Recon update

The simultaneous manifestation of obesity, sarcopenia, and osteoporosis represents a condition known as osteosarcopenic adiposity (OSA). While evidence suggests that vitamin D status may influence the development of OSA, the results are still divergent, and no clear understanding of how vitamin D, through serum concentrations or supplementation, impacts OSA and its metabolic implications. Although several studies have explored the association between vitamin D and various diseases, research specifically focused on OSA is limited, making it unfeasible to conduct a systematic review. Thus, this integrative review aims to provide a comprehensive overview of the relationship between vitamin D (dietary intake and 25-hydroxyvitamin D serum levels) and OSA. The literature search was conducted in the PubMed/MEDLINE database. Overall, 16 studies were included (cross-sectional studies, n = 7; a scoping review, n = 1; and integrative reviews, n = 8). Observational studies consistently support the association between low levels of vitamin D and OSA, especially in females and older adults. However, this review highlights the lack of standardized diagnostic methods for OSA and the absence of clinical trials assessing the effect of vitamin D supplementation on this syndrome. Further research with a larger sample size is necessary to strengthen the findings. This is a promising area for research and could greatly improve the health and quality of life of people with OSA.

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.

Morquio syndrome, a lysosomal storage disease, is associated with an increased risk of spinal cord ischemia with positioning changes.1 Though uncommon in non-spine surgeries, intraoperative neuromonitoring (IONM) can facilitate prompt detection of ischemia.2,3 We utilized IONM in an 11-year-old undergoing bilateral distal femoral osteotomies and lumbar epidural placement. After induction and supine baseline signal acquisition, the patient was positioned laterally. Signals were lost, and hypotension ensued. Phenylephrine and fluids were administered, but hypotension resolved only after supine repositioning. Without IONM, spinal cord ischemia may have caused permanent injury. This case emphasizes the importance of pre-positioning IONM in patients with Morquio Syndrome.

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.

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.