Patellar Instability Following Total Knee Arthroplasty: A Review of Etiology, Diagnosis, and Management Strategies.

Patellar instability remains one of the most challenging and persistent complications following total knee arthroplasty (TKA), significantly affecting patient satisfaction and functional outcomes. Despite advances in implant technology and surgical techniques, patellofemoral maltracking remains a leading cause of anterior knee pain and one of the most frequent non-infectious reasons for revision surgery. The etiology is complex and often involves a combination of component malposition, soft-tissue imbalance, patient-specific anatomical risk factors, and suboptimal implant design.

Enhancing Efficiency in Acute Arthroplasty Case Management Through Secure Messaging: A Siilo-Based Multidisciplinary Team (MDT) Audit.

Background: Timely decision-making in complex arthroplasty cases such as prosthetic joint infections (PJIs) and periprosthetic fractures is critical to optimizing patient outcomes. Traditional weekly multidisciplinary team (MDT) meetings often delay these decisions. This study evaluates the use of Siilo (Doctolib Siilo, Amsterdam, NLD), a secure medical messaging app, to facilitate expedited MDT discussions in acute arthroplasty admissions.

A review on Moringa oleifera polysaccharides: Extraction, purification, structure-activity, bioactivities and application.

Moringa oleifera, a versatile plant widely recognized for its nutritional and medicinal properties, has attracted significant attention for its rich polysaccharide content and diverse biological activities. This review offers a holistic analysis of the extraction, characterization, and health implications of M. oleifera polysaccharides (MOPs).

Perceptions of caffeine among high school students in the Greater Toronto and Hamilton Area.

Objectives: This clinical cross-sectional study examines the perceptions of caffeine consumption among high school students in the Greater Toronto and Hamilton Area. The purpose of the study is to gain insight into the motives behind caffeine consumption among this population.

Methods: A total of 2273 high school students participated in the study by anonymously filling out an online questionnaire via Cognito forms.

Supracondylar Dome Osteotomy for Post-traumatic Cubitus Varus in Children: A Retrospective Study.

Objective: Cubitus varus is a frequent sequela of pediatric supracondylar humerus fractures and presents with varus malalignment, extension, and internal rotation of the elbow. Although often regarded as a cosmetic deformity, it can lead to significant functional impairments, including chronic pain, ulnar nerve palsy, and posterolateral elbow instability.We retrospectively analyzed the effectiveness of supracondylar dome osteotomy in restoring alignment and function in children with post-traumatic cubitus varus.

A Prospective Comparative Study of Postoperative Pain and Functional Outcomes With and Without Cryotherapy Following Total Knee Arthroplasty.

Background Total knee arthroplasty (TKA) is a major orthopedic procedure often associated with significant postoperative pain, inflammation, and reduced range of motion (ROM). Effective pain management and functional recovery remain key challenges in postoperative care. This study aims to evaluate the impact of cryotherapy on postoperative pain and range of motion (primary outcomes) and to assess functional improvement using the Knee Society Score (KSS; secondary outcome) in patients undergoing total knee arthroplasty.

Titanium Elastic Nailing Versus Hip Spica Cast in the Treatment of Femoral Shaft Fractures in Children.

Objective The objective of this study is to compare titanium elastic nailing (TEN) to hip spica casting (HSC) in the treatment of paediatric femoral shaft fractures, focusing on hospital stay duration and time to initiation of weight bearing. Study design This was a quasi-experimental study conducted at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, Rawalpindi, over a six-month period. Duration and place of study The data for this study were collected at the Department of Orthopaedic Surgery, Benazir Bhutto Hospital, a major tertiary care and trauma referral centre, over a six-month period from 8 August 2018 to 8 February 2019.

Iliopsoas Impingement After Total Hip Arthroplasty: A Review of Diagnosis and Management.

Iliopsoas impingement is a growingly acknowledged yet frequently overlooked cause of persistent groin pain after total hip arthroplasty (THA), occurring in a small percentage of patients undergoing the procedure. It typically results from mechanical irritation of the iliopsoas tendon by anterior acetabular component overhang, retained cement, long screws, or other prosthetic hardware. Clinically, patients report pain that worsens with active hip flexion, stair climbing, and transitioning from sitting to standing.

Base of Thumb Fractures: A Review of Anatomy, Classification, and Management.

Fractures of the thumb metacarpal base are uncommon but significant due to their critical role in hand functionality and hand grip strength. These fractures exhibit diverse patterns, including extra-articular, Bennett, Rolando, and highly comminuted fractures, each with unique implications for management and outcomes. Each type presents unique challenges in achieving anatomical reduction, stability, and favorable long-term outcomes.

Improving Adherence to National Institute for Health and Care Excellence (NICE) Guidelines for the Use of Tranexamic Acid in Primary Total Knee Arthroplasty: A Quality Improvement Initiative.

Background: Tranexamic acid (TXA) is a pharmacological agent used in reducing blood loss during orthopaedic surgeries, including total knee arthroplasty (TKA). Despite its proven efficacy and National Institute for Health and Care Excellence (NICE) guidelines recommending combined topical and intravenous administration, compliance in clinical practice often lags.

Objective: This study aimed to evaluate and improve adherence to NICE guidelines for TXA use during TKA through a quality improvement initiative.

Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium.

Background Postoperative delirium (POD) is a common and debilitating complication in elderly hip fracture patients, associated with significant clinical and functional consequences. Early identification of risk factors, such as cognitive impairment and vitamin D deficiency, is essential to mitigate its impact. However, preoperative screening practices are often inconsistent.

Wide Awake Local Anaesthesia No Tourniquet Surgery of the Foot and Ankle: A Review of Indications, Technique, Patient Satisfaction, and Complications.

Wide-awake surgery of the hand was surrounded by a lot of apprehension, mainly over concerns around using epinephrine near digits and its potential to cause digital ischemia and necrosis. With multiple reports underlining its safety and effectiveness, it is now being widely adopted in hand and wrist surgery. The British Society for Surgery of the Hand has already published guidelines on operating outside of main theatres, with an emphasis on wide awake local anaesthesia no tourniquet (WALANT).

Functional Outcomes of Pilon Fractures Treated by External Fixation, Delayed Plating, and Open Reduction and Internal Fixation (ORIF): A Prospective Cohort Study.

Objective: This study aimed to evaluate the functional outcomes of three surgical management strategies for pilon fractures, including primary external fixation with delayed plating, external fixation with minimal internal fixation, and single-stage open reduction and internal fixation (ORIF) with plating.

Methods: This prospective cohort study included 34 patients with complex intra-articular fractures of the distal tibia (AO-OTA type 43-C) treated between June 2018 and December 2019. Patients were managed surgically based on the local skin condition and swelling, employing either primary-stage external fixation with delayed plating (Group A), external fixation with minimal internal fixation (Group B), or single-stage ORIF with plating (Group C).

Functional Outcomes of Radial Head Fractures Treated With Open Reduction and Internal Fixation (ORIF).

Background: Radial head fractures (RHFs) account for a considerable injury. This study focuses on the functional results of people who had open reduction and internal fixation (ORIF).

Objective: To evaluate the functional outcomes of Mason type II and III RHFs treated with ORIF using the Mayo Elbow Performance Score (MEPS) over a 12-month postoperative period.

Functional Outcomes and Complications After Open Reduction and Internal Fixation of Mid-shaft Clavicle Fractures: A Retrospective Study.

Introduction: Clavicle fractures are routinely encountered in orthopedic clinical practice and have often been the subject of debate when it comes to optimal treatment. Clavicle fracture surgery has come a long way with excellent pre-contoured superior locking plates available for fixation. This study aimed to evaluate a cohort of patients operated for displaced mid-shaft clavicle fractures by open reduction and internal fixation using superior clavicle locking plates.

Preoperative Prediction of the Scaphoid Screw Length for the Fixation of Fractures Using MRI Measurements of Finger Phalanges.

Introduction: Scaphoid fractures are one of the most common carpal bone fractures, with most fractures involving the waist. When surgery is indicated, internal fixation with screws is the standard method for the fixation of these fractures. Accurate length and trajectory of the screw are two crucial parameters essential for optimal internal fixation.

Evaluation of Patient-Initiated Follow-Up (PIFU) Service in a Fracture Clinic: A Comprehensive Service Evaluation and Patient Satisfaction Audit.

Background Outpatient clinics are increasingly challenged by high patient volumes and rising "did not attend" (DNA) rates, leading to extended wait times and declines in patient satisfaction. Traditional follow-up (FU) models with routinely scheduled appointments contribute to inefficiencies, as stable patients may attend unnecessary visits, thus straining clinic resources. The patient-initiated follow-up (PIFU) model offers an alternative where patients schedule appointments only when necessary.

Proximal Humerus Fractures: A Review of Anatomy, Classification, Management Strategies, and Complications.

Proximal humerus fractures are prevalent in older adults, particularly women, primarily due to osteoporosis and increased fall risk. These fractures often result from low-energy falls in elderly patients, while in younger individuals, they are more likely to occur with high-energy trauma, which may involve additional injuries to soft tissue and neurovascular structures. Proper anatomical understanding, including key structures and blood supply, is crucial for effective management and to prevent complications.

Study Comparing Topical Ivermectin Versus Topical Permethrin in the Treatment of Scabies.

Introduction Scabies is a highly contagious skin disease caused by an ectoparasite mite called . Ivermectin and permethrin have been commonly used for the treatment of scabies. However, topical ivermectin has been compared to other treatment modalities to a lesser extent.

Age and sex-related comparison of referral-based telemedicine service utilization during the COVID-19 pandemic in Ontario: a retrospective analysis.

Background: The COVID-19 pandemic has led to increased utilization of telemedicine services.

Methods: A retrospective analysis of all referral-based ambulatory telemedicine services in Ontario from November 2019 to June 2021 was collected from the Ontario Health Insurance Plan (OHIP) billing database. Only fee-for-service billings were included in the present analysis.

Rise in the Number of Complex Skin Cancers Necessitates Establishing Mohs Micrographic Surgery Fellowships in Pakistan.

As more and more patients seek treatment for increasingly complicated and cosmetically challenging skin cancers, Mohs Micrographic Surgery (MMS) is now exceedingly in demand. Training in MMS could help dermatologists improve patient outcomes allowing them to handle complex lesions safely and efficiently and hence, provide the best possible care. As a result, there is an urgent need to train additional dermatologists in Mohs Surgery in order to meet the huge demand for dermatologists with imperative expertise, specifically in this field.

Coronoid fixation and lateral collateral ligament repair in varus posteromedial rotatory instability of the elbow.

Background: Varus posteromedial rotatory instability is a relatively rare elbow injury, that has been infrequently reported in published literature. We intended to evaluate the outcomes of surgical management of this rare injury with anteromedial coronoid fixation, and, in selected patients, lateral ulnar collateral ligament (LUCL) repair.

Methods: Between 2017 and 2020, we identified 12 patients with anteromedial coronoid fractures, and a varus posteromedial rotatory instability, who underwent surgery for fixation of the coronoid fracture, with or without LCL repair.

Innovative online care: A cross-sectional survey study of potential benefits and challenges of online lactation consultation service with paediatrician consultation.

Background: Telelactation, a virtual lactation support platform, is a convenient and effective way of providing virtual breastfeeding support services and communicating proper breastfeeding techniques to new mothers to address any breastfeeding challenges and boost overall maternal breastfeeding confidence all from the comfort of their homes. This Ontario Health Insurance Plan (OHIP) covered service benefits more mothers in the remote areas where in-person LC service is not easily accessible.

Objective: The objective of this cross-sectional survey study is to explore the feasibility, potential benefits, and challenges, and level of patient satisfaction in virtual lactation consultation services along with virtual paediatrician consultation available in Ontario, Canada.

Pembrolizumab-Induced Lichen Planus in a Patient With Non-Small-Cell Lung Carcinoma (NSCLC) That Correlates to Therapeutic Response.

Immune checkpoint inhibitors are increasingly being used in the treatment of various solid organ and hematologic malignancies. Dermatologic toxicities associated with programmed cell death protein-1 (PD-1) and programmed death ligand-1 (PD-L1) therapy have been widely reported in the literature. Lichen planus is an inflammatory disease frequently seen in areas of the skin and oral mucous membrane lining.

Mental Health Consequences of the COVID-19 Pandemic Among Ontario's Youth: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the mental health and wellbeing of Ontario's youth. Our study investigated the psychological impacts of COVID-19 on the pediatric population of Ontario, using a survey derived from the Revised Children's Anxiety and Depression Scale (RCADS) system to identify children who may benefit from seeking professional help. Our cross-sectional study examined the potential risk factors that contributed to worsening mental health and wellbeing in children, including changes in sleep patterns, appetite, and physical activity levels, as well as the diagnosis of a family member with COVID-19.