Search Results (325)

Background/Objectives: Orbital reconstruction remains one of the most demanding procedures in maxillofacial surgery. It requires not only precise anatomical knowledge but also poses multiple intraoperative challenges. Limited surgical visibility—especially in transconjunctival or transcaruncular approaches—demands exceptional precision from the surgeon. At the same time, the complex anatomical structure of the orbit, its rich vascularization and innervation, and the risk of severe postoperative complications—such as diplopia, sensory deficits, impaired ocular mobility, or in the most serious cases, post-traumatic blindness due to nerve injury or orbital compartment syndrome—necessitate the highest level of surgical accuracy. In this context, patient-specific implants (PSIs), commonly fabricated from zirconium oxide or ultra-high-density polyethylene, have become invaluable. Within CAD-based reconstructive planning, especially for orbital implants, critical factors include the implant’s anatomical fit, passive stabilization on intact bony structures, and non-interference with orbital soft tissues. Above all, precise replication of the orbital dimensions is essential for optimal clinical outcomes. This study compares the morphological accuracy of orbital structures based on anthropometric measurements from 3D models generated from fan-beam computed tomography (FBCT) and cone-beam computed tomography (CBCT). Methods: A cohort group of 500 Caucasian patients aged 8 to 88 years was analyzed. 3D models of the orbits were generated from FBCT and CBCT scans. Anthropometric measurements were taken to evaluate the morphological accuracy of the orbital structures. The assessed parameters included orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Results: Statistically significant differences were observed between virtual models derived from FBCT and those based on CBCT in several key parameters. Discrepancies were particularly evident in measurements of orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Conclusions: The statistically significant discrepancies in selected orbital dimensions—particularly in regions of so-called thin bone—demonstrate that FBCT remains the gold standard in the planning and design of CAD/CAM patient-specific orbital implants. Despite its advantages, including greater accessibility and lower radiation dose, CBCT shows limited reliability in the context of orbital and infraorbital reconstruction planning. Full article

Background/Objectives: The calcaneus is the most commonly injured tarsal bone, potentially resulting in long-term functional deficiencies and disability. The type of treatment mainly depends on fracture type and morphology. Treatment of these fractures can be challenging due to a limited soft tissue envelope and is frequently associated with complications. The aim of this study was to classify fracture types and identify factors associated with in-hospital complications. Methods: Patients with calcaneal fractures treated at our level I trauma center between 1997 and 2017 were included. Demographic data, comorbidities, fracture characteristics, type of treatment, complications and revisions, compliance and accompanying injuries were evaluated. Results: A total of 238 patients (m = 163, f = 75) at a mean age of 40 years sustaining either uni- or bilateral calcaneal fracture resulting in a total of 288 calcaneal fractures. Concomitant injuries were present in 103 patients (35.9%). Traumatic spine lesions were present in 21.9%. Complications were recorded in 59 fractures (20.5%). Open fractures were more likely to develop complications (76.0% vs. 15.2%, p < 0.001). Significant complication (33% vs. 14%, p < 0.001) and wound complication rates (29% vs. 10%, p < 0.001) were found in multiple-injured patients. All open fractures were surgically treated on the day of admission. In calcaneal fractures with a Böhler angle below 0 degrees, more complications were seen (33% vs. 17%, p < 0.05). Conclusions: High complication rates following calcaneal fractures were detected, with an increased likelihood in open fractures and in patients with multiple injuries. A negative Böhler angle was associated with worse outcomes. Full article

Background/Objectives: The increased risk of developing tendinopathies in athlete populations has led to investigations of several genes associated with tendon properties, suggesting that some individuals have a greater genetic predisposition for developing tendinopathies. The main purpose of this study was to investigate how the functional polymorphisms within the COL5A1, COL27A1 and TNC genes impact the risk of developing tendinopathies in high-level Croatian athletes. Methods: For this case–control genetic study, we recruited 63 high-level athletes with a diagnosis of tendinopathies and 92 healthy asymptomatic individuals as controls. All individuals were genotyped for three single-nucleotide polymorphisms (SNPs) within the COL5A1, COL27A1 and TNC genes using the pyrosequencing method. Results: TNC rs2104772 TT (p = 0.0089) and the T-T-T haplotype (p = 0.0234), constructed from rs12722, rs946053 and rs2104772, were significantly overrepresented in cases versus controls, implicating a predisposition for tendinopathies. COL27A1 rs946053 GG (p = 0.0118) and the G-A-C haplotype (p = 0.0424), constructed from rs12722, rs946053 and rs2104772, were significantly overrepresented in controls, implicating a protective role. Conclusions: These results further support associations between functional polymorphisms within the COL27A1 and TNC genes and the risk of tendinopathies in high-level athletes. Further research is needed to replicate these results in various populations and larger cohorts. Full article

Heterotopic ossification (HO) refers to the pathological formation of bone in soft tissues, typically following trauma, surgical procedures, or as a result of genetic disorders. Notably, injuries to the central nervous system significantly increase the risk of HO, a condition referred to as neurogenic HO (NHO). This review outlines the cellular and molecular mechanisms driving HO, focusing on the inflammatory response, progenitor cell reprogramming, and current treatment strategies. HO is primarily fuelled by a prolonged and dysregulated inflammatory response, characterized by sustained expression of osteoinductive cytokines secreted by M1 macrophages. These cytokines promote the aberrant differentiation of fibro-adipogenic progenitor cells (FAPs) into osteoblasts, leading to ectopic mineralization. Additional factors such as hypoxia, BMP signalling, and mechanotransduction pathways further contribute to extracellular matrix (ECM) remodelling and osteogenic reprogramming of FAPs. In the context of NHO, neuroendocrine mediators enhance ectopic bone formation by influencing both local inflammation and progenitor cell fate decisions. Current treatment options such as nonsteroidal anti-inflammatory drugs (NSAIDs), radiation therapy, and surgical excision offer limited efficacy and are associated with significant risks. Novel therapeutic strategies targeting inflammation, neuropeptide signalling, and calcium metabolism may offer more effective approaches to preventing or mitigating HO progression. Full article

Background/Objectives: Recent breakthroughs in three-dimensional (3D) printing and high-resolution imaging have opened up new possibilities in personalized medicine, surgical planning, and forensic reconstruction. This study breaks new ground by evaluating the integration of high-resolution peripheral quantitative computed tomography (HR-pQCT) with multimodal imaging and additive manufacturing to assess a chronic, infected gunshot injury in the knee joint of a red deer. This unique approach serves as a translational model for complex skeletal trauma. Methods: Multimodal imaging—including clinical CT, MRI, and HR-pQCT—was used to characterise the extent of osseous and soft tissue damage. Histopathological and molecular analyses were performed to confirm the infectious agent. HR-pQCT datasets were segmented and processed for 3D printing using PolyJet, stereolithography (SLA), and fused deposition modelling (FDM). Printed models were quantitatively benchmarked through 3D surface deviation analysis. Results: Imaging revealed comminuted fractures, cortical and trabecular degradation, and soft tissue involvement, consistent with chronic osteomyelitis. Sphingomonas sp., a bacterium that forms biofilms, was identified as the pathogen. Among the printing methods, PolyJet and SLA demonstrated the highest anatomical accuracy, whereas FDM exhibited greater geometric deviation. Conclusions: HR-pQCT-guided 3D printing provides a powerful tool for the anatomical visualisation and quantitative assessment of complex bone pathology. This approach not only enhances diagnostic precision but also supports applications in surgical rehearsal and forensic analysis. It illustrates the potential of digital imaging and additive manufacturing to advance orthopaedic and trauma care, inspiring future research and applications in the field. Full article

Orthotics are often used to support the metacarpophalangeal joint (MCPj) in horses recovering from soft tissue injury; however, their effect on the MCPj biomechanics remain largely underexplored. The MCPj moves primarily in the sagittal plane, flexing during the swing phase and extending during the stance phase. The suspensory ligament and flexor tendons act as biological springs resisting MCPj extension. Injuries to these structures are common and, although early mobilization promotes their healing, controlled loading may be beneficial during rehabilitation. This study aims to evaluate the efficacy of a semirigid orthotic in limiting the MCPj extension and the MCPj range of motion, and its influence on the MCPj kinematics. Twelve healthy horses were equipped with portable inertial sensors on the distal limb. The MCPj extension and the MCPj range of motion were assessed during walking and trotting without the orthotic (S0) and with the orthotic using two different support settings (S1 and S4). Data were evaluated for normality and homoscedasticity. A Student t-test was used to compare the MCPj angle pattern of the two forelimbs of each horse at the baseline. Data were analysed using one-way ANOVA to compare the mean values across conditions, followed by paired t-tests for post-hoc comparison (significance set at p < 0.05). The results showed significant reductions in both the MCPj extension and the MCPj range of motion, with the greatest restriction occurring at the highest support setting. These results suggest that the semirigid orthotic limits the MCPj movement in the sagittal plane and consequently the load on the suspensory ligament and flexor tendons. Therefore, this orthotic device is an effective tool during rehabilitation for forelimb tendon and ligament injuries. Full article

Background/Objectives: High-energy trauma to the lower limb often results in extensive soft tissue loss with exposure of critical structures, posing a serious threat to limb viability. Early and effective coverage is crucial to prevent infection, promote bone healing, and preserve function. This report presents the use of a latissimus dorsi free flap for circumferential soft tissue reconstruction following a severe crush injury. Methods: We describe the case of a young female patient who sustained a high-energy crush trauma with a comminuted, displaced fracture of the middle and distal third of the tibia and complete circumferential soft tissue loss. Due to the extent and location of the defect, a latissimus dorsi free flap was selected for reconstruction. The surgical technique, microsurgical anastomosis, postoperative care, and rehabilitation protocol are detailed. Results: The latissimus dorsi flap provided reliable coverage of the entire defect, protected the underlying bone and hardware, and promoted wound healing. No major complications were observed. Functional recovery was satisfactory, with progressive weight-bearing and joint mobility achieved during follow-up. Conclusions: In complex lower limb injuries with extensive soft tissue damage, free flap transfer remains a key strategy for limb salvage. The latissimus dorsi flap, due to its size, reliability, and versatility, represents a valuable option for circumferential coverage and restoration of limb function following high-energy trauma. Full article

Many surgical and nonsurgical options are available to patients seeking facial rejuvenation. In this review, we aim to provide an overview of the current trends in facelift and necklift procedures while simultaneously highlighting the utility of nonsurgical treatments. A comprehensive literature review was performed using the PubMed, Google Scholar, and Cochrane Library databases, with the objective of including recent literature published on facelift and necklift procedures from 2015 to 2025. Articles were selected based on relevance, with a specific focus on including a wide breadth of techniques. A considerable body of literature has been published to further classify the soft-tissue anatomy of the face and neck. In particular, these studies focus on the characterization of the three-dimensional anatomy of the facial nerve with emphasis on safe planes of dissection to avoid inadvertent facial nerve injury. The current literature continues to debate both the theoretical and practical advantages and disadvantages of various facelift techniques. Broadly speaking, facelift techniques can be divided into those that manipulate the superficial musculoaponeurotic system (SMAS) layer on its superficial surface and those that undermine the SMAS to varying extents. Numerous approaches are available to improve the contour of the neck and jawline, including manipulation of the platysma muscle and subplatysmal volume reduction. Other surgical procedures and nonsurgical treatments should be considered to optimize and enhance facelift and necklift results. Advancements in patient safety include a focus on minimizing complications while reducing the length of recovery. Facelift and necklift procedures remain the foundational pillars for facial rejuvenation. With attention to patient-specific anatomy, surgeons can work collaboratively with patients to provide global facial optimization by choosing appropriate facelift and necklift techniques in combination with other ancillary procedures. Doing so will deliver enduring, elegant results. Full article

Introduction: Rotational ankle instability (RAI), involving combined medial and lateral ligament insufficiency, is an increasingly recognized clinical entity. While open surgery has traditionally been the mainstay for treating deltoid ligament injuries, recent developments in arthroscopic techniques offer a minimally invasive alternative. This systematic review aimed to evaluate the current evidence on the arthroscopic management of medial and rotational ankle instability, focusing on surgical techniques, clinical outcomes, and complications. Methods: A systematic literature search was conducted following PRISMA guidelines using the PubMed, Scopus, and Web of Science databases. The search strategy included the following terms: ((rotation instability) OR (deltoid) OR (medial ankle instability)) AND (ankle arthrosc*). Eligible studies included adult patients undergoing arthroscopic repair of medial ankle instability with a mean 26.4 months follow-up and reported clinical outcomes. Ten studies met the inclusion criteria, encompassing 336 patients and 346 ankles. Results: The mean patient age was 32.6 ± 5.0 years, with 80.6% being male. MRI was the primary diagnostic tool across most studies. Ankle sprains were the most common cause of instability. Lateral ligament insufficiency was frequently associated with medial injuries, reported in all studies evaluating this parameter. All patients underwent prior conservative treatment (mean duration: 5.6 months). Surgical management involved all-inside arthroscopic repair using knotless suture anchors. Additional procedures were performed in 90% of studies, including osteophyte resection (33.3%) and microfracture (22.2%). The mean follow-up period was 26.4 months. The mean postoperative AOFAS score was 95.3, with return to sport generally achieved between 3 and 5 months. Complications were minimal, primarily consisting of superficial wound issues and transient nerve irritation; no major complications or revision surgeries were reported. Discussion: Arthroscopic management of medial and rotational ankle instability is associated with excellent functional outcomes, low complication rates, and early return to sport. Compared to open procedures, arthroscopic techniques offer advantages including reduced soft tissue trauma, fewer wound complications, and the ability to address concomitant intra-articular lesions in a single session. Although technically demanding, this approach is particularly beneficial in athletic populations. However, high-quality prospective studies are still needed to validate these findings and establish long-term comparative outcomes with open reconstruction techniques. Full article

Firework-related injuries remain a serious public health issue in Germany, especially during New Year’s Eve. While many injuries are minor, the misuse of illegal or homemade fireworks can cause severe trauma resembling military combat injuries and can heavily burden emergency services. Notably, injury rates declined during the COVID-19 firework bans, underscoring the impact of preventive measures. We report two cases of young males with severe injuries from illicit fireworks. The first is a case of a 16-year-old that detonated an illegal Polish firework ball bomb, sustaining 9% total body surface area (TBSA) burns (second- to third-degree), hand fractures, compartment syndrome of the hand, and soft-tissue trauma. He underwent multiple surgeries, including fasciotomy, osteosynthesis, and skin grafting. The other case presented is a 19-year-old man who was injured by a homemade device made of bundled firecrackers, suffering deep facial and bilateral hand burns. He required prolonged ventilation, surgical debridement, and treatment with Kerecis^® fish skin and Epicite^® dressings. Both required intensive ICU care, interdisciplinary management, and lengthy rehabilitation. Total hospital costs amounted to €58,459.52 and €94,230.23, respectively, as calculated according to the standardized German DRG. These cases illustrate the devastating impact of illegal fireworks. The devastating consequences of explosive trauma are often difficult to treat and may lead to long-term functional and psychological impairments. Prevention through public education, stricter regulations, and preparedness is essential. Pandemic-era injury reductions support sustained policy efforts. Full article

Background: Forensic investigation of child homicides presents unique challenges due to the vulnerability of children and the complexity of distinguishing between natural, accidental, and intentional manner of death. A multidisciplinary approach integrating traditional forensic methods with emerging technologies is crucial to ensure accurate diagnosis and effective legal outcomes. Methods: This review examines current and emerging forensic techniques used in neonate, infant, and older child homicide investigations. It highlights advancements in postmortem imaging, histological examination, microbiological analysis, toxicology, and molecular autopsy. Results: Traditional forensic autopsy remains the cornerstone of child homicide investigations, providing critical insights into external and internal injuries. Histological examination enhances diagnostic accuracy by detecting microscopic evidence of trauma and infectious diseases. Postmortem imaging techniques are complementary for better identifying fractures, soft tissue injuries, and vascular abnormalities. Forensic toxicology plays a key role in detecting poisoning, while postmortem microbiology aids in identifying infectious causes of death. Furthermore, advancements in molecular autopsy and genetic testing have significantly enhanced the identification of hereditary conditions linked to sudden unexplained deaths in children, especially in cases involving multiple child fatalities within the same family, where forensic investigations are needed to accurately differentiate between natural causes and potential criminal involvement. Conclusions: A multidisciplinary approach incorporating traditional autopsy with postmortem imaging, histological examination, toxicology, postmortem microbiology, and molecular autopsy is essential for comprehensive forensic analysis, promoting both justice and prevention of fatal child abuse/homicide. Future research should focus on standardizing forensic protocols and exploring the potential of artificial intelligence (AI) in forensic investigations. Full article

Background: Previous studies have tested the association between the COL5A1 rs12722 polymorphism and the risk of anterior cruciate ligament (ACL) injury. Overall, their results are contradictory because most studies used relatively small samples and data from ACL ruptures during sport activities have been mixed with ruptures suffered in non-sporting contexts. Objective: To examine the association between the COL5A1 rs12722 polymorphism and the prevalence of ACL rupture in a homogeneous sample of professional male football players. Methods: A total of 268 professional male football players participated in this study. The COL5A1 rs12722 genotype (CC, CT and TT) was obtained from each player using genomic DNA samples obtained from a buccal swab and measured with PCR RFLP. Players with history of ACL rupture during their professional career were identified by the medical staff of each team. Only ACL injuries obtained during football exposure were considered for this investigation. In this process, we identified 49 ACL ruptures pertaining to 43 players suffered between 2013 and 2024. The situational pattern (i.e., attacking or defending, type of football action, moment of the season, match/training exposure, etc.) was also obtained for each injury. A sub-analysis of non-contact ACL ruptures was conducted, as these injuries are more likely to be influenced by genetic factors. Results: The distribution of genotypes was similar in players with history of ACL rupture (n = 43; CC/CT/TT, 24.4/48.9/26.7%) and with no history of ACL rupture (n = 225; 25.3/49.8/24.9%; p = 0.973). Overall, the prevalence of players with history of ACL injury was 16.2% for the whole group of CC players (11 out of 68 players), 16.4% for whole group of CT (22 out of 135 players) and 15.2% for the group of TT players (10 out of 66 players; p = 0.973). However, the COL5A1 rs12722 genotype affected the dominance of the injured leg (p = 0.012), the type of action that originated the injury (p = 0.047), and the distribution of non-contact ACL injuries depending on the time of the match (p = 0.020). Specifically, CC players suffered ruptures predominantly in the dominant leg, when landing or reaching (offensive actions) and in the last 15 min of the match (all p < 0.050). On the contrary, TT players had ACL ruptures predominantly in their non-dominant leg, when pressing the opponent (defensive actions) and in the first 15 min of the match (all p < 0.050). Conclusion: There was no association between any of the COL5A1 rs12722 genotypes and the overall prevalence of ACL rupture in professional football players. However, the COL5A1 rs12722 polymorphism appeared to influence specific characteristics of the injury, such as the type of action leading to the rupture and the timing within the match, suggesting a potential genetic contribution to injury susceptibility. Full article

Injuries characterized by significant loss of skeletal muscle tissue volume, known as volumetric muscle loss (VML), lead to substantial impairment in functional capabilities. Natural repair processes and existing medical interventions fall short of fully restoring function post-VML. Despite progress in the VML field, there is an unsatisfactory success rate, donor site morbidity, and inefficient reconstruction of lost muscle tissue. This leads to persistent strength and functional deficits, impacting the quality of life for VML patients. In recent years, studies have explored the potential of bioactive glasses (BGs) as crucial materials in regenerating tissues beyond the skeletal system. BG, used mainly in bone engineering, can aid muscle repair by releasing ions like calcium and phosphate to stimulate cellular response. However, current BG composites struggle to match the mechanical properties of soft tissues, limiting seamless healing. This review summarizes recent advances in various BG structures studied for skeletal muscle tissue regeneration. Full article

External fixators are frequently used to treat complex fractures with multiple bone fragments and soft tissue injuries. Inaccurate assessment of bone union and premature removal of the fixator may necessitate revisions and prolong treatment. The decision to remove an external fixator typically depends on an orthopedist’s experience. The accuracy of diagnosis can be improved by using a force sensor integrated into the modified external fixator according to Mitkovic. A sensor measuring axial compressive force is mounted between two vertical rods. Experiments with the modified external fixator were carried out using three different axial loads delivered by the universal electromechanical testing machine (UETM) and a sensor that detected the corresponding axial force. Springs with variable rigidity were used to simulate bone callus stiffness. Low rigidity springs represented a high elasticity callus, whereas high rigidity springs represented a callus with lower elasticity. The results show that the force detected by the sensor was nearly identical to the force delivered by the UETM while the callus did not form, decreased as spring rigidity increased, and eventually zeroed out as the leg healed. The findings indicated that using modified external fixator according to Mitkovic can help orthopedists assess bone healing more accurately. Full article

Background: Tibial plateau fractures (TPFs) are complex injuries often leading to long-term complications such as knee instability, limited range of motion, and osteoarthritis. Accurate diagnostic evaluations combining subjective and objective assessments are essential for identifying functional limitations, guiding rehabilitation, and improving recovery outcomes. This study examines the role of diagnostic predictors in differentiating recovery trajectories in two groups of patients treated for closed TPFs by open reduction and internal fixation (ORIF), comparing patients with less severe fractures and patients with more severe fractures (BCFs). Methods: A consecutive series of patients with a diagnosis of TPFs treated by ORIF at our institution between 2009 and 2016 were analyzed in this retrospective study. All injured patients were divided according to the Schatzker classification into two groups: mono-condylar (MCF) and bi-condylar (BCF) fracture patient groups. Diagnostic evaluations included patient-reported outcome measures (PROMs) such as KOOS, IKDC, and AKSS, alongside objective assessments of functional recovery using dynamometers, force platform tests (single-leg stance and squat jump variations), and measurements of active range of motion (AROM). Results: A total of 28 patients were included: 17 in the MCF patient group (Schatzker: 12 II; 5 III; 0 IV) and 11 in the BCF patient group (Schatzker: 6 V; 5 VI). Patients with less severe MCFs exhibited significantly better recovery outcomes, including higher KOOS (86.0 vs. 64.6, p = 0.04), IKDC (80.3 vs. 64.6, p = 0.04), and AKSS (95.3 vs. 70.5, p = 0.02) scores. They also demonstrated greater knee flexion (122.8° vs. 105.5°, p = 0.04) and faster neuromuscular recovery, as evidenced by higher rates of force development (RFD) during dynamic performance tests. Conversely, patients with more severe BCFs showed lower RFD values, indicating slower recovery and greater rehabilitation challenges. Conclusions: Integrating diagnostic tools like PROMs, AROM, and neuromuscular performance tests provides valuable insights into recovery after ORIF for TPFs. Fracture severity significantly impacts functional recovery patients with MCFs showing better outcomes and faster neuromuscular recovery, while subjects with BCFs require a longer rehabilitation treatment focusing on neuromuscular re-education and soft tissue recovery. Full article