Search Results (845)

Background: Pediatric proximal humerus fractures (PHFs) typically heal well due to their strong remodeling potential, supporting non-operative management even in displaced injuries. However, surgery for Neer–Horowitz grade III–IV fractures has become more frequent despite limited evidence of superior outcomes. Methods: A retrospective analysis of 152 children (<14 years) treated for isolated PHFs at a tertiary pediatric orthopedic center (2004–2023) was performed. Clinical records and telephone follow-up provided demographic data, fracture classification, management, complications, and functional outcomes (QuickDASH, Tegner, return to sport). A direct cost analysis compared conservative and surgical pathways. Results: Of 152 patients, 133 were treated non-operatively and 19 surgically. Conservative management achieved excellent results across all fracture types: nearly all patients reported normal QuickDASH scores and full shoulder function. Among Neer III–IV fractures (n = 37), functional outcomes, activity levels, and sport resumption were similar between treatment strategies. Minor transient issues (pin migration, temporary stiffness, delayed return to sport) occurred only after surgery. No meaningful complications were observed in the conservative cohort. Mean costs differed substantially: €1452.09 for non-operative management versus €7832.12 for surgical treatment. Conclusions: Long-term outcomes of pediatric PHFs were uniformly excellent, regardless of fracture severity or treatment modality. Surgery did not improve recovery, function, or return to sport and was associated with higher costs and minor postoperative issues. Conservative management should remain the standard of care for nearly all pediatric PHFs, with surgery reserved for exceptional circumstances such as open fractures, neurovascular compromise, or failed closed reduction. Full article

Osteoporosis is highly prevalent in postmenopausal women, causing chronic pain, fractures, and limited mobility that burden individuals and society. While resistance exercise benefits bone health, its role in osteoporotic bone injury healing and underlying mechanisms remain unclear. This study aimed to explore the effects of 10-week weight-bearing ladder climbing exercise on ovariectomy (OVX)-induced osteoporosis and subsequent bone injury healing, and to investigate whether these effects are associated with the myostatin (MSTN) and Wnt/β-catenin pathways. Fifty-four 12-week-old female SD rats were randomized into Sham, OVX, and OVX + EX groups. Rats in the OVX and OVX + EX groups underwent ovariectomy to induce postmenopausal osteoporosis, and those in the OVX + EX group received 10-week weight-bearing ladder climbing. After the exercise intervention, 6 rats in each group were sacrificed; the remaining rats underwent femoral midshaft drilling to establish bone injury. The improvement in osteoporosis was evaluated via Micro-CT, biomechanical tests, RT-qPCR for mRNA detection, and Western blot for measuring protein levels of MSTN and Wnt/β-catenin pathway-related molecules at post-exercise and 21 days post-injury. Bone healing was reflected by the bone volume fraction at the bone injury site detected via Micro-CT at 10 and 21 days post-injury. This exercise significantly enhanced muscle strength and improved femoral bone mineral density (BMD), trabecular microstructure, and biomechanical properties in OVX rats. Meanwhile, the level of MSTN in the OVX + EX group was decreased, the expression of its downstream signaling pathways was inhibited, and the mRNA and protein expressions of Wnt/β-catenin were upregulated. Moreover, 21 days after exercise intervention, the biomechanical properties and bone microstructure of the OVX + EX group were still significantly superior to those of the OVX group, and the aforementioned molecular regulatory effect remained. In addition, pre-conducted exercise was able to promote increases in bone volume fraction at the bone injury site 10 and 21 days after drilling, which was conducive to bone injury healing. Ten-week weight-bearing ladder climbing ameliorates OVX-induced bone loss and promotes osteoporotic bone repair via regulating the MSTN/ActRIIB/Smad3 and Wnt/β-catenin pathways, providing evidence for exercise as a safe non-pharmacological intervention. Full article

Severe lost circulation frequently occurs in deep and ultra-deep wells under high-temperature/high-pressure (HPHT) conditions and in fracture-cavity composite loss channels. Conventional lost-circulation materials (LCMs) often fail because of premature loss of mobility, insufficient residence in loss paths, and irreversible failure after solidification. Cement-based sealing systems, owing to their ability to plug large leakage channels and their cost-effectiveness, have become the mainstream solution. To improve their performance under extreme downhole conditions, recent studies have focused on base-cement design, reinforcement phases, and property regulation strategies-including the use of granular/fibrous/nanoscale additives for bridging reinforcement, rheology and thickening control to enhance injectability and residence, and chemical/functional modifiers to improve compactness and durability of the hardened matrix. Significant progress has been achieved in terms of HPHT resistance, densification design, regulation of rheological properties and thickening behavior, and self-healing/responsive sealing functions. However, most existing studies still focus on improving individual properties and lack a cross-scale, holistic design and unified mechanistic perspective for fracture-cavity coupled flow and long-term sealing stability. Distinct from previous reviews that mainly catalogue material types or discuss single-performance optimization, this review is framed by fracture-cavity composite loss channels and long-term sealing requirements under HPHT conditions, systematically synthesizes the material design strategies, reinforcement mechanisms and applicability boundaries of cement-based plugging systems, builds cross-scale linkages among these aspects, and proposes future research directions toward sustainable plugging design. Full article

Background/Objectives: Biodegradable implants have emerged as a promising alternative to traditional metallic fixation devices in pediatric orthopedic surgery. Avoiding implant removal is especially advantageous in children, who would otherwise require a second operation with additional anesthetic and surgical risks. This study reviews the current use of poly(lactic-co-glycolic acid) (PLGA) implants in pediatric fracture fixation and evaluates how they address limitations associated with traditional hardware. Methods: A narrative review was conducted summarizing current evidence, clinical experience, and case examples involving PLGA-based devices used in pediatric trauma. Special emphasis was placed on the degradation mechanism of PLGA, its controlled hydrolysis profile, and the capacity of the material to provide temporary mechanical stability during bone healing before complete resorption. The review included studies of PLGA use in forearm, distal radius, ankle, and elbow fractures, comparing outcomes to those obtained with metallic implants. Results: Across multiple clinical reports and case series, PLGA implants demonstrated effective fracture healing, stable fixation, and complication rates comparable to traditional metallic devices. Patients treated with resorbable implants benefited from reduced postoperative morbidity, no requirement for implant removal, and improved imaging compatibility. Conclusions: PLGA-based bioabsorbable implants represent a safe and effective alternative to conventional metal fixation in children. Their favorable degradation kinetics and clinical performance support their growing use in pediatric trauma surgery, while ongoing advances in polymer design and bioresorbable alloys continue to expand future applications. Full article

Background: Vertical root fracture (VRF) is a severe complication of endodontically treated teeth with a poor prognosis. Despite many tentative tooth-preserving approaches, the current main treatment remains tooth extraction or root resection, which is largely due to the difficulty in balancing the mechanical strength for fracture fixation and biological properties for periodontal healing. Moreover, all documented reports regarding VRF repairing so far were limited to anterior teeth and premolars. Thus, the objective of this case report was to present a novel surgical treatment approach for repairing VRF of molars. Methods: Three patients (2 females, 1 male; aged 30–33 years) with endodontically treated molars (Tooth #46, #16, #37) diagnosed with VRF were treated with a dual-layered repair approach with modified fracture lines and retention forms through intentional replantation. Results: After 18, 21, and 36 months of follow-up, respectively, all three cases showed no clinical symptoms, normal tooth mobility and periodontal probing, as well as reduced periradicular radiolucency on radiographs. Root resorption or ankylosis was not observed. Conclusions: The novel surgical treatment approach demonstrates effectiveness in preserving endodontically treated molars with VRF, but its long-term treatment results for various VRF of molars need further randomized and controlled clinical investigations. Full article

Background/Objectives: Chronic locked posterior shoulder dislocations (PSDs) are rare and often misdiagnosed, leading to delayed treatment and complex management. This study retrospectively evaluates surgical outcomes in patients treated for chronic PSDs and reports our clinical experience. Methods: Ten male patients with chronic PSDs treated between 2016 and 2022 at “Vito Fazzi Hospital” (Lecce) were analyzed. Lesions were classified according to the Randelli system (Type 1: 20–50% bone loss; Type 2: >50%; Type 3: fracture dislocation without bone loss; Type 4: multifragmentary fracture dislocation). Surgical options—subscapularis transposition, bone grafting, osteosynthesis, and reverse shoulder arthroplasty—were selected based on lesion type, age, and functional demand. Follow-ups at 1, 3, 6, and 12 months assessed ROM, SF-36, and SDQ scores. Results: Six patients had Type 1 lesions, two Type 2, and two Type 4. The mean diagnostic delay was 6 weeks (up to 5 months). Early follow-ups showed superior ROM and SDQ in patients with reverse prostheses, while at 12 months, cancellous grafts achieved better functional recovery. Subscapularis transpositions resulted in minor internal rotation loss and increased pain. One Type 4 case developed avascular necrosis. Mean healing time was 2.9 ± 0.5 months. Although SDQ differences at 12 months were not significant, internal rotation was reduced by 10% in patients treated with the McLaughlin technique (p < 0.05). Conclusions: Prompt diagnosis and tailored surgical management are key to favorable outcomes in chronic PSDs. While various techniques provide good results, subscapularis transposition should be limited to unstable cases, and osteosynthesis should be used only when strictly indicated due to necrosis risk. Full article

Background: Covering the defects around the calcaneus is still a largely debatable subject. In the classical view, the defects at the level of the foot can be treated only by a free flap. In a modern approach, it has been observed that for small or moderate foot defects, a local flap can be used. Methodology: In this case series, we have retrospectively selected the patients who were admitted to the orthopedic department for a calcaneal fracture and who presented soft-tissue complications during the treatment. The patients have been selected from the past five years if they have undergone reconstructive surgery with a local or regional flap. Results: By applying the inclusion and exclusion criteria, we found that out of 79 patients who have been admitted to the orthopedic department, only two patients met the criteria. Two flaps have been used to treat the defects that developed at the level of the calcaneus after traumatic injury of the foot. The reverse-flow sural flap, as a tunneled flap, had a good evolution, without vascular suffering of the flap. On the other hand, for defects at the medial level of the calcaneus, we have used the dorsalis pedis flap. The healing was fast, and the patient presented no complications at the level of the donor site. Conclusions: Both flaps presented a good evolution. We try to emphasize through this article that soft tissue defects around the non-weight-bearing area of the heel can also be treated through a non-microsurgical option. These two options can help the ortho-plastic team to manage difficult cases by avoiding a free flap or a split-thickness skin graft. Full article

Silicon is widely recognized as a next-generation anode owing to its exceptional theoretical capacity, yet its practical deployment in lithium-ion batteries is constrained by severe volume expansion, particle fracture, loss of electrical percolation, and solid electrolyte interphase layer instability. Polymer-based strategies have emerged as accessible solutions to engineer extensive volume changes and interfacial compatibility, while preserving pathways for charge transport. Viscoelastic polymer binders dissipate stress, catechol-inspired chemistries strengthen adhesion and tailor interphases, and conductive polymers can function simultaneously as binder, electronic additive, and artificial SEI. This review describes these approaches through a structure–process–performance perspective, emphasizing practically relevant metrics, such as initial capacity, initial Coulombic efficiency, and long-term cycling stability. We organize the main section into (i) dopamine-derived interfacial engineering, (ii) self-healing three-dimensional network binders, and (iii) conductive-polymer-based designs. In the last section, we articulate the functional requirements of polymers in silicon anodes, outline the ideal structural designs, and provide forward-looking avenues for future lithium-ion battery anode research. Full article

Background: Bone fracture is a partial or complete break in the continuity of a bone, which poses a significant healthcare burden. It is important to discover a novel method to stimulate and speed-up the healing of bone fractures. Aim: This study aimed to investigate the effects and mechanisms of alternating current (AC) in promoting bone fracture healing. Methods: A rabbit bone fracture model was used. X-ray and Micro-CT evaluated fracture healing, while HE staining and immunohistochemistry assessed morphological changes. In vitro, pre-osteoblastic cells were tested with alizarin red S staining and alkaline phosphatase (ALP) activity. RNA-seq analysis explored potential mechanisms. Results: X-ray evaluation showed that alternating current stimulation (ACS) promoted bone formation and shaping by day 14 post-treatment. Micro-CT results revealed significant new bone formation as early as day 3 and day 7 (p < 0.05). HE staining indicated more trabecular bone formation in the ACS group compared to the model group at days 7 and 14. Immunohistochemistry showed higher expression of BMP-2 and VEGF in the ACS group by day 7. In vitro, ACS enhanced osteogenic differentiation, increasing calcified nodule formation and ALP activity. Gene expression analysis demonstrated significant changes in key osteogenic genes, confirmed by multiple immunohistochemical staining. Conclusions: ACS may be a novel method for treating bone fractures more rapidly, significantly relieving the patient’s burden, particularly in the early stages of bone healing. Full article

The main role of panoramic radiography lies in its rapid screening capability and its ability to detect and identify bone lesions, pathologies, and tooth-bearing structures. Since panoramic radiographs are widely used, they provide a good view of the jaw bones, maxillary sinus, and temporomandibular area. However, their major limitation is the reduced ability to accurately assess bone conditions, particularly in evaluating cortical integrity or identifying subtle, nondisplaced, or greenstick-type fracture lines. Other limitations include the presence of artifacts, image distortion, magnification variability, and high sensitivity to patient and film positioning, all of which can compromise image quality and diagnostic confidence. This 2D imaging method is still used worldwide, especially by dentists; however, this type of radiograph can be unpredictable due to structural superimposition and reduced ability to clearly establish, measure, and verify the precise dimensions, boundaries, and areas occupied by selected lesions. Many patients undergo panoramic imaging to assess possible mandibular fractures after trauma or following the removal of cysts, tumors, or impacted teeth. In most cases, the occurrence of a fracture without displacement can be misjudged, omitted, or underestimated. In such cases, either cone-beam computed tomography is performed or a detailed clinical examination before or during surgery, followed by intraoperative assessment, helps identify a possible fracture line, bone bending, mandibular instability, or the potential need for simultaneous prophylactic plating during dental procedures or the use of maxillomandibular fixation. This paper presents the author’s own experience regarding the limitations of panoramic radiographs in estimating bone condition and detecting fracture lines. Therefore, it is essential to highlight the role of prophylactic (preventive) mandibular plating (PMP) or fixation and to clarify when it should be considered. Full article

We report a rare case of isolated bilateral pedicle fractures in the lumbar spine that occurred without any identifiable risk factors. Such fractures are uncommon, as they are typically accompanied by multiple other fractures. This type of fracture is commonly associated with widely acknowledged predisposing factors, including high-energy trauma, degenerative spine disease, previous spinal surgery, stress-related activities, or osteoporosis. Additionally, some reports suggest these fractures can result from low-energy trauma when underlying conditions such as osteoporosis are present. This report describes a 43-year-old female who presented with gradually aggravating low back pain in the absence of any significant trauma history. Initially, she denied any preceding injury, considering the event too trivial to mention. However, upon detailed history taking, she later recalled minor contact with the edge of her bed two days prior to symptom onset. Conservative management, consisting of administration of painkillers, adequate rest, the use of a brace, and rehabilitation exercises, led to significant improvement, with marked relief of clinical symptoms and fracture healing observed in follow-up imaging. Early identification and appropriate management of isolated pedicle fractures are essential, as delayed diagnosis may lead to chronic pain or long-term sequelae. Furthermore, unilateral fracture can increase mechanical loading on the contralateral pedicle, making it vulnerable to secondary stress injury. Therefore, clinicians must remain alert to the possibility of isolated pedicle fractures even in patients without risk factors. Thorough history taking is also essential, as unrecognized minor trauma may hinder timely diagnosis and optimal outcomes. Full article

Background/Objective: To outline strategies for the safe clinical use of orthodontic temporary anchorage devices (TADs) by analyzing papers that examine associated risks, complications, and approaches for their prevention and resolution. Methods: The research protocol used PubMed, Medline, and Scopus up to May 2024, focusing on controlled and randomized clinical trials aligned with the review objective. Fourteen studies were included; bias risk was assessed, key data extracted, and a descriptive analysis performed. Study quality and evidence strength were also evaluated. Results: TADs optimize anchorage control without relying on patient compliance. However, they carry risks and complications. TAD contact with the periodontal ligament or root without pulp involvement requires removal for spontaneous healing. If pulp is involved, the TAD should be removed and endodontic therapy performed. If anatomical structures are violated, TAD should be removed. If transient, spontaneous recovery occurs, but sometimes pharmacological treatment may be needed. A 2 mm gap between the TAD and surrounding structures can prevent damage. In the maxillary sinus, a less than 2 mm perforation of the Schneiderian membrane recovers spontaneously; wider perforations require TAD removal. Good oral hygiene and TAD abutments prevent soft tissue inflammation, which resolves with 0.2% chlorhexidine for 14 days. Unwanted forces can cause TAD fractures, requiring removal. Minor TAD mobility due to loss of primary stability can be maintained; significant instability requires repositioning. Conclusions: The use of TADs requires meticulous planning, radiological guidance, and monitoring to minimize risks and manage complications. With proper care, TADs improve orthodontic outcomes and patient satisfaction. Full article

Background/Objectives: Long-term bisphosphonate (BP) therapy is an effective treatment for osteoporosis but has been associated with rare complications such as atypical femoral fractures (AFFs). Emerging reports suggest that similar insufficiency fractures may also occur in other skeletal sites, including the lumbar pedicles. This study reports two rare cases of isolated bilateral lumbar pedicle stress fractures in patients on prolonged BP therapy. Along with a structured literature review, the objective was to evaluate whether diagnostic criteria derived from those used for AFFs may apply to these atypical vertebral fractures. Methods: Two patients with osteoporosis and on long-term BP therapy diagnosed with isolated lumbar pedicle stress fractures were retrospectively analyzed. A structured literature review identified similar reported cases. All cases were evaluated using the 2010 American Society for Bone and Mineral Research AFF criteria to assess applicability to isolated pedicle stress fractures. Results: Both patients demonstrated bilateral lumbar pedicle fractures without vertebral body involvement. One was treated conservatively; the other underwent robotic-assisted percutaneous pedicle screw fixation with documented fracture healing at six months. The literature review identified eight similar cases of isolated pedicle fractures in patients on prolonged BP therapy. Clinical course and imaging findings demonstrated stress-type features analogous to AFFs. The proposed AFF-based diagnostic criteria for pedicular insufficiency fractures were found to be applicable to all ten patients. Conclusions: Isolated bilateral pedicle stress fractures may represent a spinal analog of AFFs. Based on shared clinical and imaging features, we propose preliminary diagnostic criteria for atypical pedicular insufficiency fractures. Increased awareness and standardized criteria may aid in early diagnosis and reporting, encouraging further studies on this rare spinal entity. Full article

Background/Objectives: Femoral intertrochanteric fractures (ITFs) in older adults are associated with a substantial risk of mechanical failure after fixation, which can lead to persistent pain, delayed mobilization, and increased mortality. Injectable calcium composite bone substitute (ICCBS) augmentation has been proposed as a strategy to enhance construct stability and promote bone healing, but clinical evidence remains limited. The purpose of this study was to evaluate the efficacy of ICCBS in the management of osteoporotic ITFs. Methods: We conducted a multicenter, prospective, non-randomized controlled study of patients undergoing surgical fixation for osteoporotic ITFs using proximal femoral nails. Patients who consented to augmentation received ICCBS, while the control group underwent standard fixation alone. Demographic and injury-related variables were documented, and outcome data were prospectively collected. The primary outcome was time to radiographic bone union, while secondary outcomes included functional recovery (pain and ambulatory status) and complications, including fixation failure. Results: The mean time to radiographic bone union did not differ significantly between groups (p = 0.28). However, patients receiving ICCBS augmentation reported significantly lower postoperative pain scores up to 6 weeks and demonstrated reduced lag screw sliding and varus collapse at the time of bone union. There were no significant differences in complication rates, fixation failure, or ambulatory status at last follow-up between the two groups. Conclusions: ICCBS augmentation may improve early postoperative pain, construct stability, and functional recovery in patients with osteoporotic ITFs, although its effect on fracture healing and long-term outcomes remains uncertain. Further high-quality randomized trials are warranted to confirm these findings. Full article

Aim: Periprosthetic fracture-related infections (PFRIs) are a serious complication of total arthroplasty, with incidence rates increasing in line with the growing number of joint replacements. PFRI can lead to prolonged hospitalization, multiple surgical procedures and suboptimal functional outcomes. The diagnosis of PFRI remains challenging due to the overlap of clinical symptoms with other post-traumatic conditions, and identification of the pathogen often fails through conventional methods. This study also highlights the importance of a personalized medicine approach in managing PFRI, where diagnostic and therapeutic decisions are tailored to the individual patient’s comorbidities, immune status and bone healing capacity. By integrating clinical, microbiological and imaging data, our findings support precision-based strategies to optimize outcomes and minimize complication. Methods: This retrospective case series was conducted at the Unit of Osteoarticular Infection of the University of Turin, Italy, from January 2018 to December 2023. Patients who developed septic complications after open reduction and internal fixation (ORIF) of periprosthetic fractures involving hip or knee implants were included. The infection was diagnosed in accordance with established guidelines, and treatment decisions were based on clinical, microbiological and radiological findings. Results: In the present study, periprosthetic fractures complicated by infections were identified in nine patients (5.4%), constituting a small but significant subset of cases. The cases were then categorized into four clinical scenarios based on the following variables: joint involvement, fracture healing and infection progression. Scenario A, involving fractures without prosthetic involvement and unhealed fractures, included three patients (33%) and was treated with debridement and change of the fixation device. Scenario B, involving fractures without prosthetic involvement but with healed fractures, involved one patient (11%), where the ongoing infection was confirmed despite the healed fracture and where the device could be removed. The third scenario (C), which pertains to cases involving prosthetic involvement, included three patients (33%) who required replacement or removal of the prosthesis and, in some cases, a second stage. The fourth scenario, involving patients with limited operability, included two patients (22%) for whom no surgery was performed. Despite the significant clinical challenges encountered, the paucity of literature on the management of periprosthetic fractures with septic complications is limited, highlighting the need for further research in this understudied area. Conclusions: PFRI remains a challenging complication that necessitates a multidisciplinary approach to diagnosis and treatment. Despite advances in imaging and microbiological testing, the early detection and identification of pathogens remain challenging, emphasizing the necessity for enhanced diagnostic methods. This study offers valuable insights into the management of PFRI and provides a foundation for future research to develop optimal diagnostic and therapeutic strategies. Full article