Hao Xing Lai

Introduction: Both subtalar arthroereisis and osteotomies are well-recognised surgical reconstructive options for paediatric pes planus deformity. We compared the clinical and radiographic outcomes of subtalar arthroereisis versus osteotomies in the surgical management of symptomatic idiopathic flexible pes planus in paediatric patients 2–18 years old. Specifically, we evaluated changes in key radiographic parameters and validated patient-reported outcome measures, as well as complications, to determine relative efficacy and safety. Methods: Electronic databases (PubMed, Embase, and The Cochrane Library) were searched from inception through August 23, 2024, following PRISMA guidelines. We reviewed studies involving patients aged 18 years or younger with idiopathic pes planus. The inclusion criteria encompassed all types of osteotomy procedures and subtalar arthroereisis, including both exosinotarsal (screw-type) and endosinotarsal (spacer-type) techniques. A random-effects meta-analysis was conducted to assess unweighted mean differences for radiographic angles and AOFAS scores. Results: Sixty studies (4,555 feet) were included: 46 arthroereisis (4,089 feet), 15 osteotomy (448 feet), and 1 combined (18 feet). Osteotomy demonstrated greater radiographic improvement in AP Meary’s angle (MD − 12.7 degrees vs. − 9.8 degrees; p < .0001), calcaneal pitch (MD 11.1 degrees vs. 4.1 degrees; p < .0001), and Kite’s angle (MD − 11.7 degrees vs. − 6.8 degrees; p < .0001). Arthroereisis achieved superior correction of lateral Meary’s (MD − 11.7 degrees vs. − 10.1 degrees; p < .0001), lateral Kite’s (MD − 7.1 degrees vs. − 4.2 degrees; p < .0001), and talonavicular coverage (MD − 15.6 degrees vs. − 12.7 degrees; p < .0001). Post-operative AOFAS improvements were similar (MD 29.2 vs. 26.4). Overall complication rates were 9.2% for arthroereisis (predominantly sinus tarsi pain) and 10.5% for osteotomy (primarily infections). Conclusion: While osteotomy yields greater correction of calcaneal inclination and hindfoot valgus, subtalar arthroereisis provides superior restoration of the lateral longitudinal arch and forefoot adduction. Despite these radiographic differences, both techniques provide equivalent functional gains. Due to its minimally invasive nature and favorable safety profile, arthroereisis is a viable first-line option, while osteotomy remains essential for correcting severe structural calcaneal pathology.

Different approaches have been proposed to treat patients with pulseless supracondylar humeral fractures (SHF). We aim to analyze the current outcomes of p

Background: Early breast cancer outcomes have improved substantially, yet surgery may carry physical and psychosocial costs. Cryotherapy has gained attention as a minimally invasive alternative to surgery for select patients with breast cancer: particularly, those with small, unifocal, hormone receptor-positive tumors. Given rapidly expanding but heterogeneous reports, this state-of-the-art review therefore aims to synthesize information on how breast cryotherapy is performed, for whom it is most suitable, what outcomes to expect, and where evidence is still immature. Methods: We queried MEDLINE (via PubMed), Embase (via Ovid), and the Cochrane Library up to January 2025, using terms related to “breast neoplasms,” “cryotherapy,” and “cryoablation.” Eligible studies included clinical trials, cohort studies, and case series reporting outcomes of cryotherapy in breast cancer. Data were extracted on patient characteristics, procedural parameters, recurrence, survival, and complications. The risk of bias was assessed using the MINORS tool, and certainty of evidence was appraised with the GRADE framework. Results: A total of thirty one studies (comprising 1357 patients) formed the evidence corpus summarized here. Most involved early-stage, hormone receptor-positive breast cancers ≤ 2 cm treated with percutaneous cryoablation. Local recurrence, defined as any ipsilateral breast tumor recurrence confirmed radiologically or histologically, ranged from 0 to 68.8%, with smaller, unifocal tumors achieving the best control. Overall survival exceeded 80% in early-stage disease, while complications were generally minor, including bruising, hematoma, and skin erythema. Patient satisfaction was high, with favorable cosmetic outcomes reported in limited studies. However, the follow-up duration ranged from 1 month to 10 years (with nearly half < 1 year), and protocols varied substantially across studies. In summary, breast cryotherapy appears safe and can achieve encouraging local control and cosmetic results in carefully selected early-stage cases. Its role in aggressive subtypes, larger or multifocal disease, and as part of multimodal regimens requires further study. Conclusions: Standardized protocols, imaging/reporting conventions, and longer follow-up with patient-reported outcomes are needed to advance the field and further define where cryotherapy can appropriately de-escalate surgery.