Trauma Surgery

AR improves novice technical performance but shows expertise reversal

Systematic review of 11 studies (n=347) found AR often reduced errors and accelerated early learning for surgical novices. Nine of 11 studies reported improvement in at least one objective technical metric; error reduction was consistent across relevant trials. An expertise-reversal effect emerged: benefits diminished as operator experience increased. Heterogeneous outcome measures, varied hardware, and short-term follow-up limit generalizability and cost-effectiveness conclusions. 1

Protocol: nitrous oxide versus placebo for pain during elderly post-THA rehabilitation

Randomized, double-blind protocol plans to enroll 160 patients ≥65 years with VAS ≥4 during rehabilitation after THA. Intervention is nitrous oxide versus placebo gas during therapist-led sessions, with primary outcome pain at rehabilitation (T1) by VAS. Secondary outcomes include anxiety, balance, ambulation, side effects, and satisfaction with continuous safety monitoring. This is a protocol; effectiveness and safety results are pending and not yet actionable for practice change. 2

Pediatric polytrauma causes early immunosuppression linked to nosocomial infections

Prospective cohort (controls n=10, monotrauma n=9, polytrauma n=10) found stronger immunosuppression after polytrauma compared with monotrauma. Patients who later developed nosocomial infections had deeper immune suppression by ER and PID1 measurements. Ex vivo co-stimulation with interferon-γ partially reversed depressed cytokine production capacity. Findings are exploratory with small numbers and require larger studies before clinical immunomodulation strategies. 3