Search Results (408)

Background/Objectives: To evaluate the clinical and demographic characteristics of patients with impaired union of long bone fractures admitted to a specialized orthopedic center and to identify factors associated with infection on admission. Methods: A retrospective, single-center cohort study was conducted at the National Scientific Center of Traumatology and Orthopedics named after Academician N.D. Batpenov. The study included patients hospitalized between 2023 and 2025 with diagnoses of fracture nonunion or delayed union. Demographic characteristics, lesion location, interval from injury to hospitalization, previous treatment, presence of revision osteosynthesis, infection on admission, and length of hospitalization were analyzed. Univariate analysis and multivariate logistic regression were used to identify factors associated with infection. Patients with osteomyelitis were excluded from the regression model to avoid definitional collinearity. Results: During the study period, 360 hospitalizations were recorded in 336 unique patients. The annual incidence increased from 79 in 2023 to 166 in 2025. The median patient age was 50 years, with women accounting for 52.5% of the sample. The most common bone sites were the femur (36.1%), humerus (23.6%), and tibia (15.0%). The median interval from injury to hospitalization at a specialized center was 2 years. Prior revision osteosynthesis was noted in 34.2% of patients. Infection on admission was detected in 20.3% of patients and was associated with a longer hospital stay. In an exploratory multivariable model (EPV ≈ 2.8), previous revision osteosynthesis was associated with infection on admission (OR 8.26; 95% CI 2.76–24.74; p < 0.001). Conclusions: Patients with nonunion and delayed union of long-bone fractures referred to a specialized center represent a clinically complex population characterized by prolonged time from injury, previous surgical interventions, and a substantial burden of infection. In an exploratory multivariable analysis, previous revision osteosynthesis was associated with infection on admission and may represent a marker of clinical complexity and prior treatment burden rather than a causal determinant of infection. Further prospective studies are required to clarify factors associated with infection and treatment outcomes in this patient population. Full article

Cranial cruciate ligament (CrCL) rupture in cats is less common than in dogs, and its optimal treatment remains a subject of debate. This study aimed to evaluate the application of cranial tibial wedge osteotomy (CTWO) as a dynamic stabilization technique in cats with CrCL rupture, describing the technical aspects and clinical outcomes obtained. Five cases with a confirmed diagnosis of CrCL rupture between 2020 and 2024 were included in this study. All patients were treated with CTWO using specific osteosynthesis locking plates designed for use in dogs and a complementary cerclage wire. Radiographic rechecks were performed at 8 and 12 weeks postoperatively, and clinical evaluations were performed 24 h, 8 weeks, 12 weeks, and 6 months postoperatively in every patient. Successful and complete bone healing of the tibial osteotomy was observed in every case. No intraoperative or postoperative complications related to implants or soft tissues were recorded. All cats achieved complete functional recovery without lameness at the last recheck six months after surgery. The technique was performed without significant technical difficulties, providing adequate stability and favorable clinical outcomes in all cases. These preliminary results support the use of CTWO as an effective surgical alternative for the treatment of CrCL rupture in cats. However, further studies with a larger number of cases and a longer follow-up are required to better evaluate its clinical application, outcomes, and influence on osteoarthritis progression in the long term. Full article

Background: Forearm nonunions represent a challenging clinical condition that significantly impairs upper limb function. Various surgical techniques have been proposed, including vascularized bone grafts. Although these procedures are not considered first-line treatment, they play a crucial role in complex or recalcitrant cases, particularly after failure of conventional methods, where their superior biological potential can significantly enhance bone healing. Despite the widespread use of the medial femoral condyle corticoperiosteal flap, simultaneous bilateral harvest has not been previously described in the literature. Case Presentation: We report the case of a 50-year-old male presenting with persistent nonunions of both the radius and ulna following previous osteosynthesis and revision surgery with iliac crest bone graft. The patient was successfully treated using bilateral vascularized corticoperiosteal free flaps harvested from both medial femoral condyles. Conclusions: Double vascularized corticoperiosteal free flaps may represent an effective and reliable option for the treatment of complex forearm nonunions, especially in cases with multiple previous surgical failures. To the best of our knowledge, this case represents the first report of simultaneous bilateral medial femoral condyle corticoperiosteal flap harvest. Full article

Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from typical ballistic wounds and require adapted surgical strategies. This study was conducted to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh War. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, which were frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up period. Patients with extensive soft tissue defects, particularly nasal and lip amputations, required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes. Full article

Objective: Osteosynthesis in the case of a sternal wound infection is challenging. It requires osteosynthesis systems that go beyond the usual wire techniques. In principle, there are three different systems, namely plates with locking screws, clips, and distance systems, which are the original methods used in chest wall reconstruction. The aim of this study is to assign these systems to the corresponding sternal pathologies. Patients and methods: This is a retrospective single-center analysis. Bone pathology is divided into three grades: grade I (good substance/no fractures), grade II (good substance/few transverse fractures), grade III (poor substance/substance defects/multiple transverse fractures). The individual osteosynthesis systems are assigned to the different grades accordingly. The suitability of the individual systems is analyzed in the short term and long term. Results: A total of 130 patients were included. Stable osteosynthesis was achieved in all patients. For grade I defects, 75 plates and 24 clips were used. For grade II defects, mainly plates (255) but also clips (16) were used. A distance system was used 24 times for grade III defects. One plate fractured. No other implant-related complications occurred. Discussion: If the different osteosynthesis systems are used according to the bone pathology, a stable chest wall can be restored in all patients. The individual systems have their own specific characteristics, which must be taken into account with regard to the suitability and invasiveness of the procedure. No single system is suitable for treating all sternal pathologies. Full article

A 61-year-old woman developed prosthetic valve infective endocarditis after osteomyelitis caused by extensively drug-resistant (XDR) Acinetobacter baumannii. Moreover, a systematic descriptive review of published case reports was performed to describe the main features, treatment, and outcomes of this condition. Methods: Apart from the description of our case, a PubMed and Embase literature review was conducted up to January 2026 using the terms “A. baumannii” AND (“infective endocarditis” OR “endocarditis” OR “valvular infection”). We included clinical cases of IE caused by A. baumannii published as full-text articles in English. Results: After orthopedic osteosynthesis surgery following a femur fracture, our patient developed osteomyelitis by XDR A. baumannii and was treated for a short period of time. Later, prosthetic aortic valve endocarditis was diagnosed. Despite treatment with cefiderocol and eravacycline, she died. An additional 18 clinical cases of IE by A. baumannii were identified from the literature, bringing the total to 19 cases. IE affected prosthetic valves in nine cases, native valves in nine and involved a right atrial mass in one. Twelve cases were caused by MDR or XDR A. baumannii. Mortality occurred more frequently in cases not treated with surgery (9/13, 69%) compared to those treated with surgery (1/6, 16.7%). However, given the very small sample size, these data should be interpreted with caution. Conclusion: This case, together with previously reported observations, highlights the severity of EI by A. baumannii and the need of multidisciplinary management. Full article

This study evaluates the mechanical behavior of bone-implant assemblies used in treating complex proximal humerus fractures, a clinical challenge due to the anisotropic nature of bone and variability in patient-specific conditions. The aim of this study was to compare the stability and stress distribution of three fixation methods: polyaxial locking plates, monoaxial locking plates, and intramedullary nails. Using 4th-generation composite humerus models, a four-part fracture (Neer IV) was simulated. The assemblies underwent axial compression testing using a universal testing machine, complemented by finite element analysis (FEA) and stereomicroscopy. The results indicate that while both plate types exhibited similar mechanical behavior—with stiffness values around 113–115 N/mm and failure initiated by plastic deformation of the implant—the intramedullary nail configuration demonstrated higher stiffness values under the tested experimental conditions (1084 N/mm), approximately 9.5 times higher than that of the plates. However, the nail assembly failed through brittle fracture of the bone rather than implant deformation. We conclude that while the intramedullary nail configuration demonstrated higher stiffness under the tested experimental conditions, its performance is heavily dependent on bone quality. In contrast, locking plates may provide a more gradual load-transfer behavior by transferring a greater proportion of the mechanical load to the implant, potentially making them more suitable for osteoporotic bone conditions, where reducing excessive stress concentration within the bone tissue may be beneficial. Full article

Background: Rehabilitation of edentulous mandibles in a post-oncologic setting remains a major clinical challenge. In such situations, placement of conventional endosseous implants may be compromised by severe bone deficiency, a history of peri-implant infection, and constraints related to reconstructive soft tissues. Customized titanium subperiosteal implants, made possible by three-dimensional imaging, computer-aided design, and additive manufacturing, represent a potential alternative when conventional options are unfavorable. This case report describes a full-arch fixed rehabilitation of an edentulous mandible in a patient previously treated for squamous cell carcinoma of the floor of the mouth. Methods: A patient-specific titanium additively manufactured subperiosteal jaw implant (AMSJI) made of biocompatible titanium was designed using a digital planning workflow. Implant placement was performed in a single surgical session under general anesthesia, with fixation using osteosynthesis screws. A screw-retained full-arch provisional prosthesis was delivered intraoperatively, allowing immediate loading with adjustments aimed at avoiding compression of the healing soft tissues. Results: The patient achieved satisfactory functional and esthetic rehabilitation. Postoperative follow-up showed overall favorable mucosal tolerance; an early, limited peri-abutment mucosal dehiscence was observed and managed with suturing under local anesthesia, without compromising implant stability. Conclusions: This case highlights the clinical interest of patient-specific titanium subperiosteal implants as a fixed rehabilitation option in post-oncologic patients with major osseous and mucosal constraints and a history of reconstructive procedures. The combination of accurate digital planning and custom-made manufacturing may avoid the need for extensive bone grafting. However, these findings should be interpreted with caution due to the short-term follow-up and the inherent limitations of a single-case report, which limit the level of evidence and generalizability. Full article

Bone fractures are often treated using invasive methods involving osteosynthesis plates. These plates are typically made of metallic materials such as titanium or steel. However, their high stiffness relative to bone tissue can contribute to the undesirable stress shielding effect. Therefore, there is a growing interest in developing new, more friendly biocompatible materials with improved mechanical properties. A promising candidate is a polymer composite made of high-strength PEEK reinforced with carbon fibers, which was the subject of this study. The aim of this work was a numerical analysis of osteosynthesis plates made from conventional materials and from PEEK-CF composite. The study also included geometric modification of the composite plate using topology optimization methods to reduce the stress shielding effect. The obtained results confirmed that the use of a geometrically optimized composite osteosynthesis plate can reduce bone unloading and ensure an appropriate stress distribution in the implant–bone system. Full article

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

Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer biological advantages; however, their long-term outcomes, especially regarding mechanical complications and comprehensive patient-reported well-being, require further detailed exploration, particularly in cohorts utilizing non-vascularized grafts. Objective: This retrospective study evaluated the complication rates, bone hypertrophy, limb function, and quality of life following non-vascularized fibular graft reconstruction for malignant bone tumors in a single-center cohort. This study offers insights into long-term success and patient well-being, with a particular focus on correlations with systemic therapy and defect size, factors that remain insufficiently explored in the current literature. Methods: In this single-center retrospective study, twenty-four non-vascularized fibular grafts were used to reconstruct intercalary bone defects following malignant tumor resection. Complications were categorized using the Clavien–Dindo classification. Graft hypertrophy was evaluated according to the method described by Weiland and de Boer. Functional outcomes were assessed using the MSTSs and TESSs, while quality of life was measured using the SF-36 questionnaire. Notably, the cohort analyzed represents a relatively large single-center series focusing exclusively on the outcomes of non-vascularized fibular grafts. Results: Our findings revealed significant rates of mechanical complications, with osteosynthesis material failure occurring in 50.0% of cases, pseudarthrosis in 47.6%, and fractures of the fibular grafts in 38.1% of cases. Importantly, there were significant correlations between mechanical complications and systemic therapy (p = 0.017), as well as between defect size and fractures (p = 0.013), identifying critical risk factors. Despite these considerable complication rates, patients achieved satisfactory limb function (MSTS: 74 ± 17; TESS: 83 ± 15) and quality of life scores comparable to national norms, with notably higher mental health indices, highlighting their psychological resilience. Conclusions: Non-vascularized fibular graft reconstruction, despite high mechanical complication rates, significantly facilitates long-term functional recovery and psychological well-being. These findings emphasize the necessity of risk-adapted surgical strategies and long-term follow-up protocols to mitigate complications, optimize long-term function, and ultimately advance patient-centered care. Full article

Background: Over the past 25 years, advances in knee surgery have been driven by an improved understanding of fracture morphology and associated injuries, as well as by significant technological progress. The introduction of novel classification systems has led to the refinement of treatment strategies, particularly with respect to the selection of surgical approaches. Furthermore, advances in biomechanical understanding have facilitated the development of new osteosyntheses designed to promote earlier rehabilitation while simultaneously reducing complication rates. Research Question: Which key milestones over the last 25 years have significantly influenced treatment strategies for knee joint fractures, with a perspective on unresolved issues? Results: Recent advances in fracture management, osteosynthesis, imaging techniques, and biomechanical research have substantially improved clinical outcomes, including a reduction in infection rates and improved postoperative results. The implementation of new classification systems has enabled more precise preoperative planning, allowing surgeons to define approaches that ensure adequate visualization of the articular surface while facilitating optimal positioning of the osteosynthesis. In terms of osteosynthesis, the introduction of locking plate technology has become widely established and supported by biomechanical evidence and has largely replaced traditional methods such as tension-band wiring of the patella. Despite these advances, fracture management in geriatric patients remains a considerable challenge, as compromised bone quality frequently limits the ability to achieve sufficiently load-stable osteosynthesis. Direct visualization of the articular surface is essential for adequate assessment and reduction of the affected articular segment. However, there is currently no consensus on which surgical approach or possible extension is most appropriate while simultaneously ensuring a low complication rate. Full article

Objectives: Management of unstable pelvic fractures during pregnancy presents a major therapeutic challenge, requiring careful multidisciplinary evaluation to balance maternal benefits and fetal radiation risks. Methods: We report the case of a 32-year-old patient who presented with a pelvic fracture due to a road traffic accident at three months of pregnancy. A left sacroiliac osteosynthesis was performed to treat a left sacroiliac diastasis with pelvic osteosynthesis using a trans-iliosacral approach under cone-beam CT (CBCT) guidance using a very-low-dose protocol. Radiation parameters and fetal dose estimates were calculated in advance in collaboration with a medical physicist. Tight beam collimation, a reduced field of view, and minimization of fluoroscopic checks were applied to keep fetal exposure as low as reasonably achievable. This article aims to demonstrate the feasibility of managing a complex pelvic fracture using interventional radiology and to review the literature on management options and gestational age-dependent fetal risks. Results: The estimated cumulative fetal dose from initial imaging, open surgery, and CBCT-guided osteosynthesis remained below 70 mGy using a pregnant phantom (Duke Organ Dose–Dosewatch–General Electric system), which is below thresholds associated with deterministic effects. The procedure achieved optimal screw positioning with less than 40 s of fluoroscopy. Maternal postoperative recovery was favorable, and follow-up revealed normal fetal development. Conclusions: This case demonstrates that CBCT-guided percutaneous iliosacral screw fixation can be safely performed during pregnancy with meticulous planning, dose-reduction strategies, and multidisciplinary collaboration, maintaining fetal radiation exposure below accepted safety thresholds. Full article

Background and Objectives: High rates of mortality and morbidity among elderly hip fracture patients are a recognized global issue. This study aimed to evaluate risk factors for early complications and 30-day mortality in hip fracture patients. Materials and Methods: The prospective study included 583 patients over 65 years old who sustained hip fractures from fall and underwent surgery. Each patient was followed up for 30 days and complications were recorded. Regression models were used to assess the influence of patient characteristics and laboratory markers on 30-day mortality and complications. Results: Any complication increased the risk of mortality by 5.6 times (95% CI 1.6–19.9, p = 0.008). Having > 6 comorbidities increased the risk of mortality by 8.2 (95% CI 1.9–35.5, p = 0.005) and the risk of complications by 2.3 (95% CI 1.9–35.5, p = 0.000). Patients > 85 years old had increased risk of mortality by 2.2 times (95% CI 1.2–4.1, p = 0.015) and a 1.7-fold increase in risk of complications (95% CI 1.2–2.4, p = 0.005). Vitamin D significantly predicted mortality with odds ratio of 2.1 (95% CI 1.1–4.1, p = 0.028). Serum N-terminal pro-brain natriuretic peptide levels > 780 ng/L predicted 2.3-fold increase in mortality (95% CI 1.0–4.9, p = 0.040) and a 2.6-fold risk of complications (95% CI 1.7–3.9, p = 0.000). Conclusions: Occurrence of complication increases the risk of mortality. Age and comorbidities are significant factors associated with 30-day mortality and complications. Vitamin D levels are associated with higher risk of mortality. N-terminal pro-brain natriuretic peptide levels correspond to higher risks of death and complications. Full article

Background: Treatment of failed osteosynthesis of fractures of the proximal humerus with one-stage or two-stage surgery is difficult and clinical results are poor. The aim of this work is to evaluate the microbiological positivity of devices removed due to osteosynthesis failure. Furthermore, the clinical outcomes of these patients were evaluated at a follow-up of minimum 6 months, to assess the recovery of range of motion and the reduction in pain. Methods: A retrospective analysis was performed on 15 patients treated from September 2021 to September 2023 for failure of previous proximal humerus synthesis. These treatments included implant removal and arthrolysis. None of these patients showed signs of infection. Demographic data, VAS, ASES, Constant score, and range of motion (ROM) were assessed before surgery and at least 6 months of follow-up. Removed devices were processed in MicroDTTect^® system, to increase the sensitivity of microbiological cultures. The cultural and clinical results of device removal surgery were analyzed. Results: Culture results were positive in eight out of 15 patients. Slow-growing anaerobic bacteria were the most isolated microorganisms, particularly C. acnes (62.5%). Improvement in patients’ passive ROM was observed. The patients went from a preoperative VAS of 8.4 (±1.1) to a VAS of 2 (±1.1) at follow-up. Similarly, we observed an increase in ASES from 9 ± 6 to 50.2 ± 2.3 and Constant score from 17 (15–18) to 40.7 ± 3.3 at a follow-up of at least 6 months. Conclusions: Two-stage procedure should always be considered in the context of proximal humerus synthesis failure. Arthrolysis with postoperative physiotherapy prepares the shoulder for definitive prosthesis implantation. Full article