OBJECTIVES:To introduce a surgical technique and evaluate the clinical outcome of minimally invasive treatment of calcaneal fractures based on 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor. METHODS: DESIGN:Retrospective case series. SETTING:Single Level-1 trauma center. PATIENTS:Adult patients with calcaneal fractures (OTA/AO 82C, Sanders type II, III) who were treated with 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor from January 2022 to June 2024 were included. OUTCOME MEASURES AND COMPARISONS:Demographic characteristics, operative information, radiological and functional outcomes, and complications. RESULTS:Forty-seven patients (43 men and 4 women, 52 fractures) with a mean age of 46.5 ± 12.2 years (range: 24-73), a mean weight of 73.4 ± 13.0 kg (range: 55-106), and a mean height of 170.1 ± 6.4 cm (range: 150-180) were followed for an average duration of 20.4 months (range: 9-36 months). According to the Sanders classification, there were 39 type II and 13 type III fractures. Based on the Essex-Lopresti classification, 25 fractures were tongue-type and 27 were joint depression-type. The average time from injury to surgery was 8.7 ± 4.2 days (range: 2-18), and the mean operative duration was 86.8 ± 33.9 minutes (range: 45-180). Postoperative radiographic parameter assessment revealed significant restoration of the calcaneal anatomy, with a marked reduction in width (from 47.8 ± 4.6 to 43.4 ± 4.2 mm, P < 0.001) and significant improvements in height (from 39.3 ± 4.8 to 46.2 ± 4.0 mm, P < 0.001) and length (from 79.2 ± 5.9 to 81.6 ± 5.1 mm, P < 0.001). Furthermore, both Böhler angle (from 7.4 ± 13.5 to 25.4 ± 9.2 degrees, P < 0.001) and Gissane angle (from 119.3 ± 13.4 to 113.4 ± 10.1 degree, P < 0.001) were significantly corrected. The vertical articular step significantly decreased from 4.3 ± 0.8 mm before the operation to 0.9 ± 0.5 mm ( P < 0.001). There were no wound complications. At the final follow-up, the mean Maryland Foot Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, and visual analogue scale score were 93.5 ± 6.4, 91.3 ± 7.6, and 1.0 ± 1.0, respectively. No patients required secondary surgery, except for 5 patients for whom the internal fixation was removed. CONCLUSIONS:This study demonstrated favorable clinical outcomes for the minimally invasive treatment of calcaneal fractures using 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation in combination with a novel circular distractor. This surgical protocol is suggested to be both safe and reliable on the basis of this findings. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

ABSTRACT Purposes Open elbow arthrolysis (OEA) is a common method for treating post‐traumatic elbow stiffness, which may lead to severe bleeding when resecting heterotopic ossification (HO) and fibrous scar tissue. The purpose of this study is to compare the efficacy and safety among three different ways of using tranexamic acid (TXA) in reducing total blood loss and drainage volume in OEA. Patients and Methods This was a pilot, double‐blinded, randomized controlled trial involving a total of 60 patients of post‐traumatic elbow stiffness. Patients in the IV group (n = 20) received TXA intravenously, those in the intra‐articular group (n = 20) received TXA topically, and those in the combined group (n = 20) received TXA both intravenously and topically. The primary outcome measure was postoperative blood loss and drainage volume. The secondary outcome measures included elbow function, complications, and secondary surgery. Results The postoperative blood loss on the first and third days and the drainage volume on the first day was similar among the three groups (p > 0.05). The total postoperative drainage volume in the IV group was significantly higher than in the combined and intra‐articular group, with no significant difference observed between the combined and intra‐articular group (534.5 mL vs. 378.0 mL vs. 356.5 mL; p < 0.05). There were no significant differences in elbow flexion‐extension and rotation range of motion (ROM) and the Visual Analogue Scale (VAS) and Mayo Elbow Performance Score (MEPS) scores at the follow‐up (p > 0.05). Conclusion Intravenous, topical, or combined TXA administration showed no significant difference in reducing postoperative blood loss after OEA. However, both combined and topical TXA significantly reduced postoperative drainage volume compared to intravenous administration. Level of Evidence Therapeutic Level I.

Bone organoids have evolved from simple osteogenic spheroids to increasingly sophisticated systems incorporating vascular networks, bone marrow niches, and multicellular interactions, yet achieving functional maturation remains limited by long-term viability, tissue organization, and metabolic homeostasis. Mitochondrial metabolic homeostasis represents a promising strategy in this regard. Mitochondria serve as both the core of energy metabolism and a vital signaling hub governing bone development, remodeling, and homeostasis. The metabolic switch from glycolysis to oxidative phosphorylation in osteogenic lineage cells, regulated by mitochondrial programming, directly determines bone matrix synthesis and mineralization. This review systematically summarizes the fundamental mechanisms of mitochondria in osteogenic differentiation, calcium signaling, and bone quality control, and highlights how mechanical cues, electromagnetic stimulation, and biomaterial microenvironments drive functional maturation of bone organoids by targeting mitochondria. Bone organoid construction should integrate mitochondrial metabolic requirements across developmental stages, ensuring energy-redox adaptation, organelle quality control, and intercellular metabolic coupling among heterogeneous cell populations. Accordingly, we propose a novel strategy for next-generation bone organoid engineering focused on mitochondrial metabolic microenvironment modulation. Active intervention in cellular energy metabolism can significantly enhance organoid maturity and physiological fidelity, providing a new theoretical framework and technical route for developing high-fidelity bone organoid models. Translational potential: This review delineates mitochondrial reprogramming as the core driver of bone organoid maturation. We highlight strategies targeting mitochondrial bioenergetics via physical cues, ions, and bioactive factors. Bridging molecular mechanisms with biomaterial design, this framework establishes standardized organoids with homeostatic resilience, advancing clinically translatable in vitro bone models.

ABSTRACT Objective Total elbow arthroplasty (TEA) is a commonly performed surgical technique for the management of elbow disorders. The Coonrad–Morrey (CM) prosthesis is the most commonly used prosthesis in TEA. The study from Chinese cohorts remains limited, particularly regarding differences between patients with and without RA. Therefore, the purpose of this study was to evaluate the medium‐ to long‐term clinical outcomes using the CM prosthesis in a Chinese cohort, and to compare clinical outcomes between patients with and without RA. Methods A retrospective cohort study was conducted involving 74 patients (75 elbows) who underwent TEA using CM prostheses between March 2015 and February 2019. All patients were followed up for a minimum of 5 years (mean follow‐up: 83.4 months) and were assessed for elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), Quick‐Disabilities of the Arm, Shoulder and Hand (Quick‐DASH) score, pain, complications, and revision surgeries. Kaplan–Meier survivorship analysis was conducted. The differences between patients with and without rheumatoid arthritis (RA) were compared in the subgroup analysis. Results At the final follow‐up, the average flexion‐extension ROM was 105.3° ± 33.6°. The mean MEPS was 85.5 ± 14.3, with a good‐to‐excellent rate of 81.3%. The mean Quick‐DASH score was 30.8 ± 18.1. A total of 26 complications (26/75, 34.7%) were observed in 22 elbows (22/75, 29.3%). Nine elbows (9/75, 12.0%) underwent reoperation. The revision‐free rates were 98.7% at 1 year, 94.7% at 2 years, and 90.7% at 5 years. There were no significant differences in elbow function or revision‐free rate between patients with and without RA. Conclusion TEA using CM prosthesis in Chinese patients can achieve favorable functional outcomes regardless of RA status, with a high 5‐year prosthesis survival rate. However, a larger sample size and a longer follow‐up period are still required.

OBJECTIVE:To compare the efficacy of three surgical methods-Robot-Assisted Percutaneous Reduction and Screw Fixation (RA-PRSF), Sinus Tarsi Approach for Open Reduction and Plate Fixation (STA-ORPF), and Extended Lateral Approach for Open Reduction and Plate Fixation (ELA-ORPF)-in the treatment of displaced intra-articular calcaneal fractures (DIACFs). METHODS:A retrospective cohort study was conducted involving 190 patients (202 fractures) with Sanders type II or III DIACFs. Patients were divided into three groups based on the surgical method. Perioperative outcomes, radiological parameters, functional scores, and complication rates were compared. RESULTS:All three groups achieved comparable radiological outcomes and final AOFAS and VAS scores. However, the RA-PRSF group demonstrated significant advantages in intraoperative blood loss, weight-bearing time, and early functional recovery (AOFAS at 3 months, P < 0.001). The ELA-ORPF group had the highest wound complication rate (12.2%), significantly greater than the RA-PRSF (0%) and STA-ORPF (1.8%) groups (P < 0.05). No significant differences were observed in overall complication rates. CONCLUSIONS:While all three methods are effective for DIACF management, RA-PRSF offers superior perioperative outcomes and early recovery with minimal soft tissue complications. STA-ORPF provides a balanced minimally invasive alternative, whereas ELA-ORPF, though effective, carries a higher risk of wound complications.

Background The objective of this study is to compare the clinical outcomes of robot-assisted percutaneous screw fixation with traditional ORIF for treating displaced intra-articular glenoid Ideberg Ia fractures. Methods This retrospective study included all patients diagnosed with displaced intra-articular glenoid fractures between January 1, 2021, and December 31, 2024, at our Level 3 hospital who met the inclusion and exclusion criteria. Patient demographics and intraoperative parameters were meticulously documented. Clinical outcomes were measured using the Constant Murley Shoulder score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the Visual Analogue Scale for pain. Each patient was asked to assess their satisfaction with the appearance of their scars using a 10-point Likert scale. The range of motion and any complications were thoroughly documented for further analysis. In addition, the time taken to resume work, sports activities, and recover the previous range of motion in the shoulder was also recorded. Results 18 patients were included in the final analysis—8 in the robot-assisted group and 9 in the ORIF group. The robot-assisted group required significantly less operative time (70.00 ± 16.04 vs. 108.22 ± 34.67minutes, P < 0.05), reduced blood loss (11.25 ± 7.44 vs. 120.00 ± 65.00 mL, P < 0.05), smaller incision length (1.18 ± 0.26 vs. 12.24 ± 2.74 cm, P < 0.05), faster resume work (13.13 ± 1.81 vs. 23.78 ± 15.57 weeks), quicker return to sports (17.00 ± 1.85 vs. 27.53 ± 13.63 weeks, P < 0.05), a shorter time to regain full range of motion (13.00 ± 1.85 vs. 29.00 ± 12.05 weeks, P < 0.05), and a higher scar cosmesis score (9.88 ± 0.35 vs. 5.17 ± 3.4, P < 0.05). The robot-assisted group achieved bone union substantially faster, with an average time of 8.12 ± 0.35weeks compared to 13.33 ± 2.46 weeks in the ORIF group (P < 0.05). In terms of active range of motion, patients in the robot-assisted group had a significantly better function in forward flexion, abduction, and internal rotation (150.00 ± 9.26 vs. 126.67 ± 21.94, 138.75 ± 12.46 vs. 106.25 ± 32.27, 84.38 ± 4.96 vs. 59.58 ± 15.73, respectively) (P < 0.05). Conclusion Robot-assisted percutaneous screw fixation offers a safe and minimally invasive treatment option for displaced intra-articular glenoid Ideberg Ia fractures. This technique not only promotes faster healing but also provides superior cosmetic results and excellent functional outcomes when compared to traditional ORIF.

Achieving effective bone regeneration of critical-size bone defects resulted from either trauma or metabolic disorders is a big clinical challenge. Biodegradable and bioactive bone substitutes designed for filling up bone defects to enhance osteogenesis and angiogenesis have become the focus for clinical use over the past few decades. We developed a novel porous composite scaffold (known as Bongolle®) is composed of bioactive magnesium (Mg), poly(lactide-co-glycolide) (PLGA) and β-tricalcium phosphate (β-TCP). We fabricated Bongolle® by a unique low-temperature rapid prototyping (LT-RP) technology with a well-designed biomimetic structure. We then tested Bongolle® in a multi-centered, prospective randomized controlled trial (RCT). The RCT suggests that The Bongolle® group demonstrated a 40 % faster scaffold residual bone fusion rate at 12 weeks post-surgery compared to the control group (χ2 = 10.175, P < 0.01). By 24 weeks post-surgery, both groups exhibited a similar fusion rate (χ2 = 1.101, P > 0.05). Radiographic density of the implanted scaffolds revealed that the Bongolle® group experienced a 9.29 ± 17.80 % increase at 12 weeks and a 12.68 ± 21.86 % increase at 24 weeks post-surgery (P < 0.01), while the control group showed no significant changes. These findings suggest that Bongolle® is a promising bioadaptive scaffold material for inducing scaffold fusion with the local host bone and new bone regeneration accompanied by scaffold degradation with its implantation overtime. This study is the first RCT to report that Bongolle® has strong potential for future clinical applications where it might synergistically facilitate bone regeneration and early healing in critical-size bone defects.

Background:The objective of this study was to compare the clinical outcomes of robot-assisted retrograde elastic intramedullary nailing and open reduction and internal fixation (ORIF) with a plate for displaced midshaft clavicular fractures. Methods:All patients diagnosed with displaced midshaft clavicular fractures between November 1, 2022, and June 30, 2023, in our level-III hospital (most advanced level) were enrolled in this retrospective study; a total of 116 patients met the inclusion criteria. Patients were divided into 2 groups on the basis of treatment: robot-assisted retrograde elastic intramedullary nailing (RAN group) and ORIF with a plate (plate group). Operations in the RAN group were carried out using the novel TIANJI Robot system (TINAVI Medical Technologies) for navigation and planning of the optimal retrograde intramedullary nailing trajectory. Patient demographics, perioperative parameters, and complications were documented. Patients were followed at the trauma clinic for clinical and radiographic assessment. Results:There were 74 patients in the RAN group and 42 patients in the plate group. The RAN group exhibited a significantly shorter total operative time (mean, 52.20 ± 20.76 versus 86.83 ± 27.42 minutes), less blood loss (mean, 7.38 ± 5.54 versus 59.05 ± 30.11 mL), shorter incision length (mean, 1.28 ± 0.85 versus 9.79 ± 1.63 cm), and shorter duration of hospital stay (mean, 3.38 ± 0.73 versus 5.50 ± 1.99 days) (all p < 0.05). Nail treatment was also associated with a significantly shorter time to bone union (mean, 7.92 ± 2.46 versus 16.79 ± 5.18 weeks), a higher SCAR score (mean, 9.77 ± 0.51 versus 5.74 ± 1.15), a shorter time to return to sports (mean, 12.70 ± 2.35 versus 20.10 ± 4.10 weeks), and a shorter time to regain full range of shoulder motion (mean, 9.46 ± 2.35 versus 12.05 ± 2.95 weeks) (all p < 0.05). At the final follow-up, the Constant-Murley shoulder score was significantly higher in the RAN group (mean, 97.57 ± 2.77 versus 93.29 ± 7.63) (p < 0.05). Compared with the RAN group, the plate group had more complications (p < 0.05). Conclusions:Robot-assisted retrograde elastic intramedullary nailing is a safe and minimally invasive treatment option for displaced midshaft clavicular fractures that promotes rapid healing, good cosmesis, excellent functional outcomes, and fewer complications compared with ORIF with a plate. Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Magnesium alloys have gained popularity in orthopedic implants due to their excellent biocompatibility and biodegradability, which eliminates the need for secondary surgeries for removal. However, uncontrolled rapid degradation of most magnesium alloys can lead to early failure of implants with unexpected accumulation of gas,disturbing regeneration of surrounding tissues. In this article, we introduce new Mg-Zn-Zr-Mn magnesium alloys with biocompatible elements in low concentrations, which can form single-phase alloy and diminish corrosion due to galvanic corrosion due to multiple phases. These alloys also demonstrated outstanding mechanical properties with tensile strength of 332 MPa and excellent biocompatibility. Degradation tests were conducted in vitro by electrochemical tests and measuring mass loss and hydrogen gas released, and nearly constant degradation behavior was observed. In vivo degradation experiments were done using goats as models, and long-term observation demonstrated excellent biocompatibility and controlled degradation pattern of our new Mg alloys.Our results provided insights into the in vitro and in vivo performance of our new Mg alloys, and they can be highly promising for widespread use in orthopedic implants.

BACKGROUND:Post-traumatic elbow stiffness poses significant clinical challenges for upper limb surgeons and severely impairs patients' ability to perform essential daily activities, including eating, dressing, and personal hygiene, thereby imposing substantial socioeconomic burdens. Open arthrolysis is widely employed when conservative therapies fail, yet current literatures demonstrate considerable heterogeneity in treatment concepts, surgical techniques, and perioperative management. This evidence-based clinical practice guideline aims to standardize treatment profiles and improve surgical outcomes for open arthrolysis of post-traumatic elbow stiffness in adult patients globally. METHODS:The Chinese National Center for Orthopaedics (Shanghai and Beijing, China) and Asan Medical Center (Seoul, Korea) initiate, sponsor, and organize a collaboration among worldwide experts in the field of elbow to develop this guideline, adhering to the Reporting Items for Practice Guidelines in Healthcare. Evidence searches focus on meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control studies, and case series studies. The Grading of Recommendations Assessment, Development and Evaluation system and Delphi method process are used to assess the level of evidence and strength of recommendations. RESULTS:Finally, a total of 28 evidence-based recommendations for open arthrolysis in adult post-traumatic elbow stiffness are formulated in response to 13 most concerned important clinical questions. On the whole, recommendations span 4 domains: (1) Indications/Timing; Q1-Q2, 2 recommendations; (2) Surgical Techniques; Q3-Q8, 15 recommendations; (3) Perioperative Care; Q9-Q11, 8 recommendations; and (4) Complication Prevention; Q12-Q13, 3 recommendations. CONCLUSION:This multinational initiative provides the first comprehensive clinical practice guideline for open arthrolysis in adult post-traumatic elbow stiffness. The recommendations provided herein are grounded in a comprehensive review of existing literatures, and they establish actionable standards for preoperative decision-making, intraoperative techniques, and postoperative care, ultimately hoping to enhance patients' functional recovery and quality of life.

Objectives The ankle fracture with both deltoid ligament (DL) rupture and syndesmotic diastasis was treated by fixing syndesmosis after open reduction and plate fixation of the fibular fracture. The present study aimed to evaluate the effect of deltoid ligament augmentation (DLA) replacing syndesmosis fixation for the treatment of such a fracture. Methods This randomized controlled trial recruited acute ankle fracture patients with syndesmotic instability and DL rupture. Patients were randomized into DLA and trans-syndesmotic screw fixation (TSSF) groups. The primary outcome measure was the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale at 1 year post-surgery. The secondary outcome measures included Philips and Schwartz clinical scoring system of the ankle, the short-form (SF-36) questionnaire for quality of life, the range of ankle motion, the time to partial weight-bearing, the time to full weight-bearing, the time to return to previous work, the time to preinjury-level play, radiographic parameters, and complications. The analyses followed the intention-to-treat principle. Results A total of 60 patients were randomized, and 59 were included for analysis: 30 in the DLA group and 29 in the TSSF group. The AOFAS scores at 1 year after surgery showed no statistical significance between the two groups. However, clinical scores at 3 months after surgery, including AOFAS score, Philips and Schwartz score, and subscales of SF-36 (physical function, general health, and social function), were significantly better in the DLA group than the TSSF group. Time to partial-weight-bearing, full-weight-bearing, return to work, and return to preinjury-level play were significantly reduced in the DLA group. No major complications were observed in both groups, and no difference was detected in the radiographic parameters immediately after surgery and at 1-year follow-up. Conclusion DLA achieved satisfactory clinical and radiographic outcomes at 1-year follow-up with rapid recovery post-surgery. This treatment method should be considered as an alternative option in ankle fractures associated with deltoid ligament rupture and syndesmotic diastasis.

BACKGROUND:The development of heterotopic ossification (HO) is a common yet debilitating complication after elbow injuries and related surgical procedures. We intend to evaluate the regional distribution features of HO around the elbow joint in patients with post-traumatic elbow stiffness (PTES), and explore the independent risk factors for HO development in different regions. MATERIALS AND METHODS:Patients who presented with PTES attributed to HO from January 2018 to December 2019 were consecutively enrolled. The pattern of HO distribution was analyzed using Mimics software (Mimics 21.0, Materialise NV, Leuven, Belgium) and classified into 8 distinct regions: anteromedial (AM), anterolateral (AL), posteromedial (PM), posterolateral (PL), posterior (P), medial (M), lateral (L), and proximal radioulnar (PRU) regions. The initial injuries were further categorized based on the presence or absence of 5 fundamental injury types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. With the occurrence of HO in a specific region as the dependent variable and the initial injury patterns and baseline clinical data as independent variables, logistic regression analyses were conducted to identify the associated independent risk factors for HO development in different regions. RESULTS:A total of 170 patients were included. We identified PM HO in 166 patients (97.6%), P HO in 135 patients (79.4%), PL HO in 128 patients (75.3%), AM HO in 92 patients (54.1%), AL HO in 57 patients (33.5%), PRU HO in 32 patients (18.2%), M HO in 12 patients (7.1%), and L HO in 11 patients (6.5%). The results of logistic regression analyses: (1) AM HO: time interval between the initial injury and this admission ≥1 year (odds ratio [OR] = 2.338), the presence of elbow dislocation (OR = 3.193) and olecranon fracture (OR = 0.305); (2) AL HO: high energy trauma (OR = 2.073) and the presence of olecranon fracture (OR = 0.367); (3) P HO: immobilization for more than 2 weeks after the initial injury or subsequent surgical procedures (OR = 2.466); (4) PL HO: the presence of radial head fracture (OR = 2.805); (5) PRU HO: the presence of radial head fracture (OR = 8.186); (6) PM + P + PL HO: the presence of radial head fracture (OR = 2.235). CONCLUSION:The regional distribution of HO in patients with PTES exhibits distinct features, and PM HO is observed in almost all patients. The type of initial injury and its subsequent management are closely related to the occurrence and development of HO in different regions. Our findings provide valuable insights and serve as a useful reference for the clinical assessment of HO in patients with PTES.

BACKGROUND:Posttraumatic elbow stiffness together with severe bony deformity of the distal humerus poses a great challenge for elbow surgery specialists. For young and high-demand patients suffering from grievous bony deformity but with no/mild joint degeneration, total elbow arthroplasty is not a suitable option, and hemiarthroplasty often results in a significant amount of bone stock loss, making it difficult to perform a revision procedure. Resurfacing arthroplasty has been applied in the shoulder, hip, and knee joints, as well as the radiocapitellar joint. However, resurfacing arthroplasty for the entire distal humeral articular surface was not available among current clinical studies. CASE PRESENTATION:We report a case of a 66-year-old male patient who presented with elbow stiffness and grievous malunion of the distal humerus due to delayed treatment after a distal humerus fracture. However, there was only mild joint degeneration observed at the proximal ulna and radius owing to long-term functional impairment. Total elbow replacement was not suitable considering certain inevitable manual labor he must attend. We customized a cementless and stemless resurfacing prosthesis for the distal humerus based on contralateral articular anatomy using a 3D-printing technique with Co-Cr-Mo alloy. The traditional cemented stem was replaced with criss-cross screws to provide primary stability. The bone-implant interface was covered with a 3D-printed trabecular-like porous structure for bone in-growth and several grooves designed for bone grafting, eventually forming a stable multinested mortise-and-tenon joint structure at the bone-implant interface. At the last follow-up, significant improvements in functional outcomes of the elbow joint were observed without any prosthesis-related complications. The patient was able to return to his previous manual labor and reported improved weight-bearing capability of the affected upper limb up to 25 kg without pain or instability. While he complained of postoperative ulnar nerve palsy, the symptom markedly improved at the final follow-up. CONCLUSION:The novel prosthesis we have designed for resurfacing arthroplasty of the distal humerus can provide adequate primary stability and bone in-growth capability, making it a reliable alternative for patients with severe bony deformity of the distal humerus and no/mild joint degeneration at the proximal ulna and radius, particularly young patients or those with high functional demands.

BackgroundAlthough brachial plexus injury following clavicle fractures is rare, it can be a serious complication with significant implications for recovery. In this report, we present a case of midshaft clavicle fracture treated with elastic intramedullary nailing, where the patient developed brachial plexus injury symptoms two months post-surgery.Case presentationA 37-year-old woman with a middle-third clavicle fracture presented to the emergency room 5 days after a traffic accident. The patient underwent robot-assisted minimally invasive elastic intramedullary nail fixation for the left clavicle fracture with TiRobot assistance. 2 months after surgery, the patient reported numbness in all fingers of the left hand, affecting both the palmar and dorsal sides, with a pronounced impact on the thumb. Additionally, the patient was unable to move the shoulder and elbow actively (grade 1). x-ray and CT imaging revealed significant callus formation at the fracture site. Electromyography (EMG) and Doppler ultrasound all suggested left incomplete brachial plexus injury with root-level impairment. Conservative treatment, including regular physiotherapist-supervised rehabilitation, was initiated. Over time, the patient experienced gradual improvement in muscle strength and resolution of numbness. 6 months after the onset of brachial plexus injury, the elastic intramedullary nail was removed. x-ray imaging revealed notable bone remodeling with reduced callus formation at the fracture site compared to the findings observed at the onset of the brachial plexus injury. The patient reported an overall recovery of 95% compared to her condition at the time of the injury, reflecting a highly satisfactory outcome.ConclusionsThis case highlights the importance of vigilance for brachial plexus injury in patients with clavicle fractures and demonstrates the potential for successful outcomes with conservative treatment. Furthermore, it contributes to the limited body of literature regarding the rare occurrence of brachial plexus injury after elastic intramedullary nailing of clavicular fractures.

Background: Coronoid fractures are often part of a complex fracture-dislocation of the elbow. For an optimum prognosis, it is important to understand the characteristics of coronoid fractures in different elbow injury patterns. Significant differences in these characteristics have been observed in various studies, but these previous studies have suffered from limitations, such as insufficient quantification and unknown prognostic differences among different injury patterns. Therefore, we aimed to quantitatively analyze coronoid fracture characteristics and functional outcomes in different elbow injury patterns using three-dimensional computed tomography. Methods: All patients with coronoid fractures surgically treated at our hospital between January and December 2017 were categorized into 3 groups according to elbow injury pattern: posterolateral rotational instability (PLRI), varus posteromedial rotational instability (VPMRI), and olecranon fracture-dislocation (OFD). 3D models were reconstructed using Mimics 17.0, and the total volume and number of coronoid fragments were measured. The coronoid process edge was classified into different anatomical regions, and each region was assigned a number to quantify the distribution of fracture lines. At the last follow-up, the range of motion, visual analog scale, Mayo Elbow Performance Score, complications and reoperations were recorded. Results: The 92 patients enrolled had an average age of 42 +/- 15 years and a male-to-female ratio of 66:26. The median total volume in PLRI patients was less than that in VPMRI patients [431 (132, 818) mm3 vs. 1125 (746, 1421) mm3, adjusted P < .001] and OFD patients [431 (132, 818) mm3 vs. 2565 (381, 4076) mm3, adjusted P = .001]. The median number of coronoid fragments in PLRI patients was also less than that in VPMRI patients [1(1, 2) vs. 2 (1, 3), adjusted P = .043]. Most of the PCFL-Rs (79%) were located around the volar edge of the lesser sigmoid notch. Compared with that of PLRI, the PCFL-Us of the VPMRI and OFD tended to be located on the more ulnodorsal side of the coronoid process edge. The median ROM [110 (90, 133), P = .001] and the median Mayo Elbow Performance Score [85 (68, 95), P = .038] of patients with OFD were significantly less than those of patients with the other 2 patterns. The incidence of elbow stiffness (56%, 5/9, P = .001) and implant-related irritation (44%, 4/9, P < .001) in the OFD group was significantly higher than that in the other 2 groups. Conclusion: Coronoid fractures differ significantly in fragment volume, comminution severity, and fracture line distribution among different elbow injury patterns. OFD has the worst functional outcomes among complex elbow injury patterns. Level of evidence: Level III; Retrospective Cohort Comparison; Prognosis Study (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Olecranon fractures account for 8 ∼ 10

Objective Periprosthetic joint infection (PJI) poses significant challenges to arthroplasty outcomes, necessitating translational animal models for pathogenesis studies and therapeutic development. This study aimed to establish a standardized Beagle PJI model by integrating species-specific 3D-printed femoral prostheses with quantitative bacterial inoculation, while evaluating the dose-dependent effects of Staphylococcus aureus (S. aureus) on infection progression. Methods Two titanium alloy prostheses were designed using CT-based anatomical data: BFP-C (canine-optimized) and BFP-H (human-derived). Prostheses underwent mechanical compression tests, finite element analysis (FEA) simulating postoperative and osseointegration phases, and in vivo validation in Beagles. The optimized BFP-C was selected for PJI model construction via hemi-hip arthroplasty (HHA), with intraoperative inoculation of S. aureus ranging from 250 to 10^8 colony-forming units (CFU). Longitudinal evaluation included radiography (X-ray/CT), mechanical pull-out tests, histopathology (H&E/Masson/Giemsa staining), bacterial cultures, and mobility assessments using open-field behavioural tracking. Results BFP-C exhibited superior biomechanical compatibility, with 12.3-fold higher yield strength (6836 ± 157 N vs. 553 ± 49 N) and 97 % reduction in bone strain (0.71 % vs. 20.32 %) compared to BFP-H. All inoculated groups developed PJI with dose-dependent severity: ultra-high-dose (10^8 CFU) groups displayed severe osteolysis (pull-out strength: 24 ± 8 N vs. 924 ± 45 N in controls), biofilm formation, and mobility impairment (74 % reduction in distance travelled, 2003 ± 276 cm vs. 7976 ± 333 cm in controls), whereas low-dose (250 CFU) groups established PJI with milder manifestations, evidenced by sinus tract formation, 55.1 % reduction in pull-out strength (406 ± 15 N vs. 924 ± 45 N in controls), and concordant radiological/histopathological signs of infection. Imaging examinations revealed differential osteolytic patterns corresponding to bacterial loads. Combined wound evaluation and microbiological analyses confirmed consistent infection establishment across all replicates. Conclusion This Beagle PJI model successfully recapitulates clinical infection dynamics, emphasizing the critical role of species-specific prosthesis design and standardized bacterial quantification. The integrated multimodal evaluation system (imaging, biomechanical, and behavioural analyses) demonstrated both the reliability of the model and its sensitivity in detecting infection progression. Its modular design supports customization for studying biofilm-resistant implants or antibiotic delivery systems. These findings not only provide a critical tool for mechanistic PJI research but also establish a theoretical foundation for clinical translation, with the quantitative multimodal framework directly informing diagnostic and therapeutic strategies. Translational potential Beyond serving as a preclinical platform for anti-infective therapies, the model provides actionable insights into optimizing human prosthetic biomechanics, such as reducing stress shielding through FEA-informed design principles. The 3D printing workflow further demonstrates rapid prototyping capabilities for patient-specific orthopaedic implants.

Humans, as natural carriers of Staphylococcus aureus (SA), have developed nonprotective immune imprints that can be reactivated by SA antigen vaccination and that contribute to the failure of SA vaccine trials. To test whether an epitope-focused vaccine strategy can overcome this issue, we explored the protective epitope of the notable SA antigen MntC. A surface loop of MntC (Loop101) was found to be essential for SA to absorb manganese(II) ion and survive oxidative stress. Our Loop101-deficient versus -competent MntC-based differential screening identified a Loop101-specific human monoclonal antibody (Hm0686). Hm0686 blocked SA from absorbing manganese(II) ion and exhibited a strong opsonophagocytic activity, suggesting that Hm0686-targeted Loop101 may be a protective epitope. A Loop101 epitope vaccine but not the whole MntC antigen protected against SA infection in mice with prior exposure-induced nonprotective imprints. Thus, this effective protective epitope-based vaccine strategy may be explored to overcome nonprotective immune imprints in humans.

ABSTRACTObjectivePlate fixation is the preferred method for treating forearm shaft fractures. However, it remains controversial regarding the necessity of implant removal after bone union. This review aims to assess refracture risk after plate removal.MethodsWe searched various data sources, including PubMed, Embase, Web of Science, and Cochrane Library. A total of 6749 papers were identified, of which 23 studies were eligible for final quantitative syntheses. Subgroup analyses and sensitivity analyses were conducted to reduce heterogeneity and make the results more reliable.ResultsThe total risk difference (RD) was 0.06 (0.04–0.09), indicating that the difference was significant. In the “Reasons for Removal” subgroup analysis, the RD of the “No Symptom” subgroup was 0.07 (95% CI = 0.04–0.11), while the RD of the “Symptoms” subgroup was 0.04 (95% CI = −0.02 to 0.10). In the “Plate Type” subgroup analysis, the RD of the “LCP” subgroup was 0.07 (95% CI = 0.02–0.13), while the RD of the “DCP” subgroup was 0.07 (95% CI = 0.01–0.13). After omitting each study one by one, the RDs were all significant.ConclusionsPlate retention is significantly associated with a lower rate of refracture than plate removal. Consequently, it is not recommended to remove implants, especially for patients without implant‐related symptoms, but more reliable evidence is still needed.Trial RegistrationThe review was registered on PROSPERO and the registration ID is CRD42023424743, and a protocol was not prepared

PURPOSE:To investigate the injury mechanism, diagnosis, and treatment of varus-posteromedial rotational instability of the elbow joint in children. METHODS:According to the diagnostic criteria of varus posteromedial rotational instability of elbow joint, 16 children with coronoid process fractures treated in our department from July 2013 to July 2017 were re-evaluated. There were 14 males and 2 females, aged 7 to 14 years, with an average age of 11.6 years. Eight cases on left and 8 cases on right side. An associated elbow dislocation occurred in 8 of 16 cases. Nine patients were treated with a lateral soft tissue repair only. In 7 other patients in addition to the lateral soft tissue repair, the coronoid process fractures were treated with open reduction and fixation. At the last clinical follow-up, each elbow joint range of motion was recorded, radiographs were obtained, and functional performance was evaluated by the Mayo elbow performance score (MEPS). RESULTS:The average follow-up time was 81.9 months for the 9 patients treated with lateral elbow soft tissue repair. At the last follow-up, 2 of the patients had MEPS scores as excellent, 1 was good, and 6 were rated as moderate or poor. Four patients had a cubitus varus deformity. The average follow-up time was 30.3 months for the 7 patients treated with both soft tissue repair and coronoid fracture stabilization. The elbow joint MEPS scores for each of these 7 patients was excellent at the last follow-up, and no complications such as cubitus varus occurred. CONCLUSION:The results of the study suggest that children could also develop elbow varus-posterior medial rotational instability injuries under the same mechanism. Although the morbidity rate is low, due to insufficient understanding of the injury mechanism, it is prone to missed diagnosis, misdiagnosis, and delayed treatment, resulting in severe complications such as elbow instability, dislocation, traumatic arthritis, and elbow stiffness. On the contrary, according to the treatment principle of the posterior medial rotational instability of the elbow joint in adult, while the lateral repair is carried out, strong and effective reduction and fixation of the coronoid process fractures are adopted, it is expected that such children with rare elbow injuries can obtain excellent treatment outcomes.