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Subpectoral Biceps Tenodesis with a Bicortical Button and Proximity to the Axillary Nerve: An Anatomical Study
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Investigation and Management of Painful Os Peroneum Syndrome: A Narrative Review of the Current Literature
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The Validation of the Tanner–Whitehouse 3 Method for Radiological Bone Assessments in a Pediatric Population from the Canary Islands
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Risk-Weight Calculation of Candidate Risk Factors for Incidental Osteoporotic Fracture in Patients with Rheumatic Diseases: A Potentially Accurate Approach
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Comparative Outcomes of Minimally Invasive Versus Open Hallux Valgus Surgery: A Systematic Review and Meta-Analysis
Journal Description
Osteology
Osteology
is an international, peer-reviewed, open access journal on the basic and clinical research of bone science published quarterly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 22.3 days after submission; acceptance to publication is undertaken in 5.6 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: APC discount vouchers, optional signed peer review, and reviewer names published annually in the journal.
- Osteology is a companion journal of Journal of Clinical Medicine.
Latest Articles
Scapular Asymmetries and Dyskinesis in Young Elite Swimmers: Evaluating Static vs. Functional Shoulder Alterations
Osteology 2025, 5(3), 22; https://doi.org/10.3390/osteology5030022 - 3 Jul 2025
Abstract
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.
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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.
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(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)
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Open AccessCase Report
Congenital Clubfoot with Agenesis of the 4th and 5th Toes: A Case Report and Review of the Literature on Skeletal Malformations
by
Giuseppe Vena and Gualtiero Cipparrone
Osteology 2025, 5(3), 21; https://doi.org/10.3390/osteology5030021 - 3 Jul 2025
Abstract
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
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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
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology)
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Open AccessCase Report
Augmented Repair of Achilles Tendon Rupture with Bioinductive Regeneten Implant: A Case Report on Enhanced Healing and Functional Recovery
by
Umile Giuseppe Longo, Antonio Suma, Gianmarco Marcello, Alessandra Corradini, Alice Ceccaroli, Pieter D’Hooghe and Alessandro de Sire
Osteology 2025, 5(3), 20; https://doi.org/10.3390/osteology5030020 - 1 Jul 2025
Abstract
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
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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
(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)
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Open AccessArticle
Verification of the Semiquantitative Assessment of Vertebral Deformity for Subsequent Vertebral Body Fracture Prediction and Screening for the Initiation of Osteoporosis Treatment: A Case-Control Study Using a Clinical-Based Setting
by
Ichiro Yoshii, Naoya Sawada and Tatsumi Chijiwa
Osteology 2025, 5(3), 19; https://doi.org/10.3390/osteology5030019 - 23 Jun 2025
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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.
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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.
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Open AccessArticle
Accuracy of Dynamic Computer-Aided Implant Surgery for Biconometric Implant Positioning: A Retrospective Case Series Analysis
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Luca Comuzzi, Tea Romasco, Massimo Del Fabbro, Margherita Tumedei, Luca Signorini, Francesco Inchingolo, Lorenzo Montesani, Giulia Marchioli, Carlos Fernando Mourão, Adriano Piattelli and Natalia Di Pietro
Osteology 2025, 5(2), 18; https://doi.org/10.3390/osteology5020018 - 16 Jun 2025
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Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant
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Background/Objectives: This retrospective study assessed the accuracy of implant positioning with dynamic computer-aided implant surgery (dCAIS) for Toronto Bridge fabrication, using a conometric prosthetic concept and a new intraoral splinting technique (CLIKSS). It compared discrepancies across various anatomical regions, bone qualities, and implant sites. Methods: This study involved 52 patients undergoing full-arch rehabilitation (17 in the mandible, 30 in the maxilla, and 5 in both), with 366 implants placed (125 in the mandible, 241 in the maxilla; 128 in post-extraction sites, and the remainder in healed sites). All implants were immediately loaded. Precision was assessed by measuring linear and three-dimensional (3D) angular deviations between planned and actual implant positions. Results: Measurement errors for apical linear and 3D deviations at the apex and entry point ranged from 0.24 ± 0.10 to 0.55 ± 0.57 mm, and angular deviations varied from 0.32 ± 0.65° to 0.35 ± 0.71°. Maxillary measurements were significantly higher at the entry, apical, and vertical levels, even when comparing anterior and posterior regions with the corresponding mandibular areas, while no differences were found in the angular deviation. Significant discrepancies were observed among different mandibular bone types. Maxillary post-extraction sites exhibited significantly greater deviations than mandibular sites in all parameters except angular deviation. No significant differences were found between healed and post-extraction sites within the same jaw. Conclusions: dCAIS improved implant placement accuracy, leading to predictable prosthetic outcomes, especially during parallel multi-implant insertions. This report introduced dCAIS for conometric/biconometric implant placement combined with the innovative CLIKSS technique as an effective intraoral split method for this prosthesis connection.
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Open AccessArticle
Impact of Drilling Speed and Osteotomy Technique (Primary Bone Healing) on Dental Implant Preparation: An In Vitro Study Using Polyurethane Foam
by
Luca Comuzzi, Margherita Tumedei, Tea Romasco, Alessandro Cipollina, Giulia Marchioli, Adriano Piattelli and Natalia Di Pietro
Osteology 2025, 5(2), 17; https://doi.org/10.3390/osteology5020017 - 10 Jun 2025
Abstract
Background/Objectives: The achievement of primary stability in low-density bone represents a critical endpoint in clinical practice. The aim of the present investigation was to evaluate the effectiveness of different drilling osteotomy techniques on polyurethane bone substitutes in vitro. Methods: A total
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Background/Objectives: The achievement of primary stability in low-density bone represents a critical endpoint in clinical practice. The aim of the present investigation was to evaluate the effectiveness of different drilling osteotomy techniques on polyurethane bone substitutes in vitro. Methods: A total of 320 osteotomies have been conducted on 10 pound per cubic feet (PCF) and 20PCF, respectively, with and without cortical layer. The simultaneous and progressive drilling protocol has been conducted at two different rotational speeds considering two different implant profiles (TAC conical vs. NT cylindrical implants). The study variables were insertion torque, removal torque, and resonance frequency analysis (RFA). Results: A significantly higher insertion torque, removal torque, and resonance frequency analysis RFA was detected at low speed with simultaneous drilling protocol (RPM) (p < 0.05). A TAC implant produced an increased implant stability compared to NT implants in all conditions tested (p < 0.05). Conclusions: The conical TAC implant showed higher implant stability in low-density polyurethane, and it is strongly recommended in critical bone quality. Simultaneous drilling osteotomy at low speed could further improve torquing positioning and significantly achieve primary stability in this condition.
Full article
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology)
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Open AccessCase Report
A Not-So-Pleasant Surprise: Ochronotic Knee Encountered During Primary Arthroplasty
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Bana Awad, Shahem Elias, Bezalel Peskin, Nabil Ghrayeb and Farouk Khury
Osteology 2025, 5(2), 16; https://doi.org/10.3390/osteology5020016 - 31 May 2025
Abstract
Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this
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Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. Methods: A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. Results: The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. Conclusions: This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings.
Full article
(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies, 2nd Volume)
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Open AccessArticle
Improvement of the Obliteration of Non-Critical Size Defects by Using a Mixture of Bone Dust and Bone Replacement Material (Bioactive Glass S53P4)
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Max Kemper, Anne Kluge, Ines Zeidler-Rentzsch, Susanne Isabella Günther and Marcus Neudert
Osteology 2025, 5(2), 15; https://doi.org/10.3390/osteology5020015 - 19 May 2025
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Background/Objectives: Obliterates such as autologous bone dust (BD) or the synthetic bioactive glass S53P4 (BA) are frequently used for the obliteration of non-critical size defects (NCSDs), especially in otosurgery. Both obliterates have advantages and disadvantages, so that the combination of both for
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Background/Objectives: Obliterates such as autologous bone dust (BD) or the synthetic bioactive glass S53P4 (BA) are frequently used for the obliteration of non-critical size defects (NCSDs), especially in otosurgery. Both obliterates have advantages and disadvantages, so that the combination of both for the obliteration of NCSDs is analysed. Methods: As part of a large animal project with sheep, four NCSDs were created in the calotte of thirteen animals using a drill. These were filled with BD, BD and BA, or BA, and the reference defect remained empty. After three weeks, the explanted calottes were examined with regard to their newly formed bone using digital volume tomography, bone density measurement, fluorochrome sequence labelling, and histological analysis. In addition, human cell culture analyses were carried out on the quality of the BD. Results: BD collected at 7.000 and 15.000 rpm shows a higher activity of new bone formation. In combination with BA, bone is formed centripetally and centrifugally. Defect filling with BA and BD shows a higher bone density and compactness than BD alone. Conclusions: BD should be harvested at a speed of less than 15.000 rpm. Using this BD in combination with BA to obliterate NCSDs enables the defect to be obliterated quickly and completely, with more newly formed bone, creating a bone network with incorporated BA. Further studies are needed to investigate the long-term stability of this obliteration and to determine which other parameters of the extraction can increase the amount of vital BD.
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Open AccessArticle
The Correlations of the Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio with Bone Mineral Density in Postmenopausal Women: A Cross-Sectional Study
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Pierpaolo Panebianco, Gianluca Testa, Giulia Barbagallo, Luciano Costarella, Alessia Caldaci, Sveva Condorelli, Marco Sapienza and Vito Pavone
Osteology 2025, 5(2), 14; https://doi.org/10.3390/osteology5020014 - 6 May 2025
Abstract
Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation
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Background/Objectives: Osteoporosis is a skeletal disorder characterized by reduced bone mineral density (BMD) and increased fracture risk. Chronic inflammation is implicated in osteoporosis pathogenesis, with inflammatory mediators promoting bone resorption. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of systemic inflammation and have emerged as potential indicators of bone health. This study’s aim was to highlight the potential role of the NLR and PLR as markers of bone health in postmenopausal women affected by osteoporosis or osteopenia and to evaluate the possible influence of autoimmune disease in this context. Methods: This cross-sectional study included 124 postmenopausal women diagnosed with osteopenia or osteoporosis at the Orthopedic Unit of the Policlinico G. Rodolico in Catania, Italy. Demographic, clinical, laboratory, and diagnostic imaging data were collected. The NLR and PLR were calculated from complete blood counts, and BMD was measured using dual-energy X-ray absorptiometry (DEXA). Statistical analyses included correlations, group comparisons, and multiple and logistic regressions. Results: The NLR and PLR did not directly correlate with BMD or fracture incidence. However, the PLR weakly correlated with vitamin D levels. Notably, women without Hashimoto’s thyroiditis exhibited higher NLR values than those with the condition. Hypertensive women had a lower PLR than non-hypertensive women, while euthyroid women had a higher PLR than hyperthyroid or hypothyroid women. Multiple regression analysis revealed that age, BMI, CKD stage, vitamin D levels, NLR, PLR, diabetes, and autoimmune diseases significantly predicted BMD at the femur neck, with the PLR contributing significantly. Logistic regression confirmed these predictors for osteoporosis or osteopenia, with an increased PLR being associated with a higher likelihood of osteoporosis. Conclusions: While the NLR and PLR may not independently predict bone health, their inclusion in a multifactorial assessment considering age, BMI, vitamin D, and comorbidities could enhance osteoporosis management.
Full article
Open AccessPerspective
Robotic Innovations in Orthopedics: A Growing Landscape, Challenges, and Implications for Care
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Robin Hu, Umile Giuseppe Longo, Jason Pittman and Ara Nazarian
Osteology 2025, 5(2), 13; https://doi.org/10.3390/osteology5020013 - 21 Apr 2025
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This perspective work focuses on the transformative role of robotics in orthopedic surgery, enhancing precision and efficiency. It details the evolution of robotic systems such as ROBODOC, Mako, and Da Vinci, outlining their contributions to procedures such as total knee and hip replacements.
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This perspective work focuses on the transformative role of robotics in orthopedic surgery, enhancing precision and efficiency. It details the evolution of robotic systems such as ROBODOC, Mako, and Da Vinci, outlining their contributions to procedures such as total knee and hip replacements. It also discusses future trends, including the integration of AI, augmented reality, personalized implants, and the potential for telesurgery. Challenges such as high costs, the learning curve, and regulatory concerns are noted, but the field is poised for significant growth and innovation in orthopedic care.
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Open AccessCase Report
Bridging the Gap in Partial Repair of Full-Thickness Rotator Cuff Tears: A Case Report on the Rationale Behind Bioinductive Collagen Implants
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Arianna Carnevale, Gianmarco Marcello, Matilde Mancuso, Alice Ceccaroli, Alessandra Corradini, Letizia Mancini, Pieter D′Hooghe, Miguel Angel Ruiz Iban, Emiliano Schena and Umile Giuseppe Longo
Osteology 2025, 5(2), 12; https://doi.org/10.3390/osteology5020012 - 7 Apr 2025
Cited by 1
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Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to
[...] Read more.
Background/Objectives: Rotator cuff tears are a prevalent cause of shoulder pain and functional impairment. Full-thickness tears often require surgical intervention, but managing such injuries can be challenging, particularly when complete anatomical repair is unattainable. Bioinductive implants have emerged as an innovative adjunct to enhance tendon healing and regeneration. Methods: This case report details the partial repair of a full-thickness rotator cuff tear in a 66-year-old woman, augmented with a bioinductive implant. Postoperative recovery was monitored through clinical examinations, MRI, and kinematic analysis at 3 and 6 months. Results: The findings suggest that bioinductive implants may offer a promising strategy for managing complex rotator cuff tears, particularly when complete repair is not feasible. The patient reported improvement in function and pain reduction. Conclusions: The use of bioinductive implants showed promising results, promoting tendon regeneration and improving functional outcomes. Future research should explore patient selection criteria and the long-term effectiveness of this strategy.
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Open AccessSystematic Review
Correlation Between the Severity of Flatfoot and Risk Factors in Children and Adolescents: A Systematic Review
by
Gabriele Giuca, Daniela Alessia Marletta, Biagio Zampogna, Ilaria Sanzarello, Matteo Nanni and Danilo Leonetti
Osteology 2025, 5(2), 11; https://doi.org/10.3390/osteology5020011 - 3 Apr 2025
Abstract
Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous
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Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I2 up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions.
Full article
(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology)
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Open AccessArticle
Physiotherapy Intervention on Functional Health in Aging on Functional Capacity, Risk of Falls, Cognitive Function, and Back Pain
by
Gustavo Desouzart
Osteology 2025, 5(1), 10; https://doi.org/10.3390/osteology5010010 - 10 Mar 2025
Abstract
Background/Objectives: Aging is associated with a progressive decline in biological function due to a complex interplay of physical, psychological, and social factors. This randomized controlled trial aimed to evaluate the effects of a functional health education program on functional capacity in older
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Background/Objectives: Aging is associated with a progressive decline in biological function due to a complex interplay of physical, psychological, and social factors. This randomized controlled trial aimed to evaluate the effects of a functional health education program on functional capacity in older adults. Methods: Twenty participants (mean age: 80.70 ± 5.992 years) were randomized to either an experimental group that received a 12-week exercise program or a control group. The exercise program included aerobic, flexibility, strength, and cognitive components. Outcomes were assessed using the Timed Up and Go (TUG) test, Falls Efficacy Scale (FES), and Visual Analog Scale (VAS) for pain. Results: In the population studied, 80% of the older adults indicated some type of back pain. The experimental group results showed a significant reduction in back pain (p = 0.032) and risk of falling (p = 0.013). Additionally, the experimental group demonstrated significant improvements in functional capacity (p = 0.016) and cognitive capacity (p = 0.023). Conclusions: This study demonstrated that a specific activity significantly improved participants’ perceived risk of falls, functionality, cognitive function, and reduced back pain complaints in the experimental group.
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(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology)
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Open AccessArticle
Association Between Bone Mineral Density Around the Stem, Morphology of the Proximal Femur, and Effects of Osteoporosis Treatment in Patients with Femoral Neck Fracture
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Keisuke Oe, Shinya Hayashi, Tomoaki Fukui, Yoshitada Sakai, Shunsuke Takahara, Takashi Iwakura, Atsushi Sakurai, Etsuo Shoda, Ryosuke Kuroda and Takahiro Niikura
Osteology 2025, 5(1), 9; https://doi.org/10.3390/osteology5010009 - 4 Mar 2025
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Background/Objectives: The aim of this study was to evaluate changes in bone mineral density (BMD) around the stem in elderly patients with femoral neck fractures who underwent hemiarthroplasty using a collared and full hydroxyapatite coated cementless stem, as assessed using the Dorr classification
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Background/Objectives: The aim of this study was to evaluate changes in bone mineral density (BMD) around the stem in elderly patients with femoral neck fractures who underwent hemiarthroplasty using a collared and full hydroxyapatite coated cementless stem, as assessed using the Dorr classification and with anti-osteoporosis drug intervention. Methods: This study followed 85 older patients with femoral neck fractures classified by Dorr’s classification. We measured their BMD around the stem using dual-energy X-ray absorptiometry according to Gruen 7 zones classification and clinical scores. We compared the rate of BMD change based on Dorr’s classification and clinical scores. We also investigated the effect of osteoporosis treatment interventions on the rate of BMD change. The study followed up with the patients for one year after surgery. Results: After excluding patients with missing data, 40 patients were included in the analysis. The rate of change in BMD in zone 2 was significantly reduced in Dorr type C compared to Dorr type B. Clinical scores did not significantly differ between the three groups. Regarding the association between osteoporosis treatment and the rate of BMD change, the pre-injury intervention group had a significantly suppressed decline in the rate of BMD change in zones 1 and 7 compared to the post-injury intervention and no-intervention groups. Conclusions: Careful follow-up examination is crucial when performing hemiarthroplasty in patients with Dorr type C femoral neck fractures because the rate of BMD change may decline postoperatively. Pre-injury osteoporosis intervention therapy may suppress BMD loss around the stem.
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Open AccessSystematic Review
Effectiveness of Virtual Reality Exposure Therapy for Postoperative Rehabilitation Following Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis
by
Sebastián Eustaquio Martín Pérez, Carmen Pérez Canosa, Iván Pérez Aguiar, Alexandra Marina Medina Rodríguez and Isidro Miguel Martín Pérez
Osteology 2025, 5(1), 8; https://doi.org/10.3390/osteology5010008 - 17 Feb 2025
Cited by 3
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Background/Objectives: Cruciate ligament injuries, particularly those involving the anterior cruciate ligament and posterior cruciate ligament, are common among active individuals and often require surgical reconstruction followed by intensive rehabilitation to restore knee stability, movement, and strength. Virtual reality exposure therapy has emerged
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Background/Objectives: Cruciate ligament injuries, particularly those involving the anterior cruciate ligament and posterior cruciate ligament, are common among active individuals and often require surgical reconstruction followed by intensive rehabilitation to restore knee stability, movement, and strength. Virtual reality exposure therapy has emerged as a potentially beneficial adjunct to traditional rehabilitation, offering immersive, interactive environments that may aid in pain relief, balance, proprioception, and functional recovery. This meta-analysis aimed to evaluate the efficacy of VRET compared to conventional rehabilitation for postoperative cruciate ligament reconstruction, focusing on outcomes in pain, balance, proprioception, and the knee flexion range of motion. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines and registered in PROSPERO (CRD42024604706). A comprehensive search across databases including MEDLINE (PubMed), SPORTDiscus, ScienceDirect, Web of Science (WOS), Cochrane Library, Scopus, and EBSCOhost included studies from inception until the date of search, using terms such as “cruciate ligament”, “virtual reality”, “rehabilitation”, “pain”, and “balance”, combined with Booleans “AND” and “OR”. Methodological quality, risk of bias, and recommendation strength were assessed using PEDro Scale, Cochrane Risk of Bias Tool (RoB 2.0), and GRADE, respectively. Results: Eleven studies (n = 387) met the inclusion criteria, involving patients who had undergone ACL or PCL reconstruction. Virtual reality exposure therapy showed significant benefits in reducing pain intensity [SMD = −2.33, 95% CI: −4.24 to −0.42, Z = 2.40, p = 0.02], improving proprioception, and enhancing the knee flexion range of motion. However, the results for static balance [SMD = −0.37, 95% CI: −1.62 to 0.88, Z = 0.58, p = 0.56] and dynamic balance [SMD = −0.37, 95% CI: −1.83 to 1.09, Z = 0.50, p = 0.62] were mixed and not statistically significant. Conclusions: Virtual reality exposure therapy is an effective adjunct therapy to postoperative rehabilitation for cruciate ligament reconstruction, particularly in reducing pain and enhancing proprioception. However, the small sample sizes and variability across studies underscore the need for further research with larger cohorts to validate these benefits in diverse patient populations.
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Open AccessReview
Investigation and Management of Painful Os Peroneum Syndrome: A Narrative Review of the Current Literature
by
Marwan Tahoun, Abdul-Hadi Kafagi, Rana Tahoun, Omar Tariq Al Zareeni, Anand Pillai, Hashim Abdelrazik and Khaled El Aloul
Osteology 2025, 5(1), 7; https://doi.org/10.3390/osteology5010007 - 13 Feb 2025
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Painful Os Peroneum Syndrome (POPS) is a rare cause of lateral midfoot pain due to pathologies involving the os peroneum, an accessory ossicle within the peroneus longus tendon. POPS may result from fractures, tendon tears, tenosynovitis, or degenerative changes. This review evaluates outcomes
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Painful Os Peroneum Syndrome (POPS) is a rare cause of lateral midfoot pain due to pathologies involving the os peroneum, an accessory ossicle within the peroneus longus tendon. POPS may result from fractures, tendon tears, tenosynovitis, or degenerative changes. This review evaluates outcomes of conservative and surgical management of POPS based on the current literature. A comprehensive review of published case reports, series, and relevant studies on POPS management was conducted. Clinical outcomes, radiographic findings, and complications following conservative and surgical interventions were analysed. Conservative management, including immobilisation, physiotherapy, cryotherapy, and corticosteroid injections, showed variable success, particularly in nondisplaced fractures or inflammatory causes. Surgical management demonstrated better outcomes in severe cases, including displaced fractures or tendon ruptures. Techniques such as os peroneum excision, tendon repair, tenodesis to the peroneus brevis, and tendon grafting yielded high patient satisfaction, reduced pain scores, and improved functional outcomes. Reported complications included delayed wound healing, sural neuritis, and chronic pain. Despite promising surgical results, a lack of standardised treatment protocols remains a challenge. Both conservative and surgical management of POPS can be effective, depending on injury severity and pathology. Surgical intervention appears superior for advanced cases, especially with tendon rupture or os peroneum fracture. Further research with standardised scoring systems and larger cohorts is needed to establish optimal treatment algorithms and improve clinical outcomes.
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Open AccessArticle
The Validation of the Tanner–Whitehouse 3 Method for Radiological Bone Assessments in a Pediatric Population from the Canary Islands
by
Sebastián Eustaquio Martín Pérez, Isidro Miguel Martín Pérez, Ruth Molina Suárez, Jesús María Vega González and Alfonso Miguel García Hernández
Osteology 2025, 5(1), 6; https://doi.org/10.3390/osteology5010006 - 6 Feb 2025
Cited by 1
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Background/Objectives: Bone age assessments are essential for evaluating the growth and skeletal development of children and adolescents, influenced by factors such as genetics, ethnicity, culture, and nutrition. Clinical standards for these assessments must be adapted to the specific populations under study. This
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Background/Objectives: Bone age assessments are essential for evaluating the growth and skeletal development of children and adolescents, influenced by factors such as genetics, ethnicity, culture, and nutrition. Clinical standards for these assessments must be adapted to the specific populations under study. This study validates the use of the Tanner–Whitehouse 3 method for determining bone age in pediatric and adolescent populations in the Canary Islands. Methods: This cross-sectional study analyzed 214 posteroanterior radiographs of the left hand and wrist from 80 females and 134 males, aged between 5 and 18 years. The radiographs were independently evaluated by three raters: a Radiologist Specialist (Rater 1), a General Practitioner (Rater 2), and a Medical Student (Rater 3). Intra- and inter-rater reliability were assessed using intraclass correlation coefficients (ICCs). Accuracy was evaluated by comparing estimated bone age with chronological age, stratified by sex and developmental stage. Results: Strong intra-rater reliability was observed across all raters. Raters 1 and 2 demonstrated excellent consistency (ICCs: 0.990–0.996), while Rater 3 exhibited slightly lower yet robust reliability (ICCs: 0.921–0.976). Inter-rater agreement was high between Raters 1 and 2 but decreased with Rater 3, reflecting the influence of experience (ICCs: 0.812–0.912). Bone age was underestimated in preschool children (mean difference: 3.712 mos.; 95% CI: 1.290–6.130; p = 0.199) and school-age males (mean difference: 3.978 mos.; 95% CI: −12.550 to 4.590; p = 0.926), with minimal discrepancies in females. In teenagers, the Tanner–Whitehouse 3 method slightly overestimated bone age (mean difference: −0.360 mos.; 95% CI: −0.770 to −0.954; p = 0.299). Conclusions: In conclusion, the Tanner–Whitehouse 3 method demonstrates overall precision and reliability but requires caution, as it underestimates bone age in preschool children and school-age males, while slightly overestimating it in adolescents.
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Open AccessArticle
Risk-Weight Calculation of Candidate Risk Factors for Incidental Osteoporotic Fracture in Patients with Rheumatic Diseases: A Potentially Accurate Approach
by
Ichiro Yoshii, Naoya Sawada and Tatsumi Chijiwa
Osteology 2025, 5(1), 5; https://doi.org/10.3390/osteology5010005 - 27 Jan 2025
Abstract
Background/Objectives: To assess the risk of osteoporotic fractures in patients with rheumatic diseases (RDs), we introduced a new approach for predicting incident osteoporotic fractures (OF), employing a risk-weight calculation for each candidate risk factor. Methods: RD outpatients were picked up, and
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Background/Objectives: To assess the risk of osteoporotic fractures in patients with rheumatic diseases (RDs), we introduced a new approach for predicting incident osteoporotic fractures (OF), employing a risk-weight calculation for each candidate risk factor. Methods: RD outpatients were picked up, and their histories, including OFs, were studied. A Cox regression analysis that evaluated candidate risk factors was conducted with a multivariate model. The variants were selected as candidate risk factors that showed statistical significance using a univariate model. Using the risk ratio or the β-value and p-value, different approaches to acquire a total risk weight (TRW) for each patient were determined to compare the sensitivity and specificity among the approach methods. The cut-off index (COI) was determined using receiver operating characteristic analysis. Sensitivity and specificity for incident OFs were determined using the Kaplan–Meier survival analysis. Results: In a total of 1228 patients, incidental OF occurred in 179 (14.58%) who were included. Factors with significantly higher risk ratios were a history of vertebral and non-vertebral fractures (p < 0.001), cognitive impairment (p < 0.001), anti-osteoporosis drug intervention (p < 0.001), and rehabilitation (p < 0.001). The excellent approach to acquire the best sensitivity and specificity was to calculate the β-value multiplied by the logarithm of the p-value based on 0.05, including non-significant factors (sensitivity: 31.2%, specificity: 94.9%, and area under the curve (AUC): 0.774) compared to 29.4%, 91.6%, and 0.723, respectively, with a counted significant risk factors approach. Conclusions: This novel approach, which includes non-significant factors, can achieve a more accurate sensitivity and specificity to accidental OF in patients with RDs.
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(This article belongs to the Topic Bone-Related Diseases: From Molecular Mechanisms to Therapy Development)
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Open AccessArticle
Subpectoral Biceps Tenodesis with a Bicortical Button and Proximity to the Axillary Nerve: An Anatomical Study
by
John L. Eakin, Ryan J. Whelan, Jason T. Goodrum and Kyle E. Swanson
Osteology 2025, 5(1), 4; https://doi.org/10.3390/osteology5010004 - 16 Jan 2025
Abstract
Background/Objectives: Subpectoral biceps tenodesis using a bicortical button has been associated with the risk of damage to the axillary nerve. The purpose of this study is to describe the anatomical relationships between the long head of the biceps tendon tenodesis location, the
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Background/Objectives: Subpectoral biceps tenodesis using a bicortical button has been associated with the risk of damage to the axillary nerve. The purpose of this study is to describe the anatomical relationships between the long head of the biceps tendon tenodesis location, the bicortical tenodesis button, the pectoralis major tendon, and the axillary nerve to help clarify the safety of using bicortical button fixation. Methods: Subpectoral biceps tenodesis with a bicortical button was performed on ten cadaveric shoulders. The specimens were dissected to identify the tenodesis button, the pectoralis major tendon, and the axillary nerve. Distances were measured between the anterior cortical drill hole and the proximal border of the pectoralis major tendon and between the tenodesis button and the axillary nerve. Results: The distance between the tenodesis button and the axillary nerve demonstrated a very high positive and statistically significant correlation with the distance between the anterior cortical drill hole and the proximal border of the pectoralis major tendon (R = 0.9586, p = 1.22 × 10 −5). Conclusions: The proximal border of the pectoralis major tendon correlates with the level of the anterior branch of the axillary nerve. Subpectoral biceps tenodesis using a bicortical button is a safe procedure with regard to the axillary nerve given it is performed well below the proximal border of the pectoralis major tendon. The inferior border of the pectoralis major tendon is a useful intraoperative landmark.
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(This article belongs to the Special Issue Current Trends in Sports Medicine Based on Orthopedics and Osteology)
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Open AccessSystematic Review
Comparative Outcomes of Minimally Invasive Versus Open Hallux Valgus Surgery: A Systematic Review and Meta-Analysis
by
Abdul-Hadi Kafagi, Abdul-Rhaman Kafagi, Marwan Tahoun, Omar Tariq Al Zareeni, Khaled El Aloul, Mohammad Usman Ahmad and Anand Pillai
Osteology 2025, 5(1), 3; https://doi.org/10.3390/osteology5010003 - 9 Jan 2025
Abstract
Objectives: To compare the safety and efficacy of open surgery (OS) and minimally invasive surgery (MIS) techniques in the correction of symptomatic hallux valgus (HV). Methods: A systematic review of studies up to January 2024 was conducted, identifying all the relevant literature comparing
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Objectives: To compare the safety and efficacy of open surgery (OS) and minimally invasive surgery (MIS) techniques in the correction of symptomatic hallux valgus (HV). Methods: A systematic review of studies up to January 2024 was conducted, identifying all the relevant literature comparing OS and MIS for symptomatic HV. Searches were performed across major databases including MEDLINE, Cochrane and EMBASE. A total of 32 studies were included, comprising randomised control trials, prospective and retrospective cohort studies as well as grey literature. Key outcomes assessed included radiographic measures such as the hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA), with preoperative and postoperative angles analysed to calculate the power of correction. Secondary outcomes included American Orthopaedic Foot and Ankle Society (AOFAS) scores, operative time, hospital stay duration, radiation exposure and complication rates. Both fixed-effect and random-effects models were applied based on the observed heterogeneity in the data. Results: Thirty-two studies with 2423 patients contributed to the summative outcome. Postoperative HVA and IMA were comparable between OS and MIS groups. However, MIS showed a significantly lower DMAA angle (MD = −0.90, CI: −1.55 to −0.25, p = 0.01). In radiographic correction analysis, MIS demonstrated significantly greater DMAA correction (MD = 1.09, CI: 0.43 to 1.75, p = 0.001). The odds of hardware removal were significantly higher with MIS (OR = 2.37, CI: 1.41 to 4.00, p = 0.001). Functional analysis showed that MIS achieved significantly higher postoperative AOFAS scores (MD = 2.52, CI: 0.92 to 4.13, p = 0.002). MIS was associated with a shorter operative (MD = −12.07 min, CI: −17.02 to −7.11, p < 0.00001) and a significantly shorter hospital stay (MD = −0.76, CI: −1.30 to −0.21, p = 0.007). MIS was linked to higher radiation exposure (MD = 51.18, CI: 28.71 to 73.65, p < 0.00001). Conclusions: There is no definitive superiority between MIS and OS for hallux valgus correction. While MIS offers benefits such as improved DMAA correction, higher functional AOFAS scores, shorter operative times and reduced hospital stays, it also carries risks like increased radiation exposure and a higher rate of hardware removal. The decision between MIS and OS should be personalised, taking into account the specific needs and circumstances of each patient. Larger studies are warranted to validate these findings as newer MIS techniques continue to emerge and evolve.
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(This article belongs to the Special Issue Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology)
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