Chemoprophylaxis for preventing venous thromboembolism (VTE) in spine surgery is debated due to effectiveness and safety concerns. Guidelines lack consensus on regimens and timing for spinal trauma. We examined chemoprophylaxis in spine trauma surgery to further guide surgeon decision-making. This systematic review and meta-analysis searched PubMed, CINAHL, MEDLINE, and Web of Science until March 14, 2024, for articles on chemoprophylaxis and spine trauma surgery. A random-effects meta-analysis compared VTE events by chemoprophylaxis use and timing. Fourteen observational studies (n = 13,754 patients; mean age: 41.74 ± 9.09 years; mean follow-up: 76.98 ± 213.45 days) were included. The total VTE prevalence was 6.28% (425/6771). VTE prevalence was 4.08% (143/3502) with chemoprophylaxis and 8.62% (282/3269) without. Meta-analysis showed no significant VTE difference between patients with (n = 516; 3.88%) and without chemoprophylaxis (n = 528; 5.68%) (P = 0.119, relative risk [RR]: 1.03; 95% confidence interval [CI]: [0.99, 1.08]). No significant difference in postoperative bleeding was found between patients with (3.01% of 722 patients) and without chemoprophylaxis (5.74% of 766 patients) (P = 0.549, RR: 1.00; 95% CI: [0.99, 1.02]). Comparing early (n = 305; 5.90%) and late chemoprophylaxis (n = 271; 8.86%) showed no significant VTE difference (P = 0.289, RR: 1.06; 95% CI: [0.96, 1.14]). Postoperative bleeding was also not significantly different between early (n = 305; no complications) and late chemoprophylaxis (2.58%) (P = 0.328, RR: 1.14; 95% CI: [0.88, 1.48]). No significant association was found between chemoprophylaxis use or timing and VTE risk after spine trauma surgery, though this finding may be underpowered. Chemoprophylaxis did not appear to significantly increase postoperative bleeding.

Introduction: Osteomyelitis is a serious bone infection commonly caused by bacterial pathogens, with Staphylococcus aureus being the most prevalent. The condition poses significant challenges in patients with underlying autoimmune disorders such as scleroderma and Raynaud’s syndrome, where vascular dysfunction and immunosuppression heighten infection risks. This case report illustrates the complex interplay between these conditions and underscores the importance of early diagnosis and comprehensive management to prevent severe complications. Case Report: We present the case of a 79-year-old female with a history of Raynaud’s syndrome and suspected scleroderma who developed osteomyelitis of the left middle finger following a paronychial infection. The patient experienced persistent pain and swelling despite multiple debridement procedures. Physical examination revealed necrosis and gangrene of the affected finger, and magnetic resonance imaging confirmed osteomyelitis. Cultures identified Corynebacterium accolens, an uncommon pathogen in this context. The patient underwent surgical debridement, followed by antibiotic therapy and vasodilators. Her condition improved, with no signs of infection at follow-up. Conclusion: This case highlights the critical need for early and thorough assessment of infections in patients with autoimmune conditions such as scleroderma and Raynaud’s syndrome. The vascular dysfunction inherent in these diseases can exacerbate infections, leading to severe outcomes such as osteomyelitis. A multidisciplinary approach involving early surgical intervention and tailored medical management is essential to optimize patient outcomes. Keywords: Osteomyelitis, Raynaud’s syndrome, scleroderma, autoimmune disease, vascular dysfunction.

Background: Depression in pediatric populations is rising rapidly and may adversely impact recovery from orthopaedic procedures such as anterior cruciate ligament (ACL) reconstruction. Although the psychological consequences of musculoskeletal injuries have been explored in adults, there remains a gap in understanding how depression affects postoperative outcomes in pediatric ACL patients. Objective: This study aimed to evaluate whether depression is associated with differences in postoperative outcomes — including pain, physical function, medication use, and reoperation rates — among pediatric patients undergoing ACL reconstruction. Methods: A retrospective cohort study was conducted using the TriNetX Global Collaborative Network. Pediatric patients (18 ​​​​​​years or younger) who underwent arthroscopically assisted ACL reconstruction were divided into 2 cohorts: those with a diagnosis of depression before surgery (ACL + Depression) and those without (ACL − Depression). Propensity score matching was used to control for race and sex. Outcomes assessed during the 6-month postoperative period included pain in the knee, joint stiffness, effusion, gait abnormalities, opioid and nonopioid analgesic use, physical therapy visits, and subsequent ACL reconstruction. Risk ratios, 95% confidence intervals, and P values were calculated. Results: After matching, 354 patients were included in each cohort. The ACL + depression group had significantly higher use of nonopioid (21.5% vs. 12.4%, P=0.001) and opioid analgesics (21.8% vs. 13.6%, P=0.004), and higher rates of joint stiffness (17.2% vs. 11.9%, P=0.043) and knee effusion (14.1% vs. 7.6%, P=0.005). Rates of reported knee pain were similar between groups (39.5% vs. 34.5%, P=0.161). A trend toward increased gait abnormalities was observed in the depression group (8.8% vs. 5.1%, P=0.088). Subsequent ACL reconstructions occurred in 2.8% of the ACL + depression group and 0% of the nondepressed group (P=0.001). Conclusion: Depression is associated with increased medication use, physical recovery challenges, and higher reoperation rates in pediatric patients following ACL reconstruction, despite similar rates of reported pain. These findings emphasize the need for integrated physical and mental health care during the postoperative period. A multidisciplinary approach — including early mental health screening and support — may improve outcomes in this vulnerable population.

Firearm-related injuries in the USA are increasing, with over 105,000 cases annually. Gunshot wounds (GSWs), especially those involving retained bullets, present complex challenges due to bullet trajectories and embolization risks. This study reviews two cases of bullet emboli, focusing on bullet localization strategies and timing of removal. Imaging techniques such as chest X-ray, CT scan, intraoperative fluoroscopy, and transesophageal echocardiogram were employed for localization. In Case 1, a stable patient with a left-back GSW had a bullet embolism from the inferior vena cava to the right ventricle, necessitating prompt removal. In Case 2, an unstable patient with thoracoabdominal GSWs experienced a delayed embolism to the aortic root, requiring multiple surgeries. Effective management of retained bullets involves diverse imaging and timely surgical intervention, especially for stable patients, emphasizing individualized and proactive strategies to enhance outcomes in bullet embolization cases.

Compartment syndrome, an exceptionally rare condition, is a surgical emergency that can quickly escalate to limb ischemia and necrosis without treatment. Most cases occur post-trauma, typically affecting the anterior compartment of the leg. Patients present with pain out of proportion to their physical examination findings and often have an early hallmark discovery of pain with passive extension. Compartment syndrome of the buttock requires an even higher index of suspicion, as the condition is even more uncommon, and the diagnosis is complicated by it being difficult to palpate the affected area and passively extend the leg when the patient is supine. This case report presents an 83-year-old female with compartment syndrome of the left gluteal region, status post-fall 1 day earlier. She was admitted to the medical team for observation and failed to respond to narcotic pain medication. The physical examination revealed firm, tense, left gluteal compartments with buttock hematoma and surrounding muscle induration, significant pain, and extremity weakness in the sciatic nerve distribution. An emergent fasciotomy was performed to decompress the affected compartments. All physicians must be mindful of gluteal compartment syndrome in patients complaining of buttock pain, especially after pelvic trauma, who present with buttock swelling, tense gluteal compartments, and severe gluteal pain. A delay in diagnosis or treatment can lead to severe consequences, including disability, irreversible gluteal muscle damage, sciatic nerve dysfunction, kidney failure, or death.