Search Results (648)

Background: Central giant cell granuloma of the jaw is a benign but potentially aggressive lesion that can cause pain, facial deformity, tooth loss, and jaw destruction. Many treatment methods are described in the literature, but the less invasive ones are associated with a higher recurrence rate. For several decades, extensive bone resection procedures have been the most effective treatment to date. This study aimed to evaluate a minimally invasive treatment protocol combining multiple weekly intralesional steroid injections with surgical removal of residual tumor tissue and chemical cauterization using Carnoy’s solution. Methods: Thirteen patients with histologically confirmed central giant cell granulomas of the jaws were treated according to the protocol, including weekly triamcinolone injections and, when necessary, fenestration of the cortical bone to access residual lesions. Patients were monitored clinically and radiologically over six years, with reconstruction of bone defects using autogenous grafts and platelet-rich fibrin. Results: The treatment effectively reduced tumor size, restored cortical bone, and allowed preservation of jaw structure. Only one recurrence was observed, and complications were minor and transient. The protocol was equally effective for both aggressive and non-aggressive lesions, regardless of patient age or comorbidities. Conclusions: These findings suggest that combining pharmacological and surgical approaches with chemical cauterization provides a safe, effective, and tissue-preserving strategy for managing central giant cell granulomas, minimizing recurrence while reducing surgical morbidity. Full article

Background: Sacral and pelvic insufficiency fractures (SIFs and PIFs) are increasingly recognized yet frequently underdiagnosed complications after adult spinal deformity (ASD) surgery, particularly in patients undergoing long-segment spinal fusion to the sacrum or pelvis. Methods: We present a representative case of sacral and pelvic insufficiency fractures following extensive spinal fusion, highlighting diagnostic and therapeutic challenges. In addition, a systematic review of the literature was performed according to PRISMA guidelines through PubMed, MEDLINE, and Scopus databases, including studies up to December 2024. Data regarding demographics, risk factors, diagnostic modalities, management strategies, and outcomes were extracted and narratively synthesized. Results: A total of 21 studies comprising 89 patients were included. The majority were elderly postmenopausal women with osteoporosis and additional risk factors such as chronic corticosteroid therapy or high body mass index. Diagnosis was frequently delayed due to low sensitivity of plain radiographs, whereas computed tomography was the most reliable modality. Management was surgical in 49 patients (55%)—most commonly extension of fixation to the pelvis or use of S2-alar-iliac screws—with favorable fracture healing reported in most cases. Conservative treatment, employed in 40 patients (45%), included bracing, restricted activity, and bone health optimization, also leading to healing in the majority of cases. Conclusions: Sacral and pelvic insufficiency fractures represent an underrecognized but clinically significant complication after ASD surgery. Early recognition through cross-sectional imaging (CT/MRI) is crucial, and both surgical and conservative approaches can be effective if tailored to patient and fracture characteristics. Full article

Background/Objectives: X-linked hypophosphatemia (XLH) is the most common form of inherited rickets, caused by pathogenic mutations in the PHEX gene (phosphate-regulating endopeptidase homolog, X-linked). These mutations increase fibroblast growth factor 23 (FGF23) activity, resulting in renal phosphate wasting and defective bone mineralization. The disorder manifests with variable skeletal, dental, and extraskeletal involvement. Conventional therapy with oral phosphate and active vitamin D offers limited benefit, whereas burosumab, an anti-FGF23 monoclonal antibody, has transformed disease management. Methods: The index case, a 43-year-old woman, remained undiagnosed until adulthood, leading to severe deformities, osteoarthritis, chronic pain, and complete edentulism. Her 55-year-old sister presented with a milder phenotype. The 20-year-old nephew, diagnosed in childhood and intermittently treated with phosphate and alfacalcidol, developed short stature, genu varum, and early degenerative joint disease. Following genetic confirmation, he began burosumab therapy, which normalized phosphate metabolism, reduced pain, and improved mobility. Results: XLH demonstrates marked intrafamilial phenotypic variability despite identical PHEX mutations. In this series, delayed recognition in adults led to irreversible skeletal deformities, osteoarthritis, and dental loss, whereas earlier diagnosis in the younger patient allowed timely intervention. Conventional therapy only partially mitigated complications, while burosumab achieved rapid biochemical correction and symptomatic improvement. This contrast highlights the importance of early genetic testing, family screening, and prompt initiation of targeted treatment. Conclusions: This family cluster underscores the critical need for early diagnosis, genetic confirmation, cascade screening, and lifelong multidisciplinary care. Burosumab represents a therapeutic paradigm shift in XLH, capable of altering disease trajectory when initiated early. Full article

Background: Cephalomedullary nails are the standard treatment of trochanteric fractures, and some implants with a perforated blade allow augmentation with bone cement to increase mechanical stability. The study compares the results of PFNA and TFNA implants (DePuy Synthes) with or without cement augmentation of the blade. Methods: A retrospective study evaluated 219 trochanteric fractures. The study included 59 men (27%) and 160 women (73%), with a mean patient age of 82 years. The most common fractures were type 31A2 (56%), followed by type 31A1 (25%) and type 31A3 (19%). The monitored parameters were evaluated from anteroposterior and axial images of the proximal femur and pelvis. TAD, blade position, lateral blade prominence, fracture varus, and cut-out were evaluated. Results: Cement-augmented blade implants (CABs) in 68 patients (31%) and cement-free implants (NCABs) in 151 patients (69%) were used. The average age difference between the groups was 7 years (CAB 86.07 ± 5.85 and NCAB 79.13 ± 8.48). CABs were used more frequently in women (60 cases) than in men (8 cases). Blade position was optimal in 68% of cases and suboptimal in 32%. The risk of varus deformities was not statistically significantly affected by the blade position. The statistical significance of CABs for reducing the risk of varus deformities in stable fractures (p = 0.396) or unstable fractures (p = 0.101) was not confirmed. The average varus angulation during treatment was 2.57° (CAB 2.53° and NCAB 2.67°). A varus deformity greater than 10° was confirmed in 8 eight patients (3.7%) and cut-out in three patients (1.4%). All patients with cut-out were in the NCAB group. Cement leakage occurred in two cases and was asymptomatic. One case of deep infection, lateral blade prominence, and avascular necrosis (AVN) were recorded. Conclusions: Cement augmentation of the blade did not significantly reduce varus deformity in this cohort, regardless of blade position of fracture stability. CABs may prevent cut-out in specific subgroups, but this requires further investigation. Full article

Bone-anchored implants have transformed prosthetic technology by providing a promising alternative to traditional socket-based prostheses through enhanced stability, comfort, and natural limb functionality. These advancements result from developments in osseointegration techniques, improved surgical methods, and innovative implant materials. To address current limitations, continued research remains essential to enhance safety and effectiveness, thereby promoting wider adoption of these advanced prosthetic solutions. This study focuses on modeling bone-anchored implants for limb prostheses in amputees. The research evaluates structural behavior and performance of osseointegrated implants under various conditions while optimizing implant design. The investigation examines different materials including aluminum, Ti-6Al-4V, and Ti-6Al-4V coated with 10 µm platinum. Additionally, implants of different lengths (207 mm, 217 mm, and 197 mm) were analyzed. The results indicate that Ti-6Al-4V and Ti-6Al-4V coated with ten µm platinum reduce stress by 46% and 65%, respectively. Ti-6Al-4V coated with platinum demonstrates the lowest equivalent stress, highlighting the coating’s effectiveness. Furthermore, the coated implant exhibits the lowest deformation—22.92% less than aluminum and 5.13% less than uncoated Ti-6Al-4V. Shorter implant lengths reduce deformation through increased stiffness, whereas longer implants, such as the 217 mm length display greater deformation due to enhanced flexibility. Full article

Background: Robotic-assisted systems have transformed total knee arthroplasty (TKA), promising improved accuracy and intraoperative consistency, yet real-world data from non-academic centers remain limited. Objective: This study evaluates five-year clinical integration of a semi-autonomous, CT-based, robotic-arm-assisted TKA at a tertiary non-teaching hospital in Germany, focusing on planning accuracy, gap balancing, and intraoperative outcomes. Methods: We retrospectively analyzed all patients (n = 457) who underwent MAKO-assisted TKA from 2020 to 2025, performed by three orthopedic surgeons using a standardized subvastus approach. We assessed preoperative deformities, intraoperative alignment, implant sizing, and gap balancing. Surgical plans were adapted intraoperatively when indicated. Pre- vs. post-implantation values were compared using slopes to evaluate execution consistency. Results: Median patient age was 67.0 years (IQR: 60.0–75.0), with varus in 84.1% (7.0°, IQR: 4.0°–10.0°), valgus in 13.2% (3.0°, IQR: 1.5°–5.8°), and neutral alignment in 2.7%. Flexion contracture occurred in 80.4% (6.0°, IQR: 3.0–10.0%), hyperextension in 12.7% (2.0°, IQR: 1.5°–5.0°). Planning-to-execution consistency was high, even with plan adaptations. Slope values for alignment parameters were: tibial rotation in degrees (slope value: 1.0), femoral sagittal angle in degrees (0.8), tibial sagittal angle in degrees (0.9), coronal posterior condylar angle in degrees (0.9), femoral component size (1.0), tibial component size (1.0). Over 95% of cases showed ≤3.0° deviation between planned and final values. Bone resection concordance showed moderate agreement, with slopes from 0.8 (posterior medial femoral cut in mm) to 0.5 (lateral tibial cut in mm). Gap balancing improved at all stages, with reduced variability in medial/lateral extension and flexion gaps (all p < 0.05). Functional reconstruction showed significant improvements in extension, flexion, and deformities (all p < 0.001). Conclusions: Semi-autonomous, CT-based, robotic-arm-assisted TKA was successfully implemented in this non-academic setting, demonstrating acceptable intraoperative and functional reconstruction outcomes, supporting the feasibility of robotic-assisted surgery outside academic centers. Full article

Background: Congenital talipes equinovarus (clubfoot) affects 1–2 per 1000 newborns worldwide. The Ponseti method, based on staged manipulations and casting, is the gold standard for correction. However, the biomechanical processes underlying these corrections remain poorly understood, as infants rarely undergo imaging. Computational modeling may offer a non-invasive approach to studying correction pathways and exploring novel applications, such as customized casts. Methods: We developed a proof-of-concept framework using iterative finite element analysis (iFEA) to approximate the surface-level geometric corrections targeted in Ponseti treatment. A 3D surface model of a training clubfoot foot was scanned, meshed, and deformed stepwise under applied computational loads. The model was assumed to be homogeneous and hyperelastic, and correction was quantified using Cavus, Adductus, Varus, Equinus, and Derotation angles. We also introduced a secondary adult leg 3D surface model to assess whether model simplification influences correction outcomes, by comparing a homogeneous soft tissue model with a non-homogeneous model incorporating bone structure. Results: In the training model, iFEA generated progressive deformations consistent with Ponseti correction, with mean angular deviations of ±3.2°. In the adult leg model, homogeneous and non-homogeneous versions produced comparable correction geometries, differing by <2° in outcomes. The homogeneous model required less computation, supporting its use for feasibility testing. Applied loads were computational drivers, not physiological forces. Conclusions: This feasibility study shows that iFEA can reproduce surface-level geometric changes consistent with Ponseti correction, independent of model homogeneity. While not replicating clinical biomechanics, this framework lays the groundwork for future work that incorporates clinician-applied forces, pediatric tissue properties, and patient-specific geometries, with potential applications in customized 3D-printed casts. Full article

Cerebral palsy (CP) is a group of permanent, but not immutable, disorders of movement and posture caused by a non-progressive lesion or an abnormality in the development of the immature brain. It is the leading cause of motor disability in childhood. The most common sign is muscle spasticity, which leads to the development of contractures and bone deformities. Among the treatments for spasticity, botulinum toxin injection has the strongest scientific evidence and is used from the age of 2 years. In this article, we report three pediatric patients with CP who developed muscle fasciculations after botulinum toxin injection, which were administered according to planned dosages and required clinical monitoring and stretching by a healthcare professional. We review the literature and analyze the possible physiopathological mechanisms; however no other similar clinical cases have been reported. In conclusion, we propose to include muscle fasciculations as a potential transient and non-harmful adverse effect of botulinum toxin infiltration, which remains the treatment of choice for muscle spasticity when combined with rehabilitation in cerebral palsy. Full article

Background: Type I collagen is the most abundant protein of the extracellular matrix. Pathogenic variants in COL1A1 or COL1A2 are classically associated with osteogenesis imperfecta (OI) and Ehlers–Danlos syndrome (EDS). An emerging clinical entity—COL1-related overlap disorder—encompasses individuals exhibiting phenotypic features of both conditions. Methods: We report a 55-year-old male presenting with disproportionate short stature, grayish-blue sclerae, multiple fractures, long bone deformities, joint hypermobility, and atrophic surgical scarring. The patient also had long-standing, untreated childhood-onset hypopituitarism. Imaging studies revealed numerous prior fractures, bowing of forearm bones, and multiple Wormian bones. Results: Genetic testing confirmed a novel heterozygous COL1A1 exon 14 variant (c.940G > A, p.Gly314Arg), presenting with a phenotype consistent with a COL1-related overlap syndrome. Conclusions: This case expands the phenotypic spectrum of COL1A1 mutations and supports the concept of COL1-related phenotypic overlap. Full article

Strain-induced deformations and phase evolutions are two hidden factors that may influence cytocompatibility of Gum Metal alloys during processing for relevant implant applications. In the present research, changes in cell viability of a new Gum Metal Ti-Nb-Zr alloy in its cold-rolled state and after heat treatments (at 700, 850, and 900 °C) were investigated by a comprehensive study of microstructural phases and their role in deformation mechanisms as well as mechanical properties. In its cold-rolled state, the alloy showed a lamellar microstructure along with stress-induced α″ martensite and ω phases, as confirmed by optical microscopy (OM) and X-ray diffractometry (XRD) analysis. The instability in the β phase led to a strain-induced martensitic (SIM) transformation from β to α′/α″ phases, causing lower viability of MG-63 cells compared with commercially pure titanium. MG-63 cell viability was significantly higher (p < 0.0001) in the alloy heat-treated at 900 °C compared with those heat-treated at 700 and 850 °C. This can be directly attributed to the increased portion of the stable and dominant β phase. The stabilized β phase greatly improved the alloy’s cellular response by reducing harmful phase interactions and maintaining mechanical compatibility with bone (admissible strain of 1.3%). Importantly, heat treatment at high temperatures (between 850 and 900 °C) effectively converted the stress-induced α″ and ω phases back into a stable β phase matrix as the dominant phase. Full article

Background/Objectives: Managing long bone fractures and deformities in osteogenesis imperfecta (OI) with telescoping rods is a common but challenging procedure. A rare complication is the distal migration of the rod’s proximal female component, which complicates standard revision surgery. This article aims to describe a surgical technique for the revision of a distally migrated Fassier–Duval (FD) femoral rod. Methods: We present the case of an 8-year-old girl with OI type IV who experienced distal migration of her right femoral FD rod—the surgical technique involved extracting the rod retrogradely through the fracture/osteotomy site. We used a trephine to remove surrounding bone within the canal, thereby preserving the critical bone stock in the greater trochanter needed for secure fixation of the revision implant. Results: The distally migrated female component was successfully removed through the trephined canal with a combination of axial traction and rotational force. The proximal bone stock was preserved, allowing for the stable placement of a revision FD rod. Conclusions: The retrograde trephine technique is a viable and effective strategy for revising a distally migrated telescoping rod in patients with OI. This approach prioritizes the preservation of proximal bone stock, which is crucial for the stability and longevity of the revision implant. Full article

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these defects, traditionally relying on autologous bone. However, limitations such as donor site morbidity and insufficient graft volume have made urgent the development and adoption of biologic substitutes and synthetic alternatives. Additionally, innovations in three-dimensional (3D) printing offer emerging solutions for graft customization and improved osseointegration. Objective: This scoping review maps the evidence of the effectiveness of the use of biologic and synthetic bone grafts in scoliosis surgery. It focusses on the role of novel technologies, particularly osteobiologics in combination with 3D-printed scaffolds, in enhancing graft performance and surgical outcomes. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published within the last 15 years. Inclusion criteria focused on clinical and preclinical research involving biologic grafts (e.g., allografts, demineralized bone matrix-DBM, bone morphogenetic proteins-BMPs), synthetic substitutes (e.g., ceramics, polymers), and 3D-printed grafts in the context of scoliosis surgery. Data were extracted on graft type, clinical application, outcome measures, and complications. The review followed PRISMA-ScR guidelines and employed the Arksey and O’Malley methodological framework. Results: The included studies revealed diverse grafting strategies across pediatric and adult populations, with varying degrees of fusion success, incorporation rates, and complication profiles. It also included some anime studies. Emerging 3D technologies demonstrated promising preliminary results but require further validation. Conclusions: Osteobiologic and synthetic bone grafts, including those enhanced with 3D technologies, represent a growing area of interest in scoliosis surgery. Despite promising outcomes, more high-quality comparative clinical studies are needed to guide clinical decision-making and standardize practice. Full article

Accurately identifying fractures from X-ray images is crucial for timely and appropriate medical treatment. However, existing models suffer from problems of false localization and poor accuracy. Therefore, this research proposes a medical X-ray fracture detection model with precise localization based on the You Only Look Once version 11 nano (YOLOv11n) model. Firstly, a data augmentation technique combining random rotation, translation, flipping and content recognition padding is designed to expand the public dataset, alleviating the overfitting risk due to scarce medical imaging data. Secondly, a Bone-Multi-Scale Convolutional Attention (Bone-MSCA) module, designed by combining multi-directional convolution, deformable convolution, edge enhancement and channel attention, is introduced into the backbone network. It can capture fracture area features, explore multi-scale features and enhance attention to spatial details. Finally, the Focal mechanism is combined with Smoothed Intersection over Union (Focal-SIoU) as the loss function to enhance sensitivity to small fracture areas by adjusting sample weights and optimizing direction perception. Experimental results show that the improved model trained with the expanded dataset outperforms other mainstream single-object detection models. Compared with YOLOv11n, its detection accuracy, recall rate, F1-Score and mean Average Precision 50 increase by 4.33%, 0.92%, 2.52% and 1.24%, respectively, reaching 93.56%, 86.29%, 89.78% and 92.88%. Visualization of the results verifies its high accuracy and positioning ability in medical X-ray fracture detection. Full article

Background and Objectives: Hemophilic arthropathy, the end result of recurrent hemarthroses in patients with hemophilia, often necessitates total knee arthroplasty (TKA) using constrained implants to address severe deformities and joint destruction. Revision TKA is often required due to aseptic loosening, implant malposition, infection, or periprosthetic fractures. The extended tibial tuberosity osteotomy (ETTO) has emerged as a critical technique for the safe removal of well-fixed tibial stems in such complex cases, demonstrating high union rates and minimal complications. The aim of this study is to evaluate the safety, effectiveness, and clinical outcomes of the ETTO technique during complex revision TKA in patients with hemophilia. Materials and Methods: A retrospective analysis was conducted on seven male hemophilic patients who underwent revision TKA with ETTO between 2015 and 2023. The procedure involved the creation of an extended proximal tibial bone flap, laterally retracted to facilitate tibial stem exposure and removal. Postoperative outcomes included radiological confirmation of osteotomy union, assessment of complications, and evaluation of functional outcomes, including range of motion and extensor mechanism integrity. Results: Osteotomy union was achieved in all patients (mean age 57.5 ± 1.50 years and mean body mass index 26.07 ± 0.67 kg/m²) within four months, confirmed by radiographic evidence of bridging callus. No significant complications, such as nonunion, fragment displacement, or symptomatic hardware, were observed. There was one patient who experienced delayed wound healing, managed successfully with surgical debridement. Postoperative mean knee flexion was 92°, with no extensor lag reported. ETTO enabled safe tibial stem removal and successful revision arthroplasties in all cases. Conclusions: ETTO is a technically demanding but indispensable approach for addressing the challenges of revision TKA in patients with hemophilia. It allows for secure tibial stem removal while maintaining excellent union outcomes and a low rate of complications. Due to its complexity, ETTO should be performed by experienced surgeons in specialized centers. Full article