More metal is not always better: Cortical fixation density and early outcomes in elderly distal femur fractures.

Prognostic value of tip-to-apex distance in prophylactic fixation for pathological peritrochanteric femur fractures.

The Effectiveness of the Patient-Reported Outcomes Measurement Information System Global Health Instrument Mental Health T-Score Versus the Brief Resiliency Scale at Identifying the Potential for Poor Outcomes Following Elective Total Knee and Hip Arthroplasty.

Patients with Coronavirus Disease 2019 (COVID-19) pneumonia often experienced reduced activities of daily living due to isolation-related inactivity and muscle deconditioning. This study aimed to assess the safety and feasibility of early pulmonary rehabilitation (PR) in isolated patients with COVID-19 pneumonia and to evaluate their functional status and health-related quality of life. A bedside PR program-prioritizing early mobilization and ambulation, supplemented with calisthenic and device-based resistance exercises, chest mobilization, and breathing exercises-was delivered in isolation rooms. Assessments included the 1-min sit-to-stand test (1MSTST), COPD Assessment Test (CAT), and Hospital Anxiety and Depression Scale (HADS) at baseline and discharge. In this single-arm study, 23 hospitalized patients (mean age 61±11 years, 78% male) completed the program with an adherence rate of 71%. No adverse events occurred. 1MSTST repetitions increased (median change 8.0 [3.0, 12.8]; p<0.002), with increases in oxygen saturation nadir and peak heart rate (p=0.012 and p<0.001, respectively). Higher adherence was correlated with greater increase in 1MSTST (r=0.626, p=0.010), and lower baseline 1MSTST predicted larger gains (r=-0.662, p=0.005). CAT total score and items related to cough, phlegm, and chest tightness decreased significantly, whereas HADS depression scores worsened at discharge. Early bedside PR was safely and feasibly delivered to isolated patients with COVID-19 pneumonia. 1MSTST and CAT were useful tools for functional evaluation during the acute phase. UMIN Clinical Trials Registry, UMIN000057259. Retrospectively registered on March 11, 2025.

Preoperative education is routinely integrated into enhanced recovery pathways for hip and knee arthroplasty, yet its independent effect on early outcomes remains uncertain. This study examined whether completion of structured preoperative education was associated with length of stay (LOS), early mobilization, and 30-day readmission, adjusting for patient risk factors including frailty. A retrospective study was performed using routinely collected data from adults undergoing elective primary hip or knee arthroplasty across 17 NHS and independent hospitals (2019 to 2024). Completion of preoperative education (Advancing Quality measure HK-07) was the primary exposure. LOS and 30-day readmission were primary outcomes; early mobilization within 24 hours (HK-05) was secondary. Multivariable regression models were adjusted for age, sex, procedure type, comorbidity category, and Hospital Frailty Risk Score, with restricted cubic splines for non-linear age effects and cluster-robust estimation for site variation. Of 21,225 included patients, 93.4% completed preoperative education and 97.2% mobilized within 24 hours. Completion of education was associated with a modest reduction in LOS, with the greatest effect observed in younger patients and attenuation beyond 70 years of age. No significant associations were observed between education and 30-day readmission, whereas completion of education was associated with early mobilization. Increasing frailty and comorbidity were associated with longer LOS and higher readmission risk. Preoperative education is associated with a shorter hospital stay for younger and lower-risk patients but does not appear to influence 30-day readmission. Frailty and comorbidity remain dominant drivers of outcome variation. Education should be considered one component of perioperative care, and additional tailored support may be required for older and frailer individuals.

Early mobilization in neurocritical care may support neurological recovery but is often deferred because of concerns regarding hemodynamic instability, airway compromise, and device-related adverse events. Current ICU mobilization frameworks provide limited neurocritical-specific guidance, leading to practice variation and preventable safety risks. System-level risk-mitigation strategies are therefore required. We conducted a prospective, single-center pre-post quality-improvement evaluation in a tertiary neurotrauma ICU. Healthcare Failure Mode and Effects Analysis (HFMEA) mapped the baseline mobilization process into 25 subprocesses, identifying 60 potential failure modes. High-risk pathways informed development of a standardized workflow incorporating eligibility thresholds, graded activity progression, structured interdisciplinary handoff, airway and device securement, and real-time electronic safety reporting. Mobilization-related adverse events, ventilator-tubing dislodgement, and screening accuracy were compared between a 6-month pre-implementation and a 12-month post-implementation phase, analyzed at the session level. A total of 950 mobilization sessions were recorded pre-implementation and 781 post-implementation. Adverse-event rates decreased from 1.89% to 0.64% (relative risk: 0.34; 95% CI: 0.13-0.91; P =0.023), representing a 66.2% relative risk reduction. Ventilator-tubing dislodgement decreased from 0.42% to 0% (4/950 vs. 0/781). Eligibility-screening accuracy improved from 85% to 95% ( P <0.001). Structured handoff completion increased from 30% to 100%, and real-time electronic adverse-event reporting increased from 72% to 95%. An HFMEA-guided, standardized early-mobilization workflow reduced mobilization-related adverse events and improved process reliability in neurocritical care. Treating early mobilization as a safety-engineered process supports safer, more consistent ICU rehabilitation and provides a reproducible model for patient-safety improvement.

Background Peroneal tendon disorders, encompassing tendinopathy, tears, subluxation, and instability, represent a significant source of lateral ankle pain and functional impairment, often exacerbated by underlying conditions such as cavovarus foot deformities or chronic lateral ankle instability. In cases of severe peroneus brevis degeneration or irreparable tears, peroneal longus to brevis tendon transfer is an effective technique to restore eversion strength and dynamic stability, though challenges persist in patients with poor tissue quality necessitating augmentation. Purpose To present a novel case of peroneus longus-to-brevis transfer augmented with the TeKBrace synthetic graft for complex peroneal pathology. Case Presentation. A 31-year-old man presented with persistent lateral ankle pain following an inversion injury 6 months prior. Conservative management, including an orthopaedic boot, home exercises, nonsteroidal anti-inflammatory drugs, physical therapy, and a peroneal tendon steroid injection, provided limited relief. Physical examination revealed cavus foot posture, tenderness over the peroneal tendons and lateral ligaments and pain with eversion. Magnetic resonance imaging showed tears in both peroneal tendons and increased signal at the peroneal tubercle. Surgery involved lateral incision, excision of the torn peroneus brevis segment, side-to-side anastomosis of the peroneal longus to brevis, peroneal tubercle planing, and lateral ankle ligament imbrication using anchors. The anastomosis was reinforced with TeKBrace synthetic graft. Postoperative protocol included non-weight-bearing in a posterior splint for 1 week, short leg cast for 2 weeks, and full weight-bearing in a walking boot at 3 weeks. Results The augmentation facilitated early mobilization and protected weightbearing, resulting in minimal muscle atrophy, shorter rehabilitation time, rapid return to activities, and no device-related complications (infection, foreign body reaction, or mechanical failure). Conclusion This single case highlights the feasible use of TeKBrace augmentation in peroneal longus to brevis transfer, suggesting potential benefits for select patients with complex peroneal tendon reconstructions. Larger series with longer-term outcomes are needed to confirm durability, integration, and any advantage over nonaugmented transfers or other reinforcement options.

This meta-analysis study was conducted to evaluate the effect of education-based interventions on the development of deep vein thrombosis (DVT) in patients undergoing orthopedic surgery. In this study, the terms "deep vein thrombosis," "orthopedic surgery," and "patient education" were searched in Turkish and English in the relevant literature published in the last 20 years in the Web of Science, PubMed, ScienceDirect, Scopus, and Google Scholar databases. A total of 8021 studies were found as a result of the search. Six studies that met the inclusion criteria were reviewed. In the meta-analysis, the Odds Ratio (OR) was calculated as the effect size, and Cochran's Q test and I² statistic were used for heterogeneity analysis. Publication bias was assessed using funnel plots and Egger regression tests. The meta-analysis found that the risk of developing DVT was significantly lower in groups that received educational interventions compared to control groups (OR ≈ 0.50, 95% CI: 0.37-0.69, p <0.001). Educational interventions have been effective through mechanisms such as encouraging early mobilization, increasing compliance with anticoagulant medication use, and raising awareness about DVT symptoms (p <0.05). In orthopedic surgery patients, education-based interventions applied in conjunction with pharmacological and mechanical methods are effective in preventing DVT. Systematic integration of patient education programs into clinical practice will contribute significantly to improving patient safety and reducing postoperative complications. Future studies should focus on the integration of digital health technologies and the evaluation of long-term effects. The study has been registered with PROSPERO (CRD420251047966).

Total knee arthroplasty (TKA) allows immediate weightbearing and avoids challenges associated with secondary arthroplasty following conservative management or failed fixation of tibial plateau fractures (TPFs). Metaphyseal sleeves may overcome the limitations of conventional implants by addressing issues of deficient bone stock and inadequate proximal fixation in the fracture zone. We conducted a retrospective case series of patients undergoing TKA with metaphyseal sleeves for acute TPFs at a single tertiary centre between January 2019 and June 2025. Demographic details, injury characteristics, clinical outcomes, and complications were extracted from electronic records. A total of 16 patients were included (mean age 73.8 years (SD 6.0), 93.8% female). Of these patients (87.5% (n = 14/16) were osteoporotic, and 37.5% (n = 6/16) had pre-existing osteoarthritis. The median follow-up was 12 months (IQR 3 to 72). Immediate weightbearing was achieved in all. Radiographs in all patients showed metaphyseal sleeve integration and no subsidence by three months. One patient was followed up at six years showing no adverse radiological signs. Mean knee range of motion improved from 90.7° at sixweeks to 108.1° at final follow-up. Complications occurred in 25.0% of patients (n = 4/16), most commonly wound-related (n = 2/16). Two patients (12.5%) required further surgical intervention. TKA with metaphyseal sleeves has a role in selected elderly patients with TPF not amenable to reconstruction. It addresses fixation failure in TPF and enables early mobilization with acceptable outcomes.

To examine whether early multidimensional mobility assessments discriminate independent ambulation and functional independence on discharge in subacute stroke inpatients with supervised walking ability. Retrospective cohort study. Fifty subacute stroke inpatients (≤ 5 months post-stroke). Independent ambulation and functional independence were defined as Functional Ambulation Category ≥ 4 and Modified Barthel Index 75 on discharge, respectively. Discriminative ability of admission assessments was evaluated using univariate binary logistic regression andreceiveroperating characteristic curve analysis. The Berg Balance Scale and the modified Four Square Step Test demonstrated the highest discriminative performance. For independentambulation, the Berg Balance Scale (≥ 40.5)yielded an area under the curve of 0.74 (95% confidence interval: 0.60-0.88) with 82% accuracy, and the modified Four Square Step Test(≤ 31.52 s) yielded an area under the curve of0.78 (0.64-0.91) with 80% accuracy. For functional independence, the Berg Balance Scale (≥ 42.5) yielded an area under the curve of 0.74 (0.60-0.88) with 74% accuracy, and the modified Four Square Step Test (≤ 32.88 s) yielded an area under the curve of 0.71 (0.57-0.86) with 70% accuracy. Early balance and multidirectional stepping performance may be useful for screeningtosupport goal-setting and discharge planning.

Bilateral clavicle fractures represent one of the rarest patterns of shoulder girdle trauma, occurring predominantly after high-energy mechanisms and posing unique challenges in diagnosis and management. Their simultaneous disruption compromises both clavicular struts, resulting in impaired shoulder biomechanics and necessitating timely stabilization for optimal functional recovery. A 25-year-old male sustained high-velocity trauma following a motorcycle accident and presented with severe bilateral shoulder pain, deformity, swelling, and markedly restricted arm elevation. Neurological and distal vascular examinations were normal. Radiographs demonstrated displaced bilateral midshaft clavicle fractures (Allman Group I), with no associated thoracic or systemic injuries. Due to significant displacement and bilateral involvement, open reduction and internal fixation was performed using 8-hole titanium anatomical locking plates on both sides through an anterior approach. Stable fixation was confirmed intraoperatively. Early pendulum exercises were initiated, followed by progressive passive and active range-of-motion rehabilitation. Postoperative recovery was uneventful. At 1 month, the patient achieved shoulder abduction of 110° on the right and 100° on the left, with full muscle strength bilaterally. Serial imaging demonstrated progressive fracture consolidation with maintained anatomical alignment. Bilateral displaced midshaft clavicle fractures, though rare, can be effectively managed with anatomical locking plate fixation, providing stable reconstruction and permitting early mobilization. This case reinforces the value of operative intervention in high-energy bilateral clavicular injuries, contributing to the limited but growing evidence guiding treatment of this uncommon trauma pattern.

Background: In a 30-bed medical-surgical unit, only 53% of patients received complete mobility screening versus the 80% national benchmark due to incomplete activity orders and poor communication among providers, nurses, and therapists. Objective: The aim of the study is to enhance mobility management by integrating systematic mobility discussions into daily multidisciplinary rounds and achieving 100% comprehensive mobility screenings. Methods: This 15-week project implemented staff training on the care team rounds flow sheet. Patient mobility was reviewed during daily rounds, with providers completing missing activity orders to enable nursing screenings and rehabilitation referrals. Weekly data were analyzed using Research Electronic Data Capture (REDCap). Results: Among 359 patients, 5.6% (n = 20) lacked activity orders and 7% (n = 24) lacked mobility screenings. During rounds, 100% of patients with missing activity orders received appropriate orders and subsequent screenings. Run-chart analysis showed decreasing trends in missing orders. Conclusions: The intervention achieved 100% compliance in placing missing activity orders and assessing mobility status. Using validated tools within interdisciplinary discussions enhances patient outcomes and hospital efficiency. Implications for Nursing: This approach empowers nurses to conduct comprehensive mobility assessments, improving care coordination and patient safety while establishing clear protocols for mobility management.

Chronic subdural hematoma (CSDH) is among the most common neurosurgical conditions, yet management strategies vary worldwide despite an expanding evidence base. To harmonize clinical practice andfacilitate the establishment of transnational recommendations,the 2024 joint iCORIC/DACSUHS symposium in Copenhagen included aDelphiprocess on the key aspects of CSDH management. A modified Delphi process was conducted among 32 participants from 14 countries, including neurosurgeons, neurointerventionalists, and CSDH researchers. Eighteen topics were assessed across three survey rounds, based on the revised Danish national CSDH guidelines. Consensus was defined as ≥ 75% agreement and strong consensus as ≥ 95%. Response rates were 84.3%, 100%, and 59.3% across the three rounds. Unanimous or strong consensus was achieved for several core practices: surgical evacuation for hematomas with significant mass effect, conservative management for mild cases, use of burr hole or twist-drill craniostomy as primary treatment, and postoperative drainage after evacuation. Consensus also supported irrigation with warm (37C°) Ringer's lactate, bilateral evacuation for large bilateral hematomas, and early postoperative mobilization. Areas lacking consensus included management of antithrombotic therapy, drain duration beyond 24h, the role of routine postoperativeComputed Tomography (CT)in asymptomatic patients, and the adoption of eMMA as standard or preventive treatment. The 2024 iCORIC/DACSUHS Delphi consensus process identified broad international agreement onseveral aspectsof CSDH management while exposing persistingdisagreementin othersincludingantithrombotic reversal, imaging protocols, and embolization strategies.Knowledge of the common understanding of agreement and disagreement within CSDH treatmentform aplatformfor future multinationalcollaborationand highlight priorities for further clinical research.

DesignRetrospective multicentre cohort study.SettingData were collected between 2015 and 2024 from the orthopaedic departments of multiple hospitals.ParticipantsAdult patients with isolated Mason type I and selected Mason type II radial head fractures (≤2 mm displacement, no mechanical block) treated nonoperatively between 2015 and 2024 were included. A total of 174 patients met the inclusion criteria and completed a minimum follow-up of 24 months.InterventionPatients were allocated to either early controlled mobilisation using a functional brace (Group 1) or delayed rehabilitation following four weeks of long-arm cast immobilisation (Group 2).Main measuresPrimary outcome measures were the Mayo Elbow Performance Score at final follow-up. Secondary outcomes included elbow range of motion, pain assessed using the visual analogue scale, time to return to work, and treatment-related complications.ResultsEarly controlled mobilisation was associated with slightly higher functional outcome scores, including the Mayo Elbow Performance Score (89.5 vs 87.0) and the Oxford Elbow Score (87.3 vs 85.0). Differences were also observed in elbow flexion (138.0° vs 134.8°), pain scores (0.67 vs 1.01), and time to return to work (10.5 vs 11.7 weeks), whereas extension loss and forearm rotation were comparable between groups. Complication rates were similar. However, the magnitude of these differences did not exceed established minimal clinically important difference thresholds.ConclusionsEarly controlled mobilisation is a safe and reasonable approach in the nonoperative management of radial head fractures. Although small differences favouring early mobilisation were observed, no clinically meaningful difference was identified between the two approaches.

This case report details a 16?year?old male admitted to the emergency department after a high-speed motor vehicle accident. He was diagnosed with a grade?IV (2?degree) liver damage, with blunt abdominal injury considered in the differential diagnosis. Surgeon did the exploratory laparotomy as well as stitched the laceration to arrest bleeding, preserved a clear surgical field, achieved proper hemostasis, and avoided fluid gathering. Core features of the case report encompasses the incorporation of early initiation of movement, ventilatory exercises, core stability, muscle power boosting activities, and pain relief techniques into the treatment plan for grade?IV hepatic damage. These measures facilitate early movement, minimize adverse events of extended bed confinement, and support generalized body healing. Physical therapy measures target maximize recovery, augment functional capacities, and reduce postoperative sequelae. The report also covers the postoperative medicines administered to the patient.

The ERACS method is the latest birthing method resulting from innovation and development of the ERACS (Enhanced Recovery After Caesarea Section) concept. With the ERACS method, patients can mobilize as early as possible and also overcome post-operative pain. Mobilization is a person's ability to move freely and is a prominent factor in accelerating recovery after surgery and anesthesia. While post-operative pain is something that is feared by patients, pain also causes patients to be afraid to move and do activities, especially in the first 24 hours after surgery. The purpose of this study was to determine the ability of early mobilization and pain in post-cesarean section patients with the ERACS method at RSIA Azzahra Palembang in 2024. This study used a descriptive analytical design with a cross-sectional approach. The sample collected was 77 respondents with the accidental sampling technique. The data analysis carried out was Univariate Analysis where out of 77 patients, 74 respondents were able to mobilize early and 3 patients were unable to mobilize early while for pain from 77 respondents, 72 respondents experienced mild pain and 5 respondents experienced moderate pain. From the results of this study, it can be concluded that patients are able to perform early mobilization and are free from post-cesarean section pain using the eracs method at RSIA Azzahra Palembang.

Hip fractures are a significant public health concern affecting millions of patients globally, particularly elderly and osteoporotic patients. The management of this injury is typically surgical in order to facilitate early mobilization; however, a small subset of patients is managed non-operatively. The aims of this study were to evaluate patients with hip fractures managed non-operatively in Ireland to determine their clinical outcomes and mortality rates post-injury. A retrospective cohort study using data from the Irish Hip Fracture Database (IHFD) from 2017 to 2021 was carried out. The primary outcome was 30-day mortality, with secondary variables including admission source, gender, age, pre-injury outdoor mobility, pressure ulcer development, hospital length of stay, and discharge destination. Among 15,427 patients, 3% received non-operative care (n = 405). Mortality at 30days was significantly higher in hip fracture patients managed non-operatively (21% versus 4%; p < 0.001). Displaced intracapsular and subtrochanteric fractures were associated with higher mortality, while periprosthetic fractures were associated with survival (relative risk 2.57 and 2.55, respectively, p < 0.001 versus RR 0.09 p < 0.001). Independent pre-fracture mobility was also associated with survival in non-operatively managed patients (RR 0.32 p < 0.001). Non-operative management of hip fractures is associated with significantly higher mortality rates compared to surgical intervention at 30days post-injury. Fracture morphology in the form of unstable patterns including displaced intracapsular and sub-trochanteric fractures are negative prognostic factors for such patients managed non-operatively, whilst independent pre-fracture mobility was correlated positively with post-injury clinical outcomes.

The Effect of Early Mobilization on Postoperative Recovery in Abdominal Surgery: A Randomized Controlled Trial.

To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. Systematic review and meta-analysis. Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in 6467 (11.7%) participants across all included trials. High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval 0.71 to 0.92). Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level. Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation. By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty. This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery. Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice. Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions. Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention. These findings facilitate prioritisation of effective interventions and development of evidence based guidelines. PROSPERO CRD42025637449.

Implementing early mobilization protocols can improve patient outcomes and accelerate postoperative recovery. This pre-test and posttest randomized controlled experimental study aims to evaluate the effects of early mobilization training on mobility, pain, comfort, and sleep quality in patients undergoing laparoscopic abdominal surgery. The study was conducted at a state hospital in Northern Cyprus between June and October 2022, and participant recruitment and follow-up were reported using the CONSORT 2010 flow diagram. The sample of the study comprised 78 abdominal surgery patients who were equally assigned to the intervention (n = 39) and control groups (n = 39). Perioperative information form and patient mobility scale were used for data collection. The mean ages of the intervention and control groups were 44.82 ± 12.37 and 44.41 ± 10.80 years, respectively. The total duration of mobilization in the intervention group (58.33 ± 11.20 min) was significantly higher than that of the control group (24.92 ± 5.64 min). Postoperative pain scores of the intervention group were significantly lower than those of the control group. Comfort and sleep quality scores of the intervention group were significantly higher than those of the control group. Finally, the length of hospital stay in the intervention group was significantly lower than that of the control group. The findings of this study imply that early mobilization training had a positive impact on reducing postoperative pain and increasing the duration of mobilization, comfort while turning in bed, and lying and the quality of sleep on the first postoperative day. This study provides practical insights for enhancing comfort, mobility, pain management, and sleep quality, while addressing a key gap in the literature and contributing to evidence-based clinical practice.