Aims: The aim of this study was to evaluate the efficacy of induced membrane technique (IMT), and to analyze the relationships between patient factors and surgical parameters as well as their impacts on achieving bone union and complication rates. Materials and methods: A comprehensive, computerized search of PubMed, Embase, and The Cochrane Library was conducted, and articles published from January 1, 1978 to February 1, 2021 were included. Clinical trials matching the following inclusion criteria were included: Univariate and multivariate logistic regression were performed with random intercepts to determine the association of specific predictor variables with nonunion rate, postoperative infection, the need for additional procedures, and time to union. Results: Seventy eight trials were included in the study with a total of 3840 patients managed with IMT. Mean age was 38.6 (0.8–88) years, mean size of bone defects was 6.4 (0–25) cm primarily distributed in the tibia (n = 1814, 60.9%), and overall union rate was 87.6%. Multivariate analysis showed the odds of nonunion were significantly increased in patients with an interval between two stages from 8 to 12 weeks and ≥12 weeks. Patients with preoperative infection and addition of antibiotic to bone cement during IMT had significantly decreased odds of longer union time, but preoperative infection caused increased odds of additional surgery. External fixation throughout 2 stages had significantly increased odds of postoperative infection and additional surgery. Conclusions: We recommend that the timing of the second stage should be delayed until 6 to 8 weeks after the first stage. Bone cement with antibiotics can control the infection rate and shorten the healing time. Furthermore, there is no need to avoid using internal fixation due to possible concerns about causing postoperative infection.

The study aimed to validate a newly developed postoperative stability score for evaluating clinical follow-up in elderly patients with low-energy hip fractures. From 1 January 2020 to 31 December 2021, we enrolled patients aged over 65 who underwent cephalomedullary nail fixation using proximal femoral nail antirotation II (PFNAII) and had at least 6 months of follow-up; excluding multiple fractures, pathological fractures, and periprosthetic fractures. We collected general patient data. Parameters such as TAD, Parker’s ratio (AP and lateral), and the new postoperative stability score were recorded. A loss of reduction was defined using the decline in the Chang reduction quality criteria (CRQC) score within one month. Among the 108 enrolled patients, 23 (21.3%) experienced a loss of reduction, with a mean age of 82.1 years and a mean follow-up time of 7.4 months. Univariate analysis showed no significant association between loss of reduction and general data. However, the new postoperative stability score correlated significantly with loss of reduction (mean scores: 6.68 vs. 4.83, p = 0.045). Multivariate analysis confirmed this association (odds ratio: 0.076, 95% confidence interval: 0.022–0.263, p < 0.05). The newly developed postoperative stability score, incorporating surgical technique assessment, improves prediction accuracy for loss of reduction in elderly intertrochanteric fracture (ITF) patients.

Background/Objectives: Post-stroke dysphagia (PSD) is a common complication following cerebrovascular events, and many affected patients also present with pre-existing dementia or post-stroke cognitive impairment (PSCI). PSD primarily affects the oropharyngeal phase of swallowing, whereas cognitive impairment often compromises the oral phase. This overlap complicates diagnosis and highlights the importance of accurate assessment to guide appropriate treatment strategies. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising therapeutic intervention for both cognitive impairment and dysphagia. Methods: In this study, we report a case of a patient with pre-existing dementia who experienced an ischemic stroke, resulting in PSD and PSCI. Videofluoroscopic swallowing study (VFSS) revealed oral-phase-predominant dysphagia. rTMS targeting the dorsolateral prefrontal cortex (DLPFC) was administered with the aim of enhancing cognitive function. Results: Following two cycles of rTMS in combination with ongoing swallowing therapy, the patient demonstrated notable improvement in both cognitive and swallowing function. Conclusions: Although limited by a single-case design and the possibility of spontaneous recovery, this case demonstrates that rTMS targeting the DLPFC combined with swallowing therapy may be a potential intervention for managing concurrent post-stroke dysphagia and cognitive impairment.