Search Results (689)

Background: The choice between fixed-bearing (FB) and mobile-bearing (MB) prostheses in total knee arthroplasty (TKA) remains controversial, and longitudinal evidence based on objective instrumented assessment is limited. Objectives: To compare global spatiotemporal gait performance and ambulation capacity across three postoperative assessments in patients receiving FB versus MB/rotating-platform implants. Methods: In this retrospective, longitudinal, observational cohort study, patients who had undergone primary unilateral TKA were assessed at up to three postoperative visits approximately 12 months apart, the first at a median of 12 months after surgery. Gait speed, cadence, stride length, a step-time symmetry index and a gait quality index were obtained from a single lumbar-mounted inertial measurement unit during steady-state level walking, and ambulation capacity was measured with the 2-Minute Walk Test (2MWT). Linear mixed-effects models with a random intercept per patient, adjusted for age and sex, were fitted for all six outcomes, with time specified both as a linear term and, in a sensitivity analysis, as a categorical factor yielding estimated marginal means and between-group contrasts at each visit. Results: A total of 105 observations from 54 patients were analysed (29 FB, 25 MB/PS-RP). Groups were comparable at the first assessment on age, sex, body mass index, WOMAC score and all gait outcomes. No between-group difference reached statistical significance for any outcome, in either the linear or the categorical specification; all 18 visit-specific contrasts included the null value. Within the FB group, gait speed, stride length, the symmetry index, the gait quality index and 2MWT distance decreased significantly between the second and third assessments, a change based on six patients. Conclusions: Under the conditions of this study, no significant differences in global spatiotemporal gait performance or ambulation capacity were detected between FB and MB/rotating-platform prostheses. Because the study was not designed or powered as an equivalence trial, lacks preoperative and joint-level kinematic data, and cannot separate bearing design from the surgical approach with which it was collinear, these findings do not establish that the two designs perform equivalently. Full article

Spinal accessory nerve (SAN) injury is one of the most common causes of shoulder impairment after neck dissection for head and neck cancer. Dysfunction of trapezius muscle function is related to scapular biomechanics, and it results in pain, along with a reduction in range of motion, muscle weakness, and limitations in activities of daily living. Recently, exercise-based rehabilitation has been recognized as an important component of care. Evidence regarding the most effective rehabilitation strategies remains limited. The aim of this narrative review is to provide a comprehensive overview of SAN-related shoulder dysfunction following neck dissection for head and neck cancer, with particular emphasis on three main aspects: surgical strategies for preventing SAN injury, postoperative rehabilitation interventions for patients with established or suspected SAN-related dysfunction, and clinical and patient-reported outcome measures used to assess shoulder function and disability. A narrative review was conducted. Papers evaluating rehabilitation interventions for spinal accessory nerve injury after head and neck cancer surgery were included, and studies on rehabilitation interventions (manual therapy, strengthening, and supervised exercise) that are related to a reduction in pain and improvements in shoulder mobility, disability, and function were analyzed. Manual therapy enhanced cervical mobility and quality of life, strengthening improved short-term shoulder abduction, and supervised programs were more effective than home-based rehabilitation for pain and disability reduction. Targeted rehabilitation, including structured exercises and supervised physiotherapy, may improve shoulder mobility, reduce pain, and enhance functional recovery following spinal accessory nerve injury. Hospital-based supervised programs appear to offer greater short-term benefits. However, the limited evidence, small sample sizes, and heterogeneity in interventions prevent definitive recommendations. Further high-quality randomized trials with standardized protocols and long-term follow-up are needed. Full article

Background/Objectives: The optimal surgical approach for patients with lumbar degenerative disc disease (DDD) remains a subject of ongoing debate, particularly when comparing anterior lumbar interbody fusion (ALIF) and total disc replacement (TDR). The primary objective of this study was to compare short-term outcomes between these two surgical approaches in terms of clinical efficacy, patient satisfaction, and safety profile. The secondary objective was to evaluate patient-specific variables associated with postoperative improvement in order to identify potential factors that may guide a personalized surgical strategy. Methods: This retrospective, single-center observational study included 87 patients who underwent single-level lumbar surgery using either an ALIF (n = 38) or TDR (n = 49) approach between January 2021 and May 2025. Eligible patients were younger than 45 years and had complete preoperative, intraoperative, and 1-year follow-up data. Demographic, clinical, preoperative, and intraoperative variables, as well as patient satisfaction and quality-of-life improvement, were collected, analyzed, and compared between groups. The primary between-group analysis used analysis of covariance (ANCOVA) with adjustment for baseline outcome values and prespecified confounders (age, sex, body mass index, smoking status, ASA class). Longitudinal effects were assessed using a linear model with treatment × time interaction and cluster-robust standard errors. A formal smoking × surgical-strategy interaction was tested in a multivariable regression on 12-month Oswestry Disability Index (ODI) change. Reporting followed the STROBE guidelines for observational studies. Results: Both groups showed substantial within-group improvement at all follow-up time points (all p < 0.05 except ALIF leg pain at 6 months; paired Wilcoxon test). Baseline-adjusted between-group comparisons (ANCOVA) showed a numerically modest early difference favoring TDR for Visual Analogue Score (VAS) low-back pain at 3 and 6 months (adjusted Δ = −1.46, 95% CI −2.63 to −0.30, p = 0.016 at 3 months; −1.35, 95% CI −2.63 to −0.07, p = 0.043 at 6 months), below the minimum clinically important difference of 2 points though neither survived Holm–Bonferroni correction for multiple comparisons. The formal treatment × time interaction test was not significant for any outcome (ODI p = 0.39; VAS back p = 0.29; VAS leg p = 0.06. Overall, 92% of patients in the ALIF group and 86% of patients in the TDR group reported being satisfied or very satisfied, and 60–72% of patients returned to work. Radiographic analysis in the TDR group showed maintained segmental mobility, with median range of motion of 4.0° (IQR 2.0–8.0°) overall (median 6.0°, IQR 4.0–8.5° at L4–L5; 3.0°, IQR 2.0–6.0° at L5–S1). A multivariable regression model on 12-month ODI change, adjusted for age, sex, BMI, ASA class, and baseline ODI, showed a highly significant smoking-burden × surgical-strategy interaction (dose–response smoker code × TDR coefficient = −9.47, 95% CI −15.6 to −3.3, p = 0.004): higher preoperative smoking burden was associated with reduced ODI improvement specifically in the TDR group (Spearman r = −0.41, p = 0.004) but not the ALIF group (Spearman r = +0.17, p = 0.32). Conclusions: This cohort study suggests that both ALIF and TDR were associated with substantial clinical improvement and high patient satisfaction at 1 year postoperatively; because treatment selection was not randomized, these findings should not be interpreted as evidence of comparative effectiveness. A modest early difference favoring TDR was observed for VAS low-back pain (below the minimum clinically important difference); no statistically significant between-group differences were demonstrated for any outcome after correction for multiple comparisons. The observed associations between 1-year ODI improvement and patient-specific variables require confirmation in larger independent cohorts. The finding of a significant smoking-burden × surgical-strategy interaction is an exploratory and hypothesis-generating and, if confirmed in prospective cohorts, may inform preoperative optimization strategies for TDR candidates. Full article

Background/Objectives: Advanced acquired or congenital temporomandibular joint (TMJ) pathology may severely impair oral function and quality of life, often requiring total joint replacement when conservative and reconstructive treatments fail. Custom-made TMJ prostheses (CMTMJP) have been developed to improve anatomical adaptation and functional outcomes. The aim of this study was to evaluate the medium- to long-term clinical outcomes of CMTMJP from Avinent^® in patients with advanced TMJ pathology requiring TMJ replacement. Methods: An observational follow-up study was conducted in patients treated with CMTMJP at the Department of Oral and Maxillofacial Surgery of Hospital Clínic and Barnaclínic (Barcelona, Spain). Clinical outcomes, including pain intensity assessed using a numerical rating scale, maximum interincisal opening (mm), and occlusal stability, were evaluated before and after surgery. Patients were followed for 50–70 months after implantation. Results: Functional improvement was maintained over time, with satisfactory pain control, stable occlusion, and adequate mandibular mobility. No CMTMJP failures, complications, or adverse events related to the prostheses were recorded. Surgeons reported favorable outcomes regarding the planning protocol, surgical placement, and postoperative management of the CMTMJP. Conclusions: CMTMJP replacement appears to be a predictable and reliable treatment option when the TMJ needs to be replaced for any cause, such as degenerative, acquired or congenital condition. The CMTMJP described in this series demonstrated good functional performance and long-term stability, with no major complications observed during 50–70 months of follow-up. Full article

Introduction: Abdominal wall hernias (AWH) represent distinct pathological structural defects, with incisional hernias occurring as late surgical failures following laparotomy, and prehabilitation has shown promise in improving functional recovery. However, access to hospital-supervised programmes is frequently limited. Methodology: A multidisciplinary team developed the HERNIACare Lab mobile application, integrating clinical surgery, biomedical engineering, and sports science expertise. The development process involved clinical evidence synthesis, structured exercise protocol design (FITT-VP principles), software architecture development, and system integration. Results: The application incorporates four primary functional modules: baseline isometric strength stratification, programme scheduling, progressive multicomponent training, and post-session exertion and symptom monitoring. It features sex-specific tertile-based stratification, progressive overload principles with intra-abdominal safety constraints, and an accessible interface. Discussion: HERNIACare Lab addresses practical barriers to prehabilitation by delivering a structured home-based intervention tailored to baseline functional status. Conclusions: The application provides a clinically informed, accessible framework for remote prehabilitation, with clinical safety, usability, and effectiveness to be evaluated in prospective clinical trials. Full article

Background: Endovascular exclusion of popliteal artery aneurysms (PAAs) with long covered stent-grafts is valuable for patients unfit for open surgery but is undermined by late stent thrombosis, even in fully scaffolded segments without kinking, a failure best clarified by computational fluid dynamics (CFD), which requires anatomically accurate 3D models—difficult to obtain in the mobile knee. Methods: In this prospective, single-centre study, consecutive patients undergoing endovascular PAA repair over 24 months (≥20 patients) underwent CT angiography in three knee positions (full extension, 45° and 90° flexion). Every treated limb was included, with limb as the unit of analysis. Images undergo a geometric pipeline: segmentation in 3D Slicer, then refinement in MeshLab, Meshmixer and VMTK. Meshes are converted to hexahedral volumes (ANSA Cadense) and simulated under pulsatile flow (ANSYS Fluent). Primary endpoints are time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative residence time (RRT) over the stented segment, plus the surface proportion meeting thrombogenic criteria; positions are compared via linear mixed-effects models with limb nested within patient. Results: The protocol reproducibly yields watertight, artefact-free models preserving physiological morphology and supporting TAWSS, OSI and RRT quantification across knee positions. Conclusions: This protocol standardizes generation of CFD-ready popliteal geometries, enabling positional analysis of stent thrombosis. Full article

Bladder retroflexion associated with perineal hernia may cause urinary dysfunction, and surgical correction can be challenging after repeated procedures because of extensive adhesions and altered anatomy. An 11-year-old, 7.5 kg, castrated male Pomeranian was referred for recurrent bilateral perineal hernia, bladder retroflexion, and persistent urinary dysfunction after multiple perineal and abdominal surgeries. A previous attempt at abdominal bladder reduction and cystopexy had failed because adhesions prevented adequate mobilization of the bladder. During salvage surgery, bilateral perineal adhesiolysis was performed first to release the displaced urinary tract structures, followed by an abdominal approach to restore the bladder to its normal intra-abdominal position. Modified bilateral vas deferens pexy was then performed by fixing the residual vasa deferentia to the rectal wall, and each side of the pelvic diaphragm was reconstructed according to the available tissues and defect configuration. Retrograde urethrocystography performed 8 days postoperatively demonstrated short-term anatomical correction, with restoration of the normal positions of the bladder, bladder neck, and urethra. Urinary function gradually improved but had not completely normalized by 150 days. Without further objective imaging, long-term mechanical stability and prevention of recurrence could not be established. This case describes a multimodal salvage strategy for recurrent bilateral perineal hernia with markedly altered anatomy after repeated surgery. Full article

Background/Objectives: Inpatient falls are an important patient-safety concern in rehabilitation hospitals; however, factors determining whether a fall results in fracture remain poorly understood. This study investigated clinical factors associated with radiographically confirmed fracture after inpatient falls, evaluated the fracture-discrimination performance of the Morse Fall Scale and Hendrich II Fall Risk Model, and characterized the resulting orthopaedic burden. Methods: This single-center retrospective cohort study included adults who experienced a documented fall while hospitalized in a tertiary physical medicine and rehabilitation hospital. Patients with and without radiographically confirmed fractures were compared regarding demographic characteristics, comorbidity burden, bone health, continence, mobility, medication exposure, laboratory findings, and fall circumstances. Factors associated with fracture were evaluated using univariable analyses and a parsimonious Firth penalized logistic regression model. Discrimination of the Morse and Hendrich II scores was assessed using receiver operating characteristic analysis. Results: Among 91 adult inpatient fall events, 51 (56.0%) resulted in fracture. In unadjusted analyses, patients with fractures had lower lumbar spine T-scores and higher frequencies of urinary and fecal incontinence, whereas age, sex, femoral T-score, mobility status, fall location, and fall mechanism did not differ significantly between groups. In the adjusted Firth model comprising 87 complete cases and 49 fracture events, no variable reached independent statistical significance; lower lumbar T-score (adjusted odds ratio [aOR], 0.74; 95% confidence interval [CI], 0.52–1.05; p = 0.073) and urinary incontinence (aOR, 2.30; 95% CI, 0.87–6.12; p = 0.082) showed the strongest associations. The Morse and Hendrich II scores demonstrated poor fracture discrimination, with AUCs of 0.372 (95% CI, 0.255–0.489) and 0.411 (95% CI, 0.295–0.526), respectively, without a significant difference between them (p = 0.500). Among patients with fractures, 41.2% sustained major fractures, 27.5% underwent surgery, and 11.8% developed complications. Conclusions: Among documented inpatient falls in this rehabilitation cohort, fractures were common and imposed a clinically important orthopaedic burden. Conventional fall-risk scores did not distinguish falls resulting in fracture, suggesting that prediction of fall occurrence and prediction of orthopaedic injury represent distinct clinical objectives. Fracture-prevention strategies in rehabilitation settings should therefore complement general fall-risk assessment with targeted evaluation of skeletal and functional vulnerability. Full article

Background: Perioperative blood loss represents a major challenge in elderly patients undergoing hip fracture surgery. Although tranexamic acid (TXA) has been shown to reduce bleeding complications, evidence from large registry-based cohorts remains limited. This study assessed the efficacy and safety of perioperative TXA administration in geriatric proximal femoral fracture surgery and evaluated in a subgroup analysis whether repeated TXA administration provides additional benefit compared with a single intraoperative dose. Methods: Data were derived from the Registry for Geriatric Trauma of the German Trauma Society (ATR-DGU), a prospective multicenter registry of patients aged ≥70 years undergoing surgery for proximal femoral fractures. From a total cohort of 23,830 patients, 1:1 nearest-neighbor matching based on age, sex, America Society of Anesthesiologists (ASA) classification, fracture type, and pre-fracture mobility yielded 3697 patients receiving intraoperative TXA and 3697 controls without TXA. Outcomes included transfusion requirements, thromboembolic events, mortality, reoperation rate, and length of stay. A subgroup analysis compared single-dose intraoperative TXA with combined pre- and intraoperative administration. Results: Intraoperative TXA significantly reduced packed red blood cell transfusion rates compared with controls (44.6% vs. 52.2%; p < 0.001). No significant differences were observed in thromboembolic events, mortality, overall complication rates, or length of hospital stay. Subgroup analysis showed no additional benefit of repeated pre- and intraoperative TXA administration compared with a single intraoperative dose but was associated with a significantly higher incidence of thromboembolic risks in the multiple-dose cohort (3.56% vs. 1.1%; p = 0.038). Conclusions: Intraoperative TXA administration significantly reduces transfusion requirements in geriatric patients undergoing surgery for proximal femoral fractures without increasing thromboembolic complications or mortality. TXA should therefore be considered a safe and effective adjunct in the perioperative management of geriatric hip fracture patients. Full article

Background: Accurate pain assessment in children remains challenging because conventional behavioural assessment tools are subjective and provide only intermittent observations. This study evaluated a vision-based sensing system for automated paediatric pain detection using two-dimensional facial landmark trajectories derived from three-dimensional geometric normalisation of frontal facial video recordings. Methods: In a prospective observational study, 125 children aged 6–17 years undergoing elective surgery had frontal facial videos recorded pre- and postoperatively using a custom-developed iOS mobile application. Video frames were processed using the MediaPipe Face Mesh framework to estimate 478 facial landmarks with three-dimensional coordinates. After three-dimensional normalisation, the normalised x- and y-coordinates were segmented into one-second trajectories, and analysed using a previously developed Spatial-Temporal Attention Long Short-Term Memory (STA-LSTM) framework. Reference pain labels (pain vs. no pain) were derived from observer-rated revised Face, Legs, Activity, Cry, Consolability (r-FLACC) scores. Results: The sensing system analysed 971 annotated clips and was trained on 6438 balanced landmark trajectories. On an independent validation dataset, it achieved an area under the receiver operating characteristic curve of 0.994, with an accuracy of 97.15%, precision of 86.78%, recall of 97.83%, and F1-score of 91.97% for binary pain classification. Conclusions: A landmark-based, non-contact vision sensor combined with a STA-LSTM network achieved high performance for automated detection of observer-labelled pain states in children, supporting facial landmark trajectories as a practical signal representation for privacy-conscious continuous pain monitoring. Full article

Background: Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA), also known as the Liwen procedure, is an emerging septal reduction therapy for obstructive hypertrophic cardiomyopathy (OHCM), but standardized early rehabilitation pathways after PIMSRA are lacking. We aimed to develop an enhanced recovery after surgery (ERAS)-informed, risk-stratified stepwise rehabilitation pathway after PIMSRA, describe its documented early inpatient implementation in selected clinically stable patients, report preliminary in-hospital safety observations, and explore its associations with hospitalization outcomes. Methods: This exploratory single-center retrospective cohort study included 102 patients with OHCM who underwent first-time PIMSRA between 1 July 2023 and 3 August 2025 and met the same predefined post-PIMSRA rehabilitation eligibility criteria. Patients were classified according to the care pathway actually received: usual care (n = 53) or early inpatient implementation of the ERAS-informed rehabilitation pathway plus usual care (n = 49). The planned pathway incorporated rehabilitation eligibility screening, risk stratification, staged early mobilization, structured physiological monitoring with predefined stop criteria, multidisciplinary coordination, and patient education. Pathway selection was nonrandomized and reflected patient- or family-related preferences and implementation or logistical factors. Results: The ERAS-informed group had a shorter ICU length of stay than the usual-care group in the primary analysis [20.0 (5.8–26.6) h vs. 23.0 (17.1–45.5) h; Hodges–Lehmann difference, −6.0 h; 95% CI, −16.51 to −0.53; p = 0.022]. Three ICU stays > 100 h occurred in the usual-care group and none in the ERAS-informed group; after excluding these observations, the comparison was attenuated (p = 0.060). The total hospital length of stay was shorter in the ERAS-informed group [8.0 (7.0–11.0) d vs. 9.0 (8.0–13.0) d; difference, −1.0 d; 95% CI, −2.02 to −0.03; p = 0.029], whereas the post-PIMSRA length of stay did not differ significantly (p = 0.058). The admission-to-PIMSRA interval was also not significantly different (p = 0.309). No rehabilitation-related adverse events were recorded in the ERAS-informed group during hospitalization (0/49; exact binomial 95% CI, 0.0–7.3%). Conclusions: Among selected clinically stable patients after PIMSRA, early inpatient implementation of pathway components was achievable, primarily during the period corresponding to planned stages 1–2. No rehabilitation-related adverse events were recorded, providing preliminary patient-level in-hospital safety observations. Fidelity, adherence, completion, and reproducibility of the complete four-stage, risk-stratified pathway were not established. Length-of-stay associations were exploratory and should not be interpreted causally. Full article

Background and Objectives: Reconstruction of extensive acetabular bone defects in revision total hip arthroplasty (THA) remains technically demanding and is associated with a high risk of complications. Custom-made three-dimensional (3D)-printed implants have emerged as a patient-specific option for managing severe bone loss, particularly in Paprosky type 3A and 3B defects. The aim of this multicentre study was to evaluate the early clinical, radiographic, and surgical outcomes following single-stage reconstruction using custom-made 3D-printed acetabular implants. Materials and Methods: This retrospective multicentre study included 62 patients treated between 2021 and 2024 at four orthopaedic departments. All patients had Paprosky type 3A (n = 34) or 3B (n = 28) acetabular defects and underwent reconstruction with custom-made 3D-printed implants. A minimum clinical follow-up of 6 months was required for inclusion. Preoperative computed tomography was used for implant design and surgical planning. Clinical assessment included pain using the Visual Analogue Scale, functional evaluation using the Harris Hip Score and Karnofsky Performance Scale, mobility, range of motion, and use of orthopaedic aids. Radiographic evaluation included plain radiographs and computed tomography. Standardised functional and CT outcome assessments were performed during the first 6 months after surgery, whereas the mean overall follow-up represented subsequent clinical surveillance. Mean follow-up was 27 months. Results: All patients had undergone multiple previous surgical procedures before implantation of the custom-made prosthesis. The interval between primary arthroplasty and implantation of the custom-made implant ranged from 9 to 31 years. During follow-up, improvements in pain, mobility, and functional performance were observed across the entire cohort. The reported functional and CT outcomes refer to the standardised 6-month assessment period. Radiographic evaluation demonstrated satisfactory implant positioning and restoration of hip biomechanics. Progressive radiographic findings suggestive of implant integration were observed during follow-up. The most common complications were postoperative wound-healing disorders and prosthetic dislocation, particularly in patients with more extensive bone defects. Conclusions: Single-stage reconstruction using custom-made 3D-printed implants appears to be a feasible treatment option for patients with Paprosky type 3A and 3B defects, resulting in improvements in pain, mobility, and functional performance. Radiographic assessment suggested stable implant fixation and progressive implant integration during early follow-up. However, postoperative wound-healing disorders, infection, and prosthetic dislocation remain clinically relevant complications, particularly in patients with more extensive bone defects. Further studies with longer follow-up are required to determine long-term implant durability, implant survivorship, and functional outcomes. Full article

Although robust observational data have long associated physical activity with improved colon cancer survival, the lack of randomized evidence has perpetuated a “causality gap,” confining exercise to supportive lifestyle advice and creating a clinical dilemma for surgeons. This paradigm has been fundamentally reshaped by the landmark phase III CHALLENGE trial. This review synthesizes the clinical, epidemiological, and translational evidence establishing exercise as a validated, disease-modifying intervention. In the CHALLENGE trial, a 3-year structured physical activity program significantly improved both disease-free survival (HR 0.72) and overall survival (HR 0.63) in patients with resected stage III or high-risk stage II colon cancer post-adjuvant chemotherapy, demonstrating a clinically meaningful additive benefit following completion of standard adjuvant chemotherapy. Mechanistically, exercise drives a multi-layered host–tumor reprogramming. Each acute exercise bout triggers transient surges of muscle-derived myokines (e.g., IL-6, SPARC) and immune-cell mobilization, enhancing natural killer and CD8⁺ T cell tumor infiltration. Cumulatively, these repeated acute pulses drive chronic adaptations, including downregulation of the pro-proliferative insulin/IGF-1 axis, attenuation of pro-tumor systemic inflammation, and microenvironmental remodeling at metastatic sites. To bridge the implementation gap, exercise oncology must transition from vague recommendations to structured, biomarker-driven clinical prescriptions defining type, dose, and duration. Mirroring the institutional success of Enhanced Recovery After Surgery (ERAS) protocols, physical activity should be systematically embedded into multidisciplinary, post-adjuvant oncologic care pathways. As the primary coordinators of colorectal cancer care, gastrointestinal surgeons must lead the transformation of exercise from optional supportive care into a validated, disease-modifying standard of care. Full article

Background and Clinical Significance: Local recurrence of extremity leiomyosarcoma after multiple operations and radiotherapy presents a major therapeutic challenge. Adequate oncologic clearance must be balanced against preservation of skeletal stability and reliable wound coverage within a scarred and poorly vascularized tissue bed; Case presentation: A 78-year-old woman presented with a painful recurrent leiomyosarcoma of the anterior proximal third of the right leg after three previous operations and adjuvant radiotherapy. Preoperative magnetic resonance imaging demonstrated a recurrent soft-tissue lesion extending to the anterior surface of the proximal tibia. Staging computed tomography of the chest, abdomen, and pelvis showed no distant metastatic disease before definitive surgery. A one-stage limb-sparing procedure was performed, including resection of the recurrent tumor bed and an approximately 7-cm anterior cortical lamella of the proximal tibia containing an area considered suspicious for neoplastic involvement. A locking tibial plate was applied prophylactically to reduce the risk of pathological fracture. The approximately 12 × 10-cm soft-tissue defect was covered with a muscle flap from the medial head of the gastrocnemius and a free skin graft harvested from the paraumbilical region. Gross pathological examination identified an 8-cm subcutaneous tumor formation. Histopathological examination demonstrated well-differentiated leiomyosarcoma; the spindle cells expressed vimentin, actin, and desmin. All examined resection lines were free of tumor infiltration. No pathogenic microorganism was isolated, and no early postoperative complication was documented. The patient mobilized with walking aids and protected weight bearing for 30 days. At approximately 16 months, the flap and skin graft provided stable coverage, no postoperative tibial fracture or clinically apparent implant-related complication had occurred, and the patient was independently ambulatory. Postoperative MRI demonstrated expected postoperative changes and a small indeterminate subcutaneous focus without diffusion restriction, requiring continued surveillance; Conclusions: This case illustrates the feasibility of combining oncologic resection, prophylactic tibial stabilization, and vascularized soft-tissue reconstruction in a previously irradiated extremity. The documented early functional and reconstructive outcome supports this individualized limb-sparing approach, although longer oncologic surveillance is required. Full article

Background: Geriatric trauma centers (ATZ) in Germany provide interdisciplinary care for elderly trauma patients with the objective of enhancing treatment outcomes following proximal femur fractures. Delirium, a prevalent and grave complication in this patient population, has been associated with elevated mortality and functional limitations. The objective of this study was to examine the prevalence and consequences of delirium in proximal femur fractures by utilizing the Registry for Geriatric Trauma (ATR-DGU). Methods: The study encompassed 32,934 patients aged ≥70 years who sustained proximal femoral fractures during the period 2022–2023. The demographic and clinical parameters, fracture type, time of surgery, mobility, complications, and mortality were meticulously documented. The primary endpoint of the study was the occurrence of delirium and its influence of the outcome of hip fracture patients. Additionally an analysis was conducted to account for peri-implant/periprosthetic fractures. Results: Of the 21,127 patients who underwent screening, 23.6% had already been diagnosed with delirium upon admission. The delirium rate did not differ between hip-/pertrochanteric and peri-implant/periprosthetic fractures. Patients in a delirious state were found to be older, frailer, and more dependent on care. They exhibited more non-surgical complications, poorer mobility, and more frequent transfers to nursing homes. In the context of peri-implant/periprosthetic fractures, delirium showed no significant difference regarding surgical revision (p = 0.192) and mortality rates (p = 0.229). Conclusions: Delirium is therefore a prevalent and clinically significant complication. Its early detection and prevention are essential for proximal femur fracture patients in orthogeriatric care. Full article