Introduction: To perform a systematic review of meta-analyses to compare the clinical and radiological outcomes following an anterior cervical discectomy and fusion with stand-alone cage (SAC) and anterior cervical cage-plate constructs (ACCPC). Methods: The systematic overview was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and reported as per the Cochrane Handbook for Systematic Reviews of Interventions following the methodology described in reporting Overview of reviews. Results: Based on the available level-1 evidence, SAC offers significantly better benefits over ACCPC, in terms of shorter operative time (p<0.00001; I2=0%), lower blood loss (p=0.01; I2=0%), lesser rates of post-operative dysphagia (p=0.02; I2=0%), reduced overall expenditure (p=0.001) and long-term adjacent segment degeneration (ASD)/ anterior longitudinal ligament ossification (ALO;p=0.0003; I2=0%). There is no significant difference between the two constructs with regard to fusion rates, functional outcome scores, follow-up radiological sagittal alignment parameters, or cage subsidence. Conclusion: Based on the available evidence, SAC constructs in ACDF reduce blood loss, decrease operative time, mitigate post-operative dysphagia, lessen hospital-related expenditure, and minimize long-term ASD rates.

Liquid crystalline (LC) arrangement such as bone is a chosen structure in biological evolution1. It can self-assemble into hierarchical long-range-ordered structures with complex biofunctions in organisms. Bone defects caused by various reasons make bone the second most transplanted tissue worldwide, and artificial bone has become a popular resolution for bone defects or fractures. However, there is not sufficient evidence showing how the ordered structure of native bone is regenerated, and whether the calcium deposits on existing scaffold materials can achieve anisotropically ordered structures from the nano- to macroscale. Inspired by the natural liquid crystalline organisation of bone, we investigate the role of the LC structure in guiding the proliferation, differentiation, and secretion of cells and its underlying molecular mechanism. A uni-directional LC phase of HAp nanorods was developed. Taking advantage of such a self-assembled ordered nanostructure, we investigated the mechanism that controls the growth direction of long-range aligned extracellular matrix (ECM) and calcium deposit formation during the osteogenic differentiation of human bone marrow-derived stem cells (hBMSCs) for the first time. RNA sequencing revealed that the genes COL1A1 and COL4A6 are key regulators, which results in ECM alignment and PI3K-Akt signalling pathway activation. This study shows evidence depicting the mechanism of LC-induced anisotropic calcium deposition at the molecular level, shedding more important insight into bone regeneration. It may also inspire biomimetic artificial bone design and fabrication and studies on more types of biological LC for medical applications in the future.

Aim:Our purpose was to introduce the use of ICG fluorescence angiography to evaluate the blood flow of bone in patients with atrophic non-union Background:Bone perfusion is surgically assessed based on the surgeon’s experience and paprika sign.
Large bone defects are missed due to the surgeon’s inability to determine the amount of affected bone that needs to be removed.Intraoperative estimation of bone microcirculation in traumatology using indocyanine green (ICG) fluorescence may serve as a valuable and safe procedure that may aid in decision making Technique:We preliminary used this technique in our institute from April 2019 to June 2021 on twelve patients treated for tibia non-unions.We used Stryker System for ICG fluorescence imaging.After debridement,the tourniquet was deflated, 0.5 mg/kg of ICG powder dissolved in sterile saline at 2.5 mg/ml concentration was administered.The time from injection and the beginning of appreciation of the green area was measured.Non-viable bone was resected accordingly Conclusion:ICG fluorescence angiography allowed a rapid visualization of blood flow in the bones after 25–45 s.In all patients, tissue resection was less than what planned preoperatively and what observed intraoperatively.No intraoperative or post-operative adverse events were observed.After ICG injection, the oxygen level was reduced due to a bias in pulse oximeter reading.This phenomenon was not clinically relevant Clinical Significance:ICG fluorescence imaging is promising in the treatment of non-union defects because it is safe, easy,rapid and contribute in intraoperative decision for establishing resection levels. Using ICG fluorescence could demonstrate bone perfusion to help surgeons to reduce bone resection and avoid massive bone defects

Objective: Random skin flaps are often placed by plastic surgeons to treat limb deformities and dysfunction. Nesfatin-1 (NES) is a peptide that exerts angiogenic, anti-inflammatory, and anti-oxidant effects. We assessed the impact of NES on flap survival and the underlying mechanism.Methods: We modified the McFarlane random skin flap rat model. Thirty-six male Sprague-Dawley rats were randomly divided into a control group (corn oil solution with DMSO), low-dose group (NES-L at 10 µg/kg/day), and high-dose group (NES-H at 20 µg/kg/day). On day 7 after surgery, average flap survival areas were calculated. Laser Doppler blood flow monitoring and lead oxide/gelatin angiography were used to evaluate blood perfusion and neovascularization, respectively. Flap histopathological status was evaluated by hematoxylin and eosin (H&E) staining. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) were determined. Immunohistochemical techniques were used to evaluate the expression of angiogenetic and inflammatory factors.Results: In the experimental groups, the mean skin flap survival areas and blood perfusion increased considerably. The SOD activities in the experimental groups increased and the MDA contents decreased. Immunohistochemically, VEGF expression was upregulated in the experimental groups and the expression levels of inflammatory factors decreased markedly.Conclusion: NES inhibited ischemic skin flap necrosis, promoted angiogenesis, and reduced ischemia-reperfusion injury and inflammation. Inhibition of the inflammatory HMGB1-TLR4-NF-κB signal pathway, which reduced flap inflammation and oxidative stress, may explain the enhanced flap survival.

BACKGROUND: Total knee arthroplasty (TKA) is an efficient and common procedure used to treat advanced osteoarthritis of the knee. Geriatric patients make up the majority of TKA patients. For the surgical management of bilateral knee arthritis, there is still debate regarding whether to do a simultaneous or staged TKA. We through this study have gathered data and aimed to assess the safety of simultaneous bilateral TKA in patients over 75 years of age.
MATERIALS AND METHODS: We conducted a study according to the PRISMA guidelines by searching through various databases for the following search terms: total knee arthroplasty (TKA), complications following TKA, bilateral TKA, and bilateral vs. unilateral TKA. The search included case series and clinical trials and excluded review articles, yielding 35 articles from the original search. We extracted data upon the outcomes in patients above 75 years of age undergoing simultaneous bilateral TKA. We performed additional bias assessments to validate our search algorithm and results.
RESULTS: One hundred and three published articles were identified, and thirty-five that included a total of 1, 62,168 patients were included in the meta-analysis. The prevalence of deep venous thrombosis was lower after simultaneous bilateral TKA. There were no significant differences in mortality, pulmonary embolism, revision, superficial infection, cardiac complications, neurological complications, and urinary complications between both the procedures.
CONCLUSION: Simultaneous bilateral TKA is safe and cost-effective procedure with acceptable complication rates as compared to a staged bilateral TKA for bilateral symptomatic knee osteoarthritis in patients above 75 years of age.

Gradual correction with external fixation (EF) has been the gold standard of treatment in limb deformity correction, despite being associated with pain, discomfort and functional incapacitation. Recent literature highlights the role of fixator-assisted internal fixation (FAIF) in deformity correction, which is known to improve patient compliance and comfort, by shortening the duration of treatment. However, there is limited data available for upper limb and complex, rotational deformities. Aim: To assess the results of acute correction using FAIF or a short period of EF, with the aim of improving patient satisfaction and compliance. The objectives were to assess the accuracy of correction by analyzing the radiographic parameters and to evaluate the patient satisfaction levels post-intervention using the PODCI (Paediatric Outcomes Data Collection Instrument) questionnaire. Methods: 12 patients with cubitus varus/valgus, genu valgus, tibia vara, juxta-articular growth arrests, hemimelias and diaphyseal malunions, underwent acute intra-operative correction following the principles of deformity correction. All planning was performed using a CAD software. Surgical techniques employed were: simple mono-lateral fixator; fixator-assisted nailing (FAN) or plating (FAP); computer hexapod-assisted orthopaedic surgery (CHAOS). The pre and post-operative deformity parameters were then compared using the software. Results: A significant improvement of all parameters was seen following the intervention. The mean global PODCI score improved from 77.4 to 89.9, which was statistically significant. One hardware-related complication arose, requiring implant removal. Conclusion: Complex deformities can be safely and accurately corrected using modern techniques, which can decrease the duration or circumvent the need for EF, thereby improving patient satisfaction and compliance.