Search Results (54)

Background and Objectives: Routine laboratory markers may support diagnostic risk stratification for osteoporosis, but their incremental value beyond the Osteoporosis Self-Assessment Tool for Asians (OSTA) remains uncertain in referral-based practice. We evaluated whether serum uric acid, albumin, alkaline phosphatase (ALP), and systemic inflammatory indices improve prediction of DXA-defined osteoporosis beyond OSTA in postmenopausal women. Materials and Methods: This retrospective cross-sectional study included 3504 postmenopausal women referred for DXA between January 2021 and May 2025. Osteoporosis was defined as the lowest T-score ≤ −2.5 at the lumbar spine, total hip, or femoral neck. Sequential exclusions removed patients with chronic hepatobiliary disease, chronic systemic inflammatory disease, bone-active medication exposure, systemic glucocorticoid use, abnormal liver biochemistry, or missing required variables. Multivariable logistic regression assessed associations, and OSTA-based prediction models were internally validated using stratified 10-fold cross-validation. Results: Osteoporosis was present in 1660 women (47.4%). Higher BMI, uric acid, and albumin were independently associated with lower odds of osteoporosis, whereas ALP and calcium were associated with higher odds. OSTA alone achieved an AUC of 0.679. Adding uric acid, albumin, and ALP increased AUC to 0.695 and slightly improved the Brier score, with good calibration. Adding the systemic immune-inflammation index did not materially improve performance. Conclusions: Routine laboratory variables provided only modest incremental value beyond OSTA. The model should be interpreted as an exploratory referral-pathway prioritization approach, not as a standalone population-screening tool. It should not be used as a diagnostic surrogate for DXA or as a fracture-risk model. Full article

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies. Full article

Background: Critical upper airway obstruction caused by advanced laryngeal malignancy poses an extreme risk of airway loss during induction of anesthesia and instrumental airway management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a strategy to enable safe performance of high-risk airway interventions. However, reports on heparin-free protocols in this setting remain scarce. Methods: A 46-year-old male with progressive dyspnea caused by a large laryngeal tumor reducing the residual glottic lumen to ~1 mm was admitted urgently. Safe endotracheal intubation was deemed impossible. Elective heparin-free VV-ECMO was established under local anesthesia via percutaneous femoro-femoral cannulation before induction of general anesthesia. Results: Under ECMO support, a technically demanding tracheostomy and tumor biopsy were performed without hypoxemic episodes. VV-ECMO was maintained postoperatively for 48 h without systemic anticoagulation and was weaned without hemorrhagic or thrombotic complications. Histopathology confirmed squamous cell carcinoma grade 2; the patient was discharged home after initiation of systemic immunotherapy. Conclusions: Elective heparin-free VV-ECMO can provide effective and safe respiratory support for patients with critical airway obstruction undergoing high-risk airway procedures. Pre-emptive cannulation under local anesthesia, femoro-femoral access in anatomically compromised necks, and short heparin-free circuit runs mitigate both airway and hemorrhagic risk. Prospective studies are needed to establish standardized patient selection criteria and anticoagulation protocols. Full article

Proximal femoral fractures associated with osteoporosis are an important clinical problem, yet how bone quality independently influences stress distribution remains insufficiently understood. This study aimed to quantitatively compare surface stress distribution between normal and osteoporotic proximal femoral models using thermoelastic stress analysis (TSA). Fourth-generation composite femurs with identical external geometries were subjected to cyclic compressive loading at a 9° adduction angle, with different maximum loads applied to avoid structural failure (normal: 1900 N; osteoporotic: 1000 N). TSA was performed using an infrared lock-in system to obtain surface stress maps, and stress values were evaluated across key proximal regions and along the medial and lateral cortices. The osteoporotic group showed higher maximum stress values in the medial neck (−37.79 vs. −11.52 MPa), lateral neck (24.70 vs. 8.75 MPa), and intertrochanteric crest (−17.98 vs. −6.05 MPa), corresponding to approximately 1.8–3.5-fold increases compared with the normal model values normalized to 1000 N. Mean stress values were also higher by approximately 1.9–2.4-fold across regions. These results suggest that reduced bone quality is associated with increased proximal stress concentration. They may also help guide implant and fixation strategies, including stem selection and fixation configuration, by identifying regions susceptible to stress concentration under different bone quality conditions. Full article

Background/Objectives: Proximal femoral fractures (PFF) are associated with substantial morbidity and mortality in elderly patients. Early identification of individuals at increased risk of death remains challenging. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive and readily available biomarker reflecting systemic inflammation and physiological stress, but its role as a risk stratification tool in surgically treated PFF patients is not fully established. The aim of this study was to validate NLR as a prognostic biomarker for mortality risk stratification in elderly hip fracture patients by evaluating its independent association with mortality, establishing clinically relevant risk categories, and assessing its ability to identify distinct mortality risk groups. Methods: This retrospective cohort study included 1113 patients aged ≥ 65 years who underwent surgery for AO/OTA 31.A (trochanteric) or 31.B (femoral neck) proximal femoral fractures between January 2021 and February 2024 at a single institution. NLR was calculated from routine admission bloodwork. The primary outcome was all-cause mortality. Kaplan–Meier survival analysis stratified patients by clinically relevant NLR categories (<5, 5–10, >10). Cox proportional hazards regression identified independent predictors of mortality. ROC analysis was performed secondarily to identify an optimal binary threshold. Results: At mean follow-up of 33.9 months, overall mortality was 36.2% (352/972). Stratified survival analysis demonstrated a clear dose–response relationship, with mortality rates of 26.2%, 36.5%, and 54.4% for NLR < 5, 5–10, and >10, respectively (log-rank p < 0.001). In multivariable Cox regression, NLR remained independently associated with mortality (HR = 1.042, 95% CI: 1.032–1.053, p < 0.001) after adjusting for age and time to surgery. ROC analysis identified an optimal binary cut-off of 6.59 (AUC 0.614). Conclusions: Elevated preoperative NLR is independently associated with increased mortality following surgery for proximal femoral fractures, particularly in very elderly patients. Given its simplicity and universal availability, NLR may represent a useful adjunct for early perioperative risk stratification. Full article

Background/Objectives: To assess the clinical similarity in terms of efficacy, pharmacodynamics (PD), pharmacokinetics (PK), safety, and immunogenicity between MB09 (denosumab biosimilar) and the reference product [RP, (Prolia^®)] up to 18 months in women with postmenopausal osteoporosis (PMO). Methods: Women with PMO received three doses of 60 mg of MB09 or RP subcutaneously, every 6 months [two doses in the main treatment period and one dose in the transition period (TP)]. The primary efficacy endpoint was the percent change from baseline (%CfB) in lumbar spine bone mineral density (BMD). Secondary endpoints included other efficacy parameters and PD, PK, safety, and immunogenicity assessments. Results: A total of 555 subjects received MB09 (N = 278) or RP (N = 277). At month 12, %CfB in lumbar spine BMD was comparable between groups (MB09 versus Prolia) and met the predefined equivalence margins. Secondary efficacy endpoints—%CfB in lumbar spine BMD at 6 months and %CfB in hip and femoral neck BMD at 6 and 12 months—were similar between groups. PD marker (serum carboxy terminal cross linking telopeptide of type I collagen) was similarly suppressed in both groups, and the inhibition was maintained in the TP. PK results showed similar denosumab systemic exposure for MB09 and the RP. Both study treatments were well tolerated with similar safety profiles throughout the study period. The incidence of anti-denosumab antibodies was very low. Conclusions: MB09 demonstrated equivalent efficacy to the reference denosumab in women with PMO. All secondary efficacy endpoints, together with PD, PK, safety, and immunogenicity assessments, supported MB09 as a denosumab biosimilar (NCT05338086, EudraCT No. 2021-003609-24). Full article

Background: The clinical meaning of hip joint synovial cavity thickness (HJSCT) on ultrasound (US) in juvenile idiopathic arthritis (JIA) without effusion is uncertain. Methods: In this cross-sectional study, we analyzed 369 children (187 JIA; 182 controls) undergoing hip US at a referral center in Kraków, Poland. JIA examinations were performed upon initial referral, early in the care pathway. We excluded patients with hip effusion and pre-existing inflammatory, traumatic or degenerative hip pathology. HJSCT was defined as the distance from the outer capsule margin to the femoral neck cortex. We used a Toshiba Aplio 400 system with a 12 MHz probe to measure and derive mean bilateral HJSCT. Bilateral concordance was assessed. Iterative multivariable linear regression modeling was used to compare groups, adjusting for non-linear age effects (natural splines) and WHO height-for-age z-scores (HAZ). Results: Left–right HJSCT agreement was high (ICC 0.947; mean difference 0.03 mm; 95% limits of agreement −0.64–0.70). In unadjusted analysis, mean (SD) HJSCT was similar in JIA versus controls: 5.83 (1.09) vs. 5.95 (0.99) mm, respectively (p = 0.25). In the final model (adj. R2 0.656), HJSCT was strongly associated with age (non-linear, p < 0.001) but not significantly associated with HAZ (β = 0.04; p = 0.11) or JIA status (β = 0.07; p = 0.30). Predicted HJSCT showed a steep increment in childhood and plateau in adolescence. Conclusions: In children without hip effusion, HJSCT mainly reflects physiological growth and does not differ significantly between early JIA patients and healthy controls. These findings suggest that capsular thickening is not a reliable standalone marker for early disease in the absence of effusion. Full article

Background/Objectives: Femoral anteversion (FA) is the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Surgeons generally estimate intraoperative femoral stem anteversion visually relative to the PCA, but this method can be challenging even for experienced surgeons. This study aimed to find an anatomical proximal landmark within a CT coordinate system for intraoperative estimation of femoral stem anteversion. Methods: Seventy patients were included. The anterior lesser trochanter line (ALTL) was defined as the line passing through two tangent points: one between the rounded part of the lesser trochanter and the medial edge of the anterior lesser trochanter cortex, and the other between the anterior cortex of the femur and the lateral edge of the anterior lesser trochanter cortex at the level of the lesser trochanter tip. The following angles were measured and analyzed: Angle 1 (angle between the FNA and the ALTL), Angle 2 (angle between the ALTL and the PCA), and Angle 3 (angle between the FNA and the PCA [FA]). Results: In all measurements, the inter-observer and intra-observer intraclass correlation coefficients exceeded 0.81. Angle 1 negatively correlated with Angle 2 (r = −0.79, p < 0.01), whereas Angle 1 positively correlated with Angle 3 (r = 0.70, p < 0.01). Conclusions: We found a consistent relationship between the ALTL and FA, and the ALTL may serve as a proximal landmark for intraoperative estimation of femoral stem anteversion during anterior or anterolateral approaches. Full article

Purpose: Revision total hip arthroplasty (RTHA) in the presence of a well-fixed femoral stem is associated with increased risk, as stem removal often results in bone loss, prolonged operative time, and greater blood loss. This problem is particularly relevant for older implants with a 14/16 taper, which is incompatible with most modern femoral heads. The Bioball™ System, a modular head–neck adapter, allows for acetabular or head-only revision while preserving the femoral stem. This study aimed to evaluate long-term clinical and radiological outcomes of RTHA using the Bioball™ System in patients with 14/16 tapers. Methods: A total of 38 patients (23 women, 15 men; mean age 73.5 years) met the inclusion criteria. All procedures were carried out with a well-fixed femoral stem and a 14/16 taper. Revisions were limited to exchange of the acetabular component, liner, or both, avoiding stem removal. The primary indication was acetabular cup loosening (n = 29, 76.3%); liner-only exchange was performed in 9 patients (23.7%). Clinical outcomes were assessed using the modified Merle d’Aubigné and Postel (MAP) score, and radiological evaluation focused on fixation, migration, and loosening. Mean follow-up was 8.44 years. Results: Both the acetabular component and liner were replaced in 76.3% of patients, while 23.7% underwent liner and head exchange only. Longer adapter sizes were most frequently used, and a 7.5° offset adapter was applied in 57.9% of cases. The modified MAP score improved by a mean of 5.7 points (p < 0.05), and VAS pain scores decreased from 7.4 to 2.6 (p < 0.05). No radiological signs of loosening were observed at final follow-up. Conclusions: The Bioball™ System enables effective restoration of hip stability and offset without femoral stem removal, offering favorable long-term clinical and radiological outcomes in revisions involving older 14/16 tapers. Full article

Canine hip dysplasia (CHD) is a common orthopedic condition characterized by joint laxity, abnormal femoral head development, and osteoarthritis. Radiography remains the gold standard in diagnosis; however, ultrasonography (US) can detect changes in bone and periarticular soft tissue earlier in CHD progression. Forty-four hips from twenty-two adult dogs of various breeds were graded according to the Fédération Cynologique Internationale (FCI) grading system, and grouped as normal (A, B) or dysplastic (C, D, E). Canine hip US evaluation, using the ventral femoral head–neck approach, included the following: capsule thickness at the femoral head index (CTFHi) and capsule thickness at the femoral head–neck index (CTFHNi), both measured in mm/body weight × 100; femoral head shape score (FHSs) and femoral head–neck transition score (FHNTs); and osteophyte score (Os). These findings were evaluated qualitatively and then converted into numerical scores. Twenty-three hips were graded on the FCI system as being normal, and twenty-one as dysplastic. Median values of the US parameters CTFHi, CTFHNi, FHSs, FHNTs, and Os were 2.02, 7.79, 1.00, 1.00, and 0.00 in the normal-hips group, and 3.11, 9.32, 3.00, 2.00, and 1.00 in the dysplastic-hips group. Significant differences were observed between most US parameters evaluated. Strong associations were found between CTFHi, FHNTs, and Os, indicating progressive bone remodeling. These findings support US usage as a potential tool for CHD diagnosis and monitoring. Full article

Background: Femoral neck fractures (FNFs) in the ageing population carry high risks of postoperative dislocation, with traditional total hip arthroplasty (THA) reporting rates up to 10%. Dual mobility THA (DM-THA) may provide enhanced stability, but evidence for third-generation implants like the Zimmer Biomet G7^® system remains limited. Methods: This retrospective cohort study evaluated 120 patients (mean age 71.6 years; 74% female) with acute displaced intracapsular FNF treated with DM-THA (2021–2023) using the G7^® system. Demographics, surgical details (cemented/uncemented stems), complications, and functional outcomes (Oxford Hip Score (OHS) at one year) were analysed against national benchmarks. Results: Zero dislocations and two peri-prosthetic fracture (0.8%, cemented stem) occurred. Thirty-day mortality was 0.8% (below national averages). Functional recovery was excellent (mean OHS: 41/48; 69% scoring ≥40). Surgical complications were minimal (one deep infection 0.8%). Medical complications (anaemia 6.6%, venous thromboembolism 4.2%) were significantly higher in high ASA groups (III-IV). Radiographs confirmed stable implants without loosening. Conclusions: The G7^® DM-THA system demonstrates exceptional stability and safety in FNF patients, with no dislocation risk and low peri-prosthetic fracture rates—even with cemented stems. These outcomes support its use in high-risk populations, though comparative studies with conventional THA are needed. Full article

Objectives: This study investigates the effectiveness of dexamethasone when utilized as an adjunct agent in enhancing the outcomes of a pericapsular nerve group (PENG) block compared to its systemic administration for managing pain in patients having surgery for femoral fractures. Methods: This study enrolled 44 patients who received a PENG block following spinal anesthesia. Two groups were formed by stratifying the patients, involving those in whom dexamethasone was received through perineural administration (Group P, n = 22) and those in whom it was received through systemic administration (Group S, n = 22). Information concerning the demographic features of the patients, along with operative and postoperative details, was meticulously documented for analysis. The patients’ pain levels were recorded using the numerical rating scale (NRS) at multiple time points. Results: In the perineural dexamethasone group, the length of time of sensory and motor blockade and the time elapsed until the initial analgesic requirement were longer (p < 0.001). The consumption of tramadol and the pain scores measured were noted to be decreased. (p < 0.001). There were no notable distinctions regarding patient mobilization or the length of inpatient stay. Conclusions: The perineural administration of dexamethasone in PENG block procedures may provide more effective analgesia for surgeries involving femoral neck fractures. By minimizing the use of systemic opioids, it may also help mitigate potential side effects. These findings indicate that perineural dexamethasone could serve as a beneficial adjuvant agent for patients undergoing femoral neck fracture surgeries. Full article

Background and Clinical Significance: Adverse reactions to metal debris (ARMD) are a rare but increasingly recognized complication following total hip arthroplasty (THA), with some studies suggesting upwards of 5% of metal-on-metal (MoM) and 3% of metal-on-polyethylene (MoP) prostheses being attributed to this. Historically, metallosis due to MoM implant design was the primary cause of ARMD. However, ARMD can also arise in metal-on-polyethylene (MoP) prostheses due to trunnionosis, which involves wear and corrosion at the modular femoral head–neck interface. Clinically, ARMD can resemble periprosthetic joint infection (PJI), complicating both diagnosis and management. Case Presentation: We present the case of a 40-year-old female with a history of systemic degenerative joint disease with bilateral MoP THAs who developed progressive pain and swelling in the upper left thigh, in which the prosthesis was first put in 22 years prior. The patient presented initially in a vascular surgery department for an infected iliopsoas cyst communicating with the hip where she had received surgery 2 years prior. The symptomatology reoccurred, and imaging revealed a large mass near the prosthesis and elevated inflammatory markers. Intraoperatively, a large volume of sero-purulent fluid was encountered, prompting a diagnostic workup for PJI. All cultures returned negative, and histopathology revealed macrophage-dominant infiltration with metallic debris, consistent with ARMD. After infection was definitively excluded, a revision THA was performed with an exchange of all modular components. The patient recovered without complications, and at six months follow-up, she demonstrated stable implant positioning, restored function, and no recurrence of symptoms. Conclusions: This case highlights the diagnostic complexity of PJI in joint arthroplasty and reveals the importance of a protocol-driven approach to exclude it prior to surgical revision. As the incidence of trunnion-related failure becomes more recognized in the literature, clinicians must consider ARMD in the differential diagnosis of late THA complications. Appropriate diagnosis is essential for guiding treatment and avoiding unnecessary complications, morbidity, and treatment related side-effects. Full article

Background: Malnutrition is highly prevalent among older patients with hip fractures and significantly impacts recovery and survival. This narrative review synthesizes current evidence on the prevalence, pathophysiology, and clinical consequences of malnutrition in hip fracture patients, along with diagnostic tools and nutritional interventions. Methods: A literature search of studies from 2000 to 2025 identified consistent associations between malnutrition—defined using tools such as the Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), and serum albumin levels—and increased risks of postoperative complications, prolonged hospital stays, functional decline, and mortality. Pathophysiological mechanisms include sarcopenia, systemic inflammation, and impaired bone metabolism. Results: Notably, malnutrition is associated with fracture type, with low lean body mass and poor nutritional status correlating with intracapsular femoral neck fractures. Conclusions: Interventional studies demonstrate that oral nutritional supplementation (ONS) reduces complications and improves biochemical parameters but shows mixed effects on long-term mortality and function. The findings support routine nutritional screening and early intervention in older hip fracture patients to improve outcomes and reduce the healthcare burden. Full article

Hip fractures pose a significant challenge to healthcare systems due to their high costs and associated mortality rates, with femoral neck fractures accounting for nearly half of all hip fractures. This study addresses the challenge of diagnosing nondisplaced femoral neck fractures, which are often difficult to detect with standard radiographs, especially in elderly patients. This research evaluates a deep learning model that employs a convolutional neural network (CNN) within a ResNet framework, designed to enhance diagnostic accuracy for nondisplaced femoral neck fractures. The model was trained and validated on a dataset of 2032 hip radiographs from two hospitals, with additional external validation performed on datasets from other institutions. The AI model achieved an accuracy of 94.8% and an Area Under Curve of 0.991 on anteroposterior pelvic/hip radiographs, outperforming emergency physicians and delivering results comparable to expert physicians. External validation confirmed the model’s robust accuracy and generalizability across diverse datasets. This study underscores the potential of deep learning models to act as a supplementary tool in clinical settings, potentially reducing diagnostic errors and improving patient outcomes by facilitating a quicker diagnosis and treatment. Full article