Search Results (846)

Background and Objectives: Individuals classified as having very high fracture risk remain vulnerable to imminent fractures even when treated with antiresorptive therapies. This meta-analysis evaluated whether initiating treatment with anabolic agents, including teriparatide, abaloparatide, and romosozumab, provides superior fracture protection in this high-risk population. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted following PRISMA standards. Eligible studies included adults at very high fracture risk, defined by recent or multiple fragility fractures or markedly low bone mineral density, who received anabolic therapy as initial treatment compared with placebo or antiresorptive agents. Outcomes of interest were new vertebral, non-vertebral, hip, and clinical fractures. Effect estimates were pooled using random-effects models. Results: Six randomized trials encompassing 17,872 participants were analyzed. Initiation with anabolic therapy was associated with a marked reduction in incident vertebral fractures. The labeled pooled summary estimate for vertebral fractures was 0.43 (95% confidence interval 0.34–0.54). Significant risk reductions were also observed for clinical fractures (hazard ratio 0.62, 95% confidence interval 0.51–0.75), non-vertebral fractures (pooled effect estimate 0.71, 95% confidence interval 0.59–0.85), and hip fractures (risk ratio 0.65, 95% confidence interval 0.45–0.96). Exploratory subgroup analyses suggested greater vertebral fracture protection versus placebo and persistent benefit versus active antiresorptive comparators. Sequential therapy using an anabolic agent followed by an antiresorptive reduced spinal fracture risk by approximately half. Considerable heterogeneity was noted for vertebral fracture outcomes. Conclusions: Starting osteoporosis treatment with anabolic agents results in faster and more-pronounced fracture risk reduction across all major fracture categories in patients at very high fracture risk. These findings support a shift toward anabolic-first treatment sequencing in this particularly vulnerable group. Full article

Background: Vertebral fractures are the most common osteoporotic fractures and are frequently underdiagnosed. Although prior fragility fractures increase the risk of subsequent fractures, the magnitude and distribution of extremity fracture risk following vertebral fractures remain incompletely defined. Objective: The objective of this study is to evaluate the risk of subsequent extremity fractures following vertebral fractures in adults aged ≥50 years and to characterize fracture patterns and timing. Methods: A systematic review was conducted using three databases (PubMed, OVID, and Scopus) covering studies published between January 2005 and December 2025. Studies reporting subsequent extremity fractures after an index vertebral fracture in adults aged ≥50 years were included. Data extraction included patient demographics, fracture characteristics, treatment variables, and incidence of subsequent fractures. Results: Eight studies were included in the qualitative (narrative) synthesis, comprising a total of 488,770 patients with an index vertebral fracture. The reported incidence of subsequent extremity fractures ranged from 1.4% to 12.4%, with a crude aggregated incidence of 6.90% (33,605 patients). Hip fractures accounted for 73.3% of extremity fractures, followed by forearm/wrist (11.8%), humerus (10.3%), and ankle fractures (3.26%). Most subsequent extremity fractures occurred within 1–3 years after the index vertebral fracture. Additionally, 23,542 patients (4.82%) experienced subsequent vertebral fractures. Rates of dual-energy X-ray absorptiometry utilization and pharmacologic treatment ranged from 5% to 34.5%. Conclusions: Vertebral fractures in adults aged ≥50 years are strong predictors of subsequent extremity fractures, particularly hip fractures, with risk concentrated in the early post-fracture period. These findings support the concept of a systemic fracture cascade and emphasize the need for early detection and structured secondary prevention strategies. Full article

Background: Interpersonal violence is one of the most common causes of maxillofacial injuries. These injuries can range from minor soft-tissue injuries to serious, life-threatening conditions. This is particularly important when injuries occur in an exposed and vulnerable area of the body, such as the facial area. This study aimed to analyse the types of maxillofacial injuries, assess a profile of a typical victim of violence and determine the circumstances of the injury. Methods: A retrospective review was performed on the clinical data of patients managed for maxillofacial trauma resulting from interpersonal violence at the Department of Maxillofacial Surgery, University Clinical Hospital, Poznan, spanning the period from 2021 to 2025. Results: The study group included 510 patients, of which 95.41% were males, and the median age in the study group was 34 years. Furthermore, 14.71% of patients were under the influence of alcohol at the time of the violent incident. Most injuries occurred in 2022 (25.88%). Regarding months, June had the highest reported incidents (10.59%), while Saturday was the most injury-prone day (25.10%). The median days of hospitalisation in the study group was five. The mandible was the most frequently affected area. The most common types of fractures were single mandible fractures (30.59%) and double mandible fractures (27.25%). Most injuries were treated surgically (96.67%). In 10.20% of cases, the intervention of other specialists was needed. Conclusions: It is important to effectively prepare medical staff to receive patients with a history of interpersonal violence to diagnose and treat these types of injuries properly. Full article

Glucocorticoids (GCs) are widely used for their potent anti-inflammatory and immunosuppressive effects, but their use is strongly associated with negative impacts on bone health. Rapid bone loss and an increased risk of fragility fractures are characteristics of glucocorticoid-induced osteoporosis (GIOP), the most common type of secondary osteoporosis. While oral GCs are a well-known cause of GIOP, growing evidence suggests that non-oral routes of administration may also negatively affect the skeleton. This review summarizes current knowledge on the pathophysiology of GIOP, highlighting the complex relationship between direct and indirect mechanisms. It examines the effects of various routes of GC administration—oral, intravenous, inhaled, topical, and epidural—on bone mineral density, microarchitecture, and fracture. While parenteral GCs may have fewer systemic effects than oral therapy, long-term exposure or high cumulative doses may still cause clinically significant skeletal deterioration. This review also discusses current methods for assessing, preventing, and treating the fracture risk associated with GIOP. These strategies include lifestyle modifications, calcium and vitamin D supplements, and medications such as denosumab, bisphosphonates, and anabolic agents. Reducing the incidence of glucocorticoid-associated fractures and improving prevention and treatment requires an understanding of how GCs impact bone. Full article

Background/Objectives: Hospital-acquired and fracture-related infections remain major complications in orthopedic trauma surgery, with significant clinical and socio-economic impact. Antibacterial implant surface coatings represent a promising strategy to reduce early postoperative bacterial adhesion and biofilm formation. Methods: This retrospective matched case–control study evaluated the clinical effectiveness of an antibiotic-free fast-resorbable hyaluronic acid and poly-d, l-lactide hydrogel (DAC^®) applied intraoperatively to orthopedic implants. A total of 222 patients with comorbidities who underwent open reduction and internal fixation between May 2023 and April 2024 in two trauma centers were included: 99 patients received the DAC^® coating and 123 served as controls with standard fixation. The primary endpoint was infection incidence within 6 months; secondary endpoints included wound complications, revision surgery, prolonged antibiotic therapy, and bone healing. Results: Postoperative infection incidence was significantly lower in the DAC^® group compared with controls (0.7% vs. 5.3%; p = 0.0363). Wound complications were also reduced (1.3% vs. 8.0%; p = 0.028), and only one patient in the DAC^® cohort required additional surgical interventions or prolonged antibiotic therapy. Bone healing outcomes were comparable between groups, with no delayed unions reported in the treated cohort. Conclusions: Even if larger prospective studies with longer follow-up are required to further confirm these findings and better define long-term safety and effectiveness, the routine intraoperative use of DAC^® hydrogel without antibiotic loading appears to be a safe and promising strategy to reduce early postoperative infections and wound complications in orthopedic trauma patients with comorbidities. Full article

Background: Calcaneal fractures are complex injuries frequently associated with significant soft tissue damage and a high risk of post-operative complications, particularly infection. Despite advances in surgical techniques, infectious complications remain a major cause of morbidity and can severely compromise functional outcomes. The aim of this systematic review was to analyze the incidence, management strategies, and clinical impact of infectious complications following surgical treatment of calcaneal fractures. Methods: A systematic literature search was conducted in MEDLINE, Scopus, and Web of Science in accordance with PRISMA guidelines, including studies published up to May 2025. Randomized controlled trials and prospective and retrospective cohort studies involving adult patients surgically treated for calcaneal fractures and reporting post-operative infectious outcomes were included. Data extraction focused on patient demographics, fracture characteristics, surgical techniques, infection rates, microbiological findings, management strategies, complications, and functional outcomes. Methodological quality and risk of bias were assessed using the MINORS score. Due to substantial heterogeneity, results were synthesized descriptively. Results: Forty studies met the inclusion criteria, encompassing 5343 patients and 4638 surgically treated calcaneal fractures. Displaced intra-articular fractures predominated, with Sanders type II and III accounting for 79.8% of classified fractures, while Sanders type IV fractures represented 20.2% and were associated with higher complication rates. The overall post-operative infection rate was 9.4%, including 6.3% superficial surgical site infections and 3.0% deep infections. Open fractures accounted for 7.5% of reported cases and demonstrated markedly higher infection rates than closed injuries. Deep infections frequently required implant removal (62%), prolonged intravenous antibiotic therapy (100%), and additional surgical procedures (71%). Staphylococcus aureus, including methicillin-resistant strains, was the most commonly isolated pathogen. Functional outcomes were consistently worse in patients who developed infections. Conclusions: Infectious complications remain a clinically significant problem following surgical treatment of calcaneal fractures, particularly in severe fracture patterns, open injuries, and patients with relevant comorbidities. Deep infections are associated with substantial morbidity and inferior functional outcomes. Optimization of patient-related risk factors, careful surgical planning, and the selective use of minimally invasive approaches may help reduce infection risk. Further high-quality prospective studies with standardized outcome measures are needed to define optimal management strategies. Full article

Bone is a dynamic and multifunctional tissue that provides mechanical support, regulates mineral homeostasis, supports hematopoiesis, and relies on complex interactions among multiple cell types. The increasing incidence of bone-related diseases, such as osteoporosis, osteoarthritis, fracture non-union, and bone cancer, highlights the need for in vitro models that better reflect human bone physiology. Bone-on-a-chip technology, developed through advances in microfluidics, biomaterials, and tissue engineering, offers a promising approach to recreate key features of the bone microenvironment in vitro. By incorporating bone-mimicking materials, relevant bone cells, vascular components, fluid perfusion, and mechanical stimulation, these platforms allow more realistic investigation of bone remodeling, regeneration, disease mechanisms, and drug responses. In parallel, bone organoids and their integration with microfluidic chips have further expanded the capabilities of in vitro bone models by enabling the formation of self-organized, human-relevant bone tissues with increased cellular complexity. This review summarizes recent progress in bone-on-a-chip systems, including models for osteogenesis and bone regeneration, vascularized bone, bone marrow and hematopoietic niches, cancer bone metastasis, and mechanobiological studies. Key design principles, materials, cellular components, and applications in disease modeling, drug screening, toxicity assessment, and personalized medicine are discussed. Current challenges and future directions are also discussed to support the continued development of more physiologically relevant in vitro bone models. Full article

Introduction: Glucocorticoid (GC)-sparing treatment strategies, such as the C5a receptor antagonist avacopan, could potentially replace the need for long-term GC therapy in ANCA-associated vasculitis (AAV). Therefore, an assessment of GC-related morbidity is required to provide justification for such therapies. The aim of this study was to assess the incidence and management of common GC-related adverse events. Methods: In this single-center cohort study, medical records were screened for patients with a diagnosis of AAV admitted to the Robert Bosch Hospital (RBK) in Stuttgart, Germany. A total of 74 patients admitted for treatment of AAV between 2004 and 2023 were included. We assessed the dosage and duration of GC therapy used to treat AAV, as well as the incidence of new-onset and worsening arterial hypertension and diabetes mellitus, using over 150,000 individual medication time points for calculation of GC therapy. Additionally, incidence of infections and fractures was recorded. Results: Including relapses, 127 vasculitis events were observed during a median follow-up time of 8.3 years (IQR 5.3–10.6). Median duration of glucocorticoid therapy was 2.9 years (IQR 1.3–5.8). Regarding adverse events, 15 patients (20%) developed new-onset diabetes mellitus and a significantly higher cumulative GC dose was observed in patients requiring insulin therapy compared with those on oral antidiabetics (p = 0.02). Furthermore, 38 (51%) patients were diagnosed with new-onset arterial hypertension. Patients requiring escalation of antihypertensive therapy had significantly higher cumulative GC dose after a vasculitis event (p = 0.0001). A total of 325 infectious events occurred across 69 patients (93%) during follow-up, mostly requiring (85%; n = 277) hospital admission. Cumulative GC dose was significantly higher in patients with documented infections (p = 0.002). Conclusions: GC-related adverse events are common in patients with AAV. This study provides evidence on the incidence of presumably treatment-related harms in AAV and further promotes the importance of reduced-dose or even GC-free treatment approaches. Full article

Carbonate reservoirs, characterized by extensive fractures and cavities, are prone to gravity displacement during drilling when the bottom-hole pressure approaches equilibrium. This phenomenon, driven by density differences between drilling and formation fluids, can result in simultaneous overflow and leakage, posing significant well control risks such as kicks or blowouts. The occurrence of gravity displacement downhole makes its timely detection through conventional annular flow monitoring techniques challenging. This study investigates the triggering conditions and safe density window for gravity displacement in fractured and cavernous formations. Through theoretical analysis and experimental simulation, we examined the displacement mechanisms in both fractured and cavernous conditions. Computational fluid dynamics (CFDs) simulations were used to validate critical fluid column heights for fractured formations and the proposed safe density window. Based on these findings, practical methods to mitigate the hazards associated with gravity displacement overflow are proposed. The results offer valuable guidance for the field identification and mitigation of such incidents, contributing to managed pressure drilling and enhancing drilling safety in complex carbonate reservoirs. Full article

Regional curtain grouting for water interception serves as a critical technique for achieving safe and efficient mining under complex hydrogeological conditions in deep mine deposits. This study focuses on the Cuihongshan Iron-Polymetallic Mine, where repeated incidents of water inrush and sand outbursts have occurred due to complex hydrogeological conditions. By identifying the water-conducting pathways and characterizing the spatial distribution of relative aquitards within the mining area, a precise hydrogeological model was established. On this basis, the engineering application and performance evaluation of horizontal curtain grouting were systematically investigated. Through field monitoring and multi-method joint analysis, the water-blocking effectiveness of the grouting technique was comprehensively assessed. The results demonstrate a significant sequential reduction in grout take per meter for primary, secondary, and tertiary grouting holes, indicating a clear cumulative grouting effect. The grout effectively filled karst fractures, forming a continuous and stable water-resisting curtain. The project successfully severed the hydraulic connection between the highly water-rich Quaternary aquifer and the mine workings, substantially reducing mine water inflow. This study provides important theoretical support and practical reference for water hazard control in similar deep metal mines. Full article

The stability of deep water-saturated rock masses under dynamic disturbance is crucial for the efficient development of deep geothermal resources. This study focuses on granite as the research object, using the Split Hopkinson Pressure Bar (SHPB) system to investigate the dynamic mechanical properties, energy dissipation, and failure characteristics of dry and saturated granite under impact loading, and to analyze the influence of water on the dynamic mechanical properties of granite. The results show that granite exhibits a Type II stress–strain curve (rebound phenomenon) at low strain rates, while at high strain rates, it exhibits a Type I stress–strain curve. The dynamic mechanical parameters of granite exhibit significant strain rate dependence, with water-saturated granite showing a stronger strain rate sensitivity. The dissipated energy and dissipation coefficient of the granite samples increase linearly and logarithmically, respectively, with the increase in incident energy. The dissipated energy of water-saturated granite is higher than that of dry granite. As the strain rate increases, the failure mode of the granite specimens transitions from splitting to fragmentation, with a more pronounced ductile fracture mode. The degree of fragmentation of water-saturated specimens is greater than that of dry specimens. As the strain rate increases, the difference in fractal dimensions between dry and water-saturated specimens decreases. At high strain rates, the free water within the rock generates inertial effects, meniscus effects, and viscous effects. When the strain rate reaches 124.22 s⁻¹, the strength of the water-saturated specimen matches that of the dry specimen. The research findings provide theoretical support for the safe and efficient development of deep geothermal resources. Full article

Peri-Prosthetic Femur Fractures (PPFFs) are occurring with increasing frequency as the incidence of hip and knee arthroplasty is rising globally. PPFFs are presenting with more complex patterns commensurate with the increasing sophistication of implant technology and surgical technique. Moreover, with patients undergoing arthroplasty procedures at a younger mean age, it is not uncommon to see both ipsilateral implants (hip and knee) being affected by the fracture. Previous classifications have separated PPFFs into the hip or knee regions, and most do not include fracture patterns about revision-style implants. Prior schemes are antiquated and are not applicable to all current fracture patterns. We present a codified anthropometric, rule-based staging system that incorporates PPFFs across the entire femur. This system is designed to standardize communication and capture variables relevant to treatment planning and future research analysis. Formal reliability and clinical validation studies are ongoing. Full article

Ultrathin two-dimensional (2D) coatings exhibit functional properties that are strongly defined by morphological features such as sheet edges, fracture sites, overlaps, folds, and local thickness variations, which are often difficult to resolve using conventional scanning electron microscopy (SEM) configurations. Here, we introduce a grazing-incidence SEM approach based on controlled sample tilting close to 90° for enhancing surface sensitivity and morphological feature detectability in ultrathin coatings. The method is proved on colloidal MoS₂ nanosheet coatings prepared by liquid-phase exfoliation. Optical absorption spectroscopy confirms the presence of mono- and few-layer MoS₂ nanosheets in the dispersion, confirming the ultrathin nature of the deposited coating. Compared to standard 0° imaging, grazing-incidence SEM reveals clearer boundaries and discontinuities. Quantitative Sobel-based image analysis supports these observations, showing an increase in edge density from 5.9% to 7.6% and in average gradient magnitude from 0.151 to 0.172 a.u. under grazing incidence, indicating a higher amount of retrievable morphological information. The proposed approach relies only on standard stage tilting and provides a broadly applicable framework for the surface-sensitive morphological characterization of ultrathin 2D coatings and thin films. Full article

Background: Kyphotic deformity following osteoporotic vertebral fracture (KDOVF) often requires corrective surgery to restore sagittal alignment; however, mechanical complications, such as proximal junctional failure (PJF) and distal junctional failure (DJF), remain major concerns. Selection of the lower instrumented vertebra (LIV) plays a critical role in balancing mechanical stability and functional preservation; however, the optimal criteria for LIV selection have not been fully established. Methods: This multicenter retrospective cohort study included 52 patients who underwent corrective surgery for KDOVF, with a minimum 1-year follow-up. The patients were classified into a long-fixation group with pelvic fixation (n = 27) and a short-fixation group with lumbar LIV fixation (n = 25). Mechanical complications, radiographic parameters, patient-reported outcomes, and paraspinal muscle fatty degeneration were compared between groups. Subgroup analysis was performed within the short-fixation group to identify the factors associated with DJF. Results: The incidence of PJF was significantly higher in the long-fixation group than in the short-fixation group (37% vs. 8%, p < 0.01), whereas DJF was observed only in the short-fixation group (24%). Within the short-fixation group, patients who developed DJF demonstrated significantly greater preoperative sagittal malalignment, a lower rate of cement-augmented pedicle screw, and more advanced fatty degeneration of the paraspinal muscles. The short-fixation group also showed better postoperative lumbar function. Conclusions: LIV selection in KDOVF surgery is associated with distinct patterns of junctional mechanical complications. Short fixation may be feasible in carefully selected patients who demonstrate preserved compensatory capacity. Full article

Background: Pediatric orbital floor fractures differ from adult injuries due to bone elasticity and a higher incidence of trapdoor-type defects with extraocular muscle entrapment, often presenting with limited external signs but carrying a high risk of functional impairment. Early recognition and prompt surgical release are essential to prevent irreversible neuromuscular damage and persistent binocular vision disturbances. Case Presentation: A 13-year-old patient sustained an orbital floor blow-out fracture with inferior rectus muscle incarceration following blunt trauma. The child presented with vertical diplopia, ocular motility restriction, and infraorbital hypoesthesia. Computed tomography demonstrated a posteriorly located linear orbital floor defect with soft-tissue entrapment, supporting the indication for urgent surgical intervention to avoid ischemic injury. Management and Outcome: Through a transconjunctival retroseptal approach, the entrapped muscle was promptly released, and orbital floor continuity was restored using an autologous bone graft harvested from the anterior maxillary wall with piezosurgery. This technique allowed controlled and precise bone harvesting while preserving adjacent anatomical and developing dental structures. Postoperative recovery was uneventful, with complete resolution of diplopia and full restoration of binocular ocular motility during follow-up. Conclusion: Early surgical intervention plays a pivotal role in achieving functional recovery in pediatric orbital floor fractures with muscle entrapment. Autologous reconstruction supported by piezosurgical bone harvesting represents a safe and effective approach in growing patients, providing reliable functional and anatomical outcomes. This case reinforces the clinical relevance of timely intervention and highlights practical considerations in pediatric orbital trauma management. Full article