Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a “component disorder“ of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.

Background/Objectives: Mild traumatic brain injury (mTBI) is a leading cause of pediatric emergency department visits, particularly among children under three years old. Although computed tomography (CT) is the gold standard for diagnosing intracranial injuries, its use in young children poses radiation risks. Identifying reliable clinical indicators that justify CT imaging is essential for optimizing both patient safety and resource utilization. Objective: This study aimed to evaluate CT findings in children under three years of age with mTBI and no focal neurological deficits, as well as to identify clinical predictors associated with skull fractures and intracranial injuries. Methods: A retrospective analysis was conducted on 224 children under 36 months who presented with mTBI to a tertiary pediatric hospital from July 2019 to July 2024. Demographic data, injury mechanisms, clinical presentation and CT findings were evaluated. Univariate and multivariate regression analyses were performed to identify risk factors associated with skull fractures and intracranial injuries. Results: Falls accounted for 96.4% of injuries, with the majority occurring from heights of 0.5–1 m. The parietal region was the most frequently affected site (38%). Skull fractures were present in 46% of cases and were primarily linear (92.8%). Intracranial hematomas were identified in 13.8% of cases, while brain edema was observed in 7.6%. Significant predictors of skull fractures included age under 12 months (p < 0.001), falls from 0.5–1 m (p = 0.005), somnolence (p = 0.030), scalp swelling (p = 0.001) and indentation of the scalp (p = 0.016). Parietal bone involvement was the strongest predictor of both skull fractures (OR = 7.116, p < 0.001) and intracranial hematomas (OR = 4.993, p < 0.001). Conversely, frontal bone involvement was associated with a lower likelihood of fractures and hematomas. Conclusions: The findings highlight key clinical indicators that can guide decision-making for CT imaging in children with mTBI. Infants under 12 months, falls from moderate heights and parietal bone involvement significantly increase the risk of fractures and intracranial injuries. A more refined diagnostic approach could help reduce unnecessary CT scans while ensuring the timely identification of clinically significant injuries.

Background: The purpose of this study was to collect all available randomized controlled trials (RCT) on the treatment of open tibial fractures with an external fixator (EF) and intramedullary nailing (IMN) for meta-analysis to provide reliable evidence-based data for clinical decision-making. Material and methods: The systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR (Assessing the Methodological Quality of Systematic Review). An electronic search of PubMed, Cochrane Library, and Web of Science was performed until 1 March 2023 to identify RCTs which compared either IMN or EF to fix the open tibial fracture. Outcome measures were: postoperative superficial and deep infection, time to union, delayed union, malunion, nonunion and hardware failure. In addition, pain and health-related quality of life were evaluated after 3 and 12 months of follow-up. Results: Sixteen publications comprising 1011 patients were included in the meta-analysis. The pooled results suggested that the IMN technique had a lower postoperative superficial infection and malunion rate (RR = 3.56, 95%CI = 2.56–4.95 and RR = 1.96, 95%CI = 1.12–3.44, respectively), but higher hardware failure occurrence in contrast to EF (RR = 0.30; 95%CI = 0.13–0.69). No significant differences were found in the union time, delayed union or nonunion rate, and postoperative deep infection rate between the treatments. Lower levels of pain were found in the EF group (RR = 0.05, 95%CI = 0.02–0.17, p < 0.001). A difference in quality of life favoring IMN after 3 months was found (RR = −0.04, 95%CI = −0.05–0.03, p < 0.001), however, no statistical difference was found after 12 months (RR = 0.03, 95%CI = −0.05–0.11, p = 0.44). Conclusions: Meta-analysis presented reduced incidence rates of superficial infection, malunion, and health-related quality of life 3 months after treatment in IMN. However, EF led to a significant reduction in pain and incidence rate of hardware failure. Postoperative deep infection, delayed union, nonunion and health-related quality of life 12 months following therapy were similar between groups. More high-quality RCTs should be conducted to provide reliable evidence-based data for clinical decision-making.

Background/Aim. There are few research papers in Serbia reporting on the clinical results of scarf osteotomy and its long-term effects. The aim of this retrospective study was to evaluate the efficacy of the scarf osteotomy in hallux valgus (HV) deformity correction, as well as the degree of recurrence and its possible causes. Methods. The study included 48 patients (52 feet) who underwent scarf osteotomy. Average follow-up time was 103.9 months (63-156). In order to clinically evaluate the results, the scale of the American Orthopedic Foot and Ankle Society (AOFAS) and the Visual Analogue Scale (VAS) of pain were used. Preoperatively and postoperatively, in order to radiographically determine the degree of deformity, radiographs of the feet were taken in the standing position and the parameters determined were: HV angle (HVA), intermetatarsal angle (IMTA), distal metatarsal articular angle (DMTAA) and sesamoid position. Results. The AOFAS scores increased from 19 (5-45) points preoperatively, to 92 (54-100) points at the time of the latest follow-up examination (p < 0.001). The VAS values significantly improved from 10 (8-10) preoperatively, to 0 (0-6). The average HVA correction was 24.8°. The recurrence rate in patients in whom the HVA was greater than 20° was 26.9%. Conclusion. Although scarf osteotomy is a proven procedure for the correction of HV, long-term results still show a relatively high rate of recurrence.

Introduction/Aim: COVID-19-associated pneumonia is a serious form of the disease that can result in severe life-threatening complications. This study aims to evaluate the prognostic value of the CAR index in hospitalized patients with COVID-19-associated pneumonia. Material and Methods: This was a single-centre prospective study conducted at the University Clinical Centre Zvezdara during April 2020 which included hospitalized patients diagnosed with moderate to severe COVID-19-associated pneumonia. The COVID-19 infection was verified by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test on a sample obtained from a swab of the nasopharynx. The CAR was calculated as CRP and albumin ratio. Results: Two hundred and eight hospitalized patients with COVID-19-associated pneumonia were enrolled. Average age was 54.5±14.6 years, and participants were predominantly male (64.4%). Comorbidities were present in 67.3% of patients. The overall in-hospital mortality was 14.4%. CAR index level of 2.0 was identified as the cut-off point for predicting mortality, with sensitivity of 86% and specificity of 72% (AUC=0.844). In univariate regression analysis age, comorbidities, breathing difficulties and CAR index were identified as significant predictors of mortality (p<0.050 for all). In the multivariate analysis, age (RR=1.06; 95% CI: 1.02-1.09; p=0.001) and CAR index (RR=1.12; 95% CI: 1.02-1.23; p=0.019), were independent predictors of mortality in COVID-19-associated pneumonia patients. Conclusion: This study demonstrated that routine blood testing can be beneficial in identifying COVID-19 patients with associated pneumonia who are at an increased mortality risk. The CAR index is a widely accessible, simple inflammatory marker that can be a valuable indicator for early differentiating levels of severity in patients hospitalized due to COVID-19-associated pneumonia.