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Throughout history, many innovations have contributed to the development of modern cardiothoracic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern cardiothoracic surgery: cardiopulmonary bypass, surgical pacemakers, video assisted thoracic surgery, robotic surgery and mechanical circulatory support. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of cardiothoracic surgery and their ongoing relevance in contemporary and perioperative practice., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Introduction Female sports players are at increased risk of soft tissue knee injuries (STKIs) compared to their male counterparts. Injury prevention programs effectively reduce the incidence of anterior cruciate ligament (ACL) knee injuries. This pilot study, therefore, aimed to examine the prevalence, type, and management of STKIs within a population of female university sports players at the University of Cambridge. Additionally, this study aimed to examine the perceived risk of ACL injuries and knowledge of long-term complications, alongside participation and attitudes towards injury prevention programs. Methodology A survey was distributed to women's university sports teams at the University of Cambridge. Information was gathered on participant demographics and sporting history. Relevant medical history, including joint laxity, connective tissue disorders, and previous knee injuries, was also collected. Participant involvement in and attitudes towards injury prevention programs were evaluated. Results Data from eighty-five participants (n = 85) were collected, all of whom were female. Forty-two percent of participants had sustained a previous knee injury, of which the majority (44%) were ACL injuries. In the ACL-injured group, 38% (n=6) had undergone ACL reconstructive surgery, 44% (n=7) had received only physiotherapy, and 19% (n=3) had received no form of treatment. Only 44% of these participants sustaining an ACL injury reported a return to the same level of post-injury sport. Seventy-two percent of respondents felt they were at increased risk of ACL injury compared to males. Most participants (87%) did not follow an injury prevention program, but 95% expressed a willingness to enroll in one. Conclusions This pilot study indicates that most knee injuries in female university athletes in this cohort at Cambridge University are ACL injuries, with a considerable number being managed conservatively. The low rate of return to pre-injury sporting levels highlights the significant impact of ACL injuries on athletic careers. This study demonstrates results similar to previous studies on the broader population. However, due to the pilot nature of the research and limited statistical power, the results should be interpreted with caution before transposing to the wider population. Further investigation is required into why many of these ACL-injured female athletes were managed conservatively and whether this finding is mirrored in their male counterparts. Despite recognizing their higher risk than males, participants displayed low engagement in injury prevention programs, indicating a gap between awareness and action. The willingness to participate in prevention programs suggests the potential for improved engagement through targeted interventions. Future research should focus on identifying and addressing specific barriers to participation in injury prevention programs and exploring the reasons behind the preference for conservative management of ACL injuries. Additionally, expanding the sample size and including a more diverse athletic population would enhance the generalizability of the findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gompels et al.)

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality., Methods: Using a multicentre study design, independent of registry data, we included adult patients sustaining a PPF around a knee arthroplasty between 1 January 2010 and 31 December 2019. Univariate, then multivariable, logistic regression analyses were performed to study the impact of patient, fracture, and treatment on mortality., Results: Out of a total of 1,667 patients in the PPF study database, 420 patients were included. The in-hospital mortality rate was 6.4%. Multivariable analyses suggested that American Society of Anesthesiologists (ASA) grade, history of peripheral vascular disease (PVD), history of rheumatic disease, fracture around a loose implant, and cerebrovascular accident (CVA) during hospital stay were each independently associated with mortality. Each point increase in ASA grade independently correlated with a four-fold greater mortality risk (odds ratio (OR) 4.1 (95% confidence interval (CI) 1.19 to 14.06); p = 0.026). Patients with PVD have a nine-fold increase in mortality risk (OR 9.1 (95% CI 1.25 to 66.47); p = 0.030) and patients with rheumatic disease have a 6.8-fold increase in mortality risk (OR 6.8 (95% CI 1.32 to 34.68); p = 0.022). Patients with a fracture around a loose implant (Unified Classification System (UCS) B2) have a 20-fold increase in mortality, compared to UCS A1 (OR 20.9 (95% CI 1.61 to 271.38); p = 0.020). Mode of management was not a significant predictor of mortality. Patients managed with revision arthroplasty had a significantly longer length of stay (median 16 days; p = 0.029) and higher rates of return to theatre, compared to patients treated nonoperatively or with fixation., Conclusion: The mortality rate in PPFs around the knee is similar to that for native distal femur and neck of femur fragility fractures. Patients with certain modifiable risk factors should be optimized. A national PPF database and standardized management guidelines are currently required to understand these complex injuries and to improve patient outcomes., Competing Interests: A. A. H. H. Nasser and A. Mahmood report funding from Queen Elizabeth Hospital Birmingham Charity Trauma Research and Education Fund, related to this study., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip., Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period. Univariate and multivariable logistic regression analyses were performed to study the independent correlation between patient, fracture, and treatment factors on mortality., Results: A total of 1,109 patients were included. The in-hospital mortality rate was 5.3%. Multivariable analyses suggested that age, male sex, abbreviated mental test score (AMTS), pneumonia, renal failure, history of peripheral vascular disease (PVD) and deep surgical site infection were each independently associated with mortality. Each yearly increase in age independently correlates with a 7% increase in mortality (OR 1.07, p=0.019). The odds of mortality was 2.99 times higher for patients diagnosed with pneumonia during their hospital stay [OR 2.99 (95% CI 1.07-8.37) p=0.037], and 7.25 times higher for patients that developed renal failure during their stay [OR 7.25 (95% CI 1.85-28.47) p=0.005]. Patients with history of PVD have a six-fold greater mortality risk (OR 6.06, p=0.003). Mode of treatment was not a significant predictor of mortality., Conclusion: The in-hospital mortality rate of PPFs around the hip exceeds 5%. The fracture subtype and mode of management are not independent predictors of mortality, while patient factors such as age, AMTS, history of PVD, pneumonia, and renal failure can independently predict mortality. Peri-operative optimisation of modifiable risk factors such as lung and kidney function in patients with PPFs around the hip during their hospital stay is of utmost importance., Competing Interests: Declaration of Competing Interest A.M is the president of the British Trauma Society. The author(s) received no financial or material support for the research, authorship, and/or publication of this article., (Copyright © 2023 Elsevier Ltd. All rights reserved.)