Search Results (78)

In the context of the circular bioeconomy and environmental protection trends, the efficient use of renewable resources has become a driving force for industry, and lignin represents precisely a renewable carbon resource, abundant in terrestrial biomass that could become a sustainable substitute for fossil resources, under conditions of full exploitation. This study systematically evaluates the biosorption of Manganese (Mn(II)) from aqueous media using unmodified Tripidium bengalense (Sarkanda grass) lignin. Under optimal operating conditions (adsorbent dosage of 5 g/L, pH 6.5, and 20 °C), a highly competitive experimental adsorption capacity of 12.52 mg/g was achieved. Kinetic studies revealed exceptionally rapid uptake rates, with thermodynamic equilibrium established within the first 30 min, fitting perfectly with the pseudo-second-order (Ho-McKay) model (R² ≥ 0.9998). Equilibrium data were best described by the Freundlich isotherm (R² ≥ 0.9886), confirming chemisorption via preferential inner-sphere complexation on a heterogeneous surface. Thermodynamic analysis verified that the process is spontaneous (ΔG ranging from −13.24 to −26.19 kJ/mol) and endothermic (ΔH from 11.21 to 14.83 kJ/mol). FTIR, SEM-EDX, and TG/DTG analyses confirmed successful Mn–O coordination involving phenolic hydroxyl and carboxylic groups. Furthermore, the lignin showed excellent recyclability, maintaining a retention efficiency over 70% (70.7–85.8%) after three desorption-resorption cycles using 1N HCl. Ecotoxicological validation via Sorghum bicolor L. germination tests confirmed the complete detoxification of the post-adsorption filtrates (up to 100% germination capacity), while the Mn(II)-loaded lignin completely suppressed seed germination (0%), proving secure metal immobilization. These findings establish raw Sarkanda grass lignin as an efficient, scalable, and ecologically sustainable biosorbent for heavy metal remediation. Full article

Background: The prevalence of adhesive capsulitis (AC) is estimated to be 2–5% in the general population. However, the etiology of AC remains unclear. Among the various proposed factors, the precise role of cervical disease, and the severity of cervical degeneration, in the development of AC has not been fully elucidated. This study aimed to analyze the contribution of cervical disease to AC in patients with shoulder pain. Methods: A total of 409 patients who visited the Department of Rehabilitation Medicine for shoulder pain were retrospectively reviewed. The outcome variable was the presence of AC. In addition to cervical disease, other independent variables affecting AC, including sex, diabetes, obesity, dyslipidemia, thyroid disease, immobilization after surgery, rotator cuff tear, subacromial spur, and shoulder joint osteoarthritis were reviewed. To compare the two groups, an independent t-test or chi-square test was performed for continuous and categorical data. Multivariate regression analysis was used to assess the effects of independent factors on AC, adjusting for confounders. Results: Among the 409 patients, 176 (43.0%) were diagnosed with AC. Multivariate analysis demonstrated that diabetes (OR 3.03, 95% CI 1.55–5.91, p = 0.001) and cervical disease (OR 3.03, 95% CI 1.75–5.25, p < 0.001) were significantly associated with increased odds of AC. In contrast, increasing age (OR 0.95, 95% CI 0.92–0.98, p = 0.007), dyslipidemia (OR 0.55, 95% CI 0.31–0.98, p = 0.044), and postoperative immobilization (OR 0.64, 95% CI 0.41–0.99, p = 0.046) were associated with decreased odds of AC. The prevalence of AC increased with the severity of cervical degeneration. Conclusion: In patients with shoulder pain, diabetes and cervical disease were positively associated with AC, whereas age, dyslipidemia, and postoperative immobilization showed inverse associations. These findings suggest that both metabolic and cervical factors may contribute to the development of AC, highlighting the importance of considering cervical pathology in patients with shoulder pain. Full article

The Apennine wolf (Canis lupus italicus) is a distinct subspecies whose ongoing population recovery in Italy has progressively increased the demand for live capture protocols validated for scientific monitoring and conservation management. Despite the widespread use of mechanical and chemical immobilization in European wolf management, no study has to date systematically evaluated the combined use of the Fremont™ humane foot snare with a medetomidine-ketamine-acepromazine (MKA) protocol in this subspecies, nor characterized the associated cardiorespiratory, thermal, and hematobiochemical parameters under operational field conditions. Between June 2010 and July 2017, thirteen free-ranging Apennine wolves were captured in Maiella National Park (central Apennines, Italy) using the Fremont™ snare and immobilized with a standardized MKA protocol; only animals immobilized with this protocol are reported here, as three additional capture events employed different drug combinations. Cardiorespiratory parameters, body temperature, peripheral oxygen saturation, venous blood gas values, and a comprehensive hematological and serum biochemical panel were recorded during immobilization. Mean heart rate was 100 ± 15 bpm, respiratory rate 24 ± 13 breaths/min, body temperature 38.1 ± 1.3 °C, and mean SpO₂ 88 ± 11% (range: 66–97%; n = 12). No clinically significant hyperthermia requiring active intervention was recorded in the cohort as a whole. Hematological and biochemical values were broadly consistent with published reference ranges for the species, with condition-specific deviations identified in two individuals—one pregnant female and one juvenile presenting signs of transient capture-related myopathy—both of which resolved without clinical sequelae. No capture-related mortality occurred. All thirteen individuals survived the minimum post-capture monitoring period. Preliminary GPS observations in a subset of individuals (n = 3) suggest a transient reduction in movement activity in the immediate post-release period. These findings support the safety and operational feasibility of the combined Fremont™ snare–MKA protocol for the Apennine wolf, and provide baseline physiological and hematobiochemical reference data for Canis lupus italicus relevant to future capture and conservation management programmes. Full article

Background/Objectives: Posterior C1–C2 fusion is commonly used for unstable traumatic odontoid injuries, but it is less commonly used for patients who initially undergo nonoperative management and later require salvage fusion. This study compared hospital length of stay, short-term complications, and postoperative radiographic alignment between salvage posterior C1–C2 fusion after failed nonoperative management and primary posterior C1–C2 fusion. Materials and Methods: A retrospective cohort study was performed of 106 adult patients who underwent posterior C1–C2 instrumented fusion for traumatic cervical spine injuries from 2011 to 2023. Patients were stratified into the salvage fusion group after radiographic nonunion following attempted nonoperative management with external immobilization or the primary fusion group, who underwent initial surgical management. The primary outcome was hospital length of stay. Secondary outcomes included postoperative radiographic alignment, screw loosening, hardware failure, revision surgery, and 30-day emergency department visits. Propensity score matching and full-cohort augmented inverse probability weighting were used to account for baseline differences between groups. Results: Twenty-seven patients underwent salvage fusion and 79 underwent primary fusion. Propensity score matching produced 25 matched pairs. In the matched cohort, salvage fusion was associated with significantly shorter length of stay than primary fusion, with a median of 2 versus 5 days, respectively (p < 0.001). This remained significant in the full-cohort augmented inverse probability weighting analysis, where salvage fusion was associated with a 2.41-day reduction in length of stay (95% CI, −3.63 to −1.19; p < 0.001). Short-term complications were uncommon in both groups, and no clear sign of increased screw loosening, hardware failure, revision surgery, or 30-day emergency department visits was observed in the salvage cohort. Salvage fusion was also associated with lower postoperative C2–C7 lordosis and a greater C1 lamina–occiput distance. Conclusions: Salvage posterior C1–C2 fusion for radiographic nonunion after attempted nonoperative management was not associated with higher short-term complication rates compared with primary fusion. While surgical-admission length of stay was shorter in the salvage cohort, this difference should be interpreted cautiously because salvage and primary fusion occur in different admission contexts and do not reflect the total episode-of-care burden. Early postoperative alignment differences were observed, but these were not correlated with clinical outcomes or longitudinal imaging, and their long-term significance remains unclear. Future multicenter studies should evaluate total healthcare utilization, fusion status, longitudinal alignment, and patient-reported outcomes after salvage C1–C2 fusion. Full article

Background/Objectives: Proximal phalangeal fractures account for 38% of all phalangeal fractures, with unstable patterns requiring surgical intervention. Various modalities have been explored, including open reduction and internal fixation, percutaneous K-wire fixation, and intramedullary techniques. This study explores the technical nuances, indication, and outcomes of antegrade cannulated compressive screw (CCS) fixation of proximal phalangeal fractures. Methods: This retrospective case series involved 18 closed proximal phalangeal fractures in 16 patients who underwent intramedullary headless screw fixation between January 2018 and December 2023. Records were reviewed for demographics, fracture characteristics, and screw type. With the metacarpophalangeal joint flexed at 60–75°, a 1 cm longitudinal incision was made, the extensor tendon split, and a 0.9 mm guidewire advanced anterogradely along the phalangeal axis under fluoroscopy. A 2.2 mm or 3.0 mm SpeedTip CCS was selected based on phalanx size and advanced until fully buried below the cartilage line. Postoperatively, patients were immobilized in a volar intrinsic-plus splint, transitioned to a gutter splint within five to seven days, and commenced on range of motion (ROM) exercises within one week. Primary outcomes included radiographic union, Total Active Motion (TAM), QuickDASH scores, and postoperative complications. Results: All fractures were healed within acceptable radiological parameters and with no postoperative complications. Mean TAM was measured to be 216.0° (SD 7.7°, range 200–230°) and mean QuickDASH was 10.1 (SD 2.8, range 5–16). Conclusions: Antegrade intramedullary headless screw fixation demonstrates feasibility, short-term safety, and excellent early functional outcomes for carefully selected unstable proximal phalanx fractures, supporting its role as a minimally invasive alternative in appropriately indicated cases. Full article

Background and Objective: This study aimed to evaluate the impact of early functional rehabilitation on clinical outcomes and tuberosity healing in older patients undergoing reverse shoulder arthroplasty for proximal humeral fractures. We hypothesized that early functional rehabilitation would not compromise tuberosity healing and would result in comparable or improved outcomes versus postoperative immobilization. Methods: This retrospective matched-pair analysis included patients aged 70 years or older who underwent reverse shoulder arthroplasty for proximal humeral fractures, with 12 to 24 months of follow-up. Group allocation was time-based: earlier patients received immobilization and later patients underwent early rehabilitation. Matching was based on sex, age, body mass index, fracture classification (Neer), and glenosphere size. Outcomes included patient-reported scores, range of motion, and radiographic assessment of tuberosity healing using standardized imaging. Results: Forty patients (20 per group) with a mean age of 80.7 years and a mean follow-up of 16.1 months were included. The early rehabilitation group demonstrated significantly higher Constant scores (p = 0.044), age- and sex-adjusted Constant scores (p = 0.033), and greater active external rotation (p = 0.002). Anatomical tuberosity healing was seen in 28 of 40 patients (70%). Greater tuberosity healing occurred in 75% and lesser tuberosity healing in 85% of patients with available axial imaging. One deep infection occurred in the early rehabilitation group and was successfully managed. Conclusions: Early functional rehabilitation after reverse shoulder arthroplasty in older adults with proximal humerus fractures improved functional outcomes without compromising tuberosity healing. Full article

Background/Objectives: Distal biceps tendon rupture (DBTR) significantly impairs upper-limb function, particularly in movements requiring elbow flexion and forearm supination. This condition continues to attract clinical interest due to its complex biomechanics, evolving surgical strategies, and the growing emphasis on comprehensive rehabilitation. Contemporary evidence highlights the value of a multidisciplinary approach that integrates precise surgical repair with structured, progressive physiotherapy to optimize outcomes effectively. Methods: We performed a comprehensive review of the literature by searching PubMed/MEDLINE, and a narrative review format was adopted to synthesize the available evidence. Results: Studies comparing single-incision and double-incision techniques show that both achieve excellent outcomes, although the decision should be tailored to patient-specific factors, surgeon expertise, and the reported complication risk, which may vary between 5% and 63%. Regardless of technique, restoring tendon integrity is essential for regaining normal strength and supination capability. Rehabilitation following DBTR repair relies on a phased and carefully monitored program. Early physiotherapy focuses on a controlled range of motion and the prevention of stiffness while protecting the repair. As healing progresses, strengthening exercises targeting the biceps, triceps, and brachialis are introduced, alongside endurance training to enhance overall functional capacity. Evidence strongly supports early mobilization protocols, where active motion and graded resistance are initiated within the first postoperative week, resulting in faster and more complete functional recovery compared to prolonged immobilization. Conclusions: Long-term outcomes after DBTR repair are consistently favorable. Most patients return to full activity or sport at an average of 5.4 months, although timelines vary with rehabilitation intensity and baseline fitness. Notably, 93–100% recover their pre-injury activity level, including participation in competitive sports. Full article

Background/Objectives: Trochanteric pressure ulcers represent a challenging reconstructive problem due to their depth, frequent infection, and tendency for recurrence. Durable coverage with well-vascularized tissue capable of effective dead-space management is essential for long-term stability. The pedicled musculocutaneous anterolateral thigh (ALT) flap offers substantial soft-tissue volume with reliable regional vascularity. Methods: A retrospective review was performed of consecutive patients with Stage IV trochanteric pressure ulcers who underwent reconstruction using musculocutaneous pedicled island ALT flaps between January 2020 and August 2023. Ulcers were classified according to the European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance International Guidelines. Patients with a minimum follow-up of 24 months were included. Demographic characteristics, ulcer etiology, prior flap history, comorbidities, flap dimensions, postoperative complications, and recurrence rates were analyzed. Results: Eight patients (4 males, 4 females; mean age 46.4 years, range 35–63) were included. Six ulcers (75%) were related to prolonged immobilization, and two (25%) developed following entrapment during the 2023 Kahramanmaraş earthquake. All donor sites were closed primarily. Minor recipient-site complications, including seroma and limited suture dehiscence, occurred in two cases. No partial or total flap necrosis was observed. During a mean follow-up of 42.4 months (minimum 24 months), no recurrence occurred. Conclusions: Musculocutaneous pedicled ALT flaps incorporating a substantial portion of the vastus lateralis muscle allowed effective dead-space obliteration and durable soft-tissue coverage in Stage IV trochanteric pressure ulcers. Primary donor-site closure was achievable without major morbidity. These findings support the use of the pedicled ALT flap as a consistent regional option in complex trochanteric defects, including both chronic immobilization-related and acute compression-related cases. Full article

Background/Objectives: Efficient allocation of hospital resources is crucial in managing lower extremity trauma. Selected patients with stable injuries may not require inpatient hospitalization while awaiting surgical fixation. This study describes the feasibility and safety of a structured Home-based Preoperative Management (HPM) pathway for such patients. Methods: We conducted a retrospective, single-center observational study of 187 adult patients with isolated lower extremity fractures managed with HPM between 2019 and 2022. All patients were discharged home from the Emergency Department with standardized instructions, immobilization, anticoagulation, and planned follow-up. No comparator group was included. Results: Of 187 patients (mean age 49.7 y), 23 patients (12.3%) returned to the Emergency Department during the preoperative waiting period. The mean time from Emergency Department presentation to surgery was 8.5 days. Overall, 164 patients (87.7%) completed the preoperative waiting period at home without requiring an additional Emergency Department visit. Within one year after surgery, 51 patients (27.3%) presented to the Emergency Department; 29 of these visits (56.9%) were considered surgery-related. Patients who returned to the Emergency Department before surgery had a higher likelihood of postoperative Emergency Department visits within one year compared with those who did not (69.6% versus 21.3%, p < 0.001). Time to surgery was not associated with postoperative Emergency Department visits (p = 0.763). Conclusions: In this retrospective cohort, Home-Based Preoperative Management was feasible and appeared safe for carefully selected patients with lower extremity trauma. Most patients were able to await surgery at home without unplanned Emergency Department visits. Given the absence of a comparator group, no conclusions regarding comparative effectiveness or superiority over inpatient management can be drawn. Full article

It is a challenge in experimental studies today to accurately predict the trapping mechanisms in saline aquifers that influence the long-term CO₂ storage capacities. The inability in current experimental studies to quantify the effects of combined processes of solubility, hysteresis, and mineralization as a means of affecting saline aquifer properties that influence CO₂ trapping mechanisms makes this topic interesting. A systematic framework in CMG-GEM compositional simulation studies is proposed in this article to assess the effects of gradually modelled trapping mechanisms on CO₂ storage performance. Simulation studies are conducted under identical constraints, trapping mechanisms, as well as operational factors in a sequential process that activates (i) solubility, (ii) solubility + hysteresis, and (iii) solubility + hysteresis + mineralization. The findings demonstrate distinct differences in trapping process behaviors as well as simulation stability under various modes: hysteresis effects largely improve immobile reserves as well as decrease plume migration, and, on the other hand, mineralization adds long-term dynamics of capacity increase as well as porosity-permeability alterations, especially in carbonate reservoirs. Through long-term post-injection simulations (up to 1000 years), the findings demonstrate that various trapping processes trigger over distinct time periods—years for immobile reserves, decades for dissolution, and centuries in the case of mineralization. This contribution is able to point out the computational efficiency as well as defective model behavior of concern to various physics levels, providing a practical guide to modelers in making a well-informed decision on what constitutes a minimum set of physics in long-term trustworthy CO₂ storage. Full article

Objectives: This study aimed to determine the incidence of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) following orthopedic surgeries and to identify independent clinical, laboratory, and procedural factors associated with thromboembolic risk. Materials and Methods: A retrospective cohort analysis was conducted on 300 patients who underwent elective or emergency orthopedic surgeries (hip/knee arthroplasty, fracture fixation, and spinal procedures) between January 2020 and December 2024 at two tertiary centers. Demographic, clinical, and biochemical data were collected. Patients were stratified into two groups: those who developed DVT/PE and those who did not. Univariate analyses were performed to identify significant factors, and a multivariate logistic regression model with stepwise variable selection was applied in accordance with the events-per-variable (EPV) criterion. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the discriminative performance of significant predictors. Results: Among 300 patients who underwent orthopedic surgery, postoperative deep vein thrombosis (DVT) and/or pulmonary embolism (PE) occurred in 50 cases (16.7%). Patients who developed thromboembolic events were older (72.5 ± 8.7 vs. 65.2 ± 10.1 years, p < 0.001), had higher body mass index (32.1 ± 5.3 vs. 28.3 ± 4.5 kg/m², p < 0.001), and showed a greater prevalence of diabetes mellitus (40% vs. 20%, p < 0.01) and chronic kidney disease (24% vs. 10%, p < 0.001) compared to those without DVT/PE. Laboratory analyses revealed significantly elevated neutrophil count, D-dimer, C-reactive protein (CRP), glucose, and troponin levels in the DVT/PE group. In the stepwise multivariate logistic regression model, age (OR = 1.44, p = 0.003), diabetes mellitus (OR = 2.88, p = 0.046), chronic kidney disease (OR = 2.33, p = 0.014), D-dimer (OR = 2.15, p = 0.019), and immobilization duration (OR = 2.21, p = 0.028) emerged as independent predictors of thromboembolic events. ROC analysis revealed that D-dimer > 0.9 mg/L had the highest discriminative performance (AUC = 0.89, sensitivity 88%, specificity 84%, p = 0.003), followed by troponin > 0.5 U/L (AUC = 0.86, p = 0.005), immobilization > 3 days (AUC = 0.82, p = 0.012), and age > 65 years (AUC = 0.74, p = 0.021). Conclusions: DVT and PE remain significant postoperative complications with a multifactorial etiology in orthopedic surgeries. Advanced age, comorbidities (such as diabetes mellitus and chronic kidney disease), and elevated inflammatory and metabolic markers (including neutrophil count, glucose, CRP, and D-dimer), together with procedural factors like prolonged immobilization, were identified as independent risk factors. Early recognition of these high-risk features and implementation of individualized prophylaxis strategies may improve postoperative outcomes and reduce thromboembolic risk. Full article

Background: The optimal timing of surgical treatment for ankle fractures remains a topic that is associated with clinical uncertainty. While delayed surgery is often necessary for safe wound closure, prolonged immobilization, impaired functional outcomes, protracted hospitalization, and an increased risk of infection are potential disadvantages. This study was aimed at investigating the interval between trauma, surgical fixation, and postoperative infections among patients with closed ankle fractures. Methods: We conducted a retrospective cohort study involving 224 patients treated surgically for fractures of the upper ankle joint between January 2020 and December 2023. The patients were stratified into two groups based on surgical timing: within 24 h of hospital admission (early surgery) or after 24 h (delayed surgery). The primary outcome was the incidence of postoperative infections. A multivariate logistic regression model was constructed to assess independent risk factors. Results: Of the 224 patients, 30 (13.4%) developed postoperative infections. Infection occurred in 11.1% of patients who underwent early surgery and 13.7% of those subjected to delayed surgery. This difference was not statistically significant in the unadjusted analysis (p = 0.747). However, an additional day of surgical delay was associated with an 11% increase in the odds of postoperative infection (OR = 1.11; 95% CI: 1.01–1.22; p = 0.034). Female patients had over threefold higher odds of infection than males (OR = 3.20; 95% CI: 1.32–8.09; p = 0.011), and diabetes was a significant risk factor, with diabetic individuals showing more than fivefold increased odds (OR = 5.56; 95% CI: 1.30–25.00; p = 0.019). Patients with delayed surgery had significantly longer hospital stays (+2.83 days, p < 0.05). Conclusions: Early surgical intervention appears to lower the risk of postoperative infections, is associated with hospitalization duration, and should be considered when clinically appropriate. Full article

Introduction: Monteggia fractures, first described by Giovanni Battista Monteggia, involve a fracture of the proximal ulna with anterior dislocation of the radial head. Bado’s 1967 classification divides these injuries into four types. Rare mixed patterns exist, overlapping with other forearm injuries such as Galeazzi and Essex–Lopresti lesions. These complex fractures/dislocations pose significant diagnostic and therapeutic challenges and are not adequately represented in current classification systems. Methods and Case Presentation: We report the case of a 56-year-old woman with a complex forearm injury sustained from a fall, presenting with radial head fracture/dislocation, mid-shaft radial fracture, distal ulna fracture, and ulnar collateral ligament rupture. Intraoperative imaging confirmed DRUJ stability and partial interosseous membrane disruption. Surgical management included radial head prosthesis implantation, radial shaft fixation with an anatomical locking plate, intramedullary nailing of the distal ulna, and ligament reconstruction. At two-year follow-up, the patient demonstrated full recovery of elbow flexion–extension and satisfactory forearm function. A narrative literature review was also conducted, focusing on hybrid injury variants. Results: Intraoperative examination under anesthesia revealed good elbow stability with 130° flexion, 15° extension lag, and forearm pronation/supination of 70°/60°. An initial Mayo Elbow Performance Score (MEPS) of 65 was recorded, limited by range of motion and stability. Pain during passive mobilization was mild, with a Visual Analogue Scale (VAS) score of 3/10. Postoperative recovery included 15 days of immobilization followed by structured rehabilitation. At two years, the patient regained full elbow flexion–extension but had residual deficits in pronation–supination, attributed to pre-existing conditions. Conclusions: This case illustrates a previously unreported hybrid Monteggia variant, combining features of Monteggia, Galeazzi, and Essex–Lopresti injuries. It highlights the limitations of current classification systems and supports the need for an expanded diagnostic framework. Successful management required a multidisciplinary surgical approach tailored to the injury’s complexity. Further studies are warranted to refine classification and treatment strategies for these rare combined injuries. Full article

Background/Objectives: Distal forearm fractures are the most common fractures in children. Three surgical techniques are most commonly used at the level of the radial diametaphysis on the distal forearm in children: K-wire, ascending ESIN (elastic stable intramedullary nail) or plate osteosynthesis. The aim of this study was to compare these procedures in children with distal diametaphyseal radius fractures regarding operative and functional outcome. Methods: A retrospective study was conducted in two level 1 trauma centers. Children and adolescents aged 2 to 15 years were included. The study period was from January 2010 to December 2022. The hospital information system was used to record patient age, gender, height, weight, fracture location, degree of angular deformity postoperatively, surgical procedure and postoperative complications, which were described in the medical records of the hospital information system. Complications graded by modified Clavien–Dindo–Sink served as the primary outcome. Reduction accuracy, operative and fluoroscopy times, immobilization length and postoperative motion were the secondary endpoints. Results: A total of 213 children were included in the study. K-wire osteosynthesis was performed in 25%, nailing in 19% and volar plate osteosynthesis in 55%. All ESIN were inserted in ascending technique. Complications occurred in 22% of patients and did not differ overall between techniques (p = 0.20). Severe complications were significantly more frequent after ESIN (20%) than after K-wires (7%) or plates (4%) (p = 0.04). Plate fixation achieved the most accurate alignment (≤5° angular deformity in 93% vs. 57% K-wires and 61% ESIN; p < 0.0001) and the fewest late motion restrictions (p = 0.02). K-wire surgery was fastest technique and required the least fluoroscopy, but necessitated the longest postoperative cast. Conclusions: Volar plating combines reliable anatomical reduction with a low rate of major complications and early mobilization, supporting its use in older children whose remodeling potential is limited. K-wires are a swift, minimally invasive option for younger patients, albeit with less precise reduction and prolonged immobilization. Conventional ESIN showed the highest burden of severe complications. Full article

Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs. Full article