Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients Length of Stay (LOS). This study aims to develop a machine learning prediction model that may aid to predict LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients undergoing elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization has been classified as “Short LOS” if it was less than or equal to 6 days and “Long LOS” if it was greater than 7 days. Clinical data coming from pre-operative laboratory analysis, vital parameters, demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting short or long LOS. Results: Final dataset was composed of 1517 patients (795 “LONG”, 722 “SHORT”, p = 0.3196) with a total of 1541 admissions (729 “LONG”, 812 “SHORT”, p < 0.000). Complete model had a prediction efficacy of 78,99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice predicting which patients are suitable for a shorter LOS, from those with a longer LOS in which a cautious approach could be recommended.

Background and objectives: As the oblique lateral interbody fusion at L5/S1 (OLIF51) and lateral corridor approach (LCA) have gained popularity, the understanding of precise vascular structure at L5/S1 level is indispensable. The objectives of this study were to investigate the vascular anatomy at L5/S1 level, and to compare the movement of vascular tissue between supine and lateral decubitus position using the intraoperative enhanced CT and MRI. Materials and Methods: A total of 43 patients who underwent either OLIF51 or LCA were investigated with the average age at surgery of 60.4 (37-80) years old. The preoperative MRI was taken to observe axial and sagittal anatomy of vascular position under supine position. The intraoperative vein-enhanced CT was taken just before incision in the right decubitus position, and compared to supine MRI anatomy. The iliolumbar vein appearance and its types were also classified. Results: The average vascular window allowed for OLIF51 was 22.8 mm and 34.1 mm at either L5 caudal endplate or S1 cephalad endplate level, respectively. It allowed for LCA was 14.2 mm and 12.6 mm at either level, respectively. The left common iliac vein moved 3.8 mm and 6.9 mm to right direction at either level from supine to right decubitus position, respectively. The bifurcation moved 6.3 mm to caudal direction from supine to right decubitus. The iliolumbar vein was located at 31 mm lateral from midline, and MRI detection rate was 52%. Conclusions: The precise measurement of vascular anatomy indicated that OLIF51 approach was the standard minimally invasive anterior approach for L5/S1 disc level compared to LCA, however, there were many variations in quantitative anatomy as well as significant vascular movements between supine and right decubitus position. In the clinical setting of OLIF51 and LCA surgeries, the careful preoperative evaluation and intraoperative 3D imaging are recommended for the safe and accurate surgery.

Background: Musculoskeletal pain is a non-negligible multifaceted condition affecting more than 30% of the global population. Superficial heat therapy (HT) through increasing tissues temperatures plays a role in increasing local metabolism and function and relieving pain. Knee pain and sports represent two relevant fields of superficial HT application. Methods: In the present paper a panel of experts performed a narrative review of the literature regarding the role of superficial HT in the management of knee pain and sport activities. Results: According to the reviewed literature, HT represents a therapeutic option in the management of musculoskeletal pain due to three main effects: pain relief, promotion of healing and return to normal function and activity. Moreover, HT plays a role in sport activities both before and after exercise. Before performing sports, HT helps in preparing muscles for performance. After performing sports, it is capable to promote recovery and healing pathways. Combining and sequencing superficial heat and cold therapy represent an interesting topic of study. Overall, application of heat wraps for superficial HT can be considered safe. Conclusions: Despite being an ancient method, HT shows to be a potentially beneficial and safe option in the management of several conditions including KP and sports. The key in the application of superficial HT is a multimodal and multidisciplinary approach.

Background: biophysical stimulation therapy, and in particular Pulsed Electromagnetic Fields (PEMFs) and capacitively coupled electric fields (CCEFs) has significantly increased in the last twenty years. For this, it is necessary to have clear information regarding the efficacy, the therapeutic indication and the expected objectives. Methods: we conducted a narrative review taking into consideration different types of studies with different areas of application. The objective was to take into consideration and analyze the different fields of use and the relevant information present in the literature. Results: There is unanimous opinion regarding the usefulness of applying biophysical therapy on the bone compartment both in terms of the tissue healing process and the symptoms associated with this situation. Differently, but no less importantly, in the joint compartment positive opinions were observed mainly on the inflammatory and catabolic process, however, at present,we did not report evidence regarding cartilaginous tissue regeneration. Conclusion: the effectiveness of PEMFs and CCEFs on the bone healing process in the Orthopedic and Traumatology fields is consolidated evidence in the literature. We have also found positive results on symptoms and patient compliance with rehabilitation therapies. Therefore, notable application can be envisaged in the fields of Prosthetic Surgery and Sports Medicine.

Keywords: Spine surgery 1; Metastatic spinal cord compression 2; Spinal metastasis 3; Cancer treatment.

Background and Objectives: This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle stability after an arthroscopic modified Broström operation (AMBO) for chronic ankle instability (CAI). Materials and Methods: The study included 47 patients diagnosed with CAI who underwent AMBO and were randomly divided into three groups: control (n=11), general balance exercise (n=17), and subtalar joint axis balance exercise (n=19), regardless of the affected area. Participants in the exercise rehabilitation group performed exercises for 60 min twice a week for 6 weeks, starting 6 weeks after AMBO. ATFL thickness, ankle strength, and ankle dynamic stability were measured using musculoskeletal ultrasonography, Biodex, and Y-balance test, respectively, before and after treatment. Results: Compared with the remaining groups, the subtalar joint axis balance exercise group had reduced ATFL thickness (p = 0.000), improved ankle strength for eversion (p = 0.000) and inversion (p = 0.000), and enhanced ankle stability (p = 0.000). Conclusions: The study results suggests that subtalar joint axis-based balance exercises may contribute to the early recovery of the ankle joint after AMBO.

Background: Periprosthetic joint infection (PJI) following total hip and knee arthroplasty remains an extremely challenging and relatively high complication. This study aims to develop, validate and evaluate the use of machine learning (ML) algorithm to predict PJI in patients undergoing revision arthroplasties. Methods: A comprehensive review of patients undergoing hip or knee revision arthroplasty from 1 January 2015 to 31 March 2021 was conducted. Clinical data coming from preoperative patients history, laboratory analysis and demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting PJI preoperatively. Results: 1360 patients were enrolled, 1141 in the aseptic cohort and 219 in the infected cohort were included. ML demonstrated good discriminatory performance in predicting PJI in the selected patients (area under the curve 0.770 ± 0.006 in the training set and 0.720 ± 0.057 in the test set), and identified 3 significant predictors of PJI. Conclusion: ML algorithm trained using preoperative clinical data accurately predicted PJI. The incorporation of ML models into preoperative assessment of patients undergoing prosthetic revision procedures are useful in providing specific risk assessment to aid individualised counselling, shared decision making and presurgical optimization.

Posterior dislocations of the sterno-clavicular joint (SCJ) are rare events, most commonly due to motor vehicle accidents or sports injuries and they often occur in young and active patients. This injury can represent a real emergency because of the vital structures located posterior to the medial clavicle such as anonymous artery, anonymous vein, trachea, subclavian artery and vein, esophagus and thoracic duct. The diagnosis could be insidious given the not peculiar clinical presentation and it is often necessary to perform a computed tomography to identify it. In case of failure of reduction maneuvers, the surgical treatment becomes a mandatory choice, but unfortunately literature reports a restricted cohort of cases and proposes different stabilization techniques without showing a significant comparison of results. Moreover, due to the rarity and high risk of complications, other than the lack of knowledge about the injury and its repair techniques, the management of these injuries are mutually discharged from orthopedic surgeon to the thoracic surgeon and vice-versa. A deep study of the joint anatomical characteristics and its biomechanics allow the surgeon to face surgery more safely, choosing the most appropriate technique. Given the importance of the SCJ for the movement of the shoulder girdle, authors believe that the surgeon’s goal should be to restore the complete range of movement of the joint in case of dislocation. For this reason, stabilization with semitendinosus tendon graft has to be considered one of the best solutions at our disposal to date.

Osteoporotic vertebral fracture is the most common fracture from osteoporosis, and are largely undiagnosed due to the mostly asymptomatic nature of the condition. It increases the risk of subsequent fractures and contributes to societal burden. Risk factors for osteoporotic fractures are found in the WHO fracture risk assessment model and used as a tool for monitoring bone health. Vertebral fractures are diagnosed from anteroposterior and lateral spine radiographs and are confirmed with an approximate loss of 20% vertebral height as compared to adjacent vertebrae. One of the most used grading for vertebral fractures is the SQ grading. Mild vertebral fractures could easily be misdiagnosed due to some peculiarities of the vertebral column. CT scan is useful for planning surgical intervention while an MRI scan can provide information about the recency of the fracture and rule out cancer-related fractures. Management depends on the severity of the fracture which could range from conservative management to surgical vertebral augmentation and decompression. Bisphosphonates are used to treat osteoporosis in acute and long-term management of fractures. Osteoimmunological therapies such as denosumab and romosozumab are new therapeutic interventions for osteoporosis while there are many other potential treatment options. Precision medicine provides an individualized treatment approach while regenerative medicine utilizes mesenchymal stem cells for fracture repair.

The aim of this retrospective case series study was to investigate outcomes in patients with lower limb loss, based on whether or not they used a training prosthesis (TP) during their rehabilitation. The medical records of 171 consecutive patients admitted to rehabilitation hospitalization between January 2014 and December 2018 following a major amputation of the lower limb were reviewed. Patients were categorized into two groups: patients who underwent rehabilitation with a TP and patients who did not used a TP. Outcomes (i.e. discharge destination, length of stay, number of sockets required and number of size adaptation of each socket as well as functional level) were compared between groups. Of the 171 patients, 126 underwent rehabilitation with a TP, and 45 patients underwent rehabilitation without any TP. We found that patients who used a TP had a significantly shorter hospital length of stay when compared to those who did not. This length of stay for patients with TP was not influenced by age but was lowered by higher BMI, tibial instead of femoral amputation and male gender. No association was found between use of TP and discharge destination, functional level, number of socket modification and number of sockets required.

Background: due to increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to raise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. Methods: the study retrospectively includes data from patients who developed VB1 PPHFs during THAs from December 3rd 2020 to November 30th 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). Results: 37 patients with mean age 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier estimated a re-operation free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69±6.07 (range -27.9 to 2.08) mm to 0.10±0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72±14.37 (range 21.00-96.00) to 94.40±10.32 (range 56.00-100.00).

(1) Background: Ferric carboxymaltose (FCM) is an intravenous (IV) high-dose iron that is effective in the treatment of iron deficiency anemia. This study was to determine if preoperative IV FCM administration could improve recovery from postoperative anemia in patients undergoing revision total joint arthroplasty. (2) Methods: This prospective randomized controlled study analyzed 82 patients undergoing revision total joint arthroplasty during a single hospitalization. Patients in the iron group (n = 41) were administered 1000 mg of IV FCM two weeks preoperatively, while those in the control group (n = 41) were not. Moreover, patients with anemia defined as a preoperative suboptimal Hb concentration <13.0 g/dl were compared according to IV FCM administration. The absolute Hb levels and changes in Hb levels, iron profiles, transfusion rate, and EuroQOL 5-dimension (EQ-5D) scores were compared. (3) Results: There were no significant differences in recovery of Hb levels at each timepoint between the two groups; however, the changes in Hb levels from baseline to four weeks postoperatively showed marginally significant differences favoring the iron group (p = 0.052). However, for preoperatively anemic patients, the change in hemoglobin (Hb) levels between baseline and four weeks postoperatively was significantly better in the iron group than in the control group (iron group [n = 26], −0.3 ± 0.7 g/dL vs. control group [n = 27], −0.9 ± 0.8 g/dL; p = 0.040), although the absolute Hb levels, transfusion rates, and patient quality of life were comparable (all p > 0.05). The iron group showed improved iron metabolite levels including serum ferritin and transferrin saturation four weeks postoperatively, and no adverse events associated with IV FCM administration occurred in either group. (4) Conclusions: Preoperative IV FCM in anemic individuals undergoing revision joint arthroplasty was effective in accelerating recovery from surgery-related anemia by improving Hb levels without any adverse events, despite similar actual Hb levels between the groups. Our findings are clinically relevant and can facilitate determination of the suitability of IV FCM as a safe and reliable protocol for iron supplementation for anemia correction.

Background and Objectives: The arthroscopic biceps rerouting (BR) technique was introduced as a novel technique for large-to-massive rotator cuff tears (LMRCT). This method can restore shoulder stability, and its biomechanical effect was verified in a cadaver experiment. Recent reports have shown favourable clinical outcomes. This study aimed to compare the clinical outcomes of partial repair with those of BR technique in LMRCT. Materials and Methods: We included 72 patients who had undergone LMRCT. Arthroscopic partial repair was performed in 31 patients (group I), while repair with the BR technique was performed in 41 patients (group II). Functional and imaging outcomes were evaluated and compared using a visual analogue scale for pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Korean Shoulder Score (KSS) before the surgery and at 3, 6, and 12 months after the surgery and at the last follow-up. Tendon integrity was investigated using magnetic resonance in all the patients at 12 months postoperative. Results: Mean follow-up period was 22.11 ± 10.47 months (range, 12–53 months). Forward flexion (P=0.02) and external rotation at the side (P=0.04) were significantly higher in group II than in group I on postoperative day (POD) 12. For internal rotation, group II showed significant improvement compared to group I on POD 3 (P=0.002) and at six months postoperative (P=0.01). On POD 12, the ASES (P=0.047) and KSS (P=0.048) were better in group II. Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, there were no significant differences in pain, clinical scores, or ROM between the two groups at the last follow-up. Retear of the repaired tendon was observed in nine patients in group I (29.03%) and 8 in group II (19.51%, P = 0.35). Conclusions: Partial repair and repair using the BR technique effectively improved clinical and radiologic outcomes. The BR technique revealed early recovery of ROM and better clinical results than partial repair until one year postoperatively. This could be a useful method in LMRCT.

Presenting a rare case of adult-onset mature cystic teratoma of the spinal cord in the thoracolumbar spinal cord in a 54-year-old male whose chief complaint was lower back pain radiating to both legs while other findings were normal. X-ray images of the thoracolumbar spine showed early degenerative changes and unfused posterior elements noted in lower sacral vertebral levels. Magnetic resonance images of the lumbar spine showed a well-defined non-enhancing intramedullary altered intensity lesion noted at the level of conus at the L1-L2 vertebral level. The resected tumour was histopathologically diagnosed as a mature cystic teratoma. The patient's symptoms improved following the surgery.

Osteoarthritis (OA) poses a growing challenge for the aging population, especially in hip and knee joints, contributing significantly to disability and societal costs. Conventional clinical evaluations, typically performed in controlled settings, face difficulties in capturing the dynamic characteristics of rehabilitation and functioning in real-life scenarios. The study assessed the use of automated unsupervised evaluations in the rehabilitation process for patients after hip and knee replacements. We analyzed data from 1144 individuals who used a digital application after surgery, activity data were collected using the Garmin Vivofit 4. Several parameters such as the Peak 6-Minute Consecutive Cadence (P6MC) and Peak 1-Minute Cadence (P1M) were computed and analyzed on a daily basis. The results indicated that cadence measurements, specifically, can effectively differ among individuals with hip and knee conditions as well as the recovery process. Moreover, these metrics demonstrated a high level of responsiveness in monitoring the progress of recovery, surpassing the effectiveness of simply measuring the total number of steps taken. The study highlighted the capacity of technology-driven, patient-centered rehabilitation to improve accuracy, tailor therapy to individual patients, and increased patient involvement. This research also highlighted the significance of automated, unsupervised assessments in enhancing rehabilitation results for OA patients following hip and knee replacement, as tele-rehabilitation becomes increasingly important.

Study design :Technical note. Objectives : To present a new unilateral biportal endoscopic technique for lumbar disc herniation without C-arm . Background : Lumbar disc herniation requires surgical intervention when conservative methods fail. Shifts towards minimally invasive percutaneous endoscopic lumbar discectomy, including uniportal and biportal approaches, have been hindered by challenges such as steep learning curves and reliance on radiation-intensive C-arm guidance. Our study introduces the use of standard intraoperative navigation in unilateral biportal endoscopy (UBE) to reduce radiation exposure and increase surgical acuracy. Materials and Methods : A 24-year-old man with low back and bilateral leg pain with gait disturbance was referred to our hospital. He had have conservative treatment for 12 months in another hospital before admission. However, the conservative treatment did not work for him. He had low back pain (VAS 4/10) and bilateral leg pain (VAS 8/10), muscle waekness of bilateral legs (Manual muscle testing ;MMT of extensor hullusis longs 4 4), and numbness of bilateral lower leg. Preoperative lumbar MRI showed L4/5 large central disc herniation. Results: He underwent C-arm free unilateral biportal endoscopic discectomy under the guidance of O-arm navigation. The patient was successfully treated surgically. Postoperative lumbar MRI showed good decompression of dural sac and bilateral L5 nerve roots. MMT and sensory function of both leg had recovered fully on final follow-up at one year. Conclusions/Level of Evidence: The new unilateral biportal endoscopic technique under navigation guidance is useful technique for lumbar disc herniation. This innovative technique proved to be safe, accurate, and minimized radiation exposure for surgeons for the treatment of lumbar intervertebral disc herniation. Level V.

Background: The COVID-19 pandemic has presented numerous challenges to global healthcare system and emerging evidence suggests a potential link between COVID-19 treatment, specifically steroid therapy, and the development of avascular necrosis (AVN) of the hip. This review aims to provide a comprehensive overview of recent studies and case reports investigating the relationship between COVID-19, corticosteroid therapy, and the development of AVN. Understanding the nuances of AVN in the context of COVID-19 is crucial for healthcare professionals to navigate treatment decisions and mitigate potential complications. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used in the systematic review until September 1st, 2023. The full-texts of the remaining twenty-three (n=23) articles were independently reviewed by the authors of this review.  Conclusions: The association between steroid therapy for COVID-19 and the development of hip AVN is a noteworthy concern even though, no relationship is evident between the duration of treatment, cumulative dosage of medication, maximum daily dosage received, and the presence of AVN. Further research with larger cohorts and long-term follow-up is needed to better understand the causative relationship and optimal management strategies for hip AVN in the context of COVID-19 and steroid therapy

Background: Genetic factors are considered important risk factors for the occurrence of osteoarthritis (OA), which has received extensive attention. This study examined the research on the relationship between genetic factors and the pathogenesis of OA from a bibliometric perspective. Methods: We searched Web of Science Core Collection for original and review articles on genetic factors and OA. We used R package “bibliometrix” to perform statistical and visualization analysis of countries, institutions, authors, journals, and keywords. Results: A total of 1,127 articles met the inclusion criteria, with an average citation of 20.41 per article. From 2012 to 2022, the average annual growth rate of research in this field was 7.83%. The corresponding authors of the published articles were mainly from China, the USA, and the UK. Boston University emerged as the most active and important institution, while the Osteoarthritis and Cartilage published the most articles in this field. The keywords “polymorphism”, “genetic” and “mendelian randomization” indicate the future research directions. Conclusion: This bibliometric study provides an overview of the key topics and trends in genetic factors and OA pathogenesis research. The high-frequency keywords suggest the current and potential future focus of this field, involving methods, mechanisms, and populations.

Background and Objectives: Although adult spinal deformity (ASD) surgery brought about the improvement of quality of life in patients, it accompanied with a high invasiveness of surgery and several complications. Specifically, mechanical complications of rod fracture, instrumentation failures, and pseudarthrosis are still unsolved issues. To better improve these problems, the oblique lateral interbody fusion at L5/S1 (OLIF51) was introduced since 2015 in my institution. The objective of this study was to compare the clinical and radiographic outcomes of anterior-posterior combined surgery for ASD between the use of OLIF51 versus transforaminal interbody fusion (TLIF) at L5/S1. Materials and Methods :A total of 117 ASD patients received anterior-posterior correction surgeries either use of OLIF51 (35 patients) or L5/S1 TLIF (82 patients). In both groups, L1-5 OLIF and minimally invasive posterior procedures of hybrid or circumferential MIS were employed. The sagittal and coronal spinal alignment and spino-pelvic parameters are recorded preoperatively and at follow-up. The quality of life parameters and visual analogue scale were evaluated as well as surgical complications at follow-up. Results: The average follow-up period was thirty months (13-84). The average fused segments were eight (4-12). The operation time and estimated blood loss were significantly smaller in OLIF51 that those in TLIF. The PI-LL mismatch, LLL, L5/S1 segmental lordosis, and L5 coronal tilt were significantly better in OLIF51 than TLIF. The complication rate was statistically equivalent between two groups. Conclusion: The introduction of OLIF51 for adult spine deformity surgery led to the decrease of operation time and estimated blood loss as well as the improvement of sagittal and coronal correction when compared to TLIF.

The incidence of radiculopathy due to lumbar spinal stenosis has been on the increase in the aging population. However, patients aged 80 years hesitate to undergo conventional open surgery under general anesthesia because of the risk of postoperative morbidity and adverse events. Therefore, less invasive surgical alternatives are required for the elderly or medically handicapped patients. Transforaminal endoscopic lumbar lateral recess decompression (TELLRD) may be helpful for those patients. This study aimed to demonstrate the efficacy of TELLRD for treating radiculopathy in octogenarian patients. A total of 21 consecutive octogenarian patients with lumbar foraminal stenosis underwent TELLRD between January 2017 and January 2021. The inclusion criterion was unilateral radiculopathy, which stemmed from lumbar lateral recess stenosis. The pain source was verified using imaging studies and selective nerve blocks. Full-scale lateral canal decompression was performed using a percutaneous transforaminal endoscopic approach under local anesthesia. We found the pain scores and functional status improved significantly during the 24-month follow-up period. The clinical improvement rate was 95.24% (20 of 21 patients) with no systemic complication. In conclusion, endoscopic lateral recess decompression via the transforaminal approach is practical for octogenarian patients while reducing the medical risks of aggressive open surgery.

We performed arthroscopically assisted coracoclavicular (CC) stabilization using a suture button device for modified Neer type IIb lateral clavicle fractures accompanied by CC ligament injury. The purpose of the present study was to evaluate the radiological and clinical outcomes of this procedure. Six consecutive patients with modified Neer type IIb fractures were treated with the technique and followed for 12 months. Postoperative ranges of motion (ROMs) and X-rays were evaluated every 3 months. Shoulder functional scores (University of California Los Angeles score, Japanese Orthopedics Association score), visual analog scale (VAS) scores for pain at rest, at night, and during motion, and VAS score for satisfaction were analyzed at 12 months after surgery. For the clinical outcomes, early ROM recovery and excellent outcomes were achieved. For the radiological outcomes, all patients accomplished bone union, slight superior displacement was noted in the CC distance and Dog Bone distance, and bone hole dilation was observed in the superior coracoid and inferior clavicle, but there were no critical complications. The present findings indicate that arthroscopically assisted CC stabilization with a suture button device for unstable lateral clavicle fractures can produce satisfactory radiological and clinical results.

Background: Idiopathic Toe Walking (ITW) is the persistence of a forefoot strike pattern at initial contact while walking beyond the age of three years, in the absence of other justifiable causes. This review aims to consolidate the current knowledge on the subject and to highlight recent advancements in literature. Methods: We conducted an electronic search in the following databases up to June 2023: Ovid MEDLINE, EBSCO, Embase, CINAHL Plus, and PubMed. The PICO framework was employed to define search terms. Results: Despite considerable methodological heterogeneity among studies, we found a stronger inclination toward investigating etiological and prognostic factors. There is a trend for a higher prevalence in boys with a positive family history. Novel classifications have been proposed to improve differential diagnosis. Among conservative treatment options, there is stronger evidence for gait improvement with the use of serial casting followed by orthoses. Severe cases may benefit from surgical Zone III gastrocsoleus lengthening. Conclusion: Further studies with standardized methodologies are required to clarify questions about the etiology, classification, and treatment of this condition. Nonetheless, there is a higher level of evidence supporting conservative treatments with serial casting and orthoses, as well as gastrocsoleus Zone III surgical lengthening for severe cases in the second decade of life.

Hallux valgus deformity (HVD) involves subluxation of the first metatarsophalangeal joint. While HVD is primarily considered a forefoot condition, midfoot instability may play a significant role in its development and severity. Therefore, this review had a particular focus on understanding midfoot instability based upon weightbearing imaging assessments of the TMT joint. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched five databases for studies on midfoot instability in HVD patients. Severity of HVD was defined by hallux valgus angle (HVA) and distal metatarsal articular angle (DMAA). Data was extracted, and articles were graded using the Methodological Index for Non-Randomized Studies (MINORS). Of 547 initially retrieved articles, 23 met inclusion criteria. Patients with HVD showed higher HVA and DMAA on weight-bearing radiographs (WBRG) and weight-bearing computed tomography (WBCT) compared to healthy individuals. Midfoot instability was assessed through intermetatarsal angle (IMA) and tarsometatarsal angle (TMT angle). Patients with HVD exhibited greater IMA and TMT angles on both WBRG and WBCT. This review highlights the importance of weight-bearing imaging assessments for midfoot instability in HVD. IMA and TMT angles can differentiate between healthy individuals and HVD patients, emphasizing the significance of midfoot assessment in understanding HVD pathology.

PURPOSE: The aim of this study was to identify the incidence of early mechanical failure in the first post-surgical year in patients who had undergone spinal surgery, and to assess the related risk factors. METHODS: Retrospective observational study of a prognostic cohort was conducted at an orthopaedic hospital, examining all patients with spine degenerative disease who consecutively underwent arthrodesis surgery between March 2018 and March 2019. The incidence of postoperative mechanical failure during the first year was calculated as primary outcome; the time between the date of the implant surgery and diagnosis of the mechanical failure was calculated as secondary outcome. RESULTS: A total of 237 patients were identified for statistical analysis. The median age of the group of patients was 47 years (IQR of 44), and 66.6% were female. The incidence of mechanical failure in the first postoperative year was 5.1% overall with 12 events and the median time between surgery and the need for revision surgery was 5 months (IQR=7.75). ASA score (OR= 2,39; p=0.134), duration of the surgical procedure (OR=1,27; p=0,006) and inability to walk at discharge (OR=7,86; p=0,072) were independent risk of factor associated with the mechanical failure. CONCLUSION: Higher ASA score and longer duration of surgery are risk factors for mechanical failure in the first year in patients who had undergone spinal surgery and must be carefully considered when planning spinal surgery. During hospitalization, recovery of ambulation must be encouraged to prevent mechanical failure. All these factors are useful in identifying patients with a closer follow-up is needed.

The management of shoulder instability in children and adolescents is a challenging field of orthopaedics. There are several complicating factors which originate from the variable underlying cause that is often a unique combination of traumatic factors, ligamentous laxity, and the pattern of muscle contractility. As the cause is often multifactorial, this makes interpretation of the literature difficult as nomenclature is variable. The purpose of this review is to shed light on the nuances of paediatric and adolescent shoulder instability.

Abstract: In complex revision total hip arthroplasties, careful preoperative planning is crucial for the proper reconstruction of hip biomechanics. With conventional 2D radiographic images and computed tomography (CT) the 3D extension of the defect and the remaining bone stock may not be evaluated properly. 3D printed models can aid the surgeon in planning complex acetabular re-construction. The purpose of this study is to compare the accuracy of bony defect assessment in severe acetabular defects surgery with 3D printing planning as compared to conventional 2D ra-diographic planning and CT. Twenty-five patients with severe acetabular defects (Paprosky IIC and III) undergoing revision surgery were enrolled. Each patient had a 3D printed model of their femur and pelvis created based on CT scans. Clinical and radiographic assessments were conducted before and after surgery, with four key bone landmarks measured and compared between X-ray, CT, 3D models, and surgical reports. The findings revealed discrepancies in defect assessment between different imaging methods. X-rays and CT scans sometimes incorrectly identified affected areas, while the 3D models showed more accurate results. This study suggests that 3D printed models can significantly improve the preoperative evaluation of complex hip arthroplasty revisions, enabling surgeons to better select optimal surgical strategies.

A recent study published in Nature Medicine (Mautner et al., Nat Med 2023 Nov 2. doi: 10.1038/s41591-023-02632-w. Epub ahead of print) reported findings regarding a four-arm parallel, multicenter, single-blind, randomized, controlled clinical trial with 480 patients, aimed at comparing the therapeutic effectiveness of orthobiologic interventions against corticosteroid injections for the treatment of knee osteoarthritis (OA). The study concluded that, one-year post-treatment, all orthobiologic therapies examined were equivalent in effectiveness to each other and to corticosteroid injections. While we commend the scope and methodological rigor of the trial, the publication could be enhanced by a more comprehensive presentation of data to support the conclusions drawn. Particularly, the omission of baseline data for primary outcomes, the missing context to evaluate absolute values, the lack of discussion regarding interindividual variability, and the unexpectedly favorable results for corticosteroids that contrast the established literature, are areas that merit additional examination and insight. Here we aim to highlight these points for consideration, and advocate for the release of supplementary data to facilitate a comprehensive understanding and utilization of this rich dataset.

Background and objectives Osteoporotic vertebral compression fractures, particularly prevalent among the aging population, constitute a pressing global healthcare challenge. They often are unnoticed until severe pain and disability manifest, making them an underdiagnosed and undertreated condition. Patients who suffer from these fractures not only endure excruciating pain but also face diminished quality of life, impaired mobility, and the risk of respiratory compromise due to altered spinal alignment. The economic repercussions of vertebral compression fractures are substantial. Hospitalization costs, rehabilitation expenses, long-term care, and indirect costs related to lost productivity significantly burden healthcare systems and society at large , offering a promising avenue for enhancing patient outcomes and relieving the healthcare and societal financial strain posed by vertebral compression fractures. Kyphoplasty, a minimally invasive surgical technique, offers rapid pain relief, vertebral height restoration and improved function. Recognizing the importance of early intervention, this manuscript highlights the potential of kyphoplasty in mitigating both clinical and economic consequences. By addressing these fractures more effectively, kyphoplasty may potentially reduce long-term healthcare expenses and indirect costs. Material and Methods 66 randomized patients were divided into 2 treatment groups (kyphoplasty using single balloon and double balloon), analyzing radiographic and clinical parameters during 12 months of follow-up. Results Patients treated with double balloon obtained greater anterior and posterior vertebral height after reduction and a better local vertebral angle. Both groups of patients obtained clinical improvement after treatment (VAS and ODI), with no differences between the groups. Conclusion Patients treated with double balloon kyphoplasty had better radiographic results. This revision manuscript delves into the critical dimensions of these fractures, encompassing demographics, clinical consequences, challenges in diagnosis and management, and their profound economic impact. This manuscript serves to introduce an improved kyphoplasty technique to guide to the multifaceted nature of osteoporotic vertebral compression fractures and their management.

Introduction: These days, obesity is considered an important factor for many medical problems such as diabetes mellitus, cardiovascular diseases and joint degeneration. Obesity is one of the leading causes of osteoarthritis and the need for arthroplasty. We aim to study the effect of obesity and the duration of knee replacement surgery.Method: A cross-sectional study was conducted at the orthopedic department between February 2023 and July 2023. We had 68 patients who underwent total knee replacement surgery. Variables like age, gender, smoking history, ASA grade, BMI, and side of injury (unilateral or bilateral) were studied.Results: Out of 68 patients, we had 37 (54.4 %) of patients were female. The most common age group was 44- 54 years. 60.3 % of patients were non-smokers. We had 50 patients with unilateral injury and the rest were bilateral. ASA grade II (51 patients) were more than ASA grade I (17 patients). In this study, 41 patients were obese and the duration for total knee replacement was 90 - 120 minutes, in contrast to overweight patients (75 – 90 minutes) and normal patients (60-75 minutes).Conclusion:We found a significant correlation between BMI and the duration of total knee replacement surgery. The time could be doubled if the arthroplasty was bilateral.

Tendon injuries, while prevalent, present a significant challenge in fully restoring their structural and functional integrity. Utilizing alpha-smooth muscle actin (α-SMA)-Ai9-scleraxis (Scx)-green fluorescent protein (GFP) transgenic mice, which exhibit both Scx (a tendon cell marker) and α-SMA (a myofibroblast marker), we explored Met's effects on tendon healing and repair and its mechanisms of action. Our findings revealed that intraperitoneal (IP) injections of Met -administered before or after injury, as well as both - effectively prevent the release of HMGB1 into the tendon matrix and reduce circulating levels of HMGB1. Additionally, Met treatment increased and activated AMPK and suppressed TGF-β1 levels within the healing tendon. These interventions also improved tendon healing by blocking the migration of α-SMA+ myofibroblasts, reducing the prevalence of disorganized collagen fibers and collagen type III, and enhancing the presence of collagen type I. These outcomes highlight Met's anti-fibrotic properties on acutely injured tendons and suggest its potential for repurposing as a therapeutic agent to minimize scar tissue formation in tendon injuries, which could have profound implications in clinical practice.

The differentiation between Neuromyelitis optica spectrum disorder (NMOSD) and cervical spondylotic myelopathy (CSM) is necessary, because both diseases have similar symptoms, such as motor weakness and sensory disturbances. The challenge arises when NMOSD presents with short-segment spinal cord lesions, which can mimic the clinical presentation of CSM. This case report presents an NMOSD misdiagnosed as CSM. A 66-year-old woman presented with neck pain, left arm pain, and motor weakness. She was initially diagnosed with CSM based on MRI findings that revealed the increased signal intensity of the spinal cord at the C3 to 4 levels and underwent surgery. Three years later, she had sudden left upper extremity motor weakness and mild gait disturbance. Physical exam showed left-side weakness and altered reflexes, with longitudinally extensive transverse myelitis (LETM) findings on cervical MRI. The CSF study revealed a 2+ AQP4-Ab finding. Finally, NMO was diagnosed. Steroid pulsed therapy and immunosuppression therapy led to improved motor function and gait after 20 days. We present a case report of a NMO patient who initially exhibited clinical and radiological features CSM but was later diagnosed with NMO. This case underscores the diagnostic challenge in distinguishing NMO from CSM, especially in elderly patients who commonly experience spinal degeneration leading to cord compression and associated cord signal changes on MRI. The misinterpretation or confusion with transverse myelitis can occur as a result. This case highlights the importance of considering NMO as a potential differential diagnosis in elderly patients with spinal degeneration, emphasizing the significance of precise and timely diagnosis for guiding optimal treatment decisions.

The incidence of articular injury, particularly osteochondral fractures (OCF), has seen a notable increase in recent years. Regardless of their location, fragments might be overlooked by plain radiographs which might lead to osteoarthritis in the long run. Diagnostic imaging has a pivotal role in the assessment and classification of the fracture severity, as well as the presence of any associated dislocations. These fractures require surgical intervention for the restoration of joint function and the reduction of long-term complications. The paper aims to present the surgical correction and post-operative treatment of osteochondral fractures with absorbable implants in three children. Affected areas are discussed as follows: lateral condyle of the femur, patella, and radial head. Utilising absorbable implants for the management of OCFs provides numerous advantages, including the elimination of the need for reanaesthesia and reoperation, reducing complications, and enabling early rehabilitation. This approach also minimises the period of hospitalisation and proved effective in pediatric OCF treatment.

Phantom Limb Pain (PLP) is a challenging condition affecting a significant proportion of amputees. In this article we describe the case of a 54-year-old Paralympic athlete with Phantom Limb Syndrome following right leg amputation and widespread sports-related enthesitic pain, who underwent a Whole Body Cryostimulation (WBC) cycle, an emerging treatment known for its rapid pain-relieving and anti-inflammatory effects. Assessments were conducted before and after a 10-session WBC cycle, including pain and quality of life assessment, and use of medications. A substantial reduction in enthesitic pain, PLP intensity, paresthesia, tingling related to atmospheric events and an improved function and quality of life were reported after the WBC cycle and lasted for two weeks. One month after WBC, the enthesitic pain following sports activity and PLP gradually returned but with lesser intensity. Similarly, the stump's sensitivity to atmospheric changes returned but with lower frequency. Pain at night remained lower than before WBC with significantly improved quality of sleep. This case study suggests that WBC could be a valuable adjuvant treatment for alleviating PLP. Controlled studies are warranted to validate the findings of this case-report and elucidate the mechanisms underlying the positive effects of WBC in this condition.

We investigated the biomechanical behaviour of different fixations of the tibial posterior malleolus (TPM), simulating distinct situations of involvement of the tibiotalar articular surface (TTAS) through a finite element model (FEM). A 3D computer-aided design model of the left ankle was obtained. The materials used were divided according to their characteristics into ductile and non-ductile, and all materials were assumed to be linear elastic, isotropic, and homogenous. Three different fracture lines of the TPM were defined, with sagittal angles of 10º, 25º, and 45º. For biomechanical comparison, different constructions using a trans-syndesmotic screw (TSS) only (Group T), a one-third tubular plate only with (Group PT) and without (Group PS) a TSS, and a locked compression plate with (Group LCPT) and without (Group LCPS) a TSS were tested. FEM was used to simulate the boundary conditions of vertical loading. Load application regions were selected in the direction of the 700N Z axis, 90% on the tibia and 10% on the fibula. Data on the displacement and stress in the FEM were collected, including the total principal maximum (MaxT) and total principal minimum (MinT) for non-ductile materials, total displacement (desT), localized displacement at the fragment (desL), localized displacement at syndesmosis (desS), and Von Mises equivalent stress for ductile materials. The data were analyzed using ANOVA and multiple comparison LSD tests were used. For TPM fractures with a sagittal angles 10º and 25º, desL in the PT and LCP groups was significantly lower, as well as Von Mises stress in Group LCPT in 10º, and PT and LCPT groups in 25º. TPM fractures with a sagittal angle of 45º, desL in the LCP group and Von Mises stress in Group LCPS and LCPT was significantly lower. We found that any TPM fracture may indicate instability of the distal tibiofibular syndesmosis, even when the fragment is small. Our study showed that in fragments involving 10% of the TTAS, the use of a TSS is sufficient, but when the involvement is greater than 25% of the TTAS, either non-locked or locked plate must be used to buttress the TPM. In posterior fragments affecting 45% or more of the TTAS, the use of a locking plate is recommended.

Arthroscopic capsular release (ACR) is used for persistent shoulder stiffness after an index surgery. No cases of post-ACR humeral head osteonecrosis have been reported to date. A 56-year-old male patient underwent open reduction and internal fixation using a hook plate for acromioclavicular joint dislocation. Despite hardware removal, the patient presented with unresolved shoulder pain and range-of-motion (ROM) limitation. He had a history of hypertension, chronic hepatitis B infection, and alcohol consumption. Preoperative ROM was forward flexion 90°and internal rotation sacral level. Preoperative functional status was visual analog scale (VAS) score 4, American Shoulder and Elbow Surgeons (ASES) score 51, and Constant–Murley (CMS) score 48, and normal radiography and magnetic resonance imaging. Standard ACR was performed with 360° release of the joint capsule via electrocautery ablation. Six-months post-ACR, ROM (forward flexion: 135°, abduction: 135°, external rotation: 70°, internal rotation: T10 vertebra) and functional outcomes (VAS 2; ASES79; CMS 75) were significantly improved, without interval change in radiographic assessment. However, 21 months later, he had recurrent shoulder pain and decreased ROM. Radiography revealed humeral head osteonecrosis. Patients with intrinsic or extrinsic risk factors related to humeral head circulation disturbance should be monitored for humeral head osteonecrosis post-ACR.

Background: Menarche as an important parameter in assessment of scoliosis progression in girls is proven to be dependent on geographical latitude. The aim of the study was to determine whether the age of menarche differs in scoliotic and non-scoliotic Balkan girls and the relation between menarche and laterality of scoliotic curves. Participants and methods: Retrospective study with three groups: scoliotic, non-scoliotic and control group. Patients data collection and analysis was approved by the Ethical committee of the Institute. Statistical analysis: Program SPSS 24 was used and included One-way ANOVA, Fisher’s and Chi-squared test to compare different groups. Statistical significance was defined as p<0,05. Results: No statistically significant difference was found in age of menarche between the three groups (p=0,168). In scoliotic postmenarchal group, primary right curve was dominant in 54,80%, while in scoliotic premenarchal group primary left curve was dominant in 60,09% (p<0,01). Conclusion: In Bosnia & Herzegovina and Serbia Balkan girls, there was no significant difference in age of menarche between scoliotic and non-scoliotic girls. A significant difference was found in laterality of primary curve in premenarchal and postmenarchal scoliotic girls.

The anterior cruciate ligament (ACL) injury in the knee is one of the most frequent injuries in the biomechanical environment during jumping exercises; however, repeated jumping, like jumping rope, has not been reported to have a significant impact on the ACL injury. Because of this, this study aimed to compare and examine any potential biomechanical risk factors that can arise during various jumping rope activities, including the basic bounce (BB), forward-backward jump (FB), side-to-side jump (SS), and high knee jump (HK). Thirty participants were recruited. A motion capture system was used to obtain synchronized kinematic and kinetic data for four different jumping rope techniques. The OpenSim modeling system was used to determine the biome-chanical knee factors. The paired samples t-test was used to compare the mean difference in each jumping rope technique of initial contact (IC) and maximum knee flexion (MKF), and a one-way ANOVA was used to compare the mean difference between four different jumping rope techniques in the IC-MKF phase. Between IC and MKF, knee flexion angle, moment, joint ground reaction forces (GRF), and muscle forces of four jumping rope techniques were significantly different (p <.05). Also, in the IC-MKF phase, knee flexion angle and knee extension moment; HK was lower than others; vertical GRF; HK and FB were higher than others; anteroposterior, mediolateral GRF, and muscle forces; SS was higher than others (p <.05). Depending on the jumping rope techniques, the lower knee flexion angle in HK, the higher knee vertical GRF in HK and FB, the higher knee extension moment, anteroposterior, mediolateral GRF, and muscle forces on SS could be a pos-sibility of ACL injury risk compared to others. Therefore, it is recommended that SS be used in risk assessment of ACL in future studies, and BB will be suitable for normal people in daily exercises or will be the alternative intervention program for knee rehabilitation with the lowest risk of injury.

Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal the effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercise. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. DASH score, grip strength, and ROM were significantly improved in the rehabilitation group from that preoperatively at final follow-up. Pain was significantly improved in both groups from that preoperatively at final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms &gt; 12 months between the control and rehabilitation groups at the final follow-up.

Computed tomography (CT) offers detailed insights into the internal anatomy of patients, partic-ularly for spinal vertebrae examination. However, CT scans are associated with higher radiation exposure and cost compared to conventional X-ray imaging. In this study, we applied a Genera-tive Adversarial Network (GAN) framework to reconstruct 3D spinal vertebrae structures from synthetic biplanar X-ray images, specifically focusing on anterior and lateral views. The synthetic X-ray images were generated using the DRRGenerator module in 3D Slicer, by incorporating segmentations of spinal vertebrae in CT scans for the region of interest focussing. The approach leverages a novel feature fusion technique based on X2CT-GAN to combine information from both views and employs a combination of Mean Squared Error (MSE) loss and adversarial loss to train the generator, resulting in high-quality synthetic 3D spinal vertebrae CTs. A total of n=440 CT data were processed. We evaluated the performance of our model using multiple metrics, in-cluding Mean Absolute Error (MAE) (for each slice of the 3D volume [MAE0] and for the entire 3D volume [MAE]), Cosine Similarity, Peak Signal-to-Noise Ratio (PSNR), 3D Peak Sig-nal-to-Noise Ratio (PSNR-3D), and Structural Similarity Index (SSIM). The average PSNR was 28.394 dB, PSNR-3D was 27.432, SSIM was 0.468, cosine similarity was 0.484, MAE0 was 0.034, and MAE was 85.359. The results demonstrated the effectiveness of the approach in reconstruct-ing 3D spinal vertebrae structures from biplanar X-rays, although some limitations in accurately capturing the fine bone structures and maintaining the precise morphology of the vertebrae were present. This technique has the potential to enhance the diagnostic capabilities of low-cost X-ray machines while reducing radiation exposure and cost associated with CT scans, paving the way for future applications in spinal imaging and diagnosis.

Cervical injuries from athletic activities are rare; they can have severe consequences if not diagnosed and managed promptly. The choice of diagnostic imaging modality is pivotal in ensuring timely and accurate diagnosis. We detail the case of a 19-year-old female athlete who sustained a C2 Durel Type II Subclass C fracture during a short-track speed skating championship. Initial evaluation using X-ray imaging at the athletic center medical facility did not detect the injury, allowing her to continue competing. Persistent pain led to further evaluation at our institution, where MRI and CT scans confirmed the fracture. Approximately 45 days post-injury, the patient underwent a successful surgical intervention utilizing O-arm CBCT navigation for C1-C2 dorsal fusion. Post-surgery, she embarked on a comprehensive rehabilitation program and fully recovered within 12 weeks. This case underscores the limitations of relying solely on X-ray imaging for diagnosing cervical fractures post-trauma. Our findings advocate prioritizing CT scans as a primary diagnostic tool in such scenarios, emphasizing the need for a robust diagnostic approach to ensure athlete safety and well.

(1) Background: Patella and achilles tendon injuries have become increasingly prevalent due to an increasingly active population. These injuries can cause significant dysfunction which is especially true for elite athletes. Standard B-Mode ultrasound has been useful in the diagnosis of these injuries, however, only to a limited extent. Shear wave elastography (SWE) can aid in evaluation by objectively measuring tissue stiffness. Prior studies have proven shear wave values can be used to evaluate tendon tissue noting differences in healthy versus pathologic tendons. One main limitation remains a lack of normative data for specific tendon tissues which we aim to address in this study; (2) Methods: A cross-sectional study of healthy volunteers aged 18-65 without lower extremity injury was evaluated using A Samsung RS85 Prestige ultrasound machine with a 14L-2 MHz transducer. Shear wave values were collected in a standardized manner for the patellar tendon at one location, as well as the achilles tendon at the midportion and insertional areas; (3) Results: Data for 54 healthy adult patellar and achilles tendons was collected bilaterally. The mean SWE average of the patellar tendon (P1-P3) for all subjects was 96.3 +/- 10.9 kPA. A higher BMI was correlated with a decrease in patella tendon kPA and the mean PT1 was higher for males compared to females (adjusted mean 96.4 kPA for males and 88.5 kPA for females, mean difference = 7.9 kPA; P = 0.009). The mean SWE average of the insertional Achilles (AT1-AT3) for all subjects was 101.7 +/-16.2 kPA and for the midportion achilles (MTP1-MTP5) was 145.6 +/- 18.8 kPA. There was a decrease in kPA for insertional Achilles measurements in those with a higher BMI, but this did not reach statistical significance (p=.12); (4) Conclusion: This study provides normative SWE values for the patella and achilles tendon using the Samsung RS85. These values can be used for comparison to pathological tissue by means of the same examination protocol to better understand tendon degeneration. Further studies are warranted as to how SWE can be applied to the diagnosis of tendinopathy, partial and full-thickness tears, and response to treatment.

Introduction Despite efforts to use scaffolds to treat meniscus tears, minimal progress has been made in facilitating meniscus regeneration and return of function. Our research objective was to develop a meniscus repair and regeneration implant by applying a resorbable scaffold in combination with cells and growth factors. We report here the results of using platelet-rich plasma (PRP) as a source of growth factors to induce fibrochondrogenic differentiation of human adipose-derived mesenchymal stem cells (hADSC) in a three-dimensional (3D) Type I collagen-based scaffold in vitro. Methods Scaffold Preparation. Type I collagen scaffolds were prepared following a protocol previously published. Two different densities of scaffolds, high density (HD) and low density (LD), were produced for in vitro study. hADSC and PRP Preparation. hADSCs were cultured to the fifth passage to reach the desired number for experimentation. PRP was collected from human blood and activated. Cell Culture Procedure. Effects of PRP on hADSC proliferation and differentiation into fibrochondrogenic cells were examined in four scaffold groups: LD, HD, LD+PRP and HD+PRP. hADSCs were seeded onto scaffolds (n=5) at a concentration of 2 × 106 cells/scaffold. 1% of PRP was added to the experimental media. Cellular proliferation was assessed at 1, 7, 14, and 21 days. Differentiation was measured using qRT-PCR on Days 14 and 21. qRT-PCR analysis of gene expression was completed with primers for COLLAGEN 1 and AGGRECAN. Data Analysis. ANOVAs were conducted (two-tailed tests) at the .05 significance level. Results Cellular proliferation of hADSCs seeded on each scaffold increased over time. Similar trend was observed for cells seeded on HD scaffolds with and without PRP. hADSC showed significant increase in cellular proliferation on the LD scaffolds at Days 1 and 7. At Day 21, PRP treatment and LD scaffold had a synergistic positive effect on Type I collagen gene expression. PRP did not elevate type I collagen gene in the HD group, the HD scaffold alone had the same level of type I collagen gene expression as LD+PRP. Aggrecan expression was elevated in the presence of PRP in both the HD and LD scaffold groups, indicating enhanced fibrochondrogenic differentiation of hADSCs. Effective cell infiltration was observed across both HD and LD scaffolds with and without PRP treatment. HD scaffolds displayed larger cell clusters and more extensive cell migration over time compared to LD scaffolds. However, LD scaffolds resulted a more uniform cellular distribution than HD scaffolds. Conclusion Our study demonstrates that PRP can play an important role in directing hADSCs towards fibrochondrogenic differentiation in Type I collagen-based scaffolds in vitro. Additionally, our study shows that collagen scaffold density can influence the spatial distribution and cellular behavior of infiltrated cells.

Objective: To evaluate the clinical efficacy of antibiotic bone cement plus lateral bone repositioning for severe diabetic foot and its impact on wound healing rate. Methods: Sixty patients with hemodialysis anemia admitted to the endocrinology department of our hospital from July 2020 to July 2021 were included and randomly assigned to receive antibiotic bone cement plus lateral bone repositioning (observation group) or vacuum sealing drainage (VSD) (control group). Outcome measures included skin temperature of the affected limb, ankle-brachial index, sensory threshold, foot wound healing, dorsalis pedis artery hemodynamics, lower limb function and clinical efficacy. Results: Antibiotic bone cement plus lateral bone repositioning resulted in significantly higher treatment efficiency and transcutaneous partial pressure of oxygen, smaller wound, and lower trauma pH versus VSD, suggesting that antibiotic bone cement plus lateral bone repositioning contributes to potentiating the treatment efficacy and reducing the foot ulcer trauma, thereby facilitating rapid recovery. Patients given antibiotic bone cement plus lateral bone repositioning had larger vascular internal diameter and blood flow and better sensory conduction velocity of the common peroneal nerve and the motor conduction velocity of the tibial nerve versus those given VSD, indicating its vascular and neurological benefits. Conclusion: Antibiotic bone cement plus lateral bone repositioning enhances the treatment efficiency, boosts trauma healing, and promotes postoperative functional recovery of patients.

Background and objectives: Unrestricted kinematic alignment total knee arthroplasty (KA-TKA) with a soft tissue respecting technique (STRT) is a soft tissue-dependent tibial resection entailing restoration of the original soft tissue tension using ligamentotaxis after resurfacing the femur, based on the concept of restoring the native or pre-osteoarthritis alignment in each patient. However, there is no consensus on the indications of unrestricted KA-TKA with STRT. We modified the STRT, followed by investigation of the effects of surgery on the postoperative hip-knee-ankle angle (HKAA). Materials and Methods: We retrospectively analyzed the clinical background data, including the preoperative and postoperative HKAA, of 87 patients who underwent unrestricted KA-TKA with the modified STRT. Univariate and multivariate analyses were performed to determine the factors affecting the postoperative HKAA. A receiver operating characteristic (ROC) curve was plot-ted to investigate the change in the cut-off values of preoperative HKAA with respect to the safe zone of the postoperative HKAA. We generated two regression models, the linear regression model and generalized additive model (GAM) using machine learning, to predict the postopera-tive HKAA. Results: Univariate and multivariate analyses revealed the preoperative HKAA as the factor most relevant to the postoperative HKAA. ROC analysis revealed that the preoperative HKAA exhibited high predictive utility, with a cut-off value of -10°, when the safe range of postoperative HKAA was set at ± 5°. The GAM was the superior machine learning model, indicating a non-linear association between the preoperative and postoperative HKAA. Patients with preoperative HKAAs ranging from -18° to 4° were more likely to fall within the ± 5° safe range of the postoperative HKAA. Conclusions: The preoperative HKAA influences the postoperative HKAA in unrestricted KA-TKA with the modified STRT. Machine learning using the GAM may contribute to the selection of patients eligible for the surgical approach.

Hip replacement has significantly improved the quality of life of patients with symptomatic hip osteoarthritis. Metal-on-metal (MoM) bearings have been used with conventional total hip re-placement (THR) for several decades with promising results from early applications. Wear and corrosion of these implants may lead to a release of metal products into surrounding tissue and body fluids. From the 1980s onwards, the search for increasingly better coupling materials with low levels of wear led to the rise of hard-on-hard couplings such as ceramic-on-ceramic (CoC). The latter is currently the coupling with the longest known duration and with a wear rate close to zero. MoM coupling has been for a long time the most significative alternative, but systemic and local complications linked to the release of chromium and cobalt ions, determine the withdrawn from the market. One other alternative proposed over the time has been Ceramic-on-Metal (CoM) bearing. Preliminary results have been described as favourable, but due to the failures of metal on metal it has been withdrawn from the market, without causing significant clinical complications. In this narrative review, we analysed risks and benefits associated with the implantation of hybrid hard-on-hard bearings, such as CoM.

Introduction and Problem: With conventional mechanical rotation measurement of joints, only static measurements are possible with the patient at rest. In the future, however, it would be interesting to carry out dynamic rotation measurements, for example when walking or doing sports. Therefore, a measurement method with an elastic capacitive measuring system was developed and validated. Material and Methods: The measurement system consists of a capacitive strain gauge connected to a flexible printed circuit board. The electronics on the printed circuit board are used for data acquisition and transmission. When the sensor strip is stretched, the distance between the fingers of the strain gauge changes and with it the capacitance. Consequently, the strain can be measured via the change in capacitance. The measurement system is taped to the knee with the sensor on the skin in the direction of the anterolateral ligament (ALL). The bottom of the sensor (silicone) and the bottom of the circuit board are in contact with the knee surface. The sensor must be attached to the knee without pre-stretching The system is validated with an in vivo test on 11 patients. For this purpose, the internal rotational laxity of the knee was tested on healthy volunteers and the results compared with the measurements on the static measuring device (Laxitester). The subjects are placed in the supine position. First the left and then the right leg is clinically examined one after the other and documented using an examination form. Exclusion criteria are the presence of a pathological ligament findings in the area of the collateral/cruciate ligaments, previous knee operations or limitations in the range of motion. The distal thigh rests on a support bench on which a knee joint flexion of 30° is set by height adjustment. The femoral condyles are secured against rotation in the positioning aid by posts. This also prevents internal rotation and displacement of the thigh. The foot is strapped into the holding device without shoes. The second toe beam is centered using an adjustable side clamp on the medial and lateral edge of the foot. Dorsiflexion is set at 2 Nm with a torque meter, in accordance with previous studies, to rule out rotational laxity in the ankle. The strain gauge sensor is taped to Gerdii’s tubercle in the course of the antero-lateral ligament below the lateral epicondyle of the thigh. Then, in three repeated measurements, the internal rotation of the foot and thus the lower leg is measured with a torque of 2 Nm. The change in length of the stretch mark is compared with the measured internal rotation angle in the static measuring device (Laxitester). Results: A significant difference between the sexes was found in the internal rotation range of the knee (p=0.003). The range of rotation was greater for female participants than for male participants. Regarding the measured length change values, the measurements presented showed an individual result for each participant, which tended to decrease with increasing internal rotation angle, with no age or gender differences being observed. The stiffness of the strain gauge was in the linear range for all measurements, within the first 20% strain of the sensor. The differences determined do not result from a different stretching of the sensor, but from individual differences between the test persons. The comparison between length change and internal rotation angle of the knee showed a strong positive correlation (r=1, p&lt;0.01). Conclusion: Elastic capacitive strain gauges can be used to reliably measure the internal rotation angle of the knee joint. This will allow dynamic measurements in the future.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings emphasized a significant disparity in the occurrence and characteristics of these fractures, as multiple studies have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the research has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This research provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

Autologous micrografting technology (AMT®) involves the use of autologous micrografts to stimulate/enhance the repair of damaged tissue. This study assessed the efficacy and safety of the AMT® procedure in patients with early stages of knee osteoarthritis. Briefly, the AMT® procedure involved extraction of auricular cartilage, disaggregation using the Rigeneracons® SRT in 4.0 mL of saline solution and injection of the disaggregated micrografts into the external femorotibial compartment area of the affected knee. Ten patients (4 men, 6 women; age range: 37─84 years) were included in the study. In all patients, there was a steady improvement in knee instability, pain, swelling, mechanical locking, stair climbing and squatting at 1- and 6-months post-procedure. Improvement in mobility was observed as early as 3 weeks post-procedure in 2 patients. Significant improvements were seen in mean scores of all five subscales of Knee Injury and Osteoarthritis Outcome Score (KOOS [KOOS symptoms, KOOS pain, KOOS ADL, KOOS sport and recreation, and KOOS quality-of-life]) between pre-procedure and 1- and 6-months post-procedure (all p≤0.05). Autologous auricular cartilage micrografts obtained by AMT® procedure (using Rigenera® technology) is an effective and safe protocol in the treatment of early-stage knee osteoarthritis. These encouraging findings need to be validated in a larger patient population.

Background and Objective: There is a paucity of literature comparing unilateral instrumented transforaminal lumbar interbody fusion (UITLIF) with bilateral instrumented TLIF (BITLIF) regarding radiological alignment, including the coronal balance, even though UITLIF might have asymmetric characteristics in the coronal plane. This retrospective study aimed to compare the clinical and long-term radiological outcomes of 1-level UITLIF and BITLIF in lumbar degenerative diseases (LDD). Materials and Methods: Patients who underwent 1-level UITLIF with two rectangular polyetheretherketone (PEEK) cages or BITLIF with ≥ 5 years of follow-up at a single hospital were included. We compared the clinical and radiological outcomes between the UITLIF and BITLIF. Results: In total, 63 and 111 patients who underwent UITLIF and BITLIF, respectively, were enrolled. The median follow-up was 85.55 months (range: 60–130). The UITLIF group had a significantly shorter operation time (185.0 [170.0–210.0] vs. 225.0 [200.0–265.0], p &lt; 0.001) and lower estimated blood loss (300.0 [250.0–500.0] vs. 550.0 [400.0–800.0], p &lt; 0.001) than BITLIF group. Regarding the clinical outcomes, there were no significant differences in the intermittent claudication score (p = 0.495) and Kirkaldy–Willis criteria (p = 0.707) at 1 year postoperatively. The interval changes of the local coronal Cobb angle at the index level, L1-S1 lordotic angle, and coronal off-balance from the immediate postoperative radiograph to the last follow-up were not significantly different (p = 0.687, p = 0.701, and p = 0.367, respectively). Conclusion: UITLIF with two rectangular PEEK cages is a viable option for providing comparable clinical outcomes and radiological longevity to BITLIF in 1-level LDD. In addition, UITLIF has advantages over BITLIF in terms of operative time and blood loss.

Different bone bruise patterns observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) rupture and lateral patellar dislocation may indicate different injury mechanism of knee. In order to investigate the typical bone bruising patterns after ACL rupture and patellar dislocation. In this study, 77 ACL rupture and 77 patellar dislocation patients’ knee MR images with bone bruises between August 2020 and March 2022at our institution were selected and analyzed, respectively. Sagittal and transverse planes images were used to determine the bone bruise location in the lateral-medial and superior-inferior directions of the MR images. The presence, location, and intensity of the bone bruises within specific compartments of the femur and tibial after ACL rupture and patellar dislocation were recorded. Relative bone bruise patterns of the ACL rupture and patellar dislocation were classified and analyzed. Results showed that there were 4 kinds of bone bruise (1-,2-,3-,4- bone bruises) patterns after ACL rupture. The most common two patterns after ACL rupture were 3- bone bruises (including lateral side of femur and both lateral and medial side of tibia, LF+BT; both lateral and medial side of femur and lateral side of tibia, BF+LT, medial side of femur and both lateral and medial side of tibia, MF+BT) followed by 4- bone bruises (both lateral and medial side of femur and tibia, BF+BT), 2- bone bruises (LF+LT, lateral side of femur and tibia; MF+LT, medial side of femur and lateral side of tibia; LF+MT, lateral side of femur and medial side of tibia; MF+MT, medial side of femur and tibia; 0+BT, both lateral and medial side of tibia;), and 1- bone bruise (0+LT, only lateral side of tibia). There was only 1 pattern bone bruise (latera femur and medial patella bone bruise) of patellar dislocation, the most common pattern of patellar dislocation was in the inferior medial patella and lateral anterior inferior femur. The results suggest that the pattern of bone bruise after ACL rupture and patellar dislocation is completely different. There were 4 kinds of bone bruise patterns after non-contact ACL rupture while there was only 1 kind of bone bruise pattern after patellar dislocation bone bruise patients which was in the inferior medial patella and lateral anterior inferior femur.

(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. The study evaluated stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS – 33.76 ± 7.78, HS – 29.75 ± 7.45, p&lt;0.001; indentometry: SS – 59.73 ± 33.93, HS – 4.18 ± 12.69, p=0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter’s elasticity (SS – 0.101 ± 1.09, HS – -0.006 ± 0.29, p=0.416), cervical spine mobility (lateral flexion: SS – 37.08 ± 8.15, HS – 37.73 ± 7.61, p=0.559; rotation: SS – 73.55 ± 12.37, HS – 72.85 ± 11.10, p=0.660) and algometry (SS – 36.41 ± 17.53, HS – 37.22 ± 17.00, p=0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.

Incobotulinumtoxin A and Yoga-like Isometric Exercise in Adolescent Idiopathic Lumbar Scoliosis – a randomized pilot study Abstract: Background: Approximately 90% of scoliosis is adolescent idiopathic (AIS). From its first appearance at 10-14 until age 18 it is most vulnerable to deterioration; young people are most susceptible to the condition worsening. An effective non-surgical means of remediation would be welcome. Design: Randomized control two-arm study, assessing the safety and efficacy of combining incobotulinum injections with yoga to reverse lumbar and thoracolumbar AIS. Methods: In a private clinic setting, non-pregnant healthy 12 – 18 year-olds were either taught a symmetrical “placebo” yoga pose (control sub-group 1), given the side plank (Vasisthasana) done thrice daily with placebo injection (control sub-group 2) or given the thrice-daily side-plank with botulinum injection (Intervention group 3). Injection: 33 IU of incobotulinum toxin type A (Xeomin) injected into concave-side lumbar paraspinals and quadratus lumborum at L2-3 and the psoas muscle at L3-4, or injected similarly with placebo. Randomization by Random.com. Objective: Assess whether muscular asymmetry treated with botulinum toxin injection and the side-plank are safe and effective in AIS.Results: Outcome: Twelve intervention and 12 placebo patients (Groups 1 + 2), 12 -18 years old completed the three-month study period. Mean daily side-plank time = 165 seconds. Mean initial lumbar curvature was 36.9 degrees (SD 14.36), (p<0.0001); mean curvature at 3 weeks was 29.5 degrees. (SD 14.23) (p<0.0001); mean curvature at 3 months was 26.0 degrees (SD 12.81) Onset vs 3-month value: p<0.0001. Two patients in Group 3 complained of shoulder pain, and 2 of wrist pain that resolved when the side-plank was done on the elbow. Conclusion: Muscle asymmetry appears relevant to AIS treatment. Incobotulinum injections combined with the side-plank done with the convex side downward may be safe and helpful in adolescent idiopathic lumbar scoliosis.

Sacroiliac (SI) joint dysfunction can lead to debilitating pain but can be treated with minimally invasive sacroiliac joint fusion (SIJF). This treatment is commonly performed using 2D fluoroscopic guidance. This makes placing the implants without damaging surrounding neural structures challenging. Virtual surgical planning (VSP) using simulated fluoroscopic images may improve perioperative guidance. This article describes a workflow with VSP in SIJF using simulated fluoroscopic images and evaluates achieved implant placement accuracy. Routinely collected survey data on the added value of VSP were also evaluated. Ten interventions were performed on 10 patients by the same surgeon, comprising 30 implants; the median age was 39 years, and all patients were female. The overall mean implant placement accuracy was 4.9 ± 1.26 mm and 4.0 ± 1.44°. There were no malpositioning complications. The VSP helped the surgeon understand the anatomy and determine the optimal position and length of the implants. The average Likert scale score of the survey was 4.7, suggesting a positive role of VSP for SIJF. Planned positions of the implants could be reproduced in surgery with clinically acceptable accuracy and VSP was a valuable asset for the surgeon.

Syndactyly is the most common congenital malformation of the hand, leading to the fusion of the digits, frequently affecting the ring and middle fingers. The incidence is one out of 2500 children, predominantly occurring in boys and Caucasians. Clinically, the malformation may present as soft tissue or bony fusion, resulting in the union of the fingers characterised as complete or incomplete. This fusion may involve the phalanges but may also extend to the carpal/tarsal bones, even to the metacarpal’s or metatarsal’s level, rarely to the distal end of the forearm and lower leg. Mostly isolated but may occur together with other disorders or malformations such as synostosis, acro-syndactyly, cleft hand, clinodactyly, or polydactyly. Syndromic syndactyly can be observed in cases of Apert Syndrome, Poland’s Syndrome, Pfeiffer Syndrome and many others. A girl born in June of 2019 was diagnosed with congenital malformation of the right hand at birth —affecting the right middle, ring and little fingers, respectively. After X-ray imaging, the fusion of the third and fourth proximal phalanges to a common metacarpal was identified, forming a unique diagnosis of clino-syndactyly with metacarpal aplasia. Surgical intervention was advocated for, including a wedge osteotomy to correct the synchondrosis at the phalangeal base and a dorsal flap to close the interdigital space created during the correction of the III and IV. fingers. A trapezoid flap for the release of the syndactyly of the IV and V. fingers was applied. The paper aims to present the surgical correction and its results regarding an atypical case of syndactyly with clinodactyly and metacarpal aplasia.

Diagnosing cervical foraminal stenosis with intermittent arm radiculopathy is chal-lenging due to discrepancies between MRI findings and symptoms. This can be attributed to the fact that MRI images are often obtained in a relaxed supine position. This study aims to evaluate the feasibility of the Dynamic MRI Compression System (DMRICS) and to assess possible changes in cervical foramina, with both quantitative measurements and qualitative grading systems, with MRI during a simulated Spurling test. Ten patients (5 women and 5 men, ages 29-45) with previously confirmed cervical foraminal stenosis underwent MRI scans using DMRICS. MRIs were acquired in both relaxed and provoked states. A radiologist assessed 30 foramina (C4-C7) on the symptomatic side in both patient positions. Quantitative and qualitative measures were performed including the Numeric Rating Scale (NRS) and the Park and Kim grading systems. The provoked state induced concordant neck and arm pain in 9 of 10 patients. Significant shifts in Park and Kim fo-raminal gradings were noted: 13 of 27 Park gradings and 9 of 27 Kim gradings escalated post-provocation. No quantitative changes were observed. This pilot study indicates that the DMRICS device has potential to improve diagnostic accuracy for cervical radicu-lopathy, demonstrating induced cervical foraminal changes during a simulated Spurling test while performing MRI.

Rehabilitation after rotator cuff repair is crucial for functional recovery and for minimizing the risk of retear. There are two rehabilitation protocols (early and traditional) and the debate about which is the best is still open. This umbrella review aimed to compare the effect of these rehabilitation protocols in terms of reduction of pain, functional recovery and retear risk. We selected systematic reviews and meta-analyses published between 2012 to 2022 dealing with the aim. Nineteen systematic reviews were included. No significant differences were found between early and traditional protocols in terms of pain reduction. Early rehabilitation provided better short-term results regarding Range of Motion improvement, but long-term functional outcomes were similar. Retear risk remains a significant concern for the early protocol. We found major differences between the analyzed protocols. This review suggests that both protocols are useful to recover global shoulder function, but the standard protocol has a greater safety profile for larger tears. On the other hand, the early protocol may be preferable for smaller lesions, allowing a faster recovery and having less impact on medical costs. Further research is needed to identify optimal rehabilitation strategies tailored to the individual patient's needs and characteristics.

Articular cartilage injuries are found in up to 60 % of patients who undergo an arthroscopic knee procedure, those that totally affect articular cartilage (grade IV) have limited regenerative capac-ity and extended time for recovery, 3-D scaffolds represent a novel solution to address this type of injury. Our purpose was to analyze MRI findings and functional status of patients that underwent repair of chondral defects either by microfractures or Hyaluronan (HA) 3-D Scaffold. We con-ducted a retrospective study of patients with chondral defects. The outcomes analyzed in this study included anatomical changes envaulted by the Henderson score (based on MRI findings) at baseline, 6, and 12 months after surgery; and improvement in functionality, evaluated by the Modified Cincinnati Knee Rating System (MCKRS) at baseline and 6 months after surgery. Clini-cal and demographic characteristics were similar for both groups. There was a statistically sig-nificant improvement in Henderson score for the 3-D scaffolding treated group at 6 months, ver-sus the microfracture group (p < 0.0001). Improvement in functionality, measured by MCKRS was more frequently found in the 3-D scaffold treated group. In conclusion the use of HA 3-D scaf-folding was superior with faster recovery, evident after 6 months of the surgery, that progress to full recovery in all patients after a year of surgery. Future studies with a randomized design might help to sustain our findings. This study provides a level III of evidence.

Humeral resurfacing arthroplasty (HRA) entails the substitution of the articular surface alone with a prosthetic cap without stem. It is a more conservative procedure which can be easily converted in a total arthroplasty if necessary. The present study aimed to evaluate the clinical and radiographical outcomes in a series of patients treated with HRA. 33 patients with a mean fol-low-up of 11 years were clinically (Constant score; Disability of the Arm, Shoulder and Hand score, DASH) and radiographically assessed before and after surgery. Constant and DASH score improved significantly after surgery, and only 2 cases needed revision surgery. HRA represents a valid therapeutic option in selected cases to improve the quality of life and delaying the need for more invasive procedures.

Background and Objectives: C-arm free MIS techniques can offer significantly reduced rates of postoperative complications such as blood loss and hospitalization time. Another advantageous long-term aspect is the notably diminished exposure to radiation which is known to cause ma-lignant changes. This study emphasizes that, in some cases of spinal conditions which require a procedural intervention, C-arm free MIS techniques hold stronger indications than open surgeries guided by image intensifier. Materials and Methods: In this research, a retrospective analysis and review of various cervical and thoracic spinal procedures, performed in our hospital, by applying C-arm free techniques. The course of the study explains the basic steps of the procedures and demonstrating postoperative or intra-operative results. For anterior cervical surgery, we performed OPLL resection, while for posterior cervical surgery, we performed posterior fossa decompression for Chiari malformation, minimally invasive cervi-cal pedicle screw fixation (MICEPS) and modified Goel technique with C1 lateral mass screw for atlantoaxial subluxation. Re-garding the thoracic spine, we performed anterior correction for Lenke type 5 scoliosis, and transdiscal screw fixation for DISH fractures. Results: C-arm free techniques are safe procedures that offer precise and high-quality postoperative results by offering sufficient spine alignment and adequate decompression depending on the case. Blood loss, postoperative pain and wound infection are other important aspects of spine surgery that must be always taken into consideration. Conclusions: Navigated C-arm free techniques are safe and precise procedures implemented in the treatment of surgically demanding conditions. They can significantly increase accuracy while decreasing the operative time. They represent the advancement in the field spine surgery and are hailed as the future of the same

We overview recent findings achieved in the field of model-driven development of additively manufactured porous materials for development of a new generation of bioactive implants for orthopedic applications. Porous structures produced of biocompatible titanium alloys by selective laser melting can present a promising material to design scaffolds with regulated mechanical properties and with capacity to be loaded with pharmaceutical products. Adjusting pore geometry, one could control elastic modulus and strength/fatigue properties of the engineered structures to be compatible with bone tissues, thus preventing the stress shield effect when replacing a diseased bone fragment. Adsorption of medicals by internal spaces would make it possible to emit the antibiotic and anti-tumor agents into surrounding tissues. We critically analyze the recent advances in the field featuring model design approaches, virtual testing of the designed structures, capabilities of additive printing of porous structures, biomedical issues of the engineered scaffolds and so on. A special attention is paid to highlight the current troubles in the field and the ways of their solutions.

The purpose of this study was to determine the effects of aerobic exercise on carotid to femoral pulse wave velocity (cf-PWV), cell adhesion molecules (intracellular adhesion molecules (ICAM-1), vascular cell adhesion molecules (VCAM-1), and endothelial selectin (E-selectin), and oxidized-LDL in elderly women aged 70–85 years, and to identify the effect of and correlation with vascular stiffness. Forty participants were recruited and divided into three groups; vascular stiffness (VSG, n=14), obesity (OG, n=14), and normal (NG, n=12). All groups were given a 16-week intervention of aerobic exercise, and the data collected before and after exercise were analyzed using SPSS Ver. 23.0. Two-way repeated-measures ANOVA was used to evaluate between-group and time-dependent interaction effects. One-way ANOVA was used to evaluate between-group variations. In addition, the significance was tested using a post-hoc test (Scheffe). The within-group variations by time before and after exercise were examined using a paired t-test, and correlation analysis was performed using Pearson correlation coefficients. Simple regression analysis was performed for variables showing significant differences. The results indicated interaction effects for cf-PWV (p<.001), VCAM-1 (p<.01), E-selectin (p<.05) and oxidized LDL (p<.001). The rate of change of cf-PWV was positively correlated with that of VCAM-1 (r=.352, p<.05) and that of oxidized-LDL (r=.325, p<.05) with statistical significance. To determine the effect of the rate of change of cf-PWV on the rate of change of VCAM-1, the variables were tested, and the coefficient of determination in the regression analysis was .124, indicating that 12.4% of the tested variables fit the standard regression line. The variables for the effect of the rate of change of cf-PWV on the rate of change of oxidized LDL were also tested, and the coefficient of determination in the regression analysis was .106, indicating that 10.6% of the tested variables fit the standard regression line. Thus, the 16-week regular and consistent aerobic exercise program had significant effects on the cf-PWV, ICAM-1, VCAM-1, E-selectin, and oxidized-LDL in elderly Korean women with vascular stiffness, suggesting improvements in vascular stiffness, based on which the intervention is predicted to contribute to the prevention of vascular dysfunction by lowering the risk of cardiovascular disease due to atherosclerosis, as well as having a positive effect in the prevention of impairment of vascular endothelial cells.

Obtaining a proper position for THA’s components is a crucial aspect for the implant perfor-mance and consequently patient outcomes. Patient specific kinematic seems to be a key factor to reach the optimal implant positioning. The aim of this study was to assess the accuracy and safety of a computed dynamic analysis system which through patient specific guides tries to improve implant positioning and functional orientation according to patient’s spinopelvic mobility and anatomy.A total of 100 consecutive patients were prospectively enrolled. All patients received an OPS dynamic hip preoperative planning. A TC scan protocol follow up analysis has done at 6 month after surgery.The mean deviation from the planned acetabular inclination and anteversion was 4.3° e 3.8° respectively. The 98% of cases was within +/- 10° of Lewinnek safe zone both for inclination and anterversion. The height of osteotomy deviated on the average of 1.6mm. The 100% cases were included within 4mm of osteotomy. Patient specific and laser guided instru-mentation is safe and accurately reproduce the dynamic planning in terms of components orien-tation, osteotomy level, leg length and offset.

This study aimed to translate and psychometrically validate the Neck Outcome Score (NOOS) in the Polish population according to the recommendations of American Academy of Orthopedic Surgeons (AAOS) for the Cross-Cultural Adaptation of Health Status Measures. Participants completed the NOOS, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) for pain assessment. The questionnaires were completed by 57 women and 32 men with cervical spine ailments. A retest was performed in all patients after 48 hours. The analysis confirmed the high internal consistency (Cronbach's alpha of 0.95) of the Polish NOOS. No floor / ceiling effects were observed. The Polish NOOS showed a significant correlation with NDI (0.87; p<0.001) and VAS (0.79; p<0.001). The intraclass correlation coefficient (ICC) for the test-retest was found to be high (0.97). The Polish version of NOOS can be used for clinical and research purposes as an equivalent to the original English version. This study contributes to the area of patient-reported outcome measures available in the Polish language.

This article is a commentary on the publication Guo J, Hai H, Ma Y. Application of extracorporeal shock wave therapy in nervous system diseases: A review. Front Neurol. (2022) 13:963849. doi: 10.3389/fneur.2022.963849 (1). In the opinion of the authors of this commentary the information provided in the Section "Principles of ESWT" in (1) is partly incorrect and misleading. This is due to the fact that important, published knowledge regarding focused extracorporeal shock wave therapy (fESWT) and radial extracorporeal shock wave therapy (rESWT) was disregarded in (1).

Introduction: Suicide is the second leading cause of death among 15 to 19-years-olds in Europe. From the beginning of COVID-19 pandemic, literature confirms a significant increase in mental health disease in children and adolescents. At Bambino Gesù Pediatric Hospital emergency department (Rome, Italy) there was a dramatic increase of suicidal attempts, and particularly a rise of suicidal jumpers. Many of these patients presented vertebral fractures. Material and Methods: This retrospective study includes all suicidal jumpers with vertebral fractures treated at our Pediatric Hospital from April 1, 2017 to March 31, 2023. We collected and compared data from three years before to three years after pandemic spreading analyzing vertebral fractures. Results: From April 1 2019 to March 31, 2020 141 cases of suicide attempt arrived at Bambino Gesù Pediatric Hospital emergency department. Five of these patients were suicidal jumpers but none had a vertebral fracture. From April 1, 2020 to March 31, 2023, 362 cases of suicide attempts arrived in the same emergency department and 19 were suicidal jumpers; 12 reported vertebral fractures and were included in this study. Mean age was 14 years. Most common level of fracture was L1. Four patients presented with preoperative neurologic impairment and two cases recovered completely. There was a transforaminal sacral fracture, a spinopelvic dissociation and an Anderson-D’Alonso C2 type II fracture. Two cases with thoracolumbar vertebral fractures were conservatively treated. Seven patients were treated by percutaneous pedicle fixation to achieve an indirect decompression and to restore a better sagittal balance. Only three patients needed an open spinal surgery by posterior approach and in two cases a posterior decompression was performed. One case with cervical fractures was treated by Halo-Vest. Conclusions: Recent literature highlights concern about the consequences of COVID-19 pandemic on pediatric population mental health. This is the first report that shows a significant increase in vertebral body fractures due to suicide jumping attempt. The comparison between three years pre and post pandemic is sufficient to demonstrate a sharp increase of these cases. This could be a new epidemiological phenomenon that could persist or even increase over time because of COVID-19 pandemic.

Background: Calcaneal fractures are the most frequent traumatic injuries of the hindfoot and can cause severe disability with social and economic sequelae; since 1980 an increasing number of studies and new technologies have led to an improvement in their management and complications but treatment is still controversial. The purpose of the study to review the secondary scientific literature looking for the optimal management of calcaneal fracture; Methods: through the PubMed MEDLINE database, 4856 articles were identified; only meta-analyses and systematic reviews were included in the study. Results: 59 reviews with more than 10,000 calcaneus fractures were examined and results were divided into various topics; the majority of articles agree on the superiority of surgical versus conservative treatment; minimally invasive access to the sinus tarsi shows better results and fewer complications than traditional extended lateral access; reduction and osteosynthesis with percutaneous and/or minimally invasive techniques seem to provide better outcomes if compared to open treatments. Conclusions: The management of calcaneus fractures requires an individualized planning based on the functional demands of the patient, the type of fracture and associated injuries. New technologies and further studies may still improve the management of these lesions.

Background: Recent advances allow the usage of Augmented Reality (AR) for many medical procedures. We perform different AR-assisted knee surgery techniques using optical surgical navigation with ArUco-type artificial marker sensors. Our study aimed to evaluate the system’s accuracy using an in vitro protocol. We hypothesised that the system’s accuracy was equal to or less than 1mm and 1° for distance and angular measurements, respectively. Methods: Our research was an in-vitro laboratory with a 316 L steel model. We evaluated absolute reliability according to the Hopkins criteria with seven independent evaluators. Each observer measured the thirty palpation points and the trademarks to acquire direct angular measurements on three occasions separated by at least two weeks. Results: The accuracy of the system to assess distances had a mean error of 1.203mm and an un-certainty of 2.062, and for the angular values, a mean error of 0.778° and an uncertainty of 1.438. The intraclass correlation coefficient was for all intra-observer and inter-observer almost perfect or perfect. Conclusions: The mean error for the distance’s determination has been statistically larger than 1mm (1.203mm) but with a trivial effect size. The mean error assessing angular values was sta-tistically minor than 1°. Our results are similar to those published by other authors in accuracy analyses of AR systems.

The COVID-19 pandemic has caused unprecedented challenges in the care of children with cerebral palsy (CP) and other neuromuscular complex chronic conditions (NCCC). The purpose of this study was to explore the direct impact of the COVID-19 pandemic on healthcare delivery. From May to August 2020, medical professionals caring for CP and NCCC patients across multiple countries and disciplines completed a self-administered cross-sectional survey comparing practices before and during the COVID-19 pandemic. Of the 79 healthcare workers from 8 countries who participated—predominantly pediatric orthopedic surgeons (32%), pediatricians (30%), and pediatric physiatrists (23%)—most felt that caring for NCCC patients during the pandemic presented with unique difficulties and reported a significant decrease in in-person NCCC clinic volume (p<0.001), multidisciplinary appointments (p<0.001), surgical cases (p=0.005), and botulinum toxin/phenol injections. Most providers affirmed that institutional guidelines for perioperative emergent/urgent and elective procedures, workplace settings, and technology were modified to accommodate the ongoing public health crisis. Usage of telemedicine significantly increased for NCCC patient visits (p<0.001). During the COVID-19 pandemic, many children with NCCC lost access to routine, multidisciplinary care. Telemedicine became an integral part of communication and management. In the setting of the COVID-19 pandemic and threat of future healthcare disruptions, these data lay the foundation for trending the evolution of healthcare delivery and accelerating best practice guidelines for children with CP and NCCC.

Purpose: The study aimed to investigate the efficacy of TXA supplemented with local infiltration analgesia (LIA) in reducing blood loss in patients undergoing total knee replacement. Materials: A retrospective study on 530 individuals with a mean age of 71,44 years after posterior stabilized total knee arthroplasty was evaluated. Patients were divided into three groups, corresponding to the method of bleeding control: I - patients without additional bleeding protocol (control group); II - patients with iV TXA administration (TXA group); III - patients with exact TXA protocol combined with intraoperative local infiltration analgesia (TXA + LIA group). Blood loss was measured as a substitute for blood loss by maximal Hb drop compared to preoperative Hb level. Results: The mean hospitalization for patients from the control group was 7.02 (SD 1.34) days, 6.08 (SD 1.06) days for the TXA group, and 5.56 (SD 0.79) for the TXA + LIA group. The most significant hemoglobin drop was found in the control group, which amounted to an average of 30.08% output value. In the TXA group, the decrease in hemoglobin was, on average, 25.17% (p<0.001), and in the TXA + LIA group, it was 23.67% (p<0.001). A decrease in the rate of allogeneic blood transfusions was observed, which was 24.4% in the control group, 9.9% in the TXA group, and 8% in TXA + LIA group (p<0.01). Conclusions: Compared to the separate administration of tranexamic acid, the combination of perioperative administration with local infiltration analgesia statistically significantly reduces blood loss in patients after total knee replacement.

Background: Arthroscopic revision rotator cuff repair (ARRCR) is challenging. Biologic strategies seem to be promising. The aim was to evaluate the effectiveness of combination of microfractures of the greater tuberosity, augmentation with collagen patch graft, and platelet concentrate injections in ARRCR. Methods: A retrospective comparative study was conducted on patients that underwent ARRCR with minimum two-years follow-up. Patients in the augmentation group underwent ARRCR combined with microfractures, collagen patch graft, and postoperative subacromial injections of platelet concentrate. A standard rotator cuff repair was performed in the control group. Primary outcome: Constant Murley score (CMS). Secondary outcomes: disease-specific health-related quality of life by using the Disabilities of the Arm, Shoulder and Hand (DASH) score; assessment of tendon integrity with magnetic resonance at least six months after surgery. Significance was set at p < 0.05. Results: Forty patients were included. Mean follow-up was 36.2 + 8.7 months. The mean CMS was greater in the augmentation group (p = 0.022). No differences could be found for DASH score. Healing failure rate was higher in the control group (p = 0.002). Conclusion: Biologic augmentation of ARRCR by combination of microfractures, collagen patch graft and subacromial injections of platelet concentrate is an effective strategy in improving tendon healing rate.

Objectives: The aim of our study was to evaluate patients after suicide attempts treated at the Department of Trauma Surgery for Children before and after the outbreak of the Covid-19 pandemic. Material and methods: Retrospective review of the medical database at equal time intervals of 24 months to identify patients treated before and after the COVID-19 was done. Thorough analysis including injury mechanism, medical procedures, history of previous mental disorders or suicidal behavior was performed. Furthermore, results were compared with the Polish police suicide statistics. Results: Based on our retrospective review we found 4 patients treated in our department before the pandemic and 10 patients treated after COVID-19 outbreak. The group before SARS-Cov-2 era consisted of three girls and one boy with a mean age of 14.97 (12.7-17.6). The group treated in the pandemic crisis consisted of 8 boys and 2 girls, the mean age was 15.49 (10.8-17.2). In the pre-COVID-19 group, 2 out of 4 patients had received psychiatric treatment before, but none had attempted suicide before. In the COVID-19 group, 6 out of 10 patients had previously received psychiatric treatment, moreover 3 of them attempted suicide before. Based on our analysis, the number of individuals who displayed suicidal attempts has raised. Between 2018 and 2021 the largest number of suicides concerned the 13-18 y.o. group, both for the Silesian Voivodeship (H=9.374; p=0.0092) and for the whole country (H= 10.203; p=0.0061). Conclusions: 1. Results of our study indicate that the pandemic may have caused a wide range of negative mental health consequences for young individuals; 2. During the SARS-Cov-2 era, we observed an alarming 2.5-fold increase in the number of patients treated after suicide attempts at the children's orthopedic trauma department; 3. Suicide attempts in children are often related with high energy trauma.

The knowledge on anatomy, function, biomechanics, and role on surgical procedures of the anterolateral ligament (ALL) of the knee is still controversial. Only a few papers have examined the ALL in children. The aim of this review is to analyse all the available literature about ALL in pediatric population. Following the PRISMA criteria, the literature was systematically reviewed, examining all the articles about ALL in pediatric patients. Eight articles were involved in the study. Five cadaveric studies, 2 diagnostic studies and 1 Cross-sectional study were found. The identification of the ALL is not always possible in diagnostic studies using the Magnetic Resonance (MRI) or in dissecting specimens. A high variability in the presence of the ligament, in its origin and insertion were found among the studies. In younger patients is more difficult to identify the ligament than in older children, suggesting that its presence may develop at some point during the growth. Further studies are needed for a detailed knowledge of the ALL.

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as “comfortable” were defined as the “comfort” group; others were placed in the “discomfort” group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the "comfort" and "discomfort" groups, respectively. Patients in the "discomfort" group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

Background: Our objective was to conduct a comprehensive analysis of the reproducibility of foot and ankle anthropometric measurements with a three-dimensional (3D) optical scanner. Methods: We evaluated thirty-nine different anthropometric parameters obtained with 3D Laser UPOD-S Full-Foot Scanner in a healthy population of twenty subjects. We determined the variance of the measurements for each foot/ankle, and the average variance among different subjects. Results: For 40 feet and ankles (15 women and 5 men; mean age 35.62 +/- 9.54 years, range 9-75 years), the average variance was 1.4 ± 2 (range 0,1 to 8). Overall, the mean absolute measurement error was < 1 mm, with a maximum variance percentage of 8.3%. Forefoot and midfoot circumferences had a low variance < 2.5, with variance percentages < 1%. Hindfoot circumferences, malleolar heights, and the length of the first and fifth metatarsal to the ground contact points showed the highest variance (range 1 to 7). Conclusion: This optical scanner achieved a good reproducibility of a large set of foot and ankle anthropometric measurements. It is a valuable tool for clinical and research purposes.

This study assessed the relationship between head posture displacements and biomechanical parameters in three different tasks. One hundred male and female students (20 ± 3yrs) were assessed via the PostureScreen Mobile app to quantify postural displacements of head rotations and translations including: 1) the cranio-vertebral angle (CVA) (°), 2) anterior head translation (AHT) (cm), 3) lateral head translation in the coronal plane (cm), and 4) lateral head side bending (°). Biomechanical parameters during gait and jumping were measured using the G-Walk sensor. The assessed gait spatiotemporal parameters were cadence (steps / min), speed (m / s), symmetry index, % left and right stride length (% height), and right and left propulsion index. The pelvic movement parameters were: 1) tilt symmetry index, 2) tilt left and right range, 3) obliquity symmetry index, 4) obliquity left and right range, 5) rotation symmetry index, and 6) rotation left and right range. The jump parameters measured were: 1) flight height (cm), 2) take off force (kN), 3) impact Force (kN), 4) take off speed (m / s), 5) peak speed (m / s), 6) average speed concentric phase (m / s), 7) maximum concentric power (kW), 8) average concentric power (kW) during the counter movement jump (CMJ), and 9) CMJ with arms thrust (CMJAT). At a significance-level of p ≤ 0.001, moderate to high correlations (0.4 &lt; r &lt; 0.8) were found between CVA, AHT, lateral translation head and all the gait and jump parameters. Weak correlations (0.2 &lt; r &lt;  0.4) were ascertained for lateral head bending and all the gait and jump parameters except for gait symmetry index and pelvic symmetry index, where moderate correlations were identified (0.4 &lt; r &lt; 0.6). The findings indicate moderate to high correlations between specific head posture displacements, such as CVA, lateral head translation and AHT with the various gait and jump parameters. These findings highlight the importance of considering head posture in the assessment and optimization of movement patterns during gait and jumping. Our findings contribute to the existing body of knowledge and may have implications for clinical practice and sports performance training. Further research is warranted to elucidate the underlying mechanisms and establish causality in these relationships, which could potentially lead to the development of targeted interventions for improving movement patterns and preventing injuries.

This paper provides a comprehensive overview of the potential applications of dual energy CT (DECT) in improving image quality and diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non contrast (VNC) images, in which the injected contrast medium is reduced from the articular cavity, in order to better analyze 2D and 3D images of the bone. Moreover , virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore , the role of iodine map to enhance the contrast between soft tissues, optimizing the visualization of contrast material, and to distinguish contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high spatial resolution dual energy CT reconstructed images.

There was no significant difference in bacterial adhesion between the 3 bone graft types tested, regardless of the bacterial strain used (p &gt; 0.22). After 72 hours of culture, there was no significant difference between the Fresh and Frozen bone groups, while the number of CFU in the Decellularised group was significantly lower (p &lt; 0.01), averaging -0.72 +/- 0.08 lg, -0.20 +/- 0.01 lg and -0.78 +/- 0.48 lg with S. epidermidis, S. aureus and E. coli respectively. Absolute values differences are low, and considering fresh bone (equivalent to autograft) as the gold standard due to its low infection rates in clinical studies, we can conclude that adhesion and biolfilm development characteristics are similar between Fresh, Frozen and Decellularised bone grafts..

Pain in osteoarthritis (OA) results from erosion of joint cartilage, resulting in bone contacting bone without an intervening cushion. The periosteum, including its nociceptive innervation, ends at the border of the cartilage meaning that there is no extrinsic neuronal pathway between the opposing denuded bone surfaces to carry a bone-on-bone pain signal to the brain. The pain signaling pathway must therefore originate in nociceptive sensory endings within the subchondral bone itself. Selective ablation of this intrinsic nerve pathway, using any of a variety of approaches, is expected to permanently eliminate OA pain.

The patellofemoral joint (PFJ) is a complex articulation between the patella and the femur, in-volved in the extensor mechanism of the knee. Patellofemoral disorders can be classified into ob-jective patellar instability, potential patellar instability, and patellofemoral pain syndrome. An-atomical factors such as trochlear dysplasia, patella alta, and tibial tuberosity-trochlear groove (TT-TG) distance contribute to instability. Patellofemoral instability can result in various types of dislocations, and the frequency of dislocation can be categorized as recurrent, habitual, or per-manent. Primary patellar dislocation requires diagnostic framing, including physical examina-tion and imaging. Magnetic resonance imaging (MRI) is essential for assessing the extent of damage, such as bone bruises, osteochondral fractures, and medial patellofemoral ligament (MPFL) rupture. Treatment options for primary dislocation include urgent surgery for oste-ochondral fragments or conservative treatment for cases without lesions. Follow-up after treat-ment involves imaging screening and assessing principal and secondary factors of instability. Detecting and addressing these factors is crucial for preventing recurrent dislocations and opti-mizing patient outcomes.

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p&lt;0.05). However, degree of disc and multifidus muscle degeneration were not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc dgeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

Shape of supracondylar fracture of the humeral of pediatric patients is analysed with Procrustes method. XR–images of fractures are considered both in anterio-posterior (AP) view (66 images) and in a lateral (L) view (24 images). Applying Procrustes method for both views mean images are constructed and compared. Variability of shapes is quantified with a shape principal component analysis. Non-parametric tests (permutational and bootstrap) do not indicate statistical difference between Procrustes mean shapes in anterio-posterior and lateral projections. It is shown, however, that AP and L shapes of humeral fractures differ in their variability quantified by shape principal components.

Classifications of AAFD/PCFD have evolved with an increased understanding of the pathology involved. A review of classification systems helps identify deficiencies and respective contributions to the evolution in understanding the classification of AAFD. Using multiple electronic database searches (Medline, PubMed) and Google search, original papers classifying AAFD were identified. Nine original articles were identified that met the inclusion criteria. Johnson's original classification and multiple variants provided a significant leap in understanding and communicating the pathology but remained tibialis posterior tendon focussed. Drawbacks of these classifications include the implication of causality, linearity of progression through stages, an over-simplification of stage 2 deformity and a failure to understand multiple tendons react, not just tibialis posterior. Later classifications, such as the PCFD classification, are deformity-centric. Early instability in non-cavus feet and all stages of cavus feet can present pain and instability with minor/no deformity. These may not be captured in deformity-based classifications biased to planus feet.' The authors developed the 'Triple Classification' (TC) understanding that primary pathology is a progressive ligament failure/instability that presents as tendon reactivity, deformity, and painful impingement. There is a variable manifestation dependent on starting foot morphology. This review has identified deficiencies within classification systems used in AAFD/PCFD and, as a result, was used to help develop a more comprehensive 'Triple classification'. Advantages of the TC include representing foot types with no deformity, defining complex secondary instabilities, delinking of foot types, tendon reactivity/ligament instability and deformity to represent these independently in a more comprehensive classification system.

Purpose: Cardiovascular disease (CVD) is a major risk factor for mortality in patients with osteoarthritis, and comorbidities increase postoperative complications after total knee arthroplasty (TKA). Arteriosclerosis plays a major role in hemodynamic dysfunction and CVD; however, arteriosclerosis has not been preoperatively evaluated before TKA using the cardio–ankle vascular index (CAVI). In this study, we evaluated the degree of preoperative arteriosclerosis using the CAVI in patients undergoing TKA, as well as its correlations with several preoperative patient factors. Methods: Arteriosclerosis was evaluated in 209 consecutive patients (251 knees) with osteoarthritis who underwent TKA at our institution between May 2011 and June 2022. The CAVI was measured in the supine position 1 day before TKA, and the correlations between the CAVI and several clinical factors were analyzed. A p value of <0.05 was considered statistically significant. Results: The CAVI was normal in 62 knees (25%), borderline in 71 knees (28%), and abnormal in 118 knees (47%). Univariate analysis revealed a moderate positive correlation between preoperative CAVI and age (r = 0.451, p < 0.001) and a weak negative correlation between preoperative CAVI and body weight (r = −0.306, p < 0.001) and body mass index (BMI) (r = −0.319, p < 0.001). Multivariate analysis showed that age (β = 0.349, p < 0.001) and BMI (β = −0.235, p < 0.001) were significantly correlated with preoperative CAVI. Conclusion: Arteriosclerosis should be carefully managed intraoperatively and postoperatively in patients with osteoarthritis undergoing TKA, particularly in older patients and patients with a low BMI.

BackgroundIndex level disc herniation following lumbar spinal decompression is somewhat overlooked as postoperative complication, resulting in return of symptoms. It is proposed that the combination of local instability and degenerated disc is more likely to result in disc herniation. There is no literature comparing post-decompression disc herniation rates between different techniques. This study compares the postoperative disc herniation rates of the "mini-open" laminectomy versus the tubular system decompression.MethodsIn a retrospective comparative study, 563 patient files who underwent primary lumbar spinal decompression, were reviewed and divided into two groups, distinguished by surgical technique. Demographic, clinical, and postoperative data were collected and compared using independent two-tailed t-test and Fisher's exact test with significance set at p<0.05. Primary outcome: comparison of post-decompression surgery, index level, disc herniation occurrence between two surgical techniques.ResultsPostoperative index level disc herniation was significantly lower in the minimally invasive surgery group with 2 cases (0.8%) versus 19 cases (5.8%) in the "mini-open" group [p=0.002]. Disc herniation following single level and multi-level operations were also significantly lower in the minimally invasive group compared with the "mini-open" group (2 versus 11 and 0 versus 8 respectively; p<0.05).ConclusionPostoperative index level disc herniation following lumbar spinal decompression occurs in 3.7% of surgeries. Minimally invasive surgery is found to result in less herniations then "mini-open".

Osteoarthritis (OA) is the most common cause of pain and disability in adults. Dietary supplements such as undenatured type II collagen (UC-II) have shown to have some benefits in OA treatment. This study aimed to assess changes in pain levels among knee OA patients treated with UC-II for 6 months. Patients with knee OA of any grade were given a daily 40 mg dose of UC-II (CondroArtil®) as a dietary supplement for 6 months. Pain levels were measured using the visual analog scale (VAS) before starting UC-II 6 months thereafter. A total of 100 patients (62/38: male/female) with a mean age of 46.3 ± 13.8 years participated in the study. Most patients (60%) had mild to moderate OA (grade I or II). The UC-II supplementation was shown to significantly reduce pain levels (p<0.001) with a negative correlation between pain reduction and age (p=0.006) and BMI (p=0.049). The OA severity also affected pain reduction (p=0.011), with grade II OA experiencing higher pain levels. Previous physical therapy and food supplements had a significant impact on pain reduction (p=0.017 and p=0.012, respectively). The study suggests that UC-II is an effective treatment for reducing pain in patients with knee OA.

Patients' functional adaptation to pain can affect global sagittal alignment. This study evaluated the short-term spinal sagittal alignment change after Transforaminal Epidural Steroid Injection (TFESI) in lumbar spinal stenosis patients. Patients with lumbar spinal stenosis who underwent TFESI were retrospectively examined. Clinical outcomes were Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Before and two weeks after the intervention, whole spine lateral standing view radiographs were taken. Radiographic parameters, e.g., Sagittal Vertical Axis (SVA), C2C7 Cobb, Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Pelvic Incidence (PI), Pelvic Tilt (PT), Sacral Slope (SS), and Lumbopelvic Mismatch (PI-LL), were measured. Ninety-nine patients (mean age 64.3 ± 9.2 years) were included in this study. Both VAS and ODI outcomes were statistically improved after two weeks of intervention. Radiographic parameters showed that SVA, PT, and PI-LL mismatch were significantly decreased, while C2C7 Cobb, TK, SS, and LL were significantly increased after the intervention. SVA was improved by 29.81% (52.76 ± 52.22 mm to 37.03 ± 41.07 mm, P &lt; 0.001). PT was also decreased significantly from 28.71° ± 10.22° to 23.84° ± 9.96° (P &lt; 0.001). Transforaminal Epidural Steroid Injection (TFESI) significantly improves VAS, ODI, and global sagittal parameters in lumbar spinal stenosis patients.

Background: There is a growing interest in TKA components alignment, especially around the kinematic technique, which aims at reestablishing the alignment of the native knee. However, the practical application of this technique has some limitations; (2) Methods: A series of consecutive full weight-bearing lower limbs radiographs performed in our Hospital without signs of osteoarthritis, post-traumatic deformities, and any previous surgical procedure (e.g. any joint replacement , osteotomy, anterior cruciate ligament reconstruction) were included. Several radiological parameters as the bisector line were measured by three members of our orthopedic unit and were then used to assess the inter-observer reliability.; (3) Results: 110 radiographic images belonging to 59 patients (both legs for 51 patients and one leg for 8 patients) were finally included in the present analysis. The bisector of the trochelar groove was perpendicular to the femoral joint line (mean 89.4°).; (4) Conclusions: The main finding of the current study was that the new anatomic landmark investigated, the bisector of the trochlear groove, was perpendicular to the femoral joint line viewed in the AP weight-bearing radiograph of the entire lower limbs of the healthy knee and therefore could potentially simplify the achievement of the kinematic alignment during a TKA procedure.

This study assessed the relationship between body posture displacements and cardiopulmonary function test (CPET) and skill related physical fitness tests. One hundred male (60%) and female collegiate athletes (22.2 ± 4yrs) with a normal body mass index (BMI up to 24.9) were assessed via the PostureScreen Mobile app to quantify postural displacements as head, thorax and pelvis rotations and translations. CPET and physical performance tests including the agility T-test, the vertical jump test, the stork static balance test (SSBT) and the dynamic Y-balance test (YBT) were performed. Spearman correlation (r) and p-values are reported. Postural parameters were found to have moderate-to-high associations with CPET and the agility test, moderate correlations with the vertical jump test and the SSBT (head and pelvic postures only), and weak correlations with the YBT. As postural parameters were more asymmetric, both CPET and performance skills scores were worse. For examples: 1) a medium positive correlation was found between cranio-vertebral angle (CVA) and vertical jump test (r = 0.54; p-value &lt; 0.001) and SSBT (r = 0.57; p-value &lt; 0.001), while a strong negative correlation was found between CVA and agility test (r = -0.86; p-value &lt; 0.001). 2) A strong positive correlation was found between CVA and oxygen uptake efficiency slope, load watts VO2 at VT, VO2 / kg, load watts at respiratory compensation point (RCP), (r = 0.65 and r = 0.71; p &lt; 0.001). Conversely, a significant negative correlation was found between CVA and VE / VO2 at VT (r = -0.61; p &lt; 0.001). Postural rotations and translations of the head, thorax and pelvis were statistically correlated with physical performance skills and CPET in young collegiate athletes. There were moderate-to-high associations with cardiopulmonary functions and agility tests, moderate correlations with the vertical jump test, and weak correlations with the YBT. Postural alignment may be important for optimal physical performance and optimal cardiopulmonary function. Further research is necessary to elucidate reasons for these correlations as found in our sample of young and healthy athletes.

(1) Background: Proximal humerus fractures can be a debilitating condition if not properly treated. These fracture patterns are varied and differ in every patient. Functional outcomes may be determined by the integrity of the shoulder girdle involving the rotator cuff insertion. The post-operative resorption or malreduction of the greater tuberosity is an important factor contributing to the poor functional outcome of a patient. (2) Methods: A single-center retrospective comparative study was performed to evaluate the functional outcomes of patients undergoing operative fixation for this injury. A total of 387 consecutive cases treated operatively from 2019-2021 were included for analysis. (3) Results: 94 cases fulfilled our criteria for analysis. A matched-group comparison of 19 patients each was performed to compare demographics, post-operative fracture characteristics and functional outcomes. (4) Conclusions: The resorption or malreduction of the greater tuberosity contributes greatly to the prognostic outcome in patients treated with ORIF surgery. In our demographic study, obesity is another contributing factor affecting the parameters of post-operative reduction in proximal humerus fractures. Appropriate surgical planning and post-operative multidisciplinary care must be taken into consideration to attain a satisfactory prognostic outcome.

This study aimed to describe the injury profiles of young Korean baseball players according to position and age as the proportion and distribution of injuries based on playing position and age remains unclear. A total of 271 elite youth baseball players aged 8 to 16 years were divided into two groups: elementary school (ES) (n=135) and middle school (MS) (n=136). The participants' basic, baseball practice, and injury information were collected. Injuries in the MS group were not limited to the elbow and shoulder, and the injury prevalence varied by age group and baseball position. The most injured body region in the ES group was the elbow joint, regardless of the position. In contrast, the most injured body region in the MS group was the lower back, except for infielders whose elbows were the most injured. Additionally, the MS group was more likely to experience injuries of the lower back (OR=4.27, 95% CI=2.47–7.40), shoulder (OR=1.93, 95% CI=1.08–3.43; P=0.024), and knee (OR=2.15, 95% CI=1.17–3.94; P=0.012). Our findings indicate that excessive practice and lack of rest during MS (growth spurt period) can significantly increase the risk of lower back problems in young baseball players.

Abstract: Background: Adolescents frequently self-report pain, according to epidemiological research. The knee is one of the sites where the pain is most common. One of the main factors contributing to the number of years people spend disabled and having substantial personal, societal, and economic burdens globally is musculoskeletal disorders. Insidious, slowly building onset that neither the adolescent nor the parent is aware of [5]. Patellofemoral Pain (PFP) is a clinical knee pain commonly affecting adolescents. In the present study, the authors aimed to estimate the frequency of knee pain in Saudi adolescents. Methods: This cross-sectional survey carried out from June to November 2022 included 676 adolescents, ages 10 to 18. The data are presented as frequencies and percentages for categorical variables. Analysis of variance (ANOVA) was used to compare means between groups, while the chi-square test was used for the comparison of categorical variables. Statistical significance was set at p < 0.05. Results: Adolescents were invited to take part in the study; 57.5% were female and 42.5% were male, and 68.8% were aged between 15 and 18. The prevalence of knee pain was considerably high among females (26%), while it was 19.2% among males. Moreover, age was a significant predictor for knee pain, and BMI was as well. We also found a significant difference between BMI classification and stiffness of the knee (p = 0.008). There is a difference between adolescents who do physical activities in leisure and difficulty bending (p = 0.03). Conclusion: Our study noted a high rate of knee pain among adolescents, so we need to raise awareness about risk factors. Adolescent knee pain can be prevented with conservative methods and some minor lifestyle/activity modifications.

Background: The aim of this study was to demonstrate involvement of whole-body compensatory alignment in different conditions of spinopelvic sagittal balance (compensated/decompensated). Methods: We enrolled 330 healthy subjects and divided them according to sagittal vertical axis (SVA): the compensated group, < 4 cm, (group C) and the decompensated group, ≥ 4 cm, (group D). The correlation between lack of ideal lumbar lordosis (iLL), which is calculated by using the Schwab formula, and the compensatory radiographic parameters in each group were analyzed. The threshold value of KF angle that indicates a spinopelvic sagittal imbalance (SVA ≥ 4) was determined by ROC curve analysis. Results: Correlation analysis of lack of iLL and each com-pensatory parameter showed a strong correlation for pelvic tilt (PT) (r = -.723), and a weak cor-relation for thoracic kyphosis (TK) (r = 275) in Group C. In Group D, the correlations were strong for PT (r = -.796), moderate for TK (r = .462), and KF (r = -.415). The optimal cutoff value for KF angle was determined to be 8.4 degrees (sensitivity 89%, specificity 46%). Conclusions: The pre-sent study showed differences between compensated/decompensated spinopelvic sagittal balance in the correlation strength between lack of iLL and whole-body compensatory parameters.

Abstract: Introduction: A retrospective case-controlled study was performed to evaluate the out-comes of shoulder arthroplasty performed as a day case in carefully selected patients, compared to the traditional inpatient approach. Materials & Methods: Patients who had total or hemiarthro-plasty of the shoulder performed as a day case or inpatient procedure were recruited. The primary outcome compared rates of uneventful recovery, defined by the absence of any complications or readmission to hospital within six months of surgery, between Inpatient and Outpatient groups. Secondary outcomes included examiner-determined functional scores and patient-determined pain scores at one, six, twelve, and twenty-four weeks post-surgery. A further assessment of pa-tient determined pain scores was carried out at a minimum of two years post-surgery (5.8 ± 3.2). Results: 73 patients (36 Inpatients and 37 Outpatients) were included in the study. Within this time frame 25/36 inpatients (69%) had uneventful recoveries compared to 24/37 outpatients (65%) (p = 0.17). Outpatients showed significant improvement over pre-operative baseline levels in more of the secondary outcomes (strength and passive range-of-motion) by six months post-operation. Outpatients also performed significantly better than Inpatients in external rotation (p<0.05) and internal rotation (p=0.05) at six-weeks post-surgery. Both groups showed significant improvement compared to pre-operative baselines in all patient-determined secondary outcomes except level of activity at work and sport. Inpatients, however, less severe pain at rest at six weeks (p=0.03), sig-nificantly less frequent pain at night (p=0.03) and extreme pain (p=0.04) at 24 weeks; and less se-vere pain at night at 24 weeks (p<0.01). By minimum two years postoperation, inpatients were more comfortable repeating their treatment setting for future arthroplasty (16/18) compared to outpatients (7/22) (p = 0.0002). Conclusions: At a minimum of two years follow up, there were no significant differences in rates of complications, hospitalisations, or revision surgeries between pa-tients that underwent shoulder arthroplasty as an inpatient versus as an outpatient. Outpatients demonstrated superior functional outcomes but reported more pain at six months post-surgery. Patients in both groups expressed a preference for inpatient shoulder arthroplasty in future. What is Known About This Subject: Shoulder arthroplasty is a complex procedure, and has tradition-ally been performed on an inpatient basis, with patients admitted for six to seven days post-surgery. One of the primary reasons for this is the high level of postoperative pain, usually treated with hospital-based opioid therapy. Two studies demonstrated outpatient TSA to have a similar rate of complications as inpatient TSA, however these studies only examined patients within a shorter term 90 day postoperative period, and did not evaluate functional outcomes between the two groups or in the longer term. What This Study Adds to Existing Knowledge: This study provides evidence supporting the longer-term results of shoulder arthroplasty done as a day case in carefully selected patients, which are comparable to outcomes in patients that are admitted to hospital post-surgery.

Shoulder pain is a serious clinical disease frequently related to absence from work. It’s characterized by pain and stiffness probably connected to the presence of an inflammatory substrate involving gleno-humeral capsule and collagen tissues. A physioterapy programme has shown to be effective for the conservative treatment of this disorder. Our aim is to assess if a manual treatment directed to fascial tissues could get better improvement regarding pain, strength, mobility and function. 94 healthcare workers with recurrent shoulder pain were recruited and then randomized in two groups: the control group (CG) underwent a physiotherapy programme; the study group (SG) underwent to 3 sessions of physiotherapy and to 2 session of Fascial Manipulation (FM) technique. At the end of the treatment phase, both groups improved every outcome. Despite few statistical differences between groups, at the follow up visit a greater percentage of subjects in SG overcame the minimal clinical important difference (MCID) in every outcome. We conclude that FM is effective for treatment of shoulder pain and further studies should better assess how to manage this treatment to get better results.

Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre or intraoperative traction would be effective for severe spinal deformity, but invasive. This study aimed to evaluate the outcomes of PSF only surgery for patients with severe NMS with Cobb angle &gt;100 °. Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF only surgery for scoliosis with Cobb angle &gt;100 ° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings including Cobb angle and pelvic obliquity (PO) in the sitting position pre and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. The mean duration of surgery was 338 min, intraoperative blood loss was 1,440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group was significantly higher than that of the L5 group. Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF only surgery for severe NMS showed satisfactory outcomes, although highly invasive. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.

Background: The objective of the present study was to evaluate the formation of biofilm in bone patellar tendon bone grafts (BPTB grafts) and to compare it to the formation of biofilm formation in quadrupled hamstring anterior cruciate ligament grafts (4xHt graft). Methods: A descriptive in vitro study was conducted. One 4xHt graft and one BPTB graft were prepared. They were then contaminated with a strain of S. epidermidis. Later, a quantitative analysis was carried out by means of microcalorimetry and sonication with plating. Additionally, a qualitative analysis was carried out by means of electron microscopy. Results: No significant differences were found between the bacterial growth profiles of 4xHt graft and BPTB graft in microcalorimetry and colony counting. In the samples analyzed with electron microscopy, no specific biofilm growth pattern was identified upon comparing BPTB graft to 4xHt graft. Conclusions: There were no significant differences at either the quantitative or qualitative level when comparing bacterial growth in BPTB graft to that in 4xHt graft. Therefore, the presence of sutures in 4xHt graft cannot be established as a predisposing factor for increased biofilm growth in this in vitro study.

Introduction: The application of external fixation devices consists of wires insertion through the skin and soft tissue to the bone. We examined the possible analgesic effect of stimulating an acupoint by the fixation wires which mimics the acupunctures treatment. Material and methods: retrospective work. Between 2015 to 2018 107 patients were treated with an external fixation for a tibial fracture. 33 patient files were found to be eligible for the review. Patients were retrospectively divided into two groups: the study group included patients with a wire inserted through the ST36 (Zu San li) acupoint location, the control group had the wire inserted elsewhere. Patient's record was reviewed for 5 days following surgery. Data collected included analgesic consumption and pain level recorded on a visual analog scale (VAS). Results: 33 patients were included in the review. 20 patients in the study group and 13 served as the control group. In the study group VAS average was Mean (M)=1.4853 ± 1.30 while in the control group M=2.3885± 1.77 with no statistical relevance (P>0.05). Only on day 4 the study group had less pain than the control: M=0.40 ± 0.843, versus M=2.57 ± 2.149 (Mann=Whitney Z= -2.413, P<0.05). No statistical difference was found between groups in relation to analgesic consumption. Conclusions: In patients suffering from a tibial fracture treated with an Ilizarov external fixation device, locating a wire in the anatomical location of acupoint ST 36 had no effect on analgesic consumption and a minimal effect on patients’ pain levels.

Background: Sensor usage in the classical scientific process has allowed new experimentation in medicine. We report on the design process of a MEMS sensor being used for muscle trauma evaluation in diagnosing acute compartment syndrome (ACS), a medical ailment costing society billions of dollars per year. Objectives: Modeling the disease with scientific process allows a more complete under-standing of the disease. The goal was to formulate a hypothesis that could be tested to aid in making the diagnosis of ACS accurately. Methods: Scientific process was observed throughout the disease modelling process. Background information was improved and clarified, new pre-clinical models were de-signed and verified, a hypothesis built on pressure measurement with MEMS sensors was carried out, and the testing of the model as verified against previous clinical data was accomplished. Results: Scientific process resulted in hypothesis generation around the relationship of intracompartmental pressure measurement and the disease process and therapy. This resulted in new understanding of ACS, accurate modelling, and sensor design resulting in a MEMS device that has an extremely high sensitivity and specificity (over 99%) in treating and diagnosing the disease. Conclusion: MEMS sensor technology defines the new gold standard of implanting a sensor in a muscle compartment that allows accurate diagnosis of ACS with continuous trends in pressure.

Understanding the subtle signs of carpal instability and other unique injury patterns in the wrist is a critical skill for radiologists. Proper patient management and outcomes are directly dependent on the accurate interpretation of wrist imaging studies. This review will provide a detailed overview of typical imaging features of carpal trauma and instability, management, and complications, using multimodality imaging and original medical illustrations. A detailed overview of the osseous, ligamentous, arterial anatomy of the wrist, arcs of Gilula, and zones of vulnerability will be provided. Carpal fractures, dislocations, special radiographic views, and imaging pearls will be discussed. Instability patterns and the myriad of associate abbreviations (CID, CIND, CIC, CIA, VISI, DISI, SLD, LTD, MCI, SLAC, SNAC) will be clarified. Expected outcomes, potential complications, and management will be reviewed.

Background. To prospectively evaluate the reliability of a portable optical scanner compared to the water displacement technique for volumetric measurements of the foot and ankle, and to compare the acquisition time associated with these two methods. Methods. Foot volume was measured in 29 healthy volunteers (58 feet, 24 female/5 male) by a 3D scanner (UPOD-S 3D Laser Full-Foot Scanner ®) and by water-displacement volumetry. Measurements were performed on both feet, up to a height of 10 cm above the ground. The acquisition time for each method was evaluated. Kolmogorov-Smirnov test, Lin's Concordance Correlation Coefficient, and a Student’s t-test were performed. Results: Mean foot volume was 869.7+/-165.1cm3 (3D scanner) versus 867.9+/-155.4cm3 (water-displacement volumetry) (p <10-5). Concordance of measurements was 0.93, indicative of a high correlation between the two techniques. Volumes were 47.8 cm3 lower when using the 3D scanner versus water volumetry. After statistically correcting this underestimation, the concordance was improved (0.98, residual bias = -0.03 +/- 35.1 cm3). Mean examination time was 4.2 +/-1.7 min (3D optical scanner) versus 11.1 +/-2.9 min (water volumeter) (p<10-4). Conclusion: Ankle/foot volumetric measurements performed using this portable 3D scanner are reliable and fast, and can be used in clinical practice and research.