Search Results (203)

Background/Objectives: Complex AO type C distal radius fractures remain amongst the most difficult injuries to treat, often requiring advanced fixation techniques. This systematic review focuses on two commonly used strategies for complex injuries: combined dorsal and volar plating and dorsal bridge plating. The goal is to examine reported functional and radiographic outcomes as well as complications of both techniques. Methods: A search was conducted across Embase, Medline, and Web of Science following PRISMA guidelines. Studies were included if they reported clinical or radiographic outcomes in adult patients with complex distal radius fractures treated using either combined dorsal and volar plating or dorsal bridge plating. Results: Sixteen studies were included, encompassing a total of 629 distal radius fractures, 419 treated with combined plating and 210 with bridge plating. Both techniques were associated with improved wrist function and satisfactory radiographic alignment. The weighted mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 12.07 for combined plating and 25.20 for bridge plating. Radiographically, both techniques restored acceptable volar tilt, with a weighted mean of 5.97° for combined plating and 3.32° for bridge plating. Overall complication rates were low, with reported infection rates of 2.86% for both techniques. Revision rates for complications were 4.30% and 5.71% in dual and bridge plating, respectively. Tendon injuries occurred in 1.19% of patients after combined plating and 1.43% after spanning fixation. Conclusions: This review highlights the promising results of both combined plating and dorsal bridge plating in the treatment of complex distal radius fractures. As surgeons continue to navigate these challenging injuries, further comparative studies are required to determine the optimal management strategy. Full article

Background/Objectives: Pediatric distal diametaphyseal radius fracture (DDRF) occurs in a challenging transitional zone between the metaphysis and diaphysis, presenting distinct biomechanical characteristics. This study compared outcomes of plate versus Kirschner wire (K-Wire) fixation—including different configurations—in a consecutive cohort of pediatric unstable DDRF. Methods: We conducted a single-center retrospective review of 63 patients (aged 6–15 years) treated between 2023 and 2025, divided into plate (n = 26) and K-Wire (n = 37) groups. The K-Wire cohort was subclassified as bicortical (n = 14), bicortical + intramedullary (n = 10), and intramedullary alone (n = 13). Outcomes included alignment quality, fracture healing by modified RUST (mRUST), and the Forearm Fracture Index (FFI). Multivariable regression was used to adjust for confounding. Results: Plate patients were older (11.92 ± 2.87 vs. 9.32 ± 2.96 years, p < 0.05) and heavier (43.23 ± 11.31 vs. 30.84 ± 11.19 kg, p < 0.001) and had higher FFI (median 1.13 vs. 1.09, p < 0.05). Multivariable regression showed plate fixation was independently associated with good alignment (adjusted OR = 14.48, p = 0.018). Bicortical K-Wires yielded the highest alignment rate among percutaneous techniques (85.7%), while bicortical + IM showed poor outcomes (0% good). The unadjusted 1-month healing advantage of K-Wires (mRUST 2.53 ± 0.60 vs. 2.19 ± 0.47, p = 0.022) was non-significant after adjusting for body weight (p = 0.248). The complication rate was low (3.2%, 2/63). At final follow-up (range 6–18 months), all patients demonstrated unrestricted wrist motion and forearm rotation, and functional outcomes were assessed clinically without validated patient-reported outcome measures. Conclusions: Plate fixation independently predicts superior alignment, whereas the K-Wire group’s higher 1-month mRUST scores were attributable to their younger, lighter profile rather than the implant itself. Among K-Wire options, bicortical configuration achieves reduction quality comparable to plates, while the bicortical + IM configuration should be avoided. In this cohort, plate fixation was more common among older, heavier patients with higher FFI, whereas younger, lighter patients more often received K-Wires; both methods demonstrated low complication rates. Full article

Background/Objectives: Distal radius and carpal fractures are common injuries in emergency radiology, where accurate lateral wrist positioning is essential for diagnostic image quality. Maintaining a true lateral position can be challenging, often requiring manual support and increasing occupational radiation exposure. This pilot phantom study aimed to design, fabricate, and evaluate a novel 3D-printed wrist immobilization device and compare its performance with adhesive tape and sandbag stabilization. Methods: A wrist immobilization device was designed using computer-aided design software and fabricated by fused deposition modeling with polylactic acid. A wrist phantom was imaged using three stabilization techniques: the 3D-printed device, adhesive tape, and sandbag support. Image quality was independently assessed by two blinded observers using an eight-point scoring system. Inter-rater reliability was evaluated using the intraclass correlation coefficient (ICC). Positioning time was recorded, and radiopacity was assessed using pixel intensity measurements within predefined regions of interest. Results: No significant differences in image quality were observed among the three stabilization techniques (p = 0.263). Inter-rater reliability was excellent (ICC = 0.877). Positioning time differed significantly among techniques (p = 0.036), with sandbag stabilization requiring the shortest time. Radiopacity analysis demonstrated minimal attenuation (8.6–20.8%) in regions adjacent to the anatomical area of interest, while higher attenuation was limited to non-diagnostic regions. Conclusions: The 3D-printed wrist immobilization device produced image quality comparable to conventional stabilization methods with minimal radiographic interference. These findings support its feasibility as a low-cost positioning aid and warrant further evaluation in larger clinical studies. Full article

Distal radial and ulnar fractures in miniature- and toy-breed dogs are associated with high rates of delayed union, non-union, and refracture. This retrospective observational study evaluated the outcomes of simple distal radial and ulnar fractures treated by open reduction and internal fixation using a locking plate in a non-rigid configuration. Ten fractures in eight dogs weighing less than 5 kg were included. Cases were selected according to predefined biomechanical construct criteria, including a plate bridge ratio > 0.7, plate span ratio > 10, plate working length > 40% of the plate length, and screw density < 0.6. The median radiographic follow-up was 224 days (range, 46–408 days). Radiographic bone healing was achieved in all cases, with a mean time to union of 53 days (range, 28–113 days), and healing occurred faster in skeletally immature dogs. Indirect bone healing with callus formation was observed in 7 of 10 fractures. Minor postoperative complications occurred in three cases and resolved with local treatment. No implant failures or refractures associated with previous screw holes were observed. A reduction in ulnar thickness was identified in evaluable cases, although this finding remained stable during follow-up and did not appear clinically relevant. These findings suggest that locking plate fixation in a non-rigid configuration provides reliable bone healing with a low complication rate in simple distal radial and ulnar fractures of miniature- and toy-breed dogs. Full article

Pediatric wrist fractures are among the most prevalent musculoskeletal injuries in children. Fracture subtype, including buckle/torus, greenstick, and Salter–Harris physeal injuries, directly influences management and prognosis. Subspecialty radiographic expertise required for subtype classification is not universally available in emergency or resource-limited settings. Deep learning (DL) offers an automated approach to fracture subtype recognition from plain radiographs. This pilot study evaluated convolutional neural network (CNN)-based five-class pediatric wrist fracture classification using the GRAZPEDWRI-DX dataset.A total of 940 pediatric wrist radiographs from GRAZPEDWRI-DX (figshare ID 14825193) were labeled using Arbeitsgemeinschaft fur Osteosynthesefragen (AO) pediatric codes into five classes: no fracture, buckle/torus, greenstick, Salter–Harris physeal fracture, and other fracture. Contrast-limited adaptive histogram equalization (CLAHE) and letterbox resizing to 224 × 224 pixels were applied. Patient-level stratified splits (70/15/15%) prevented data leakage. Three ImageNet-pretrained architectures (DenseNet-169, ResNet-50, and EfficientNet-B4) underwent two-phase transfer learning. Performance was assessed by balanced accuracy, macro F1, macro area under the receiver operating characteristic curve (AUROC), and Cohen’s kappa.DenseNet-169 achieved the highest balanced accuracy (0.371; 95% confidence interval [CI]: 0.289–0.448), macro F1 (0.334; 95% CI: 0.251–0.416), and macro AUROC (0.669), with Cohen’s kappa of 0.269 on the held-out test set (n = 139) under initial five-epoch pilot training conditions. All three networks exceeded a majority-class (no-information) baseline (balanced accuracy 0.20). Extending training to 50 epochs (approximately 2100 mini-batch iterations) with GPU acceleration substantially improved DenseNet-169 to a balanced accuracy of 0.532 (95% CI: 0.451–0.614), macro F1 of 0.516, and macro AUROC of 0.815, with statistically significant pairwise architecture differences (McNemar p < 0.01); per-class sensitivity was highest for no-fracture detection (0.969) and lowest for buckle/torus fractures (0.393). Gradient-weighted class activation mapping (Grad-CAM) confirmed anatomically coherent model saliency at the distal radial metaphysis and physeal plate.DenseNet-169 achieved the best five-class classification performance among evaluated architectures under pilot training conditions, and extended training substantially improved accuracy, although classification accuracy remained below clinically usable thresholds. These results establish a reproducible, patient-stratified DL pipeline and a benchmark for full-dataset training and future methodological development, rather than a clinically deployable tool. Full article

Background: Distal radius fractures (DRFs) are common fragility fractures often associated with underlying osteoporosis. Objective: To evaluate the effect of nutraceutical supplementation in addition to pulsed electromagnetic field (PEMF) therapy on pain and early fracture healing. Methods: Sixty female patients were randomized into two groups: Group A received PEMF therapy alone, while Group B received PEMF plus nutraceutical supplementation. The primary outcome was pain reduction (NRS). Secondary outcomes included biochemical markers and ultrasound-based callus formation. Results: At T1, Group B showed a trend toward greater pain reduction compared with Group A (mean difference −0.57; p = 0.007) and higher bone alkaline phosphatase levels (p = 0.0002). A higher proportion of patients reached minimal clinically important difference (MCID) in Group B (60% vs. 30%, p = 0.02). Conclusions: Nutraceutical supplementation in addition to PEMF was associated with improved short-term outcomes; however, due to the absence of a non-PEMF control group, the independent effect of PEMF cannot be determined. Full article

Background: Distal radius fractures (DRFs) are the most common upper limb fractures worldwide. The main goal of DRF treatment is to achieve optimal functional outcomes with the lowest complication rate as rapidly as possible. Achieving full limb function may be delayed by emerging complications or, in some cases, may never occur. Preserving muscle strength and as full a range of motion (ROM) in the wrist as possible are key in DRF management since they enable patients to perform the activities of daily living. The purpose of this study was to assess the effect of ossein–hydroxyapatite complex (OHC), used as an adjunct in conservative DRF treatment, on muscle strength and ROM. Methods: This was a prospective randomized clinical study. We assessed 31 patients who underwent non-surgical DRF treatment at our center in the years 2024–2025 and were receiving OHC throughout their fracture treatment. K-Grip and K-Push dynamometers were used to measure the maximum and average muscle strength via tests of grip strength, palmar flexion, and dorsal flexion. Wrist ROM was also evaluated. The results were compared with those of the control group (31 patients receiving DRF treatment without OHC) and with the intact limb. Results: The medians of the maximum muscle strength in each test were comparable between the study groups. Both groups showed a higher median average strength in the intact limb than in the treated limb. We observed no intergroup differences in wrist ROM, with ROM parameters lower in the fractured limb than in the intact limb. Conclusions: The additional use of OHC was not associated with statistically significant improvements in functional outcomes. The patients from both groups achieved worse muscle strength and ROM outcomes in the fractured than in the intact limb. We recommend a longer and more intense rehabilitation of patients with DRFs. More studies on this topic are needed in order to unequivocally verify the effects of OHC on functional parameters in fracture patients. Full article

Background: Forearm fractures involving both bones are common orthopedic injuries. Children have a higher tolerance for greater displacement and angulation owing to the remodeling potential. The optimal fixation method for managing pediatric forearm fractures has not been definitively established. This study evaluated the safety and efficacy of a stepwise surgical algorithm, wherein single-bone plating was attempted first, and both-bone fixation was strictly reserved for cases demonstrating persistent intraoperative instability. Methods: In this retrospective analysis, we evaluated 48 skeletally immature children with both-bone forearm fractures managed via our stepwise protocol. Initially, single-bone plating was performed. Dynamic manual stress testing was then applied under fluoroscopy. If the unplated bone exhibited rotational instability, residual angulation >15°, or translation >50%, the procedure was converted to both-bone plating (Group B, n = 16). Patients who achieved stable alignment without requiring a second plate formed Group A (n = 32). Results: Both groups achieved 100% union. Postoperative angulations of the radius on the anteroposterior view were 1.91 ± 2.73° in Group A and 0.88 ± 1.96° in Group B; meanwhile, the lateral angulation of the radius in Groups A and B was 1.88 ± 3.56° and 0.00 ± 0.00°, respectively. The anteroposterior angulation of the ulna was 2.31 ± 3.60° in Group A and 2.19 ± 4.00° in Group B, whereas the lateral angulation of the ulna was 2.81 ± 3.74° in Group A and 1.75 ± 3.47° in Group B. Only the lateral angulation of the radius showed a significant difference (p = 0.0418). In the subgroup analysis, minor differences in ulna angulation on the anteroposterior view reached statistical significance in the older cohort (p = 0.027) and in the distal-third fracture group (p = 0.001). No differences in bone healing or functional outcomes were observed, and complication rates were similar. Conclusion: Our stepwise surgical algorithm appears to be a safe and effective approach. By adhering to this protocol, 66.7% of patients were successfully spared the morbidity of a second incision, while all patients achieved solid union and excellent functional outcomes. However, further high-quality studies are essential to establish comprehensive protocols for intraoperative stability assessment and postoperative care. Full article

Background and Clinical Significance: Acute compartment syndrome is a rare but limb-threatening emergency in pediatric patients. While most cases follow high-energy trauma or displaced fractures, acute compartment syndrome precipitated by initially underestimated forearm injuries is uncommon and may create a significant diagnostic challenge, particularly in young children who exhibit atypical clinical presentations, such as escalating anxiety and analgesic requirements, rather than classic ischemic signs. Case Presentation: We report the case of a 4-year-old girl who developed severe forearm and hand compartment syndrome following a delayed presentation after a fall from a height of 2–2.5 m onto the left upper extremity. Initial evaluation revealed progressive tense swelling, severe pain with passive stretch, diminished distal perfusion, and radiographic evidence of distal radius-ulna buckle fractures associated with a proximal ulna fracture. Emergent surgical decompression via extensive volar and dorsal fasciotomies revealed markedly elevated compartment pressures. Intraoperatively, deep volar muscle ischemia and necrosis were identified, requiring carpal tunnel release, serial debridements, and complex staged wound management. Multidisciplinary care and ongoing rehabilitation were essential for limb salvage and functional recovery. Conclusions: This case underscores the profound unpredictability of pediatric compartment syndrome and demonstrates that even classically stable, benign fractures can initiate a devastating ischemic cascade. A high index of suspicion, regardless of the injury mechanism, along with early recognition and prompt surgical intervention, is absolutely critical for preventing irreversible myoneural damage and optimizing management outcomes in pediatric patients. Full article

Bone densitometry in osteoporosis diagnosis via dual-energy X-ray absorptiometry (DXA) can benefit from advances in imaging detector technology. We devised a compact imaging scanner—DXA4A—using a photon-counting and energy-sensitive Timepix4 hybrid pixel detector (512 × 448 pixels, 55 µm pitch), for areal bone mineral density (aBMD) assessments in the distal radius and tibia in the clinic and for future in-flight astronauts’ bone health assessment. We present the design and Monte Carlo simulations of the scanner. A Timepix4 detector with a 1 mm thick CdTe sensor was tested in the laboratory with X-ray tube sources, acquiring first images of test samples. Monte Carlo simulations were implemented for scanner design and performance prediction, using 50 kVp unfiltered and 100 kVp Sm K-edge filtered spectra. With a digital twin of the scanner and patient wrist, we set up a virtual imaging study and determined the aBMD in the forearm of a patient (0.515 ± 0.048 g/cm²), in agreement with the clinical DXA value (0.571 g/cm² for the total forearm). This study highlights the feasibility of realizing a compact DXA scanner for the distal tibia and radius with spectral capabilities, exploiting Timepix4 hybrid detectors for its peculiar energy sensitivity and photon event timing properties for tissue identification. Full article

Background: Primary hyperparathyroidism (PHPT) has undergone notable clinical changes over recent decades, with asymptomatic cases now prevailing in Western countries. In contrast, a broad spectrum of clinical manifestations remains common in Romania, an Eastern European country. This study aims to provide a representative descriptive analysis of clinical presentations and related complications observed in this setting. Methods: We performed a cross-sectional, single-center study of 413 consecutive PHPT cases diagnosed between 2000 and 2020 at a tertiary endocrinology center in Romania. Data included demographics, clinical features, biochemistry, bone turnover markers, 25OHD, BMD by DXA, TBS, fractures, renal involvement, and etiology. Results: Patients were predominantly female (88.6%), with a mean age of 60 ± 11.7 years and a mean BMI of 27.3 ± 5.7 kg/m². Familial forms were identified in 4.4%. Mean serum calcium was 11.28 ± 1.09 mg/dL, mean PTH 248.31 ± 361.94 pg/mL, and mean 25OHD 17.95 ± 9.6 ng/mL. Symptomatic hypercalcemia was present in 23.2% and severe vitamin D deficiency in 21%. Fractures were present in 25.2% and osteitis fibrosa cystica in 1.7%. Mean T-scores (SD): LS –2.23, FN –1.85, 1/3 distal radius –1.96. Osteoporosis prevalence: LS 47%, FN 24.1%, 1/3 distal radius 38%. Mean TBS was 1.258 ± 0.115. Renal involvement included calcifications (56.7%), nephrolithiasis (53%), nephrocalcinosis (3.6%), hypercalciuria (31.7%), and reduced renal function (9.93%). Non-classical manifestations were mainly cardiovascular (58%) and osteoarticular (24.5%). Parathyroidectomy was performed in 217 patients (53%); histopathology showed adenoma (88.8%), carcinoma (5.2%), and hyperplasia (6%), with a mean adenoma weight of 2.86 ± 5.92 g. Conclusions: PHPT in Romania shows a heterogeneous phenotypic spectrum, reflecting variability in clinical presentation and suggesting an evolving epidemiological profile. Full article

Background/Objectives: Wrist fractures are common paediatric injuries, yet some remain radiographically occult. The Pronator Quadratus Sign (PQS), defined by displacement or alteration of the fat stripe overlying the pronator quadratus muscle (PQm), remains a debated radiologic diagnostic marker. This study evaluated whether PQS can serve as a diagnostic adjunct for wrist fractures and whether specific PQS morphological types are associated with different fracture patterns. Methods: This retrospective study included paediatric patients presenting with wrist trauma. Radiographs were categorized into three groups: no fracture, torus fracture, and other non-displaced distal radius fractures. PQS morphology was classified using a six-tier system. Quantitative assessment included measurement of the anterior distance from the distal radius to the external border of the pronator quadratus muscle (X) and radial width (R), expressed as the X/R ratio to standardize comparisons. Results: A total of 247 patients were included. The X/R ratio differed significantly among groups (p < 0.001), with higher values observed in patients with fractures. ROC analysis demonstrated good discrimination performance between no fracture and non-displaced distal radius fractures (AUC = 0.80), but limited performance for torus fractures (AUC = 0.62). Although PQS morphology alone was not a reliable indicator of fracture presence, the distribution of PQS types—representing distinct patterns of pronator quadratus fat stripe appearance and displacement—differed significantly across fracture groups (p < 0.001). Conclusions: Quantitative PQS assessment using the X/R ratio is associated with improved discrimination for non-displaced distal radius fractures, while PQS morphology alone shows limited diagnostic utility. Further prospective studies incorporating magnetic resonance imaging are warranted to clarify its role in occult fracture detection. Full article

Background and Objectives: Pediatric forearm fractures are among the most common childhood injuries. COVID-19-related societal restrictions, including school closures and suspension of sports activities, altered children’s daily routines and may have influenced injury patterns. This study aimed to evaluate whether periods of stricter COVID-19 restrictions were associated with changes in the incidence of pediatric distal and diaphyseal forearm fractures after accounting for seasonal variation and long-term temporal trends. Materials and Methods: This retrospective observational time-series study analyzed pediatric patients aged 0–17 years who underwent forearm radiography between January 2018 and June 2023 at a tertiary pediatric trauma center. Cases with radiologically confirmed distal or diaphyseal forearm fractures or epiphyseal injuries were included. Monthly fracture counts were analyzed using generalized linear models with logarithmic link functions. Exposure variables included a COVID-19 restriction index based on governmental measures and a binary pandemic indicator. Seasonal variation and long-term temporal trends were included as covariates. Results: A total of 5702 forearm radiographs were identified, of which 4041 trauma-related presentations met the inclusion criteria. Among these, 2014 children had confirmed forearm fractures. Boys accounted for 61% of cases, and the median age was 9 years (IQR 5). Most fractures were treated conservatively (88%). The most frequent injury mechanisms included soccer-related injuries (9.6%) and bicycle falls (7.3%). In regression analyses adjusted for seasonal variation and temporal trends, neither the COVID-19 restriction index (IRR 1.01, 95% CI 0.87–1.17; p = 0.95) nor the pandemic period indicator (IRR 0.99, 95% CI 0.37–2.65; p = 0.98) was significantly associated with monthly fracture counts. The wide confidence interval of the pandemic indicator reflects limited statistical precision and suggests that both clinically relevant decreases and increases in fracture incidence cannot be excluded. Conclusions: No sustained long-term changes in the incidence or injury patterns of pediatric forearm fractures were observed during the COVID-19 pandemic. Temporary fluctuations during early lockdown phases were not independently associated with governmental restrictions after adjustment for seasonal variability and long-term trends. Full article

External skeletal fixation (ESF) is a versatile method for fracture management in neonatal calves but confers a significant risk of iatrogenic injury to vital structures. The aim of this ex vivo study was to systematically define safe, hazardous, and unsafe corridors for transcortical pin placement in the distal long bones (radius-ulna, tibia, metacarpus, and metatarsus) of Simmental calves to provide precise anatomical guidance. Six fresh Simmental calf cadavers without orthopaedic problems were included in the study. The forearm and hindlimb were disarticulated from the shoulder and hip joints, respectively. The radius-ulna, tibia, and metacarpal and metatarsal bones were dissected transversely from five anatomical levels. Safe, hazardous, and unsafe corridors were determined in each section. No safe corridor was found in the proximal metaphysis and proximal diaphysis of the radius-ulna. Safe corridors were found on the medial side of the radius-ulna, from the mid-diaphysis to the distal metaphysis. The metacarpal and metatarsal bones showed lateral and medial safe corridors. The tibia provided a continuous medial safe corridor. In conclusion, precise topographic mapping is vital for safe ESF. While anatomically safe corridors are the primary choice for ESF, hazardous corridors are viable alternatives if meticulously utilized. By contrast, unsafe corridors must be strictly avoided to prevent severe iatrogenic trauma. Full article

Background/Objectives: Proton pump inhibitors (PPIs) are widely used for the treatment of acid-related disorders. However, there are concerns that PPI use may be associated with an increased risk of osteoporosis and fractures. This study aimed to investigate the association between PPI use and the risk of osteoporosis and fractures using national data. Methods: Two nested case—control studies using Korean National Health Insurance Service-Health Screening Cohort (514,866 participants, 2002–2019). Study I: 68,719 osteoporosis patients matched 1:1 with 68,719 controls by age, sex, income, region. Study II: 72,456 fracture patients matched 1:1 with 72,456 controls, stratified by fracture site (distal radius [n = 25,882], hip [n = 7753], spine [n = 38,821]). PPI use defined as prescription 1-year preceding index date: current users (≤30 days) and exposed group (31–365 days). Associations were analyzed using propensity score overlap-weighted logistic regression. Results: For osteoporosis, current PPI use showed odds ratio (OR) = 37.4 (95% confidence interval [CI] 33.3–42.1, p < 0.001); exposed group OR = 2.62 (95% CI 2.32–2.96, p < 0.001). Duration-dependent relationship observed: <30 days OR = 8.67, 30–180 days OR = 29.9, ≥180 days OR = 25.0. For fractures, current use associated with distal radius (OR = 37.4, 95% CI 28.8–48.7), hip (OR = 20.3, 95% CI 13.7–30.3), and spine (OR = 29.8, 95% CI 23.7–37.4). However, the exposed group showed no significant associations (distal radius OR = 1.24 p = 0.125; hip OR = 1.34 p = 0.174; spine OR = 1.26 p = 0.057). Conclusions: Current PPI use is strongly associated with increased odds of osteoporosis and fracture in the Asian population, with prominent duration—response relationship. Past PPI exposure showed no significant fracture risk. Healthcare providers should carefully assess bone health risks and consider lowest effective PPI doses. Full article