The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years. A working group (n = 43 members) conducted a literature search spanning 2019-2024 using the keywords "Global Leadership Initiative on Malnutrition or GLIM." Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus. More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update. Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.

Primary central nervous system lymphomas comprise 0.8% of all lymphomas. Burkitt's lymphoma is a B-cell lymphoma with highly aggressive features that rapidly progress and have early hematogenous spread. Sporadic Burkitt's lymphoma accounts for 1-2% of adult lymphomas worldwide. Extranodal sites are involved in approximately 40% of cases of B-cell lymphomas. Central nervous system disease is found in <15% of sporadic cases. Less than 5% of cases of all non-Hodgkin's lymphomas present with radiculopathy, with the thoracic spinal region being most commonly affected. In this report, we discuss the case of a patient with extranodal Burkitt's lymphoma within the nerve roots of the cauda equina who underwent surgical intervention due to the presence of lumbar radiculopathy and weakness. This patient also exhibited hematogenous spread with evidence of an intracranial lesion. The diagnosis of Burkitt's lymphoma was atypical, given the presentation, clinical indicators, and the appearance of the masses on magnetic resonance imaging being similar to that of a neurofibroma or schwannoma. Surgical decompression provided tissue for biopsy. However, nerve root decompression was not possible due to diffuse involvement and infiltration of the nerve roots.

This study aims to (1) develop an augmented reality (AR) navigation platform for craniomaxillofacial (CMF) and head and neck surgery; (2) apply it to a range of surgical cases; and (3) evaluate the advantages, disadvantages, and clinical opportunities for AR navigation. A multi-center retrospective case series. Four tertiary care academic centers. A novel AR navigation platform was collaboratively developed with Xironetic and deployed intraoperatively using only a head-mounted display (Microsoft HoloLens 2). Virtual surgical plans were generated from computed tomography/magnetic resonance imaging data and uploaded onto the AR platform. A reference array was mounted to the patient, and the virtual plan was registered to the patient intraoperatively. A retrospective review of all AR-navigated CMF cases since September 2023 was performed. Thirty-three cases were reviewed and classified as either trauma, orthognathic, tumor, or craniofacial. The AR platform had several advantages over traditional navigation including real-time 3D visualization of the surgical plan, identification of critical structures, and real-time tracking. Furthermore, this case series presents the first-known examples of (1) AR instrument tracking for midface osteotomies, (2) AR tracking of the zygomaticomaxillary complex during fracture reduction, (3) mandibular tracking in orthognathic surgery, (4) AR fibula cutting guides for mandibular reconstruction, and (5) integration of real-time infrared visualization in an AR headset for vasculature identification. While still a developing technology, AR navigation provides several advantages over traditional navigation for CMF and head and neck surgery, including heads up, interactive 3D visualization of the surgical plan, identification of critical anatomy, and real-time tracking.

BackgroundWith a growing number of elderly patients requiring elective and non-elective procedures, frailty-based preoperative risk stratification is an emerging tool in orthopedic surgery to minimize adverse postoperative outcomes. This paper sought to understand the current literature regarding preoperative Orthopedic Frailty Risk Stratification (OFRS) and describe the disparate frailty indices and their capabilities for discrimination in predicting adverse postoperative outcomes.MethodsA literature search was conducted in Pubmed, Cochrane, and Scopus for articles published during or prior to February 2024 assessing frailty following surgery for orthopedic pathologies. Qualitative variables including study characteristics and application of frailty were collected and synthesized. Quantitative meta-analysis was performed for pooled odds ratio (OR) and area under the curve (AUC) of frailty for mortality and complications. All methods were performed in accordance with PRISMA guidelines.ResultsOf the 81 included articles, over half (52%) addressed traumatic orthopedic pathologies with traumatic hip fractures being the most studied in the OFRS (25 studies). Less common categories included oncology, sports, and foot/ankle. Functional status and independence were the most common frailty domain (25, 96.2%) and component across scales (20, 76.9%), respectively. The 5-Item Modified Frailty Index (mFI-5) was the most common frailty index (28 publications). Meta-analysis demonstrated increasing frailty was an independent predictor of mortality (30-day OR: 2.89, 95% CI: 2.00–4.18; 1 year OR: 1.81, 95% CI: 1.48–2.22, p < 0.001), major complications (OR: 1.63, 95% CI: 1.10–2.41, p = 0.02), and Clavien-Dindo IV complications (OR: 3.26, 95% CI: 2.18–4.87, p < 0.001). Frailty had good discriminatory accuracy for predicting mortality at 30-days (AUC: 0.71, 95% CI: 0.68–0.74, p < 0.001), 3-months (OR: 0.75, 95% CI: 0.65–0.83, p < 0.001), and 1-year (OR:0.74, 95% CI: 0.73–0.75, p < 0.001).ConclusionsThe orthopedic surgery frailty literature is extremely heterogeneous, with disparate frailty scales implemented to measure varying outcomes across many orthopedic pathologies. Despite no consensus on exact scales or definitions, various frailty indices have predicted adverse outcomes.

Background: Ventilator-associated pneumonia (VAP) is linked to poor outcomes in patients with severe traumatic brain injury (TBI), yet its effect on cognitive disability is unknown. We hypothesized that there would be an association between severe cognitive disability and VAP in this patient population. Methods: We performed a post hoc analysis of a prospective, multi-center, observational study of adults with a severe, blunt TBI from 2020 to 2023. Patients were grouped by whether they developed VAP. Our primary outcome was severe cognitive disability, defined as a disability rating scale (DRS) score >13 at discharge (or 28 days post-injury if not discharged). Results: There were 309 patients in the cohort; 31.7% (n = 98) developed VAP. The VAP group had greater incidences of diffuse axonal injury (37.3% vs. 22.3%, p = 0.004), neurosurgical interventions (63.3 vs. 38.4%, p < 0.001), and tracheostomies (72.5% vs. 28.9%, p < 0.001). Patients with VAP had a longer duration of mechanical ventilation (13 d vs. 3 d, p < 0.001). Among patients with VAP, median time to diagnosis was 7 days (4-12), time to tracheostomy was 10 days (7-16), and time between the two events was 4 days (2-11). Greater proportions of cognitive disability (64.3% vs. 19.9%, p < 0.001) and worse median DRS scores (8 vs. 2, p < 0.001) occurred in the VAP group. On multi-variable regression analysis, VAP was an independent risk factor for severe cognitive disability (adjusted odds ratio [aOR]: 4.2, 95% CI: 2.2-7.8). Conclusion: Ventilator-associated pneumonia is common among patients with a severe TBI and is a risk factor for severe cognitive disability. Adherence to VAP prevention techniques may help mitigate cognitive impairment in this population.

Dysfunction of the sacroiliac (SI) joint exists in nearly one-third of patients with lower back pain. There are nuances in diagnosing SI joint dysfunction with a combination of physical exam maneuvers and intra-articular injections. The management of patients with SI joint pain can include posterior pelvic fixation, which traditionally has been described using fluoroscopy to obtain safe placement of implants. In this technique guide, we would like to introduce a novel technique of using Stealth navigation to facilitate SI fusion with the iFuse-TORQ implant. SI dysfunction is a common cause of low back pain that can be difficult to diagnose and treat. In this technique guide, we describe the successful treatment of SI pathology using the Stealth Navigation with the iFuse-TORQ implant.

Background/Objectives: Popliteal artery injury is a rare but devastating complication of knee dislocations, significantly increasing the risk of limb ischemia, amputation, and poor functional outcomes if not promptly managed. This systematic review primarily evaluates the functional outcomes associated with this injury but also reviews current research on diagnostic modalities and treatment strategies to provide a comprehensive understanding of this severe orthopedic and vascular injury. Methods: A systematic search of PubMed, in accordance with PRISMA Guidelines, identified 144 studies, of which 13 full-text articles were assessed for eligibility after excluding 131 during the title and abstract screening. Six studies were excluded due to missing vascular injury or functional outcome data or being written in a foreign language, leaving seven studies for inclusion. These studies were predominantly retrospective, focusing on knee dislocations with popliteal artery injury and reporting validated functional outcomes such as the Lysholm and International Knee Documentation Committee (IKDC) scores. The data were synthesized narratively due to heterogeneity in the study designs, interventions, and outcome reporting. Results: Patients with vascular injuries consistently demonstrated poorer functional outcomes compared to those without, with mean or median Lysholm and IKDC scores consistently being lower than non-vascular injury patients. Increased BMI, delayed intervention, and multi-ligamentous injury were associated with worse outcomes, highlighting the importance of timely surgical management. Early repair and grafting techniques improved functional recovery, while diagnostic modalities such as Doppler ultrasound and CT angiography showed high sensitivity in detecting vascular injury. Complications included limb ischemia, prolonged rehabilitation, and amputation, often linked to delayed diagnosis. Conclusions: Knee dislocations with popliteal artery injury require rapid diagnosis and early surgical intervention to optimize functional outcomes and reduce complications. Standardized outcome measures and high-quality prospective research are needed to refine management strategies and address patient-specific factors like BMI.