Background: Physical activity is widely recommended for preserving musculoskeletal health and managing osteoarthritis-related pain, although its benefits are commonly framed in terms of muscle strengthening, weight control, and physical performance. This narrative review aimed to examine movement more broadly as a physiological regulator of synovial joint homeostasis, sensory calibration, and functional adaptation. Methods: A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science from database inception to 1 February 2026. Experimental studies, observational studies, clinical trials, systematic reviews, meta-analyses, and selected narrative reviews addressing movement-responsive joint biology or pain regulation were considered. Evidence was synthesized across four interrelated domains: mechanical, fluidic, immune-metabolic, and sensory regulation. Results: The narrative synthesis indicates that the concept of the synovial joint as a dynamic mechano-fluidic organ in which cartilage, synovium, synovial fluid, capsule, subchondral bone, periarticular tissues, and sensory pathways interact continuously. Repeated physiological movement may promote synovial fluid exchange, lubrication, cartilage nutrition, hyaluronic acid and lubricin function, matrix turnover, anti-inflammatory signaling, proprioceptive control, and exercise-induced hypoalgesia. In contrast, inactivity and unloading may impair fluid dynamics, promote muscle inhibition, stiffness, inflammatory persistence, sensory deconditioning, and loss of function. Excessive or poorly distributed loading may also disrupt homeostasis through matrix injury, inflammation, fatigue, and nociceptive sensitization. These findings informed the proposed adaptive loading window, a hypothesis-generating conceptual framework rather than a clinically validated threshold, describing the dynamic range of movement within which joint function and pain regulation may be supported without sustained tissue or symptom aggravation. Conclusions: Movement should be viewed not only as a therapeutic intervention, but also as a continuous regulator of joint biology and perception. Its clinical value may depend on identifying an individualized loading range that supports adaptation, function, and confidence in movement while avoiding both underloading and overload.

A clinically useful classification system requires precise definitions, reproducibility, and applicability across different levels of clinical experience. Distal radioulnar joint instability remains insufficiently represented in fracture based classifications, contributing to diagnostic uncertainty and variability in treatment strategies. This retrospective observational study assessed the interobserver and intraobserver reliability of a previously proposed classification system for distal radioulnar joint instability. Five orthopedic surgeons, including three board-certified specialists and two final year residents, independently evaluated forty five clinical cases comprising distal radius fractures, Galeazzi fractures, and Essex Lopresti injuries, using predefined clinical and radiological criteria. Interobserver agreement was analyzed using Fleiss Kappa statistics, while intraobserver reliability was evaluated after a two week interval using Cohen Kappa. Overall interobserver agreement was excellent, with a global Fleiss Kappa value of 0.87. Agreement was highest in Galeazzi fractures and lowest in Essex Lopresti injuries, reflecting increased diagnostic complexity in this subgroup. Specialists demonstrated higher agreement than residents. Intraobserver reproducibility was excellent, with identical classifications in 96 percent of reassessed cases. These findings indicate that the proposed classification system shows high reliability and reproducibility, supporting its potential clinical utility for standardized assessment of distal radioulnar joint instability and for guiding future clinical and biomechanical research.

Hallux valgus recurrence remains one of the most important causes of unsatisfactory outcomes following corrective surgery, with reported rates varying widely because of differences in patient selection, surgical techniques, follow-up duration, and recurrence definitions. Although numerous operative procedures have been described, growing evidence indicates that durable correction depends less on the specific procedure performed than on appropriate patient selection and complete correction of the underlying deformity. A structured literature search was conducted in PubMed from database inception to 4 August 2026 and supplemented by reference-list screening. Adult primary surgical studies reporting recurrence or factors associated with recurrence were eligible when they provided an explicit recurrence definition and at least 12 months of follow-up. Forty candidate primary studies were assessed in full text, of which 30 were included in the core evidence synthesis. Findings were synthesized narratively within predefined domains covering recurrence definitions, preoperative factors, procedure selection, technical correction, postoperative alignment, patient-related factors, and clinical consequences. Particular attention is given to the role of three-dimensional deformity correction, soft-tissue balancing, sesamoid realignment, and radiographic parameters including the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and metatarsal rotation. Contemporary surgical techniques, including Chevron, Scarf, Lapidus, first metatarsophalangeal joint fusion, and minimally invasive procedures, are reviewed with respect to their indications, recurrence mechanisms, and technical considerations. Based on the available evidence, recurrence prevention requires a comprehensive strategy integrating accurate preoperative assessment, procedure selection tailored to the underlying pathology, meticulous surgical technique, and structured postoperative follow-up. Standardized recurrence definitions and greater use of weight-bearing three-dimensional imaging may further improve future research and clinical decision making.

Background: Management of surgically treated hand trauma varies according to injury characteristics, referral pathways, and institutional practice, particularly regarding postoperative antibiotic therapy and wound cleansing. This study compared injury patterns, management strategies, and early postoperative outcomes between two European referral centers and evaluated reported practice through a parallel surgeon survey. Methods: We conducted a retrospective two-center cohort study including 360 adults undergoing surgical treatment for hand trauma between April 2024 and March 2025 in Le Mans, France (n = 270), and Iași, Romania (n = 90). Injury mechanisms, anatomical involvement, postoperative antibiotic use and duration, wound irrigation and cleansing practices, follow-up, and postoperative infection were compared. Because the cohorts differed substantially in case mix, a secondary sensitivity analysis was performed using the Romanian acute-injury subgroup (n = 63). A parallel anonymous survey included 70 French and 40 Romanian surgeons involved in hand trauma care. Results: Injury mechanisms differed between centers (p < 0.001), with powered-tool or machinery injuries occurring in 34.4% of Romanian and 15.6% of French patients. The Romanian cohort also had higher frequencies of tendon injury (90.0% vs. 30.7%), neurovascular involvement (57.8% vs. 14.1%), joint involvement (23.3% vs. 12.2%), and associated fracture (27.8% vs. 5.2%; all p ≤ 0.016). Continued postoperative antibiotics were administered to 97.8% of Romanian and 55.2% of French patients (p < 0.001). Among treated patients, 1- to 3-day courses predominated in Romania (85.2% vs. 16.2%; p < 0.001). Wound-cleansing practices also differed substantially. Among patients with documented follow-up, postoperative infection was identified in 3/90 Romanian patients (3.3%) and 3/171 French patients (1.8%; p = 0.418). In the Romanian acute-injury subgroup, infection occurred in 1/63 patients (1.6%). Survey responses also demonstrated variation in postoperative antibiotic duration and perceptions of existing recommendations. Conclusions: Substantial center-level variation was observed in case mix, postoperative antibiotic prescribing, treatment duration, and wound-cleansing practices. Few postoperative infections were documented among patients with available follow-up; however, differences in eligibility criteria, injury complexity, and follow-up completeness preclude conclusions regarding comparative treatment effectiveness. Survey findings provided complementary evidence of variability in reported practice rather than validation of the center-level clinical findings. Prospective multicenter studies using standardized injury classification and follow-up are needed to develop more consistent, risk-based approaches to antimicrobial and wound management in hand trauma.

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10–30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8–9% for SJS to 14.8–48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit. Case presentation: We describe two patients from opposite ends of the SJS/TEN spectrum, managed in a burn unit with different therapeutic approaches. The first patient, a 47-year-old man with systemic lupus erythematosus, developed TEN with approximately 35% body surface area involvement, complicated by sepsis and rhabdomyolysis; he was treated with systemic corticosteroids and intravenous immunoglobulin (IVIg, 0.4 g/kg/day for 3 days). The second patient, a 66-year-old woman, developed SJS attributed to amoxicillin–clavulanic acid and was treated with systemic corticosteroids alone. Both patients achieved complete re-epithelialization without major sequelae. Conclusions: These two cases illustrate the clinical heterogeneity of the SJS/TEN spectrum and the central role of early recognition, prompt withdrawal of the culprit drug, transfer to a specialized unit, and multidisciplinary supportive care. Given the substantial differences between the two patients in age, sex, comorbidities, culprit drugs, and disease severity, no comparative or causal inference regarding the relative efficacy of the two treatment strategies can be drawn; no efficacy claim is made for either therapeutic approach; this report is descriptive, and the two cases are presented as contrasting rather than comparable.

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions.