Validity of the Arabic version of AAOS-foot and ankle outcomes questionnaire in patients with traumatic foot and ankle injuries

BACKGROUND

Arabic-speaking patients are underrepresented in orthopedic clinical studies, particularly in foot and ankle trauma research. The lack of validated Arabic language tools hinders their inclusion, creating a need for culturally and linguistically adapted instruments. The American Academy of Orthopedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) is a widely used tool but has not been adapted for Arabic-speaking patients.

AIM

To translate, cross-culturally adapt, and validate the AAOS-FAOQ for Arabic-speaking patients with traumatic foot and ankle injuries.

METHODS

The cross-cultural adaptation followed established guidelines, involving forward and backward translations, expert review, and pre-testing. The final Arabic version was administered alongside the Arabic Short-Form 36 (SF-36) to 100 patients for validity testing. Reliability was assessed through test-retest methods with 20 patients completing the questionnaire twice within 48 hours. Pearson correlation coefficients measured convergent and divergent validity with SF-36 subscales, while Cronbach's alpha and intraclass correlation coefficients (ICC) determined internal consistency and reliability.

RESULTS

Out of 100 patients, 92 completed the first set of questionnaires. The Arabic AAOS-FAOQ showed strong correlations with the SF-36 subscales, particularly in physical function and bodily pain (r > 0.6). Test-retest reliability was robust, with ICCs of 0.69 and 0.66 for the Global Foot and Ankle Scale and Shoe Comfort Scale, respectively. Cronbach's alpha for internal consistency ranged from 0.7 to 0.9.

CONCLUSION

The Arabic version of the AAOS-FAOQ demonstrated validity and reliability for use in Arabic-speaking patients with traumatic foot and ankle injuries. This adaptation will enhance the inclusion of this population in orthopedic clinical studies, improving the generalizability of research findings and patient care.

Revisiting the debate on operative vs nonoperative management of humeral shaft fractures

Operative management of humeral shaft fractures demonstrates superior early functional recovery (6-month Disabilities of the Arm, Shoulder, and Hand scores) and significantly lower nonunion rates (63.9% reduction) compared to functional bracing, particularly in complex cases, while conservative treatment remains viable for low-demand patients. Surgical techniques, including open reduction internal fixation, intramedullary nailing, and minimally invasive plate osteosynthesis, offer trade-offs between anatomic precision and complication risks (e.g., radial nerve injury vs rotator cuff damage), with over 90% of radial nerve injuries resolving spontaneously. Ultrasound-guided diagnosis (89% sensitivity, 95% specificity) optimizes decision-making for nerve entrapment. Individualized treatment selection, prioritizing fracture complexity and patient needs, is critical to balance accelerated rehabilitation with minimized complications.

Effectiveness of oral vs intravenous acetaminophen on pain management following total joint arthroplasty: A systematic review and meta-analysis

BACKGROUND

In the management of postoperative pain following total joint arthroplasty (TJA), the use of nonsteroidal anti-inflammatory drugs, including acetaminophen, plays a key role in alleviating pain. However, the comparison between intravenous and oral acetaminophen administration in patients undergoing full joint replacement surgery remains controversial.

AIM

To assess the effectiveness of intravenous and oral acetaminophen in alleviating pain and supporting rehabilitation following TJA.

METHODS

PubMed, Embase and the Cochrane Library were comprehensively searched to identify cohort studies. The effects of intravenous and oral acetaminophen for managing pain and supporting rehabilitation following TJA were analysed using randomized controlled trials. PRISMA guidelines were followed. The effectiveness of the administration routes was compared based on visual analogue scale (VAS) scores at 24 and 48 h, total morphine usage within 24 h, and total duration of hospital stay.

RESULTS

The meta-analysis included seven studies comparing intravenous acetaminophen groups and oral acetaminophen groups. The results demonstrated that oral acetaminophen was comparable to intravenous acetaminophen with regard to VAS scores at 24 h and 48 h (P = 0.76 and 0.08, respectively). The difference in total morphine use between the two groups was not significant (P = 0.22). However, the total hospital stay duration of the intravenous acetaminophen groups was significantly reduced compared to the oral acetaminophen groups (P = 0.0005), showing significant advantages in optimizing postoperative recovery and shortening hospitalisation time.

CONCLUSION

After TJA surgery, intravenous injection of acetaminophen can shorten hospitalisation time and is suitable for rapid analgesia, Oral administration has become the preferred choice for mild cases due to its convenience and economy, providing a basis for clinical drug selection.

Impact of preoperative factors on clinical outcomes after total hip arthroplasty

BACKGROUND

Although total hip arthroplasty (THA) is an established intervention for advanced hip disorders, not all patients achieve the anticipated functional improvements.

AIM

To investigate the impact of various preoperative factors on clinical outcomes after THA.

METHODS

Data of 411 patients who underwent unilateral THA were retrospectively analyzed. The associations between preoperative factors, such as age, body mass index, pain severity, functional impairment, psychological status, neuropathic pain, and central sensitization, and clinical outcomes assessed six months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and modified Harris Hip Score were evaluated.

RESULTS

Our results indicated that age and the WOMAC, Center for Epidemiologic Studies Depression Scale, and Central Sensitization Index (CSI) scores significantly predicted the modified Harris Hip Score outcomes, whereas age and preoperative WOMAC, EuroQol 5 dimensions, Center for Epidemiologic Studies Depression Scale, CSI, and Pain Detect Questionnaire scores were significant predictors of WOMAC outcomes. Age, WOMAC, and CSI were consistently significant factors. There were no significant differences in the operative time or blood loss across the outcome categories.

CONCLUSION

Our findings highlight the importance of preoperative assessment of central sensitization and psychological parameters. Patient-specific preoperative characteristics may play a greater role than intraoperative factors in determining recovery outcomes after THA.

Senility, defecation disorders, sleep disorders, and non-operative spinal infections: A single-center retrospective analysis

BACKGROUND

Non-operative spinal infections (NOSI) are caused by tuberculosis, brucella, and other specific bacteria. The etiology of the disease is insidious, the onset is slow and the diagnosis and treatment are difficult. Identifying the factors associated with spinal infection and early intervention can reduce the occurrence of the disease. At present, the research mainly focuses on the accurate diagnosis and treatment of spinal infection, and there are few studies on the prevention of spinal infection. The concept of "preventive treatment of diseases" in traditional Chinese medicine may help identify the causes and reduce the occurrence of NOSI.

AIM

To determine the association of age, bowel movements, and sleep patterns with NOSI.

METHODS

Data of 69 NOSI patients and 84 healthy controls in a tertiary hospital from January 2019 to June 2024 were collected. Patients with NOSI had imaging evidence (magnetic resonance imaging) of spinal infections (including infections caused by tuberculosis, brucopathy, and other pathogens) and had no history of spinal surgery in the last 1 year were included in the analysis. Patients with spinal infection due to spinal surgery are excluded in the study. Data including age, sex, place of residence, sleeping status, and bowel movements were collected. SPSS22.0 was used for correlation analysis of all data.

RESULTS

The mean age of the NOSI group and the control group was 63.55 ± 14.635 years and 59.18 ± 17.111 years, respectively, without statistical difference (P = 0.096). There was also no statistically significant difference in gender between the two groups. In the NOSI group, 45 (65.22%) were over 60 years old, and 44 (63.77%) were rural residents. Compared with the control group, the NOSI group had more patients with sleep disorder and defecation disorder, accounting for 69.57% and 68.12%, respectively, with significant statistical difference (both P < 0.001). Regression analysis showed that defecation and sleep disorders were closely related to NOSI (both P < 0.001).

CONCLUSION

Most patients with NOSI are older and have sleep disorders and abnormal defecation.

First metatarsophalangeal joint: Embryology, anatomy and biomechanics

The first metatarsophalangeal (MTP) joint plays a crucial role in foot biomechanics, particularly in weight-bearing activities such as walking and running. It is frequently affected by conditions like hallux valgus (HV) and hallux rigidus, with HV impacting approximately 23%-35% of the population. This narrative review explores the embryology, anatomy, and biomechanics of the first MTP joint (MTPJ), highlighting its significance in maintaining foot stability and function. A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar, analyzing 50 relevant studies, including 12 clinical trials. The joint’s complex structure and mechanical demands make it susceptible to degenerative and structural disorders. Studies indicate that 25%-40% of individuals with HV experience significant pain and functional impairment, affecting mobility and quality of life. Biomechanical stress, abnormal gait patterns, and joint instability contribute to disease progression. Understanding the anatomical and biomechanical properties of the first MTPJ is essential for improving diagnostic and therapeutic approaches. Emerging surgical techniques, such as osteotomy and joint resurfacing, show promise in reducing recurrence rates and enhancing long-term outcomes. Further research is needed to refine minimally invasive interventions and optimize treatment strategies for first MTPJ disorders.

Sixteen patients regarding the conservative treatment for hook of hamate fracture

BACKGROUND

Hook of hamate fractures occur either due to repetitive stress from gripping sports (e.g., golf, tennis, and baseball), leading to fatigue fracture, or as a result of trauma from falls or other injuries. The recommended treatment involves the excision of bone fragments to facilitate athletes’ early return to sports; excision surgery is also performed in trauma cases. However, some patients prefer nonsurgical treatment options, and conservative treatment should be considered.

AIM

To present a case series of 16 patients conservatively treated for hook of hamate fractures.

METHODS

This study included 16 (11 males and 5 females; right side, 6 cases; left side, 10) patients who desired conservative treatment and could be followed-up until bone union was achieved. The average age of the patients was 49.6 (range: 24-72) years. The average time from injury to consultation was 4.3 (range: 0.2-21.4) weeks. The treatment involved 4 weeks of casting from the forearm to the metacarpophalangeal joint, followed by 8 weeks of splint fixation of the wrist. Follow-up computed tomography scans were performed every 4 weeks.

RESULTS

Bone union was achieved in all patients. The average duration of casting was 3.7 (range: 0-5) weeks and that of splint fixation thereafter was 8.6 (range: 0-28) weeks. The patients did not exhibit joint contractures or range of motion restrictions due to prolonged immobilization.

CONCLUSION

Conservative treatment with external fixation may be an option for hook of hamate fractures.

Pathophysiology and management of crush syndrome: A narrative review

BACKGROUND

Crush syndrome refers to the traumatic rhabdomyolysis leading to a spectrum of disorders culminating in acute kidney injury. The burden of crush syndrome is high, and mortality can be as high as 20%. The significant bulk of knowledge is from old articles. Over the last 10 years new research has occurred on diagnosis and treatment in animal models.

AIM

To overview of crush syndrome and discuss the newer advances related to the pathogenesis and management of a patient with crush syndrome.

METHODS

The search of databases such as MEDLINE, Google Scholar, Web of Science, and EMBASE revealed 8226 articles. A thorough screening culminated in 83 crush syndrome articles included in this study.

RESULTS

Acute kidney injury in crush syndrome is currently thought to be due to iron retention. The management of crush syndrome has also been updated with antioxidants, and several gases are being used to treat crush syndrome. In the end, treatment of crush syndrome also includes mental, social, and physical rehabilitation for better outcomes.

CONCLUSION

The outcomes of crush syndrome have significantly improved with the introduction of newer treatment modalities, including antioxidants, hyperbaric oxygen therapy, and comprehensive mental, social, and physical rehabilitation.

Medial cortical reduction does not influence outcomes in geriatric intertrochanteric femur fractures treated with proximal femoral nail

BACKGROUND

In intertrochanteric fractures, the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.

AIM

To analyze the concept of medial cortical reduction (MCR) and its clinical and radiological association in geriatric intertrochanteric femur fractures.

METHODS

Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study. Based on the degree of MCR, they were divided into positive, neutral, or negative MCR groups. The demographic baseline characteristics, postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6, 12 and 24 weeks post-surgery. Functional outcomes such as modified Harris Hip Score (HHS) and time to full-weight bearing were also analyzed.

RESULTS

47 patients (Male: Famale 35:12) with mean age of 65.8 ± 4.2 years were included in this study. Twenty-two cases had neutral support, nine had negative support, and sixteen had positive support in the medial cortex post-operatively. Baseline characteristics of the three groups were comparable. No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups. The modified HHS was not found to be significant between the groups (P = 0.883) as that of the time to full weight bearing (P = 0.789).

CONCLUSION

The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse. Future randomized controlled trials are needed to validate the findings noted in the study.

Accuracy of artificial intelligence in prediction of osteoporotic fractures in comparison with dual-energy X-ray absorptiometry and the Fracture Risk Assessment Tool: A systematic review

BACKGROUND

Osteoporotic fractures, whether due to postmenopausal or senile causes, impose a significant financial burden on developing countries and diminish quality of life. Recent advancements in artificial intelligence (AI) algorithms have demonstrated immense potential in predicting osteoporotic fractures.

AIM

To assess and compare the efficacy of AI models against dual-energy X-ray absorptiometry (DXA) and the Fracture Risk Assessment Tool (FRAX) in predicting fragility fractures.

METHODS

We conducted a literature search in English using electronic databases, including PubMed, Web of Science, and Scopus, for studies published until May 2024. The keywords employed were fragility fractures, osteoporosis, AI, deep learning, machine learning, and convolutional neural network. The inclusion criteria for selecting publications were based on studies involving patients with proximal femur and vertebral column fractures due to osteoporosis, utilizing AI algorithms, and analyzing the site of fracture and accuracy for predicting fracture risk using SPSS version 29 (Chicago, IL, United States).

RESULTS

We identified 156 publications for analysis. After applying our inclusion criteria, 24489 patients were analyzed from 13 studies. The mean area under the receiver operating characteristic curve was 0.925 ± 0.69. The mean sensitivity was 68.3% ± 15.3%, specificity was 85.5% ± 13.4%, and positive predictive value was 86.5% ± 6.3%. DXA showed a sensitivity of 37.0% and 74.0%, while FRAX demonstrated a sensitivity of 45.7% and 84.7%. The P value for sensitivity between DXA and AI was < 0.0001, while for FRAX it was < 0.0001 and 0.2.

CONCLUSION

This review found that AI is a valuable tool to analyze and identify patients who will suffer from fragility fractures before they occur, demonstrating superiority over DXA and FRAX. Further studies are necessary to be conducted across various centers with diverse population groups, larger datasets, and a longer duration of follow-up to enhance the predictive performance of the AI models before their universal application.

Functional outcomes of peroneus longus tendon autograft for posterior cruciate ligament reconstruction: A meta-analysis

BACKGROUND

The posterior cruciate ligament (PCL) is vital for regulating posterior tibial translation in relation to the femur, which is critical for knee stability. PCL tears are infrequently isolated in knee injuries; however, the absence of the PCL results in abnormal knee kinematics, which may cause injuries to other ligaments. The ideal tendon source for PCL reconstruction is still a subject of debate.

AIM

To evaluate the results of employing the peroneus longus tendon (PLT) in PCL reconstruction.

METHODS

A comprehensive search was conducted to identify relevant randomized controlled trials and retrospective observational studies discussing the outcomes of using the PLT for PCL reconstruction. Studies published up to August 2024 were searched across multiple databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar. Full texts of the selected articles were retrieved, reviewed, and independently assessed by the investigators. Discrepancies were resolved by consensus, with any remaining disagreements being arbitrated by a third author.

RESULTS

This meta-analysis included five studies on PLT use for PCL reconstruction: (1) Four prospective studies with 104 patients; and (2) One retrospective study with 18 patients. Most studies followed up participants for 24 months, while one had a shorter follow-up of 18 months. Lysholm and modified cincinnati scores improved by pooled means of 32.2 (95%CI: 29.3-35.1, I 2 = 0%) and 31.1 (95%CI: 27.98-34.22, I 2 = 0%), respectively. Postoperative American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores were 94.5 (I 2 = 61.5%) and 94.5 (I 2 = 80.09%), respectively. Single-hop and triple-hop test scores averaged 95.5 (95%CI: 94.5-96.5) and 92.4 (95%CI: 91.9-92.9) respectively. No significant differences were observed in thigh circumference at 10 cm and 20 cm between the injured and healthy sides.

CONCLUSION

Evidence supports PLT autografts for PCL reconstruction, improving knee function and patient outcomes. Larger randomized trials are needed to confirm efficacy and compare graft options.

Investigation on the quality of life after anterior minimally invasive total hip arthroplasty: Commentary on recent findings

This editorial critically evaluated the recent study by Ishikura et al, which examined the impact of anterior minimally invasive total hip arthroplasty (MIS-THA) on postoperative quality of life, with a specific focus on the timeline and influencing factors for return to work and resumption of driving. Ishikura et al's research demonstrated that anterior MIS-THA could shorten recovery time, reduce postoperative pain, and significantly enhance patients' quality of life and productivity. Their findings identified occupational type and work intensity as key determinants of postoperative recovery. By synthesizing evidence from multiple studies, this analysis systematically evaluated the clinical advantages of anterior MIS-THA-including reduced soft tissue trauma and accelerated functional recovery-while acknowledging its limitations, such as a steep surgical learning curve and early postoperative complication risks. The discussion emphasized the necessity of designing personalized rehabilitation protocols that accounted for patients' occupational demands. Notably, while current findings primarily derived from retrospective analyses, the article highlighted the need for prospective cohort studies to validate these observations. The commentary also addressed ongoing debates in the field, particularly the elevated complication rates associated with the direct anterior approach compared to posterior techniques, thereby underscoring the critical role of surgeon expertise in optimizing procedural safety. Collectively, this evaluation advanced our understanding of postoperative recovery dynamics in anterior MIS-THA and provides evidence-based insights to refine clinical rehabilitation frameworks.

Denosumab regimens in the treatment of giant cell tumor of bone: A systematic review with meta-analysis

BACKGROUND

Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary.

AIM

To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.

METHODS

A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.

RESULTS

1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma.

CONCLUSION

Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.

Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation

BACKGROUND

Pedicle screw instrumentation is a critical technique in spinal surgery, offering effective stabilization for various spinal conditions. However, the impact of intraoperative imaging quality-specifically the use of both anteroposterior (AP) and lateral views-on surgical outcomes remains insufficiently studied. Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre (URTT) within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.

AIM

To evaluate how intraoperative imaging adequacy influences unplanned return-to-theatre rates, focusing on AP and lateral fluoroscopic views.

METHODS

This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022. Data on intraoperative imaging adequacy, screw placement, and URTT events were collected and statistically analyzed using IBM SPSS v23. Imaging adequacy was assessed based on the presence of both AP and lateral views, and outcomes were compared between imaging groups.

RESULTS

A total of 9016 pedicle screws were inserted, with 82 screws identified as malplaced in 52 patients. Of these, 46 patients required URTT due to screw malplacement, with 37 returning within 90 days (URTT90). Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved, demonstrating the critical role of imaging adequacy in improving surgical outcomes.

CONCLUSION

This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns, improves outcomes, enhances precision, and offers a cost-effective approach for better spinal surgery results.

Factors affecting outcomes of indirect decompression after oblique and lateral lumbar interbody fusions

In this editorial, the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics. We reviewed a general overview of oblique lumbar interbody fusions (OLIF) and lateral lumbar interbody fusions (LLIF), their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies. This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures. Several parameters play a critical role in patient outcomes including restoration of disc height, foraminal height, central canal squared, and foraminal area. The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis. However, the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis, severe central canal stenosis, and osteoporosis. As a result, failure of indirect decompression can lead to persistent pain, radiculopathy and unsatisfied patients. Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.

Cross-talks between osteoporosis and gut microbiome

The gut microbiome comprises a vast community of microbes inhabiting the human alimentary canal, playing a crucial role in various physiological functions. These microbes generally live in harmony with the host; however, when dysbiosis occurs, it can contribute to the pathogenesis of diseases, including osteoporosis. Osteoporosis, a systemic skeletal disease characterized by reduced bone mass and increased fracture risk, has attracted significant research attention concerning the role of gut microbes in its development. Advances in molecular biology have highlighted the influence of gut microbiota on osteoporosis through mechanisms involving immunoregulation, modulation of the gut-brain axis, and regulation of the intestinal barrier and nutrient absorption. These microbes can enhance bone mass by inhibiting osteoclast differentiation, inducing apoptosis, reducing bone resorption, and promoting osteoblast proliferation and maturation. Despite these promising findings, the therapeutic effectiveness of targeting gut microbes in osteoporosis requires further investigation. Notably, gut microbiota has been increasingly studied for their potential in early diagnosis, intervention, and as an adjunct therapy for osteoporosis, suggesting a growing utility in improving bone health. Further research is essential to fully elucidate the therapeutic potential and clinical application of gut microbiome modulation in the management of osteoporosis.

Optimization and advances in negative pressure wound therapy for the management of necrotizing fasciitis in the upper limb

Necrotizing fasciitis (NF) is a rapidly progressing, life-threatening soft tissue infection, with upper limb NF posing a particularly serious threat to patient survival and quality of life. Negative pressure wound therapy (NPWT) has shown considerable advantages in accelerating wound healing and mitigating functional impairment. A retrospective study by Lipatov et al. demonstrated that NPWT significantly reduced the time needed for wound closure preparation while enhancing the success rate of local repair. Despite its benefits, certain limitations highlight the need for further optimization. This paper investigates the potential for personalized dynamic regulation of NPWT, its integration with adjunctive therapies, and the role of multidisciplinary collaboration. Furthermore, it explores the incorporation of advanced technologies such as artificial intelligence, imaging modalities, and biomaterials, presenting novel pathways for the personalized management and global standardization of NF treatment.

Osteosarcopenia and geriatric hip fractures: Current concepts

According to World Health Organization, one in six people will be older than 60 by 2030. The rising life expectancy is anticipated to contribute to a subsequent increase of geriatric fractures worldwide. Osteosarcopenia, which is the coexistence of osteoporosis and sarcopenia, greatly affects older people. Recent studies have tried to identify the prevalence of osteosarcopenia in older populations as well as its correlation with fragility fractures such as hip fractures. The latter pose a major burden on both health loss and costs worldwide. Increasing amount of evidence suggests that osteosarcopenia in patients with hip fractures contributes to higher rates of mortality and complications. At the same time, research focuses on the molecular basis of the interplay between osteoporosis and sarcopenia by utilizing genomic or proteomic approaches. These promising studies could reveal potential preventive or diagnostic biomarkers to optimize the management of osteosarcopenia in hip fractures patients. The fact that bones and muscle can also function as endocrine organs further highlights the complex relationship between osteoporosis and sarcopenia, underscoring the need for a better understanding of the role of myokines and osteokines in osteosarcopenia. Finally, the impact of osteosarcopenia on pain management and rehabilitation after hip fracture surgery, requires further assessment.

Retrieval analysis in total knee arthroplasty

Retrieval analysis in total knee arthroplasty (TKA) has been little studied in the literature. A narrative review of the literature to understand the current importance of retrieval analysis in TKA has been conducted. On August 27, 2024, a literature search was performed in PubMed using "TKA retrieval analysis" as keywords. A total of 160 articles were found, of which only 19 were analyzed because they were directly related to the subject of this article. Rotating-platform (mobile-bearing) TKA has no surface damage advantage over fixed-bearing TKA. TKAs with central locking mechanisms are more prone to debond from the cement mantle. No major wear of the polyethylene (PE) component in TKA using oxidized zirconium components occurs. Femoral components of cobalt-chromium roughen more than oxidized zirconium femoral components. The use of a polished tibial tray over an unpolished design is advised. At short-run assessment (15 months on average), antioxidant-stabilized highly crosslinked PE components are not clinically different in surface damage, density of crosslinking, or oxidation compared to standard remelted highly crosslinked PE components. A correlation between implant position and PE component surface damage has been reported. It shows the importance of optimizing component position to reduce PE component damage. Contemporary knee tumor megaendoprostheses show notable volumetric metal wear originated at the rotating hinge. Retrieval analysis in TKA renders relevant data on how different prosthetic designs described in the literature perform. Such information can help to improve future prosthetic designs to increase prosthetic survival.

High rates of return to sport following suture button fixation for ligamentous Lisfranc injuries: A systematic review

BACKGROUND

The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.

AIM

To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.

METHODS

During March 2024, the PubMed, EMBASE, and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries. Data regarding patient demographics, pathological characteristics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed.

RESULTS

Eight studies were included. In total, 94 patients (94 feet) underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2 ± 10.2 months. The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2 ± 11.8 preoperatively to a post-operative score of 82.8 ± 5.4. The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7 ± 0.6 preoperatively to a post-operative score of 2.0 ± 0.4. In total, 100% of patients returned to sport at a mean time of 16.8 weeks. The complication rate was 5%, the most common complication of which was residual midfoot stiffness (3.0%). No failures nor secondary surgical procedures were recorded.

CONCLUSION

This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up. In addition, there was an excellent return-to-sport rate (100%) at a weighted mean time of 16.8 weeks. This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries; however, caution should be taken when evaluating this data in light of the lack of high quality, comparative studies, and short-term follow-up.

Role of WARP sequence magnetic resonance imaging with the removal of metal artifacts in the evaluation of lumbar adjacent

BACKGROUND

Posterior lumbar interbody fusion has good clinical results, but adjacent segment disease (ASD) affects its long-term efficacy. In patients with L4-5 fusion who were followed up for more than 10 years, the ASD incidence was 33.3%. Magnetic resonance imaging (MRI) is key for ASD diagnosis, but metal artifacts from internal fixation limit its use; therefore, removing the artifacts is crucial for ASD diagnosis and treatment.

AIM

To evaluate the value of WARP MRI for patients with lumbar ASD.

METHODS

In our hospital, the lumbar spines of patients with ASD were assessed via lumbar MRI, including conventional sequences and sequences for artifacts. A PACS workstation was used for image measurement, analysis, and assessment, which mainly included measurement of the internal fixation implant artifact area, evaluation of the visibility of the anatomical structures surrounding the implant, and diagnostic assessment of ASD in the section. Conventional MRI data sequences and artifacts to sequence the contrast analysis of the MRI data.

RESULTS

A total of 30 patients with ASD after lumbar fusion and internal fixation were included in the study; the patients included 13 male and 17 female patients and were aged 66.03 ± 5.83 years. The metal artifact area of the WARP T2-tirm sequence was significantly smaller than that of the conventional STIR sequence [(20.85 ± 6.27) cm² vs (50.56 ± 8.55) cm², P < 0.01]. The WARP T2-tirm sequence was observed around the implants, pedicles, intervertebral foramen, and vertebral bodies, and the conventional STIR sequence clearly displayed nerve roots within the intervertebral foramen. In all 30 patients, all adjacent segments of the WARP T2-tirm sequence could be clearly observed (above Grade 4), whereas it was difficult to observe these segments in the conventional STIR sequence due to the presence of more severe metal artifacts.

CONCLUSION

WARP sequences can significantly reduce the artifact area in the sagittal and cross-sectional images of titanium alloy spinal fixation, providing a good imaging reference for the diagnosis of ASD.

Treatment of refractory thoracolumbar spine infection by thirteen times of vacuum sealing drainage: A case report

BACKGROUND

A case study of multiple distinct levels of skipped thoracolumbar spine infection was reported in which 13 successful vacuum sealing drainage (VSD) surgeries were treated.

CASE SUMMARY

The patient underwent a total of 13 procedures within our medical facility, including five performed under local anesthesia and eight performed under general anesthesia. The source of the ailment was ultimately identified as Enterobacter cloacae. After the last procedure, the patient's symptoms were alleviated, and the recovery process was satisfactory. Three months post-operation, the Japanese Orthopaedic Association scores had improved to 100%. Imageological examination revealed a satisfactory position of internal fixation, and the abnormal signals in the vertebral body and intervertebral space had been eliminated when compared to the pre-operative results.

CONCLUSION

The study demonstrates that the extreme lateral approach debridement combined with multiple VSD operations is a secure and successful method of treatment for recurrent spinal infection, providing an alternative to traditional surgery.

Requirements for standardizing the assessment of mesenchymal stem cell therapy and its effects on osteoarthritis

Publications of Soufan et al and Kristjánsson et al in the World Journal of Orthopedics on mesenchymal stem cell (MSC) therapy for osteoarthritis (OA) represent a significant exploration of regenerative medicine's potential in OA treatment. In their research, it is highlighted that MSCs can alleviate OA symptoms and even regenerate cartilage, potentially reversing the disease. They also compared the efficacy of three MSC subtypes, emphasizing the therapeutic advantages of adipose-derived MSCs. MSC injections, a novel and less invasive alternative to traditional treatments such as chondrocyte transplantation or arthroplasty, have a low cost, low risks, and favorable outcomes, presenting a promising approach for OA patients. Additionally, we stressed that the efficacy evaluation criteria, heterogeneity, safety, and other factors must be carefully considered to further advance the clinical translation of MSC therapy for OA.

Patellar resurfacing in knee arthroplasty: A comprehensive review and meta-analysis

BACKGROUND

Patellar resurfacing in knee arthroplasty remains a contentious issue, with various strategies including routine, selective, and non-resurfacing approaches. This review and meta-analysis aim to assess the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores associated with each method.

AIM

To determine the comparative effectiveness of routine, selective, and non-resurfacing strategies in patellar resurfacing within knee arthroplasty by evaluating incidence rates, revision rates, patient satisfaction, and knee function scores.

METHODS

A systematic review spanning from 1990 to 2024 was conducted using PubMed, Embase, and Cochrane Library databases. Studies reporting on the incidence of patellar resurfacing, revision rates, patient satisfaction, and relevant knee scores were included. Data from esteemed world registries such as the Australian Orthopaedic Association National Joint Replacement Registry, the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man and Danish Knee Arthroplasty Registry among others, were meticulously examined. Meta-analysis was employed to derive pooled estimates and 95% confidence intervals.

RESULTS

Analysis of data sourced from diverse world registries and literature sources unveiled significant disparities in the incidence of patellar resurfacing across different geographic regions and healthcare institutions. For instance, the incidence of routine patellar resurfacing ranged from 60% to 90% in some regions, while in others, it was as low as 30% to 50%. The meta-analysis indicated that routine resurfacing was associated with a lower revision rate of 3.5% (95%CI: 2.8%-4.2%) compared to non-resurfacing approaches, which exhibited a higher revision rate of 6.8% (95%CI: 5.5%-8.1%). Patient satisfaction outcomes showed variability, with routine resurfacing demonstrating higher mean satisfaction scores in functionality, pain relief, and stability categories.

CONCLUSION

The findings underscore the complexity of patellar resurfacing in knee arthroplasty and highlight the need for continued research to refine clinical practice. Future studies should prioritize prospective randomized controlled trials comparing different patellar resurfacing techniques using standardized outcome measures. Longitudinal studies with extended follow-up periods are necessary to evaluate the long-term outcomes and durability of various patellar resurfacing strategies. Collaborative efforts among multidisciplinary teams will be essential to conduct high-quality research that can provide actionable insights and improve patient outcomes.

Trabecular titanium acetabular cup in patients with medial femoral neck fracture: Survivorship analysis and clinical and radiological outcomes

BACKGROUND

Clinical studies using Trabecular Titanium™ acetabular cups have shown promising short and medium-term results. This material, due to its macro and micro surface roughness, provides a substrate for osseointegration and enhances implant stability. However, there is a lack of evidence in the literature on the use of this material in patients with femoral neck fracture.

AIM

To evaluate the short-term clinical-functional and radiographic outcomes in patients with femoral neck fractures undergoing total hip arthroplasty (THA) with Trabecular Titanium™ acetabular cup implants.

METHODS

The study included 104 patients with medial femoral neck fractures who underwent THA between January 2020 and December 2020 with the Delta TT acetabular cup (Lima Corporate, Villanova di San Daniele del Friuli, Italy). The mean age of the patients was 69.57 ± 10.16 years (range: 36-85 years). The follow-up period ranged from a minimum of 3 to a maximum of 4 years. Three questionnaires (Harris Hip Score, Oxford Hip Score, and EQ5D) were administered along with radiographic evaluations. Statistical methods included the Student's t-test and one-way analysis of variance for comparisons (with significance set at 0.05), and the Kaplan-Meier curve for prosthetic implant survival.

RESULTS

The mean follow-up was 41.5 months. The Harris Hip Score (HHS) showed a mean increase of 2.74 points (mean HHS 88.52 at 6 months postoperatively and mean HHS 91.26 at the last follow-up) with statistical significance. Similarly, the Oxford Hip Score demonstrated a statistically significant difference between follow-up groups. However, the EQ5D did not show statistically significant differences among the three groups (preoperative, 6-month follow-up, and last follow-up). Revision surgery was required in 6 patients. According to Moore's criteria, 96% of the acetabular components were radiographically stable and well-integrated at the last follow-up. The Kaplan-Meier curve showed a 96% survival rate.

CONCLUSION

The clinical and radiographic results obtained in the short to medium term confirm the excellent performance of the Delta TT acetabular cup in terms of osseointegration, providing an optimal solution both for young patients with high functional recovery demands and for fragile patients requiring optimal stability of the acetabular component to reduce the risk of implant failure.