Exclusive Papers Collection of Editorial Board Members and Invited Scholars in Osteology

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. Full article

Background: Total ankle arthroplasty (TAA) is successful at reducing pain and improving patient satisfaction. A paucity of literature exists regarding racial disparities in TAA. The aim of this study was to update the literature, analyze utilization rates, and detect differences in postoperative outcomes between the racial/ethnic groups. Methods: A retrospective study was performed utilizing the National Surgical Quality Improvement Program (NSQIP) database between the years 2012 and 2018. The postoperative complications were identified as outcomes. Patients were categorized based on race/ethnicity for comparison. A p-value less than 0.05 was considered significant. Results: 1164 patients met criteria, 1051 (90.3%) were White, 113 (9.7%) were Non-White, a nearly 10-fold difference in utilization rate. The mean age of White patients undergoing TAA was older than Non-White patients, 63.7 and 55.3 years respectively (p-value < 0.01). Incidence of postoperative complications showed no significant differences based on racial group. Conclusions: Our results found a nearly 10-fold difference in White patients undergoing TAA compared to other racial/ethnic groups. This highlights the continued racial disparities present in TAA. Further efforts are needed to improve the proportion of minority populations who undergo TAA to bridge the current racial disparities present in the field of TAA. Full article

Background: Ankle fractures, comprising about 10% of musculoskeletal injuries, pose a significant healthcare burden with an increasing incidence, particularly among an aging population. This study focuses on isolated Danis-Weber type B fractures. Recent trends lean towards surgical intervention for anatomical restoration and quicker recovery, albeit with associated complications. This report aims to assess the safety and efficacy of the NewClip narrow locking plate system with early weight-bearing in treating isolated fibular fractures. Methods: The study includes patients with Danis-Weber type B fractures surgically treated with the NewClip narrow locking plate system. Exclusions involved nondisplaced fractures, open fractures, or those requiring additional fixation. Results: Fifteen patients were enrolled in this study. Minor complications, including wound swelling, were observed in two cases. The Visual Analogue Scale (VAS) for pain exhibited a steady decline postoperatively, with almost complete resolution by the third month. At three months, the FAOS demonstrated excellent results, and a final follow-up at twelve months revealed complete osseous healing without complications. Conclusions: The use of this type of plate in treating isolated fibular fractures with early weight-bearing shows promising results in terms of fracture healing, pain resolution, and functional outcomes, warranting further investigation with larger cohorts. Full article

Background: Exosomes, nanoscale extracellular vesicles, play a crucial role in tissue physiology and regeneration. This study uses infometric techniques to explore the structure of exosome-based tissue and bone regeneration research. Methods: We applied BERTopic, an advanced topic modeling algorithm, to a comprehensive corpus of the scientific literature on exosomes and tissue regeneration, identifying key themes such as stem cell studies, tissue healing, and regenerative applications, with orthopedics and dentistry emerging as dominant subfields. To further investigate the ‘ideoscape’, i.e., the conceptual landscape that maps how ideas, methods, and themes are interconnected across the field, we extracted significant concepts from abstracts using GPT 3.5 turbo and created knowledge graphs. Results: Our analysis revealed rapid growth in the field of dental stem cell regeneration, which has outpaced other bone regeneration topics by twofold. This analysis highlighted central themes such as periodontal stem cells and their cellular processes—proliferation, migration, and differentiation—along with their clinical applications. Our approach provided a clear visualization of the field’s intellectual structure, showing how emerging topics are interconnected. Our findings offer a comprehensive view of the evolving trends in exosome-based bone regeneration, revealing not only the most active research areas but also gaps and opportunities for further investigation. Conclusions: This study exemplifies the utility of combining topic modeling with knowledge graph creation to map research trends, offering a flexible and largely automated tool for researchers to explore the vast bodies of literature and guide future research directions. Full article

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

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. Full article

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors. Full article