Search Results (27)

Background: The application of large language model (LLM) in surgical decision-making is rapidly expanding, yet its potential in hand and peripheral nerve surgery remains largely unexplored. This study assessed the diagnostic and therapeutic performance of a large language model (ChatGPT-4o) in scenarios characterized by multiple valid management strategies and absent expert consensus. Methods: Three representative cases—thumb carpometacarpal (CMC I) arthritis, scaphoid nonunion, and carpal tunnel syndrome (CTS)—were developed to reflect frequent conditions in hand surgery with competing but accepted treatment options. Each case was submitted to ChatGPT-4o using a standardized prompt. LLM-generated responses were evaluated by 52 participants (34 board-certified hand surgeons and 18 residents) across diagnostic accuracy, clinical relevance, and completeness. Readability indices, including Flesch–Kincaid Grade Level, were analyzed to assess appropriateness for a medical audience. Results: ChatGPT-4o demonstrated coherent but limited diagnostic accuracy (mean 2.9 ± 1.2 SD), moderate clinical relevance (3.5 ± 1.0 SD), and slightly higher completeness (3.4 ± 1.1 SD). Performance was strongest in the standardized scenario (carpal tunnel syndrome, CTS) and weakest in individualized reasoning (CMC I arthritis). No significant differences were observed between experts and residents (p > 0.05). In higher-level reasoning, ChatGPT-4o performed best in CTS and weakest in CMC I arthritis. Readability confirmed professional-level language (mean Flesch–Kincaid Grade Level: 16.4). Conclusions: ChatGPT-4o shows promise as a supportive tool for diagnostic reasoning and surgical education, particularly where standardized frameworks exist. Its limitations in ambiguous scenarios highlight the ongoing need for expert oversight. Future large language model development should emphasize specialty-specific training and context-aware reasoning to enhance their role in surgical decision support. Full article

This exploratory study investigates the feasibility and diagnostic value of high-resolution peripheral quantitative computed tomography (HR-pQCT) in detecting structural and microarchitectural changes in lunate avascular necrosis (AVN), or Kienböck’s disease. Five adult patients with unilateral AVN underwent either MRI or CT, alongside HR-pQCT of both wrists. Imaging features such as subchondral remodeling, joint space narrowing, and bone fragmentation were assessed across modalities. HR-pQCT detected at least one additional pathological feature not seen on MRI or CT in four of five patients and revealed early subchondral changes in two contralateral asymptomatic wrists. Quantitative measurements of bone volume fraction (BV/TV) further indicated altered trabecular structure correlating with disease stage. These findings suggest that HR-pQCT may offer enhanced sensitivity for early-stage AVN and better delineation of disease extent, which is critical for informed surgical planning. While limited by small sample size, this study provides preliminary evidence supporting HR-pQCT as a complementary imaging tool in the assessment of lunate AVN, with potential to improve early detection, staging accuracy, and individualized treatment strategies. Full article

Background: Arthroereisis is a well-accepted and relatively easy procedure to treat the flexible flatfeet in children and adolescents. A mild calf-muscle shortening is not seldom an accompanying feature. The need for a gastrocnemius recession in addition to arthroereisis is controversial. Therefore, the objective of this study is to investigate the need for a gastrocnemius recession in mild cases of gastrocnemius shortening to improve ankle dorsiflexion in addition to arthroereisis. Methods: Twenty-seven patients (ages 9–15 years) who underwent arthroereisis for painful idiopathic flatfeet were included in this non-randomised retrospective study, approved by Friedrich-Alexander University, Erlangen-Nürnberg (22-86-Br). The gait data of 18 typically developed children in same age group was used as reference. Based on the intraoperative Silfverskjöld test, two groups could be identified in the collective, one with shortened of gastrocnemius who underwent gastrocnemius recession (FFGR) and one without (FF). A control group included 18 feet of 18 typically developing children. Outcomes were evaluated by comparing pre- and postoperative clinical assessments including pain scores, gait analysis using a multi-segmental foot model, and radiological imaging. The mean follow-up was 22.1 months, and statistical analysis included a two-factor ANOVA. Results: No statistically significant differences in anthropometric, clinical, and gait parameters were observed between the groups preoperatively. Improvements in ankle dorsiflexion and pain were seen in both groups without statistical significance. There was no loss of calf-muscle strength or ankle power. Conclusions: Arthroereisis effectively corrects an idiopathic flexible flatfoot and reduces pain in children and adolescents. The gastrocnemius muscle stretches following arthroereisis and therefore, no lengthening is necessary when mildly shortened. The major limitations of this study are its retrospective nature, non-randomisation, and small size of the study collective. Full article

Introduction. Pediatric polytrauma (PPT) and major trauma in pediatric patients (PMT) present unique challenges compared to adult trauma care due to distinct anatomical and physiological differences. PPT/PMT remains the leading cause of death in children, responsible for over 50% of pediatric deaths and 15% of pediatric hospital admissions due to its long-term effects. This single-institution study focuses on the initial management of PPT/PMT from an orthopedics and traumatology point of view. Material and Methods. In the present study, data of PPT/PMT managed in one single institution, an academic level I pediatric trauma center, in patients <18 years of age, were analyzed over different periods. Over a 10-year period, diaphyseal femur fractures were analyzed as indicators of damage control (DCO) versus definitive treatment. Over a 4-year period (2021–2024), the associated lesions of PPT (head injuries, thoracic and abdominal lesions, spine lesions, major blood vessel lesions, and major musculoskeletal injury) were analyzed. Over a 1-year period (2019), the overall in-hospital mortality and admission rates in the pediatric intensive care unit were analyzed. Results. In the 10-year period, among 298 diaphyseal femur fractures, 46/298 (15%) were classified as PPT in which DCO was performed according to age as follows: in the age-group 15–17 years 23/23 (100%) with temporary external fixation (ExFix); in the age group 12–14 years, 9/14 (64%) with ExFix and 5/14 (26%) and elastic stable intramedullary nails (ESINs); in the age group 5–11 years, 1/5 (20%) with ExFix and 4 with ESIN; in the age group 0–4 years, 2/4 (50%) with ESIN and 2/4 (50%) with a cast. In the 4-year period, PPT/PMTs were associated with 60% head injury, 25% thoracic lesion(s), 18% abdominal lesion(s), 16% spine injury, 5% lesion of a major blood vessel, and 30% major musculoskeletal injuries. In 2019, there were 193 patients admitted to the emergency room as PPT/PMT: 115 were ≤12 years old and 78 were >12 years old. On admission, 46% were admitted to the pediatric intensive care unit, and 65% were admitted to the department of traumatology as inpatients. The in-hospital mortality rate was 7%. Discussion and Conclusions. In our institution, pediatric trauma is assessed using the Pediatric Trauma Score (PTS), and the workup follows the ATLS guidelines with a dedicated trauma team. The role of the orthopedic surgeon during the primary evaluation of PPT/PMT is to contribute to stopping bleeding and hemorrhagic shock. In PPT/PMT, DCO in adolescents is superimposable to adults, whilst in babies and children, DCO is still performed, but it is not a form of temporary external fixation. Full article

Osteochondroses of the foot represent a unique and less frequently discussed topic. This narrative review aims to provide a comprehensive overview of foot osteochondroses, highlighting their definition, pathophysiology, clinical features, diagnosis, and treatment. Historical sources, including early case reports, were included along with the current literature to picture the current knowledge on the subject. Anatomical mapping of pain locations and associated ossification centers was employed as a framework to present the various forms of foot osteochondroses. Multiple types of foot osteochondrosis were identified. The calcaneus, navicular and lesser metatarsal are among the more common involved bones. Most forms share a multifactorial etiology involving mechanical stress, vascular insufficiency, and delayed ossification. The pain is localized and common to all forms. Diagnosis relies on clinical assessment supported by radiographic and sometimes magnetic resonance imaging findings. During the acute phase, joint rest is essential. Despite the potential for spontaneous resolution, some cases can lead to structural deformities or persistent symptoms. Foot osteochondroses, although rare, require careful clinical evaluation due to their impact on pediatric patients. Increased awareness and standardized treatment approaches may improve early recognition and management, potentially reducing long-term sequelae. Full article

Background/Objectives: The breast implant exchange/explantation rate has been increasing in recent years due to various types of long-term complications or adverse effects, such as implant migration, rippling, or capsular contracture. To reduce complications such as migration and/or implant–pocket mismatch, surgical meshes may provide implant support. Here, we present a case series about the use of a non-absorbable synthetic bra-shaped mesh in revision surgery of the breast, using implants that do not adhere to the surrounding tissues. Methods: In this retrospective case series, eight patients underwent breast revision surgery between 2021 and 2024 due to implant-related long-term complications following aesthetic surgery. Surgical revision included implant exchange, total or partial capsulectomy, creation of a pre-pectoral implant pocket for the new implant, and positioning of the non-absorbable synthetic mesh, acting as an internal support for the implants. BREAST-Qs were collected from all patients. Results: Of the eight patients included, the following symptoms were observed: symptomatic capsular contracture (n = 3), implant migration (n = 4), and breast animation deformity (n = 2). After revision surgery, during the follow-up period of 6–42 months, neither infection nor seroma occurred. No implant-related complications were registered. The BREAST-Q analysis revealed the highest patient satisfaction in the domain “satisfaction with the implants” (median score 87.5%). Conclusions: In revision surgery after breast augmentation, the synthetic, non-absorbable and titanized pocket-like mesh may provide implant support and avoid recurrence of complications related to implant position. However, due to the small and heterogeneous patient group, larger studies are needed to validate these preliminary findings. Full article

Background: Skewfoot, also known as Z-foot, is a rare and complex deformity characterized by a combination of forefoot adduction and hindfoot valgus, resulting in a “Z” shape. Due to its rarity, diagnostic criteria and standardized treatment guidelines are lacking. This scoping review aims to systematically map and summarize the current knowledge regarding skewfoot. Methods: A comprehensive literature search of the PubMed, Cochrane Library, and Scopus databases was conducted to identify relevant articles. Patient-specific data were meticulously extracted from eligible studies and analyzed in detail. Results: A total of 12 studies met the inclusion criteria. Each study was independently reviewed, and data on epidemiology, etiology, clinical presentation, imaging assessment, and treatment options were extracted. Conclusions: The true incidence of skewfoot remains unknown. Etiology is likely multifactorial, often associated with systemic and neurological disorders. Skewfoot management ranges from conservative approaches to surgery. A medial cuneiform opening wedge osteotomy is the most used technique; however, the frequent need for additional procedures emphasizes the complexity of the deformity and the importance of a personalized approach. Full article

Background: While the well-being and working conditions of healthcare professionals are increasingly scrutinized, there remains a critical research gap regarding the quality of life and job satisfaction of plastic surgeons in Switzerland. No prior national study has systematically examined these aspects within this specialty. Objective: This study aims to address this gap by evaluating workload, career satisfaction, and quality of life among Swiss plastic surgeons and trainees, thereby providing evidence to inform systemic improvements in the profession. Methods: A national, multilingual online survey was distributed to all members of the Swiss Society for Plastic Surgery and the Association of Young Plastic Surgeons. A total of 102 plastic surgeons responded (response rate: 22.7%). The survey assessed contractual versus actual working hours, work performed during personal time, mental health indicators (e.g., burnout), and career satisfaction. Descriptive and correlational analyses were conducted. Results: The respondents reported an average of 58 actual versus 49 contractual working hours per week, with an additional 8.1 h spent working during leisure time. Burnout symptoms were present in 29%, and 63% experienced work-related stress during their free time. While 42% wished to reduce their workload, 88.7% would still choose the profession again. Career satisfaction averaged 3.66/5, although 35% rated their salary as inadequate. Notably, 79.8% reported work negatively affecting private relationships, despite 82.65% feeling supported by their environment. Conclusion: This first nationwide assessment highlights the high workload and psychological strain faced by Swiss plastic surgeons. Key priorities include targeted burnout prevention, structural workload reduction, enhanced support for work–life integration (especially among women and younger surgeons), and improved compensation. These measures are essential to sustain the well-being of practitioners and ensure long-term quality in surgical care. Full article

Background: Breast cancer, irrespective of gender, stands as the most prevalent cancer globally, with an annual estimate of 2.3 million new cases. Surgical intervention, including therapeutic mastectomy (excluding prophylactic procedures), is performed on approximately 28% of patients, necessitating subsequent breast reconstruction. Although implant-based breast reconstruction (IBBR) is frequently employed due to its relative ease compared to autologous methods, it presents a notable risk for complications at mid-term such as peri-prosthetic infections. These complications can lead to implant loss and the eventual compromise of the mastectomy pocket. To address these complications, negative pressure wound therapy with instillation and dwell (NPWTi-d) emerges as a promising rescue intervention, known for its capacity to significantly reduce bacterial load and potentially salvage compromised soft tissues. However, the evidence supporting its effectiveness in infected pockets after mastectomy is currently insufficient. This study aims at investigating the efficacy of NPWTi-d in the management of peri-prosthetic mastectomy pocket infection. Methods: A thorough literature search has been concluded through PubMed, Web of Science, and Cochrane databases up until 18th March 2025 on evaluating NPWTi-d’s ability to manage peri-prosthetic infections and preserve mastectomy pockets for subsequent reconstruction. Furthermore, a meta-analysis on the salvage rate of the mastectomy pocket was carried out, while for other outcomes, a descriptive analysis was applied. Results: Nine studies (n = 230 patients) were included, investigating whether the us NPWTi-d was successful in treating peri-prosthetic infection and preserving the mastectomy pocket for subsequent reconstruction by expander or implant. The pooled salvage rate of the implant-based BR due to the use of NPWTi-d was 86.1% (95%CI: 80.6–91.6%). Preservation of the skin envelope avoided secondary reconstruction after a defined time interval, reducing number and complexity of surgeries and related costs. Conclusions: This innovative surgical approach should be considered in selected cases of infected implants after breast reconstruction in breast cancer centers. However, the actual low level of evidence is based on case series, and it is not possible to define generally accepted recommendations for the use of NPWTi-d to save the mastectomy pocket. Full article

Objective: Navigated transcranial magnetic stimulation (nTMS) has seldom been used to study visuospatial (VS) circuits so far. Our work studied (I) VS functions in neurosurgical oncological patients by using repetitive nTMS (rnTMS), (II) the possible subcortical circuits underneath, and (III) the correspondence between nTMS and direct cortical stimulation (DCS) during awake procedures. Methods: We designed a monocentric prospective study, adopting a protocol to use rnTMS for preoperative planning, including VS functions for lesions potentially involving the VS network, including neurosurgical awake and asleep procedures. nTMS-based-DTI tractography allowed the visualization of subcortical circuits. Statistical analyses on nTMS/DCS points were performed. Clinical results were collected pre- and postoperatively. Results: Finally, 27 patients with primitive intra-axial brain lesions were enrolled between April 2023 and March 2024. Specific tests and an experimental integrated VS test (VISA) were used. The clinical evaluation (at 5 ± 7, 30 ± 10, 90 ± 10 days after surgery) documented 33% of patients with neglect in the left hemisphere four days after surgery and, during the 3-month follow-up, preservation of visuospatial function/clinical recovery (90.62% in MMSE, 98.86% in the bell test, 80% in the clock test, and 98% in the OCS test). The surgical strategy was modulated according to the nTMS map. Subcortical bundles were traced to identify those most involved in these functions: SFLII > SLFII > SLFI. A comparison of the nTMS and DCS points in awake surgery (n = 10 patients) documented a sensitivity (Se) of 12%, a specificity (Sp) of 91.21%, a positive predictive value (PPV) of 42%, a negative predictive value (NPV) of 66%, and an accuracy of ~63.7%. Conclusions: Based on our preliminary results, nTMS is advantageous for studying cognitive functions, minimising neurological impairment. Further analyses are needed to validate our data. Full article

Crop segmentation, the process of identifying and delineating agricultural fields or specific crops within an image, plays a crucial role in precision agriculture, enabling farmers and public managers to make informed decisions regarding crop health, yield estimation, and resource allocation in Midwest Brazil. The crops (corn) in this region are being damaged by wild pigs and other diseases. For the quantification of corn fields, this paper applies novel computer-vision techniques and a new dataset of corn imagery composed of 1416 256 × 256 images and corresponding labels. We flew nine drone missions and classified wild pig damage in ten orthomosaics in different stages of growth using semi-automatic digitizing and deep-learning techniques. The period of crop-development analysis will range from early sprouting to the start of the drying phase. The objective of segmentation is to transform or simplify the representation of an image, making it more meaningful and easier to interpret. For the objective class, corn achieved an IoU of 77.92%, and for background 83.25%, using DeepLabV3+ architecture, 78.81% for corn, and 83.73% for background using SegFormer architecture. For the objective class, the accuracy metrics were achieved at 86.88% and for background 91.41% using DeepLabV3+, 88.14% for the objective, and 91.15% for background using SegFormer. Full article

Background: Fractures of the clavicle are the most common birth injury among newborns. Aim of this systematic review was to provide a comprehensive analysis of the role of ultrasound (US) in diagnosing clavicular fractures in neonates. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed and Embase, including studies focusing on US in neonatal clavicle fracture. Age at US, number of cases examined by US and X-ray, US and X-ray diagnoses, US probe used, fracture site were systematically extracted. Results: A total of 231 articles were found. We ultimately selected 7 publications that satisfied the inclusion criteria, involving 136 patients examined between 3 days and 3 weeks of age, with 135 confirmed fractures. US was performed on all patients and correctly diagnosed all fractures (135/135, 100%). X-ray was performed on 94/136 patients (69.1%) and correctly diagnosed 89/93 fractures (95.7%). Fracture site was: medial in 2/79, middle in 37/79, and lateral in 40/79. In the remaining 57 cases, site was not reported. Conclusions: This review indicates that ultrasound is extremely reliable in diagnosing clavicle fractures in newborns and should be considered as the gold standard in this context. Full article

Background: Metastatic pancreatic lesions (MPLs) are relatively uncommon, constituting 2 to 5% of all pancreatic tumors. They often manifest as solitary lesions without distinct clinical symptoms, usually identified incidentally during radiologic imaging for the surveillance of prior malignancies. Differentiating these lesions from primary pancreatic tumors presents a significant challenge due to their nonspecific presentation. Methods: We aimed to prospectively assess the effectiveness of endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration/biopsy (EUS-FNA/B) in diagnosing MPLs in a carefully selected cohort of patients presenting with pancreatic masses. Additionally, we sought to examine the relevance of specific EUS findings in supporting the initial diagnosis of MPLs and their agreement with the definitive cytological diagnosis. This study retrospectively analyzed data from 41 patients diagnosed with MPLs between 2013 and 2023, focusing on their clinical and pathological characteristics, the echogenic features of the pancreatic lesions, and the techniques used for tissue acquisition. Results: The incidence of MPLs in our cohort was 3.53%, with the most frequent primary tumors originating in the kidney (43.90%), colorectum (9.76%), lung (9.76%), lymphoma (9.76%), and breast (4.88%). MPLs typically presented as hypoechoic, oval-shaped lesions with well-defined borders and were predominantly hypervascular. Interestingly, 68.29% of the cases were discovered incidentally during follow-up of the primary tumors, while the involvement of the common bile duct was uncommon (19.51%). Conclusions: EUS and EUS-FNA/B have been validated as valuable diagnostic tools for identifying MPLs. While our findings are promising, further multicenter studies are necessary to corroborate these results and elucidate the predictive value of specific EUS characteristics in determining the metastatic origin of pancreatic lesions. Full article

Background: Nowadays, multimodal cancer therapy results in very high survival rates of early-stage breast cancer and microsurgical flap-based breast reconstruction has become safe and reliable, with gradually increasing demand because of its durable and aesthetically pleasing results. This study aimed to explore the impact of different flap shaping and inset techniques on patient-reported outcome measures (PROMs) with regard to the aesthetic result in abdominal flap-based breast reconstruction. Methods: A systematic review was performed screening Pubmed, Cochrane Library and Web of Science for original articles reporting flap inset strategies, concomitantly providing PROMs on the aesthetic result. Results: Of 319 studies identified, six met the inclusion criteria. The studies described different flap rotation options according to the patient’s morphology, different inset planes, and avoidance of the monitoring skin paddle, and suggested that a higher flap-to-mastectomy mass ratio was associated with better aesthetic results. In two comparative studies, according to the PROMs (BREAST-Q, Likert scale) and independent observer judgement, both higher patient satisfaction and superior aesthetic results were observed with the newly described techniques. Conclusions: Emphasis on the aesthetic outcome in terms of breast shape and symmetry, providing an individualized approach of flap inset, considering the contralateral breast’s shape and volume, results in higher satisfaction scores. Full article

Background. During the treatment of unstable hips in developmental hip dysplasia (DDH), the position of the femoral head must be assessed in spica cast (SC) after reduction. A transinguinal sonographic technique (TIT) to the hip joint has been previously described in the literature. The aim of this study is to evaluate the agreement among TIT and MR to identify hip reduction. Methods. From 2016 to 2019, 14 consecutive newborns (10 female, 4 males) with a mean age of 2.97 ± 1.29 months were treated with closed reduction in SC. A total of 4/14 children had bilateral unstable DDH. Out of 18 hips, there were 8 hips type IV and 10 hips type IIIA, according to Graf. SC were changed monthly and hips were checked both with TIT and MR, looking for persistent dislocation. Results. Overall, a mean of 2.61 SC/hip (mode = 3) was accomplished, accounting for 47 procedures, with 46 reduced hips and 1 dislocated hip: TIT and MR always agreed on the same result (47/47; Cohen k = 1, CI95 1.00 to 1.00). Conclusions. The inguinal ultrasound technique described by van Douveren showed perfect agreement with MR and might be considered a reliable alternative to check the position of the femoral head during the conservative treatment of hip dysplasia in spica cast. Full article