Fat embolism syndrome (FES) is a rare complication that can occur between 12 and 72 h after the initial insult. Isolated cerebral FES without pulmonary symptoms is rarer. Early fracture fixation might prevent FES. We report a case of multiple-fracture with FES despite definite fixation three hours post-injury. A 54-year-old man presented with multiple fractures: left femoral shaft (AO B2), left distal radius (AO C3), left comminuted patella, right comminuted 1st metatarsal base and left 2nd-4th metatarsal neck. Because he was stable, we gave him early total care and definite fixation, which required seven hours and yielded no complications. After he recovered from anesthesia, however, his eyes deviated right, his right upper arm was paralyzed, his consciousness level was poor, and his Glasgow Coma Scale score was E3VeM4. Chest X-rays showed clear lung fields, and brain computed tomography showed no intracranial hemorrhage. He did, however, have tachycardia, anemia, and thrombocytopenia. Brain magnetic resonance images showed a hyperintensive starfield pattern on diffuse weighted images, which suggested cerebral FES. After supportive care, his consciousness cleared on postoperative day 17, and he recovered full right upper arm muscle power after four months; however, he had a significant cognitive deficit. One-year post-injury, after regular rehabilitation therapy, he was able to independently perform his activities of daily living but still had a residual mild cognitive deficit. Early fixation can attenuate but not eliminate the incidence of FES. Early assessment and rehabilitation therapy might be required for patients with cerebral FES and cognitive deficits; however, such deficits are difficult to predict and need long-term follow-ups.

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d’Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d’Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes.

Background Lumbar interbody fusion with screw fixation is a standard treatment for lumbar degenerative diseases. While full-endoscopic lumbar interbody fusion is minimally invasive, it utilizes smaller cages compared with the oblique lateral interbody fusion (OLIF) technique, which offers superior biomechanical support. To merge full-endoscopic lumbar interbody fusion minimal invasiveness with OLIF’s advantages, we developed a novel instrument, the Single Beak Adjustable Cage Glider, to facilitate OLIF cage insertion via the full-endoscopic trans-Kambin triangle approach. This note and case report introduce this alternative solution. Case Presentation In a case of L4 to L5 spondylolisthesis, we performed fluoroscopy-guided uniportal facet-preserving trans-Kambin endoscopic fusion surgery. We initially installed percutaneous pedicle screws and rods to correct the anterolisthesis, then established the endoscopic trans-Kambin approach. After releasing the disc-endplate junction, the nerve root was mobilized and protected by the beak of the cage glider. The disc space was cleared, and a 22 × 40 × 12 mm interbody device was inserted through the cage glider under fluoroscopic guidance. The integrity of the exiting nerve root was confirmed with an endoscope. Results Postoperatively, the patient experienced significant improvements in both low back pain and bilateral lower limb numbness. Muscle strength in both lower limbs returned to baseline, and the patient was able to walk independently without assistive devices. Follow-up radiographs and computed tomography scans showed a well-reduced regional lordotic angle, and the axial computed tomography view confirmed adequate decompression of the spinal canal while preserving the facet joints. Conclusions The Single Beak Adjustable Cage Glider enables precise positioning of the OLIF cage through the Kambin triangle lumbar interbody fusion approach, avoiding nerve root injury and preserving facet joints. This technique reduces surgical trauma and maintains spine biomechanics, potentially improving patient outcomes. Clinical Relevance This technique potentially reduces the cage subsidence rate. Level of Evidence 5.