Yahya Ali

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.

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.

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.

Purpose Pre-operative alpha blockers (α-blockers) have demonstrated improved ureteral access during ureteroscopy (URS) in patients with urolithiasis, with Tamsulosin or Silodosin interchangeably administered. This network meta-analysis (NMA) of randomized controlled trials (RCTs) aims to compare pre-operative Tamsulosin, Silodosin, and placebo in-terms of successful stone-access rate (SAR). Secondary outcomes are stone-free rate (SFR), operative time, ureteral dilatation requirement, ureteral wall (UW) injury and overall complications. Methods A systematic review in-line with PRISMA guidelines was conducted, with multiple databases searched from inception till December 26,2024. Inclusion was restricted to published journal RCTs in English that compared each α-blocker to placebo in patients undergoing URS, measuring relevant outcomes. A frequentist NMA was conducted, using odds ratios (OR) for binary endpoints, and mean difference for continuous outcomes (MD). Results 20 RCTs and 2377 patients (Silodosin(n = 443), Tamsulosin(n = 762), Control(n = 1172)) were included, with only 1 RCT directly comparing both drugs. Overall, no significant difference was found between Silodosin and Tamsulosin across primary nor secondary outcomes. Silodosin yielded higher SAR (OR = 1.77,95%CI[0.95,3.29], P > 0.05) less need for ureteral dilatation (OR 0.72,95%CI[0.47,1.32], P > 0.05), and less operative time (MD -3.80,95%CI[-16.17, 8.56], P > 0.05) compared to Tamsulosin, although non-significant. No significant difference was found in SFR (P > 0.05), overall complications and UW injury. Both α-blockers were significantly favored over control across all outcomes (P < 0.05) except for operative time where Tamsulosin yielded no difference. Conclusions Silodosin and Tamsulosin are both viable options pre-URS, with Silodosin potentially yielding shorter operative time, less ureteral dilatation required and higher SAR. However, these differences are non-significant and stem from indirect estimates. Therefore, randomized head-to-head comparison trials are warranted.

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.