Search Results (113)

Introduction: Management of trochanteric fractures in revision hip surgery has a high incidence of non-union and complications. Fixation devices are often bulky, prone to breakage, and necessitate reoperation. This study describes a novel soft tissue and bony abductor repair that reduces the forces on bony fragments without the need for prominent metalwork. Methods: This novel surgical technique involves fixation of the abductor mechanism with polyester and polyethylene sutures that are woven through the abductors and secured to the femoral shaft with a proprietary suture cerclage tape with cerclage wire supplementation in select cases. All patients undergoing fixation were retrospectively reviewed with a minimum follow-up period of 12 months. Outcomes relating to dislocation, reoperation, fracture union and the incidence of symptomatic Trendelenburg gait were recorded. Results: A total of 17 patients underwent this novel intervention. There were no dislocations or reoperations for prominent metalwork at the last follow-up. One patient had evidence of greater trochanter (GT) non-union, and three had GT displacement of over 3 mm. Eight (47.1%) patients were independently mobile and seven (41.2%) were mobile with only one walking aid. No patients required plate or bolt fixation. Conclusions: GT fractures and abductor deficiency are difficult to manage, with most reported methods utilising bulky metalwork to treat a soft tissue injury. We describe a novel combined soft tissue and bony fixation without the need for excessive metalwork. Our pilot study demonstrates satisfactory outcomes of this intervention that are technically reproducible and more appropriately addresses the deforming forces involved with a low complication profile. Full article

Background/Objectives: Calcinosis cutis universalis is a rare and severe manifestation of dystrophic calcification, most associated with connective tissue diseases such as dermatomyositis, systemic sclerosis, and systemic lupus erythematosus. It is characterized by widespread deposition of calcium salts throughout the soft tissues, leading to pain, recurrent infections, restricted mobility, and significant impairment in daily functioning and quality of life. Management remains challenging due to the absence of standardized treatment guidelines with risks including delayed wound healing and recurrence. Adjunctive therapies may support symptom control in refractory cases. Conclusions: Management of calcinosis cutis universalis requires an individualized, multimodal strategy. Based on available evidence and expert opinion, a stepwise therapeutic decision-making algorithm integrating medical, minimally invasive, and surgical approaches is proposed to guide clinical practice and the variable efficacy of available therapies. This review aims to summarize current therapeutic strategies and to propose a pragmatic approach to clinical decision-making. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar. The review focused primarily on calcinosis cutis universalis and severe or extensive forms of calcinosis cutis, with particular emphasis on surgical management and its integration with medical and minimally invasive treatments. Results: Pharmacological treatments—including bisphosphonates, calcium-channel blockers, tetracyclines, phosphate binders, probenecid, immunomodulatory agents, biologics, colchicine, sodium thiosulfate and JAK inhibitors—show heterogeneous and often partial efficacy, with more favorable responses in early or localized disease. Surgical interventions such as excision, curettage, CO₂ laser ablation, and reconstructive procedures provide meaningful symptomatic relief in selected patients but are associated. Full article

Flexible sensors have emerged as critical interfaces for information exchange between soft biological tissues and machines. Here, we present a dual-mode stretchable sensor system capable of synchronous strain and electromyography (EMG) signal detection, integrated with wireless WIFI transmission for real-time joint movement monitoring. The system consists of two key components: (1) A multi-channel gel electrode array for high-fidelity EMG signal acquisition from target muscle groups, and (2) a novel capacitive strain sensor made of stretchable micro-cracked gold film based on Styrene Ethylene Butylene Styrene (SEBS) that exhibits exceptional performance, including >80% stretchability, >4000-cycle durability, and fast response time (<100 ms). The strain sensor demonstrates position-independent measurement accuracy, enabling robust joint angle detection regardless of placement variations. Through synchronized mechanical deformation and electrophysiological monitoring, this platform provides comprehensive movement quantification, with data visualization interfaces compatible with mobile and desktop applications. The proposed technology establishes a generalizable framework for multimodal biosensing in human motion analysis, robotics, and human–machine interaction systems. Full article

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes. Full article

The chest wall represents a complex musculoskeletal structure that provides protection to intrathoracic organs, mechanical support for respiration, and mobility for the upper limbs. Neoplastic diseases of the chest wall encompass a heterogeneous group of benign and malignant lesions, which may be classified as primary—originating from bone, cartilage, muscle, or soft tissue—or secondary, resulting from direct invasion or metastatic spread, most commonly from breast or lung carcinomas. Approximately half of all chest wall tumors are malignant, and their management remains a significant diagnostic and therapeutic challenge. Surgical resection continues to represent the mainstay of curative treatment, with complete en bloc excision and adequate oncologic margins being critical to minimize local recurrence. Advances in reconstructive techniques, including the use of prosthetic materials, biological meshes, and myocutaneous flaps, have markedly improved postoperative stability, respiratory function, and aesthetic outcomes. Optimal management requires a multidisciplinary approach involving thoracic and plastic surgeons, oncologists, and radiotherapists to ensure individualized and comprehensive care. This review summarizes current evidence on the classification, diagnostic evaluation, surgical strategies, and reconstructive options for chest wall tumors, emphasizing recent innovations that have contributed to improved long-term survival and quality of life in affected patients. Full article

Background: Approximately one quarter of community-dwelling older adults experience at least one fall each year. Falls can result in soft tissue injuries, fractures, or even death. Given this high prevalence, it is essential to identify fall-related risk factors, develop predictive models, and prescribe effective exercise-based interventions to prevent falls. Objective: To analyze risk factors, predictors, and therapeutic interventions for falls in older adults. Methods: A literature search was conducted in SCIELO, PUBMED, and PEDro databases between 15–20 October 2025. Inclusion criteria comprised peer-reviewed, open-access studies in English published from 2020 onward. Findings were categorized into three domains: (1) fall risk factors, (2) predictive models, and (3) exercise-based interventions. Twenty studies met the inclusion criteria. Results: Falls among older adults arise from multifactorial interactions involving physical, clinical, cognitive, and social factors such as impaired mobility, comorbidities, polypharmacy, and cognitive decline. Lower-limb strength and functional performance are key determinants of fall risk. Current predictive models show limited accuracy, with fall history as the strongest predictor. Exercise-based interventions, particularly multicomponent and home-based programs, improve balance, strength, and mobility but show variable effects on fall rates. The absence of standardized parameters for exercise prescription limits the development of evidence-based guidelines. Conclusions: Falls in older adults are multifactorial events influenced by physical and cognitive decline. Predictive models remain imprecise, and although exercise interventions improve functional outcomes, their impact on reducing falls is inconsistent. Standardized exercise protocols are needed to optimize fall prevention strategies. Full article

Background/Objective: To outline strategies for the safe clinical use of orthodontic temporary anchorage devices (TADs) by analyzing papers that examine associated risks, complications, and approaches for their prevention and resolution. Methods: The research protocol used PubMed, Medline, and Scopus up to May 2024, focusing on controlled and randomized clinical trials aligned with the review objective. Fourteen studies were included; bias risk was assessed, key data extracted, and a descriptive analysis performed. Study quality and evidence strength were also evaluated. Results: TADs optimize anchorage control without relying on patient compliance. However, they carry risks and complications. TAD contact with the periodontal ligament or root without pulp involvement requires removal for spontaneous healing. If pulp is involved, the TAD should be removed and endodontic therapy performed. If anatomical structures are violated, TAD should be removed. If transient, spontaneous recovery occurs, but sometimes pharmacological treatment may be needed. A 2 mm gap between the TAD and surrounding structures can prevent damage. In the maxillary sinus, a less than 2 mm perforation of the Schneiderian membrane recovers spontaneously; wider perforations require TAD removal. Good oral hygiene and TAD abutments prevent soft tissue inflammation, which resolves with 0.2% chlorhexidine for 14 days. Unwanted forces can cause TAD fractures, requiring removal. Minor TAD mobility due to loss of primary stability can be maintained; significant instability requires repositioning. Conclusions: The use of TADs requires meticulous planning, radiological guidance, and monitoring to minimize risks and manage complications. With proper care, TADs improve orthodontic outcomes and patient satisfaction. Full article

Background and Clinical Significance: Advanced periodontitis with severe vertical bone loss and grade III mobility is usually managed by extraction and implant placement. Digital workflows and modern regenerative techniques have opened the possibility of preserving teeth that would traditionally be considered for extraction. This report describes a digitally guided modified intentional replantation (MIR) protocol applied to a maxillary tooth with severe periodontal involvement and unfavourable prognosis. Case Presentation: A 68-year-old male, non-smoker, with a history of heart transplantation under stable medical control, presented with generalized Stage IV, Grade C periodontitis. Tooth 21 showed >75% vertical bone loss, probing depths ≥ 9 mm, bleeding on probing, and grade III mobility. After non-surgical therapy and periodontal stabilization, a CAD/CAM-assisted MIR procedure was planned. Cone-beam computed tomography (CBCT) and a 3D-printed tooth replica were used to design a surgical guide for a new recipient socket. The tooth was atraumatically extracted, stored in chilled sterile saline, and managed extraorally for approximately 10 min. Apicoectomy and retrograde sealing with Biodentine^® were performed, followed by immediate replantation into the digitally prepared socket, semi-rigid splinting, and guided tissue regeneration using autologous bone chips, xenograft (Bio-Oss^®), enamel matrix derivative (Emdogain^®), and a collagen membrane (Bio-Gide^®). A conventional orthograde root canal treatment was completed within the first month. At 12 months, tooth 21 exhibited grade 0 mobility, probing depths of 3–4 mm without bleeding on probing, and stable soft tissues. Standardized periapical radiographs and CBCT showed radiographic bone fill within the previous defect and a continuous periodontal ligament-like space, with no signs of ankylosis or root resorption. The tooth was fully functional and asymptomatic. Conclusions: In this medically complex patient, digitally guided MIR allowed preservation of a tooth with severe periodontal involvement and poor prognosis, achieving favourable short-term clinical and radiographic outcomes. While long-term data and larger series are needed, MIR may be considered a tooth-preserving option in carefully selected cases as an alternative to immediate extraction and implant placement. Full article

Objective: This in vitro study aimed to evaluate and compare the trueness and precision of four extraoral 3D facial scanning systems using a standardized 3D-printed human head model. Methods: A 3D-printed head model with 16 anatomical landmarks and 17 inter-landmark linear distances was fabricated using a high-resolution 3D printer. Caliper measurements were used as reference standards. The model was scanned 15 times by four systems: a handheld scanner (MetiSmile, Shining 3D, Hangzhou, China), a desktop scanner (RAYFace v2.0, Ray Co., Seongnam, Gyeonggi-do, Republic of Korea), and two mobile applications (Heges and Polycam, iPhone 15, Apple Inc., Cupertino, CA, USA). All digital distances were measured in Blender software. To assess intra-observer reliability, all measurements were repeated twice by the same examiner with a 3-week interval between sessions, and intra-class correlation coefficients were calculated using a two-way mixed-effects, single-measurement, absolute-agreement model (ICC 3,1). Trueness, defined as the absolute deviation from the reference caliper values, was compared across scanners using the Kruskal–Wallis test due to its non-normal distribution. Precision, regional trueness and precision values across the four scanners defined as the standard deviation of repeated scans, was analyzed using One-way ANOVA with Tukey post-hoc comparisons for normally distributed datasets (α = 0.05). Distances were measured digitally in Blender software, and trueness (absolute deviation from reference) and precision (standard deviation of repeated scans) were analyzed using the Kruskal–Wallis test and One-way ANOVA with Tukey post hoc comparisons (α = 0.05). Results: The Polycam application demonstrated the highest trueness (0.49 ± 0.32 mm), followed by MetiSmile (0.51 ± 0.36 mm), RAYFace (0.58 ± 0.39 mm), and Heges (0.73 ± 0.42 mm). The MetiSmile scanner showed the highest precision (0.12 ± 0.07 mm), while RAYFace and Polycam exhibited moderate precision (0.28 ± 0.19 mm and 0.15 ± 0.06 mm, respectively). Vertical measurements tended to be more accurate than horizontal ones, and the lower facial region showed smaller deviations; however, these differences were not statistically significant (p > 0.05). Conclusions: MetiSmile achieved the highest precision and Polycam the highest trueness. Although all systems showed mean deviations < 1 mm, only three demonstrated <0.6 mm accuracy (except for Heges scanner). These results suggest that professional and mobile-based scanners can provide clinically acceptable facial data for educational and preliminary digital workflow applications, though further validation under clinical conditions is required. This study provides quantitative evidence on the accuracy and repeatability of commonly available extraoral 3D facial scanning systems under controlled laboratory conditions. The results indicate that both professional-grade and mobile-based scanners can reproduce facial morphology with clinically acceptable deviations, particularly in flat and stable regions such as the forehead and chin. Although only three systems achieved mean trueness below 0.6 mm, all demonstrated errors within 1 mm, sufficient for diagnostic visualization, digital smile design, and preliminary virtual patient modeling. These findings support the safe and cost-effective adoption of extraoral facial scanning in dental education and treatment planning, while emphasizing the need for further validation in real clinical environments where motion, lighting, and soft-tissue variability may affect accuracy. Full article

Background: Instrument-assisted soft-tissue mobilization (IASTM) is a popular intervention used for myofascial treatment. Healthcare professionals using IASTM must consider precautions and contraindications prior to administering the intervention. A recent international Delphi survey of IASTM experts recommended a list of 39 conditions to be considered as precautions and contraindications. The clinical relevance of these recommendations among healthcare professionals is of interest. The purpose of the survey was to explore healthcare professionals’ agreement regarding the IASTM Delphi recommendations for precautions and contraindications. Methods: A 16-question electronic survey was emailed to members of the Academy of Orthopedic Physical Therapy, American Academy of Sports Physical Therapy, National Athletic Trainers Association, and members of private physical therapy and athletic training Facebook^® and LinkedIn™ groups. Survey inclusion criteria included being a healthcare professional who has clinical experience using IASTM with patients. The strength of agreement grade scale was used to explore professionals’ opinions and agreement with the expert recommendations. Results: Four hundred and forty-five professionals (men = 52%; women = 46%; other = 2%) (mean age = 49 ± 12.33 years old) completed the survey. Most respondents (mean = 62%) agreed with 12 of 39 recommended conditions across the strength of agreement grade categories. The conditions included five precautions, four contraindications, and three conditions that could be both. Respondents also listed 32 other conditions they felt were relevant. Discussion: These survey results illustrate diversity among professionals’ agreement with expert recommendations. This may be explained by variations in clinical practice patterns and gaps in the research on this topic. The IASTM Delphi study’s recommended list of precautions and contraindications provides valuable information but is not all-inclusive, as other conditions may exist for different patients. When exploring understudied topics, researchers may want to begin with a Delphi study to establish expert recommendations, followed by an assessment of their clinical relevance through related survey studies of healthcare professionals’ agreement on the topic. Conclusions: This exploratory survey introduced a novel method of assessing the clinical relevance of a Delphi study on IASTM precautions and contraindications among healthcare professionals. Full article

Background and Objectives: Patellofemoral pain (PFP) is the most prevalent running-related injury due to underlying biomechanical factors, particularly among female runners. Although instrument-assisted soft tissue mobilization (IASTM) is a popular therapeutic technique, the optimal application site for the short-and long-term outcomes of PFP has not been well established. This aim of this study was to compare the immediate and short-term (1-week) effects of a single IASTM treatment applied to the hip and knee versus the knee alone on running-related pain. Range of motion (ROM), muscle strength, and functional performance were also assessed to compare change between the two treatment conditions. Materials and Methods: Twenty-eight female runners with PFP were randomly assigned to either the Hip and Knee (HK) group (n = 14) or the knee-only (K) group (n = 14). The HK group received a 7-min IASTM treatment targeting the quadriceps, patella, iliotibial band (ITB), and gluteus medius, whereas the K group received a 3-min treatment targeting the quadriceps and patella. Visual analog scale (VAS), hip adduction ROM, hip abduction/external rotation strength, and step-down test scores were measured at baseline, immediately post-intervention, and 1 week later. Results: Running-related pain significantly decreased in both groups (main effect of time, p < 0.001) from baseline (HK: 5.49 ± 2.14 [95% CI: 4.78–6.68]; K: 5.30 ± 1.45 [95% CI: 4.69–5.91]) to week 1 (HK: 1.30 ± 1.08 [95%CI: 0.69–1.90]; K: 1.57 ± 1.20 [95%CI: 0.93–2.21]). However, no significant difference was found between the groups. Significant improvement was also observed in hip adduction ROM (p < 0.001), hip abduction strength (p = 0.02), step-down pain (p < 0.001), and patellofemoral function (p < 0.001) immediately after the intervention, which was sustained at the 1-week follow-up. However, no significant difference was found between the groups. Also, hip external rotation strength showed no significant change over time or between groups (p = 0.737). Conclusions: A single IASTM session effectively reduced pain and improved function in female runners with PFP. However, the hip treatment did not show a significant additional benefit compared with knee treatment alone. IASTM can provide immediate and short-term relief of pain and functional limitations. Full article

Objectives: This study aimed to evaluate the available evidence on the use of orthodontic mini-implants (MIs) as temporary anchorage devices (TADs), with particular focus on how insertion angulation may influence clinical outcomes. A clinical case report was also included to complement the review findings. Methods: A systematic review was performed following PRISMA guidelines and a focused PICO question. Searches in PubMed, Web of Science, and Scopus, supplemented by manual screening of reference lists. Duplicates, systematic reviews, and studies outside the PICO scope were excluded. An observational analysis of CBCT and intraoral images, and a clinical case report, were evaluated with a standardized protocol for angulation classification based on anatomical landmarks and angular measurements. Results: Ten studies met the eligibility criteria. Most reported high survival rates, with stability defined by the absence of TAD mobility or loss. CBCT-derived data from two studies, together with one clinical case, demonstrated maintenance of alveolar bone. Improved outcomes were occasionally associated with changes in insertion angulation. Vertical positioning was more frequently linked to complications in shorter TADs, while horizontal placement preserved bone but introduced hygiene-related difficulties. Conclusions: TAD success and bone preservation may depend on insertion angulation, TAD size, and soft tissue conditions. Further standardized prospective studies are needed to validate these findings, particularly regarding intermediate diagonal insertion angles (between vertical and horizontal) extending from palatal to buccal, as observed in our clinical case, which is not yet reported in the literature. Full article

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas of the tongue, floor of the mouth, or gingiva, the additional preparation of a perforator-supported external abdominal oblique (EAOM) muscle flap can be useful. The aim of this study was to introduce the use of a DCIA flap with an IAOM and EAOM island in the reconstruction of oral cavity compound defects. Methods: A retrospective analysis was performed involving eight patients who underwent reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Patients underwent the operation between June 2021 and February 2025 in the Department of Maxillofacial Surgery of the Rydygier Hospital in Kraków, Poland. Results: A group of eight patients underwent an operation due to squamous cell carcinoma of the oral cavity. The most common primary subsite of disease was the floor of the mouth (n = 4, 50%), followed by the lower gingiva (n = 2, 25%) and retromolar area (n = 2, 25%). All patients required resection involving part of the mandible, the floor of the mouth, and part of the tongue simultaneously with reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Osteotomies were performed in two flaps (one single osteotomy, one double osteotomy). Reconstruction was successfully performed in seven out of eight patients (overall success rate 88%). Conclusions: The DCIA free flap with IAOM and perforator-supported EAOM flap is a reliable method for compound soft tissue and bone defects in maxillofacial reconstruction. The use of IAOM and EAOM can be helpful in cases of three-dimensional soft tissue defects of the lower gingiva, the floor of the mouth, and the tongue. The lower gingiva and floor of the mouth can be reconstructed with IAOM, while the more mobile part of the tongue can be reconstructed with a perforator-supported EAOM island. Full article

Palatal abscesses of endodontic origin are rarer than buccal ones due to maxillary anatomy. Their clinical appearance may resemble that of other palatal illnesses, complicating diagnosis and treatment. Prevention of problems requires early detection and endodontic treatment. A 26-year-old female patient presented with a 2 cm diameter palatal abscess, significant pulsatile discomfort, fever, and enlargement of the anterior hard palate. Clinical examination showed grade 1 mobility of the central and lateral incisors, percussion discomfort, and negative pulp vitality in the case of the lateral incisor. Cone-beam computed tomography (CBCT) showed two radiolucent lesions: a posterior cystic lesion near the first molar and an anterior lesion near the upper left lateral incisor. Palatal cortical bone puncture and soft tissue extension indicated the abscess origin. According to the clinical and imaging evaluation, the upper left lateral incisor had a persistent periapical lesion of endodontic origin that a palatal abscess with cortical bone perforation had exacerbated. Full article

Background: Soft tissue sarcomas (STSs) are rare and heterogeneous malignancies requiring a multidisciplinary approach to diagnosis and treatment. Advances in surgical techniques, chemotherapy, and radiotherapy have improved survival rates but often result in significant functional impairments, particularly in patients undergoing limb-sparing procedures. Rehabilitation is crucial for restoring mobility and independence, with recent studies emphasizing the importance of personalized rehabilitation protocols tailored to specific surgical interventions. Quantitative assessments, such as 3D motion capture and surface electromyography, provide objective insights into gait performance and motor function, enabling more precise rehabilitation strategies to optimize recovery. Methods: This study evaluated gait performance in 21 patients with lower-limb impairment following limb-sparing surgery for STS. Patients underwent two instrumented gait assessments using marker-based 3D motion capture and surface electromyography to measure spatiotemporal gait parameters, joint kinematics, and muscle activity. Independence in the activity of daily living was assessed with the modified Barthel Index in both timepoints. Results: Following rehabilitation, patients demonstrated significant improvements in functional independence, as reflected by an increase in the modified Barthel Index (p < 0.001). Gait analysis revealed increased walking speed, stride length, cadence, and improved joint range of motion at the hip, knee, and ankle, though electromyographic analysis showed no statistically significant differences in muscle activation patterns or co-contraction indices. Conclusions: These findings underscore the importance of a rehabilitation programs personalized on gait strategies. A deeper understanding of motor adaptations based on sarcoma location and surgical approach could further refine rehabilitation protocols, ultimately enhancing patient outcomes and quality of life. Full article