Osteology

Background/Objectives: The primary aim of this study is to evaluate the impact of two different drilling methods on the primary stability of implants inserted into polyurethane blocks simulating different bone densities. The secondary aim is to analyse the indication provided by three different methods used to assess primary stability. Methods: The study was performed on two artificial bone blocks of solid rigid polyurethane without cortical layer and one laminated one. A total of 48 implants were placed following either a Regular Primary Stability (RPS) or an Enhanced Primary Stability (EPS) protocol based on site underpreparation. Immediately after implant placement, artificial intelligence tool (AIT) indication, peak insertion torque (pIT) and Resonance Frequency Analysis (RFA) values were recorded. The values were then categorised as suitable or not suitable for single-crown immediate loading by bone density and drilling protocol. Results: EPS drilling protocol produced significantly higher primary stability values than those in all bone densities, regardless of the primary stability measurement method used, except for the implants placed in D4 and evaluated by AIT. The grouping of values shows that implants placed in D3 and D4 never reached the immediate loading threshold for a single crown. In D2, EPS and RPS protocols both reach the threshold for all implants when evaluated with pIT or RFA; when AIT is used, RPS protocol was not able to reach the single-crown threshold in 50% of cases. Conclusions: Within the limitations of this in vitro study, underpreparation appears a viable technique to improve primary stability, nevertheless it might be insufficient to reach the threshold of immediate loading suitability in low density bone. All systems used are able to report the primary stability increase obtained by underpreparation, but AIT showed the potential to detect a loss of primary stability related to torque drop during insertion. These findings require further confirmation. Full article

Primary acute patellar dislocation (PAPD) is a common knee injury, particularly among adolescents and young adults, and is associated with variable risks of recurrent instability, osteochondral injury, and long-term patellofemoral degeneration. The aim of this narrative review was to summarize current evidence on the epidemiology, injury mechanisms, risk factors, diagnosis, emergency management, definitive treatment, complications, and prognosis of PAPD. A structured literature search was conducted in MEDLINE, Scopus, CINAHL, and Google Scholar from database inception to July 2025 using terms including patellar dislocation, acute patellar dislocation, primary patellar dislocation, first-time patellar dislocation, MPFL injury, risk factors, emergency management, treatment, and outcomes. Peer-reviewed studies, systematic reviews, meta-analyses, randomized trials, cohort studies, and clinical guidelines addressing acute first-time patellar dislocation were considered. Evidence was narratively synthesized across clinically relevant domains. Current literature supports a risk-stratified approach in which radiographs remain the first-line imaging modality after acute presentation or reduction, while MRI is useful for identifying osteochondral injuries, MPFL lesions, and anatomical risk factors. Conservative rehabilitation remains appropriate for low-risk first-time dislocations without major osteochondral injury or significant malalignment, whereas surgery may be considered in selected patients with displaced osteochondral fragments, loose bodies, persistent instability, or high-risk anatomy. Because available studies are heterogeneous and long-term evidence remains limited, further prospective research is required to refine patient selection and optimize treatment pathways. Full article

Background: Septic arthritis (SA) is a serious and rapidly progressive condition that can result in significant morbidity and mortality. Current clinical guidelines endorse a combination of surgical debridement and targeted antibiotic therapy as the gold standard treatment for adults with knee SA. Despite the effectiveness of this approach, patients often experience prolonged inflammation, leading to long-term complications such as cartilage degeneration and chronic pain. Since inflammatory cytokines contribute to cartilage destruction, it is considered to be possible that mitigating their levels through the use of steroids could potentially prevent cartilage damage. Methods: This study is designed as a multicenter, open-label, randomized controlled trial aimed at evaluating the efficacy of intravenous dexamethasone as an adjunctive therapy for adults diagnosed with knee joint SA. Participants aged 18 years and older will be randomized to receive either standard treatment (surgical debridement and antibiotics) or the same regimen with the addition of dexamethasone. The primary objective is to assess pain reduction at four days post-surgery using the EQ-VAS scale and knee joint effusion, while secondary objectives will include the evaluation of additional surgical interventions, pain control over time, joint function, normalization of inflammatory markers, and overall healthcare resource utilization. Discussion: While corticosteroids have demonstrated efficacy in pediatric populations with septic arthritis, the evidence for their use in adults remains limited. This trial aims to ascertain whether the anti-inflammatory effects of corticosteroids can mitigate complications and enhance clinical outcomes in adult patients with SA. The findings from this study could provide critical insights into optimizing treatment strategies for this complex condition, ultimately improving patient quality of life. Full article

Background/Objectives: The aims of this study were to investigate maxillofacial trauma resulting from electric scooter accidents and to identify risk factors associated with the location of injuries. Methods: An 8-year retrospective cohort study was conducted involving all patients presenting with electric scooter-related maxillofacial fractures at a tertiary care center from 2017 to 2024. Data recorded for each patient included gender, age, date and cause of injury, contributing factors, type of facial fractures, other injuries, helmet use, and length of hospital stay. Results: Maxillofacial fractures were diagnosed in 138 patients (18.5% of e-scooter accident presentations). The study included 93 male and 45 female patients (ratio 2:1), with a mean age of 25.8 ± 7.75 years (range 14–45 years). Patients aged 20–29 years formed the largest group (51%). Most patients (89%) sustained a single facial fracture, and the most affected facial area was the lower third, with 80 cases (58%), followed by the middle third (36%). The remaining patients were represented by a combination of the various facial thirds, with thirds I-II being the most representative (12%). The most recurrent patterns were multifocal mandibular fractures (55%), followed by fractures of the orbito-malar-zygomatic complex (33%). Dental injuries were also frequent and were recorded in 40 patients (29% of all cases). Concomitant injuries outside the facial region were documented in 32 patients (23%), among which orthopedic limb injuries were most common (44% of patients with concomitant injuries). Contributing factors were identifiable in 102 patients (74%). Self-reported helmet use was low, with 63% of patients reporting never wearing a helmet, and 27% reporting inconsistent or occasional use. Conclusions: Accidents involving personal mobility vehicles have become a primary cause of emergency room admissions in recent years. Although electric-scooter-related maxillofacial fractures are a new phenomenon, an awareness of their frequency, contributing factors, and anatomical distribution is important for emergency and trauma teams who assess these patients first. Early recognition and timely management are crucial because missed diagnoses or delayed treatment can lead to permanent facial deformities and functional disability. These findings can inform targeted public health strategies and injury-prevention programs. In the future, helmet designs should be modified to improve maxillofacial protection in scooter-related injuries. Full article

Background/Objectives: This updated systematic review and meta-analysis provide a focused synthesis of contemporary evidence on clinical outcomes reported after the Latarjet procedure and Free Bone Block (FBB) techniques for anterior shoulder instability, focusing on recurrence, patient-reported outcome measures (PROMs), return to sport, complications, and osteoarthritis progression. Given that most available studies report single-procedure cohorts, between-technique comparisons were interpreted in the context of indirect evidence and study-level heterogeneity. Methods: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. The updated search included studies published from 2019 to May 2024 and was integrated with 70 studies from the previous review that were re-screened according to the same eligibility criteria. Eligible studies reported outcomes for the Latarjet or FBB procedure, with a minimum 2-year follow-up and at least five patients in the relevant treatment cohort. Risk of bias was assessed using the RoB 2 and MINORS tools. Outcomes were synthesized using random-effects meta-analysis. Pooled estimates were calculated separately for each procedure, and between-technique contrasts were treated as exploratory and descriptive when appropriate. Heterogeneity was assessed using I². Results: Ninety-eight studies with 6043 patients and 6071 shoulders were included: 72 on Latarjet, 23 on FBB, and 3 direct comparative studies. Both procedures were associated with low recurrence rates, improved PROMs, and comparable return-to-sport rates. Recurrence was 7% for Latarjet and 5% for FBB. Return to sport was 66% after Latarjet and 65% after FBB. Complication rates were 5% for Latarjet and 8% for FBB, while osteoarthritis progression was 12% and 9%, respectively. PROMs improved after both techniques, although differences between procedures should be interpreted cautiously because of the indirect nature of most comparisons and substantial heterogeneity across studies. Conclusions: Both Latarjet and FBB procedures were associated with generally favorable outcomes for anterior shoulder instability with bone loss in the included studies. The available evidence suggests broadly comparable clinical outcomes, with possible differences in complication profile, recurrence pattern, and osteoarthritis progression. However, these findings should be interpreted considering differences in patient characteristics, follow-up duration, surgical technique, graft type, and outcome definitions across studies. Current evidence does not allow definitive conclusions regarding the superiority of one technique over the other, but it provides useful descriptive outcome profiles to inform clinical decision-making and guide future direct comparative research. Full article

Minimally invasive spine surgery (MISS) has progressively transformed the management of spinal disorders by reducing soft-tissue disruption, perioperative morbidity, and recovery time while maintaining clinical outcomes comparable to conventional open techniques. Beyond its technical evolution, MISS has increasingly assumed a central role in the treatment of bone-related spinal conditions, including vertebral fractures, degenerative instability, metastatic disease, and osteoporosis-associated pathology. This narrative review provides a comprehensive overview of the evolution of MISS with a specific focus on its interaction with vertebral bone biology, implant stability, and fusion processes. A structured literature search of the PubMed/MEDLINE database was conducted, including English-language studies published between 1980 and June 2025 addressing MISS techniques, enabling technologies, and bone-related clinical outcomes. Current evidence suggests that MISS may preserve paraspinal vascularization and soft tissue integrity, potentially supporting bone healing and fusion, although high-quality comparative data remain limited. The effectiveness of MISS in osteoporotic and metastatic vertebral disease is closely linked to bone quality, implant anchorage, and biomechanical considerations, particularly in the context of pedicle screw fixation and interbody support. Emerging technologies—including navigation, robotics, and artificial intelligence—may enhance accuracy in implant placement and reduce bone-related complications, but robust evidence of long-term benefit is still lacking. Despite its advantages, MISS presents important limitations, including a steep learning curve, increased costs, and uncertain superiority in terms of fusion rates and long-term biomechanical stability. Future research should prioritize high-quality comparative studies focusing on bone healing, implant integration, and patient-specific factors such as bone density. MISS should therefore be interpreted not only as a surgical paradigm shift but as an evolving strategy for optimizing outcomes in bone-related spinal disorders. Full article

Background/Objectives: Osteoporosis-related fragility fractures are sentinel events that should trigger timely secondary prevention, yet post-fracture care remains inconsistent. Leveraging the NIH All of Us Research Program, we quantified initiation of osteoporosis pharmacotherapy after fragility fracture and explored associations by age, sex at birth, race, and ethnicity. Methods: Retrospective cohort study using All of Us Controlled Tier data (v8) included adults aged 45 to 100 years with an index fragility fracture using prespecified OMOP concept sets intended to capture fractures commonly associated with osteoporosis. A new-user design excluded participants with any osteoporosis pharmacotherapy in the 365 days before fracture; participants required at least 180 days of follow-up. The primary outcome was initiation of osteoporosis pharmacotherapy (bisphosphonates, denosumab, or anabolic agents) within 180 days. Secondary outcomes were completion of dual-energy x-ray absorptiometry (DXA) and bone-health laboratory testing within 180 days. Multivariable logistic regression estimated adjusted odds ratios (OR) for each outcome by age at fracture, sex at birth, race, and ethnicity. Results: Among 1492 eligible participants, 87 initiated pharmacotherapy within 180 days (5.83%). After adjustment, older age was associated with higher odds of initiation (OR 1.04 per year; 95% CI 1.02 to 1.05). Male participants had markedly lower odds of pharmacotherapy initiation (OR 0.20; 95% CI 0.11 to 0.37) and DXA screening (OR 0.22; 95% CI 0.15 to 0.32) compared with female participants. In exploratory adjusted models, we did not detect an independent association between race and pharmacotherapy initiation (White vs. Black/African American OR 1.01; 95% CI 0.49 to 2.09), while White participants had higher odds of DXA screening than Black/African American participants (OR 1.79; 95% CI 1.02 to 3.28). Conclusions: In this diverse national EHR-based cohort, initiation of osteoporosis pharmacotherapy after fracture was uncommon, highlighting a substantial secondary prevention gap. In exploratory adjusted models, male sex was associated with lower odds of pharmacotherapy initiation and DXA receipt, while White participants had higher odds of DXA receipt than Black participants. System-level post-fracture pathways, including fracture liaison services and EHR-based prompts, may improve equitable identification and treatment of osteoporosis for All of Us participants and their communities. Full article

Background/Objectives: The aim of this study is to describe clavicular morphometric parameters and key bony landmarks relevant to plate-and-screw fixation and ligamentous reconstruction procedures. Methods: Morphometric measurements were performed on 179 adult human clavicles: 84 right and 95 left. Linear measurements were obtained using a Mitutoyo digital caliper (0.01 mm precision). Angular measurements were conducted using ImageJ software (LOCI, University of Wisconsin, Madison, USA). Results: The mean distance between the sternal articular surface and the midpoint of the sternoclavicular curvature was 49.23 ± 8.86 mm. The mean distance between the midpoints of the sternoclavicular and acromioclavicular curvatures was 65.16 ± 12.17 mm. The mean distance between the midpoint of the acromioclavicular curvature and the acromial articular surface was 41.58 ± 4.85 mm. The mean sternoclavicular angle was 153.31 ± 9.53° and the mean acromioclavicular angle was 119.95 ± 10.92°. The average thickness of the narrowest middle part of the clavicle was 11.61 ± 1.77 mm. The mean projection distance from the middle part of the clavicle to the most prominent point of the conoid tubercle was 43.81 ± 6.33 mm. The distances from the middle part of the clavicle to the medial trapezoid line and to the lateral impression of the costoclavicular ligament were 50.10 ± 6.31 mm and 42.29 ± 5.88 mm, respectively. The mean projected clavicular length was 142.76 ± 12.29 mm. Conclusions: In conclusion, these findings offer an anatomical reference that may assist radiological evaluation of clavicular shortening and support orthopaedic surgeons in implant selection and planning of ligament reconstruction procedures. Full article

Background/Objectives: A short scarf osteotomy involves the conventional “Z”-shaped osteotomy which is shorter in length with promising results. Fixation can be performed with a single screw or two screws. This observational study evaluated the clinical effectiveness of single-screw versus traditional two-screw scarf osteotomies for the correction of hallux valgus deformities. Methods: Forty-eight hallux valgus cases treated between 2019 and 2024 were reviewed. Data collected included patient demographics, operative details, radiological outcomes, and patient-reported outcome measures (PROMs). PROMs were assessed using the Manchester Oxford Foot Questionnaire (MOxFQ) and the visual analogue scale (VAS). A cost analysis was also performed. Results: Fourteen patients (29.2%) underwent traditional two-screw scarf osteotomies. In this group, the hallux valgus angle (HVA) improved from 37.4° to 19.6° (p < 0.001), and the intermetatarsal angle (IMA) improved from 16.5° to 8.9° (p = 0.004). MOxFQ scores decreased from 37.8 to 27.4 (p = 0.139), and VAS scores improved from 7.4 to 3.3 (p = 0.012). Complications were limited to two superficial infections (14.3%). The remaining 34 patients (70.8%) underwent modified single-screw scarf osteotomies. This group demonstrated an HVA improvement from 34.7° to 12.6° (p < 0.001) and an IMA improvement from 15.5° to 7.8° (p < 0.001). MOxFQ scores improved from 39.4 to 10.4 (p < 0.001), and VAS scores decreased from 6.6 to 2.5 (p = 0.002). Complications included three superficial infections (8.8%), two intraoperative fractures (5.9%), and two cases of complex regional pain syndrome (5.9%). Conclusions: The modified single-screw scarf osteotomy appears clinically non-inferior to the traditional two-screw technique. Although wider validation is required, these findings suggest that the single-screw technique may offer an alternative that maintains clinical outcomes while supporting more sustainable healthcare resource use. Full article

Background/Objectives: The increasing prevalence of foot and ankle procedures in the United States has coincided with rising costs of care, exposing socioeconomic disparities within this area of orthopedics. Insurance payor status is one such factor that can affect the quality and accessibility of medical care and has been implicated in orthopaedic patient outcomes. While previous studies in other fields of orthopaedics have demonstrated an association between insurance status and access to treatment, length of hospital stay, post-operative outcomes and complication rates, no comprehensive review has yet explored this relationship in foot and ankle surgery. Thus, the goal of this study is to examine the association between insurance payor status and outcomes in foot and ankle procedures. Methods: A systematic review of five databases was conducted, focusing on the interplay between insurance coverage and foot/ankle procedures. Included studies reported on insurance payor status and patient outcomes following foot and ankle surgery. Extracted outcomes included time to be seen by a provider, complication and revision rates, post-operative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to work/activity, and follow-up. Meta-analyses were performed using the Revman 5.3 software. Studies that did not qualify for meta-analyses were described qualitatively. Results: Of 1401 studies identified, 24 texts met inclusion and exclusion criteria. Across the 24 studies, there were a total of 20,950 patients. Noninsured patients had a 59% higher risk of ED/urgent care utilization within 30 days of surgery compared to insured patients [Risk Ratio (RR) = 1.59, 95% Confidence Interval (CI) = 1.18 to 2.12, p < 0.05]. Privately insured patients were seen 3.65 days earlier than patients with government insurance [95% CI = 2.02 to 5.27, p < 0.0001]. Worker’s Compensation patients had statistically significant findings for poorer outcomes, higher pain scores, and lower functional scores. Similarly, Medicaid patients also fared worse on functional scores and had delayed access to appointments and treatments. Conclusions: Patients without private insurance have worse pain and functional outcomes, delayed access to care, and increased utilization of emergency resources following foot and ankle procedures. It is crucial for providers to be cognizant of these discrepancies when caring for patients. Further research is needed to better understand the nuances of these insurance-related disparities within foot and ankle subspecialties. Full article

Background: In revision total knee arthroplasty (rTKA), clinical focus is mainly on the femoral and tibial components, while patellar complications are often underemphasized. However, patellar bone deficiency is a significant issue that can negatively affect surgical outcomes, especially in septic revisions. Objective: This review provides an overview of contemporary approaches to the evaluation and treatment of patellar bone loss in rTKA, emphasizing preoperative planning, classification frameworks, and treatment options. Methods: A narrative review of the literature was conducted. Studies published between 2000 and 2024 addressing preoperative assessment, surgical techniques, and outcomes in the management of patellar bone loss in rTKA were screened. Discussion: A recent consensus has addressed the evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA), providing specific recommendations for the management of patellar bone loss and extensor mechanism involvement in cases of severe bone deficiency. In this review, the principal surgical strategies described in the literature are summarized, including patellar component retention or revision, the use of biconvex inlay and trabecular metal implants, bone grafting, various augmentation techniques, resection arthroplasty, gull-wing osteotomy, and patellectomy. Conclusions: Despite various surgical strategies, no consensus exists on a universally superior approach. Ongoing research is essential to establishing standardized, evidence-based protocols for effective management of patellar bone loss in rTKA. Full article

Background/Objectives: The anatomical variability of the human foot represents a subject of substantial interest, offering valuable insights in anthropological research as well as in clinical practice. The aim of this study is to document anatomical variants of the tarsal bones in a CISC//XXI skeletal sample (21st Century Identified Skeletal Collection), with a particular focus on the prevalence of accessory ossicles. Methods: The studied sample consisted of 163 individuals (83 females and 80 males). The prevalence of six accessory tarsal bones was recorded (os trigonum, calcaneum secundarium, the accessory navicular bone, os sustentaculum, os vesalianum and os intermetatarseum). Results: A total of 35 individuals (21.4%; 35/163) exhibited at least one accessory ossicle, with 13 females (15.7%; 13/83) and 22 males (27.5%; 22/80). The os trigonum and calcaneum secundarium were the most frequently observed accessory bones, respectively, in 9.3% (15/162) and 6.9% (11/159) of the individuals. No sex differences were observed. All accessory bones occurred more frequently unilaterally, and no co-occurrences of accessory bones were observed. Conclusions: These findings are crucial in both the biomedical and anthropological fields, where a detailed knowledge of foot anatomy and its variations is relevant. Full article

Background/Objectives: Magnetic resonance arthrography is the reference standard for evaluating glenoid labral lesions. Deep learning (DL) reconstruction algorithms may accelerate 3D acquisitions while maintaining image quality. This study assesses the diagnostic accuracy of DL-based isotropic 3D MR imaging for detecting glenoid labral lesions. Methods: This prospective study included 128 consecutive patients (79 men, 49 women; mean age 38.4 years) undergoing shoulder MR arthrography between June 2023 and April 2025. DL-based 3D sequences (acquisition time: 3:26) were compared with conventional multiplanar TSE and PD-FS sequences (acquisition time: 24–28 min). Two independent radiologists assessed glenoid labral lesions, bone marrow edema, and rotator cuff abnormalities using a four-point Likert scale. Sensitivity, specificity, and interobserver agreement were calculated. Results: DL-based 3D sequences demonstrated 94.7–95.1% sensitivity and 100% specificity for glenoid labral lesions, with excellent interobserver agreement (κ = 0.812). The area under the ROC curve was 0.894. Combined 3D protocols (T1 + PD-FS) showed superior accuracy (97.8%) compared to single sequences (90.5%, p = 0.012). For bone marrow edema, sensitivity was 82.9% with 100% specificity. Rotator cuff evaluation achieved 75% sensitivity with 100% specificity. Conclusions: DL-based isotropic 3D sequences provide high diagnostic accuracy for glenoid labral pathology while reducing scan time by 75%. Combined T1 and PD-FS protocols optimize performance. These findings support selective implementation of DL-accelerated 3D protocols in shoulder MR arthrography, particularly for labral assessment, while acknowledging that conventional protocols may remain preferable in specific clinical scenarios. Full article

Background: The present case report study aims to describe, from both clinical and histological aspects, the bone healing pattern in a patient under oral bisphosphonates therapy. Case Presentation: an 82-year-old female patient has been under oral nitrogen bisphosphonates therapy for two years. She underwent a tooth extraction. After four months, two bone biopsies were harvested, during standard implant drilling procedures. The first one corresponded to the healed alveolar socket of the previously extracted tooth (specimen A), while the second one corresponded to the bone ridge that was edentulous before starting the bisphosphonates therapy (specimen B). Morphometric and histologic analyses were performed. Results: In both, the bone resulted vital and no evidence of empty lacunae was detected. A reduction in the haversian canal diameter was observed in specimen B. The present case report highlights histological findings suggesting that patients undergoing oral bisphosphonates therapy may be eligible for surgical therapy. A pre-operative careful anamnesis and the observance of international guidelines for treating patients taking bisphosphonates are mandatory. Conclusions: These preliminary results will be used to plan a large clinical study in order to better understand the influence of bisphosphonates on the bone healing process. Full article

Bone remodeling is a dynamic process involving bone resorption and formation that is regulated on a cellular level and impacted by mechanical stress. A variety of Orthopedic surgery treatment strategies can affect bone remodeling, which can in turn may have long-term impacts on skeletal stress tolerance and function. This review provides a comprehensive overview of bone remodeling involved in Orthopedic surgery. Materials related to bone remodeling principles across Orthopedic surgery domains were selected and compiled using databases including PubMed, MEDLINE, AccessMedicine, and CINAHL; case studies were not included. Relevant literature was summarized for a general review of bone remodeling and as it relates to treatment principles in trauma, arthroplasty, and amputation with the aim of providing a relevant, comprehensive review. Overall, the purpose of this review is to provide an overview of bone remodeling principles that are implicated in various techniques within Orthopedic surgery. Full article

Background: Low peak bone mass (PBM) is a major contributor to later osteoporosis risk. This study sought to understand young people’s knowledge of factors associated with bone health. Methods: Young people in Aotearoa New Zealand were approached. Eight focus groups (26 participants in total, aged 11 to 17 years) were conducted using a semi-structured approach with open-ended questions and prompts. Transcripts were thematically coded using an inductive content analysis approach. Results: Knowledge of factors associated with good bone health was limited. There was a general awareness of the positive and negative impacts of many lifestyle behaviours on health generally, but not specifically PBM. Dairy intake was commonly mentioned as being beneficial for bone health. Some participants reported potential benefits of sport, but most did not know that weight bearing activity specifically was beneficial. Conclusions: Knowledge of osteoporosis and lifestyle factors that impact PBM was limited. Educational interventions involving promotion of bone health knowledge and supporting weight bearing physical activity in adolescents may be an important contributor to public health strategies. Full article

Background/Objectives: To determine whether patients under 30 years of age who have experienced symptoms for a duration of less than 1 year before undergoing hip arthroscopy (HA) for femoracetabular impingement (FAI) have better patient-reported outcomes than patients aged 40 years or older who have experienced symptoms for a duration of more than 1 year. Methods: This is a single-center, single-surgeon, retrospective analysis performed between August 2007 and May 2023 analyzing patients who underwent hip arthroscopy. Patients were divided into those who were 18 to 30 years old and patients that were 40 years and older. All patients who underwent primary hip arthroscopy for FAI and had completed mHHS or NAHS surveys prior to surgery with at least a 2-year follow-up were initially included in the study. Patients were excluded if they had no symptom duration information documented in their electronic medical record, a history of inflammatory arthritis, previous ipsilateral hip surgery, or future conversion to total hip arthroplasty (THA) before final follow-up. Results: A total of 236 hip arthroscopies were analyzed, including 147 patients ≥40 years and 89 patients 18–30 years, with symptom duration being significantly longer in the older cohort (28.4 vs. 17.5 months, p < 0.001). At 2 years, there was no difference in mHHS or NAHS between groups; however, younger patients with shorter symptom duration were more likely to achieve PASS for NAHS (87.5% vs. 58.7%, p = 0.036). At 5 years, the older cohort showed greater improvement in mHHS (33.1 vs. 22.9, p = 0.048), while patients 18–30 years continued to demonstrate higher absolute mHHS and NAHS at both 2 and 5 years. Regression analysis confirmed that increasing age was associated with lower PROs at follow-up. Conclusions: There was a significantly greater number of patients who achieved PASS for NAHS at 2-year follow-up for patients who were 18–30 years old with symptom duration ≤ 1 year compared to those aged 40+ years old with symptom duration ≥ 1 year. Additionally, patients ≥40 years old experienced a significantly longer symptom duration before surgery and had worse outcomes for mHHS and NAHS at 2- and 5-year follow-up compared to the 18–30 year cohort. Full article

Background/Objectives: Charcot-Marie-Tooth (CMT) disease, the most common hereditary peripheral neuropathy, often causes cavovarus foot deformity in children. Surgical interventions to correct deformity or improve function can involve either primary fusion or reconstruction. However, the optimal surgical approach remains contested. This systematic review aims to present and evaluate existing data on both fusion and reconstruction surgical interventions in treating pediatric CMT cavus foot. Methods: A PRISMA-guided search of five electronic databases was conducted (from inception to 17 February 2025). Studies were eligible if they reported surgical outcomes for CMT pediatric patients ($\le$18 years) with cavovarus foot treated by primary fusion or reconstruction. Titles, abstracts and full texts were screened by four independent reviewers, and data were extracted on patient demographics, procedures, follow-up, functional scores, radiographic correction and complications. Results: Fourteen studies met inclusion criteria, encompassing 169 patients and 276 feet, with a mean age at surgery of ~13.5 years. Nine studies evaluated joint-sparing reconstruction, three assessed primary fusion, and two combined both reconstruction and fusion. Both interventions yielded improved outcomes post-operatively. Reconstruction generally produced high patient satisfaction and near-normal radiographic parameters but carried recurrence or reoperation rates of 10–40%. Fusion provided durable correction of rigid deformities but was associated with nonunion, adjacent joint arthritis and higher revision rates. Conclusions: Joint-sparing reconstruction is an effective first-line approach for flexible cavovarus deformities in pediatric CMT patients, while fusion should be reserved for severe, rigid or recurrent cases. A patient-specific staged approach is recommended, and higher-quality comparative studies are needed to refine surgical decision-making. Full article

Background: Risk factors, including Joint Index Vector (JIV), a new disease activity indicator based on three-axis coordinates, and a pain score using a visual analog scale (PS-VAS), were evaluated for incident bone fragility fractures (inc-BFF) in patients with rheumatoid arthritis (RA) in a retrospective case–control study. Methods: RA patients who were followed for at least two consecutive years (RA) and a control group consisting of patients without RA but with similar background demographics (non-RA) were recruited and monitored. The prevalence of inc-BFF was compared between the two groups. Common potential risk factors in both groups and RA-specific factors within the RA group regarding inc-BFF were analyzed statistically. Results: A total of 278 patients were studied in each group. There was no significant difference in the prevalence of inc-BFF between the two groups. Presenting RA was not a major factor in developing inc-BFF. Higher Vz in the JIV, which reflects the difference in the involvement ratio between large and small joints, and higher PS-VAS showed significantly higher hazard ratios in a univariate model. Vz > 0.01, PS-VAS ≥ 25.5, and simplified disease activity index ≥ 2.11 at follow-up, along with PS-VAS at baseline > 21.0, are the key cutoff indices for RA-specific risk factors. When two of these factors were combined, the combination of Vz and PS-VAS at follow-up resulted in the highest hazard ratio (4.25; p < 0.001). Conclusions: These results suggest that combining Vz and PS-VAS is the key risk indicator for inc-BFF. Full article