Deep vein thrombosis is a well-known complication of fracture occurrence, lower limb surgery and periods of prolonged immobilisation. Its incidence can be increased even more in specific cases with metastatic bone disease and adjuvant treatment. There is a small amount of literature that addresses the incidence of DVT by comparing osteosynthesis and arthroplasty as surgical treatments. Current recommended anticoagulation protocols might be inadequate for specific groups of cancer patients undergoing osteosynthesis or arthroplasty. The study was designed and performed in a retrospective manner and carried out on patients that presented at our Emergency Clinical County Hospital between 01.01.2008–31.12.2016. The patients’ evolution was followed for a standard of 2 months. All our deep vein thrombosis events were diagnosed via venous duplex imaging. The studied lot (n = 85) was paired with a control group (n = 170) with similar baseline characteristics. Our lot was comprised of 85 patients that underwent 85 surgeries, on both of our hospital’s Orthopaedic and Traumatology wards. When performing the student t-test and calculating OR (odds ratio) and RR (risk ratio) we encountered 11 cases of DVT in our studied group and 12 cases of DVT in our control group (p < 0.04). We found statistical significance when correlating DVT with type of implant (prosthesis), the presence of metastases over primary tumour and the choice of implant (prosthesis over intramedullary nail). There was no statistical significance found when correlating DVT events with the type of anticoagulation and the amount of blood transfusion units required. Patients who undergo surgical treatment for lower limb pathological fracture due to malignancy are at increased risk of DVT or death due to PE under current general thromboprophylaxis regimens. The risk is higher for the immediate postoperative period (10 days). The risk is increased by metastasis, arthroplasty and adjuvant therapy (radiotherapy, chemotherapy), and we think that a more aggressive prophylactic protocol should be used.

Purpose: This systematic review aimed to investigate the association between serum vitamin D levels and key outcomes following anterior cruciate ligament reconstruction (ACLR), including ACL injury risk, postoperative muscle recovery and post‐reconstruction functional outcomes.Methods: We conducted a comprehensive search across five databases (Cochrane Library, EMBASE, MEDLINE, Scopus and Web of Science) until July 2024. Studies were selected based on specific inclusion criteria, such as studies evaluating the relationship between vitamin D and injury risk, ACLR outcomes and muscle strength. Risk of bias was assessed using the MINORS tool, and results were synthesized narratively due to study heterogeneity.Results: Five studies with 656,243 participants met the inclusion criteria. Most studies reported that low vitamin D levels were associated with a significantly increased risk of ACL injuries and poorer postoperative muscle strength recovery. However, evidence regarding bone health and functional outcomes was inconsistent. No meta‐analysis was conducted due to the variability of study designs and outcomes, but qualitative synthesis indicated a potential protective role of vitamin D in ACL recovery.Conclusions: Vitamin D deficiency appears to increase the risk of ACL injury and impede muscle recovery post‐surgery. However, limitations include a high risk of bias and inconsistent evidence on functional outcomes, underscoring the need for further research. The review was registered in PROSPERO (ID: CRD42024584483).Level of Evidence: Level III, systematic review.

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: Tranexamic acid (TXA) has become a cornerstone in total hip arthroplasty for reducing blood loss and minimizing transfusion requirements. However, its influence on postoperative infection rates, including surgical site infections and periprosthetic joint infections (PJIs), remains a topic of debate. This systematic review aims to explore the association between tranexamic acid use and infection rates in total hip arthroplasty. Methods: Following PRISMA 2020 guidelines, an electronic search was performed in the PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos databases. A PICO-based question was developed to select relevant studies, which were assessed for quality using the MINORS tool for non-randomized studies and the RoB 2 tool for randomized controlled trials (RCTs). This review critically appraises three studies, including one RCT and two retrospective cohort studies. Results: Of 277 studies identified, 3 met inclusion criteria, totaling 146,227 patients. Findings indicate that tranexamic acid is generally associated with reduced periprosthetic joint infections and surgical site infection rates, with some variability based on administration routes and dosages. Despite these promising results, methodological limitations in the included studies underscore the need for further high-quality research to establish optimal tranexamic acid protocols. Conclusions: In summary, this systematic review indicates that TXA could reduce postoperative infection rates following total hip arthroplasty (THA). Further well-designed randomized controlled trials are required to validate these findings and determine the best dosing and administration strategies. PROSPERO registration: CRD42024589078.