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Aims: The objective of this study was to evaluate the effectiveness of batroxobin in improving functional outcomes and reducing stroke recurrence among patients with acute ischemic stroke beyond the therapeutic time window for thrombolytic therapy. Methods: This multicenter, retrospective study enrolled 492 patients with acute moderate‐to‐severe ischemic stroke within 24 h. 238 patients were given standard (basic) therapy. On the basis of standard treatment, 254 patients received an initial intravenous infusion of batroxobin 10 U on day 1, followed by subsequent infusions of batroxobin 5 U on the 3rd and 5th days, respectively. Results: In the batroxobin group, 8.3% of patients experienced recurrence stroke, compared to 17.2% in the control group (HR, 0.433; 95% CI, 0.248 to 0.757; p = 0.003). Furthermore, intravenous batroxobin significantly improved the distribution of 90–120 day disability. Moderate‐to‐severe bleeding events were reported in three patients (1.2%) in the batroxobin group and one patient (0.4%) in the control group (p = 0.369). Conclusions: Among patients with acute moderate‐to‐severe ischemic stroke beyond the time window for thrombolytic therapy, treatment with intravenous batroxobin had a lower risk of stroke recurrence and a better recovery of function outcome without increasing bleeding events. Prospective studies are needed to further confirm. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To investigate the association between additional weekend rehabilitation and functional outcomes among different age groups. Findings: After matching 129,583 pairs of cases, a significantly higher correlation was found between patients who had received weekend rehabilitation and improved physical function at discharge compared with those who had not received weekend regarding function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15–1.19], 1.17 [1.15–1.2], and 1.06 [1.03–1.08], respectively). Message: Weekend rehabilitation was significantly associated with improved physical function; to optimise rehabilitation therapy given limited healthcare resources, low demand activities can be more effective in older age groups, whereas high demand activities should be aimed at younger age groups. Purpose: Rehabilitation after hip fracture surgery is crucial for improving physical function. Additional rehabilitation over the weekend or after working hours is reportedly associated with improved physical function; however, this may not apply to an aging population, including patients aged > 90 years. This study aimed to investigate the association between additional weekend rehabilitation and functional outcomes in different age groups. Methods: This study analyzed a cohort of patients aged ≥ 60 years who had hip fractures and were operated on from 2010 to 2018. Data were extracted from a nationwide multicentre database. Functional outcomes at discharge were compared between patients who underwent rehabilitation on weekdays only and those who underwent rehabilitation on both weekdays and weekends. The patient groups were selected using propensity score matching analysis. Furthermore, a subgroup-analysis was conducted on patients in their 60 s, 70 s, 80 s, and 90 s. Results: A total of 390,713 patients underwent surgery during the study period. After matching, each group comprised 129,583 pairs of patients. Patients who underwent weekend rehabilitation exhibited improved physical function in transferring, walking, and stair climbing at discharge, as compared with patients who did not (odds ratio [95% confidence interval]: 1.17 [1.15–1.19], 1.17 [1.15–1.2], and 1.06 [1.03–1.08], respectively). In subgroup analysis, except for stair climbing, the positive association between weekend rehabilitation and patient function was observed across all age groups. Conclusion: Weekend rehabilitation was significantly associated with improved physical function. Given the limited healthcare resources, high-demand activities such as stair climbing may be reserved for younger age groups to optimise rehabilitation therapy. [ABSTRACT FROM AUTHOR]

• The meta -analysis included 11 studies (7 RCTs and 4 cohort studies) with varied geographical representation and patient demographics. Most studies were rated as having low to moderate risk of bias. However, some outcomes displayed heterogeneity, which was addressed through sensitivity analyses to ensure robust results. • Clazosentan significantly reduces the incidence of vasospasm, including moderate to severe vasospasm, and delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). The risk ratios for vasospasm, moderate to severe vasospasm, and DCI were 0.49, 0.53, and 0.70 respectively, indicating a substantial reduction compared to placebo. • The use of clazosentan significantly lowers the need for rescue therapy among aSAH patients. The pooled analysis showed a risk ratio of 0.65, suggesting a 35 % reduction in the requirement for additional interventions. • Clazosentan is associated with increased rates of specific adverse events such as pulmonary complications (RR = 1.89), hypotension (RR = 2.47), and anemia (RR = 1.49). However, it does not increase the risk of hepatobiliary adverse events or cerebral hemorrhage. • Despite its efficacy in reducing vasospasm and DCI, clazosentan does not show a significant improvement in functional outcomes (measured by GOSE and mRS) or mortality rates. This suggests that while it mitigates certain complications, it does not necessarily enhance overall survival or recovery quality. Aneurysmal subarachnoid hemorrhage (aSAH) is a severe event often complicated by cerebral vasospasm (CV). This study aimed to assess the efficacy and safety of clazosentan, an endothelin receptor antagonist, in reducing CV, delayed cerebral ischemia (DCI), and the need for rescue therapy in aSAH patients, while evaluating its impact on functional outcomes and mortality. We conducted a literature search across multiple databases to identify relevant studies evaluating the effects of clazosentan in aSAH patients. Both cohort studies and randomized controlled trials (RCTs) were included. The primary outcomes were vasospasm incidence, moderate to severe vasospasm, DCI, and the need for rescue therapy. Secondary outcomes included functional outcomes, mortality, and adverse events. The data were pooled as Risk ratios (R/R) with 95 % confidence intervals (CI) using RevMan 5.4 software. A total of 11 studies, including 10 published and one unpublished, comprising 8,469 patients were included in the meta -analysis. Clazosentan significantly reduced the incidence of vasospasm (R/R = 0.49: 0.34–0.70), moderate to severe vasospasm (R/R = 0.53: 0.46–0.61), DCI (R/R = 0.70: 0.59–0.82), and the need for rescue therapy (R/R = 0.65: 0.52–0.83) compared to placebo. However, no significant improvement in functional outcomes or mortality rates was observed. Clazosentan was associated with increased rates of pulmonary adverse events (R/R = 1.89: 1.64–2.18), hypotension (R/R = 2.47: 1.79–3.42), and anemia (R/R = 1.49: 1.23–1.79) but no increased risk of hepatobiliary adverse events or cerebral hemorrhage. Clazosentan demonstrates efficacy in reducing vasospasm, moderate to severe vasospasm, DCI, and the need for rescue therapy in aSAH patients, but does not significantly improve functional outcomes or mortality rates. While associated with specific adverse events, clazosentan may be a valuable adjunctive therapy in the management of aSAH, particularly in a high-risk population for vasospasm. [ABSTRACT FROM AUTHOR]

Management of displaced distal clavicle fractures remains a topic of discussion because of notoriously high nonunion rates, but there is little documented in the literature as to what effect this may have on patient-reported function. The aim of this systematic review was to look at nonoperative management following displaced distal clavicle fractures to determine union rates, complications, and patient-reported outcome measures. A review of the online databases MEDLINE and Embase was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies that included a cohort of nonoperatively managed displaced distal clavicle fractures and reported on union rate, complications, and patient-reported functional scores were included. Eleven studies were eligible for inclusion (2 randomized controlled trials, 1 prospective noncomparative cohort study, 5 retrospective comparative cohort studies, and 3 case series) with a total of 779 patients included in this review. Average union rate was 63.2% (22.2%-94.4%) in nonoperatively managed patients, compared with 96.3% (87.9%-100%) in operatively managed patients. The Constant-Murley score and Disabilities of the Arm, Shoulder, and Hand questionnaire were the most frequently used outcome measure tools. No study demonstrated any significant difference in any outcome measure when comparing nonoperative with operative treatment. Complication rate (including nonunion) in nonoperatively managed patients was 45.1%, with 11.1% requiring delayed surgery. Average complication rate in the operatively managed groups was 41.2%, with 40.1% requiring a second operation. Nonoperative management of displaced distal clavicle fractures results in higher nonunion rates, but shoulder function remains excellent, and risk of complications and delayed surgery are low. Decision making must take into account patient factors and expectations to provide high-quality, individualized care. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the effect of curative‐intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC). Study Design: Retrospective observational study of patients diagnosed from 2014 to 2021. Setting: Single tertiary care academic center. Patients having undergone curative‐intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry. Methods: LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest. Results: Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty‐seven (21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty‐five percent of patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87‐12.2) while adjusting for multiple confounders. Conclusion: LOI is common in older adults undergoing curative‐intent surgery for OCSCC and associated with poor treatment tolerance. [ABSTRACT FROM AUTHOR]

Background: Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee injuries (MLKIs). Purpose: To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radiographic osteoarthritis (OA) (Kellgren-Lawrence grade ≥2) after MLR for MLKI. Study Design: Case-control study; Level of evidence 3. Methods: Included were 52 consecutive patients (age, 35.5 ± 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 ± 1.6 years, patient-reported outcome measure scores—including the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey—RTW, return to sports, and weightbearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant (P <.10) were entered into a multivariate logistic regression model. Results: The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC (P =.002) and all 5 KOOS subscales (P ≤.007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score (P =.007) and RTW failure (odds ratio [OR], 36.8; P =.035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score (P ≤.001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade >2 [37%]) was associated with secondary patellofemoral (OR, 10; P =.012) and medial tibiofemoral (OR, 10; P =.019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; P =.006). Conclusion: Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prognostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA. [ABSTRACT FROM AUTHOR]

Background: The timing of surgical intervention for Hirschsprung's disease (HSCR) has been a topic of continued discussion. The objective of this study was to evaluate the significance of age at surgery in the management of HSCR by conducting a comparative analysis of the correlation between surgical age and midterm outcomes. Methods: We conducted a retrospective analysis of children with HSCR who underwent one-stage laparoscopic assisted pull-through surgery with modified Swenson technology at our hospital between 2015 and 2019. The study population was stratified into two groups based on surgical age: patients who underwent surgery within a period of less than 3 months and those who underwent surgery between 3 and 12 months. The basic conditions, complications at 3–7 years after surgery, anal function (Rintala scale) and quality of life (PedsQLTM4.0) were compared between the groups. Results: A total of 235 children (196 males and 39 females) were included in the study. No statistically significant differences in postoperative bowel function (P = 0.968) or quality of life (P = 0.32) were found between the two groups. However, there was a significant reduction in the incidence of Hirschsprung-associated enterocolitis (HAEC) among individuals under the age of three months prior to undergoing surgical intervention (69.1%) compared to the incidence observed postsurgery (30.9%). This difference was statistically significant (P < 0.001). Conclusion: In the current study, the age at which surgery was performed did not exhibit a discernible inclination towards influencing mid-term anal function or quality of life. Early surgical intervention can effectively diminish the occurrence of HAEC, minimize the extent of bowel resection, and expedite the duration of the surgical procedure. [ABSTRACT FROM AUTHOR]

Background: The density of contrast medium in digital subtraction angiography (DSA) have been used to evaluate the cerebral circulation function. Our aim was to study the effect of difference in arteriovenous peak optical density (POD) after thrombectomy on functional outcomes. Methods: Consecutive patients with acute ischemic stroke due to large vessel occlusion who underwent thrombectomy were reviewed. We processed DSA images with ImageJ software to measure the POD of internal carotid artery (ICA) and cortical veins. The average POD of cortical veins (PODVA) and the POD difference between ICA and cortical veins (PODICA-CV) were calculated. Primary outcome was good functional outcome (modified Rankin scale score of 0-2 at 90 days). Results: One hundred sixty-six patients were finally included in the study. Patients with good functional outcome had lower ipsilateral PODVA (median [interquartile range (IQR)], 257.198 [216.623-296.631] vs. 290.944 [248.647-338.819], p < 0.001) and lower ipsilateral PODICA-CV (median [IQR], 128.463 [110.233-153.624] vs. 182.01 [146.621-211.331], p < 0.001). Multivariable logistic regression analyses showed that ipsilateral PODVA (odds ratio [OR] 0.991, 95% confidence interval [CI] 0.984-0.999, p = 0.019) and ipsilateral PODICA-CV (OR 0.975, 95% CI 0.963-0.986, p < 0.001) were associated with good functional outcome. The predictive ability was significantly enhanced in the model including ipsilateral PODICA-CV (0.893 vs. 0.842, p = 0.027). No correlation was found between ipsilateral PODICA-CV and expanded Thrombolysis in Cerebral Infarction grades (r = -0.133, p = 0.099). Conclusion: Ipsilateral PODICA-CV is an additional indicator of cerebral reperfusion status and predicts functional outcomes after thrombectomy. [ABSTRACT FROM AUTHOR]

Aim Open fracture of the tibia is most common in road traffic accident specially motor cycle accident. Topics of debate in the orthopaedic traumatology continue regarding the specific methods of bone stabilization and soft tissue management of open fracture of Tibia. Objectives To evaluate the results of intramedullary nailing in the open fractures of the tibia in Combined Military Hospital, Dhaka. Material and Methods A prospective study was done from January 2018 to June 2019in Combined Military Hospital, Dhaka. Total twenty cases were selected who sustained open fractures of tibia Gustilo and Anderson grades I, II and IIIA. Primary undreamed intramedullary interlocking nail fixation done after thorough debridement and wounds were closed with suture. All the patients were followed up for a minimum of one year. Results Of the total twenty cases, ten were of grade I, seven were of grade II and three were of grade IIIA injury. Dynamization was done in nine cases. The average time to union was 16.0 weeks in the grade I cases, 18.3 weeks in the grade II cases and 23.6 weeks in the grade III A cases. The mean time to union was 19.3 weeks. Infection occurred in 3 cases. Mal union was observed in one case of type IIIA. No case had any implant failure (nail / screw breakage), or deep vein thrombosis. Conclusion From our study we have concluded that the unreamed intramedullary nailing in cases of open fractures of the tibia with soft tissue closure results faster soft tissue and bony healing. Biomechanical stability, early rehabilitation and infection rates are also comparable to those which are seen with other methods. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the learning curve (LC) on perioperative and long‐term functional outcomes of a consecutive single‐centre series of robot‐assisted radical cystectomy with Padua intracorporeal orthotopic neobladder. Patients and Methods: Patients treated between 2013 and 2022 were included, with ≥1 year of follow‐up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1‐year day‐ and night‐time continence. Uni‐ and multivariable Cox regression analyses identified predictors of day‐ and night‐time continence recovery. Day‐time continence was defined as 'totally dry' (no pads), night‐time continence as pad wetness ≤50 mL (one safety pad). Results: Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30‐day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1‐year day‐ and night‐time continence probabilities displayed a significant improving trend (day‐time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night‐time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day‐ (hazard ratio [HR] 1.008; P < 0.001) and night‐time continence (HR 1.004; P = 0.03) over time. Conclusion: Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10‐year analyses, we observed a significant improving trend for both the 1‐year day‐ and night‐time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day‐ and night‐time continence rates. [ABSTRACT FROM AUTHOR]

Background: It is assumed that robotic-assisted surgery (RAS) may facilitate complex pelvic dissection for rectal cancer compared to the laparoscopic-assisted resection (LAR). The aim of this study was to compare perioperative morbidity, short- and long-term oncologic, and functional outcomes between the RAS and LAR approaches. Methods: Between 2015 and 2021, all rectal cancers operated on by (LAR) or (RAS) were retrospectively reviewed in two colorectal surgery centers. Results: A total of 197 patients were included in the study, with 70% in the LAR group and 30% in the RAS group. The tumor location and stage were identical in both groups (not significant = NS). The overall postoperative mortality rate was not significantly different between the two groups. (0% LAR; 0.5% RAS; NS). The postoperative morbidity was similar between the two groups (60% LAR vs 57% RAS; NS). The number of early surgical re-interventions within the first 30 days was similar (10% for the LAR group and 3% for the RAS group; NS). The rate of complete TME was similar (88% for the LAR group and 94% for the RAS group; NS). However, the rate of circumferential R1 was significantly higher in the LAR group (13%) compared to the RAS group (2%) (p = 0.009). The 3-year recurrence rate did not differ between the two groups (77% for both groups; NS). After a mean follow-up of three years, the incidence of anterior resection syndrome was significantly lower in the LAR group compared to the RAS group (54 vs 76%; p = 0.030). Conclusions: The use of a RAS was found to be reliable for oncologic outcomes and morbidity. However, the expected benefits for functional outcomes were not observed. Therefore, the added value of RAS for rectal cancer needs to be reassessed in light of new laparoscopic technologies and patient management options. [ABSTRACT FROM AUTHOR]

First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct. This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded. Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware. Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities. [ABSTRACT FROM AUTHOR]

Background: Intertrochanteric fractures are common injuries, particularly in the elderly population, and are associated with significant morbidity and mortality. The proximal femoral nail (PFN) has gained popularity in the treatment of unstable intertrochanteric fractures. This prospective study aimed to evaluate the clinical and functional outcomes of PFN in the management of these fractures. Methods: Twenty patients with intertrochanteric fractures (9 males, 11 females; mean age: 61.7 years) were included in this study. Fractures were classified according to the Boyd and Griffin system, with 35% type 2, 40% type 3, and 25% type 4 fractures. All patients underwent PFN fixation by a single experienced surgeon. Functional outcomes were assessed using the Harris Hip Score, and complications were recorded. The mean follow-up duration was 12.5 months (range: 8-17 months). Results: The mean surgical time was 32 minutes (range: 20-65 minutes), and the average intraoperative blood loss was approximately 100 ml. Functional outcomes were excellent in 55% of patients, good in 20%, fair in 20%, and poor in 5%. Superficial surgical site infections occurred in 10% of patients, and varus collapse with limb shortening was observed in 10%. No cases of Z-effect, reverse Z-effect, or implant cutout were reported. Conclusion: PFN is an effective treatment option for intertrochanteric fractures, offering a minimally invasive approach, satisfactory functional outcomes, and an acceptable complication rate. Further research with larger sample sizes and longer follow-up is needed to establish the long-term efficacy of PFN in the management of these fractures. [ABSTRACT FROM AUTHOR]

Background: Displaced intra-articular calcaneal fractures remain challenging to manage due to the complex anatomy, soft tissue envelope, and high risk of complications. This prospective study aimed to evaluate the functional and radiological outcomes of surgical treatment using open reduction and internal fixation with calcaneal locking plates. Methods: Twenty patients with displaced intra-articular calcaneal fractures underwent open reduction and internal fixation with calcaneal locking plates. Radiographic outcomes, including Böhler's angle, Gissane's angle, and calcaneal width, were assessed pre- and postoperatively. Functional outcomes were evaluated using the Maryland Foot Score (MFS). Postoperative complications and occupational rehabilitation were also recorded. Results: Radiographic outcomes showed significant improvements in Böhler's angle (from 1.7 ± 3.2° to 26.85 ± 4.1°, p < 0.001), Gissane's angle (from 158.55 ± 8.3° to 127.7 ± 6.2°, p < 0.001), and calcaneal width (from 7.58 ± 0.6 cm to 6.76 ± 0.4 cm, p < 0.001) following surgery. Functional outcomes were excellent or good in 90% of patients, with a mean MFS of 86.25 ± 8.4. Complications were observed in 20% of patients, with each of wound dehiscence, superficial skin necrosis, deep infection, and subtalar arthritis occurring in 5% of patients. Occupational rehabilitation was achieved in 80% of patients. Conclusion: Open reduction and internal fixation with calcaneal locking plates is an effective treatment for displaced intra-articular calcaneal fractures, resulting in significant improvements in radiographic parameters, good to excellent functional outcomes, and a high rate of occupational rehabilitation with minimal complications. [ABSTRACT FROM AUTHOR]

Speech, language and communication needs (SLCN) remain one of the main areas of concern impacting children and young people's life outcomes. This article sets out the case for taking a population-health based approach to anticipating need and building whole systems around children in their functional contexts, whether home, early years setting, school or further education. The demand on services providing speech and language therapy continues to increase year on year. Using a population-health approach to predicting areas of higher anticipated SLCN and establishing robust collaborative approaches to improving the context for children and young people vulnerable to SLCN, there is the potential to address a significant number needs within everyday contexts. This approach continues to require a highly skilled speech and language therapy workforce. For maximum impact, those skills should be deployed in the places children and young people live, learn and have leisure, working directly with children but also ensuring the wider workforce are supported to enable early identification, prevention, and intervention. This approach requires a move away from a traditional referral model to one of easy access to expertise. Finally, the implications for paediatric services and the opportunities presented by a different way of using the multi-disciplinary team are proposed. [ABSTRACT FROM AUTHOR]

Background: Transoral robotic surgery (TORS) for oropharyngeal malignancy optimizes oncologic outcomes while preserving functionality. This study identifies patterns of functional recovery after TORS with free flap reconstruction (FFR). Methods: Retrospective cohort study at a tertiary care center of patients with primary oropharyngeal tumors treated with TORS with FFR between 2010 and 2022. Patients were categorized into: adjuvant chemoradiation or radiation, or no adjuvant therapy (NAT). Functional outcomes were measured by functional oral intake scale (FOIS). Results: 241 patients were included. FOIS declined at first postoperative appointment (median = 7.0 to 2.0, IQR = [7.0, 7.0], [2.0, 4.0]), and progressively improved to 6.0 (5.0, 6.0) after 1 year, with NAT having the highest FOIS (7.0, p < 0.05). Predictors of poor long‐term FOIS included RT and hypoglossal nerve (CN XII) involvement (p < 0.05). Conclusions: TORS with FFR leads to good long‐term function with minimal intake restrictions. Radiation therapy and CN XII involvement increase risk of worse functional outcomes. [ABSTRACT FROM AUTHOR]

Aim: The aim of this analysis was to assess the cost–effectiveness of the EmboTrap Revascularization Device compared with the Solitaire™ Revascularization Device and Trevo Retriever for the treatment of acute ischemic stroke (AIS) from the perspective of the Chinese healthcare system. Methods: According to MASTRO I, a recent living systematic literature review and meta-analysis, mechanical thrombectomy (MT) with EmboTrap in the treatment of AIS resulted in better functional outcomes compared with the use of Solitaire or Trevo. Based on the proportion of patients that achieved 90-day modified Rankin Scale (mRS) scores of 0–2, 3–5 and 6 reported in MASTRO I, a combined 90-day short-term decision tree and Markov model with a 10-year time horizon was used to compare the cost–effectiveness of the three devices. The primary outcome was the incremental cost–effectiveness ratio (ICER), representing the incremental cost (in 2022 Chinese Yuan [CNY]) per incremental quality-adjusted life-year (QALY). The ICERs were compared against willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 national gross domestic product (GDP) per capita in China. Results: Treatment with EmboTrap resulted in total QALYs of 3.28 and total costs of 110,058 CNY per patient. Treatment with Trevo resulted in total QALYs of 3.05 and total costs of 116,941 CNY per patient. Treatment with Solitaire resulted in total QALYs of 2.81 and total costs of 99,090 CNY per patient. Trevo was dominated by EmboTrap as it was a more costly and less effective intervention. As such, Trevo was not cost-effective at any WTP threshold. Compared with Solitaire, EmboTrap was more effective and more costly, with an ICER of 23,615 CNY per QALY. This result suggests that EmboTrap is cost-effective when compared with Solitaire since the ICER was lower than all WTP thresholds assessed. Conclusion: EmboTrap dominated Trevo and is cost-effective for the treatment of patients with AIS compared with Solitaire when assessed from the perspective of the Chinese healthcare system and based on the devicelevel meta-analysis MASTRO I. Selecting a stent retriever (SR) that optimizes 90-day mRS score is an important consideration from both a clinical and healthcare payer perspective in China as it is associated with reduced long-term costs and increased quality of life.

Summary: Background: In isocitrate dehydrogenase (IDH)-mutant low-grade gliomas (LGGs), awake functional-based resection (i.e., resection based on intraoperative functional responses rather than anatomical margins) has emerged as an efficient method to reduce tumour volume (TV) while minimizing postoperative deficits. Here, our goal was to assess the long-term onco-functional outcomes after awake functional-based resection in IDH-mutant LGGs, in conjunction with clinico-radiological and molecular factors. Methods: We retrospectively studied a consecutive cohort (June 1997–January 2023) of 949 patients. Six hundred patients with IDH-mutant LGGs benefited from an awake functional-based resection with a median follow-up of 7.8 years (95% Confidence interval [CI]: 7.1–8.4 years). The main outcomes were the overall survival (OS), the OS with Karnofsky performance status ≥80% (OSKPS≥80%), cognition measures, and professional activities at 12 months post-surgery. Findings: 600 patients were included in the cohort (274 female [46.0%], median age: 36 years [Interquartile range, IQR: 30–44 years]). The rate of return to work was 93.7%. The impact of surgery on cognition was of limited magnitude. The median postsurgical TV of 2.5 mL (IQR: 0–8.0 mL). The median OS was over 20 years (median: NA, 95% CI: 17.0-NA years). The median OSKPS≥80% was 14.7 years (95% CI: 13.2–17.2 years). Factors associated with longer OS and OSKPS≥P80% were 1p19q codeletion (Hazard ratio [HR]OS: 0.27, 95% CI: 0.16–0.43, HRKPS≥80%:0.25, 95% CI: 0.17–0.36), supratotal resection (HROS: 0.08, 95% CI: 0.005–0.40, HRKPS≥80%:0.12, 95% CI: 0.03–0.34) and total resection (HROS: 0.31, 95% CI: 0.16–0.59, HRKPS≥80%:0.21, 95% CI: 0.12–0.36). Recursive partitioning analyses established three OS and OSKPS≥80% prognostic groups, highlighting the contributions of histomolecular status, extent of resection, postsurgical and presurgical TV. Further propensity-matching analyses confirmed the oncological benefits of supratotal resections. Interpretation: Awake functional-based resection surgery in newly diagnosed IDH-mutant grade 2 LGG, was an effective strategy associated with long survival (median OS over 20 years) and long-term preservation of autonomy. More complete tumor resections favored better onco-functional outcomes across all molecularly-defined subtypes. Short-term effects were of limited magnitude regarding postoperative cognitive and professional outcomes. Supratotal functional-based resections offered additional survival benefits. Funding: None.

Introduction: To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. Methods: We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. Results: In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p

BACKGROUND: Both anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) reliably improve pain and function for a variety of indications. However, there remain concerns about these procedures among elderly patients due to their general health, the potential for lesser functional gain, and the possible need for revision at an even older age. The purpose of this review is to compare the clinical outcomes, radiographic outcomes, and complications of ATSA and RTSA among patients older than 70 years. METHODS: A systematic review was performed using searches of PubMed, Embase, and Cochrane databases. The inclusion criteria were studies with patients older than 70 years who were treated with a primary ATSA or RTSA and clinical results reported at a minimum of 2 years. All indications for primary RTSA except for tumor were included. Outcomes of interest included patient-reported outcomes (PROs), range of motion, patient satisfaction, radiographic changes, complication and revision rates, and implant survival. RESULTS: A total of 24 studies met the inclusion criteria. At a mean follow-up of 3.4 years for ATSA and 3.1 years for RTSA, there were significant improvements in pain, range of motion, and PROs for both prostheses. Patients who underwent ATSA generally had better motion and functional outcomes compared to those who underwent RTSA, though these comparisons were made across different indications for arthroplasty. The satisfaction rate was 90.9% after ATSA and 90.8% after RTSA. Furthermore, 10.2% of ATSA patients and 9.9% of RTSA patients experienced a surgical complication, whereas 2.3% of ATSA and 2.2% of RTSA patients underwent a revision. Secondary rotator cuff tear was the most common complication after ATSA, occurring in 3.7% of patients, but only 1.1% of patients required revision surgery. Both ATSA and RTSA implant survivorship was reported to range from 93.1% to 98.9% at 5- and 8-year follow-up, respectively. Patient mortality was estimated to be 19.3% with a mean time to death of 6.1 years. CONCLUSIONS: Elderly patients with primary osteoarthritis and an intact rotator cuff can have predictable pain relief, restoration of functional range of motion, and significant improvement in PROs after ATSA with low complication rates. Secondary rotator cuff failure and revision arthroplasty occur infrequently at early to mid-term follow-up. Although elderly patients who underwent ATSA generally had better functional outcomes compared to those who underwent RTSA for differing indications, patient satisfaction after both procedures were similar.

Background and objectives. This study explores the impact of plasma exchange therapy (TPE) on muscle strength and functional outcomes in patients with acute immune-mediated neuropathy. Materials and methods. We retrospectively analyzed clinical data from patients diagnosed with acute immune-mediated neuropathy at the Department of Neurology, Bolan University of Medical Sciences, Baluchistan, from January 2016 to December 2021. Results. The study, comprising 141 patients with various neurological disorders, underscores the efficacy of plasma exchange therapy in improving muscle strength and functional outcomes, particularly in Guillain-Barré Syndrome (GBS). Notably, after four weeks of treatment, a significant proportion of patients demonstrated improved mobility, with 51.8% able to walk without assistance. However, despite the positive response to therapy, a small percentage (2.8%) experienced unfavorable outcomes marked by expiration. Additionally, the study identifies significant associations between treatment outcomes and patient characteristics, such as the number of plasma exchange cycles and diagnosis (p

Abstract Background Both length of hospital stay and discharge to a skilled nursing facility are key drivers of total knee arthroplasty (TKA)-associated spending. Identifying patients who require increased postoperative care may improve expectation setting, discharge planning, and cost reduction. Balance deficits affect patients undergoing TKA and are critical to recovery. We aimed to assess whether a device that measures preoperative balance predicts patients’ rehabilitation needs and outcomes after TKA. Methods 40 patients indicated for primary TKA were prospectively enrolled and followed for 12 months. Demographics, KOOS-JR, and PROMIS data were collected at baseline, 3-months, and 12-months. Single-leg balance and sway velocity were assessed preoperatively with a force plate (Sparta Science, Menlo Park, CA). The primary outcome was patients’ discharge facility (home versus skilled nursing facility). Secondary outcomes included length of hospital stay, KOOS-JR scores, and PROMIS scores. Results The mean preoperative sway velocity for the operative leg was 5.7 ± 2.7 cm/s, which did not differ from that of the non-operative leg (5.7 ± 2.6 cm/s, p = 1.00). Five patients (13%) were discharged to a skilled nursing facility and the mean length of hospital stay was 2.8 ± 1.5 days. Sway velocity was not associated with discharge to a skilled nursing facility (odds ratio, OR = 0.82, 95% CI = 0.27–2.11, p = 0.690) or longer length of hospital stay (b = -0.03, SE = 0.10, p = 0.738). An increased sway velocity was associated with change in PROMIS items from baseline to 3 months for global07 (“How would you rate your pain on average?” b = 1.17, SE = 0.46, p = 0.015) and pain21 (“What is your level of pain right now?” b = 0.39, SE = 0.17, p = 0.025) at 3-months. Conclusion Preoperative balance deficits were associated with postoperative improvements in pain and function after TKA, but a balance focused biometric that measured single-leg sway preoperatively did not predict discharge to a skilled nursing facility or length of hospital stay after TKA making their routine measurement cost-ineffective.

Dusica Hadzi Boskovic,1 Jayne Smith-Palmer,2 Johannes Pöhlmann,2 Richard F Pollock,2 Steve Hwang,1 David Bruhn1 1Global Value and Real World Evidence, Otsuka Pharmaceutical Development & Commercialization Inc, Princeton, NJ, USA; 2Covalence Research Ltd, Harpenden, Hertfordshire, UKCorrespondence: Jayne Smith-Palmer, Email smith-palmer@covalence-research.comAim: Negative symptoms of schizophrenia (NSS) have been linked with poor functional outcomes. A literature review was performed to identify instruments used to assess functional outcomes and quality of life in clinical trials and observational studies conducted in groups of people with NSS.Methods: Literature search strings were designed using Medical Subject Headings combined with free-text terms and searches were performed using the PubMed, Embase and the Cochrane Library databases. For inclusion, articles were required to be published as full-text articles, in English, over the period 2011– 2021, include at least one group or treatment arm of people with NSS and report either functional outcomes or quality of life (QoL).Results: Literature searches identified a total of 3,268 unique hits. After two rounds of screening, 37 publications (covering 35 individual studies) were included in the review. A total of fourteen different instruments were used to assess functional outcomes and eleven different instruments were used to assess QoL. In studies in people with NSS, the most frequently used functional outcome measures were the Personal and Social Performance scale and the Global Assessment of Functioning. The most frequently used QoL instruments included the Manchester Short Assessment of Quality of Life, the Heinrich Carpenter Quality of Life Scale, the Schizophrenia Quality of Life Scale and the EQ-5D.Conclusion: A large number of measures have been used to assess functional outcomes and QoL in people with NSS, these include both generic and condition-specific as well as both interviewer-administered and self-reported instruments.Keywords: schizophrenia, quality of life, functional outcomes, negative symptoms

Tu Li,1 Runting Li,1 Fa Lin,1 Xiaolin Chen1– 3 1Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, People’s Republic of China; 2Stroke Center, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China; 3Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Xiaolin Chen, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Beijing, Fengtai District, 100070, People’s Republic of China, Email chenxiaolin@bjtth.orgPurpose: Early systemic inflammatory changes are increasingly recognized as factors influencing outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Systemic inflammation response index (SIRI), an inflammation biomarker, was thought to be associated with adverse outcomes in many other diseases. However, in aSAH, research on SIRI remains limited. Thus, our objective was to investigate the association between SIRI and poor long-term functional outcomes while evaluating the mediating role of in-hospital complications in this association.Patients and Methods: SIRI was defined as neutrophil count × monocyte count/lymphocyte count. Patients were categorized according to SIRI quartiles. Stabilized inverse probability of treatment weighting (sIPTW) was utilized to minimize group differences. The association between SIRI and in-hospital complications as well as poor 90-day functional outcomes (mRS 3– 6) was estimated by multivariable logistic regression analyses. Mediation analysis was performed to investigate the relationship between SIRI and poor functional outcomes mediated by in-hospital complications.Results: A total of 650 patients were prospectively included. After sIPTW, compared to the lowest quartile, an elevated SIRI was associated with delayed cerebral ischemia (DCI) (OR 2.12, 95% CI 1.20– 3.74), post-operative pneumonia (POP) (OR 2.16, 95% CI 1.29– 3.62) and poor 90-day functional outcomes (OR 3.03, 95% CI 1.55– 5.91). In-hospital complications including DCI (mediation proportion, 18.18% before sIPTW and 20.0% after sIPTW) and POP (mediation proportion, 18.18% before sIPTW and 26.7% after sIPTW) partially mediated the association between SIRI and poor 90-day functional outcomes. Mediation analysis yielded comparable results in subgroups stratified by age and sex.Conclusion: In this study, SIRI was associated with poor long-term functional outcomes in aSAH, which was partially mediated by DCI and POP with a mediation proportion exceeding 18%. Our findings might underscore the potential utility of SIRI in prompting physicians to address systemic inflammatory status timely to prevent in-hospital complications, including DCI and POP, and ultimately improve long-term functional outcomes.Keywords: aneurysmal subarachnoid hemorrhage, systemic inflammation response index, complications, functional outcomes, mediation analysis

Aims: Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time, complications, and revisions. Methods: The literature search was conducted on three databases (PubMed, Cochrane, and Web of Science) on 20 February 2024 according to the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Inclusion criteria were comparative studies, written in the English language, with no time limitations, on the comparison of R-UKA and C-UKA. The quality of each article was assessed using the Downs and Black Checklist for Measuring Quality. Results: Among the 3,669 articles retrieved, 21 studies on 19 series of patients were included. A total of 3,074 patients (59.5% female and 40.5% male; mean age 65.2 years (SD 3.9); mean BMI 27.4 kg/m2 (SD 2.2)) were analyzed. R-UKA obtained a superior Knee Society Score improvement compared to C-UKA (mean difference (MD) 4.9; p < 0.001) and better Forgotten Joint Score postoperative values (MD 5.5; p = 0.032). The analysis of radiological outcomes did not find a statistically significant difference between the two approaches. R-UKA showed longer operating time (MD 15.6; p < 0.001), but reduced complication and revision rates compared to C-UKA (5.2% vs 10.1% and 4.1% vs 7.2%, respectively). Conclusion: This meta-analysis showed that the robotic approach for UKA provided a significant improvement in functional outcomes compared to the conventional manual technique. R-UKA showed similar radiological results and longer operating time, but reduced complication and revision rates compared to C-UKA. Overall, R-UKA seems to provide relevant benefits over C-UKA in the management of patients undergoing UKA. Cite this article: Bone Jt Open 2024;5(5):374–384.

Aims: Isolated fractures of the ulnar diaphysis are uncommon, occurring at a rate of 0.02 to 0.04 per 1,000 cases. Despite their infrequency, these fractures commonly give rise to complications, such as nonunion, limited forearm pronation and supination, restricted elbow range of motion, radioulnar synostosis, and prolonged pain. Treatment options for this injury remain a topic of debate, with limited research available and no consensus on the optimal approach. Therefore, this trial aims to compare clinical, radiological, and functional outcomes of two treatment methods: open reduction and internal fixation (ORIF) versus nonoperative treatment in patients with isolated ulnar diaphyseal fractures. Methods: This will be a multicentre, open-label, parallel randomized clinical trial (under National Clinical Trial number NCT01123447), accompanied by a parallel prospective cohort group for patients who meet the inclusion criteria, but decline randomization. Eligible patients will be randomized to one of the two treatment groups: 1) nonoperative treatment with closed reduction and below-elbow casting; or 2) surgical treatment with ORIF utilizing a limited contact dynamic compression plate and screw construct. The primary outcome measured will be the Disabilities of the Arm, Shoulder and Hand questionnaire score at 12 months post-injury. Additionally, functional outcomes will be assessed using the 36-Item Short Form Health Survey and pain visual analogue scale, allowing for a comparison of outcomes between groups. Secondary outcome measures will encompass clinical outcomes such as range of motion and grip strength, radiological parameters including time to union, as well as economic outcomes assessed from enrolment to 12 months post-injury. Ethics and dissemination: This trial has been approved by the lead site Conjoint Health Research Ethics Board (CHREB; REB14-2004) and local ethics boards at each participating site. Findings from the trial will be disseminated through presentations at regional, national, and international scientific conferences and public forums. The primary results and secondary findings will be submitted for peer-reviewed publication. Cite this article: Bone Jt Open 2024;5(5):411–418.

Aims: Ilium is the most common site of pelvic Ewing’s sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients’ outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods: Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results: The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion: Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed. Cite this article: Bone Jt Open 2024;5(5):385–393.

Abstract Background This retrospective medium-term follow-up study compares the outcomes of medial fixed-bearing unicompartmental knee arthroplasty (mUKA) using a cemented metal-backed (MB) or an all-polyethylene (AP) tibial component. Materials and methods The database of our institution was mined for primary mUKA patients implanted with an MB or an AP tibial component (the MB-UKA and AP-UKA groups, respectively) from 2015 to 2018. We compared patient demographics, patient-reported outcome measures (PROMs), and motion analysis data obtained with the Riablo™ system (CoRehab, Trento, Italy). We conducted propensity-score-matching (PSM) analysis (1:1) using multiple variables. Results PSM analysis yielded 77 pairs of MB-UKA and AP-UKA patients. At 5 years, the physical component summary (PCS) score was 52.4 ± 8.3 in MB-UKA and 48.2 ± 8.3 in AP-UKA patients (p

The aim of this study was to assess surgical treatment in metacarpal shaft fractures of the second to fifth ray to determine the functional outcomes and complications in open reduction and internal fixation (ORIF) versus closed reduction and internal fixation (CRIF). This was a retrospective study that included patients with metacarpal shaft fractures of the second to fifth rays who were treated surgically between 1 January 2007 and 31 December 2019. Functional outcomes were scored using the QuickDASH and Eq5D score. A total of 231 treated patients were included. Single fractures were seen in 180 patients, and multiple fractures in 51 patients. ORIF was applied in 141 patients and CRIF in 90 patients. The functional outcomes were not significantly different between the groups. Complications were found in 41 (29%) of the ORIF patients and 15 (17%) of the CRIF patients. The functional outcomes after single or multiple metacarpal shaft fractures were similar in the ORIF and CRIF patients. ORIF showed significantly more complications, such as functional impairment and infections and a higher reoperation rate. In conclusion, CRIF is as safe as ORIF for the surgical treatment of metacarpal shaft fractures in terms of its functional outcome and slightly preferable due to its lower complication rate.

Aims: Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods: A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results: Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion: Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311.

Aims: This study reports the results of 38 total hip arthroplasties (THAs) in 33 patients aged less than 50 years, using the JRI Furlong hydroxyapatite ceramic (HAC)-coated femoral component. Methods: We describe the survival, radiological, and functional outcomes of 33 patients (38 THAs) at a mean follow-up of 27 years (25 to 32) between 1988 and 2018. Results: Of the surviving 30 patients (34 THAs), there were four periprosthetic fractures: one underwent femoral revision after 21 years, two had surgical fixation as the stem was deemed stable, and one was treated nonoperatively due to the patient’s comorbidities. The periprosthetic fracture patients showed radiological evidence of change in bone stock around the femoral stem, which may have contributed to the fractures; this was reflected in change of the canal flare index at the proximal femur. Two patients (two hips) were lost to follow-up. Using aseptic loosening as the endpoint, 16 patients (18 hips; 48%) needed acetabular revision. None of the femoral components were revised for aseptic loosening, demonstrating 100% survival. The estimate of the cumulative proportion surviving for revisions due to any cause was 0.97 (standard error 0.03). Conclusion: In young patients with high demands, the Furlong HAC-coated femoral component gives excellent long-term results. Cite this article: Bone Jt Open 2024;5(4):286–293.

Background: The use of postoperative MRI to assess the healing status of repaired menisci is a long-standing issue. This study evaluates and compares functional and MRI outcomes following an arthroscopic meniscus repair procedure with the aim of postoperative MRI diagnostic accuracy clarification in young patients. Methods: A total of 35 patients under 18 years old who underwent isolated meniscus repair were included. The Pedi-IKDC score, Lysholm score, and Tegner activity index (TAS) were compared between the groups formed according to the Stroller and Crues three-grade classification of postoperative MRI-based evaluations. Grade 3 MRI views were classified as unhealed, grade 2 as partially healed, and grade 1 as fully healed within the repaired meniscus, whereas grade 3 cases were considered unsuccessful due to MRI evaluation. Results: MRI assessment revealed 4 cases of grade 1 (11.4%), 14 cases of grade 2 (40.8%), and 17 cases of grade 3 (48.0%) lesions. Pedi-IKDC and TAS scores were significantly higher among MRI grade 2 patients than among MRI grade 3 patients (p < 0.05). Weak negative correlations between MRI grades and all functional scales were found (p < 0.05). ROC analysis showed that Pedi-IKDC and TAS scores could correctly classify 77% and 71% of MRI grade 3 patients, respectively. The optimal cut-off values to detect grade 3 patients were 88.74 for the Pedi-IKDC score and 4.5 for the TAS score. Conclusions: To conclude, established functional score cut-off values may help identify unhealed meniscus repair patients.

Cognitive impairment has a profound deleterious impact on long-term outcomes of glioma surgery. The human insula, a deep cortical structure covered by the operculum, plays a role in a wide range of cognitive functions including interceptive thoughts and salience processing. Both low-grade (LGG) and high-grade gliomas (HGG) involve the insula, representing up to 25% of LGG and 10% of HGG. Surgical series from the past 30 years support the role of primary cytoreductive surgery for insular glioma patients; however, reported cognitive outcomes are often limited to speech and language function. The breath of recent neuroscience literature demonstrates that the insula plays a broader role in cognition including interoceptive thoughts and salience processing. This article summarizes the vast functional role of the healthy human insula highlighting how this knowledge can be leveraged to improve the care of patients with insular gliomas. [ABSTRACT FROM AUTHOR]

Background: Biomarkers that reflect brain damage or predict functional outcomes may aid in guiding personalized stroke treatments. Serum neurofilament light chain (sNfL) emerges as a promising candidate for fulfilling this role. Methods: This prospective, observational cohort investigation included 319 acute ischemic stroke (IS) patients. The endpoints were the incidence of early neurological deterioration (END, an elevation of two or more points in the National Institute of Health stroke scale score within a week of hospitalization compared with the baseline) and functional outcome at 3 months (an mRS score of >2 at 3 months was categorized as an unfavorable/poor functional outcome). The association of sNfL, which was assessed within 24 h of admission, with END and unfavorable functional outcomes at follow-up was assessed via multivariate logistic regression, whereas the predictive value of sNfL for unfavorable functional outcomes and END was elucidated by the receiver operating characteristic curve (ROC). Results: Of 319 IS individuals, 89 (27.90%) suffered from END. sNfL not only reflects the severity of stroke measured by NIHSS score (p < 0.05) but also closely related to the severity of age-related white matter changes. Higher initial NIHSS score, severe white matter lesions, diabetes mellitus, and upregulated sNfL were significant predictors of END. Similarly, the multivariate logistic regression analysis results showed that elevated sNfL, a higher baseline NIHSS score, and severe white matter lesions were substantially linked with unfavorable outcomes for 3 months. Similarly, sNfL was valuable for the prediction of the 3 months of poor outcome (95%CI, 0.504-0.642, p = 0.044). Kaplan-Meier analysis shows that patients with elevated sNfL levels are more likely to reach combined cerebrovascular endpoints (log-rank test p < 0.05). Conclusion: This investigation suggests that sNfL can serve as a valuable biomarker for predicting END and 3-month poor functional outcomes after an IS and has the potential to forecast long-term cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Aim: Attention is increasingly being turned to functional outcomes as being central to colorectal cancer (CRC) survivorship. The current literature may underestimate the impact of evacuatory dysfunction on patient satisfaction with bowel function after anterior resection (AR) for CRC. The aim of this study was to investigate the impact of post‐AR symptoms of storage and evacuatory dysfunction on patient satisfaction and health‐related quality of life (HRQoL). Method: A cross‐sectional study was performed at an Australian hospital of patients post‐AR for CRC (2012–2021). The postoperative bowel function scores used were: low anterior resection syndrome (LARS), St Mark's incontinence, Cleveland Clinic constipation and Altomare obstructive defaecation syndrome scores. Eight 'storage' and 'evacuatory' dysfunction symptoms were derived. A seven‐point Likert scale measured patient satisfaction. The SF36v2® measured HRQoL. Linear regression assessed the association between symptoms, patient satisfaction and HRQoL. Results: Overall, 248 patients participated (mean age 70.8 years, 57.3% male), comprising 103 with rectal cancer and 145 with sigmoid cancer. Of the symptoms that had a negative impact on patient satisfaction, six reflected evacuatory dysfunction, namely excessive straining (p < 0.001), one or more unsuccessful bowel movement attempt(s)/24 h (p < 0.001), anal/vaginal digitation (p = 0.005), regular enema use (p = 0.004), toilet revisiting (p = 0.004) and >10 min toileting (p = 0.004), and four reflected storage dysfunction, namely leaking flatus (p = 0.002), faecal urgency (p = 0.005), use of antidiarrhoeal medication (p = 0.001) and incontinence‐related lifestyle alterations (p < 0.001). A total of 130 patients (53.5%) had 'no LARS', 56 (23.1%) had 'minor LARS' and 57 (23.4%) had 'major LARS'. Fifty‐seven (44.5%) patients classified as having 'no LARS' had evacuatory dysfunction. Conclusion: Postoperative storage and evacuatory dysfunction symptoms have an adverse impact on patient satisfaction and HRQoL post‐AR. The importance of comprehensively documenting symptoms of evacuatory dysfunction is highlighted. Further research is required to develop a patient satisfaction‐weighted LARS‐specific HRQoL instrument. [ABSTRACT FROM AUTHOR]