The use of glucagon-like peptide-1 (GLP-1) receptor agonists is increasingly common among orthopaedic patients, often prescribed for type 2 diabetes mellitus and obesity, which are frequent comorbidities. Recent studies have explored the effects of GLP-1's on postoperative outcomes in orthopaedic procedures. This study evaluates the impact of GLP-1 on re-operation risk following rotator cuff repair (RCR). A retrospective cohort analysis of patients aged 18 and older from 2014 to 2024 was conducted using the TriNetX US collaborative network. Patients with documented RCR and no prior GLP-1 use were included in the control group. Those taking semaglutide, dulaglutide, or liraglutide for at least 3 months before RCR comprised the GLP-1 group. After comparing baseline characteristics, cohorts were matched based on selected covariates. Outcomes were compared using risk ratios (RR) with 95 % confidence intervals (CI). A subgroup analysis by GLP-1 indication (type 2 diabetes or weight loss) was performed. Propensity score matching yielded well-balanced cohorts of 5306 patients. Subgroup analysis included 781 patients per group. At 3, 6, and 12 months post-RCR, the control group showed no difference in reoperation risk. In a sub-analysis of the GLP-1 group, those receiving it for diabetes, compared to obesity, showed an increased risk of adhesive capsulitis at 3 months (RR = 2.20, 95 % CI [1.05-4.62], P = 0.0321). The use of GLP-1 was not associated with a higher reoperation risk after RCR, suggesting that these medications can safely be taken leading up to RCR. However, increased short-term risks in diabetes patients highlight the need for individualized care and further study of GLP-1 effects on orthopaedic outcomes.

Introduction: Traumatic brain injury (TBI) involves a diverse group of head blunt and/or penetrating injuries and is a leading cause of death in the U.S., accounting for one-third of all injury-related deaths. A post-injury hyperglycemic state may commonly impact TBI prognosis and strongly correlate with injury severity. Diabetes mellitus (DM) may also be a source of concomitant hyperglycemia that can worsen prognosis, with previous literature suggesting that DM could be an independent predictor of poor outcome and mortality after TBI. Methods: Using the multi-center, national TriNetX database, we performed a propensity score-matched analysis of severe TBI patients with (DM) and without DM (NDM) from 2014 to 2024. We examined the risk of mortality and complications, including sepsis, cerebral infarction, and pulmonary embolism. We also performed a sub-group analysis comparing the risk of mortality and complications between patients with either insulin-dependent or insulin-independent forms of DM. Results: A total of 26,019 patients were included (4604 DM vs. 21,415 NDM). After propensity score matching, patients with DM had a significantly lower risk of mortality (RR: 0.815; 95% CI: 0.771–0.861; p < 0.05) and ventilator dependency (RR: 0.902; 95% CI: 0.844–0.963; p < 0.05) compared to NDM patients. However, patients with DM had a significantly higher risk of cerebral infarctions, seizures, pneumonia, and sepsis (p < 0.05). Sub-group analysis found no significant difference in mortality or complications between insulin-dependent and insulin-independent forms of DM. Conclusion: Our results suggest that hyperglycemia secondary to DM plays a complicated role in the outcomes after severe TBI. Unexpectedly, we identified both increased and decreased complications in patients with DM. These results reflect the current challenges in the literature surrounding pre-existing DM in patients’ outcomes, the impact of diabetic medications on patient outcomes, and the changing role of aggressive glucose management in critical care patients.

Introduction: As the US population continues to age and diversify, so have treatment strategies for proximal humerus fractures (PHFs). The primary hypothesis of this study is that PHFs are increasing in prevalence with an associated increase in the rate of its surgical management. Methods: The TriNetX US Collaborative Network database was queried for all patients diagnosed with PHFs between 2016 and 2022. Current Procedural Terminology codes were used to group patients into cohorts based on surgical versus nonsurgical treatment. Incidence and treatment rate differences were analyzed between demographic groups such as age, sex, and ethnicity. Results: A total of 74,781 PHFs were identified and analyzed between 2016 and 2022. The average overall PHF surgical incidence rate between 2016 and 2022 was 10.5%. Open reduction and internal fixation (ORIF) was the most common surgical treatment (68.5%). Overall utilization of total shoulder arthroplasty (TSA/rTSA) surgical techniques increased from 2016 to 2022 for all fracture types (P < 0.0001), while ORIF (P = 0.0079) and hemiarthroplasty (P = 0.0432) utilization decreased. Women were less likely to undergo surgical treatment than men (odds ratio [OR], 0.9490; P < 0.05). White patients were more likely to receive surgical treatment than Black (OR, 0.7688; P < 0.0001) and Asian patients (OR, 0.7770; P = 0.0043). Conclusion: Surgical management strategies have changed with TSA/rTSA becoming more frequently used for all fracture types with a decline in the utilization of ORIF and hemiarthroplasty. This study suggests a shift in surgical treatment strategies between 2016 and 2022, and reflects increased utilization of arthroplasty procedures for fracture management.

Alterations in running shoe design have been studied and used in the prevention of injury and enhancement of performance allowing running shoe companies to market to a variety of runners based on skill level, foot-strike pattern, and even sex. These alterations have been shown to affect biomechanical and physiological variables associated with running. Some shoe companies have designed shoes specifically for biological female runners due to the morphological differences found between male and female feet. The purpose of this study is to determine if sex-specific running shoes can alter female runner biomechanics or physiology. Female runners were asked to run in the male and female models of the Altra Torin 4 Plush shoe to determine if there were differences in ground reaction forces (GRFs), sagittal plane joint angles and moments, oxygen consumption (VO₂), respiratory exchange ratio (RER), and perceived level of comfort while running; There were no significant differences in GRFs, sagittal joint angles and moments, VO₂, RER, or perceived comfort; There were no differences in measured biomechanical or physiological variables between the female and male version of the shoes suggesting that the alterations made to the female-specific shoe do not provide any additional benefit to female recreational runners.

Background: Traumatic brain injury (TBI) is a leading cause of mortality and disability, particularly in patients on anticoagulation therapy. While anticoagulants are linked to higher TBI mortality, the specific impact of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) on severe TBI (sTBI) outcomes remains unclear, especially in light of newer reversal agents. Therefore, this study evaluates long-term mortality and complication risks associated with pre-injury use of DOACs and VKAs in sTBI patients from a large, real-world cohort. Methods: A retrospective cohort study was conducted using the TriNetX global research network, identifying patients with sTBI between 2016 and 2022. Patients were grouped based on pre-injury anticoagulant use: DOAC, VKA, or none. Propensity score matching was performed, adjusting for age, comorbidities, and baseline characteristics. The primary outcome was all-cause mortality at 1-, 3-, 6-, and 12-months post-injury. Secondary outcomes included hospital and surgical complications up to 30 days post-injury. Results: A total of 40,563 patients met the inclusion criteria. At all time intervals, no significant mortality differences were found between the PSM-matched groups. Conclusions: In patients with sTBI, pre-injury DOAC or VKA use was not associated with increased short- or long-term mortality. These findings suggest that, with current perioperative practices, anticoagulation can be managed without adversely affecting outcomes.

Chordomas are rare malignant tumors arising from embryonic remnants of the notochord, most commonly affecting the axial skeleton. Although advances have been made in surgical resection and radiation therapy, systemic treatment options remain limited. Bone-modifying agents (BMAs), including zoledronic acid and denosumab, as well as multikinase inhibitors (MKIs) like lenvatinib and cabozantinib, have emerged as potential targeted therapies based on preclinical models. However, comparative real-world data evaluating their outcomes in chordoma patients is lacking. A retrospective cohort study was conducted using the TriNetX Research Network. Patients with chordoma (ICD-10-CM C41.0, C41.2, C41.4) were stratified into treatment groups based on receipt of zoledronic acid, denosumab, or multikinase inhibitors (MKIs). Propensity score matching was used to adjust for baseline confounders. Outcomes evaluated at 5 years post-diagnosis included all-cause mortality, pathologic fracture, spinal cord compression, and osteonecrosis. Risk ratios with 95 % confidence intervals were calculated. Compared to denosumab, zoledronic acid was associated with a higher 5-year mortality risk, but a lower osteonecrosis risk. Comparisons involving MKIs showed no difference in mortality. No pathologic fractures were reported across cohorts. Spinal cord compression was not different among treatments. This study highlights potential differences in survival and skeletal-related outcomes among chordoma patients treated with BMAs, specifically denosumab and MKIs. These preliminary findings underscore the need for prospective studies to better define optimal systemic therapies for this rare malignancy.