Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making.

Multi-trauma patients require a multidisciplinary team, especially in the presence of various body systems injuries. The evaluation focuses on the decision regarding the DCO and ETC approaches. A 24-year-old male patient with Glasgow Coma Score 8, arrived at the emergency room, followed by ATLS protocol. Orthopedic trauma included D8 vertebra unstable burst fracture, right open femur shaft fracture, left closed midshaft femur fracture, and right tibial plateau fracture of the knee. A hemodynamically stable patient with bilateral femur fractures is directed toward the DCO approach. An initial treatment for an external fixator across the knee on the right leg and a spine fusion and decompression of D5–10 surgery was made on the day of admission. Definitive fixation and conversion to internal fixators were done on day 9 after the accident. Postoperative drop-foot injury was seen in the right leg. A Masquelet technique was applied for the right femur segmental fracture due to gaps. DCO may be employed to temporarily stabilize fractures, allowing the patient to recover from other life-threatening injuries before definitive fixation. Further secondary procedures, such as the Masquelet technique, should be considered to optimize the results. Long-term follow-up and rehabilitation are part of recovery, aiming to optimize functional recovery and improve the patient's quality of life.

Introduction: Distal radius fractures are prevalent, with management dependent on accurate radiological assessment. Most morphologic reference values derive from Western cohorts, raising questions about their generalizability. This study established reference distal radius radiological parameters in the Israeli population derived from emergency department patients with non-fractured wrist injuries and explored the effects of age, gender, and menopause. Methods: A retrospective review included adults with wrist contusions at an Israeli emergency department. Exclusions were prior fractures, surgery, or poor radiographs. Standardized anteroposterior and lateral wrist radiographs were reviewed for 6 parameters: radial height, inclination, radiocarpal angle, volar angulation, volar tilt, and ulnar variance, measured twice by a blinded observer (intraclass correlation coefficient, 0.92-0.98). Stratification by age and gender used 50 years as a menopause proxy. Statistical analysis included t tests (Bonferroni correction, α = 0.010) and effect sizes. Results: Of 585 patients, 466 met criteria (mean age, 45 years; 40.6% female). Mean values were 13.4 mm for radial height, 25.4° for inclination, 11.6° for radiocarpal angle, 145.1° for volar angulation, and 17.1° for volar tilt. Radial height was significantly greater in males than in females ( P < .001). Ulnar variance was neutral in 69.5%, negative in 17.8%, and positive in 12.7%. Volar angulation declined significantly with age in women, especially post-menopause ( P < .01), but not in men. Conclusions: Distal radius morphology in Israelis aligns with international norms. Age-stratified differences in volar angulation among women over 50, which may reflect menopausal bone remodeling, indicate that both age and sex should be incorporated into individualized assessments. In the management of distal radius fractures in postmenopausal women, baseline volar angulation is approximately 3° lower than in younger women, a factor that may influence reduction targets.

BACKGROUND The coronavirus disease 2019 (COVID-19) virus has been a world-known pandemic since February 2020. Multiple variances had been established; the most common variants in Israel were omicron and delta. AIM To analyze and compare laboratory values in the "omicron" and "delta" variants of the coronavirus by conducting follow-up examinations and laboratory audits on COVID-19 patients admitted to our institution. METHODS A retrospective study, two groups, 50 patients in each group. Patients examined positive for COVID-19 were divided into groups according to the common variant at the given time. We reviewed demographic data and laboratory results such as complete blood count and full chemistry, including electrolytes and coagulation parameters. RESULTS The mean age was 52%, 66.53 ± 21.7 were female. No significance was found comparing laboratory results in the following disciplines: Blood count, hemoglobin, and lymphocytes (P = 0.41, P = 0.87, P = 0.97). Omicron and delta variants have higher neutrophil counts, though they are not significantly different (P = 0.38). Coagulation tests: Activated paritial thromoplastin test and international normalized ratio (P = 0.72, P = 0.68). We found no significance of abnormality for all electrolytes. CONCLUSION The study compares laboratory results of blood tests between two variants of the COVID-19 virus – omicron and delta. We found no significance between the variants. Our results show the need for further research with larger data as well as the need to compare all COVID-19 variants.

Background/Objectives: Proximal femur fractures are common in the older population and are related to bone quality. Our work evaluates bone parameters from pelvic anteroposterior (AP) radiographs in patients with trochanteric and sub-capital fractures to determine if there are predictive morphology parameters for each fracture type. Methods: Data from 237 medical records were extracted from patients who arrived at our hospital with trochanteric and sub-capital femoral fractures. Descriptive data and radiological evaluation of the calcar-to-canal ratio (CCR), cortical thickness index (CTI), and Dorr classification were measured by two observers and statistically evaluated. Results: A total of 202 patients were found to be eligible for the study. The mean patient age was 81.41 ± 7.27 years old. The mean age of the trochanteric group was significantly higher than that of the sub-capital group (p = 0.005). There were no statistically significant differences in gender and comorbidities. The CCR showed significance, but the CTI and Dorr classification did not show a significant difference (p = 0.001, p = 0.78, and p = 0.98). A high degree of reliability was shown for all measurements. The ICC for CTI and CCR was p = 0.791 and p = 0.770 (p < 0.001), and Cronbach’s alpha was 0.815 and 0.796, respectively. Logistic regression was found to be significant in predicting 60.4% of correct forecasts with an odds ratio of 0.011 and 95% confidence interval (p = 0.001). For CTI, the correct forecasting rate was 48%, with an odds ratio of 0.615 (p = 0.78). Conclusions: We found that, out of the measured parameters, the CCR stood out as important, showing that higher CCR levels are linked to an increased likelihood of trochanteric fractures.

Background and objective Surgical site infections (SSIs) following orthopedic procedures are associated with significant morbidity and continue to pose an ongoing clinical challenge. Pathogen patterns vary by surgical category and may not be adequately covered by standard perioperative antibiotic prophylaxis, which has remained largely unchanged for decades. This study aimed to characterize pathogen distribution patterns across different orthopedic surgical categories and to evaluate whether current prophylactic regimens align with the observed microbiological profile. Methods This retrospective single-center study included 98 patients who developed SSIs involving implanted hardware following elective, semi-elective, or trauma-related orthopedic surgeries. Inclusion criteria required a positive wound culture obtained using a sterile technique during the first surgical debridement. Results The mean age of the cohort was 68.5 years. The mean interval from primary surgery to debridement and irrigation was 67.1 days. Patients undergoing elective arthroplasty presented at a chronic stage, with a mean interval of 132 days. The most frequently isolated pathogen was methicillin-sensitive Staphylococcus aureus (MSSA; n = 23, 23.5%, 95% confidence interval (CI): 16.2%-32.9%). Gram-negative organisms predominated in spine surgeries, accounting for 69% of isolates (n = 9/13, 95% CI: 39.5%-88.1%). The trauma and femur fracture groups were predominantly infected with Gram-positive organisms. Mixed Gram-positive and Gram-negative bloodstream infections were detected in 14% of blood cultures (n = 14, 95% CI: 8.7%-22.6%), exclusively in the femur fracture and trauma groups. Conclusions Pathogen patterns differ substantially across orthopedic surgical categories. The predominance of Gram-negative organisms in spine SSIs suggests that further investigation of pathogen-specific prophylactic strategies in spine surgery may be warranted. Prospective studies are needed to determine whether targeted adjustments to prophylactic regimens can effectively decrease SSI rates in spine surgery.