Search Results (156)

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions. Full article

Background and Objectives: Postoperative delirium (POD) is a frequent neuropsychiatric complication following hip fracture surgery in older adults and is associated with prolonged hospitalization, functional decline, and increased mortality. Systemic inflammation is thought to play a central role in its pathogenesis, and the C-reactive protein CRP-to-albumin ratio (CAR) has emerged as a promising inflammatory biomarker. This study aimed to investigate the association between the preoperative CAR and POD and to identify clinical and perioperative factors independently associated with POD. Materials and Methods: This retrospective cohort study included 962 consecutive patients who underwent surgery for hip fractures between January 2022 and December 2025. Patients with femoral neck fractures underwent hemiarthroplasty, whereas those with intertrochanteric fractures were treated with proximal femoral nailing. Cases of postoperative delirium were evaluated following psychiatric consultation requested based on clinical suspicion by the orthopedic team, nursing staff or the patient’s caregiver; the definitive diagnosis was made by consultant psychiatrists according to the DSM-5 diagnostic criteria. Demographic characteristics, perioperative variables, and preoperative laboratory parameters were analyzed. Univariable and prespecified multivariable logistic regression analyses were performed to identify factors independently associated with POD. Model discrimination and calibration were assessed using receiver operating characteristic analysis, bootstrap internal validation, and the Hosmer–Lemeshow goodness-of-fit test. Results: Postoperative delirium developed in 112 of 962 patients (11.6%). Patients who developed POD had significantly higher preoperative CAR values than those without POD (0.76 vs. 0.33, p < 0.001). In the multivariable analysis, male sex (OR 1.567, 95% CI 1.007–2.438; p = 0.046), hemiarthroplasty (OR 1.931, 95% CI 1.213–3.075; p = 0.006), perioperative blood transfusion (OR 1.870, 95% CI 1.178–2.971; p = 0.008), general anesthesia (OR 1.829, 95% CI 1.093–3.061; p = 0.021), higher ASA physical status classification (OR 2.154, 95% CI 1.346–3.446; p = 0.001), longer time from hospital admission to surgery (OR 1.250 per 24 h increase, 95% CI 1.103–1.417; p < 0.001), and a higher log₂-transformed CAR (OR 1.184 per doubling, 95% CI 1.037–1.352; p = 0.013) were independently associated with POD. The final model demonstrated acceptable discrimination (AUC 0.764; optimism-corrected AUC 0.744) and satisfactory calibration (Hosmer–Lemeshow p = 0.242). Conclusions: A higher preoperative C-reactive protein-to-albumin ratio was independently associated with postoperative delirium after hip fracture surgery, even after adjustment for established demographic and perioperative risk factors. Male sex, hemiarthroplasty, general anesthesia, higher ASA physical status classification, perioperative blood transfusion, and delayed surgery were also independently associated with POD. These findings suggest that CAR may be a low-cost and readily available inflammatory biomarker that could be used to develop a preoperative risk classification system for the development of postoperative delirium. However, since routine standardized delirium screening was not performed during the study, cases of hypoactive delirium in particular may not have been adequately identified. For this reason, the findings should be interpreted with caution. Prospective, multicenter studies incorporating standardized delirium screening methods are needed to validate these results and determine the additional predictive value of CAR beyond established clinical risk factors. Full article

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery. Full article

Background: Inpatient falls are among the most common adverse events in acute-care hospitals and may result in functional decline, prolonged hospitalization, and increased healthcare costs. However, the characteristics of fall-related fractures and recurrent falls in university hospitals have not been fully investigated. Methods: We retrospectively reviewed all inpatient fall events reported to the Department of Patient Safety at Niigata University Medical and Dental Hospital between January 2021 and December 2025. Patients younger than 20 years were excluded. Data regarding patient characteristics, mobility status, fracture occurrence, recurrent falls, medication use, and clinical departments were collected from medical records. Univariate and multivariable logistic regression analyses were performed to identify factors associated with fall-related fractures and recurrent falls. Results: A total of 2571 fall events were identified, yielding an incidence of 2.306 falls per 1000 inpatient-days. Malignant neoplasms were the most common primary diagnosis (36.9%). The incidence of falls was highest in the Departments of Neurology and Neurosurgery. Fall-related fractures occurred in 54 cases (2.1%), most commonly involving the lower extremities, including 17 proximal femoral fractures. Multivariable analysis identified mobility status as the only independent factor associated with fractures (odds ratio [OR], 1.821; 95% confidence interval [CI], 1.263–2.627; p = 0.001). Receiver operating characteristic analysis demonstrated a mobility cutoff value of 2.5, indicating an increased fracture risk among patients who were ambulatory with assistive devices or had higher mobility levels. Recurrent falls were observed in 439 patients (24.2%). Reduced mobility (OR, 0.837; 95% CI, 0.713–0.981; p = 0.028), polypharmacy (≥5 medications) (OR, 1.634; 95% CI, 1.254–2.016; p < 0.001), and use of central nervous system depressants (OR, 1.363; 95% CI, 1.124–1.653; p = 0.002) were independently associated with recurrent falls. Conclusions: Patients with fall-related fractures tended to have relatively high mobility, whereas recurrent falls were associated with reduced mobility, polypharmacy, and central nervous system depressant use. Different characteristics of falls were observed across clinical departments. These findings may help identify patients at high risk for adverse fall-related outcomes and support the development of targeted fall-prevention strategies in university hospitals. Full article

Background and Objectives: The method of femoral canal opening during intramedullary fixation may influence the biological response to surgery. The aim of this study was to compare the early biological responses associated with mechanical canal opening and manual canal opening during Proximal Femoral Nail Antirotation (PFNA) fixation in patients with pertrochanteric femoral fractures, with a particular focus on inflammation, coagulation, organ dysfunction, and bone metabolism. Materials and Methods: This single-centre prospective randomised study consisted of 60 participants (50 women) with a mean age of 80.33 ± 11.13 years, who were randomly assigned to either manual femoral canal opening (n = 30) or mechanical canal opening (n = 30). Outcomes were assessed preoperatively and postoperatively during a 72 h follow-up period. This study was registered at ClinicalTrials.gov (ClinicalTrials.gov ID NCT07648719; registration date: 15 June 2026; study start: 1 March 2025). Results: Across all participants, surgery was associated with a significant decrease in haemoglobin levels, calcium, and estimated glomerular filtration rate, while fibrinogen, urea, creatinine, CRP (C-reactive protein), and NT-proBNP (N-terminal pro-B-type natriuretic peptide) significantly increased postoperatively. Patients in the mechanical canal opening group demonstrated significantly higher postoperative levels of leukocytes (p = 0.002), CRP (p = 0.001), NT-proBNP (p = 0.002), fibrinogen (p = 0.026), activated partial thromboplastin time (p = 0.035), urea (p = 0.001), and creatinine (p = 0.018), as well as greater reductions in haemoglobin (p < 0.001), compared with the manual canal opening group. Bone turnover markers also differed between groups: postoperative bone-specific alkaline phosphatase levels were significantly higher in the mechanical canal opening group (p = 0.001), whereas the increase in total procollagen type 1 N-terminal propeptide was more pronounced in the manual canal opening group (p = 0.045). Conclusions: The method of femoral canal opening during PFNA fixation significantly influences early postoperative systemic inflammation, coagulability, organ stress, and bone turnover dynamics. Manual opening of the femoral canal was associated with lower early systemic and bone stress biomarker responses compared with mechanical canal opening. Whether these differences translate into improved clinical outcomes, particularly in elderly patients with limited physiological reserve, remains to be determined. Full article

Background: Mortality after geriatric hip-fracture surgery remains substantial. This study evaluated whether preoperative GNRI, comorbidity burden, and CBC-derived inflammatory indices were associated with one-year and long-term mortality after PFN for pertrochanteric/intertrochanteric fractures. Methods: In this single-centre retrospective cohort study of prognostic risk markers, 248 PFN records were screened. After excluding six incomplete records and 25 patients aged <65 years, 217 older fracture/surgical episodes formed the time-to-event cohort; 194 were evaluable for binary one-year mortality. Living patients/episodes with <365 days of follow-up were censored in survival analyses. Logistic and Cox models were supported by Firth penalized logistic regression, calibration assessment, and internal validation. Results: Median age was 82 years, 65.0% were female, and 68.7% were ASA III–IV. Overall, 96/217 (44.2%) died during median follow-up of 570 days. Thirty-day, 90-day, and one-year evaluable mortality were 7.4%, 15.2%, and 27.3%. GNRI < 82 identified a small high-risk subgroup: 10/13 evaluable patients/episodes (76.9%) died within one year versus 43/181 (23.8%) with GNRI ≥ 82. GNRI < 82 remained associated with one-year mortality in adjusted logistic regression, although with a wide confidence interval due to sparse subgroup size (OR 6.43, 95% CI 1.50–27.55; p = 0.012), and in Firth penalized sensitivity analysis (OR 5.51, 95% CI 1.34–22.61; p = 0.018). In Cox analysis, age, ASA III–IV, available Charlson-domain comorbidity burden, and lower continuous GNRI were associated with long-term mortality, whereas adding GNRI < 82 and NLR did not materially improve cross-validated discrimination. Conclusions: GNRI < 82 identified a small subgroup with high observed mortality after PFN. Because the subgroup was sparse and biomarker addition did not materially improve internally validated discrimination, GNRI should be treated as an alerting clinical flag rather than a stand-alone basis for patient-level risk prediction. External validation is required. Full article

Background: Massive post-traumatic segmental bone defects exceeding 5 cm—particularly those resulting from Gustilo–Anderson type IIIB open fractures—present a formidable reconstructive challenge. Autologous bone graft, though biologically superior, is restricted in this context by limited harvest volume and donor-site morbidity. Nonvascularized structural bone allografts provide unrestricted graft volume and immediate mechanical support, but data on their performance in severely compromised post-traumatic environments remain sparse. Methods: This retrospective case series evaluated three patients with massive distal femoral bone loss following high-energy trauma. All were managed with a staged protocol: radical debridement and temporary joint-spanning external fixation at index surgery, followed by definitive reconstruction with a matched nonvascularized structural allograft and retrograde intramedullary nailing once the host bed was aseptic and soft-tissue coverage was established. Results: Limb salvage was achieved in all three patients at a mean follow-up of 18 months. Two patients attained stable biological integration and restored anatomical alignment; one of these progressed to full unassisted weight-bearing by four months postoperatively. The third patient developed symptomatic pseudarthrosis at the distal host–graft junction. The proximally integrated allograft had preserved sufficient femoral bone stock to serve as anchorage for a segmental total knee arthroplasty performed two years after the index reconstruction, ultimately preventing amputation. Conclusions: Nonvascularized structural allografts combined with rigid intramedullary nailing constitute a reproducible limb salvage strategy for massive femoral defects. The allograft functions not only as a vehicle for primary biological union, but as a structural reserve—maintaining femoral axis and bone stock that remains available for secondary arthroplasty reconstruction should union fail. Full article

Background: Intraoperative periprosthetic femoral fractures (IPFF) represent a concerning and often under-recognized complication in total hip arthroplasty (THA). Although several risk factors have been reported, their association with specific femoral morphology and stem geometry has not been fully addressed. This study aimed to identify the incidence and risk factors for IPFF in THA using cementless tapered stems. Methods: A retrospective review was conducted on 3137 primary THAs (2622 patients) performed with cementless tapered stems at a single institution between February 2011 and August 2018. Femoral morphology was classified according to the Dorr types; A (1425 hips, 45.4%), B (1542, 49.2%), and C (170, 5.4%). Femoral stems were categorized as flat, rectangular, or quadrangular tapered designs. The occurrence of IPFF was identified through surgical records and postoperative radiographs. Multivariate regression analysis was performed to identify independent risk factors for IPFF. The mean age at THA was 55 years (range, 15–96), and 52.9% of the patients were women. Results: The overall incidence of IPFF was 2.2% (69 hips). Non-displaced cracks in the proximal metaphysis (58 hips, 84.1%) were the most common type of fracture. The incidence of IPFF was significantly higher in Dorr type A (3.0%) and type C (4.7%) femurs compared with type B (1.2%) femurs. Multivariate regression revealed that female sex (odds ratio [OR], 1.752; p = 0.032) and Dorr type A (OR, 2.898; p < 0.001) and type C (OR, 4.530; p < 0.001) were significantly associated with IPFF. Additionally, the use of quadrangular tapered stems was associated with a higher risk compared with flat tapered stems (OR, 7.382; p < 0.001). Conclusions: Dorr type A and C femurs, along with female sex and the use of quadrangular tapered stems, were significant risk factors for IPFF. Our findings suggest that preoperative consideration of individual femoral morphology and careful selection of stem design are essential to mitigate the risk of IPFF in THA using cementless tapered stems. Full article

Background: Intraoperative periprosthetic proximal femoral fractures (PPFFs) represent a significant complication during total hip arthroplasty (THA), especially when using cementless stems via a direct anterior approach (DAA). Methods: This retrospective case series evaluated 10 patients with Vancouver A2 PPFFs treated with 2.7 mm lag screws alone or in combination with plates during DAA THA or partial hip arthroplasty between January 2021 and March 2024. Results: All fractures healed. One patient experienced 1 cm of stem subsidence without the need for revision. The mean Harris Hip Score improved from 35.4 preoperatively to 85.6 postoperatively. Functional recovery and radiological stability were comparable between fixation methods, though the screw-only group experienced slightly more postoperative pain. Patients in the screw-and-plate group were significantly older than those in the screw-only group (p = 0.026). No significant differences were found between groups regarding surgical time (p = 0.62) or BMI (p = 0.82). Due to the limited number of subsidence events, the statistical comparison of subsidence rates was inconclusive. Conclusions: In this preliminary retrospective case series, the use of 2.7 mm lag screws and small locking plates appeared feasible and was associated with favorable short-term outcomes in selected Vancouver A2 intraoperative PPFFs during DAA. These findings are hypothesis-generating and require confirmation in larger, prospective comparative studies. Full article

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies. Full article

Background/Objectives: Due to the inherent rotational instability of the proximal fragment in unstable basicervical intertrochanteric (IT) fractures, the biomechanical effect of lag screw position may differ from that observed in typical unstable IT fractures. This study aimed to evaluate the influence of lag screw positioning on proximal fragment displacement and stress distribution after cephalomedullary nailing (CMN) in unstable basicervical IT fractures using finite element analysis. Methods: Twelve finite element models of unstable basicervical IT fractures fixed with a CM nail were constructed with lag screws placed in four anteroposterior (AP) positions (superior 5 mm, center, inferior 5 mm, and inferior 10 mm) and three axial positions (anterior, center, and posterior). The positional change of the proximal fragment and stress concentration on the nail construct were measured. Results: In this computational model, proximal fragment displacement and stress concentration, including peak von Mises stress and mean stress over a region of interest, increased as the lag screw was positioned more inferiorly on the AP view and more posteriorly on the axial view. Conversely, a relatively superior-anterior lag screw position was associated with the lowest proximal fragment displacement and reduced stress concentration on the nail construct and around the lag screw tip. Conclusions: Within the limitations of this finite element analysis using a single femoral model and axial loading condition, a relatively superior-anterior lag screw position was associated with more favorable biomechanical behavior compared with more inferior or posterior positions. These findings should be interpreted as hypothesis-generating biomechanical observations rather than direct clinical guidance. Full article

Background and Objectives: Malnutrition is common among older adults with fragility fractures and is linked to poor clinical outcomes in orthopedic surgery. However, the association between nutritional status and bone-related parameters, including bone mineral density (BMD) and bone turnover markers, remains inadequately characterized in this population. This study evaluated these associations in patients with proximal femoral fragility fractures. Materials and Methods: In total, 108 patients who underwent surgery for proximal femoral fragility fractures were retrospectively analyzed. Nutritional status was evaluated using the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) score. BMD was measured at the femoral neck of the proximal femur and the lumbar spine using dual-energy X-ray absorptiometry. Serum 25-hydroxyvitamin D (25[OH]D) and bone turnover markers, including total procollagen type I N-terminal propeptide and tartrate-resistant acid phosphatase 5b, were also evaluated. Correlation analyses, group comparisons, and multivariate linear regression analysis were performed to identify factors independently associated with femoral neck BMD. Results: GNRI and PNI were significantly positively correlated with femoral neck BMD (r = 0.48 and r = 0.26, respectively; both p < 0.01), while the CONUT score showed a significant negative correlation (r = −0.27, p < 0.01). Nutritional indices were not significantly correlated with lumbar spine BMD. Patients classified as malnourished by GNRI or PNI had significantly lower femoral neck BMD and serum 25(OH)D and higher bone turnover markers than well-nourished patients. Multivariate linear regression analysis revealed that GNRI, PNI, and CONUT score remained independently associated with femoral neck BMD after adjusting for age, sex, and body mass index. Conclusions: Nutritional status assessed by hematological indices was significantly associated with femoral neck BMD and bone metabolism markers in patients with proximal femoral fragility fractures. Findings underscore the importance of nutritional status in bone health and should be considered in the management of osteoporosis and fragility fractures. Full article

Stress shielding (SS) after cementless total hip arthroplasty arises from the stiffness mismatch between conventional Ti-6Al-4V femoral stems (110 GPa) and cortical bone (10–30 GPa). The β-type Ti-33.6Nb-4Sn (TNS) alloy femoral stem addresses this limitation through a continuous Young’s modulus gradient (~70 GPa proximally to ~40 GPa distally) achieved by localized heat treatment of a single homogeneous alloy. This review synthesizes a translational research program encompassing material characterization, finite element modeling (FEM), preclinical animal studies, and prospective clinical follow-up of up to seven years. FEM demonstrated favorable proximal micromotion well below the osseointegration threshold, with physiological proximal stress concentration concordant with clinical outcomes. At seven years, SS grade distribution was significantly lower in the TNS group than in Ti-6Al-4V controls, with SS frequency reduced in Gruen Zones 2, 3, and 6, and no stem-related failures; however, third-degree SS was still observed in 11 of 34 evaluable cases (32%), indicating that modulus-gradient optimization alone is insufficient to fully prevent SS. TNS alloy is currently the only β-type titanium alloy clinically applied in joint prostheses. Remaining challenges include stem geometry optimization, additive manufacturing-based porous structures, and dual-energy X-ray absorptiometry-based bone density quantification. Future directions encompass long-term follow-up, cyclic fatigue FEM simulations, and expansion to fracture fixation devices and dental implants. Full article

Background: Implant-related infection following femoral fracture surgery is a severe complication in elderly patients and is associated with high morbidity and mortality. Most available evidence on periprosthetic joint infection (PJI) derives from elective arthroplasty populations, which differ substantially from patients undergoing surgery for femoral fractures. This study aimed to investigate the microbiological profile and clinical characteristics of implant-related infections after proximal femoral fracture surgery. Materials and Methods: A retrospective observational study was conducted on 20 patients aged ≥70 years who developed implant-related infection after surgical treatment of proximal femoral fractures between 2020 and 2025 at a referral trauma center. Surgical procedures included intramedullary nailing, hemiarthroplasty, and total hip arthroplasty. Only patients with Charlson Comorbidity Index ≥ 4 and infection occurring within one year of the index surgery were included. Clinical, surgical, microbiological, and antibiotic therapy data were retrospectively reviewed. Results: The cohort had a mean age of 82.4 years and a high comorbidity burden (mean Charlson index 4.8). The most frequently isolated pathogen was Staphylococcus aureus (25.9%), with 85% methicillin-resistant strains. Other pathogens included Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. Polymicrobial infections were observed in 25% of patients. One-year mortality was 25%. Conclusions: Implant-related infections after femoral fracture surgery represent a distinct clinical entity compared with elective PJI, characterized by frail patients and a higher prevalence of multidrug-resistant organisms. These findings highlight the need for tailored preventive and therapeutic strategies in this high-risk population. Full article

Background/Objectives: In periarticular knee surgery, such as osteotomies, ligament reconstruction, and fracture fixation, surgeons face a dilemma: ensuring the safety of the popliteal artery (PA) while securing adequate surgical access to the bone. While macroscopic anatomical studies suggest knee flexion protects the PA, they often fail to account for physiological muscle tension in living knees. This study aimed to quantitatively evaluate the dynamic positional changes in the PA and the vastus medialis and lateralis muscles (VM and VL, respectively) using Open Magnetic Resonance Imaging (MRI) to determine the optimal limb position for each surgical step. Methods: Twenty-three living knees were evaluated using Open MRI. The shortest perpendicular distances from the posterior aspect of the femur and tibia to the PA, and from the femoral cortex to the posterior border of the VM and VL, were measured at 10° knee-flexed position (representing the extended position) and 90° knee-flexed position. Results: The PA shifted significantly away from the bone in 90° knee-flexed position compared to extension at the distal femur (0 and 1 cm proximal to the intercondylar line (Blumensaat’s line)) and the proximal tibia (0, 1, and 2 cm distal to the joint line) (Q < 0.05). Conversely, both the VM and VL moved significantly closer to the femur in flexion at all measured levels (0–4 cm) (Q < 0.05), often causing the muscles to compress tightly against the bone. Conclusions: The vascular safety margin is maximized in flexion, whereas surgical exposure for the distal femur is optimized in extension due to vastus muscle relaxation. We suggest performing superficial exposure and femoral plate insertion in extension, and surgical maneuvers involving the posterior cortex in flexion to minimize neurovascular and soft tissue complications. Full article