Search Results (109)

Birmingham hip resurfacing (BHR) is an alternative to bone-sparing total hip arthroplasty; however, failures may be associated with the cementing technique. This study aimed to evaluate the characteristics of the cement layer and potential failure mechanisms. BHR explants were analyzed using radiographic evaluation, stereomicroscopy, scanning electron microscopy (SEM), and histopathology. The cement layer was nonuniform, with excessive thickness in the dome regions and insufficient lateral coverage. Increased cement penetration values exceeded recommended thresholds. SEM analysis revealed inhomogeneous cement with cracks, air inclusions, and loosening at the cement–prosthesis interface. BHR failure may be associated with a complex interplay between cementation parameters, cement mantle morphology, and the biological response at the bone–cement interface, as well as interactions at the cement–prosthesis interface. Microscopic evaluation may provide valuable insights into the mechanisms potentially contributing to BHR prosthesis failure. Full article

Primary Objective: To characterize high-resolution computed tomography (HRCT) fracture patterns, namely orientation and otic capsule status, among Sudanese patients with acute temporal bone trauma. Secondary Objectives: (i) To quantify the prevalence and pattern of concomitant craniofacial fractures, (ii) to describe early audiologic outcomes, and (iii) to document facial nerve dysfunction. Methods: Prospective cross-sectional study of 45 consecutive patients (≥5 years) with HRCT-confirmed TBF sustained within 7 days of injury, managed at two tertiary otolaryngology centers in Khartoum (October 2022–March 2023). All imaging, clinical, and audiologic variables were recorded once at the index presentation (≤7 days after trauma); the study did not include longitudinal follow-up. Two blinded experts independently classified fracture orientation (longitudinal, transverse, mixed/oblique), otic capsule status (sparing [OCS] vs. otic capsule-violating [OCV]), and ancillary HRCT signs (ossicular chain disruption, tympanic plate fracture, pneumolabyrinth/CSF leak); inter-observer reliability was assessed with Cohen’s κ. Concomitant craniofacial fractures, pure-tone audiometry, and House–Brackmann facial nerve grades were recorded. Predictor–outcome associations were examined with χ² statistics (p < 0.05). Results: Mean age 35.9 ± 17.4 years; 78% male. Road traffic accidents were associated with 58% of injuries. HRCT showed 60% longitudinal, 20% transverse, and 20% mixed/oblique fractures; 27% were OCV. Ossicular chain disruption, tympanic plate fracture, and ppneumolabyrinthCSF leak were present in 17.8%, 13.3%, and 8.9%, respectively. Concomitant craniofacial fractures occurred at 27%, chiefly Lefort III (15.6%) and Lefort II (8.9%). Transverse/mixed fractures were strongly associated with Lefort II–III injuries (χ² = 16.2, p = 0.001); age (p = 0.21) and sex (p = 0.08) were non-significant. Conductive, sensorineural, and mixed hearing loss affected 69%, 13%, and 18%; facial nerve palsy occurred in 58%. Inter-observer agreement was substantial to almost perfect for all imaging variables (κ = 0.77–0.92). Conclusions: Although longitudinal fractures predominated, over one-quarter breached the otic capsule and one-fifth followed transverse/mixed planes, configurations associated with higher odds of conductive deafness, facial nerve palsy, and complex mid-facial fractures. HRCT provides reliable characterization and should underpin comprehensive head-and-mid-face trauma protocols. Enhanced road safety policies and multidisciplinary trauma care are vital for reducing neuro-otologic morbidity in resource-limited settings. Full article

Background: Autologous bone graft is widely used for lumbar interbody fusion but may increase operative time and donor-site morbidity. Gene-activated grafts combining an osteoconductive scaffold with pro-angiogenic signaling may provide comparable fusion without graft harvesting. The aim of this paper is to compare radiographic fusion and health-related quality of life after single-level transforaminal lumbar interbody fusion (TLIF) using a gene-activated octacalcium phosphate graft containing plasmid DNA encoding vascular endothelial growth factor (OCP/VEGF) versus an autologous bone graft. Methods: 200 adults undergoing first-time single-level TLIF for degenerative lumbar stenosis were allocated 1:1 to OCP/VEGF (n = 100) or autograft (n = 100), prospectively. CT-based fusion assessment and SF-36 outcomes were evaluated at 6 and 12 months follow-up. Results: At 12 months after surgery, mean fusion-zone density was 617.6 ± 180.9 HU in the OCP/VEGF group versus 599.8 ± 181.9 HU in the autograft group (mean difference 17.8 HU; p = 0.484). Complete fusion on qualitative CT grading occurred in 77% versus 73%, respectively (risk difference 4%; p = 0.583). SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) improved significantly from baseline in both groups (p < 0.001), without clinically meaningful between-group differences at follow-up. Revision surgery occurred in 3% versus 5%. Conclusions: In single-level TLIF for degenerative lumbar stenosis, OCP/VEGF produced radiographic fusion and patient-reported outcomes comparable to autograft at 12 months, supporting its use as an autograft-sparing alternative. Full article

Objectives: To develop a simplified MRI-based shorthand assessment method, referred to as the Sagittal Tibial Epi-Physis (STEP) Shorthand, for skeletal age assessment in skeletally immature patients with anterior cruciate ligament (ACL) injuries. This study aimed to elaborate a single-plane MRI-based skeletal age estimation tool and to explore its feasibility and inter-rater reliability in comparison with existing MRI-based shorthands. Methods: This prospective study included 130 knee MRIs (79% males) from 97 skeletally immature patients (overall average age of 14.0 ± 2.1 years) with ACL injuries treated between February 2022 and January 2025. A new shorthand assessment method was developed based on sagittal T1-weighted MRI evaluation of the proximal tibial epiphysis. A validation cohort of 74 MRIs was independently evaluated by four raters with different levels of expertise using the STEP, Meza, and Politzer shorthand atlases. Inter-rater reliability (ICC), intra-rater agreement (Cohen’s kappa), and association with chronological age (Spearman rho) were calculated. Results: The STEP Shorthand tool demonstrated a strong association with chronological age (rho = 0.890, p < 0.001) with consistent associations across sex subgroups. Inter-rater reliability was high and comparable to established MRI-based shorthands. The use of a focused sagittal T1-weighted evaluation allowed for a simplified and reproducible assessment across raters with varying experience levels. Conclusions: The STEP Shorthand represents a pragmatic and reliable tool for MRI-based skeletal age assessment in pediatric and adolescent patients with ACL injuries. The STEP Shorthand can support timely decision-making in surgical planning and enhance standardization across different levels of clinical expertise. Full article

Background/Objectives: The combination of chemotherapy and radiotherapy represents a standard adjuvant treatment for patients with high-risk endometrial cancer. However, limited access to radiotherapy in many healthcare systems frequently results in treatment delays, potentially compromising outcomes. The aim of this study was to evaluate the oncologic outcomes and toxicity profile of an inverted treatment sequence consisting of upfront chemotherapy followed by concurrent chemoradiotherapy. Methods: We conducted a retrospective single-center study including patients with non-metastatic high-risk endometrial cancer. Eligible patients had FIGO stage I grade 3 disease with lymphovascular space invasion, stage II–III disease, or non-endometrioid histology. All patients received four cycles of paclitaxel–carboplatin followed by pelvic radiotherapy with concurrent cisplatin. Survival outcomes, including local recurrence-free survival, disease-free survival, metastasis-free survival, and overall survival, were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Acute hematologic toxicity was graded according to CTCAE v5.0. Bone marrow dose–volume parameters were evaluated, and receiver operating characteristic curve analysis was performed to identify thresholds associated with grade ≥ 2 hematologic toxicity. Results: Fifty-two patients were included, with a median follow-up of 31.4 months. Five-year overall survival and disease-free survival rates were 86.1% and 77.5%, respectively. Ten patients relapsed, with distant metastases observed in all cases and synchronous local recurrence in one. Delays between surgery and radiotherapy of 20 weeks or more, as well as delays exceeding 10 weeks before initiation of chemotherapy, were associated with significantly reduced disease-free survival. Grade ≥ 2 hematologic toxicity was frequent, and neutropenia was associated with inferior overall survival. Bone marrow dose–volume thresholds predictive of hematologic toxicity included V40 Gy < 20–25% and V30 Gy < 40%. Conclusions: A chemotherapy-first adjuvant strategy provides favorable oncologic outcomes and excellent locoregional control in high-risk endometrial cancer when radiotherapy is delayed. However, increased hematologic toxicity highlights the importance of optimized bone marrow sparing. Full article

Background: Primary fibula tumours are rare, representing approximately 0.25% of all primary bone tumours. While benign lesions are often asymptomatic, malignant ones typically present with pain and functional impairment. Most tumours arise in the proximal third of the fibula, yet the literature regarding their epidemiology and clinicopathological features remains limited. This systematic review aims to synthesise current evidence on presentation, diagnosis, management, and prognosis of primary malignant tumours of the proximal fibula. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and the Cochrane Register were searched on 28 October 2025 for English-language case reports and case series on primary malignant tumors of the proximal fibula. Two reviewers independently performed study selection and data extraction, collecting information on demographics, tumor characteristics, diagnostic approaches, treatments, and outcomes, with disagreements resolved by a third reviewer. Results: Thirty-three papers involving 228 patients (78 females, 128 males, 22 unknown) were included. The mean age at diagnosis was 22.8 years (range 4–79). The most common symptoms were painful mass and neurological complaints. Osteosarcoma and Ewing’s sarcoma were predominant histological types. Limb-sparing surgeries were most common, although 16 patients underwent amputation. At mean follow-up of 48.9 months, local recurrence occurred in 44 cases, and 12 developed distant metastases, most commonly in the lungs. Overall, 38 patients died, 37 due to disease progression. Conclusions: Primary malignant tumours of the proximal fibula, while rare, pose significant therapeutic challenges. Accurate diagnosis, appropriate multimodal treatment, and careful surgical planning are crucial to optimise oncological control and functional outcomes. Full article

Background and Objectives: Organ dysfunctions affect the quality of bone and body fluids. This case report seeks links between the underlying conditions of three patients undergoing hip arthroplasty (HA) with uncemented implants, the quality of their bones, and their Ti-6Al-4V orthopaedic implants, on different time spans. Femoral stems are investigated. A brief review supports our findings. Materials and Methods: Cases: two women (F1 35+, F2 80+), and one man (M 65+), all having diabetes, dyslipidaemia, and kidney dysfunction. Samples: a segment of a broken 7-year-old stem, bone with a metallic layer, soft tissue, segments of one spare stem, and synthetic plasma enriched with glucose and urea according to the biochemistry tests of the respective patients. Vast studies show that cholesterol influences bone quality only. The stem pieces were ultrasonicated for 7 h at 37 °C in synthetic plasma. Scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDX), and profilometry investigated the Ti-alloy samples, electrochemistry analysed the post-sonication plasma, and histopathology examination was performed on the soft tissue remnants on the broken stem. Results: EDX show that all stem samples are Ti-6Al-4V with minute additions of other elements and hydroxyapatite (HAp) coating. SEM and profilometry analysis are consistent for the roughness in the outer layers of the stems. Electrochemistry on the bone fragment shows migration of vanadium during the 6 months since fracture to revision for M. Conclusions: Stems in altered synthetic plasma are affected by glucose and urea. Metal migration from the prostheses can occur through the chemical interactions between body fluids with abnormal biochemistry and the orthopaedic prostheses, favoured by cracks and concurring with wear following friction during usual movements. Cholesterol influences on the bone quality. Full article

Background and Clinical Significance: Tyrosine kinase inhibitors (TKIs) have transformed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) into a largely manageable chronic disease. However, off-target toxicities are increasingly recognized; rarer complications such as bone marrow edema (BME) remain underreported. BME is a radiological syndrome characterized by excess intramedullary fluid on fat-suppressed T2/STIR magnetic resonance imaging sequences and may progress to irreversible osteochondral damage if unrecognized. We report a case series of TKI-associated BME and propose a practical diagnostic-therapeutic framework. Case Presentation: We describe three patients with Ph+ CML who developed acute, MRI-confirmed BME of the lower limb during TKI therapy. Case 1 developed unilateral then bilateral knee BME, temporally associated first with dasatinib and subsequently with imatinib; symptoms improved after TKI interruption, bisphosphonate therapy, and supportive measures, and did not recur after switching to bosutinib. Case 2 presented with proximal femoral BME during long-term imatinib; imatinib was stopped, intravenous neridronate administered, and bosutinib initiated with clinical recovery and later near-complete radiological resolution. Case 3 experienced multifocal foot and ankle BME during imatinib; symptoms resolved after drug discontinuation and bisphosphonate therapy, and disease control was re-established with bosutinib without recurrence of BME. All patients underwent molecular monitoring and mutational analysis to guide safe therapeutic switching. Discussion: Temporal association across cases and the differential kinase profiles of implicated drugs suggest PDGFR (and to a lesser extent, c-KIT) inhibition as a plausible mechanistic driver of TKI-associated BME. PDGFR-β blockade may impair pericyte-mediated microvascular integrity, increase interstitial fluid extravasation, and alter osteoblast/osteoclast coupling, promoting intramedullary edema. Management combining MRI confirmation, temporary TKI suspension, bone-directed therapy (bisphosphonates, vitamin D/calcium), symptomatic care, and, when required, therapeutic switching to a PDGFR-sparing agent (bosutinib) led to clinical recovery and preservation of leukemia control in our series. Conclusions: BME is an underrecognized, potentially disabling, TKI-related adverse event in CML. Prompt recognition with targeted MRI and a multidisciplinary, stepwise approach that includes temporary TKI adjustment, bone-directed therapy, and consideration of PDGFR-sparing alternatives can mitigate morbidity while maintaining disease control. Prospective studies are needed to define incidence, risk factors, optimal prevention, and management strategies. Full article

Background/Objectives: Vertical ridge augmentation (VRA) is often necessary in severe bone atrophy, yet the most predictable approach remains unclear. This systematic review compared Guided Bone Regeneration (GBR) and the Shell Technique (ST) for vertical bone gain (VBG), bone quality, complications, patient-reported outcomes (PROMs), and implant survival. Methods: Following PRISMA 2020 and PROSPERO registration (CRD420251128502), PubMed and Scopus databases were searched. Adults requiring VRA before implants were included. Interventions were GBR using titanium-reinforced dense PTFE (Polytetrafluoroethylene) or collagen membranes and ST using autogenous or allogeneic cortical plates. Results: Both techniques achieved clinically meaningful vertical augmentation. Median VBG was 4.24 mm for GBR (range 2.20–8.78 mm) and 5.16 mm for ST (range 3.10–7.60 mm) at re-entry (typically 4–9 months). Long-term series showed maintained gains for ST up to 10 years and multi-year stability after GBR in selected cohorts. Major early-healing complications were uncommon with both methods. Minor soft-tissue events varied; several GBR cohorts reported more exposures/dehiscence and occasional infections. Implant survival was uniformly high; validated PROMs were seldom reported. Conclusions: GBR and ST both enable vertical reconstruction sufficient for implant placement. ST tended toward higher median VBG but requires greater technical expertise and, when autogenous, adds donor-site morbidity; allogeneic shells reduce harvesting needs. GBR remains a versatile, donor-site-sparing alternative. Standardized outcome (including validated PROMs) reporting and head-to-head randomized trials are needed to refine case selection and confirm comparative effectiveness. Full article

Despite advances in staged protocols and fixation techniques, treatment of pilon fractures remains a significant challenge in orthopedic trauma, with up to 21% of patients requiring revision surgery. Management of a pilon fracture that has failed initial treatment involves navigating a myriad of complicating variables, including infection, bone loss, malalignment, and nonunion. Although no single surgical approach can be aptly applied to the broad range of pathology and severity spanned by these patients, this narrative review provides a systematic framework for developing a revision pilon reconstruction plan. We present a protocol for pre-operative assessment and review current techniques for infection eradication, bone defect management, deformity correction, and joint-preserving versus joint-sparing surgery. These fundamental strategies form the foundation of a successful salvage plan and can be personalized to address specific fracture morphology, host factors, and goals of care. Full article

Background: We evaluated certain factors relative to onion (Allium spp.) and onion-derived polyphenols. Methods: We searched PubMed, Scopus, and Google Scholar from 2010 to 20 October 2025 without language limits. Eligible designs comprised of in vitro, animal, and human studies assessing onion, onion extracts, or isolated onion-derived polyphenols with bone outcomes. Two reviewers independently screened, extracted, and assessed risk of bias (RoB 2 for RCTs; SYRCLE for animals). Results: We included X studies (a in vitro, b animal, and c human RCTs; N samples). In vitro limitations included the following: heterogeneous models, short human follow-up, small samples, and moderate-to-serious risk of bias in animals. Reports included improvements in bone mineral density (BMD), bone mineral content (BMC), bone turnover markers, and osteoclast/osteoblast activity. Onion extracts consistently inhibited RANKL-induced osteoclastogenesis while sparing osteoblast function. In animals, onion or quercetin/kaempferol preserved BMD and improved mineral content and (in several models) fracture healing. In one small RCT of onion juice (8 weeks), antioxidant status improved with a trend to attenuated BMD loss; a resveratrol RCT was excluded/included as a benchmark. Conclusions: Pre-clinical evidence suggests anti-resorptive and osteogenic effects of onion-derived polyphenols; human evidence is limited and characterized by low certainty. Longer RCTs are needed to define effective doses and clinical relevance. Full article

Background/Objectives: Human ovarian granulosa cells (hGCs) are crucial to ovarian follicle development and function, exhibiting multipotency and the ability to differentiate into neuronal cells, chondrocytes, and osteoblasts in vitro. 3,4,5,4′-tetramethoxystilbene (DMU-212) is a methylated derivative of resveratrol, a natural polyphenol found in grapes and berries, with a wide spectrum of biological activities, including notable anticancer properties. Interestingly, DMU-212 exhibits cytotoxic effects predominantly on cancer cells while sparing non-cancerous ones, and evidence suggests that similar to resveratrol, it may also promote hGC differentiation. This study aimed to investigate the effects of the liposomal formulation of this methylated resveratrol analog—lipDMU-212—on the osteogenic differentiation ability of hGCs in a primary three-dimensional cell culture model. Methods: lipDMU-212 was formulated using the thin-film hydration method. GC spheroids’ viability was evaluated after exposure to lipDMU-212, an osteoinductive medium, or both. Osteogenic differentiation was confirmed using Alizarin Red staining and quantified by measuring Alkaline Phosphatase (ALP) activity on days 1, 7, and 15. RNA sequencing (RNA-seq) was performed to explore molecular mechanisms underlying lipDMU-212-induced differentiation. Results: lipDMU-212 promoted osteogenic differentiation of hGCs in the 3D cell culture model, as evidenced by increased mineralization and a ~4-fold increase in ALP activity compared with the control. RNA-seq revealed up-regulation of genes related to cell differentiation and cellular identity. Furthermore, JUN (+2.82, p = 0.003), LRP1 (+2.06, p = 0.05), AXIN1 (+3.02, p = 0.03), and FYN (+3.30, p = 0.01) were up-regulated, indicating modulation of the Wnt/β-catenin signaling pathway, a key regulator of osteoblast differentiation. Conclusions: The ability of GCs to differentiate into diverse tissue-specific cell types underscores their potential in regenerative medicine. This study contributes to the understanding of lipDMU-212’s role in osteogenic differentiation and highlights its potential in developing future therapies for degenerative bone diseases. Full article

Background/Objectives: Resection arthroplasty is well established in treating bone defects following tumor resection, with the distal femur and proximal tibia being its most common localizations. The aim of this study was to analyze the functional outcomes and quality of life following endoprosthetic reconstruction for malignant bone tumors of the knee joint. Methods: We retrospectively included all patients treated with an endoprosthetic reconstruction following resection of a malignant bone tumor of the knee at our institution. Functional outcomes (KOOS, OKS, MSTS, and KSS) and health-related quality of life scores [QoL] (SF-36, Karnofsky Index) were evaluated. Chi-square and Fisher’s exact test was used for categorical variables, T-test and Whitney U-Mann tests for continuous variables. Survival was calculated using the Kaplan–Meier curves. Results: 32 patients were included. A total of 12 patients had died at the time of follow-up. Among the remaining 20 patients (m:w 17:3), mean follow-up was 8.1 years (range, 8.12 ± 6.8). Mean age at the time of tumor diagnosis was 50 ± 23.3 (10–83) years. According to age, patients were divided into two groups (group C1: <29 years, group C2: >29 years). Group C1 showed significantly better results regarding functional outcome (p < 0.05). The anatomic location of the replacement and a revision surgery did not influence the functional outcome (p > 0.05). QoL showed no significant differences in subgroup analysis (p > 0.05). Primary bone tumors had a significantly better survival (primary tumor: 216.90 months [168.42–265.83]; secondary tumor: 37.03 months [11.71–62.35] p = 0.01). Furthermore, pathologic fractures were associated with significantly worse survival (pathologic fracture: 50.24 months [0.00–102.43]; pathologic fracture 190.63 moths [139.28–241.45]; p = 0.007). Conclusions: Knee resection arthroplasty can offer meaningful long-term functional outcomes and acceptable quality of life in selected patients with musculoskeletal tumors. While the rarity and heterogeneity of such cases remain a challenge, our findings contribute to the growing evidence supporting this complex but limb-sparing surgical option. Full article

Anterior cruciate ligament (ACL) injuries in skeletally immature patients pose unique clinical and surgical challenges due to the presence of open physes and ongoing growth. In recent years, multiple surgical strategies have been developed to restore knee stability while minimizing the risk of growth disturbances. However, clinical decision-making remains complex due to the lack of consensus regarding the optimal timing, technique, and graft selection for this population. This narrative review outlines the current clinical and radiological tools used to assess skeletal maturity and explores how maturity status informs surgical approach, with particular emphasis on physeal-sparing, hybrid, and transphyseal techniques. We summarize postoperative complications—including growth disturbances and graft failure—while highlighting current guideline recommendations and ongoing controversies. Lastly, we propose a multimodal model for skeletal maturity assessment to support individualized treatment strategies and emphasize the need for standardized protocols and high-quality research to improve long-term outcomes in pediatric ACL reconstruction. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article