Search Results (44)

Spinal sarcomas are rare, aggressive tumors requiring wide resection that creates large, challenging defects. Conventional reconstruction using allografts or metallic implants is prone to failure in compromised settings like irradiated or infected tissue. This narrative review synthesizes the literature on biologic reconstruction strategies, focusing on vascularized bone grafts (VBGs) and the ‘spinoplastic’ reconstruction approach, to provide a clinical framework for their application. We performed a narrative literature review using PubMed and Scopus to synthesize clinical studies describing biologic spinal reconstruction in compromised host beds. The main findings show that pedicled VBGs (e.g., rib, iliac crest) and free VBGs (e.g., fibula) function as living structural components. ‘Spinoplastic’ reconstruction leverages these grafts to promote biologic fusion, with clinical series reporting high union rates, even in irradiated or revision settings, offering a durable alternative to avascular constructs. Biologic reconstruction using VBGs is a critical strategy for achieving durable spinal stability in these challenging scenarios, and future directions point toward hybrid strategies combining 3D-printed implants with the biologic power of VBGs. Full article

Background/Objectives: Pseudoarthrosis continues to be a public health problem; however, in our country, information is scarce, particularly when talking about the clinical and sociodemographic characterization of the Mexican population with pseudoarthrosis. Methods: In this study, clinical and sociodemographic characteristics such as sex, age, educational level, nutritional status, comorbidities, affected bone, fracture characteristics, degree of exposure, and waiting time for the patient to undergo surgery were analyzed. Results: A total of 267 patients were included in the present study. A higher frequency of men (53.6%) was identified compared to women, and the main age group was 46–75 years (50.1%). The main comorbidities identified in our population were smoking (n = 141; 52.8%) and osteoporosis (n = 84; 31.5%). When evaluating the clinical characteristics of pseudoarthrosis, the tibia (n = 65; 24.3%) and radius (n = 54; 20.2%) were the main bones affected. Fracture exposure could be identified in 17.65% (n = 47) of the population, and the main grade of involvement was II (46.8%). Regarding the prevalence of the affected bone, the tibia was the main one, with 13.5% (9.38–17.58%) female patients, 12.7% (8.73–16.73%) with overweight, 18.0% (13.37–22.59%) with osteoporosis, and 14.2% (10.04–18.42%) with a history of smoking. Conclusions: In our cohort, we identified a high prevalence of the tibia as the affected bone, while overweight, obesity, osteoporosis, and smoking were the clinical and sociodemographic characteristics that characterized our population. The findings of this study lay the groundwork for understanding the clinical and sociodemographic context of a Mexican cohort with nonunion. Full article

Background: Humeral shaft fractures (HSFs) represent 13–25% of humeral fractures and are frequently complicated by radial nerve palsy and nonunion. While conservative management was historically preferred, surgical fixation with intramedullary nailing (IMN) has gained increasing popularity. The aim of this study was to evaluate the effectiveness of IMN in the treatment of HSFs, focusing on postoperative complications and functional outcomes. Methods: A bicenter retrospective analysis was conducted on 202 patients who underwent antegrade IMN fixation for HSF between 2014 and 2019, with a minimum follow-up of four years. Demographic data, trauma characteristics, surgical details, and postoperative complications were recorded. Functional outcomes were assessed at one year using the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and Visual Analogue Scale (VAS). Statistical analysis included ANOVA, Student’s t-test, Spearman’s correlation, and multivariate regression. Results: The mean follow-up was 57.7 ± 19.6 months. At one year, mean OSS, DASH, CSS, and VAS scores were 39.0, 16.6, 73.5, and 0.9, respectively. Excellent or good Constant outcomes were recorded in 89.6% of patients. Sixteen complications (7.9%) occurred, including nerve injuries (4.0%) and pseudoarthrosis (1.5%). Patients operated within 48 h had significantly better functional scores compared to those treated later (p < 0.01). No differences were found according to fracture pattern, sex, diabetes, or osteoporosis. Age showed a weak correlation with functional outcomes. Conclusions: IMN is a safe and effective option for the treatment of HSFs, with high rates of functional recovery and a low incidence of complications. Early surgical intervention appears to improve outcomes, supporting its role as a valuable strategy in HSF management. Full article

Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications. Full article

Background/Objectives: We sought to characterize the variance and overlap among definitions of Proximal Junctional Kyphosis (PJK) used in the adult spinal deformity (ASD) literature. PJK is defined as excess in PJK angle, a Cobb angle between the upper-instrumented vertebra (UIV) and a supra-adjacent vertebra (SAV), either one (UIV+1) or two (UIV+2) levels rostral of the UIV. No expert consensus exists for threshold angle or which SAV to use. Methods: A total of 116 thoracolumbar fusion patients ≥ 65 years old were reviewed. The UIV+1 and UIV+2 angles were measured. Six definitions of PJK from the literature were evaluated. These definitions were selected based on citation frequency, historical relevance, and accessibility through commonly used databases. Pearson’s Chi-squared and pairwise comparisons were performed to evaluate the distinctness and agreement rates among these definitions. Results: The six definitions of PJK were as follows: [PJK20] PJK angle ≥ 20° with UIV+2 as the (SAV), [PJK10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+2 as the SAV, [PJK2SD] PJK angle > 2 standard deviations from average with UIV+1 as the SAV, [PJK10+10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+1 as the SAV, [PJK15] PJK angle > 15° with UIV+1 as the SAV, and [PJK30] PJK angle > 30° with UIV+2 as the SAV, or displaced rod fracture, or reoperation within 2 years for junctional failure, pseudoarthrosis, or rod fracture. [PJK10] and [PJK2SD] were the most distinct definitions while [PJK20], [PJK10+10], [PJK15], and [PJK30] showed no significant pairwise differences. [PJK2SD] was stringent, while definition [PJK30] included unique diagnostic information not captured by other definitions. Conclusions: The use of [PJK20], [PJK10+10], [PJK15], or [PJK30] is recommended for consistency, with [PJK15] presenting the best balance. Stringent [PJK2SD] may be beneficial for identifying severe PJK, though with low sensitivity. Overall, PJK definitions must be standardized for the consistent reporting of clinical outcomes and research comparability. Full article

Objective: This study aimed to compare the clinical and radiological outcomes of dynamic rod stabilization with and without transforaminal lumbar interbody fusion (TLIF) in patients undergoing surgery for degenerative lumbar instability. Specifically, we evaluated the prognostic value of hybrid systems in reducing adjacent segment disease (ASD), enhancing fusion rates, and improving functional outcomes. Methods: A retrospective analysis was conducted on 62 patients treated between 2019 and 2022. Group 1 (n = 34) underwent dynamic rod stabilization alone, while Group 2 (n = 28) received dynamic stabilization combined with TLIF. Radiological assessments included disk height index (DHI) and fusion rates. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain at baseline, 12, and 24 months. Statistical analysis was performed using Jamovi^® software (version 2.4.1). Results: The hybrid group (dynamic + TLIF) demonstrated significantly higher anterior fusion rates (p < 0.001) and greater improvement in VAS scores for back (p = 0.005) and leg pain (p < 0.001) at 12 months. Although operative time was longer (p = 0.002), there was no significant difference in hospital stay (p = 0.635). No significant differences were observed in ASD development (p = 0.11) or pseudoarthrosis (p = 0.396). The hybrid group maintained better lumbar lordosis and higher adjacent segment DHI. Conclusions: Hybrid dynamic stabilization combined with TLIF provides superior clinical outcomes and fusion rates compared to dynamic stabilization alone, without significantly increasing the risk of ASD. These findings support the use of hybrid constructs as a balanced strategy for treating degenerative lumbar instability. Full article

Background/Objectives: Spinoplastic surgery is an emerging multidisciplinary field developed to address and reduce the complication of pseudoarthrosis following complex spinal reconstructions. While the number of spinal fusion procedures continues to rise every year, fusion failure rates remain as high as 40%. Although pseudoarthrosis may not always manifest clinically, it remains a leading cause of persistent pain and need for subsequent revision surgeries. The multidisciplinary collaboration between spine and plastic surgeons in spinoplastic surgery has therefore emerged as a proactive strategy aimed at preventing complications, particularly in patients identified as high-risk for pseudoarthrosis. As the patient population expands and spinoplastic surgery continues to evolve, refining patient selection criteria becomes essential for achieving optimal surgical outcomes. This review aims to provide a comprehensive overview of recent advancements in spinoplastic surgery, highlighting current indications, surgical techniques, recent case reports, and strategies for identifying suitable candidates. Methods: We performed a narrative review of English language literature through April 2025. Spinoplastic case reports and case series published within the last 20 years were included in the review. Results: Indications for use of a spinoplastic approach clustered into prior fusion failure, extensive oncologic resection, severe spinal deformity, procedures requiring extensive spinal involvement, and/or patients at risk for impaired bone healing. Succesful radiographic union and improvement of symptoms were widely reported across all 9 case reports/series. Conclusions: Although evidence is presently limited, spinoplastic surgery appears to achieve high bone graft fusion rates with acceptable morbidity and functional improvement in a carefully selected group of high-risk spinal reconstruction patients. Still, larger prospective studies are warranted to refine patient selection and validate functional benefit. Full article

Nonunion of the second metatarsal presents a significant clinical challenge, often leading to pain, functional impairment, and deformity. Various treatment strategies have been described in the literature, tailored to the patient’s specific characteristics. To provide a comprehensive overview of the available therapeutic options, a literature review was conducted. In this context, this article aims to present an innovative and personalized surgical technique for patients with nonunion and an altered metatarsal formula following a proximal shaft fracture of the second metatarsal. This technique enables the simultaneous consolidation of the nonunion and restoration of metatarsal alignment, with favorable clinical, functional, and radiological outcomes observed over a three-year follow-up period. Full article

Coronoid process fractures in the pediatric population are rare and often misdiagnosed, leading to chronic elbow instability. We aim to evaluate the surgical management of two adolescent cases of inveterate coronoid fractures using autologous bone grafting. Both patients, with a history of recurrent elbow dislocations, presented with pseudoarthrosis and were initially misdiagnosed due to minor or subtle fractures. Comprehensive imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), confirmed the presence of significant coronoid defects. The surgical intervention involved employing autografts from the iliac wing to reconstruct the coronoid process, followed by fixation with screws. Both patients underwent postoperative rehabilitation via physiotherapy, resulting in full functional recovery. At their one-year follow-ups, both patients regained full elbow function, achieving range-of-motion measurements of 0–0–130° flexion–extension and 90–0–90° pronation–supination; no recurrence of instability was reported, with no complications at the yearly follow-ups. This approach demonstrates the efficacy of autograft reconstruction in restoring elbow stability, particularly in cases with substantial bone loss or pseudoarthrosis. Our study highlights the importance of advanced imaging and individualized treatment strategies, emphasizing that early surgical intervention can prevent long-term disability in pediatric patients with chronic coronoid fractures. Full article

Intramedullary nails (IMNs) are the most frequent surgical fixation method for femur fractures. Although IMNs provide good healing outcomes and low complication rates, concerns persist regarding potential complications such as malunion, nonunion, and infections. This multicenter retrospective study aims to assess the epidemiology and outcomes of IMNs for diaphyseal femoral fractures. Data from 91 patients who underwent IMN fixation at two Brazilian hospitals between 2020 and 2024 were analyzed, with a mean age of 33.3 years (SD ± 12.7) and 76.9%% of male patients. Traffic accidents were the most common mechanism of trauma (84.61%). The bone healing rate was 96.7% within six months, and 98.9% within one year, with a complication rate of 3.26%, including two cases of pseudoarthrosis, one case of pseudoarthrosis and infection, and two reoperations. There was a significant association between previous external fixation and fracture type (open/closed) (χ²(1) = 17.5, p_Fischer < 0.001). Previous external fixation was also associated with lower consolidation rates six months post-surgery (χ²(1) = 9.83, p_Fischer = 0.031), but not after one year (χ²(1) = 8.19, p_Fischer = 0.11). The retrograde approach was associated with a lower consolidation rate after six months (χ²(1) = 6.98, p_Fischer = 0.027), but no significant association was found after one year (χ²(1) = 2.27, p_Fischer = 0.308). Only one patient with pseudoarthrosis did not consolidate after one year. The outcomes support the efficacy of IMNs in achieving bone consolidation with low complication rates. Full article

Pseudoarthrosis—the failure of normal fracture healing—remains a significant orthopedic challenge affecting approximately 10–15% of long bone fractures, and is associated with significant pain, prolonged disability, and repeated surgical interventions. Despite extensive research into the pathophysiological mechanisms of bone healing, diagnostic approaches remain reliant on clinical findings and radiographic evaluations, with little innovation in tools to predict or diagnose non-union. The present review evaluates the current understanding of the genetic and biological basis of pseudoarthrosis and highlights future research directions. Recent studies have highlighted the potential of specific molecules and genetic markers to serve as predictors of unsuccessful fracture healing. Alterations in mesenchymal stromal cell (MSC) function, including diminished osteogenic potential and increased cellular senescence, are central to pseudoarthrosis pathogenesis. Molecular analyses reveal suppressed bone morphogenetic protein (BMP) signaling and elevated levels of its inhibitors, such as Noggin and Gremlin, which impair bone regeneration. Genetic studies have uncovered polymorphisms in BMP, matrix metalloproteinase (MMP), and Wnt signaling pathways, suggesting a genetic predisposition to non-union. Additionally, the biological differences between atrophic and hypertrophic pseudoarthrosis, including variations in vascularity and inflammatory responses, emphasize the need for targeted approaches to management. Emerging biomarkers, such as circulating microRNAs (miRNAs), cytokine profiles, blood-derived MSCs, and other markers (B7-1 and PlGF-1), have the potential to contribute to early detection of at-risk patients and personalized therapeutic approaches. Advancing our understanding of the genetic and biological underpinnings of pseudoarthrosis is essential for the development of innovative diagnostic tools and therapeutic strategies. Full article

Background/Objectives: The increasing complexity of spinal oncology procedures, particularly in en-bloc tumor resections, creates challenges in tissue perfusion assessment due to extended operative times and extensive surgical dissection. Real-time visualization of tissue perfusion can be achieved with ICG using commercially available handheld imaging systems, offering potential advantages in spinal oncology cases. This study assessed the utility of ICG in analyzing soft-tissue viability during complex spine procedures extending beyond 7.5 h, with a particular focus on oncologic resections. Methods: Three cases that required over 7.5 h of operative time were chosen for ICG utilization. These cases included an en-bloc malignant peripheral nerve sheath tumor resection, an en-bloc resection of a malignant epithelioid neoplasm, and a long-segment fusion revision for pseudoarthrosis. At the conclusion of the critical portion of the procedure, a handheld intraoperative fluorescence camera was utilized to visualize the tissue penetration of intravenous ICG. Results: Prior to injecting ICG, devascularized tissue was not clearly visible. Injecting ICG allowed clear separation of vascularized (fluorescing) and devascularized (non-fluorescing) tissues. One region of non-florescent tissue was later confirmed to be devascularized with MRI and experienced postoperative infection. Conclusions: As the complexity of spinal oncology procedures increases, ICG fluorescence imaging offers a novel method for real-time assessment of tissue perfusion. This technique may be particularly valuable in extensive tumor resections, post-radiation cases, and revision surgeries where tissue viability is at risk. Further investigation in the spinal oncology population could help establish whether early identification of poorly perfused tissues impacts wound healing outcomes. Full article

Subtrochanteric nonunion is especially challenging. Extramedullary fixation using fixed-angle devices with a closing lateral wedge osteotomy is the standard surgical procedure for restoring the hip’s normal alignment and achieving bone union. However, this procedure is technically demanding and relies on devices that facilitate bone union in a non-dynamic manner, along with the limitations that this type of fixation entails, especially in this highly biomechanically stressed area. This paper aims to describe a novel surgical technique to heal subtrochanteric nonunion based on dynamic fixation performed through an over-valgus correction of the hip and fixed with a dynamic hip screw (DHS). Between March 2022 and July 2023, five patients diagnosed with nonunion of a subtrochanteric fracture were operated on by a single surgeon and followed prospectively. The average age of the patients was 64 (range: 34–85). The mean duration of surgery was 112 min (range: 63–153). The femoral neck angle before surgery was 120° (range: 110°–122°) and 147° (range: 142°–150°) after surgery. The mean leg length increased by 8 mm (range: 6–12). The Harris hip score improved from 38 points (range: 30–44) to 90 points (range: 88–96), corresponding to excellent or good results. All patients healed without major complications and were asymptomatic after 12 months of follow-up. In conclusion, over-valgus correction using a DHS is a novel technique that seems helpful for subtrochanteric nonunion. It allows for dynamic fixation, offering the advantages of dynamic fixation, especially in this high-stress area. It is also performed without osteotomy, making it a less demanding technique than the current methods described. Full article

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19–62 years) and a mean follow-up time of 15 months (range 5–24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine. Full article

Transition (Ti, Zr) metal-substituted calcium hexaorthophosphate CaTi_4-zZr_z(PO₄)₆ coatings with an NaSICon structure were deposited by atmospheric plasma spraying (APS) onto Ti6Al4Veli substrates using a statistical design of experiments (SDE) methodology. Several coating properties were determined, including chemical composition, porosity, surface roughness, tensile adhesion strength, shear strength, and solubility in protein-free simulated body fluid (pf-SBF) and TRIS-HCl buffer solution. The biological performance evaluation involved cell proliferation and vitality studies and osseointegration tests of coated Ti6Al4Veli rods intramedullary implanted in sheep femora. After a 6 months observation time, a satisfactory gap-bridging potential was apparent as shown by a continuous, well-adhering layer of newly formed cortical bone. These tests suggest that the coatings possess a suitable osseoconductive potential and present an enhanced expression of bone growth-supporting non-collagenous proteins and cytokines, a high cell proliferation, spreading and vitality, and substantial osseointegration by strong bone apposition. The moderate intrinsic ionic conductivity of CaTi_4-zZr_z(PO₄)₆ compounds can be augmented by doping with highly mobile Na⁺ or Li⁺ ions to levels that suggest their use in electric bone growth stimulation (EBGS) devices, able to treat nonunion (pseudoarthrosis) and osteoporosis, and that may also support spinal stabilisation by vertebral fusion. Full article