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Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)Application for ESRA Abstract Prizes: I don’t wish to apply for the ESRA PrizesBackground and Aims Fasting guidelines have been established to reduce the risk of a pulmonary aspiration event in patients undergoing anaesthesia. Excessive fasting can contribute to anxiety, nausea, dehydration and physiological derangement. In practice, patients are likely to be fasted for longer than the conventional times. The aim of our project was to identify the average length of fluid fast in our elective patients.MethodsThis was a retrospective case-note review of 50 patients undergoing elective upper limb surgery in our tertiary orthopaedic institution. Their reported fasting times for solids and liquids were recorded. Their sent for operation times were interrogated from Operating Room Management Information System (ORMIS) computer system. This information was subsequently compiled into a datasheet.ResultsThe average fasting time for solids was 14h 30mins. The average conventional fluid fasting time was 3h 29 mins. When this adjusted to a sent for operating time, the average time was 6 h 11min (range 0min to 18h 10 min). 16% of patients included in the study were fluid fasted for greater than 12 hours.ConclusionsOur study revealed excessive fasting times in the majority of our patients. Evidently a two-hour fluid fasting target becomes a longer fast in the real world. We have adapted out current fasting guidelines to align with progressive institutions which use a sip-till-send approach to allow 170ml of water each hour until sent for operating (Checketts 2023). We will re-audit these times after implementation of the guideline.

Background Women and minorities remain underrepresented in orthopaedic surgery. In an attempt to increase the diversity of those entering the physician workforce, Nth Dimensions implemented a targeted pipeline curriculum that includes the Orthopaedic Summer Internship Program. The program exposes medical students to the specialty of orthopaedic surgery and equips students to be competitive applicants to orthopaedic surgery residency programs. The effect of this program on women and underrepresented minority applicants to orthopaedic residencies is highlighted in this article. Questions/purposes (1) For women we asked: is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic surgery residency? (2) For underrepresented minorities, is completing the Orthopaedic Summer Internship Program associated with higher odds of applying to orthopaedic residency? Methods Between 2005 and 2012, 118 students completed the Nth Dimensions/American Academy of Orthopaedic Surgeons Orthopaedic Summer Internship Program. The summer internship consisted of an 8-week clinical and research program between the first and second years of medical school and included a series of musculoskeletal lectures, hands-on, practical workshops, presentation of a completed research project, ongoing mentoring, professional development, and counselling through each participant’s subsequent years of medical school. In correlation with available national application data, residency application data were obtained for those Orthopaedic Summer Internship Program participants who applied to the match between 2011 through 2014. For these 4 cohort years, we evaluated whether this program was associated with increased odds of applying to orthopaedic surgery residency compared with national controls. For the same four cohorts, we evaluated whether underrepresented minority students who completed the program had increased odds of applying to an orthopaedic surgery residency compared with national controls. Results Fifty Orthopaedic Summer Internship scholars applied for an orthopaedic residency position. For women, completion of the Orthopaedic Summer Internship was associated with increased odds of applying to orthopaedic surgery residency (after summer internship: nine of 17 [35%]; national controls: 800 of 78,316 [1%]; odds ratio [OR], 51.3; 95% confidence interval [CI], 21.1–122.0; p < 0.001). Similarly, for underrepresented minorities, Orthopaedic Summer Internship completion was also associated with increased odds of orthopaedic applications from 2011 to 2014 (after Orthopaedic Summer Internship: 15 of 48 [31%]; non-Orthopaedic Summer Internship applicants nationally: 782 of 25,676 [3%]; OR, 14.5 [7.3–27.5]; p < 0.001). Conclusions Completion of the Nth Dimensions Orthopaedic Summer Internship Program has a positive impact on increasing the odds of each student participant applying to an orthopaedic surgery residency program. This program may be a key factor in contributing to the pipeline of women and underrepresented minorities into orthopaedic surgery. Level of Evidence Level III, therapeutic study.

Introduction Flexion contracture of the knee has been reported to induce forward trunk inclination and pelvic retroversion, whereas the progression of pelvic retroversion may further exacerbate knee joint symptoms, suggesting a close relationship between the knee and spinal alignment. The purpose of this study was to investigate the effects of lower limb alignment changes after opening wedge high tibial osteotomy (OWHTO) on spinopelvic sagittal alignment. Methods We retrospectively analyzed 34 knees that underwent OWHTO for medial compartment knee osteoarthritis between 2023 and 2025. Standing full-length lower limb and whole-spine radiographs were obtained preoperatively and at one year postoperatively. Lower limb alignment parameters, i.e., the percentage of mechanical axis (MA), mechanical medial proximal tibial angle (mMPTA), mechanical lateral distal femoral angle (mLDFA), joint line convergence angle (JLCA), and posterior tibial slope (PTS), were evaluated. Spinopelvic parameters included pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), thoracic kyphosis (TK), lumbar lordosis (LL), and the mismatch between PI and LL (PI-LL) Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) before surgery and at one year postoperatively. Correlations between postoperative spinopelvic parameters and clinical outcomes were also examined. Results Pelvic tilt and the mismatch between PI and LL significantly decreased following OWHTO (p = 0.003 and p = 0.044, respectively), indicating improvement in spinopelvic sagittal alignment. However, no significant correlations were found between changes in spinal alignment and postoperative scores on the KOOS. Conclusion Both pelvic tilt and the mismatch between PI and LL, which reflect lumbopelvic alignment, were significantly decreased after OWHTO. This may have arisen because the correction of knee alignment improved the load distribution in the lower limbs, which in turn contributed to the improvement of lumbopelvic alignment. Our findings suggest that OWHTO not only corrects lower limb alignment but may also have a positive effect on lumbopelvic alignment.

Olecranon osteotomy is commonly used for surgical exposure in distal humeral fractures, with subsequent fixation typically performed using tension band wiring (TBW). However, the optimal osteotomy angle for maximizing interfragmentary compression remains unclear. Using finite-element analysis of a 30-year-old male's elbow CT data, we analyzed seven osteotomy angles relative to the ulnar axis: 20° proximal (P20), 10° proximal (P10), vertical (V), 10° distal (D10), 20° distal (D20), 30° distal (D30), and 40° distal (D40). Wire tightening force (30N) and triceps traction force (100 N) were applied sequentially. Contact pressure was measured across the entire osteotomy surface and the articular half. The 20° distal angle (D20) produced maximum contact pressure (317 kPa) across the entire osteotomy surface compared to other angles (P20: 237 kPa, P10: 295 kPa, V: 276 kPa, D10: 259 kPa, D30: 171 kPa, D40: 130 kPa). Articular-side pressure was also highest at D20 (206 kPa). The ratio of articular-side to total pressure increased progressively with more distal angles, from 23% (P20) to 80% (D40). A 20° distal osteotomy angle provides optimal biomechanical conditions for TBW fixation, maximizing interfragmentary compression essential for bone healing. This finding may guide surgical technique selection to improve clinical outcomes.

Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical procedure increasingly referenced in patient-oriented websites. However, the quality of such online health information is inconsistent. This study evaluates the quality of Italian-language web content on PELD using the DISCERN tool. A systematic search was conducted on 25 May 2025 using the Italian-language interface of Google (Google LLC, Mountain View, California, United States) with the keywords \"PELD,\" \"discectomia endoscopica percutanea,\" and \"ernia del disco PELD.\" Twenty websites targeted at the general public were selected. Each was independently assessed using the 16-item DISCERN instrument by two trained reviewers. Inter-rater reliability was calculated using Cohen's kappa coefficient. The mean overall DISCERN score across the 20 websites was 39.5 (SD = 8.7) out of 80, indicating moderate-to-low quality. High-scoring domains included clarity of procedural explanation (mean = 4.2/5), while critical aspects such as citation of sources (mean = 2.1/5) and discussion of uncertainties (mean = 1.7/5) were underrepresented. Cohen's kappa was 0.82, indicating strong agreement between reviewers. Online Italian-language resources on PELD exhibit moderate quality and frequently omit essential components such as treatment risks and alternative options. Enhancing transparency and evidence citation is essential to improve the quality of patient education materials.

Osteogenesis imperfecta (OI) is a rare genetic disorder that causes frequent fractures. Bisphosphonates play a key role in managing OI. This manuscript examines the comparative effectiveness of alendronate, neridronate, olpadronate, pamidronate, risedronate, and zoledronic acid on fracture rate reduction, increases in lumbar spine (LS) bone mineral density (BMD), and adverse effects compared to placebos and each other. A PubMed search using specific keywords for bisphosphonates and OI yielded 21 sources, from which data about fracture rates, fracture risk, and/or LS BMD were collected. The inclusion criteria consisted of randomized controlled trials involving bisphosphonates to treat OI with data regarding fracture rates, fracture risk, and/or BMD, and the exclusion criteria were any sources that did not meet such standards. A one-way analysis of variance (ANOVA) was conducted to assess the significance of differences among bisphosphonates. Neridronate, olpadronate, and risedronate had a lower fracture risk and fracture rate than their placebo counterparts. Olpadronate demonstrated a markedly lower fracture rate compared to its placebo, and neridronate similarly showed a substantially reduced fracture risk relative to its placebo. Risedronate was effective but less so than the other two. Pamidronate showed the largest overall increase in LS BMD, while alendronate demonstrated the highest placebo-adjusted ratio. Despite ANOVA testing finding insignificant differences between drugs, except for fracture risk, limited data constrained the analysis. Adverse effects varied: alendronate caused the most gastrointestinal distress, zoledronic acid and neridronate caused illness-like symptoms, risedronate had illness-like and gastrointestinal symptoms, and pamidronate was linked to severe effects, including death. This analysis highlighted the efficacy and safety profiles of bisphosphonates in the treatment of OI. Neridronate and olpadronate were highly effective in reducing fracture risk and rates, and olpadronate demonstrated superior efficacy in reducing fracture rates. Future research should focus on large, diverse samples, detailed fracture and BMD data, and comparisons across multiple bisphosphonates to refine treatment strategies.

Calcium pyrophosphate dihydrate deposition (CPPD) disease, also known as pseudogout, is the most common cause of calcification of ligamentum flavum (CLF) compared to other degenerative conditions. Symptomatic CLF is a rare cervical spine disorder that leads to spinal cord compression, resulting in myelopathic symptoms. We report two rare cases of pseudogout-induced cervical myelopathy, along with a review of the literature. Both patients were seen at Al-Azhar University Hospital in Cairo, Egypt, presenting with severe neck pain, gait disturbances, and hand clumsiness. The first patient had these symptoms for two months, while the second patient experienced them for three months. The second patient also had restricted motion in extension and rotation, as well as shooting pain in both upper extremities. Cervical spine MRI revealed posterior cord compression and myelomalacia at the C3-C6 levels in the first patient and at the C4-C5 levels in the second patient. Pseudogout (CPPD) disease was suspected as the cause of spinal cord compression, and histopathological analysis of the deposits found at the site of compression during the decompression procedure confirmed the diagnosis. The deposits were characterized by rhomboid blue calcium crystals that were mildly birefringent, distinguishing them from the needle-shaped crystals seen in gout. At the four-week postoperative follow-up, both patients showed significant improvement in clinical and functional outcomes, as measured by the Japanese Orthopaedic Association score. In summary, CLF due to pseudogout (CPPD deposition) is a rare but clinically significant cause of cervical myelopathy. Histopathological examination is crucial for a definitive diagnosis. Early posterior cervical decompression with instrumentation appears to be an effective treatment, though larger studies and long-term follow-up are necessary to confirm these findings and optimize management strategies.

This study aims to investigate the clinical outcomes and magnetic resonance imaging evaluation (MRI) of intra-articular injection of autologous protein solution (APS) in patients with knee osteoarthritis of varying severities. A retrospective analysis was conducted on the clinical data of consecutive subjects with knee osteoarthritis (KOA) of varying Kellgren-Lawrence (KL) grades who underwent a single APS injection. The Knee injury and Osteoarthritis Outcome Score (KOOS), covering symptoms (S), pain (P), activity (A), sports (SP), and quality of life (Q), was used to evaluate the patients at pre-treatment and 12 months post-treatment. Minimal Clinically Important Difference (MCID) and Osteoarthritis Research Society International Set Responder Criteria Osteoarthritis Clinical Trials Revisited (OMERACT-OARSI) tools were used to observe improvement in different KL grades. Additionally, an MRI was performed pre-treatment and 12 months post-treatment. Semi-quantitative analysis (Magnetic Resonance Imaging Osteoarthritis Knee Score (MOAKS)) was applied to assess bone marrow lesions (BMLs), articular cartilage, osteophytes, synovitis and effusion, and meniscal lesions in various subregions of the knee joint. A total of 53 patients (66 knees) were included in the final analysis. At 12 months post-treatment, overall KOOS scores showed improvement. The responder rates were 78.6% (11 knees) in KL2, 68.4% (13 knees) in KL3, and 51.5% (17 knees) in KL4. Significant improvements were observed in KOOS-S, KOOS-P, and KOOS-Q across all patients. KOOS-A and KOOS-SP demonstrated statistically significant differences only in the KL2 and KL4 groups (P < 0.05). Comparisons of KOOS score differences between groups revealed that patients in the KL2 group experienced greater improvements in activity levels and quality of life compared to those in the KL3 and KL4 groups (P < 0.05). MOAKS evaluation revealed no significant improvement in cartilage damage, BMLs, synovitis-effusion, and meniscal status. In the KL4 group, the post-treatment scores for patellar superior and inferior osteophytes were higher than the pre-treatment scores (P = 0.039). This study provides evidence supporting the clinical efficacy of a single intra-articular injection of APS in KOA. However, the therapeutic effect of APS for structural changes in imaging remains limited.