Search Results (48)

This article argues that suffering exemplifies a distinctive mode of objectless yet meaningful experience that challenges the assumption that intuition must be grounded in the presence of a determinate object. Drawing on phenomenological and metaphysical resources, it brings Max Scheler’s phenomenology of feeling into dialogue with Mullā Ṣadrā’s ontology of graded existence to reconceptualize the epistemic and ontological status of pain. Against views that treat non-objectual experiences as merely subjective or epistemically deficient, the paper contends that suffering discloses a structured form of meaning that operates before and beyond object-based cognition. Scheler’s account of emotional intentionality is shown to illuminate how suffering reveals value and orientation without presenting an identifiable object, disclosing instead an invisible dimension of life as inhibited, fractured, or diminished. This non-objectual disclosure, while irreducible to sensory intuition, nevertheless grounds judgment and meaningful comportment toward the world. Ṣadrā’s metaphysics of tashkīk al-wujūd deepens this account by situating suffering within an ontology in which experience corresponds to graded intensities of being. On this view, suffering indexes a real ontological deficiency or limitation—neither sheer non-being nor objectifiable presence—that is known indirectly through its experiential effects. By integrating Scheler’s phenomenology with Ṣadrā’s doctrine of the primacy and gradation of existence, the article shows that suffering functions as an experiential access point to the invisible, where epistemology and ontology converge. The limits of intuition thus appear not as boundaries of knowledge, but as sites where non-objectual disclosure enables meaningful judgment about being itself. Full article

Background: With the rising volume of knee arthroplasty and increasing adoption of robotic- and computer-assisted systems, the routine use of tracker pins has introduced procedure-specific risks. This systematic review aimed to characterize the types and incidence of pin-site complications associated with robotic-assisted and computer-navigated primary knee arthroplasty and to describe the timing, management strategies, and reported outcomes. Methods: A PRISMA-guided search of PubMed/MEDLINE was performed using terms related to pin-related complications, robotic assistance, computer navigation, total and unicompartmental knee arthroplasty procedures. Clinical studies (RCTs, cohorts, case series, and case reports) that explicitly documented pin-related complications in robotic- or computer-assisted knee arthroplasty in English were included. Two independent reviewers performed study selection and data extraction; the methodological quality of non-randomized studies was assessed with the MINORS instrument. Extracted variables encompassed study design, patient demographics, pin characteristics, type and timing of complications, treatments, and outcomes. Descriptive statistics and means were used where appropriate. Results: From 1231 initial records, 28 studies met the inclusion criteria, comprising 15,004 cases in cohort/series analyses. The aggregate pin-related complication incidence in non-case-report series was 0.95% (142 events). Of these, 13.4% were intraoperative and 86.6% postoperative. The most common postoperative events were pin-site wound issues and infections (each ≈35.7% of complications); pin-site fractures accounted for 0.16% in cohort/series data. Case reports (n = 17 patients) showed fractures chiefly at femoral pin sites, arising on average 8.5 weeks postoperatively; management ranged from protected weight-bearing to intramedullary nailing or ORIF. Potential risk factors suggested in the literature include higher BMI, bicortical or transcortical fixation, metaphyseal pin placement, and larger pin diameter, but findings were inconsistent. Conclusions: Pin-related complications after robotic- and computer-assisted knee arthroplasty are uncommon but clinically significant (≈0.95%). There is insufficient evidence to define optimal pin-placement strategies or fixation configurations. Surgeons should include pin-related risks in informed consent discussions. Further prospective research is required to identify patient- and technique-specific risk factors and to establish evidence-based pin-placement guidelines. Full article

Background and Objectives: Collared, triple-tapered femoral stems have gained increasing popularity in primary total hip arthroplasty (THA) due to their stable metaphyseal fixation and ability to restore native hip biomechanics. This study evaluated the short-term clinical and functional outcomes of a novel collared triple-tapered femoral stem design in primary THA. Materials and Methods: This was a retrospective review of all patients who underwent primary, elective THA using a collared, triple-tapered femoral system at a single, urban, high-volume, academic hospital between September 2024 and February 2025. All procedures were performed by fellowship-trained arthroplasty surgeons. A total of 101 patients (102 hips) with a median follow-up of 1.1 years (range, 1.0 to 1.4 years) were included. Results: Most procedures were performed for primary osteoarthritis (96%). Mean operative time, from skin incision to skin closure, was 93 min, and most femoral stems implanted had a high offset (89%). Most patients were discharged home (96%), with a mean length of stay of 27 h. Within 90 days, three patients were readmitted for surgery-related reasons: one for superficial wound dehiscence, and two for periprosthetic joint infection (PJI). One PJI was treated with irrigation and debridement, antibiotics, and implant retention (DAIR) two months after primary THA. The other required a DAIR three weeks after primary THA, followed by a single-stage revision one week later. No dislocations, periprosthetic fractures, mechanical failures, or aseptic revisions of the femoral stem occurred. All stems were well-fixed at the latest follow-up, with no aseptic loosening observed. Mean Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) improvement was 15.0 points at six weeks, 25.2 points at three months, and 45.3 points at one year. Conclusions: Our results support encouraging early outcomes with no femoral aseptic complications observed using this novel collared, triple-tapered femoral system. A longer follow-up period is needed to assess mid- and long-term durability. Full article

Purpose: The treatment of proximal humerus fractures (PHFs) remains debated, and similar fracture patterns may be managed with different strategies. The aim of this retrospective single-center case series without a control group was to evaluate clinical and radiographic outcomes after treatment of selected PHFs with the Galaxy Fixation System. The primary endpoint was functional recovery at 12 months, assessed using the Constant Shoulder Score and QuickDASH. Secondary endpoints included radiographic maintenance of reduction, quality of life, treatment-related complications, and need for revision surgery. Methods: We retrospectively analyzed 48 consecutive patients with proximal humeral fractures treated at the Orthopaedic and Traumatology Unit of Versilia Hospital, Viareggio, Italy, between November 2017 and February 2022. Fractures were assessed using trauma-series radiographs and computed tomography when required, and were classified by two senior surgeons according to the Neer, AO/OTA, and Hertel classifications. Eligible patterns included 2-part, 3-part, and selected 4-part fractures with at least two-thirds of intact metaphyseal bone stock. Results: Forty-six patients completed the 12-month follow-up; two patients died during follow-up from causes unrelated to the index procedure. The mean Constant Shoulder Score improved from 62.7 at 6 months to 69.3 at 12 months, and the mean QuickDASH improved from 9.4 to 8.1. The mean postoperative head-shaft angle was 137.2 degrees and remained substantially stable at 135.1 degrees at 12 months. Pin-tract infection occurred in 5 patients, pin migration in 4, algodystrophic syndrome in 1, and avascular necrosis requiring revision arthroplasty in 1. Conclusions: In this retrospective uncontrolled series, external fixation with the Galaxy system was associated with progressive functional recovery, satisfactory radiographic maintenance of reduction, and a low rate of revision surgery in carefully selected PHFs. These findings should be interpreted cautiously because of the retrospective design, limited sample size, absence of a control group, incomplete availability of some baseline variables, and lack of formal comparative or cost-effectiveness analyses. Full article

Background/Objectives: Conservative management of pediatric forearm fractures remains challenging due to the high incidence of secondary displacement. Given the remarkable remodeling potential of children’s bones, clinicians must decide whether to rely on natural healing or intervene. This study evaluated whether accepted secondary displacements affect long-term outcomes and sought to identify predictors of functional impairment. Methods: This retrospective cohort study assessed the long-term outcomes of a cohort of 410 consecutive children who presented with 212 distal metaphyseal and 198 diaphyseal both-bone forearm fractures between 2006–2010. In all patients, closed reduction was recommended for ≥50% displacement, ≥15° angulation (<10 years), or ≥10° angulation (10–16 years). Secondary displacements were frequently accepted, anticipating remodeling. We included 316 children (<16 years) with both-bone forearm fractures (147 diaphyseal, 169 distal metaphyseal), representing 77% of the original cohort, for long-term follow-up (mean 7.2 years, minimum 4 years). Functional and radiographic outcomes were compared between accepted secondary displacements and maintained alignments, stratified by fracture location. Multivariate logistic regression identified predictors of long-term functional impairment, defined as ≥15° loss of pro-supination or QuickDASH ≥ 20. Results: In the distal metaphyseal group there were 50 secondary displacements out of 212 fractures, of which 31 were accepted. In the diaphyseal group there were 60 secondary displacements, of which 49 were accepted. At long-term follow-up, patients with accepted secondary displacements had no clinically relevant differences in functional or radiographic outcomes compared with those with maintained alignments across both diaphyseal and distal metaphyseal fracture groups. For distal fractures, complete initial radial displacements, re-fractures, and bicortical ulnar fractures predicted pro-supination loss ≥ 15° or QuickDASH ≥ 20. For diaphyseal fractures, older age at trauma predicted increased risk of pro-supination limitation. Conclusions: Accepted secondary displacements did not worsen long-term outcomes, supporting reconsideration of strict reduction criteria. The substantial remodeling capacity of pediatric bone—especially in distal metaphyseal fractures in skeletally immature children—should be emphasized when making treatment decisions to avoid unnecessary surgical interventions. Full article

Background: Tibial shaft fractures are frequently treated with intramedullary nailing; however, malalignment remains a concern, particularly in proximal metaphyseal fractures. The surgical approach influenced the nail entry point; however, the three-dimensional (3D) geometric characteristics of the entry point among different approaches remain unclear. Methods: This single-center retrospective study included 68 patients with acute tibial shaft fractures (AO/OTA type 42) treated with reamed and locked intramedullary nails from January 2014 to June 2024. The surgical techniques employed included lateral parapatellar (LPA, n = 31), infrapatellar (IPA, n = 27), and suprapatellar (SPA, n = 10) approaches. Postoperative computed tomography (CT) data were reconstructed into standardized 3D images. The mediolateral insertion ratio was calculated as the percentage distance from the lateral tibial plateau edge to the nail entry point relative to the plateau’s width in the coronal plane. The shortest distance from the tibial articular surface to the nail (r) was measured in the sagittal plane. The Kruskal–Wallis test and Dunn’s post hoc comparisons were used to analyze group differences. Results: Baseline patient and fracture characteristics did not significantly differ among the groups. The mediolateral insertion ratio significantly differed (p < 0.0001), with a more lateral entry for the LPA (44.0% [43.0–47.0]) than for the IPA (51.0% [49.0–53.0], post hoc p < 0.0001) and SPA (49.0% [47.0–51.3], post hoc p = 0.0034). Further, the sagittal distance r significantly differed (p < 0.0001), with a more distal entry for the LPA (14.8 [12.8–20.1] mm) than for the IPA (9.7 [7.0–11.8] mm, post hoc p < 0.0001) and SPA (10.5 [5.5–12.9] mm, post hoc p = 0.0008). No statistically significant difference was observed between the IPA and SPA. Conclusions: The LPA generates a significantly more lateral and distal tibial nail entry point than the IPA and SPA. No statistically significant differences were detected between the IPA and SPA in either plane. These 3D-CT findings may warrant attention during approach selection and guidewire placement, particularly for fractures extending into the proximal metaphysis. Full article

This study restores the late Western Han thinker Yan Zun to his rightful place in the history of Daoist thought. Despite the deep influence of his Laozi zhigui, its fractured transmission has led to modern neglect. This paper illuminates Yan Zun’s overlooked philosophy through a comparative analysis of four readings of Daodejing Chapter 42, a passage famous for its generative ambiguity. It juxtaposes Laozi’s Yangsheng phenomenology of co-presence, Heshang Gong’s Huang-Lao typological metaphysics, and Wang Bi’s Xuanxue radical metaphysics. Situated against this fully developed philosophical backdrop, Yan Zun’s commentary emerges as a sophisticated synthesis. By distinguishing between xu (emptiness) for an ontological non-being and wu (nothingness) for a generative cosmology, Yan Zun forges a unique “onto-cosmology.” He integrates a transcendent Dao as non-being with an immanent Dao as cosmogonic source, a creative tension his successors would later dissect. This analysis recovers Yan Zun both as a lost Daodejing commentator and as the architect of a pivotal, synthetic path in Daoist philosophy. Full article

Background: Tibial distal diaphyseal–metaphyseal junction (DDMJ) fractures are rare in children and pose therapeutic challenges due to their morphology and risk of displacement. This study compared the clinical, radiological, and economic outcomes of elastic stable intramedullary nailing (ESIN), plate fixation, and Kirschner wire (K-wire) fixation. Methods: A retrospective review was conducted on 64 patients (6–15 years) treated between 2014 and 2023. Patients were grouped according to fixation method. Demographic, operative, radiographic, functional (AOFAS), complication, and cost data were analyzed. Results: The K-wire group, plate group, and ESIN group consisted of 27, 19, and 18 patients, respectively. The mean follow-up duration was 18.03 ± 6.87 months. Of the patients, 38 were male and 26 were female. Concomitant fibula fractures were present in 43 patients and were not present in 21 patients. AOFAS scores were highest in the plate group at the 4th month, while they were similar in all groups in the subsequent follow-ups. The costliest method was plate (2517.64 ± 104.83 $) (p = 0.001). Conclusions: All three fixation methods provided satisfactory long-term outcomes. Plate fixation offers faster early recovery but at higher cost and risk of soft-tissue complications; ESIN balances stability and invasiveness; K-wire is economical but less stable. Treatment choice should be individualized according to fracture pattern, patient factors, and resource availability. Full article

Adding a fibular strut bone graft to locking plate fixation has been introduced to improve stability and prevent varus collapse. The purpose of this study was to perform finite element analysis (FEA) of the biomechanical characteristics of different insertion angles of the fibular strut graft in proximal humerus fractures. Proximal humerus fractures with metaphyseal comminution and instability were simulated by creating wedge-shaped osteotomies medially and laterally for varus and valgus models, respectively. Three-dimensional finite element models were reconstructed from computed tomography images. A locking compression plate with a length of 90 mm (three holes) was applied to the proximal humerus fracture model. Fibular allografts were inserted at 0° and 30° to the humeral shaft. Axial and traction forces of 70°, 90°, and 110° relative to the vertical axis were applied to each model to simulate stress on the plate and graft. At axial loads, stresses in both the plate and the graft were lower when the graft was inserted at 0° than at 30°. Under traction loads, plate stress was lower with 30° insertion. Graft stress was also lower with 30° in most experimental conditions in both the valgus and varus models. These findings suggest that oblique insertion may provide biomechanical advantages under traction forces in unstable proximal humerus fractures. Full article

Background: Osteodysplastic syndromes comprise a very diverse group of clinically and genetically heterogeneous disorders characterized by defects in bone and connective tissue development, as well as in bone density. Here, we report the case of a 48-year-old female with a complex medical history characterized by bone dysplasia, hyperostosis, and partial tooth agenesis. Methods: Genetic testing was performed using WES analysis and Sanger sequencing. Molecular modeling analysis and dynamics simulation explored the impact of detected pathogenic variants. Results: The genetic analysis detected multiple pathogenic variants in genes CREB3L1, SLCO2A1, SFRP4, LRP5, and LRP6, each of which has been associated with rare osteodysplastic syndromes. The patient was homozygous for the same rare alleles associated with three of the identified autosomal recessive disorders osteogenesis imperfecta type XVI, primary hypertrophic osteoarthropathy, and metaphyseal dysplasia Pyle type. She also had a variant linked to autosomal dominant endosteal hyperostosis and a variant previously associated with increased risk of osteoporosis and bone fractures. Two of the detected variants are predicted to cause abnormal splicing, while molecular modeling and dynamics simulations analysis suggest that the other three variants probably confer altered local secondary structure and flexibility that may have functionally devastating consequences. Conclusions: Our case highlights the rare coexistence of multiple osteodysplastic syndromes in a single patient that may complicate differential diagnosis. Furthermore, this case emphasizes the necessity for early genetic investigation of such complex cases with overlying phenotypic traits, followed by genetic counseling, facilitating orchestration of clinical interventions and allowing prevention and/or prompt management of manifestations. Full article

Osteogenesis imperfecta type VI is a rare autosomal recessive disorder characterized by bone fragility and defective mineralization, caused by pathogenic variants in the SERPINF1 gene. This study aimed to expand the understanding of OI type VI by analyzing clinical, radiological, and molecular findings in four patients from three unrelated families. Genotyping revealed two novel SERPINF1 variants, c.185G>T (p.Gly62Val) and c.992_993insCA (p.Glu331Asnfs), in a compound heterozygous state in one patient, and a known pathogenic variant, c.261_265dup (p.Leu89Argfs26), in a homozygous form in three patients. Clinical manifestations included early-onset fractures, severe skeletal deformities, impaired mobility, and growth failure. Radiological assessments revealed multilevel and multiplanar bone deformities and metaphyseal widening. RNA analysis demonstrated that the c.992_993insCA variant results in a truncated PEDF protein without triggering nonsense-mediated decay. Population screening identified a carrier frequency of 0.0044 for the c.261_265dup variant, suggesting a founder effect in the Tuvinian population. These findings expand the mutational spectrum of the SERPINF1 gene and provide new insights into the phenotypic variability of OI type VI. Our results highlight the importance of genetic screening in isolated populations and emphasize the need for further research to develop more effective therapeutic approaches for patients with limited response to bisphosphonate therapy. Full article

Background: Stress shielding (SS) after total hip arthroplasty (THA) leads to proximal femoral bone loss and increases the risk of complications such as implant loosening and periprosthetic fracture. While various low-stiffness stems have been developed to prevent SS, they often compromise mechanical stability. A novel femoral stem composed of Ti-33.6Nb-4Sn (TNS) alloy offers a gradually decreasing Young’s modulus from proximal to distal regions, potentially improving load distribution and reducing SS. This study aimed to evaluate the mid-term clinical and radiographic outcomes of the TNS stem, with a particular focus on its effectiveness in suppressing SS. Methods: A prospective clinical study was conducted involving 35 patients who underwent THA using the TNS stem, with a minimum follow-up of 7 years. Twenty-one patients with Ti6Al4V metaphyseal-filling stems served as controls. Clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) scores, and radiographic SS was graded using Engh’s classification and analyzed in Gruen zones. Inter-examiner reliability and statistical comparisons between groups were performed using appropriate tests. Results: The TNS group showed significantly higher preoperative JOA scores than the control group, but no significant difference in final scores. Both groups demonstrated significant improvement postoperatively. Third-degree SS occurred in the TNS group, although the overall SS grade distribution was significantly lower than in the control group (p = 0.03). SS frequency was significantly reduced in Gruen Zones 2, 3, and 6 in the TNS group. Conclusions: The TNS stem demonstrated a significant reduction in SS progression compared to conventional titanium stems over a 7-year period, with comparable clinical outcomes. However, the occurrence of third-degree SS indicates that material optimization alone may be insufficient, highlighting the need for further design improvements. Full article

Background/Objectives: Biomineral adhesive bone adhesives composed of phosphoserine combined with magnesium oxides or phosphates exhibit exceptional adhesive properties. This study evaluates two experimental mineral–organic cementitious adhesives in a clinical test setup, investigating their potential for fracture reduction and simultaneous defect filling. Methods: The two experimental adhesives (Groups B and C) and a standard hydroxyapatite cement (Group A, reference) underwent compressive strength testing, shear strength testing, and screw pullout tests as part of a first biomechanical characterization. Furthermore, all materials were tested in a porcine tibial split depression fracture model, where they served both for fracture reduction and for filling the metaphyseal bone defect, supplementary to plate osteosynthesis. Fracture stability was assessed under cyclic loading in a materials testing machine. Results: The OPLS (O-phospho-L-serine) containing adhesive (Group B) demonstrated the highest compressive strength as well as the highest shear strength. All three materials showed comparable maximum pullout forces. Both experimental adhesives (Groups B and C) exhibited higher pullout stiffness compared to the standard cement (Group A). In the fracture model, no significant differences in displacement under cyclic loading were observed between groups. Conclusions: The biomineral adhesive bone adhesives (Groups B and C) demonstrated biomechanical advantages in axial compression, adhesive (shear) strength, and screw fixation compared to the standard hydroxyapatite cement (Group A). Furthermore, they achieved comparable stabilization of metaphyseal fractures under clinically relevant dynamic loading conditions. Full article

Background/Objectives: The pullout failure of conventional locking screws (LSs, screws with a locking mechanism) may occur in patients with osteoporosis, particularly when inserted near joints or across periarticular fractures (e.g., proximal humerus). The two-part locking cancellous screw modification (TP-LCS, screws composed of two parts) in metaphyseal cancellous bone is hypothesized to increase bone purchase and holding power. This study aimed to test the hypothesized advantages of TP-LCS over LSs. Methods: An MTS 370 series frame with an axial/torsional load cell was used to test driving torque and axial pullout strength, following ASTM F543-07 standards. The TP-LCS group featured a newly modified screw design made from titanium alloy (Ti6Al4V), while conventional LSs (Synthes) were used for the control group. Statistical significance was assessed for selected comparisons relevant to the research objectives, including driving torque and axial pullout strength. Results: The driving torque test showed that TP-LCS had a significantly higher maximum insertion torque (4.9 ± 0.4 N·cm) compared to LSs (4.2 ± 0.4 N·cm) (p = 0.0269), although no significant difference was found in maximum removal torque (p = 0.1046). The axial pullout test revealed that TP-LCS had significantly higher pullout strength (223.5 ± 12.2 N) compared to LSs (203.5 ± 11.5 N) (p = 0.0284). Failure during the axial pullout test often involved cracking of the test block material around the screw threads, causing the screw to pull out. Conclusions: These results support the hypothesis that TP-LCS may offer improved axial pullout resistance compared to LSs, making it a potentially beneficial modification for LSs in osteoporotic metaphyseal regions or near joints. This study provides biomechanical insights into the advantages of the modified screw design over conventional LSs. Full article

Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. Methods: In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). Results: No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, p > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, p = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, p = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, p = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. Conclusions: The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems. Full article