IntroductionVertical femoral neck fractures—those with a Pauwels angle >70°—are an especially demanding subset, notorious for their recalcitrance to fixation and high risk of non-union. We propose a previously unrecognized variant of femoral neck fracture in which the fracture plane is vertical (Pauwels ≥ 90°) and lacks any Gotfried-positive cortical contact, a configuration we designate “reverse-obliquity femoral neck fracture” (ROFNF). This report describes two cases of ROFNF and their respective therapeutic strategies.Case reportThe index patient was a 56-year-old woman who sustained a Pauwels-III femoral neck fracture (95°) after slipping while playing table tennis. The second patient, a 45-year-old male, sustained a right femoral neck fracture (Pauwels III, 90°) during an electric vehicle rollover. Lumbar epidural anesthesia was administered supine on a fluoroscopy-compatible table for both cases. Following unsuccessful closed anatomical reduction, an anterior hip approach was utilized for open reduction. Fixation consisted of three 7.3 mm cannulated screws supplemented by a medial buttress plate; radiographs at 8–9 months confirmed uneventful union in both patients.ConclusionWe were unable to find any prior description of a femoral-neck fracture whose inclination reaches or exceeds 90° while also failing every Gotfried cortical-support criterion. In the two patients presented, closed manipulation could not restore a stable reduction; instead, an anterior approach with open reduction and a screw-plus-medial-buttress construct produced solid union.

To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma. A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024. Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267). Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.

PurposeTo investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.MethodsThis single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.ResultsThis study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (P < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.ConclusionsBMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.

Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.

To investigate the current status and risk factors of frailty among patients with peripheral artery disease, and to develop a risk prediction model to inform targeted clinical interventions. Patients were consecutively recruited for this investigation from August 2024 to May 2025. The study included 499 individuals with peripheral artery disease who were hospitalized in the vascular surgery department of a tertiary hospital in Southwest China. Data were collected using a general information questionnaire, laboratory test results, the Barthel Index, and the Social Support Rating Scale. The Tilburg Frailty Indicator was used to classify patients into a non-frailty group and a frailty group. The dataset was randomly split in a 7:3 ratio into a training set and a validation set. Independent predictors of frailty were identified through univariate and multivariate logistic regression analyses. The risk prediction model was developed using R software. Discrimination of the model was evaluated by plotting receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC), sensitivity, and specificity in both the training and validation sets. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test and calibration curves. Clinical utility was evaluated using decision curve analysis. Age, hemoglobin level, number of comorbidities, and activities of daily living were identified as independent risk factors for frailty. In the training set, the AUC was 0.771 (95% CI: 0.721-0.821), with a sensitivity of 0.788 and a specificity of 0.808. In the validation set, the AUC was 0.704 (95% CI: 0.620-0.788), with a sensitivity of 0.743 and a specificity of 0.682. The Hosmer-Lemeshow test indicated good calibration in both the training set (χ 2 = 7.967, P = 0.435) and the validation set (χ 2 = 9.642, P = 0.291). DCA showed that the model provided net clinical benefit within threshold probability ranges of 10%-80% in the training set and 20%-74% in the validation set. The developed risk prediction model exhibited predictive performance and can assist clinical healthcare providers in identifying populations at high risk of frailty among patients with PAD, thereby providing a reference for developing intervention strategies targeting relevant risk factors.

Total hip arthroplasty (THA) reliably restores function and quality of life in patients with end-stage hip disease. Individuals with end-stage renal disease (ESRD) requiring dialysis are vulnerable to perioperative complications due to immune dysfunction, hemodynamic instability, and impaired wound healing. Evidence on risk-adjusted outcomes remains limited. A retrospective cohort study was conducted using the Nationwide Inpatient Sample (2016-2022). Dialysis dependence was identified using ICD-10-CM Z99.2. Primary outcomes included in-hospital mortality, length of stay (LOS), and hospital charges; secondary outcomes were major complications. Propensity score matching (10:1 nearest neighbour) balanced baseline demographics and comorbidities. Survey weights were used for national estimates. Post-matching outcomes were compared using risk ratios (RR) with 95% CIs. Among 1,957,284 THA patients, 2,730 (0.1%) were dialysis dependent. In unmatched analysis, dialysis dependence was associated with substantially increased in-hospital mortality (1.3% vs. 0.03%; crude RR: 31.9, 95% CI: 22.7-44.9). After 10:1 propensity-score matching, dialysis-dependent patients had 62.5% longer LOS (3.9 vs. 2.4 days, p < 0.01), 95.8% higher hospital charges ($98,454 vs. $60,741, p < 0.01), and persistently elevated in-hospital mortality (matched RR: 10.1, 95% CI: 6.3-16.2). Major complications were significantly more frequent. Dialysis dependence is a strong independent predictor of higher perioperative morbidity, mortality, and cost following THA. Targeted multidisciplinary optimization and enhanced perioperative care pathways are warranted.

Split liver transplantation (SLT) expands the donor pool, but optimal arterial configuration remains debated. We report outcomes of right-sided in situ SLT with systematic celiac trunk preservation with the right graft. Retrospective Multicentre analysis of 36 consecutive adult recipients of right-sided split grafts (2015-2025) with celiac trunk preservation. Primary outcomes included vascular complications, patient/graft survival, and comparison with published benchmarks. Recipients (mean age 54.0 ± 12.6 years, 53% male) underwent SLT for HCV (30.6%), NASH (19.4%), and other etiologies. Major vascular complications occurred in 12/36 (33%) of cases, though life-threatening events remained uncommon: HAT 2.8%, postoperative PVT 5.6%, arterial stenosis 5.6%. Biliary complications occurred in 25% (ischemic 8.3%, technical 17%). Patient survival was 86% at 1 year and 81% at 3 years. Reoperation rate was 47%, primarily for biliary complications (17%) and intra-abdominal abscess (14%). Retransplantation rate was 11%. Right-sided SLT with celiac trunk preservation achieves excellent vascular outcomes, with both HAT (2.8%) and PVT (5.6%) rates meeting international benchmarks. These results strongly support this configuration as the preferred technical approach for in situ split liver transplantation.

BackgroundRobotic right colectomy (RRC) with complete mesocolic excision (CME) and central vascular ligation (CVL) has become a standard oncologic approach for right-sided colon cancer. However, evidence regarding hand-sewn intracorporeal anastomosis (ICA) and its associated learning curve remains limited.MethodsThis single-center retrospective study analyzes a series of consecutive patients with histologically confirmed right-sided colon adenocarcinoma who underwent fully robotic RRC with CME, CVL, and hand-sewn ICA. Perioperative outcomes, pathological results, and the learning curves of three colorectal surgeons were evaluated using cumulative sum (CUSUM) and risk-adjusted CUSUM (RA-CUSUM) methods.ResultsOverall, 71 patients were treated by RRC from April 2021 through December 2024. All surgical procedures were completed robotically. The median operative time was 165 min (Q1–Q3: 147–192). Major complications (Clavien–Dindo ≥ IIIb) occurred in 9.9% of cases, with an anastomotic leak rate of 5.6%. Mean lymph-node yield was 29.6 ± 11.2, and R0 resection was achieved in 98.6%. The CUSUM learning curves for the three surgeons revealed a comparable trend, starting with a rise during the learning phase and followed by a decline reflecting increased efficiency. The learning curve plateau was reached after approximately 16 cases for each surgeon.ConclusionRRC with CME, CVL, and hand-sewn ICA is feasible, safe, and oncologically effective. Proficiency is typically achieved after 15–20 cases, supporting its role as a reproducible and teachable procedure in structured robotic colorectal programs.

BackgroundThis investigation aimed to assess the long-term effectiveness and symptomatic manifestations of the combined therapy of sclerosing foam and endovenous laser ablation (ELA) for treating lower-extremity varicose veins.Materials and methodsIn this study, we examined 2,118 patients (2,324 limbs) diagnosed with varicose veins in one or both lower extremities. These patients were treated at our center between January 2019 and December 2021. All individuals underwent the combined treatment of sclerosing foam and ELA. We closely monitored the occlusion status of the great saphenous vein (GSV) trunk and its tributaries, along with the postoperative therapeutic outcomes and symptomatic presentations. The average follow-up duration was 41.3 months, and data were collected via outpatient appointments and telephone follow-up inquiries.ResultsThe success rate of the treatment procedure was 100%. Based on the outcomes of continuous follow-up spanning from 1 to 3 years after the surgery, among the 2,324 legs, 16 legs still required repeated foam sclerotherapy for varicose veins, 2 legs exhibited venous edema, and 11 legs showed skin pigmentation. At one week and one year after the procedure, incomplete closure of the GSV trunk (characterized by patency, blood flow, and reflux) was observed in 1.8% (38 limbs) and 1.1% (23 limbs), respectively. Nineteen patients with local recurrence of varicose veins decided not to undergo further treatment.ConclusionThe long-term follow-up data demonstrated that the combination of sclerosing foam and endovenous laser was highly efficacious in treating varicose veins. The main postoperative symptoms included the requirement for additional sclerosing foam injections, skin pigmentation, pain and tissue induration.

BackgroundEsophageal variceal (EV) rupture is a life-threatening complication of liver cirrhosis. Although upper gastrointestinal endoscopy is recommended for routine screening and risk assessment of EV bleeding, it is an invasive and often unpleasant procedure. This study aims to develop a non-invasive nomogram model based on spleen volume changes to predict the presence of high-risk esophageal varices (HREVs).MethodsA total of 150 patients with liver cirrhosis (mean age 62.3 ± 10.0 years; 95 men and 55 women) who underwent upper gastrointestinal endoscopy were retrospectively included. Spleen volume was measured using abdominal computed tomography. Predictors were identified through multivariate logistic regression and subsequently used to construct a nomogram model. The discriminative ability, calibration ability, and clinical utility were assessed. Internal validation was performed using 1,000 bootstrap resampling iterations.ResultsBased on endoscopic findings, 74 patients were categorized into the HREV group and 76 patients were categorized into the non-HREV group. Multivariate regression identified three independent predictors of HREV: the presence of ascites [odds ratio (OR) = 2.656, 95% confidence interval (CI): 1.224–5.763], prothrombin time (OR = 1.217, 95% CI: 1.043–1.419), and spleen volume enlargement rate (OR = 1.589, 95% CI: 1.276–1.979). These variables were incorporated into the nomogram model. The area under the receiver operating characteristic curve of the nomogram model was 0.793 (95% CI: 0.723–0.863), outperforming previously reported models, such as the platelet-to-spleen volume ratio (0.724), platelet-to-spleen diameter ratio (0.673), aspartate aminotransferase-to-platelet ratio index (0.590), and aspartate aminotransferase-to-alanine aminotransferase ratio (0.558). At a probability cutoff of 0.421, the nomogram demonstrated a sensitivity of 0.797, a specificity of 0.671, a positive predictive value of 0.702, a negative predictive value of 0.773, and an accuracy of 0.733. Internal validation yielded a C-index of 0.779 (95% CI: 0.714–0.853). Overall, the nomogram model exhibited good calibration and favorable clinical utility.ConclusionThe nomogram incorporating ascites, prothrombin time, and spleen volume enlargement rate effectively predicts HREVs in patients with liver cirrhosis. This non-invasive and user-friendly tool offers an efficient approach for timely HREV evaluation and preventive treatment of variceal bleeding.