To describe a novel percutaneous technique utilizing a curved intramedullary implant for fixation of complex anterior pelvic ring fractures and to report preliminary clinical outcomes from a retrospective case series. Retrospective case series. Single academic Level I trauma center. Nine female patients (mean age 74.8 years, range 53-89 years) with anterior pelvic ring injuries treated with percutaneous trans-symphyseal fixation using a curved intramedullary device between June 2023 and December 2024. All patients were treated by a single orthopaedic trauma surgeon and followed for a minimum of 6 months. Percutaneous intramedullary fixation of the superior pubic ramus crossing the pubic symphysis and terminating in the contralateral ramus using a novel flexible, curved implant. Operative time, estimated blood loss, implant complications, fracture union, and discharge disposition. The novel technique was successfully performed in all 9 patients. Average total surgical time was 106.3 minutes, with a mean of 54.8 minutes dedicated to the anterior fixation. Average estimated blood loss was 132.2 mL. All fractures progressed to union with no cases of implant failure or surgical site infection. Assistive measures were required in 3 of 9 cases. Discharge disposition was favorable, with 5 of 9 patients discharged to home or acute rehabilitation. No complications related to the anterior implant were noted. This retrospective review suggests that trans-symphyseal curved intramedullary fixation is a feasible and safe technique for managing anterior pelvic ring fractures, including fragility and high-energy patterns. The method provides stable fixation while minimizing operative time, blood loss, and surgical exposure. Further studies are warranted to compare this technique against established modalities in larger cohorts. Level IV-Therapeutic study.

A scoping review of modifications of the transconjunctival approach for maxillofacial fracture management and proposal of evidence-based algorithm for incision selection.

A randomised controlled trial evaluating the effects of intraoperative computed tomography on the outcomes of zygomatic fractures.

Artificial intelligence tools show promise in fracture detection but may be impaired by hidden stratification. We aim to evaluate the diagnostic accuracy of a commercially available AI tool for detecting hip and pelvic fractures, with emphasis on clinically relevant subgroups and AO/OTA fracture classifications. This retrospective multicenter diagnostic test accuracy study included consecutive trauma patients who underwent hip or pelvic radiography. The reference standard was based on post-conference clinical radiology reports, incorporating MRI, CT, and radiography in hierarchical order. Fractures were classified according to the AO/OTA system. Studied subgroups included surgical metal, degenerative disease, old fractures, radiographically occult fractures and fracture classification. Sensitivity and specificity were calculated with 95% confidence intervals. Among 642 patients (median age 82years), 262 (42%) had fractures. Overall sensitivity was 87% [83-91%] and specificity 86% [82-89%]. Specificity was reduced in cases with old fractures (29% [13-51%]). Sensitivity was high for femoral neck (95% [88-98%]) and trochanteric fractures (92% [82-97%]) and moderate for pelvic (82% [70-91%]) and acetabular fractures (58% [28-85%]). Within each segment the classifications with most missed fractures were unilateral anterior pelvic arch (61A2.2), subcapital femur neck (31B1), and simple trochanteric fractures (31A1). In summary, while specificity was notably reduced in cases with old fractures and sensitivity was moderate for pelvic and acetabular fractures, the AI tool demonstrated high diagnostic accuracy for hip-region trauma radiographs, with most missed cases occurring among the subtle AO/OTA fracture groups.

Despite development of open and endovascular treatments of the iliac veins, there is no reported research on the biomechanical properties of human iliac veins. The specific requirements for devices and prosthesis for venous interventions are primarily empirical adaptations of devices developed for treating arteries. Although a lot of research has gone into developing devices, the receiving organ has not yet been studied in detail. Using the new methods and testing protocols described in this article we aim to investigate and determine the biomechanical properties of the common and external iliac veins in comparison to the common iliac artery, with the future goal of formulating a new mathematical model for the pelvic veins to facilitate in silico modeling. After consulting literature and experts in the field of biomechanics in search of suitable testing protocols, porcine samples were used to review, develop and confirm methods of conservation, biomechanical testing and histological investigation. Extension-inflation and planar biaxial extension testing for mechanical data, and histological and structural investigations were evaluated. The protocol is specifically tailored to the mechanical and structural investigation of human iliac veins and arteries, to allow comprehensive comparison of these vessels, for a better understanding and improvements in biomechanical modeling. Porcine tissue was used to show feasibility of the tests performed for ethical reasons and in anticipation of future research to evaluate the porcine model currently frequently used in endovascular research and training.

Ilio-rectal fistula : A rare cause of lower gastrointestinal bleeding: case report and literature review

Mechanical augmentation for vertebral compression fractures: A scoping review.

The oversimplification of fracture geometric features, such as roughness and aperture, is a prevalent issue in rock fluid flow studies, resulting in inaccurate characterization for nonlinear flow. To investigate the influence of complex fracture geometry on flow behavior, spectral method was employed to digitally generate 40 mismatched fracture-surface pairs, enabling a broader spectrum of roughness variables. The roughness and mechanical aperture of these digital surface pairs with central flow paths were described with surface roughness ( Z 2 ) and mechanical apertures normal to flow path ( e m_NMA ), respectively. Compared to the vertical traditional aperture ( e m_t ), the e m_NMA yields smaller values and also inherently captures the aperture directionality. Replicas with various mismatched-surface combinations were manufactured through 3D printing and mortar for constant-head flow tests under 6 different pressure gradients (1.01 × 10 4 –11.86 × 10 4 Pa m −1 ) to capture distinct nonlinear flow status. To address the limitations of single-parameter roughness descriptions and non-directional aperture models in hydraulic characterization, a new geometric parameter, G h , was developed by integrating multiple parameters from both individual and coupled fracture surfaces. Compared with the e m_t -based approach, the e m_NMA -based G h is more strongly correlated with both Forchheimer's and Izbash's coefficients and has potential for identifying critical flow regimes and assessing flow nonlinearity, as clearly revealed by its correlation with the critical Reynolds number (Re c ). Considering the robust correlations of the surface-pair geometry and Forchheimer–Izbash-modeled hydraulic properties, the superior hydraulic performances of e m_NMA and the composite geometry index G h were confirmed, thereby overcoming the limitations of the oversimplified geometric parameters commonly used in previous studies. The new index G h and related hydraulic performance presented herein are conducive to comprehending the morphology-hydromechanical coupled processes, quantitatively refining rock mass classifications before and after the excavation or drilling, informing hydraulic fracturing strategies in underground fluid resource exploration.

Patient and fracture characteristics associated with six-month patient-reported outcomes following acetabular fracture fixation.

Finite element modeling of lag screw with plate fracture fixation: Effects of screw angle, countersinking, and plate configuration.

The goal is to anatomically reconstruct the patellar joint surface in order to restore the function of the extensor apparatus. This forms the basis for astable knee function and physiological gait. Furthermore, it prevents retropatellar arthritis. Early functional mobilization can prevent joint stiffness, muscle atrophy and subsequent complications. Open or closed patellar fractures with > 2 mm joint incongruity or displacement, impaired extensor mechanism or absent active extension, even if not displaced. Stable, nondisplaced fractures, minimal displacement with an intact extensor mechanism, limited surgical eligibility, here conservative therapy is preferred. The choice of procedure depends on the fracture type: for simple vertical fractures, screw osteosynthesis; for transverse fractures (1)tension band wiring with Kirschner wires or (2)cannulated screws, alternatively (3)conventional angle stable plate fixation (preferred); for complex, multifragmentary fractures, locking plate fixation. Additional procedures, such as suture augmentation or cerclage wiring can be used as needed. Full weight-bearing in an extension splint is permitted, with gradual passive mobilization: up to 30° in weeks1-2, 60° in weeks3-4, and 90° in weeks5-6. Subsequent transition to unlimited flexion and active mobilization. Sport-specific training is possible after 3-6months. Tension band wiring has traditionally been used for patellar fractures but shows high complication rates, especially in complex, multifragmentary fractures. Recent studies show that locking plate osteosynthesis is more stable and has fewer complications.

Modern trauma surgery requires advanced strategies to manage complex fracture patterns effectively, ensuring optimal anatomical alignment and functional outcomes while minimizing soft tissue damage. Among the tools available, the small distractor has proven invaluable in achieving precise fracture reduction across various anatomical regions. By utilizing principles such as ligamentotaxis or temporary overdistraction of joints, the small distractor allows for effective approximation of fracture fragments with minimal manipulation for better visualization of articular surfaces, thus preserving vascular integrity and surrounding soft tissues. Its ability to maintain specific force vectors enables correction of axial and torsional malalignments, while providing provisional stabilization before definitive fixation. The advantages of the small distractor include quick and versatile placement, reduced soft tissue damage, shorter operation times, decreased radiation exposure, fewer wound healing complications, and faster recovery for patients. Despite requiring specialized instruments and carrying some risks, such as malalignment from unrecognized forces, the benefits far outweigh these drawbacks. The small distractor is routinely used in our clinic and has become indispensable for its versatility and effectiveness in improving surgical outcomes. Its ability to enhance fracture reduction and alignment highlights its role as acritical tool in modern trauma surgery. With consistent success across diverse cases, it represents asignificant advancement in achieving optimal patient care.

This study investigated whether mandibular angle bone apposition (MABA) observed in temporomandibular disorder (TMD) patients reflects intrinsic joint pathology or represents a skeletal response to altered biomechanical loading related to occlusal and demographic factors. Panoramic radiographs and temporomandibular joint (TMJ) magnetic resonance imaging (MRI) scans from 282 patients with TMDss (564 TMJs) were retrospectively analyzed. Bone apposition was graded on panoramic images, while MRI findings (disc position, condylar morphology, effusion) were recorded. Demographic data and individual tooth loss patterns were evaluated. Statistical analyses included chi-square tests with Bonferroni-adjusted post hoc comparisons and ordinal logistic regression based on generalized estimating equations. MABA showed no significant association with MRI-detected intra-articular TMJ abnormalities (p > 0.05). In univariate analyses, higher apposition levels were associated with increasing age, male sex, and greater numbers of missing maxillary and mandibular teeth (p ≤ 0.05). Tooth-level analysis demonstrated a localized association involving the right maxillary second premolar (p = 0.037). In multivariable analysis using generalized estimating equations, male sex, right-side location, and higher grades of joint effusion remained significantly associated with bone apposition levels (p ≤ 0.05). Although a causal relationship cannot be confirmed in this retrospective design, the observed associations suggest that MABA may be more closely related to functional and demographic factors than to intra-articular TMJ pathology. When MABA is detected on panoramic radiographs, assessment of occlusal stability may be considered, as functional loading patterns could play a role in mandibular remodeling.

This study examined the early (30-d) course of post-traumatic stress symptoms after simple upper extremity fractures and factors associated with symptom progression. A total of 109 children with simple upper extremity fractures were included in the study; patients were treated with either surgical or conservative (cast) methods. Child Posttraumatic Stress Symptom Scale (CPSS) scores from the pre-trauma period were assessed retrospectively on day 7; follow-up CPSS assessments were conducted prospectively on days 7 and 30 after the trauma. The subscales of re-experiencing, avoidance, and increased arousal were recorded at the same time points. The subjective impact of the event was measured using the Impact of Event Scale-Revised on day 7 (IES-R 7) and day 30 (IES-R 30). Random-effects linear mixed models were established at the patient level; fixed effects included time, age, BMI, sex, AO classification, trauma mechanism, surgery, cast type, and parental status variables. The effects of surgical treatment and trauma mechanism on changes in post-traumatic stress disorder (PTSD)-related symptoms over time were evaluated. Total CPSS score increased from baseline at day 7 (β≈4.1, P<0.001) and returned to baseline levels at day 30. The subscales showed similar increases at day 7 and approached normal at day 30 (all P<0.001). Older age was associated with higher total CPSS, particularly re-experiencing. Surgical treatment was independently associated with higher total CPSS (β≈1.7, P≈0.03) and re-experiencing and avoidence scores. The increase on day 7 was ~2.8 points higher in the surgical group (time × surgery, P≈0.002); the between-group difference reached ~3.5 points on day 7 and disappeared by day 30. IES-R scores decreased by ~4.6 points from day 7 to day 30 (P<0.001). PTSD symptoms after simple upper extremity fractures mostly emerge within the first week and largely subside within a month. Although surgery is associated with a higher symptom burden in the early period, this difference diminishes by day 30; therefore, surgery should not be avoided in clinically necessary cases. Level II.

The clinical data of 42 consecutive patients with extracranial carotid artery aneurysms (ECAA) who underwent surgical treatment in the Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, from January 2012 to December 2024 were retrospectively collected. Based on the Attigah classification of aneurysms, while evaluating anatomical characteristics such as bifurcation involvement, proximal and distal landing zone conditions, and parent artery tortuosity, combined with etiological risks including infection, inflammation, or trauma, individualized treatment plans were formulated. Ultimately, 36 patients underwent endovascular treatment and 6 cases underwent open surgical treatment. In the perioperative period, immediate postoperative digital subtraction angiography (DSA) or postoperative computed tomography angiography (CTA) was used to evaluate aneurysm exclusion and parent-artery patency. The patients were aged (53.3±7.3) years, including 17 females and 25 males. Among them, there were 20 true aneurysms, 19 pseudoaneurysms, and 3 dissecting aneurysms. The surgical technical success rate was 97.6% (41/42). During the perioperative period, 1 (2.2%) patient developed cranial nerve injury after open surgery. The postoperative follow-up time was (18.5±4.6) months, no deaths occurred, and 2 (4.8%) patients developed in-stent restenosis at 6 months postoperatively. Treatment of ECAA should be individualized according to etiology and anatomic characteristics, and endovascular therapy represents a relatively straightforward, safe, and effective option for ECAA.

Purpose To explore stakeholder experiences of rehabilitation following complex fractures and identify key components considered important for recovery. Methods Thirty-three individual interviews were conducted with adults who had lived experience of complex fractures (n = 16) and health professionals and commissioners (n = 17). Data were analysed using inductive reflexive thematic analysis. Results Four themes with related subthemes emerged: (1) personalisation—needs-led and holistic, meaningful to the person, and desire to see progress; (2) adjustment to reality—making sense of the situation, support system, and practical reality; (3) accessibility and delivery—skilled and flexible workforce, accessibility, and systems approach; and (4) professional support—guidance and active monitoring, navigating transitions, and supervised physical activity. Conclusions This is the first study to identify rehabilitation components valued by people with complex fractures. Participants considered it important for rehabilitation to be personalised and holistic, delivered by experienced and competent professionals, and focused on meaningful, person-specific activities. However, a perceived mismatch exists between what people want and what current services can provide. Future research should explore how to deliver accessible, personalised rehabilitation that supports long-term engagement while remaining feasible within existing resources.

The gold standard for patella fracture fixation is tension band wiring; however, achieving stable anatomic fixation can be challenging in comminuted patterns. The "star" variable-angle locking patella plate is an alternative fixation construct that is meant to address these limitations by providing multiple fixation points and dorsal cortical stability. The purpose of this study was to analyze the outcomes of patients treated with the variable-angle locking "star" patella plate. A total of 358 patients who underwent repair of a displaced patella fracture over a 10-year period were reviewed. Patients who sustained an isolated orthopaedic trauma association (OTA) 34-C3 patella fracture and underwent open reduction internal fixation (ORIF) with the variable-angle locking star-shaped patella plating system with at least 6 months of follow-up were analyzed. Demographic and treatment characteristics, fracture union, complications, and functional outcome measures as measured by knee range of motion (ROM) were collected retrospectively at standard follow-up intervals. Thirty-seven patients (mean age 60.17 ± 16.72 [standard deviation, SD] years; mean body mass index [BMI] 25.12 ± 5.04 [SD] kg/m2) treated at one multisite, urban, academic institution were identified. All fractures were classified as OTA 34-C3. The mean operating room time (wheels-in wheels-out) was 149.43 ± 50.82 (SD) minutes. One patient (2.7%) developed a fracture-related infection (FRI), two patients (5.4%) had wound complications, and one patient (2.7%) developed a deep vein thrombosis (DVT) following surgery. All fractures healed by 6 months, and no patient underwent removal of symptomatic hardware. Three patients underwent secondary operation; one patient had repeated irrigation and debridement of a confirmed FRI, one manipulation under anesthesia for knee contracture, and one revision ORIF after loss of distal fixation. Patients displayed a mean knee ROM of 106.53 ± 21.64 degrees (SD) and 118.51 ± 16.87 degrees (SD) at the 3- and 6-month points, respectively. The novel locking "star" patella plate appears to be a reliable and safe method of treatment for the most complex patella fractures.

An isolated fish skull from the Early Eocene Green River Lagerstätte from southwestern Wyoming, USA was tentatively identified as a regurgitalite. It consists of a skull of the perciform moronoid Mioplosus labracoides and articulated vertebrae. After mechanical preparation, the specimen was studied in detail and it could represent a regurgitalite, a pabulite (remnant of predation) or a portion of a decayed fish. Fish decay rarely results in an isolated skull, so this specimen probably pertains to a bromalite (pabulite or regurgitalite). We consider that it most likely is a regurgitalite because of the breakage of bones and displacement of elements.

Distal femoral periprosthetic fractures (DFPF) are an increasingly prevalent complication following total knee arthroplasty (TKA), representing a significant challenge to the orthopedic community. As the volume of primary and revision TKA continues to rise globally, a clear understanding of the epidemiological landscape and standardized classification are paramount for appropriate treatment, clinical communication, and research. This review provides a focused analysis of the current epidemiological propensities of DFPF, identifying the specific patient populations and temporal trends that define these injuries. Identifying, reporting, and treating DFPF requires standardized nomenclature to classify these injuries. Currently, multiple classification systems are utilized. Each system demonstrates individual strengths and weaknesses, from simple descriptive models to management-oriented frameworks. By focusing on the relationship between fracture location, implant stability, and bone stock, these systems provide algorithmic workflow for the surgical decision-making process between internal fixation construct type or the need for revision arthroplasty. As the incidence of these complex fractures continues to rise, the integration of epidemiological data with reliable classification remains essential for optimizing surgical outcomes and developing effective preventative strategies.

Association of tongue-hyoid bone motion parameters measured dynamically by submental ultrasound with the severity of post-stroke dysphagia.