Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult v...Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult vascular injuries.Clinical deterioration is frequently subtle,with signs like fatigue or confusion mis-attributed to baseline status.In frail patients,these injuries may rapidly evolve into life-threatening scenarios.Conservative management,while standard,may be insufficient when vascular frailty or anticoagulation are present.Early clinical suspicion,serial hemoglobin checks,and multidisciplinary involvement are crucial.A dynamic assessment model that incorporates frailty,comorbidities,and physiological reserve alongside radiographic findings can better guide inter-vention and monitoring.Clinicians must lower the threshold for advanced imaging,such as computed tomography angiography,and consider early vascular consultation even in seemingly stable cases.Adopting a holistic,risk-based approach can mitigate complications and improve outcomes for this vulnerable population.展开更多
Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased ri...Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.展开更多
Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary pers...Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary perspectives that address two underrepresented dimensions:Vascular surgical decision-making and psychiatric rehabilitation.We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management.Additionally,we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors.Embedding these domains into standardized protocols could enhance both short-and long-term outcomes,particularly in highimpact trauma and disaster settings.展开更多
Cardiovascular diseases are a leading cause of both short-term and long-term complications in patients who are candidates for liver transplantation.The increasing prevalence of cardiovascular risk(CVR)factors like hyp...Cardiovascular diseases are a leading cause of both short-term and long-term complications in patients who are candidates for liver transplantation.The increasing prevalence of cardiovascular risk(CVR)factors like hypertension,diabetes,and dyslipidemia in this population is linked to lower overall survival rates with an increased risk of major cardiovascular events during and after the procedure.However,while guidelines for CVR stratification exist,their clinical application remains inconsistent.A significant challenge is the high cost of comprehensive cardiovascular evaluation,which often involves advanced diagnostic tests,imaging,and multidisciplinary specialist consultations.This issue is especially challenging in public healthcare systems,where the financial burden of thorough cardiovascular examinations can stretch already limited resources.Given the increasing pressures on healthcare sustainability,it is essential to balance careful cardiovascular screening with the efficient use of resources.The rising costs highlight the need for evidence-based updates to practices that optimize patient outcomes while reducing the strain on the healthcare system.Tailored approaches should focus on both managing cardiovascular issues and considering the economic impact.Considering these challenges,adaptable protocols are needed to improve transplantation safety and efficacy while addressing the financial realities of public health systems and minimizing unnecessary costs.展开更多
文摘Frailty fractures of the pelvis,particularly isolated pubic ramus fractures,are often perceived as benign,especially in elderly patients.However,this perception can obscure the risk of delayed hemorrhage from occult vascular injuries.Clinical deterioration is frequently subtle,with signs like fatigue or confusion mis-attributed to baseline status.In frail patients,these injuries may rapidly evolve into life-threatening scenarios.Conservative management,while standard,may be insufficient when vascular frailty or anticoagulation are present.Early clinical suspicion,serial hemoglobin checks,and multidisciplinary involvement are crucial.A dynamic assessment model that incorporates frailty,comorbidities,and physiological reserve alongside radiographic findings can better guide inter-vention and monitoring.Clinicians must lower the threshold for advanced imaging,such as computed tomography angiography,and consider early vascular consultation even in seemingly stable cases.Adopting a holistic,risk-based approach can mitigate complications and improve outcomes for this vulnerable population.
文摘Anterior cruciate ligament(ACL)injuries are among the most frequent knee pathologies,with athletes—particularly females and those in pivot-heavy sports such as soccer,basketball,volleyball,and skiing—at increased risk.The success of ACL reconstruction is multifactorial,relying on individualized graft selection,surgical precision,patient-specific characteristics,and optimized rehabilitation.Despite the availability of various graft options—hamstring tendon,bone-patellar tendon-bone,and quadriceps tendon—no single type has demonstrated clear superiority,reinforcing the need for patient-tailored approaches based on anatomical,functional,and age-related factors.Surgical techniques continue to evolve,with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery.Rehabilitation is a critical determinant of functional out-comes.Current evidence supports immediate mobilization,early weight-bearing,and initiation of neuromuscular and strength training,while routine use of continuous passive motion and bracing is discouraged,except in multi-ligament injuries.Prehabilitation is recommended,though accelerated rehabilitation remains controversial.Implant choice and fixation strategy are also essential to long-term success.The use of materials that reduce the risk of chronic complic-ations and support biological integration is increasingly favored.Nevertheless,rare mechanical failures emphasize the need for accurate tunnel placement,appropriate implant selection,and vigilant postoperative monitoring.Outcomes are further influenced by patient-specific variables,including bone quality,metabolic status,and physical activity levels.Optimal ACL reconstruction results from a comprehensive,patient-centered strategy that integrates surgical accuracy,individualized rehabilitation,and continuous follow-up to minimize complications and enhance recovery.
文摘Crush syndrome demands an integrated multidisciplinary approach that spans acute surgical decisions and long-term functional recovery.In response to Khan et al’s recent systematic review,we propose complementary perspectives that address two underrepresented dimensions:Vascular surgical decision-making and psychiatric rehabilitation.We emphasize the use of intraoperative technologies such as indocyanine green fluorescence angiography and compartment pressure monitoring to guide limb salvage strategies and reperfusion management.Additionally,we advocate for the systematic integration of mental health screening and trauma-informed psychiatric care to address the high prevalence of psychological distress in survivors.Embedding these domains into standardized protocols could enhance both short-and long-term outcomes,particularly in highimpact trauma and disaster settings.
文摘Cardiovascular diseases are a leading cause of both short-term and long-term complications in patients who are candidates for liver transplantation.The increasing prevalence of cardiovascular risk(CVR)factors like hypertension,diabetes,and dyslipidemia in this population is linked to lower overall survival rates with an increased risk of major cardiovascular events during and after the procedure.However,while guidelines for CVR stratification exist,their clinical application remains inconsistent.A significant challenge is the high cost of comprehensive cardiovascular evaluation,which often involves advanced diagnostic tests,imaging,and multidisciplinary specialist consultations.This issue is especially challenging in public healthcare systems,where the financial burden of thorough cardiovascular examinations can stretch already limited resources.Given the increasing pressures on healthcare sustainability,it is essential to balance careful cardiovascular screening with the efficient use of resources.The rising costs highlight the need for evidence-based updates to practices that optimize patient outcomes while reducing the strain on the healthcare system.Tailored approaches should focus on both managing cardiovascular issues and considering the economic impact.Considering these challenges,adaptable protocols are needed to improve transplantation safety and efficacy while addressing the financial realities of public health systems and minimizing unnecessary costs.
