Rheumatoid arthritis (RA) is a chronic autoimmune disorder with complex pathogenesis, and conventional biomarkers often fail to capture disease-associated metabolic changes. A more comprehensive understanding of the metabolic alterations in RA may provide deeper insights into disease mechanisms. This study aimed to identify serum metabolic changes associated with RA using non-targeted metabolomics and lipidomics, and to explore the potential impact of these metabolic alterations on RA pathophysiology. A case-control study was conducted using baseline data from the Inflammatory Immune Disease Cohort at the First Affiliated Hospital of Anhui Medical University (October 2021 to June 2023). A total of 91 RA patients and 125 healthy controls were included. Serum samples were analyzed by non-targeted liquid chromatography-mass spectrometry (LC-MS). Differential metabolites were identified using orthogonal partial least squares discriminant analysis (OPLS-DA), followed by filtration with Student's t-test (P < 0.05). Logistic regression was applied to identify potential metabolic alterations for further investigation. Pathway enrichment analysis identified significant metabolic pathways associated with RA. The median age of both groups was 50.0years, with no significant demographic differences (P > 0.05). Metabolomics and lipidomics identified 41 differential metabolites, including 16 small molecules and 25 lipids. Pathway analysis revealed disturbances in the urea cycle, sphingolipid metabolism, arginine and proline metabolism, and glycine and serine metabolism. These findings suggest systemic metabolic alterations in RA and provide new insights into the disease's metabolic profile. The study identified significant metabolic alterations in RA, contributing to a better understanding of the disease's pathophysiology. These findings highlight the importance of metabolic reprogramming in RA and offer directions for further investigation into metabolic pathways involved in disease progression.

Emerging Signs of Rapidly Progressive Arthritic Changes in Dogs and Cats Receiving Bedinvetmab and Frunevetmab.

While arthroscopic irrigation and débridement are commonly used to treat septic arthritis of the shoulder because of their minimally invasive nature and favorable clinical outcomes, reinfection remains a concern. Povidone-iodine has demonstrated broad-spectrum antimicrobial activity and is increasingly used for surgical site irrigation. However, its efficacy and safety in the arthroscopic management of septic shoulder arthritis have not been well established. We retrospectively reviewed 15 shoulders in 15 patients with septic arthritis of the shoulder who underwent arthroscopic irrigation and débridement using a 0.35% povidone-iodine solution. Functional outcomes, reoperation rates for reinfection, and radiographic changes were assessed after a minimum postoperative follow-up period of 6 months. Although the reoperation rate for reinfection was 0%, 1 patient (6.7%, 1 of 15) experienced reinfection, which was managed nonoperatively. No adverse effects attributable to povidone-iodine were observed. Radiographic progression of glenohumeral arthritis was noted in 4 patients (26.7%). Functional outcomes were significantly worse in patients with progressive arthritic changes compared to those without progression. Arthroscopic débridement combined with irrigation using diluted 0.35% povidone-iodine was associated with a low reoperation rate for reinfection in septic arthritis of the shoulder, without significant adverse effects. Further controlled studies are required to confirm the safety and efficacy of this approach.

Background: Frailty is a fluctuating health state that may worsen or improve over time and is linked to adverse outcomes, including musculoskeletal disorders such as arthritis. However, evidence on whether frailty changes predict arthritis onset remains limited. This study examined the relationship between changes in frailty status and incident arthritis among Chinese adults aged 45 years and older. Methods: We performed a longitudinal cohort analysis using data from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was quantified with a 30-item Frailty Index (FI) and categorized as robust, pre-frail, or frail. Frailty transitions were defined by changes in FI-based categories across survey waves. Incident arthritis was identified as self-reported physician-diagnosed arthritis during follow-up. Associations between frailty transitions and arthritis onset were evaluated using Cox regression, reporting hazard ratios (HRs) and 95% confidence intervals (CIs). Models were adjusted for demographic characteristics, health behaviors, and biochemical indicators, and sensitivity analyses were conducted to verify result stability. Results: Among 4982 participants (mean age 58.97 years; 45.58% female). Relative to robust individuals, baseline pre-frailty (HR 1.67, 95% CI 1.41-1.97) and frailty (HR 2.76, 95% CI 1.97-3.85) were associated with higher arthritis risk. Participants whose frailty status worsened from robust to pre-frail or frail also showed higher arthritis risk (HR 1.68, 95% CI 1.34-2.10). In contrast, transitions from frail to pre-frail or robust were associated with lower risk (HR 0.44, 95% CI 0.21-0.92). Higher cumulative frailty burden and greater frailty progression were also associated with increased arthritis risk. Conclusions: Frailty transitions are strongly associated with incident self-reported physician-diagnosed arthritis. Monitoring frailty trajectories may improve arthritis risk stratification and support prevention strategies.

Capitellum fractures are rare injuries contributing only 1% of all elbow fractures. Being such a rare injury, there is a lack of consensus with regard to the treatment recommendations. This study aims to evaluate the functional outcome of capitellum fractures treated by open reduction and internal fixation (ORIF) with headless screws through a lateral approach. The study design was a prospective observational study conducted on 61 patients who were undergoing ORIF through a lateral approach to the elbow, between January 2023 and August 2025, at a tertiary care level 1 trauma center. The Oxford elbow score (OES) was recorded post-surgery, starting at 2 weeks and then at 2-monthly intervals. The mean OES at 6 months was 32.6 ± 7.3 (18-46). Mean pronation-supination arc was 86.9 ± 20.2 (range 40-110°). Mean flexion-extension arc was 131.1 ± 2.9° (range 110-150°, standard deviation 11.5), with a 95% confidence interval of 128.2-134.0°. Our results suggest that ORIF is a safe and effective treatment option for a stable, pain-free elbow with a good range of motion. There was no evidence of avascular necrosis or arthritic changes. The mean duration of follow-up was 15.8 ± 3.2 months (range: 12-27 months). Headless compression screw fixation via a lateral elbow approach yielded stable fixation with excellent functional outcome for capitellum fractures in our study.

The post-Covid-19 syndrome, also referred to as "Long Covid", can present with arthritic symptoms. A cross-sectional, prospective study was done on post Covid-19 patients at a tertiary centre in Telangana. This study included a total of 139 RT-PCR-confirmed Covid-19 patients, who were diagnosed with arthritis in the time interval between 1 to 6 months post Covid recovery. Demographic data, clinical data, blood investigations, inflammatory markers and imaging investigations were recorded. Majority of the patients (65.5%; n=91) were women and the mean age of the participants was 50.8 years. 77.0% (n=107) had arthralgia, 44.6% (n=62) had joint swelling, 25.2% (n=35) had myalgia and 5.8% (n=8) had fatigue. The most common joint affected was the knee (92.0%; n=128), followed by wrist (10.25%; n=4) and ankle (n=1). Abnormal Hb levels (43.9%; n=61), RBC counts (9.4%; n=13), WBC counts (13.7%; n=19) and ESR (26.6%; n=37), D-dimer (50.4%; n=70), LDH levels (49.6%; n=69), uric acid (36.0%; n=50), ferritin (35.5%; n=49) and rheumatoid factor (10.8%; n=15), were recorded in participants. Joint arthritic changes on radiographs and ultrasoundwere recorded in 77.0% had 95.7% of the participants respectively. Covid arthritis is one of the common features of Long Covid patients. Many patients suffer from joint aches and swelling which cause sufficient impairment causing majority of the individuals.

Bucket-handle medial meniscal (BHMM) tears are a complex injury commonly found in young athletes. The literature reports that, on average, 85% of BHMM repairs are successful 1 year postoperatively. When failure occurs, a revision repair is optimal to prevent long-term arthritic changes and further stress on other knee ligaments. A revision repair of BHMM tears in adolescents is preferred compared with a meniscectomy due to a higher likelihood of the revision fully healing compared with older patients, and a higher chance of preventing the effects of increased joint contact stresses. The literature has reported that grade 3 medial collateral ligament (MCL) reconstructions may be indicated in symptomatic patients when medial compartment gapping exceeds 3 mm on stress x-rays. A reconstruction of the superficial medial collateral ligament (sMCL) with a locked BHMM revision repair was performed. Dissection of significant scarring surrounding the semitendinosus and gracilis tendons was performed for graft harvesting. Tibial suture anchors were placed 6 cm distal to the joint line at the distal tibial attachment of the sMCL. A Beath pin was passed through the femoral sMCL attachment site anterolaterally, over reamed with a 7-mm reamer, and placed into the femoral tunnel with a passing suture. A medial meniscal retear was confirmed through arthroscopy. Twelve vertical mattress inside-out sutures were used to repair the BHMM tear. The sMCL graft was fixed with a slight varus force with the knee flexed to 20° in the femoral tunnel. Lastly, another suture anchor was placed at the proximal tibial sMCL attachment 15 mm distal to the joint line and sewn into the sMCL graft. BHMM tears in the adolescent population have demonstrated a higher healing rate than similar tears in adults. Therefore, a revision BHMM tear repair is indicated, especially in the setting of a concomitant grade 3 sMCL tear. One risk involved in BHMM tears and MCL reconstruction is damage to the posterior neurovascular structures. The technique presented attempts to restore the native contact pressures and biomechanics within the knee through a revision BHMM repair with an anatomic sMCL reconstruction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Medial meniscus posterior root tears (MMPRTs) are a common form of meniscal tear and are increasingly recognized as one of the most detrimental insults to knee health. Root repairs have mainly focused on reestablishing the biomechanics of the medial knee compartment and preventing joint deterioration; however, meniscal extrusion persists even after the best root repairs and remains an independent risk factor for knee degeneration. Furthermore, chronic MMPRTs are more likely to be associated with significant extrusion, chondromalacia, and fibrotic changes, which make successful repair more challenging. Careful meniscal mobilization and centralization can provide consistent, repeatable results. This technique is indicated for patients with chronic MMPRTs, meniscal extrusion of at least 3 mm, minimal arthritic changes, minimal-to-no varus knee alignment, and the ability to be nonweightbearing for 6 weeks postoperatively. The following technique demonstrates the senior author's method of repairing a chronic MMPRT in an anatomic fashion using a 2-tunnel transtibial pull-out repair and footbed anchor fixation. An all-outside centralization is performed using 2 all-suture knotless anchors to address meniscal extrusion and reestablish the biomechanics of the meniscotibial ligament by approximating the posteromedial joint capsule with the rim of the tibial plateau. By repairing a chronic root tear and addressing meniscal extrusion, the native biomechanics of the medial compartment are restored, and the meniscus's ability to withstand hoop stress is preserved. Centralization has been shown to lead to favorable improvements in patient-reported and functional outcomes during short-term follow-up and may significantly reduce strain on the root repair construct, thereby improving healing of the meniscal root attachment. We present our preferred technique for augmenting a chronic MMPRT repair with centralization using all-suture knotless anchors. This method mobilizes fibrotic adhesions and reduces the medial meniscus and peripheral capsule to the rim of the tibial plateau. The advantages include eliminating intra-articular knot-related issues, avoiding the need for an additional tibial tunnel-thereby reducing the risk of tunnel coalition-and offering a streamlined, reproducible approach to minimize meniscal extrusion, with favorable short-term outcomes. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background/Objectives: Atlantoaxial posterior fusion has unique characteristics, and it is anticipated that adjacent segment degenerative changes following fusion surgery may present distinctive findings. This study aims to analyze the risk factors for degenerative changes in subaxial levels following the increasingly common atlantoaxial posterior fusion procedure. Methods: A total of 58 patients (19 males, 39 females) who had neutral, flexion, and extension plain lateral radiographs taken and a follow-up record of approximately two years post-surgery were included in the final study cohort. The study analyzed surgical methods, patient demographics, hospitalization-related factors, visual analog scale (VAS) for neck pain, and radiologic parameters. Patients were classified into the radiologic subaxial pathology (RSP) group (n = 34) and the non-RSP group (n = 24) using several radiologic indicators of spinal instability or arthritic changes, and the risk factors for RSP were analyzed. Results: The RSP group showed a significantly higher proportion of females and prevalence of rheumatoid arthritis (RA). At 3 months postoperatively, the C1-7 sagittal vertical axis (SVA) was significantly lower in the RSP group. Multivariate regression analysis using significant variables (p < 0.05) such as sex, RA and 3-month C1-7 SVA showed that RA and 3-month C1-7 SVA were significantly associated with RSP. Among radiologic parameters related to surgery, multivariate analysis identified 3-month C1-7 SVA as the sole risk factor for RSP. To explore its correlation with other radiologic parameters at 3 months postoperatively, linear logistic regression analysis was conducted. Significant positive correlations were observed with the C1-2 Cobb angle. Conclusions: This study identified RA and C1-7 SVA as the most significant risk factors for RSP in atlantoaixal posterior fusion.

Hip disorders in childhood and adolescence require precise imaging to prevent maldevelopment, deformities, and early osteoarthritis. Ultrasound is the primary first-line modality: radiation-free, dynamic, and indispensable in infancy. It provides detailed assessment of cartilaginous and soft-tissue structures and is essential in developmental dysplasia of the hip (DDH) to evaluate maturation and femoral head centration. It also enables rapid detection of joint effusions in transient synovitis or septic arthritis, as well as inflammatory changes in juvenile idiopathic arthritis (JIA). In addition, ultrasound offers useful early clues in Legg-Calvé-Perthes disease and slipped capital femoral epiphysis (SCFE). From about 6months of age, radiography becomes central to evaluating the bony anatomy. Standard projections such as the anteroposterior pelvic view and the frog-leg lateral view allow reliable assessment of acetabular morphology, femoral head position, and head-neck geometry. Magnetic resonance imaging (MRI) is the most comprehensive cross-sectional technique. It expands diagnostic capabilities in Perthes disease, SCFE, inflammatory conditions, and tumors, and provides detailed visualization of cartilage, the labrum, bone marrow edema, and torsional alignment. Modern fast sequences enable short, focused examinations in young children, often without the need for sedation. Computed tomography (CT) is reserved for specific indications and is valuable for analyzing complex osseous structures.

Rheumatoid arthritis (RA) is an inflammatory autoimmune condition affecting the joints and other organs such as the heart, eyes, and lungs. For decades, it has been diagnosed through assessing a combination of clinical picture, serologic biomarkers, and radiographic studies. However, the possibility of false negative test results and inability to detect early arthritic changes make RA diagnosis challenging. The diagnostic accuracyof theRAdiagnostic modalities hassubstantially improvedsince the emergence of artificial intelligence (AI)-based medical algorithms, resulting intimelydisease prediction and prevention of irreversible joint damage. AI computational models employ machine learning (ML), natural language processing (NLP), and rule-based expert systems to enhance the diagnostic accuracy ofrheumatologicaldiseases, particularly rheumatoid arthritis. AI-based algorithms not onlyidentifyspecific disease patterns to predict the early course of disease but also use visual scoring systems, enhancing imaging characteristics. Radiological studies such as X-ray, MRI, CT, and PET scan can quantify joint space narrowing, cartilage loss, synovitis, bone erosions, and bone marrow edema. In addition, ML-integrated microRNA gene profiling reshaped the microenvironment of joint space by modulating gene expression and reducing joint deterioration in rheumatoid arthritis patients, surpassing the rheumatoid factor (RF) and cycliccitrullinatedpeptide (CCP) risk scoring models.

Abstract Background Rheumatoid arthritis (RA) is an autoimmune inflammatory disease affecting 0.5-1% of adult population(1,2,3) and confers a 1.8-fold increased cardiovascular risk, comparable to diabetes(4). Persistent inflammation leads to diffuse myocardial fibrosis(5), contributing to cardiac dysfunction, though underpinning mechanisms remain unclear. Cardiovascular magnetic resonance (CMR) can sensitively detect myocardial fibrosis and oedema using T1 mapping and extracellular volume (ECV)(6), therefore offers a unique opportunity to detect early myocardial involvement(7,8), given RA’s often prolonged subclinical cardiac course. This study aims to explore the association between RA and CMR-derived myocardial abnormalities. Purpose To assess the association and potential causality between RA and CMR phenotypes in individuals without overt coronary artery disease (CAD). Methods This study used the data from the UK Biobank, a large population-based cohort study, which provides detailed information on demographics, lifestyle and medical history along with CMR data. We investigated the association between RA diagnosis and eight CMR-derived left heart phenotypes including chamber volumes, mass, strain, and tissue characterisation (native T1 mapping) using multivariable linear regression adjusted for age, sex, height, BMI, hypertension, diabetes, hyperlipidaemia, and smoking, after excluding individuals with prevalent CAD. Two-sample Mendelian Randomisation (MR) was conducted using published genome-wide association summary statistics of native T1 and RA, to explore the casual relationship. Results A total of 42,227 individuals (mean [standard deviation] age = 63.9 [7.7] years, 53% female, RA n = 255) were included. In multivariable linear regression models, individuals with RA had higher native T1 values (β [95% CI] = 3.8 [0.8 to 6.8] ms, p = 0.013) (Figure 1). No significant associations were detected between RA and other CMR phenotypes. The MR analysis exploring the effect of RA on native T1 showed support for a positive causal association (MR-inverse variance weight [IVW] beta [95% CI] = 0.009 [0.0004 to 0.016], p = 0.039) (Figure 2). MR-Steiger test suggested that the assumption of RA causing myocardial fibrosis and oedema (higher native T1) was correct. Conclusion In this large population study, RA is independently associated with diffuse myocardial fibrosis and oedema (inflammation) indicated by higher native T1 signals after accounting for traditional cardiovascular risk factors in a cohort free from overt CAD. This association appears to be causal in nature based on the MR analysis. These findings highlight the role of non-traditional CV risk factors including systemic and local myocardial inflammation driven by RA in subclinical myocardial remodelling and underscore the value of CMR in early cardiac risk assessment in autoimmune rheumatic diseases.Figure 1 Figure 2

Abstract Neglected perilunate fracture–dislocations are uncommon yet disabling wrist injuries, typically resulting from missed diagnoses after high-energy trauma. Chronic cases (&gt;6 weeks' postinjury) present formidable reconstructive challenges due to fibrosis, malalignment, and arthritic change. Although traditional teaching discouraged late reduction, advances in staged distraction, internal fixation, and salvage techniques have redefined management expectations. This systematic review and meta-analysis synthesized available evidence on treatment strategies, functional outcomes, and complications in chronic or neglected perilunate injuries. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, PubMed, Scopus, Embase, and Web of Science were searched (1983–2025) for studies reporting outcomes of perilunate dislocations treated ≥6 weeks after trauma. Data extracted included patient demographics, injury chronicity, surgical method, and functional results (Mayo Wrist Score, QuickDASH, range of motion, grip strength, and arthritis). A random-effects meta-analysis pooled the proportion of patients achieving “good/excellent” results, whereas heterogeneous data were summarized descriptively. Thirteen studies (158 patients) met the inclusion criteria. Most were young males (mean: 30 years) sustaining high-energy mechanisms; 59% were transscaphoid fracture–dislocations, 30% ligamentous perilunate dislocations, and 11% isolated lunate dislocations. Median delay to treatment was 4.5 months (range: 6 weeks–16 years). Open reduction and internal fixation (ORIF) predominated (49%), followed by proximal row carpectomy (34%) and limited wrist fusion (7%). The pooled proportion of good/excellent Mayo Wrist Scores was 60% (95% confidence interval: 48–72). Mean postoperative flexion–extension arc reached approximately 50% of the contralateral side and grip strength approximately 85%. Radiographic arthritis developed in approximately 28%, but few required later arthrodesis. Staged distraction-assisted reduction improved outcomes in markedly chronic presentations. Even after prolonged delay, selected patients with neglected perilunate fracture–dislocations may achieve meaningful function and pain relief. ORIF within 4 to 6 months appears associated with better functional scores than later reconstruction, whereas very late presentations often necessitate salvage procedures. However, these conclusions are based on very low-certainty evidence from small, heterogeneous observational studies, and should be interpreted with caution Level IV

The clinical implications of operatively fixed pilon, talar, and calcaneal fractures lie in the long-term observation of posttraumatic arthritis of the injured joint. For example, a review found an approximately 39% rate of posttraumatic arthritis after fractures of the tibial plafond1. Specifically, radiographic appearance of subtalar arthritis after intra-articular calcaneal fractures has been noted in >21% of patients at 17 months2. A prospective multicenter observational case study of 116 enrolled patients with a pilon fracture evaluated the extent of cartilage damage intraoperatively as well as radiographic evidence of osteoarthritis and functional outcomes (using the Foot and Ankle Ability Measure [FAAM] subscales for activities of daily living and sport activities) at 2 years after injury in the 56% of patients who had not been lost to follow-up. Initial cartilage damage was associated with early to mid-term osteoarthritis development and worse functional outcomes3. In contrast, little has been written about the natural history of the contiguous joint after an isolated traumatic injury to a joint—such as the contiguous subtalar joint after operative fixation of a pilon fracture, as studied by Joshi et al. Information regarding the natural history is critical for patient prognostication—such as the potential for further degenerative changes leading to the development of accelerated radiographic subtalar changes and/or clinical symptoms. Joshi et al. provide insight regarding the development of subtalar arthritis in a series of 474 operatively treated pilon fractures in adults, with the exclusion of patients who had a concurrent talar or calcaneal fracture. When patients were grouped according to the time from the injury to the last imaging studies (<12, 12 to 24, 25 to 48, and >48 months), the mean Kellgren-Lawrence (K-L) grade of subtalar osteoarthritis on radiographs was significantly higher in both of the groups with >24 months of follow-up compared with the group with <12 months: by 0.34 (95% confidence interval [CI], 0.03 to 0.66; p = 0.04) for 25 to 48 months and by 0.37 (95% CI, 0.08 to 0.66; p = 0.01) for >48 months. Although the study demonstrated increasing radiographic subtalar joint arthritis over time, it did have some limitations. These include the absence of patient-reported outcomes and the absence of an assessment of the initial subtalar injury by either intraoperative observations or advanced imaging. Other limitations involve the variability in the mechanisms related to the development of subtalar arthritis alone as well as the inability to determine the severity of the initial pilon fracture, which may mitigate or worsen the development of posttraumatic subtalar arthritis. Patients with a fracture involving the articular surface of the calcaneus, talus, or pilon, with or without malalignment, need to be informed that a substantial risk of subtalar arthritis exists. Even if the articular reduction and anatomic alignment are performed optimally, that may not prevent the development of additional morbidity, such as subtalar arthritis. One other key point involves the difference between radiographic changes and clinical symptoms of arthritis. Often, early radiographic changes are observed but clinical symptoms occur many years later. This study provides critical insight into the effect of time, and patients need to be warned and educated about the development of posttraumatic subtalar arthritis after operative fixation of a pilon injury. Such arthritic changes over time may become radiographically evident beyond the first 2 years and subsequently become clinically relevant. In conclusion, the incidence of subtalar joint arthritis leading to additional morbidity is very high after fractures involving joints about the hindfoot (i.e., calcaneal, talar, or pilon fractures). As demonstrated by Joshi et al., it is reasonable to expect an elevated risk of subtalar arthritis after operative fixation of a high-energy pilon fracture caused by an axial load, but the precise incidence is difficult to ascertain due to the absence of patient-reported outcomes in their study. The incidence of posttraumatic arthritis after lower-energy extra-articular ankle fractures is less well defined in the literature, but it is probably lower than the incidence after a high-energy pilon fracture. A need exists for additional studies with long-term follow-up (over 5 to 10 years) that involves routine radiographs of the subtalar joint as well as clinical outcomes after operative fixation of pilon fractures. Furthermore, studies should stratify by fracture severity and assess the effects of articular comminution of the pilon fracture, reduction quality, and the initial extent of subtalar involvement.

Navicular stress fractures are difficult to treat with high risks of non-union, and there are few studies evaluating treatment strategies and outcomes for chronic navicular stress fractures with non-union, particularly in professional elite athletes. Hence, the aim of this study is to evaluate the outcomes of vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes while reporting on the complications, rate of reoperations and ability to return to sports (RTS). Seventeen elite athletes with isolated chronic navicular stress fracture non-union treated with vascularized pedicle bone grafting from 2018 to 2023 were reviewed. Demographic details, intraoperative findings, return to training (RTT), ability to RTS, player status at last visit and complications were analyzed and reported. Fifteen out of 17 elite athletes were males (88.2%), and the average age was 22.4 years (standard deviation [SD] = 3.7). More than 75% of them had a failed prior surgical fixation, with only four athletes (23.5%) who had no prior surgical intervention but failed conservative management for an average duration of 8.7 months before the vascularized pedicle bone grafting. These athletes had an average follow-up duration of 42.8 months (SD = 13.5). All of them achieved bony union with no major complications or reoperations. The average time taken to RTT was 16.1 weeks (SD = 1.8). There was one case of superficial wound infection and another with deep peroneal nerve sensory injury. Sixteen out of 17 athletes were able to RTS to their preinjury level. One rugby player failed to return to competitive sports due to persistent pain in the navicular despite union on CT scan and had developed early arthritic changes at his final follow-up. Vascularized pedicle bone grafting for chronic stress fractures of the navicular with non-union in a cohort of professional elite athletes yielded good bony union and ability to RTS without significant complications. Level IV.

Long-term outcomes of the congruent arc Latarjet procedure: evaluation of 136 patients with a minimum follow-up of 10 years.

Scapholunate (SL) ligament injury represents the most common form of carpal instability and typically occurs following a fall onto an outstretched hand.Patients often present with dorsoradial wrist pain, swelling, or mechanical symptoms such as clicking on the affected side.Despite its prevalence, diagnosis in the acute phase can be challenging due to the nonspecific nature of early clinical findings and the frequently inconclusive appearance of initial radiographs.Although outpatient wrist arthroscopy may facilitate early diagnosis and treatment, its availability is generally limited to tertiary care centers.Delayed or missed diagnosis may lead to chronic wrist pain, progressive instability, and long-term functional impairment.Several classification systems have been proposed for SL ligament injuries.This review focuses on static, reducible scapholunate ligament injuries without radiographic evidence of degenerative changes.According to contemporary practical management guidelines, these injuries correspond to stages III through V of the modified Garcia-Elias classification, reflecting increasing severity of ligamentous and capsuloligamentous disruption.These types of injuries are commonly encountered in patients whose symptoms have persisted for more than six weeks, representing the chronic phase of scapholunate ligament injury.Surgical reconstruction remains the cornerstone of management for these lesions.However, no single operative technique has been universally accepted as the standard of care.The objective of this review is to synthesize the most current evidence and provide an educational summary of the available surgical options for treating static, reducible SL ligament injuries, with particular attention to reported clinical outcomes associated with each technique.

Objectives: Bicondylar tibial plateau fractures are technically demanding fractures that have a high rate of complications. The aim of this study was to analyse the outcomes of patients diagnosed with bicondylar tibial plateau fractures (AO41.C of the AO/ASIF classification) who were treated by osteosynthesis with plates and screws.Methods: A retrospective observational study of 27 patients was conducted. The mean follow-up was 49.52 months. The minimum follow-up was 2 years. The mean age of the patients was 51.44 years. Fifty-two percent of the patients required external fixation due to poor soft tissue condition, with a mean time to definitive surgery of 9.42 days. The 27 patients were definitively treated by open reduction and internal fixation with plates and screws. In 21 patients, the osteosynthesis was carried out with two plates using a dual approach (anterolateral and posteromedial). In addition to the medial and lateral plate, in 2 patients, a posterior plate was used. In 4 patients, the chosen option was a synthesis with a single plate through the anterolateral approach.Results:The average score on the KOOS (Knee Injury and Osteoarthritis Outcome Score) scale at the end of the follow-up was 53.26 points. The use of external fixation did not correlate with a worse clinical result at the end of the follow-up. According to the Kellgren-Lawrence scale, all patients presented different degrees of arthritic changes. The main complication was discomfort related to the hardware, and 15 patients (55,56%) underwent hardware removal. One of the patients also required a high tibial corrective osteotomy due to the malunion of the fracture in valgus.Conclusion: Although a notable reduction and union of the fracture are achieved, bicondylar tibial plateau fractures result in a major loss of articular function and posttraumatic radiological changes.

Introduction. The immune system plays a central role in the development of degenerative diseases of bone and cartilage, particularly osteoarthritis, which most often affects the knee joint. Interleukin-1β (IL-1β), synthesized by myeloid cells, plays a leading role in the development of the inflammatory process. It is activated through interaction with pathogen- or damage-associated molecular patterns and subsequent interaction with cell membrane receptors. Adipose tissue is an additional source of inflammation in the body, and can also be a source of IL-1β, leading to joint inflammation and the progression of arthritic changes and destruction of cartilage, as well as subchondral bone. To relieve pain and inflammation, doctors often use dexamethasone, either in short courses or over long periods. Aim of the research. To study the concentration of IL-1β in the blood plasma of rats with obesity, combined with gonarthrosis amid the correction with dexamethasone on the 3rd, 5th, 10th day. Materials and methods. The study was performed on 180 male Wistar rats, 8-10 weeks old and weighing 200-250 g, divided into 5 groups of 36 animals each. Group I was administered 1.0 ml of saline solution, while groups II, III, IV, and V were treated for knee osteoarthritis and obesity. Group II received 1.0 ml of saline solution intramuscularly. Groups III, IV, and V received dexamethasone at doses of 1 ng/ml, 10 ng/ml, and 100 ng/ml, respectively. Blood samples (1 ml) were collected on days 3, 5, and 10 of the experiment. Results were evaluated at a statistical significance level of p &lt; 0.05, with the first group’s values being considered as 100% of the baseline data. Results. The study demonstrated a dose-dependent relationship between IL-1β concentration and the administered substance in patients with obesity and gonarthrosis. The greatest changes were observed in Group II, where cytokine levels were significantly higher than in the other groups and continued to rise by day 10. When dexamethasone was administered at a dose of 1 ng/ml, IL-1β levels increased by day 3 and then decreased by day 5. By day 10, the decrease was less significant, indicating a weak anti-inflammatory effect at this dose. In group IV, amid the administration of 10 ng/ml dexamethasone, the level of IL-1β decreased by the 3rd day, by the 5th day the effect was even more significant, and by the 10th day the level of the cytokine decreased slightly, remaining stably high. In group V, an increase in IL-1β concentration was observed by the 3rd day, then on the 5th day, a decrease ensued, and by 10th day this decrease slowed down. Dynamic analysis showed that in all groups the concentration of IL-1β has increased compared to 3rd day, reflecting the development of the inflammatory process. Conclusion. A dependence between plasma IL-1β concentrations and obesity associated with knee osteoarthritis, and the dexamethasone dose was established. The greatest positive effect was observed with dexamethasone at a dose of 10 ng/ml, especially until the 5th day; by the 10th day the effect remained relatively high. Doses of 1 ng/ml and 100 ng/ml demonstrate a pronounced anti-inflammatory effect only in the first 3 days; then the activity decreases.

Purpose To investigate retinal and choroidal microvascular alterations in patients with rheumatoid arthritis (RA) via optical coherence tomography angiography (OCT‐A) and explore the association of anticyclic citrullinated peptide (anti‐CCP) levels with choroidal thickness (ChT). Methods This cross‐sectional study included patients with RA and matched controls. Subjects with retinal or optic disc abnormalities were excluded. Vessel density was measured using OCT‐A. ChT was measured using the enhanced‐depth imaging SD‐OCT. Between‐group differences in vessel density and ChT were evaluated, and their associations with anti‐CCP positivity were explored. Results A total of 28 RA patients (age, mean ± SD: 58 ± 11 years, female sex: 93%) and 28 matched controls (age, mean ± SD: 57 ± 10, female sex: 93%) were analyzed. Compared with controls, RA patients had significantly higher vessel density in the parafoveal temporal ( p = 0.003), perifoveal temporal ( p &lt; 0.001), and perifoveal superior ( p = 0.010) quadrants. ChT was significantly higher in the perifoveal temporal and superior quadrants ( p &lt; 0.001). Anti‐CCP levels correlated significantly with parafoveal nasal vessel density ( r = 0.542, p &lt; 0.010) and perifoveal inferior vessel density ( r = 0.377, p &lt; 0.05). Logistic regression identified increased parafoveal nasal ChT as a factor independently associated with anti‐CCP positivity ( p = 0.034, OR = 4.739). Conclusion These findings suggest that RA is associated with subtle yet significant alterations in the retinal microvasculature and ChT, particularly in relation to anti‐CCP positivity, indicating a potential role for ocular imaging as a complementary indicator of systemic disease activity in RA patients.