Fractures of the neck of the femur are one of the most common types of lower extremity fractures that occur in people of all ages. Specific vascularization, anatomy and morphology of the femoral neck are key factors that play a role in the treatment and outcome of these fractures. A simple fall or high-intensity trauma can lead to a femoral neck fracture. In young patients, fixation of these fractures is the method of choice for treatment, and many fixation methods have been used over the years. Cannulated screws, DHS are still the type of fixation that the largest number of surgeons use. We believe that the cephalomedullary nail with linear compression provides adequate rotational and angular stability of the fracture as key factors in union. Immediate compression through the fracture site and fixation with two screws are the most important factors for stable fixation. Over the last 4 years we have treated 30 hips with this nail. We followed the patients for at least one year after the operation. 26 fractures were healed, one cut-out, two avascular necrosis, while we have no information about one patient. Our data encourage us that the cephalomedullary nail with linear compression can be an effective method of treating femoral neck fractures if there is an adequate indication for its application and if the correct surgical technique is used.

Introduction: Necrotizing fasciitis (NF) is a rare, rapidly progressive soft tissue infection affecting the skin, subcutaneous tissue and fascia. NF can be caused by a single bacteria or can be polymicrobial, resulting from either injury to skin or haematogenous spread. Early diagnosis and aggressive surgical debridement are vital in reducing mortality. Methods: In this case series we describe the clinical presentation, demographics, laboratory and microbiological features, management and outcomes of patients presenting with NF over a 4 year period in a UK district general hospital. We also assess the validity of the LRINEC scoring system amongst our study population. Results: A total of 19 patients were diagnosed with necrotising fasciitis during this time. There were 8 females and 11 males, and average age was 63.5 years. 14 cases involved the lower limb and 5 the upper limb. All cases were managed operatively. Mean time from admission to surgery was 24.2 hours and a mean of 2.9 surgeries were needed per patient. Wound swabs and intra-operative cultures were performed in all cases demonstrating in most cases polymicrobial infection. All patients had complex underlying comorbidities. Mean LRINEC score was 6.9 and demonstrated a high predicting value. Conclusion: Necrotising fasciitis is a life threatening infection. Early empiric broad spectrum antibiotics and surgical debridement with routine re-examination and further debridement as needed are imperative for optimal outcome. We present our 4 year results in the management of this critical condition in a general district hospital in UK.

Hand injuries are extremely common in domestic and industrial setting. Around 10% of these injuries require hospitalization and surgery. Even though these injuries are not life threatening, they can result in severe disability and can significantly decrease quality of life and work ability. In 2023, 86 patients with hand injuries were surgically treated at a single center. Severity was determined by the Hand Severity Score. Quality of life assessment was done after six months using Disabilities of Arm, Shoulder, and Hand (DASH) score, Body Dysmorphic Disorder Examination Self Report – Munich Version (BDDE – SR) and Hospital Anxiety and Depression Score (HADS). Patients were predominantly male (91.86%), with the mean age of 51.40 ± 14.25 years. The average DASH score in males was 20,73, and females 17,20, and was mostly affected by severity of the injury. Average BDDE-SR was 58,25 in males and 73,12 in females, and the mean HADS was 3,27 for depression in males and 4,59 in females, and for anxiety 2,02 in males and 3,06 in females. Worse BDDE-SR scores were seen in younger patients, in females, and in patients who had at least one finger amputated. HADS scores mostly depended on hospital length of stay, and higher depression scores were seen in older patients. Depending on their severity, hand injuries decrease quality of life to a different degree. Patient dissatisfaction was the greatest when the injury involved finger amputation, especially in younger females, and when the injury resulted in long hospital stay and worse functional results.

Introduction: Traumatic amputations of the fingers are devastating injuries that cause loss of pinch and grip function and lead to profound disability, prolonged rehabilitation and compromised quality of life. Case: We present the case of a 49-year-old female, victim of a traumatic amputation of the first 3 rays of the right hand. She went to our consult two years after the initial accident, and underwent reconstruction of the thumb by transfer of the second toe by performing an anastomosis of the dorsal pedis artery and vein to the branch of the radial vessels in the wrist as well as an anastomosis of the external saphenous vein to the basilica, and tenorrhaphy of the extensor and flexor tendons. The patient required subsequent reinterventions to optimize skin coverage and function - firstly a total skin graft in the 1st interdigital space of the palmar and dorsal surface of the hand and later an excision and degreasing of excess skin on the base and back of the first finger. The patient progressively recovered joint mobility with the ability to pinch, gradual gain in sensitivity, with only some decrease in muscle strength. Discussion: Reconstruction of a posttraumatic first finger defect is a challenging surgical endeavor, with multiple options available. Although free toe transfer techniques continue to evolve, such procedures are technically demanding and result in inevitable morbidity in the donor area. Nonetheless, compared to patients who have not undergone thumb reconstruction, toe transfer improves pinch strength, grip strength and static two-point discrimination.

Introduction: The cervical paraspinal muscle (CPM) has an essential role in positioning, stabilizing and directing the cervical spine. However, information is lacking regarding the influence of CPM on outcomes following anterior cervical surgery. This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes and analyze the relationship between FI and cross-sectional area (CSA) of CPM.
Methods: A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level hybrid surgery. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons.
Results: Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p=0.053). No statistically significant differences were presented among the three groups regarding pre- and postoperative clinical evaluation scores. The cervical lordosis was significantly higher in the normal group before surgery (p=0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p=0.046). Moreover, after correction according to vertebral body area, no statistically significant relationship existed between CSA ratio and FI grade.
Conclusion: CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and postoperative sagittal balance disorder, particularly in C2-7 SVA and segmental alignment of arthroplasty level.

Introduction:
Fibrous dysplasia is characterised by weak bony architecture due to overproduction of disorganised fibrotic matrix. There is significant morbidity secondary to pain, deformities, and pathological fractures. Intramedullary fixation is the best treatment to prevent recurrent fractures and deformities. We describe our experience with the use of zoledronic acid therapy and cephalomedullary fixation, showcasing how this enhances biomechanical stability, improves function, and provides pain relief in compromised bones.

Materials & Methods:
Ten patients were treated for proximal femur fibrous dysplasia with coxa vara. All the patients received adjuvant zoledronic acid therapy and underwent valgus osteotomy and cephalomedullary fixation. In children, where cephalomedullary fixation could not be done, paediatric hip plate was used . Patients were examined clinically using modified criteria of Guille.

Results:
The mean age was 22.6 years (range 7-39). The mean neck-shaft angle pre-operatively and postoperatively was 94° (range 84°–107°) and 124° (range 117°–131°) respectively. Limb-length discrepancy was corrected from 3.0 (range 1.8–4.5) cm preoperatively to 0.7 (range 0–1.9) cm postoperatively. All osteotomies had healed at the final followup examination. The clinical scores (modified criteria of Guille), improved from an average of 2.9 (range 1–7) to 8.5 (range 6–10).

Conclusion:
Valgus osteotomy and cephalomedullary fixation provides good results in fibrous dysplasia of proximal femurs, however, challenges faced include addressing >1 CORA in proximal femoral fibrous dysplasia, with additional presence of compensatory genu valgum; difficulty in complete correction of neck-shaft angle owing to fixed angle cephalomedullary fixation devices.

Keywords: Fibrous dysplasia; Zoledronic acid; Valgus osteotomy; Cephalomedullary nailing

Background: Robotic-assisted unicompartmental knee arthroplasty (UKA) has improved component alignments and clinical outcomes. Aim of this study was to compare the clinical outcomes, radiologic outcomes, survivorship of implant, and revision rates of robotic-assisted UKA to those of conventional mobile Oxford UKA in long-term follow-up at a minimum of ten years.
Method and materials: a prospective study, One hundred knees, ninety-two patients with medial unicompartmental osteoarthritis were assigned to treatment with either conventional Oxford mobile UKA or robotic-assisted surgery UKA (MAKO). Radiographic outcomes and Oxford knee score was evaluated at 1,5 and 10 years after surgery. Revision rates and mode of failure were recorded compared and analyzed.
Results: The comparison between the two groups in terms of post-operative radiographic measurement included femorotibial angle (0.02° ± 4.40 vs. 3.38° ±3.45), femoral component alignment (3.13° ± 2.11 vs 8.08° ± 2.99), tibial component alignment (1.47° ± 1.59 vs. 0.33° ± 2.49), posterior slope (3.89° ±3.15 vs 2.02° ±1.87) in robotic group were superior than conventional group (p<0.05). Only ten years survivorship curve in robotic group was lower than conventional group. However, Oxford knee scores of one year, five years, and ten years follow-up were not significant differences for both groups.
Conclusion: Robotic-assisted UKA surgery makes prosthesis positioning more accurate than conventional UKA. However, no differences in clinical outcomes and rates of revision were found in the midterm statistically significant. Early revision rates were observed in the robotic-assisted UKA group

Purpose: Congenital dislocation of the patella with concurrent knee external rotational dislocation is a rare condition that results in substantial functional disability. This condition is present at birth, and the correction should be planned as soon as the diagnosis is confirmed. Still, unfortunately, the treatment may be delayed until late childhood in some patients. We retrospectively reviewed the results of operative treatment of the five knees presented late in three patients with congenital patella and concurrent knee dislocation. Methods: The ages of the three patients at surgical treatment are 9, 10, and 11 years, respectively. All knees were treated operatively with quadricepsplasty, lateral release, medial plication, medial transfer of the lateral patellar tendon, knee reduction, and lateral collateral ligament reconstruction. Results: The patella and knee reduction were achieved, and knee function improved in all five knees. Conclusion: Good clinical outcomes can be achieved with surgery for children with congenital dislocation of the patella with concurrent knee external rotational dislocation. Keywords: Congenital dislocation, Patella dislocation, knee dislocation, Operative treatment

Reconstructions of the soft-tissue defects over the distal lower extremities in the elderly patients (≥60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients. Between March of 2005 and December of 2021, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study.The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥60 years old) and group B (ranging from 18 to 30 years old). The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05). The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary.

Introduction: To construct a three-dimensional finite element model of Perthes disease to evaluate the impact of different surgical methods on the stress distribution of the hip in children biomechanically. Methods: Two patients, one was Herring type B, the other was type C, were chosen to establish the finite element model. According to different proximal femoral osteotomy methods (10°, 15°, 20° each for varus osteotomy and valgus osteotomy), the changes in bone and cartilage stress around the hip joint were analyzed. Results: By finite element analysis, different proximal femoral osteotomy methods can change the stress distribution of the hip joint, and the proximal femoral varus osteotomy method is better than the proximal femoral valgus osteotomy method, which can progress the stress distribution of the hip. Conclusion: For Perthes disease, the maximum stress is mostly concentrated on the anterolateral side of the femoral head. This may be the biomechanical basis for the deformation, fragmentation, and collapse of the femoral head. As for the treatment, the proximal femoral varus osteotomy is better than the proximal femoral valgus osteotomy, which can improve the stress distribution of the hip joint and make it closer to the normally developed hip joint.

Introduction: To study the recovery of the appearance and function of the finger after the free part of the toenail bed tissue flap was transplanted to the finger. Methods: A retrospective analysis was made of 11 cases of finger deformity repaired by free partial toenail bed flap transplantation from January 2018 to January 2023. There were 5 thumb deformities, 2 index finger deformities, 2 middle finger deformities and 2 ring finger deformities. All patients had terminal segment deflection, nail bed defect and deformity. The patients were followed up, X-ray films were taken, force lines were measured, and the range of motion of interphalangeal joint was measured. Results: All patients were followed up after the operation. Part of the toenail bed flaps of 11 patients survived, the force line improved, the nail bed increased by 26%, and the interdigital mobility increased by 21% compared with the previous operation. Conclusion: Transplantation of free partial toenail bed flap to correct finger deformity can achieve good therapeutic effect.