Background: Locking plate fixation is widely used for the treatment of displaced proximal humerus fractures; however, robust long-term data regarding its function and late complications remain limited. We report 6-year clinical and radiographic outcomes of locking plate fixation, including data regarding the relationship between avascular necrosis (AVN), post-traumatic osteoarthritis (PTA), and shoulder function. Methods: Between 2017 and 2019, 31 consecutive patients (21 women, 10 men; mean age, 63 years) with displaced proximal humerus fractures underwent fixation with a locking plate. Follow-up data were obtained at 3, 12, and 72 months. The fractures were classified using the Neer classification system (9 patients with 2-part fractures, 16 with 3-part fractures, and 6 with 4-part fractures). Functional outcomes were assessed using the Constant score. Radiographs were evaluated for AVN (y/n) and PTA (y/n). Reoperations and complications were also recorded. Results: At 72 months, the mean Constant score was 66.2, with no improvement beyond 12 months. AVN occurred in 19% of patients and PTA in 34% of patients. Despite marked radiographic changes, the patients with AVN showed better shoulder function than those with PTA (P < .05). Reoperations were required in 32% of patients at a mean of 11 months and were most commonly implant removal with or without arthrolysis. Conclusion: Long-term function after locking plate fixation is moderate and plateaus after one year. Although radiographically severe, AVN does not necessarily impair shoulder function. In contrast, PTA is associated with progressive functional decline. These findings emphasize the importance of differentiating between necrotic and degenerative radiographic sequelae and of carefully tailoring the indication for locking plate fixation, particularly in complex fracture patterns.

Tibiofemoral dislocations in children and adolescents are rare, and treatment guidelines are primarily based on adult data and algorithms. This case series of four pediatric and adolescent patients aims to add to the limited literature and highlights key aspects of diagnosis, treatment, and patient-reported outcomes. We conducted a retrospective-prospective single-center case series of pediatric and adolescent patients (< 18 years, open growth plates) treated for tibiofemoral knee dislocations at a Level 1 trauma center between 2017 and 2019. Clinical, radiographic, and intraoperative data were reviewed. In addition, long-term patient-reported outcomes covering both functional recovery and health-related quality of life were assessed using KOOS, IKDC, and EQ-55 D-L. Four patients (2 male, 2 female), aged between 12 and 16 years, were included in this case series. The mean follow-up was 7.3 years (range 6 to 8 years). All patients sustained Schenck Type III-L dislocations. Early MRI and vascular imaging identified frequent associated injuries such as meniscal and chondral lesions, avulsion fractures, in one case, peroneal nerve injury. A staged surgical approach was used in two of the four cases. No growth disturbances or deformities were observed in the patients based on the available clinical and radiological follow-up. Functional outcomes ranged from moderate to excellent (KOOS: 59–92

Abstract:Equestrian sport is a major component of German athletics, with broad recreational participation and a strong competitive sector. In 2019, about 2.32 million people identified as active riders, and more than 60,000 competitional licences were issued in 2021, reflecting substantial competitive engagement across the Olympic disciplines and national performance levels. Hip pain is a frequent and clinically relevant complaint among athletes and can stem from structural, degenerative, or overuse-related causes. In riding, the hip joint is crucial for transmitting forces and coordinating rider-horse interaction. Fine adjustments in tension and release at the hip allow riders to follow and influence the horse's movement; pain can therefore disrupt key control mechanisms. Studies consistently show a notable burden of musculoskeletal symptoms among equestrians. Hip pain affects 8-19% of riders and is associated with impaired pelvic stability, reduced lower limb control, and performance limitations. Chronic symptoms frequently relate to previous injuries, and older riders report persistent discomfort, likely due to cumulative mechanical loading. This study aims to determine the prevalence and characteristics of hip problems in competitive German equestrians and identify relevant risk and protective factors.

Pain in the scapular region is a common musculoskeletal complaint, yet its anatomical basis often remains unclear. This study investigates the supraspinatus fascia as a potential contributor to shoulder pain, with particular emphasis on its surgical relevance. A total of 24 body donors were examined using dissection and histological analysis to characterize the fascia’s morphology, topography, and neurovascular features. The supraspinatus fascia consistently demonstrated a distinct two-layered architecture. Both layers showed considerable interindividual variability, ranging from thin and translucent to dense and collagen rich. There is an interposed fat layer between the superficial and deep fascial layer suggesting a potential sliding interface. The fascia forms a tubular sheath around the supraspinatus muscle, attaching to the margins of the supraspinatus fossa as well as the superior transverse scapular ligament, clavicle, and coracoid process. The deep layer is continuous with the subacromial bursa and the posterior origin of the supraspinatus muscle. In contrast, the superficial layer integrates into surrounding fascial systems, including connections to the fasciae of the levator scapulae and rhomboid minor muscles. Histological analysis identified neurovascular bundles within and traversing both fascial layers. A subset of nerve fibres showed substance P immunoreactivity, supporting a nociceptive role of the supraspinatus fascia. The supraspinatus fascia is a complex structure rather than a passive wrapping. Its distinct two-layered architecture and substance P-positive innervation provide an anatomical basis for idiopathic scapular pain. Clinically, the deep layer’s continuity with the subacromial bursa suggests that inadequate fascial release during subacromial decompression may lead to persistent symptoms. Finally, the superficial layer’s connection to the “levator-rhomboid-minor-fascia” establishes a myofascial bridge for force transmission, suggesting that “shoulder pain” could be a manifestation of cervicoscapular fascial tension.

Die Osteochondrosis dissecans (OD) ist definiert als eine fokale idiopathische Veränderung des subchondralen Knochens mit dem Risiko der Instabilität und Diskontinuität des angrenzenden Gelenkknorpels. In Folge der kompletten Separierung des Fragments besteht die Gefahr einer symptomatischen Verschlechterung mit Blockierung und Bewegungseinschränkung bis hin zur Entwicklung einer Osteoarthrose. Insgesamt zeigen stabile Läsionen mit geringer Größenausdehnung, fehlender subchondraler Zystenbildung, ohne Vergrößerung des Radiuskopfes, offener Wachstumsfuge, kurzer Symptomdauer ein hohes Potenzial der Konsolidierung. Als prognostisch günstig gelten zudem eine progrediente Ossifikation innerhalb der ersten 3 Monate sowie eine gute Compliance hinsichtlich der Aktivitätseinschränkung. Die chirurgischen Verfahren werden in reparative (arthroskopische Fragmententfernung mit oder ohne knochenmarksstimulierende Verfahren, Fragmentrefixation), regenerative („minced cartilage“, autologe Chondrozytentransplantation) und rekonstruktive Therapien (osteochondrale Auto- bzw. Allotransplantation, Keilosteotomien) unterteilt. Fragmentgröße, -stabilität, zirkumferente Abstützung durch gesunde Knorpelanteile („containment“) und die Lokalisation des Defekts („centralized, lateral localized, lateral widespread type“) bestimmen die Wahl der Versorgung wie auch den chirurgischen Zugangsweg. Zur Optimierung der Knorpel- und Knochenheilung werden klassische Verfahren zunehmend durch eine biologische Augmentation ergänzt, insbesondere durch „platelet-rich plasma“ (PRP) und Knochenmarkaspiratkonzentrat („bone marrow aspirate concentrate“, BMAC). Erste Fallserien am Ellenbogen zeigten eine potenzielle Verbesserung der Regenerationsqualität und eine raschere Symptomreduktion, belastbare Langzeitdaten und randomisierte Studien fehlen jedoch.

The prefemoral fat pad (PFP) is located anterior to the distal femur and adjacent to the patellofemoral joint. While the infrapatellar fat pad (IFP) has been extensively studied, morphometric data on the PFP are scarce. The purpose of this study was to characterize the morphology of the PFP on MRI and to evaluate its relationship to adjacent osseous and soft tissue structures. Twenty healthy volunteers were prospectively enrolled, and MRI examinations of 38 knees from 19 participants were analysed. Volumes of the PFP, IFP, and suprapatellar fat pad (SFP) were measured using manual segmentation. Additional morphometric parameters included body height, weight, BMI, age, numerous femoral and tibial osseous dimensions, the Insall-Salvati ratio, and the suprapatellar axial PFP area (SAPA). Correlation and regression analyses were performed to identify predictors and surrogate measures of PFP volume. Mean PFP and IFP volume were comparable. PFP volume showed significant correlations with selected osseous parameters of the distal femur and proximal tibia. IFP volume and SAPA demonstrated a strong correlation with PFP volume and emerged as surrogate parameters. No significant relationship was found between PFP volume and patellar height as assessed by the Insall-Salvati ratio. In healthy adults, the PFP is similar in size to the IFP and shows consistent morphometric relationships with adjacent structures. SAPA may represent a simplified, time-efficient candidate surrogate measure that showed a strong association with total PFP volume in this healthy cohort; further validation in larger and symptomatic populations is required before it can substitute for complete volumetric segmentation in clinical practice. These findings provide baseline morphometric data for future studies investigating pathological alterations of the PFP.

Background Pathologies of the long head of the biceps (LHB) tendon are common, including tendinopathy, instability, pulley lesions and SLAP lesions. Lesions of the short head of the biceps (SHB) tendon are rare, mostly traumatic or iatrogenic but can be clinically relevant in complex injury patterns, such as superior shoulder suspensory complex (SSSC, floating shoulder) injuries. Objective Presentation of current diagnostic and treatment concepts for proximal biceps tendon pathologies and the coracoid region, with a focus on differentiated indications. Material and methods Selective review of the current literature, complemented by clinical experience and illustrative cases from arthroscopic and open surgery. Results Conservative treatment is the first choice for LHB pathologies. In cases of persistent symptoms or structural lesions, tenotomy and tenodesis are established surgical options. Both yield comparable functional outcomes but differ in cosmetic results (higher rate of Popeye deformity after tenotomy) and muscular cramping rates. Anatomical repair (SLAP, pulley) is successful in young, active patients, while tenodesis is preferable for degenerative alterations. Pathologies of the SHB can be treated conservatively in cases of low functional demands, whereas traumatic ruptures and complex injury patterns require surgical reconstruction. Conclusion Individualized decision-making considering age, functional demands, cosmetic expectations and concomitant pathologies is essential for an optimal outcome.

PURPOSE:Optimal treatment strategies for (osteo-)chondral injuries following patellar dislocation remain unclear. This retrospective multicentre study aimed to compare outcomes between chondral and osteochondral lesions and to explore factors associated with revision surgery. METHODS:Patients who underwent surgical treatment for (osteo-)chondral injuries secondary to patellar dislocation over a 10-year period were included. The primary endpoint was revision surgery; secondary endpoints included patient-reported outcome measures (PROMs) (Banff Patellofemoral Instability Instrument 2.0, EuroQol 5-Dimension [EQ-5D], International Knee Documentation Committee [IKDC-2000] and Marx Activity Rating Scale). Outcomes were compared between chondral and osteochondral lesions using multivariable regression models to adjust for clinically relevant confounders. RESULTS:A total of 208 patients with chondral and/or osteochondral defects were included (chondral: 27.4%; osteochondral: 71.2%; combined chondral and osteochondral: 1.4%). Only patients with purely chondral or osteochondral lesions were further analysed (n = 205). Treatment strategies differed between groups, with fragment refixation more commonly performed in osteochondral lesions (62.8% vs. 19.3%, p < 0.001). Overall, 11.2% of patients underwent revision surgery, with no significant difference between lesion types. Concomitant stabilising procedures were associated with lower odds of revision surgery (adj. p = 0.005). Patients with chondral lesions had higher scores in the Marx Activity Rating Scale (adj. p = 0.017). CONCLUSIONS:No significant difference in revision rates was observed between chondral and osteochondral lesions following patellar dislocation. Concomitant stabilising procedures were associated with lower odds of revision surgery. Given the retrospective design and limited number of events, these findings should be considered exploratory and require confirmation in prospective studies. LEVEL OF EVIDENCE:Level III.

Background The hip plays a central role in handballers performance and is therefore prone to injuries and degeneration. There however exist limited data on hip and groin complainsin elite handball players. This study aimed to assess the incidence, characteristics, and risk factors of hip and groin complaints in elite players in Germany. Methods A cross-sectional online survey was distributed to all professional handball teams in Germany (male and female). The questionnaire included anthropometric data, sport-specific variables, and patient reported outcome measures (Copenhagen Hip and Groin Outcome Score and EQ-5D-5L) Results 246 athletes (135 female) completed the survey. Hip and groin complaints were reported by 48% of participants, with significantly higher incidence among males than females (p = 0.05). Complaints were most common in male goalkeepers (81%). Among symptomatic athletes, 24% had missed training due to hip complaints. Increased body weight was significantly associated with hip complaints. Players with hip and groin complains reported significantly lower scores across all HAGOS subscales (p < 0.001) and reduced EQ-5D-5L index scores (p = 0.005). Conclusion Hip and groin complaints are common among elite handball players and are associated with significant functional impairment. The findings highlight the need for sex- and position-specific prevention, early diagnosis, and individualized training and rehabilitation strategies to mitigate long-term morbidity.

In 61% of multiligament knee injuries (MLKIs), the posterolateral corner (PLC) is involved. These patients frequently require anterior cruciate ligament (ACL) and/or posterior cruciate ligament (PCL) reconstruction in addition to lateral stabilization. Consequently, two or more tendon grafts are often necessary to achieve adequate knee reconstruction. The aim of this study was to describe a surgical technique for combined anterolateral and posterolateral reconstruction without the need for additional autologous tendon harvesting. This technique utilizes a continuous iliotibial band (ITB) autograft. The novel surgical technique was performed on eight cadaveric specimens that had not undergone any previous knee surgery. A long, continuous ITB graft is harvested using a double-bladed scalpel. Distally, it remains attached to Gerdy's tubercle. It is then routed through the periarticular tissue and secured dorsocranially to the lateral femoral epicondyle, creating a lateral extra-articular tenodesis. The remaining graft is then shuttled towards the anterior fibular head and passed through a previously drilled fibular tunnel. After exiting the fibular tunnel dorsally, the graft is shuttled towards the femoral insertion of the popliteal tendon and secured. This cadaveric study illustrates that a continuous iliotibial band autograft can be utilized to perform a combined anterolateral and posterolateral reconstruction, with the graft sequentially following the trajectory of a Lemaire’s lateral extra-articular tenodesis and Arciero’s posterolateral reconstruction technique. This technique may present a useful alternative in cases of complex lateral multiligament knee injuries.

Objective:To investigate the association between coronal plane malalignment of the lower extremity and talar osteochondritis dissecans (OCD) localization, and assess the influence of mechanical axis deviations and local joint morphology on lesion distribution. Design:This retrospective monocentric study included 50 patients (mean age 31 ​± ​12 years) with 52 talar OCD lesions who underwent standing whole-leg radiography, which were analyzed digitally. The primary outcome was OCD lesion localization (medial vs. lateral) in relation to coronal plane lower limb alignment (varus, neutral, valgus). Secondary outcomes included angular parameters of the knee and ankle (mLDFA, mMPTA, mLDTA, JLCA, KAJA, talar inclination, talar tilt) and associations lower limb alignment patterns with lesion location. Associations were assessed via univariate testing and binary logistic regression. Results:Talar OCDs occurred medially in 83 ​% and laterally in 17 ​%. Lower limb malalignment was significantly associated with lesion localization (p ​= ​0.024), with varus correlated with medial, while valgus predicted lateral OCD lesions (OR 2.63; 95 ​% CI 1.1-6.4; p ​= ​0.034). Talar tilt independently correlated with lesion site (p ​< ​0.001); tibiotalar valgus tilt increased odds for lateral lesions (OR 0.084; 95 ​% CI 0.01-0.73; p ​= ​0.025). Combined knee and ankle alignment subtypes also influenced lesion laterality (p ​= ​0.017). Conclusions:Lower limb malalignment and talar tilt are independent predictors of OCD localization. Coronal plane deviations and joint morphology alter load across the talar dome, contributing to medial or lateral predilection. Whole-leg alignment analysis should be considered in diagnostic and surgical planning, particularly in revision cases.

PURPOSE:The prefemoral fat pad (PFP) is a widely known but in comparison to the suprapatellar and infrapatellar fat pad (IFP) a drastically underreported anatomical structure in the ventral knee. Although it is mentioned in the context of osteoarthritis and as a source of ventral knee pain, there are no reports on its anatomical characteristics and relationships. METHODS:We investigated the PFP radiologically and via dissection in 10 fresh frozen cadaveric knees. Thereby we focused on its size, anatomical relationship to neighboring structures and blood and nerve supply and compared our findings to the IFP. Samples of the PFP were also evaluated histologically and through epoxy resin plastination. Additionally, we compared its size to the size of the IFP and the extracted descriptive data of the cadavers. RESULTS:We found the PFP in all knees with a mean size of 24,79 cm3, whereas the mean size of the IFP was 20,06 cm3. The PFP was directly adjacent to the femur, the articularis genus muscle and suprapatellar bursa, as well as the medial and lateral intermuscular septum and the trochlear cartilage. We found blood vessels and nerves inserting into the PFP in all cases. The size of the PFP significantly correlated with the size of the IFP and the weight of the body donor. Additionally, the PFP was larger in males than in females. CONCLUSION:In our study the PFP was the largest of the three fat pads in the anterior knee. It always exists with a describable anatomy. The anatomical similarities between the PFP and the IFP may imply that characteristics and properties of the PFP may be similar to those of the IFP. Ultimately, the PFP's anatomical existence suggests a potential role in patellar stability and tracking.

Die proximale Humerusfraktur ist nicht nur eine häufige Verletzung, sondern auch ein wichtiger Hinweis auf eine möglicherweise zugrunde liegende Osteoporose. Daher sollten neben der Frakturversorgung auch die frühzeitige Diagnostik und Therapie der Osteoporose im Mittelpunkt stehen. Die Behandlungsentscheidung zwischen konservativem und operativem Vorgehen erfordert eine differenzierte Betrachtung des Frakturtyps, der individuellen Patientencharakteristika und der funktionellen Erwartungen. Die konservative Therapie bietet in bestimmten Fällen eine adäquate Alternative, insbesondere bei geriatrischen Patienten mit geringer Belastungserwartung. Allerdings bleibt die Standardisierung dieser Behandlungsstrategie eine Herausforderung. Operative Verfahren haben sich insbesondere bei komplexen Frakturen bewährt, wobei die inverse Prothese zunehmend als zuverlässige Option gilt. Verschiedene Augmentations- und Fixationstechniken, wie die Kombination aus winkelstabiler Platte mit Fibula-Graft oder Doppelplattenosteosynthese, gehen mit biomechanischen Vorteilen einher und können die Primärstabilität verbessern. Innovative Technologien wie die 3D-Planung, intraoperative Navigation und Robotik bieten neue Möglichkeiten zur Optimierung der Implantatplatzierung und können langfristig zur Verbesserung klinischer Ergebnisse beitragen. Ökonomische Analysen deuten darauf hin, dass die inverse Prothetik in bestimmten Fällen nicht nur klinische Vorteile bietet, sondern auch wirtschaftlich sinnvoll sein kann. Die langfristigen Auswirkungen auf das Gesundheitssystem müssen jedoch weiterhin evaluiert werden.

Background Large language models (LLMs) are increasingly used in the medical sector, raising questions about their reliability for patient education. With more LLMs becoming publicly available, it remains unclear whether meaningful performance differences exist between them. This is particularly relevant for anterior cruciate ligament (ACL) injuries, which mainly affect young, active individuals, those most likely to seek health advice from AI. This study aimed to evaluate and directly compare the accuracy of five leading LLMs in answering common patient questions about ACL tears. Methods Fourteen commonly asked patient questions were identified in a systematic online search. Each question was submitted to five LLMs: ChatGPT-4, Gemini 2.0, Llama 3.1, DeepSeek-V3, and Grok3. Responses were assessed for accuracy by orthopedic consultants using a five-point Likert scale. Word count was recorded as a proxy for readability. Statistical analysis included ANOVA by Tukey’s HSD post hoc test. Results All models achieved mean accuracy scores ≥3 (mostly accurate). DeepSeek (3.61) and Grok (3.59) demonstrated significantly higher mean accuracies than Llama (3.25; P < 0.05). ChatGPT and Gemini achieved mean scores of 3.48 and 3.52, respectively. Models generating longer responses, such as Grok and DeepSeek, tended to offer greater accuracy, whereas Llama produced the shortest and least accurate answers. Conclusions All tested LLMs show promise for patient education regarding ACL injuries, but notable performance differences exist. Model choice is therefore critical. While all responses were evaluated by clinical experts, the lack of guideline-based validation highlights the need for further studies assessing both accuracy and patient comprehension.

BACKGROUND:The number of reverse shoulder arthroplasty (RSA) procedures performed worldwide has increased over the last 10 years, with a corresponding increase in revision shoulder arthroplasty (SRSA). SRSA is often used for post-traumatic revision surgery in cases of infections and failure of anatomical prostheses. Data on outcomes with specific detail for each indication for the prosthetic solution as a secondary treatment are scarce, and inhomogeneous. METHODS:The questionnaires were sent by mail to 65 patients who underwent SRSA between January 2014 and November 2023. Based on the indications for SRSA, patients were categorized into post-traumatic shoulder arthritis, humeral head necrosis, failed proximal humerus fractures, failed proximal humerus osteosynthesis, prostheses loosening, and infection groups. RESULTS:Of the 65 patients included in the study, 39 completed the questionnaire, and the mean follow-up duration was 44 months (range, 12-104 months). The Constant score ranged from 28 points for all 6 groups (range, 38-66). The post-infection group showed the highest results, with 66 points (range, 24-90) on the Constant score; followed by 26 points (range, 49-6) points on the DASH score; and 0.90 (range, 0.763-1) on the EQ-5D-5L. Failed proximal humerus fractures presented the lowest scores: 38 points (range, 22-63) on the Constant score; 51 points (range, 73-30) points on the DASH score; and 0.61 (range, -0.496-1) on the EQ-5D-5L. CONCLUSIONS:No previous study has investigated the influence of indications on the clinical outcome of SRSA so circumstantial. In this study, the highest outcome scores were observed in the post-infection group, whereas the lowest scores were observed in the failed humerus fracture group. Our results underline the influence of the indication on the clinical outcome of SRSA.

Background: Various techniques are available for the reconstruction of acromioclavicular joint (ACJ) dislocations, with the main focus being on restoration of the AC capsule or coracoclavicular ligaments. Recent research has underlined the significance of the deltotrapezial fascia (DTF) and related muscles as dynamic stabilizers of the ACJ. The Hypothesis was that a reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state. Hypothesis: Reconstruction of the DTF increases the stability of the ACJ in the horizontal plane more than a complete transection of the fascia, while not restoring the stability of the native state. Methods: Five pairs of human cadaveric shoulders including the torsos were included in the study and underwent cyclic anterior- posterior loading using an electromechanical testing machine. The shoulders were put into 3 groups: group N (n = 10): native ACJ; group T (n = 10): ACJ with transected DTF; group R (n = 10): ACJ with reconstruction of the DTF after transection. The dislocation was recorded with a 3D optical measuring system. Results: Group N showed a mean horizontal displacement of 2.94 mm (+/- 1.26), group T showed a mean anterior displacement of 3.33 mm (+/- 1.37), and group R showed a mean anterior displacement of 2.95 mm (+/- 1. 08). The mean anterior displacement for group T was significantly higher after every measured number of cycles compared with groups N and R. There was no significant difference in mean anterior displacement between groups N and R. Conclusion: The transection of the DTF results in significantly reduced stability in the horizontal plane of the ACJ. A reconstruction the DTF restores the stability of the native ACJ in the horizontal plane. Further clinical and biomechanical investigations should focus on reconstruction techniques of the DTF. Level of evidence: Basic Science Study; Biomechanics (c) 2024 The Author(s). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Anteroinferior shoulder dislocations require surgical intervention when related to critical glenoid bone loss. Scapular spine bone blocks have emerged as a promising alternative to traditional bone augmentation techniques. However, limited data exist on their biomechanical stability when using different suture-based fixation techniques. This study aimed to evaluate primary stability and micromotion after glenoid augmentation using a scapular spine bone block. A total of 31 fresh-frozen human shoulder specimens underwent bone block augmentation. The specimens were randomized into three groups: double-screw fixation (DSF), single-suture bone block cerclage (SSBBC), and double-suture bone block cerclage (DSBBC). Biomechanical testing was conducted using cyclic loading (5000 cycles at 1 Hz) and micromotion was analyzed using an optical 3D measurement system. Statistical analysis showed that medial irreversible displacement was significantly greater in the SSBBC group compared to DSF (p = 0.0386), and no significant differences were found in anterior or inferior irreversible displacements. A significant difference was noted in posterior reversible displacement (p = 0.0035), while no differences were found in inferior or medial reversible displacements. Between DSF and DSBBC, no significant differences were found in irreversible or reversible displacements in any direction. DSBBC provided stability comparable to DSF while offering a viable metal-free alternative. In contrast, SSBBC displayed inferior biomechanical properties, raising concerns about its clinical reliability.