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 Stiffness after total knee arthroplasty (TKA) is a common early complication and multiple risk factors are recognized. We aimed to investigate the risk factors for manipulation under anesthesia after primary TKA and for the subsequent revision TKA in patients requiring manipulation using national healthcare registers.  We used the comprehensive register data of the PERFECT project that included data from the Finnish arthroplasty register (FAR) and the Care Register of Health Care (CRHC). We excluded patients under 40 years old. The Aalen-Johansen estimator and Cox proportional hazards regression model were used in the risk assessment.  154,883 patients had primary TKA in Finland in 1999-2020 , of which 3,861 patients required manipulation within 1 year of primary TKA. The 1-year cumulative incidence of manipulation was 2.5%. In the multivariable analysis, female sex (hazard ratio [HR] 1.53, CI 1.42-1.64), diabetes mellitus (HR 1.19, CI 1.08-1.31), coronary artery disease (HR 1.25, CI 1.12-1.39), and hypercholesterolemia (HR 1.16, CI 1.06-1.28) were associated with an increased risk of manipulation. Increasing age was associated with a decreased risk of manipulation (multivariable HR 0.94 per year, CI 0.94-0.94). Patients requiring manipulation within 1 year of primary TKA had a significantly increased risk of revision TKA (HR 2.26, CI 2.05-2.50). The 10-year cumulative risk of revision TKA after manipulation was 15% (CI 14-16).  Manipulation was more likely to be performed for females, relatively younger patients, and patients with diabetes mellitus, coronary artery disease, or hypercholesterolemia. Patients who had manipulation within 1 year of primary TKA had an increased risk of revision with a 10-year cumulative risk of revision of 15%.

In recent years, Israel has experienced a rise in rocket attacks, forcing civilians to evacuate quickly to bomb shelters. These rapid evacuations have resulted in increased fall-related injuries, particularly among vulnerable groups such as the elderly and those with preexisting medical conditions. To assess the patterns of injuries, the contributing factors to falls and orthopedic injuries, particularly fractures, sustained during falls in the process of evacuation to shelters during rocket warning sirens. We conducted a retrospective cohort study, including 174 patients treated at Rambam Health Care Campus for falls and injuries sustained during evacuation to bomb shelters following rocket warning sirens. The mean age was 54.4 years; 106 (60.9%) were female. We found that women were significantly older than men, with a 50% likelihood of being >56 years (P = 0.017; relative risk (RR) = 1.50; 95% confidence interval (CI) = 1.07-2.09). The most prevalent injuries were contusions (100, 57.5%) and fractures (60, 34.5%). The most common injury sites were the neck (42, 24.1%), back (29, 16.7%), wrist (23, 13.2%), and knee (21, 12.1%). The predominant chronic diseases were metabolic (74, 42.5%) and cardiovascular (46, 26.4%). Most injuries occurred at home (153, 87.9%). Falls during shelter evacuation constitute a major orthopedic hazard. Women were significantly older and consequently more susceptible to serious fall incidents. Comorbidities (especially metabolic and cardiovascular) may further increase risk. Preventive measures should focus on house security and the specific protection of high-risk individuals.

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Flat-top talus (FTT) is a recognized sequela of clubfoot associated with stiffness and early ankle degeneration. However, its frequency after Ponseti treatment and associated clinical and treatment-related factors remain poorly defined. This study aimed to identify clinical and treatment-related factors associated with FTT in Ponseti-treated clubfeet. We performed a retrospective dual-center cohort study (2005 to 2023) of children with idiopathic and non-idiopathic clubfoot treated using the Ponseti method who had at least one adequate lateral radiograph for evaluation. Talar morphology was classified qualitatively (flat vs. round) by independent blinded raters. Clinical variables and treatment exposures were analyzed at the foot level, and univariate logistic regression identified factors associated with FTT. Ninety-eight patients (152 feet) met inclusion criteria. FTT was identified in 104 of 152 radiographically evaluated feet (68%). Higher Pirani score at diagnosis was associated with increased odds of FTT (OR: 1.58, 95% CI: 1.09-2.48; P=0.027). Feet with FTT demonstrated more limited pre-tenotomy dorsiflexion (P=0.034 in idiopathic feet). Greater cumulative casting exposure was associated with FTT, including ≥13 corrective casts before imaging (OR: 2.72, 95% CI: 1.06-7.15; P=0.038). In site-specific analysis, each additional cast increased the odds of FTT by 13% (OR: 1.13, 95% CI: 1.03-1.27; P=0.020), and surgery before imaging was associated with increased odds of FTT (OR: 4.29, 95% CI: 1.40-14.50; P=0.013). Relapse rates after radiographic detection did not differ significantly between groups. FTT in Ponseti-treated clubfeet undergoing radiographic evaluation is associated with greater baseline deformity severity, cumulative casting exposure, and prior surgery. FTT seems to represent a marker of intrinsic rigidity and treatment burden rather than an independent driver of recurrence. Recognition of these associated factors may assist clinicians in monitoring talar morphology and counseling families regarding possible long-term limitations in ankle dorsiflexion. Level III-Retrospective cohort study.

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To compare the clinical and radiological outcomes of anterior cruciate ligament reconstruction (ACLR) augmented with platelet-rich plasma (PRP) (1) or bone marrow aspirate concentrate (BMAC) (2) against a control group undergoing standard ACLR without biological additives. One hundred seventy-five patients undergoing biologically enhanced ACLR using semitendinosus quadruple autograft were prospectively included in this randomized controlled trial. Patients were randomized to either the control group (no biological additives, n = 79) or ACLR plus application of PRP to the graft (n = 53) or ACLR plus BMAC application to the graft (n = 43). ACLR techniques were standardized for all patients, and all were performed by a senior surgeon. Biological additives were also standardized and prepared by a senior laboratory physician in the operating room. After an average of 2 years, patients were assessed clinically, and SI of the ACL graft was measured in the magnetic resonance imaging (MRI). There was no clinically significant difference in clinical outcomes (clinical examination [p = 0.867] and patients' reported outcome scores, Lysholm [p = 0.881], International Knee Documentation Committee [p = 0.864] and Marx activity return to sport scale [p = 0.666]). There was no significant difference in MRI SI of the intra-articular graft or the graft inside the tunnels (p = 0.898) after a mean of 2 years. Cases with BMAC addition to the graft showed poorer MRI SI. Biological ACL reconstruction enhanced with PRP or BMAC did not reveal any statistically significant clinical or radiological results; on the contrary, BMAC application may lead to poorer MRI SI. Level I, randomized controlled trial.

Age-related skeletal muscle aging can lead to sarcopenia and is closely associated with cellular senescence and mitochondrial dysfunction. Neonatal mammalian muscle exhibits a strong regenerative capacity, and neonatal muscle extracellular vesicles (NMEVs) show therapeutic potential against skeletal muscle aging. In this study, we isolated NMEVs for the first time and found that they significantly alleviated palmitic acid (PA)-induced senescence, mitochondrial dysfunction, and lipid accumulation in C2C12 cells. in vivo, we developed a bilayer microneedle (MN) system loaded with NMEVs (NMEVs@PLGA@Fucoidan-HA MN) and applied it to aged mice. The MN effectively enhanced mitochondrial function, reduced muscle aging and fibrosis, and decreased lipid deposition. Mechanistically, miR-542-3p enriched in NMEVs directly targeted and downregulated Asxl2-PPARγ, leading to reduced lipid accumulation. At the same time, it suppressed Eef1a1 to activate the AMPK pathway, thereby improving mitochondrial function and attenuating cellular senescence. Our findings demonstrate the protective role of NMEVs delivered via an innovative MN system against muscle aging, where miR-542-3p plays a central role by concurrently targeting Eef1a1 and Asxl2 to mitigate senescence and lipid dysregulation. This study reveals a novel molecular mechanism underlying the anti-aging potential of NMEVs and offers a promising therapeutic strategy for skeletal muscle aging.

Fracture fixation timing and strategy in polytrauma patients with traumatic brain injury (TBI) remain controversial. This study investigates treatment patterns and outcomes for femoral and/or pelvic fractures stratified by TBI severity. Patients in the TraumaRegister DGU® (2016-2022) with pelvic and/or femoral fractures (AIS ≥3) and TBI (head AIS ≥3) were included. Strategies were non-operative management (NOM), early total care (ETC), and damage-control orthopedics (DCO). Outcomes included treatment allocation, fixation timing, and in-hospital mortality. 985 patients were included (mean age 52.5, SD 26.3 years; ISS 27.8, SD 8.1). Allocation was NOM in 320 (32.5%), ETC in 336 (34.1%), and DCO in 329 (33.4%) patients. Head AIS was 3 in 48.5%, 4 in 31.1%, and 5 in 20.3%. NOM patients were older, had the highest ISS and estimated mortality, and showed the largest proportion of critical TBI (AIS 5: NOM 30.9%, ETC 14.3%, DCO 16.1%). Femoral ETC was mainly performed within the first day (median 0, IQR 0-1 days), whereas pelvic ETC was delayed with increasing TBI severity (median 3, IQR 0-5 days for head AIS 3; 5, IQR 0-7 days for AIS 4). Observed mortality was 37.2% after NOM, 9.2% after ETC, and 10.3% after DCO. ETC in patients with moderate TBI (AIS 3) was associated with reduced observed mortality relative to NOM and matching DCO. Increasing TBI severity shifted practice patterns to DCO/NOM. These findings suggest that critical head injuries may prolong time to definitive fixation being associated with higher morbidity and mortality.

This study aimed to analytically map functional knee phenotypes (FKP) to the Coronal Plane Alignment of the Knee (CPAK) classification, evaluate CPAK's ability to represent native coronal alignment variability in non-osteoarthritic (NO) and osteoarthritic (OA) populations and propose a simplified translational framework between both systems. It was hypothesized that CPAK represents a discretized form of native coronal alignment and that its relationship with functional phenotypes is inherently probabilistic. Arithmetic hip-knee-ankle angle and joint line obliquity were analytically derived from femoral and tibial mechanical angles, enabling direct conversion of functional phenotypes into CPAK types. A theoretical cartography was constructed using mean values and full angular intervals (&#xb1;1.5&#xb0;). Four assignment strategies were applied: deterministic assignment, interval propagation, stochastic Monte Carlo simulation and least probable CPAK scenario. Conversions were performed in 308 NO and 2692 OA knees from the functional phenotype cohort and compared with 500 NO and 507 OA knees from the CPAK cohort. A synthetic bidimensional framework (Hirschmann-CPAK Translational grid [HCT-9]) was analytically derived. Considering angular intervals, each functional phenotype corresponded to multiple CPAK types (mean 1.7 per phenotype), showing that deterministic conversion underestimated variability. In NO knees, distributions obtained using the mean, interval, stochastic and rare methods differed significantly from the original cohort (all p&#x2009;<&#x2009;0.001). In OA knees, the distribution obtained using stochastic conversion showed no significant difference (p&#x2009;=&#x2009;0.188), suggesting probabilistic convergence. Extreme types were overrepresented in the rare scenario. The HCT-9 framework identified zones of low and high ambiguity, particularly in central phenotypic regions. The relationship between FKP and CPAK is inherently probabilistic. The HCT-9 framework enables structured translation between both systems and supports a shared alignment language for total knee arthroplasty. Level III, comparative retrospective study.

Radiographic correction after hallux valgus surgery may not fully explain clinical outcomes, and first metatarsal length change may be an additional structural factor associated with function. To evaluate the association between postoperative first metatarsal length change and clinical outcomes after distal Turan (Lindgren-Turan) and proximal medial open-wedge osteotomies for mild-to-moderate incongruent hallux valgus. Retrospective cohort study (Level 3). Fifty patients who underwent isolated distal Turan (Lindgren-Turan) or proximal medial open-wedge osteotomy for mild-to-moderate incongruent hallux valgus were retrospectively analyzed. Outcomes were assessed preoperatively and at final follow-up using weight-bearing radiographs, VAS, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the EQ-5D summed descriptive score. The primary analysis evaluated the association between first metatarsal length change and postoperative AOFAS score, with an exploratory adjusted regression model. Mean follow-up was 38 months. Significant postoperative improvement was observed in hallux valgus angle, intermetatarsal angle, VAS, AOFAS, and EQ-5D score. Greater positive first metatarsal length change was associated with lower postoperative AOFAS score (rho&#x202f;=&#x202f;-0.401, p&#x202f;=&#x202f;0.004), persisting in the adjusted model (B&#x202f;=&#x202f;-0.50 per mm, p&#x202f;=&#x202f;0.003), and with less AOFAS improvement (rho&#x202f;=&#x202f;-0.361, p&#x202f;=&#x202f;0.010). No significant association was observed with angular parameters or angular correction. First metatarsal length change was associated with postoperative function and may add information beyond angular measurements. Because it was closely related to surgical technique and not randomized, it should be interpreted as a procedure-associated structural marker rather than a causal effect. 3.

Esophageal squamous cell carcinoma (ESCC) remains a major public health challenge in China. Diet is a modifiable risk factor, and the esophageal mucosa-associated microbiome may contribute to esophageal disease progression. However, population-based evidence integrating plant-based diet quality, esophageal microbiome profiles anddisease severity remains limited. We conducted a cross-sectional study including 236 participants undergoing upper gastrointestinal screening in Linzhou, a high-risk region for ESCC. Dietary intake was assessed using a food frequency questionnaire, and plant-based diet indices, including the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI), were calculated. Esophageal mucosal swabs were profiled by 16S rRNA gene sequencing. Associations among diet indices, microbiome features, and esophageal disease severity were evaluated using regression and risk stratification models. Higher hPDI was inversely associated with esophageal disease severity, whereas higher uPDI were positively associated. Higher hPDI was associated with greater relative abundance of Rothia and Prevotellaceae-related taxa, whereas higher uPDI was associated with enrichment of Streptobacillus and Fretibacterium. Integrating dietary indices with microbiome features modestly but consistently improved risk stratification beyond epidemiological factors alone (e.g. AUC for the combined hPDI-microbiome model was 0.93, 95%CI: 0.89-0.98). Healthful and unhealthful plant-based diet patterns showed opposite associations with esophageal disease severity and distinct mucosa-associated microbiome profiles, supporting an exploratory diet-microbiome framework for ESCC risk stratification.

Cardiac sarcoidosis is a rare but life-threatening manifestation of systemic sarcoidosis, frequently presenting with ventricular arrhythmias, heart block, or sudden cardiac death. It remains underdiagnosed owing to its diverse clinical presentation and rarity and the limitations of conventional diagnostic modalities. We report a case of a 42-year-old man with no prior cardiac history who presented with a three-day history of recurrent palpitations and three to four syncopal episodes. Electrocardiography during syncope demonstrated self-terminating ventricular tachycardia (VT), with one episode lasting five hours, requiring pharmacological cardioversion. Coronary angiography revealed entirely normal coronary arteries. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) identified a non-ischemic, epicardial-to-mid-myocardial enhancement pattern involving the interventricular septum, inferior wall, and lateral wall, accompanied by mediastinal and hilar lymphadenopathy. Two-dimensional echocardiography revealed severe left ventricular (LV) dysfunction with an ejection fraction of 15%. Serum angiotensin-converting enzyme levels were&#xa0;markedly elevated at 90 U/L (reference: 12-66 U/L). The patient was commenced on systemic corticosteroids (prednisolone), antiarrhythmic therapy (amiodarone), anticoagulation, and guideline-directed heart failure therapy. This case underscores the diagnostic utility of CMR-LGE in identifying non-ischemic infiltrative cardiomyopathy and highlights the importance of considering cardiac sarcoidosis in patients presenting with unexplained VT and severely reduced LV function. Early immunosuppressive therapy and multidisciplinary management are pivotal in improving clinical outcomes.

The optimal management of nondisplaced femoral neck fractures in very elderly patients remains controversial. Although hip arthroplasty is frequently advocated, internal fixation with cannulated screws may represent a less invasive alternative in carefully selected patients. A retrospective single-centre cohort study was conducted including patients aged 80 years or older with nondisplaced femoral neck fractures treated with cannulated screw fixation between 2010 and 2019. Primary outcomes were fixation failure and conversion to hip arthroplasty. Secondary outcomes included reoperation rate, radiographic fracture collapse, ambulatory status, weight-bearing protocol, and radiographic measurements related to screw positioning. A total of 170 patients were included, with a mean age of 86.9 years. Fixation failure occurred in 17 patients (10%). Reoperation for any cause was required in 15 patients (8.8%), and conversion to hip hemiarthroplasty was performed in 6 patients (3.5%). Radiographic fracture collapse was observed in 46 patients (30%), although only 7 patients (15.2%) required reoperation. Immediate full weight-bearing was not associated with increased fixation failure or fracture collapse and was associated with improved ambulatory status at 6 months. Greater femoral head occupancy on lateral radiographs was associated with fracture collapse, whereas tip-apex distance was not. In carefully selected patients older than 80 years with nondisplaced femoral neck fractures, cannulated screw fixation was associated with low rates of fixation failure and conversion to hip arthroplasty. Immediate full weight-bearing did not increase complication rates and was associated with improved early mobility, supporting a less invasive treatment strategy in this super-aged population.

After severe hemorrhage and polytrauma, late complications such as multi-organ failure (MOF) remain major contributors to morbidity and mortality. Especially after hemorrhagic shock the kidney is known to be at high risk. As laboratory parameters, like creatinine, provide only delayed and indirect information about kidney function, our study evaluated whether iodine-based spectral computed tomography (SDCT) can quantify renal perfusion in a large-animal polytrauma model. Thirty-two Landrace pigs (70&#xb1;5&#xa0;kg) were used, randomized into four groups (n=8). Tissue trauma group (TTFx) received a blunt chest injury and bilateral femur shaft fractures. In the shock (HS) group, hemorrhagic shock was induced by controlled blood withdrawal. The polytrauma (PT) group underwent tissue trauma and hemorrhagic shock. Eight uninjured pigs served as controls. Whole-body SDCT with iodine mapping was performed after trauma and after 24 hours. Serum creatinine was measured in parallel. Urine was sampled at baseline, after resuscitation, and after 24 hours. Significant differences in renal perfusion measured by iodine uptake were found during shock and after polytrauma: groups with hemorrhagic shock showed reduced renal perfusion compared with controls (P<0.001). Decreased iodine uptake correlated strongly with increased creatinine levels (&#x3c1;=-0.505, P=0.009). Hemorrhagic shock caused pronounced intrarenal functional impairment, reflected by elevated fractional sodium excretion (FENa 2.49% vs. 0.35%, P<0.001), reduced urine osmolality (P<0.001), and decreased urinary urea concentrations (P<0.001). Fractional calcium excretion (FECa), a novel parameter, was strongly increased in the shock group (6.18% vs. 0.19%, P<0.001). After 24-hour resuscitation, no significant differences between the groups were observed in either iodine uptake, creatinine levels, or urinary parameters. Spectral iodine imaging seems to reflect renal perfusion impairment after hemorrhagic shock. The observed correlations with creatinine and urinary parameters suggest that spectral CT may provide a rapid, imaging-based assessment of kidney dysfunction. The renal perfusion normalizes with resuscitation along with renal function parameters. (J Trauma Acute Care Surg. 2026;101: 121-128. c 2026 The Author (s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Surgery of Trauma.). Not applicable.

Although most Patient-Reported Outcome Measures (PROMs) in sports medicine are anatomy-specific and limited in scope, the 4-Domain Sports PROM (4-DSP) offers a comprehensive, athlete-centered, and anatomy-independent alternative. Validating the Persian version addresses a critical need for Iran's substantial athletic community, which experiences a high prevalence of sports-related injuries. To translate, culturally adapt, and validate the Persian 4-DSP for Persian-speaking athletes. Cross-sectional observational study following COSMIN and STROBE guidelines. Following Beaton and ISPOR guidelines, the 4-DSP underwent forward-backward translation. Psychometric evaluation involved 112 Persian-speaking athletes (61 men, 51 women; mean age: 27.45&#xb1;4.52 years) with orthopedic injuries 3-12 months prior. Face validity was assessed by 20 athletes using I-FVI. Content validity was evaluated by 10 experts using I-CVI, S-CVI/Ave, S-CVI/UA, and modified Kappa. Test-retest reliability was assessed using ICC with 24-48-hour intervals. Internal consistency (Cronbach's alpha), measurement error (SEM, MDC), feasibility (missing data), and interpretability (floor/ceiling effects) were also evaluated. Analyses were performed using SPSS v29. All items showed acceptable face validity (I-FVI&#x2265;0.83); scale-level indices were excellent (S-FVI/Ave=0.95, S-FVI/UA=0.36). Content validity was robust (I-CVI&#x2265;0.78, S-CVI/Ave=0.95, modified kappa=0.94; S-CVI/UA=0.45). Test-retest reliability was excellent for the total score (ICC=0.91; 95% CI: 0.87-0.94) and good-to-excellent across domains (ICC: 0.84-0.93). Internal consistency was acceptable (&#x3b1;=0.77). Missing data were <2%, and no floor/ceiling effects were detected (<15%). SEM and MDC values supported clinical interpretation. The Persian 4-DSP demonstrates excellent face and content validity, very good reliability, and acceptable internal consistency, supporting its use as a feasible, culturally adapted tool for assessing treatment outcomes in Persian-speaking athletes. Future research should address convergent validity and responsiveness to fully establish construct validity.

Metallic foreign bodies (MFB) in the extremities are a common clinical problem that requires removal to prevent complications and to avoid contraindications to magnetic resonance imaging. While magnetic extraction represents an alternative to conventional surgical techniques, systematic data regarding its efficacy and clinical utility remain limited. This study aimed to evaluate the clinical efficacy of magnetic extraction for MFBs in extremities, its impact on radiation exposure, and success rates across different anatomical locations and foreign body types. We retrospectively reviewed data on patients who underwent MFB removal surgery between 2017 and 2025 at a tertiary trauma center. Of the 364 patients reviewed, 51 met the inclusion criteria after excluding non-metallic foreign bodies, cases in which magnets were not used, and incomplete records. Demographic data, anatomical location, foreign body characteristics, use of image intensifier, and magnet efficiency were recorded. A magnet was used for 52 MFBs in 51 patients. Magnetic extraction of MFBs was successful in 87% (45/52) of cases. The success rate was 100% for metal splinters but decreased to 63% for the needle-type foreign bodies (p&#xa0;<&#xa0;0.001). Magnetic extraction succeeded in all upper-extremity cases (28/28, 100%) and in 68.2% (15/22) of lower-extremity cases; the single patient with bilateral involvement was successfully managed at both sites (p&#xa0;=&#xa0;0.003, Fisher-Freeman-Halton exact test). In 70% of all cases and 80% of magnet successful cases, the image intensifier was not used. Stratified analysis by anatomical location revealed that the inverse relationship between image-intensifier use and magnet-only success was particularly pronounced in lower extremity cases (p&#xa0;=&#xa0;0.020). Magnet-assisted extraction is an easy and feasible method with high success rates for MFB removal. The use of a magnet may reduce radiation exposure during MFB removal. Its efficacy decreases at lower-extremity sites, particularly in the sole, and with needle-type foreign bodies. These findings indicate that magnetic extraction of MFBs should be planned according to anatomical location and foreign body type.

Thumb carpometacarpal (CMC) osteoarthritis in advanced stages is frequently associated with metacarpophalangeal (MCP) hyperextension, resulting in the characteristic Z-deformity and reduced pinch stability. Standard basal joint reconstruction may fail to correct MCP hyperextension, contributing to persistent functional impairment. Prosthetic trapeziometacarpal arthroplasty may partially correct Z-deformity but becomes unreliable when MCP hyperextension exceeds 30 degrees. This article describes a reproducible surgical technique combining trapeziectomy, APL suspension arthroplasty, and EPB reinsertion onto the dorsal aspect of the first metacarpal head to restore sagittal balance of the MCP joint. In this configuration, the EPB is intentionally converted from an active extensor into a passive dorsal stabilizer, providing a tenodesis-like restraint against hyperextension while preserving flexion arc. In 10 consecutive patients with Eaton-Littler stage III-IV disease and MCP hyperextension &#x2265;30 degrees, mean hyperextension improved from 38.6 degrees preoperatively to 5.4 degrees at 12-month follow-up, with preservation of MCP flexion and improvement of key pinch strength and QuickDASH scores. This approach provides stable correction of MCP hyperextension while maintaining MCP motion, offering a motion-preserving alternative to capsulodesis or arthrodesis.

To investigate the association of preoperative paraspinal muscle quality (quantified by fat infiltration) on the clinical and radiographic outcomes following open pedicle screw fixation (OPSF) for thoracolumbar fractures. This retrospective study analyzed the clinical data of 48 patients with single-segment thoracolumbar fractures who underwent OPSF surgery between January 2021 and December 2023. Patients were stratified into a low-fat group (LFG, FI&#x2009;<&#x2009;25%, n&#x2009;=&#x2009;26) and a high-fat group (HFG, FI&#x2009;&#x2265;&#x2009;25%, n&#x2009;=&#x2009;22) based on the preoperative fat infiltration rate (FI) of paraspinal muscles at the L4/5 level measured on MRI. General clinical data, perioperative indicators, radiographic parameters (anterior vertebral body height ratio - AVBHr, vertebral body angle - VBA, regional kyphosis angle - RKA), and clinical efficacy scores (Visual Analogue Scale - VAS, Oswestry Disability Index - ODI) were compared between groups preoperatively, at 1 month, and 1 year postoperatively. The groups were comparable in all baseline and perioperative characteristics (P&#x2009;>&#x2009;0.05). The LFG demonstrated significantly better paraspinal muscle parameters at multiple spinal levels (P&#x2009;<&#x2009;0.05). Although the immediate postoperative radiographic correction achieved was similar between groups (P&#x2009;>&#x2009;0.05), the HFG exhibited significantly greater loss of correction in both VBA and RKA at the 1-year follow-up (P&#x2009;<&#x2009;0.05). This difference in correction loss was particularly pronounced in the subgroup of patients with more severe, unstable fractures (AO type A3/A4). No significant differences were found in VAS and ODI scores at any postoperative time point (P&#x2009;>&#x2009;0.05). Complication rates were similar between groups (P&#x2009;>&#x2009;0.05). Preoperative lumbar paraspinal muscle quality is not associated with the initial surgical reduction but is significantly associated with the long-term maintenance of radiographic correction after OPSF, especially in unstable fracture patterns. Assessment of paraspinal muscle quality could serve as a valuable prognostic tool for surgical planning and patient counseling.

Patients use artificial intelligence-based large language models (AI-LLMs) to research minimally invasive surgery (MIS) for hallux valgus; however, their reliability remains uninvestigated. To compare the quality and readability of ChatGPT and Gemini responses regarding MIS bunion surgery. Ten frequently asked questions reflecting diverse clinical and procedural inquiries were submitted to ChatGPT and Gemini. Quality was assessed via DISCERN and 5-point Likert scales. Readability and actionability were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and Flesch-Kincaid Reading Ease (FKRE). No significant differences existed between models (p&#x202f;>&#x202f;0.05). Both exceeded sufficiency thresholds for DISCERN (49.7; 49) and Likert (5.0; 4.9). While understandability (85.9%; 83.3%) and FKRE (32.9; 33.5) met requirements, both failed actionability (38.3%; 34%). Both AI models offer reliable, high-quality theoretical information regarding MIS hallux valgus surgery. However, they are insufficient in providing actionable guidance and exceed ideal reading complexity for general patient populations.