Purpose: The purpose of this study is to systematically review multiligament knee injury (MLKI) outcome studies to determine definitions of arthrofibrosis (AF) and provide information about incidence, management as well as potential risk factors. Methods: A systematic literature search was performed (PubMed and Cochrane library) following the PRISMA guidelines of operatively treated MLKI (Schenck II–IV) studies reporting the incidence of AF. Twenty-five studies met the inclusion criteria. Injury pattern, timing of surgery, surgical technique, treatment of AF, rehabilitation programs and PROMS were inquired. Risk of bias and quality of evidence were assessed using the Coleman methodological score. Results: Twenty-five studies with a total of 709 patients with a mean age of 33.6 ± 4.8 years were included and followed 47.2 ± 32.0 months. The majority of studies (22/25) used imprecise and subjective definitions of AF. A total of 86 patients were treated for AF, resulting in an overall prevalence of 12.1% (range 2.8–57.1). Higher-grade injuries (Schenck III–IV), acute treatment and ROM (range of motion) limiting rehabilitation programs were potential risk factors for AF. The time from index surgery to manipulation anesthesia (MUA) and arthroscopic lysis of adhesions (LOA) averaged at 14.3 ± 8.8 and 27.7 ± 12.8 weeks. Prior to MUA and LOA, the ROM was 51.7° ± 23.5 and 80.2° ± 17.0, resulting in a total ROM gain after intervention of 65.0° ± 19.7 and 48.0° ± 10.6, respectively; with no reports of any complication within the follow-up. The overall methodological quality of the studies was poor as measured by the Coleman score with average 56.3 ± 12.5 (range 31–84) points. Conclusions: AF is a common but poorly defined complication particularly in high-grade MLKI. Early postoperative and intensified physiotherapy is important to reduce the risk of AF. MUA and LOA are very effective treatment options and result in good clinical outcome. Prospective studies with bigger study population are needed to optimize treatment algorithms of further patients after MLKI. The protocol of this systematic review has been prospectively registered with PROSPERO (CRD42021229187, January 4th, 2021).

Pelvic fractures are serious and oftentimes require immediate medical attention. Pelvic binders have become a critical tool in the management of pelvic injuries, especially in the prehospital setting. Proper application of the pelvic binder is essential to achieve the desired result. This study evaluates the effectiveness of prehospitally applied pelvic binders in improving outcomes for patients with pelvic fractures. This retrospective cohort study analyzed 66 patients with unstable pelvic ring fracture classified as AO61B or 61C, who were treated at a Level I hospital in the emergency room between January 2014 and December 2018. The ideal position for a pelvic binder was determined, and patients were divided into three sub-groups based on whether they received a pelvic binder in the ideal position, outside the optimal range, or not at all. The primary outcome measure was the survival rate of the patients. 66 trauma patients with unstable pelvic fractures were enrolled, with a mean age of 53.8 years, who presented to our ER between 2014 and 2018. The mean ISS score was 21.9, with 60.3 % of patients having a moderate to severe injury (ISS > 16 points). Pelvic binder usage did not differ significantly between patients with an ISS < or ≥ 16 points. A total of 9 patients (13.6 %) died during hospitalization, with a mean survival time of 8.1 days. The survival rate did not differ significantly between patients with or without a pelvic binder, or between those with an ideally placed pelvic binder versus those with a binder outside the ideal range. The ISS score, heart rate, blood pressure at admission, and hemoglobin level were significantly different between the group of patients who died and those who survived, indicating their importance in predicting outcomes. Our study found that prehospital pelvic binders did not significantly impact patient outcomes for unstable pelvic fractures, with injury severity score (ISS) being the strongest predictor of survival. Assessing injury severity and managing blood loss remain crucial for these patients. While pelvic binders may not impact survival significantly, they still play a role in stabilizing pelvic fractures and managing blood loss.

Introduction: Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones. Materials and methods: We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options. Results: We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection. Conclusions: Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.

Intramuscular myxomas (IMMs) are benign tumors. Evidence regarding diagnostic and therapeutic pathways is rare, and guidelines do not exist due to their low incidence. The aim of this study was a retrospective analysis at a university cancer center and the interdisciplinary re-evaluation of the individual diagnostic and therapeutic procedures. Overall, 38 patients were included in the study. IMMs occurred mostly in middle-aged women. At the time of first consultation, 57.9% had few symptoms or were asymptomatic. In 92.1% of the cases, the tumor was localized in the extremities. The lower extremity was affected in 73.7%. The average size of IMMs was 5.0 cm. The proximally located tumors in the gluteus, thighs, and upper arms were significantly larger (p = 0.02) than the distally-located tumors in the forearms and lower legs. An MRI was performed in 97.4%. Based on imaging, an IMM was suspected in 5.6% by radiologists and in 54.1% by musculoskeletal surgeons. An incision biopsy was performed in 68.4% and led in 100.0% to the right histopathological diagnosis. In total, 89.5% of IMMs were resected. Postoperative complications requiring revision occurred in 8.8%. Recurrences or degenerations of IMMs were not reported in any of these cases.

As of September 2023, the number of SARS-CoV-2 infections worldwide has exceeded 770 million, with ongoing research recognizing its long-term health effects. This study investigates the effects of the pandemic on participants with and without SARS-CoV-2 infection on musculoskeletal status. The Hamburg City Health Study (HCHS) is an ongoing, prospective, population-based cohort study (trial registration number: NCT03934957). Participants (n = 2660) examined prior to the SARS-CoV-2 pandemic were compared with non-infected participants (n = 2660) in a 1:1 matched cohort analysis after the pandemic onset. Furthermore, participants who had recovered from a SARS-CoV-2 infection (n = 428) were compared with non-infected participants (n = 1712) in 1:4 matched cohort analysis. Increased relative fat mass and reduced skeletal muscle mass were observed in the post-pandemic group. No significant differences were observed between the groups regarding handgrip strength and timed up and go test. The comparison of the infection group with non-infected participants showed no significant differences in relative fat mass, handgrip strength and timed up and go test. The skeletal muscle mass was increased in the infection group but linear regression analysis adjusted for body surface area revealed no significant differences. This prospective study shows no association between SARS-CoV-2 infection and changes in basic musculoskeletal parameters in the cohort studied, suggesting that the infection may not be a significant cause of major deterioration in musculoskeletal function. Instead, it appears that lifestyle changes in daily routines and physical activities associated with the pandemic itself are the main influence on the musculoskeletal system.

Objectives: Intramuscular myxomas (IMMs) are rare benign soft tissue tumors arising within large skeletal muscles. Their etiology is incompletely understood, but they are frequently associated with mutations (e.g., GNAS) and may occur in syndromic conditions such as Mazabraud and McCune–Albright syndromes. This study retrospectively analyzed clinical, radiological, histopathological, and molecular features of IMMs, including syndromic associations. Methods: A retrospective analysis was performed on 41 patients diagnosed with IMM who underwent biopsy or surgical resection between September 2011 and September 2022. Clinical, imaging, histopathological, and molecular data were evaluated using descriptive statistics. Results: The cohort included 27 females and 14 males with a mean age of 52.8 years. The most common tumor location was the quadriceps femoris, followed by other thigh muscles. Most patients presented with mild symptoms due to slow tumor growth. MRI was performed in all but one case, with additional imaging in 12 patients. Radiological differential diagnoses commonly included soft tissue sarcoma and hematoma. Complete tumor resection was achieved in 90.2% of patients. Immunohistochemistry was performed in 78.0%, most frequently showing CD34 positivity. GNAS mutation analysis was conducted in 85.4% of cases and was positive in 57.1%. Complications occurred in 9.8%, and no recurrences were observed during follow-up. Conclusion: IMMs are rare benign tumors that can be reliably diagnosed using histology supported by immunohistochemistry and GNAS mutation analysis. Complete surgical resection provides excellent outcomes with a low risk of complications or recurrence. Mazabraud syndrome should be considered in patients with multiple or recurrent IMMs and GNAS mutations.