Nader Maai

Background: Sonication of explanted implants has improved microbiological detection in implant-associated infections. However, large inter-laboratory variability in sonication protocols limits comparability and clinical interpretability. Thus, a national consensus-driven initiative was launched to standardize the diagnostic sonication process, using current Swiss practice and the published evidence as a foundation. Methods: A Delphi-informed process was conducted, including a national protocol survey and a scoping literature review of published sonication workflows, key parameters, and reporting practices. An online consensus meeting followed, with structured item-by-item discussion and anonymous voting (completeness >80% per item; abstentions excluded from percentage calculations). Results: Twenty-one laboratories participated in the national survey; four without sonication, and one duplicate response was identified. T Consensus was reached in 8 of 9 domains: sonication frequency (40 kHz, 100%), intensity (0.22 W/cm ² , 100%), temperature (room temperature, 100%), duration (1 min, 90.5%), fluid (Ringer's solution, 95.5%), pre- and post-sonication vortexing (30 s each, 94.4%), processing within 6 h (87.5%), culture media panel (aerobic blood agar 93.8%, chocolate agar +5% CO ₂ 100%, thioglycolate broth 100%, anaerobic Schaedler agar +5% sheep blood 87.5%), incubation (14 days, 84.6%), and quantitative reporting (CFU/mL, 100%). In contrast, volume standardization proposal was predominantly rejected (weight-based volume: 33.3% agreement,; minimum-volume rule: 37.5% agreement), reflecting ongoing feasibility and implementation concerns also noted in the literature. Conclusion: A national consensus protocol was developed to harmonize sonication-based implant microbiology processing across key technical, handling, culture, incubation, and reporting domains informed by a scoping synthesis of published workflows and an assessment of current Swiss practice, while volume standardization remained open due to operational constraints. This framework now represents a reproducible baseline to facilitate inter-laboratory comparability and places future work in the position of implementation evaluation and evidence-based interpretive thresholds.

Background : The co-occurrence of periprosthetic fractures and infection, referred to as infected periprosthetic fracture (iPPF), represents a highly burdensome complication in orthopedic surgery. Management is challenging since not rarely treatment principles of prosthetic joint infections and fracture-related infections have to be combined. The aim of this scoping review was to map the current literature on management and outcome of iPPFs. Methods : A scoping review was conducted in accordance with PRISMA-ScR guidelines. Five major databases were systematically searched. Studies reporting on diagnostic principles and/or treatment strategies for iPPF around the hip and knee were included. Data were mapped regarding study design, diagnostic approaches, surgical strategies, and outcome. Results : A total of 32 studies comprising 273 patients with iPPFs were included; 8 addressed diagnostic strategies, and 24 reported on treatment and outcome. Diagnostic studies demonstrated limited reliability of serum inflammatory markers, and although synovial fluid analysis appeared most informative, optimal thresholds remain uncertain. Most treatment studies were small and heterogeneous. A staged surgical approach, predominantly two-stage revision, was reported in 83 % of the included studies. Across nine studies reporting outcomes, mean infection eradication and recurrence rates were 76.1 % and 22.3 %, respectively. The majority of the studies (58.3 %) described that additional surgeries were needed to cure infection. Fracture healing outcomes were inconsistently reported (bone healing in 4 out of 9 studies with 53/58 fractures, mean 91.4 %). Conclusion : This scoping review demonstrates that management of iPPFs remains highly challenging, with high rates of recurrent infection and unplanned revision surgery. However, the reported quantitative outcome data represent descriptive summaries derived from heterogeneous, predominantly small observational studies and case series and should not be interpreted as definitive benchmarks for clinical outcomes. The current evidence base remains limited, highlighting the need for standardized diagnostic criteria, uniform outcome reporting, and well-designed prospective multicenter studies.

Implant-associated infections, including periprosthetic joint infections (PJI) and fracture-related infections (FRI), are severe complications following orthopedic surgery. Conventional tissue cultures often yield false-negative results, especially after antibiotic initiation or in chronic biofilm-associated infections. Sonication of explanted implants enhances bacterial recovery, but heterogeneous protocols limit comparability. This scoping review maps sonication protocols currently reported in the literature. A comprehensive literature search across three databases (PubMed, Embase, and Scopus) was performed. Clinical studies that reported on sonication protocols used in the microbiological workup of PJIs and FRIs published from 2007 to October 2025 were eligible for inclusion. Eligible studies were screened for the following information: container size and material and fluids, sonication device and settings, pre- and post-sonication handling, culture conditions, reporting format, and/or diagnostic thresholds. Data were extracted and synthesized descriptively. After duplicate removal, 312 records were screened, and 146 studies were included. Reporting was incomplete for several key parameters. Container material was not specified in 43.2% of studies, container type in 30.8%, and fluid type in 31.0%. Among reported protocols, hard plastic containers (54.8%) and Ringer’s lactate or saline (40.4%) were most frequently used, with fluid volumes ranging from 50 to 800 mL. Sonication frequency was reported in 50.7% of studies, most commonly 40 kHz (28.8%). Sonication time was not reported in 34.2%, with reported durations ranging from 1 to 10 min and most frequent duration as 5 min (30.1%). Vortexing and centrifugation were applied in 55.5% and 45.9% of studies, respectively. CFU thresholds varied widely, ranging from any growth to ≥50 CFU/mL or per plate. Time-to-culture and storage conditions were rarely reported. Sonication protocols vary greatly across almost all parameters, with detailed descriptions often lacking, and certain variables rarely reported. Standardizing these protocols is essential to ensure reproducibility and to establish clinically reliable diagnostic cut-offs. IMPORTANCE: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) are serious complications associated with substantial morbidity, repeated surgeries, and a high healthcare burden. Accurate and early pathogen detection is critical for guiding targeted antimicrobial therapy and improving treatment outcomes. Sonication of explanted implants has emerged as a valuable diagnostic tool by disrupting biofilms and enhancing bacterial recovery, particularly in antibiotic-exposed patients. However, sonication protocols vary widely across studies, including differences in containers, fluids, ultrasound settings, processing steps, and colony-forming unit thresholds, with inconsistent reporting further compounding the issue. This variability directly affects diagnostic performance, complicates the distinction between true infection and contamination, and limits inter-laboratory comparability. By systematically mapping this heterogeneity across 146 studies, this scoping review provides a foundation for developing standardized protocols and consensus definitions to improve diagnostic reliability and patient care.

Critical-sized long-bone defects and non-unions are among the most challenging complications in fracture care, as they lack the capacity for spontaneous he

Vitamin D is essential for optimal athletic performance; however, the evidence for its effect on athletic performance remains inconclusive. This systematic review aimed to investigate the effect of vitamin D supplementation on athletic performance in athletes. A comprehensive and systematic search of six electronic databases was conducted in accordance with PRISMA reporting guidelines, using a combination of Boolean operators and MeSH keywords. A total of 13 studies were included in the review. The included studies demonstrated that vitamin D supplementation consistently elevates serum 25(OH)D levels in athletes. A subset of the included studies reported significant improvements in athletic performance following the administration of vitamin D supplements, particularly in those athletes with low vitamin D status initially. Another cluster of studies focused on the effects of vitamin D supplementation on parameters of haematological and muscle recovery, with mixed results. Additionally, there were observations of seasonal fluctuations in vitamin D levels, which highlight the importance of considering the timing of supplementation. Vitamin D supplementation has been linked to improved athletic performance, particularly in athletes with low initial vitamin D status. However, the impact of this intervention is influenced by individual characteristics, the type of exercise, and the specific dosage and duration of supplementation. To gain a more comprehensive understanding of the mechanisms and optimal protocols for vitamin D supplementation in athletes, further research is required.

It is generally accepted that the maintenance of the health of the musculoskeletal system is highly dependent on vitamin D. However, the relationship between vitamin D levels and the incidence of musculoskeletal injuries is still uncertain. This systematic review aimed to summarize the available information on the association between vitamin D levels and musculoskeletal injuries. Seven electronic databases were searched using Boolean operators to link MeSH (Medical Subject Headings) terms and free text phrases. This improved the sensitivity and specificity of the search results. Studies investigating the association between vitamin D status and musculoskeletal damage were included. Twelve studies met the inclusion criteria. The majority of studies reported an increased prevalence amongst individuals with low vitamin D levels and musculoskeletal symptoms or injury. This underlines the important role of vitamin D screening and supplementation. Some studies have associated certain vitamin D metabolites with injury occurrence, suggesting that levels and balance of these metabolites may influence injury risk. However, there have been conflicting results on the effect of vitamin D supplementation on muscle function and exercise-induced muscle injury, with some studies failing to find any significant changes. Consistent evidence has demonstrated the benefits of vitamin D supplementation in reducing the incidence of stress fractures in athletes. One study suggests that genetic variations may influence how vitamin D is related to musculoskeletal health. The reviewed studies revealed a complex relationship between the vitamin D status and musculoskeletal injuries. While low vitamin D levels were consistently observed, the effects of supplementation on various musculoskeletal outcomes varied. These findings emphasize the need for further research to better understand the underlying mechanisms and to develop targeted interventions for specific populations, considering factors such as vitamin D metabolites, supplementation dosage, and genetic variations.

Background: Limb-lengthening surgeries via nail distraction osteogenesis (DO) have become more popular lately. This provides an opportunity to study human bone that has grown longer. Case details: We present a case of a 22-year-old male who underwent internal upper and lower leg lengthening by 12 cm and 6 cm, respectively, under full weight bearing. He requested bilateral femoral shortening by 4 cm using a shortening nail, 24 months after the index surgery. The regenerated bones were harvested and analyzed. Results: Good bone quality and well-organized structure were observed in the regenerated bones compared with the native human adult bony architecture. Conclusions: This case demonstrates that bilateral bone regeneration during DO with a nail can result in a bone morphology that is comparable to that of native adult human bony macro- and micro-anatomy. This supports the effectiveness and potential of this surgical approach for limb lengthening and shortening procedures, although more investigations are necessary in this regard.