Search Results (389)

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient’s quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations—an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a decade (2004–2015) and patients who were treated for acute metastatic spinal compression (AMSCC) (2007–2017) were retrieved. There were no patients lost to follow-up. Results: The treatment cohorts were similar in terms of age, gender, tumour origin, and the number of spinal metastases. Fifty-four patients were diagnosed with AMSCC. Following treatment, the Frankel muscle grading improved by 0.5 ± 0.8 grades. Two hundred and eighteen patients underwent surgical intervention for FMD. Seventy percent of femoral metastases were located in the femoral neck and trochanteric area. Impending fractures accounted for 52% of the cohort. The FMD cohort, including impending and pathological fractures, was similar to the AMSCC cohort in terms of age and the time interval between cancer diagnosis and surgery (56.7 ± 74.2 vs. 51.6 ± 69.6, respectively, p = 0.646). The Karnofsky functional score was higher for the FMD cohort (63.3 ± 16.2) than for the AMSCC cohort (48.5 ± 19.5; p < 0.001). The mean survival time for the FMD cohort was double that of the AMSCC, at 18.4 ± 23.5 months versus 9.1 ± 13.6 months, respectively (p = 0.006). Conclusions: In conclusion, this study is novel in proposing that FMD and AMSCC are distinct clinical entities, differing in their impact on patient function and, most importantly, on patient survival. Full article

Background/Objectives: Pathological vertebral fragility (path-VF) increases the risk of osteoporotic fractures and pedicle screw loosening (PSL) after posterior instrumented spinal fusion (PISF). While WHO body mass index (BMI) categories broadly identify risks related to underweight and obesity, fixed thresholds may inadequately reflect vertebral fragility risks among elderly patients, especially within the normal-weight range. This study investigates whether current BMI classifications sufficiently capture the risk of path-VF in older adults. Methods: This retrospective study included 225 patients who underwent kyphoplasty or PISF (2022–2023). Path-VF was defined by non-tumorous fractures, screw reinforcement, or PSL within six months without prior reinforcement. Patients were grouped into the path-VF (n = 94) and control (n = 131) groups. HU and BMI values, BMI-related ORs, and age trends were analysed, and a logistic regression was performed. Results: Mean HU values were significantly lower in the path-VF group (71.37 ± 30.50) than in controls (130.35 ± 52.53, p < 0.001). Path-VF females (26.26 ± 5.38) had a lower BMI than the control females (29.33 ± 5.98, p = 0.002); no difference was found in males. Normal-weight females showed a borderline risk for path-VF (OR 2.03, p = 0.0495). Obesity (OR_male 0.31/OR_female 0.37) and being male and overweight (OR 0.21) were protective (all p < 0.05). BMI declined with age in path-VF males (p = 0.001) but increased in the controls (p = 0.023). A logistic regression identified a BMI < 22.5 kg/m² and age > 67.5 years as significant risk thresholds. Notably, 20.2% of path-VF patients over 67.5 had a normal weight, suggesting a potentially overlooked subgroup. Conclusions: The current WHO lower limit for normal BMI (18.5 kg/m²) may underestimate the risk of path-VF in patients older than 67.5 years, potentially overlooking 24.7% of cases. The results offer a new approach for clinicians to interpret BMI values at the lower end of the normal range (<22.5 kg/m²) with caution in elderly patients undergoing spinal surgery. Full article

Objectives: Spinal diseases are commonly encountered health problems with a wide spectrum. In addition to degenerative changes, other common spinal pathologies include metastases and compression fractures. Benign tumors like hemangiomas and infections such as spondylodiscitis are also frequently observed. Although magnetic resonance imaging (MRI) is considered the gold standard in diagnostic imaging, the morphological similarities of lesions can pose significant challenges in differential diagnoses. In recent years, the use of artificial intelligence applications in medical imaging has become increasingly widespread. In this study, we aim to detect and classify vertebral body lesions using the YOLO-v8 (You Only Look Once, version 8) deep learning architecture. Materials and Methods: This study included MRI data from 235 patients with vertebral body lesions. The dataset comprised sagittal T1- and T2-weighted sequences. The diagnostic categories consisted of acute compression fractures, metastases, hemangiomas, atypical hemangiomas, and spondylodiscitis. For automated detection and classification of vertebral lesions, the YOLOv8 deep learning model was employed. Following image standardization and data augmentation, a total of 4179 images were generated. The dataset was randomly split into training (80%) and validation (20%) subsets. Additionally, an independent test set was constructed using MRI images from 54 patients who were not included in the training or validation phases to evaluate the model’s performance. Results: In the test, the YOLOv8 model achieved classification accuracies of 0.84 and 0.85 for T1- and T2-weighted MRI sequences, respectively. Among the diagnostic categories, spondylodiscitis had the highest accuracy in the T1 dataset (0.94), while acute compression fractures were most accurately detected in the T2 dataset (0.93). Hemangiomas exhibited the lowest classification accuracy in both modalities (0.73). The F1 scores were calculated as 0.83 for T1-weighted and 0.82 for T2-weighted sequences at optimal confidence thresholds. The model’s mean average precision (mAP) 0.5 values were 0.82 for T1 and 0.86 for T2 datasets, indicating high precision in lesion detection. Conclusions: The YOLO-v8 deep learning model we used demonstrates effective performance in distinguishing vertebral body metastases from different groups of benign pathologies. Full article

Background/Objectives: Vertebral fractures (VFs) are a global health issue caused by traumatic or pathological factors that compromise spinal integrity. The burden of VFs is increasing, particularly in older adults. Methods: Data from the Global Burden of Disease 2021 were analyzed to estimate the prevalence, mortality, and years lived with disability due to VFs from 1990 to 2021. Estimates were stratified according to age, sex, and region. Bayesian meta-regression models were used to generate age-standardized rates, and projections for 2050 were calculated using demographic trends and the sociodemographic index. Das Gupta’s decomposition assessed the relative contributions of population growth, aging, and prevalence changes to future case numbers. Results: In 2021, approximately 5.37 million people (95% Uncertainty Interval [UI]: 4.70–6.20 million) experienced VFs globally, with an age-standardized prevalence of 65 per 100,000. Although the rates have declined slightly since 1990, the absolute burden has increased owing to population aging. VF prevalence was the highest in Eastern and Western Europe and in high-income regions. Males had higher VF rates until 70 years of age, after which females surpassed them, reflecting postmenopausal osteoporosis. Falls and road injuries were the leading causes of VF. By 2050, the number of VF cases is expected to increase to 8.01 million (95% UI: 6.57–8.64 million). Conclusions: While the age-standardized VF rates have decreased slightly, the global burden continues to increase. Targeted strategies for the early diagnosis, osteoporosis management, and fall prevention are necessary to reduce the impact of VFs. Full article

Background/Objectives: Recent breakthroughs in three-dimensional (3D) printing and high-resolution imaging have opened up new possibilities in personalized medicine, surgical planning, and forensic reconstruction. This study breaks new ground by evaluating the integration of high-resolution peripheral quantitative computed tomography (HR-pQCT) with multimodal imaging and additive manufacturing to assess a chronic, infected gunshot injury in the knee joint of a red deer. This unique approach serves as a translational model for complex skeletal trauma. Methods: Multimodal imaging—including clinical CT, MRI, and HR-pQCT—was used to characterise the extent of osseous and soft tissue damage. Histopathological and molecular analyses were performed to confirm the infectious agent. HR-pQCT datasets were segmented and processed for 3D printing using PolyJet, stereolithography (SLA), and fused deposition modelling (FDM). Printed models were quantitatively benchmarked through 3D surface deviation analysis. Results: Imaging revealed comminuted fractures, cortical and trabecular degradation, and soft tissue involvement, consistent with chronic osteomyelitis. Sphingomonas sp., a bacterium that forms biofilms, was identified as the pathogen. Among the printing methods, PolyJet and SLA demonstrated the highest anatomical accuracy, whereas FDM exhibited greater geometric deviation. Conclusions: HR-pQCT-guided 3D printing provides a powerful tool for the anatomical visualisation and quantitative assessment of complex bone pathology. This approach not only enhances diagnostic precision but also supports applications in surgical rehearsal and forensic analysis. It illustrates the potential of digital imaging and additive manufacturing to advance orthopaedic and trauma care, inspiring future research and applications in the field. Full article

Background: Magnetic resonance imaging (MRI) plays a crucial role in staging and preoperative evaluation in osteosarcoma patient. Fewer studies have focused on 2-year survival, which reflects tumour aggressiveness and early disease progression. This study examines the association between MRI characteristics and 2-year survival outcomes in osteosarcoma to better understand the imaging characteristic of high-risk patients. Methods: A retrospective case–control study was conducted at a tertiary university hospital. Patients diagnosed with osteosarcoma between 2010 and 2022 were included if they had a pre-treatment MRI and at least 2 years of follow-up. MRI scans were reviewed by two blinded radiologists to assess tumour location, volume, growth pattern, presence of fluid–fluid levels (FFL), pathological fractures, skip metastases, neurovascular bundle involvement, regional lymphadenopathy, and physeal or joint involvement. Statistical analyses, including Fisher’s exact test, Chi-square test, and Mann–Whitney U test, were performed to determine associations between MRI features and survival outcomes. Results: Twenty-eight patients (n = 28) met the inclusion criteria. Larger tumour volume (>300 mls) was significantly associated with poorer 2-year survival (p = 0.008). The presence of skip metastases also correlated with worse outcomes (p = 0.041). While presence of FFL, concentric growth pattern, regional lymphadenopathy, and physeal involvement showed trends toward poorer prognosis, these associations were not statistically significant. Conclusions: MRI characteristics, particularly tumour volume and skip metastases, are significant prognostic indicators of 2-year survival in osteosarcoma. These findings highlight the potential role of MRI in risk stratification and treatment planning, aiding in the identification of high-risk patients that can help with management. Full article

Background/Objectives: Periprosthetic fractures (PFs) can occur in both the upper and lower limbs, commonly resulting from falls at the same level. The frequency of PFs following total hip arthroplasty (THA) ranges from 0.045% to 4.1%, and this incidence is influenced by several factors, including age, gender, the type of prosthesis used, and existing comorbidities. Previous studies on this subject have been small in scale and did not adequately address the associated comorbidities, which pose a challenge for the aging population. This study aims to comparatively assess the incidence of THA-related PFs, immediate postoperative complications, and comorbidities in patients with PFs from three emergency hospitals. Methods: A retrospective observational study was conducted from 1 January to 31 December 2024, in which 54 patients with PFs hospitalized in three emergency hospitals (Bucharest, Oradea, and Ploiești) were evaluated, divided into Group B (n = 29), Group O (n = 14), and Group P (n = 11). Results: Of all patients with PFs, 81.48% had minor complications—grade 1, 9.26% had grade 2 complications (complications requiring medical treatment or other minor interventions), and 3.70% had complications requiring surgery or invasive procedures. Clavien–Dindo grade 5 (patient death) had an incidence of 3.70%. Cardiac pathology was the most common pathology; hypertension predominated in Group O (42.85%). Alzheimer’s disease was associated in 7 patients (12.96%). Without associated pathology, about 13% of patients were identified. Diabetes mellitus also occurred frequently in 31.50%. Data analysis indicates a very weak positive correlation between the Dindo Index and the Charlson Comorbidity Index (r = 0.046), which is not statistically significant (p = 0.628). The effect size, measured by Fisher’s z, is also reported as 0.046. Conclusions: No significant differences were found among the evaluated centers regarding therapeutic approaches, postoperative complications, and associated comorbidities. Furthermore, there is insufficient evidence to suggest a significant association between the Charlson Comorbidity Index and the Clavien–Dindo Index. Full article

Osteoporosis is a systemic bone disorder characterized by decreased bone mass and deteriorated microarchitecture, leading to an increased risk of fractures. Recent studies have revealed that its pathogenesis involves complex biological processes beyond bone remodeling, including oxidative stress, chronic inflammation, cellular senescence, osteoimmunology, gut microbiota alterations, and epigenetic modifications. Oxidative stress disrupts bone homeostasis by promoting excessive free radical production and osteoclast activity. Chronic inflammation and the accumulation of senescent cells impair skeletal repair mechanisms. Advances in osteoimmunology have highlighted the critical role of immune–bone crosstalk in regulating bone resorption and formation. Moreover, the gut–bone axis, mediated by microbial metabolites, influences bone metabolism through immune and endocrine pathways. Epigenetic changes, such as DNA methylation and histone modification, contribute to gene–environment interactions, affecting disease progression. Multi-omics approaches (genomics, proteomics, and metabolomics) systematically identify molecular networks and comorbid links with diabetes/cardiovascular diseases, revealing pathological feedback loops that exacerbate bone loss. In conclusion, osteoporosis pathogenesis extends beyond bone remodeling to encompass systemic inflammation, immunometabolic dysregulation, and gut microbiota–host interactions. Future research should focus on integrating multi-omics biomarkers with targeted therapies to advance precision medicine strategies for osteoporosis prevention and treatment. Full article

The proximal femur represents the most frequent site in the appendicular skeleton for metastatic bone disease (MBD) to occur, with a high risk for pathologic fracture. While surgical stabilization is typically used to manage fractures, reconstruction approaches are gaining popularity due to improved survival. Previous studies have focused on clinical outcomes, but patient-centered outcomes remain underexplored. This study aims to develop a patient-centered primary outcome for the Proximal FEmur Reconstruction or Internal Fixation fOR Metastases (PERFORM) Randomized Controlled Trial, employing a mixed-methods approach. First, a focus group with advanced cancer patients and caregivers identified relevant outcomes. Next, a discrete choice experiment (DCE) assessed the importance of these outcomes among stakeholders, including surgeons, patients and caregivers. The most important components for the primary outcome were identified: mortality within twelve months, physical function assessed at four months using the PROMIS^® Global Physical Function score, and the number of days at home within twelve months. The DCE further confirmed that survival and physical function were most prioritized. The PERFORM trial’s primary outcome, developed through extensive stakeholder engagement, will guide the evaluation of surgical approaches for MBD of the proximal femur and has the potential to influence patient-centered practice. Full article

Background/Objectives: Orbital fractures are a very serious problem due to the close location of the eyeball and a direct path to brain injuries, which is associated with serious consequences. This study aims to assess the usefulness of the Orbital Destruction Intensity (ODI) scale. Additionally, this article includes elements of an epidemiological study. Methods: A retrospective study of 160 patients admitted to the Department of Maxillofacial Surgery in Łódź (Poland) between January 2021 and June 2024 was conducted. In this study, general patient information (gender, age), details about the injuries (cause, affected orbit, accompanying symptoms), diagnosis (ODI scale, pathological classification), and treatment were assessed. Analysis of the distribution of features and regression analysis was performed in the case of quantitative data. To compare the assessment of the impact of a categorical variable on a quantitative variable, the Kruskal–Wallis test was used. A p-value of less than 0.05 was considered statistically significant. Results: The main cause of the accident was assault, which accounted for 39% of cases. An X-ray examination showed that patients had an average ODI score of 2.92 ± 1.69. Patients with low ODI scores mostly had isolated fractures of the orbital floor. As ODI scores increased, zygomaticomaxillary complex (ZMCO) fractures became more common as an additional fracture (p < 0.05). For patients with low ODI scores, treatment generally involves reconstructing the orbital wall with titanium mesh. For those with higher ODI scores, treatment may include microplate osteosynthesis or a combination of both methods (p < 0.05). Conclusions: A correlation was observed between the diagnosis based on ODI, anatomical classification, and the treatment provided. This relationship is related to the nature of the ODI scale, as, when the severity of the injury increases, additional anatomical structures (walls or rims of the orbit) are included. Full article

Approximately 50–70% of patients with advanced cancer will experience bone metastases. The link between metastatic lesions and pathological bones is especially troubling since more metastases mean a higher chance of painful fractures, which can reduce mobility and often require surgery. Therefore, fracture risk predictions are essential for managing patients with bone metastases. However, the current methods for evaluating the risk of fractures are subjective, with low predictive value. This paper highlights how there being no effective comprehensive models for grouping patients by fracture risk due to skeletal metastases makes it harder to create personalized treatment plans; presents the methods currently used for objective evaluations of the pathological fracture risk in bone metastases; and discusses their pros and cons. Full article

For centuries, the most prevalent antler abnormalities observed worldwide have been attributed to trauma. However, detailed pathological investigation of these cases has not yet been carried out. In free-living fallow deer (Dama dama), we identified a chronic osteomyelitis-like condition—Pedunculitis Chronica Deformans (PCD)—using pathological and radiological diagnostics. We propose that inflammation during post-casting wound healing and consequent scar formation can trigger the development of PCD. In this study, we characterize the pathomorphology of PCD and introduce a scoring system to describe its severity. Furthermore, we describe the histoanatomy of the junction between the pedicle and the surrounding skin—an area essential for the integrity of the integument—which, when compromised, may predispose cervids to PCD. Our findings suggest that the most common antler abnormality results from a pathological fracture associated with PCD, which can be further complicated by fatal meningoencephalitis and brain abscesses. PCD-related lesions, while less frequently observed, can also be identified in roe deer (Capreolus capreolus) and red deer (Cervus elaphus), with species-specific differences. These findings overlap with cases reported in other cervid species, suggesting a more general disorder of antler formation. Describing this condition provides a basis for assessing its epidemiology and understanding its relevance to wildlife health. Full article

Introduction: Headshaking is a common condition in horses, most cases are presumed idiopathic/trigeminal-nerve mediated. Diagnostic work-up of a headshaking horse may involve computed tomography (CT) of the head to exclude causative structural pathology. The relevance of the presence and severity of hyoid apparatus findings at CT to headshaking is unknown. Materials and methods: A retrospective analysis of CT changes in the hyoid apparatus in horses was carried out. Comparisons were performed between horses with signs of headshaking and a control population and a subgroup of horses with signs of headshaking and no other ‘likely relevant findings’ to headshaking and the control population. Results: The grade of temporohyoid joint sheath ossification, mineralisation of the tympanohyoid cartilage, and widening and narrowing of the temporohyoid joint all showed significant correlation with age. Findings of the remaining hyoid apparatus (fracture, deformation, or arthropathy) showed significant correlation with temporohyoid joint grade. Centres of ossification of the epihyoid, thyrohyoid, and lingual processes were described. No consistent association of headshaking to hyoid changes was found. Odds ratios were increased in many cases, particularly in comparisons of the subgroup with no ‘likely relevant findings’; however, statistical significance was not reached. Conclusions: CT findings of the temporohyoid joint are not consistently associated with clinical signs of headshaking. Full article

Background and Objectives: This study aimed to assess the frequency and distribution of facial bone injuries in terms of age, sex, residence, location, and etiology in the north-eastern region of Romania. Materials and Methods: This retrospective study was conducted within the Oral and Maxillofacial Clinics of “Sf. Spiridon” Hospital, Iași. The study group included 701 subjects (mean age 41.02 ± 18.45; sex: 603 males and 98 females) who were diagnosed with an orbital wall disorder. The epidemiological data on orbital wall fractures—including sociodemographic features, etiology, and location—were statistically analyzed. Results: The prevalence of orbital pathology was 1.47% congenital cases, 1.75% tumors, and 96.7% orbital fractures. The distribution of sex, age group, residence, and orbital localization varied significantly among the three diagnostic categories: tumors, congenital conditions, and fractures. Regarding sex, fractures were significantly more frequent in males (87.0%) compared to congenital cases (70.0%) and tumors (41.7%), while tumors showed a female predominance (58.3%) (p < 0.001). Congenital conditions predominantly affected patients under 20 years old (90.0%), whereas fractures were more evenly distributed across age groups, with higher frequencies between 31 and 50 years. In contrast, tumors involving the orbital walls were more frequent in older patients, with 33.3% in the 61–70 age group and 25.0% over 70 years. Regarding orbital localization, fractures were more likely to be bilateral (37.3%) or on the right side (44.3%), whereas congenital orbital defects and orbital tumors were predominantly unilateral and left-sided (70.0% and 66.7%, respectively). Bilateral involvement was rare in congenital cases (10.0%) and absent in tumors. Conclusions: The data support the finding that men are significantly more prone to trauma and orbital fractures, especially as a result of interpersonal violence and accidents, highlighting the need for preventive measures tailored to sex and socio-professional context. Full article

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article