Purpose: Tension band fixation (TBF) using screws or wires is the widely accepted standard of care for patellar fractures. This meta-analysis aims to quantitatively compare postoperative outcomes between Kirschner wire tension band fixation (KWTB) and cannulated screw tension band fixation (CSTB) to determine the optimal fixation method. Methods: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for comparative studies on KWTB vs. CSTB. Primary outcomes included union rate, time to union, infection, reoperation rate and pain. Secondary outcomes included range of motion, time to weight bearing, implant complications, and functional scores. Results: This meta-analysis included 10 studies with 1,272 patients. KWTB was associated with a significantly longer time to union (p = 0.02), greater pain scores (p < 0.0001), and higher infection rates (p = 0.04). However, union and reoperation rates were comparable. For secondary outcomes, CSTB had significantly improved time to full weight bearing (p < 0.00001). In addition, KWTB had higher complication rates, including implant migration/loosening (p < 0.00001), implant prominence, skin irritation (p = 0.003), and implant removal (p < 0.00001). The Lysholm score (p < 0.00001) and range of motion (p = 0.03) were significantly higher in the CSTB group. Conclusion: While union rates are comparable, CSTB for TBF in patellar fractures is associated with improved functional outcomes and a reduced complication rate compared with KWTB. Level of Evidence: Level III , systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.

To discuss the prevalence of amaurosis post-bilateral radical neck dissections; and to provide a management algorithm that highlights the approaches undertaken in available literature to minimize incidence and maximally improve outcomes. This objective will be achieved by systematically reviewing and highlighting current literature. We systematically reviewed Pubmed, EMBASE, and Web of Science for articles pertaining to the management of amaurosis post-bilateral neck dissection. A comprehensive search of available literature was conducted by two independent authors to yield 23 articles to be included in the review. Due to the heterogeneity of study designs and outcome measures, findings were summarized and analyzed descriptively. 23 cases were reported between 1960 and 2021; n = 21 were reported through case reports. Neck dissection type alongside pharyngectomy (n = 7) and laryngectomy (n = 13) status were documented. Mean symptomatic onset was 7.3 ± 5.561 days; median onset n = 3. Seven reported symptoms post-operative day (POD) 0. n = 17 patients underwent bilateral radical neck dissections. n = 16 patients reported intraoperative hypotension. Investigations the patients underwent were documented. The most common causes of the disease included posterior ischaemic optic neuropathy (PION) (n = 8) and anterior ischaemic optic neuropathy (AION) (n = 5). The mean transfused amount of blood was 750 ml. The most common management of amaurosis post-bilateral neck dissection were through high dose corticosteroids. Mannitol and acetazolamide were also documented managements of the condition. Overall, there is a paucity of evidence pertaining to the management of amaurosis post-bilateral neck dissection; highlighting the importance of reviewing the available literature and proposing a management algorithm.

Introduction: Venous thromboembolism (VTE) remains a major complication following orthopedic trauma and fracture surgery. Low-molecular-weight heparin (LMWH) is widely used for prophylaxis; however, aspirin (ASA) has emerged as a potential alternative due to its ease of administration and cost-effectiveness. This study aimed to compare the efficacy and safety of aspirin (ASA) versus low-molecular-weight heparin (LMWH) in orthopedic trauma patients. Methods: A systematic review and meta-analysis was conducted by searching PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials and comparative observational studies evaluating aspirin (ASA) versus low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in orthopedic trauma patients were included. Outcomes assessed included overall venous thromboembolism (VTE), deep-vein thrombosis (DVT), pulmonary embolism (PE), fatal PE, mortality, bleeding complications, wound site infection, and hematoma formation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I(2) statistic. Results: Five studies comprising a heterogeneous orthopedic trauma population were included. No statistically significant difference between aspirin (ASA) and low-molecular-weight heparin (LMWH) in the incidence of venous thromboembolism (VTE) was noted (OR 0.52, 95% CI 0.02–12.25, p = 0.68). No significant differences were observed in the incidence of DVT between aspirin (ASA) and low-molecular-weight heparin (LMWH) (OR 1.00, 95% CI 0.46–2.16, p = 1.00). Pulmonary embolism (PE) (OR 0.96, 95% CI 0.72–1.28, p = 0.80), fatal PE (OR 0.55, 95% CI 0.18–1.65, p = 0.28), and mortality (OR 1.02, 95% CI 0.68–1.54, p = 0.91) were comparable between the two groups. Similarly, no significant differences were observed in bleeding complications (OR 0.95, 95% CI 0.86–1.05, p = 0.33) or wound complications (OR 1.05, 95% CI 0.81–1.37, p = 0.70). Hematoma formation showed a trend favoring aspirin (ASA) (OR 0.36, 95% CI 0.13–1.02, p = 0.05), although this did not reach statistical significance. Conclusions: Aspirin (ASA) may be a reasonable alternative to low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in selected orthopedic trauma patients, with comparable outcomes for pulmonary embolism (PE), mortality, bleeding and wound complications. Larger high-quality randomized trials with standardized protocols in clearly defined orthopedic trauma populations are warranted to confirm these findings and guide clinical decision-making.

Large to massive rotator cuff tears are challenging to repair, with partial and complete techniques showing variable outcomes. The purpose of this study is to systematically compare clinical, functional, and structural outcomes following partial and complete repairs. This Preferred Reporting Items for Systematic Reviews and Meta-Analyses‑compliant systematic review screened MEDLINE, Embase, and Cochrane Central Register of Controlled Trials through June 15, 2025. Study quality was assessed using Risk Of Bias In Non-randomized Studies of Interventions. Included studies involved patients with large (≥ 3 cm) or massive (≥ 5 cm, ≥ 2 tendons, or ≥ 30 cm²) rotator cuff tears, comparing arthroscopic partial vs. complete repair and reporting at least one clinical or functional outcome. Only comparative human studies published in English were considered. Primary outcomes were post-operative range of motion and strength; secondary outcomes included functional scores, acromiohumeral distance, structural failure rates, post-operative tear size, and post-operative pain score. Data were pooled using random-effects meta-analysis with standardized mean differences and odds ratios with 95% confidence intervals. Nine studies with 508 patients (220 partial and 288 complete repairs) met inclusion criteria. Complete repair demonstrated greater post-operative strength recovery (standardized mean difference = -0.363, 95% confidence interval: [-0.685, 0.042], P = .027; I² = 0%). Forward flexion and internal rotation were comparable between groups with negligible heterogeneity (I² = 0% for both), whereas external rotation showed no difference but substantial heterogeneity (I² = 73.0%). Patient-reported outcomes were largely similar; American Shoulder and Elbow Surgeons and Subjective Shoulder Value did not differ (I² = 0% for both), while Constant scores favored complete repair but with substantial heterogeneity (I² = 67.2%). Across studies that performed post-operative imaging, rates of imaging-defined structural failure/progression were similar, although imaging protocols and failure definitions varied. In comparative studies of large-to-massive rotator cuff tears, partial repair achieved clinical improvement comparable to complete repair across most patient-reported and range-of-motion outcomes. Complete repair showed modest but consistently superior outcomes in post-operative strength recovery, whereas differences in composite functional scores were less consistent and sensitive to between-study heterogeneity and tear-severity mix. Interpretation of these findings is further limited by tear characteristics and reparability which heavily influenced the repair strategy implemented. Accordingly, these findings should not be interpreted as evidence of equivalence between repair techniques in otherwise repairable tears.

Background: Tranexamic acid (TXA) is increasingly used to reduce perioperative blood loss during scoliosis surgery; however, its effectiveness in pediatric patients with non-idiopathic scoliosis remains underexplored. Unlike adolescent idiopathic scoliosis, non-idiopathic scoliosis is frequently associated with neuromuscular, syndromic, or other underlying disorders that increase surgical complexity and may limit the generalizability of evidence from idiopathic populations. This systematic review and meta-analysis evaluated the impact of TXA on surgical outcomes in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. Methods: This analysis encompassed five studies (comprising one randomized controlled trial and four observational studies) involving a total of 230 patients (TXA group: 98; control group: 132). The primary outcomes were estimated blood loss and the volume of packed red blood cells (PRBCs) transfused. Secondary outcomes included total transfusion amount, operation duration, complications, cell salvage application, preoperative hematocrit levels and blood loss percentage. A random-effects model was used. Mean difference (MD) was used for continuous outcomes, and odds ratio (OR) for dichotomous variables, both with 95% confidence intervals (CIs). Results: The use of TXA during posterior fusion surgery showed to be of benefit and was associated with significantly less estimated blood loss (p < 0.0001) and cell salvage volume transfusion (p < 0.0001). The remaining secondary outcomes did not show significant differences when compared with the control. Conclusion: Current evidence suggests that TXA is an effective blood conservation strategy in pediatric patients undergoing posterior spinal fusion for non-idiopathic scoliosis. However, the available evidence remains limited, particularly regarding perioperative complications, and further high-quality prospective studies are required to strengthen the evidence base. Clinical relevance: Exploring the use of TXA in scoliosis surgery has the potential to influence the standard of care, especially if associated with significantly more desirable post-operative and long-term outcomes.