Haad A. Arif

Lactoferrin (LF) is a natural glycoprotein. Its diverse biological roles include immune modulation and osteogenesis. Evidence shows that LF promotes collagen synthesis and fibroblast activity, thereby accelerating wound healing. This study investigates the role LF plays in wound healing and potential future applications. A systematic review was conducted in accordance with PRISMA guidelines. Articles were sourced from MEDLINE, Embase, Web of Science, and the Cochrane Central Register. Studies published before September 2025 were eligible. The primary outcome of interest was wound healing rate, while secondary outcomes included collagen synthesis and fibroblast migration associated with LF exposure. An NIH quality assessment was performed to score the quality of the papers. Comparative analyses and descriptive statistics were performed to synthesise the findings. Of the 261 screened articles, 17 studies met the inclusion criteria. Twelve studies reported that LF accelerated wound healing compared to controls, 12 demonstrated increased collagen synthesis, and 9 showed enhanced fibroblast migration. All included studies were preclinical, comprising human in vitro or animal models. Most originated from Japan ( n = 6), followed by China ( n = 3) and Russia ( n = 2), and were published within the last 20 years. This review highlights consistent preclinical evidence linking LF to enhanced wound healing. These findings provide a strong rationale for future clinical trials investigating LF as a therapeutic agent for wound healing. To date, no human studies have directly evaluated LF in wound repair, further emphasising the need for well‐designed clinical trials.

Purpose: To compare postoperative complications, rehabilitation outcomes, and health care utilization in children undergoing primary medial patellofemoral ligament reconstruction for patellofemoral instability with and without a pre‐existing mental illness. Methods: The TriNetX U.S. Collaborative Network was queried to identify patients younger than 18 years old undergoing medial patellofemoral ligament reconstruction for patellar instability in the United States between 2000 and 2020. Patients were then separated into those with a pre‐existing mental illness (PMI Group) and those without (Control Group). After propensity score matching for patient demographics, chronic pain, and obesity, postoperative complication rates, rehabilitation outcomes, and health care utilization of both groups were compared across 1 year. Results: After propensity score matching, each group consisted of 223 patients for a total cohort of 446 patients. The PMI Group showed significantly greater rates of postoperative knee pain (51.5% vs 41.0%, P = .004, risk ratios (RR): 1.40), opioid analgesic use (42.2% vs 31.4%, P = .018, RR: 1.34), nonopioid analgesic use (34.5% vs 22.0%, P = .006, RR: 1.27), emergency department visits (22.0% vs 4.9%, P < .001, RR: 4.46), and physical therapy treatment sessions (61.4% vs 51.1%, P = .028, RR: 1.20). Conclusions: Children with pre‐existing mental illness exhibit significantly greater rates of persistent knee pain, higher opioid consumption, and increased health care utilization following medial patellofemoral ligament reconstruction. Level of Evidence: Level III, retrospective comparative study.

Background: Outpatient pin removal after pin fixation of supracondylar humerus (SCH) fractures is a frequent source of pain and anxiety in children. While pharmacologic and digital distraction strategies have demonstrated minimal efficacy in reducing procedural distress, animal-assisted therapy (AAT) remains an unexplored alternative in pediatric orthopaedics. The purpose of this study was to assess the effect of AAT on patient-reported pain and behavioral distress during office SCH pin removal. Methods: A randomized controlled trial was conducted at a tertiary pediatric hospital. Pediatric patients aged 3 to 10 years undergoing office pin removal after SCH fracture fixation were randomized to pin removal with or without the presence of a certified therapy dog. Outcomes included patient-reported pain using the Wong-Baker FACES Pain Rating Scale, behavioral distress using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, heart rate measurements, and parental-reported anxiety assessed through survey. Results: A total of 52 patients were enrolled in this study with 27 randomized to the Dog cohort and 25 to the control cohort. Patients in the Dog cohort demonstrated significantly lower patient-reported pain (FACES: 2.9 vs. 6.4, P P =0.02) during pin removal. Peak heart rate was significantly lower in the Dog cohort (121.3 vs. 138.4 bpm, P =0.04), although change from baseline heart rate did not differ significantly ( P =0.09). Conclusions: Animal-assisted therapy was associated with reduced patient-reported pain and behavioral distress during office SCH pin removal, supporting its role as a non-pharmacologic adjunct in pediatric orthopaedic care. Level of Evidence: Level I, randomized controlled trial.

Purpose: Surgical site infections (SSIs) are the third most common complication following spine surgery. The effect of topical vancomycin in addition to perioperative systemic cefazolin remains uncertain. This study sought to investigate the effect of topical vancomycin administration on 90-day postoperative infection risk following adult posterior spinal fusion (PSF). Methods: The TriNetX Global Collaborative database was queried to identify adult patients undergoing PSF. Patients were stratified into two cohorts based on documented administration of topical vancomycin and systemic cefazolin (topical cohort) versus systemic cefazolin alone (control cohort). Patients underwent 1:1 propensity matching based on demographics and relevant comorbidities. The primary outcomes of interest included 90-day rates of infection-related complications. Subgroup analyses were performed to identify the influence of neuromuscular scoliosis, PSF with osteotomies, pelvic fixation, or fusion of greater than six levels on infection rates. Infectious complication rates were also compared between patients receiving topical vancomycin with and without topical gentamicin or tobramycin. Results: After propensity matching, 63,455 patients were included in each cohort. Patients in the topical cohort demonstrated comparable rates of overall infection (3.0% vs. 3.1%, p = 0.794), superficial surgical site infection (SSI) (0.9% vs. 0.8%, p = 0.151), deep SSI (0.6% vs. 0.6%, p = 0.070) and all other infectious complications when compared to the control cohort. Subgroup analysis revealed decreased rate of deep SSI when using topical gentamicin or tobramycin with vancomycin versus topical vancomycin alone (0.7% vs. 1.7%, p = 0.019). No other between-group differences were observed. Conclusion: This study found no significant difference in 90-day postoperative infectious complications following PSF when topical vancomycin was added to standard systemic cefazolin prophylaxis compared to cefazolin prophylaxis alone. Vancomycin with the addition of gentamicin or tobramycin, however, was associated with decreased rates of deep SSI. Level of evidence: Level III, retrospective cohort study.