Background Migraines are a chronic disease for millions worldwide and have been hypothesized to be hormonally mediated due to their higher prevalence in females and menstrual associations. Estrogen has been commonly implicated in migraine pathogenesis, yet its exact role in the pathophysiology of migraines has yet to be fully understood. Method We conducted a scoping review of the literature regarding estrogen’s role in migraine pathogenesis and included 19 studies out of an initial 202 in the final review. Two independent reviewers screened and extracted data from included studies based on predetermined inclusions and exclusion criteria. Results The estrogen withdrawal hypothesis, discussed by 12 of the reviewed studies, is the most discussed theory about estrogen’s role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels, particularly when estrogen levels fall below 45–50 pg/mL after an extended period of priming. Additional findings suggest that women with a history of migraine have an increased sensitivity to physiologic fluctuations in estradiol levels. Several studies suggest that migraines are associated with menstruation. Conclusion It appears that estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their past medical history, age, and use of hormonal therapy. Further research is warranted to isolate the effects of estrogen in each unique patient population, and we believe that studies comparing menstruating women to postmenopausal women could help shed light in this area.

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Background:Migraine headaches are a chronic and complex medical issue for millions of patients worldwide. Despite how common migraines are, there is much to be unveiled regarding their pathogenesis due to the numerous factors implicated in the pathophysiology of migraines. Migraines are significantly more common in women and many female migrainers notice menstrual associations of their headaches. Because of this, migraines have popularly been hypothesized to be largely hormonally mediated. Estrogen has been commonly implicated in migraine pathogenesis yet its exact role in the pathophysiology of migraines has yet to be fully understood. Methods: We conducted a scoping review of the literature regarding estrogen’s role in migraine pathogenesis and included 11 studies out of an initial 199 in the final review. Results: The estrogen withdrawal hypothesis is the most discussed theory about estrogen’s role in migraine physiology and describes the association of migraine onset with natural declines in estrogen levels. Estrogen is also implicated in biochemical pain pathways, and specifically effects pain processing, trigeminal nociception, and neural inflammatory peptides. Human studies have been conducted in female populations such as pregnant women and postmenopausal women, and these studies have supported the estrogen withdrawal hypothesis.Conclusions: Hormone replacement therapy remains to treat migraines is promising, yet still lacks definitive evidence in its efficacy. More primary research into estrogen’s mechanisms in migraine pathogenesis is needed, as its specific roles are still unclear. While human-based, clinical trials on the subject are rare, they would provide great insight into migraines and would allow clinicians to better treat patients. Systematic Review registrations: none

Background:This closed reduction and percutaneous fixation (CRPF) technique utilizing suspensory fixation is indicated for the treatment of Lisfranc injuries with displacement or instability of the tarsometatarsal joint complex—and typically only for low-energy, purely ligamentous Lisfranc injuries. The goal of this procedure is to restore joint stability and prevent common complications of Lisfranc injuries (e.g., midfoot arch collapse and posttraumatic arthritis) while avoiding the complications and risks associated with open reduction and internal fixation (ORIF) and primary arthrodesis. We recommend performing the procedure within 10 to 14 days of the injury; otherwise, an open debridement may be necessary to address scar tissue formation.Description:We start with the patient in the supine position and perform a fluoroscopic stress examination of the joint. Next, the Lisfranc joint undergoes closed reduction, which is held in place with a clamp. Following reduction, a guidewire is drilled from the lateral border of the base of the 2nd metatarsal medially through the medial cuneiform, followed by a medial-to-lateral cannulated drill. The suspensory fixation is then passed lateral-to-medial, placing the suture button on the lateral cortex of the 2nd metatarsal base. The tape is then tensioned while a bioabsorbable interference screw is inserted to maintain tension.Alternatives:Prior studies have assessed both operative and nonoperative alternatives to CRPF with suspensory fixation for the treatment of Lisfranc injuries. Nonoperative treatment with closed reduction and cast immobilization of Lisfranc injuries is typically reserved for nondisplaced injuries; however, a number of studies have shown poor outcomes with use of this technique1-3. The 2 most common operative alternatives are ORIF and primary arthrodesis4.Rationale:CRPF with suspensory fixation offers several benefits over both traditional surgical techniques such as ORIF and primary arthrodesis, as well as over percutaneous reduction and internal fixation (PRIF) with a screw. Compared with ORIF and primary arthrodesis, a number of studies have shown that percutaneous treatment of Lisfranc injuries minimizes soft-tissue trauma and reduces the risk of postoperative complications such as wound breakdown, infection, and complex regional pain syndrome, while allowing for earlier participation in rehabilitation5-10. A systematic review of outcomes following PRIF with screw fixation also showed that percutaneous treatment of Lisfranc injuries is a safe and effective technique with good functional outcomes11. When comparing PRIF with a screw to our technique of CRPF with suspensory fixation, CRPF has the added benefit of creating a nonrigid fixation in the Lisfranc joint, which allows for increased range of motion of the medial column and improved return to activity12,13. The rigid fixation in PRIF with a screw can also lead to metal irritation, intra-articular screw fracture, and impaired mobility, which often necessitate the need for screw removal13-15. This ...

Background: An increasing number of patients with a history of solid organ transplantation (SOT) are presenting for total joint arthroplasty (TJA). The primary aim of this study is to evaluate clinical outcomes after primary total joint arthroplasty in patients with a history of SOT compared to matched controls. Methods: We performed a review of prospectively collected data on consecutive adult patients with a history of SOT undergoing TJA from January 2014 to January 2021. Pearson-Chi square tests were used to compare differences in baseline demographics and clinical characteristics between SOT and matched controls. Multi-variate logistic regression analyses were used to assess whether patients who had a prior SOT were at higher risk of experiencing post-operative complications, readmissions, reoperations, longer length of stay and non-home discharges after primary TJA. Results: A total of 81 operations met inclusion criteria which were compared to 82 age matched controls without a history of SOT. Patients with a history of SOT were more likely to require a hospitalization greater than 2 days compared to the control group (n=63, 77.8% vs. n=16, 19.5%; P=0.011), had an increased risk of hyperkalemia (n=15, 18.5% vs. n=1, 1.2%; P=0.049), and any post-operative complication (n=55, 67.9% vs. n=21, 25.6%; P=0.025). Conclusions: Despite the increased risk of acute post-operative complications and longer hospital stays, primary TJA has been shown to be a safe and effective option for treatment of DJD or AVN in patients with a history of SOT when completed via a multi-disciplinary approach. Level of Evidence: Retrospective Analysis, Level IV.