Search Results (168)

The material selection process can be viewed as a multi-criteria decision-making (MCDM) problem with multiple objectives, which are often conflicting and of different importance. The selection of the most suitable biomaterial is considered as a very complex, important, and responsible task that is influenced by many factors. In this paper, a procedure for biomaterial selection based on MCDM is proposed by using a developed decision support system (DSS) named MCDM Solver. Within the framework of the developed DSS, the complete procedure for selecting the criteria weights was developed. Also, in addition to the adapted standard MCDM methods such as TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) and VIKOR (VIšekriterijumsko KOmpromisno Rangiranje), an extended WASPAS (Weighted Aggregated Sum Product Assessment) method was developed, enabling its application for considering target-based criteria in solving biomaterial selection problems. The proposed MCDM Solver enables a structured decision-making process helping decision-makers rank biomaterials with respect to multiple conflicting criteria and make rational and justifiable decisions. For the validation of the developed DSS, two case studies, i.e., the selection of a plate for internal bone fixation and a hip prosthesis, were presented. Finally, lists of potential biomaterials (alternatives) in the considered case studies were ranked based on the selected criteria, where the best-ranked one presents the most suitable choice for the specific biomedical application. Full article

Background/Objectives: Trochanteric femoral fractures pose significant surgical challenges, particularly in elderly patients. Intramedullary nailing (IMN) and plate fixation (PF) are the primary operative strategies, yet their comparative efficacy and safety remain debated. This meta-analysis synthesizes randomized controlled trials (RCTs) to evaluate clinical, functional, perioperative, and biomechanical outcomes of IMN versus PF specifically in trochanteric fractures. Methods: A systematic search of six databases was conducted up to 20 May 2024, to identify RCTs comparing IMN and PF in adult patients with trochanteric femoral fractures. Data extraction followed PRISMA guidelines, and outcomes were pooled using random-effects models. Subgroup analyses examined the influence of fracture stability, implant type, and patient age. Risk of bias was assessed using the Cochrane RoB 2.0 tool. Results: Fourteen RCTs (n = 4603 patients) were included. No significant differences were found in reoperation rates, union time, implant cut-out, or mortality. IMN was associated with significantly reduced operative time (MD = −5.18 min), fluoroscopy time (MD = −32.92 s), and perioperative blood loss (MD = −111.68 mL). It also had a lower risk of deep infection. Functional outcomes and anatomical results were comparable. Subgroup analyses revealed fracture stability and nail type significantly modified operative time, and compression screws were associated with higher reoperation rates than IMN. Conclusions: For trochanteric femoral fractures, IMN and PF yield comparable results for most clinical outcomes, with IMN offering some advantages in surgical efficiency and perioperative morbidity, though functional outcomes were comparable. Implant selection and fracture stability influence outcomes, supporting individualized surgical decision making. Full article

Background: Greater tuberosity fracture–dislocations (GTFDs) represent a distinct subset of proximal humerus fractures, occurring in up to 57% of anterior glenohumeral dislocations. Malreduction may result in impingement, instability, and functional limitation. Treatment is influenced by the displacement magnitude and direction, bone quality, and patient activity level. Methods: This narrative review was based on a comprehensive search of PubMed, Scopus, and Web of Science for English-language articles published between January 2000 and March 2025. Studies on pathomechanics, classification, diagnosis, treatment, and outcomes of GTFDs in adult and pediatric populations were included. Data were analyzed to summarize the current evidence and identify clinical trends. Results: A displacement ≥ 5 mm is the standard surgical threshold, though superior or posterosuperior displacement ≥ 3 mm—and ≥2 mm in overhead athletes—may justify surgery. Conservative treatment remains appropriate for minimally displaced fractures but is associated with up to 48% subacromial impingement and 11% delayed surgery. Surgical options include arthroscopic repair for small or comminuted fragments and open reduction and internal fixation (ORIF) with screws or plates for larger, split-type fractures. Locking plates and double-row suture constructs demonstrate superior biomechanical performance compared with transosseous sutures. Reverse shoulder arthroplasty (RSA) is reserved for elderly patients with poor bone stock, cuff insufficiency, or severe comminution. Pediatric cases require physeal-sparing strategies. Conclusions: GTFDs management demands an individualized approach based on fragment displacement and direction, patient age and activity level, and bone quality. While 5 mm remains the common threshold, lower cutoffs are increasingly adopted in active patients. A tiered treatment algorithm integrating displacement thresholds, fracture morphology, and patient factors is proposed to support surgical decision making. The incorporation of fracture morphologic classifications further refines fixation strategy. Further prospective and pediatric-specific studies are needed to refine treatment algorithms and validate outcomes. Full article

Background: Atypical subtrochanteric femoral fractures (ASFs), frequently linked to long-term bisphosphonate use, present significant fixation challenges due to impaired bone healing. While intramedullary (IM) nailing is the standard treatment, delayed union or nonunion remains common. This study aimed to evaluate whether supplementing IM nailing with lateral plate augmentation improves radiographic healing in patients with ASFs. Methods: This retrospective comparative study included 12 elderly female patients with ASFs treated between October 2013 and October 2023. Five patients underwent IM nailing alone (IM group), while seven received IM nailing with additional lateral plate fixation (Plate + IM group). Fracture healing was assessed using the modified Radiographic Union Score for Tibial fractures (mRUST) at 3, 6, and 12 months postoperatively. Intergroup comparisons were performed using the Mann–Whitney U test. Results: The median mRUST scores in the IM group were 4 (IQR 3.5–4), 6 (IQR 4.5–6.5), and 8 (IQR 7–9) at 3, 6, and 12 months, respectively. In the Plate + IM group, the scores were 5 (IQR 4–6), 8 (IQR 8–8), and 10 (IQR 10–11), respectively. The Plate + IM group demonstrated significantly higher mRUST scores at all assessed time points (3 months: p = 0.018; 6 months: p = 0.003; 12 months: p = 0.006). No implant failures or postoperative infections occurred in either group during the 12-month follow-up period. One patient (20%) in the IM group developed fracture nonunion, while no nonunion cases were observed in the Plate + IM group. Conclusions: Lateral plate augmentation as an adjunct to IM nailing may promote faster and more consistent radiographic healing in atypical subtrochanteric femoral fractures. This dual-fixation strategy may offer a biomechanically more robust option for patients at risk of delayed union, potentially contributing to a lower risk of nonunion, though further prospective studies are required to confirm this finding. Full article

Study design: The advent of the Matrix Wave^TM System (Depuy-Synthes)—a bone-anchored Mandibulo-Maxillary Fixation (MMF) System—merits closer consideration because of its peculiarities. Objective: This study alludes to two preliminary stages in the evolution of the Matrix Wave^TM MMF System and details its technical and functional features. Results: The Matrix Wave^TM System (MWS) is characterized by a smoothed square-shaped Titanium rod profile with a flexible undulating geometry distinct from the flat plate framework in Erich arch bars. Single MWS segments are Omega-shaped and carry a tie-up cleat for interarch linkage to the opposite jaw. The ends at the throughs of each MWS segment are equipped with threaded screw holes to receive locking screws for attachment to underlying mandibular or maxillary bone. An MWS can be partitioned into segments of various length from single Omega-shaped elements over incremental chains of interconnected units up to a horseshoe-shaped bracing of the dental arches. The sinus wave design of each segment allows for stretch, compression and torque movements. So, the entire MWS device can conform to distinctive spatial anatomic relationships. Displaced fragments can be reduced by in-situ-bending of the screw-fixated MWS/Omega segments to obtain accurate realignment of the jaw fragments for the best possible occlusion. Conclusion: The Matrix Wave^TM MMF System is an easy-to-apply modular MMF system that can be assembled according to individual demands. Its versatility allows to address most facial fracture scenarios in adults. The option of “omnidirectional” in-situ-bending provides a distinctive feature not found in alternate MMF solutions. Full article

Background/Objectives: The most common limb-salvage procedure for end-stage ankle arthropathy with severe bone defect is arthrodesis. Successful fusion requires rigid metal fixation, effective filling of the bone defect space, and maximal securing of the contact area between the tibia and talus. In cases with severe bone defect, sufficient grafting using autogenous bone alone is limited, and there is still controversy regarding the effectiveness of allogeneic or xenogeneic bone grafting. This study aimed to evaluate the intermediate-term clinical outcomes after shortening arthrodesis using fibular osteotomy for ankle arthropathy with severe bone defect. Methods: Twenty-two patients with shortening ankle arthrodesis were followed up ≥ 3 years. All operations were performed by one senior surgeon and consisted of internal fixation with anterior fusion plate, fibular osteotomy, and autogenous bone grafting. The causes of ankle joint destruction were failed total ankle arthroplasty (7 cases), neglected ankle fracture (6 cases), delayed diagnosis of degenerative arthritis (5 cases), avascular necrosis of talus (2 cases), and diabetic neuroarthropathy (2 cases). Clinical outcomes including daily living and sport activities were evaluated with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). Radiological evaluation included fusion rate, time to fusion, leg length discrepancy, and degenerative change in adjacent joints. Results: The FAOS and FAAM scores significantly improved from a mean of 21.8 and 23.5 points preoperatively to 82.2 and 83.4 points at final follow-up, respectively (p < 0.001). Visual analogue scale for pain during walking significantly improved from a mean of 7.7 points preoperatively to 1.4 points at final follow-up (p < 0.001). The average time to complete fusion was 16.2 weeks, and was achieved in all patients. The average difference in leg length compared to the contralateral side was 11.5 mm based on physical examination, and 13.8 mm based on radiological examination. During the average follow-up of 56.2 months, no additional surgery was required due to progression of degenerative arthritis in the adjacent joints, and no cases required the use of height-increasing insoles in daily life. Conclusions: Shortening ankle arthrodesis using fibular osteotomy and anterior fusion plate demonstrated satisfactory intermediate-term clinical outcomes and excellent fusion rate. Advantages of this procedure included rigid fixation, preservation of the subtalar joint, effective filling of the bone defect space, and maximal securing of the contact area for fusion. The leg length discrepancy, which was concerned to be a main shortage, resulted in no significant clinical symptoms or discomfort in most patients. Full article

Background: Displaced proximal humerus fractures (PHFs) in adults represent a common orthopedic challenge, especially in elderly patients with compromised bone quality. Intramedullary nails (IM) and locking plates (LP) are the most widely used fixation techniques, though the literature remains inconclusive regarding their comparative efficacy. Methods: This retrospective cohort study included 187 patients (mean age: 65.4 years) treated surgically for Neer ≥ 2-part proximal humerus fractures at a single tertiary referral center between 2018 and 2023. Patients underwent either IM nailing or LP fixation. Baseline characteristics included age, sex, smoking status, ASA score, trauma mechanism, and bone quality (assessed by the Deltoid Tuberosity Index). Functional outcomes (DASH and Constant–Murley scores), range of motion (ROM), radiographic healing, and complications were evaluated at 1, 3, 6, and 12 months postoperatively. Results were stratified by fracture type (two-, three-, and four-part fractures) and treatment group. Results: At 12 months, no statistically significant differences were found between groups in terms of DASH (p = 0.484) or Constant–Murley scores (p = 0.057). ROM recovery was comparable across all time points. Stratified analysis showed similar outcomes across fracture types. Age, smoking, and bone quality did not significantly influence clinical results. The overall complication rate was 11.8%, with no significant difference between groups. Avascular necrosis and hardware-related issues occurred predominantly in four-part fractures. Conclusions: Both intramedullary nailing and locking plate fixation provided comparable short-term outcomes for displaced PHFs. Functional recovery appeared more dependent on fracture complexity than on the choice of implant. Surgical technique should therefore be selected based on fracture morphology, patient characteristics, and surgeon experience. Full article

Bending fatigue significantly affects the mechanical stability and lifespan of biomedical implants, such as bone plates and orthopaedic fixation devices, which undergo cyclic loading in the human body. This study examines the microstructure, porosity, and bending fatigue properties of PBF-LB/M SS316L. Samples were analysed across three faces (top, front, and side) using optical microscopy (OM) and scanning electron microscopy (SEM) to observe microstructural features and porosity. Elemental composition was measured by energy-dispersive X-ray spectroscopy (EDX). Phase structures and grain orientations were characterised via X-ray diffraction (XRD) and electron backscatter diffraction (EBSD). Four-point bending fatigue tests, conducted under two loading conditions, below and slightly above the yield point, demonstrated that defects inherent to the PBF-LB/M process, particularly micropores and unmelted powder particles, strongly influence fatigue crack initiation. Real-time monitoring of crack initiation and propagation on the external sample surface was performed using a high-speed digital microscope. These findings indicate the influence of microstructural defects on fatigue performance in PBF-LB/M SS316L, supporting the design and development of more reliable patient-specific biomedical implants. Full article

Background/Objectives: Atrophic nonunion presents a significant challenge in hand surgery, often resulting in chronic pain and functional disability. Traditional surgical treatments such as bone grafting and internal fixation may be insufficient. This study evaluates the feasibility, safety, and preliminary effectiveness of a regenerative-first surgical protocol that combines autologous bone micro-grafts with a fresh human amniotic membrane to create a biologically active regenerative chamber. Methods: A total of 8 patients (6 males, 2 females; age range: 22–56 years) with an atrophic nonunion of metacarpals and phalanges were treated using a regenerative-first surgical approach. Autologous bone was harvested from the iliac crest and mechanically disaggregated via Rigenera^® technology to obtain micro-grafts enriched with osteoprogenitor cells and extracellular matrix fragments. These were applied to the bone defect and wrapped in a fresh amniotic membrane, creating a biologically active chamber. Fixation was achieved using low-profile plates or screws, and all patients underwent early protected mobilization. Results: Radiographic consolidation was achieved in all patients within 2 months postoperatively. Functional outcomes at final follow-up demonstrated excellent or good results in Total Active Motion (TAM), with grip and pinch strength within normative ranges and minimal residual pain. Conclusions: This preliminary series suggests that combining autologous bone micro-grafts with an amniotic membrane in a regenerative surgical protocol is a promising strategy for managing atrophic nonunion in the hand. The approach was associated with rapid consolidation and excellent functional recovery. Further research with larger, controlled cohorts is warranted to validate efficacy and define standardized indications and techniques. Full article

Metallic biomaterials are prevalent in medical applications. In the treatment of mandibular fractures, the use of metallic biomaterials makes it possible to recover the ability to bite and partially recover speech through preventing ankylosis of the temporomandibular joints, the formation of pseudoarthritic joints, and the consolidation of reduced bones. This article presents the concept of a triaxial plate for osteosynthesis of basal fractures of the mandibular condyle, which are very common fractures in humans. Approximately half of patients with such fractures have wide (squat) condylar processes, which allows for the use of as many as three straight plates. However, installing three plates is quite troublesome, and the use of a single and transversely reinforced plate would facilitate treatment. This study proposes a plate with three reinforcements running along three divergent axes. The plate is fixed to the bone fragments with 11 screws. This concept for the treatment of basal fractures allows patients to quickly recover their primary system functions due to rigid fixation through the use of short (4 mm) screws, as there is no trauma to the medial pterygoid muscle and the mandible canal contents and no intermaxillary immobilization. Full article

Background/Objectives: Biomineral adhesive bone adhesives composed of phosphoserine combined with magnesium oxides or phosphates exhibit exceptional adhesive properties. This study evaluates two experimental mineral–organic cementitious adhesives in a clinical test setup, investigating their potential for fracture reduction and simultaneous defect filling. Methods: The two experimental adhesives (Groups B and C) and a standard hydroxyapatite cement (Group A, reference) underwent compressive strength testing, shear strength testing, and screw pullout tests as part of a first biomechanical characterization. Furthermore, all materials were tested in a porcine tibial split depression fracture model, where they served both for fracture reduction and for filling the metaphyseal bone defect, supplementary to plate osteosynthesis. Fracture stability was assessed under cyclic loading in a materials testing machine. Results: The OPLS (O-phospho-L-serine) containing adhesive (Group B) demonstrated the highest compressive strength as well as the highest shear strength. All three materials showed comparable maximum pullout forces. Both experimental adhesives (Groups B and C) exhibited higher pullout stiffness compared to the standard cement (Group A). In the fracture model, no significant differences in displacement under cyclic loading were observed between groups. Conclusions: The biomineral adhesive bone adhesives (Groups B and C) demonstrated biomechanical advantages in axial compression, adhesive (shear) strength, and screw fixation compared to the standard hydroxyapatite cement (Group A). Furthermore, they achieved comparable stabilization of metaphyseal fractures under clinically relevant dynamic loading conditions. Full article

In modern surgery, the internal fixation plates fabricated from hydroxyapatite/poly(L-lactide) (HA/PLLA) composites encounter clinical limitations in fracture treatment due to their inadequate mechanical properties. In this work, pressure-induced flow (PIF) technique is employed to address this limitation. Under optimal processing conditions (140 °C and 250 MPa), the HA/PLLA composites exhibit an impressive flexural strength of 199.2 MPa, which is comparable to that of human cortical bone, the strongest bone tissue in the body. The tensile strength and the notched Izod impact strength are close to 84.2 MPa and 16.7 kJ/m², respectively. Meanwhile, the HA/PLLA composites develop multi-level stacked crystal layers during PIF processing, accompanied by increases in crystallinity (53.1%), crystal orientation (81.6%) and glass transition temperature (78.8 °C). After 2 months of in vitro degradation, the HA/PLLA composites processed by the PIF technique still maintain considerable flexural strength (135.3 MPa). The excellent mechanical properties of HA/PLLA composites processed by PIF technique expand their potential as an internal fixation plate. Full article

Background: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. Methods: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Results: Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (p = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, p = 0.03). However, intraoperative blood loss (p = 0.36), Mayo Elbow Performance Score (p = 0.71), range of motion (p = 0.36), and complication rates (p = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (p = 0.17), and four cases required implant removal due to discomfort (p = 0.18) in the anterolateral group. Conclusions: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection. Full article

In the design of mandibular implants, the application of previous research findings, which highlight the significance of asymmetric occlusal load transfer schemes, is often lacking. The generated identical oblique occlusal force for maximum muscle efficiency may not be the sole criterion for assessing the load-bearing capacity of a mandibular prosthesis. The hypothesis of this study was that the load-bearing capacity of extensive mandibular prostheses is significantly underestimated when assuming mandibular support at the temporomandibular joint on the occlusal side compared to the assumption of perfect osseointegration between the implant and bone. Finite Element Method (FEM) simulation studies were conducted to analyze occlusal load transfer, considering two joint support conditions: support in both temporo-mandibular joints and support in only one joint, opposite the bite side. Additionally, two variants of the implant-bone connection were examined: an optimistic scenario assuming complete osseointegration and a pessimistic scenario assuming no osseointegration, with fixation achieved solely through bone fixation plates. The findings indicated a significant underestimation of the loads transferred by the implant and bone tissue when symmetrical joint support and osseointegration were assumed. Although there is currently no conclusive evidence supporting the complete exclusion of the joint, the computational results demonstrated that, in the absence of precise data regarding the percentage contribution of the joint on the occlusal side, it is preferable to employ more stringent criteria for assessing the load-bearing capacity of mandibular prostheses. This assessment should include the exclusion of joint support on the occlusal side to ensure a more conservative and reliable evaluation of the prosthesis’s mechanical performance. Full article

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article