2026

A Prospective Study of the Operative Treatment of Clavicular Fractures (2026)

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Type of publication:

Journal article

Author(s):

Bhakar, Ranj; Chakrapani, Arjun S; Shaik, Arfaz; Alexander, Aaron; Murugesan, Thivagar; Anbazhagan, Prasanna Kumar; Ghent, Dan.

Citation:

Cureus. 18(1):e102481, 2026 Jan.

Abstract:

Objective This study aimed to evaluate the functional and radiological outcomes associated with the operative management of displaced midshaft clavicular fractures using pre-contoured locking compression plates (LCPs), specifically in cases that met surgical indications such as fracture displacement, shortening, or comminution. Methodology In this prospective study, 30 adult patients with displaced midshaft or lateral clavicular fractures underwent open reduction and internal fixation (ORIF) with pre-contoured LCPs at a tertiary care center. Patients were followed clinically for six months postoperatively. Functional outcomes were assessed using the Constant-Murley Score (CMS), and radiological union was evaluated through serial radiographs. Data were analyzed using SPSS Statistics version 25.0 (IBM Corp., Armonk, NY), and results were reported as mean +/- standard deviation (SD). Results The mean age of the patients was 36.4 +/- 10.2 years, with 21 patients (70%) being male. The mean time to radiographic union was 12.8 +/- 2.3 weeks. At the final follow-up, the mean Constant-Murley Score (CMS) was 91.2 +/- 6.4, with 24 patients (80%) demonstrating excellent shoulder function. Complications were limited to two patients (6.7%), while three patients (10%) experienced superficial infections or implant-related irritation. There were no observed cases of nonunion or implant failure. Conclusions Operative fixation of displaced clavicular fractures using pre-contoured LCPs provides stable fixation, facilitates early mobilization, and results in excellent functional recovery with minimal complications. Surgical management may be considered in active adults with displaced fractures to help optimize outcomes.

DOI: 10.7759/cureus.102481

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Robotic hysterectomy: an umbrella review and regional access in the Midlands, UK - Is there inequity? (2026)

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Type of publication:

Journal article

Author(s):

Saoudi, Tareq Al; Kanani, Trisha; McGill, Shaun; Isherwood, John; Fan, Frankie; Brown, Luke; Williams, Philippa; Sahare, Pankhuri; Sisodia, Shilpa; McVicar, Kathryn; Lacey, Patricia; Elleray, Rebecca; *Cheetham, Mark; Habiba, Marwan; Orrock, Emma; Wilson, Robert; Dennison, Ashley.

Citation:

European Journal of Obstetrics, Gynecology, & Reproductive Biology. 321:115041, 2026 Feb 28.

Abstract:

STUDY OBJECTIVE: To review current evidence on robotic-assisted hysterectomy (RAH) and assess hysterectomy practices across the Midlands, UK, with a focus on the availability of robotic procedures, geographical variations in the incidence of uterine cancer, and service provision.

DESIGN: An umbrella review conducted in accordance with the PRISMA guidelines combined with a descriptive regional data analysis.

SETTING: Midlands, UK.

PATIENTS: Women undergoing hysterectomy for uterine cancer between 2019 and 2023, based on national and regional datasets.

INTERVENTION: Comparison of RAH with open and laparoscopic approaches, and assessment of access to robotic surgery across integrated care boards (ICBs) in the Midlands.

MEASUREMENTS AND MAIN RESULTS: The final analysis included 12 systematic reviews. Compared with open hysterectomy, RAH was associated with reduced blood loss, lower transfusion rate, shorter hospital stay, and lower complication rates, while benefits over laparoscopic hysterectomy were less consistent. Descriptive regional analysis demonstrated substantial variation in uterine cancer incidence and hysterectomy rates across ICBs in the Midlands. Visual comparison suggested that areas with a higher
incidence of uterine cancer did not align consistently with higher rates of RAH, and access to robotic surgery varied across the region, with some ICBs having no local provision.

CONCLUSION: The continued expansion of RAH in the UK highlights the need for coordinated governance and service planning. Observed regional variation supports the development of clear referral pathways, standardized patient selection criteria, and regional oversight to guide equitable and effective integration of robotic surgery, particularly in areas with limited local provision.

DOI: 10.1016/j.ejogrb.2026.115041

Arteriolar Collapse and Haemodynamic Incoherence in Shock: Rethinking Critical Closing Pressure (2026)

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Type of publication:

Journal article

Author(s):

*Miller, Ashley; Rola, Philippe; Spiegel, Rory; Haycock, Korbin.

Citation:

Journal of Personalized Medicine. 16(2), 2026 Feb 01.

Abstract:

Critical closing pressure (CCP) and the vascular waterfall have long been used to explain perfusion failure in shock, yet their physiological meaning has been inconsistently interpreted. CCP is frequently treated as a continuous downstream pressure and inserted into formulas such as mean arterial pressure (MAP) – CCP, implying that a collapse threshold behaves like an opposing pressure even when vessels remain open. Drawing on classical vascular mechanics, whole-bed flow studies, microvascular models, and contemporary clinical physiology, we show that this interpretation is incorrect. Tone-dependent arteriolar collapse does not behave as a Starling resistor: CCP is a threshold at which smooth-muscle tension exceeds intraluminal pressure and vessels close, not a pressure governing flow in patent vessels. Perfusion becomes heterogeneous because different vascular beds reach their collapse thresholds at different pressures (via excessive tone, extrinsic compression, or profound hypotension), disconnecting macro-haemodynamics from microcirculatory flow. This explains why systemic variables such as MAP and systemic vascular resistance (SVR) may appear adequate even while tissues are under-perfused, a phenomenon now termed haemodynamic incoherence. Reframing CCP as a binary collapse threshold resolves longstanding contradictions in the literature, clarifies why MAP-centred targets often fail, and unifies the behaviour of shock states within a four-interface model of circulatory coupling. Therapeutically, the aim is not to "restore a waterfall" but to reopen closed vascular territories by lowering excessive tone, relieving external pressure, or raising truly low arterial inflow. This mechanistic reinterpretation provides a more coherent, physiologically grounded approach to personalised perfusion management in critical illness.

DOI: 10.3390/jpm16020078

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Day case and inpatient elective thyroid lobectomy across England: observational study of variation in practice and safety (2026)

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Type of publication:

Journal article

Author(s):

Monaghan, Michael; Gray, William K; *Cheetham, Mark; Dent, Paul; Briggs, Tim W R; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

BACKGROUND: Day case elective surgery is becoming increasingly common across a range of procedures. The aim of this study was to investigate the safety of day case thyroid lobectomy, a procedure with low uptake in the UK.

METHODS: This study analysed the Hospital Episode Statistics administrative data set for all first-time elective thyroid lobectomies performed on adults in England from 1 April 2017 to 31 March 2024. The primary outcome was 30-day emergency readmission and secondary outcomes were 30-day emergency readmission for complications and specifically for haemorrhage. The primary exposure variable was whether patients were day case patients or inpatients. Models were adjusted for the demographic and frailty characteristics of the patients.

RESULTS: Over the 7-year interval, 41 518 elective thyroid lobectomies were performed by 127 different hospital trusts. The day case rate was 9.9% (4125 patients) across all hospital trusts. Rates in the 118 hospital trusts conducting >20 procedures during the 7 years varied from 0% to 74.6%. Day case surgery was associated with a lower 30-day emergency readmission rate (OR 0.73 (95% c.i. 0.56 to 0.96); P < 0.021), with no evidence of association with poorer outcomes. There was no evidence that trusts with day case rates >30% had poorer outcomes than trusts with day case rates <1%.

CONCLUSION: In low-risk patients, day case thyroid lobectomy is safe.

DOI: 10.1093/bjs/znaf299

Pulmonary Embolism and Myocardial Infarction With Non-obstructive Coronary Arteries in Immune Thrombocytopenia: Unmasking Underlying Antiphospholipid Syndrome (2026)

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Type of publication:

Journal article

Author(s):

*Shahzeb, Muhammad; Naeem, Faiqa Jabeen; *Naz, Kiran; *Irfan, Muhammad; *Ahmad, Nawaid; Rafiq, Nawal; Ul Haq, Ijaz.

Citation:

Cureus. 18(1):e100731, 2026 Jan.

Abstract:

This case report presents the clinical scenario of a 35-year-old male patient who experienced chest pain due to a combination of pulmonary embolism (PE) and myocardial infarction with non-obstructive coronary arteries (MINOCA), concurrently while undergoing treatment with avatrombopag for immune thrombocytopenia (ITP). His investigations included a CT pulmonary angiogram that confirmed a PE, a coronary angiography which was normal, a cardiac MRI which showed evidence of subendocardial infarct, and a CT coronary angiogram, which was normal. His unique presentation with these findings prompted further investigations, which revealed an undiagnosed antiphospholipid syndrome (APS) alongside a patent foramen ovale (PFO). Hence, the paradoxical thrombotic incidents were precipitated by this unique diagnosis. After establishing the diagnosis, our patient was commenced on warfarin, and his treatment protocol for ITP was changed to a different drug. He remains under haematology follow-up.

DOI: 10.7759/cureus.100731

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

A worldwide perspective on chronic Achilles tendon rupture: An ESSKA AFAS survey initiative (2026)

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Type of publication:

Journal article

Author(s):

Vide, Joao; Santos, Francisco; Dantas, Sofia; Seica, Emanuel; Caetano, Joao; Mendes, Daniel; Sousa, Manuel Resende; Anderson, Mette; Guelfi, Matteo; Hong, Choon Chiet; van Dijk, Pim; Spennacchio, Pietro; Cordier, Guillaume; van Dijk, Niek; Ling, Samuel; Hua, Yinghui; Vega, Jordi; Fernandes, Pedro; *Carmont, Michael.

Citation:

Knee Surgery, Sports Traumatology, Arthroscopy. 2026 Feb 06.

Abstract:

PURPOSE: Management of chronic Achilles tendon ruptures (CATR) varies according to patient and injury characteristics, but clear guidelines regarding the evaluation and treatment options are still lacking. This study aims to identify tendencies regarding the evaluation and management of CATR among foot and ankle orthopaedic surgeons. The research question is if there is any tendency regarding evaluation, preoperative planning, choice of surgical approach and technique for management of CATR.

METHODS: A web-based questionnaire was distributed through 56 national and international foot and ankle orthopaedic societies. Replies were pooled and analysed. A 'main tendency' was considered when 75% of the participants chose the same treatment method, a 'tendency' for 50%-75%, and 'no tendency' when less than 50% choose the same method.

RESULTS: A total of 667 orthopaedic surgeons from 60 countries participated. Most respondents were experienced, specialised foot and ankle surgeons; however, 68% managed fewer than five CATR annually. MRI was the predominant imaging modality selected for surgical planning (88%). Gap size (80%) is the principal determinant of technique selection, followed by time from injury (61%) and then patient age (57%). Open repair was the most common technique (66%). End-to-end repair for defects <2 cm was the only treatment tendency (68%). Rehabilitation strategies were heterogeneous, though plaster immobilisation in equinus (55%), walker boot use for partial weight-bearing (90%), and physiotherapy initiation at 4-6 weeks following surgery were common tendencies. Compared with acute ruptures, functional outcomes were perceived as slightly worse in CATR (54%).

CONCLUSION: This study confirms significant variation in CATR management internationally. While end-to-end repair is a consistent choice for gaps smaller than 2 cm, the variability observed in responses reflects the lack of evidence and clear treatment algorithms.

LEVEL OF EVIDENCE: Level IV.

DOI: 10.1002/ksa.70327

Investigating the course of atopic eczema up to 1 year following completion of Narrowband UVB (NBUVB) phototherapy (2026)

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Type of publication:

Journal article

Author(s):

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

Citation:

Clinical & Experimental Dermatology. 2026 Feb 10. [epub ahead of print]

Abstract:

BACKGROUND: Narrowband UVB (NBUVB) 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 NBUVB.

OBJECTIVES: We aimed to investigate the severity of atopic eczema in adults, 1 year following completion of NBUVB, using validated clinical activity measures.

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

RESULTS: Eighty participants with moderate-to-severe atopic eczema (mean SCORAD 39.2, POEM 18.5, IGA 3.2) underwent NBUVB therapy. Significant reductions were observed post-treatment: SCORAD decreased to 17.8, POEM to 8.2, and IGA to 1.7 (p<0.001 achieved for all time points). These therapeutic effects were sustained at 4, 8, and 12 months post-treatment (n=27 at 12 months). Loss of follow-up was attributed to non-attendance 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 NBUVB 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

Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

James, Anthony P; Gray, William K; *Cheetham, Mark J; Eardley, Ian; Lansdown, Mark.

Citation:

British Journal of Surgery. 113(2), 2026 Feb 11.

Abstract:

INTRODUCTION: Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.

METHODS: Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.

RESULTS: In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).

CONCLUSION: A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.

DOI: 10.1093/bjs/znaf292