We introduce a type of surgery on metric spaces. This surgery, in some sense, seeks to replace a subspace $S$ of a metric space $X$ with another metric space $T$ via a function $f : S \to T$. When $T$ is a discrete space, this amounts to collapsing the subspace according to the function. This surgery results in a new metric space we denote $\widehat{X}_f$ and there is a natural function $F : X \to \widehat{X}_f$ induced from $f$. Our primary interest is investigating if properties of the original function $f$ are inherited by the induced function $F$. We show that if $f$ is a pseudo-isometry then so is $F$. However, for a quasi-isometry, a very natural generalization of a pseudo-isometry that is prevalent in geometric group theory, such a result does not hold.
Khushboo Verma, Alan Michels, Ergi Gumusaneli
et al.
Referral workflow inefficiencies, including misaligned referrals and delays, contribute to suboptimal patient outcomes and higher healthcare costs. In this study, we investigated the possibility of predicting procedural needs based on primary care diagnostic entries, thereby improving referral accuracy, streamlining workflows, and providing better care to patients. A de-identified dataset of 2,086 orthopedic referrals from the University of Texas Health at Tyler was analyzed using machine learning models built on Base General Embeddings (BGE) for semantic extraction. To ensure real-world applicability, noise tolerance experiments were conducted, and oversampling techniques were employed to mitigate class imbalance. The selected optimum and parsimonious embedding model demonstrated high predictive accuracy (ROC-AUC: 0.874, Matthews Correlation Coefficient (MCC): 0.540), effectively distinguishing patients requiring surgical intervention. Dimensionality reduction techniques confirmed the model's ability to capture meaningful clinical relationships. A threshold sensitivity analysis identified an optimal decision threshold (0.30) to balance precision and recall, maximizing referral efficiency. In the predictive modeling analysis, the procedure rate increased from 11.27% to an optimal 60.1%, representing a 433% improvement with significant implications for operational efficiency and healthcare revenue. The results of our study demonstrate that referral optimization can enhance primary and surgical care integration. Through this approach, precise and timely predictions of procedural requirements can be made, thereby minimizing delays, improving surgical planning, and reducing administrative burdens. In addition, the findings highlight the potential of clinical decision support as a scalable solution for improving patient outcomes and the efficiency of the healthcare system.
The self-repair ability of articular cartilage is limited, which is one of the most difficult diseases to treat clinically. Kartogenin (KGN) induces chondrogenesis by regulating RUNX1 mRNA translation and the small molecule compound TD-198946 (TD) promotes chondrogenic differentiation of mesenchymal stem cells (MSCs) through increasing the transcription of RUNX1 mRNA. GelMA hydrogel and liposomes are respectively similar to the extracellular matrix (ECM) and extracellular vesicles (EVs). So, we developed an “EVs-in-ECM” mimicking system by incorporating GelMA and KGN/TD-loaded liposomes to investigate the repair effects of cartilage defect. First, western-blot, RNA fluorescence in situ hybridization (FISH), cellular immuno-fluorescence, co-immuno-precipitation (CO-IP), and qRT-PCR techniques showed that KGN regulated RUNX1 mRNA expression, and then promote chondrogenic differentiation of MSCs. Second, the role of RUNX1 was amplified by orchestrating RUNX1 transcription and translation through TD-198946 (TD) and KGN respectively, and the synergistic effects of TD and KGN on chondrogenesis of MSCs in vitro were discovered. Finally, an “EVs-in-ECM” mimicking system was designed for in situ cartilage repair. When GelMA loaded with KGN and TD liposomes, the hydrogel (KGN + TD@ GelMA) showed biological functions by the continuously controlled release of KGN and TD while maintaining its porous structure and mechanical strength, which enhanced the chondrogenesis of MSCs in one system. The repair performance of “EVs-in-ECM” in vivo was assessed using the articular osteochondral defect model of rat. The implantation of KGN + TD@ GelMA hydrogels effectively exerted favorable osteochondral repair effects showing structures similar to the native tissue, and prevented chondrocyte hypertrophy. The study indicate that the “EVs-in-ECM” mimicking system can act as a highly efficient and potent scaffold for osteochondral defect regeneration.
Abstract Osteosarcoma (OS) is the most common primary bone malignancy because of its extra high tendency of metastasis. In-depth research is needed to uncover the pathogenesis of patients with OS cells. We collected 74 tissue samples from patients with OS cells and measured the expression levels of ghrelin by immunohistochemistry. Ghrelin was added into OS cell lines in CCK8 assays, JC-1 staining and Western blot analysis were performed to explore its effect on the aggressiveness of OS cells and drug resistance. To determine its function, ghrelin was overexpressed or knocked down in OS cells and then detect cell proliferation in the xenograft mouse model and orthotopic model. Western blot analysis was performed to explore ghrelin-regulated signal pathways. In this work, we identified the relation between the level of ghrelin expression and poor prognosis of OS patients. As well as promoting proliferation, migration, and invation, ghrelin promotes the survival of OS in vitro as well as in vivo, and reduces the apoptosis of OS cells. What’s more, ghrelin increases the resistance of cis-platinum by changing mitochondrial function and decreases the expression of MDR-1. Above all, these results demonstrated ghrelin exerts tumorigenic and metastatic effects and may be a potential therapeutic target.
Orthopedic surgery, Diseases of the musculoskeletal system
ObjectiveThe present study aimed to investigate the efficacy of the lateral parapatellar approach combined with multiple Kirschner wire tension bands (“Hedgehog” technique) in the treatment of complex comminuted patellar fractures, improving surgical outcomes, and promoting early recovery of knee joint function.MethodsThis study adopted a retrospective design. Based on the inclusion and exclusion criteria, patients with complex comminuted patellar fractures admitted to the hospital from January 2018 to January 2024 were enrolled. Among them, 21 patients in Group A were treated via the lateral parapatellar approach combined with multiple Kirschner wire tension bands and Ethibond suture fixation, whereas 24 patients in Group B underwent conventional midline anterior patellar approach combined with Kirschner wire tension band fixation. The two groups were compared and analyzed in terms of incision length, intraoperative blood loss, operation time, reduction quality, VAS score, postoperative complications, Böstman score, initiation time of postoperative knee functional exercises and the last follow-up KOOS score.ResultsAll patients had complete follow-up data, with a mean follow-up duration of 18 months, and there were no statistically significant differences in baseline characteristics between the two groups. Compared with Group B, Group A had significantly better outcomes in terms of operation time, reduction quality, VAS score (3 days postoperatively), incidence of postoperative complications (scarring), Böstman score (3, 6, and 12 months postoperatively), fracture healing time, initiation time of knee functional exercises and KOOS score (P < 0.05). No statistically significant differences were observed between the two groups in terms of incision length, intraoperative blood loss, VAS score (1 day postoperatively), or postoperative complications (pin migration, irritation, and infection) (P > 0.05).ConclusionIn the surgical management of complex comminuted patellar fractures, the lateral parapatellar approach allows for precise reduction of fracture fragments under direct visualization, achieving anatomical reduction with reliable fixation. This approach facilitates early functional exercises, accelerates rehabilitation, and achieves favorable clinical outcomes while avoiding patellectomy, and thus may represent a valuable alternative technique. The simple and cost-effective internal fixation technique using a Kirschner wire tension band combined with Ethibond suture remains vigorously viable in the era of rapidly advancing orthopaedic treatment technologies.
Background/Aims: Osteoarthritis (OA) is the second common rheumatologic disorder and the most prevalent joint disease in India, affecting 20–40% of the population. Low-level laser therapy (LLLT) has been used to alleviate pain in musculoskeletal conditions. Despite the fact that LLLT is extensively used, the consequences from both experimental and medical research continue to be inconsistent. This study aims to assess the pain-relieving effectiveness of LLLT in patients with Kellgren–Lawrence Grade I and II knee OA, using the Visual Analog Scale (VAS) and the Western Ontario McMaster Osteoarthritis Index (WOMAC).
Materials and Methods: The study was carried out at a tertiary care center in Bengaluru. Fifty patients were recruited primarily based on the following inclusion criteria:
1. Idiopathic knee OA
2. Grade I or II bilateral knee OA confirmed by X-ray
3. Average pain intensity of 40 or greater on a 100-mm VAS
4. Age: 45–65 years, of both sexes.
Patients attended weekly therapy sessions. Each session included isometric quadriceps muscle contractions and 10 repetitions of active range of motion exercises for the knee joint, following a 5-min LLLT application.
Results: On X-ray, 52% (22 patients) had Grade I OA knee, and 48% (20 patients) had Grade II OA knee. There was a significant reduction in VAS and WOMAC post-treatment scores compared to pre-treatment.
Conclusion: OA is a long-term, degenerative condition that causes deterioration of joint tissues, resulting in excessive pain, stiffness, and restricted mobility. Treatment strategies for OA continue to be crucial for research. Our study suggests a widespread improvement in pain alleviation with LLLT. Further studies are needed to compare the efficacy of LLLT with other pain management strategies and explore combined treatment plans.
Aims: This study was to propose novel measurements to assess severity of ligament injury in simple elbow dislocation using axial imaging. This study assessed inter- and intraobserver reliability of the proposed novel measurements and compared their application as measures of severity of medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries.Methods: This retrospective study included patients diagnosed with simple elbow dislocations from January 2013 to December 2023. The degree of MCL and LCL injuries was assessed by four grades: (0 (normal); 1 (sprain); 2 (partial tear); and 3 (complete tear)) using MRI. Patients were classified into two groups according to the severity of MCL and LCL injuries (Group I (degree of MCL injury ≥ LCL injury); and Group II (degree of MCL injury < LCL injury)). The novel measurements were defined by measuring congruence angle (CA), medial ulnar translation (TRANS), and lateral ulnar tilt (TILT) as determined by axial MRI. Adjusted medial ulnar translation (ADJ-TRANS) was calculated. Two observers measured all parameters twice over four weeks.Results: A total of 21 patients were analyzed. Interobserver reliability was moderate to good for CA and good for TRANS. Both CA and TRANS showed excellent intraobserver reliability. Grade 2 MCL injury had significantly higher ADJ-TRANS than grade 1, while grade 2 LCL injury had significantly higher TRANS than grade 1. Meanwhile, grade 3 LCL injury had significantly higher CA and TRANS than grade 2, and significantly higher CA, TRANS, and ADJ-TRANS than grade 1. Group II also had significantly higher CA, TRANS, and ADJ-TRANS than Group I.Conclusion: Novel measurements using axial images of MRI scans achieved overall good inter- and intraobserver reliability. Higher grade LCL injury exhibited higher CA, TRANS, and ADJ-TRANS. Patients with LCL injury graded higher than that of MCL injury exhibited higher CA, TRANS, and ADJ-TRANS.Cite this article: Bone Jt Open 2025;6(11):1468–1474.
Eduardo Borges Ferreira Jr, Daniel Yiteh Lin, Maria Mascarenhas
et al.
Introduction:
Injuries to the brachial triceps (BT) tendon are rare, accounting for about 1% of all tendon injuries. The complexity of these injuries, especially in their proximal portion, and the scarcity of data in the literature make each case essential to expand knowledge. This report demonstrates an effective treatment method for extensive muscle loss around the shoulder using a homologous graft, offering new perspectives for similar cases.
Case Report:
A 65-year-old female patient presented with a history of desmoid tumor treated surgically through an extensive surgical resection of the proximal portion of the BT muscle, followed by a third-degree burn in the left scapular region. The patient exhibited sequelae, manifesting complaints related to esthetics and reduced active extension of the elbow. Hypotrophy of the deltoid muscle was also observed, associated with paresthesia in the corresponding C5 dermatome. The patient underwent surgical treatment for reconstruction of the proximal portion of the BT muscle using a homologous graft from the tensor fascia lata muscle, which resulted in esthetic and functional improvements without additional neurological deficits.
Conclusion:
The case report demonstrates that reconstruction of the proximal portion of the BT muscle with a homologous graft is a promising approach for treating this type of injury, bringing significant improvements in muscle function and esthetics. Furthermore, a multidisciplinary approach, postoperative surveillance, and the continuous pursuit of technical advancements are essential to optimize results and minimize complications, broadening therapeutic options in complex cases.
Orthopedic surgery, Diseases of the musculoskeletal system
Panos Christodoulou, Donald Osarumwense, Antonios Papadopoulos
Introduction:
Acute carpal tunnel syndrome (CTS) is a rare but serious condition requiring prompt diagnosis and intervention to prevent permanent neurological deficits. This case series presents our department’s experience in managing this condition, highlighting diagnostic challenges, treatment strategies, and patient outcomes.
Materials & Methods:
This retrospective study analyses medical records of patients diagnosed with acute carpal tunnel syndrome from 2021 to 2023 within our coverage area. Information was extracted from medical records, including diagnostic codes and clinical assessments for all cases of acute carpal tunnel syndrome, diagnosed during the period from 2021 to 2023. Data analysed, include age, sex, medical history, symptoms, mechanism of injury, clinical features, imaging, management, and follow-up. Six native Scottish patients, aged 43 to 65, developed acute carpal tunnel syndrome due to various causes, including flexor sheath infection, wrist soft tissue injury, distal radius fractures (with and without plate fixation), and scaphoid fracture.
Discussion and Results:
Our case series highlights the heterogeneous presentation and aetiology of acute carpal tunnel syndrome, with causes ranging from trauma to infection. Early recognition remained challenging due to overlapping symptoms with other wrist pathologies. Surgical decompression was the mainstay of treatment, performed with variable urgency depending on clinical progression. Despite intervention outcomes were mixed. Some patients experienced full recovery while others had lingering symptoms.
Conclusion:
These findings underscore the importance of high clinical suspicion and prompt surgical intervention to optimise outcomes.
Orthopedic surgery, Diseases of the musculoskeletal system
Abstract Background Metacarpal neck fractures are common and there are numerous surgical methods available, but each has certain disadvantages and limitations. We modified the conventional Ilizarov external mini-fixator and this study is designed to compare the biomechanical stability of a modified Ilizarov external mini-fixator with conventional fixation methods for metacarpal neck fractures and to provide a basis for its clinical application. Methods Forty fresh porcine metacarpal specimens were used to create metacarpal neck fracture models. The specimens were randomly assigned to four fixation groups (n = 10) as follows: (1) modified Ilizarov external mini-fixator (IEF), (2) retrograde crossed Kirschner wires (KW), (3) antegrade intramedullary Kirschner wires (IK), and (4) locking plate fixation (LP). In the IEF group, the modified design involved crossing two Kirschner wires (K-wires) through the fracture line, with their tails bent twice and connected to the external fixator frame. Biomechanical testing was performed using a modified three-point bending test. Maximum fracture force and bending stiffness were calculated from the force-displacement curves. Kruskal–Wallis test was used to compare statistical differences in maximum fracture force and stiffness among the groups, followed by post hoc pairwise comparisons adjusted with Bonferroni corrections. Results The median maximum fracture force values (± interquartile range, IQR) for each group were as follows: IEF 160.3 ± 55.6 N, LP 173.5 ± 42.6 N, KW 91.1 ± 23.1 N, and IK 79.8 ± 37.8 N. The corresponding stiffness values were as follows: IEF 29.5 ± 10.4 N/mm, LP 32.9 ± 10.4 N/mm, KW 17.2 ± 11.3 N/mm, and IK 18.2 ± 13.7 N/mm. The IEF group demonstrated significantly higher maximum fracture force and stiffness than the KW and IK groups; however, no statistically significant differences were observed in the IEF group compared with the LP group. Conclusion The modified Ilizarov external mini-fixator provided significantly greater biomechanical stability for metacarpal neck fractures than retrograde crossed K-wires and antegrade intramedullary K-wires, achieving comparable performance to the locking plate system. This modified design combines the simplicity and minimally invasive advantages of K-wire fixation with enhanced stability, potentially facilitating early joint mobilization and minimizing the risk of complication.
Orthopedic surgery, Diseases of the musculoskeletal system
We prove a surgery formula for the ordinary Seiberg-Witten invariants of smooth $4$-manifolds with $b_1 =1$. Our formula expresses the Seiberg-Witten invariants of the manifold after the surgery, in terms of the original Seiberg-Witten moduli space cut down by a cohomology class in the configuration space. This formula can be used to find exotic smooth structures on nonsimply connected $4$-manifolds, and gives a lower bound of the genus of an embedding surface in nonsimply connected $4$-manifolds. In forthcoming work, we will extend these results to give a surgery formula for the families Seiberg-Witten invariants.
It is clear that every rational surgery on a Hopf link in $3$-sphere is a lens space surgery. In this note we give an explicit computation which lens space is a resulting manifold. The main tool we use is the calculus of continued fractions. As a corollary, we recover the (well known) result on the criterion for when rational surgery on a Hopf link gives the $3$-sphere.
Satoshi Onoue, Noriaki Maeda, Yasunari Ikuta
et al.
Abstract The level of dynamic mechanical instability between the bony parts of the ankle joint provides important information on biomechanical function. However, the dynamics of the distance between the talus and lateral malleolus during gait remain unclear. This study aimed to compare the distance between the talus and lateral malleolus and the ankle joint angles during the stance phase of gait between individuals with chronic ankle instability (CAI) and healthy adults. The comparison was conducted using a synchronized ultrasound (US) imaging with a three-dimensional motion analysis (MA) system. This cross-sectional study included 12 participants (5 males, 7 females; age, 20.5 ± 1.8 years; height, 166.6 ± 9.4 cm; body weight, 60.2 ± 5.3 kg; body mass index, 21.7 ± 2.0 kg/m2; 16 feet) with CAI and 10 healthy controls (4 males, 6 females; age, 21.2 ± 1.6 years; height, 164.6 ± 10.5 cm; body weight, 56.8 ± 11.3 kg; body mass index, 20.8 ± 2.6 kg/m2; 20 feet). The distance between the talus and lateral malleolus during gait was significantly increased in the CAI group compared with that in the control group throughout the stance phase. The ankle dorsiflexion angle was smaller in the CAI group during the middle and terminal stance phases. Additionally, the ankle inversion angle was greater in the CAI group than in the control group. Our findings show the application of the synchronized US and MA system in the assessment of mechanical instability in CAI group, which may be used to determine treatment efficacy.
Abstract Background The relationship between obesity and type 2 diabetes with bone health has always been a topic of debate. The weight-adjusted waist index has become a commonly used indicator for assessing central obesity, fat, and muscle mass. However, currently there is no research reporting the association between weight-adjusted waist index and risk of osteoporosis in populations of type 2 diabetes. Therefore, this study aims to provide new information on the association between weight-adjusted waist index and risk of osteoporosis in type 2 diabetes. Methods This cross-sectional study involved 963 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Cangzhou Central Hospital. Multivariate logistic regression models were used to assess the association between weight-adjusted waist index and osteoporosis. The potential nonlinear association was evaluated. The effects of interaction between subgroups were assessed using the likelihood ratio test. Results Weight-adjusted waist index was positively associated with the risk of osteoporosis, regardless of traditional confounding factors. For each 1 unit increased in weight-adjusted waist index, the risk of osteoporosis increased by 67%. Furthermore, there was a nonlinear relationship between weight-adjusted waist index and osteoporosis. The subgroup analysis did not reveal any significant interactions. Conclusions Our study indicated a positive association between weight-adjusted waist index and the risk of osteoporosis in adult Chinese type 2 diabetes patients, and this relationship was nonlinear.
Orthopedic surgery, Diseases of the musculoskeletal system
We give several new perspectives on the Heegaard Floer Dehn surgery formulas of Manolescu, Ozsváth and Szabó. Our main result is a new exact triangle in the Fukaya category of the torus which gives a new proof of these formulas. This exact triangle is different from the one which appeared in Ozsváth and Szabó's original proof. This exact triangle simplifies a number of technical aspects in their proofs and also allows us to prove several new results. A first application is an extensions of the link surgery formula to arbitrary links in closed 3-manifolds, with no restrictions on the link being null-homologous. A second application is a proof that the modules for bordered manifolds with torus boundaries, defined by the author in a previous paper, are invariants. Another application is a simple proof of a version of the surgery formula which computes knot and link Floer complexes in terms of subcubes of the link surgery hypercube. As a final application, we show that the knot surgery algebra is homotopy equivalent to an endomorphism algebra of a sum of two decorated Lagrangians in the torus, mirroring a result of Auroux concerning the algebras of Lipshitz, Ozsváth and Thurston.
In this paper, for the first time, a method is presented that can provide a fully automated surgery based on software and computer vision techniques. Then, the advantages and challenges of computerization of medical surgery are examined. Finally, the surgery related to isolated ovarian endometriosis disease has been examined, and based on the presented method, a more detailed algorithm is presented that is capable of automatically diagnosing and treating this disease during surgery as proof of our proposed method where a U-net is trained to detect the endometriosis during surgery.
Meloria Hoskins, Jacob R. Staub, Zachary Koroneos BS
et al.
Category: Midfoot/Forefoot Introduction/Purpose: Surgical treatment options for Lisfranc injuries include open reduction and internal fixation (ORIF) and primary arthrodesis. To date, various options of ORIF exist, including transarticular screws, dorsal plates, and more recently, flexible fixation methods such as suture button and InternalBrace (Arthrex Inc, Naples, FL).1-4 Flexible fixation techniques attempt to minimize post-surgical joint immobilization and prevent the articular cartilage damage seen with transarticular screws.4-6 Unlike other flexible fixation techniques, the InternalBrace avoids placement of a suture button on the medial cuneiform and prevents disruption of the tibialis anterior tendon.4,7 Patient outcomes have been reported for suture button and transarticular screw fixation; however, there is a lack of clinical data reported utilizing InternalBrace in Lisfranc injuries due to its recent FDA approval in 2019.1,2,4 Methods: A retrospective chart review was performed as part of a case study investigation of 9 patients who underwent ORIF with InternalBrace fixation by a single surgeon. Patients over 18 years of age were included. Results: The average follow-up time was 6.6 months (SD = 5.1 months). The average time to weight-bearing as tolerated was 6.8 weeks (n=9), while the average time to return to work/sport as tolerated was 14.3 weeks (n=7). The only complication noted at follow-up was hypersensitivity along the foot [1 (11%)] (Table 3). No hardware complications were noted at either 6-week and 12-week post-operative x-rays. Conclusion: In this retrospective chart review, the time to return to work/sport as tolerated was comparable to that of return to sport after ORIF with screws and combined bridge-plating (19.6 weeks) and suture button (19.4 weeks).8 Future research involving a larger cohort of patients is required and is currently being performed by our institution to further evaluate outcomes after use of the InternalBrace for Lisfranc injuries.
Myers shows that every compact, connected, orientable $3$--manifold with no $2$--sphere boundary components contains a hyperbolic knot. We use work of Ikeda with an observation of Adams-Reid to show that every $3$--manifold subject to the above conditions contains a hyperbolic knot which admits a non-trivial non-hyperbolic surgery, a toroidal surgery in particular. We conclude with a question and a conjecture about reducible surgeries.
Abstract Background The localization of lumbar fourth spinous process (L4-SP) is an important anatomical landmark, and identifying its accurate position is essential for the diagnosis and treatment of waist diseases. Methods Five hundred participants were scanned with positive and lateral computed tomography (CT), which aimed to clarify anatomic characteristics of L4-SP. Anatomical parameters of the surface localization of L4-SP were measured and recorded through a three-dimensional (3D) reconstruction. Results Five hundred participants were classified into three types according to the position of BC with the iliac spine. There are just 266 that the line between the highest point of the iliac spine on both sides located on L4-SP (type I, 53.20%), 16 above L4-SP (type II, 3.20%), and 218 below L4-SP (type III, 43.60%). BC in type I (15.92 ± 1.30 mm) is longer than type III (15.56 ± 1.32 mm). While the angle combined with AB and BC is different in the three groups, the angle in type I (173.00 ± 4.83°) is larger than that in type II (164.69 ± 5.50°) and type III (159.45 ± 8.39°). Other measurements were not found any significant differences between above. Conclusion The traditional palpation for L4-SP is not absolutely exact. The accuracy rate is only 53.20%, and the errors may cause serious consequences.
Orthopedic surgery, Diseases of the musculoskeletal system