The COVID-19 pandemic has put an enormous burden on healthcare systems. As a direct consequence, many elective procedures were cancelled and available resources were relocated to emergencies and COVID-19 patients. We aimed to analyze the impact on orthopedic surgery in Romania. We performed a retrospective analysis of orthopedics and trauma cases admitted over the first six months of 2019 and 2020 in three representative clinics. In total, there were 1900 patients: 1241 from Timisoara, 216 from Cluj-Napoca, and 443 from Bucharest. In April, activity for all cases in the regional trauma center dropped to 23.8% and stopped in the other two. No arthroscopies or elective joint replacements were performed in April. By June, hospital admissions resumed for trauma cases while arthroscopies and joint replacements still lagged behind.

There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave.

Background: Determining the association of neutrophil to lymphocyte ratio (NLR) and clinical disease severity in patients with mild and advanced stage knee osteoarthritis (OA).Method: We analyzed clinical scores and routine hematology panels of 111 subjects with symptomatic knee degeneration: mild OA (66) who underwent knee arthroscopy and advanced OA (45) who had total replacement. Results: Compared to the advanced OA group, the mild OA group was younger (54/67), had fewer females (1.75/5.43), and better scores: Euroqol EQ5D Index (0.50/0.25), VAS (visual analog scale) (65/44); International knee documentation committee subjective knee evaluation form—IKDC (31.6/20.24); Knee disability and osteoarthritis outcome score for joint replacement—KOOSJR (15.5/18.3); and better Kellgren–Lawrence stage (1.3/3.8). Patients with advanced disease had higher NLRs compared to mild OA group and controls: 2.82 versus 1.99 (p = 0.004) and 1.98 (p = 0.002). In the multiple regression model, NLR was only influenced by age (p < 0.001). In the subgroup analysis, for the early OA cases, NLR was significantly dependent to VAS (p = 0.006), IKDC (p = 0.001) and KOOSJR (p < 0.001). Conclusion: NLR was not associated with symptomatic knee OA, as determined by commonly used patient reported outcomes. However, for patients with mild degenerative modifications, EQ5D, VAS, and IKDC were independent predictors of NLR.

Aim: To perform validation of the Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR). Method: Ninety-six patients (101 knees) with advanced osteoarthritis (OA) scheduled for total knee replacement completed Romanian translations of KOOSJR and IKDC (International Knee Documentation Committee – subjective knee form) and Euroqol EQ-5D-5 L, and the treating physician completed the original knee society score (KSS). Results: Average age was 66.4 (range 50–83) years and male to female ratio 1:3.76. There was moderate correlation between the test-retest (average 4 days) KOOSJR (r = 0.618, n = 45) and IKDC (r = − 0.671, n = 99), weak between KOOSJR and EQ-5D-5 L Index (r = − 0.431, n = 100) and VAS (r = − 0.364, n = 99) and very weak to KSS score (r = − 0.133, n = 98) and function (r = − 0.072, n = 97) For the first KOOSJR, Cronbach’s alpha was 0.816 and intraclass correlation coefficient (ICC) 0.816 (95% CI 0.755–0.866) for average measures. For the retest, Cronbach’s alpha was 0.841 (95% CI 0.760–0.903) for averages. Conclusion: The Romanian Knee disability and Osteoarthritis Outcome Score for Joint Replacement (KOOSJR) is a valid, reliable, consistent and reproducible clinical score for patients with OA requiring arthroplasty.

Background and Objectives: While numerous studies have been conducted on syndesmotic screw management following distal tibiofibular diastasis repair, a clear consensus remains unclear. This research aims to evaluate whether the postoperative removal of syndesmotic screws leads to improved patient outcomes, specifically in quality of life, mobility, and daily living activities, and whether it offers a cost-effective solution. Materials and Methods: Patients with a history of unimalleolar or bimalleolar ankle fractures, classified according to the Danis–Weber and Lauge–Hansen systems, were included. Comprehensive evaluations were made via standardized questionnaires like the SF-36 Health Survey, HADS, and WHOQOL-BREF, distributed approximately 2 months post surgery. A total of 93 patients underwent syndesmotic screw removal while 51 retained the screws (conservative approach). Results: Patients who underwent screw removal reported superior satisfaction in mobility, with a score of 7.8, compared to 6.7 in the conservative approach (p = 0.018). Similarly, their ability to perform daily activities scored 8.1, higher than the 6.5 from the conservative cohort (p < 0.001). Pain levels were also more favorable in the screw removal group, with a score of 5.3 against 6.8 in the conservative group (p = 0.003). On the SF-36 physical domain, the screw removal group achieved a mean score of 55.9 versus 53.3 for the conservative group (p = 0.027). Notably, the HADS anxiety subscale highlighted reduced anxiety levels in the screw removal cohort with a mean score of 5.8 against 7.3 in the conservative group (p = 0.006). However, overall quality of life and recommendations to others showed no significant difference between the groups. Conclusions: Syndesmotic screw removal postoperatively leads to marked improvements in patients’ mobility, daily activity abilities, and reduced postoperative pain and anxiety levels. However, overall quality of life was similar between the two approaches. The findings offer valuable insights for orthopedic decision making and patient-centered care concerning the management of syndesmotic screws after distal tibiofibular diastasis repair.

This study investigates the impact of cooling rate after heat treatment on the electrochemical and microstructural properties of three dental Co-Cr alloys. Advanced techniques, such as scanning electron spectroscopy and X-ray diffraction, were used to evaluate the microstructures and compositions of the alloys, revealing the influence of elements such as tungsten and niobium on their electrochemical behavior. The results have shown that the alloys with 5%Mo exhibited higher porosity than the alloy with Nb and W. High melting temperature due to the presence of Nb and W ensured a more homogeneous material and a slightly altered structure. For all alloys, heat-treated samples showed higher microhardness compared with casting samples. A passive behavior was observed for all the samples with the best stability at high potential for the alloy with the highest Cr content due to the formation of a protective Cr ₂ O ₃ passive layer. Water-quenched samples showed high impedance values, demonstrating their effectiveness in corrosion resistance. The choice of cooling methods and alloy composition is crucial for improving corrosion resistance and mechanical properties of dental frameworks.