Author: Jason Curtis

Tjalma Syndrome: A Rare Autoimmune Cause of Multisystem Serositis (2026)

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Type of publication:

Journal article

Author(s):

Kodamanchile, Aaditya; Ekhelikar, Sowmya; AbiMusaAsa'ari, Ahmad Kamal Azri; Aboushehata, Moustafa; *Ahmad, Nawaid.

Citation:

Cureus. 18(3):e105188, 2026 Mar.

Abstract:

Tjalma syndrome is a rare manifestation of systemic lupus erythematosus (SLE) characterized by pleural effusion, ascites, and elevated cancer antigen 125 (CA-125) levels in the absence of ovarian malignancy. We report the case of a woman in her 50s who presented with recurrent pleuritic chest pain, dyspnea, peripheral edema, ascites, and constitutional symptoms. Initial investigations were inconclusive, resulting in repeated admissions and multidisciplinary referrals. Subsequent immunological testing confirmed SLE. Given the constellation of serositis and elevated CA-125, a diagnosis of Tjalma syndrome was established. Treatment with immunosuppressants such as corticosteroids, hydroxychloroquine, and azathioprine resulted in symptomatic improvement. However, the disease course was complicated by constrictive pericarditis requiring pericardiectomy and later inflammatory arthritis requiring escalation of immunosuppression. This case highlights the importance of considering autoimmune etiologies in patients with unexplained multisystem effusions and elevated tumor markers, thereby avoiding misdiagnosis and unnecessary oncological interventions.

DOI: 10.1177/17562848261446551

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The UK vedolizumab real-life experience study in inflammatory bowel disease (VEST): patient characteristics, drug persistence and patient-centred outcomes (2026)

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Type of publication:

Journal article

Author(s):

Bodger, Keith; Booker, Cheryl; Taylor, Frederick; Ahmad, Tariq; Bloom, Stuart; *Butterworth, Jeffrey; Kok, Klaartje; Lobo, Alan; Irving, Peter; Cummings, J R Fraser.

Citation:

Therapeutic Advances in Gastroenterology. 19:17562848261446551, 2026.

Abstract:

Background: VEST was a multi-centre study of real-world use of vedolizumab in inflammatory bowel disease (IBD) in routine practice in the United Kingdom.

Objectives: To describe real-world indications, effectiveness, patient-reported outcomes and safety.

Design: Prospective observational cohort study at 22 centres.

Methods: Patients receiving vedolizumab as part of standard care were included. Data were collected at infusion visits for activity indices (Harvey-Bradshaw Index (HBI) or partial Mayo Score (PMS)), physician global assessment (PGA), patient-reported quality-of-life and treatment perception (IBD-Control Questionnaire) and adverse events. Clinical response (Wk14) was defined as a reduction in HBI 3 or PMS 2, clinical remission as HBI 4 or PMS 1 and analysed using non-responder imputation. One-year persistence was defined as continuing on vedolizumab after an infusion at 48 weeks. Biomarker and endoscopic data were not available.

Results: 364 patients, mean age: 48 years; 132 (36%) with Crohn's disease (CD), 224 (62%) with UC and 8 (2%) with IBD-U; 174 (48%) male; 142 (39%) receiving steroids at baseline (Wk0); 141 (39%) bio-naive. At baseline, 279 (77%) had "active" disease. One-year persistence: 58% overall (54% for active disease). Among persistent cases (n = 212), median (IQR) IBD-Control-8 scores improved from 6 (3-10) at baseline to 14 (10-16) at post-induction (Wk14) and 1 year (p < 0.001 vs baseline). Corresponding scores for IBD-Control-VAS were: 50 (30-70), 80 (65-90) and 85 (70-95), respectively (p < 0.001 vs baseline). Each domain of IBD-Control-8 showed improvement. Baseline and post-induction health status (activity index, PGA or IBD-Control) were associated with 1-year persistence, but no significant associations were observed for disease type, duration, bio-naive status or baseline steroids. Of those with active disease at Wk0, clinical remission rates were 29%, 30% and 38% for CD, UC and IBD-U, respectively, and steroid-free remission rates were 26%, 27% and 38%. Similar remission rates were observed at 1 year. Possible adverse events leading to treatment cessation were rare (3%).

Conclusion: In routine clinical practice in the UK, vedolizumab demonstrated high levels of persistence. Similar rates of clinical response, remission and 1-year persistence were seen in UC and CD patients, and in bio-experienced versus naive cases. Persistent cases experienced significant and sustained improvements in quality of life and treatment perception. Persistence does not imply anti-inflammatory efficacy, as biomarker data were not available.

DOI: 10.1177/17562848261446551

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Rotating Hinge Knee Versus Constrained Condylar Knee Revision: A Single Centre, Retrospective Comparative Study (2026)

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Type of publication:

Journal article

Author(s):

*Bishi, Habeeb; Afzal, Irrum; Wang, Chao; Stammers, John; Madanipour, Suroosh; Radha, Sarkhell; Field, Richard; Mitchell, Philip; Alazzawi, Sulaiman.

Citation:

Cureus. 18(7):e112443, 2026 Jul.

Abstract:

Introduction In revision total knee arthroplasty, rotating hinge implants (RHK) have been presumed to result in higher complication rates and lower survivorship when compared to constrained condylar implants (CCK). This study aimed to compare patient-reported outcome measures (PROMs), complication rates and survivorship of RHK and CCK used in revision arthroplasty at a single, high-volume elective orthopaedic centre with a previously validated bespoke database. Methods Patients (n=108) who underwent revision knee arthroplasty with either CCK or RHK and matched our inclusion criteria were identified. EuroQol Five Dimensions (EQ5D), EuroQol Five Dimensions (EQ5D)-Health State and Oxford Knee Scores were collected pre-operatively and at one year post-operatively. Complication data was collected at six weeks, six months and one year post-operatively. National Joint Registry (NJR) data were interrogated, in addition to our orthopaedic database, to investigate implant survival with a maximum follow-up of 12 years. Results There was no statistical significant difference between RHK and CCK in implant survival at two to 12 years of follow up. In addition, we observed no statistical significant difference in the PROMs scores and complication rates of the two implants. Conclusion This study shows that both the RHK and CCK remain viable options in revision arthroplasty; the implant survival and complication rates were comparable. We recommend future research through prospective randomised control trials with long-term follow up to further investigate the use of CCK and RHK implants in revision knee arthroplasty.

DOI: 10.7759/cureus.112443

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Refining prognosis in advanced renal cell carcinoma: international real-world validation of the Meet-URO score in first-line immunotherapy combinations (2026)

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Type of publication:

Journal article

Author(s):

Rebuzzi, Sara Elena; Ghose, Aruni; Rudman, Sarah; Venugopal, Balaji; Young, Kate; Frazer, Ricky Dylan; Ayodele, Olubukola; Stares, Mark; O'Carrigan, Brent; Ali, Waqas; McGrane, John; Jain, Ankit; Fiala, Ondrej; Chauhan, Vishwani; Michael, Agnieszka; Zarkar, Anjali; Kapur, Gaurav; Charnley, Natalie; Afshar, Mehran; Vengalil, Salil; Forde, Caroline; Brown, Janet; Urun, Yuksel; Bianchini, Diletta; Bahl, Amit; *Srihari, Narayanan; Di Costanzo, Fabrizio; Smalley, Benjamin; Parkes, Joanne; Crabb, Simon; Vasudev, Naveen; Poprach, Alexandr; Brown, Nicholas; James, Lijo; Haywood, Sophia; Tapia, Jose; Vijay, Anupama; Parry, Jane; Cheung, Michael; Mahajan, Ishika; Moon, Niall O; Abrol, Ritika; Tkadlecova, Michaela; Soe, Yamin Shwe Yee; Zargham, Anum; Smith, Michelle; Ashley, Sophie; Hardy, Orla; Patel, Grisma; Tun, Kyaw Kyaw; Johnston, Emma; Sarwer, Abdullah; Bolek, Hatice; Shrestha, Roshani; Challapalli, Amarnath; *Meegan, James; Anpalakhan, Shobana; Buono, Francesco; Kolarikova, Eva; Leung, David Ka-Wai; Murianni, Veronica; Catalano, Fabio; Bimbatti, Davide; Buti, Sebastiano; Signori, Alessio; Fornarini, Giuseppe; Rescigno, Pasquale; Teoh, Jeremy Yuen Chun; Banna, Giuseppe Luigi.

Citation:

Oncologist. 31(7), 2026 Jun 06.

Abstract:

BACKGROUND: Effective risk stratification is essential for guiding treatment decisions in patients with metastatic renal cell carcinoma (mRCC). The Meet-URO score is a novel prognostic model that integrates the International Metastatic RCC Database Consortium (IMDC) criteria with neutrophil-to-lymphocyte ratio (NLR) and the presence of bone metastases. Developed in the immunotherapy era, it has demonstrated superior prognostic accuracy compared to the IMDC score across various clinical settings and treatment strategies. Its validation in the context of first-line immune-based combinations has been awaited.

METHODS: External validation of Meet-URO was performed using a large retrospective real-world cohort of mRCC patients treated with first-line immune-based combinations. Secondary analyses included a comparison with the IMDC score for predicting overall survival (OS) and progression-free survival (PFS). Additionally, restricted mean survival time (RMST) was assessed.

RESULTS: A total of 1,418 patients were included in the analysis: 54% received ICI-ICI regimen (nivolumab plus ipilimumab), while 46% received the ICI-TKI combination. At baseline, 52.5% of patients had an NLR >= 3.2, and 32% had bone metastases. After a median follow-up of 26.8 months, the median OS and median PFS were 34.7 and 11.3 months, respectively. Meet-URO demonstrated effective prognostic stratification, identifying patient groups with markedly different outcomes (median OS 11.5-51.4 months; 3-year OS 26-66%; RMST 20.0-42.8 months). Compared to IMDC, Meet-URO showed a significantly better OS (c-index 0.675 vs 0.643; DELTAc = 0.032, P < .001) and PFS (c-index 0.60 vs 0.58; P < .001) prediction performance.

CONCLUSIONS: Meet-URO demonstrated robust prognostic accuracy. Its integration into routine clinical practice and use as a stratification factor in clinical trials may support more personalized treatment strategies and enhance clinical trial design.

DOI: 10.1093/oncolo/oyag203

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Real-world experience of transoesophageal echocardiography for detection of clinically significant persistent foramen ovale (2026)

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Type of publication:

Journal article

Author(s):

Wilmshurst, Peter; *Pearson, Matthew; Walsh, Kevin; Morrison, W Lindsay.

Citation:

Diving & Hyperbaric Medicine. 56(2):148-153, 2026 Jun 30.

Abstract:

Introduction: Transoesophageal echocardiography (TOE) is claimed to be the investigation of choice for detecting a persistent foramen ovale (PFO) with almost 100% diagnostic accuracy. If true, TOE would detect all large/clinically significant PFOs.
Methods: Retrospective analysis to determine the sensitivity of TOE for detection of clinically significant PFOs. Patients were from a consecutive series of 150 patients who had transcatheter closure of a PFO following events attributed to paradoxical embolism (decompression sickness or stroke). In each patient, transthoracic echocardiogram with bubble contrast showed a clinically significant atrial right-to-left shunt. The data reported are from the sub-group of the 150 patients with a clinically significant PFO who also had a TOE performed in other hospitals.
Results: Twenty seven of 150 consecutive patients had a total of 31 TOEs performed at 22 United Kingdom regional cardiac centres. TOE failed to detect a PFO in 17 of the 27 patients. Four patients had a TOE on two separate occasions and in each case both of the TOEs failed to show a PFO. TOE gave a false negative test in 21 of 31 investigations (sensitivity 32%). The mean PFO diameter was 9.4 mm (median 9 mm, range 5-16 mm) in the 21 patients in whom balloon sizing was performed and 9.8 mm (median 10 mm, range 5-16 mm) in the 13 patients in whom balloon sizing was performed and a TOE failed to show a PFO.
Conclusions: These finding demonstrate that the precision of TOE for detecting a PFO in real world clinical practice is considerably lower than generally believed.Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.28920/dhm56.2.148-153

Liver Transplantation as a Salvage Therapy Option in Colorectal Liver Metastases: Feasibility, Oncologic Outcomes, and Survival After Failure of Conventional Therapy-A Systematic Review and Meta-Analysis (2026)

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Type of publication:

Systematic review

Author(s):

Soomro, Faiza Hashim; Kazmi, Tehreem Fatima; *Ansar, Mehwish; Gulnaz, Nadia; Arshad, Rabia; Aiste, Gulla.

Citation:

Cancers. 18(8), 2026 Apr 15.

Abstract:

Introduction: Liver transplantation has re-emerged as a potential therapeutic option for patients with unresectable colorectal liver metastases after failure of standard treatments. This systematic review and meta-analysis evaluated survival outcomes, recurrence patterns, and prognostic factors associated with this approach. Materials and Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Electronic databases were searched for studies published between November 2015 and November 2025, that assessed liver transplantation in the context of unresectable colorectal liver metastases. Random-effect meta-analyses were conducted to estimate the pooled overall survival, disease-free survival and recurrence rates. Heterogeneity was assessed using I2 statistics.
Results: Twenty-three studies involving patients with unresectable liver-only colorectal metastases were included. Pooled overall survival after liver transplantation was 96.6% at 1 year (95% CI 93.9-99.4; I2 = 44.3%), 73.4% at 3 years (95% CI 62.9-83.9; I2 = 95.4%), and 49.4% at 5 years (95% CI 35.4-63.3; I2 = 90.5%). Ten-year overall survival was approximately 27%. The pooled recurrence rate was 63.5% (95% CI 52.5-76.8), and the type of recurrence was mainly extrahepatic, most commonly pulmonary. Disease-free survival was 64.1% (95% CI 47.5-80.7) with substantial heterogeneity (I2 = 95.6%). Biological risk factors, including carcinoembryonic antigen levels, metabolic tumor volume, and composite risk scores, consistently influenced survival outcomes.
Conclusions: In highly selected patients with unresectable colorectal liver metastases, liver transplantation is associated with favorable long-term survival despite frequent recurrence. Outcomes appear to be primarily driven by tumor biology rather than tumor burden, supporting the cautious use within specialized centers under structured selection protocols.

DOI: 10.3390/cancers18081254

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Investigating the course of atopic eczema up to 1 year following completion of narrowband ultraviolet B phototherapy (2026)

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Type of publication:

Journal article

Author(s):

Bajaj, Sonali; Desai, Prachi; Singh, Akansha; *Jain, Dimple; Wahie, Shyamal.

Citation:

Clinical & Experimental Dermatology. 51(8):1412-1418, 2026 Jul 24.

Abstract:

BACKGROUND: Narrowband (NB)-ultraviolet B (UVB) is a second-line treatment for chronic moderate-to-severe atopic eczema unresponsive to adequate topical therapy, and is known to induce good short-term improvement of eczema severity. However, it is unclear how adult patients fare with their eczema severity long after completion of a course of NB-UVB.

OBJECTIVES: To investigate the severity of atopic eczema in adults, 1 year following completion of NB-UVB, using validated clinical activity measures.

METHODS: We undertook a multicentre prospective observational study of adults with moderate-to-severe atopic eczema who were prescribed NB-UVB as part of their standard clinical care. Assessments were made at baseline prior to starting NB-UVB, at the end of NB-UVB and at 4, 8 and 12 months after completion of NB-UVB.

RESULTS: Eighty participants with moderate-to-severe atopic eczema [mean Objective SCORing Atopic Dermatitis (SCORAD) 39.2 (SD 12.8), Patient-Oriented Eczema Measure (POEM) 18.5 (SD 6.4) and Investigator Global Assessment (IGA) 3.2 (SD 0.5)] underwent NB-UVB therapy. Significant reductions were observed post-treatment: Objective SCORAD decreased to 17.8 (SD 11.4), POEM to 8.2 (SD 6.2) and IGA to 1.7 (SD 1.0) (P < 0.001 achieved for all timepoints). These therapeutic effects were sustained at 4, 8 and 12 months post-treatment (n = 27 at 12 months). Loss to follow-up was attributed to nonattendance exacerbated by the COVID-19 pandemic and patient relocation. Mild adverse events (n = 5), including erythema and eczema flares, were reported, with no serious events.

CONCLUSIONS: These findings indicate that NB-UVB may provide a long-lasting effect for patients who complete a course, helping to diminish their eczema severity to a more manageable level.

DOI: 10.1093/ced/llag066

Infection following foot and ankle surgery : a subanalysis of data captured from the UK Foot and Ankle Thromboembolism (FATE) audit (2026)

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Type of publication:

Journal article

Author(s):

Shepherd, Jenna; Mason, Lyndon; Houchen-Wolloff, Linzy; Malhotra, Karan; Mangwani, Jitendra; Ahmad, Irfan; Zeb, Junaid; Ishaq, Usman; Thomas, Jija; Jain, Kowshik; Goff, Thomas; Bagshaw, Oliver; Slade, Henry; Andrzejowski, Paul; Gomati, Ayoub; Drake, Chris; Akram, Nimra; Lowdon, Hamish; Sherif, AhmedKamel-; Jones, Anette; Best, Alistair; Zabaglo, Mate; Masunda, Stanley; Federer, Simon; Ahmad, Faheem; Lashin, Ahmed; Kaddah, Ahmed; Oladeji, Emmanuel; Dawe, Ed; Akram, Nimra; Al-Hubeshy, Zahra; Patel, Bhavi; Hussein, Mohamed; Clark, Callum; Giddie, Jasdeep; Dega, Raman; Islam, Amirul; Molloy, Andy; Nusir, Ben; Chapman, James; Holmes, David; Mamoowala, Neville; Almond, Kieran; Wright, Claire; Loveday, David; Bawa, Akshdeep; Gilmore, Rebecca; Schankat, Kerstin; Koc, Togay; Morcos, Zeid; Robertson, Gregory; Holmes, Natal; Tribe, Howard; Pearkes, Tim; Soliman, Ahmed; Valente, Lucia; Ajis, Adam; Ghani, Yaser; Chandrashekhar, Suresh; Millan, Ravi Kant; Elhassan, Yahya; Adeniyi, Adebowale; Aspinall, Will; Matthews, Hannah; Shiers-Gelalis, Fleur; Ting, Jason; Place, Stuart; Budgen, Adam; Stanley, James; Jowett, Charlie; Welck, Matthew; Patel, Shelain; Sykes, Adam; Thibbaiah, Mahesh Mamballi; Hadi, Hosain; Haldar, Anil; Ardakani, Amir Gahanbani; Jani, Priyanka; Prasanna, Anil; Blomfield, Mark; Craven, Joanna; Malhotra, Anubhav; Toner, Aileen; Jackson, Gillian; Render, Luke; Ashley, Connor; Limb, Richard; Ayyaswamy, Brijesh; Prasad, Pradeepsyam; Anand, Mr; Sunilraj, Dr; Lane, Suzanne; Prathap, Swetha; Limaye, Rajiv; Johnson-Lynn, Sarah; Sethi, Mohit; *Zahra, Wajiha; *Heaver, Catriona; Duffy, Sean; Harries, William; Riddick, Andrew; Ghobra, Amro; Kinsey, Harry; Marsh, Luke; Corin, Nicole; Walls, Andrew; Robinson, Peter; Winson, Ian; Lines, Steve; Morriss, Felix; Pwint, Zalatt; Ghandour, Omar; Hepple, Steve; Smith, Robert; Hughes, Luke; Mohamed, Muyed; Fraser, Debbie; Elhalawany, Ahmed; Beastall, James; Cousins, Gerard; Nunag, Perrico; Deol, Rupinderbir; Faroug, Rad; Johal, Karan; Mordecai, Simon; Argyropouos, Miltiadis; Chawla, Amit; Ibrahim, Mohamed; Pereira, Marta; McIntyre, Joshua; Blacklock, Calum; Middleton, Scott; Clayton, Robert; Tong, Aureola; Joyner, Claire; Dean, Mike; Hughes, Adrian; Shuttlewood, Kimberley; Little, Zoe; Saleem, Jawaad; Jolly, Lewis; Jain, Aman; Qadri, Ansar; Alvi, Farhan; Jacob, Jagan; Reddy, Raji; Sateesh, Vaishnav; Hrycaiczuk, Alex; Thornhill, Christopher; Jeyakumar, Gowsikan; Vaithilingam, Delani; Potter, Kate; Jamal, Bilal; Chan, Pete; Barton, Tristan; Robinson, Derek; Graham, Selina; Zeolla, Julian; Kapoor, Smriti; Bailey, James; Mukhopadhyay, Ishani; Rana, Sarina; Tarig, Hamza; Qualaghassi, Mahdi; Seewoonarian, Sheena; Rose, Barry; Makwana, Nilesh; Kaisi, Kahlan Al; Al-Musabi, Musab; Crate, Georgina; Abbott, Sarah; Fenner, Christopher; Geleit, Ryan; Yousaf, Sohail; Flanagan, George; Uddin, Akram; Reilly, Ian; Pillai, Anand; Madhi, Imad; Alsalihy, Mazin; Elamin, Khadija; Yip, Chee Rong; Tew, Lucy; Dahiya, Rohan; Sayani, Junaid; Kyaw, Olive; Khin, Chan; Ali, Ramla; Shaik, Yousufuddin; Hossain, Natasha; Guha, Abhijit; Pereira, Melwyn; Ayoub, Atif; Paraoan, Vlad; Hali, Nayeem; Baird, Charles; Kugan, Raj; Abdallatif, Ahmad; Bashir, Muhammad Amer; Saini, Jigyasa; Atkinson, Henry; Lever, Caroline; Bansod, Vaibhav; Iyengar, Kartik; Wadood, Abdul; McMillan, Lara; Toh, Eugene; Rymaruk, Sophy; Igbagiri, Kueni; Gaukroger, Andrew; Solan, Matthew; Peacock, Christian; Fan, Ka Siu; Lau, Benjamin; Naik, Arjun; Tung, Eleanor; Murhekar, Siddhartha; Ray, Mr Robbie; Lyle, Miss Shirley; Shaikh, Rabia; Alfred, Wilam; Okhifun, Imobhio; Cinar, Ece; Bua, Nelson; Vemulapalli, Krishna; Acharya, Ashok; Teoh, Kar; Kamat, Sanil; Bajracharya, Abhijit; Ngwayi, James Reeves Mbori; Imtiaz, Galal; Blackmore, Noah; Clark, Andrew; Rahman, Kashed; Sykes, Mark; Joseph, Vinay; Day, Miriam; Kulkarni, Avadhut; Garabadi, Mohanrao; Akhtar, Meraj; Hossain, Munier; Yunus, Shamael; Saleem, Maleeha; Fong, Joanna; Simons, Michiel; Hodgson, Paul; Thomas, Rhys; Stevens, Sam; Dasari, Kishore; Nandhara, Gurbinder; Kumar, Pritesh; Gupta, Prateek; Poole, Hope; Zace, Pamela; Gadd, Richard; Money-Taylor, John; Kantharaju, Rohit; Bhosale, Abhijit; Bahri, Suchita; Broadbent, Rosie; Kutuzov, Vladislav; Gibbons, James; Trussler, Daniel; Hawley, Eve; Akhtar, Sabeen; Caruana, Ethan; Watson, Thomas; Allison, Georgia; Barr, Lynne; Julies, Elda; Hill, Francesca; Butler, Katherine; Kendal, Adrian; Bugeja, Mark; Mooteeram, Justin; Saedi, Farid; Azhar, Muhammad Saad; Sturdee, Simon; Hussain, Halima; Sonde, Sarah; Luqman, Muhammad Qais; Farooq, Rahy; Wells, Gareth; Shenolikar, Aneil; Rajan, Praveen; Patil, Vijay; Amer, Omer; Malik, Kalim; Pavanerathan, Pranavan; Mallick, Arijit; Seferiadis, Ilias; Hind, Jamie; Morgan, Rebecca; Khalaf, Ahmed; Ditta, Adeel; Ramasamy, Arul; Khan, Shahrukh; Balasubramanian, Satishkumar; Fawcett, Nicholas; Fraig, Hossam; Hamad, Farouk; Marsland, Daniel; Elliot, Robin; Nolan, Ciaran; El-Bayouk, Khalil; Dhukaram, Vivek; Chapman, Anna; Mckenzie, James; Budair, Basil; Prem, Hari; Elmajee, Mohammed; Rajgor, Harshadkumar Dhirajlal; Thurston, Daniel; Pond, Erika; Brooks, Margaret; Everett, Samuel; Iqbal, Mohammad; Gourbault, Lysander; Singh, Shashwat; Tang, Cary; Tarhini, Mariam; Kankate, Mr Raghubir; Aktselis, Mr Ioannis; Davda, Mr Kinner; Vijapur, Mr Arvind; Tayyem, Mr Mohammed; Chau, Ms Jackie; Alzaranky, Muhammed; Elhassan, Osman; Chhantyal, Kishor; Arora, Abhishek; Abiddin, Zain; Kucharski, Robert; Gledhill, Andrea; Craven, James; Cichero, Matt; Yates, Ben; Newton, Ayla; Grice, John; Beddard, Laura; Thomas, Alex; Garg, Vipul; Taylor, Heath; Kelsall, Nikki; Roslee, Charline; Elsenosy, Adelfatah; Martin, Miss Rebecca; Pujol-Nichol, Miss Andrea; Carroll, Miss Natalie; Boucher, Alexander; Alward, Mustafa; Myint, Yuland; Currall, Verity; Sadasivan, Preetha; Kumar, Sunil; RezaSanjani, Shahrukh; Ciaccio, Maria; Jeyaseelan, Lucky; Drummond, Isabella; Jones, Neil; Shah, Savan; Ravindrarjah, Thuwarahan; Yasen, Zaid; Singh, Kunjshri; Al-Habsi, Ruqaiya; Jeyaseelan, Lucky; Habbiba, Abdullah; Walker, Thomas; Dewhurst, Maximilian; Glasgow, Nisha; Eze, Dominic; Carter, Gary.

Citation:

Bone & Joint Journal. 108-B(6):781-786, 2026 Jun 01.

Abstract:

Aims: The UK Foot and Ankle Thromboembolism (UK-FATE) Collaborative evaluated incidence of venous thromboembolism (VTE) in foot and ankle surgery and Achilles tendon (AT) rupture. As part of the data collection, infection within 90 days was a secondary outcome. This study aimed to evaluate overall rate of superficial and deep infection following foot and ankle surgery in trauma, elective, and acute diabetic surgery.

Methods: Data were collected prospectively across 68 centres in the UK for all patients who underwent foot and ankle surgery between 1 June and 30 November 2022. Over 500,000 data points were collected, including development of superficial and deep infection within 90 days of procedure and presence of comorbidities.

Results: UK-FATE captured 90-day infection data for a total of 9,723 cases. When nonoperatively managed AT ruptures were excluded, infection data were available for 9,591 trauma, elective, and acute diabetic procedures. Overall superficial and deep infection rates in all procedures were 4.1% (n = 397/9,591) and 1.4% (n = 133/9,591), respectively. Both superficial (7.4% (n = 29); p < 0.001) and deep infection (8.7% (n = 34); p < 0.001) rates were highest in acute diabetic procedures. Deep infection differed between trauma (1.4% (n = 65/4,351)) and elective (0.7% (n = 34/4,785)) procedures (p < 0.001), but superficial infection rates were similar (3.9% (n = 171/4,245) and 4.1% (n = 197/4,588), respectively (p = 0.638)). On multivariate regression analysis, peripheral vascular disease (OR (odds ratio) 2.86 (95% CI 1.74 to 4.56); p < 0.001), smoking (OR 1.54 (95% CI 1.18 to 2.00); p = 0.001), diabetes (OR 1.83 (95% CI 1.35 to 2.44); p < 0.001), American Society of Anesthesiologists grade III to IV (OR 1.94 (95% CI 1.37 to 2.73); p < 0.001), and chemical VTE prophylaxis (OR 1.38 (95% CI 1.03 to 1.85); p = 0.031) were independent predictors for developing infection.

Conclusion: Rates of superficial and deep infection were significantly higher in patients with acute diabetic surgery. Deep infection rates were higher in trauma than in elective surgery, but superficial infection rates were similar. Comorbidities and smoking affected infection rate in foot and ankle surgery, and should be optimized preoperatively and considered in postoperative monitoring.

DOI: 10.1302/0301-620X.108B6.BJJ-2025-1345.R1

Incidence, reason for treatment delay and patient-reported outcome of patients affected by a chronic Achilles tendon rupture in a Swedish population (2026)

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Type of publication:

Journal article

Author(s):

Nilsson, Niklas; Larsson, Elin; Dyrehag, Emma; *Carmont, Michael; Brorsson, Annelie; Nilsson Helander, Katarina.

Citation:

BMC Musculoskeletal Disorders. 27(1), 2026 May 01.

Abstract:

BACKGROUND: As the incidence of ATR is increasing the risk of ruptures being missed escalates and more injuries are suspected to become chronic. This study aimed to assess the incidence and causes of delayed diagnosis in chronic ATR. Additionally, the patient-reported outcome of surgical versus non-surgical treatment following delayed presentation was evaluated.

METHODS: The study is of patients with chronic ATR treated at the Sahlgrenska University Hospital between 2015 and 2020. Patients were identified using specific International Classification of Diseases (ICD) codes for ATR and included all patients in whom the treatment had been delayed for more than 14 days. The patients who accepted to participate in the study completed the Achilles tendon Total Rupture Score (ATRS) and a questionnaire regarding recovery rate in percentage.

RESULTS: Out of the 958 patients with ATR, 102 were identified as chronic, comprising 11% of the overall dataset. A total of 75 patients were included. Patients with chronic injury exhibited higher age, BMI, and comorbidity rates compared with patients with acute ruptures. Fifty-two (84%) patients delayed seeking medical attention. The rates of patients initially receiving an incorrect diagnosis was low, with 10 (1%) directly associated with trauma and 28 (3%) during later medical visits. Patients that were surgically treated (n = 57) for their chronic Achilles tendon rupture yielded significantly higher median (IQR) ATRS scores; 77 (50 ; 92) vs. 34 (23 ; 82) and recovery rates; 85% (70 ; 95) vs. 40% (20 ; 78) compared with patients treated with a non-surgical approach (n = 18).

CONCLUSIONS: This study reveals that chronic ATRs constitute a significant portion of all ATR. These were primarily due to "patient's delay" rather than the relatively rare misdiagnosis. Patient-reported outcomes, such as ATRS scores and self-reported recovery, exhibit considerable variability. Surgical intervention gave superior patient reported outcome compared with non-surgical treatment for patients affected by a chronic Achilles tendon rupture.

DOI: 10.1186/s12891-026-09890-y

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Impact of surgical timing on wound complications following ankle fracture fixation: A 22-year retrospective cohort study (2026)

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Type of publication:

Journal article

Author(s):

Zahra, Wajiha; Gomaa, Abdul-Rahman; Babatunde, Jubril; Seifo, Mina; *Cool, Paul; *Pickard, Simon.

Citation:

Journal of Clinical Orthopaedics & Trauma. 76:103405, 2026 May.

Abstract:

Background: Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections.

Methods: A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48 h), Intermediate (48 h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates.

Results: There was no significant association between surgical timing and the incidence of superficial wound infections (p = 0.274). However, a significant difference was observed in deep wound infection rates (p = 0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p < 0.001) and deep infections (p = 0.019). Patients over 60 years had an increased risk of superficial infections (p = 0.016) but not deep infections (p = 0.261). Superficial wound infections required longer hospital stay (p < 0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p < 0.001) and deep infections (p < 0.001).

Conclusion: In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections.

Level of evidence: IV.

DOI: 10.1016/j.jcot.2026.103405

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