Introduction:
Unstable pelvic ring fractures can result in severe and life-changing injuries, making their management critical. The current literature on the emergency treatment and management of these injuries is highly variable. This study aims to identify areas of agreement and differences in the treatment of unstable pelvic ring injuries.

Materials and Methods:
A standardized questionnaire with 15 questions was distributed online among 358 trauma surgeons from 80 countries that are members of SICOT in 2022. The survey included questions on surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Respondents rated their treatment strategies on a 4-point rating scale (always, often, seldom, or never).

Results:
Young and Burgess and Tile/AO classifications were most commonly used, and preoperative 3D CT scans were utilized by 93% of respondents. Rescue Screws, C-Clamps, angioembolization, and pelvic packing were rarely implemented in practice, while external fixation was the most common method of pelvic temporization. Percutaneous screw fixation was the most commonly utilized definitive fixation technique, while 3D navigation techniques were rarely used. Angioembolization and REBOA had more usage in Europe, North America, and Oceania.

Conclusion:
This study found that the Young-Burgess and Tile/AO classifications are used equally across the world, initial stabilization with binders/sheet is commonly used worldwide, and pelvic stabilization with an external fixator is common. Hemostatic techniques such as pelvic packing and angioembolization are rarely used, and REBOA almost never. The study also identified regional differences in the use of technically advanced interventions, which require further investigation.

Femoral neck fractures of Pauwel’s III type are inherently unstable and notorious for failures. The concept of primary valgus osteotomy for such fractures has always generated interest among Orthopedic surgeons. Although double-angled blade-plates and double-angled dynamic hip screws have been the implants of choice for these osteotomies, these surgeries often prove technically demanding for inexperienced surgeons. Therefore, we prospectively studied the use of high-angle DHS (1450) for the fixation of valgus osteotomies to evaluate its technical superiority over the double angled devices. Twenty-two patients of Pauwel’s type III femoral neck fractures were managed with primary valgus intertrochanteric osteotomy using 1450 DHS. The mean age of the patients was 31.6 years and the mean corrected angle was 18.4 degrees. Eighteen patients achieved union of the fracture as well as the osteotomy site at mean follow-up of 16.3 weeks. Two patients had avascular necrosis of the head and two had implant cut-out. No other complication was noted up to a mean follow-up period of 2.7 years. By inserting a 1450 DHS in the center of the neck, a minimum of 100 of valgus correction is automatically achieved when shaft and plate are apposed together; further correction is easily achieved by changing the insertion angle. It also leaves enough space for a de-rotation screw. Using this device causes lateralization of the shaft, which is biomechanically and anatomically superior than medialization. Valgus osteotomy using a high-angle DHS is a promising technique, easy to perform with reproducible results.

Purpose: Treatment of late stages of Legg-Calvé-Perthes disease is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in late stages of Perthes disease as it does not improve symptoms in terms of limb length discrepancy and gait. We aim to assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late stage of Perthes disease.

Materials and Methods: From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using IOWA score and range of motion variables. Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years or older at time of surgery, in a post-fragmentation stage, complaining of pain, limited range of motion, Trendelenburg gait, and/or abductor weakness.

Results: Preoperative IOWA score (average: 53.27) markedly improved at 1-year post follow-up period (average: 85.41) then slightly improved at the last follow-up (average: 89.41) (P-value < 0.05). Range of Motion: internal rotation increased on average: 22° (10° preoperatively, 32° postoperatively) and abduction increased on average: 15.7° (25° preoperatively to 41° postoperatively). Mean Mose deviation of femoral heads was 4.1 mm at the end of follow up. Tests used were Paired t-test and Pearson correlation test where the level of significance was at P-value less than 0.05.

Conclusion: Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late stages of Legg-Calvé-Perthes disease.

Background : Femoral head retroversion as a sequence of slipped capital femoral epiphysis (SCFE) is an important etiology of femoroacetabular impingement (FAI) which one of leading factors of premature osteoarthritis of the hip and limitation of hip movements especially internal rotation, abduction and flexion which result in physical disability and abnormal gait. Patients and method* :Between January 2015 and january 2021, twenty one hips, six female and eleven male with moderate and severe malunited slipped capital femoral epiphysis were treated with surgical hip dislocation and subcapital osteotomy was don. Age from 13 to 19 years old. We perform a retrospective review of patients hostories, physical examinations, pre and postoperative radiographic analysis and operative findings. There is significant improvement in post operative Harris Hip Score was noticed with follow up. Complications occurred in three hips, AVN in two hips, and post operative traumatic dislocation in one hip. Conclusion :Subcapital osteotomy can correct the proximal femoral deformitiy for moderate and severe malunited slipped capital femoral epiphysis. Subcapital osteotomy, while potentially improving hip biomechanics and hip outcomes does carry significant risk of major complications. However, surgeons and patients should be aware about the risks and difficulties of this procedure. Anatomical restoration of the proximal femoral deformity may postpone the progression to severe osteoarthritis of the hip and thus delay the need for hip Arthroplasty in those young populations.

Background: The success of primary total knee arthroplasty (TKA) depends on the restoration of mechanically neutral limb alignment and precise ligament balancing. Several techniques have been described to achieve soft tissue balance in a Varus knee, but there is a lack of consensus among surgeons about the most suitable medial release method. We report our experience with MTRO (medial tibial reduction osteotomy) in TKA for the correction of moderate to severe Varus deformity. Method: A total of 324 patients (488 cases) with ≥10° tibiofemoral Varus deformity on the preoperative whole leg standing AP view, who underwent primary TKA performed by the same senior surgeon at our institution between June 2018 and June 2021, were included in this prospective study. MTRO, involving the removal of the posteromedial tibial bony flare, was used to achieve deformity correction. Results: We included 254 female and 70 male patients in the age group of 55-80 years. The mean preoperative tibiofemoral angle was 16 ± 5.8° Varus (range: 10°–34°). At a mean follow-up of 1.6 years (range 1.2–2.6 years), the mean tibiofemoral angle was corrected to 5.9 ± 2.4° valgus (range 1.5°–8°). The KSS and KFS knee score improved to 91.8 and 78.3 points, respectively. Conclusion: MTRO, a technique of medial release for the correction of moderate to severe Varus deformity, permits reliable, replicable, and quantifiable medial compartment opening without weakening the MCL. A 1 mm posteromedial and medial bone resection achieves a 1.6°-1.8° Varus deformity correction when our standard release protocol is followed

Introduction: robotic total knee arthroplasty (RoTKA) is becoming a routine orthopedic practice. Purpose: comparative analysis of the accuracy of implant positioning in primary total knee arthroplasty using a robot - robotic total knee arthroplasty (RoTKA) with conventional manual technique (CtTKA) and computer navigation (CnTKA). Method: a prospective single-center study included 180 patients with end-stage primary osteoarthritis of the knee (KL), with isolated unilateral osteoarthritis, without signs of knee ligament instability, mean age 68±6 years, 116 women and 64 men, body mass index (BMI) <30 kg/m2,without comorbidities (ASA 3°. Conclusion: Among patients undergoing primary TKA, there was a decrease in final bias associated with the use of RoTKA compared with a different technique, regardless of age, gender, BMI, and pre-replacement alignment.

Background: This study compared the kinematics and plantar pressures between unilateral and bilateral standing positions in a group of asymptomatic volunteers. Methods: 8 patients were included for study, standing either on both feet or a single foot switching between the above two positions three times. Kinematic data was collected using an eight-camera Optitrack 3D motion capture system to reflect changes in alignments of the ankle, subtalar, and midtarsal joints. Plantar pressure distribution was assessed using a pressure platform. Paired t-tests were used to compare the metrics between the two standing positions. Results: From bilateral to unilateral weightbearing, 5 out of 21 kinematic angular parameters showed medium to high level of statistical significance (p=0.003-0.037) reflecting differences in the relative positions of the ankle, subtalar, and midtarsal joints in the two weightbearing positions resulting from pronation of the hindfoot and midfoot (Table 1) There was a significantly higher plantar pressure increase on the medial than the lateral side of the feet corresponding to the kinematic changes. Conclusions: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot but increase that of a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to bearing weight naturally without concerning about one foot blocking the other during the radiographic imaging.

Despite advances in navigated and robotic-assisted surgery, there is no direct comparison to identify differences in radiological and clinical outcomes in patients undergoing Total Knee Arthroplasty (TKA) using different techniques. Our study reviewed a matched cohort of patients undergoing conventional, navigated and robotic assisted TKA to identify if there is a difference in radiological and clinical outcomes in these patients. 

A total of 264 TKA. In each of the different surgical techniques, there were 88 TKA. All patient cohorts were matched for valgus and varus pre-operative deformity, grade of pre-operative osteoarthritis and patient demographics Intra-operative data, post-operative data, patient reported outcomes and radiographic data were reviewed. 

The mean correction for tibiliofemoral alignment for the robotic assisted TKA (RTKA) was – 3.58 degrees, for the navigated assisted TKA (NTKA) was – 5.00 degrees, for the conventional TKA (CTKA) was – 4.16 degrees. The mean posterior slope was 4.46 degrees, 7.89 degrees and 5.20 degrees respectively. An independent KW test comparing the posterior slope showed there was statistical significance between the different types of surgical techniques. There was no statistical significance between the individual groups for the OKS and EQ-5D scores. CTKA had the shortest length of stay, length of operation and lowest readmission rate. There was statistical significance between the individual groups for the length of operation.

Technology may offer better short-term results based on literature, our results show CTKA to have the greatest mean improvement in OKS and EQ-5D scores, lowest LOS, lowest length of operation and lowest 30-day re-admission.

Introduction: To date, there exists significant ambiguity regarding the benefits and pitfalls of the use of autograft, other bone graft substitutes, and different constructs for reconstruction in patients undergoing ACDF. The current study was conducted to compare the fusion outcomes and complications for different 1 or 2-level anterior cervical decompression and fusion (ACDF) constructs performed with and without the application of autologous bone graft. Methods: We performed an independent and duplicate search in electronic databases including PubMed, Embase, Web of Science, Cochrane, and Scopus for relevant articles published between 2000 and 2020. We included comparative studies reporting fusion rate and complications with and without the use of autografts in ACDF across 5 different fusion constructs. A network meta-analysis was performed with the included studies in Stata, categorized based on the type of fusion constructs utilized. Results: A total of 2,216 patients from 22-studies including 6 Randomized Controlled Trials (RCTs) and 16 non-RCTs were included in the network analysis. The mean age of included patients was 49.3(±3.62) years. Based on our meta-analysis, we could conclude that the neither use of autograft nor different cage constructs in 1- or 2-level ACDF affected final fusion or mechanical implant-related complications. The use of plated constructs was associated with a significant increase in the post-ACDF dysphagia rates [OR 3.42; 95% CI (0.01,2.45)], as compared to stand-alone constructs. Conclusion: The choice of fusion constructs and use of autografts does not significantly affect the fusion and overall complication rates following 1 or 2-level ACDF.

Background : Realignment osteotomies are joint preserving operations usually utilized in eccentric ankle arthritis where there is focal overload to one side of the joint in one or more plane. Aim : Report the functional and radiographic outcomes of supramalleolar medial open and closing wedge osteotomies in management of eccentric varus and valgus ankle arthritis respectively . Methods : A retrospective case series study from foot and ankle tertiary referral centre including 42 ankles operated on by a single surgeon between 2010 and 2020 . We assessed the functional outcome of the patients utilizing the AOFAS and MOXFQ score. The radiological parameters measured included Tibial articular surface angle , and Talar tilt angle .Results : Out of 42 osteotomies , 24 patients had medial opening wedge osteotomy for varus deformity and 18 patients had medial closing wedge osteotomy for valgus deformity. Mean follow-up at the end of the study was 39.5 months (range 23- 56 months). The mean AOFAS has improved from a preoperative mean of 20.84 to a postoperative mean of 62.45 . The MOXFQ decreased from a preoperative mean of 54.53 to a mean of 21.32 post-operatively. All the radiological parameters showed statistically significant improvement. The arthritis progressed in two cases, both had ankle arthrodesis. Conclusion: Supramalleolar osteotomy is a viable option for patients with asymmetric ankle arthritis with improved functional and radiological outcome and good medium term survival rate.