➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.

Nutrition in Surgery: An Orthopaedic Perspective.

Objectives This study aimed to determine the influences of vitamin D3 and omega-3 polyunsaturated fatty acids (PUFAs) on fracture union in rats radiologically, histologically, and biomechanically. Materials and methods Forty-eight male Sprague-Dawley rats (mean weight: 435±31.15 g; range, 398 to 510 g) were indiscriminately separated into four groups, with 12 rats in each: Group 1 was the control group, Group 2 received vitamin D3, Group 3 received omega-3 PUFA, and Group 4 received both vitamin D3 and omega-3 PUFA. One day after surgery, only one intramuscular dose of 50,000 IU/kg vitamin D3 was administered to Group 2. From the first postoperative day until sacrification, 300 mg/kg omega-3 PUFA by oral feeding was administered to Group 3. In Group 4, both an intramuscular dose of 50,000 IU/kg vitamin D3 on the initial postoperative day and 300 mg/kg omega-3 PUFA were administered by oral feeding until sacrification. All rats were sacrificed by intracardiac potassium injection at the sixth postoperative week, and radiological, biomechanical, and histological studies were conducted. Results According to the radiological scores, the best scores were obtained in Group 4, and callus density and ossification were advanced in Groups 2 and 3 compared to Group 1. There was no statistically significant distinction between Groups 3 and 4, while a significant distinction was found between Group 4 and Groups 1 and 2. Biomechanically, the advanced values were attained in Groups 1 and 3. However, there was no statistically significant distinction among the groups. Histologically, although the advanced scores were attained in Groups 3 and 4, there was no statistically significant distinction among the groups. Conclusion The use of omega-3 PUFA together with vitamin D3 might have beneficial influences on fracture union. In the future, the combination of omega-3 PUFA and vitamin D3 might be used as an encouraging treatment choice that contributes to fracture healing.

pdf/vitamin-d3-and-omega-3-polyunsaturated-fatty-acids-have-3q0td9mkze.pdf

Vitamin D3 and omega-3 polyunsaturated fatty acids have beneficial effects on fracture union in an experimental rat model

Vitamin D has more functions than those classically attributed to a single vitamin. Its relationship in a multitude of processes goes beyond its classic role in the ossification and mineralization of bones. There are painful disorders in which it can play an important role (always individualizing with each patient). With this article, we try to shed light on all the possible applications in clinical practice that have been considered up to now, in order to continue investigating possible benefits in a multitude of processes associated or not with pain.

/pdf/vitamina-d-una-mirada-moderna-como-coadyuvante-en-el-dolor-2g40lieo.pdf

Vitamina D: una mirada moderna como coadyuvante en el dolor

Dementia, osteoporosis, and fragility fractures are chronic diseases, often co-existing in older adults. These conditions pose severe morbidity, long-term disability, and mortality, with relevant socioeconomic implications. While in the research arena, the discussion remains on whether dementia is the cause or the consequence of fragility fractures, healthcare professionals need a better understanding of the interplay between such conditions from epidemiological and physiological standpoints. With this review, we summarized the available literature surrounding the relationship between cognitive impairment, dementia, and both low bone mineral density (BMD) and fragility fractures. Given the strength of the bi-directional associations and their impact on the quality of life, we shed light on the biological connections between brain and bone systems, presenting the main mediators, including gut microbioma, and pathological pathways leading to the dysregulation of bone and brain metabolism. Ultimately, we synthesized the evidence about the impact of available pharmacological treatments for the prevention of fragility fractures on cognitive functions and individuals' outcomes when dementia coexists. Vice versa, the effects of symptomatic treatments for dementia on the risk of falls and fragility fractures are explored. Combining evidence alongside clinical practice, we discuss challenges and opportunities related to the management of older adults affected by cognitive impairment or dementia and at high risk for fragility fracture prevention, which leads to not only an improvement in patient health-related outcomes and survival but also a reduction in healthcare cost and socio-economic burden. 

Dementia, osteoporosis and fragility fractures: intricate epidemiological relationships, plausible biological connections, and twisted clinical practices.

Calcaneal osteotomy, subtalar fusion, and triple fusion are the main surgical interventions used to correct foot deformities, reduce pain, and restore functionality in arthritis, flatfoot deformity, and post-traumatic complications. The outcomes of these surgical interventions are dependent on careful surgical planning, postoperative patient compliance, and comprehensive multidisciplinary management. Rehabilitation generally follows a stepwise approach, starting with non-weight-bearing and partial weight-bearing and ending with targeted physiotherapy. This will enhance mobility and strength and minimize complications such as muscle atrophy and joint stiffness. Patient compliance is critical to achieve adequate results as it greatly influences bone healing and leads to better functional recovery. Patient demographics and comorbidities and specific surgical techniques often influence rehabilitation approaches and need individualized tailored treatment plans. This review presents updated evidence and recommends a standard postoperative rehabilitation protocol for these three surgical techniques. Additionally, it will discuss the variations between different protocols in clinical practice, highlight the causes of those differences, and propose recommendations for future research. Recently, it has become increasingly clear that there is a lack of consistent, high-quality evidence to guide postoperative rehabilitation after hindfoot surgery. This highlights the growing need for large-scale research to define postoperative protocols, weight-bearing guidelines, and advanced therapeutic modalities. Establishing evidence-based, broadly accepted guidelines could significantly enhance healing outcomes, functional recovery, and patient satisfaction in foot surgery rehabilitation.

pdf/surgery-to-strength-a-literature-review-of-postoperative-zcyldmf3mtpn.pdf

Surgery to Strength: A Literature Review of Postoperative Rehabilitation for Hindfoot Surgeries

While most literature on vitamin D supplementation in fracture patients focuses on fracture prevention, the effect of vitamin D on bone healing is a much less studied concept. The primary aim of this systematic review was to assess whether vitamin D supplementation in fracture patients improves clinical or radiological union complications. The secondary aims were to assess supplementation effect on patient functional outcome scores and bone mineral density (BMD). A systematic search of all relevant articles was performed using the following databases: MEDLINE, Embase, Google Scholar, and Web of Science. The population selection included human patients with a fresh fracture treated conservatively or operatively. The intervention included any form of vitamin D supplementation, compared to no supplementation or a placebo. The primary outcomes assessed were clinical or radiological union rates or complications arising from the nonunion. The secondary outcomes assessed were functional outcome scores, BMD scores after treatment, and pain scores. A total of fourteen studies, assessing a total of 2734 patients, were included. Eight studies assessed the effect of vitamin D on clinical or radiological union. Five studies reported no significant difference in complication rates when supplementing fracture patients. Alternatively, three studies reported a positive effect with supplementation between the groups. One of these studies found a difference only for early orthopaedic complications (<30 days), but no differences in late complications. The other two studies found significant differences in clinical union; however, no changes were observed in radiological union. Six studies investigated functional outcome scores after supplementation. Four of these studies found no significant differences between most functional outcome scores. Only three studies reported BMD outcomes, one of which found limited effect on total hip BMD. The overall findings are that vitamin D alone does little to influence fracture healing and subsequent union rates or functional outcome. The studies suggestive of a positive effect were generally of a lower quality. Further high quality RCTs are needed to justify routine supplementation at the time of fracture.

/pdf/the-effect-of-vitamin-d-supplementation-for-bone-healing-in-2174e071.pdf

The Effect of Vitamin D Supplementation for Bone Healing in Fracture Patients: A Systematic Review

Abstract The effect of banning of nonessential services during the novel coronavirus disease 2019 (COVID-19) pandemic led to a perceived change in the volume of trauma cases and injury patterns. Literature indicates trends toward less trauma overall, with a decrease in outdoor, sporting, and motor vehicle injuries. However, studies focusing on outpatient orthopaedic trauma are less common. The main aim of this study was to assess the effect of COVID-19 pandemic on differences in inpatient and outpatient injury patterns and mechanisms. Patients requiring orthopaedic inpatient admission to Mater Dei Hospital, Malta, were analyzed between March 15 and June 17 between 2019 and 2021. For outpatients, all newly referred patients seen at the fresh trauma clinic (FTC) on the first 5 clinic days of each month from April to June between 2019 and 2021 were assessed. There were a total of 503, 362, and 603 hospital admissions during the data collection period from 2019, 2020 and 2021, respectively. There was a decrease in elbow ( p  = 0.015) and pelvis ( p  = 0.038) pathology since COVID-19 pandemic. In contrast, there was an increase in shoulder injuries ( p  = 0.036) and lacerated wounds ( p  = 0.012) in 2021. The most frequent mechanisms of injury for inpatients were low impact falls, and fall from heights greater than 1 m. Machine-related injuries ( p  = 0.002), blunt trauma ( p  = 0.004), and twisting injuries ( p  = 0.029) increased in 2021. In the outpatient setting, there were a total of 367, 232, and 299 new referrals in 2019, 2020, and 2021, respectively. Injury patterns in this cohort were similar throughout, except for a significant increase in shoulder injuries during 2020 ( p  = 0.009). There appears to be some minor variation in injury mechanisms due to lifestyle changes; however, most injury patterns have remained fairly constant. Further research should focus on the use of public awareness campaigns to decrease home-related trauma during enforced periods of lockdown.

The Impact of the COVID-19 Pandemic on Injury Patterns in Inpatient and Outpatient Orthopaedic Trauma

Introduction Anterior cruciate ligament (ACL) tears are common injuries that can considerably impact an individual’s quality of life and athletic performance. In these cases, surgical reconstruction of the ligament can be considered to restore stability to the knee. This study aims to investigate the time taken for individuals to return to sport post-ACL reconstruction, assess the rate of re-injury and evaluate the reliability of the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scoring systems in predicting a return to sport at the pre-injury level. Methods In this retrospective study, a total of 104 patients who underwent ACL reconstruction between January 2016 and December 2022 by one surgical team at Mater Dei Hospital, Malta were evaluated using a self-administered questionnaire. The questionnaire was based on different components including the sport practised at the time of injury, sport engagement classification, return to sport, the ability to return to pre-injury levels of performance and re-injury. The participants then had to fill in IKDC and KOOS evaluation forms. Results In this study, 73% (n=76) of individuals successfully returned to sport after ACL reconstruction, with no significant difference being found between professional and recreational athletes (Chi-squared=0.00455, p=0.95). After reconstruction, 31.7% (n=33) of participants experienced an ipsilateral or contralateral ACL tear, with those returning to sport within six months showing a fivefold increase in re-injury risk compared to individuals who returned at eight or 12 months, suggesting a significant association between return duration and re-injury. The relationship between scoring systems and return to sport at the pre-injury level of performance was analysed using binary logistic regression, revealing that achieving scores of 85.6 or higher in IKDC or 89 or higher in KOOS meant having a 95% probability of returning to sport at the pre-injury level. Conclusions By considering these scoring systems with other post-operative criteria, clinicians can offer a more customised rehabilitation plan tailored to each patient who undergoes ACL reconstruction.

Return to Sport, Re-injury and Performance After the Anterior Cruciate Ligament Reconstruction: Evaluating the Role of International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Scoring Systems

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The Effect of Vitamin D Supplementation for Bone Healing in Fracture Patients: A Systematic Review

The Impact of the COVID-19 Pandemic on Injury Patterns in Inpatient and Outpatient Orthopaedic Trauma

Return to Sport, Re-injury and Performance After the Anterior Cruciate Ligament Reconstruction: Evaluating the Role of International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Scoring Systems