Short-Term Results of an Algorithm for Brachial Artery Injury Repair Favoring a Reversed Ipsilateral Arm Vein Conduit.

Safety and clinical outcomes of RefluxStop procedure: systematic review and meta-analysis.

Adult spinal deformity (ASD) leads to pain, disability, and reduced quality of life. Traditional multilevel posterior osteotomies are associated with complication rates up to 78%. Anterior column realignment (ACR) through an oblique minimally invasive surgery (MIS) approach offers direct visualization of the anterior longitudinal ligament, reducing motor injury risk. This study evaluates the safety and efficacy of this technique through illustrative case series, systematic review, and meta-analysis. A single-center retrospective case series presents 3 patients with class III ASD undergoing oblique ACR with robot-assisted posterior fixation. PubMed, Embase, and Cochrane were searched (July 25, 2025) for studies on MIS oblique ACR for ASD. Studies lacking sagittal imbalance or complete clinical data were excluded. Three studies met inclusion criteria and passed Joanna Briggs Institute critical appraisal. In the case series, sagittal alignment improved: mean sagittal vertical axis decreased from 11.1 to 3.7 cm, lumbar lordosis increased from 12.7° to 61.0°, and pelvic incidence-lumbar lordosis decreased from 50.3° to 4.7°. Postoperative L1-pelvic angle improved to within 6° of each patient's ideal, highlighting correction toward contemporary targets. Functional gains were notable, no complications occurred, and improvements persisted at 6 to 24 months. The systematic review corroborated low complication rates and effective correction with pooled vessel injury rate of 1.6% (95% CI, 0%-3.8%) and no proximal junctional failure. Across 124 patients and 222 segments, pooled disc angle correction was 11.53° (95% CI, 10.73-12.33), pooled fusion rate was 95.4% (95% CI, 91.7%-99.0%), and pooled complication rate was 21.9% (95% CI, 12.0%-36.6%). Oblique ACR is an emerging MIS strategy for ASD, providing robust spinal realignment. Our findings suggest that this advanced technique may be considered in medically and radiographically complex patients. Future studies are needed to evaluate long-term durability and comparative effectiveness vs alternative MIS or open techniques.

Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke. Although early endovascular stenting trials showed high complication rates, the low-profile Neuroform Atlas stent may offer a safer alternative. This systematic review and single-arm meta-analysis consolidates current evidence on its safety and efficacy in treating ICAS. PubMed, Embase, and Web of Science were searched through August 3, 2025, for observational studies or randomized controlled trials (RCTs) reporting outcomes of the Neuroform Atlas in adult ICAS patients. Pooled proportional analyses used a double-arcsine transformation and a random-effects model. Risk of bias was assessed using the ROBINS-I tool. Primary endpoints included complication rates, stroke, mortality, and functional outcome (mRS 0-2). Five observational studies, including 419 patients, were analyzed. The pooled complication rate was 8% (95% CI: 2-26%), with ischemic stroke at 12% (95% CI: 9-18%), hemorrhagic stroke at 2% (95% CI: 1-8%), and mortality at 3% (95% CI: 0-19%). A good functional outcome (mRS 0-2) was achieved in 85% (95% CI: 44-98%) of patients. Heterogeneity was moderate to high across outcomes (I2: 46.4-92.2%). Risk of bias was rated low to moderate. The Neuroform Atlas stent appears technically feasible and relatively safe for patients with symptomatic ICAS refractory to medical therapy, achieving high rates of functional independence. However, the evidence is limited by small, retrospective, single-arm studies and substantial heterogeneity. Large, randomized controlled trials are needed to define its role more clearly.

Bullous lung disease (BLD) is frequently associated with spontaneous pneumothorax and may require surgical intervention. The use of vacuum-assisted chest tube drainage after bullectomy is controversial. This study aimed to compare the results of vacuum versus non-vacuum assisted chest tube drainage in patients after bullectomy. This randomized controlled study included 80 patients who underwent bullectomy between September 2023 and July 2024 at Kasr Al-Ainy Hospitals. Patients were randomly allocated to either vacuum-assisted or non-vacuum chest tube drainage. Postoperative outcomes including chest tube duration, air leak duration, drainage volume, pain scores, length of hospital stay, and complication rates were compared between the two groups. No statistically significant differences were observed between the two groups regarding chest tube duration (7.0 ± 1.5 vs. 6.7 ± 4.03days), duration of air leak (4.67 ± 1.36 vs. 4.43 ± 3.7days), or amount of drained fluid (726.7 ± 161.7mL vs. 669.5 ± 299.1mL) in the vacuum and non-vacuum groups, respectively. Postoperative pain scores, length of hospital stay, and complication rates (including bleeding, wound infection, empyema, residual cavity, and mortality) were also comparable between groups. By focusing exclusively on bullectomy patients (a group under-represented in prior trials that mainly combined lobectomy and other resections), our study provides procedure-specific evidence showing no clinical advantage of routine suction. These findings help clarify inconsistencies in the literature by demonstrating that the benefit of suction may not extend to bullectomy, where postoperative physiology differs from major lung resections.

Subtalar arthroereisis is widely used to treat flexible flatfoot in growing patients. Metallic implants have historically been standard, whereas bioabsorbable devices have emerged as an alternative that may reduce implant-related symptoms and avoid elective hardware removal. We systematically compared clinical and radiographic outcomes, complication rates, and patient-reported satisfaction between metallic and bioabsorbable implants. We performed a PRISMA-compliant systematic review and meta-analysis. PubMed, Embase, the Cochrane Library, and Web of Science were searched to December 2024. We included clinical studies of subtalar arthroereisis using metallic and/or bioabsorbable implants in pediatric and adolescent flexible flatfoot. Primary outcomes were complication rates (complications, non-routine implant removal, persistent sinus tarsi pain), radiographic parameters, and patient-reported outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects models were used for quantitative synthesis. Thirty-nine studies, mostly involving pediatric patients, reported consistent clinical and radiographic improvement after subtalar arthroereisis irrespective of implant material. Pooled single-arm analyses showed persistent sinus tarsi pain in 8.0% of metallic-implant cases and 6.3% of bioabsorbable-implant cases, and non-routine implant removal/revision in 7.7% and 5.2%, respectively. In the two comparative studies, metallic implants showed a trend toward higher odds of non-routine implant removal (pooled OR 2.20; 95% CI, 0.97-5.00) and significantly higher odds of persistent sinus tarsi pain (pooled OR 1.77; 95% CI, 1.03-3.03) compared with bioabsorbable devices. Radiographic correction and patient satisfaction were high in both groups, with no consistent evidence of superiority of either material. Subtalar arthroereisis with metallic or bioabsorbable implants yields substantial clinical and radiographic improvement in pediatric flexible flatfoot. Available data suggest that bioabsorbable devices may be associated with lower rates of implant-related symptoms, but comparative evidence, limited to two non-randomized studies, is of low-to-moderate certainty. High-quality randomized trials with standardized, long-term outcome reporting are needed to define the optimal implant choice.

Outcomes and complications of surgical management for adult iatrogenic hallux varus: A systematic review.

Wheelchair-dependent individuals place high mechanical demand on their upper extremities, relying on their shoulders as weight-bearing joints for propulsion and transfers. Although reverse total shoulder arthroplasty (rTSA) is effective for rotator cuff-deficient shoulders, outcomes in wheelchair users remain understudied. This study evaluated short-term complication and revision rates following rTSA in wheelchair-dependent patients using a large national claims database. A retrospective cohort study was performed using PearlDiver Mariner, identifying patients who underwent primary rTSA. Wheelchair dependence was defined by International Classification of Diseases-Ninth Revision, International Classification of Diseases-10th Revision, and Current Procedural Terminology codes. Wheelchair users were propensity score-matched 1:5 to controls by age, sex, Charlson-Deyo Comorbidity Index, and length of stay. The primary outcomes were 2-year revision rates and 90-day all-cause readmission and emergency department (ED) visits. Secondary analyses evaluated specific post-operative complications including dislocation, periprosthetic fracture, and infection. Of 106,362 patients undergoing rTSA, 133 wheelchair users were matched to 665 controls. No significant difference was observed in 2-year revision rates (6.76% vs. 3.61%; P = .09). However, wheelchair users demonstrated higher 90-day rates of dislocation (4.51% vs. 1.65%; P = .048) and periprosthetic fracture (3.76% vs. 0.30%; P = .0019). All-cause 90-day ED utilization was also greater among wheelchair users (27.1% vs. 18.1%; P = .017). Wheelchair-dependent patients undergoing rTSA experience significantly higher early complication and ED visit rates, though 2-year revision rates appear similar. These findings highlight the unique mechanical and functional challenges faced by wheelchair users, underscoring the importance of specialized perioperative care and rehabilitation strategies in this high-demand population.

The impact of rheumatoid arthritis and immunotherapy on outcomes following cervical fusion.

Efficacy and safety of collagenase Clostridium histolyticum in men who have sex with men.

Iatrogenic risk of tube thoracostomy: A retrospective trauma database analysis.

Microvascular decompression (MVD) for hemifacial spasm (HFS) is commonly conducted under a microscope. We report a large series of fully endoscopic MVDs for HFS and describe our initial experience with 3-dimensional (3D) endoscopy. Clinical data of 204 patients with HFS who underwent fully endoscopic MVD using 2-dimensional (2D) and 3D endoscopy (191 and 13 patients, respectively) from July 2017 to October 2024 were retrospectively analyzed. Patients were grouped according to timing of surgery within the study period: early, middle, and late. The mean follow-up was 20.4 months (range, 3-87). At last follow-up, surgery had achieved cessation or significant reduction of spasms in 198 patients (97.1%). Complications immediately after surgery were as follows: facial weakness, 7 patients; hearing loss, 11 patients; tinnitus, 1 patient; infection, 1 patient; dysphagia, 1 patient; and cerebrospinal fluid leakage, 1 patient. The patients who experienced infection, dysphagia, and leakage recovered before discharge. Ten patients had complications that were present at last follow-up (1 tinnitus, 3 facial weakness, 6 hearing loss). The rate of complete or significant remission of spasms in the early, middle, and late groups was 95.6%, 97.1%, and 98.5%, respectively; the corresponding complication rates were 5.9%, 5.9%, and 2.9%, respectively. Compared with the 2D endoscope, the 3D endoscope provided subjectively enhanced stereoscopic vision and depth perception, which facilitated the operation. Fully endoscopic MVD for HFS offers wide visualization of the neurovascular conflict area and minimizes brain injury caused by retraction. Once technical proficiency is achieved, surgical outcomes are favorable and complications are low. Despite the drawbacks such as a slight sense of vertigo during use and high cost, the 3D endoscope provides a stereoscopic view. More research is essential to verify its role in MVD surgery.

Risk factors and exploratory clustering of complications after reconstruction following Mohs surgery: A national NIH All of Us study.

Recurrent myocardial infarction: In-Hospital mortality, cardiovascular complications, and comorbidity profiles.

Double-button fixation provides superior horizontal stability in acute acromioclavicular joint reconstruction: A comparative radiologic analysis.

Anterior cruciate ligament reconstruction using peroneus longus with lateral extra-articular tenodesis has excellent functional outcomes with a high return to sport rate: A prospective cohort study of 482 patients over 2years.

Chronic pain poses a significant challenge to quality of life throughout the USA. It is estimated that as much as 21% of the US population experiences chronic pain, and the incidence of new chronic pain cases is shockingly high, at 52.4 cases per 1000 persons per year. An intrathecal pump (ITP) consists of a small pump surgically implanted under the skin, along with a catheter inserted into the intrathecal space in the spine. Medication, usually in the form of opioids, local anesthetics, or muscle relaxants, is then delivered through the catheter into the spinal fluid, where it can act directly on nerves to provide pain relief or reduce spasticity. The use of intrathecal drug delivery has been established for decades and is used for various conditions, including chronic noncancer pain and cancer-related pain. ITPs are also employed for managing severe spasticity in conditions such as multiple sclerosis or spinal cord injury. Over the years, there has been a gradual increase in the use of ITPs, particularly as awareness of their benefits and technological advancements has increased. ITPs have been historically placed in the abdomen. However, more recently, some ITPs have begun to be placed in the lower back. Placing ITPs in the lower back has the potential to lower operative time and complication rates, but more research in this area is warranted. This study analyzes the outcomes of posterior ITP placement to evaluate their suitability and potential benefits. This study consisted of a retrospective review including data from 115 procedures completed between 2015 and 2025. Data collection included patient demographics, preoperative and postoperative pain scores, surgical time, needle and catheter locations, and adverse events. Pain scores were collected using the visual analog scale (VAS), and data were analyzed using SPSS 29. Two-tailed paired t-tests were used to determine the significance of the difference between preoperative and postoperative pain scores. A total of 115 procedures from 103 patients were included in the statistical analysis. The average preoperative pain was 6.54 (6.54 ± 2.00, n = 114), and the average postoperative pain score in the first year following the procedure was 4.45 (4.45 ± 2.30, n = 114), with a p value of < 0.001. The average surgical time for the procedure was 49.00 ± 19.53min (n = 113). In this study, ITPs implanted in the lower back were associated with greater pain relief, shorter surgical times, and fewer complications than those placed in the abdomen. These findings, while indirect, provide evidence for promoting ITP placement in the lower back as a safe and effective option for patients experiencing chronic pain.

Mid- to Long-Term Outcomes of Intracranial Aneurysms Treated with the Silk Flow Diverter: A Single-Center Experience.

Management and outcome of traumatic spinal injury in a low resource Sub-Saharan African setting: A 5-year retrospective cohort study.

Several methods of surgically treating displaced, ulno-humerally stable olecranon fractures (Mayo type 2a and 2b) have been suggested. Cerclage wires have been used for at least a century to achieve fracture fixation but have been replaced by tension band wiring or plate fixation as the commonly recognized "gold standard" treatments. Thin soft tissues and migrating K-wires result in high complication rates following these 2 methods. We suggest double cerclage wiring as an alternative method that allows for the omission of K-wires. The method can be used for the same indications as tension band wiring: Mayo type 2a and 2b fractures. Two cerclages are placed, in figure-of-eight and figure-of-zero configurations, respectively, through separate drill holes distally and through the triceps tendon proximally. In a retrospective study, the reoperation rate and complication rate were twice as high following tension band wiring compared with double cerclage wiring (27% vs. 13% and 45% vs. 18%, respectively). An ongoing RCT will provide more robust evidence, but current studies indicate that double cerclage wiring is a safe and possibly superior alternative to tension band wiring.