Comparing the benthic nitrogenase activity and diazotrophic community assembly of three large river-connected freshwater lakes in eastern China.

Biological nitrogen fixation (BNF) is a crucial process that provides bioavailable nitrogen and supports primary production in freshwater lake ecosystems. However, the characteristics of diazotrophic community and nitrogenase activity in freshwater lake sediments remain poorly understood. Here, we investigated the diazotrophic communities and nitrogenase activities in the sediments of three large river-connected freshwater lakes in eastern China using 15N-isotope tracing and nifH sequencing. The sediments in these lakes contained diverse nitrogenase genes that were phylogenetically grouped into Clusters I and III. The diazotrophic communities in the sediments were dominated by stochastic processes in Hongze Lake and Taihu Lake, which had heterogeneous habitats and shallower water depths, while in Poyang Lake, which had deeper water and a shorter hydraulic retention time, the assembly of the diazotrophic community in the sediments was dominated by homogeneous selection processes. Temperature and water depth were also found the key environmental factors affecting the sediment diazotrophic communities. Sediment nitrogenase activities varied in the three lakes and within distinct regions of an individual lake, ranging from 0 to 14.58 nmol/(kg·hr). Nitrogenase activity was significantly correlated with ferric iron, total phosphorus, and organic matter contents. Our results suggested that freshwater lake sediment contain high diversity of nitrogen-fixing microorganisms with potential metabolic diversity, and the community assembly patterns and nitrogenase activities varied with the lake habitat.

Bone grafting augmentation choices in complex proximal humerus fractures: A systematic review.

Objective: To systematically identify and evaluate different bone graft augmentation techniques in the operative treatment of complex proximal humerus fractures. Methods: Four databases were searched from 1970 to February 2023 for Level I to IV English studies that investigated outcomes of different bone augments in the primary surgical fixation of proximal humerus fractures. The JBI critical appraisal checklist, methodological index for non-randomized studies and cochrane risk of bias tool were used to assess study quality. Descriptive statistics including weighted means are presented where applicable. Methods: Thirty-three articles including 964 patients met the inclusion. Seven bone augments were identified, including fibular strut allograft (693 patients across 21 studies), femoral head allograft (84 patients across 4 studies), iliac crest allograft (54 patients across 3 studies), iliac crest autograft (94 patients across 5 studies), humeral endosteal allograft (6 patients in 1 single study), unspecified cancellous allograft (28 patients in 1 single study) and distal clavicle autograft (3 patients in 1 single study). Mean patient age was 67.1 years, with female patients comprising 65.2 %. Fracture union rates were similar between groups, with an average of 99.6 %. The average Constant Murley Score (CMS) was not reported in the humeral endosteal allograft or the distal clavicle autograft group but was 81.8 (fibular strut allograft), 79.1 (femoral head allograft), 76.8 (iliac crest allograft), 77.7 (iliac crest autograft), and 81.5 (unspecified cancellous allograft) in the remaining groups. Revision surgery was required in 16.7 % of patients receiving humeral endosteal allograft, 7 % of patients with femoral head allograft, 2 % of iliac crest autografts and 1.9 % in the fibular allograft group. Reported complications included avascular necrosis, hardware complications and loss of reduction. Conclusion: Bone graft augmentation is an effective adjunct to open reduction internal fixation of complex proximal humerus fractures. Fibular strut allograft is the most common bone graft augment used. Majority of patients treated with bone graft augmentation achieved bony union (83%-100 %) and average CMS scores at final follow-up were similar between graft types (76-82). However, no conclusive data suggests superiority of one bone graft type over another. Future studies should aim to compare the outcomes amongst graft types.

Our Experience With 200 Cases of Inguinal Hernia Repair Using the Dynamic Self-Adjusting Prosthesis: A Case Series and Literature Review.

Introduction Inguinal hernioplasty (IH) is one of the most frequently performed surgical procedures globally. Today, a variety of surgical techniques and prosthesis types are available for this procedure. Methods At our center, we performed 200 inguinal hernioplasties using the dynamic self-adjusting prosthesis (protesi autoregolantesi dinamica, PAD) from May 1, 2022, to May 31, 2023. Our objective was to retrospectively analyze the outcomes and compare them with the current scientific literature on this surgical technique. Results Our results align with those reported by other authors using the same surgical technique. With the PAD technique, we assessed the type and frequency of adverse events up to 12 months following IH. All patients were male, with an average BMI of 26.6. Among the 200 hernias, 99 were right-sided, 101 were left-sided, 63 were direct, and 137 were indirect. The average length of hospitalization was one day. The most common postoperative complication was hematoma near the surgical site, but no prosthesis displacement was observed. In 71% of patients, analgesics were discontinued within 24 hours. The outcomes of our study are comparable to those reported by the inventor of this surgical technique. Conclusion The procedure has demonstrated safety and effectiveness and could serve as a viable alternative to traditional IH techniques.

Global trends of Pauwels type III femoral neck fractures: bibliometric analysis and visualized study.

Background: Pauwels type III femoral neck fractures, as a serious type of femoral neck fractures, have brought about a heavy economic burden on families and society for the high disability rate. Through bibliometric research and visualized analysis, this study aimed at elucidating the global research status of Pauwels type III femoral neck fractures to date, and predicting the future research trends in this field. Methods: Publications and associated information on Pauwels type III femoral neck fractures to date were retrieved from Web of Science Core Collection, and by VoSviewer and R package "bibliometrix", bibliometric analysis and visual presentation was conducted. Results: By retrieval, a total of 98 studies were refinedly extracted, and the volume of publications in this field increased year-over-year. China ranked first in terms of total publication volume and H-Index, with its total citation records second only to the United States. The country with the highest average citation frequency was Switzerland. SHANGHAI JIAO TONG UNIVERSITY was the most productive research institution. Among the authors in this field, Li, Jiantao had published the most researches. INJURY INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED and JOURNAL OF ORTHOPAEDIC TRAUMA were the two magazines with the highest publication volume, total citation records, and H-index. According to keywords co-occurrence analysis, the research content in the past 24 years is mainly divided into four different dimensions. Finite element analysis, femoral neck system, medial buttress plate, cannulated screws, hip screw, open reduction, complications are hot topics for future research. Conclusions: According to the global trends analysis of publications production, Pauwels type III femoral neck fractures are receiving increasing attention and input from scholars. China has made the greatest scientific research contribution among countries, but its academic quality should be improved further. The modified therapeutic methods designed for addressing the complications of traditional internal fixation for Pauwels III femoral neck fractures will be the future research hotspot.

A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing.

C1-C2 fixation has been developed for the rigid fusion of atlantoaxial instability. C1 lateral mass screw (C1 LMS)-C2 pedicle screw fixation is used more frequently due to its rigid fixation and high bone fusion rate. However, C1 screw placement is relatively unsafe even with recently developed image-based navigation systems. Patient-specific screw guide templates (PSGT) were developed to improve the accuracy and safety of C1 screw placement. Herein, we investigated the outcomes of the C1-C2 posterior fixation technique using PSGT. This was a retrospective study of six patients who underwent posterior cervical spinal fusion using the PSGT between January 2022 and April 2023. Operative time, estimated blood loss, intraoperative radiation dose, surgical cost, and screw placement accuracy were evaluated and compared with those achieved with preoperative CT-based navigation (navigation group, n = 15). Screw accuracy was assessed using Neo's classification. PSGT showed good results, although the differences were not statistically significant (operation time: 104.3 ± 9.7 min vs 116.4 ± 20.8 min; estimated blood loss: 56.7 ± 72.4 mL vs 123.2 ± 162.3 mL; and radiation dose: 1.8 ± 1.2 mSv vs 2.6 ± 0.8 mSv, respectively). PSGT was particularly better in terms of the accuracy of C1 LMS (PSGT: 100%, navigation: 83.3%). The deviation at the entry point was minimal, and the difference between the sagittal and transversal angles from the preoperative plan was small. We investigated the clinical efficacy of using the PSGT for C1-C2 posterior fixation. PSGT improved the accuracy of C1 LMS insertion.

Investigation of the emission and leaching behavior of characteristic heavy metals in sintered bricks prepared from oil-based drill cutting residues.

Oil-based drill cutting residues (OBDCR) are hazardous waste generated by the thermal desorption of oil-based drill cuttings. Recently, the utilization of OBDCR as building materials has attracted extensive attention, but the environmental risks during preparation and long-term usage remained unclear. In this study, OBDCR with a 40 % (wt./wt.) mixing ratio was used to prepare sintered bricks, and the emission and leaching behaviors of Ba, Mn, Zn, Ni, Cr, and Pb were investigated. The results indicated that the addition of OBDCR in bricks showed insignificant increase in the emission of Ba, Mn, Zn, Ni, and Cr, whereas the emission of Pb slight decreased from 10.5 to 8.6 µg/m3. The volatilization rates of these heavy metals were considerably low, with Ni showed the highest volatilization rate of only 1.45 % in OBDCR bricks. Moreover, the leaching behavior of Ba, Mn, Zn, Ni, Cr, and Pb in bricks were studied. The results indicated that surface wash-off was the main controlling leaching mechanism of Ba and Cr, whereas the leaching of Mn, Zn, Ni, and Pb was controlled by diffusion. The Elovich and second-order kinetic equation were identified as the leaching models for Mn, Zn, Pb, and Ni. The life-time leaching predictions of OBDCR bricks indicated that the leaching of Ni and Mn after 10 and 20 years of leaching were 0.1529, 0.257, 0.1530, and 0.274 mg/L, respectively, exceeding the relevant standards. Therefore, the leaching risks of Ni and Mn should be emphasized when using OBDCR bricks with a 40 % OBDCR mixing ratio.

Diatom pyrenoids are encased in a protein shell that enables efficient CO2 fixation.

Pyrenoids are subcompartments of algal chloroplasts that increase the efficiency of Rubisco-driven CO2 fixation. Diatoms fix up to 20% of global CO2, but their pyrenoids remain poorly characterized. Here, we used in vivo photo-crosslinking to identify pyrenoid shell (PyShell) proteins, which we localized to the pyrenoid periphery of model pennate and centric diatoms, Phaeodactylum tricornutum and Thalassiosira pseudonana. In situ cryo-electron tomography revealed that pyrenoids of both diatom species are encased in a lattice-like protein sheath. Single-particle cryo-EM yielded a 2.4-Å-resolution structure of an in vitro TpPyShell1 lattice, which showed how protein subunits interlock. T. pseudonana TpPyShell1/2 knockout mutants had no PyShell sheath, altered pyrenoid morphology, and a high-CO2 requiring phenotype, with reduced photosynthetic efficiency and impaired growth under standard atmospheric conditions. The structure and function of the diatom PyShell provide a molecular view of how CO2 is assimilated in the ocean, a critical ecosystem undergoing rapid change.

A clinical study on robot navigationassisted intramedullary nail treatment for humeral shaft fractures.

BACKGROUND: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. MATERIALS AND METHODS: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant-Murley score) between the two groups of patients. RESULTS: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). CONCLUSION: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes.

Successful Management of a Neglected Talonavicular Joint Dislocation Using Corrective Osteotomy and Subtalar Fixation: A Case Report.

The complete loss of articular relationships between the talus and navicular bone is known as talonavicular joint (TNJ) dislocation. Medial dislocation of the TNJ is more common than lateral dislocation. Lateral dislocation is usually associated with a fracture of the calcaneocuboid joint. Surgeons encounter difficulties when treating these dislocations. It occurs following high-energy trauma and is managed with immediate closed reduction of the joint and immobilization, but some complicated cases require open reduction and fixation to achieve alignment, strength, and function. This case report describes a six-month-old neglected case of TNJ dislocation managed with corrective osteotomy and subtalar fixation. Fusion of the talonavicular and talocalcaneal joints was performed. This procedure had a satisfactory outcome, as the patient was completely relieved of pain.

Outcomes of Percutaneous Fixation in Intra-articular Calcaneal Fractures.

Displaced intra-articular calcaneal fractures have been proven to be challenging for orthopaedic surgeons worldwide due to the poor clinical outcomes. Historically, the decision whether for fixation or conservative management depended mostly on the literature of the time, initially favouring conservative management but attitudes slowly shifted to operative intervention. Percutaneous fixation options have been increasingly popular for their ability for fracture reduction without skin and wound complications of the open method. A retrospective study of 17 patients with a total of 18 calcaneal fractures treated in our hospital by a single surgeon from January 2017 to December 2019 was conducted. Fixation was done percutaneously using cannulated screws, with the patients in a lateral position. Intraoperative imaging was done using a mini-image intensifier to visualise fracture reduction, and the O-arm was used in most cases. Using the Sanders classification, there were a total of 4 IIA, 3 IIB, 2 IIC, 2 IIIAB, and 7 IIIAC. Results showed that 16 calcaneal fractures (94%) had good to excellent outcomes with the American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS), while 14 calcaneal fractures (78%) showed good to excellent outcomes with the Kerr calcaneal score. There were no wound complications encountered in our series. However, there was one patient with a k-wire broken intraoperative and left in situ and there were two patients with prominent screws. Despite this, our experience with percutaneous fixation of displaced intra-articular calcaneal fractures has been generally favourable, allowing for good outcomes and satisfactory reduction of the fracture fragments.

Surgical Treatment of Non-Displaced Subcapital Hip Fracture: Femoral Neck System vs. Cannulated Screws. Comparative Study. / Tratamiento quirúrgico de fractura subcapital de cadera no desplazada: Femoral Neck System vs Tornillos canulados. Estudio Comparativo.

OBJECTIVE: The objective of this study is to compare the outcomes of using the Femoral Neck System (FNS) (DePuy Synthes®) versus the use of cannulated screws (CS) in the surgical treatment of non-displaced subcapital hip fractures. MATERIALS AND METHODS: A retrospective cohort study was conducted on non-displaced subcapital hip fractures treated with CS or FNS between 2020 and 2023, with a minimum follow-up of one year. A total of 28 patients were included, 14 treated with CS and 14 with FNS. Demographic, radiological, clinical, and functional variables were analyzed. RESULTS: In the CS group, 64% were male, with a mean age of 66.5 years (SD 14.9) and an average follow-up of 22 months (range, 12-36 months). In the FNS group, 57% were male, with a median age of 60.8 years (SD 13.78) and an average follow-up of 16 months (range, 12-24 months). Regarding functional outcomes, no significant differences were found between FNS and CS in the Harris scale: 94.21 ± 11.55 for FNS and 96.50 ± 6.9 for CS (p=0.618). The total postoperative complications (FNS/CS) were 7.1% versus 43%, and implant failure with conversion to total hip replacement was 0% versus 43%, both significantly higher in the CS group (p=0.047; p=0.016, respectively). The FNS also presented a lower rate of avascular necrosis (0% versus 11.1%, p=0.391) and nonunion (0% versus 20%, p=0.163), although these differences did not reach statistical significance. CONCLUSIONS: Although both treatment methods, cannulated screws and the Femoral Neck System (FNS), showed similar short-term functional outcomes in the management of undisplaced subcapital femoral fractures, the FNS demonstrated a significantly lower rate of complications and reoperations. These results suggest that the FNS could be considered a safer and more effective option compared to cannulated screws.

Crystal Structure and Molecular Mechanism of Isocitrate Lyase from Chloroflexus aurantiacus.

Chloroflexus aurantiacus is a green, nonsulfur bacterium that employs the 3-hydroxypropionate cycle to grow, using carbon dioxide/bicarbonate as its primary carbon source. Like most bacteria, it possesses the glyoxylate cycle, facilitated by malate synthase and isocitrate lyase (ICL), allowing a "tricarboxylic acid cycle" bypass. C. aurantiacus also harbors ICL, an enzyme that catalyzes reversible isocitrate cleavage into glyoxylate and succinate. This study presents the crystal structures of C. aurantiacus-derived ICL (CaICL), in its Mg2+-bound and Mn2+ and isocitrate-bound forms, elucidating its substrate-binding mechanism and catalytic loop dynamics. CaICL forms a homotetramer and interacts with isocitrate via critical active-site residues, revealing its catalytic mechanism. The stabilization of the catalytic loop and adjacent terminal regions upon isocitrate binding underscores its functional significance. These findings advance our understanding regarding ICL enzymes, offering a basis for future investigations into their biological roles and potential applications.

Unbalanced metaphyseal fixation is associated with an increased aseptic loosening of revision total knee arthroplasty at mean 4-year follow-up.

INTRODUCTION: The total number of total knee arthroplasty performed is rising, and the number of revisions is rising accordingly. Periprosthetic joint infection emerged in recent years as a leading cause of total knee revisions. Bone loss is a real challenge when facing septic knee revisions since radical debridement is crucial to overcome infection. Many devices have already demonstrated to reliably address bone loss and guarantee enhanced fixation. However, the role of balancing metaphyseal fixation and its interplay with the level of constraint has not been elucidated yet. MATERIAL AND METHODS: An institutional arthroplasty registry was retrospectively reviewed looking for patients who underwent two-stage revision of the knee and metaphyseal cones implantation. Patients were divided into two groups based on the presence of cones only on one side (femoral or tibial, Group U) or both femoral and tibial side (Group B). Failure, aseptic loosening, and revision rates were compared between groups, as were values of patient-reported outcome measure. Kaplan-Meier analysis was used to assess survival of implants. RESULTS: A total of 65 patients were included in the analysis and were evaluated at a mean final follow-up of 4 years (range, 2-7). Mean age was 67 (range, 43-81) years. Mean BMI was 27.4 (range, 20-37) kg/m2. The overall mean KSS, OKS, ROM significantly increased from baseline values to last follow-up (p < 0.001). Kaplan-Meier analysis demonstrated that patients included in Group U had a significantly lower rate of implant survival compared to those included in Group B. CONCLUSIONS: Patients undergoing revision total knee arthroplasty for periprosthetic infection present considerable rates of complication and failure. Management of bone loss represents a concern for the surgeon, who must achieve a stable fixation. Our study demonstrated that implants characterized by an unbalanced metaphyseal fixation are at higher risk of aseptic loosening and consequent revision, especially when coupled with hinged inserts.

Influence of Tibial Component Design Features and Interference Fit on Implant-Bone Micromotion in Total Ankle Replacement: A Finite Element Study.

BACKGROUND: Implant survivorship in uncemented total ankle replacement (TAR) is dependent on achieving initial stability. This is because early micromotion between the implant and bone can disrupt the process of osseointegration, leading to poor long-term outcomes. Tibial implant fixation features are designed to resist micromotion, aided by bony sidewall retention and interference fit. The goal of this study was to investigate design-specific factors influencing implant-bone micromotion in TAR tibial components with interference fit. METHODS: Three implant designs with fixation features representative of current TAR tibial components (ARC, SPIKES, KEEL) were virtually inserted into models of the distal tibias of 2 patients with end-stage ankle arthritis. Tibia models were generated from deidentified patient computed tomography scans, with material properties for modeling bone behavior and compaction during press-fit. Finite element analysis (FEA) was used to simulate 2 fixation configurations: (1) no sidewalls or interference fit, and (2) sidewalls with interference fit. Load profiles representing the stance phase of gait were applied to the models, and implant-bone micromotions were computed from FEA output. RESULTS: Sidewalls and interference fit substantially influenced implant-bone micromotions across all designs studied. When sidewalls and interference fit were modeled, average micromotions were less than 11 µm, consistent across the stance phase of gait. Without sidewalls or interference fit, micromotions were largest near either heel strike or toe-off. In the absence of sidewalls and interference fit, the amount of micromotion generally aligned inversely with the size of implant fixation features; the ARC design had the largest micromotion (~540 µm average), whereas the KEEL design had the smallest micromotion (~15 µm). CONCLUSION: This study presents new insights into the effect of TAR fixation features on implant-bone micromotion. With sidewalls and interference fit, micromotion is predicted to be minimal for implants, whereas with no sidewalls and no interference fit, micromotion depended primarily on the implant design. CLINICAL RELEVANCE: This study presents new insights into the effect of TAR primary fixation features on implant-bone micromotion. Although design features heavily influenced implant stability in the model, their influence was greatly diminished when interference fit was introduced. The results of this study show the relative importance of design features and interference fit in the predicted initial stability of uncemented TAR, potentially a key factor in implant survivorship.

Trends in management of odontoid fractures 2010-2021.

Background Context: Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized. Purpose: To investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures. Study Design/Setting: Retrospective database cohort study. Patient Sample: Adult patients with odontoid fractures between 2010 and 2021. Outcome Measures: Yearly trends and predictors of odontoid fracture management. Methods: Adult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010-2021). Univariate and multivariable analyses were performed for both sets of comparisons. Results: For assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p < .001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p < .001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p < .001 for each). Conclusions: The overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with nonclinical factors suggesting room for more consistent algorithms.

Case Report: Medial Clavicle Physeal Injury Mimicking a Posterior Clavicular Dislocation in a Young Adult.

Introduction: Sternoclavicular injuries are rare and account for 1 % of all dislocations. Medial clavicular physeal separation is another rare entity and may sometimes mimic a sternoclavicular dislocation. Diagnosis is usually missed in young adults due to lack of clinical suspicion. Case Report: A 22-year-old male patient sustained a right shoulder girdle injury due to a motorcycle accident. He was clinically diagnosed as a posterior sternoclavicular dislocation. On further imaging a medial clavicular physeal injury was suspected. An attempt of closed reduction was attempted but not successful so it was converted to an open reduction. Physeal injury was confirmed and reduction was fixed with transosseous sutures using low cost polyglactin suture material. Patient had a good clinical recovery. Conclusion: Medial clavicle physeal injury may mimic sternoclavicular dislocations and should be clinically suspected in young adult patients.

Pseudoaneurysm Formation in the Superior Gluteal Artery Following Short Femoral Nail Placement in an Intertrochanteric Femur Fracture: A Case Report.

Introduction: Superior gluteal artery (SGA) injury is an uncommon, yet critical complication associated with trochanteric fracture surgery. While deep femoral artery branches are more frequently affected, SGA involvement is infrequent but potentially life threatening. Knowledge of anatomy plays a crucial role in reducing the likelihood of such complications. Factors contributing to deep femoral artery injury include direct trauma from fracture fragments, excessive drilling, or inadvertent arterial damage during instrumentation. To date, only a few cases have reported SGA injuries following trochanteric fracture surgery. In this study, we report a late presented SGA pseudoaneurysm after intramedullary nailing of intertrochanteric fracture. Case Report: A 72-year-old female with a right intertrochanteric fracture underwent surgery involving the placement of a short cephalomedullary nail. In the 3rd week postoperatively, the patient presented with a sizable hematoma near the proximal and posterior section of the incision. Subsequent investigations unveiled a pseudoaneurysm in the SGA as the source of the hematoma and declining hemoglobin levels. The pseudoaneurysm was successfully treated with embolization, and the patient recovered without complications. Conclusion: Prompt recognition of post-operative hemoglobin decrease, regardless of clinical symptoms, is essential. Computed tomography angiography is valuable for early detection and intervention of SGA injuries. Surgeons must be careful when opening the incision and determining the entry point, as anterior incision and medialized guidewire may increase the risk of SGA injury. Awareness of this rare complication and its management is vital to prevent possible complications.

Suture Fixation of Coronoid Fractures - Using an 18 g Needle as Suture Passer - A Novel Technique.

Introduction: Coronoid fractures in complex elbow dislocations and terrible triad injuries are usually tip avulsions. Only suture fixation of tip fragments may be possible. Case Report: We have described a simple and cost-effective technique for suture fixation of the coronoid fracture using an 18 G needle as a suture passer. Conclusion: This novel technique of using an Ethibond 18 gauge needle as a suture passer may obviate the difficulty usually associated with suture fixation of the coronoid.

The Functional Outcome of Open Reduction and Internal Fixation of Unstable Floating Shoulder Injuries: A Prospective Study with Good Short-Term and Medium-Term Outcome.

Introduction: The term "superior shoulder suspension complex (SSSC)" coined by Goss is a bone and soft tissue stable ring made up of clavicular-acromioclavicular strut, the three-process scapular body and the clavicular-coracoclavicular ligamentous-coracoid (C-4) linkage. Disruption at any one site of the SSSC complex makes the other site unstable in a vicious cycle altering the functional anatomy and muscular forces resulting in a "floating shoulder injury" (FSI). The purpose of this study is to evaluate the functional outcome after open reduction and internal fixation of both clavicle and scapula in FSI using Herscovici and American shoulder and Elbow score (ASES) scores. Materials and Methods: This is a prospective study conducted at level 1 trauma care center in India from May 2019 to May 2023 in 18 cases of unstable FSI. All the cases were followed up post-operatively for a period of 18 months. Results: All the injuries were high energy motor vehicular accidents. Fracture union was seen in all cases with mean period of 13.55 weeks for clavicle and 8.5 weeks for scapula on plain radiographs. 72.22% of the patients had an excellent to good functional outcome assessed by Herscovici scoring system and 61% had an ASES score between 50 and 100. No patient had any adverse complication which precluded their return to their daily activities. Conclusion: Early open reduction and internal fixation of significantly displaced unstable FSIs allows early rehabilitation and better functional outcome.

Transforaminal Migration of K-Wire From Clavicle to Cervical Spinal Canal: A Case Report and Review of Literature.

Introduction: Kirshner wires are commonly used for orthopedic surgical fixation for shoulder injuries, particularly around the acromioclavicular joint. They are versatile, cheap, and minimally invasive in stabilizing bone fragments. However, there have been cases of secondary migration of K-wires from the clavicle to surrounding tissues, particularly around the cervical spine. Case Report: We present a case of a 60-year-old female with left-sided neck pain and radiation to the left upper limb, a K-wire was found to have migrated through the C7-T1 foramina left side into the spinal canal posterior to the vertebral body in a transverse trajectory. The patient underwent surgical removal of the K-wire, and post-operative pain improved without neurological complaints. Conclusion: Even though Kirshner wires are versatile, cheap, and minimally invasive in stabilizing bone fragments, but migration to unexpected anatomical sites remains a concern. This paper reviews the literature and discusses clinical presentation, diagnostic modalities, and surgical approaches related to spinal canal migration of K-wires.