Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used in management of type 2 diabetes mellitus (T2DM) and obesity. Beyond glycemic control, these agents may influence orthopaedic outcomes. This study aimed to assess the relationship between preoperative GLP-1 RA use and postoperative complications in T2DM patients undergoing operative ankle fracture repair. Methods: A retrospective cohort study was conducted using the TriNetX database, identifying adult patients with T2DM who underwent operative ankle fracture repair from 2005 to 2024. Patients were stratified based on preoperative GLP-1 RA exposure within 180 days of surgery. Propensity score matching (1:1) was performed on demographics, medications, comorbidities, and laboratory values. Postoperative outcomes were analyzed in 3 domains: (1) medical complications within 90 days, (2) operative and implant-related complications from 90 to 180 days, and (3) health care utilization at 30, 90, and 180 days. Results: A total of 1,107 patients were analyzed in each group after matching. After false discovery rate correction, GLP‑1 RA use was associated only with lower all‑cause mortality (odds ratio [OR] 0.33, 95% CI 0.16-0.67, adjusted P = .011; number needed to treat = 56) and higher fall‑related injuries (OR 1.32, 95% CI 1.12-1.57, adjusted P = .011; number needed to harm = 15). No significant differences were observed in infection, posttraumatic arthritis, persistent opioid use, and wound healing complications. Conclusion: Preoperative GLP-1 RA use in T2DM patients undergoing operative ankle fracture repair may reduce postoperative all-cause mortality but increase fall-related injuries. These findings underscore a complex risk-benefit profile of GLP-1 RA therapy in orthopaedic care.

Background and Objectives: In-toeing and out-toeing gait are rotational deformities commonly observed in children with neuromuscular conditions. These gait abnormalities often result from internal tibial torsion, increased femoral anteversion, and metatarsus adductus. This study was conducted to create a comprehensive evaluation of the effectiveness of lower extremity orthotics as a non-operative treatment option, given their regular use in clinical settings. The aim of this literature review was to understand the efficacy of various orthotic devices in correcting rotational deformities in the transverse plane, thereby improving ambulation stability and 3D joint motion. Materials and Methods: Literature published after 1 January 1990 was reviewed, utilizing databases such as CENTRAL (Wiley), CINAHL (EBSCO), Medline (OVID), Scopus (Elsevier), and Web of Science (Clarivate). In totality, 13 studies were included, evaluating 365 participants with neuromuscular conditions using various orthotic devices. Results: Among these studies, two were randomized control trials (Level 1), nine were quasi-experimental studies (Level 2), and two were case studies (Level 4). Quality assessment determined that 69% of the included studies had a low risk of bias, while 31% demonstrated a moderate risk. Compression garments and rotational systems showcased the greatest change in proximal lower extremity rotation at 19.73° ± 1.57 and 24.13° ± 8.49, respectively. The most significant difference in foot progression angle is through the use of rotational systems, 19° ± 26.87. Conclusions: In a short-term treatment, children with neuromuscular disorders exhibiting in-toeing or out-toeing gait may benefit from different types of orthoses. Compression garments may aid joint alignment and enhance proprioception, rotational systems correct alignment with precise adjustability, AFOs that achieve effective stabilization can deliver benefits in the transverse plane, and foot orthotics may be appropriate for mild gait abnormality management.

Background/Objectives: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder characterized by the posterior and inferior slippage of the femoral head through the growth plate. This study aimed to assess seasonal trends in the incidence of SCFE above 40° N latitude using cosinor regression analysis. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registration in Prospero. A keyword search of PubMed, Scopus, Web of Science, and Ovid was conducted using terms related to SCFE and seasonal or monthly variation. Studies were included if they reported month-by-month SCFE incidence in pediatric populations. Studies were excluded if they had duplicated population cohorts. Data from studies conducted above 40° N were extracted for cosinor regression analysis. Quality assessment was performed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: A total of seventeen studies were included, amassing a total of 21,428 children analyzed. Six investigations reported monthly incidence data for populations > 40° N. The highest pooled monthly incidence was observed in August (482 cases). Alternatively, February was the month with the lowest SCFE incidence (293). Cosinor regression analysis demonstrated that SCFE occurs more frequently during early summer and fall months (p < 0.0001). Conclusions: SCFE incidence follows a significant seasonal trend in higher-latitude (>40° N) populations, with a consistent late-summer peak. Recognizing seasonal variation patterns may inform early diagnosis and intervention in SCFE, improving outcomes in pediatric physeal injuries.

Background: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder occurring during the pubertal growth spurt, and prior studies have demonstrated regional seasonal variation in presentation volume. The relationship between seasonality, socioeconomic deprivation, and disease severity remains incompletely characterized. This study investigated whether SCFE presentation volume demonstrates seasonal variation and whether seasonality is associated with socioeconomic deprivation, body mass index (BMI), and radiographic severity. Methods: We retrospectively reviewed children newly diagnosed with SCFE at a single institution in Wisconsin (USA) between January 2012 and March 2024. Variables included age, sex, race, Area Deprivation Index (ADI), BMI, month of symptom onset, Southwick slip angle, stability, chronicity, and symptom duration. Presentation volume was analyzed using 3-month rolling averages and sinusoidal regression with 12-month periodicity. Associations among ADI, BMI, and slip angle were assessed using linear regression and Spearman’s correlation. Results: In total, 122 of 160 patients met the inclusion criteria. SCFE presentation volume demonstrated significant seasonality (p < 0.05). Lower-volume months were associated with higher neighborhood deprivation and greater radiographic severity (p < 0.05). ADI correlated with slip angle (r = 0.29, p < 0.05) and BMI (r = 0.33, p < 0.05), whereas BMI was not significantly associated with slip angle. Chronic slips demonstrated greater slip angles than acute presentations (p < 0.05). Conclusions: SCFE presentation volume in Wisconsin follows a significant seasonal pattern, and social determinants of health may influence the timing of presentation and disease severity.

The Providence nighttime brace (PNB) is an emerging conservative treatment modality in adolescent idiopathic scoliosis (AIS). The purpose of this study was to map the extent and nature of published evidence on the PNB, to summarize outcomes and patient-reported effects, and to identify gaps for future investigation. This study followed Joanna Briggs Institute methodology and was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A keyword search was queried in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases. Included studies were original articles focused on PNB utilization in AIS treatment. Non-peer-reviewed, opinion, editorial, or review articles were excluded. A total of 24 studies were included, encompassing 2,262 patients. Six studies compared outcomes to full-time orthoses; eleven examined ways to improve PNB success; three evaluated the PNB’s impact on quality of life. The literature suggests the PNB consistently prevents curve progression in indicated patients, especially in curves measuring <35° and those with an apex at or below T9. Most comparative studies report that the PNB achieves similar outcomes to full-time orthoses when patients are appropriately selected. However, differences in study design, patient selection, and outcome definitions limit firm conclusions. The PNB was generally reported to have a manageable impact on quality of life. Innovations such as ultrasound custom fitting, predictive models, and temperature sensors may improve brace fit, adherence, and outcomes. The literature identifies the Providence brace as a viable, patient-compliant treatment in mild to moderate AIS. While the PNB shows promise, variability in study design and indications underscores the need for prospective, randomized studies. Researchers should use Scoliosis Research Society criteria for inclusion and assessment, as well as objective compliance measures when feasible. Continued innovation with predictive models, custom brace-fitting, and temperature sensors may further improve outcomes. (1) The Providence nighttime brace (PNB) effectively prevents curve progression in adolescent idiopathic scoliosis (AIS), especially in lumbar or thoracolumbar curves measuring <35°. (2) Most comparative studies suggest the PNB achieves similar outcomes to full-time orthoses in appropriately selected patients, but heterogeneity in study design, patient selection, and outcome definitions limits firm conclusions. (3) Preliminary evidence suggests the PNB may offer an acceptable quality of life profile, although current data are limited and further comparative studies using validated instruments are needed. (4) Prospective studies using Scoliosis Research Society criteria with standardized outcomes, predefined subgroups, and objective compliance measures are needed to solidify indications and patient education. (5) Predictive models, custom brace-fitting, objective compliance monitoring, and adjunctive physiotherapeutic exercises are promising innovations for improving PNB outcomes. V