Proximal humerus fractures are a heterogeneous group of injuries with increasing incidence, particularly among older adults. Management remains controversial and is influenced by fracture morphology, patient characteristics, functional demands and evolving surgical options. Traditional classification systems, including Neer and AO/OTA, assist treatment planning but have limited reproducibility and predictive value. This contemporary narrative review integrates current evidence with expert clinical insight to provide a pragmatic framework for managing adult proximal humerus fractures. PubMed, Embase and the Cochrane Library were searched for studies published between 2000 and 2025, including randomised controlled trials, systematic reviews, meta-analyses and key cohort studies addressing operative and non-operative treatment. Undisplaced fractures are generally managed non-operatively with good outcomes. Fracture-dislocations and completely displaced humeral shaft injuries are biomechanically unstable and usually require early surgery. Most other fractures lie within a clinical grey zone in which treatment can be individualised according to age, fracture pattern, bone quality and functional demand. Younger patients with reconstructable fractures may benefit from early fixation, whereas some complex, non-reconstructable injuries can still achieve acceptable outcomes with conservative treatment. In elderly patients, early arthroplasty may be indicated for fractures extending into the proximal shaft, with delayed intervention suitable in selected cases. Advances in imaging, implant design and artificial intelligence may further improve patient-specific decision-making.
Background:Hip fractures are a common indication for red blood cell transfusion among elderly patients. Blood transfusion may be clinically necessary, yet it carries risks and should be anticipated according to patient and surgical characteristics. Objective:This retrospective study aimed to identify clinical and perioperative factors associated with the need for blood transfusion among patients hospitalized with hip fracture. Methods:The study included 150 patients with hip fracture treated at the Orthopedic Department of Bnei Zion Medical Center between April 2014 and June 2015. The transfusion group included 100 patients who received blood transfusions, and the control group included 50 surgically treated patients who did not require transfusion. Group comparisons were performed using t tests, chi-square tests, Fisher exact tests, and multivariable logistic regression. Results:Transfused patients were older than non-transfused controls (84.5 ± 7.4 vs 80.2 ± 8.1 years; P = 0.002). Age above 90 years (34% vs 14%; P = 0.030), subtrochanteric fracture (20% vs 6%; P = 0.031), aspirin use (41% vs 18%; P = 0.006), surgery duration exceeding 90 minutes (33% vs 8%; P = 0.0079), and B+ blood type (26% vs 6%; P = 0.041) were significantly associated with transfusion in univariate analysis. In multivariable logistic regression, age above 90 years (OR, 2.64; 95% CI, 1.08-6.45; P = 0.033), subtrochanteric fracture (OR, 3.21; 95% CI, 1.01-10.18; P = 0.048), and surgery duration exceeding 90 minutes (OR, 4.87; 95% CI, 1.62-14.63; P = 0.005) remained significant predictors. Conclusions:Among elderly patients with hip fracture, advanced age, subtrochanteric fracture, and prolonged surgical duration were the main independent predictors of blood transfusion. Aspirin use and B+ blood type were significant in univariate analysis but should be interpreted cautiously. Recognition of high-risk profiles may improve perioperative planning, blood bank preparation, and patient management.
The tendon interconnection between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) at the knot of Henry has important anatomical and clinical implications, particularly in tendon transfer surgery. Although previous anatomical studies have consistently shown that FHL-derived slips are distributed mainly to the second through fourth toes, the reason for their minimal contribution to the fifth toe remains unclear. This narrative review examined anatomical and functional studies identified through PubMed and Google Scholar, focusing on the FHL-FDL interconnection, toe-specific tendon distribution, and the role of the quadratus plantae (QP). Six major anatomical studies were identified. Across studies, FHL-derived slips consistently supplied the second and third toes and occasionally the fourth toe, whereas direct contribution to the fifth toe was absent or extremely rare (<1%). Anatomical evidence also demonstrated close integration of the QP with the lateral digital flexor system. Biomechanical findings suggest that the FHL primarily supports medial forefoot propulsion, whereas the lateral column, including the fifth toe, is more closely associated with balance and stabilization through the FDL-QP complex. Together, these findings support the concept of functional differentiation within the long digital flexor system. The selective distribution of FHL-derived slips appears to represent a consistent anatomical pattern rather than random variation, with the fifth toe functioning as a relatively independent unit associated with the FDL-QP complex. This concept may provide a useful framework for interpreting checkrein deformity and for planning tendon-level surgical procedures.
Background:Adolescent patellofemoral pain syndrome (APFS) is the most common cause of knee pain in this population. Despite its high prevalence, it remains frequently underestimated and is often considered a benign and self-limiting condition. However, persistent symptoms, significant psychosocial burden, and limited long-term efficacy of conventional treatments challenge this traditional view and call for an updated understanding of its underlying mechanisms and management. Main body:This narrative review is based on a structured literature search conducted in PubMed and Google Scholar, with studies selected according to predefined relevance criteria. APFS typically develops around puberty and predominantly affects physically active adolescents, particularly females. Clinical presentation is characterized by activity-related anterior knee pain and pain during prolonged sitting. Diagnosis remains primarily clinical, although it should incorporate assessment of biomechanical, functional, and psychosocial factors. While standard imaging is usually unremarkable, advanced magnetic resonance imaging techniques have revealed early structural and biochemical cartilage alterations. Current evidence supports a multifactorial model of pain involving both peripheral nociceptive sources and central sensitization mechanisms, further supported by neuroimaging studies. Psychosocial factors, including kinesiophobia, reduced participation in physical activity, and impaired quality of life, play a key role in symptom persistence. Standard management based on education, load management, and rehabilitation yields suboptimal outcomes in a substantial proportion of adolescents. Emerging approaches include psychologically informed interventions, digital adherence strategies, and adjunctive therapies such as intra-articular hyaluronic acid. Conclusion:APFS should no longer be regarded as a benign condition. A shift toward earlier, multimodal, and individualized management is warranted, integrating physical, psychological, and educational components. Improved understanding of central pain mechanisms and the development of adjunctive therapeutic strategies may contribute to better outcomes and prevention of chronicity.
Background:Neuromuscular electrical stimulation (NMES) is widely used in the rehabilitation of knee osteoarthritis (KOA) to improve quadriceps activation and counteract arthrogenic muscle inhibition. However, randomized controlled trials (RCTs) have reported inconsistent findings, and the overall clinical effectiveness of NMES across key patient outcomes remains uncertain. Objective:To evaluate the effects of NMES, administered alone or in combination with exercise, on pain, self-reported disability, quadriceps muscle strength, and functional performance in adults with KOA, and to explore whether treatment effects differ according to comparator intervention. Methods:A systematic review and meta-analysis of RCTs was conducted according to PRISMA 2020. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception to April 20, 2026. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Prespecified subgroup and sensitivity analyses were undertaken, and risk of bias was assessed using the Cochrane RoB 2 tool. Results:Eight unique RCTs (10 publications) were included. Overall, NMES did not significantly improve pain, self-reported disability, quadriceps strength, or six-minute walk distance compared with pooled comparator interventions. A significant improvement was observed for Timed Up and Go performance, although this estimate was largely driven by a single trial. Prespecified subgroup analyses demonstrated that treatment effects differed according to comparator intervention. NMES combined with exercise resulted in greater pain reduction than exercise alone, whereas no consistent advantage was observed when NMES was compared with alternative conservative interventions. Most trials were judged to have low risk of bias or some concerns. Conclusions:NMES does not appear to provide consistent clinical benefits across all rehabilitation settings for KOA. Rather, its effectiveness depends on the therapeutic context in which it is delivered, with the greatest benefit observed when used as an adjunct to structured exercise rather than as a stand-alone intervention. Larger, methodologically rigorous RCTs using standardized stimulation protocols are required to define the patients most likely to benefit.
Introduction:Competitive swimming has grown substantially worldwide, bringing increased attention to the prevalence of overuse injuries among athletes. One of the most common conditions, swimmer's shoulder, is closely associated with orthopedic pathologies including rotator cuff tendinopathy, labral injury, and scapular dyskinesis, resulting from the repetitive overhead motion required in swimming. Despite growing clinical and research interest in these injuries, the global landscape and evolution of scientific research on swimming-related shoulder injuries have not yet been investigated. Methods:Using Web of Science, a total of 542 publications concerning shoulder disorders in swimmers between 1965 and 2026 were analyzed to investigate key factors, contributors, and overall research trends. VOSviewer was also used during this process to assess co-authorship networks, journal distribution, and collaboration patterns. Lastly, Microsoft Excel was used to evaluate publication trends over time, citation patterns, language distribution, and geographic contributions. Results:Publication and citation output increased substantially over time, with particularly rapid growth starting from the 2010s. A geographical examination found that the United States accounted for the highest proportion of publications, followed by England, Australia, Canada, and Brazil. The most prolific publication sources included Journal of Sport Rehabilitation, Journal of Athletic Training, American Journal of Sports Medicine, British Journal of Sports Medicine, and International Journal of Sports Physical Therapy. Lastly, author and affiliation patterns suggested that research output is concentrated among a limited number of institutions and collaborative networks. Conclusion:The steady increase of research on swimmer's shoulder reflects a growing awareness of shoulder overuse injuries as a significant issue in sports medicine. Much of this work comes from English publications, high-income countries, and various author and institution networks. This shows improvements in understanding injury mechanisms and management. Additionally, the high number of studies in sports medicine, rehabilitation, and orthopedic journals emphasizes the clinical focus of this field and provides a future avenue for research. However, gaps still exist in global representation, language diversity, and the application of findings into prevention and rehabilitation strategies. Further efforts should emphasize international collaboration and clinically applicable research to enhance long-term swimmer health.
Lumbar transforaminal epidural steroid injections (TFESIs) are commonly performed for the treatment of lumbosacral radicular pain related to disc herniation, foraminal stenosis, lateral recess stenosis, and degenerative spinal conditions. The conventional supraneural or subpedicular approach targets the superior aspect of the neural foramen, historically described as the “safe triangle.” This is what is commonly taught in pain medicine fellowships. However, this region may contain radicular or radiculomedullary arteries, and inadvertent intra-arterial injections have been implicated in rare but catastrophic complications, including spinal cord infarction and paralysis. The infraneural approach, often described in relation to Kambin’s triangle, targets the lower portion of the neural foramen below the exiting nerve root. This technique is a valuable alternative route that may reduce needle placement in the superior-anterior foraminal region while maintaining targeted delivery to the affected nerve root and ventral epidural space. This concise review examines the anatomic rationale, technical considerations, potential advantages, limitations, and safety implications of the infraneural approach for lumbar TFESIs. Although available evidence suggests that infraneural TFESI can provide similar clinical outcomes to traditional approaches in appropriately selected patients, the literature remains limited by technique, injectate selection, and outcome reporting. Careful preprocedural imaging review, fluoroscopic guidance, contrast injection, and preferential use of non-particulate steroid remain essential regardless of approach.
Background Pediatric upper extremity fractures are common and frequently require surgical intervention. Traditional fixation methods using metallic implants, such as Kirschner wires and elastic stable intramedullary nails, offer reliable mechanical stability but necessitate secondary procedures for hardware removal. Polymer-based resorbable implants offer an advantage by eliminating the need for secondary procedures for hardware removal while maintaining efficacy. This systematic review evaluates the safety, efficacy, and clinical outcomes of resorbable compared to non-resorbable implants in pediatric patients. Methods A systematic search of PubMed, Embase, and Web of Science was conducted according to PRISMA guidelines. Inclusion criteria targeted studies comparing outcomes of resorbable versus non-resorbable implants in pediatric upper extremity fractures. Risk of bias was assessed using the JBI critical appraisal tools. Nine studies met inclusion criteria, comprising one randomized controlled trial and eight retrospective cohort studies. Results Nine studies including 391 pediatric patients were analyzed. The most common fractures involved the forearm (four studies), followed by lateral condyle (three studies) and medial epicondyle injuries (two studies). Mean patient age ranged from 5.6 to 11.6 years. Surgical site infections, skin irritation, postoperative pain, and nonunion were less common with resorbable implants with only one case requiring implant removal. Re-displacement was more frequent with resorbable implants but rarely required revision. Functional outcomes were comparable across groups. Conclusions Resorbable implants are a safe and efficacious alternative to traditional metallic devices for pediatric upper extremity fractures. Their favorable complication profile and elimination of hardware removal procedures support wider clinical adoption. Further randomized trials are warranted.
Background:Carpal tunnel syndrome (CTS) and trigger finger (TF) are common hand disorders that frequently coexist. Most available data originate from North American, European, and East Asian populations, whereas data from Central Asian countries remain limited. This study aimed to estimate the prevalence of concurrent CTS and TF and identify associated demographic and clinical factors in a clinical cohort from Kazakhstan. Methods:This cross-sectional study included patients diagnosed with CTS, TF, or both conditions. Demographic characteristics, comorbidities, and clinical variables were analyzed. Group differences were assessed using chi-square tests and one-way analysis of variance. Multivariable logistic regression analysis was performed to identify factors associated with concurrent CTS and TF. Results:A total of 138 patients were included. Among them, 82 (59.4%) had CTS, 48 (34.8%) had TF, and 8 (5.8%) had both conditions. Significant differences between groups were observed for sex (p = 0.001), ethnicity (p < 0.001), diabetes mellitus (p = 0.008), thyroid disease (p = 0.010), and hormone therapy (p = 0.030). In multivariable logistic regression analysis, diabetes mellitus was strongly associated with concurrent CTS and TF (OR = 72.96; 95% CI 2.41-2208.9; p = 0.014), whereas increasing age was associated with lower odds of coexistence (OR = 0.77; 95% CI 0.63-0.92; p = 0.005). Conclusions:Concurrent CTS and TF were identified in a limited number of patients in this cohort. Diabetes mellitus and age were associated with their coexistence. These findings provide clinical data from an understudied Kazakhstani population.
Background:Pregnancy-associated low back and pelvic pain is a common musculoskeletal condition associated with substantial pain, impaired mobility, and functional limitation during pregnancy. Pharmacologic pain management is constrained by maternal and fetal safety considerations, increasing reliance on conservative musculoskeletal interventions. Methods:A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception through February 2026. Eligible studies included pregnant women with pregnancy-associated low back pain, pelvic girdle pain, or mixed lumbopelvic pain syndromes receiving conservative musculoskeletal interventions. Primary outcomes were pain intensity and functional disability assessed using validated instruments. Random-effects meta-analysis using standardized mean differences with Hedges g correction and 95% confidence intervals was performed. Results:Six randomized controlled trials met inclusion criteria for qualitative synthesis, of which four studies involving 254 participants contributed directly extractable data for the primary quantitative meta-analyses. Conservative musculoskeletal interventions were associated with significant reductions in pain intensity (SMD -0.85, 95% CI -1.18 to -0.53; P < 0.001; I² = 34%) and functional disability (SMD -0.84, 95% CI -1.31 to -0.37; P < 0.001; I² = 66%). Subgroup analysis demonstrated numerically larger pain effects for device-assisted interventions, followed by acupuncture-based and manual or manipulative approaches, although subgroup differences were not statistically significant (P = 0.26). One trial was judged at high risk of bias, while the remaining studies were classified as having some concerns. Conclusions:Conservative musculoskeletal interventions were associated with improvements in pain intensity and functional disability among women with pregnancy-associated low back and pelvic pain. However, limited trial numbers, methodological heterogeneity, and risk of bias constrain treatment-specific conclusions. Larger, adequately powered, methodologically rigorous randomized controlled trials are needed to inform higher-confidence clinical recommendations.
Calcified thoracic disc herniation is an uncommon but clinically important spinal pathology that may cause progressive myelopathy, neurological deterioration, and complex ventral spinal cord compression. Compared with non-calcified thoracic disc disease, calcified lesions are often more rigid, centrally located, and adherent to the dura, making surgical management technically demanding. Although anterior, anterolateral, posterolateral, minimally invasive, and endoscopic approaches have all been described, no universally accepted surgical strategy exists. Approach selection remains dependent on lesion morphology, degree of calcification, canal compromise, neurological status, patient comorbidity, and surgeon experience. This narrative review summarizes the current evidence on surgical management of calcified thoracic disc herniation, with emphasis on preoperative evaluation, decision-making variables, indications, limitations, and outcomes of the major operative corridors. Central, giant, densely calcified lesions may favor anterior or anterolateral access for direct ventral decompression, whereas paracentral or lateral lesions may be suitable for posterolateral, minimally invasive, or endoscopic approaches in selected patients. Emerging evidence suggests that posterior and endoscopic techniques may also be feasible in more complex calcified lesions when performed by experienced surgeons. Optimal management should therefore be individualized, balancing adequate neural decompression with approach-related morbidity and the technical capabilities of the treating team.
Background and aim Subungual exostosis is a relatively uncommon benign ostecartilaginous lesion of the distal phalanx of the great toe, responsible for pain and nail deformity. Material A case of subungual exostosis in a female patient is reported. Diagnosis was made performing clinical examination and plain foot radiographs. The treatment proposed was a complete surgical excision. Results At the 9-month follow-up, there was no evidence of recurrence, and the patient was fully satisfied with the cosmetic and functional results. Conclusions Subungual exostosis is a relatively rare condition which can cause pain and discomfort to the patient but, once correctly diagnosed, it can be successfully solved with a complete surgical excision.
Background:Bicondylar tibial plateau fractures are complex injuries that frequently involve a posteromedial fragment and carry a high risk of post-traumatic osteoarthritis. However, long-term outcome data on dual locking-plate fixation are limited, particularly in Southeast Asian populations. Objective:The aim of this prospective study was to evaluate longitudinal clinical and imaging outcomes of bicondylar tibial plateau fractures managed with anterolateral and posteromedial locking plates via two mini-incisions. Methods:This prospective study included 55 patients treated with open reduction and dual locking-plate fixation via anterolateral and posteromedial mini-incisions. Outcomes included radiographic parameters, clinical function and complications. Results:The mean age was 45.4 ± 12.4 years; 60% of patients were male and motorcycle accidents accounted for 90.9% of injuries. Forty-five patients (81.8%) completed the 60-month assessment. Lateral plateau depression was reduced from 5.25 mm preoperatively to 1.00 mm postoperatively and was 2.17 mm at 5 years. KSS Knee peaked at 12 months (83.4 ± 8.2) and was 78.9 ± 8.8 at 5 years; the Rasmussen clinical score followed a similar trajectory. The overall complication rate was 23.6%, with a single deep infection (1.8%). Kellgren-Lawrence grade ≥ 2 increased from 14.5% of injured knees at 12 months to 53.3% at 60 months. Schatzker VI was associated with smaller Rasmussen clinical improvement than Schatzker V (-2.09; p = 0.023). Conclusions:Dual locking-plate fixation through two mini-incisions provides favorable clinical and functional outcomes up to 5 years for bicondylar tibial plateau fractures; however, progressive post-traumatic osteoarthritis remains a long-term concern warranting surveillance.
Background Cephalomedullary nails (CMNs) are frequently utilized for subtrochanteric femur fractures but a lack of cortical fit in proximal fractures may lead to varus deformity. We hypothesize that as the difference between fracture site canal width and diameter of the nail increases so will the risk of varus deformity. Methods A retrospective study of subtrochanteric femur fractures fixed with CMNs at an academic, level one trauma center over a 6.5-year period was performed. Patients were divided into two cohorts: CMN with sliding blade/screw (TFNA) or greater trochanteric entry recon nail (GTE). The primary outcome analyzed was the correlation between nail-canal mismatch with final neck shaft angle. Secondary outcomes analyzed included rates of nonunion and malunion. Results Seventy-one patients met the inclusion criteria (35 TFNA and 36 GTE). There was not a significant correlation between the nail-canal mismatch with final neck shaft angle for GTE nails (Pearson correlation coefficient r: -0.187, p=0.274). However, when TFNAs were subdivided into 125° and 130° cohorts, there was a stronger negative correlation for 125° (r: -0.678, p=0.001) compared to the 130° (r: -0.515, p=0.041). For 125° TFNAs, linear regression analysis demonstrated that for every 1 mm increase in nail-canal mismatch there was a decrease in final neck shaft angle by 0.757⁰. There was no difference in secondary outcomes. Conclusion GTE nails and TFNAs have similar rates of malunion and nonunion when managing subtrochanteric femur fractures. However, 125° TFNAs may be associated with increased varus neck shaft angles as the nail-canal mismatch increases.
Background:Lumbar facet-mediated pain is a common contributor to axial low back pain and may occur after traumatic or mechanical injury, even when advanced imaging demonstrates only mild degenerative or nonspecific findings. Standard interventional treatment pathways often include diagnostic medial branch blocks followed by radiofrequency ablation, or intra-articular facet joint injections with corticosteroids. However, some patients wish to avoid corticosteroid exposure or neuroablative procedures. Platelet-rich plasma (PRP) is a biologic injectate that could be used for the treatment of facet-mediated low back pain, although the available clinical evidence remains very limited. Case Presentation:We present two patients with post-traumatic axial low back pain clinically localized to the lumbar facet joints who elected to undergo lumbar facet joint PRP injections after declining medial branch blocks, radiofrequency ablation, and corticosteroid injections to the facet joints. The first patient was a woman in her 40s who developed low back pain after a motor vehicle collision. Lumbar MRI demonstrated minimal structural abnormalities, but examination revealed focal facet-region pain worsened with lumbar extension. She underwent PRP injections at the bilateral L3-4 and L4-5 facet joints, corresponding to the areas of maximal pain. At 6-week follow-up, she reported approximately 60% pain relief and continued participation in physical therapy and a home exercise program. The second patient was a man in his 50s who developed low back pain after falling from a ladder. Imaging demonstrated mild lumbar spondylosis and degenerative disc disease. He preferred PRP over corticosteroid injections, medial branch blocks, or radiofrequency ablation. PRP injections were performed at the L4-5 and L5-S1 facet joints, corresponding to his areas of maximal pain. At 6-week follow-up, he reported approximately 70% sustained pain relief. No complications were noted in either case. Conclusion:These cases suggest that lumbar facet joint PRP injections may provide moderate pain improvement in carefully selected patients with clinically suspected facet-mediated pain after acute injury, particularly those wishing to avoid corticosteroid injections or ablative procedures. However, diagnostic certainty may be lower when confirmatory medial branch blocks are not performed. Further controlled studies are needed to define optimal patient selection, PRP preparation, injection technique, and durability of response.
Background Epidural steroid injections (ESIs) are widely used for the treatment of chronic spinal pain, particularly in cervical and lumbar radiculopathy. Corticosteroids used in ESIs are broadly classified as particulate or non-particulate formulations, each with distinct safety and pharmacologic profiles. Comparative efficacy remains controversial. However, safety concerns regarding particulate steroid use in transforaminal injections are well established. However, physician perception of steroid effectiveness may influence clinical decision-making and practice patterns. Objective To evaluate physician perceptions regarding the comparative efficacy of particulate versus non-particulate corticosteroids in ESIs. Methods A survey-based study was conducted assessing physician beliefs on the duration and effectiveness of pain relief achieved with particulate and non-particulate steroids in ESIs. Responses were analyzed descriptively and compared to current literature. Results Most physicians perceived particulate steroids to provide either equivalent or longer-lasting pain relief compared to non-particulate steroids, with a slight majority favoring particulate formulations. Very few respondents believed particulate steroids were inferior. These findings align with existing literature demonstrating largely comparable efficacy between steroid types, with inconsistent evidence suggesting minor differences in duration of pain relief. Conclusions Despite mixed evidence regarding comparative efficacy, physician perception continues to favor particulate steroids for longer duration of analgesia. Given the known safety risks associated with particulate steroids, clinical decision-making should incorporate both efficacy data and patient-specific risk profiles. These findings highlight the importance of aligning physician perception with evolving evidence and safety guidelines.
Purpose of Review The purpose of this narrative review is to explain the cellular mechanisms behind chronic pain, the mechanisms behind extracorporeal shockwave therapy, and its efficacy for the treatment of various chronic pain conditions including tendinopathies, greater trochanteric pain, de quervain tenosynovitis, myofascial pain, plantar fasciitis, fibromyalgia, osteoarthritis, fractures, osteonecrosis, bone edema, coccydynia, low back pain, chronic pelvic pain syndrome/chronic prostatitis, ulcers, and carpal tunnel syndrome. Recent Findings Many recent clinical trials and meta-analyses from the year 2024 overall supported the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions with minimal adverse effects. Summary Extracorporeal shockwave therapy is a novel technique that uses mechanotransduction to induce a cellular response that prevents central sensitization, reduces inflammation, and contributes to healing that alleviates pain. The specific mechanisms through which extracorporeal shockwave therapy are largely unknown or poorly understood. A literature search of Scopus, PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted to identify 84 studies from 2000-2024 evaluating the efficacy of extracorporeal shockwave therapy for the treatment of chronic pain conditions. The results indicate that extracorporeal shockwave therapy holds strong promise for the treatment of numerous chronic pain pathologies with minimal adverse effects and should be studied further.
Background Functional alignment (FA) has emerged as a personalized strategy for robotic-assisted total knee arthroplasty (ra-TKA), aiming to preserve constitutional knee anatomy and native soft-tissue balance. However, evidence directly comparing robotic-assisted FA and mechanical alignment (MA) using the same robotic platform remains limited. The aim of the study To compare the early clinical, radiographic, and constitutional phenotype outcomes of ra-TKA performed using FA and MA. Methods In this prospective randomized single-center study, 100 patients with primary varus knee osteoarthritis underwent primary ra-TKA using the CORI Surgical System and were randomized to the FA (n=50) or MA (n=50) group. Clinical outcomes (KSS, FJS-12, VAS), radiographic alignment (HKA, LDFA, MPTA), soft-tissue release, and postoperative CPAK phenotype preservation were evaluated over 12 months. Results Both groups demonstrated significant postoperative improvement. At 3 months, the FA group achieved significantly higher KSS Knee, KSS Function, and FJS-12 scores together with lower VAS pain scores than the MA group (all p<0.05). These differences were no longer significant at 12 months. FA required fewer soft-tissue releases while maintaining radiographic accuracy comparable to MA. Constitutional CPAK phenotype was preserved in 82% of FA patients, whereas all mechanically aligned knees were converted to CPAK phenotype V. Native joint-line orientation and constitutional varus alignment were preserved in all FA cases. Conclusion Robotic-assisted functional alignment provides accurate and reproducible component positioning while preserving constitutional knee phenotype and reducing soft-tissue release. Although long-term clinical outcomes were comparable, FA resulted in superior early functional recovery and represents a safe personalized alignment strategy.
Background:Impaired bone regeneration remains a major challenge in orthopedic reconstruction, particularly in distraction osteogenesis, limb reconstruction, and delayed union, where prolonged healing increases treatment burden and complication risk. Adjunctive biophysical stimulation, including low-intensity pulsed ultrasound and pulsed electromagnetic field stimulation, has been investigated as a noninvasive strategy to improve bone-healing outcomes, but evidence in reconstructive orthopedic settings remains limited and heterogeneous. Methods:A systematic review and meta-analysis of randomized controlled trials was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Scopus, and Web of Science were searched from database inception to March 21, 2026. Eligible studies evaluated adjunctive low-intensity pulsed ultrasound or pulsed electromagnetic field stimulation in distraction osteogenesis, limb reconstruction, or delayed union using comparative control groups. Random-effects meta-analysis was performed for clinically comparable outcomes. Fixation-normalized healing outcomes were pooled as mean differences, radiographic healing outcomes as standardized mean differences, and methodological quality was assessed using RoB 2. Results:Seven randomized controlled trials met eligibility criteria for qualitative synthesis. Two studies contributed to quantitative pooling of fixation-normalized healing efficiency, demonstrating significantly shorter healing duration with adjunctive intervention compared with control (mean difference, -16.78 days/cm; 95% CI, -22.72 to -10.83; P < 0.001; I² = 0%). Three studies contributed to radiographic meta-analysis, showing a significant benefit favoring adjunctive biophysical stimulation (SMD, 0.40; 95% CI, 0.07-0.74; P = 0.02; I² = 42.1%). Secondary clinical burden and safety outcomes were not suitable for quantitative pooling because of heterogeneous reporting. Six studies were judged as having some concerns and one as high risk of bias. Conclusions:Adjunctive biophysical stimulation was associated with favorable healing-related outcomes in selected distraction osteogenesis, limb reconstruction, and delayed-union settings. However, the evidence base remains limited by small study numbers, methodological heterogeneity, and inconsistent outcome reporting, supporting the need for larger contemporary randomized trials.
Purpose Orthopedic trauma patients have variable analgesic and anesthetic requirements dependent on injury pattern, severity, and comorbidities. Inadequate pain control can delay rehabilitation, prolong hospitalization, and contribute to chronic pain and opioid dependence. This review aims to summarize contemporary regional anesthesia (RA) strategies in orthopedic fracture care and highlight their indications, benefits, and limitations in the trauma setting. Methods A comprehensive literature search was conducted across PubMed, Google Scholar, and Web of Science to identify relevant studies on regional anesthesia techniques in orthopedic trauma. Search terms included “regional anesthesia,” “peripheral nerve block,” “orthopedic trauma,” “fracture,” “perioperative analgesia,” and “multimodal analgesia.” Following initial broad search, focused secondary searches were conducted for specific regional techniques. Review articles, randomized controlled trials, prospective and retrospective cohort studies, and landmark technique descriptions were all considered. Results Advances in ultrasound-guided regional anesthesia have significantly improved the precision, safety, and reliability of neuraxial and peripheral nerve block techniques. RA has been associated with superior early pain control, reduced opioid consumption, improved patient satisfaction, and facilitation of early mobilization when compared to systemic analgesia or general anesthesia alone. Although concerns persist regarding hemodynamic instability, masking of acute compartment syndrome, and peripheral nerve injury, current evidence supports the use of RA when appropriately indicated. Conclusion RA is an increasingly important component of multimodal analgesia in orthopedic trauma care. Familiarity with available techniques, anatomic considerations, and injury-specific applications allows orthopedic surgeons to collaborate effectively with anesthesia teams and optimize perioperative pain management. These strategies can improve functional recovery while minimizing opioid requirements.
