Orthopedic Surgery

Protocol: individualized intraoperative SBP targets versus standard MAP ≥65 mmHg in older hip fracture patients

This single-center randomized protocol will enroll 180 patients aged 65–85 undergoing hip fracture repair under general anesthesia. Intervention targets systolic blood pressure within ±10% of baseline versus reactive standard care with a universal MAP ≥65 mmHg. Primary outcome is postoperative organ dysfunction within 7 days; secondary outcomes include ICU/hospital stay and 30-day mortality. Results are pending; this is hypothesis-generating and not yet practice-changing. 1

Augmented reality versus monitor-based 3D models for shared decision making in orthognathic surgery

In a multicentre RCT (n=60) AR did not improve patient knowledge compared with monitor-based 3D models. Patient satisfaction favored the control group (p = 0.04), and women preferred monitor-based consultations. Observed effect sizes and post-hoc power were reported but findings show no clear clinical advantage for AR. For now, monitor-based 3D models remain a practical patient-education tool. 2

Anabolic-first sequential therapy yields larger BMD gains than step-therapy in high-risk patients

This scoping review of 37 studies found anabolic-first sequential therapy generally produced greater BMD gains and fracture risk reduction than step-therapy. A representative trial reported 16.8% lumbar spine BMD increase with romosozumab→denosumab versus 7.5% with monotherapy. Anabolic-first approaches achieved higher proportions reaching treatment targets (92% vs 47%) and lower vertebral and hip fracture risks in ARCH. Prior antiresorptive exposure reduced anabolic response, supporting earlier anabolic use in selected high-risk orthopedic patients. 3