Although impaction of the pharyngoesophageal fishbone represents a common otolaryngological emergency, migration of an ingested fish bone into the nasopharynx is an extremely rare clinical occurrence. We present a 57-year-old woman who developed acute odynophagia one hour after fish ingestion, accompanied by a single choking episode, in the absence of nausea or vomiting. The oropharyngeal examination at the bedside failed to identify any foreign body. Given the patient's refusal to computed tomography (CT), she was discharged for outpatient surveillance. Twenty-four hours later, she returned with persistent refractory pharyngeal pain. Repeated pharyngeal endoscopy revealed neither foreign material nor mucosal injury. Multiplanar coronal CT reconstruction identified a 2.63 cm linear hyperattenuating bone fragment within the nasopharyngeal cavity. After topical nasal decongestion, flexible fiberoptic nasopharyngoscopy confirmed a partially embedded migrated fish bone, which was successfully retrieved endoscopically using alligator grasping forceps. Odynophagia resolved immediately after extraction and the patient remained asymptomatic throughout the 2 week follow-up. For patients with persistent pharyngeal pain and high clinical suspicion of retained foreign bodies despite negative physical examination and endoscopic findings, CT should be considered the first-line cross-sectional modality to prevent missed.diagnoses and life-threatening cervicofacial septic complications.

Unicompartmental knee arthroplasty (UKA) is a core procedure in the stepped treatment of knee osteoarthritis. It has been increasingly widely used due to its advantages, such as minimal trauma, rapid recovery, and preservation of bone mass, yet it still faces challenges. In terms of patient selection, traditional criteria have been reasonably expanded on the basis of clinical evidence, and individualized comprehensive assessment has become the core principle. In terms of surgical techniques, precision and intelligence are the key breakthrough points. AI-assisted preoperative planning, 3D-printed patient-specific instruments, and robot-assisted surgery have significantly improved the accuracy, but the "gold standard" for prosthesis positioning remains undefined. Kinematic optimization is crucial for enhancing therapeutic efficacy; relevant technologies can reduce complications, but the understanding of postoperative UKA kinematic still needs to be deepened. Regarding prosthesis selection, fixed-bearing and mobile-bearing prostheses each have their merits and drawbacks, while cementless prostheses and new materials show promising potential, requiring multi-dimensional collaborative optimization. There is a lack of exclusive standardized protocols for perioperative management in UKA, while the management system constructed by digital technology has achieved remarkable results. In the future, UKA will develop towards the deep integration of digitalization and intelligence, the collaborative innovation of materials and kinematics, and the internationalization of Chinese treatment protocols, aiming to further improve knee preservation efficacy. Based on existing literature evidence and clinical practice, this article discusses the evolution of case-selection criteria and individualized assessment for UKA, the values and limitations of digital and intelligent technologies in precision surgery, the concept and implementation of kinematic optimization, prosthesis design, fixation modes and material selection, as well as perioperative management. It is intended to provide references for the standardized, precise and function-oriented development of UKA.

Postoperative cognitive dysfunction (POCD) is a common neurological complication following surgery and anesthesia, particularly in older adults, and is associated with delayed recovery, prolonged hospitalization, and reduced quality of life. Orthopedic and spinal procedures are linked to a relatively high risk of POCD; however, preclinical models that closely reflect the perioperative features of spinal surgery remain limited. Commonly used models, including laparotomy and tibial fracture, may produce persistent locomotor impairment and prolonged peripheral inflammation that can confound the interpretation of cognitive behavioral outcomes. Here, this protocol describes a standardized, low-cost protocol for modeling POCD using L5 lumbar laminectomy under sevoflurane anesthesia in 18-month-old male C57BL/6J mice. The procedure is performed using routine surgical instruments and produces a controlled surgical injury while minimizing persistent motor deficits. Cognitive function is evaluated using the novel object recognition test, novel arm Y-maze, and Barnes maze, whereas hippocampal neuronal injury and neuroinflammatory changes are assessed by Nissl staining and Iba1 immunofluorescence, respectively. Representative results demonstrate preserved locomotor activity, impaired cognitive performance, reduced hippocampal neuronal integrity, and enhanced hippocampal neuroinflammation following surgery. This standardized and accessible model provides a clinically relevant platform for investigating the mechanisms underlying spine surgery-associated cognitive dysfunction and for evaluating candidate perioperative neuroprotective interventions.

The definitive reconstruction of a pilon fracture can be technically demanding and requires meticulous preoperative planning. Besides selecting the appropriate surgical approach and implant, particular attention must be paid to the reduction strategy, including the sequence of reconstruction, the required reduction maneuver and the necessary instruments. Successful execution of the surgical plan also depends on recognizing suboptimal reduction during the definitive reconstruction, a task that can be particularly challenging in the presence of extensive metaphyseal comminution. Various pitfalls can be encountered during definitive treatment, affecting both fracture reduction and stabilization of the tibia or the fibula. Malreduction of one bone, most commonly the fibula as it is frequently addressed first, often compromises the reduction of the other, thereby jeopardizing the anatomical reconstruction of the ankle joint. As the number and length of surgical approaches to the distal tibia are limited due to the often critical soft tissue envelope, assessment of the reduction quality can be hampered. There is also a tendency to minimize the number of implants, which can lead to the surgeon avoiding using an additional plate, which would actually be necessary based on the fracture pattern. This article highlights and illustrates several common pitfalls encountered during definitive reconstruction of pilon fractures. Recognizing these pitfalls and understanding appropriate strategies to avoid them may help surgeons optimize decision-making and improve the quality of definitive treatment and patient outcomes.

Purpose: To evaluate and compare the efficacy of physics forceps versus conventional forceps in primary mandibular second molar extractions among children aged 7 to 10 years of age. Methods: A randomized split-mouth trial was conducted with children requiring bilateral primary mandibular second molar extractions. Outcomes assessed included extraction time, tooth fracture, anxiety, and complications. Results: Fifty children participated. Physics forceps significantly reduced extraction time (mean difference=7.7 seconds, 95 percent confidence interval= -11.5 to -3.9; P<0.001) and anxiety reduction was greater (-1.94 versus -0.56; P<0.001). Tooth fractures were less frequent with physics forceps (12% versus 32%; P=0.05). No post-operative complications occurred. Conclusions: Physics forceps shortened extraction time, reduced anxiety and lowered fracture incidence, making them advantageous for pediatric dental extractions.