OBJECTIVE: Current studies on the treatment of adolescent patients with disc displacement without reduction (DDWOR) are limited by short follow-up periods and small sample sizes, and there are few comparative studies on the efficacy of conservative treatment with and without disc reduction for acute DDWOR. This study compared the therapeutic effects of two conservative treatment methods: physical therapy alone and physical therapy combined with non-surgical manual disc reduction and anterior repositioning splints (ARS), in adolescent patients with acute DDWOR.
METHODS: This retrospective study included adolescent patients with DDWOR who underwent physical therapy at the Temporomandibular Joint Rehabilitation Department of the Shanghai Ninth People\'s Hospital from January 2018 to December 2021. Patient assessment data were collected before and after treatment. Patients were followed up through telephone and online questionnaires from March to August 2023.
RESULTS: The results indicate that compared to physical therapy alone, the combination of physical therapy and non-surgical manual disc reduction with ARS showed better short-term efficacy, improved mouth opening, and better long-term pain control. Also, it may be effective in preventing degenerative joint disease.
CONCLUSIONS: This combination therapy is recommended for clinical application in adolescent patients with acute DDWOR.
CONCLUSIONS: The present research demonstrates the superior efficacy of physical therapy and non-surgical manual disc reduction combined with anterior repositioning splint in adolescent patients with acute DDWOR.

BACKGROUND: Early and accurate diagnosis is critical to preserve function and reduce healthcare costs in patients with hand and wrist injury. As such, artificial intelligence (AI) models have been developed for the purpose of diagnosing fractures through imaging. The purpose of this systematic review and meta-analysis was to determine the accuracy of AI models in identifying hand and wrist fractures and dislocations.
METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Diagnostic Test Accuracy guidelines, Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to October 10, 2023. Studies were included if they utilized an AI model (index test) for detecting hand and wrist fractures and dislocations in pediatric (<18 years) or adult (>18 years) patients through any radiologic imaging, with the reference standard established through image review by a medical expert. Results were synthesized through bivariate analysis. Risk of bias was assessed using the QUADAS-2 tool. This study was registered with PROSPERO (CRD42023486475). Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.
RESULTS: A systematic review identified 36 studies. Most studies assessed wrist fractures (27.90%) through radiograph imaging (94.44%), with radiologists serving as the reference standard (66.67%). AI models demonstrated area under the curve (0.946), positive likelihood ratio (7.690; 95% confidence interval, 6.400-9.190), and negative likelihood ratio (0.112; 0.0848-0.145) in diagnosing hand and wrist fractures and dislocations. Examining only studies characterized by a low risk of bias, sensitivity analysis did not reveal any difference from the overall results. Overall certainty of evidence was moderate.
CONCLUSIONS: In demonstrating the accuracy of AI models in hand and wrist fracture and dislocation diagnosis, we have demonstrated that the potential use of AI in diagnosing hand and wrist fractures is promising.
METHODS: Level III. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND: It is currently unknown to what degree surgical or nonoperative treatment of acromioclavicular (AC) dislocation influences the development of osteoarthritis (OA). The aim of this study was to evaluate AC OA after surgical and nonoperative treatment for AC dislocations, compare OA prevalence between treatment options, and compare OA prevalence between the injured and contralateral shoulder.
METHODS: Articles reporting on the prevalence of OA after surgical or nonoperative treatment of an AC dislocation with a minimal 2-year follow-up were included. AC OA presence was extracted for the injured and contralateral shoulder. Treatment categories were defined based on anatomical variation in the reattachment of ligaments: AC fixation, coracoclavicular (CC) fixation, AC and CC fixation, Bosworth screw synthetic graft, tendon graft, and conservative. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
RESULTS: Ninety-four articles were included for qualitative analysis, and 7 articles were included for meta-analysis (n = 3,812; follow-up = 2.0-24.2 years; mean age 37.6 ± 10.4 years). A total of 3,483 patients underwent surgical treatment, and 329 patients underwent conservative treatment. OA prevalence ranged from 6.7%-29.3% between 7 pooled treatment categories. Most included studies had a follow-up <10 years (94%) and OA prevalence increased with time, regardless of treatment option. There was no difference in OA prevalence between the injured and contralateral shoulder (p = 0.120). MINORS scores were varied, ranging from poor to very good.
CONCLUSIONS: The pooled AC OA prevalence of the 7 treatment categories ranged from 6.7% for the CC fixation surgical group to 29.3% for the conservative treatment group. However, the included studies were predominantly of low quality and had varying follow-up periods, with most having relatively short follow-up durations. No difference in AC OA prevalence was found between the injured and contralateral shoulder. Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC AO.
METHODS: Level IV. See Instructions for Authors for a complete description of levels of evidence.

Isolated cuboid dislocation without fracture is a rare injury, and there is a lack of literature describing its treatment. Studies report the use of closed or open reduction, with Kirschner wire fixation in the treatment of these injuries. This case report presents the clinical condition of a 24-year-old male patient who arrived at the emergency department with an isolated dislocation of the right foot cuboid bone without the presence of a fracture, after suffering trauma during a football game. Open reduction was performed in the surgical center with stabilization and fixation using a Kirschner wires. The patient showed an excellent response to the treatment, with no loss of the foot\'s range of motion.

Fahr\'s disease is characterized by idiopathic bilateral deposition of calcium in the striopallidodentate area. We are presenting 83-year-old female, who failed responding while having lunch around 10 AM soon after she lost consciousness for an hour. It was associated with difficulty in walking, mood disturbances, fatigability, blurring of vision and occasional dizziness since past 4 months. Her neurological examination revealed Parkinsonian features. Her computed tomography of head report showed bilateral, symmetrical, large area of calcification over the basal ganglia, the thalamus and the cerebellum. To rule out the seizure disorder we have done an electroencephalogram and some laboratory test including calcium, Phosphorus, Parathyroid hormone and magnesium, vitamin D which were suggestive of Fahr\'s disease.

Dislocations of the fourth and fifth carpometacarpal joints (CMCJs) are rare and often misdiagnosed via radiography. Moreover, treatment strategies have not yet been standardized. Herein, we report a case of chronic dislocations of the fourth and fifth CMCJs with delayed diagnosis and successful treatment via ligament repair. A 29-year-old male patient who was initially diagnosed with contusion at another center following a fall on the stairs was referred to our hospital one month later due to persistent pain and swelling. Fourth and fifth CMCJ dislocations were diagnosed using radiography and computed tomography. Closed reduction attempts were unsuccessful, prompting open reduction. The operative findings included rupture of the dorsal carpometacarpal ligament and hamate cartilage injury. Using two mini anchors, the fourth and fifth dorsal carpometacarpal ligaments were repaired, and Kirschner-wire (K-wire) pinning was performed. The K-wire was extracted after four weeks. At the eight-month follow-up, the only remaining symptom was mild discomfort, and the range of motion and grip strength was fully recovered. Our findings highlight the difficulties in diagnosing CMCJ dislocation and suggest ligament repair as a treatment option for chronic cases of CMCJ dislocation.

UNASSIGNED: To compare the effectiveness of robot-assisted and traditional freehand screw placement in the treatment of atlantoaxial dislocation.
UNASSIGNED: The clinical data of 55 patients with atlantoaxial dislocation who met the selection criteria between January 2021 and January 2024 were retrospectively analyzed. According to different screw placement methods, they were divided into the traditional group (using the traditional freedhand screw placement, 31 cases) and the robot group (using the Mazor X robot-assisted screw placement, 24 cases). There was no significant difference in gender, age, body mass index, etiology, and preoperative visual analogue scale (VAS) score, cervical spine Japanese Orthopaedic Association (JOA) score between the two groups ( P>0.05). The operation time, intraoperative blood loss, operation cost, and intraoperative complications were recorded and compared between the two groups. The VAS score and cervical spine JOA score were used to evaluate the improvement of pain and cervical spinal cord function before operation and at 1 month after operation. CT examination was performed at 3 days after operation, and the accuracy of screw placement was evaluated according to Neo grading criteria.
UNASSIGNED: All the 55 patients successfully completed the operation. The operation time, intraoperative blood loss, and operation cost in the robot group were significantly higher than those in the traditional group ( P<0.05). A total of 220 C 1 and C 2 pedicle screws were inserted in the two groups, and 94 were inserted in the robot group, with an accuracy rate of 95.7%, among them, 2 were inserted by traditional freehand screw placement due to bleeding caused by intraoperative slip. And 126 pedicle screws were inserted in the traditional group, with an accuracy rate of 87.3%, which was significantly lower than that in the robot group ( P<0.05). There were 1 case of venous plexus injury in the robot group and 3 cases in the traditional group, which improved after pressure hemostasis treatment. No other intraoperative complication such as vertebral artery injury or spinal cord injury occurred in both groups. All patients were followed up 4-16 months with an average of 6.6 months, and there was no significant difference in the follow-up time between the two groups ( P>0.05). Postoperative neck pain significantly relieved in both groups, and neurological symptoms relieved to varying degrees. The VAS score and cervicle spine JOA score of both groups significantly improved at 1 month after operation when compared with preoperative scores ( P<0.05), and there was no significant difference in the score change between the two groups ( P>0.05).
UNASSIGNED: In the treatment of atlantoaxial dislocation, the accuracy of robot-assisted screw placement is superior to the traditional freedhand screw placement.
UNASSIGNED: 比较机器人辅助与传统徒手植钉治疗寰枢椎脱位的临床疗效。.
UNASSIGNED: 回顾分析2021年1月—2024年1月收治且符合选择标准的55例寰枢椎脱位患者临床资料。根据植钉方式不同分为传统组（采用传统徒手植钉技术，31例）和机器人组（采用Mazor X脊柱外科机器人辅助植钉技术，24例）。两组患者性别、年龄、身体质量指数、病因及术前疼痛视觉模拟评分（VAS）、颈椎日本骨科协会（JOA）评分等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、术中出血量、手术费用及术中并发症发生情况。术前及术后1个月采用VAS评分和颈椎JOA评分评价患者疼痛和颈脊髓功能改善情况。术后3 d进行CT检查，参照Neo分级标准进行植钉精确性评价。.
UNASSIGNED: 55例患者均顺利完成手术，机器人组手术时间、术中出血量和手术费用明显高于传统组，差异有统计学意义（ P<0.05）。两组共植入C 1、C 2椎弓根螺钉220枚，机器人组植入94枚，植钉精确率为95.7%，其中因术中滑移导致出血转传统徒手植钉2枚；传统组植入126枚，植钉精确率为87.3%，明显低于机器人组（ P<0.05）。术中机器人组和传统组分别出现1例和3例静脉丛损伤，均经压迫止血处理后好转；两组均无椎动脉损伤、脊髓损伤等其他术中并发症发生。患者均获随访，随访时间4～16个月，平均6.6个月；两组随访时间比较差异无统计学意义（ P>0.05）。两组患者术后颈部疼痛均明显缓解，神经症状得到不同程度缓解；术后1个月两组VAS评分与颈椎JOA评分均较术前明显改善（ P<0.05），两组间评分变化值比较差异均无统计学意义（ P>0.05）。.
UNASSIGNED: 在寰枢椎脱位治疗中，与传统徒手植钉技术相比，机器人辅助植钉的精确性具有显著优势。.

UNASSIGNED: To investigate the effectiveness of computer-assisted and robot-assisted atlantoaxial pedicle screw implantation for the treatment of reversible atlantoaxial dislocation (AAD).
UNASSIGNED: The clinical data of 42 patients with reversible AAD admitted between January 2020 and June 2023 and met the selection criteria were retrospectively analyzed, of whom 23 patients were treated with computer-assisted surgery (computer group) and 19 patients were treated with Mazor X spinal robot-assisted surgery (robot group). There was no significant difference in gender, age, T value of bone mineral density, body mass index, etiology, and preoperative Japanese Orthopaedic Association (JOA) score, Neck Dysfunction Index (NDI) between the two groups ( P>0.05). The operation time, screw implantation time, intraoperative blood loss, hand and wrist radiation exposure, and complications were recorded and compared between the two groups. Gertzbein classification was used to evaluate the accuracy of screw implantation. JOA score and NDI were used to evaluate the function before operation, at 3 days after operation, and at last follow-up. At last follow-up, the status of screws and bone fusion were observed by neck three-dimensional CT.
UNASSIGNED: The operation time and hand and wrist radiation exposure of the computer group were significantly longer than those of the robot group ( P<0.05), and there was no significant difference in the screw implantation time and intraoperative blood loss between the two groups ( P>0.05). All patients were followed up 11-24 months, with an average of 19.6 months. There was no significant difference in the follow-up time between the two groups ( P>0.05). There was no significant difference in the accuracy of screw implantation between the two groups ( P>0.05). Except for 1 case of incision infection in the computer group, which improved after antibiotic treatment, there was no complication such as nerve and vertebral artery injury, screw loosening, or breakage in the two groups. The JOA score and NDI significantly improved in both groups at 3 days after operation and at last follow-up ( P<0.05) compared to those before operation, but there was no significant difference between the two groups ( P>0.05). At last follow-up, 21 patients (91.3%) in the computer group and 18 patients (94.7%) in the robot group achieved satisfactory atlantoaxial fusion, and there was no significant difference in the fusion rate between the two groups ( P>0.05).
UNASSIGNED: Computer-assisted or robot-assisted atlantoaxial pedicle screw implantation is safe and effective, and robotic navigation shortens operation time and reduces radiation exposure.
UNASSIGNED: 探讨计算机导航和机器人导航辅助寰枢椎椎弓根螺钉植入治疗可复性寰枢椎脱位（atlantoaxial dislocation，AAD）的疗效。.
UNASSIGNED: 回顾分析2020年1月—2023年6月收治且符合选择标准的42例可复性AAD患者，其中23例采用计算机导航辅助手术（计算机组），19例采用Mazor X脊柱机器人导航辅助手术（机器人组）。两组患者性别、年龄、骨密度T值、身体质量指数、病因及术前日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者手术时间、螺钉植入时间、术中出血量、手腕部辐射暴露量及并发症发生情况；采用Gertzbein分类法进行植钉准确度评估；术前、术后3 d及末次随访时采用JOA评分和NDI评价功能；末次随访时通过颈部三维CT观察螺钉状态以及骨融合情况。.
UNASSIGNED: 所有患者均顺利完成手术，计算机组手术时间和手腕部辐射暴露量均明显多于机器人组（ P<0.05），两组螺钉植入时间及术中出血量比较差异均无统计学意义（ P>0.05）。所有患者均获随访，随访时间11～24个月，平均19.6个月；两组随访时间比较差异无统计学意义（ P>0.05）。术后采用Gertzbein分类法评估，两组均为安全植钉，两组螺钉准确度比较差异无统计学意义（ P>0.05）。除计算机组出现1例切口感染，经抗生素治疗后好转外，两组均未发生神经、椎动脉损伤及螺钉松动、断裂等并发症。两组术后3 d及末次随访时JOA评分和NDI均较术前显著改善（ P<0.05），但两组间差异无统计学意义（ P>0.05）。末次随访时，计算机组21例（91.3%）、机器人组18例（94.7%）患者寰枢椎获满意骨融合，两组融合率比较差异无统计学意义（ P>0.05）。.
UNASSIGNED: 计算机导航和机器人导航辅助寰枢椎椎弓根螺钉植入治疗可复性寰枢椎脱位均安全有效，但机器人导航能缩短手术时间并减少辐射暴露。.

METHODS: We present a 17-year-old male patient with an initially missed posterior sternoclavicular fracture dislocation who presented with symptoms related to thrombotic emboli arising from a pseudoaneurysm. He was treated 6 weeks after injury with a figure-of-eight tendon allograft repair with good clinical outcomes.
CONCLUSIONS: This is a unique presentation that highlights the significant risk of a missed diagnosis, life-threatening complications that may ensue, and biomechanically superior surgical intervention.

CONCLUSIONS: Monteggia fracture is a complex fracture consisting of a proximal ulna fracture with a dislocation of the radial head. This review article highlights the relevant anatomy, clinical evaluation, classification, surgical management, recent innovation, and advancements with treating these injuries. A thorough understanding of these fractures allows for detailed operative plans and reconstitution of normal anatomy.