Search Results (82)

Objectives: Osteoarthritis (OA) of the medial compartment in varus knee is a common degenerative condition. High tibial osteotomy (HTO) has been recognized as a primary joint-sparing procedure. The aim of this systematic review was to investigate functional and radiological outcomes, complications, and the progression of knee OA in patients undergoing medial opening wedge HTO. Methods: A total of 18 studies were included. Patients’ demographics, Knee Injury and Osteoarthritis Outcome Score (KOOS), number and types of complications, conversion in arthroplasty surgery rate, survival rate, and radiological evaluation were recorded. Results: A total of 2683 patients were evaluated. The frequency-weighted mean follow-up was 168.6 ± 54.6 months. The mean preoperative KOOS score was 46.5 ± 19, while postoperatively the mean score was 66.4 ± 22.9 (p < 0.001). The pre- and postoperative mTFA angle was −5.7° ± 2.8°, and 1.4° ± 2.4°, respectively; with a statistically significant improvement (p = 0.002). A total of 12.5% of patients had a conversion to a total knee arthroplasty and 1.5% had a conversion to unicompartmental knee arthroplasty, while 1.3% of the patients had a revision surgery unrelated to arthroplasty. The survival rate after 10 years was 86.3%. The nonunion rate was 1.3% and the infection rate was 0.9%. Conclusions: Patients who underwent medial opening wedge HTO achieved a significant correction of mTFA associated with an improvement in functional outcomes. An 86% survivorship rate at 10 years was observed, while a 14% conversion rate to knee arthroplasty for OA progression was reported after a mean follow-up of 14 years. Full article

Background/Objectives: Implant-associated infections are challenging conditions in orthopedic surgery. This experimental study aimed to evaluate phage localization within infected tissues following different routes of administration. Methods: An implant-related infection model was created using methicillin-resistant Staphylococcus aureus (MRSA) in twenty-four rats. Subjects were randomly divided into four groups depending on the bacteriophage administration route. Three rats were designated as the control group. Phage suspension was applied intraperitoneally, intravenously, orally and locally at 0.1 mL/day of 1 × 10⁸ PFU/mL suspension for three consecutive days. In the control group, intravenous, intraperitoneal and oral phage suspensions were administered separately at the same dose for 3 days. After completion of the experiment, tibia samples were taken in the experimental group. Additionally, liver, kidney, stomach, brain, heart muscle and striated muscle tissue samples were taken from the three subjects in the control group. Results: In the control group, unconfirmed phage-like structures were incidentally observed in some mitochondria of renal proximal tubular epithelial cells on transmission electron microscopy. In the experimental group, there was a strong positive linear relationship between the total number of bacteria and the number of bacteriophage clusters, independent of the groups. Conclusions: Bacteriophage clusters were detected in infected tibial tissues after all administration routes, suggesting phage localization at the infection site. Unexpected phage-like clusters were observed within mitochondria of proximal tubular epithelial cells in the control animals. This finding should be regarded as an unconfirmed incidental finding requiring further validation. Full article

Background: Thromboangiitis obliterans (TAO) is a nonatherosclerotic inflammatory vascular disorder affecting small- and medium-sized vessels, often leading to critical limb ischemia and a high risk of amputation. Conventional medical and surgical treatments remain limited, particularly for advanced diseases. Tibial transverse bone transport (TTT), based on the principles of distraction osteogenesis, has emerged as a novel technique to promote angiogenesis and improve microcirculation. This systematic review evaluated the clinical efficacy and safety of TTT in the management of TAO. Methods: A systematic review was conducted according to the PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar was performed until December 2025. Eligible studies included clinical investigations that evaluated TTT in patients with TAO. Data on patient characteristics, surgical techniques, clinical outcomes, and complications were extracted and analyzed descriptively because of the heterogeneity in study design and reporting. Results: Ten studies involving 368 patients were included in this review. TTT was consistently associated with significant clinical improvement, including pain relief, increased claudication distance, and ulcer healing, which were typically observed within weeks after the procedure. Limb salvage rates were high, with major amputation rates generally ranging from 3.3% to 13.3%. Objective improvements in perfusion parameters have also been reported in several studies. The most common complication was pin-site infection (up to 30%), while fractures, delayed consolidation, and osteomyelitis were less frequent complications. Conclusions: Current evidence suggests that TTT is a promising limb-salvage strategy for TAO and is associated with favorable clinical and functional outcomes, with an acceptable complication profile. However, the available evidence remains limited, partly because of the rarity of TAO and the specialized nature of the TTT procedure. Most available studies are observational, and further high-quality prospective and randomized trials are required to validate the long-term efficacy of this technique. Full article

Background/Objectives: Accurate tibial tunnel placement is critical for successful posterior cruciate ligament reconstruction (PCLR), yet remains technically demanding due to limited visualization and anatomic variability. This study aimed to demonstrate the feasibility of an arthroscopic technique for remnant-preserving PCLR using the champagne-glass drop-off and lateral cartilage point as consistently identifiable arthroscopic anatomic bony landmarks, and to evaluate the success rate of tibial tunnel placement in targeted position using postoperative magnetic resonance imaging (MRI). Methods: A retrospective review was performed of patients who underwent arthroscopic remnant-preserving PCLR using a trans-septal approach with the described dual-landmark technique between March 2020 and October 2022. Of 31 eligible patients, 20 with complete clinical follow-up and postoperative 1-year MRI were included for analysis. Tibial tunnel position was assessed on MRI to determine success rate of placement in the targeted inferior–lateral tibial footprint based on anatomic reference. Clinical outcomes, including knee range of motion and posterior laxity, were also evaluated. Results: MRI evaluation demonstrated tibial tunnel consistent placement with the predefined targeted zone in all patients (20/20). At a median follow-up of 745 days, the mean knee range of motion was 140.0 ± 12.7 degrees. Posterior stability assessment showed grade 0 laxity in 75% of patients and grade 1 laxity in 25%. No graft failures, neurovascular complications, infections, or revision PCLR procedures were observed. Conclusions: This retrospective case series suggests that the dual-landmark technique (champagne-glass drop-off and lateral cartilage point) may facilitate consistent tibial tunnel placement in remnant-preserving PCLR. Level of Evidence: IV (Retrospective case series). Full article

Lameness associated with bacterial chondronecrosis with osteomyelitis (BCO) continues to be an important topic of great interest to global poultry production. Caused by bacterial infection of susceptible necrotic bone tissue, the disease severely affects animal health, welfare, and productivity, leading to significant economic losses annually. In recent years, the Kazakhstan poultry industry has enjoyed significant investment and strong growth, with goals of self-sufficiency within the decade. However, there remains a significant knowledge gap in poultry research in the nation, especially regarding the topic of BCO lameness. As such, this study aims to provide a preliminary evaluation of BCO lesion prevalence in different geographical regions of the country―namely Abai, Almaty, and Akmola. In each region, about 200 broilers from local poultry farms were procured, humanely euthanized, and necropsied to evaluate prevalence of femoral and tibial lesions commonly associated with BCO lameness. On average, most broilers had no damage to femoral head (78.17%) followed by femoral head separation (FHS, 11.94%), while the tibial head saw ubiquitous degrees of damage ranging from severe (71.42%) to observable (23.06%). These findings signify potential underlying issues connected to BCO lameness that will necessitate early management and intervention measures to prevent future spread of the disease. Full article

Background/Objectives: Reconstruction of complex lower extremity soft tissue defects remains challenging, particularly in the proximal and middle tibial regions, including the knee, where suitable recipient vessels are often limited due to prior trauma, infection, or surgical intervention. This study aimed to evaluate the feasibility and clinical applicability of anterior tibial vessel turnover as an alternative recipient vessel strategy in free flap reconstruction. Methods: A retrospective review was conducted of seven patients who underwent free flap reconstruction using anterior tibial vessel turnover as the recipient vessel between 2019 and 2024. Preoperative imaging was performed to assess vascular status and collateral circulation. Clinical data, including patient demographics, defect characteristics, flap parameters, and postoperative outcomes, were analyzed. Results: The mean patient age was 62.7 years (range, 38–86 years). Defects were primarily located in the proximal and middle tibial regions and were associated with trauma, postoperative infection, chronic osteomyelitis, or burn injury. The mean flap size was 137.4 cm² (range, 49.5–280 cm²). All flaps survived, resulting in a flap survival rate of 100%, with no cases of total flap loss or re-exploration due to vascular compromise. One patient experienced partial flap loss, while no other flap-related complications were observed. Most patients achieved stable wound coverage and favorable functional recovery. Conclusions: Anterior tibial vessel turnover may serve as an alternative recipient vessel strategy for selected cases of complex lower extremity free flap reconstruction. This technique enables microvascular anastomosis in a more superficial and accessible field and expands reconstructive options in cases with compromised recipient vessels. Full article

Background: Pilon fractures refer to distal tibial fractures that may involve extra-articular, partial articular, or complete intra-articular components, most commonly caused by high-energy trauma. The choice between early (<72 hours) and delayed (>7 days) surgical fixation significantly impacts clinical outcomes. This study aimed to compare the effects of early vs. delayed plate fixation on fracture healing time, functional outcomes, and complication rates. Materials and Methods: This retrospective study analyzed 80 patients who underwent surgical treatment for pilon fractures between 2018 and 2023. Patients were divided into two groups: Early surgery (<72 hours, n=40); Delayed surgery (>7 days, n=40). Additionally, patients were categorized based on the fixation method: Single plate fixation (n=40); Double plate fixation (n=40). Outcome Measures: Fracture healing time (weeks) - Defined as cortical continuity on radiographs; Functional outcomes (AOFAS score); Complication rates (infection, malunion, implant failure). Results: Shorter healing time was observed in the early surgery group (14.2 vs. 16.8 weeks, p<0.05). Better functional outcomes were recorded in the early surgery group (AOFAS score: 82.3±6.5 vs. 78.1±7.2, p<0.05). Lower infection rates were noted in the delayed surgery group (7.5% vs. 12.5%, p<0.05). Double plate fixation provided better mechanical stability but resulted in higher soft tissue complication rates. Single plate fixation preserved soft tissue integrity but had higher malunion and implant failure rates. Conclusion: Early surgery is associated with shorter healing time and better functional outcomes, but increased soft tissue complications require careful management. Delayed surgery offers a safer approach for soft tissue healing but may prolong functional recovery. While double plate fixation ensures greater stability, it may increase soft tissue morbidity, whereas single plate fixation reduces soft tissue complications but may compromise stability. A personalized surgical approach is recommended for optimal outcomes in pilon fracture management. Full article

Background: Long-bone non-unions complicated by osteomyelitis remain a major reconstructive and healthcare challenge, particularly in resource-limited settings with a high prevalence of multidrug-resistant (MDR) pathogens. Conventional staged management is associated with a prolonged treatment burden, repeated procedures, and delayed functional recovery. This study evaluated the clinical, radiological, functional, and short-term safety outcomes of a single-stage approach using custom-threaded antibiotic-coated locking nails (TACLNs) in a high-resistance cohort. Methods: This prospective single-center cohort study enrolled 30 adults with osteomyelitis-associated femoral or tibial nonunion at a tertiary hospital in Peshawar, Pakistan. All patients underwent radical debridement and single-stage stabilization with a chest tube mold TACLN loaded with vancomycin and gentamicin, with culture-directed adjunctive antibiotics for resistant organisms. Outcomes were assessed at baseline, Weeks 3 and 6, and Month 6 using inflammatory markers, RUST score, VAS pain, EQ-5D-5L, ASAMI criteria, and return to work or usual activity. No formal sample size calculation was performed, and this study was exploratory in nature. Results: The cohort (mean age 44.9 ± 9.9 years) had a challenging microbiological profile, with 40.0% MDR and 13.3% extensively drug-resistant (XDR) infections. By Month 6, short-term infection control was achieved in 96.7% of patients, with significant reductions in ESR and CRP (both p < 0.001). Radiographic union was achieved in 90.0% of cases at a mean of 18.6 weeks, and the mean RUST score improved from 4.87 to 10.43 at the final follow-up. The VAS pain decreased from 5.23 at week 3 to 0.73 at month 6, EQ-5D-5L improved from 0.39 to 0.84, and 90.0% returned to work or usual activity by month 6. No cement debonding, implant failure, or nephrotoxicity was noted. Conclusions: In this single-arm exploratory cohort, TACLNs were associated with favorable short-term infection control, radiographic union, and functional recovery in osteomyelitis-associated long-bone nonunion, including in an MDR/XDR setting. The independent contribution of the threaded core design cannot be established. Larger multicenter comparative studies with longer follow-ups are needed to confirm the durability and implementation feasibility. Full article

Background/Objectives: Staphylococcus epidermidis (RP62A) and Staphylococcus aureus (UAMS-1) are clinically relevant pathogens frequently implicated in implant-associated infections due to their ability to form biofilms. RP62A is typically linked to persistent, chronic, low-grade infections, whereas UAMS-1 is associated with acute, invasive disease. Both strains serve as representative models for chronic and acute periprosthetic joint infections (PJIs). The objective of this study was to examine and compare in vitro biofilm formation by RP62A and UAMS-1 on orthopaedic materials/disc surfaces of defined composition. Methods: In vitro biofilm formation assays were performed using orthopaedic disc surfaces composed of cobalt–chromium alloy (CoCr), titanium alloy (Ti), and polyethylene (PE) after 72 h of incubation. Biofilm biomass was quantified using crystal violet staining, with absorbance measured at OD₅₇₀. A polystyrene (PS) surface served as a control. Additionally, retrieved orthopaedic explant components were used as substrates for in vitro biofilm assays, in which RP62A was incubated for 72 h on the explanted surfaces. Supporting assays on glass slides were conducted to examine strain-specific biofilm-related architecture. Results: In vitro biofilm mass quantification assays showed strong biofilm formation by RP62A across all tested surfaces, with the highest absorbance on CoCr (OD₅₇₀ = 5.80 ± 0.19). Notably, biofilm formation on CoCr was 76% higher compared to PS (p < 0.0001). No significant differences were observed among all three surface discs (p > 0.1). Biofilm formation was highest on PE for UAMS-1 (OD₅₇₀ = 1.29 ± 0.09) and was significantly greater than on Ti (178%, p < 0.001) and CoCr (196%, p < 0.0001). In the in vitro assays performed on retrieved explant components, RP62A showed pronounced biofilm accumulation on polyethylene tibial inserts, particularly in regions of mechanical wear and friction. Supporting assays on glass slides were performed to examine strain-specific surface microstructural, revealing dense network-like structures for RP62A and thinner, discontinuous layers for UAMS-1. Conclusions: RP62A formed dense biofilms in vitro on multiple orthopaedic implant materials and retrieved explant components, consistent with its association with chronic periprosthetic joint infections. Increased biofilm accumulation was observed on mechanically worn polyethylene surfaces. In contrast, UAMS-1 showed lower biofilm formation on metallic disc surfaces, indicating strain- and material-dependent differences. These findings highlight the relevance of implant material selection and surface integrity for strategies targeting biofilm-associated implant infections. Full article

Bacterial Chondronecrosis with Osteomyelitis (BCO) lameness is an infection of opportunistic bacteria in the structural skeletal bones impacting multiple animal species, particularly poultry species. BCO lameness results in significant financial losses to industrial poultry production and increases the risk of foodborne illnesses, posing a major threat to consumers’ food safety. As BCO lameness is an inherent risk of fast body weight gain in poultry species, especially broiler chickens, abundant studies have been conducted in broilers and turkeys. Nevertheless, BCO lameness incidence in ducks remains elusive. Thus, this is the first survey investigating the prevalence of BCO lameness cases in ducks. The survey was conducted in commercial duck farms in Indonesia, the fourth biggest duck-producing country globally. Two hundred birds from four commercial duck farms in Mojokerto, East Java, Indonesia, were necropsied to examine their lameness lesions in the femoral head and proximal tibia. Of the 44% birds showing BCO lameness lesions, 3% were evidently clinically lame birds, particularly exhibiting limping gait. Femoral head separation (FHS) and tibial head necrosis (THN) are the most frequently observed lesions in ducks, representing a mild-to-moderate BCO lameness state. Based on the results of this study, intervention measures to boost the immune system and skeletal bone integrity of ducks are urgently required. Full article

Background/Objectives: Open tibial shaft fractures are severe injuries associated with high risks of infection and malunion. Although external fixation is commonly used for provisional stabilization, it provides limited control over alignment and soft tissue handling. This study aimed to evaluate and compare provisional reduction plating with external fixation for the staged management of Gustilo–Anderson type II–III open tibial fractures. Methods: Fifty-nine patients (mean age, 38.5 years) treated with staged debridement and delayed intramedullary nailing (IMN) were retrospectively reviewed. Thirty-two patients underwent reduction plating with external fixation (group A), and 27 underwent external fixation alone (group B). Clinical, radiographic, and functional outcomes, including infection, union, malunion, operative time, and Lower Extremity Functional Scale (LEFS) scores, were analyzed. Results: Deep infection and nonunion rates were comparable between the groups. Group A had fewer malunions (3.1% vs. 18.5%), shorter operative times, and faster progression to union than group B. The LEFS scores were higher in group A, indicating better functional recovery. Conclusions: Provisional reduction plating before IMN appears to enhance alignment, preserve soft tissue integrity, and improve surgical efficiency without increasing the risk of infection or delaying union. These findings suggest that it may be a safe and effective adjunct to the staged treatment of complex Gustilo–Anderson type II–III open tibial fractures. Full article

New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales represent a major therapeutic challenge due to their resistance to nearly all β-lactams and frequent co-resistance to other antibiotic classes, leaving clinicians with few effective options. These challenges are amplified in orthopedic infections with hardware involvement, where biofilm formation and the need for prolonged antimicrobial therapy limit success. We describe a 55-year-old female with a history of right type 3 open pilon fracture complicated by hardware failure and revision, who presented with septic tibial nonunion and chronic drainage. During this admission, she underwent irrigation and debridement with hardware removal and intramedullary nail placement. Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime–avibactam, meropenem–vaborbactam, and cefiderocol, as well as Candida parapsilosis. Molecular testing confirmed NDM production, while reference testing showed susceptibility to aztreonam–avibactam (ATM-AVI). The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days. Due to outpatient administration barriers with ATM-AVI, the patient was transitioned to eravacycline and micafungin. At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management. Full article

Background/Objectives: The rate of periprosthetic joint infection (PJI) is expected to increase in the next years worldwide, mainly due to increasing volume of total joint replacement, longer prosthesis lifespans, and patients with multiple comorbidities. The aim of this study is to describe our personal technique, the modified Hofmann Articulated Spacer (mHAS), in which a CR femoral shield and a partially threaded cannulated screw are inserted into the liner replicating a tibial stem, and to evaluate the efficacy of the spacer as a definitive treatment option in selected patients with knee infections. Methods: A consecutive series of 132 patients were treated for orthopedic infection at the Orthopedic and Trauma Center, University of Turin, between November 2023 and May 2025. All patients included in the study had undergone knee prosthesis removal followed by the implantation of a modified Hofmann Articulated Spacer (mHAS). Functional recovery was evaluated through clinical examination, particularly knee range of motion, and patient-reported outcome measures (PROMs), including the Knee Society Score (KSS), Oxford Knee Score (OKS), and the EQ-5D-5L Visual Analogue Scale (VAS). Results: Nine patients were enrolled in the study, at a mean follow-up of 8.12 months (range: 3–13). The mean range of motion of the knee was 95 degrees (range: 80–120°, SD: 15°). The Knee Society Score (KSS) presented a mean value of 71.9 (SD: 18.11). The Oxford Knee Score (OKS) showed a mean value of 30.8 (SD: 8.5). The EuroQol-5 Dimension-5 Level Visual Analogue Scale (EQ-5D-5L VAS) scores demonstrated an excellent quality of life among the participants. Conclusions: The Modified Hofmann Articulated Spacer demonstrated good functional, qualitative outcomes and eradication rates in patients who underwent the first-stage revision TKA for PKI. This has led us to propose it as a definitive treatment option for more critical and low-demand patients and to postpone the second-stage surgery in the remaining cohort due to satisfactory spacer joint function without pain. Full article

Background: Bone defects resulting from trauma, infection, or benign tumors pose major challenges in orthopedic surgery. Traditional approaches, such as autologous bone grafting, are limited by donor site morbidity and graft availability. CERAMENT™, a synthetic bone substitute composed of calcium sulfate and hydroxyapatite, offers an alternative with osteoconductive properties, controlled resorption, and injectability. Methods: A scoping review was conducted in accordance with PRISMA-ScR guidelines. Literature searches were performed in PubMed, Embase, and Scopus through 3 July 2025, using the terms “CERAMENT™” and “Orthopedics.” Studies were selected based on the PICO framework, focusing on clinical applications of CERAMENT™ in human orthopedic procedures. Results: Out of 480 initial records, 22 studies met the inclusion criteria. CERAMENT™ demonstrated favorable outcomes in a range of orthopedic settings. In the CERTiFy trial, it was non-inferior to autologous grafting in tibial plateau fractures. CERAMENT™ achieved full wound healing and bone remodeling in chronic osteomyelitis. Additional studies reported positive outcomes in tumor-related defect reconstruction, spinal augmentation, and foot and ankle surgery, highlighting reduced surgical morbidity and faster recovery. Conclusions: CERAMENT™ offers a versatile, effective solution for bone reconstruction across multiple orthopedic domains. Its clinical performance, ease of use, and antimicrobial capabilities support its integration into routine orthopedic practice. Further research may refine its indications and long-term benefits. Full article