The narrative review is conducted based on the literature on the hip joint capsule anatomy, biomechanics and arthroscopy capsular management to summarize the evolution of capsulotomy concepts and practice. Traditional transverse capsulotomy and T-shaped capsulotomy provide a good surgical visualization but affect the stability of joint. This has led to the adoption of modified transverse capsulotomy techniques and capsular closure; longitudinal capsulotomy techniques preserve joint stability and ensure a clear visualization, and the publication of expert consensus guidance has contributed to their ongoing standardization and normalization, but there are still certain limitations. However, evidence for the outside-in longitudinal capsulotomy techniques remains limited and largely indirect, derived mainly from technique descriptions and early case series. Hip arthroscopy capsular management has improved over time. This shows how modern surgical philosophy is gradually developed from just repairing anatomy. And it now pays more attention to rebuilding and protecting the capsular function. Besides, evidence of the outside-in longitudinal capsulotomy is still limited and largely indirect, so further comparative studies are needed.
BACKGROUND Depressed tibial plateau (TP) fractures frequently result in metaphyseal cancellous bone voids following fracture reduction. The influence of cancellous bone void volume (CBVV) and location on the rigidity of fracture fixation constructs remains poorly understood despite potential implications for surgical decision-making. AIM To assess the effect of CBVV on the rigidity of TP fracture fixation. METHODS TP fractures with different levels of CBVV (Scenario 1: 10% distal, Scenario 2: 50% distal, and Scenario 3: 50% proximal) were created in fourth-generation Sawbones models and fixed according to standard surgical practice. The samples were loaded under controlled conditions, and rigidity was assessed. Descriptive statistics were used to test for normality, and statistical significance was determined using one-way analysis of variance. RESULTS All samples completed all loading sequences without failure. Loading to the capacity of the load frame (3 kN) did not result in fixation failure; therefore, no compressive load at failure was recorded. As expected, vertical displacement increased with increasing compressive load. The average fracture gap opening at the maximum applied load (2900 N) was 0.057 ± 0.056 mm, 0.066 ± 0.044 mm, and 0.124 ± 0.077 mm for scenarios 1-3, respectively. The average construct stiffness was 1469 ± 57 N/mm, 1484 ± 73 N/mm, and 1467 ± 23 N/mm for scenarios 1-3, respectively. No statistically significant differences were observed in vertical displacement, gap opening, or stiffness (P > 0.05). CONCLUSION No statistically significant differences in rigidity were found between constructs with varying CBVV. However, a trend was observed, with the 50% proximal deficit demonstrating the least rigidity. Further research is warranted to investigate if proximal cancellous bone voids may warrant adjunctive support during TP fracture fixation.
Postmenopausal osteoporosis is primarily driven by estrogen deficiency, while gut dysbiosis, inflammation, microbial metabolites, and immune reprogramming may modify bone loss, although current evidence remains largely preclinical or associative. Natural bioactive compounds, probiotics, fermented foods, and medicinal-food resources have emerged as potential interventions, but existing research is fragmented and rarely distinguishes direct skeletal effects from microbiota-dependent actions. This review proposes a hypothesis-generating microbiota-dependent classification, rather than a validated clinical system, comprising phytoestrogens; polyphenols, flavonoids, and terpenoids; polysaccharides and dietary fibers; probiotics and postbiotics; fermented foods and dietary-pattern interventions; and complex traditional herbal formulations. These interventions may act directly on bone cells or indirectly through microbial biotransformation, intestinal barrier-mmune signaling, endocrine and estrobolome pathways, and epigenetic regulation. We additionally propose a microbiota-etabolite-xtracellular vesicle microRNA-one marrow cell fate axis as an unvalidated regulatory model. Preclinical evidence is strongest for short-chain fatty acid-related and gut barrier-mmune mechanisms, whereas the skeletal roles of bile acids, tryptophan-derived metabolites, microbiota-associated vitamins, and extracellular vesicle microRNAs remain uncertain, particularly in humans. Future studies should prioritize causal validation and microbiota-stratified clinical investigations.
