Search Results (373)

Ribulose bisphosphate carboxylase (RuBisCO) is the primary regulator of carbon fixation in the plant kingdom. Although the large subunit (RBCL) is the site of catalysis, RuBisCO efficiency is also influenced by the sequence divergence of the small subunit (RBCS). This project compared the RBCS gene family in C3 and C4 grasses to identify genetic targets for improved crop photosynthesis. Triticeae/Aveneae phylogeny groups exhibited a syntenic tandem duplication array averaging 326.1 Kbp on ancestral chromosomes 2 and 3, with additional copies on other chromosomes. Promoter analysis revealed a paired I-box element promoter arrangement in chromosome 5 RBCS of H. vulgare, S. cereale, and A. tauschii. The I-box pair was associated with significantly enhanced expression, suggesting functional adaptation of specific RBCS gene copies in Triticaeae. H. vulgare-derived pan-transcriptome data showed that RBCS expression was 50.32% and 28.44% higher in winter-type accessions compared to spring types for coleoptile (p < 0.05) and shoot, respectively (p < 0.01). Molecular dynamics simulations of a mutant H. vulgare Rubisco carrying a C4-like amino acid substitution (G59C) in RBCS significantly enhanced the stability of the Rubisco complex. Given the known structural efficiency of C4 Rubisco complexes, G59C could serve as an engineering target for enhanced RBCS in economically crucial crop species which, in comparison, possess less efficient Rubisco complexes. Full article

Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article

Cannabis sativa L. is a versatile plant with significant medicinal, industrial, and recreational applications. Its therapeutic potential is attributed to cannabinoids like THC and CBD, whose production is influenced by environmental factors, such as radiation, temperature, and humidity. Radiation, for instance, is essential for photosynthetic processes, acting as both a primary energy source and a regulator of plant growth and development. This review covers key factors affecting C. sativa cultivation, including photoperiod, light spectrum, cultivation methods, environmental controls, and plant growth regulators. It highlights how these elements influence flowering, biomass, and cannabinoid production across different growing systems, offering insights for optimizing both medicinal and industrial cannabis cultivation. Studies indicate that photoperiod sensitivity varies among cultivars, with some achieving optimal flowering and cannabinoid production under extended light periods rather than the traditional 12/12 h cycle. Light spectrum adjustments, especially red, far-red, and blue wavelengths, significantly impact photosynthesis, plant morphology, and secondary metabolite accumulation. Advances in LED technology allow precise spectral control, enhancing energy efficiency and cannabinoid profiles compared to conventional lighting. The photoperiod plays a vital role in the cultivation of C. sativa spp., directly impacting the plant’s developmental cycle, biomass production, and the concentration of cannabinoids and terpenes. The response to photoperiod varies among different cannabis cultivars, as demonstrated in studies comparing cultivars of diverse genetic origins. On the other hand, indoor or in vitro cultivation may serve as an excellent alternative for plant breeding programs in C. sativa, given the substantial inter-cultivar variability that hinders the fixation of desirable traits. Full article

Background: Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace^® device for treating recurrent apical POP. Methods: A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace^® device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024. Results: The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP. Conclusions: Minimally invasive SSL fixation using the EnPlace^® device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates. Full article

A new, simple machine was developed to address a long-standing challenge in biomedical and mechanical engineering: how to enhance the primary stability and long-term integration of screws and implants in low-density or heterogeneous materials, such as bone or composite substrates. Traditional screws often rely solely on external threading for fixation, leading to limited cohesion, poor integration, or early loosening under cyclic loading. In response to this problem, we designed and built a novel device that leverages a unique mechanical principle to simultaneously perforate, collect, and compact the substrate material during insertion. This mechanism results in an internal material interlock, enhancing cohesion and stability. Drawing upon principles from physics, chemistry, engineering, and biology, we evaluated its biomechanical behavior in synthetic bone analogs. The maximum insertion (MIT) and removal torques (MRT) were measured on synthetic osteoporotic bones using a digital torquemeter, and the values were compared directly. Experimental results demonstrated that removal torque (mean of 21.2 Ncm) consistently exceeded insertion torque (mean of 20.2 Ncm), indicating effective material interlocking and cohesive stabilization. This paper reviews the relevant literature, presents new data, and discusses potential applications in civil infrastructure, aerospace, and energy systems where substrate cohesion is critical. The findings suggest that this new simple machine offers a transformative approach to improving fixation and integration across multiple domains. Full article

This study investigates hearing outcomes of stapedotomy using two different types of prostheses: manually crimped MatriX and thermally activated NiTiBOND. The primary objective was to determine whether the method of prosthesis fixation to the long process of incus influences postoperative results. A retrospective analysis was conducted on 155 patients with otosclerosis; 90 received the NiTiBOND prosthesis and 65 received the MatriX prosthesis. Choice of prosthesis was determined intraoperatively based on position of chorda tympani. If the nerve was located near the incus and the prosthesis fixation site, the surgeon opted for MatriX prosthesis to avoid potential injury from activation of the NiTiBOND. Audiometric evaluations revealed no statistically significant differences in bone conduction thresholds on the first postoperative day (p = 0.275) or at six weeks (p = 0.899), postoperative air-bone gap (p = 0.810), air-bone gap closure (p = 0.489), overclosure (p = 0.436), or bone conduction at 4 kHz (p = 0.324). Chorda tympani nerve injury occurred in 9.2% of cases with MatriX prosthesis and 6.7% with NiTiBOND prosthesis (p = 0.556). Our findings highlight the theoretical and practical significance of comparing both prostheses, demonstrating that NiTiBOND can serve as an alternative in anatomically favorable cases, thereby guiding treatment choices. Full article

Volcanic ash from explosive eruptions can significantly alter lake water chemistry through ash–water interactions, potentially influencing primary productivity. Alkaline (soda) lakes, mostly found in volcanic regions, are particularly sensitive due to their unique geochemical properties. However, the effects of volcanic ash on the biogeochemistry and phytoplankton dynamics of soda lakes remain poorly understood. This study presents the first nutrient release experiments using natural alkaline water from Lake Van (Türkiye) and volcanic ash from four volcanoes (Hekla, Arenal, Sakurajima, Rabaul-Tavurvur) with different compositions. Sixteen abiotic leaching experiments were conducted over contact durations ranging from 1 to 24 h. Results show rapid increases in pH (~0.4–0.5 units), enhanced silica and phosphate concentrations, and elevated levels of Na, K, Ca, Sr, and S. Nitrate and Mg were generally depleted. The low N:P ratio (~0.06) in Lake Van water indicated nitrogen limitation, partially mitigated by ash-derived inputs. Cyanobacteria dominated the phytoplankton community (95%), consistent with nitrogen fixation under low-nitrate conditions. Elevated silica may promote diatom growth, while changes in Mg/Ca ratios suggest possible impacts on carbonate precipitation and microbialite development. These findings highlight the biogeochemical and ecological relevance of volcanic ash inputs to soda lakes. Full article

Azospirillum is a well-studied genus of plant growth-promoting rhizobacteria (PGPR) and one of the most extensively researched diazotrophs. This genus can colonize rhizosphere soil and enhance plant growth and productivity by supplying essential nutrients to the host. Azospirillum–plant interactions involve multiple mechanisms, including nitrogen fixation, the production of phytohormones (auxins, cytokinins, indole acetic acid (IAA), and gibberellins), plant growth regulators, siderophore production, phosphate solubilization, and the synthesis of various bioactive molecules, such as flavonoids, hydrogen cyanide (HCN), and catalase. Thus, Azospirillum is involved in plant growth and development. The genus Azospirillum also enhances membrane activity by modifying the composition of membrane phospholipids and fatty acids, thereby ensuring membrane fluidity under water deficiency. It promotes the development of adventitious root systems, increases mineral and water uptake, mitigates environmental stressors (both biotic and abiotic), and exhibits antipathogenic activity. Biological nitrogen fixation (BNF) is the primary mechanism of Azospirillum, which is governed by structural nif genes present in all diazotrophic species. Globally, Azospirillum spp. are widely used as inoculants for commercial crop production. It is considered a non-pathogenic bacterium that can be utilized as a biofertilizer for a variety of crops, particularly cereals and grasses such as rice and wheat, which are economically significant for agriculture. Furthermore, Azospirillum spp. influence gene expression pathways in plants, enhancing their resistance to biotic and abiotic stressors. Advances in genomics and transcriptomics have provided new insights into plant-microbe interactions. This review explored the molecular mechanisms underlying the role of Azospirillum spp. in plant growth. Additionally, BNF phytohormone synthesis, root architecture modification for nutrient uptake and stress tolerance, and immobilization for enhanced crop production are also important. A deeper understanding of the molecular basis of Azospirillum in biofertilizer and biostimulant development, as well as genetically engineered and immobilized strains for improved phosphate solubilization and nitrogen fixation, will contribute to sustainable agricultural practices and help to meet global food security demands. Full article

Background: Femoral neck fractures (FNF) have high mortality rates. Surgical delay likely contributes. Dynamic hip screw (DHS) fixation is common for FNF, and the tip–apex distance (TAD) measures screw position in the femoral head. A TAD >20–25 mm is considered a risk factor for screw cut-out. This study investigated the association between (1) surgical delay and complication/mortality rates within two years post-surgery and (2) TAD and postoperative complications following DHS in FNF. Methods: This retrospective study included 325 FNF patients who underwent DHS osteosynthesis at Regional Hospital Randers, Denmark from 2015–2021. The primary composite outcome included complications measured on radiographs (e.g., screw cut-out, avascular necrosis), reoperation, or death within 2 years. Radiographs were evaluated for TAD and postoperative complications/reoperations. Surgical delay was defined as the time from the diagnostic radiograph to the start of the operation. TAD was measured based on radiographs. Electronic patient journals and national SSN registers were used to assess reoperation and death rates. Results: The mortality rate was 16% within 1 year and 26% within 2 years. The complication rate was 16% within 2 years. The median surgical delay was 7.9 h (IQR 5; 14). Surgical delay was significantly associated with the 1-year mortality rate (p < 0.01), but not with the 1-year complication rate (p = 0.77). Surgical delay was associated with complication rates 2 years post-surgery only for undisplaced fractures, p = 0.046. The median TAD was 16.3 mm (13.8; 18.7); no association with complications <1 year (p = 0.56) or <2 years (p = 0.99) was observed. There were 59/325 patients with TAD >20 mm, six of whom had complications, and 6/59 with TAD >25 mm, none of whom had complications. Conclusions: We report a significant association between surgical delay and mortality rates in FNF, despite surgical delays <24 h. Additionally, there was a significant association between surgical delay and risk of complication/reoperation 2 years post-surgery for undisplaced fractures. No association was found between TAD and complication rates following DHS fixation for FNF; however, only a few TAD outliers were observed. Full article

Background/Objectives: Ketorolac is commonly used for pain management after orthopedic surgery, but concerns regarding its effects on postoperative complications remain. This study evaluates the impact of ketorolac use on short- and long-term outcomes in adult patients undergoing uncemented primary total hip arthroplasty (THA), where implant stability relies on biological fixation through bone ingrowth into a porous-coated prosthesis rather than bone cement. Methods: A retrospective cohort study was conducted using the TriNetX Research Network. Patients aged 18 years or older who underwent uncemented primary THA between 1 January 2004 and 1 January 2024 were included. Two cohorts were compared: those who received ketorolac on the day of or within one week of surgery and those who did not. Cohorts were propensity score-matched. Outcomes were assessed at 30 days, 1 year, and 5 years postoperatively. Results: At 30 days, ketorolac use was associated with significantly lower risks of transfusion (RR: 0.6, p < 0.01). However, it was linked to higher rates of acute posthemorrhagic anemia (RR: 1.2, p < 0.01) and periprosthetic fracture (RR: 1.4, p < 0.01). At 1 year, ketorolac use was associated with reduced risks of death (RR: 0.8, p < 0.01) and transfusion (RR: 0.7, p < 0.01), but increased risks of acute posthemorrhagic anemia (RR: 1.2, p < 0.01), deep surgical site infection (SSI) (RR: 1.8, p = 0.01), superficial SSI (RR: 1.9, p < 0.01), periprosthetic joint infection (RR: 1.1, p < 0.01), wound dehiscence (RR: 1.2, p < 0.01), periprosthetic mechanical complication (RR: 1.2, p < 0.01), and periprosthetic fracture (RR: 1.5, p < 0.01). Conclusions: Our findings highlight the complex risk profile of ketorolac in uncemented THA patients and suggest that clinicians should carefully consider individual patient factors and engage in shared decision-making when counseling patients on the use of ketorolac in the perioperative setting. Full article

Inner Mongolia, a typical arid and semi-arid region in northern China, has undergone significant ecological transformation over the past two decades through climate shifts and large-scale ecological restoration projects. However, the relative contributions of climate and anthropogenic drivers to these ecological changes have not been sufficiently quantified. This study presents a comprehensive quantitative evaluation of the relative contributions of climate change, land conversion, and ecological management to changes in four critical ecosystem services—carbon sequestration, hydrological regulation, soil and water conservation, and windbreak and sand fixation—between 2001 and 2020. Using the residual trend method—a technique to separate climate-driven from human-induced effects—we further decomposed human influence into land conversion and management components. The results show that climate change was the primary driver, enhancing carbon sequestration and hydrological regulation but negatively impacting erosion control, with contributions often over 90%. In contrast, human activities had more spatially variable effects; while land conversion improved several services, it also heightened the vulnerability of sand fixation functions. The analysis further revealed ecosystem-type-specific responses, where grasslands and deserts responded better to management measures and forests and croplands showed greater improvements from land conversion. These findings offer crucial insights into the differentiated mechanisms and outcomes of ecological interventions, providing a scientific basis for optimizing restoration strategies and achieving sustainable ecosystem governance in climate-sensitive regions. Full article

Background/Objectives: Patellar instability in adolescents is a significant cause of short- and long-term morbidity and disability. Traditionally, patients with first-time patellar dislocation are managed nonoperatively, although most studies are not focusing on the adolescent athletic population. The primary objective of the current study was to compare patient-reported outcomes and complications in adolescent athletes who underwent surgery either after the first patellar dislocation or after the recurrence of the dislocation with a minimum postoperative follow-up of 48 months (48–75 months). Methods: A total of 39 adolescent athletes who underwent medial patellofemoral ligament (MPFL) reconstruction (Group A, after the first dislocation, and Group B, recurrent patella dislocation) were included in this study. In all the patients, the same MPFL reconstruction technique was applied using a semitendinosus autograft. The graft was fixed on the patella using a transverse tunnel and adjustable loop button fixation and, in the femur, using a tunnel and absorbable screw fixation. The tunnel was drilled obliquely to prevent penetration of the distal femoral physis. The preoperative and postoperative clinical and functional evaluations of the patients were conducted via the visual analog scale (VAS), the Lysholm Knee Scoring System, the Kujala Anterior Knee Pain Scale, and the Pediatric International Knee Documentation Committee (Pedi-IKDC), and the return to sports score was assessed via the Tegner Activity Scale (TAS). Results: At the latest follow-up, both groups demonstrated significant improvement in the Lysholm scores, with Group A achieving a mean of 92.57 ± 6.21 and Group B achieving a mean of 90.53 ± 8.21 (p = 0.062). Postoperatively, Group A achieved a mean Kujala score of 94.21 ± 9.23, whereas Group B reached 92.76 ± 12.39, with no statistically significant difference (p = 0.08). The Pedi-IKDC score improved postoperatively in both groups. In Group A, it increased from 67.98 ± 12.29 to 93.65 ± 4.1, and in Group B, from 56.21 ± 13.6 to 91.67 ± 6.21 (p = 0.067). The preoperative visual analog scale (VAS) score for pain was significantly lower in Group A (3.1 ± 1.13) than in Group B (4.2 ± 3.01, p < 0.01). At the latest follow-up, the VAS scores improved in both groups, with Group A reporting a mean score of 0.47 ± 1.01 and Group B 0.97 ± 1.32 (p = 0.083). The Tegner activity scores were similar between the groups preoperatively, with Group A at 7.72 ± 1.65 and Group B at 7.45 ± 2.09 (p = 0.076). Postoperatively, Group A had a mean score of 7.28 ± 2.15, whereas Group B had a mean score of 6.79 ± 3.70 (p = 0.065). The mean time to return to sports was significantly shorter in Group A (5.1 ± 1.3 months) than in Group B (7.6 ± 2.1 months) (p < 0.01). Overall, 84.61% of the patients returned to their previous activity level. Specifically, 95.2% (20/21) of patients in Group A achieved this outcome, whereas 72.22% (13/18) achieved it in Group B. Patient satisfaction was generally high, with 76% (16/21) of patients in Group A reporting being satisfied or very satisfied, compared with 77% (14/18) in Group B. Conclusions: MPFL reconstruction is a safe and effective procedure for both acute and recurrent patellar dislocation in adolescent athletes. While patients who underwent acute reconstruction returned to sport more quickly and showed higher absolute postoperative scores, the greatest overall improvement from preoperative to final follow-up was observed in those treated for recurrent instability. Both surgical approaches demonstrated high satisfaction rates and minimal complications, supporting MPFL reconstruction as a reliable option in both acute and recurrent cases. Full article

Brucellosis is a highly contagious, neglected, and re-emerging zoonotic bacterial disease that poses significant health and economic challenges globally for both humans and animals. Extensive literature is available for various diagnostic strategies; however, no comprehensive meta-analysis comparing the diagnostic tests used has been published. The present study aimed to estimate the relative risk (RR) of diagnostic tests used in humans and animals published between 2013 and 2023. Four databases were systematically searched, and the articles were screened using predefined inclusion and exclusion criteria. Ultimately, the screening process resulted in a total of 135 studies, including 328 comparisons of relevant data of 19,921 humans and 64,145 animals. The data from these studies were extracted, and the subgroup meta-analyses were conducted using the METABIN procedure in the “meta” package of the R statistical software (version 4.4.1). The forest plots were generated to estimate RR, and the funnel plots were used to assess publication and report bias. The subgroup analysis revealed that primary binding assays had higher comparative detection rates than the Rose Bengal plate test (RBPT) for brucellosis in humans [RR = 1.75 (95% CI: 1.35–2.26), I² = 73%]. Slow agglutination tests had lower detection rates than the RBPT, both in humans [RR = 0.68 (95% CI: 0.48–0.96), I² = 90%] and cattle [RR = 0.41 (95% CI: 0.25–0.68), I² = 96%]. Similarly, the complement fixation test (CFT) had a lower detection rate than the RBPT for brucellosis both in cattle [RR = 0.97 (95% CI: 0.94–0.99), I² = 9%] and sheep [RR = 0.97 (95% CI: 0.95–0.99), I² = 0%]. This meta-analysis demonstrated that, for the screening of brucellosis in both humans and animals, primary binding assays are the preferred diagnostic tools, followed by the RBPT and slow agglutination tests. However, their effective implementation requires context-specific diagnostic strategies and combined testing approaches to enhance accuracy and reliability. Full article

Open reduction and internal fixation (ORIF) is widely regarded as the primary treatment for acetabular fractures, but limitations arise in complex cases, leading to non-anatomical reductions and increased risk of post-traumatic osteoarthritis. Given the high incidence of secondary arthritis (12–57%) following ORIF, total hip arthroplasty (THA) is often necessitated, particularly in scenarios unsuitable for ORIF, such as extensive comminution or combined femoral head and neck fractures. The surgical landscape has shifted from a traditional “fix or replace” to a more integrated “fix and replace” approach, especially beneficial in managing elderly patients with osteoporotic bones. THA is applied across various timelines, including acute (0–3 weeks), delayed (3 weeks to 3 months), and late (beyond 3 months), each presenting distinct challenges and requiring specific strategies to optimize outcomes. The importance of precise bone defect classifications and the role of dual mobility cups in reducing dislocation risks are highlighted, alongside the use of modern surgical and fixation techniques to improve stability and patient outcomes. Enhanced recovery protocols and meticulous postoperative management are critical to addressing complications, such as infections and hardware interference, tailoring treatment approaches to each patient’s needs, and advancing care for complex acetabular fractures. Full article

Background/Objectives: Distal forearm fractures are the most common fractures in children. Three surgical techniques are most commonly used at the level of the radial diametaphysis on the distal forearm in children: K-wire, ascending ESIN (elastic stable intramedullary nail) or plate osteosynthesis. The aim of this study was to compare these procedures in children with distal diametaphyseal radius fractures regarding operative and functional outcome. Methods: A retrospective study was conducted in two level 1 trauma centers. Children and adolescents aged 2 to 15 years were included. The study period was from January 2010 to December 2022. The hospital information system was used to record patient age, gender, height, weight, fracture location, degree of angular deformity postoperatively, surgical procedure and postoperative complications, which were described in the medical records of the hospital information system. Complications graded by modified Clavien–Dindo–Sink served as the primary outcome. Reduction accuracy, operative and fluoroscopy times, immobilization length and postoperative motion were the secondary endpoints. Results: A total of 213 children were included in the study. K-wire osteosynthesis was performed in 25%, nailing in 19% and volar plate osteosynthesis in 55%. All ESIN were inserted in ascending technique. Complications occurred in 22% of patients and did not differ overall between techniques (p = 0.20). Severe complications were significantly more frequent after ESIN (20%) than after K-wires (7%) or plates (4%) (p = 0.04). Plate fixation achieved the most accurate alignment (≤5° angular deformity in 93% vs. 57% K-wires and 61% ESIN; p < 0.0001) and the fewest late motion restrictions (p = 0.02). K-wire surgery was fastest technique and required the least fluoroscopy, but necessitated the longest postoperative cast. Conclusions: Volar plating combines reliable anatomical reduction with a low rate of major complications and early mobilization, supporting its use in older children whose remodeling potential is limited. K-wires are a swift, minimally invasive option for younger patients, albeit with less precise reduction and prolonged immobilization. Conventional ESIN showed the highest burden of severe complications. Full article