Osteology, Volume 5, Issue 3 (September 2025) – 4 articles

Background/Objectives: Overhead athletes, including swimmers, are prone to shoulder adaptations and pathologies, such as scapular dyskinesis (SD) and glenohumeral internal rotation deficit (GIRD). While SD has been extensively studied in various overhead sports, its prevalence and clinical implications in swimmers remain unclear. This study aims to evaluate static scapular asymmetries (SAs), defined as differences in the observed position of the scapulae at rest or in a fixed position, in young elite swimmers and compare these findings with functional scapular dyskinesis (SD) tests, which assess alterations in scapular motion patterns during arm movement. It also assesses potential relationships between SA and SD. Methods: A cohort of 661 young elite swimmers (344 males, 317 females) was assessed during the National Young Swimming Championships. Scapular asymmetries were measured in two positions: at rest and at 90° abduction with internal rotation. The measurements included the following: (1) dHeight: Difference in superomedial scapular angle height from the C7 spinal process; (2) dDistance: Difference in the distance of the superomedial scapular angle from the body midline; (3) dAngle: Angular deviation of the medial scapular border from the plumb line, assessed using a goniometer. The presence of scapular dyskinesis (SD) was determined using a functional test, and SA findings were compared with SD results. Statistical analyses included ANOVA and chi-square tests, with significance set at p < 0.05. Results: Scapular asymmetries were observed in 3.63% to 15.43% of swimmers, with no significant associations with age, gender, BMI, training years, or swimming characteristics (p > 0.05). A significant difference was observed between dominant limb and scapular height in abduction (p < 0.05). In position 1 (resting position), SA was significantly more prevalent in swimmers without SD (p < 0.001 for dHeight, p = 0.016 for dDistance). In position 2 (abduction), SA was significantly associated with SD-negative subjects in dAngle (p = 0.014) and dDistance (p = 0.02), while dHeight was not significant (p > 0.05). These findings suggest that static scapular asymmetries do not necessarily correlate with dynamic scapular dysfunction (SD), and, indeed, a negative correlation was observed where SA was significantly more prevalent in swimmers without SD in several measures (position 1, p < 0.001 for dHeight and p = 0.016 for dDistance; position 2, p = 0.014 for dAngle and p = 0.02 for dDistance). Conclusions: Young elite swimmers exhibit a relatively symmetrical scapular positioning, with scapular asymmetries potentially representing normal adaptations rather than pathological findings. The lack of positive correlation between SA and SD, and the higher prevalence of SA in SD-negative subjects, suggests the need for caution when interpreting static scapular assessments in swimmers as SA may reflect sport-specific adaptations rather than pathology. Full article

Background/Objectives: Congenital clubfoot (CC) is one of the most common congenital deformities of the lower limbs, typically presenting as a complex skeletal malformation. It is frequently associated with other congenital anomalies, although the co-occurrence with agenesis of the toes is rare. This case report describes a unique presentation of congenital clubfoot associated with agenesis of the 4th and 5th toes, focusing on clinical management and reviewing the literature on skeletal malformations linked to CC. Methods: A comprehensive literature review was conducted, focusing on studies published in the last decade regarding congenital clubfoot and its association with other skeletal malformations. A clinical analysis of a patient with congenital clubfoot and digital agenesis was performed, including diagnostic methods, treatment approach, and follow-up results. The patient was treated with the Ponseti method, followed by percutaneous Achilles tendon tenotomy due to insufficient correction. Due to persistent equinus deformity, a second intervention involving Achilles tendon lengthening and syndesmotic capsulotomy was performed. Results: The patient presented with unilateral congenital clubfoot and agenesis of the 4th and 5th toes, a rare combination. Initial correction was achieved with the Ponseti method, but further surgical intervention was needed. Follow-up at 2 years showed excellent results, with the patient able to walk without difficulty. The literature review revealed limited cases involving digital agenesis associated with clubfoot. Conclusions: This case report highlights the rare association between congenital clubfoot and agenesis of the 4th and 5th toes. While satisfactory outcomes were achieved, further studies are needed to explore potential worse outcomes in cases with associated malformations and the genetic factors involved. Full article

Background/Objectives: Complete rupture of the Achilles tendon is a common and challenging injury, specifically for individuals engaged in high-demand activities such as sports. Surgical repair is often required, but conventional methods, including direct suture repair, may fail to address the biological limitations associated with tendon healing, especially in cases involving chronic degeneration or extensive tissue damage. Methods: This case report explains how bioinductive implants, such as the Regeneten collagen-based scaffold, have gained attention as an innovative approach to augment tendon repair. Results: These implants not only provide mechanical stabilization but also promote the regeneration of tendon-like tissue by enhancing the biological healing environment. Conclusions: The use of bioinductive implants, such as the Regeneten scaffold, improves outcomes in tendon repair by augmenting both mechanical stabilization and biological healing. This approach represents a valuable alternative to improve clinical outcomes, particularly in patients with poor prognostic factors. Full article

Background/Objectives: Semiquantitative grading of the vertebral body (SQ) is an easy screening method for vertebral body deformation. The validity of SQ as a risk factor and screening tool for incident osteoporotic fractures in the vertebral body (OF) was investigated using retrospective case-control data. Methods: Outpatients with osteoporosis who were followed up for ≥2 years as patients with osteoporosis were recruited. All of them were tested using X-ray images of the lateral thoracolumbar view and other tests at baseline. Patients were classified according to the SQ grade, and potential risk factors were compared for each SQ group. Cox regression analyses were conducted on the incident OFs. Statistical differences in the possible risk factors among the groups and the likelihood of incident OFs in the variables were examined. After propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) for confounding factors, the possibility of incident OFs was compared between the SQ grade groups. Results: In the crude dataset, the probability of incident OF in SQ Grade 3 was significantly higher than in other grade groups. Using a Cox regression analysis in multivariate mode, SQ grade was the only statistically significant factor for incident OF. However, no significant differences were observed between PSM and IPTW. Conclusions: These results suggest that the SQ classification was inappropriate for predicting incident OFs. However, the grading showed a significantly higher risk than that available for screening. Full article