Trauma update

Inner myometrial laceration (IML) is a rare but potentially life-threatening obstetric emergency that can cause severe antepartum or postpartum haemorrhage. The pathogenesis of this condition is not fully understood, and this condition is often associated with abnormal uterine contractions, fetal position factors, or obstetric interventions. Its clinical manifestations are nonspecific, making early diagnosis difficult and leading to potential misdiagnosis or missed diagnosis./r/nThis report describes a 26-year-old primigravida at 38⁺¹ weeks gestation who underwent oxytocin induction for preeclampsia. During induction, she suddenly developed 1200 ml of vaginal bleeding. An emergency caesarean section revealed a 4 cm inner myometrial laceration on the posterior wall of the lower uterine segment, with the serosal layer intact. Haemostasis was successfully achieved using a "figure-of-8" suture combined with a continuous suture, supplemented with bilateral ligation of the ascending branches of the uterine arteries. The patient recovered well postoperatively, with no complications during follow-up, and her uterus was preserved./r/nIML is an important and occult cause of refractory antepartum or postpartum haemorrhage. Diagnosis relies on careful intraoperative exploration. Individualized suturing techniques and necessary vascular ligation are key to preserving fertility, whereas hysterectomy should be reserved as a last resort when conservative measures fail. Enhancing clinical vigilance for IML, early surgical exploration, and targeted repair is crucial for improving maternal and fetal outcomes.

Sternocleidomastoid muscle injury is a rare traumatic lesion of the neck that may mimic several severe emergent conditions. Additionally, it can result in a significant hematoma that compresses vital structures. We herein report the case of a 27-year-old male patient who presented with sudden-onset neck pain following exercise. Ultrasound revealed a linear anechogenic area within the enlarged, relatively heterogeneous, and hyperechogenic left sternocleidomastoid muscle, with a hematoma originating from the muscle and herniating through a disrupted fascia. Contrast-enhanced computed tomography demonstrated a protruding cystic lesion from the enlarged sternocleidomastoid muscle, consistent with a hematoma. The hematoma was mild and did not compress the neighboring structures; therefore, the patient was managed conservatively with analgesics and motion restriction. Awareness regarding the radiological findings of the sternocleidomastoid muscle is essential for ruling out several emergent conditions and determining the extent of the hematoma.

Autosomal recessive hypophosphatemic rickets type 2 (ARHR2) is an ultra-rare disorder characterized by renal phosphate wasting and patients may exhibit an increased risk of vascular calcification. Phosphate supplementation, a standard treatment for hypophosphatemic rickets, may further increase this risk by elevating the calcium-phosphate product./r/nTo expand the phenotypic spectrum of ARHR2 and heterozygous ENPP1 variant carriers and to review safety concerns related to phosphate supplementation in affected individuals./r/nWe describe an 11-year follow-up of a pediatric patient with ARHR2, focusing on skeletal and extraskeletal manifestations, particularly the response to a brief period of phosphate supplementation. Additionally, we present a phenotypic analysis of four heterozygous family members, highlighting potential implications of carrier status./r/nThe patient was homozygous for the ENPP1 variant c.2677G > T, p.(Glu893*), exhibited progressive skeletal symptoms, and developed vascular calcifications following phosphate supplementation. Heterozygous family members showed mild alterations in bone and phosphate metabolism, suggesting a possible subclinical phenotype./r/nThis case highlights the complexity of ARHR2 management, the importance of accurate genetic diagnosis, and concerns regarding the safety of phosphate supplementation. Close cardiovascular monitoring is essential, and future therapies should aim to correct phosphate imbalance without increasing calcification risk-potentially through combined treatment strategies or enzyme replacement therapy.

Chest wall deformities are considered a risk factor for lung transplantation. A 5-year-old girl with protein surfactant C deficiency, interstitial lung disease, pulmonary hypertension, and pectus excavatum (Haller 5.9) underwent lung transplantation and Nuss bar placement. Correction of her pectus was necessary to accommodate donor lungs. She was discharged after 18 days. We hope this youngest described child who underwent simultaneous transplant and pectus correction with excellent outcomes will lead others to consider concomitant surgeries.

Pathological fractures, both completed and impending, of the humeral diaphysis from primary or metastatic disease demand a reconstruction that restores stability while preserving shoulder function and alleviating pain. Conventional reconstructive approaches include the use of long-stemmed endoprosthetic devices, plate-and-screw fixation or intramedullary nailing, all of which can be limited in their success when residual bone is short or biologically weak. This case study details the management of a patient with metastatic leiomyosarcoma who presented with refracture through a previously cement-augmented lesion. Following resection, the diaphyseal defect was spanned using a custom humeral cage. A NuVasive PRECICE magnetically controlled intramedullary nail, pre-lengthened before insertion, was placed through the cage and shortened intraoperatively to achieve axial compression between the cage and bone segments. At the 6 month follow-up, the patient had excellent shoulder range of motion, apparent ingrowth into the cage, and he was able to resume activities of daily living with minimal pain.

Relapsing polychondritis (RP) is an immune-mediated disorder that primarily involves the targeting of cartilaginous tissues for inflammation and destruction. Limbic encephalitis (LE) is a rare central nervous system (CNS) manifestation of RP. We report the case of a 39-year-old man who was diagnosed with RP complicated by anti-gamma-aminobutyric acid B receptor (anti-GABABR) antibody-associated LE and presented with recurrent headaches, fever, bilateral auricular swelling, scleral injection, and cognitive impairment. Laboratory tests revealed positive anti-GABABR IgG antibodies in both the serum (titer 1:100) and the cerebrospinal fluid (CSF) (titer 1:1), along with CSF lymphocytic pleocytosis. A brain MRI revealed bilateral frontal and parietal subcortical and periventricular T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) hyperintensities. Immunosuppressive therapy with high-dose methylprednisolone and cyclophosphamide induced rapid symptom resolution, and no relapse occurred during a follow-up period of 1 year. This case expands the spectrum of RP-associated LE, emphasizes the necessity of neuronal autoantibody screening in RP patients with neurological symptoms, and suggests potential pathogenic links involving antigenic cross-reactivity between cartilage and neural tissues and GABAergic metabolism dysregulation.

A man in his late 70s presented with venostatic symptoms and bilateral varicose veins due to bilateral saphenofemoral junction incompetence. Systemic examination revealed a left inframammary swelling that increased in size on inspiration and decreased on expiration and was linked to an old chest wall trauma. Imaging identified a giant intercostal lung herniation through the fractured ribs, which was managed conservatively three decades ago. As he presently remains asymptomatic for the lung herniation, he decided to continue with the conservative management. The varicose veins were treated with endothermal ablation, allowing him to resume routine activities.

Anterior shoulder instability is a common condition, especially among young and active individuals, often associated with both osseous and soft tissue injuries. Recent innovations have introduced various surgical options for managing critical and subcritical instability. Therefore, the primary objective of this systematic review was to collect, synthesize, and integrate international research published across multiple scientific databases on shoulder ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization (DAS), and arthroscopic Trillat techniques used in the treatment of shoulder instability./r/nA structured search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PICOS model, up to January 30, 2025, in the MEDLINE/PubMed, Web of Science (WOS), ScienceDirect, Cochrane Library, SciELO, EMBASE, SPORTDiscus, and Scopus databases. The risk of bias was evaluated, and the PEDro scale was used to assess methodological quality./r/nThe initial search yielded a total of 964 articles. After applying the inclusion and exclusion criteria, the final sample consisted of 25 articles. These studies demonstrated a high standard of methodological quality. The review summarized the effects of ligamentoplasty, arthroscopic Latarjet, dynamic anterior stabilization, and arthroscopic Trillat techniques in treating shoulder instability, detailing the sample population, immobilization period, frequency of instability episodes-including recurrent dislocations and subluxations-surgical methods, study designs, assessed variables, main findings, and reported outcomes./r/nArthroscopic ligamentoplasty is advantageous in preserving the patient's native anatomy, maintaining joint integrity, and allowing for alternative interventions in case of failure. The arthroscopic Trillat technique offers a minimally invasive solution for anterior instability without significant bone loss. The DAS technique utilizes the biceps tendon to provide dynamic stabilization, aiming to generate a sling effect over the subscapularis muscle. The Latarjet procedure remains the gold standard for managing anterior glenoid bone loss greater than 20%. Each surgical option for anterior shoulder instability carries specific implications, and treatment decisions should be tailored based on bone loss severity, capsuloligamentous quality, and the patient's functional needs.

Gait abnormalities often persist after anterior cruciate ligament reconstruction (ACLR) and may increase the risk of reinjury and joint degeneration. This review aimed to assess differences in key gait parameters between ACLR patients and healthy controls, and to estimate when these parameters normalize postoperatively./r/nStudies comparing individuals ≥ 3 months post-ACLR with healthy controls were included. A systematic search across five databases yielded 5251 records, with 20 studies (n = 976) retained. A longitudinal multilevel meta-analysis was performed, with pooled effect sizes calculated using Cohen's d, representing the standardized mean difference. Postoperative time was modeled as a moderator in meta-regression analyses./r/nCompared to healthy controls, ACLR patients assessed at 3-107 months postoperatively exhibited significantly lower peak knee flexion angle (d = -0.48, 95 % CI: -0.87 to -0.10) and peak knee flexion moment (d = -1.06, 95 % CI: -2.06 to -0.07), while walking speed was non-significant (d = -0.17, 95 % CI: -0.47-0.13). Logarithmic modeling indicated that group differences became non-significant at 16.2 months for flexion angle and 10.1 months for flexion moment. Walking speed was statistically non-significant at any timepoint./r/nAt ≥ 3 months post-ACLR, patients exhibited significantly reduced peak knee flexion angle and flexion moment compared to controls. These deficits normalized at approximately 16.2 and 10.1 months, respectively. Walking speed did not significantly differ at any postoperative timepoint. These findings suggest that early-phase rehabilitation should emphasize quadriceps strengthening and knee flexion restoration within the first 10-16 months to address persistent biomechanical deficits.

Avascular necrosis (AVN) is a severe complication following pediatric femoral neck fractures (PFNFs). Identifying risk factors for AVN is critical for guiding timely treatment and follow-up. However, prior studies report inconsistent associations. This systematic review and meta-analysis aimed to identify risk factors associated with AVN after PFNFs./r/nA comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, and the Cochrane Library through April 30, 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess the association between potential risk factors and AVN. Leave-one-out sensitivity analyses, meta-regression, and subgroup analyses were performed./r/nThirty-four studies comprising 1332 pediatric patients (1340 fractures) were included. Older age (≥ 12 years; RR = 1.40, 95% CI 1.09-1.82), Delbet type I/II fractures (RR = 1.96, 95% CI 1.60-2.39), initial displacement (RR = 2.98, 95% CI 2.04-4.35), and poor reduction quality (RR = 2.43, 95% CI 1.46-4.05) were significantly associated with increased AVN risk. Gender, injury mechanism, time to reduction, and reduction method showed no overall association. Meta-regression identified follow-up duration as a significant moderator. Subgroup analyses of long-term follow-up (≥ 5 years) revealed that delayed reduction increased AVN risk (RR = 2.63, 95% CI 1.35-5.11), while closed reduction and internal fixation (CRIF) reduced risk compared to open reduction (RR = 0.40, 95% CI 0.24-0.65). Subgroup differences between long-term and short-term follow-up were both statistical significant./r/nOlder age, Delbet type I/II classification, initial displacement, and poor reduction quality are significant predictors of AVN following PFNFs. Early reduction and CRIF may provide superior long-term outcomes. Further high-quality prospective studies with extended follow-up are needed to confirm these findings.

The incidence and predictors of residual back pain (RBP) following percutaneous vertebral augmentation (PVA) in osteoporotic vertebral compression fractures (OVCFs) remain unclear. This review aims to clarify these factors to guide clinical practice and enhance patient outcomes. Four English and three Chinese databases were systematically searched from their inception until June 1, 2024. Data were analyzed using Stata 16.0. Incidence rates of RBP were pooled from all included studies, and predictors identified in two or more studies were aggregated. Sensitivity analyses were conducted for stability and reliability. Meta-regression and subgroup analyses were conducted to explore the causes of heterogeneity, while Begg, Egger test, and funnel plots were used to assess publication bias. This meta-analysis included 27 studies with a total of 8,806 patients, found that the incidence rate of RBP in patients with OVCFs after PVA was 24.4% (95% CI: 19.5-29.3%). Seventeen predictors for RBP were identified, which included demographic and personal history factors, injury characteristics, and bone cement and postoperative factors. The most frequent predictor was low preoperative bone density (OR = 2.208, 95% CI: 2.018-2.415, p < 0.001), followed by thoracolumbar fascia injury (OR = 3.875, 95% CI: 2.752-5.457, p < 0.001) and maldistribution of bone cement (OR = 2.065, 95% CI: 1.728-2.467, p < 0.001). Fifteen risk factors and two protective factors for RBP were identified. These findings highlight the importance of thorough preoperative assessment and meticulous surgical technique in reducing the risk of RBP in patients with OVCFs undergoing PVA. This study conducted a systematic review and meta-analysis to explore the incidence and predictors of residual back pain (RBP) in patients with osteoporotic vertebral compression fractures (OVCFs) who had underwent percutaneous vertebral augmentation (PVA).The findings identified a total of fifteen risk factors and two protective factors associated with RBP. Specifically, low preoperative bone density, thoracolumbar fascia injury, and maldistribution of bone cement were revealed to be the most common predictors.

Knee osteoarthritis (KOA) is a highly prevalent degenerative joint disease worldwide and an important cause of disability. Currently, medication and surgical interventions are commonly used in clinical practice, but there are limitations such as significant side effects and high medical costs. Tai Chi, as a non-pharmacologic intervention, is recommended for its safety and few adverse effects. However, there is still a lack of consensus on the optimal course and frequency of Tai Chi intervention, and there is an urgent need to optimize clinical intervention protocols. In order to scientifically assess the optimal course and frequency of Tai Chi for the treatment of KOA, this study integrates the existing evidence through a systematic review and meta-analysis, and aims to provide standardized protocols for Tai Chi training in clinical practice./r/nPubMed, Embase, Cochrane Library, Web of Science, Scopus, EBSCO, CNKI, Wanfang Database, and VIP database were searched from establishment to August 30, 2025. Two reviewers independently extracted data and assessed the quality of the literature and the certainty of the evidence for each outcome according to the Cochrane Risk of Bias Tool and the Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach. Outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC stiffness, WOMAC physical function, Visual Analogue Scale (VAS) pain, 36-item Short Form Health Survey (SF-36) Physical Component Summary (PCS), and SF-36 Mental Component Summary (MCS). For combined outcomes, standardized mean difference (SMD) and 95% confidence interval (CI) were calculated. Review Manager 5.4.1, Stata 15.0 and GRADE profiler software were used to statistically analyze and plot the included information./r/nA total of 13 randomized controlled trial (RCT) studies ( = 701) were included in this review. The results of the meta-analysis showed that Tai Chi relieved pain (WOMAC pain: SMD = -0.41, 95%CI [-0.58, -0.25], < 0.01; VAS pain: SMD = -0.33, 95% CI [-0.57, -0.10], < 0.01), reduced stiffness (SMD = -0.27, 95% CI [-0.43, -0.11], < 0.01), improved physical function (SMD = -0.52, 95% CI [-0.68, -0.36], < 0.01), and improved physical health (SMD = 0.47, 95% CI [0.27, 0.67], < 0.01). Subgroup analyses showed that the long-term (>16 weeks)/three-times-weekly Tai Chi training protocol was optimal (SMD = -0.74, 95% CI [-1.06, -0.41], < 0.01; SMD = -0.96, 95% CI [-1.30, -0.63], < 0.01) in terms of improvement of pain and physical function; and that in terms of improvement of stiffness, the short-term (≤16 weeks)/three-times-weekly Tai Chi training protocol was optimal (SMD = -0.52; 95% CI [-0.84, -0.19], < 0.01); and in terms of improving physical functioning, a short-term (≤16 weeks)/twice-weekly Tai Chi training protocol was optimal (SMD = 0.44, 95% CI [0.21, 0.68], < 0.01)./r/nThis meta-analysis suggests that Tai Chi is effective in improving pain, stiffness, physical function, and physical health in patients with KOA. Patients with KOA should consider their specific conditions and choose a Tai Chi training protocol that suits their needs. The preliminary results of this meta-analysis indicate that for patients with pain and physical functional limitations, a long-term (>16 weeks)/three times weekly Tai Chi training regimen may be selected; for patients experiencing knee stiffness, a short-term (≤16 weeks)/three times weekly Tai Chi training regimen may be considered; and for KOA patients seeking to improve physical health through Tai Chi training, a short-term (≤16 weeks)/twice weekly Tai Chi training regimen may be selected. However, the number of large-sample studies in this review is limited, and more studies are urgently needed to confirm these results./r/nIdentifier-CRD42024599921, https://www.crd.york.ac.uk/PROSPERO/myprospero.

We explored whether general anesthesia or spinal anesthesia were more beneficial for patients undergoing total hip replacement and total knee replacement, offering new clinical evidence to guide the selection of the optimal anesthesia solution for total hip replacement and total knee replacement./r/nA systematic search was conducted in PubMed, Web of Science, Scopus and the Cochrane Library to find relevant studies from January 1, 2010 to November 31, 2024. Non-randomized, retrospective studies that reported mortality, postoperative pain, and other postoperative complications after comparing two anesthesia methods in total hip replacement and total knee replacement were included in this meta-analysis. Data were pooled using the risk ratio or standardized mean difference with 95% confidence interval. The fixed-effect model is used when the outcome heterogeneity is small, otherwise the random-effects model is used./r/nA total of 41 retrospective studies were included, involving 2,291,587 patients. Results show that spinal anesthesia significantly reduces the risk of postoperative mortality (RR=1.17; 95% CI: 1.04 to 1.32; P=0.008) and other complications, shortens the length of hospital stay (SMD=0.18; 95% CI: 0.12 to 0.23; P<0.00001), and has better analgesic effects. And the GRADE evidence evaluation results show that the main outcomes have a certain recommendation strength./r/nIn total hip replacement and total knee replacement, spinal anesthesia may be more beneficial to patients. Therefore, if contraindications to spinal anesthesia are excluded, spinal anesthesia should be used as much as possible, especially for some special populations, such as patients with poor basic conditions, based on our results, who should be more inclined to spinal anesthesia.

This study aimed to evaluate the prevalence and risk factors of sarcopenia in patients with knee osteoarthritis (KOA) through a systematic review and meta-analysis./r/nA comprehensive search was conducted in PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure, and WanFang databases for studies published between January 2000 and June 2025. Eligible studies were screened according to predefined inclusion and exclusion criteria. Data were extracted, study quality was assessed, and meta-analyses were performed using Stata 17.0./r/nA total of 35 studies involving 13,528 KOA patients were included, of whom 3597 were diagnosed with sarcopenia. The pooled prevalence of sarcopenia and sarcopenic obesity was 25.07% (95% CI 18.85-31.29%) and 12.06% (95% CI 8.24-15.87%), respectively. Subgroup analyses revealed that sarcopenia prevalence increased with disease severity, reaching 26.01% (95% CI 16.27-35.75%) in patients with Kellgren-Lawrence grade 4 KOA. Prevalence was 25.65% (95% CI 20.30-31.00%) among female and 25.85% (95% CI 18.64-33.06%) among Asian populations. Among patients with osteoporosis and diabetes mellitus, prevalence rates were 21.68% (95% CI 8.84-34.53%) and 28.36% (95% CI 17.43-39.29%), respectively. Additionally, sarcopenia was more common among alcohol consumers (30.72%, 95% CI 15.58-45.86%) and smokers (29.82%, 95% CI 18.87-40.77%), with the prevalence being notably higher at 35.20% (95% CI 28.09-42.31%) among patients with irregular physical activity./r/nSarcopenia and sarcopenic obesity are highly prevalent in patients with KOA and are significantly associated with disease severity, gender, geographic region, comorbidities, and lifestyle factors. These findings highlight the clinical importance of assessing sarcopenia in KOA management. Early screening and timely interventions may improve patient outcomes and quality of life.

Most of the previous meta-analyses examining the effects of non-steroidal anti-inflammatory drugs (NSAIDs) on preventing heterotopic ossification (HO) following total hip arthroplasty (THA) have separately analyzed Brooker's classification I, II, III, and IV which may misrepresent their ordinal nature. We therefore applied a Bayesian network meta-regression that incorporates the ordinal nature of Brooker's classification to more robustly assess NSAID efficacy and determine the optimal regimen./r/nWe searched the Cochrane Library, Embase, and PubMed for randomized controlled trials (RCTs). Cumulative regressions were conducted for ordinal variants to generate Napierian Logarithm odds ratios (lnOR) and the standard error of lnOR (selnOR) for each study. Subsequently these data were used to conduct Bayesian network meta-analysis and further network meta-regression to generate pairwise ORs, showing pairwise effect sizes (ESs)./r/n17 studies (5436 patients,14 regimens) were eligible. In the raw data analysis, celecoxib 400 mg/d, etoricoxib 90 mg/d, ibuprofen 1200 mg/d, indomethacin 75 mg/d, indomethacin 100 mg/d, indomethacin 150 mg/d, meloxicam 7.5 mg/d, meloxicam 15 mg/d, and naproxen 750 mg/d were conspicuously effective (OR: 0.048 ~ 0.351) compared with placebo. The ESs were comparable among these regimens except for ibuprofen 1200 mg/d, which was inferior to indomethacin 100 mg/d (OR = 0.382, 95%CI: 0.171 to 0.887) and indomethacin 150 mg/d (OR = 0.136, 95%CI: 0.020 to 0.970). In the network meta-regression analysis, after adjusting for follow-up time, the significance of diclofenac 150 mg/d (OR = 0.102, 95%CI: 0.013 to 0.835) emerged compared with placebo. The results of effective regimens aforementioned resembled the initial findings (OR: 0.039 ~ 0.249). All the effective agents, including diclofenac 150 mg/d, were comparable in ESs./r/nConsidering the efficacy of preventing HO following THA observed in our research, together with analgesic effect and gastrointestinal tract safety from previous literature, etoricoxib 90 mg/d is recommended as the optimal choice for patient undergoing THA. More head-to-head and long-term studies are needed.

Femoral impaction bone grafting (IBG) is an established technique for managing severe bone loss during revision total hip arthroplasty (rTHA). Despite its widespread use, the extent of graft incorporation and the degree of stem subsidence remain incompletely characterized. This systematic review evaluates graft incorporation and stem subsidence outcomes in femoral IBG for rTHA./r/nA systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Three databases were searched from inception to December 31, 2024, for studies involving rTHA with femoral IBG and a minimum follow-up of 12 months. Meta-analyses focused on graft incorporation rates and stem subsidence. Subgroup analysis examined age, pre-operative bone loss, graft type, follow-up duration and other predictors. Heterogeneity was assessed using the I statistic under a random-effects model./r/nA total of 33 studies (2395 patients; 2514 hips) met inclusion criteria. The mean patient age was 66 years (range 22-95 years), with a male-to-female distribution of 48%/52%. The hips-weighted mean follow-up was 8.8 years (range of study means 1.1-17.0 years). Overall, the pooled proportion of graft incorporation was 76%; 95% confidence interval (CI) 63%-85%. The weighted average subsidence across all studies was 2.5 mm (95% CI 1.7-3.1 mm). Subgroup analyses showed no statistically significant differences in graft incorporation rates based on graft type (p = 0.399), age (p = 0.742), or follow-up duration (p = 0.560). Similarly, stem subsidence did not differ significantly by gender (p = 0.181), graft type (p = 0.460), or age (p = 0.301). Preoperative bone loss classification (Endo-Klinik, Paprosky) was not associated with notable differences in graft incorporation (p = 0.263) or subsidence (p = 0.486)./r/nFemoral IBG for rTHA demonstrates variable but generally favorable graft incorporation rates, averaging 76% (95% CI 63%-85%), with a mean stem subsidence of 2.5 mm at mid-to-long-term follow-up. Neither graft type, stem design, age, nor preoperative bone loss classification significantly influenced subsidence or incorporation variability.

: Oxidative stress and inflammation contribute to osteoporosis. Berries provide polyphenols especially anthocyanins that may modulate bone remodeling. This review is the first to synthesize evidence specifically on berries and bone health, integrating human, animal, and in vitro data under the GRADE framework. : We systematically searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Library through 23 April 2025 for human, animal, and in vitro studies on berries or berry-derived compounds and bone outcomes. Risk of bias was assessed with RoB 2.0, ROBINS-I, SYRCLE, and an adapted ToxRTool; certainty of human evidence was appraised with GRADE. : Nineteen studies were included (5 human, 9 in vivo, 5 in vitro). Observational cohorts linked higher anthocyanin intake with greater BMD. Small randomized trials suggested modest benefits of blackcurrant and blueberry on whole-body BMD, bone turnover markers, and calcium retention, while results for biomarkers were mixed. Animal models generally showed attenuation of ovariectomy- or age-related bone loss, and in vitro experiments indicated inhibition of osteoclastogenesis with stimulation of osteoblast activity. By GRADE, certainty was low-moderate for BMD, low for biomarkers, and very low for fractures. : Berry polyphenols may support skeletal health via antioxidant and anti-resorptive mechanisms, but current clinical evidence is limited by small samples, heterogeneity, and lack of fracture outcomes. Larger, longer, standardized RCTs with exposure profiling are needed before dietary recommendations can be made.

Complex distal tibial injuries with segmental bone loss, joint destruction, and osteomyelitis present a formidable limb salvage challenge. A novel technique using circular external fixation with trifocal balanced cable transport combined with primary ankle arthrodesis is described. This technique allowed early weightbearing, soft tissue preservation, and alignment correction, while minimizing time in external fixation. Despite the risk of complications such as docking site nonunion and pin tract infections, adjunctive staged conversion to internal fixation mitigated these concerns. This report is the first to describe automated balanced cable trifocal transport with speed multiplier pulleys to the talus for ankle arthrodesis. The approach offers a powerful option for limb salvage in patients with complex distal tibial and osteochondral defects while minimizing external fixation time.

We report the case of a patient with a below-the-knee amputation who sustained a complex femur fracture ipsilateral to his residual limb after a fall from height. His fracture was managed with a lateral locking plate of the distal femur for fixation. He was followed for 16 months; at 7 months, he demonstrated return to pretrauma functional status./r/nFixation of the distal femur with a lateral locking plate did not interfere with the patient's ability to wear a prosthesis and should be considered for managing "periprosthetic" femur fractures in those with a below-the-knee amputation to maintain prosthetic usage.

Reconstruction following segmental resection of the mandible due to tumors poses significant aesthetic and functional challenges. While vascularized free tissue flaps remain the gold standard, they are associated with prolonged operative time, high cost, requirement for microsurgical expertise, and donor site morbidity. We present a novel technique combining a nonvascularized iliac crest bone graft (NVICBG) with a submental island flap (SIF) for mandibular reconstruction. Between February 2024 and May 2025, three patients underwent this procedure. Graft and flap survival was achieved in all cases, with satisfactory functional and aesthetic outcomes based on clinical evaluation. Despite the limited sample size, this technique demonstrates promise as a practical and effective alternative, offering a short learning curve, high feasibility, and low complication rates. To our knowledge, this is the first report describing the combined use of NVICBG and SIF for mandibular reconstruction.

Later-stage exercise interventions refer to rehabilitation exercises implemented after the initial healing phase. Following total knee arthroplasty (TKA), patients generally begin these high-intensity exercises at the 2-month mark. Nevertheless, the duration of these exercise programs varies across studies, and the extent to which later-stage exercises contribute to improvements in the knee outcome measures over time remains unclear. This study aims to systematically evaluate the changes in the knee outcome measures following later-stage exercise interventions implemented at ≤ 12 weeks versus > 12 weeks after TKA./r/nThe PubMed, Scopus, and Web of Science databases were searched through May 2025 to identify the randomized controlled trials evaluating the effects of later-stage exercise interventions on the knee outcome measures. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Additionally, the completeness of the intervention descriptions was evaluated using the Template for Intervention Description and Replication checklist. A subgroup analysis was conducted to compare the outcomes of interventions lasting ≤ 12 weeks with those lasting > 12 weeks. Moreover, the minimal detectable change (MDC) values were referenced to interpret the clinical relevance of the observed changes./r/nFifteen studies involving 1,160 TKA patients were included. Across all studies, the sit-to-stand performance was observed to be enhanced by 2.61 s or 2.7 repetitions; the stair climbing duration decreased by 3.35 s; the knee flexor strength increased by 3.36 kg-force; and the knee extension angle reduced by 3.96°. For interventions ≤ 12 weeks, the timed up-and-go improved by 2.78 s. For interventions > 12 weeks, the knee extensor strength increased by 15.59 kg-force, and the knee flexion angle improved by 14.40°. The certainty of evidence ranged from low to moderate, and the intervention descriptions demonstrated moderate completeness./r/nMany observed changes in the knee outcome measures exceeded the MDC thresholds, indicating clinically meaningful benefits from later-stage exercise interventions post-TKA. The interventions implemented at ≤ 12 weeks primarily improved the functional performance, whereas those lasting > 12 weeks resulted in greater gains in the muscle strength and joint flexibility. Stronger evidence and more detailed intervention descriptions are needed to better integrate these findings into rehabilitation practice.

Sleep disturbances are common after total joint arthroplasty and can impair recovery, increase complications, and reduce patient satisfaction. Nonpharmacological interventions (NPIs) may offer safer alternatives to medications, but their effectiveness in improving postoperative sleep remains unclear. The aim of this study was to systematically evaluate the impact of NPIs on sleep outcomes following hip or knee arthroplasty./r/nWe conducted a systematic review in November 2024 across PubMed, Scopus, Web of Science, and Embase for studies investigating NPIs related to sleep outcomes after hip or knee arthroplasty. Data extraction and quality assessment were performed independently using the National Institutes of Health tools. A meta-analysis was conducted on studies reporting Pittsburgh Sleep Quality Index scores, and the mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed by the Cochran Q statistic and the I2 test./r/nTen studies (n = 1,545; mean age 65.69 years, 54.43% female) were included. NPIs were categorized into nursing-based interventions, environmental controls, relaxation techniques, neuromodulation, and movement restriction. The pooled analysis of 6 studies (n = 760) showed that NPIs significantly improved sleep quality compared with controls (MD = -2.61; 95% CI -3.27 to -1.95; p < 0.00001; I2 = 86%). Subgroup analysis revealed the greatest benefit from nursing-based interventions (MD = -3.06; 95% CI -3.39 to -2.73; I2 = 30%), while environmental interventions showed a smaller but significant effect (MD = -1.58; 95% CI -2.75 to -0.40; I2 = 79%). Functional, psychological, and quality-of-life outcomes showed variable results across studies./r/nNPIs, particularly nursing-based interventions and environmental controls, appear effective in improving postoperative sleep after joint arthroplasty. However, heterogeneity and limited high-quality evidence warrant further randomized trials with standardized protocols and objective sleep measures./r/nTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for obesity and type 2 diabetes mellitus (T2DM). While their metabolic benefits are well-established, their impact on postoperative outcomes following total joint arthroplasty (TJA) remains controversial. This study aimed to systematically evaluate the association between GLP-1 RA use and postoperative outcomes in patients undergoing total hip (THA), knee (TKA), or shoulder arthroplasty (TSA).MethodsWe conducted a PRISMA-compliant systematic review and meta-analysis across PubMed, Embase, Web of Science, and Scopus through April 24, 2025. Eligible retrospective cohort studies compared adults undergoing TJA with and without preoperative GLP-1 RA exposure. Primary outcomes were 90-day readmission and all-cause revision. Pooled odds ratios (ORs) and standardized mean differences (SMDs) were calculated under random-effects models. Subgroup analysis based on the type of arthroplasty was conducted where applicable.ResultsFourteen studies (total sample size of 365,154; including 62,117 (17.01%) GLP-1 consumers, and 303,037 (82.98%) control cases) met the inclusion criteria (All studies included primary TJA cases). GLP-1 RA use was associated with lower 90-day readmission (OR = 0.86, 95% CI: 0.74-0.99, = 0.033) and reduced sepsis incidence (OR = 0.63, 95% CI: 0.46-0.88, = 0.006). No significant differences were observed for all-cause revision, thromboembolic events, and other medical and surgical complications. Length of stay was marginally shorter in GLP-1 users (SMD = -0.09, = 0.048). Subgroup analyses showed the strongest sepsis reduction in TSA.ConclusionGLP-1 RA use before TJA is associated with reduced readmission and sepsis risk without increasing surgical or thromboembolic complications. These findings support the potential perioperative benefits of GLP-1 RAs, warranting prospective trials to confirm causality and define optimal perioperative strategies for high-risk arthroplasty patients.

Most patients recover well following fingertip injuries. Outcomes vary along a spectrum, influenced by both pathophysiological severity and psychosocial factors, which strongly influence patient-reported outcome measures (PROMs). General instruments (e.g., Disabilities of the Arm, Shoulder, and Hand [DASH]; Michigan Hand Questionnaire [MHQ]; and Patient-Reported Outcomes Measurement Information System [PROMIS]) are reliable but often overlook fingertip-specific concerns such as nail deformity, cold intolerance, pulp loss, or subtle sensory changes. To address this gap, the Fingertip Injuries Outcome Score (FIOS) was developed, integrating objective domains (grip strength, range of motion, 2-point discrimination [2PD], and bone union) with patient-reported domains (nail esthetics, sensibility, cold intolerance, pain, and return to work), providing a fingertip-specific assessment. This study systematically reviews outcome scoring systems for fingertip injuries, evaluating their validity, reliability, responsiveness, and clinical utility, with a particular focus on the FIOS-the only instrument specifically designed for fingertip injuries./r/nA systematic search (PubMed, Scopus, Web of Science; up to December 2024) identified studies evaluating fingertip injuries with defined outcome scores. Data included score domains, psychometrics, and applicability./r/nFIOS was the only fingertip-specific score identified, demonstrating strong internal consistency (Cronbach α = 0.796) and excellent interrater reliability (κ = 0.844) in its validation study (n = 199), with 93% of patients achieving excellent or good outcomes. An independent pilot (n = 58) confirmed its sensitivity to injury severity. Subgroup analysis showed no significant difference in FIOS outcome distribution across injury mechanisms, though whether this reflects robustness or limited discrimination requires study. General PROMs (MHQ, DASH, Hand20, and PROMIS) each had high internal consistency (α ≥ 0.90) and correlated strongly with psychosocial factors but lacked fingertip-specific coverage. The Hand Injury Severity Score correlated with MHQ but served only as a severity index. By integrating objective and patient-reported domains, FIOS is the most fingertip-specific assessment available./r/nFIOS is the most complete fingertip-specific outcome instrument and should be adopted as the primary standard for outcome reporting and long-term follow-up across fingertip injuries. For comprehensive assessment, pair FIOS with a general hand/upper-extremity PROM and objective tests (e.g., 2PD, ROM/TAM, and grip strength). Standardizing on FIOS in practice, registries, and trials will harmonize reporting for current and future cohorts and enable clearer comparisons across treatments. While further multicenter validation and responsiveness/minimal clinically important difference estimates remain priorities, the need for a fingertip-specific standard justifies adopting FIOS now with ongoing evaluation./r/nTherapeutic Level III. Systematic review of cohort and observational studies without randomized controlled trials. See Instructions for Authors for a complete description of levels of evidence.

A 32-year-old man sustained a rare and complex injury pattern representing an anterior glenohumeral fracture dislocation with critical intra-articular glenoid bone loss, and a double disruption of the superior shoulder suspensory complex (acromion + coracoid fractures), following a fall. To restore joint stability, surgical reconstruction of the glenoid fossa was performed, while fixation of the acromion and coracoid fractures was necessary to re-establish superior shoulder suspensory complex integrity./r/nAchieving structural stability facilitated fracture healing and rehabilitation, resulting in excellent functional outcomes at 1 year. This report presents a clinical entity that has not been previously described in literature.

This study identifies the outcome domains used in recently published studies on the treatment of hand flexor tendon injuries in adults, in order to inform the development of a core outcome set (COS). Seven databases were searched from January 2013 to March 2023 for randomized and quasi-randomized studies, trial registrations, large observational studies, database studies and systematic reviews. From the 91 eligible original studies/trial registrations, the primary outcome was appropriately identified in only 52% (13/25) of randomized and quasi-randomized controlled trials. We identified 419 author-defined outcomes, further categorized into 147 distinct outcomes and mapped into 72 outcome domains according to the World Health Organization International Classification of Functioning, Disability and Health framework. The large heterogeneity in the outcome domains being assessed/measured across studies highlights the need for a consistent COS to be measured in future clinical research on hand flexor tendon injuries.

Kinesiophobia, defined as the fear of reinjury and movement, is a risk factor for recurrent shoulder instability and remains unchanged unless specifically treated in clinical practice. Fear of reinjury is a reason for athletes not returning to sport after shoulder instability or stabilization surgery. Although physical rehabilitation is commonly used to address deficits in strength and range of motion after shoulder stabilization surgery, there are few documented clinical strategies to address kinesiophobia in athletes after shoulder stabilization surgery./r/nThis case report outlines the postoperative rehabilitation of a 23-year-old male who had undergone repeat Latarjet stabilization surgery, following previous failed Latarjet and arthroscopic stabilization surgeries and multiple episodes of instability. He presented with increased levels of kinesiophobia and decreased range of motion and strength following his Latarjet surgery./r/nAs an adjunct to his physical rehabilitation, graded exposure to fear-eliciting images was used to decrease kinesiophobia and was measured with the Tampa Scale of Kinesiophobia 11-item questionnaire. Usual physical rehabilitation included progressive range of motion and strength exercises. Kinesiophobia decreased with a change in Tampa Scale of Kinesiophobia-11 scores from 33/44 (moderate kinesiophobia) to 24/44 (low kinesiophobia) during his rehabilitation, which is greater than the minimal detectable change of the Tampa Scale of Kinesiophobia-11 (5.6-5.9). The secondary outcome of shoulder strength improved to within 5% of the opposite side below shoulder height, although strength deficits remained overhead. Range of movement also improved; specifically, external rotation in neutral increased from 5° to 40°./r/nMotor imagery techniques such as graded exposure to fear eliciting images may be used in clinical practice as an adjunct to physical rehabilitation to decrease kinesiophobia in people with shoulder instability. Clinical rehabilitation could address the physical and psychological impact of shoulder instability using graded imagery. Future research could explore the use of fear-eliciting images on physiological and clinical outcomes.

To evaluate clinical outcomes of hip arthroscopy for patients with global acetabular overcoverage, as defined by a lateral center-edge angle (LCEA) >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle./r/nA search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases in July 2024. Studies were included if they had a minimum 2-year follow-up and reported on outcomes of hip arthroscopy for patients with global acetabular overcoverage, which was defined as a LCEA >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle. The primary evaluated outcomes included patient-reported outcomes (PROs) and rates of revision and conversion to total hip arthroplasty (THA)./r/nEight studies comprising 369 hips (58.5% female; age range: 31.2-42.4 years; follow-up range, 24.0-73.2 months) with global acetabular overcoverage treated with arthroscopy were included. For labral management, 0-30% of patients underwent debridement, 65-100% underwent repair, and 0-100% underwent reconstruction. Femoroplasty and acetabuloplasty were performed in 73.3-100% and 94.7-100% of patients, respectively. Six studies reporting both preoperative and postoperative PROs reported significant improvements in all PROs. Rates of revision and conversion to THA ranged from 1.5 to 27.3% and from 1.8 to 13.6%, respectively. Of studies comparing outcomes between patients with global overcoverage versus normal coverage, there were no significant differences in any PROs (4/5 studies), revision rates (5/5 studies), and conversion to THA rates (3/5 studies)./r/nHip arthroscopy for global acetabular overcoverage can allow patients to achieve significant improvements in PROs along with low to moderate rates of revision and conversion to THA that are comparable to patients with normal acetabular coverage LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

The purpose of this narrative synthesis was to identify and synthesise the literature focused on sports medicine practitioners' (SMPs) decision-making practices during return to play (RTP) after musculoskeletal (MSK) injury. Using the Preferred Items for Reporting Systematic Reviews and Meta-Analyses guidelines, four electronic databases were searched from the start of the database to July 2024 using terms related to SMPs and RTP in MSK injury. The Appraisal Tool of Cross-Sectional Studies (AXIS) and the Johanna Briggs Institute (JBI) critical appraisal tools were used to assess the overall quality of the identified studies. A narrative synthesis format was considered the most appropriate methodological approach to review and synthesise the pool of literature. Data synthesis included the participating SMPs profession, study sample size, injury location, activity level, RTP outcome measures and results. Data were further characterised by the RTP practices for specific MSK injuries, including spine, shoulder, wrist, hand, hip, knee, ankle and foot. Eighty-seven (n = 87) publications were identified based on the inclusion and exclusion criteria. Forty-seven percent (n = 41) of the studies focused on surgeon practices and 29.9% (n = 26) reported practices of multidisciplinary teams (MDTs). Almost half of all studies (40.2%; n = 35) addressed knee injuries, 85.7% (n = 30/35) specific to the anterior cruciate ligament (ACL). Eighty-three percent (n = 34/41) of medical doctors consider injury and postoperative timelines compared to other SMP groups (47.8%; n = 22/46). Multidisciplinary team studies report the use of psychological readiness (50%; n = 13/26) and sport-specific testing (38.5%; n = 10/26) criteria in RTP studies. Functional assessment and strength are reported in at least 50% of physiotherapist (n = 18) and rehabilitation specialist (n = 2) studies. Reference to RTP frameworks, guidelines and protocols in RTP decision-making was found in less than 20% of the publications. Studies addressing input from other SMPs to assist decision-making was also found in less than 20% of the studies despite research. From these studies, shared decision-making with an athlete-centred approach is preferred. The type of sport and the ambition of the athlete were the biggest influencing factors on decision surrounding RTP both reported in 26.4% (n = 23) of all SMP studies. This suggests an athlete-centred approach to SMPs RTP decision-making. Similar RTP criteria was used between practitioner groups, although criteria were weighted differently, due to the different scopes of practice and complexity surrounding RTP decisions. This review provides context for future research to assist and guide RTP decision-making practices after MSK injuries. The need for clear, uncomplicated and practical definitions, guidelines, protocols and criteria will improve the RTP process and reduce the risk of reinjury after MSK injury. This review included all study designs and there was heterogeneity in the analysed studies, which can be viewed as a limitation. TRIAL REGISTRATION: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration ID: CRD42021270638) and OSF registries (registration doi: https://doi.org/10.17605/OSF.IO/DKQ7V).

To systematically review the effects of blood flow restriction training (BFRT) on postural control and ankle function in patients with chronic ankle instability (CAI)./r/nWe systematically searched PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, and Scopus databases up to February 2, 2025. This study was registered in PROSPERO (CRD42025642187). The search aimed to collect randomized controlled trials examining the effects of BFRT on patients with CAI. Four outcomes including Y balance test reach distance, Cumberland Ankle Instability Tool scores, ankle muscle strength, and ankle muscle activation were selected. Quality of the included studies was assessed using the Cochrane Risk of Bias Tool Version 1, and meta-analysis was performed with RevMan 5.3./r/nA total of eight randomized controlled trials were included, involving 243 patients with CAI. Compared to the control group, BFRT significantly improved Y balance anterior reach distance (MD = 4.90, 95% CI: 1.73 to 8.08, P = 0.002), Cumberland Ankle Instability Tool scores (MD = 3.09, 95% CI: 1.59 to 4.59, P < 0.001), ankle dorsiflexor strength (SMD = 0.90, 95% CI: 0.03 to 1.77, P = 0.04), ankle plantar-flexor strength (SMD = 1.12, 95% CI: 0.20 to 2.04, P = 0.02), and tibialis anterior muscle activation (MD = 11.13, 95% CI: 4.12 to 18.14, P = 0.002)./r/nCurrent evidence showed that BFRT significantly improved Y-balance anterior reach distance, CAIT scores, ankle dorsiflexor and plantarflexor strength, and tibialis anterior activation. These findings supported its effectiveness in improving postural control and ankle function in patients with CAI. However, some included studies are of low quality, requiring larger, high-quality studies for validation.

AO Trauma Fireside Module 5 Fireside: Your 2025 Approach to Malunions and Nonunions 10-21-2025

People with Sweet's syndrome often wake up with a fever, body aches, and blisters on their neck, limbs and face. Also known as acute febrile neutrophilic dermatosis, it is an inflammatory skin disease marked by severe symptoms and elevated counts of white blood cells.

Module 5: Webinar Your 2025 Approach to Malunions and Nonunions Tips and Tricks

Involvement of Oxidative Stress and Glycation Stress in Frozen Shoulder

Fourth-Generation Percutaneous Transverse Osteotomies for Hallux Valgus

Surgical treatments for proximal humerus metastasis include modular prosthesis, intramedullary nailing, plate fixation, and hemiarthroplasty. However, it is controversial which surgical treatment could offer less complications and implant failure. The purpose of our study was to report the risk of complications, reoperations and revisions in patients with proximal humerus metastasis treated with modular prosthesis, intramedullary nailing, plate fixation, or hemiarthroplasty./r/nWe performed research in the PubMed and Scopus libraries, obtaining 2247 studies. We analyzed studies reporting the risk of complications, reoperations and removal of the implant in patients with proximal humerus metastasis treated with intramedullary nailing, plate fixation, hemiarthroplasty, or megaprosthesis./r/nWe included 11 studies (357 patients) reporting patients treated with modular prosthesis (n = 181), intramedullary nailing (n = 101), plate fixation (n = 51) and hemiarthroplasty (n = 24). The risk of complications in patients with proximal humerus metastasis treated with modular prosthesis was 0-40%, with intramedullary nailing was 0-39%, with plate fixation was 0-67% and with hemiarthroplasty was 8%. The risk of reoperation in patients treated with modular prosthesis was between 0 and 20%, with intramedullary nailing was 0-3%, and with plate fixation was 0-33% and no patient treated with hemiarthroplasty had a reoperation. The risk of removal of the implant in patients treated with modular prosthesis and plate fixation was 0-20% and 0-33%, respectively. No patients treated with intramedullary nailing and hemiarthroplasty had a removal of the implant./r/nModular prosthesis, intramedullary nailing, plate fixation and hemiarthroplasty seem to have similar risk of complications, reoperation and removal of the implant. Surgeons should consider the indications of each treatment option, taking into account other factors such as the location and size of the lesion, the quality of the cortical bone and the patient's life expectancy.

To establish consensus statements on the treatment of ulnar collateral ligament (UCL) injuries and to investigate whether consensus on these distinct topics could be reached./r/nA modified consensus technique was conducted among 26 elbow surgeons and 3 physical therapists/athletic trainers. Strong consensus was defined as 90% to 99% agreement./r/nOf the 19 total questions and consensus statements 4 achieved unanimous consensus, 13 achieved strong consensus, and 2 did not achieve consensus./r/nThere was unanimous agreement that the risk factors include overuse, high velocity, poor mechanics, and previous injury. There was unanimous agreement that advanced imaging in the form of either magnetic resonance imaging or magnetic resonance arthroscopy should be performed in a patient presenting with suspected/known UCL tear that plans to continue to play an overhead sport, or if the imaging study could change the management of the patient. There was unanimous agreement regarding lack of evidence for the use of orthobiologics in the treatment of UCL tears as well as the areas pitchers should focus on when attempting a course of nonoperative management. The statements that reached unanimous agreement for operative management were regarding operative indications and contraindications for UCL tears, prognostic factors that should be taken into consideration in when performing UCL surgery, how to deal with the flexor-pronator mass during UCL surgery, and use of an internal brace with UCL repairs. Statements that reached unanimous agreement for return to sport (RTS) were regarding portions of the physical examination should be considered when determining whether to allow a player to RTS; unclear how velocity, accuracy, and spin rate should be factored into the decision of when players can RTS and sports psychology testing should be used to determine whether a player is ready to RTS./r/nV, expert opinion.

We set out to systematically evaluate and compare the safety and efficacy outcomes of laparoscopic and vaginal approaches in uterosacral suspension./r/nWe searched major databases using appropriate terms to find studies comparing laparoscopic (or robotic-assisted laparoscopic) versus vaginal techniques for the repair of pelvic organ prolapse (POP). We searched from each database's inception until January 01, 2024./r/nWe included studies of patients undergoing POP surgery via either vaginal or laparoscopic routes, with or without concomitant hysterectomy. Ultimately, 9 studies met our criteria./r/nWe conducted this meta-analysis utilizing Review Manager Software and OpenMeta [Analyst]. The laparoscopic group had a longer operative time (mean difference [MD] = 5.77 minutes, p = .02, I = 47%) and lower estimated blood loss (MD = -49.71 mL, p = .05, I² = 81%). The length of hospital stay was similar between groups (MD = -0.26 days, p = .28, I² = 97%). The recurrence rate of any POP was lower in the laparoscopic group (risk ratio [RR] = 0.53, p = .03, I² = 0%). There were no significant differences in anatomical success rate (RR = 1.06, p = .16, I² = 35%), dyspareunia (RR = 0.79 p = .5, I² = 0%), or postoperative POP quantification stages I (RR = 1.11, p = .31, I² = 60%), II (RR = 0.93, p = .77, I² = 0%), and III (RR = 0.54, p = .52, I² = 0%). Following subgroup analysis with only cases that did not include hysterectomy, the differences in operative time ([-3.26,9.77] [p = .11]; I² = 55%), and estimated blood loss ([-55.75,7.66]) [p =.14]; I² = 54%) were no longer statistically significant./r/nBoth techniques proved effective. Laparoscopic uterosacral ligament suspension (L-USLS) involved longer operative times and less blood loss than vaginal-USLS. Adjusting for concomitant hysterectomy eliminated differences in operative time, blood loss, and hospital stay. Both methods showed similar hospital stay lengths, urinary tract infection rates, transfusion needs, reoperation rates, readmission rates, dyspareunia, and postoperative POP quantification stages. L-USLS displayed lower POP recurrence and urinary retention rates. While L-USLS may have advantages with hysterectomy, particularly in reduced blood loss, vaginal-USLS is also viable without hysterectomy. Due to study heterogeneity and lack of large randomized controlled trial data, more rigorous studies are essential to better define these surgical options.

In a new position paper, the American College of Physicians (ACP) identifies core clinical topics of importance to internal medicine physicians, sets a framework for identifying a streamlined set of core performance measures, and calls for the use of high-quality, evidence-based performance measures to be used nationally across all payers and systems. This is significant because many performance measures currently used are not based on high certainty evidence and are burdensome, with low or no value to patient care.

To present a technical process for robot-assisted, minimally invasive bone extraction-implant implantation-bone augmentation in patients with bone defects or bone atrophy./r/nIn this technical process, the surgical trajectory was preplanned within the robotic system. After patient registration and completion of robotic arm calibration, precise movement of the robotic arm enabled minimally invasive bone extraction using a trephine, followed by reaming with a single spiral drill. The final placement of implants was conducted manually. Autologous bone, bone marrow blood, and Bio-Oss granular bone were collectively mixed for grafting into the defect area, accompanied with collagen membrane coverage and subsequent suturing./r/nThe osteotomy of autologous bone was precisely executed. Meanwhile, the accuracy of implant placement was clinically acceptable. The bone graft surgery was successfully completed without any significant postoperative complications. The vertical and lateral forces exerted by the robotic arm during drilling were within an acceptable range. The robotic surgery exhibited consistent stability throughout its operation and demonstrated a relatively short drilling time./r/nThe novel protocol enabled precise osteotomy of autologous bone and enhanced bone grafting in patients with bone defects or atrophy. However, further clinical studies are necessary./r/nThe primary finding of this study is a promising alternative for individuals suffering from bone defects or bone atrophy.

First light field-enabled surgical technology company secures additional institutional capital to drive adoption of its AI-driven platform SEATTLE, July 27, 2023 /PRNewswire/ — Proprio, a Seattle-based surgical technology company, today announced that it has secured $43 million in Series B funding from new and existing investors. The capital fuels commercialization to address significant demand for Proprio’s AI-driven surgical navigation platform in the US and overseas. Proprio’

JERSEY CITY, N.J., July 24, 2023 /PRNewswire/ — EpiBone has received Investigational New Drug (IND) clearance from the FDA to begin testing its lab-grown knee cartilage in humans. The treatment, known as an engineered allogenic osteochondral graft, has shown promise in pre-clinical studies and could benefit people with damaged knee cartilage caused by sports injuries, trauma or post-traumatic arthritis. Clinical trials will evaluate the safety and efficacy of EpiBone’s graft compared

Begad H M Z Abdelrazek, Mohamed R WalyThe Egyptian Orthopaedic Journal 2022 57(3):180-185Background Fractures of the calcaneus pose a great challenge both to surgeons and patients. They are considered life-changing injuries. Anatomical reduction of fragments is one of the important variables affecting outcome. Extensile lateral approach has been used widely to facilitate good visualization and reduction. Skin complications like wound infection and dehiscence are a major concern. Therefore minima

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November 2022 myAO is running a Christmas Clinical Case Competition across the 5 clinical divisions! Participate and win the chance to have your clinical case featured on the AO website, myAO blog and on the Clinical Case Roundup that will be sent in January to the myAO users with interests related with the winning case! The post myAO Christmas Clinical Case Competition appeared first on myAO.

Mohammed Rabie Abdalla Saleh, Mohamed Hussein FadelThe Egyptian Orthopaedic Journal 2022 57(2):122-133Background and aim A rotator cuff injury has a significant effect on the quality of life and overall health of patients. Surgical treatment for rotator cuff disease has been found to enhance general health and shoulder discomfort. The surgical repair of rotator cuff tears can be divided into three categories: open, mini-open, and arthroscopic. Independent studies comparing the long-term success

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