Search Results (149)

Background: Preventing postoperative infections in hand surgery is an important factor for achieving sustainable results of surgical procedures. To prevent infections, especially when implants are used, preoperative prophylactic antibiotics are applied in adherence to predominantly national guidelines, which are not specifically tailored to hand surgery. However, several studies related to elective soft tissue hand surgery indicate that the preoperative use of antibiotics does not reduce the incidence of postoperative infections. Evidence regarding their efficacy in osteosynthesis of the hand and wrist remains limited. Methods: In this retrospective study, we analyzed 542 adult patients who underwent hand or wrist osteosynthesis between 2016 and 2019 at our university center. They were enrolled in an antibiotic treatment group and a control group without antibiotic treatment. The prophylaxis group (P) underwent surgery in the main operating theater under intravenous anesthesia, whereas the non-prophylaxis group (NP) was treated under WALANT (Wide Awake Local Anesthetic No Tourniquet) in an outpatient operating theater without receiving preoperative antibiotics. Theater construction and installation were otherwise similar, and both were classified as grade 1 theaters. We applied propensity modeling and inverse probability of treatment weighting (IPTW) to achieve balanced treatment groups with respect to risk factors for infection, and we calculated the odds ratio of prophylaxis and infection. Inclusion factors for risk of infection were age, female sex, smoking, diabetes, metabolic disease, inflammatory disease, substance abuse, cardiovascular disease, hepatopathy, renal disease, polytrauma, open fracture, being a manual worker, and occupational accidents. To assess the severity of the cases, we considered whether the fractures were intraarticular, multi-fragmentary, or open, and we collected data on the types of surgical implants that were used. Results: No significant association was found between antibiotic prophylaxis and postoperative infection rate (infection rate P: 3.86%; NP: 3.27%; unadjusted OR: 1.19; adjusted OR after IPTW: 1.09). In terms of risk factors, there was an insignificant trend of higher infection rates in the subgroups smoking, cardiovascular disease, open fracture, occupational accident, and open fixations. Conclusions: In this cohort, routine use of preoperative antibiotics in hand osteosynthesis did not reduce infection rates. The effectiveness of the widespread standardized application of prophylactic antibiotics to reduce the risk of postoperative infections in osteosynthesis of the hand and wrist remains debatable. Our findings set the basis for further prospective studies aiming at clearer guidelines for evidence-based perioperative patient care. Full article

Background/Objectives: Ceramic and polymer-based abutments and crowns are increasingly used for esthetic implant restorations, but their mechanical reliability under functional loading remains unclear. This study aimed to evaluate the fracture strength of implant-supported restorations with different abutment–crown material combinations. Methods: Ninety titanium implants (4.1 × 15 mm; BEGO, Germany) were restored with nine combinations of CAD/CAM-fabricated abutment and crown materials (zirconia, lithium disilicate, and ceramic-reinforced polymer; crowns of zirconia, advanced lithium disilicate, and hybrid nanoceramic; n = 10 per group). Ti-base abutments were bonded and cemented following material-specific surface treatments and thermocycled 5000 times (5–55 °C). Fracture tests were performed under static vertical loading at 1 mm/min in a universal testing machine. Data were analyzed using two-way ANOVA and Tukey HSD (α = 0.05). Results: Fracture resistance differed significantly among groups (p < 0.001). The highest mean strength was obtained for zirconia abutment–zirconia crown restorations (1417 N), followed by lithium-disilicate abutment–zirconia crown (1349 N), whereas BioHPP abutment–Tessera crown showed the lowest (823 N). Hybrid composite (Cerasmart) crowns exhibited stable performance across abutments, while Tessera crowns showed lower resistance. BioHPP abutments produced only crown-level fractures (p = 0.004), indicating a more reparable failure mode. Conclusions: Zirconia-based combinations showed the highest fracture resistance and are suitable for posterior use. Clinicians should balance strength with esthetics when considering translucent materials like advanced lithium disilicate or hybrid ceramics. Long-term clinical studies are needed to confirm these results and guide material selection. Full article

Background: Medial-compartment knee osteoarthritis with varus alignment is treated surgically by realignment (high tibial osteotomy, HTO), resurfacing (unicompartmental knee arthroplasty, UKA), or proximal fibular osteotomy (PFO), which aims to indirectly unload the medial tibial plateau. Methods: We conducted a structured narrative review (PubMed/MEDLINE, Google Scholar; 2000–2025; last search 30 August 2025) of comparative clinical, biomechanical and safety data for HTO, UKA and PFO, including prior meta-analyses and mechanistic reports. One hundred fourteen studies met prespecified criteria. Results: HTO reliably corrects coronal alignment and unloads the medial compartment; long-term survivorship varies by selection and technique, and complications include hinge fracture, delayed/nonunion and hardware problems. UKA typically yields faster early pain relief and recovery in pooled analyses, with implant-specific failure risks and mid-term revision dependent on design and surgical experience. PFO cohorts consistently report early pain and function gains with plausible biomechanical rationale, but evidence is dominated by small, heterogeneous series with short follow-up and limited comparative data. Adjusted head-to-head comparisons generally favor UKA for early pain yet show HTO and UKA can achieve similar patient-reported improvements in selected younger cohorts; robust comparative trials including PFO are lacking. Conclusions: HTO and UKA are established, mechanistically distinct options best matched to patient age, alignment, activity goals, and comorbidity. PFO is a low-burden, promising alternative with uncertain durability; longer-term, controlled evaluation and registry surveillance are required before broad adoption. Findings should inform shared decision-making while acknowledging differences in evidence maturity. Full article

Background: Cephalomedullary nails are the standard treatment of trochanteric fractures, and some implants with a perforated blade allow augmentation with bone cement to increase mechanical stability. The study compares the results of PFNA and TFNA implants (DePuy Synthes) with or without cement augmentation of the blade. Methods: A retrospective study evaluated 219 trochanteric fractures. The study included 59 men (27%) and 160 women (73%), with a mean patient age of 82 years. The most common fractures were type 31A2 (56%), followed by type 31A1 (25%) and type 31A3 (19%). The monitored parameters were evaluated from anteroposterior and axial images of the proximal femur and pelvis. TAD, blade position, lateral blade prominence, fracture varus, and cut-out were evaluated. Results: Cement-augmented blade implants (CABs) in 68 patients (31%) and cement-free implants (NCABs) in 151 patients (69%) were used. The average age difference between the groups was 7 years (CAB 86.07 ± 5.85 and NCAB 79.13 ± 8.48). CABs were used more frequently in women (60 cases) than in men (8 cases). Blade position was optimal in 68% of cases and suboptimal in 32%. The risk of varus deformities was not statistically significantly affected by the blade position. The statistical significance of CABs for reducing the risk of varus deformities in stable fractures (p = 0.396) or unstable fractures (p = 0.101) was not confirmed. The average varus angulation during treatment was 2.57° (CAB 2.53° and NCAB 2.67°). A varus deformity greater than 10° was confirmed in 8 eight patients (3.7%) and cut-out in three patients (1.4%). All patients with cut-out were in the NCAB group. Cement leakage occurred in two cases and was asymptomatic. One case of deep infection, lateral blade prominence, and avascular necrosis (AVN) were recorded. Conclusions: Cement augmentation of the blade did not significantly reduce varus deformity in this cohort, regardless of blade position of fracture stability. CABs may prevent cut-out in specific subgroups, but this requires further investigation. Full article

Background: This longitudinal cohort study evaluated implant-associated bone remodeling and paranasal sinus (PNS) status after the insertion of patient-specific titanium orbital implants (PSIs) in adult trauma patients. Sixteen patients with various orbital fractures underwent CT-based reconstruction at the University Hospital Halle (Germany) and were followed up to 6.5 years (observation period February/2019–October/2025). Post-operative CT scans assessed orbital bone remodeling, patency of the ostiomeatal unit, and PSI/screw exposure. Findings: Bone apposition was observed in 16 cases; 13 showed a patent maxillary sinus outflow tract. The median Lund score for the injured sides was 1.0 vs. for the uninjured sides 0 (Wilcoxon test, p = 0.131). PSI or screw exposure occurred in isolated cases, and basal maxillary sinusitis was noted in four patients. Significant bone remodeling was detectable from 6 months post-operatively. No implant-associated complications required further intervention. Conclusions and Relevance: These findings highlight the safety and precision of PSIs, with low long-term complication rates and preserved sinus function in non-irradiated patients, supporting their use in complex orbital reconstructions. Full article

Proximal humerus fractures are frequent injuries that often require internal fixation. Conventional metallic plates, however, present significant drawbacks such as corrosion, secondary removal surgeries, and adverse reactions in patients with metal hypersensitivity. This study evaluates biocomposite plates fabricated from polylactic acid (PLA) and polyvinyl alcohol (PVA), reinforced with hydroxyapatite (HA) derived from sugar industry by-products (BCF) at 10% and 20% concentrations. These composites are compatible with both injection molding and 3D printing, enabling the design of patient-specific implants. Characterization by SEM, FTIR, XRD, and DSC confirmed that BCF incorporation enhances strength, stiffness, osteoconductivity, and biocompatibility. Mechanical testing showed that PVA/BCF exhibited greater tensile strength and stiffness, suggesting suitability for load-bearing applications, though their water solubility restricts use in humid environments and prevents filament-based 3D printing. PLA/BCF composites demonstrated better processability, favorable mechanical performance, and compatibility with both manufacturing routes. Finite element analysis highlighted the importance of plate–humerus contact in stress distribution and fixation stability. Compared with non-biodegradable thermoplastics such as PEI and PEEK, PLA/BCF and PVA/BCF offer the additional advantage of controlled biodegradation, reducing the need for secondary surgeries. Cell viability assays confirmed cytocompatibility, with optimal outcomes at 10% BCF in PVA and 20% in PLA. These results position PLA/BCF and PVA/BCF as sustainable, patient-tailored alternatives to metallic implants, combining adequate mechanical support with bone regeneration potential. Full article

Background/Objectives: Modular dual mobility (MDM) cups are constituted by a cobalt-chromium liner inserted into a standard acetabular shell, allowing for intraoperative indication and supplementary screw fixation of the acetabular component. MDM could face mechanical and biological issues, with the associated risk of elevated blood metal ions levels and adverse local tissue reactions. Methods: This is a monocentric retrospective study on a consecutive series of 105 patients who underwent primary unilateral THA with the G7 Dual Mobility Acetabular System cup (Zimmer Biomet, Warsaw, IN, USA) from March 2019 to April 2023, and who were evaluated clinically and radiographically at a minimum two-year follow-up. All complications and revisions were recorded. Survivorship analysis with any revision surgery as endpoint was performed using Kaplan–Meier survival curves. Results: There were eighty-nine patients (follow-up rate 84.8%) who underwent clinical and radiographic follow-up. The mean follow-up was 2.5 ± 0.8 years. Revision-free survival was 98.0%. Three complications (2.8%) were recorded: one case of posterior dislocation, one periprosthetic joint infection and one post-traumatic periprosthetic femur fracture. Dislocation rate and infection rate were less than 1.0%. None of the patients were revised for adverse local tissue reactions. No cup loosening was observed. No cases of intraprosthetic dislocation, liner malseating or femoral notching were observed. Retroacetabular stress shielding was present in 43.0% of patients. Clinical scores significantly improved at the last follow-up compared with preoperative status (p < 0.0001): the final mean mHHS was 87.5 ± 5.3 and the final mean VAS was 0.5 ± 0.9. Conclusions: The Zimmer G7 modular dual mobility cup appears to be a safe and effective option and does not present specific implant-related mechanical and biological issues in primary total hip arthroplasty at a minimum two-year follow-up. Full article

Background: Post-traumatic osteomyelitis (PTO) of the lower extremity is among the most demanding problems in orthoplastic reconstructive surgery. It typically follows open fractures, failed osteosynthesis, or implant infection. Effective management requires coordinated infection control, stable skeletal fixation, and timely vascularized soft-tissue coverage. Methods: We conducted a retrospective case series of 20 consecutive patients with PTO of the lower limb treated between 2021 and 2024 at a tertiary orthoplastic center. All patients underwent radical debridement, culture-directed intravenous antibiotic administration, and soft-tissue reconstruction using local muscle, fasciocutaneous, or free flaps; vascularized bone flaps were used to select nonunion cases. The primary outcomes were flap survival, complications, infection resolution, and limb salvage. Exploratory analyses included descriptive subgroup summaries by flap category. Results: Among 20 patients (15 men, 5 women; mean age 53.6 years), reconstructions included reverse/pedicled sural flaps (n = 9), hemisoleus muscle flaps (n = 7), medial gastrocnemius muscle flaps (n = 2), peroneus brevis muscle flaps (n = 2), and free flaps (n = 6), which comprised anterolateral thigh (ALT), medial femoral condyle (MFC) osteoperiosteal, deep circumflex iliac artery (DCIA) osteocutaneous, and radial forearm free flaps (RFFFs). Single-flap reconstructions were performed in 13 cases, whereas multistage/multiflap strategies were used in 7. Overall flap survival was 90%. Major flap complications comprised partial necrosis in two reverse sural flaps and one complete loss of a reverse sural flap; two patients had minor wound dehiscence. Infection resolved in 18/20 patients (90%; 95% CI ≈ 0.70–0.97). One patient requested below-knee amputation due to persistent nonunion associated with a pathological fracture. At a mean 10-month follow-up, all limb-salvaged patients were ambulatory. Conclusions: Effective reconstruction of PTO is improved by using a patient-specific algorithm that considers the defect location, vascular status, and host comorbidities. Local muscle and fasciocutaneous flaps remain dependable for most defects, with free or vascularized bone flaps reserved for composite or recalcitrant cases. Early referral to high-volume centers, radical debridement, and orthoplastic collaboration are critical for optimizing limb salvage. Our findings should be interpreted in light of the study’s retrospective design and small sample size. Full article

Background: Midfacial trauma involving the zygomatic-maxillary-orbital (ZMO) complex poses significant reconstructive challenges due to anatomical complexity and the necessity for high-precision alignment. Traditional manual reduction techniques often result in inconsistent outcomes, necessitating revisions. Methods: This feasibility study presents two clinical cases treated using a novel, fully digital workflow incorporating computer-aided design and manufacturing (CAD/CAM) of patient-specific osteosynthesis plates and surgical drill guides. Following virtual fracture reduction and implant design, drill guides and implants were fabricated using selective laser melting. Surgical procedures included intraoral and transconjunctival approaches with intraoperative 3D imaging (mobile C-arm CT) to verify implant positioning. Postoperative results were compared to the virtual plan through image fusion. Results: Both cases demonstrated precise fit and anatomical restoration. The “one-position-fits-only” orbital implant design enabled highly accurate orbital wall reconstruction. Key procedural refinements between cases included enhanced interdisciplinary collaboration and improved guide designs, resulting in decreased planning-to-surgery intervals (<7 days) and seamless intraoperative application. Image fusion confirmed near-identical congruence between planned and achieved outcomes. Conclusions: The presented method demonstrates that fully digital, CAD/CAM-based midface reconstruction is feasible in the primary trauma setting. The technique offers reproducible precision, reduced intraoperative time, and improved functional and aesthetic outcomes. It may represent a paradigm shift in trauma care, particularly for complex ZMO fractures. Broader clinical adoption appears viable as production speed and workflow integration continue to improve. Full article

The French Bulldog is a breed predisposed to lateral humeral intercondylar fractures. A transcondylar lag screw combined with an epicondylar pin is most commonly used for their repair. However, improper screw and pin placement is common. This study used a 3D-printed plastic bone model, designed from a 5-year-old 19.5 kg French Bulldog’s humerus. Then, a 3D-printed drill guide was designed specifically for a lateral humeral condylar fracture. The bone models were divided into two groups: the first group included the use of the 3D-printed drill guide during the screw and pin placement, and the second group did not. After implantation, we compared the angle deviation of the transcondylar screw and the epicondylar pin, as well as the exit point translation of the transcondylar screw. The results showed differences between the two groups. The first group exhibited a lower angle deviation than the second group. Additionally, the exit point translation of the transcondylar screw was reduced in the drill guide group. The use of a custom-designed 3D-printed drill guide significantly improved the accuracy of the transcondylar screw and epicondylar pin placement. This advancement could reduce the incidence of postoperative complications. Full article

Objectives: The aim of this study was to evaluate the performance of GPT-4o in identifying nine common dental conditions on panoramic radiographs, both overall and at specific tooth sites, and to assess whether the use of different tooth numbering systems (FDI and Universal) in prompts would affect its diagnostic accuracy. Methods: Fifty panoramic radiographs exhibiting various common dental conditions including missing teeth, impacted teeth, caries, endodontically treated teeth, teeth with restorations, periapical lesions, periodontal bone loss, tooth fractures, cracks, retained roots, dental implants, osteolytic lesions, and osteosclerosis were included. Each image was evaluated twice by GPT-4o in May 2025, using structured prompts based on either the FDI or Universal tooth numbering system, to identify the presence of these conditions at specific tooth sites or regions. GPT-4o responses were compared to a consensus reference standard established by an oral-maxillofacial radiology team. GPT-4o’s performance was evaluated using balanced accuracy, sensitivity, specificity, and F1 score both at the patient and tooth levels. Results: A total of 100 GPT-4o responses were generated. At the patient level, balanced accuracy ranged from 46.25% to 98.83% (FDI) and 49.75% to 92.86% (Universal), with the highest accuracies for dental implants (92.86–98.83%). F1-scores and sensitivities were highest for implants, missing, and impacted teeth, but zero for caries, periapical lesions, and fractures. Specificity was generally high across conditions. Notable discrepancies were observed between patient- and tooth-level performance, especially for implants and restorations. GPT-4o’s performance was similar between using the two numbering systems. Conclusions: GPT-4o demonstrated superior performance in detecting dental implants and treated or restored teeth but inferior performance for caries, periapical lesions, and fractures. Diagnostic accuracy was higher at the patient level than at the tooth level, with similar performances for both numbering systems. Future studies with larger, more diverse datasets and multiple models are needed. Full article

Background/Objectives: Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. Methods: This retrospective cohort study analyzed 61 patients with T11–L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at p < 0.05. Results: PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, p < 0.01) and blood loss (165 cc vs. 317 cc, p < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (−7.77° vs. −1.53°, p = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio (p = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. Conclusions: PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation. Full article

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes. Full article

Background: Wrist arthritis significantly impacts the quality of life in elderly populations. While total wrist arthroplasty and wrist arthrodesis are established treatments, partial resurfacing procedures are emerging as a solution offering advantages for patients over 70 years of age. Objective: To systematically evaluate the efficacy, safety, and functional outcomes of radial versus carpal resurfacing procedures for the management of wrist arthritis in patients over 70 years of age. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published from these databases’ inception to May 2025. Studies reporting the outcomes of either radial or carpal resurfacing in patients ≥70 years of age with wrist arthritis were included. Primary outcomes were pain reduction, functional improvement, and complication rates. Results: Twenty studies met the inclusion criteria. Both carpal and radial resurfacing provided pain relief, with mean VAS scores ranging from 0 to 3.8 across studies and DASH scores ranging from 13 to 59 points, while carpal resurfacing showed better preservation of range of motion, with flexion/extension arcs of 27–65° compared to 22–46° for radial implants. Complication rates were comparable, though implant loosening was uncommon with both radial and carpal resurfacing. Both procedures demonstrated satisfactory patient-reported outcomes at midterm follow-up (median: 32 months; range: 6–84 months). Conclusion: In patients over 70 years of age with wrist arthritis, both radial and carpal resurfacing appear to be viable options with distinct advantages. Radial resurfacing may be preferred for patients with previous distal radius fractures, while carpal resurfacing offers better motion preservation and is indicated in SLAC and SNAC wrists. Patient selection should consider specific arthritis patterns, activity requirements, and comorbidities. Long-term studies are needed to evaluate durability beyond 5–10 years in this population. Full article

Background/Objectives: Tapered, fluted, modular titanium stems (TFTSs) are widely used in complex femoral reconstructions during total hip arthroplasty (THA), but evidence regarding the clinical performance of specific modular implant designs remains limited. This study aimed to compare the early clinical and radiographic outcomes of complex primary and revision THA using the M-Vizion^® modular stem system. Methods: We retrospectively analyzed 109 patients (46 complex primary and 63 revision THA cases) treated with the M-Vizion^® cementless modular TFTSs between 2020 and 2023. Clinical outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Forgotten Joint Score (FJS) at 1- and 2-years post-surgery. Radiographic evaluation included stem subsidence, radiolucent lines, heterotopic ossification, and complications. Clinically relevant subsidence was defined as >5 mm. Statistical analysis was performed using ANOVA. Results: The mean follow-up was 33.3 months for complex primary and 31.8 months for revision THA. Both groups demonstrated significant improvement in FJS over time (p < 0.05). In the revision group, HOOS improved significantly from baseline to follow-up (p < 0.001). Mean stem subsidence was 2.1 mm in the complex primary group and 1.8 mm in the revision group; nine patients (8.3%) had subsidence greater than 5 mm. No cases of aseptic loosening or stem fracture were observed. The overall complication rate was low, with dislocations (3.2%) and infections (2.8%) requiring revision. Conclusions: The M-Vizion^® TFTS system demonstrated favorable short-term outcomes in both complex primary and revision THA. These findings suggest potential utility in complex femoral reconstruction, although confirmation through longer-term studies is warranted. Full article