific benefit for a particular protocol.

    Limitations

    • Substantial heterogeneity affected many pain analyses and virtually all analyses of opioid consumption.
    • Two open-label studies were judged to have a high risk of bias for subjective outcomes.
    • One study did not use an intention-to-treat analysis.
    • Several trials had problems with missing data or lacked a pre-registered analysis plan.
    • When the more conservative Hartung–Knapp adjustment was applied, some apparently significant pain results were no longer statistically significant.

    What might change in practice — and what does the study not prove?

    The meta-analysis strengthens the argument that duloxetine may be considered as one element of an opioid-sparing strategy in appropriately selected patients. It does not justify routine use in every patient after THA or TKA, and it does not demonstrate a large, clinically important analgesic advantage. It also does not establish the optimal dose, timing, duration of treatment or the subgroup most likely to benefit.

    Duloxetine has its own adverse-effect and interaction profile. Any perioperative use therefore needs to follow a defined protocol and individual assessment of contraindications rather than the meta-analysis result alone.

    Reference

    Ibrahim A, Abdelnabi M, Sheta RA. Duloxetine for postoperative pain management in total hip and knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2026;21:527. DOI: 10.1186/s13018-026-07176-6. Published 2 September 2026.

    ← Research Updates, Literature and Evidence-Based Medicine

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Pes Anserine Pain — A Cause of Medial Knee Pain

    Pain several centimetres below the medial knee joint line, aggravated by stairs, rising from a chair or prolonged activity, can come from the pes anserine region. Not every case of medial knee pain is caused by the pes anserinus, however: a meniscal problem, medial collateral ligament injury or knee osteoarthritis can produce similar symptoms.

    Polish version: Gęsia stopka — ból po wewnętrznej stronie kolana

    What is the pes anserinus?

    The pes anserinus is the combined insertional region of three tendons on the medial side of the proximal tibia: sartorius, gracilis and semitendinosus. A bursa lies between these tendons and the deeper tissues. Symptoms may reflect tendon overload, irritation of the bursa or a combination of both, so the label “pes anserine bursitis” does not always describe the full clinical picture.

    How does pes anserine pain usually present?

    • pain is usually located on the medial side of the tibia, approximately 4–5 cm below the knee joint line,
    • there may be focal tenderness when the area is pressed with one finger,
    • stairs, rising from a chair, longer walks, running or kneeling can aggravate symptoms,
    • the pain may coexist with knee osteoarthritis, so there can be more than one source of symptoms.

    If the most painful point is directly at the joint line, there is true mechanical locking, or symptoms began after a twisting injury, a meniscal lesion should also be considered.

    How does an orthopaedic surgeon assess a pes anserine problem?

    The history and a careful examination of the knee are the foundation of diagnosis. Pain location is particularly useful because symptoms from the pes anserine region can resemble pain arising from the medial meniscus. The examination also assesses range of motion, ligament stability, limb alignment, muscle strength and other possible sources of pain.

    Is ultrasound necessary?

    Not always. A typical clinical presentation may be recognised without additional imaging. Ultrasound can be useful when the tendons, bursa and neighbouring tissues need to be assessed, when a fluid-containing lesion needs to be distinguished from other structures, or when a precise injection is being planned. The absence of obvious bursal fluid does not exclude symptoms from this region, and an abnormal ultrasound finding alone does not prove that it is the only source of pain.

    When are X-ray or MRI more useful?

    Plain radiographs are often more important than ultrasound when osteoarthritis or another bony or joint-related cause is suspected. MRI may be considered when symptoms suggest an intra-articular problem, meniscal injury or ligament damage and the clinical examination together with simpler imaging does not provide a satisfactory answer.

    How is it treated?

    Treatment usually starts non-operatively. The aim is not to rest the leg completely for many weeks, but to reduce and restructure loading so that the tissues can gradually regain tolerance to activity.

    • activities that clearly provoke pain can be reduced temporarily,
    • strength and movement-control exercises can then be progressed gradually,
    • when knee osteoarthritis coexists, treatment should also address the joint itself,
    • pain-relieving or anti-inflammatory medication should be used only with appropriate attention to contraindications and the patient’s other medical conditions.

    Can an injection help?

    For some people with persistent symptoms, an injection into the painful region or bursa may be considered. Randomized studies have reported short-term improvement after corticosteroid injection, and a trial comparing ultrasound-guided with landmark-based injection found a greater reduction in pain in the ultrasound-guided group. These are relatively small studies, however, and they do not mean that injection should be the first-line treatment for every patient.

    When an injection is considered, accurate needle placement is only one part of the decision. The procedure still needs to be matched to a plausible pain source and a clear clinical indication.

    What about PRP, shockwave therapy and other methods?

    PRP, shockwave therapy, dextrose and other injection-based approaches have also been studied. Results from individual trials are heterogeneous, protocols differ and follow-up is often short. The available evidence therefore does not establish one of these methods as universally superior. Correctly identifying the source of pain and addressing coexisting knee pathology remain more important than choosing a treatment solely because it is technically available.

    When does medial knee pain require urgent assessment?

    • the knee is rapidly swelling, clearly hot and red, particularly with fever,
    • after an injury, weight bearing is impossible or there is a deformity,
    • the knee is truly locked and cannot be fully extended,
    • there is increasing one-sided calf swelling, especially with shortness of breath or chest pain,
    • pain is severe, continuously worsening or accompanied by systemic symptoms.

    Key point: pain location is not yet a diagnosis

    The pes anserine region is one possible extra-articular source of medial knee pain, but symptoms may coexist with osteoarthritis, a meniscal problem or another condition. Treatment should therefore follow the clinical assessment, with ultrasound, X-ray or MRI selected to answer a specific diagnostic question rather than used automatically.

    References

    1. Poboży T, Janowski K, Domański P, Michalak K, Poboży K, Domańska-Poboża J, Konarski W, Chuść I, Kielar M. The Hidden Burden of Entheseal Pathology in Lower-Limb Pain: A Real-World Ultrasound Study of 667 Adults. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2026;10(4):100734. DOI: 10.1016/j.mayocpiqo.2026.100734. This study concerned a broader group of lower-limb enthesopathies and tendinopathies, not pes anserine pathology alone.
    2. Hasan M, Berkovich Y, Khatib M, et al. Knee Bursae: A Comprehensive Review of Clinical Evaluation, Imaging Differentiation, and the Expanding Role of Biologic Therapies. Cartilage. 2025. DOI: 10.1177/19476035251362434.
    3. Zavarei S, Khalifeh Soltani S, Raissi G, et al. Efficacy of ultrasonography-guided compared to surface landmark-based corticosteroid injection for people with chronic pes anserine tendinitis or bursitis: a randomised controlled trial. International Journal of Therapy and Rehabilitation. 2023;30(4):1–10. DOI: 10.12968/ijtr.2021.0140.
    4. Babaei-Ghazani A, Eftekharsadat B, Soleymanzadeh H, ZoghAli M. Ultrasound-Guided Pes Anserine Bursitis Injection Choices: Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial. American Journal of Physical Medicine & Rehabilitation. 2024;103(4):310–317. PMID: 37752656.

    ← Knee Conditions

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Weber C Ankle Fracture — Should the Deltoid Ligament Be Repaired?

    A randomized trial in patients with Weber C ankle fractures and deltoid ligament injury found an important difference between early mechanical stability and later clinical outcome. Direct deltoid repair improved early talar stability on weight-bearing or stress imaging, but at 12 months it did not provide an advantage in the radiographic outcomes assessed or in ankle function.

    Polish version: Złamanie Weber C — czy naprawiać więzadło trójgraniaste?

    Why is this study clinically relevant?

    In unstable ankle fractures with injury to the medial ligament complex, a practical question remains after fracture anatomy has been restored: should the deltoid ligament be repaired routinely? In theory, direct repair may improve stability of the medial column, but it also adds another surgical step. Choi and colleagues evaluated this question in a randomized controlled trial.

    Study question and methodology

    The study included patients with Weber C fractures corresponding to OTA/AO type 44C, produced by a pronation-external rotation mechanism and associated with deltoid ligament injury. After the fracture fixation strategy had been established, patients were randomized to direct repair of the deltoid ligament or to no ligament repair.

    Medial clear space and talar tilt were assessed on standing and stress radiographs at 3, 6 and 12 months. Functional outcome was measured with the FAAM. Seventy-one patients completed the 12-month follow-up: 35 in the repair group and 36 in the no-repair group.

    Key results

    • Medial clear space was comparable between groups across the imaging views and time points assessed.
    • At 3 months, the group without deltoid repair showed greater valgus talar tilt on stress imaging. This was a signal of better early stability after direct repair.
    • At 12 months, the difference in talar tilt was no longer statistically significant.
    • FAAM scores improved in both groups. At 12 months, the activities-of-daily-living component was approximately 89–90% in both groups.

    Clinical interpretation for an orthopaedic surgeon

    The most useful conclusion is not that the deltoid ligament should never be repaired. Rather, in this specific fracture group, routinely adding medial ligament repair did not translate into better function at one year despite an early improvement in talar stability.

    This distinction matters. A better postoperative radiographic parameter is most clinically important when it translates into better function, less late instability, fewer reoperations or lower risk of post-traumatic degeneration. A 12-month follow-up cannot resolve all of those questions.

    Limitations

    • The trial was conducted at a single centre and included 71 patients with complete one-year follow-up.
    • It addressed a narrowly defined group of Weber C fractures with deltoid ligament injury; the findings should not automatically be applied to every unstable ankle fracture.
    • One year is adequate for assessing early function but too short for reliable evaluation of late instability, post-traumatic osteoarthritis or revision risk.
    • The absence of a statistically significant difference at 12 months is not formal proof that the two strategies are equivalent.
    • The publicly available abstract does not answer every subgroup question, including whether particular patterns of medial injury may benefit more from repair.

    What might change in practice — and what does the study not prove?

    The trial provides an argument against treating direct deltoid ligament repair as an automatic component of every Weber C fracture fixation when the ligament is injured. The decision may still depend on the quality of fracture reduction, residual ankle stability after fixation, the character of the medial injury and the overall fracture pattern.

    The study does not prove that repair is unnecessary in every patient, nor does it prove that a transient early difference in stability has no longer-term significance. Larger cohorts and longer follow-up are needed to answer those questions.

    Reference

    Choi JY, Yu OJ, Jung YH, Suh JS. Deltoid Ligament Repair Does Not Improve Radiographic or Clinical Outcomes in Weber Type C Pronation-External Rotation Ankle Fractures: A Randomized Controlled Trial. Journal of Orthopaedic Trauma. 2026;40(8):399–407. DOI: 10.1097/BOT.0000000000003189. Issue date: 1 August 2026.

    ← Research Updates, Literature and Evidence-Based Medicine

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Adult Hip Dysplasia — Symptoms, Diagnosis and Treatment

    Adult hip dysplasia means that the acetabulum provides insufficient coverage of the femoral head. It can cause groin pain, a sense of overload or instability and, over time, contribute to labral and cartilage damage. The diagnosis should not be made from a single X-ray angle alone: symptoms, clinical examination and appropriately performed imaging all matter.

    Polish version: Dysplazja biodra u dorosłych — objawy, diagnostyka i leczenie

    What is adult hip dysplasia?

    In a normally shaped hip, the acetabulum covers enough of the femoral head to distribute load across an adequate joint surface. In dysplasia, that coverage is reduced. This can increase stress at the acetabular rim, labrum and articular cartilage and may contribute to hip microinstability.

    Not every radiographic feature of undercoverage represents a symptomatic condition that requires treatment. Similar morphology can also be found in people without hip pain. Imaging therefore needs to be interpreted together with symptoms and the clinical examination.

    Which symptoms can suggest hip dysplasia?

    • groin pain, especially with prolonged walking, running or deep hip flexion,
    • a sense of fatigue or overload around the hip after activity,
    • pain on the lateral side of the hip or, less commonly, in the buttock,
    • a feeling of instability or that the hip is giving way,
    • catching, clicking or sharp pain during twisting movements, particularly when labral damage is also present.

    These symptoms are not specific to dysplasia. Similar pain can arise from femoroacetabular impingement, the labrum, tendons, the lumbar spine or other soft tissues around the hip. The source of pain therefore needs to be established rather than assumed from one imaging measurement.

    How does an orthopaedic surgeon diagnose hip dysplasia?

    Assessment starts with the history and clinical examination. The location of pain, range of motion, signs of instability or impingement, muscle strength and other potential sources of symptoms are considered. Properly performed radiographs of the pelvis and hip are the basic imaging tests.

    What does the Wiberg angle mean?

    One commonly used measurement is the lateral centre-edge angle, also known as the Wiberg angle or LCEA. An international 2026 consensus considered an LCEA below 20° typical of dysplasia, while values of 20–25° may raise suspicion of possible instability.

    This is not a rule in which “below 25° means surgery”. Pelvic positioning and radiographic technique can affect the measurement, and acetabular shape is three-dimensional. Other measurements, acetabular version, proximal femoral morphology and the condition of the cartilage may therefore also need to be considered.

    When are MRI or CT useful?

    MRI may be needed to assess the labrum, cartilage and other soft tissues, particularly when surgery is being considered or when symptoms are not adequately explained by radiographs. CT can be useful for a more detailed three-dimensional assessment of acetabular and femoral anatomy and orientation.

    Ultrasound is not the primary test for assessing femoral-head coverage in an adult. It can, however, be useful when tendons or other soft tissues around the hip need evaluation or when a diagnostic injection is to be performed accurately.

    Does hip dysplasia always require surgery?

    No. Management depends on the severity of symptoms, the degree of undercoverage, joint stability, the biological condition of the joint and the presence of osteoarthritis. For some patients, non-operative treatment is a reasonable first step.

    • modifying activities that clearly provoke pain without eliminating movement altogether,
    • exercises aimed at improving hip and trunk strength and control,
    • gradual adjustment of sporting and occupational loads,
    • pain-relieving or anti-inflammatory medication when appropriate and when there are no contraindications.

    In a review that included several non-arthritic causes of hip-related pain, including dysplasia, roughly half of patients achieved a satisfactory response to non-operative treatment. That figure should not be interpreted as the response rate for every form of dysplasia, because the included studies combined several different diagnoses.

    What is periacetabular osteotomy?

    In appropriately selected patients with symptomatic dysplasia and preserved cartilage, periacetabular osteotomy (PAO) may be considered. Controlled bone cuts allow the acetabulum to be mobilised and reoriented so that it provides better coverage of the femoral head. The aim is to improve joint mechanics while preserving the native hip.

    Long-term reviews report improvement in patient-reported outcomes after PAO, but most available evidence comes from observational studies of carefully selected patients. The presence of dysplasia on an X-ray is therefore not, by itself, an indication for osteotomy.

    What about hip arthroscopy?

    Hip arthroscopy can address labral damage or coexisting impingement, but it does not increase bony coverage of the femoral head. In true instability caused by dysplasia, repairing the labrum alone does not correct the underlying biomechanical problem. Borderline cases in particular require assessment of the hip’s overall geometry rather than one isolated measurement.

    When is joint replacement considered instead of joint-preserving surgery?

    If dysplasia is accompanied by advanced osteoarthritis and substantial cartilage damage, the potential benefit of a joint-preserving procedure may be limited. Depending on symptoms and function, total hip replacement may then be considered. More about this pathway: Hip Replacement.

    When does hip pain need more urgent assessment?

    • after an injury, you cannot bear weight or there is an obvious deformity,
    • the joint is very painful and hot, particularly with fever or systemic illness,
    • pain is rapidly increasing at rest or at night, especially with unexplained general symptoms,
    • there is sudden weakness, sensory loss or another new neurological symptom in the limb.

    Key point: treat the symptomatic hip, not an X-ray angle

    Hip dysplasia is a structural problem, but treatment decisions come from the combination of symptoms, examination, properly obtained radiographs and, when needed, MRI or CT. A single angle can support the diagnosis but cannot replace a complete assessment. Non-operative care is sufficient for some people, while selected patients with persistent symptoms and limited degenerative change may be candidates for surgery that preserves the native joint.

    References

    1. Leopold VJ, Rakhra K, Spiker AM, et al. Which Imaging Modalities, Parameters, and Diagnostic Thresholds Best Define Hip Instability? Consensus Statements From a Scoping Review and an International Multidisciplinary Delphi Study. Clinical Orthopaedics and Related Research. 2026;484(5):899–915. DOI: 10.1097/CORR.0000000000003905.
    2. MacLeod JS, Zhu JR, Lee MS, et al. Periacetabular Osteotomy Leads to Improved Long-term Patient-reported Outcomes: A Systematic Review. Orthopedics. 2025;48(3):e113–e123. DOI: 10.3928/01477447-20250409-03.
    3. O’Brien MJM, Semciw AI, Mechlenburg I, et al. Pain, function and quality of life are impaired in adults undergoing periacetabular osteotomy for hip dysplasia: a systematic review and meta-analysis. Hip International. 2024;34(1):96–114. DOI: 10.1177/11207000231179610.
    4. Probst DT, Sookochoff MF, Harris-Hayes M, et al. What is the Rate of Response to Nonoperative Treatment for Hip-Related Pain? A Systematic Review With Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(5):286–306. DOI: 10.2519/jospt.2023.11666.

    ← Hip Conditions

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Partial-Thickness Rotator Cuff Tears — New ESSKA-ESA Consensus

    A new formal ESSKA-ESA consensus clarifies how partial-thickness posterosuperior rotator cuff tears should be described and assessed. The most practical message is that these lesions should not be reduced to a single percentage of tendon thickness or one classification. The report should reflect location, depth and the tendon involved, while also distinguishing acute from chronic tears. At the same time, the document makes clear where evidence is still weak — particularly for natural progression and the choice of the best imaging test.

    Polish version: Częściowe uszkodzenia stożka rotatorów — nowy konsensus

    Why is this consensus useful?

    Partial-thickness rotator cuff tears are common, but their clinical significance is often difficult to judge. In practice, it is easy to place too much weight on one ultrasound or MRI measurement of tear depth even though treatment decisions also depend on the lesion’s location, mechanism, tendon involvement, symptoms and the patient’s functional demands.

    The consensus from the European Society of Sports Traumatology, Knee Surgery and Arthroscopy and the European Shoulder Associates, published on 7 September 2026, addresses this part of the problem: definitions, classification, aetiology, natural history and diagnosis of partial-thickness posterosuperior rotator cuff tears.

    Methodology

    The steering group formulated 33 clinical questions, followed by a standardized literature search and evidence assessment. Statements were developed for each question with recommendation grades ranging from A to D, and an independent expert panel assessed them until strong consensus was reached.

    This distinction matters. The publication is not a narrative review or an informal collection of expert opinions, but a formal consensus developed using a predefined ESSKA methodology. Its strength nevertheless remains constrained by the quality of the underlying evidence, which is limited in several areas.

    Key findings

    • One classification is not enough. The strongest recommendations support combining descriptive systems so that location, depth and involvement of individual tendons are captured.
    • Acute and chronic tears should be distinguished. This also received a high-grade recommendation and directly affects interpretation and management.
    • Articular-sided lesions are more common in overhead and contact athletes. The evidence supporting this finding was weaker than the evidence behind the core classification recommendations.
    • No association was demonstrated between partial-thickness posterosuperior cuff tears and calcific tendinopathy.
    • Natural history remains difficult to predict. Evidence on the risk and rate of progression is less robust.
    • There is no single ideal imaging test. The consensus highlights limitations of current modalities in fully characterising these lesions.

    Clinical interpretation for an orthopaedic surgeon

    The most useful practical message concerns how these tears are described. A statement such as “50% tendon thickness tear” does not define the whole problem. Two lesions with similar depth may have different locations, mechanisms and tendon involvement, and may occur in patients with very different functional requirements.

    The second point concerns imaging. Both ultrasound and MRI can be highly useful, but this consensus does not support treating any single examination as an infallible map of the lesion. Imaging should be interpreted together with the history and clinical examination. This is particularly important in partial-thickness abnormalities, where the distinction between tendinopathy, delamination and a true fibre defect may be less clear than in a large full-thickness tear.

    Limitations

    • This is a formal consensus, not a randomized trial comparing treatment strategies.
    • Some recommendations rely on lower-quality evidence, particularly those concerning natural progression and optimal imaging.
    • The document addresses partial-thickness tears of the posterosuperior cuff, so its conclusions should not automatically be applied to every type of rotator cuff lesion.
    • This first part of the consensus focuses on definitions, classification, aetiology, natural history and diagnosis; it is not a ready-made algorithm for deciding who should undergo surgery.
    • The authors label the publication “Level I, formal consensus”. This should not be equated with the evidence level of a well-conducted randomized trial evaluating treatment efficacy.

    What may change in practice — and what does the consensus not prove?

    The document may improve communication between radiologists, musculoskeletal ultrasonographers and shoulder surgeons. A report of a partial-thickness tear should ideally provide more than a percentage estimate: location, extent, tendon involvement and whether the lesion appears acute or chronic all add useful clinical context.

    The consensus does not show that a particular percentage of tendon involvement automatically requires surgery, that one imaging modality is always superior to the others, or that progression can be predicted reliably in an individual patient. Better prospective evidence is still needed in these areas.

    Reference

    Kany J, Ruiz Iban MA, Rosso C, et al. The 2026 ESSKA-ESA formal consensus on partial-thickness posterosuperior rotator cuff tears (Part 1): Definitions, classifications, etiologies, natural history and diagnosis. Knee Surgery, Sports Traumatology, Arthroscopy. Published online 7 September 2026. DOI: 10.1002/ksa.70587. PMID: 42704696.

    ← Research updates, literature and EBM

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Radial Head Fracture — When Is Surgery Needed?

    Most isolated, nondisplaced or only mildly displaced radial head fractures can be treated without surgery. Management usually involves brief support for comfort followed by controlled restoration of motion as early as the injury safely allows. Fragment displacement of more than 2 mm is not, by itself, an automatic indication for an operation. Mechanical blockage of forearm rotation, comminution, elbow instability and associated injuries are more important.

    Polish version: Złamanie głowy kości promieniowej — kiedy potrzebna jest operacja?

    How does a radial head fracture occur?

    The usual mechanism is a fall onto an outstretched hand. Force travels through the wrist and radius to the elbow, where the radial head impacts the distal humerus. The injury may be a small fracture line, a displaced fragment, or — in more severe trauma — a comminuted radial head fracture.

    The radial head is not simply a piece of bone that needs to unite. It contributes to elbow stability. In complex injuries, treatment therefore depends not only on the fracture itself but also on the ligaments, the other bony structures around the elbow and the stability of the joint as a whole.

    Typical symptoms

    • pain on the lateral side of the elbow, particularly after a fall onto the hand,
    • swelling and tenderness over the radial head,
    • pain or restriction when turning the palm up or down,
    • difficulty fully bending or straightening the elbow,
    • pain with tasks such as turning a key, a door handle or opening a bottle.

    Similar post-traumatic pain can also come from ligaments, cartilage or other elbow structures, so the diagnosis should not be based on pain location alone.

    How is the fracture diagnosed?

    Assessment should include the whole upper limb rather than only the most painful point. Elbow motion — especially pronation and supination — joint stability, circulation and sensation are checked. The forearm and wrist also deserve examination because some radial head fractures are accompanied by injuries farther from the elbow.

    Plain radiographs are the basic imaging test. CT can be helpful in more complex or comminuted fractures when the number and position of fragments need to be defined more precisely or when surgery is being planned. Ultrasound does not replace radiographs for diagnosing an acute adult fracture, although it can complement soft-tissue or effusion assessment in selected situations.

    What does the Mason classification mean?

    In simplified terms, Mason type I describes a fracture without substantial displacement, type II a displaced fragment involving part of the radial head, and type III a comminuted fracture. In the Johnston modification, type IV refers to a radial head fracture associated with elbow dislocation.

    The classification is useful for describing the injury, but it does not choose the treatment by itself. Two fractures within the same category may differ in stability, available motion and associated damage.

    When can treatment be non-operative?

    Non-operative management is appropriate mainly for nondisplaced and minimally displaced fractures when the elbow is stable and there is no mechanical block to motion. This is typical for Mason type I fractures and also applies to many carefully selected isolated Mason type II injuries.

    A key goal is to avoid unnecessary elbow stiffness. If fracture and joint stability permit, controlled range-of-motion exercises are introduced after a short period of protection. The exact timing and progression of loading depend on the injury pattern rather than a single fixed timetable for every patient.

    A randomized trial of 45 adults with isolated Mason type II fractures found no significant one-year functional advantage of screw fixation over non-operative treatment. A 2026 meta-analysis involving 181 patients likewise found no clear operative advantage in function or range of motion. The evidence remains limited, however: the meta-analysis included only four studies, just one of which was randomized, and some analyses were heterogeneous.

    Does displacement of more than 2 mm mean surgery?

    No. A review in EFORT Open Reviews emphasizes that displacement beyond 2 mm, in the absence of a mechanical block to pronation or supination, is not by itself an unequivocal indication for surgery.

    What matters is the overall pattern: fragment size and position, remaining bony contact, comminution, unrestricted motion, joint stability and associated injuries. Treatment should therefore not be decided from a millimetre measurement in a radiology report alone.

    When is surgery more likely to be needed?

    • A true mechanical block to forearm rotation — a bony fragment prevents pronation or supination rather than motion being limited only by pain.
    • Marked comminution of the radial head, particularly when reliable reconstruction is difficult or impossible.
    • Loss of elbow stability or an associated dislocation, ligament injury or additional fracture.
    • Major displacement with loss of fragment contact, especially when other features of a complex injury are present.
    • A situation in which acceptable elbow anatomy and function cannot be restored with non-operative treatment.

    In a complex injury, preserving or reconstructing the radial head may be important for joint stability. Simply removing an inconvenient fragment is therefore not a universal solution.

    What does surgery involve?

    If the fracture can be anatomically reconstructed, open reduction and internal fixation is commonly performed with screws and, in some patterns, a plate. If a severely comminuted fracture cannot be reconstructed reliably and the radial head is needed for elbow stability, radial head replacement may be considered.

    The choice of procedure depends on the entire injury pattern. There is no single operation that is appropriate for every radial head fracture.

    Return to function

    Loss of motion is one of the main problems after elbow injury. When the fracture and the joint are stable, the aim is therefore to begin controlled movement as early as safely possible. Heavier loading, lifting and return to sport require adequate healing progress and restoration of function.

    Recovery speed depends on the fracture pattern, associated injuries, treatment method and individual response. The absence of pain at rest does not by itself mean that the bone is fully healed or ready for high loads.

    When is urgent assessment needed?

    • the elbow is visibly deformed or dislocation is suspected,
    • there is an open wound or exposed bone,
    • the hand becomes pale, blue or clearly colder than the other hand,
    • numbness, finger weakness or other neurological symptoms are increasing,
    • pain and swelling are rapidly worsening despite protection and analgesia,
    • forearm rotation is essentially impossible or there is a clear mechanical block,
    • the forearm or wrist also hurts, suggesting that more than one structure may be injured.

    Key point for an orthopaedic surgeon

    A radial head fracture does not automatically require surgery. Stable, isolated fractures without a mechanical block often do well with non-operative treatment and early controlled motion. Mechanical blockage, comminution, instability and associated injuries are usually more important than a single displacement measurement. The whole elbow and upper limb therefore need to be assessed, not just one fragment on an image.

    References

    1. van der Windt AE, Langenberg LC, Colaris JW, Eygendaal D. Which radial head fractures are best treated surgically? EFORT Open Reviews. 2024;9(5):413–421. DOI: 10.1530/EOR-24-0035.
    2. Goy C, van de Wall BJM, Beeres FJP, et al. Operative vs. nonoperative treatment in Mason type II fractures: a meta-analysis. JSES Reviews, Reports, and Techniques. 2026;6(3):100773. DOI: 10.1016/j.xrrt.2026.100773.
    3. Mulders MAM, Schep NWL, de Muinck Keizer RJO, et al. Operative vs. nonoperative treatment for Mason type 2 radial head fractures: a randomized controlled trial. Journal of Shoulder and Elbow Surgery. 2021;30(7):1670–1678. DOI: 10.1016/j.jse.2021.02.025.

    ← Elbow conditions

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.