Osteochondral lesions of the femoral head are rare. For the treatment of these lesions, various joint-preserving procedures, particularly in young, active patients, have been developed. Mosaicplasty is a well-established surgical procedure for the knee. However, there is little evidence that this method can also be used to treat osteochondral lesions in the hip. The indication for cartilage procedures continues to evolve for the knee, and a similar strategy may be adopted for the hip joint. Due to limited evidence and a lack of experience, mosaicplasty treatment of these lesions remains challenging, especially in young patients. This study shows that open and arthroscopic management using the knee and femoral head as donor sites yielded good to excellent short- to mid-term outcomes. For osteochondral lesions of the femoral head, mosaicplasty may be a new alternative treatment option, although this needs to be proven with longer follow-ups and in a larger sample of patients.

Background: To investigate the functional status and recording the most common injuries of the upper limb in male Greek boxing squad in comparison to the general population.Methods: A retrospective injury surveillance study using an electronic questionnaire was performed in 2021. The questionnaire was sent to male members of the Greek Boxing Federation and consisted of three parts. Demographic data, functional status scales, training conditions, hours of training, the location and description of upper limb injuries and whether the injury occurred during competition or training and also whether it was a new or a recurrent one were gathered. The same questionnaire was sent to non-boxer males (military recruits), but without asking them to report any training parameters. Inclusion criteria were age < 35 years-old for all participants and no involvement in martial arts for the control group. Also, all participants (boxers and non-boxers) completed the Patient Rated Wrist Evaluation (PRWE) scale and the Quick Disabilities of Arm, Shoulder and Hand (quick-DASH) score.Results: The final study cohort was consisted of 62 elite or amateur boxers and 75 non-boxer males, less than 35 years old. The quick-DASH score was found to be significantly lower (better) in boxers in comparison to the general population (15.65 ± 10.25 vs. 12.55 ± 8.62;p = 0.020) whereas the PRWE score was similar in both groups (9.25 ± 14.96 vs. 8.61 ± 13.05;p = 0.843). Physical therapy sessions, thumb injuries and boxer’s knuckle were also found to be significantly higher in the boxers group. On the other hand, upper limb surgeries were significantly less in the boxers group. Finally, the size of boxing gloves was associated to the number of finger fractures, thumb injuries and ulnar sided wrist pain in boxers.Conclusions: Although a controversial sport, boxing appears to have no long-term consequences to the upper limb function, especially regarding hand performance. The size of gloves during heavy bag training was found to be an aggravating factor for hand injuries.

The combination of a tibial tubercle fracture with patellar tendon avulsion in adolescents is an extremely rare injury that needs to be managed properly. Herein, we report the case of a 15-year-old boy who presented to our department two months after sustaining a tibial tubercle fracture that had been managed with mini-open reduction and internal fixation in another hospital; he had restricted range of motion and complete inability to extend his knee. Clinical and radiological investigations revealed a neglected avulsion of the patellar tendon with marked scarring and severe retraction. The patient underwent patellar tendon reconstruction using the ipsilateral semitendinosus tendon that passed through separate tunnels in the patella and proximal tibia. The postoperative course was uneventful, and one year later the patient had a satisfactory range of motion and a Lysholm score of 90. To our knowledge, a neglected patellar tendon avulsion after tibial tubercle fracture fixation has been reported only once in the literature. The reconstruction of the patellar tendon using an ipsilateral semitendinosus autograft is an excellent surgical technique, especially when severe tendon retraction has occurred.

Background: Delirium is a frequent and serious complication in elderly patients with hip fractures and is associated with adverse outcomes. Early identification requires a brief and reliable screening tool suitable for routine clinical practice. The 4 ‘A’s Test (4AT) is a rapid instrument for delirium detection that requires minimal training. Objective: To translate, culturally adapt, and validate the Greek version of the 4AT in elderly patients with hip fractures. Methods: A total of 103 patients aged ≥65 years who were admitted with hip fracture were enrolled. The 4AT was translated using a forward–backward translation process and culturally adapted according to established guidelines. Delirium diagnosis was established using DSM-5 criteria by trained clinicians, serving as the reference standard. The 4AT was administered independently within 3 h. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). The optimal cut-off was determined using Youden’s index. Results: At a cut-off score ≥4, the Greek 4AT demonstrated a sensitivity of 87.5% and specificity of 91.1%, with PPV 75% and NPV 96%. The AUC was 0.94, indicating excellent diagnostic performance. Conclusions: The Greek version of the 4AT is a valid and reliable screening tool for detecting delirium in elderly patients with hip fractures.

Introduction: A clay-shoveler’s fracture is a relatively uncommon stress-type avulsion fracture typically affecting the lower cervical or upper thoracic spinous processes. Historically named after clay shovelers due to their predisposition to such injuries, this type of fracture is now more frequently observed in individuals participating in sports activities that entail rotational movements of the upper spine. Case Report: A 13-year-old patient, while performing agricultural work and using a manual shovel to excavate an area, experienced cramping in the cervical spine, neck pain, and a significant limitation in the range of motion. The patient presented with a history and physical examination suggestive of a clay-shoveler’s fracture. Subsequent X-ray images demonstrated an acute soft-tissue avulsion of the spinous process at C7. With non-operative therapy, the patient returned to work within 2 months, experiencing occasional, intermittent discomfort 6 months after the injury, which did not limit any activities. After 2 years of follow-up, the patient reported no pain. Conclusion: A clay-shoveler’s fracture is a rare stress-type avulsion fracture, particularly in children. Diagnosis necessitates clinical suspicion, a targeted history, and a thorough physical examination. Radiographs play a crucial role, and in challenging cases, magnetic resonance imaging may be warranted to detect soft-tissue avulsions. Treatment typically involves cervical immobilization of the cervical spine for 4–6 weeks. Keywords: Cervical spine fracture, spinous process, spine, clay-shoveler’s fracture, children

Purpose: This systematic review aimed to evaluate whether augmenting hamstring autografts with the Ligament Augmentation and Reconstruction System (LARS) during anterior cruciate ligament reconstruction (ACLR) enhances early recovery, improves functional outcomes, and accelerates return to sport (RTS), compared to standard hamstring autografts alone. With increasing emphasis on accelerated rehabilitation, the study seeks to clarify the clinical role of synthetic graft augmentation. Methods: Following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta‐Analyses) guidelines, a comprehensive systematic review was conducted focusing on ACLR using hamstring autografts augmented with LARS. The protocol was registered on PROSPERO (CRD42024536835). A literature search was performed using PubMed and Scopus databases. Primary outcome was anterior laxity based on KT‐1000, while secondary outcomes included the Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), anterior cruciate ligament‐return to sport after injury (ACL‐RSI), complication rates, graft failure and RTS. Methodological quality was assessed using the Newcastle–Ottawa Scale. Six studies involving a total of 764 patients met the inclusion criteria. Results: LARS‐augmented ACLR was associated with significantly better early functional outcomes, including higher Lysholm, IKDC and Tegner scores (standardized mean difference [SMD] = 0.83, 0.5 and 0.72, respectively), higher psychological readiness (ACL‐RSI) and earlier RTS. KT‐1000 measurements showed no statistically significant difference between the hybrid and autograft groups. However, long‐term outcome differences between augmented and non‐augmented groups were minimal. Conclusion: LARS augmentation in ACLR is a promising technique, supporting early rehabilitation, secure graft stability and timely return to activity, potentially benefiting older individuals or those with higher body mass index (BMI). Selective use of LARS may be advantageous in high‐demand patients or early RTS protocols, while future implications could include augmentation in case of suboptimal graft quality. Level of Evidence: Level III.