BACKGROUND:Diabetes and obesity are recognized as risk factors for postoperative complications including increased surgical site infection (SSI) and reoperation in patients undergoing knee extensor mechanism repair. However, limited literature evaluates how preoperative glucagon-like peptide-1 (GLP-1) receptor agonist therapy may influence these outcomes. This study evaluated GLP-1 receptor agonist use as an independent risk factor for postoperative outcomes following knee extensor mechanism repair. MATERIALS AND METHODS:Patients who underwent quadriceps or patellar tendon repair from 2012 to 2025 were identified in the TriNetX database and stratified by GLP-1 agonist use within 1 year of surgery. One-to-one propensity score matching yielded 2 well-balanced cohorts (n = 546). Postoperative complications were assessed at 90 days, 1 year, and 2 years, and Kaplan-Meier survival analysis was performed. RESULTS:No significant 90-day postoperative differences were observed. At 1 year, patients using GLP-1 agonists demonstrated significantly lower rates of SSI (2.38% vs 5.31%; odds ratio [OR] = 0.435; P = .0118) and wound complications (2.02% vs 5.31%; OR = 0.367; P = .0037). Differences persisted at 2 years, with lower rates of SSI (2.75% vs 6.04%; OR = 0.439; P = .0079), wound complications (2.38% vs 6.04%; OR = 0.379; P = .0026), and acute kidney injury (9.71% vs 13.55%; OR = 0.686; P = .0474). No significant differences in revision surgery were found. Kaplan-Meier analysis demonstrated significant separation for SSI and wound complications beginning at 1 year. CONCLUSION:Preoperative GLP-1 receptor agonist therapy was associated with reduced postoperative SSI and wound complications following knee extensor mechanism repair. These findings suggest potential for perioperative risk modulation as GLP-1 use becomes increasingly prevalent in patients undergoing knee extensor mechanism repair.
BACKGROUND:Volar shear distal radius fractures are technically challenging due to the difficulty in controlling small volar fragments. This study aimed to evaluate the clinical and radiographic outcomes of a distractor-assisted reduction technique in the surgical management of these fractures. MATERIALS AND METHODS:We retrospectively reviewed 23 consecutive patients treated with distractor-assisted reduction and volar plating between January 2024 and March 2025. Radiographic outcomes (ie, radial height, inclination, volar tilt) and functional outcomes, including wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Modified Mayo Wrist Score (MMWS), were assessed. RESULTS:A total of 23 patients completed follow-up at a mean of 13.4 months. Radiographic alignment was well restored, with a mean radial height of 11.6 ± 1.8 mm, radial inclination of 22.4° ± 3.1°, and volar tilt of 11.2° ± 3.6°. Wrist motion recovered satisfactorily, with mean wrist extension of 64° ± 11° and flexion of 71° ± 12°. The mean DASH score was 12.8 ± 7.4. According to the MMWS, outcomes were rated as excellent in 15 patients, good in 7, and fair in 1. Grip strength recovered to 83% ± 9% of the contralateral side. No major complications were observed. CONCLUSION:Distractor-assisted reduction appears to be a useful adjunct in the surgical treatment of volar shear distal radius fractures.
BACKGROUND:A gap exists in understanding the association of health-related social needs (HRSN), social determinants of health, and patients' physical function after orthopedic surgery. In this study, we asked: (1) Are HRSN and the social vulnerability index (SVI) associated with each other, and (2) are HRSN and SVI associated with patients' physical function after surgery? MATERIALS AND METHODS:We conducted a prospective study in a multispecialty academic orthopedic clinic from June 2024 to October 2024. We enrolled new adult patients who consented to participate and presented with an orthopedic condition. Patients completed the Accountable Health Communities HRSN Screening Tool to assess HRSN; and the Patient-Reported Outcome Measure Information System Physical Function 10a (PROMIS PF-10a), which measures a patient's self-reported physical function. We also used patient addresses to determine the SVI for each participant. The primary outcome was the association between HRSN and SVI. The secondary outcome was the association between HRSN or SVI and PROMIS PF-10a. RESULTS:We enrolled 127 new patients. Housing and food were the most frequently reported unmet HRSNs, affecting 14 (11.0%) patients each. There was no significant association between HRSNs and SVI. HRSNs and SVI showed inverse correlations with PROMIS PF-10a scores (r = -0.30 and r = -0.32, respectively; P < .001 for both). CONCLUSION:The findings suggest that area-level social determinants of health and individual patient HRSNs may independently affect physical function in orthopedic patients, which should be reflected in screening tools.
BACKGROUND:Postoperative delirium (POD) is frequent after hip fracture surgery, yet objective biomarkers that improve risk stratification beyond age, dementia, and frailty are limited. The serum copper-to-zinc (Cu/Zn) ratio reflects combined inflammatory and nutritional vulnerability, but its association with POD after hip fracture surgery is uncertain. MATERIALS AND METHODS:We performed a single-center retrospective cohort study of 420 consecutive patients aged ≥65 years undergoing surgery for low-energy hip fracture. The preoperative Cu/Zn ratio, measured within 48 hours before surgery, was the exposure (prespecified high ratio >2.0). The primary outcome was POD within 7 postoperative days or before discharge. Secondary outcomes were numeric rating scale pain scores, 24-hour morphine-equivalent opioid consumption, and hospital length of stay (LOS). RESULTS:In the matched cohort, POD occurred in 23/124 (18.5%) patients with low Cu/Zn ratios and 56/124 (45.2%) with high ratios (odds ratio [OR], 3.62; 95% confidence interval [CI], 2.04-6.42; P < .001). In the full cohort, high Cu/Zn remained associated with POD after adjustment (adjusted OR, 3.35; 95% CI, 2.00-5.59; P < .001). After matching, early postoperative pain and 24-hour opioid consumption were not significantly different, whereas LOS was modestly longer in the high Cu/Zn group (mean difference = 1.0 day). CONCLUSION:A high preoperative Cu/Zn ratio (>2.0) was independently associated with increased odds of POD and slightly longer hospital LOS after hip fracture surgery in older adults, with minimal impact on early pain-related outcomes.
BACKGROUND:Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). Vancomycin powder has been proposed as a low-cost adjunct to reduce infection by providing high local antibiotic concentrations with minimal systemic exposure; however, clinical evidence remains inconsistent. This study aimed to evaluate the effect of intra-articular vancomycin powder on PJI, aseptic wound complications, and renal function in primary TKA. MATERIALS AND METHODS:Patients who underwent primary TKA between 2022 and 2024 with at least 1 year of follow-up were retrospectively analyzed. A total of 661 patients were included: 247 received 1 g intra-articular vancomycin powder and 414 served as controls. All procedures were performed with standardized perioperative protocols. Demographics, comorbidities, and high-risk status were recorded. Outcomes included PJI, aseptic wound complications, and acute kidney injury. RESULTS:PJI occurred in 7 patients (1.1%): 6 in the control group (1.4%) and 1 in the vancomycin group (0.4%), with no significant difference (P = .266). Aseptic wound complications were observed in 28 patients (4.2%), including 20 control patients (4.8%) and 8 vancomycin patients (3.2%) (P = .326). Acute kidney injury occurred in 12 patients (1.8%), with comparable rates between groups (P = 1.000). CONCLUSION:Intra-articular vancomycin powder did not result in a statistically significant reduction in PJI rates, while demonstrating a favorable safety profile. Although safe, routine use may not provide additional measurable benefit in optimized surgical settings with low baseline infection rates. Larger, well-designed randomized trials are required to identify patient subgroups who may benefit from selective application.
BACKGROUND:The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate. MATERIALS AND METHODS:A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications. RESULTS:Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group (P = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, P = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance. CONCLUSION:The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.
BACKGROUND AND OBJECTIVE:Locked intramedullary (IM) nails are the primary treatment modality for femoral shaft fractures. This study aimed to determine the risk of developing a femur nonunion as a function of nail-to-bone diameter mismatch. MATERIALS AND METHODS:A retrospective case-control study was performed at a Level I trauma center. Adult patients with femoral shaft fractures (AO/OTA 32 classification) treated with IM nail fixation from 2016 to 2022 were identified from the institutional database. Cases required nonunion surgery. Controls were randomly selected in a 3:1 ratio and included only if fractures healed at final follow-up based on the modified Radiographic Union Score of the femur (mRUSF). The primary outcome was nonunion. The study compared the association of nonunion with nail diameter (range, 9 mm to 13 mm) relative to femur width (range, 12 mm to 36 mm) and adjusted for smoking status, open fracture, and the degree of comminution. RESULTS:In total, 203 patients were included: 50 cases and 153 controls. Patients with a femur anterior-to-posterior diameter >22 mm at the level of the lesser trochanter (11% of this sample) were at increased odds for nonunion when treated with a small diameter IM nail (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.7; P = .01). In patients with narrower femur diameters, the nail diameter was not associated with increased odds of nonunion surgery. CONCLUSION:Larger IM nails (≥11 mm) might have protected against nonunion in patients with wide femoral canals (≥22 mm) but likely conferred no significant benefit in patients with narrower femoral canals.
BACKGROUND AND OBJECTIVE:Orthopedic oncology surgeries frequently involve complex resections where critical neurovascular structures are at risk, and vascular injury can result in severe complications, including functional loss and mortality. Although multidisciplinary vascular collaboration is increasingly recognized as beneficial in oncologic surgery, limited evidence exists regarding optimal timing of vascular surgery consultation in orthopedic oncology. This study evaluated whether preoperative planned consultations improve intraoperative and postoperative outcomes compared to intraoperative consultations. MATERIALS AND METHODS:A retrospective review identified 30 patients who underwent orthopedic oncology surgery requiring vascular surgery involvement between 2015 and 2025 at a single academic institution. Patients were categorized into planned vascular consultations (n = 18) and intraoperative consultations (n = 12). Data collection included demographics, operative details, estimated blood loss (EBL), complications, and type of vascular intervention. RESULTS:The intra-operative consultation group experienced significantly higher median EBL (1,225 mL vs 325 mL, P = .015). Additionally, intraoperative consultations demonstrated trends toward longer operative times (307 vs 185.5 minutes) and higher postoperative complication rates. Infections occurred in 42% of intraoperative cases compared to 17% of planned cases. One intraoperative patient also experienced cardiac arrest, and another developed deep vein thrombosis. CONCLUSION:Planned vascular surgery consultations are associated with significantly reduced intraoperative blood loss and trend toward improved operative efficiency and fewer postoperative complications. This is the first study directly comparing outcomes between planned and intraoperative vascular consultations in orthopedic oncology. Early vascular involvement enables better anticipation of vascular challenges and supports proactive multidisciplinary collaboration to enhance patient safety and optimize resource use.
BACKGROUND:Although venous thromboembolism (VTE) prophylaxis has been widely studied, comparative data evaluating aspirin versus direct oral anticoagulants (DOACs) following primary total knee arthroplasty (TKA) remain limited. The study evaluated deep vein thrombosis (DVT) and pulmonary embolism (PE) incidence in patients prescribed aspirin or DOACs. MATERIALS AND METHODS:We retrospectively examined patients undergoing primary TKA at a single academic medical center over a 10-year period. There were 2,232 patients in the aspirin group and 1,638 in the DOAC group. Primary outcome measures include incidence of DVT and PE. A logistic regression model adjusted for differences across groups in relation to the primary outcome measures. RESULTS:The incidence of PEs (0.4% vs 0.6%, P = .486) and DVTs (1.3% vs 1.4%, P = .780) at 90 days were similar between the aspirin and DOAC groups, respectively. After adjusting for significant covariates in the logistic regression model, there remained no differences in the rate of PE and DVT between groups. The incidence of re-operation (0.4% vs 1.0%) was statistically different (P = .009) between the aspirin and DOAC groups at 90 days, respectively. CONCLUSION:Our study revealed no significant differences in the incidence of PE and DVT among patients receiving either DOACs or aspirin following primary TKA. While the rate of reoperation at 90 days was higher in the DOAC group, no differences were observed at 1 year. This study adds to the growing body of evidence demonstrating the safety and efficacy of aspirin for VTE prophylaxis in TKA.
BACKGROUND:Orthopedic surgeons use a combination of plain radiographs and computed tomography (CT) to diagnose and manage pelvic ring injuries. Historically, pelvic ring asymmetry has been calculated using the Keshishyan index (KI) measured in 2 dimensions. Three-dimensional (3D) CT modeling may assess deformity more comprehensively, aiding in treatment decisions. This study aimed to evaluate the accuracy and reliability of a modified KI (MKI) derived from 3D models of pediatric patients with pelvic fractures. MATERIALS AND METHODS:Two separate raters identified landmarks 3 separate times on 29 generated models. Traditional KI (TKI) was calculated using the contralateral distance between the most anterior portion of the sacroiliac joint (SAAS) and the deepest point of the acetabulum. The MKI used the contralateral distance between the SAAS and pubic tubercle. KI was calculated on correlating radiographs (RxKI). Bland-Altman analyses and intra-/interclass correlation coefficients (ICC) were used to evaluate agreement between measurement methods and reliability. RESULTS:RxKI and TKI measurements exhibited similar agreement with a mean bias (MB) of -0.0205. RxKI and MKI had a MB of 0.0012, and TKI and MKI had a MB of 0.0210. TKI reliability ranged from good to excellent (Intra = 0.923, 95% confidence interval [CI], 0.892-0.947; Inter = 0.897, 95% CI, 0.852-0.928), and MKI reliability was excellent (Intra = 0.938, 95% CI, 0.911-0.959; Inter = 0.912, 95% CI, 0.876-0.937). CONCLUSION:All methods exhibited excellent reliability, with MKI having the highest ICCs. MKI provided similar, reproducible values compared with RxKI, suggesting that clinicians can compare pelvic asymmetry values between CT and radiograph images.
Primary bone tumors are rare yet present a significant burden to patients, with surgery being the mainstay of treatment. We reviewed outcomes of limb salvage (LS) and amputation for management of upper extremity tumors. We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. A total of 2,886 studies were screened, and 5 studies were included (n = 187 patients; LS = 101, Amputation = 86). Commonly reported outcomes included local recurrence, metastasis at follow-up, and survival. Metastasis and local recurrence rates were in favor of LS surgery, with some studies reporting no differences. Survival was consistently reported to be statistically significantly in favor of LS.
BACKGROUND AND OBJECTIVE:Standard-length hydroxyapatite (HA)-coated femoral stems have demonstrated strong performance and survivorship in total hip arthroplasty. However, limited data exist comparing these outcomes to those of newer, shortened HA-coated stems. MATERIALS AND METHODS:This retrospective cohort study evaluated intraoperative and postoperative outcomes in patients who underwent total hip arthroplasty using either the standard-length Origin Stem or the shortened Alteon HA Femoral Stem. RESULTS:A total of 479 patients were included (151 Origin, 328 Alteon HA). The Origin group showed higher rates of calcar fracture (3.3% vs 2.1%), distal femur reaming (2.0% vs 0.3%), and revision (1.3% vs 0.3%), though not statistically significant. Osseointegration was achieved in the majority of cases (Origin: 96.8%; Alteon HA: 95.0%). Both groups experienced significant improvements in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and EQ-5D scores (P < .0001), as well as having comparable Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 scores. Leg length discrepancy occurred significantly more frequently in the Origin group compared to the Alteon HA group (2.6% vs 0.3%). The Alteon HA group demonstrated a 2-year survivorship rate of 98.2%. CONCLUSION:Both the standard-length Origin and shortened Alteon HA stems showed excellent short-term results, with 96% of patients in each group experiencing meaningful functional improvement. Both implants showed high osseointegration with low complication and revision rates. The Origin stem required more distal reaming and had an increased leg length discrepancy risk, whereas the shorter Alteon HA stem provided greater intraoperative flexibility with equally strong early results.
BACKGROUND:The purpose of this study was to demonstrate the clinical efficacy of the Endobutton in combination with medial plate fixation for the treatment of Lisfranc injuries. MATERIALS AND METHODS:We analyzed clinical data from 30 patients with Lisfranc injuries between February 2021 and October 2024 to assess foot function using Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale score, plantar pressure assessment, and weight-bearing imaging. We evaluated patients' postoperative pain and foot function, examined the appearance of the foot for any obvious deformities, assessed plantar pressure distribution, and conducted weight-bearing imaging to evaluate the gaps in patients' joints. RESULTS:All 30 patients received effective follow-up for a duration of 12 to 14 months (mean ± standard deviation, 12.92 ± 1.129 months). At the final follow-up, no clinically significant foot deformities were observed, and weight-bearing radiographs demonstrated stable tarsometatarsal alignment without evidence of progressive joint subluxation or displacement. The differences in the first and second tarsometatarsal joints gap distances and VAS and AOFAS scores at 3 months postoperatively and at the final follow-up were statistically significant (P < .05) when compared to the preoperative period. The difference in the results of the plantar pressure test between the injured foot and the contralateral foot was not statistically significant (P > .05). CONCLUSION:For low-energy and crush Lisfranc injuries, Endobutton combined with medial plate fixation yielded favorable early clinical outcomes and reliable short-term surgical results in this single-center retrospective study. Although the clinical benefits of this combined technique are promising, its efficacy compared with conventional fixation methods requires further validation in well-designed prospective controlled trials.
BACKGROUND:Socioeconomic status (SES) is increasingly recognized as a key factor influencing outcomes after orthopedic procedures. The objective of this study was to determine the effect of socioeconomic disadvantage on patient-reported outcomes (PROs) after orthopedic trauma. MATERIALS AND METHODS:A retrospective review of PROs was performed for orthopedic trauma patients from 2018 to 2023. The Area Deprivation Index (ADI) was used as a surrogate for socioeconomic disadvantage. Outcomes included Patient-Reported Outcomes Measurement Information System Global Physical Health and Global Mental Health 10-item short forms (PROMIS 10 GPH and GMH) at 6 weeks, 3 months, 6 months, and 1 year postoperatively. A mixed-model analysis was performed to compare outcomes among ADI cohorts. RESULTS:In total, 844 patients were included. Of these, 313 (37.1%) were in the least socioeconomically disadvantaged group. There was a significant difference in the distributions of age, marital status, smoking status, and self-reported race among the five ADI cohorts (P < .002). Patients with an ADI of 1 or 2 (low disadvantage) had significantly higher PROMIS 10 GPH scores compared with their counterparts in ADI Groups 3/4, 5/6, and 9/10, although all groups saw a similar significant improvement from the 6-week to 1-year follow-up. CONCLUSION:Socioeconomic disadvantage has a significant effect on PROMIS 10 GPH and GMH scores following orthopedic trauma procedures. However, patients in all ADI cohorts saw improvements in PROMIS 10 GPH up to 1 year postoperatively. It is important to identify patients in socioeconomically disadvantaged areas and create care pathways to better optimize their improvements postoperatively.
BACKGROUND:Purely ligamentous Lisfranc injuries are challenging to manage. Traditional open reduction and internal fixation provides rigid stability but risks cartilage damage, hardware failure, and the need for removal. Flexible fixation methods such as the suture-button (SB) and InternalBrace (IB) systems aim to maintain reduction while allowing physiological motion. This study compared clinical and radiographic outcomes of SB and IB fixation for these injuries. MATERIALS AND METHODS:A retrospective comparative study included 64 patients (SB, n = 34; IB, n = 30) with acute, purely ligamentous Lisfranc injuries and ≥24-month follow-up. Primary outcomes were American Orthopaedic Foot & Ankle Society (AOFAS) midfoot and visual analog scale (VAS) pain scores; radiographic outcomes included maintenance of the first cuneiform to second metatarsal (C1-M2) interval. Secondary measures were time to full weight bearing, return to sport, and complications. RESULTS:Both groups demonstrated significant improvements in AOFAS and VAS scores from preoperative to final follow-up (P < .001). There was no statistically significant difference between the SB and IB groups in mean final AOFAS scores (92.4 vs 91.5, respectively; P = .58) or VAS scores (1.5 vs 1.2, respectively; P = .21). Both techniques effectively maintained anatomic reduction, with no significant difference in the final C1-M2 diastasis (P = .75) and no clinically significant loss of reduction at final follow-up. CONCLUSION:SB and IB fixation provide excellent function, stable radiographic results, and low complication rates for purely ligamentous Lisfranc injuries, offering reliable alternatives to rigid fixation.
BACKGROUND:Chronic kidney disease (CKD) alters bone metabolism, immune function, and vascular health, potentially increasing postoperative risk following distal radius fracture (DRF) operative fixation (ie, open reduction and internal fixation, percutaneous pinning). However, data stratifying risk by CKD severity remain limited. This study evaluated the association between CKD stage and 90-day complications and 1-year orthopedic-related events following DRF operative fixation. MATERIALS AND METHODS:Adults aged 18 to 65 undergoing isolated DRF operative fixation were identified in the PearlDiver M170 database. Patients were stratified by CKD status: none, stage 1 to 2, stage 3 to 4, and stage 5 or end-stage renal disease (ESRD). Ninety-day medical complications and 1-year orthopedic-related events were assessed using univariable and multivariable logistic regression controlling for age and sex, with and without adjustment for Elixhauser Comorbidity Index (ECI). Bonferroni correction was significant at P ≤ .001. RESULTS:Among 29,009 patients, 28,411 (97.9%) had no CKD history, 101 (0.3%) had stage 1 to 2 CKD, 336 (1.2%) had stage 3 to 4, and 161 (0.6%) had stage 5/ESRD. Complication risk increased stepwise with CKD severity. Adjusting for age and sex, odds ratios (OR) for any 90-day complication were 5.62, 15.07, and 30.63 for stages 1 to 2, 3 to 4, and 5/ESRD, respectively (all P < .001). After ECI adjustment, associations remained significant, although attenuated (OR = 2.23, 5.93, and 11.04, respectively). No differences were observed in 1-year orthopedic-related events, including hardware removal or malunion/nonunion. CONCLUSION:CKD independently and incrementally increased short-term complication risk following DRF operative fixation, even after accounting for comorbidity burden. These findings support stage-based perioperative counseling and multidisciplinary optimization in patients with CKD.
BACKGROUND:Traditional flap transplantation for complex hand defect repair faces challenges like insufficient blood supply and scar contracture. This study aimed to explore the clinical value of the "canopy flap" with three-dimensional shaping in such repairs. MATERIALS AND METHODS:A retrospective analysis was conducted on 13 patients with irregular single wounds and complex tissue defects (accompanied by deep tissue exposure and nerve injury) treated with canopy flaps from June 2021 to March 2025. The technique included preoperative wound contour tracing, flap design based on a single perforator vessel, harvesting under tourniquet control, tension-dispersed transfer, microvascular anastomosis, and standardized postoperative management. Follow-up assessments used the British Medical Research Council sensory grading scale and hand function evaluation. RESULTS:Of the 13 flaps, 12 survived completely with primary healing; 1 developed postoperative venous crisis that was successfully salvaged. Follow-up showed flap appearance/texture similar to surrounding skin and no significant scar contracture. Sensory recovery reached S4 (4 cases), S3 (7 cases), and S2 (2 case). Approximately 70% of patients achieved excellent/good hand function, with all donor sites healing without functional impairment. CONCLUSION:The canopy flap has high survival rate, good three-dimensional conformability, and reduces complications. It achieves favorable sensory and functional recovery, providing a valuable option for complex hand defect repair.
This article reports three cases of ipsilateral limb swelling following total hip arthroplasty secondary to vascular compression from iliopsoas bursitis. The etiology was attributed to insufficient acetabular component anteversion, leading to polyethylene liner wear and iliopsoas impingement. Two patients underwent revision surgery and achieved symptom resolution. In contrast, the third patient opted for conservative management, resulting in recurrent limb swelling and the development of deep vein thrombosis. The patient required interventional treatment by the vascular surgery service and ultimately showed clinical improvement.
Previously reported cases of cauda equina herniation primarily involve compression of the spinal cord caused by fracture fragments intruding into the spinal canal following traumatic spinal burst fractures or by dural tears occurring during spinal endoscopic surgery. Such cases can often be evaluated preoperatively or intraoperatively to facilitate the selection of an appropriate treatment plan. However, cauda equina herniation resulting from the use of a drainage tube following spinal endoscopic surgery has not yet been reported. In this article, we present a case of a 76-year-old male patient who experienced a dural tear resulting in cauda equina herniation due to the positioning of the drainage tube following an L4/5 lumbar unilateral biportal endoscopy procedure. This case highlights the importance of timely surgery following cauda equina herniation and provides guidance for intraoperative procedures and perioperative management of patients undergoing spinal endoscopic surgery.
We present the case of a 64-year-old male patient who reported right shoulder radiculopathy, right-hand weakness, and 3 kg weight loss. Physical examination revealed restricted active shoulder mobility. Magnetic resonance imaging showed a massive septated lesion in the glenoid that infiltrated adjacent tissues, indicating sarcoma. Core needle biopsy revealed metastatic poorly differentiated squamous cell cancer. Positron emission tomography scan results showed a primary lung tumor (stage IVB) with metastases to the left adrenal gland and a large mass in the right glenoid. This case describes the first documented case of metastatic lung squamous cell carcinoma to the shoulder glenoid, an uncommon metastatic location.
