Introduction: Tibial shaft fractures commonly occur because of high-velocity trauma. Considerable debate exists over the optimal approach for nailing tibial shaft fractures. We aimed to compare the clinical, radiological and functional outcomes and intra-operative fluoroscopy time, total blood loss and operative time between Supra-patellar and Infra-patellar techniques in the treatment of extra-articular tibial shaft fractures. Methods: Patients between 18-45 years presenting to our Level I trauma-centre with AO/OTA type 42 fractures were randomized into Suprapatellar and Infrapatellar groups. Severity of knee pain (VAS) and knee range of motion were documented at 2 weeks, 6 weeks, 3 months and 6 months follow-up. Functional outcomes were measured using Knee Society Score, Lysholm Knee Score, KOOS-PF score and radiological union assessed with radiographs done at 6 weeks, 3 months and 6 months post-operatively.Results: Thirty patients underwent nailing by suprapatellar approach and 30 by infrapatellar approach. A significant difference (p-value 0.003) was noted in the operative time which was shorter in the suprapatellar compared to the infrapatellar group. The suprapatellar group had a significantly lower mean intra-operative blood loss compared to the latter (p-value 0.027). There was no difference between the two groups in terms of pain or range of motion. The mean functional scores were higher in the suprapatellar group at all time points of follow-up though this difference was not significant. Conclusion: Suprapatellar nailing of tibial shaft fractures may help reduce operative time and intra-operative blood loss with similar intra-operative radiation exposure, clinical and functional outcomes compared to infrapatellar nailing.

Introduction: Hand soft tissue infections are common in manual workers, with most of these entities comprising common skin bacterial agents. Frequently these infection cases have a benign course and are successfully treated with oral antibiotics. Mycobacterium agents are extremely rare causes of soft tissue infections and can lead to self-limiting, ulcerative, and granulomatous skin lesions, particularly when there is direct risk exposure. We present the clinical case of a 39-year-old woman with pain, warmth, and redness in the second finger of her right hand, one month after a traumatic injury at work. Initial evaluation revealed swelling with inflammatory signs and fluctuation at the medial phalanx. Spontaneous drainage appeared purulent. Oral antibiotic treatment was instituted, with no signs of clinical improvement. As such, surgical lavage and debridement was performed. Microbiological cultures were negative and after a period of antibiotic treatment, clinical resolution was not achieved. Further investigation revealed occupational exposure to aquariums as the patient worked in a pet shop. Mycobacterial infection was suspected and as such Molecular and targeted cultural analyses identified Mycobacterium Marinum infection in the wound samples. Treatment with clarithromycin, rifampicin, and ethambutol led to documented healing within a month OF follow-up with full disease resolution at 3 months of follow-up.
Conclusion: The identification of M. Marinum infection requires a high degree of suspicion due to its rarity. This case also illustrates the importance of a thorough exposure hazard clinical history in difficult-to-treat soft-tissue infections in order to diagnose and treat rare pathological agents.

Introduction: Prosthetic joint infection (PJI) is one of the most challenging complications of knee replacement surgery. Synovaure lateral flow test was developed as a rapid test for the detection or exclusion of PJI by detecting alpha-defensin in synovial fluid. Alpha-defensin is an antimicrobial peptide that is secreted by human neutrophils in response to pathogenic presence. Methods: A retrospective study included 63 patients with symptomatic knee arthroplasty with no clinical signs of acute infection. Aspiration is done in theatre under complete sterile conditions, with one sample for Synovasure test and another sample for culture and sensitivity. Results: Patients had a male-to-female ratio of 1.03 (32 males to 31 females) with a mean age 69 years; 52 to 87). Two patients (3.1%) had positive synovasure tests with only one of them had a positive culture. 59 patients (93.6%) had negative synovasure tests, and three of them had positive cultures. Two samples were blood-stained (unsuitable for synovasure), and one of them had a positive culture. The synovasure test achieved a sensitivity of 25% and a specificity of 98.2%. The positive predictive value (PPV) was 50%, and the negative predictive value (NPV) was 94.9%. Conclusion: Synovasure is a good negative test with low sensitivity, which makes the test not reliable enough to confirm the positive results. Given the big consequences and the high cost of the missed diagnosis of PJI before revision, continuation of the culture and sensitivity tests, along with Synovasure test to rule out PJI is recommended.

CT-guided, minimally invasive, percutaneous thermal ablation of oligometastatic disease in the bones has unique advantages compared with surgery or radiation therapy. Thermal ablation, including cryoablation and microwave ablation of osseous lesions can result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This treatment option has become increasingly integrated into interventional oncology over the past several years.
Indications for thermal ablation include treatment of painful metastases refractory or unsuitable to conventional therapies, local control of limited metastatic disease and prevention of critical skeletal events.
Osseous metastases are ablated for pain palliation and/or local tumor control when there is persistent pain or imaging tumor progression despite maximum radiation therapy, radiation therapy is contraindicated, or there is inadequate response to systemic therapies and analgesics, Combination of radiation therapy and thermal ablation is also considered for radiation-insensitive tumors. Cementation may be performed following thermal ablation for added pain relief or pathologic fracture prevention/stabilization.
We report retrospectively our experience on safety, pain relief and local tumor control achieved with
percutaneous MWA and cryoablation of bone metastases in 21 patients at our center from 2019 to 2023. Five patients were treated with palliative and 16 with curative intent. Mean tumor diameter was 24 mm (range 11-92mm). External radiation therapy had been performed on four metastases prior to ablation. There was no major complications, and 4 minor complications.
Percutaneous ablation of bone metastases is safe and results in significant long lasting pain relief and good local tumor control in selected patients.

Introduction: hip osteoarthritis (HOA) is a major cause of severe pain, limited mobility and disability resulting in a significant reduction in quality of life (QoL). Intestinal health (IH) and nutrition may have impact on the severity of HOA and patient’s QoL. Patient-reported outcome (PRO) measures are promising tools for the evaluation of the burden of illness and treatment outcomes. There are a number of PRO measures for HOA but none of them covers areas related with IH and nutrition.
Purpose: we aimed to develop a new questionnaire in accordance with COSMIN Guidelines.
Material and methods: development of HOA-PRO consisted of several consecutive stages under coordination by the Study Expert Committee (SEC). The concept of HOA-PRO and item selection was based on literature review (2010-2023). Item selection resulted in a list of 104 items categorized into 5 domains: pain, function, psychosocial well-being, IH and nutrition. The domains and items were reviewed by the experts (n=15) to test content validity of the items and to generate additional items. Then 30 HOA patients were interviewed for clarity, usefulness and applicability of the items with further item reduction and additional items generation. Respondents’ preferences for mode of administration were analyzed, length of the questionnaire, wording and the response scale for HOA-PRO were reviewed by the SEC.
Results: the prototype of HOA-PRO consisting of 66 items was created and tested in the group of 100 patients. The HOA-PRO is the first specific instrument to measure PROs in HOA with the focus to IH and nutrition.

Introduction:
Phalanx fractures are very common, often neglected and considered minor injuries by patients, they can be responsible for joint stiffness impairing finger function, their treatment depends on the degree of instability and associated injuries. The objective of our study is to evaluate the functional outcomes of hand phalanx fractures treated by pinning.

Materials and Methods:
A retrospective study over a period of 3 years of cases collected including 54 patients. An average age of 26 years with male predominance, with an average follow-up of 18 months. Evaluation included total active motion (TAM) after pin removal.

Results:
Open fracture of the P1 of the 5th finger is the most frequent in our series. All our patients were operated under locoregional anesthesia, based on pinning (Kirschner wires), with repair of associated injuries. Most of our patients started rehabilitation at 3 weeks postoperatively, pin removal was done at 6 weeks. Evaluation of patients after rehabilitation sessions found good recovery of hand function in 65% with their return to work. Complications found: stiffness first, followed by infection and delayed union.

Discussion:
Phalanx fractures are considered unstable, and there is no therapeutic consensus for non-displaced fractures, regardless of the chosen therapeutic method, early mobilization of all digital joints is indicated. Pinning offers remarkable stability, compatible with rapid rehabilitation.

Conclusion:
Pinning is a simple and economical technique, providing satisfactory stability for displaced phalanx fractures, allowing the patient to start early rehabilitation with satisfactory clinical outcomes.

Purpose: Stress shielding in press-fit radial head arthroplasty (RHA) often leads to bone resorption around the proximal radial neck. Radiographic loosening, defined by >2mm radiolucency in "Gruen" zones, indicates potential loosening. This study compares bone resorption characteristics in stress shielding with and without radiographic loosening. Methods: Sixteen patients who underwent anatomical press-fit radial head arthroplasty (RHA) were included in the analysis. Radiographs were conducted postoperatively and at intervals of one, six, and nine weeks, as well as three, six, nine, 12, and 24 months. The extent and distribution of bone resorption around the proximal radial neck and stem were measured in two groups: Group A (with radiographic loosening) and Group B (without signs of loosening). Results: Follow-up averaged 20 months (12-36). Stress shielding occurred in 85.7% (n = 7) of Group A and 100% (n = 9) of Group B. A significant difference in mean proximal radial neck resorption (PRNR) was observed between Group A and B (P < 0.05). Group A had a final mean PRNR of 1.78 mm (SD 2.6), while Group B had 5.23 mm (SD 2.1). Moderate PRNR (>3mm) in Group B started after a mean of 5.3 months (SD 2.2). In Group A, the degree of PRNR in any area of each observation subject during the entire follow-up period was always less than 3 mm and failed to reach a moderate level. Conclusion: Delayed and lower degree PRNR correlates with a higher risk of radiographic loosening in RHA.

[Background] Wind swept elbow is a sweeping injury that causes marked elbow instability due to loss of a medial or lateral epicondyle and collateral ligaments. Reconstruction of medial or lateral collateral ligaments is challenging due to loss of the isometric attachment point. We report a case of lateral type of wind swept elbow treated with a unique surgical technique to restore joint stability using a bone tendon autograft. [Case] A 38-year-old woman had a traffic accident and had a lateral type of wind swept elbow. She was transferred to our hospital for reconstruction on day 3. The day after transfer, debridement and evaluation revealed defects of lateral epicondyle, 2/3 of capitellum, 2/5 of radial head, proximal lateral ulnar cortex, LCL complex and soft tissue around the elbow. Varus instability and posterolateral instability (PLRI) were also observed. One week after transfer, the capitellum and LCL complex reconstruction was performed using iliac bone grafting with the iliotibial band, and the soft tissue defect was reconstructed with a pedicled forearm radial flap. Six months after the surgery, the range of motion was relatively maintained -35° in extension and 120° in flexion, and there was no varus/valgus instability or PLRI. [Discussion] When reconstructing the lateral collateral ligament complex for PLRI, it is important to reconstruct the LUCL at the isometric point. This is the first report of reconstruction of LCL complex including LUCL in wind swept elbow with bone tendon autograft. The short-term result was good, suggesting that it is highly useful.

Random skin flaps are commonly used to repair skin damage.Nevertheless,ischemic and hypoxic necrosis limits their wider clinical application.Daphnetin,7,8-dithydroxycoumarin,extracted from from the traditional Chinese medicine Zushi Ma,was reported to have vasodilation and anti-inflammation outcomes.Our study was performed to assess the effect of Daphnetin on flap survival.
Twenty-four male SD rats with a modified McFarland flap were randomly divided into four groups:control (solvent 10% DMSO + 90% corn oil), low-dose Dap (20 mg/kg), middle-dose Dap(40 mg/kg) and high-dose Dap (60 mg/kg).All rats were treated once a day.Seven days after the surgery, the range of necrosis was calculated.The activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were measured. H&E staining was performed to assess the histopathological changes in skin flaps, and the levels of microvascular density (MVD) were determined. Laser Doppler Flowmetry was used to evaluate microcirculation blood flow.Western blot was used to measure the expression levels of vascular endothelial growth factor (VEGF), recombinant sirtuin 1 (SIRT1), nuclear factor erythroid-2-related factor 2(Nrf2),NADH dehydrogenase quinone 1(NQO1) and heme oxygenase 1 (HO1).And expression levels of recombinant NLR family pyrin domain containing protein 3 (NLRP3),tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), interlukin-1β(IL-1β)were evaluated by immunofluorescence.
Consequently,daphnetin increased the flap survival area,reduced the level of MDA and improved SOD activity.With increasing expressions of SIRT1,Nrf2,NQO1,HO1 , daphnetin alleviated ferroptosis through SIRT1/Nrf2 pathway.VEGF expression was increased and levels of TNF-α, IL-6,IL-1β decreased.Daphnetin enhanced angiogenesis and relieved inflammation.These changes were more pronounced in the Dap-H group. Our findings indicate that Daphnetin significantly improves skin flap survival.

Objective: To present a new method of surgical treatment for spondylosis and low-grade spondylolisthesis, using personalized 3D-printed titanium implants.
Materials and Methods: 18 patients with symptomatic L5 spondylosis underwent surgical treatment, including 13 with Grade I spondylolisthesis. The mean age of the patients was 15.4 years.
Based on these CT examination data, a custom titanium implant was printed using 3D printing technology.
Standard pedicle screws were inserted in L5 vertebra. Then personalized implant were installed on L5 lamina and screws. After tightening the nuts pars integrity were restored. If there was anterior displacement of the L5 body, the implant was designed to reduce slippage. The supraspinatus ligament were preserved in all cases.
Results: The mean follow-up time was 12.8 months. All patients recovered to their initial sports activities. Preop the Pediatric Quality of Life (PedsQL) measure results were 73.1 ± 9.4; 3 months postop. - 87.7 ± 8.1 and 6 months F-Up - 89.6 ± 6.4. Back pain, as measured by the Visual Analog Scale (VAS), preop was 6.3 ± 2.7; 3 months after surgery - 3.3 ± 0.9; and 6 months postop. - 2.6 ± 0.4. Functional X-rays and CT scans demonstrated maintaining the range of motion at the L5-S1 level and stability of the pars fixation.
Conclusion: This study demonstrates that personalized 3D printed implants can be used effectively in the treatment of spondylosis and low-grade spondylolisthesis, even in cases with pronounced dysplastic changes of the lamina, providing relief from pain and restoring function.