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10 pages, 1321 KB  
Article
Investigation of the Medium- and Long-Term Results of a Pioneering Method in the Treatment of Geriatric Intertrochanteric Femur Fractures: Osteosynthesis Using the WALANT Technique
by Yusuf Murat Altun, Mete Gedikbaş and Murat Aşçı
J. Clin. Med. 2025, 14(17), 6078; https://doi.org/10.3390/jcm14176078 - 28 Aug 2025
Viewed by 5
Abstract
Background/Objectives: Femoral neck and proximal femur fractures in the elderly can result from low-energy trauma due to osteoporotic changes and contribute significantly to increased morbidity and mortality. Despite various treatment options, closed reduction and internal fixation (CRIF) with intramedullary nails has become [...] Read more.
Background/Objectives: Femoral neck and proximal femur fractures in the elderly can result from low-energy trauma due to osteoporotic changes and contribute significantly to increased morbidity and mortality. Despite various treatment options, closed reduction and internal fixation (CRIF) with intramedullary nails has become the predominant approach. While a minimally invasive approach reduces complications and speeds recovery, this outcome is not always feasible in practice. The primary surgical goal remains achieving a stable and precise fracture reduction, favoring CRIF when possible. Our study aims to evaluate the clinical, radiological, and functional outcomes of patients operated on using the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique. Methods: Patients who underwent surgery for intertrochanteric femur fractures between June 2019 and June 2021 were analyzed. Patients who were between 75 and 90 years old and had undergone surgery with a proximal femoral nail (PFN) were included in the study. Patients were excluded if they required general anesthesia, if an acceptable reduction could not be achieved with the PFN, if they did not attend the last follow-up examination, or if the follow-up period was <4 years. Patients were functionally assessed using the Harris hip score at the 6th month and at the last follow-up and using the visual analog scale at the surgery, at the 4th hour after surgery, and at the time of discharge. For radiological assessment, the classification of reduction quality and the measurement of the tip–apex distance were used. Results: Forty patients (22F/18M) were included in the study. Their mean age was 83.0 ± 2.9 years. The mean time from trauma to surgery was 6.8 ± 2.3 h. Patients were mobilized on average 1.53 ± 0.8 h after surgery, and the mean hospitalization time was 27.4 ± 8.1 h. No statistically significant decrease in hemoglobin value was observed before or after surgery (p = 0.476). The Harris hip score was 73.3 ± 3.2 at the 6th month postoperatively and 74.9 ± 2.5 at the last follow-up (p = 0.296). The reduction quality was found to be poor in only two patients. Conclusions: The WALANT technique’s promising results in terms of pain management, blood loss control, and early mobilization show that it is a viable alternative to conventional anesthesia methods in geriatric hip fractures. Full article
(This article belongs to the Section Orthopedics)
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10 pages, 730 KB  
Article
Retrospective Validation Study of a Treatment Strategy for Benign Bone Lesions in the Proximal Femur
by Naohiro Shinohara, Satoshi Nagano, Hiromi Sasaki and Noboru Taniguchi
Surg. Tech. Dev. 2025, 14(3), 29; https://doi.org/10.3390/std14030029 - 22 Aug 2025
Viewed by 230
Abstract
Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression [...] Read more.
Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression hip screw [CHS] or intramedullary nail [IMN]) with or without bone grafting. This study aims to validate our treatment strategy through a retrospective analysis and a review of previous surgical outcomes. Methods: We sought to validate this strategy through a retrospective analysis of 16 patients (6 males and 10 females, mean age at surgery 37.4 years [range, 16–64 years]) with primary benign bone tumors or tumor-like conditions of the proximal femur, including the femoral head and neck. Curettage and synthetic or autologous bone graft was performed according to our treatment flowchart, utilizing either CHS or IMN for internal fixation. We compared the blood loss, operative time, time to full weight bearing, and perioperative complications between the CHS and IMN groups. Results: Blood loss did not significantly differ between the CHS and IMN groups (p = 0.11), but the operative time was significantly longer in the CHS group (p < 0.01). Two CHS cases experienced local recurrence, while no postoperative fractures were observed in either group. The median time to full weight bearing was 5 weeks, consistent with previous reports. No perioperative complications were noted. Conclusions: Our strategy achieved favorable clinical outcomes. IMN was selectively used in patients with non-aggressive benign tumors not involving the femoral head and neck, yielding good results with reduced surgical invasiveness, while in those patients with aggressive disease involving the head and neck, CHS was more appropriate. This approach may serve as a practical guide for surgical decision-making in benign proximal femoral bone tumors. Full article
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14 pages, 587 KB  
Article
Which Patients in the FLS Should Be Prioritised for a DXA Scan Within 12 Weeks?
by Hege Nysted, Oda Horpestad and Ane Djuv
J. Clin. Med. 2025, 14(16), 5619; https://doi.org/10.3390/jcm14165619 - 8 Aug 2025
Viewed by 368
Abstract
At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality [...] Read more.
At Stavanger University Hospital (SUH), patients aged 50 years and above with a fracture after a fall are included in our Fracture Liaison Service (FLS) at the orthopaedic department, due to their high imminent fracture risk. The FLS at SUH keeps a quality registry, including index fractures, fall from standing/walking, preventive factors, Dual Absorptiometry X-ray (DXA) results and treatment status, in addition to risk factors such as chronic diseases. As in many other hospitals and countries, the capacity of the DXA scanner at SUH does not meet the needs of the ageing population. As such, FLS patients should be prioritised for DXA scanning according to their need for anti-osteoporotic treatment. The aims of this study were (1) to identify whether any risk factors are more strongly associated with osteoporosis than others, and (2) to use this information as a tool to prioritise patients for which the decision to initiate anti-osteoporotic treatment should be assessed by a DXA scan. Method: We used software from CheckWare to keep a structured health record, submitting journal text to the health record and data to our fracture quality registry from 1 June 2022 to 31 December 2024. The fracture coverage of the registry, as part of the medical record, was 100%. Both men and women aged over 50 years with fragility-related fractures were included in the analysis, with index fracture having been reported within 24 months prior to FLS assessment. Exclusion criteria: short life expectancy (<3 years), already started on anti-osteoporotic treatment, living in nursing home, age >97 years, or multi-trauma patients. Statistics were calculated using SPSS and logistic regression. The results are presented as odds ratio (OR) and 95% confidence interval (95% CI). Significant differences were considered at a p-value of <0.05. Results: A total of 6974 patients were included, 81% of which were female. After the DXA scan, 5307 of the patients were started on anti-osteoporotic treatment (76%). Patients aged 50–70 years were the largest group. Female patients or those aged 80 years or older had an increased odds ratio (OR) of starting treatment after a fracture. The index fractures included in the logistic regression analysis and were most likely to initiate anti-osteoporotic treatment in the FLS, were vertebral fracture (p < 0.000, OR 3.1, 95% CI: 2.4–4.0), hip fracture (p < 0.000, OR 2.60, 95% CI: 1.9–3.5), costa fracture (p-value = 0.028, OR:1.3, 95% CI:1.0–1.5), pelvic fracture (p-value < 0.000, OR 3.1, 95% CI: 1.8–5.1). Patients with lack of sufficient vitamin D had increased odds with OR of 1.7 (p-value < 0.00, 95% CI: 1.3–2.2) for having osteoporosis compared to the other FLS patients. Fall from standing, walking or sitting increased the odds for osteoporosis treatment (p-value < 0.000, OR 2.8, 95% CI: 2.3–3.3). Conclusions: The listed risk factors for needing treatment were high for most fractures, especially vertebral, hip, and pelvic fractures. Patients aged 80+ years and with a fracture from standing/walking could also start treatment directly, without waiting for a DXA scan. Thus, these patients should be shifted rapidly to FLS and started on treatment without delay. In this way, DXA scanning can be prioritised for patients for whom supporting information is needed regarding the decision to initiate anti-osteoporotic treatment, such as those with proximal humerus, wrist, or ankle fractures. Time to DXA scan could be shortened for these patients and 12 weeks may be achievable. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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15 pages, 3059 KB  
Article
The Sonographic Evaluation of Abductor Injury After Intramedullary Nailing for the Hip Fractures
by Yonghyun Yoon, Howon Lee, King Hei Stanley Lam, Minjae Lee, Jonghyeok Lee and Jihyo Hwang
J. Clin. Med. 2025, 14(15), 5498; https://doi.org/10.3390/jcm14155498 - 5 Aug 2025
Viewed by 1994
Abstract
Background/Objectives: Iatrogenic abductor muscle injury following intramedullary nailing for proximal hip fractures can negatively impact postoperative rehabilitation and clinical outcomes. To quantify iatrogenic abductor muscle injury after intramedullary nailing and detect the degree of degenerative change in muscle around the entry point of [...] Read more.
Background/Objectives: Iatrogenic abductor muscle injury following intramedullary nailing for proximal hip fractures can negatively impact postoperative rehabilitation and clinical outcomes. To quantify iatrogenic abductor muscle injury after intramedullary nailing and detect the degree of degenerative change in muscle around the entry point of trochanteric fractures. Methods: This cross-sectional study used data from a single center database from May to December 2023. This study utilized ultrasound examinations performed by a single expert orthopedic surgeon. This study included 61 patients who underwent intramedullary nailing surgery for adult hip fractures. All surgeries were performed by a single experienced hip surgeon. Patients who declined sonographic evaluation or did not undergo ultrasound during their admission were excluded. For more accurate comparison, sonography was also conducted on the healthy, non-operative limb. Descriptive statistics were used to summarize patient and ultrasound findings. A subgroup analysis using Fisher’s exact test was performed to assess the association between implant type and the incidence of iatrogenic gluteus medius tendon injury. Results: Of the 61 patients, tendon tears were identified in 35 cases (57%) on the affected side, with 20 cases (33%) involving gluteus medius tendon tears without fractures on the ipsilateral facet. Gluteus minimus tendon tears were observed in 13 cases (21%), while gluteus medius tendon tears were noted in 31 cases (51%). In the unaffected limbs, tendon degeneration was detected in the form of tendinosis and calcification. Overall, 39 patients (64%) exhibited abductor tendon tendinosis, and 30 patients (49%) were diagnosed with calcification. Conclusions: Gluteus medius and Gluteus minimus are important abductors for hip disease rehabilitation. Iatrogenic gluteus medius tendon injury during the intramedullary nailing showed 33%. Abductor degeneration also showed 92% of the unaffected limbs. This study suggests that abductor degeneration can be a risk factor of falling among the elderly population and an iatrogenic abductor injury can be an obstacle for the early recovery of ambulation in the hip fracture patients. Prevention of abductor degeneration and iatrogenic abductor injury might be important for the hip fracture prevention and rehabilitation. Full article
(This article belongs to the Section Orthopedics)
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10 pages, 506 KB  
Article
How Much Variance Exists Among Published Definitions of Proximal Junctional Kyphosis? A Retrospective Cohort Study of Adult Spinal Deformity
by Tim T. Bui, Karan Joseph, Alexander T. Yahanda, Samuel Vogl, Miguel Ruiz-Cardozo and Camilo A. Molina
J. Clin. Med. 2025, 14(15), 5469; https://doi.org/10.3390/jcm14155469 - 4 Aug 2025
Viewed by 269
Abstract
Background/Objectives: We sought to characterize the variance and overlap among definitions of Proximal Junctional Kyphosis (PJK) used in the adult spinal deformity (ASD) literature. PJK is defined as excess in PJK angle, a Cobb angle between the upper-instrumented vertebra (UIV) and a [...] Read more.
Background/Objectives: We sought to characterize the variance and overlap among definitions of Proximal Junctional Kyphosis (PJK) used in the adult spinal deformity (ASD) literature. PJK is defined as excess in PJK angle, a Cobb angle between the upper-instrumented vertebra (UIV) and a supra-adjacent vertebra (SAV), either one (UIV+1) or two (UIV+2) levels rostral of the UIV. No expert consensus exists for threshold angle or which SAV to use. Methods: A total of 116 thoracolumbar fusion patients ≥ 65 years old were reviewed. The UIV+1 and UIV+2 angles were measured. Six definitions of PJK from the literature were evaluated. These definitions were selected based on citation frequency, historical relevance, and accessibility through commonly used databases. Pearson’s Chi-squared and pairwise comparisons were performed to evaluate the distinctness and agreement rates among these definitions. Results: The six definitions of PJK were as follows: [PJK20] PJK angle ≥ 20° with UIV+2 as the (SAV), [PJK10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+2 as the SAV, [PJK2SD] PJK angle > 2 standard deviations from average with UIV+1 as the SAV, [PJK10+10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+1 as the SAV, [PJK15] PJK angle > 15° with UIV+1 as the SAV, and [PJK30] PJK angle > 30° with UIV+2 as the SAV, or displaced rod fracture, or reoperation within 2 years for junctional failure, pseudoarthrosis, or rod fracture. [PJK10] and [PJK2SD] were the most distinct definitions while [PJK20], [PJK10+10], [PJK15], and [PJK30] showed no significant pairwise differences. [PJK2SD] was stringent, while definition [PJK30] included unique diagnostic information not captured by other definitions. Conclusions: The use of [PJK20], [PJK10+10], [PJK15], or [PJK30] is recommended for consistency, with [PJK15] presenting the best balance. Stringent [PJK2SD] may be beneficial for identifying severe PJK, though with low sensitivity. Overall, PJK definitions must be standardized for the consistent reporting of clinical outcomes and research comparability. Full article
(This article belongs to the Special Issue Optimizing Outcomes in Scoliosis and Complex Spinal Surgery)
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13 pages, 5349 KB  
Article
Effects of Weak Structural Planes on Roadway Deformation Failure in Coastal Mines
by Jie Guo, Guang Li and Fengshan Ma
Water 2025, 17(15), 2257; https://doi.org/10.3390/w17152257 - 29 Jul 2025
Viewed by 313
Abstract
Roadway deformation failure is often related to the presence of weak structural planes (WSPs) in the surrounding rock mass. Especially in coastal mining environments, WSP-induced deformation can create pathways that connect faults with seawater, accelerating groundwater seepage and inrush hazards. This study employs [...] Read more.
Roadway deformation failure is often related to the presence of weak structural planes (WSPs) in the surrounding rock mass. Especially in coastal mining environments, WSP-induced deformation can create pathways that connect faults with seawater, accelerating groundwater seepage and inrush hazards. This study employs an optimized Finite–Discrete Element Method (Y-Mat) to simulate WSP-driven fracture evolution, introducing an elastoplastic failure criterion and enhanced contact force calculations. The results show that the farther the WSP is from the roadway, the lower its influence; its existence alters the shape of the plastic zone by lengthening the failure zone along the fault direction, while its angle changes the shape and location of the failure zone and deflects fracture directions, with the surrounding rock between the roadway and WSP suffering the most severe failure. The deformation failure of roadway surrounding rock is influenced by WSPs. Excavation unloading reduces the normal stress and shear strength in the weak structural plane of surrounding rock, resulting in slip and deformation. Additionally, WSP-induced fractures act as groundwater influx conduits, especially in fault-proximal roadways or where crack angles align with hydraulic gradients, so mitigation in water-rich mining environments should prioritize sealing these pathways. The results provide a theoretical basis for roadway excavation and support engineering under the influence of WSPs. Full article
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23 pages, 2407 KB  
Article
Replication of Sensor-Based Categorization of Upper-Limb Performance in Daily Life in People Post Stroke and Generalizability to Other Populations
by Chelsea E. Macpherson, Marghuretta D. Bland, Christine Gordon, Allison E. Miller, Caitlin Newman, Carey L. Holleran, Christopher J. Dy, Lindsay Peterson, Keith R. Lohse and Catherine E. Lang
Sensors 2025, 25(15), 4618; https://doi.org/10.3390/s25154618 - 25 Jul 2025
Viewed by 376
Abstract
Background: Wearable movement sensors can measure upper limb (UL) activity, but single variables may not capture the full picture. This study aimed to replicate prior work identifying five multivariate categories of UL activity performance in people with stroke and controls and expand those [...] Read more.
Background: Wearable movement sensors can measure upper limb (UL) activity, but single variables may not capture the full picture. This study aimed to replicate prior work identifying five multivariate categories of UL activity performance in people with stroke and controls and expand those findings to other UL conditions. Methods: Demographic, self-report, and wearable sensor-based UL activity performance variables were collected from 324 participants (stroke n = 49, multiple sclerosis n = 19, distal UL fracture n = 40, proximal UL pain n = 55, post-breast cancer n = 23, control n = 138). Principal component (PC) analyses (12, 9, 7, or 5 accelerometry input variables) were followed by cluster analyses and numerous assessments of model fit across multiple subsets of the total sample. Results: Two PCs explained 70–90% variance: PC1 (overall UL activity performance) and PC2 (preferred-limb use). A five-variable, five-cluster model was optimal across samples. In comparison to clusters, two PCs and individual accelerometry variables showed higher convergent validity with self-report outcomes of UL activity performance and disability. Conclusions: A five-variable, five-cluster model was replicable and generalizable. Convergent validity data suggest that UL activity performance in daily life may be better conceptualized on a continuum, rather than categorically. These findings highlight a unified, data-driven approach to tracking functional changes across UL conditions and severity of functional deficits. Full article
(This article belongs to the Special Issue Sensor-Based Human Activity Recognition)
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11 pages, 764 KB  
Article
Subscapularis CT-Scan Evaluation in Patients with Proximal Humerus Fracture: Reverse Total Shoulder Arthroplasty Versus Hemi-Arthroplasty
by Edoardo Gaj, Andrea Redler, Alessandro Maggiori, Susanna Pagnotta, Natale Criseo, Vikranth Mirle, Matthew Daggett and Angelo De Carli
J. Clin. Med. 2025, 14(15), 5257; https://doi.org/10.3390/jcm14155257 - 24 Jul 2025
Viewed by 425
Abstract
Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study [...] Read more.
Background/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p < 0.0001). A postoperative reduction in subscapularis size of >35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA. Full article
(This article belongs to the Section Orthopedics)
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14 pages, 561 KB  
Review
Current Evidence and Surgical Strategies in the Management of Greater Tuberosity Fracture–Dislocations: A Narrative Review
by Gabriele Colò, Federico Fusini, Luca Faoro, Giacomo Popolizio, Sergio Ferraro, Giorgio Ippolito, Massimiliano Leigheb and Michele Francesco Surace
J. Clin. Med. 2025, 14(14), 5159; https://doi.org/10.3390/jcm14145159 - 21 Jul 2025
Viewed by 654
Abstract
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, [...] Read more.
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
(This article belongs to the Special Issue Orthopedic Trauma Surgery: Current Challenges and Future Perspectives)
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8 pages, 2016 KB  
Case Report
Reverse Total Shoulder Arthroplasty for Proximal Humerus Nonunion
by James Tyler Frix, Maria Kammire, Nainisha Chintalapudi and Patrick Connor
J. Clin. Med. 2025, 14(14), 5130; https://doi.org/10.3390/jcm14145130 - 18 Jul 2025
Viewed by 384
Abstract
Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, [...] Read more.
Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients. Full article
(This article belongs to the Special Issue Clinical Updates on Shoulder Arthroplasty)
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23 pages, 4725 KB  
Tutorial
Fragility Fractures of the Pelvis—Current Understanding and Open Questions
by Amber Gordon, Michela Saracco, Peter V. Giannoudis and Nikolaos K. Kanakaris
J. Clin. Med. 2025, 14(14), 5122; https://doi.org/10.3390/jcm14145122 - 18 Jul 2025
Viewed by 1351
Abstract
Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is [...] Read more.
Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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12 pages, 225 KB  
Article
Microbiological Sampling in Total Knee Arthroplasty After Post-Traumatic Osteoarthritis: Rate of Periprosthetic Joint Infection and the Debate Around Sampling Unremarkable Tissue
by Felix Erne, Leonard Grünwald, Tina Histing and Philipp Hemmann
Microorganisms 2025, 13(7), 1690; https://doi.org/10.3390/microorganisms13071690 - 18 Jul 2025
Viewed by 388
Abstract
Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of [...] Read more.
Background: Proximal tibial fractures can lead to post-traumatic osteoarthritis (PTOA), and subsequent total knee arthroplasty (TKA) in such patients is associated with elevated complication rates. A two-stage approach, involving the elective removal of osteosynthetic hardware prior to TKA, is recommended. The utility of microbiological sampling from macroscopically unremarkable tissue during TKA implantation remains controversial. Objective: To retrospectively evaluate the rate of periprosthetic joint infection (PJI) following TKA after PTOA and to assess the potential benefit of intraoperative microbiological sampling. The secondary objective was to evaluate the presence of prior colonization in osteosynthetic hardware among the affected cases. Patients and Methods: A retrospective screening of the hospital database was conducted between 2008 and 2022, including only AO/OTA type 41-B and 41-C fractures. Patients were assigned to a sampling group (with microbiological sampling during TKA) or a control group (without sampling). All patients received structured follow-up to assess postoperative complications. Results: A total of 40 patients met the screening criteria. In the sampling group (n = 29), 17.24% required surgical revision, and the rate of PJI was 3.45%. In the control group (n = 11), 18.14% underwent revision surgery, with a PJI rate of 9.09%. The average follow-up period was 4.35 years (range 2–11.6 years). Discussion: TKA in patients with PTOA is associated with a heightened risk of complications. A noteworthy possible correlation between systematic microbiological sampling and reduced PJI incidence was observed. While the small sample size limits definitive conclusions regarding causality, the findings support the potential value of consistent intraoperative sampling. Full article
(This article belongs to the Collection Device-Related Infections and Bacterial Biofilms)
14 pages, 731 KB  
Article
Mesquite Pods (Prosopis velutina) as a Functional Ingredient: Characterization and Application in a Meat Product
by Karla Joanna Aispuro-Sainz, Rey David Vargas-Sánchez, Gastón Ramón Torrescano-Urrutia, Brisa del Mar Torres-Martínez and Armida Sánchez-Escalante
Processes 2025, 13(7), 2286; https://doi.org/10.3390/pr13072286 - 17 Jul 2025
Viewed by 343
Abstract
The present study aimed to characterize the total phenolic content and antioxidant activity of mesquite pods (Prosopis velutina) and evaluate the effect on meat qualities in a meat product, with a view to their application as a natural functional ingredient. Mesquite [...] Read more.
The present study aimed to characterize the total phenolic content and antioxidant activity of mesquite pods (Prosopis velutina) and evaluate the effect on meat qualities in a meat product, with a view to their application as a natural functional ingredient. Mesquite pods were subjected to chemical characterization, revealing the presence of polyphenol contents with antioxidant activity (reducing power and antiradical effect). In addition, pork patties were formulated with different levels of mesquite pods powder (MPP, 2% and 5%) and mesquite pods extract (MPE, 0.1% and 0.3%), and were compared with control (CN) samples. The proximate composition of mesquite pod powder revealed a high proportion of carbohydrates and a low fat content. Additionally, the presence of polyphenols with antioxidant activity, including antiradical and reducing power, was evident. No significant differences were observed in the pork patties’ proximate composition. During 9 days of storage at 2 °C, patties treated with MPP and MPE exhibited higher pH values and lower TBARS values compared to the CN, with MPE-0.3% being the most effective in retarding lipid oxidation. Color parameters (L*, a*, b*, C*, and h*) were positively influenced by MPP and MPE, and both treatments improved water-holding capacity and reduced cooking weight loss, especially at 5% MPP. Fracture texture analysis showed that 5% MPP enhances firmness. Sensory attributes did not differ significantly from the CN. These results indicate that MPP and MPE are promising natural ingredients for extending the shelf life and maintaining the quality of pork patties without compromising sensory acceptability. Full article
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12 pages, 2989 KB  
Article
Novel Customizable Fracture Fixation Technique vs. Conventional Metal Locking Plate: An Exploratory Comparative Study of Fixation Stability in an Experimental In Vivo Ovine Bilateral Phalangeal Fracture Model
by Thomas Colding-Rasmussen, Nanett Kvist Nikolaisen, Peter Frederik Horstmann, Michael Mørk Petersen, Daniel John Hutchinson, Michael Malkoch, Stine Jacobsen and Christian Nai En Tierp-Wong
Materials 2025, 18(14), 3359; https://doi.org/10.3390/ma18143359 - 17 Jul 2025
Viewed by 414
Abstract
A novel composite patch osteosynthesis technique (CPT) has demonstrated promising ex vivo biomechanical performance in small tubular bones. To bridge the gap toward clinical evaluations, this study compared the stability of the CPT to a stainless-steel locking plate (LP) in an experimental in [...] Read more.
A novel composite patch osteosynthesis technique (CPT) has demonstrated promising ex vivo biomechanical performance in small tubular bones. To bridge the gap toward clinical evaluations, this study compared the stability of the CPT to a stainless-steel locking plate (LP) in an experimental in vivo ovine bilateral proximal phalanx fracture model. Eight sheep underwent a midline osteotomy with a 4.5 mm circular unicortical defect in the lateral proximal phalanx of both front limbs, treated with the CPT (n = 8) or the LP (n = 8). A half-limb walking cast, or a custom off-loading hoof shoe, was used for postoperative protection. Implant stability was assessed by post-surgery X-ray evaluations and post-euthanasia (16 weeks) dual-energy X-ray absorptiometry (DXA). At week one, all CPT implants demonstrated mechanical failure, while all LPs remained overall intact. Mean BMD was 0.45 g/cm2 for CPT and 0.60 g/cm2 for LP in the fracture area (p = 0.078), and 0.37 g/cm2 vs. 0.41 g/cm2 in the distal epiphysis (p = 0.016), respectively. In conclusion, the CPT demonstrated indications of inferior stability compared to the LP in this fracture model, which may limit its clinical applicability in weight-bearing or high-load scenarios and in non-compliant patients. Full article
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22 pages, 5644 KB  
Article
Analysis of the Impact of the Drying Process and the Effects of Corn Race on the Physicochemical Characteristics, Fingerprint, and Cognitive-Sensory Characteristics of Mexican Consumers of Artisanal Tostadas
by Oliver Salas-Valdez, Emmanuel de Jesús Ramírez-Rivera, Adán Cabal-Prieto, Jesús Rodríguez-Miranda, José Manuel Juárez-Barrientos, Gregorio Hernández-Salinas, José Andrés Herrera-Corredor, Jesús Sebastián Rodríguez-Girón, Humberto Marín-Vega, Susana Isabel Castillo-Martínez, Jasiel Valdivia-Sánchez, Fernando Uribe-Cuauhtzihua and Víctor Hugo Montané-Jiménez
Processes 2025, 13(7), 2243; https://doi.org/10.3390/pr13072243 - 14 Jul 2025
Viewed by 2346
Abstract
The objective of this study was to analyze the impact of solar and hybrid dryers on the physicochemical characteristics, fingerprints, and cognitive-sensory perceptions of Mexican consumers of traditional tostadas made with corn of different races. Corn tostadas from different native races were evaluated [...] Read more.
The objective of this study was to analyze the impact of solar and hybrid dryers on the physicochemical characteristics, fingerprints, and cognitive-sensory perceptions of Mexican consumers of traditional tostadas made with corn of different races. Corn tostadas from different native races were evaluated with solar and hybrid (solar-photovoltaic solar panels) dehydration methods. Proximal chemical quantification, instrumental analysis (color, texture), fingerprint by Fourier transform infrared spectroscopy (FTIR), and sensory-cognitive profile (emotions and memories) and its relationship with the level of pleasure were carried out. The data were evaluated using analysis of variance models, Cochran Q, and an external preference map (PREFMAP). The results showed that the drying method and corn race significantly (p < 0.05) affected only moisture content, lipids, carbohydrates, and water activity. Instrumental color was influenced by the corn race effect, and the dehydration type influenced the fracturability effect. FTIR fingerprinting results revealed that hybrid samples exhibited higher intensities, particularly associated with higher lime concentrations, indicating a greater exposure of glycosidic or protein structures. Race and dehydration type effects impacted the intensity of sensory attributes, emotions, and memories. PREFMAP vector model results revealed that consumers preferred tostadas from the Solar-Chiquito, Hybrid-Pepitilla, Hybrid-Cónico, and Hybrid-Chiquito races for their higher protein content, moisture, high fracturability, crunchiness, porousness, sweetness, doughy flavor, corn flavor, and burnt flavor, while images of these tostadas evoked positive emotions (tame, adventurous, free). In contrast, the Solar-Pepitilla tostada had a lower preference because it was perceived as sour and lime-flavored, and its tostada images evoked more negative emotions and memories (worried, accident, hurt, pain, wild) and fewer positive cognitive aspects (joyful, warm, rainy weather, summer, and interested). However, the tostadas of the Solar-Cónico race were the ones that were most rejected due to their high hardness and yellow to blue tones and for evoking negative emotions (nostalgic and bored). Full article
(This article belongs to the Special Issue Applications of Ultrasound and Other Technologies in Food Processing)
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