Search Results (1,516)

Marginal bone preservation around osseointegrated dental implants continues to represent a critical challenge in modern implant dentistry. To address this issue, subcrestal implant placement along the apico-coronal axis has been proposed as a reliable clinical strategy aimed at reducing the risk of implant thread exposure within the oral environment. In the present study, 38 healthy patients were treated with either bone-level implants (BLG-Control) or implants positioned 2 mm subcrestally (SCG-Test). All implants featured an internal conical connection and a platform-switching design. In addition, implants in the test group were restored using an immediate tissue-level abutment following the one-time abutment (OTA) protocol. Marginal bone modifications (MBMs) were evaluated through standardized radiographic examinations performed at surgery (T0), implant loading (T1), and after 6 (T2), 12 (T3), 24 (T4), and 36 (T5) months of functional loading. MBMs, meaning the overall changes in the radiographic bone structure over time, were categorized as bone loss (BL) when occurring apical to the implant neck, and as bone remodeling (BR) when detected coronally to the implant neck. Clinical parameters, including probing pocket depth (PPD), bleeding on probing (BoP), and plaque index (PI), were also recorded and analyzed throughout the follow-up period. At the 36-month evaluation, mean MBM values were 0.61 mm for the test group and 0.58 mm for the control group. After three years of follow-up, the test group demonstrated a mean PPD of 2.03 mm, compared with 2.78 mm in the control group. Bleeding on probing was recorded at 13% in the test group and 11% in the control group, while plaque index values were 11% and 5%, respectively. Within the limitations of the present investigation, implants placed 2 mm subcrestally and characterized by an internal conical connection combined with platform switching demonstrated favorable clinical and radiographic outcomes over a short- to medium-term observation period of three years. When compared with equicrestally positioned implants, the subcrestal approach seemed to favor the peri-implant hard tissue conditions while reducing the possibility of marginal bone loss below the implant neck. However, one should bear in mind that this clinical behavior applies specifically to the investigated implant design and should be interpreted within the limitations of the present study. Full article

Background/Objectives: Adult degenerative lumbar deformity is a heterogeneous condition in which outcome depends on radiographic correction, patient-related risk factors, and surgical burden. This study evaluated spinopelvic realignment, clinical outcomes, complications, and predictors of unfavorable postoperative course after surgical treatment of adult degenerative lumbar deformity. Methods: This three-center retrospective cohort study included adult patients who underwent posterior decompression and instrumented fusion, with or without interbody fusion, for adult degenerative lumbar deformity between January 2021 and December 2024. Of 136 screened patients, 113 completed final follow-up and were included in the analysis. The mean follow-up duration was 31.0 ± 12.9 months. Radiographic parameters were assessed preoperatively, immediately postoperatively, and at final follow-up. Patient-reported outcome measures were analyzed using available paired data. Unfavorable postoperative course was defined as persistent or worsened pain with functional limitation, symptomatic mechanical complication, deep infection requiring surgical treatment, or revision/reoperation. Results: Surgery produced significant immediate improvement in coronal and sagittal alignment. Cobb angle improved from 29.8 ± 13.1° to 13.7 ± 6.7°, lumbar lordosis increased from 28.8 ± 15.5° to 40.3 ± 16.0°, PI–LL mismatch decreased from 21.7 ± 10.0° to 10.1 ± 11.5°, and SVA decreased from 58.8 ± 31.4 mm to 32.5 ± 36.0 mm. Partial loss of correction was observed at final follow-up, although alignment generally remained improved compared with baseline. ODI improved from 57.8 ± 12.6 to 34.7 ± 8.7 in patients with available paired data. Any postoperative complication occurred in 42.5% (n = 48) of patients, revision/reoperation in 23.9% (n = 27), and unfavorable postoperative course in 35.4% (n = 40). In multivariable analysis, osteoporosis, greater fusion length, and residual immediate postoperative PI–LL mismatch were independently associated with unfavorable postoperative course. Conclusions: In this three-center retrospective cohort, surgery for adult degenerative lumbar deformity was associated with significant radiographic correction and meaningful clinical improvement in patients with available paired outcome data. However, the substantial complication and revision/reoperation burden highlights the morbidity of adult degenerative lumbar deformity surgery. Osteoporosis, fusion length, and residual immediate postoperative PI–LL mismatch may help identify patients at higher risk for unfavorable postoperative course. Full article

Background: Bone tissue is a dynamic structure capable of continuous remodeling; however, its regenerative capacity is limited in critical-size defects, often requiring the use of bone grafting procedures. Available grafting materials present inherent limitations, highlighting the need for strategies that can enhance regenerative outcomes. Hyaluronic acid (HA) has been proposed as a promising adjunctive agent because of its biological properties, including anti-inflammatory and pro-angiogenic effects. Objective: To systematically evaluate the available clinical evidence regarding the effects of HA as an adjunct in bone regeneration procedures, including alveolar ridge preservation, ridge augmentation, and maxillary sinus elevation. Materials and Methods: A systematic search was conducted in the PubMed, ScienceDirect, Google Scholar, and Wiley Online Library databases for studies published within the last 10 years. Clinical studies involving adult patients were included if they evaluated the local application of HA, regardless of formulation, and reported quantitative clinical, radiographic, histological, or histomorphometric outcomes related to bone regeneration. Results: Of the 728 records initially identified, 10 studies met the eligibility criteria and were included in the qualitative synthesis. Discussion: Overall, the available evidence suggests that HA may positively influence bone regeneration outcomes. The most consistent benefits were observed in alveolar ridge preservation and ridge augmentation procedures, including increased new bone formation, improved bone density, enhanced bone maturation, and reduced dimensional bone loss. In contrast, findings regarding maxillary sinus augmentation were less consistent. Conclusions: HA appears to be a promising adjunct in bone regeneration procedures. However, the current evidence remains limited and is primarily based on clinical outcomes, providing insufficient mechanistic data to fully elucidate its biological effects. Further well-designed randomized controlled trials with standardized protocols are required before definitive clinical recommendations can be established. Full article

Background: Wrist-hand radiographic skeletal maturation methods are widely used for forensic age estimation of living individuals, remaining among the most widely accepted imaging modalities in forensic practice despite limited evidence supporting their use at the legally relevant 18-year threshold. This systematic review aims to provide a quantitative synthesis of the widely recognized but previously unsynthesized body of evidence regarding their diagnostic accuracy (sensitivity, specificity, AUC-curve, mean absolute error-MAE) for forensic adult age estimation. Methods: Six databases (Scopus, PubMed, Google Scholar, Embase, Cochrane, Clarivate) between 1980 and 2026 were searched. Studies evaluating wrist-hand skeletal maturation for forensic age estimation in individuals ≥16 years with verified chronological age were included. Two reviewers independently screened studies and extracted data. Quality was assessed using QUADAS-2. DerSimonian-Laird random-effects model estimated the sensitivity and specificity of the wrist-hand bones maturation at the age of 18 years, and pooled MAE. GRADE assessed the certainty of evidence. Results: From 747 records, 23 studies (11,425 participants, 15 countries, 2003–2025) were included. Pooled MAE was 0. 537 years (95% CI: 0.387–0.686; 95% PI: 0.33–0.79 years), but obtained from 3 Italian studies conducted on clinical populations, and all characterized by high risk of bias. At the 18-year threshold, pooled sensitivity was 69.5% (95% CI: 61.6–77.3%; 95% PI: 35.3–100%) and specificity 85.56% (95% CI: 83.53–87.60%; 95% PI: 77.2–93.9%). Nevertheless, the heterogeneity was extreme (I² > 98%) for all diagnostic measures, and calculated prediction intervals confirm that individual study results are expected to vary widely. QUADAS-2 assessment revealed 82.6% of studies with high/unclear patient selection bias. GRADE-certainty was VERY LOW for both outcomes due to serious risk of bias, very serious inconsistency, and serious indirectness. Conclusions: Wrist-hand skeletal maturation shows low accuracy and high rates of misclassification for age estimation at the 18-year threshold. The wide prediction intervals (sensitivity 35–100%, specificity 77–94%, MAE 0.33–0.79 years) indicate that performance in a new study population may differ substantially from the pooled estimates. Very low certainty evidence, extreme heterogeneity, and substantial methodological limitations preclude confident application. Results should be interpreted with caution in forensic contexts, preferably combining multiple age indicators, in particular dental evidence. Full article

Background/Objectives: Peri-implantitis is a major complication in implant dentistry, and its radiographic diagnosis remains challenging because conventional assessment is operator-dependent and bone loss is often detected only after measurable changes occur. Artificial intelligence (AI) may support the detection, quantification, and prognostic assessment of peri-implant bone conditions. This review aimed to synthesize evidence on AI-based radiographic approaches for peri-implantitis detection, marginal bone loss measurement, and risk stratification. Methods: PubMed and Scopus were searched for original studies published between 2013 and 2025 that applied artificial intelligence (AI), including machine learning and deep learning, to peri-implantitis. Eligible studies focused on peri-implant bone assessment and reported quantitative performance metrics. Extracted data included imaging modality, AI model, task, dataset, reference standard, validation strategy, performance, and clinical relevance. A qualitative synthesis was performed. Results: Eleven studies met the eligibility criteria; however, one full text could not be retrieved, and ten studies were included. In most of the studies, peri-implant marginal bone loss detection or measurement was performed using periapical/intraoral radiographs, while only few studies used panoramic or combined imaging. Common architectures included YOLO variants, Faster R-CNN, Mask R-CNN, U-Net, ResNet, and AlexNet. Performance was generally encouraging for implant localization, bone loss detection, keypoint identification, and severity classification. Only one study addressed outcome prediction. All studies were retrospective and internally validated. Conclusions: AI may support radiographic detection and quantification of peri-implant bone loss as an adjunctive diagnostic tool. However, evidence is limited by retrospective designs, heterogeneous reference standards, lack of external validation, and limited clinical-data integration. Future studies should prioritize prospective multicenter validation, longitudinal imaging, and multimodal models. Full article

Background/Objectives: Focal fibrocartilaginous dysplasia (FFCD) is a rare, benign developmental disorder of the growing skeleton first described 40 years ago. It is characterised by a fibrocartilaginous tether adjacent to the physis, which disrupts symmetrical growth and leads to progressive angular deformity. The aim of this review was to define site-specific clinical patterns and management principles for FFCD to optimise patient outcomes. Methods: We conducted a narrative review of more than four decades of published literature on FFCD. All identified English-language case reports, case series, and review articles were analysed to synthesise evidence on clinical presentation, anatomical location, natural history and treatment strategies. Results: To date, 169 cases have been reported, with approximately two-thirds involving the proximal tibia. Tibial lesions typically present in toddlers as unilateral genu varum and, in most cases, demonstrate spontaneous remodelling and complete resolution. In contrast, femoral and upper-limb lesions rarely resolve spontaneously and often progress, thereby warranting earlier and more invasive management. Radiographic findings are highly characteristic, most commonly showing a cortically based metaphyseal lucency with a sclerotic rim. These features are generally considered sufficient for diagnosis, usually eliminating the need for biopsy. Management has evolved towards a tailored approach, consisting of observation for tibial lesions with potential for spontaneous resolution and timely surgical intervention for femoral or upper-limb lesions at risk of progression or joint compromise. Conclusions: Despite the advances made in recent decades, FFCD remains a distinctive yet heterogeneous condition in paediatric orthopaedics. This narrative review summarises more than four decades of published literature, including case reports, case series, and review articles, with particular attention to site-specific clinical patterns and their implications for optimising management. Full article

Background: Bunionette deformity is commonly treated with distal or diaphyseal osteotomy, but concerns remain regarding correction loss, implant irritation, and metatarsal shortening. This study evaluated outcomes of mini-open fifth metatarsal osteotomy stabilized with intramedullary rigid fixation in symptomatic Coughlin type II and III deformity. Methods: This single-center retrospective observational study included 32 consecutive patients treated between February 2018 and February 2023. Radiographic outcomes included the fourth-to-fifth intermetatarsal angle (IMA), fifth metatarsophalangeal angle (MPA), maintenance of correction, and fifth metatarsal shortening. Clinical outcomes included the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS) pain score, and complications. An exploratory subgroup analysis compared isolated correction with combined procedures. Results: The mean follow-up was 31.5 ± 6.8 months. The mean AOFAS score improved from 52.5 ± 4.2 to 93.4 ± 3.4, and the mean VAS score decreased from 7.8 ± 0.9 to 1.2 ± 0.6 (both p < 0.001). The mean MPA improved from 19.4° ± 3.6° to 2.3° ± 1.1°, and the mean IMA improved from 14.0° ± 1.4° to 4.5° ± 2.5° (both p < 0.001). Minor but statistically significant correction loss occurred between early postoperative and final follow-up radiographs. Mean fifth metatarsal shortening was 1.3 ± 0.8 mm. One patient required implant removal for hardware irritation. No nonunion, transfer metatarsalgia, or wound complications were observed. Conclusions: Mini-open fifth metatarsal osteotomy with intramedullary rigid fixation was associated with pain relief, functional improvement, maintained radiographic correction, limited shortening, and a low observed complication rate in this series. Full article

Objective: This cross-sectional study aimed to examine the association between recreational volleyball participation and knee osteoarthritis (KOA) risk in a community-based population, focusing on participation frequency, cumulative exposure periods, and clinical outcomes. Methods: Utilizing data from the Osteoarthritis Initiative (OAI) cohort (n = 2539; ages 45–79), volleyball engagement was assessed via the Historical Physical Activity Survey Instrument across four age periods (12–18, 19–34, 35–49, ≥50). Participants were stratified into non-volleyball, low-frequency, and high-frequency groups. Outcomes included knee pain (WOMAC score ≥ 1), radiographic OA (ROA), and symptomatic OA (SOA). Logistic regression models adjusted for age, sex, BMI, and race were employed to evaluate the associations. Results: Volleyball participation reported across all four age periods was associated with higher odds of ROA (adjusted OR = 2.394, 95%CI: 1.247–4.596, p = 0.009). High-frequency participation alone, however, was not associated with knee pain, ROA, or SOA (all p > 0.05). No significant associations were observed between cumulative participation and knee pain or SOA, and no dose–response relationship was found for participation frequency. Conclusions: Recreational volleyball participation was not associated with higher prevalence of knee pain or symptomatic radiographic KOA, outcomes that may be more clinically relevant than radiographic findings alone. Although participation across all four life periods was associated with higher odds of ROA, this structural finding should not be overinterpreted because it was based on a small subgroup and a non-monotonic pattern in a cross-sectional analysis. Full article

Background/Objectives: Alveolar ridge atrophy following tooth extraction complicates subsequent prosthetic rehabilitation and implant placement. This systematic review seeks to provide a comprehensive evaluation of existing evidence regarding the effectiveness of xenogeneic bone graft materials in socket preservation, particularly emphasizing their influence on the adjacent soft tissues. Methods: A systematic literature search was carried out across the CENTRAL, Embase, MEDLINE, PubMed, and Scopus databases. The search targeted randomized controlled trials (RCTs) published in English between January 2015 and September 2025 that examined xenogenic bone grafts used for ridge preservation in comparison either to spontaneous socket healing or to other types of grafting materials. The primary outcomes of interest were bone regeneration and alterations in soft tissues. Multiple independent reviewers performed study screening, data extraction, and risk of bias evaluation using the RoB 2 tool. Results: From 2242 initial records, 4 RCTs (138 patients) met the inclusion criteria. Studies compared xenografts (deproteinized bovine bone mineral with/without collagen), often combined with membranes, to unassisted healing. Augmentation techniques consistently showed a trend toward reduced horizontal and vertical ridge contraction compared to controls, though differences often lacked statistical significance (p > 0.05). Histological analysis revealed significantly less vital bone formation and residual graft particles in xenograft sites versus controls, suggesting volume maintenance is largely graft-dependent. Soft tissue contour changes were evaluated using 3D model scanning. Risk of bias varied, with concerns regarding randomization and reported outcomes in some studies. Conclusions: Xenogenic materials demonstrate comparable clinical effectiveness in preserving alveolar ridge dimensions, though radiographic volume stability may be partially attributed to the slow resorption of the graft material itself rather than new bone formation. Full article

Background/Objectives: To evaluate the clinical feasibility and short-term radiographic outcomes of adapting a prosthesis-based guide system originally developed for single-implant placement for multi-implant placement in the edentulous maxilla, and to compare implant-level marginal bone change from prosthetic loading to one year between full-rough (IBT/IBNT/IBR) and hybrid-surface (MSC-IBT/MSC-IBNT) implants in a split-mouth design. Patient-reported outcomes were assessed with the OHIP-14 questionnaire. Methods: Fifteen patients with an edentulous maxilla received four or five maxillary implants placed flaplessly using a 3D-printed prosthesis-based guide incorporating polyether-ether-ketone (PEEK) rails and interchangeable angulation-correction sleeves (0°, 12°, 24°). Implants had either a fully roughened or a hybrid (rough apical and middle third with a machined coronal collar) surface. Side allocation was non-randomized: the hybrid side was assigned by alternating sequence and three patients received only full-rough implants for prosthetic reasons. All patients followed a delayed loading protocol and received a screw-retained zirconia fixed bridge. Standardized periapical radiographs were obtained at definitive prosthetic loading (baseline) and at the 12-month follow-up. Implant-level marginal bone loss was calculated as the mean of mesial and distal measurements per implant. All radiographic measurements were performed by two independent examiners (M.T. and T.M.); intra-rater reliability (M.T., remeasurement of 10 radiographs) and inter-rater reliability (M.T. versus T.M., full dataset) were quantified by intraclass correlation coefficient (ICC; two-way mixed effects, absolute-agreement, single-measurement). The primary split-mouth surface comparison was performed at the patient level by averaging implant-level change scores within each surface for each patient and comparing the paired patient-level means with a Wilcoxon signed-rank test. No a priori sample-size calculation was performed; the study was designed as a feasibility pilot. Results: Sixty-one implants were placed in 15 patients (seven male, eight female; mean age 62.5 ± 8.9 years; three current smokers). Four implants in three patients required removal and replacement during the observation period (three early failures, one late failure; per-implant early-failure rate of 3/61, 4.9%); one patient (P7) withdrew from clinical follow-up. Paired baseline and 12-month radiographs were available for 53 implants from 14 patients. Median implant-level marginal bone level increased from 0.38 mm (IQR 0.20–0.54) at baseline to 0.78 mm (IQR 0.47–1.32) at 12 months (paired Wilcoxon signed-rank, p < 0.001); two implants exceeded 4 mm of bone change at 12 months. In the patient-level paired surface comparison (n = 8 patients contributing at least one full-rough and one hybrid implant with paired data), full-rough implants showed less 12-month marginal bone change than hybrid implants in every paired patient (median paired difference full-rough hybrid of −0.49 mm; Hodges–Lehmann pseudo-median of 0.55 mm; paired Wilcoxon p = 0.012). OHIP-14 scores at one year (n = 14) showed a pronounced floor effect, with most patients scoring zero across most domains. Both intra-rater (M.T.) and inter-rater (M.T. versus T.M.) reliability showed good agreement (ICC = 0.85). Conclusions: A prosthesis-based guide system originally validated for single-implant placement can be feasibly adapted for flapless multi-implant rehabilitation of the edentulous maxilla, with early clinical and radiographic outcomes broadly consistent with comparable published series. Contrary to the design rationale that a machined coronal collar would limit early crestal remodeling, full-rough implants showed less 12-month within-patient bone change than hybrid implants in the eight paired patients; this finding is preliminary and hypothesis generating given the small, unbalanced paired sample and the contrast with larger published series. The approach is best characterized as a reduced infrastructure alternative to proprietary guided-surgery platforms, remains operator dependent, and requires confirmation in formally powered, balanced split-mouth trials with concealed allocation, placement anchored bone level measurement, postoperative CBCT for deviation quantification, and longer follow-up. Full article

Aim: This study aimed to evaluate the impact of cone beam computed tomography (CBCT) on preoperative surgical decision-making and risk assessment for mandibular third molar (MM3) extractions in cases identified as high-risk by orthopantomography (OPG). Materials and Methods: This prospective observational diagnostic study utilized the purposive sampling method, recruiting 50 MM3s from 33 patients (21 females, 12 males; mean age 24.24 ± 6.77 years, range 16–42). Samples were categorized into five distinct radiographic groups based on the proximity of roots to the inferior alveolar nerve (IAN) on OPG. The methodology involved a comparative 3D analysis to determine neurovascular contact, spatial orientation, and the presence of a cortical border. Surgical strategies, specifically the necessity for coronectomy or the lingual split technique, were reassessed following 3D evaluation. Postoperative neurosensory outcomes were recorded. Statistical analysis was performed using the Fisher–Freeman–Halton and Kruskal–Wallis tests. Results: CBCT identified direct IAC contact in 74% of the cases. In 18% of the cases initially deemed high-risk by OPG, CBCT revealed a safe distance, thereby altering the surgical approach. Tooth angulation (p = 0.012) and Pell and Gregory classification (p = 0.024) were significant predictors of contact. Temporary neurosensory disturbances occurred in 4% (n = 2) of the sample, specifically in cases where CBCT had confirmed the loss of nerve canal cortication. Conclusions: In accordance with the study aim, CBCT provides essential 3D data that refines surgical planning in nearly one-fifth of high-risk cases. The findings justify selective CBCT use, guided by the ALADA principle, to minimize iatrogenic injury. Full article

Background/Objectives: Tooth impaction and transposition are developmental dental anomalies that pose significant challenges in orthodontics, oral surgery, and restorative dentistry. These anomalies disrupt normal occlusal development and complicate diagnosis and treatment planning because of altered anatomy, a higher risk of adjacent tooth resorption, associated pathology such as cyst formation, and biomechanical challenges during orthodontic intervention. Methods: Three paediatric patients with complex eruption disturbances, including impacted incisors, impacted primary molars, and transposed maxillary canines, were managed using individualised conservative orthodontic approaches. The cases involved obstruction by supernumerary teeth, ectopic eruption with space loss, and tooth transposition complicated by root dilaceration and malocclusion. Comprehensive clinical and radiographic assessment, including CBCT when indicated, guided treatment planning. Management strategies included staged surgical interventions, space maintenance using 2 × 4 appliances, bite opening, and controlled orthodontic traction with modified biomechanics to minimise the risk of root resorption and interference with adjacent teeth. Results: Favourable functional and aaesthetic outcomes were achieved in all cases, although certain limitations such as incomplete root development, residual spacing, localised restorative complications, and difficulty in correcting root angulation of dilacerated adjacent teeth were observed. Conclusions: Careful diagnosis using advanced imaging, combined with conservative orthodontic and surgical approaches, can achieve satisfactory functional and esthetic outcomes while minimising complications. Further longitudinal studies are recommended to evaluate long-term stability and optimise treatment protocols. Full article

Background/Objectives: Ankylosing Spinal Disorders (ASDs) encompass a heterogeneous group of rheumatic diseases characterized by progressive ankylosis of the axial skeleton, including Ankylosing Spondylitis (AS), Diffuse Idiopathic Skeletal Hyperostosis (DISH), and Non-Radiographic Axial Spondyloarthritis (nr-AxSpA). Spinal ankylosis profoundly alters the biomechanical properties of the vertebral column, transforming it into a rigid long-bone equivalent and dramatically increasing fracture risk even after low-energy trauma. Once a fracture occurs, the long lever arm created by the ankylosed segments generates enormous mechanical stress at the fracture site, making surgical stabilization mandatory in the vast majority of cases. Long posterior instrumentation is the treatment of choice; however, no consensus exists regarding the optimal number of instrumented levels. The aim of this study is to clinically and radiologically evaluate long posterior instrumentation in the 3 + 3 (3 proximal and 3 caudal screws), 3 + 2 (3 proximal and 2 caudal screws), or 2 + 2 (2 proximal and 2 caudal screws) configuration for the treatment of traumatic ASD thoracolumbar vertebral fractures, in terms of implant failure, infection rate, and mortality. Methods: Between 2018 and 2023, 65 consecutive patients with ASD-related thoracolumbar vertebral fractures were treated at our institution. After applying pre-defined inclusion and exclusion criteria, 37 patients were enrolled. Patients were retrospectively divided into three groups according to the posterior arthrodesis configuration (notation indicates number of instrumented vertebral levels proximal + distal to the fracture: 3 + 3, 3 + 2, or 2 + 2). Radiological outcomes were assessed for loosening, screw cut-out, and implant breakage. Infection and mortality rates within 3 months from surgery were evaluated as secondary endpoints. Statistical analysis was performed using the Fisher exact test (significance set at p < 0.05). Results: Thirty-seven patients (28 males and 9 females; mean age 77 ± 7.3 years) were included, with a mean follow-up of 30 ± 5.3 months. Instrumentation configurations were as follows: 23 (3 + 3), 5 (3 + 2), and 9 (2 + 2). Three implant failures (8.1%) and four infections (10.8%) were recorded. Eleven patients died within 3 months of surgery. A statistically significant difference was found between instrumentation length and mechanical complications (p = 0.0468), while no significant difference was observed for infection (p = 1) or mortality rate (p = 0.137). Conclusions: In this exploratory retrospective cohort, the 3 + 3 configuration was associated with the lowest observed rate of implant failure in ASD thoracolumbar fractures, suggesting a potential mechanical advantage over shorter constructs that warrants confirmation in larger prospective studies. No significant correlation was found between instrumentation length and infection rate or early mortality. Prospective, multicentre studies with larger cohorts are warranted to establish definitive guidelines for instrumentation length in this challenging patient population. Full article

Background/Objectives: Metastatic hormone-sensitive prostate cancer (mHSPC) is a biologically heterogeneous disease in which treatment intensification with androgen receptor pathway inhibitors has significantly improved clinical outcomes. However, direct comparative evidence between abiraterone and enzalutamide remains limited. We aimed to evaluate radiographic progression-free survival (rPFS) in patients with mHSPC treated with first-line abiraterone or enzalutamide and to perform exploratory subgroup analyses according to baseline clinical and laboratory characteristics. Methods: This retrospective single-center study included patients with mHSPC who received first-line abiraterone or enzalutamide in combination with androgen deprivation therapy. Baseline demographic, clinical, and laboratory characteristics were collected retrospectively. The primary endpoint was rPFS. Survival was analyzed using the Kaplan–Meier method and compared using the log-rank test. Results: A total of 172 patients were included, of whom 84 received abiraterone and 88 received enzalutamide. The median follow-up duration was 24.7 months (95% CI 21.5–27.9). In the overall population, median rPFS was comparable between the abiraterone and enzalutamide groups (50 vs. 49 months, p = 0.21). However, enzalutamide was associated with significantly longer rPFS among patients aged <70 years (HR 0.25, 95% CI 0.07–0.89; p = 0.02), those with baseline hemoglobin ≥12 g/dL (HR 0.36, 95% CI 0.15–0.85; p = 0.01), and those with baseline ALP < 147 U/L (HR 0.43, 95% CI 0.19–0.98; p = 0.04). No significant differences were observed in other subgroups. Conclusions: rPFS was comparable between abiraterone and enzalutamide in the overall mHSPC population. However, enzalutamide was associated with longer rPFS in patients aged <70 years and in those with preserved hemoglobin and lower ALP levels. These findings suggest that baseline clinical and laboratory characteristics may influence treatment outcomes and should be prospectively validated. Full article

Background: Developmental dysplasia of the hip (DDH) is one of the leading causes of secondary hip osteoarthritis and frequently results in severe anatomical alterations that make total hip arthroplasty (THA) technically demanding. Restoration of hip biomechanics, limb length, and joint stability remains challenging, particularly in patients with moderate-to-severe dysplasia. Objective: To evaluate the clinical and radiographic outcomes of cementless total hip arthroplasty combined with soft-tissue balancing, with or without acetabular reconstruction using autologous femoral head graft, in patients affected by osteoarthritis secondary to DDH. Methods: A retrospective single-center case series was conducted on eight female patients (mean age 53.9 ± 14.6 years; range 33–80 years) who underwent primary cementless THA for DDH-related osteoarthritis between 2019 and 2025. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Short Form-36 (SF-36). Radiographic evaluation included implant positioning, osteolysis, heterotopic ossification, bone graft incorporation, and leg-length discrepancy. Data normality was assessed using the Shapiro–Wilk test. Preoperative and postoperative outcomes were compared using paired Student’s t-test and confirmed with the Wilcoxon signed-rank test. Implant survival and revision-free status were recorded throughout the follow-up period. Results: At a minimum follow-up of 12 months (range 12 months–6 years), significant improvements were observed in all clinical outcome measures. Mean HHS increased from 49.3 ± 2.5 preoperatively to 90.4 ± 2.7 postoperatively (p < 0.001), while mean WOMAC decreased from 53.5 ± 5.6 to 7.4 ± 3.3 (p < 0.001). Mean SF-36 improved from 47.2 ± 3.8 to 89.9 ± 3.2 (p < 0.001). Wilcoxon analysis confirmed the statistical significance of these findings (all p = 0.0078). Radiographic assessment demonstrated satisfactory implant positioning and stable fixation in all patients, with no evidence of osteolysis or implant loosening. Minor complications included one intraoperative periprosthetic femoral fracture treated successfully with cerclage wiring, two cases of Brooker grade I–II heterotopic ossification, and one case of minimal graft resorption without clinical consequences. No revision procedures were recorded during follow-up, and implant survival was 100%. Conclusions: Cementless THA combined with selective soft-tissue balancing provides excellent clinical, functional, and radiographic outcomes in patients with osteoarthritis secondary to DDH. This approach significantly improves hip function and quality of life while ensuring stable implant fixation, low complication rates, and excellent mid-term implant survival. Full article