Purpose: Periacetabular osteotomy (PAO) is a difficult surgery, and mastering the surgical technique is challenging for hip surgeons. The use of navigation systems may allow inexperienced surgeons to achieve safe and accurate PAO. The purpose of this study was to evaluate the clinical outcomes of conventional and navigation guided PAO in inexperienced surgeons.
Methods: This study included 77 joints (8 men and 69 women with average 35.1 years) in which performed PAO by inexperienced surgeons (less than 30 PAO surgeries) for hip dysplasia between April 2016 and December 2022. The study group was divided to conventional group (37 joints; PAO using conventional method) and navigation group (40 joints; PAO using CT-based navigation system). Demographics, functional outcomes, complication rate, and radiographic parameters were compared between the groups.
Results: Age, sex and body mass index were not significant differences between the groups. There was no significant difference in the preoperative and final Harris hip score between the two groups. Complications were observed in 10 joints in the conventional group (27%) and in 5 joints in the navigation group (13%). Postoperative lateral center edge angle and acetabular head index were significantly greater in the navigation group compare to conventional group. Conversion to total hip arthroplasty were two of the 37 PAO hips (5.4%) in the conventional group and none of 40 hips (0%) in the navigation group.
Conclusion: This study demonstrated that inexperienced surgeons can perform safe and accurate surgery, reducing complications and achieving favorable acetabular coverage by PAO using navigation systems.

Introduction: Actinomyces neuii is a rare pathogen that has only recently been described and is predominantly associated with soft tissue infections. The following is a noteworthy case since, to our knowledge, only very few other diagnosis of bone infection by this rod have been reported.

Results: A 48-year-old female patient from São Tomé with chronic kidney disease (CKD) was referred to our consultation with inflammatory signs in the hind and midfoot; the previous year she had a history of trauma to the foot after stepping on a rusty nail. Clinically, there was generalized swelling and tenderness of the foot. Laboratory findings were negative and imaging showed signs of extensive osteomyelitis of multiple bones. A. neuii was isolated in a bone biopsy of the calcaneum. The patient is currently following a regimen with ampicillin.

Discussion/Conclusion: Considering our patient’s diagnosis of CKD, the clinical findings and a known traumatic injury, the diagnosis of a chronic contiguous osteomyelitis must be considered. Only a few cases of osteomyelitis caused by A. neuii have been reported: this pathogen is probably underreported due to poor detection techniques and misinterpretation as a contaminant. As in previous reports, the isolate was susceptible to beta-lactams; the regimen’s optimal duration is still controversial. As of now, she has been stable and responding to treatment.
Osteomyelitis due to Actinomyces neuii is a rare entity difficult to diagnose and it should be correctly identified as soon as possible to allow for appropriate therapy.

Introduction: Knee supplementation is widely used for knee osteoarthritis (OA). However, its efficacy remains uncertain. This study aims to compare the efficacy of supplement treatments, including glucosamine sulfate, diacerein, undenatured collagen type II (UC-II), and placebo, in improving functional and radiographic outcomes. Methods: A four-arm, randomized, double-blinded, placebo-controlled trial was conducted using 216 participants with mild to moderate knee OA. Participants were randomly assigned to one of four treatment groups, including placebo, glucosamine sulfate, diacerein, or UC-II, over a period of 24 weeks. Baseline characteristics, physical performance, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were recorded. The primary outcome, WOMAC scores, alongside secondary outcomes, including the Numerical Pain Rating Scale (NPRS), additional analgesic use, joint space width (JSW), and complications, were compared at 12 and 24 weeks. Physical performance tests (6-minute walk test and timed up-and-go test) were compared at 24 weeks. Moreover, all measurements were performed at 36 weeks to assess the carry-over effect of the study medication. Results: No significant differences were found among the four treatment groups in both primary and secondary outcomes at 12, 24, and 36 weeks. In addition, repeated measurement and time interaction analysis showed no statistically significant differences among the treatment groups in terms of knee function, pain control, physical performance, and complications. Conclusions: The administration of glucosamine sulfate, diacerein, and UC-II did not significantly improve the WOMAC score at 12, 24, and 36 weeks when compared to placebo in mild to moderate knee OA.

Introduction : Osseous tuberculosis is a rare form of extrapulmonary tuberculosis, and isolated localization at the pubic symphysis is particularly uncommon. Atypical clinical presentation can contribute to delayed diagnosis and the risk of serious complications. Case report : We report the case of a 36-year-old patient who presented with gait disturbances and pain in the pubic region, radiating to the right inguinal fold. A fistulous collection was present on the medial aspect of the root of the right thigh, producing pus. Pelvic radiographs, supplemented by a CT scan, showed destructive osteoarthropathy of the pubic symphysis. Microbiological tests did not isolate any microorganisms. Tuberculosis of the pubic symphysis was made after biopsy and histological examination, revealing a caseating granuloma surrounded by epithelioid cells. The patient underwent antitubercular treatment for 9 months. Following this treatment, clinical improvements were noted, and no recurrence was observed during the 2-year follow-up period. Conclusion : In summary, early detection of cases upon presentation is facilitated by increased awareness of the disease. Early diagnosis and intervention play a crucial role in effective treatment, ultimately contributing to a reduction in morbidity and prevention of deformities.

Introduction: The overarching objective in treating osteoarthritis of the first carpometacarpal (CMC 1) is to alleviate pain, enhance thumb motion, and establish joint stability. Case Presentation: a 51-year-old man with a previous history of an isolated trapeziometacarpal joint dislocation presented at our institution reporting significant pain and instability at the base of the thumb. X-rays revealed trapeziometacarpal joint space narrowing (Eaton-Littler II). The patient underwent trapeziometacarpal prosthetic arthroplasty. At 6 weeks postoperative, he was pain-free while retaining mobility and reporting a stable pinch. Discussion: The absence of a consensus on the superior treatment for CMC 1 joint osteoarthritis has frequently led to decisions guided by surgeon preference. Arthroscopy debridement and extension osteotomy are reserved for the early stages. LRTI is the most frequently performed procedure, however, a notable complication is the potential for loss of length and stability. Arthrodesis offers effective pain relief, and stability, and preserves length, allowing to maintain grip strength. Historically, JR was associated with a high complication rate, attributable to past design flaws. However, in a recent meta-analysis, JR emerged as yielding superior functional outcomes to LRTI. Given that the primary concern for our patient was achieving a pain-free state while maintaining range of motion, and considering that grip strength was not a critical requirement for his job, he made the informed decision to proceed with arthroplasty. JR is likely to persist as a viable treatment option for patients, but additional research is needed before it can be regarded as the gold standard.

Introduction: There are specific differences between intramedullary and extramedullary fixation of pertrochanteric fractures, influencing operation time and intraoperative fluoroscopy time. Material and methods: A comparative analysis regarding operation time and intraoperative fluoroscopy time had been performed under the series of 79 consecutive patients who were treated surgically for pertrochanteric fracture – the group treated by Selfdynamizable Internal Fixator – SIF (group A) and the other group treated by Gamma Nail (group B). Results: Average operation time were 60,9 min (group 1, and 57,7 min in group 2. Average intraoperative fluoroscopy time were 35,8 s (group A) and 81,1 s (group B). Operation time was not statistically significant between the groups (p>0,05). Intraoperative fluoroscopy time was significantly lower in the group A (p<0,05). Conclusion: Pertrochanteric fractures internal fixation is expected to be followed by a similar operation time between Selfdynamizable Internal Fixator and Gamma Nail technique, but intraoperative fluoroscopy time is expected to be significantly different. Factors influencing operation and fluoroscopy time in internal fixation of pertrochanteric fractures could be considered the number of operative technique steps, the average need for repeating some steps and the number of sliding screws.

Introduction: There is limited research on the correlation of deltoid arc length and thickness on magnetic resonance imaging (MRI) with clinical outcomes. Methods: A retrospective review of prospectively collected data was performed in a tertiary institution in Singapore. Patients who had undergone a reverse shoulder arthroplasty (RSA) from 2011 to 2021 were included. Pre- and post-operative radiographic measurements of deltoid wrap arc anteriorly and posteriorly, as well as thickness at 45-degree intervals were taken. These were correlated with forward flexion and abduction range of motion (ROM) and clinical scores pre-operatively and at 3, 6 months, and 1 year post-operatively. A statistical significance of p<0.05 was taken. Results: Forty-five cases from forty-one patients were included. Taking reference from the glenoid edge, the deltoid arc ranges at an average of 21.5˚ anteriorly to 142˚ posteriorly. The deltoid thickness is greatest 45˚ from the anterior at an average of 17.4mm. At 6 months, the Constant and UCLA scores improved from a mean of 32.1 to 51.1 (p=0.007) and 13.3 to 23.9 (p=0.004) respectively, with improvement continuing at the 2 year mark. The thickness of the deltoid at this 45˚ point was correlated with greater flexion and abduction ROM at the 6 month mark (ρ=0.371, p=0.037 and ρ=0.431, p=0.014 respectively). Conclusion: Patients who undergo RSA with a greater deltoid thickness, especially at 45˚ from the anterior, are associated with better forward flexion and abduction ROM, as well as improved functional outcomes 6 months post-operatively. There may be value in prehabilitation in such patients.

Introduction:
Flexible flatfoot (FFF) is a common skeletal disorder in children, often requiring surgical intervention for symptomatic cases resistant to conservative treatment. Subtalar arthroereisis, involving various implants to limit excessive subtalar joint eversion, has emerged as a viable surgical option. Recent advancements, such as self-locking cone-shaped screws, aim to prevent implant extrusion and improve outcomes.
Methods:
In a retrospective study spanning August 2012 to December 2023, we evaluated the effectiveness of subtalar arthroereisis using the Talar-Fit implant in 256 patients with flexible flatfoot, encompassing 493 feet. Clinical assessment employed the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and visual analog scale (VAS), while radiographic evaluation included multiple parameters.
Results:
The study focused on patients averaging 17.7 years in age, 151.5 cm in height, and 44.5 kg in weight. Initial AOFAS scores improved significantly from 50±7.2 to 71±6.5 at the last follow-up, accompanied by a decrease in VAS scores from 6.1±1.2 to 3.5±0.9. Radiographically, notable reductions were observed in Meary’s angle (9.1°±4.3° to 3.3°±1.0°) and talocalcaneal angle (45.9°±7.7° to 37.1°±7.1°). Complications, including sinus tarsi pain (19.2%) and implant extrusion (5.5%), were managed successfully without additional adverse events.
Conclusion:
Subtalar arthroereisis using subtalar implants demonstrates favorable clinical and radiographic outcomes for flexible flatfoot correction. Complications, primarily sinus tarsi pain, were effectively addressed through implant removal, while implant extrusion remained infrequent. This procedure consistently yields stable improvements in both clinical symptoms and radiographic parameters. However, further understanding of complications' contributing factors is crucial for refining surgical techniques and optimizing patient outcomes.

Objective: This study evaluated the influence of preoperative symptom duration on Cervical Spondylotic Radiculopathy (CSR) outcomes following Cervical Disc Arthroplasty (CDA).
Methods: We retrospectively reviewed data from 90 CSR patients who underwent single-segment CDA at West China Hospital, Sichuan University, between January 2008 and March 2020. Patients were categorized based on preoperative symptom duration into early (<24 months) and late (≥24 months) intervention groups. Baseline characteristics, perioperative data, and prosthesis-related complications were compared. Clinical outcomes were assessed through changes in Japan Orthopedic Association (JOA) score, Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores from preoperative to final follow-up. Radiological evaluations included cervical lordosis (CL), C2-C7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc height (DH).
Results: The follow-up ranged from 24 to 120 months, averaging 53.4 months. There were no significant differences in operation time, intraoperative blood loss, or radiological parameters between groups. However, the late intervention group exhibited a longer postoperative hospital stay (P<0.05) and an inability to maintain immediate postoperative CL levels at final follow-up. There were no significant differences in the incidence of heterotopic ossification, anterior bone loss, or prosthesis subsidence.
Conclusion: Preoperative symptom duration impacts CDA outcomes in CSR patients. Those with symptoms lasting ≥24 months experienced longer hospital stays and had a reduced ability to maintain postoperative cervical lordosis, suggesting early intervention may yield better structural outcomes.

Introduction: Gastrointestinal stromal tumor (GIST) is the most common type of sarcoma originating from the gastrointestinal tract, with an incidence of 10–30 cases per million. The predilection site for primary GIST is the stomach, while the most frequent metastasis sites are the liver and lungs. Bone metastasis of GIST, which mainly occurs in the spine, is rather rare. The surgical approach is considered a curative treatment, but occasionally, adjuvant and neoadjuvant chemotherapy are recommended. Case: A 62-year-old male was diagnosed with duodenal GIST affecting the head of the pancreas with liver metastases. Pancreaticoduodenectomy with metastases extirpation followed by adjuvant chemotherapy was the treatment of choice. The patient was considered disease-free for eight years. Afterward, he presented with a sudden left shoulder pain. Imaging showed a pathological proximal humerus fracture, while pathohistological analysis confirmed solitary GIST metastasis. En bloc tumor resection with rotator cuff muscle preservation and reversed total shoulder arthroplasty was performed. Histopathology confirmed total tumor excision with clear margins. Conclusion: We present a case of successful treatment for an infrequent occurrence of GIST bone metastasis to the proximal humerus.

Introduction: Acute soft tissue injuries such as ankle sprains are common, and cryotherapy is one popular treatment measure that can be administered readily. However, there have been varying recommendations on its use. Most recently, the use of cryotherapy is discouraged in the PEACE & LOVE guidelines. This study aims to re-evaluate the role of cryotherapy in rehabilitation post-acute soft tissue injury and if the above recommendation is warranted. Methods: A systematic search of four databases (PubMed, EMBASE, Scopus and Cochrane Library) was performed. Studies comparing pre-to-post cryotherapy outcomes or comparing cryotherapy vs control groups for acute soft tissue injuries were included. Meta-analysis was performed to compare the following outcomes between pre-to-post cryotherapy use: (a) Pain score at rest and moving (VAS), (b) Figure-of-8 ankle swelling. Results: Seven randomized controlled trials were included in this study. Total cohort size was 218, with 4 studies comparing non-cryotherapy and cryotherapy interventions. Meta-analysis revealed significant improvements in pain score both at rest and on moving pre-to-post cryotherapy use (P <0.05). Meta-analysis was not conducted between cryotherapy and non-cryotherapy interventions due to heterogeneity in controls. Further analysis revealed significantly greater improvement in pain on moving compared to at rest in the pre-to-post cryotherapy cohort. Conclusion: This study found that cryotherapy could potentially remain relevant in pain control management in the rehabilitation phase of acute soft tissue injuries. Greater improvement in pain on movement suggests that cryotherapy can be more effective when used prior to physiotherapy/return to sports to facilitate rehabilitation or to improve function.