Background: Post-tubercular kyphoscoliotic deformities are a significant complication of spinal tuberculosis, leading to severe functional impairment and neurological deficits. Posterior Vertebral Column Resection (PVCR) and reconstruction offer a surgical solution to manage such complex deformities, aiming to restore spinal alignment and function. Methods: The study included 15 consecutive patients with severe post-tubercular kyphoscoliotic deformities underwent Posterior vertebral column resection followed by spinal reconstruction between March, 2022 to September, 2024 and all the patient were followed up upto one year. During the operation, the average age was 39.2 years, with a range of 10 to 64 years. Preoperative and postoperative assessments included radiographic measures of deformity correction (kyphotic angle, Cobb angle), neurological function, and clinical outcomes by visual analogue score (VAS), Oswestry Disabilty index (ODI), and Modified Macnab’s criteria. Complications were documented and analyzed. Results: Posterior vertebral column resection resulted in significant correction of kyphosis and scoliosis, with a marked improvement in spinal alignment. Neurological function showed substantial recovery in most patients. The average blood loss amounted to 2476 millilitres, and the average duration of a posterior vertebral column resection surgery was 273.33 minutes. In cases of scoliosis and kyphosis, the average correction achieved through posterior vertebral column resection was 11.6° and 14.13°, respectively, leading to correction rates of 60.53% and 38.29%. Posterior vertebral column resection complications occurred in 20% of cases overall. Neurological issues were the most common, estimated at 13.3%. There were 6.67% patients suffered from early post-operative wound infection. Conclusion: Posterior Vertebral Column Resection (PVCR) combined with spinal reconstruction is an effective and reliable surgical technique for correcting post-tubercular kyphoscoliotic deformities. It provides significant deformity correction, functional recovery, and low complication rates, offering a promising solution for patients with severe, deformity-associated disability. Further studies with larger sample sizes and long-term follow-up are warranted to confirm these findings. Bangladesh Armed Forces Med J Vol 58 No (1) June 2025, pp 30-38
Hallux valgus (also known as a bunion) is a common forefoot deformity impacting pain, function, quality of life, and mobility, with higher prevalence in females and increasing incidence with age. The high prevalence and rates of surgical treatment potentially have a major impact on the healthcare system. The aim of this stakeholder consultation was to identify current issues with provision of hallux valgus treatment, as well as identify achievable goals to improve understanding of hallux valgus and guide future assessment, treatment pathways, and research directions with the aim of improving clinical outcomes for patients. Scoping searches were undertaken to inform and identify relevant outcome sets and existing evidence relating to hallux valgus. A one-day think tank conference was held on 21 June 2024, involving stakeholders from various sectors, including patients, primary and secondary care professionals, researchers, and representatives of national societies. Key themes and issues related to hallux valgus were identified and used to develop structured action development plans. Major issues identified include the absence of national policy recommendations, variability in treatment pathways, and gaps in research and patient education. Patient experiences highlighted the significant impact on quality of life and the need for standardized information and care pathways. Key priorities for research include developing a core outcome set and understanding the patient’s lived experience, while policy priorities focus on creating national guidelines and raising awareness of the condition’s socioeconomic and functional impacts. The inaugural UK National Hallux Valgus Think Tank identified critical issues in the management of hallux valgus and developed strategies to improve clinical outcomes through research and policy development. Establishing a working group and prioritizing both research and policy initiatives will be essential to advancing the understanding and treatment of hallux valgus. Cite this article: Bone Jt Open 2025;6(4):432–439.
This work focuses on steps towards the ability to use tight coupling between computation fluid dynamics (CFD) and rotorcraft comprehensive analysis (CSD) to predict aeroelastic stability of a rotor. First, the Rotorcraft Comprehensive Analysis System (RCAS) analysis is used to carry out traditional linear stability analysis. Next, a method of using trim springs to artificially increase the stability of the wing so that a periodic solution during the RCAS trim procedure is presented. RCAS is then used to complete time-integrated transient analysis using a lifting-line aerodynamic model following a system perturbation through a vertical force located at the wing tip. CFD/CSD coupling is used for the first time to simulate a fully-elastic semi-span tiltrotor model. Loose coupling is used to achieve a trimmed solution for a sweep of airspeeds. Tight coupling is used to observe the transient behavior of the system following a perturbation. Low-speed results are promising and clearly demonstrate differences between the higher-fidelity method and comprehensive analysis indicating Helios is capturing previously missed aerodynamic effects. At higher speeds, the perturbation used here is found to be inadequate for activating the wing beam bending mode. Finally, the tight coupling procedure predicts an unstable rotor mode that is not predicted by comprehensive analysis. The primary objective of this work is to demonstrate new capabilities introduced to the CREATE-AV software Helios and RCAS which allow for a first fully-elastic semi-span simulation of a tiltrotor using high-fidelity analysis through both loose and tight coupling methodologies.
to the knee (11.0%) and unspecified or otherwise poor knee function (10.2%).Among knee related reasons for failure to return, the most frequently cited included unspecified knee problems/poor function (28.4%), pain (24.3%), and weakness (11.9%).Evidence for potential publication bias and study heterogeneity was present.Conclusion: Multiple systematic reviews and meta-analyses have reported in detail the rate of return to sport after ACL reconstruction.However, the data reported in these studies often fails to provide insight as to the specific reasons for why an athlete fails to return to sport after this procedure.This study aims to address this gap in literature and provide the specific reasons for why an athlete fails to return to sport after ACL reconstruction.This study estimates the rate of failure to return to sports after ACL reconstruction to be 25.5%, with one-third of athletes citing fear of reinjury as the major deterrent for returning to sports.We highlight how factors independent of direct surgical outcomes may impact an athlete's ability to return to play given that the predominant reason for not returning to sport after ACL reconstruction was unrelated to the knee.
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.
