Search Results (492)

Additive manufacturing also known as three-dimensional printing (3D printing), provided the ability to produce precise three-dimensional structures, representing a rapidly growing field in Orthopaedics. Its clinical value has been attributed to the ability to create complex three dimensional objects with relative ease and at low cost. However, the available evidence regarding its applications in trauma was heterogeneous. This narrative review aimed to analyze the clinical applications of 3D printing in traumatology. Additionally, the research gaps that emerged in our literature search were underscored. Four application domains were selected based on their prevalence in the screened literature and relative level of clinical implementation within orthopaedic traumatology, including (1) 3D-printed anatomical models, (2) patient-specific surgical guides (PSSGs), (3) 3D-printed implants, and (4) temporary 3D-printed external fixation devices. 3D-printed anatomical models were found to help in reducing operative time, estimated blood loss, and the intraoperative radiation exposure. The use of PSSGs was shown to improve intraoperative accuracy and to provide a basis for consistent, accurate, and reproducible outcomes. However, their implementation was hindered by preparation time, the need for stable anatomical landmarks, and reduced accuracy due to potential soft-tissue injury and swelling. In contrast, 3D-printed implants and external fixation devices constituted promising but less extensively studied applications of 3D printing in trauma. The production of customized implants and external fixators, as suggested by the studies available, was deemed feasible, with comparable mechanical properties and significantly lower cost. Larger multicenter studies are required to support and validate these findings. Overall, based on the available evidence, 3D-printed anatomical models and patient-specific surgical guides demonstrate the highest level of clinical applicability, primarily in preoperative planning and intraoperative guidance. Full article

Background: Timely treatment is critical for patients with bone and soft tissue tumors, but access to care may not be equitable across all populations. While treatment delays have been well studied in other cancers, disparities in time to treatment remain underexplored in orthopaedic oncology. This study aimed to determine whether racial or ethnic disparities exist in the timing of surgery, chemotherapy, or radiation for patients with sarcoma or metastatic bone disease. Methods: A retrospective cohort study was conducted using the TriNetX US Collaborative Network, a multi-institutional electronic health record database. Adult patients undergoing biopsy and subsequently diagnosed with bone sarcoma, soft tissue sarcoma, or metastatic bone disease were identified. Time to treatment was defined as the number of days between biopsy and the first recorded surgery, chemotherapy, or radiation. Patients were stratified by race and ethnicity, and statistical comparisons were performed using Mann–Whitney U tests and t-tests. Results: A total of 63,087 patients met inclusion criteria (55,697 with metastatic bone disease/bone sarcoma and 7390 with soft tissue sarcoma). In the metastatic/bone sarcoma cohort, Hispanic patients had shorter mean time to resection (58 ± 94 vs. 82 ± 239 days, p = 0.008) and fixation (35 ± 142 vs. 72 ± 315 days, p < 0.001) compared to non-Hispanic patients, although median times did not differ significantly. Among black patients, time to fixation was shorter than in White patients (mean 22 ± 103 vs. 114 ± 468 days, p < 0.001; median 0 days in both groups), while delays were observed in time to radiation (median 13 vs. 7 days; mean 85 ± 284 vs. 43 ± 203 days, p < 0.001). In the soft tissue sarcoma cohort, Black patients experienced longer mean times to resection (142 ± 293 vs. 79 ± 216 days) and radiation (141 ± 514 vs. 96 ± 364 days), though comparisons were limited by sample size. Conclusions: This large, multi-institutional study demonstrates that disparities in orthopaedic oncology differ by treatment modality and clinical context. Shorter wait times to surgery among Hispanic and Black patients in metastatic disease likely reflect more advanced disease presentation and barriers to early access, whereas delays in resection and radiation highlight inequities in accessing non-emergent, coordinated oncologic care. Reporting both means and medians provides a more complex understanding of treatment delays and underscores the need for interventions that expand early access to orthopaedic oncologists and ensure timely, equitable care. Full article

Radial and ulnar fractures in toy-breed dogs are associated with a high risk of complications due to limited bone stock and soft tissue coverage. The aim of this retrospective study was to evaluate the postoperative clinical and radiographic outcomes in dogs undergoing radial and ulnar fracture stabilization with a titanium locking mini-plate system. Medical records and radiographs of toy-breed dogs weighing ≤5 kg treated between 2020 and 2025 were reviewed. Twenty-six dogs met the inclusion criteria. Radiographic union after primary fixation was observed in 92.9% of fractures. Implant failure occurred in 7.1% of cases and was successfully addressed with revision surgery, after which fracture healing was achieved. At final follow-up, limb function was graded as excellent in all dogs, including those requiring revision surgery. A shorter distal fragment length was significantly associated with implant failure, whereas implant length and proximal fragment length showed no significant association. These findings indicate that titanium locking mini-plates were associated with favorable clinical and radiographic outcomes. Distal fragment dimensions may influence the risk of implant failure and should be considered during surgical planning. However, the small number of implant failure events limits the robustness of statistical inferences, and the absence of a control group prevents direct comparison with alternative fixation techniques. Full article

Background: Posterior decompression with instrumented fusion (PDF) is a conventional surgical procedure performed in patients with massive ossification of the posterior longitudinal ligament (OPLL); however, it is invasive to the posterior cervical tissues. In this report, we introduce a novel PDF technique, exoscopic minimally invasive open-door laminoplasty with pedicle screw fixation (exLAPPS), to treat cervical OPLL, while minimizing posterior tissue damage. Methods: ExLAPPS was indicated for patients with K-line (−) OPLL or a canal occupying a ratio of ≥50%, allowing decompression from C3 to C7. A small midline incision was used for the navigation reference placement and exoscopic minimally invasive open-door laminoplasty, whereas bilateral lateral incisions were utilized for posterior fixation, including pedicle screw insertion, based on the minimally invasive cervical pedicle screw technique. Results: A total of 7 patients with K-line (-) or a canal occupancy ≥50% underwent exLAPPS for cervical OPLL. The mean operative time was 248 min (range, 165–342 min) and the mean blood loss was 320 mL (range, 50–740 mL). Postoperative imaging demonstrated adequate spinal cord decompression in all patients. A total of 52 pedicle screws were inserted, with a pedicle screw deviation rate of 1.9%. Conclusions: ExLAPPS is a minimally invasive surgical technique designed for posterior decompression and fixation in patients with cervical OPLL. In this preliminary case series, the procedure was successfully performed with acceptable operative time, blood loss, and screw placement accuracy. Although the present study did not include a direct comparison with conventional procedures, these preliminary observations suggest that ExLAPPS is a feasible surgical option for selected patients with cervical OPLL. Full article

Autoantibodies targeting α6β4 integrin have been identified in individual patients with mucous membrane pemphigoid (MMP). Reactivity against α6 integrin has been associated with oral lesions, while anti-β4 integrin reactivity has been linked to ocular involvement. However, the pathogenic effects of these antibodies have not been fully elucidated. Here, we investigated the pathogenic potential of anti-α6 and anti-β4 integrin IgG both in vitro and in vivo. Immune complexes of anti-α6 and anti-β4 integrin induced the release of reactive oxygen species from normal human leukocytes and stimulated CXCL2 secretion in cultured murine C5N keratinocytes. In vivo, repeated injections of IgG against a recombinant fragment of β4 integrin into C57BL/6 mice led to palpebral conjunctival swelling and mild oral lesions. The latter was observed following injection of IgG against a recombinant fragment of α6 integrin. Histopathological analysis revealed subepithelial inflammatory infiltrates without evidence of split formation. Direct immunofluorescence microscopy showed linear deposits of IgG at the basement membrane zone in most tissues, whereas C3 deposition was largely absent. This lack of complement activation was corroborated by a complement fixation assay, which confirmed that IgG against α6 and β4 integrin failed to induce C3 deposition in normal murine conjunctivae, buccal mucosa, or skin. Collectively, these findings indicate that IgG autoantibodies against α6 and β4 integrin exhibit pathogenic activity in vitro and induce mild disease in vivo, possibly due in part to relatively inefficient complement activation in this model. Full article

Background: Floating barbed threads are commonly used for minimally invasive midface lifting and rely on mobile subcutaneous tissue for support, which may limit stability. Fixation is primarily achieved by barb engagement within the subcutaneous fat and fibrous septa of the retinacula cutis. Objectives: To describe an anatomically guided modification of the APTOS Excellence Visage Soft (PLLA/PCL) thread technique, positioning the terminal segment posterior to the zygomatic retaining ligament line with the aim to enhancing mechanical stability. This technical report presents the anatomical rationale, procedural steps, and illustrative clinical cases demonstrating feasibility. Methods: The modified technique uses a single-entry point at the superior zygomatic margin, with five threads per hemiface. After linear insertion, the cannula is rotated laterally and inferiorly to position the terminal barbs posterior to the zygomatic retaining ligament line, thereby transferring tensile load toward a more fixed anatomical structure. Representative cases were documented and are presented. Results: Illustrative cases showed immediate midface elevation with improved malar projection and softening of the nasolabial and mentolabial folds. Standardized 3D imaging and vector analysis demonstrated a superolateral pattern of soft tissue displacement along the intended vectors, consistent with the proposed fixed-anchorage concept. The procedure was well tolerated, with only mild and transient local effects observed. One illustrative case included photographic follow-up at 12 months, in which preservation of midface contour and malar projection was visually appreciable. Conclusions: Redirecting the terminal thread segment posterior to the zygomatic retaining ligament line is a feasible modification that may contribute to improved vector stability by engaging a fixed fascial structure. Observations—including one case with 12-month follow-up—support the anatomical plausibility of the approach, although controlled studies with objective endpoints are necessary to confirm long-term efficacy and reproducibility. Full article

Cells adapt their phenotypes in noisy microenvironments while maintaining robust decision-making. We develop a coarse-grained theoretical framework in which cellular phenotypic adaptation is described as Bayesian decision-making coupled to replication and diffusion. This leads to an effective Fokker-Planck equation with an emergent fitness landscape governing phenotypic dynamics. We identify distinct phenotypic regimes homeostatic fixation, bistable decision-making, critical switching, and runaway explosion and propose a biological interpretation in which homeostatic and bistable landscapes correspond to healthy differentiated cell states, whereas explosive landscapes capture stem-like or cancer-like behavior. In the Gaussian setting, the correlation between intrinsic and extrinsic states directly encodes mutual information and acts as a bifurcation parameter: high correlation produces shallow or explosive landscapes associated with phenotypic plasticity, while reduced correlation stabilizes differentiated fates by deepening potential wells. We further show that proliferation reshapes these landscapes in a nontrivial manner. Proliferation conditionally stabilizes local homeostasis without altering global confinement, or cooperates with biased environmental sensing to eliminate homeostasis/bistability and drive cancer-like phenotypic explosion even at high phenotypic fidelity. Finally, we show that negative intrinsic–extrinsic correlations suppress explosive dynamics but also reduce bistable plasticity, suggesting a robustness–plasticity trade-off. Together, our results suggest that development, tissue homeostasis, and carcinogenesis can be understood as information-driven deformations of a Bayesian phenotypic fitness landscape. Full article

Cool-season (C3) forage grasses are a cornerstone of temperate grassland systems, where improving productivity, nutritive value, and stress resilience is essential for sustainable forage production. In this context, plant growth-promoting microorganisms (PGPMs) have gained increasing attention as potential alternatives or complements to mineral and organic fertilization in grassland management. This review synthesizes current knowledge on the role of bacterial and fungal PGPM in enhancing the growth, nutrient use efficiency, and stress tolerance of C3 forage grasses, with particular emphasis on species of the genus Lolium. Available evidence indicates that PGPMs can substantially improve biomass production and plant performance under both optimal and stress conditions through a range of direct and indirect mechanisms. These include phytohormone production, nitrogen fixation, phosphate solubilization, as well as the activation of antioxidant defense systems and stabilization of plant water relations under stress. While Lolium perenne L. and Lolium multiflorum Lam. remain the most extensively studied model species, comparable growth-promoting responses have also been reported for Dactylis glomerata L., Festuca species, and Festulolium hybrids. Increasing attention is being directed toward bacterial and fungal endophytes, which may provide more persistent physiological benefits due to their close association with plant tissues. However, PGPM effects are often strongly species-, genotype-, and environment-dependent, particularly in complex grassland systems. Overall, PGPMs represent a promising tool for sustainable grassland management, although their effective application will require long-term field studies conducted under realistic meadow and pasture conditions. Full article

Transforming growth factor-β (TGF-β) signaling plays a central role in lung tissue homeostasis, coordinating epithelial repair, immune resolution, and stromal remodeling following injury. However, persistent or dysregulated TGF-β activation is a hallmark of both idiopathic pulmonary fibrosis (IPF) and lung cancer, two devastating pulmonary diseases that are traditionally studied as distinct entities. Emerging evidence suggests that this dichotomous view may obscure shared pathogenic mechanisms driven by aberrant TGF-β signaling dynamics. In this review, we synthesize experimental, translational, and clinical findings to propose a unifying framework in which IPF and lung cancer represent endpoints along a shared TGF-β–driven pathological continuum. We highlight how the duration and intensity of TGF-β signaling determine divergent cellular outcomes across epithelial cells, fibroblasts, and immune compartments—ranging from physiological wound repair to irreversible fibrotic remodeling and the establishment of a pro-tumorigenic niche. Particular emphasis is placed on the temporal transition from acute injury responses to chronic signaling states that promote epithelial plasticity, fibroblast fixation, immune suppression, and genomic instability. By integrating fibrosis and tumorigenesis into a single pathophysiological model, this review reframes TGF-β signaling as a time-dependent disease modifier rather than a disease-specific factor. This perspective provides a conceptual basis for therapeutic strategies targeting TGF-β signaling windows to intercept disease progression before irreversible fibrosis or malignant transformation occurs. Full article

Background: Revision total knee arthroplasty (rTKA) is a technically demanding procedure that, when performed using mechanically aligned strategies, frequently relies on stems, augments, metaphyseal cones and constrained implants to restore knee alignment and stability. In carefully selected cases with preserved metaphyseal bone stock and competent collateral ligaments, robotic assistance allows a bone-preserving strategy in which alignment, joint line height, and soft-tissue balance are restored using conventional posterior-stabilized components with short cemented stems rather than higher invasive and constrained constructs. Methods: This technical note describes a step-by-step surgical workflow using the Mako robotic system (Stryker) to revise failed primary TKA associated with minimal metaphyseal bone loss to rTKA with conventional posterior-stabilized components and short cemented stems within a functional alignment framework. Results: The workflow integrates CT-based three-dimensional planning, registration on in situ implants, real-time gap assessment, and precise robotic bone preparation to correct deformity and to restore stability while minimizing additional bone resection. In this setting, limited tibial metaphyseal defects are managed with impacted autologous cancellous graft, and stable fixation is achieved with short cemented stems. Conclusions: This robotic-assisted approach is intended as a bone-preserving option for selected rTKA cases associated with minimal bone loss and as a conceptual bridge between robotic-assisted primary and conventional revision TKAs performed with mechanical techniques and alignments. Full article

Tissue adhesives offer a promising alternative to traditional sutures and staples, particularly in situations requiring rapid, minimally invasive wound closure. To address the limitations of commercially available cyanoacrylate-based adhesives, numerous hydrogel adhesives have been developed. This study presents the synthesis and characterisation of an alginate–aminophenylboronic acid (Alg-APBA) hydrogel adhesive, optimised for bioprinting as a method allowing us to control the thickness of the adhesive layer. The adhesive combines the biocompatibility of alginate with the pH-responsive bonding ability of boronic acid groups, eliminating the need for oxidative crosslinkers. Successful conjugation of APBA to alginate was confirmed via ¹H NMR, FTIR and UV-VIS spectroscopy, with a degree of substitution reaching approximately 46% or ~0.22 mol%. Rheological analysis demonstrated shear-thinning and self-healing properties suitable for bioprinting, achieving a high print fidelity (Pr ratio = 0.99 ± 0.08) and repeatability. Mechanical testing showed a shear strength of 19.0 ± 0.5 kPa and an interfacial toughness of 58.0 ± 2.11 J/m², exceeding those of commercial fibrin adhesives. Additionally, the adhesive joint remained stable after one week of incubation in an acidic environment. The material demonstrated biocompatibility during in vitro testing with keratinocytes and fibroblast cells. These results indicate that Alg-APBA is a strong, biocompatible and printable hydrogel adhesive with potential applications in soft tissue implant fixation. Full article

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Residual valgus instability following ankle fracture fixation presents a reconstructive challenge, especially when medial soft tissue compromise precludes early deltoid ligament repair. Restoring medial stability, together with fibular length and syndesmotic alignment, is crucial for re-establishing joint congruity and preventing progressive deformity or degenerative complications. In this single-patient case report, we describe a novel technique combining the use of an allograft deltoid ligament reconstruction with a Z-lengthening distal fibular osteotomy in a young adult male who developed residual valgus instability after the lateral-only fixation of a Weber C ankle fracture–dislocation. The Z-lengthening osteotomy enabled the controlled, fluoroscopy-guided restoration of fibular length and the correction of syndesmotic malreduction. Concurrently, medial stabilization was achieved with a suspensory-and-aperture fixation allograft construct, providing a tensionable anatomic reconstruction of the deltoid complex. This integrated approach restored the alignment of the medial clear space and syndesmosis, resulting in a pain-free, stable ankle mortise. At the three-year follow-up, the patient maintained a stable reduction with no radiographic signs of post-traumatic arthritis. The technique offers a reproducible, joint-preserving solution that merges mechanical correction with biological reconstruction to restore circumferential ankle stability and facilitate functional rehabilitation after complex ankle fracture fixation. Full article

Programmed death-ligand 1 (PD-L1) has become a central biomarker and therapeutic target across multiple solid tumors, yet its clinical meaning in prostate cancer (PCa) remains unsettled. PCa is commonly described as an immunologically ‘cold’ malignancy, characterized by limited baseline cytotoxic T-cell infiltration and a tumor microenvironment (TME) shaped by myeloid-driven suppression and low neoantigen load in many cases. Against this background, PD-L1 expression in PCa is typically low in untreated primary tumors but can increase in aggressive variants, advanced stages, and metastatic castration-resistant disease, where therapy pressure and microenvironmental cues may select for immune-evasive phenotypes. The literature is further complicated by major analytic variability, including differences in antibody clones and platforms, scoring algorithms (tumor proportion score, combined positive score, immune-cell scoring), cut-offs, tissue sites and timing, and pre-analytical variables such as fixation and decalcification. Collectively, available studies suggest that higher PD-L1 expression tends to be associated with adverse clinicopathological features and may enrich for responses to immune checkpoint inhibitors in selected settings, but PD-L1 immunohistochemistry alone is insufficient as a stand-alone predictive tool in unselected patients. This review synthesizes the biological drivers of PD-L1 regulation in PCa, dissects key methodological sources of heterogeneity in PD-L1 assessment, summarizes clinicopathological and therapeutic correlations, and outlines emerging biomarkers and approaches (including mismatch repair deficiency/microsatellite instability, tumor mutational burden, gene-expression signatures, liquid biopsies, and neuro-immune interactions) that may enable more actionable patient stratification. Full article

Cadaveric preservation is fundamental to medical education, research, and surgical training, offering unmatched understanding of human anatomy and tissue dynamics. Although formalin fixation facilitates extended specimen preservation, its toxicity, tissue rigidity, and disruption of molecular analysis have prompted the creation of safer, more biologically representative alternatives. This review delineates the progression of cadaveric preservation, spanning from classical formaldehyde-based techniques through transitional low-toxicity chemical approaches to emerging formaldehyde-free methodologies. We assess the composition, benefits, and drawbacks of each technique, emphasizing the integration with machine learning-guided perfusion, nanotechnology-enhanced polymers, and hybrid approaches that combine digital imaging, 3D scaffolds, and automated monitoring. We propose a decision-making framework that integrates preservation decisions with instructional goals, surgical simulation needs, and research priorities, while adhering to ethical and environmental standards. This thorough analysis combines classic and innovative methodologies to provide practical suggestions for institutions aiming to enhance cadaveric resources for future medical professionals. Full article