Search Results (101)

Background/Objectives: While bariatric surgery is known to improve plantar pressure distribution and reduce foot-related symptoms, its impact on radiographic forefoot alignment parameters, such as the intermetatarsal angle (IMA) and hallux valgus angle (HVA), remains unclear, highlighting the need for further investigation. The aim of this study was to quantitatively evaluate changes of HVA and IMA in patients undergoing bariatric surgery and to determine whether weight loss-induced reductions in mechanical load are associated with differential changes of the forefoot. Methods: Weight-bearing anteroposterior foot radiographs of 102 patients who underwent laparoscopic sleeve gastrectomy were obtained preoperatively and at 6 months postoperatively. HVA and IMA were measured using standardized digital techniques. Changes in angular parameters were analyzed in relation to body mass index reduction. Results: Intra-observer reliability was excellent for all angular measurements (ICC: 0.987–0.999, p < 0.001). Radiographic evaluation demonstrated no significant change in HVA (p = 0.147), whereas IMA showed a significant decrease postoperatively (p < 0.001). No significant change was observed in HVA distribution (p = 0.341), and although the proportion of patients within the normal IMA range increased, this did not reach statistical significance (p = 0.091). Correlation analysis revealed significant associations of postoperative angles with age and body weight parameters (p < 0.05), while no significant relationship was found between changes in body weight or BMI and angular measurements (p > 0.05). Conclusions: Sleeve gastrectomy significantly improves biomechanically driven aspects of forefoot alignment (decrease in IMA), while structural deformities (HVA) remain unchanged in the short-term. These findings highlight that obesity-related forefoot pathology is predominantly linked to altered load distribution rather than fixed structural deformity, suggesting that radiographic parameters reflecting biomechanical loading are more sensitive to weight loss. Full article

Background and Objectives: Adolescent idiopathic scoliosis (AIS) may influence pelvic orientation and lower-limb alignment; however, data on coronal lower-limb alignment after completion of spinal treatment remain limited. This study aimed to evaluate lower-limb radiographic alignment in AIS patients after spinal treatment and to determine whether these parameters differ according to main curve location. Materials and Methods: In this retrospective study, 70 AIS patients treated surgically (n = 52) or with brace therapy (n = 18) between 2010 and 2020 were analyzed. Patients were grouped according to main curve location as thoracic (n = 28), lumbar (n = 21), or thoracolumbar (n = 21). Pre-treatment standing full-spine radiographs were used to assess Cobb angle, coronal balance, and pelvic coronal obliquity angle (PCOA). After completion of spinal treatment, full-length weight-bearing lower-limb radiographs were evaluated for femoral and tibial lengths, mechanical axis deviation (MAD), femoral neck–shaft angle (NSA), anatomical lateral distal femoral angle (aLDFA), and mechanical lateral distal femoral angle (mLDFA). Additional treatment-stratified, treatment-adjusted, and threshold-based analyses were performed. Results: PCOA, coronal balance, bilateral MAD, right aLDFA, and right mLDFA differed significantly among the three curve-location groups. The lumbar group demonstrated more negative MAD values than the thoracic group, indicating a tendency toward valgus alignment (right MAD: −5.88 ± 8.8 mm vs. 3.65 ± 7.9 mm, p = 0.004; left MAD: −3.5 ± 7.5 mm vs. 3.75 ± 7.0 mm, p = 0.005). After adjustment for treatment modality, age, and main Cobb angle, curve location remained significantly associated with right MAD, left MAD, right aLDFA, and right mLDFA. However, the proportion of patients with clinically relevant malalignment, defined as MAD exceeding ±10 mm in at least one limb, did not differ significantly among the groups. Conclusions: AIS patients show subtle but measurable differences in coronal lower-limb alignment after completion of spinal treatment. Lumbar and thoracolumbar curves are associated with greater pelvic obliquity and a tendency toward more valgus mechanical-axis alignment, whereas limb lengths and NSA remain comparable among curve-location groups. These findings appear to represent mainly radiographic or biomechanical variations rather than overt clinically relevant deformity in most patients. Full article

Patellar maltracking is among the most common causes of anterior knee pain after total knee arthroplasty (TKA), underscoring the need for accurate prevention and treatment. Therefore, the purpose of this narrative review is to provide a comprehensive overview of current evidence on post-TKA tracking, focusing on component alignment, preoperative patient assessment, and revision treatment options. A PubMed database search was performed, leveraging the literature from the last 20 years, and the results were qualitatively synthesized. According to current studies, several precautions should be taken to prevent patellofemoral stress and, consequently, patellar maltracking, such as avoiding internal rotation, valgus alignment, and excessive flexion of the femoral component and internal rotation of the tibial component. Regarding alignment strategies, kinematic alignment appears to offer potential benefits over mechanical alignment in certain functional outcomes and patient satisfaction scores. However, these differences should be interpreted cautiously as they may not always exceed the minimal clinically important difference. Furthermore, recent evidence indicates that quadriceps biomechanics influence TKA outcomes, potentially suggesting that conventional surgical approaches may need to be individualized, though these preliminary findings require prospective validation. Currently, robotic-assisted surgery represents a developmental direction for patient-tailored interventions and offers great promise for better prosthesis customization to the individual patient. Integration of imaging data with dynamic soft-tissue assessment enables more predictable reconstruction of joint kinematics. Regarding surgical treatment, the selection of specific methods requires a prior clinical and radiographic assessment. Indications range from patellar maltracking direction and component malrotation to patient preferences and rehabilitation potential. Ultimately, the future of TKA relies on personalized interventions to prevent complications and improve patient outcomes. This evolution is driven by the shift from mechanical alignment to kinematic alignment, alongside quadriceps tendon assessment and intraoperative robotic-assisted measurement, all aimed at optimizing the accuracy of implant positioning. Full article

Gait analysis study comparing unicompartmental vs. total knee arthroplasty, differences in knee kinematics: a retrospective cohort study. Background and Objectives: Total knee arthroplasty (TKA) is an effective treatment for advanced knee osteoarthritis, although functional outcomes may remain suboptimal in many patients. Unicompartmental knee arthroplasty (UKA) often provides better functional recovery but shows lower long-term implant survival. Recently, personalized TKA approaches have been developed to improve kinematic restoration and patient satisfaction. This study aimed to compare knee kinematics among patients who underwent personalized TKA, medial UKA, and healthy controls. Materials and Methods: This retrospective cohort study included 9 patients treated with robotic-assisted personalized TKA, 9 patients treated with medial UKA, and 9 healthy controls matched for age, sex, and BMI. Inclusion criteria were age 60–80 years, Kellgren–Lawrence grade III–IV, a minimum follow-up of 12 months, deviation from neutral HKA < 15°, healthy contralateral knee, and high postoperative functional scores. Exclusion criteria included valgus knees (HKA > 180°), postoperative complications, and neuromotor disorders. In the TKA group, a Medial Congruent implant was implanted with ROSA robotic assistance using a restricted kinematic alignment (±5° HKA) and asymmetric intercompartmental balancing. In the UKA group, a fixed-bearing medial implant (Physica ZUK) was used. Gait analysis was performed on a markerless instrumented treadmill (WalkerView™; Dalmine, Italy). Differences between groups were analyzed using one-way ANOVA and Tukey’s post-hoc test (p < 0.05). Results: UKA patients walked with a stiffer knee during stance. Knee range of motion during stance increased from UKA (6.3° ± 7.2°) to TKA (13.6° ± 8.8°, p = 0.045) and to controls (16.6° ± 4.5°, p = 0.02). During loading response, UKA patients showed lower flexion (10.2° ± 6.1°) than TKA (19.4° ± 7.9°, p = 0.049) and controls (19.6° ± 2.8°, p = 0.004). Knee flexion during swing was comparable between UKA and TKA. Conclusions: UKA patients demonstrated reduced knee flexion during early stance compared with robotic-assisted TKA and healthy controls. The observed differences may reflect multiple factors, including surgical technique, implant design, and patient-related characteristics. Because preoperative functional data were not available, potential selection bias cannot be excluded. These findings should be interpreted cautiously and warrant confirmation in larger prospective studies. Full article

Background: Hallux valgus (HV) is a complex forefoot deformity influenced by interactions between osseous alignment, ligamentous restraint, and muscle–tendon forces. While the biomechanical role of ligament laxity and bone geometry has been extensively investigated, the contribution of tibialis anterior (TA) tendon insertion variability to medial column mechanics remains insufficiently understood. Materials and Methods: A patient-specific finite element model of the foot was developed from high-resolution computed tomography data. Five anatomically documented TA distal insertion configurations were modeled, representing different distributions of attachment to the medial cuneiform and first metatarsal base. All simulations were performed under identical boundary and loading conditions representative of the stance phase of gait. Global (full-foot) and local (first bone and first metatarsal) mechanical responses were quantified using total deformation, equivalent von Mises stress, and strain distributions. Results: Marked differences in mechanical behavior were observed across TA insertion types. The metatarsal-dominant configuration (Type 3) demonstrated the highest global and local deformation values (global deformation: 1.0928 mm; first bone deformation: 1.0928 mm) and elevated strain distributions, whereas the medial-dominant configuration (Type 2) showed minimal deformation (global: 0.0727 mm; first bone: 0.0350 mm) but the highest global equivalent von Mises stress (5.7698 MPa). The single-band insertion to the medial cuneiform (Type 5) produced the greatest localized stress in the first bone region (3.8634 MPa). Representative strain maps revealed distinct spatial redistribution patterns within the medial column associated with TA insertion geometry. Conclusions: This patient-specific finite element analysis indicated that distal TA insertion variability alone can substantially modify deformation, stress, and strain patterns within the medial column. These findings suggested that TA insertion anatomy may act as a biomechanical modulator of first-ray mechanics and should be considered in future studies investigating hallux valgus pathomechanics and personalized treatment strategies. Full article

Tibial torsion significantly influences knee biomechanics, yet its interaction with ACL reconstruction history in elite alpine skiers remains under-investigated. In this cross-sectional observational study, we analyzed 20 elite alpine skiers (7 ACL-reconstructed, 13 non-injured) using a markerless motion capture system during dynamic tasks (Squat, Single-Leg Squat, Lunge). Static tibial torsion was assessed via the Transmalleolar Axis and Thigh–Foot Angle. The results revealed a critical divergence in biomechanical strategies based on tibial alignment (p < 0.05). Skiers with rotational deformity adopted a pattern we describe as a “Stiffness Strategy”, characterized by suppressed knee valgus and hip rotation, but relied on excessive ankle dorsiflexion (39.5°)—a compensatory mechanism that may become limited when constrained by rigid ski boots. In contrast, ACL-reconstructed skiers with normal alignment exhibited what we term an “Instability Strategy”, showing dynamic valgus collapse and persistent asymmetry. These findings suggest that “one-size-fits-all” rehabilitation may be insufficient. We propose that injury prevention protocols may benefit from incorporating anatomical screening, focusing on decoupling mobility for skiers with tibial torsion and enhancing dynamic stability for those with normal alignment. Full article

Background: Intrinsic foot muscle strengthening and orthotic devices such as toe spacers are commonly used to improve foot alignment and function. However, evidence regarding the combined effects of strengthening exercises and interdigital spacers remains limited. Objective: To examine whether adding a silicone toe spacer to a foot strengthening exercise program provides additional benefits compared with exercise alone. Design: Randomized controlled trial. Setting: University biomechanics laboratory. Participants: Twenty-five healthy adults (mean age 23.8 ± 1.3 years) without lower limb injury or neurological disorders were randomly allocated to one of two intervention groups. Interventions: Participants performed a six-week foot strengthening program (22 sessions). One group performed exercises alone, while the second group performed the same exercises while wearing a silicone interdigital toe spacer. Main outcome measures: The primary outcome was hallux valgus angle. Secondary outcomes included active and passive hallux range of motion (ROM), ankle dorsiflexion ROM (weight-bearing lunge test), navicular drop, and postural stability during single-leg stance assessed using center-of-pressure (CoP) measures. Results: Both groups demonstrated improvements over time in hallux valgus angle (p = 0.001, η² = 0.361), active hallux range of motion (p < 0.001, η² = 0.545), and ankle dorsiflexion (p < 0.001). However, no significant between-group differences were observed for the primary outcome or most secondary outcomes. A significant time × group interaction was observed only for passive hallux range of motion (p = 0.040, η² = 0.170), indicating greater improvement in the exercise-only group. Navicular drop and postural stability variables did not change significantly. Conclusions: A six-week foot strengthening program improved hallux alignment, hallux mobility, and ankle dorsiflexion in healthy adults. The addition of a silicone toe spacer did not provide additional short-term benefits compared with exercise alone. Full article

Background/Objectives: Accurate implant positioning in total knee arthroplasty (TKA) depends on reliable intraoperative landmark registration. In imageless TKA, registration errors can alter cutting-plane orientation and compromise alignment. This study quantitatively evaluated how anatomical landmark registration errors affect cutting-plane orientation in imageless TKA. Methods: A CAD-based simulation with controlled experimental validation using 3D-printed bone models was performed to reproduce the imageless TKA workflow. Controlled errors were introduced into key femoral and tibial landmarks, and the resulting deviations were quantified. The primary evaluation metrics were angular deviations in varus/valgus, flexion/extension, and internal/external rotation. Results: Coronal and rotational alignment showed the greatest sensitivity to registration error. In the femur, anteroposterior epicondylar displacement had the strongest rotational influence, with sensitivity reaching about 0.5°/mm, whereas mediolateral displacement of the tibial anteroposterior landmarks showed the highest sensitivity at about 1.4°/mm. Similar trends were observed in both simulation and experimental validation cases. Conclusions: The findings indicate that small registration errors can produce clinically significant cutting-plane deviations in imageless TKA, particularly at the femoral transepicondylar and tibial anteroposterior landmarks, and may approach commonly accepted alignment thresholds. Full article

Background and Objectives: Medial opening wedge high tibial osteotomy (OWHTO) requires careful management of medial soft-tissue tension to achieve effective decompression and maintain knee stability. While superficial medial collateral ligament (sMCL) release is commonly performed, the role of pes anserinus release remains unclear. This study investigated the effect of pes anserinus release on postoperative pain, clinical outcomes, and medial stability in patients undergoing OWHTO. Materials and Methods: A retrospective analysis was performed on 80 knees (80 patients) that underwent OWHTO between 2012 and 2017. Patients were divided into two groups: Group A (n = 38, sMCL release only) and Group B (n = 42, sMCL + pes anserinus release). Immediate postoperative pain was assessed using visual analog scale (VAS) scores and rescue analgesic use. Clinical outcomes were evaluated with Knee Society Scores (KSSs). Radiographic medial joint opening (MJO) was measured on valgus stress radiographs preoperatively and at one year postoperatively. Results: Group B demonstrated significantly lower VAS pain scores at postoperative days (PODs) 1, 3, 5, 7, and 14 (p < 0.05) and required fewer rescue analgesics (5.5 ± 2.1 vs. 7.6 ± 3.7; p < 0.05). Both groups achieved comparable KSS improvement and radiographic correction (postoperative mechanical femorotibial angle: 2.1° valgus vs. 2.5° valgus). No significant intergroup or intragroup differences were observed in MJO at one-year follow-up (p > 0.05). Conclusions: Combined release of the superficial medial collateral ligament and pes anserinus during medial opening wedge high tibial osteotomy significantly reduces early postoperative pain and improves short-term functional recovery without compromising medial stability or alignment correction, although no significant long-term differences in functional outcomes or radiographic alignment were observed. Full article

Background/Objectives: Although unrestricted kinematic alignment (uKA) has gained increasing acceptance in total knee arthroplasty (TKA), its application in knees with lateral compartment osteoarthritis (OA) remains a subject of debate due to concerns over postoperative gap imbalance and alignment outliers. The purpose of this study was to evaluate the surgical, radiographic, and clinical outcomes of contralateral non-OA knee–referenced, caliper-verified uKA in lateral compartment OA. Methods: This retrospective study included 40 patients with isolated lateral compartment OA who underwent primary TKA using contralateral non-OA knee–referenced, caliper-verified uKA. Surgical outcomes were assessed by measuring bone resection thicknesses of the distal femur, posterior femur, and proximal tibia, as well as extension and 90° flexion gaps. Radiographic outcomes included mechanical hip–knee–ankle angle, medial proximal tibial angle, lateral distal femoral angle, and Coronal Plane Alignment of the Knee (CPAK) classification. Patient-reported outcomes (PROs), including Pain VAS, EQ-5D, satisfaction, and Forgotten Joint Score, were assessed at a minimum follow-up of 2 years. Results: The resected osteochondral thickness was consistently greater on the medial side than on the lateral side, and all gap balances were well maintained, with a gap difference ≤ 2 mm observed in 95% of knees in full extension. Postoperatively, restoration to the same CPAK category was achieved in approximately 90% of cases. All PROs improved and reached levels comparable to those of the contralateral knee. Conclusions: In patients with lateral compartment OA, caliper-verified uKA may be appropriately applied when guided by a reliable anatomic reference, such as the contralateral non-OA knee. This strategy achieves stable soft-tissue balance, reliable coronal alignment restoration, and favorable clinical outcomes in carefully selected valgus knees undergoing TKA. Full article

Background and Objectives: Knee osteoarthritis (OA) is a leading cause of pain and disability, with radiographic severity influenced by age, biomechanical alignment, and structural joint features. Data describing the association between common radiographic parameters and OA severity in Eastern European clinical populations remain limited. This study aimed to evaluate the associations between radiographic OA severity and coronal alignment, patellar height, and chondrocalcinosis in a Romanian clinical cohort. Materials and Methods: This single-center cross-sectional study included adult patients undergoing knee radiography for knee-related symptoms and/or functional assessment at a rehabilitation hospital between 2023 and 2025. Radiographs were obtained in the supine, non-weight-bearing position and included anteroposterior and lateral views. OA severity was graded using the Kellgren–Lawrence (KL) classification. Coronal alignment was assessed using the femorotibial angle, patellar height using the Insall–Salvati ratio (ISR), and chondrocalcinosis was recorded as present or absent. Associations between radiographic parameters and KL grade were analyzed using non-parametric statistics. Receiver operating characteristic (ROC) analyses were performed for exploratory assessment of limited separation between distributions. Results: Moderate to severe OA (KL ≥ 3) was present in 49% of patients. KL grade showed a moderate positive correlation with age (r = 0.50, p < 0.001) and differed significantly across coronal alignment categories (p < 0.001). Varus/valgus and pathological alignment classifications demonstrated moderate sensitivity (0.69–0.85) and variable specificity (0.52–0.85) for higher KL grades. ROC analyses of continuous alignment and ISR measures yielded area under the curve values ranging from approximately 0.65 to 0.68, indicating limited separation between distributions. Radiographically detected chondrocalcinosis was present in 5.3% of patients and showed no significant association with OA severity, and neither did patellar height. Conclusions: In this single-center Romanian clinical cohort, radiographic OA severity was associated with coronal plane alignment but not with patellar height or chondrocalcinosis. Alignment measures demonstrated limited discriminative ability and should be interpreted as complementary rather than diagnostic indicators of OA severity. These findings provide descriptive radiographic data from an Eastern European clinical population and highlight the need for longitudinal and population-based studies incorporating mechanical axis assessment and functional outcomes. 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

Background/Objectives: This study investigated the relationships among the Landing Error Scoring System (LESS), markerless 3D (OpenCap)-derived knee valgus, and surface electromyography (EMG) of quadriceps and hamstrings. Methods: Thirty-two healthy male university students (26 athletes, 6 non-athletes) completed a drop-landing task. LESS was video-scored; knee valgus at peak knee flexion was computed with OpenCap; and bilateral rectus femoris (RF) and biceps femoris (BF) EMG was recorded. Phase-specific EMG was normalized to peak dynamic activity. Results: LESS showed an independent negative association with left knee valgus (p = 0.001). In the regression model, bilateral BF acceleration-phase activity was a significant predictor of knee valgus (p < 0.05). Exploratory comparisons indicated that athletes exhibited lower RF deceleration activity and smaller left-side valgus than non-athletes. Conclusions: These findings suggest that hamstring activity during the transition phase is linked to knee alignment. This study demonstrates the complementary value of integrating LESS with markerless 3D motion capture, although caution is warranted when generalizing group differences due to the unequal sample size. Full article

Background/Objectives: Some personalized alignment (PA) concepts have been described with symmetrical gaps in extension and flexion. However, laxity in native knees was significantly greater laterally than medially with respect to both extension and flexion. We hypothesized that a personalized alignment can restore the native knee alignment, keep a satisfying patellar tracking, and obtain physiological ligament balancing, that is, a symmetric gap in extension and an asymmetric gap in flexion. We aimed to assess: (1) the postoperative alignment of TKA and postoperative patellar tracking (primary outcome); (2) the ligament balancing at the end of the surgery; and (3) clinical outcomes and complication rates. Methods: In this single-center, retrospective case series, we evaluated 45 patients in a consecutive series who underwent robotic-assisted primary TKA using PA between January and September 2020 with a minimum follow-up of 5 years. Complication was defined as grade ≥3 according to the Clavien-Dindo classification. Data assessed were: TKA alignment and implant positioning on postoperative radiographs, patellar tracking on the merchant view, and ligament balancing in extension and flexion upon completion of surgery. Results: Mean follow-up was 62.1 ± 2.5 months. The postoperative mean HKA angle was 177.4° ± 2.2. The medial distal femoral angle was restored (91.1° ± 1.5 postoperatively versus 91.3° ± 2). A total of four TKAs had a patellar tilt superior to 5° (8.9%). No significant difference was found in the medial gap laxity—both in extension and in flexion—and the lateral gap laxity in extension. The lateral gap laxity in flexion was significantly higher than extension or medial gap laxity (+2.9 mm). One patient was readmitted for delayed wound healing. Average improvements in Knee Society knee and function scores were 55.86 and 51.84 points, respectively. Conclusions: This personalized alignment technique using anatomo-functional implant positioning allowed restoration of native knee alignment with a “safe zone” (3° varus/valgus) for the tibial implant, maintained satisfying patellar tracking, and restituted the asymmetrical gap laxity in flexion with a higher laxity in the lateral compartment. Being the longest system-specific study to date, the results are encouraging at 5 years with no major complications. However, longer follow-up will be required to confirm the use of this technique. Full article

Background and Objectives: Femoral malunion, defined as healing of a femoral fracture in an anatomically incorrect position, can lead to significant biomechanical and functional impairment despite modern fixation techniques achieving union rates near 99%. The lack of a universal definition and standardized management approach continues to hinder optimal outcomes. This review aims to synthesize the literature on the causes, clinical presentation, radiologic assessment, surgical indications, corrective procedures, and outcomes of femoral malunion to guide clinical decision-making and future research. Materials and Methods: A narrative review of peer-reviewed orthopedic literature was conducted, focusing on adult femoral malunions across anatomical regions. Articles detailing deformity thresholds, imaging modalities, corrective osteotomies, and fixation strategies were included. Particular emphasis was placed on region-specific deformities—femoral head, neck, intertrochanteric, diaphyseal, and distal femur—and their corresponding surgical correction methods, including valgus intertrochanteric osteotomy, clamshell osteotomy, and lengthening with external or magnetic intramedullary devices. Results: Malunion most commonly presents as angular, rotational, or length deformity, with thresholds of >5–10° angulation, >10° rotation, or >1–2 cm shortening being clinically significant. Patients may experience pain, limp, gait asymmetry, and early-onset arthritis. Corrective techniques tailored to the anatomical site yield favorable results: valgus intertrochanteric osteotomy restores leg length and alignment; diaphyseal malunions respond well to single- or multi-plane osteotomies with internal fixation or gradual correction; distal femoral malunions often require multiplanar osteotomy to reestablish the joint line. Most series report high union rates and functional improvement, though complications such as infection and hardware failure may occur. Conclusions: Femoral malunion remains a complex but treatable condition. Successful outcomes rely on accurate deformity characterization, patient-specific surgical planning, and restoration of mechanical alignment. Standardized deformity criteria and long-term functional outcome studies are needed to refine management algorithms and improve patient care. Full article