Disparities in orthopedic care delivery across hospital settings and payer types may significantly correlate with length of stay (LOS), cost burden, and care efficiency. This study quantifies the associations between geographic location, case acuity, insurance status and resource utilization in Michigan. We conducted a retrospective cohort study using 2018-2020 discharge records from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for Michigan. Orthopedic-related hospitalizations were identified and stratified by hospital location (urban vs rural), injury mechanism (trauma vs non-trauma), and primary payer (Medicare, Medicaid, private, other, uninsured). Outcomes included LOS, per-discharge cost, aggregate hospital-level expenditures, and population-adjusted discharge rates. Statistical comparisons were performed using two-sample t-tests and ANOVA. Independent associations were evaluated via mixed-effects regression models with hospital-level random intercepts. Among 334,756 orthopedic discharges, urban facilities recorded longer average LOS (4.57 vs 4.09 days; P<0.001) and higher mean aggregate costs per hospital ($8.70M vs $1.74M; P<0.001) than rural counterparts. Non-traumatic cases were associated with greater per-stay costs ($19,645 vs $16,630; P<0.001). Uninsured patients experienced the longest LOS (4.70 days), followed by Medicare (4.35 days), Medicaid (3.89 days), private (3.72 days), and other (3.06 days; all P<0.001). Medicare accounted for the largest hospital-level expenditure ($3.28M mean; P<0.001). Mixed-effects models confirmed urban setting, non-trauma diagnosis, and Medicare enrollment as independent factors associated with elevated LOS and cost (P<0.001). Orthopedic care patterns demonstrate distinct variations linked to structural, clinical, and financial factors. These findings highlight disparities that may inform future discussions on reimbursement policies and rural capacity planning.

Transient hip osteoporosis (THO) is a rare, self-limiting condition characterized by acute hip pain and bone marrow edema. Although typically benign, THO may coexist with or predispose to femoral neck stress fractures, creating critical diagnostic and therapeutic challenges. We report a case of concurrent THO and femoral neck stress fracture in an elderly patient and discuss implications for management. A 72-year-old female presented with an eight-month history of persistent right hip pain. Initial radiographs suggested synovial chondromatosis; however, symptoms persisted despite conservative treatment. Repeat radiographs demonstrated subtle sclerotic change and a cortical fracture line at the medial/inferior femoral neck. MRI revealed mild-to-moderate joint effusion and diffuse bone marrow edema involving the femoral head and neck consistent with THO, along with a linear low-signal fracture line consistent with an established femoral neck stress fracture. The patient was initially managed with protected weight-bearing and analgesics. Symptoms persisted after conservative management, and prophylactic fixation with proximal femoral nail antirotation (PFNA) was performed. The patient experienced complete pain resolution by four months. At 18-month follow-up, radiographs demonstrated healing of the stress fracture with full return to weight-bearing. Diffuse marrow edema suggestive of THO does not exclude a clinically meaningful femoral neck stress fracture, particularly in older adults with persistent atraumatic hip pain. Early MRI and close follow-up are essential for detecting occult fractures, guiding weight-bearing recommendations, and preventing progression to displacement.

Tietze's syndrome is a rare inflammatory condition of the anterior chest wall that may cause chronic localized pain resistant to conservative treatment. Surgical cartilage resection often provides only temporary relief, and recurrence of pain presents a significant therapeutic challenge. We report the case of a 49-year-old female with recurrent anterior chest wall pain due to refractory Tietze's syndrome following two costal cartilage resections. Despite corticosteroid injections and physiotherapy, pain persisted with a VAS score of 7-8/10. Considering multiple treatment failures, O-arm CT-guided radiofrequency ablation (RFA) of the intercostal nerves at the 2nd-3rd ribs was performed. The procedure allowed precise cannula placement under 3D visualization and correction of intrathoracic misplacement detected on intraoperative O-arm CT (not evident on conventional fluoroscopy). After final lesioning at 80 °C for 90s, the patient experienced complete pain relief (VAS 0-1/10), restored respiratory comfort, and full functional recovery without complications. O-arm CT guidance enables accurate targeting and improved safety during intercostal nerve RFA in anatomically complex anterior chest wall regions. This technique represents a promising minimally invasive option for refractory Tietze's syndrome when surgery and conservative therapy fail.

BackgroundAchilles tendinitis (AT) is a prevalent musculoskeletal disorder with unclear etiology. This study aimed to investigate the causal relationships between circulating inflammatory cytokines (ICs), metabolites, and AT risk using bidirectional Mendelian randomization (MR), and to identify potential metabolite-mediated pathways.MethodsA bidirectional MR design was implemented, integrating genetic instruments for 91 ICs and 1400 metabolites with GWAS summary statistics from the FinnGen consortium. Causal inferences were drawn using inverse variance weighting (IVW), MR-Egger regression, and weighted median approaches, accompanied by sensitivity and mediated analyses.ResultsCCL19, CCL23, and IL17A were identified as protective factors for AT, with CCL23 demonstrating consistent associations across multiple MR methods. 65 metabolite traits were significantly associated with disease risk. Glycochenodeoxycholate glucuronide showed a protective effect (P = 0.002), whereas the alpha-tocopherol to glycerol ratio increased risk (P = 0.011). Mediation analysis indicated six pathways: CCL19 - pantothenate - AT; CCL19 - Picolinate - AT; CCL19 - X-21845- AT; CCL23 - X-12822 - AT; CCL23 - X-18921 - AT; IL17A - cysteinylglycine disulfide - AT.ConclusionThis is the first MR study to systematically assess the causal roles of ICs and metabolites in AT, identifying CCL19, CCL23, and IL17A as protective factors and highlighting multiple metabolite signatures linked to disease risk, offering novel insights for mechanistic research and targeted intervention.

A 70-year-old female with a history of hypertension presented with a complex elbow injury following a fall. Imaging revealed fractures of the capitellum, lateral epicondyle, and olecranon. The fractures were managed using an extensile posterolateral approach through the anconeus muscle, achieving anatomical reduction and satisfactory functional outcomes 110° of flexion and full pronation/supination and Mayo Elbow Performance Score (MEPS) indicated an excellent outcome. This approach preserved the extensor origin and facilitated access for fixation, suggesting its potential as an alternative for managing such rare injuries.

End-stage renal disease (ESRD) patients undergoing intertrochanteric fracture surgery face complex coagulation challenges. This study aimed to identify risk factors for coagulation dysfunction in ESRD patients during the perioperative period of intertrochanteric fracture surgery. This retrospective study included 127 patients who underwent surgical treatment for intertrochanteric femoral fractures between January 2019 and June 2023, of whom 33had end-stage renal disease (ESRD) and were receiving maintenance dialysis. Propensity score matching was performed at a 1:1 ratio based on age, gender, BMI (body mass index), fracture classification, anesthesia type, and APACHE II score, yielding 33 matched non-ESRD controls. Perioperative data, including coagulation parameters, biochemical indices, and clinical outcomes, were collected. Multivariable regression analysis was conducted to identify risk factors associated with coagulation dysfunction. The dialysis group showed significantly different coagulation profiles compared to controls, particularly in platelet count (71.6 ± 21.3 vs 159.1 ± 35.7×109/L, P = 0.003) and blood loss (609.9 ± 89.2 vs 559.3 ± 55.5 mL, P = 0.007). Regression analysis revealed that blood loss in the dialysis group was primarily influenced by platelet count (P < 0.001) and anticoagulant dose (P < 0.001), while in the control group it was mainly affected by surgery duration (P < 0.001). Although mean surgery duration did not differ significantly between groups, its relationship with blood loss varied markedly between ESRD and non-ESRD patients. The dialysis group experienced more complications, with most bleeding events occurring 5-7 days postoperatively when platelet counts reached their nadir. ESRD patients face increased bleeding risk during intertrochanteric fracture surgery, primarily associated with platelet count and anticoagulant use. The critical period for bleeding complications occurs 5-7 days postoperatively, suggesting the need for careful platelet monitoring and individualized anticoagulation protocols during this timeframe.

Readmissions are associated with worse patient outcomes, higher length of stay, and increased costs. Reducing unnecessary readmissions represents a significant opportunity for improving patient outcomes and healthcare delivery. This was a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD), part of the United States Healthcare Cost and Utilization Project (HCUP). The NRD was queried to identify all adult (>18 years old) trauma patients with an admission diagnosis of rib fractures. Demographic and hospital data, comorbidities, as well as morbidity and mortality outcomes were collected. The 2016-2020 NRD identified 553,810 patients admitted with a diagnosis of rib fractures, with 65,244 of those patients readmitted within 30 days of discharge. Patients with rib fractures who were readmitted within 30 days were associated with 9-fold higher mortality over six months than if they were not readmitted. Patients with rib fractures were more likely to be readmitted from small or medium-sized hospitals (p<0.001), had underlying depression (OR 1.42, 95% CI [1.34-1.51]), drug abuse (OR 1.23, 95% CI [1.13,1.35]), chronic pulmonary disease (OR 1.49, 95% CI [1.41,1.57]), and obesity (OR1.22, 95% CI [1.13-1.31]). There was an association with higher readmission rates in patients with a single rib fracture compared with multiple rib fractures. Patients readmitted within 30 days of discharge with rib fractures are associated with higher six-month mortality. Rib fractures are a common injury in trauma patients. Reducing unnecessary readmissions in this patient population may improve patient outcomes, satisfaction, and decrease healthcare costs.