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Abstract Aims Which is the best extensile lateral (ELA) or sinus tarsi (STA) approach for osteosynthesis displaced intraarticular calcaneal fracture (DIACF) is still debatable. The current RCT’s primary objective was to compare the complications incidence after open reduction and internal fixation of DIACFs through STA vs. ELA. The secondary objectives were the differences in intraoperative radiation exposure, time to fracture union, functional and radiological outcomes. Methods Between August 2020 and February 2023, 157 patients with Sanders type II and III fractures were randomly assigned to either ELA (81 patients with 95 fractures) or STA (76 patients with 91 fractures). The primary outcome was the incidence of complications. The secondary outcomes were Böhler’s and Gissane angles angle, fracture union, and American Orthopaedic Foot and Ankle Society (AOFAS) score. Results No statistical differences between both groups regarding basic demographic data, injury characteristics, and fracture classification; however, patients in the STA group were operated upon significantly earlier (4.43 ± 7.37 vs. 7 ± 6.42 days, p = 0.001). STA’s operative time was significantly shorter (55.83 ± 7.35 vs. 89.66 ± 7.12 min, p

The treatment of calcaneal osteomyelitis is challenging, and no effective treatment has been confirmed. In particular, Pseudomonas aeruginosa is resistant to many treatments and is associated with a high risk of amputation. The induced membrane technique has recently shown efficacy in treating osteomyelitis. In this paper, we present two cases of calcaneal osteomyelitis with Pseudomonas aeruginosa infection treated by the Masquelet technique combined with a fibular free flap. Case 1 involved a 25-year-old woman who developed calcaneal osteomyelitis following a calcaneal open fracture. Case 2 involved a 46-year-old man with paraplegia who developed calcaneal osteomyelitis secondary to a chronic skin ulcer. In the first stage of surgery, the necrotic bone and soft tissue were debrided, and a polymethylmethacrylate cement spacer was implanted into the bone defect. In the second stage of surgery, a free fibula flap was transplanted to the bone defect, and the peroneal artery and vein were anastomosed to the dorsal artery and saphenous vein. In Cases 1 and 2, the C-reactive protein concentration had decreased to normal by 21 and 36 days after surgery, respectively. Both patients showed no recurrence of osteomyelitis for >3 years of follow-up. The Masquelet technique involves the use of an induced membrane with neovascularization around the cement spacer. Drug delivery to the calcaneal region is considered to increase through this membrane, contributing to the suppression of Pseudomonas aeruginosa. The blood circulation in the free fibular flap is stable, contributing to wound healing.

Talar neck fractures, though rare, pose significant challenges in treatment due to their complex nature and potential for severe complications. Despite the fact that most of talar fractures are treated operatively, there is scarcity of clear recommendations concerning appropriate surgical technique and care. Historically, conservative management was favored, but open reduction and internal fixation (ORIF) have become the standard of care. However, merely restoring rotation, axis, and length is insufficient; restoring the articulating surface in an anatomical manner is essential for long-term joint health. Surgical access to the fracture site via anteromedial and anterolateral approaches provides visualization, but risks compromising the sensitive, partly retrograde blood supply to the talar body. While being biomechanically superior, screws inserted from a posterior to anterior direction pose challenges in soft tissue preservation and accurate placement. Despite widespread usage of this technique, postoperative outcomes remain suboptimal with considerable rates of malunion, osteonecrosis and osteoarthritis. An overlooked technique in the literature is the use of a distractor, commonly employed in minimally-invasive surgical calcaneal fracture treatment in order to maintain length, alignment and joint reposition during fixation. With the potential to reduce soft tissue damage and preserve the blood supply minimally invasive techniques present a promising advancement in fracture management of talar neck fractures.

Background: This study aims to analyze the outcomes following the minimally invasive surgery of calcaneal fractures using screw-only osteosynthesis, as well as the impact of surgical timing. Methods: Between 2015 and 2020, 155 patients with 168 fractures were included. According to the Sanders classification, 48.21% of fractures were classified as Sanders 2, 33.33% as Sanders 3, and 10.11% as Sanders 4 fractures, with the remaining fractures unclassified. A total of 117 cases were treated on the day of admission or the following day. The surgeries followed a standardized protocol for fracture analysis, positioning, and X-ray techniques, primarily using a percutaneous approach with stab incisions. Osteosynthesis was mainly performed using screws, with five cases treated with K-wires for open fractures. Results: The mean Boehler's angle improved from 8.52° preoperatively to 25.00° postoperatively. Three superficial infections were observed. Deep infections occurred in three cases, all following open fractures. Secondary dislocation was noted in five patients—one due to a deep infection, and four attributed to clear technical failures. One case involved a questionable indication for a screw change (7.3 mm screw) after two weeks due to perforation of the medial wall. A total of 79 fractures were followed up for an average of 4 years and 3 months. The mean AOFAS score was 91.3, and the mean FAOS score was 88.7. Surgery within 7 days after admission showed no significant impact on the outcomes. Conclusions: Minimally invasive screw-only osteosynthesis with early surgical intervention offers favorable outcomes with minimal risk. [ABSTRACT FROM AUTHOR]

Objective: Soft tissue defects and postoperative wound healing complications related to calcaneus fractures may result in significant morbidity. The aim of this study was to investigate whether percutaneous minimally invasive screw internal fixation (PMISIF) can change this situation in the treatment of calcaneal fractures, and aimed to explore the mechanical effects of different internal fixation methods on Sanders type III calcaneal fractures through finite element analysis., Methods: This retrospective analysis focused on 83 patients with Sanders II and III calcaneal fractures from March 2017 to March 2022. Among them, 32 patients underwent PMISIF, 24 patients underwent tarsal sinus incision plate internal fixation (TSIPIF), and 27 patients underwent extended lateral incision plate internal fixation (ELIPIF). The present study aimed to compare various parameters, including the perioperative hospital stay, intraoperative blood loss, operative time, postoperative drainage volume, incidence of postoperative wound complications, and Gissane angle and Bohler angle data before surgery, after surgery, and at the last follow-up, among the three treatment groups. Additionally, three different finite element models were created to simulate Sanders III calcaneal fractures treated with PMISIF, TSIPIF, and ELIPIF. The models were subjected to longitudinal stresses of 350 and 700 N, and the displacement and stress distribution were analyzed to compare the stability of each model., Results: Compared with ELIPIF and TSIPIF, PMISIF has several advantages, including shorter operative times, smaller incisions, shorter hospital stays, and lower incidences of postoperative complications. At the 12-month time point after the operation, the percentages of patients with excellent and good American Orthopedic Foot and Ankle Society (AOFAS) functional scores were 96.9%, 91.7%, and 96.2%, respectively, for the three methods, demonstrating similar outcomes. Intraoperative blood loss in the PMISIF group was comparable to that in the TSIPIF group and lower than that in the ELIPIF group. There were no significant differences in the Gissane or Bohler angles among the three groups before or after the operation. However, the differences in the Gissane and Bohler angles after the operation within each group were statistically significant compared with those before the operation. Finite element analysis revealed that stress in all three internal fixation models was primarily concentrated on the subtalar articular surface, whereas displacement was mainly observed on the medial side of the subtalar articular surface. The peak stress and displacement of bone fragments and implants in the PMISIF model were lower than those in both the TSIPIF and ELIPIF models., Conclusion: PMISIF can achieve excellent and good rates comparable to those of TSIPIF and ELIPIF. Additionally, this approach offers the advantages of reduced operative trauma, a lower incidence of complications, and shorter preoperative preparation and hospitalization times. Furthermore, this approach can achieve a similar level of biomechanical stability., (© 2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Introduction: Extreme beak calcaneal fractures (Type 2 Lee's tuberosity avulsion fractures) are rare injuries, accounting for only 1.3-3% of all calcaneal fractures. These injuries are considered as surgical emergency as they can lead to significant functional impairment and soft-tissue compromise if not promptly managed. This study evaluates the efficacy of cannulated cancellous (CC) screw fixation for these fractures., Materials and Methods: A prospective study of 14 patients with extreme beak calcaneal fracture (Type 2 Lee's - tuberosity avulsion fractures) treated with CC screw fixation was conducted in VMMCH, Karaikal, Puducherry between June 2022 and June 2023. Patients were followed for a minimum of 12 months. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale., Results: The mean AOFAS score at the final follow-up was 89.3 (range 78-98). Radiographic union was achieved in all cases by 20 weeks with a mean union time of 13.09 weeks in closed fractures and 18 weeks in open fractures. One patient developed a superficial wound infection without any alarming signs of hardware issues, which resolved eventually. No hardware failures or need for revision surgeries were observed., Conclusion: Early intervention with CC screw fixation appears to be an effective and safe technique for the treatment of extreme beak calcaneal fracture (Type 2 Lee's - tuberosity avulsion fractures), resulting in excellent functional outcomes and a low complication rate., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Abstract Background Sever’s disease is among the most common causes of foot pain in childhood.The etiology of Sever’s disease is still under debate.The objective of this prospective study is to investigate the relationship between Sever’s disease and attention deficit hyperactivity disorder(ADHD). Methods The study was prospectively conducted for 1 year between 2023–2024.Of 238 children admitted to our clinic with foot pain, 88 children diagnosed with Sever’s disease were included in the study.A control group including 90 individuals was employed.Patients diagnosed with Sever’s disease in the orthopedics outpatient clinic and healthy control group were evaluated by a pediatric psychiatrist in terms of ADHD based on the DSM-4 diagnostic criteria. Results Fifty-seven patients were male, and 31 were female.While 45 male patients were diagnosed with ADHD, 12 of them did not have ADHD.While 17 female patients were diagnosed with ADHD, 14 did not have ADHD. ADHD was detected in 12 (13.3%) of 90 patients in the control group, comprising 9 boys and 3 girls. The prevalence of ADHD in the Sever’s disease cohort was 62 (70.5%) out of 88, significantly higher than the control group’s 12 (13.3%) out of 90 patients (p

Background: Sever's disease is among the most common causes of foot pain in childhood.The etiology of Sever's disease is still under debate.The objective of this prospective study is to investigate the relationship between Sever's disease and attention deficit hyperactivity disorder(ADHD). Methods: The study was prospectively conducted for 1 year between 2023–2024.Of 238 children admitted to our clinic with foot pain, 88 children diagnosed with Sever's disease were included in the study.A control group including 90 individuals was employed.Patients diagnosed with Sever's disease in the orthopedics outpatient clinic and healthy control group were evaluated by a pediatric psychiatrist in terms of ADHD based on the DSM-4 diagnostic criteria. Results: Fifty-seven patients were male, and 31 were female.While 45 male patients were diagnosed with ADHD, 12 of them did not have ADHD.While 17 female patients were diagnosed with ADHD, 14 did not have ADHD. ADHD was detected in 12 (13.3%) of 90 patients in the control group, comprising 9 boys and 3 girls. The prevalence of ADHD in the Sever's disease cohort was 62 (70.5%) out of 88, significantly higher than the control group's 12 (13.3%) out of 90 patients (p < 0.01). The high number of the patients diagnosed with ADHD among the Sever's patients who were not engaged in sports was found to be statistically significant(p < 0.01).The diagnosis of ADHD was found to be statistically more significant in boys with Sever's disease compared to girls(p < 0.018). Conclusion: Children with Sever's disease can be the candidates for attention deficit hyperactivity disorder.It is thought that evaluating children, especially male children, diagnosed with calcaneal apophysitis within the framework of attention deficit hyperactivity disorder will be valuable. [ABSTRACT FROM AUTHOR]

Background: There is a high correlation between hallux valgus and pes planus deformity. We sought to evaluate the outcomes of simultaneous Scarf osteotomy and extraosseous talotarsal stabilization (EOTTS) for correcting adult hallux valgus with flexible pes planus deformity. Materials and Methods: This retrospective study enrolled patients who had hallux valgus deformity with flexible pes planus and underwent combined Scarf osteotomy and EOTTS from January 2018 to October 2021. The hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, calcaneal pitch, and lateral talocalcaneal angles were assessed preoperatively and at 1-year follow-up. Clinical outcomes were evaluated using the visual analog scale (VAS) score for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, and the Maryland foot score (MFS). Complications were recorded. Results: This study included 25 patients, 19 women and 6 men, with a mean age of 44.3 years. The mean follow-up period was 14.6 months. The mean HVA, IMA, Meary's angle, calcaneal pitch, and lateral talocalcaneal angles improved significantly at 1-year follow-up (P<.001). The mean VAS score decreased from 5.8 to 1.0, whereas the mean AOFAS forefoot score and MFS increased from 52.3 to 88.9 and 61.2 to 89.3, respectively, at 1-year follow-up (P<.001). Two patients had arthroereisis implant removal as a consequence of sinus tarsi pain. No other complications were seen during the follow-up. Conclusion: Management of hallux valgus with flexible pes planus deformity with combined Scarf osteotomy and EOTTS can achieve satisfactory clinical and radiologic results with low complication and recurrence rates. [Orthopedics. 2025;48(1):37–43.] [ABSTRACT FROM AUTHOR]

Background/Objectives: Facial bone density, including the jawbone, declines earlier than that of the lumbar spine and calcaneus. Calcium maltobionate is reported to mitigate bone resorption and maintain bone density of the lumbar spine in post-menopausal women, but its effects on facial bone density remain understudied. Therefore, this study compared variations in facial bone mineral density with variations in calcaneal bone mineral density and bone resorption markers among healthy women, examining differences between pre- and post-menopause and the effects of continuous calcium maltobionate intake. Methods: This randomized, double-blind, placebo-controlled, parallel-group trial involved 48 healthy Japanese women aged 30–69 years, divided into two groups. The test food group received tablets containing calcium maltobionate, while the placebo group received tablets containing a maltose and calcium carbonate mixture for 24 weeks. Calcaneal and facial bone densities were measured pre- and post-intervention in both groups. Results: Post-intervention calcaneal bone mineral density and bone resorption marker deoxypyridinoline (DPD) showed no statistical difference between groups in pre-menopausal women. However, in post-menopausal women, the test food group exhibited significantly higher calcaneal bone density and lower DPD levels compared with the placebo group. Facial bone mineral density increased significantly in the test food group compared with the placebo group in post-menopausal participants, with similar trends observed in pre-menopausal participants. Conclusions: Facial bone mineral density could serve as a useful indicator for monitoring bone health from middle age onward. Moreover, continuous calcium maltobionate intake appears to mitigate bone density decline in pre- and post-menopausal women, contributing to osteoporosis prevention (UMIN-CTR ID: 000046391). [ABSTRACT FROM AUTHOR]

Background: Although non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture. Methods: A retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up. Results: We bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant (p < 0.05). Conclusion: The procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon. [ABSTRACT FROM AUTHOR]

Background: Scarf osteotomy is a well-established procedure for hallux valgus, yet recurrence rates range from 3.6% to 10%. Pes planus, which often coexisting with hallux valgus, is a risk factor for recurrence. This study aimed to evaluate the effectiveness of simultaneous correction of hallux valgus and flexible pes planus. Methods: A total of 85 feet with hallux valgus associated with adult flexible pes planus were retrospectively reviewed. All patients were treated with scarf osteotomy (SO). Subtalar arthroereisis using a HyProCure implant (SOH) was performed to correct hindfoot valgus based on shared decision-making. We collected and compared pre- and at least 2 year postoperative clinical outcomes (American Orthopaedic Foot & Ankle Society (AOFAS) forefoot, hindfoot score, Visual Analog Scale (VAS) pain intensity) and radiographic outcomes (hallux valgus angle (HVA), intermetatarsal angle (IMA), Meary's angle, talonavicular coverage angle (TNCA), and calcaneal pitch (CP) angle in both groups. Results: Of the cases reviewed, 51 feet were allocated to SO group, and 34 feet were in SOH group. Recurrence frequency was 5 feet (9.8%) in the SO group, while no recurrences were reported in the SOH group. There was no significant difference in AOFAS forefoot and VAS scores between the groups, However, the SOH group demonstrated significant improvement in AOFAS hindfoot scores and CP angle, as well as a greater reduction in Meary's angle and TNCA, compared to the SO group. Changes in HVA and IMA did not differ significantly between the groups. Three feet in the SOH group experienced sinus tarsi pain, which resolved after removal of the HyProCure implant. Conclusions: Subtalar arthroereisis with a HyProCure implant is an effective treatment option for adult flexible pes planus associated with scarf osteotomy for hallux valgus, leading to a steady improvement in the patients forefoot deformity and increased patient satisfaction at least 2 years postoperatively. [ABSTRACT FROM AUTHOR]

Background: Pseudotumors are defined as exuberant non-neoplastic inflammatory masses. This condition can be associated with hip and knee arthroplasty but has not been reported in Total Ankle Arthroplasty (TAA). This paper reports a pseudotumor that formed following TAA, highlighting its clinical presentation, management, and histopathology. Methods: A 55-year-old male with end-stage post-traumatic ankle osteoarthritis underwent TAA using a mobile-bearing prosthesis. The procedure was reported to be successful, with no immediate complications. Results: Three years postoperatively, following a period of symptom resolution, the patient presented with progressively worsening ankle pain, swelling, and limited weight-bearing ability. Imaging revealed indirect signs of a periarticular mass and loosening components. Revision surgery involved prosthesis explantation and mass excision for histological and microbiological analysis, followed by concomitant tibio-talo-calcaneal fusion with a retrograde nail. The histopathology identified a pseudotumor characterized by chronic inflammation, fibrous tissue, and necrotic debris, with no evidence of infection. The postoperative recovery was uneventful, with pain resolution and successful fusion confirmed at a one-year follow-up. Conclusions: In patients experiencing unexplained pain or symptoms following TAA, the possibility of a pseudotumor, although rare, should be considered. Prompt and comprehensive clinical and radiographic evaluation is crucial to raise suspicion and prevent this condition from being overlooked. [ABSTRACT FROM AUTHOR]

Background: The outcome of a secondary subtalar arthrodesis after prior calcaneal fracture has been widely described. However, the surgical treatment has evolved significantly over the past decade, paralleling the shifts observed in primary repair strategies. Therefore, we describe the outcome following a secondary arthrodesis after an intra-articular calcaneal fracture, comparing the in situ (ISA) and bone block distraction arthrodesis (BBDA) techniques. Methods: In total, 339 patients who underwent a subtalar arthrodesis between January 1998 and November 2022 were screened for eligibility. Inclusion criteria were age ≥16 years, having undergone a subtalar arthrodesis following a calcaneal fracture, and a minimal follow-up of 1 year. Exclusion criteria were subtalar arthrodesis before January 2010 and a subtalar arthrodesis within 6 weeks of injury. A total of 259 patients did not meet the inclusion criteria, resulting in the inclusion of 80 patients with 82 fractured calcanei. Results: No significant differences between ISA and BBDA in surgical outcome were seen. Subtalar fusion was achieved in 78 of the patients (95.1%). Additionally, a deep surgical site infection occurred in 6 patients (7.8%). The American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS) and Foot Function Index (FFI) scores and the EuroQol–5 dimensions (EQ5D) index were similar between the 2 groups. However, a significantly higher EQ5D-VAS was reported by the subjects who received a BBDA (median [interquartile range], 70.0 [52.0-82.0] vs 81.0 [70.0-90.3], P = .021). Multiple regression revealed that a higher Böhler angle before the initial fracture reconstruction significantly improved the AOFAS score, whereas the FFI significantly improved by an initial conservative treatment and implant removal after arthrodesis. Finally, increasing age significantly improved the EQ5D index. Conclusion: Our study presents comparable surgical outcomes between ISA and BBDA for secondary subtalar arthrodesis following calcaneal fractures. Functional outcomes, as measured by the AOFAS and FFI scores, were also similar between the 2 techniques, although patients undergoing BBDA reported higher EQ5D visual analog scale scores. Level of Evidence: Level III, retrospective cohort study.

Background: Falls on stairs are a major cause of severe injuries among older adults, with stair descent posing significantly greater risks than ascent. Variations in stair descent phenotypes may reflect differences in physical function and biomechanical stability, and their identification may prevent falls. Aims: This study aims to classify stair descent phenotypes in older adults and investigate the biomechanical and physical functional differences between these phenotypes using hierarchical cluster analysis. Methods: Eighty-two older adults participated in this study. Stair descent was measured using a three-dimensional motion analysis system. Physical function was assessed using measures of muscle strength, walking speed, the Timed Up and Go Test (TUG), and the Community Balance and Mobility Scale (CB&M). Results: Hierarchical cluster analysis was performed on kinematic data obtained during stair descent. Three phenotypes were identified: neutral (N-type; 24%), extension (E-type; 52%), and rotation (R-type; 23%). There were no significant differences in lower limb muscle strength or walking speed among the different types, and TUG scores showed no differences in terms of mobility or balance abilities. However, CB&M scores were significantly lower for E-type and R-type compared to N-type. Sub-analyses revealed that while there were no differences in the mobility factor of CB&M between E-type and R-type, the strength factors were significantly lower compared to those for N-type. Discussion: These results suggest that E-type and R-type stair-descent patterns may be influenced by declines in standing balance ability and muscle strength. Conclusions: These findings may inform fall-prevention training programs related to stair descent among older adults. [ABSTRACT FROM AUTHOR]

This study presents an investigation of the chemical composition of Aloe vera leaf tissue with a focus on the spatial distribution of compounds. The composition was studied using two mass spectrometry imaging techniques: silver-109 nanoparticles assisted laser desorption/ionization mass spectrometry imaging (109AgNPs-LDI-MSI) and laser ablation-remote atmospheric pressure photoionization/chemical ionization mass spectrometry imaging (LARAPPI/CI-MSI) and the identification was aided by ultra-high-performance liquid chromatography and ultra-high-resolution mass spectrometry (UHPLC-UHRMS) analysis. The results showed an abundance of phenolic compounds with antioxidant, antimicrobial, and anti-inflammatory properties, making it a beneficial food additive and food packaging material. Analysis of the results of mass spectrometry imaging provided information about the potential changes in metabolic pathway expression in different regions of the leaf. [ABSTRACT FROM AUTHOR]

Background: Marathon training and running have many beneficial effects on human health and physical fitness; however, they also pose risks. To date, no comprehensive review regarding both the benefits and risks of marathon running on different organ systems has been published. Main Body: The aim of this review was to provide a comprehensive review of the benefits and risks of marathon training and racing on different organ systems. A predefined search strategy including keywords (e.g., marathon, cardiovascular system, etc.) and free text search was used. Articles covering running regardless of sex, age, performance level, and event type (e.g., road races, mountain marathons) were considered, whereas articles examining only cycling, triathlon, stress-tests or other sports were excluded. In total, we found 1021 articles in PubMed, Scopus, and Google Scholar, of which 329 studies were included in this review. Overall, marathon training offers several benefits for different organ systems and reduces all-cause mortality. As such, it improves cardiovascular risk factors, leads to favorable cardiac adaptations, enhances lung function, and improves quality of life in chronic kidney disease patients. It also enhances gastrointestinal mobility and reduces the risk of specific tumors such as colorectal cancer and hepatocellular carcinoma. Marathon training enhances bone health and skeletal muscle metabolism. It further positively affects hematopoiesis and cytotoxic abilities of natural killer cells, and may act neuroprotective on a long-term basis. After a marathon, changes in biomarkers suggesting pathological events in certain organ systems such as cardiovascular, renal, gastrointestinal, liver, hematological, immune, musculoskeletal, central nervous, and endocrine systems can often be observed. Mostly, these changes are limited to 1–3 days post-race and usually normalize within a week. Moreover, marathon running poses the risk of serious adverse events such as sudden cardiac death or acute liver failure. Concerning lung function, a decrease after a marathon race was observed. Acute kidney injury, as well as electrolyte imbalances, are relatively common amongst marathon finishers. Many runners complain of gastrointestinal symptoms during or after long-distance running. Many runners suffer from running-related musculoskeletal injuries often impairing performance. A marathon is often accompanied by an acute inflammatory response with transient immunosuppression, making runners susceptible to infections. Also, hormonal alterations such as increased cortisol levels or decreased testosterone levels immediately after a race are observed. Disturbances in sleep patterns are commonly found in marathon runners leading up to or directly after the race. Conclusion: All in all, marathon training is generally safe for human health and individual organ systems. Considering the high popularity of marathon running, these findings supply athletes, coaches, sports scientists, and sports medicine practitioners with practical applications. Further large-scale studies examining long-term effects on the cardiovascular, renal, and other system are needed. Key Points: Marathon training and racing affects several organ systems in a positive and negative way. The most common problems during or after a marathon are acute kidney injury, gastrointestinal distress, running-related injuries, and upper respiratory tract infections. Generally, marathon training is safe for different organ systems and its positive effects outweigh any potential harms [ABSTRACT FROM AUTHOR]

Background: The objective of this review is to evaluate the methodological quality of meta-analyses and observe the consistency of the evidence they generated to provide comprehensive and reliable evidence for the clinical use of three-dimensional (3D) printing in surgical treatment of fracture. Methods: We searched three databases (PubMed, Embase, and Web of Science) up until August 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were adhered to in this review. The Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 was used to rate the quality and reliability of the meta-analyses (MAs), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to grade the outcomes. Furthermore, Graphical Representation of Overlap for Overviews (GROOVE) was employed to examine overlap, and the resulting evidence was categorized into four groups according to established criteria for evidence classification. Results: Results from 14 meta-analyses were combined. AMSTAR 2 gave six meta-analyses a high rating, six MAs a moderate rating, and two MAs a low rating. Three-dimensional printing shows promising results in fracture surgical treatment, significantly reducing operation time and loss of blood for tibial plateau fracture. For acetabular fracture, apart from the positive effects on operation time (ratio of mean (ROM) = 0.74, 95% confidence interval (CI), 0.66–0.83, I2 = 93%) and blood loss (ROM = 0.71, 95% CI 0.63–0.81, I2 = 71%), 3D printing helps reduce postoperative complications (odds ratio (OR) = 0.42, 95% CI, 0.22–0.78, I2 = 9%). For proximal humerus fracture, 3D printing helps shorten operation time (weighted mean difference (WMD) = −19.49; 95% CI −26.95 to −12.03; p < 0.05; I2 = 91%), reduce blood loss (WMD = −46.49; 95% CI -76.01 to −16.97; p < 0.05; I2 = 98%), and get higher Neer score that includes evaluation of pain, function, range of motion, and anatomical positioning (WMD = 9.57; 95% CI 8.11 to 11.04; p < 0.05; I2 = 64%). Additionally, positive results are also indicated for other fractures, especially for operation time, blood loss, and postoperative complications. Conclusions: Compared with traditional fracture surgical treatment, 3D-printing-assisted surgery has significant advantages and great effectiveness in terms of operation time, loss of blood, and postoperative complications in the treatment of many different types of fractures, with less harm to patients. [ABSTRACT FROM AUTHOR]

Background: Achilles tendon ruptures are the most common lower extremity tendinous rupture. While there has been extensive research into the management of mid-substance Achilles tendon ruptures, there is a paucity of literature on the management of myotendinous Achilles tendon ruptures. Methods: The aim of this systematic review is to compile all available literature on the treatment of myotendinous Achilles tendon tears. A systematic search of Web of Science, Embase, and Medline databases was performed for all studies published from database inception to April 13, 2024. All publications addressing the treatment of myotendinous Achilles ruptures of all levels of evidence were included. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Results: A total of five studies with 70 patients were included for analysis. Sixty-seven patients underwent non-operative management with an average age ranging from 40.8 to 51.0 years. Three patients underwent operative management with ages of 16, 36, and 39. The majority of patients tore their Achilles tendon during sports. For nonoperatively treated patients, one group underwent immobilization for a total of 6 weeks and one study treated patients with functional rehabilitation. All patients were able to perform a single heel-raise, had good reported strength, and returned to work or sport. Nonoperative patients reported statistically significant improvements in subjective outcomes and high rates of satisfaction. Conclusion: Both nonoperative and operative management of myotendinous Achilles tendon ruptures demonstrated good outcomes after injury, although there is a limited amount of literature on this topic. Given that nonoperative treatment appears to yield good strength and return to activity, it may be preferred for the majority of patients. Operative management may be indicated in high level athletes. Imaging to determine the exact location of injury, quality of remaining tendon, and gap distance may further aid when considering treatment options. Higher level evidence studies are required to determine the optimal treatment of myotendinous Achilles tendon ruptures. Level of evidence: IV; Systematic review of Level IV-V studies. [ABSTRACT FROM AUTHOR]

Medial malleolar fractures are relatively uncommon, typically resulting from significant trauma or high-impact events. The likelihood of sustaining such fractures in both ankles independently, particularly in non-contact situations, is exceedingly rare. This case study presents a unique scenario involving a patient who suffered medial malleolar fractures in both the left and right ankles under separate, non-contact mechanisms of injury. Both injuries were managed through a combination of immobilization and physical therapy, with the right ankle requiring surgical intervention initially. Given the rarity of bilateral medial malleolar fractures in non-contact events, this case raises questions about potential underlying biomechanical factors contributing to the injuries. Upon further examination, the patient was found to have genu varus, a condition characterized by an inward angulation of the lower leg, which shifts the weight-bearing axis medially, and hindfoot valgus, a condition characterized by outward angulation of the Achilles tendon near the calcaneus. This malalignment can increase the stress on the medial aspect of the ankle during weight-bearing activities, potentially predisposing the individual to fractures in the medial malleolus. This case study explores the biomechanical relationship between genu varus and medial malleolar fractures, highlighting how the altered forces in the ankle joint may increase the risk of injury. The discussion will delve into the potential for genu varus and hindfoot valgus to act as a predisposing factor in the occurrence of such fractures, particularly in the absence of significant external trauma. Understanding this relationship could lead to better identification of at-risk individuals and the development of targeted interventions to prevent similar injuries. [ABSTRACT FROM AUTHOR]

Background: Serum vitamin D deficiency is intricately linked to metabolic disorders, however, evidence on its association with continuous metabolic risk in children and adolescents remains insufficient. This study aims to elucidate the relationship between serum vitamin D levels and continuous metabolic risk. Methods: The cross-sectional analysis involved 4490 participants aged 6 ~ 18, and the longitudinal investigation included 1398 individuals aged 6 ~ 12 years. Serum 25(OH)D concentrations were quantified using liquid chromatography-mass spectrometry. Continuous Metabolic syndrome risk score (CMSRS), incorporating waist, blood pressure, blood lipid levels, and glucose metabolism as four components, utilizes age- and gender-specific Z scores to evaluate metabolic risk. Restricted cubic splines (RCS) were used to visualize dose–response relationships and generalized linear models (GLM) were used to estimate potential associations. Mediation analysis was used to evaluate the mediating role of levels of Neutrophil-to-lymphocyte ratio (NLR). Results: The RCS indicated a negative linear association between serum 25(OH)D levels and CMSRS (P-overall = 0.0066, P-nonlinear = 0.1393). GLM revealed that compared to Q1, with the quartiles of serum 25(OH)D concentrations increase, the β value ranged from 0.028 (95% CI: − 0.093, 0.037) to 0.001(95%CI: − 0.067, 0.069), and then to -0.074 (95%CI: -0.146, -0.003, P for trend = 0.0659). For every 10 ng/mL increase in serum 25(OH)D concentration corresponded to the β value change -0.058 (95%CI: -0.098, -0.017). This association was more pronounced in younger or overweight/obese individuals. Furthermore, in the longitudinal study, as the baseline quartile of serum 25(OH)D concentration increased, the estimated change of subsequent CMSRS indicated a decreasing trend, ranging from -0.085 (95%CI: -0.203, 0.032) to -0.166 (95%CI: − 0.285, − 0.046), and then to − 0.174 (95%CI: − 0.296, -0.053, P for trend = 0.0031). The mediating proportion of levels of NLR was 7.2%. Conclusions: Higher serum 25(OH)D concentration is significantly associated with reduced CMSRS in children and adolescents, and adequate serum vitamin D levels play a prominent role in preventing long-term metabolic disorders, partly meditating by inflammation in peripheral blood. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the pharmacokinetic and safety profiles of generic and original blonanserin tablets under fasting and postprandial conditions, and the bioequivalence of two formulations to obtain sufficient evidence for abbreviated new drug application. Methods: A randomized, open-label, two-period, two-sequence, self-crossover bioequivalence study was conducted to assess the bioequivalence of the test and reference blonanserin tablets under fasting and postprandial conditions. Eligible healthy individuals received a single 4-mg dose of either the test or reference blonanserin tablet, followed by a wash out period of 14 days. Serial blood samples were collected for up to 72 h after administration during each period, and the plasma concentrations of blonanserin were determined using a validated method. The non-compartmental method was used to calculate the primary pharmacokinetic parameters, and the geometric mean ratios for the PK parameters of the test drug to those of the reference drug, along with the corresponding 90% confidence intervals, were obtained for bioequivalence analysis. Throughout the study, a safety evaluation was conducted. Results: Under both fasting and postprandial conditions, the pharmacokinetic parameters of the test drug were found to be similar to those of the reference drug. The 90% confidence intervals (CIs) of the geometric mean ratios of the test to reference formulations were 97.79%–118.28% for peak concentration (Cmax), 92.35%–111.78% for the area under the curve from zero to the last measurable concentration (AUC0-t) and 92.88%–111.91% for the AUC from zero to observed infinity (AUC0- ∞ ) under fasting conditions, 88.65%–103.20% for Cmax, 95.89%–106.81% for AUC0-t and 96.02%–106.91% for AUC0- ∞ under postprandial conditions, all of which were within the accepted bioequivalence range of 80.00%–125.00%. Both the test and reference formulations were well-tolerated, and no serious adverse events related to the study drug were reported during the study. Conclusion: The bioequivalence of blonanserin tablets, both test and reference, was confirmed in healthy Chinese subjects under fasting and postprandial conditions, meeting the predetermined regulatory criteria for both formulations. Both formulations were found to be safe and well tolerated. Clinical Trial Registration: http://www.chinadrugtrials.org.cn/index.html, identifier CTR20230703. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the clinical efficacy of antibiotic-loaded bone cement (ALBC) combined with Negative pressure wound therapy (NPWT) aspiration technique in the treatment of multidrug-resistant diabetic foot ulcers (MDRO-DFUs). Methods: A retrospective analysis of the clinical data of 80 patients with MDROs-DFU who were used Vacuum sealing drainage (VSD) as NPWT excipient and met the inclusion criteria from January 2019 to January 2024 at our hospital. Patients were divided into an experimental group and a control group, with 40 cases in each. The control group received conventional treatment, routine debridement, and NPWT treatment, while the experimental group received ALBC treatment in addition to the treatment plan of the control group. Measurements of blood inflammatory indicators, foot hemodynamic indicators, wound bacterial clearance time, wound healing time, and hospital stay were taken before and after treatment for both groups. Results: Inflammatory indexes, Vascular endothelial growth factor(VEGF), and internal diameter of dorsalis pedis arteriosus of both groups after treatment were significantly better than those before treatment, and the improvement of the experimental group was more obvious than that of the control group; the experimental group had a significantly shorter time of trauma bacterial turnover, healing time of trauma, and hospitalization time compared with that of the control group (P<0.05). [ABSTRACT FROM AUTHOR]

Background: Developmental knee joint deformities are a common problem in pediatric orthopedics. Children with a valgus or varus deformity of the distal femur or the proximal tibia are commonly treated with hemiepiphysiodesis. Gait analysis in patients with lower limb deformities plays an important role in clinical practice. The purpose of our study was to assess gait parameters in patients who underwent hemiepiphysiodesis procedures of the distal femur or proximal tibia due to a knee deformity and to compare them with those in healthy controls. Methods: We prospectively evaluated 35 patients (14 females and 21 males) after hemiepiphysiodesis and compared the results with a healthy control group (26 participants). Gait was analyzed with a G-Sensor device (BTS Bioengineering Corp., Quincy, MA, USA). We assessed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, and step length. We assessed these gait parameters in a group of patients before and after treatment with hemiepiphysiodesis. We compared the patients' results before and after treatment to those of a healthy control group. The level of significance was set at p < 0.05. Results: The mean follow-up period was 13 months. There was no difference in the results of gait assessments in patients prior to and after treatment. The median step length was 47.09% in the treated limb after treatment and 54.01% in the intact limb (p = 0.018). There were no other differences in gait parameters in the treated limbs and the healthy, intact limbs in the patient group after treatment. There were no significant differences in the patients before and after treatment compared with those in the healthy control group in all gait parameters. Conclusions: Valgus or varus knee deformity correction with the use of hemiepiphysiodesis does not significantly improve preoperative gait parameters. The biomechanical outcomes of hemiepiphysiodesis in the treatment of valgus or varus knee deformity are good. We observed no differences in gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, gait velocity, cadence, or step length between the experimental and healthy control groups. [ABSTRACT FROM AUTHOR]

Background: The use of foot orthoses to treat different pathologies in pronated feet in adults is widespread among podiatric professionals, although it has not been conclusively demonstrated to modify foot posture in the short or medium term. Objective: The aim of this study was to evaluate whether prefabricated foot supports reduce pronated foot posture in adults, as measured by the foot posture index (FPI). Methods: A randomised controlled clinical trial was conducted in 109 subjects with pronated feet. The participants were randomly placed into a control group that did not receive any intervention and an experimental group that used prefabricated orthoses for 6 months. The changes in the FPI were evaluated in both groups at 6 months. Results: Over the six-month follow-up period, the delta FPI variable was changed by −1.1 ± 2.2 points in the experimental group, whereas the same variable was reduced by 1.2 ± 2.1 points in the control group (p = 0.001). The participants in the experimental group neutralised their FPIs significantly more than those in the control group did (39.3% vs. 8.5%; p = 0.041). Moreover, individuals in the experimental group were more likely to migrate from highly pronated feet to pronated feet than those in the control group were (45.8% vs. 20%; p < 0.001). Finally, multivariate analysis indicated that prefabricated foot orthoses were associated with an improved FPI (OR: 6.23, CI%95: 2.72–17.09; p < 0.001). However, the corrective effect provided by the prefabricated foot orthoses, which neutralised the pronated posture, was nullified by the presence of index minus metatarsal formula. Conclusions: The use of prefabricated orthoses resulted in a decreased FPI in adults, especially in those with highly pronated feet. However, the index minus presence nullified the effect of prefabricated orthoses on foot posture neutralisation. [ABSTRACT FROM AUTHOR]

Nowadays, metallic bone replacement is in high demand due to different issues, like sicknesses and accidents. Thus, bone implants are fabricated with tailored properties and microstructure for long-term use in the human body. To improve such implants, 3D printing is the most promising technique. Therefore, this work aims to evaluate the fabrication of porous materials by extrusion 3D printing of Ti6Al4V. Cylindrical samples were fabricated from pellets for metal injection molding of Ti6Al4V powders, creating hexagonal channels with three different sizes. The densification kinetics was evaluated by dilatometry tests, which enabled following the densification of the samples during the sintering cycle. Subsequently, the samples were characterized by scanning electron microscopy and X-ray computed tomography to analyze their microstructure. Compression tests evaluated the mechanical strength of sintered samples. It was found that the hexagonal shape during printing is better defined as the channel size increases. The results show similar behavior for each of the channel sizes during sintering; however, greater densification is obtained as the channel size decreases. Additionally, microporosity is obtained at the particle level, which is completely interconnected, ensuring the passage of fluids through the entire sample. On the other hand, as the channel size increases, Young's modulus and yield strength are considerably reduced. The main conclusion is that parts with two scales of porosity can be designed by the 3D printing extrusion process. [ABSTRACT FROM AUTHOR]

This paper presents an experimental method for estimating the fatigue limit of trabecular bone using a single trabecular bone sample, the microstructural parameters of which were determined by microCT. Fatigue tests were carried out using the Locati method, with stepwise increasing load amplitude. The fatigue limits of the trabecular structures were determined experimentally in accordance with Miner's law of fatigue damage accumulation, based on the parameters of the reference S-N curve taken from the literature. On the basis of the fatigue limits, the S-N curves were determined for the tested samples, and from them the compressive strength USS-N corresponding to the fatigue limit for the N = 1 cycle. Ultimate compressive strength US was determined as a result of compression to failure tests. Computational dependencies combining the BV/TV index with US and the BMD index with US were formulated. To verify the proposed method, two groups of human trabecular bone samples were analysed: n = 42 were tested under monotonic loading, and n = 61 were tested under cyclic loading with stepwise increasing amplitude. The statistical test of the distribution conformity of the calculated USS-N compressive strength to the experimental US ultimate strength was performed. The results of the Kolmogorov–Smirnov statistical test were D = 0.19 (p = 0.314). The agreement of the distributions of BV/TV, as determined experimentally and calculated from the computational dependencies, was also tested statistically, with the result of the Kolmogorov–Smirnov test being D = 0.286 (p = 0.065). A similar analysis performed for BMD yielded D = 0.238 (p = 0.185). [ABSTRACT FROM AUTHOR]

Featured Application: This systematic review focuses on analyzing the use of 3D-printed cages in foot arthrodesis to address complex bone defects, failed prior fusions, severe bone loss, or deformities. The application of customized Ti-6Al-4V open-structure, porous implants, manufactured through additive manufacturing processes such as electron beam melting (EBM), selective laser melting (SLM), or direct metal laser sintering (DMLS), is demonstrated to ensure osseointegration and provide a proper anatomical fit and mechanical stability. In recent years, the application of 3D-printed implant cages or trusses for foot arthrodesis has emerged as a personalized approach to address complex bone defects and deformities. Twenty studies involving different regions of the foot, such as the ankle and subtalar joints, were reviewed to document the 3D-printed custom solutions. The design of these implants is also discussed, including custom titanium trusses and lattice structures, which can promote osseointegration and fit the bone geometries. From a mechanical perspective, these implants proved to be stable and compatible with natural bone, aiming to reduce stress shielding while offering the mechanical strength needed for optimal outcomes. This systematic survey also addresses the additive manufacturing processes involved, namely EBM, SLM, or DMLS. Clinical cases were focused on patients with large bone loss, failed prior fusions, and deformity corrections, with the follow-up results showing high rates of fusion and functional improvement. Of the analyzed studies, three provide level III evidence, while the rest provide level IV or V, consisting of case series or reports. Since 2015, 148 patients have been reported to receive such implants. This review addresses the question, "how effective are 3D-printed titanium cage implants in foot arthrodesis in addressing large bone defects and deformities?" It is the first review to gather data on the use of such customized implants in foot arthrodesis, providing critical insights to enhance their application, including amputation avoidance. This study highlights the advantages of personalized 3D-printed implants in achieving a better anatomical fit, improving clinical outcomes, and ensuring faster recovery times, while also addressing considerations such as the cost and the need for long-term clinical data. [ABSTRACT FROM AUTHOR]

Simple Summary: The present paper summarizes the detailed gross morphological and imagistic features of the pelvic skeletal elements alongside some radiographical interpretations. The added metrical data makes the anatomical description of the pelvic skeleton in Chlorocebus sabaeus more accurate and precise concerning these monkeys' anatomy. Several morphological features of each of the studied skeletal elements explain the different adaptative changes in this species as well, as it shows, in a comparative way, different sets of elements in the primate skeletal anatomy. The paper presents a detailed gross anatomical description of the elements of the pelvic limb in the African green monkey and provides comparative and differential elements on pelvic limb monkey osteology. The osteometric investigation adds value to the gross morphological and radiological investigation, adjoining metric data to the gross descriptive data set. The main methodology used was the gross morphological investigation, doubled by regular osteometrical and radiographical assessments. For each of the elements, several morphological aspects are described, pointing to the specific and differential aspects that might serve as landmarks in the specific diagnosis of different adaptative changes, related to the type of locomotion. For the pelvis, the aspect of the symphysis, the overall shape of the pelvic inlet, the iliac wing aspect and the acetabular shape are listed as significant elements. The femur has a spherical head with an inferior position of the femoral fovea and a well-developed (tall) greater trochanter, lacking the third trochanter. The medial condyle of the femur is better developed than the lateral one and an evident extensor's fossa is noted at the level of the distal shaft. The proximal lateral condyloid surface in the tibia is slightly larger than the medial one, with noticeable intercondilar eminences. The fibula is long and unfused with the tibia. Some specific anatomical features are listed only for the talus and calcaneus from tarsals. The study revealed the presence of the gastrocnemius sesamoid bones and the proximal sesamoidi bones as well. Investigation presents a series of osteometrical data with an attempt to show some basic metrical differences among the investigated specimens. [ABSTRACT FROM AUTHOR]

Background: To explore the advantages of a lateral tibial locking plate combined with Jail screw fixation in the treatment of anterolateral tibial plateau collapse fracture (ATPCF). Methods: A retrospective analysis was conducted on patients with ATPCFs admitted to our hospital from February 2019 to February 2023. Twenty-six patients were successfully included, including 15 males and 11 females, with an average age of 58.6 ± 7.8 years (range 45–68 years). All fractures were Schatzker type II fractures. After fracture reduction and fixation, a lateral locking titanium plate was placed through the anterolateral approach of the tibial plateau, and two screws of appropriate length were placed in the sagittal direction according to the Jail screw technique. Postoperative evaluation indices included surgery time, fracture healing time, the degree of tibial plateau collapse shown by computed tomography (CT) images at 3 days and 1 year after surgery, and the patient's knee range of motion at 1 year after surgery. The effects of fracture reduction and fixation before surgery, 3 days after surgery and 1 year after surgery were evaluated by the Rasmussen radiological score. The Hospital for Special Surgery (HSS) knee score was used to evaluate the knee joint function of patients at 1 year after surgery. Results: The average operation time was 64 ± 6.8 min (range 56–82 min). The fractures healed clinically at 13.8 ± 2.8 weeks (range 12–18 weeks) postoperation. After 15 ± 3.1 months (range 12–19 months) of average follow-up, all the patients were pain-free with a full range of motion and stable knees. At the 1-year postoperative assessment, the CT images showed no secondary collapse of the articular surface, the average knee range of motion was 136.3 ± 2.5° (range, -5° to 135°), the average Rasmussen radiological score was 16.2 ± 0.8 points, and the average HSS knee score was 93.6 ± 3.2 points. Conclusions: The fixation of a anterolateral tibial plateau collapse fracture(ATPCF) using a lateral locking plate and the Jail screw technique has achieved good knee joint function, providing a new option for the treatment of ATPCFs. The clinical efficacy is satisfactory in the short term, avoiding secondary articular surface collapse. [ABSTRACT FROM AUTHOR]

Background: Castration of adult male rats led to the development of osteoporosis. Oxidative stress and inflammatory factors have been identified as potential causative factors. Notably, oxymatrine (OMT) possesses potent anti-inflammatory and antioxidant activities. This study aims to elucidate the antiosteoporotic effects of OMT compared to testosterone in an orchiectomized (ORX) rat model of osteoporosis. Methods: A total of 60 Wistar male rats were divided into the following groups: control (CTRL), surgery + no orchiectomy (SHAM), ORX, ORX + testosterone, and ORX + OMT. Urinary deoxypyridinoline (DPD), calcium (Ca), and phosphorus (P), as well as serum testosterone, parathormone (PTH), alkaline phosphatase (ALP), osteocalcin, N-telopeptide of type I collagen (NTX I), tartrate resistance acid phosphatase (TRAP), and total Ca and P levels were evaluated. Bone was assessed for malondialdehyde (MDA), reduced glutathione (GSH), interleukin 6 (IL-6), Kelch-like ECH-associated protein 1 (Keap1), nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase 1 (HO-1) expression, and receptor activator of nuclear factor κB ligand/ osteoprotegerin (RANKL/OPG) ratio. Bone dual-energy X-ray absorptiometry (DEXA) scan and histological and immunohistochemical studies were performed. Results: Testosterone or OMT treatment ameliorated the reduced bone mineral density (BMD) and bone mineral content (BMC) in the DEXA scan and the changes in PTH and Ca levels. Compared to the ORX group, bone formation, and turnover markers were also significantly reversed in the treatment groups. Treatment with testosterone or OMT significantly reduced bone MDA, IL-6, Keap1, RANKL, and RANKL/OPG ratio, and significantly elevated bone GSH, Nrf2, and HO-1. Moreover, testosterone or OMT treatment has restored cortical bone thickness and osteocyte number and reduced bone levels of TNF-α in ORX rats. Consequently, treatment with either testosterone or OMT exhibited nearly equal therapeutic efficacy; however, neither of them could normalize the measured parameters. Conclusion: OMT treatment showed equal efficacy compared to testosterone in ameliorating osteoporosis in ORX rats, possibly by improving some inflammatory and oxidative stress parameters. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe a fixation technique for coronoid fractures using suture buttons, and to biomechanically evaluate this technique in comparison to screw fixation as a time-zero pilot study. Methods: An O'Driscoll type 2 anteromedial coronoid facet (AMCF) fracture was simulated in 20 fresh-frozen human elbows. The specimens were randomized into two groups and fracture fixation was performed with either a suture button system or a 3.5 mm cannulated screw. Ultimate load-to-failure (N) was then tested for each specimen. Results: The mean load-to-failure was 322.6 ± 75.9 N for suture button fixation and 314.2 ± 85.9 N for screw fixation. The differences were not statistically significant (p = 0.432). Additional fracturing of the coronoid fragment was observed in two specimens with screw fixation. Conclusion: Promising biomechanical evaluations show that this fixation technique using suture buttons in the treatment of coronoid fractures provides equal construct stability as screw fixation. Further studies are required to fully validate this procedure. [ABSTRACT FROM AUTHOR]

Background: This study aimed to (1) determine the association between varus knee deformity and ipsilateral foot and ankle morphology, and (2) evaluate the relationship between varus knee deformity and foot and ankle pain in patients with end-stage varus knee osteoarthritis (KOA). Methods: A total of 213 patients who underwent primary total knee arthroplasty for end-stage varus KOA were enrolled in this study and divided into a 'severe varus group' (n = 119) and a 'mild varus group' (n = 94) based on preoperative knee varus degree. Morphological parameters and pain incidence in the foot and ankle were compared between the two groups. The correlation between knee varus and foot and ankle morphology was analyzed. Results: Significant differences in ankle morphology were observed between the two groups. The deformity magnitudes of the hindfoot valgus (P < 0.001) and hallux valgus (HVA, P = 0.028; IMA, P = 0.046) were significantly higher in the severe varus group. Additionally, the incidences of ankle osteoarthritis (OA) (P = 0.005) and hallux valgus (P = 0.028) were higher in the severe varus group. Patients with severe KOA were more likely to experience medial ankle pain (P = 0.023), hindfoot pain (P = 0.034), and multiple pain locations (P = 0.015). Conclusion: Varus knee deformity was associated with morphological changes in the foot and ankle, and the incidence of ankle OA and hallux valgus deformity was significantly higher in patients with severe varus KOA. Patients with severe varus KOA were more prone to medial ankle pain, hindfoot pain, and multiple pain locations, which were associated with corresponding morphological changes. [ABSTRACT FROM AUTHOR]

In a prospective study, we examined the recovery trajectory of patients with lower extremity fractures to better understand the healing process in the absence of complications. Using a chest-mounted inertial measurement unit (IMU) device for gait analysis and collecting patient-reported outcome measures, we focused on 12 key gait variables, including Mean Leg Lift Acceleration, Stance Time, and Body Orientation. We employed a linear mixed model (LMM) to analyze these variables over time, incorporating both fixed and random effects to account for individual differences and the time since injury. This model also adjusted for varying intervals between assessments. Our study provided insights into gait recovery across different fracture types using data from 318 patients who experienced no complications or readmissions during their recovery. Through LMM analysis, we found that Tibia-Distal fractures demonstrated the fastest recovery, particularly in terms of mobility and strength. Tibia-Proximal fractures showed balanced improvements in both mobility and stability, suggesting that rehabilitation should target both strength and balance. Femur fractures exhibited varied recovery, with Diaphyseal fractures showing clear improvements in stability, while Distal fractures reflected gains in limb strength but with some variability in stability. To examine patients with readmissions, we conducted a Chi-squared test of independence to determine whether there was a relationship between fracture type and readmission rates, revealing a significant association (p < 0.001). Pelvis fractures had the highest readmission rates, while Tibia-Diaphyseal and Tibia-Distal fractures were more prone to infections, highlighting the need for enhanced infection control strategies. Femur fractures showed moderate readmission and infection rates, indicating a mixed risk profile. In conclusion, our findings emphasize the importance of fracture-specific rehabilitation strategies, focusing on infection prevention and individualized treatment plans to optimize recovery outcomes. [ABSTRACT FROM AUTHOR]

The shortage of tissues and damaged organs led to the development of tissue engineering. Biological scaffolds, created from the extracellular matrix (ECM) of organs and tissues, have emerged as a promising solution for transplants. The ECM of decellularized auricular cartilage is a potential tool for producing ideal scaffolds for the recellularization and implantation of new tissue in damaged areas. In order to be classified as an ideal scaffold, it must be acellular, preserving its proteins and physical characteristics necessary for cell adhesion. This study aimed to develop a decellularization protocol for pig ear cartilage and evaluate the integrity of the ECM. Four tests were performed using different methods and protocols, with four pig ears from which the skin and subcutaneous tissue were removed, leaving only the cartilage. The most efficient protocol was the combination of trypsin with a sodium hydroxide solution (0.2 N) and SDS (1%) without altering the ECM conformation or the collagen architecture. In conclusion, it was observed that auricular cartilage is difficult to decellularize, influenced by material size, exposure time, and the composition of the solution. Freezing and thawing did not affect the procedure. The sample thickness significantly impacted the decellularization time. [ABSTRACT FROM AUTHOR]

KPC is a clinically significant serine carbapenemase in most countries, and its rapid spread threatens global public health. blaKPC transmission is commonly mediated by Tn4401 transposons. The blaKPC gene has also been found in non-Tn4401 elements (NTEKPC). To fill the gap in the understanding of the stability and dissemination of NTEKPC-carrying plasmids, we selected and characterized carbapenem-resistant bacteria isolated between 2009 and 2016 from a hospital for a retrospective study of their plasmids conjugation capacity, impact on fitness, and replication in different species. Different clones were selected using PFGE, and their genomes were sequenced using Illumina and Oxford Nanopore methods. Minimum inhibitory concentrations (MICs) were determined by broth microdilution. Plasmid copy numbers (PCNs) were determined using qPCR. Doubling time was used to analyze fitness change. Most isolates (67%, 33/49) carried blaKPC, of which 85% presented blaKPC in a NTEKPC. The 25 isolates selected presented the blaKPC gene in NTEKPC-IId in IncQ1-type plasmids, showing multispecies dissemination. IncQ1 plasmids were mobilizable and PCN seemed to be directly linked to the species, presenting a high-copy number, mainly in K. pneumoniae. No relationship was observed between IncQ1 PCN and carbapenems MIC values. IncQ1 and a conjugative plasmid from K. pneumoniae BHKPC10 were transferred to E. coli J53 without fitness changes, and MIC values were maintained for carbapenems despite the low transconjugant PCN. In addition to IncQ1 with NTEKPC, Enterobacter cloacae BHKPC28 contained the mcr-9 gene in an IncHI2/IncHI2A conjugative plasmid, which may help the mobility of IncQ1 and the dissemination of two resistance determinants to last-resort antibiotics. Understanding the interaction between plasmids and high-risk lineages can help develop new therapies to prevent the dissemination of resistance traits. [ABSTRACT FROM AUTHOR]

Background: Flexible pediatric flatfoot is an anatomical presentation of the foot that is common in children, and its functional impact raises long-term uncertainty. Functional re-education includes strengthening and stretching exercises for the intrinsic and extrinsic musculature of the foot, proposed as an effective conservative treatment. However, to date, there is no systematic review examining its effectiveness in the pediatric population. This systematic review aims to evaluate the effectiveness of functional re-education as a conservative treatment for flexible pediatric flatfoot, determining which exercises are most effective. Methods: A search (PROSPERO: CRD42023391030) was conducted across six databases, resulting in an initial total of 327 studies. Of these, 11 randomized controlled trials (RCTs) met the inclusion criteria, resulting in a sample of 419 children aged 6 to 14 years with a diagnosis of flexible flatfoot. The evaluated studies present variations in diagnostic criteria, types of exercises, and treatment duration. Results: The results indicate that functional re-education is effective in improving the symptomatology and functionality of the foot in children. In particular, exercises targeting the intrinsic musculature proved to be among the most effective treatments, improving the structural development of the medial longitudinal arch. The reviewed literature recommends a minimum treatment duration of eight weeks. Conclusions: Functional re-education represents an effective conservative treatment option for flexible flatfoot in children, positioning it as the treatment of choice for this condition. [ABSTRACT FROM AUTHOR]