Orthopedic Research and Reviews最新文献

{"title":"The Impact of Bone Cement Distribution in Unilateral PVP on Therapeutic Outcomes of Vertebral Compression Fracture Repair.","authors":"Alimujiang Yusufu, Parhat Yasin, Abuduwupuer Haibier, Yuan Ma","doi":"10.2147/ORR.S567335","DOIUrl":"10.2147/ORR.S567335","url":null,"abstract":"<p><strong>Background: </strong>Osteoporotic vertebral compression fractures (OVCFs) are common in the elderly, severely impacting health and quality of life. Percutaneous vertebroplasty (PVP) is a primary treatment, with bone cement distribution being a key factor influencing its efficacy.</p><p><strong>Objective: </strong>This study aimed to evaluate the impact of bone cement distribution patterns on clinical outcomes in unilateral PVP for OVCFs.</p><p><strong>Methods: </strong>A total of 145 patients undergoing first-time unilateral PVP were retrospectively analyzed. Based on postoperative anteroposterior X-rays, patients were divided into three groups according to cement coverage: Group A (uniform distribution across three vertebral regions, n=57), Group B (covering >1/2 to ≤2/3, n=51), and Group C (covering >1/3 to ≤1/2, n=37). Primary outcomes (VAS, ODI, vertebral height recovery, refracture rate) and secondary outcomes were compared.</p><p><strong>Results: </strong>At one-year follow-up, VAS scores were significantly lower in Groups A (2.12±0.54) and B (2.16±0.54) than in Group C (2.43±0.50, P<0.05). Vertebral height recovery was superior in Groups A and B compared to Group C (P<0.05). The overall refracture rate was significantly lower in Group A (3.6%) than in Group C (18.9%, P<0.05), with no significant difference from Group B (3.9%). Group A received a higher cement volume (4.95±0.43 mL) than Groups B and C (P<0.05).</p><p><strong>Conclusion: </strong>Bone cement distribution crossing the vertebral midline is associated with better pain relief, improved vertebral height restoration, and a lower refracture rate after unilateral PVP. However, exceeding two-thirds vertebral coverage does not appear to be a critical factor for surgical efficacy.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"567335"},"PeriodicalIF":2.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Demographic Associations of Ligamentum Flavum Hypertrophy in Lumbar Spinal Stenosis.","authors":"Mohammad Homayun Tawhid, Naseer Ahmad Durrani, Hashmatullah Mawlana Rahimi, Abdulkhabir Khabir, Ahmad Fawad Pirzad, Mohammad Haroon Khurassani, Aziz-Ur-Rahman Niazi","doi":"10.2147/ORR.S614519","DOIUrl":"10.2147/ORR.S614519","url":null,"abstract":"<p><strong>Background: </strong>The ligamentum flavum (LF) is a posterolateral ligament of the spinal canal. Ligamentum flavum hypertrophy (LFH) is a principal degenerative determinant of lumbar spinal stenosis (LSS), causing reduction of canal and foraminal space and thereby promoting nerve roots compression. LFH prevalence and severity increase with advancing age, rendering it a key factor in the clinical presentation and surgical approaches.</p><p><strong>Objective: </strong>This study aims to determine the prevalence of LFH in patients undergoing surgical decompression for LSS.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in the Department of Neurosurgery at Aliabad University Hospital and included all patients diagnosed with LSS (per surgical protocols and/or MRI reports) from January to December 2025. The association between age, gender, and LFH was also tested using a chi-square test in SPSS 26.0.</p><p><strong>Results: </strong>Of 239 patients with LSS, 128 (53.6%) were males and 111 (46.4%) were females. LFH was present in 102 (42.7%) patients, including 64 (50.0%) males and 38 (34.2%) females; with a significant association between LFH and male sex (p = 0.014). LFH prevalence increases markedly with age (21-30 years: 18.5%; 61-70 years: 93.9%; p=0.001). Anatomically, LFH was most frequent at L4-L5 (40.2%) and L3-L4 (18.6%).</p><p><strong>Conclusion: </strong>LFH represents a major pathological component of LSS, with prevalence increasing progressively with age. LFH was more frequent in male patients and was most commonly localized to L3 to L5. Accordingly, standardized preoperative cautions for LFH should be considered to support the selection of the surgical approach.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"614519"},"PeriodicalIF":2.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuproptosis and Orthopedic Diseases: Molecular Mechanisms of Copper Metabolic Imbalance in the Skeletal System and Clinical Translation Prospects.","authors":"Fuchao Huang, Junbo Wang, Xiaohua Pan","doi":"10.2147/ORR.S597482","DOIUrl":"10.2147/ORR.S597482","url":null,"abstract":"<p><p>Copper, an essential trace element, serves as a critical cofactor for enzymes governing energy metabolism, antioxidant defense, and connective tissue synthesis. The narrow margin between physiological requirement and toxicity necessitates precise homeostatic control, as both deficiency and excess compromise bone cell viability. Dysregulated copper metabolism has emerged as a pathogenic driver in orthopedic disorders, prompting investigation of cuproptosis-a distinctive form of mitochondrial cell death triggered by copper overload. The development of numerous diseases may occur when copper levels are abnormal in the body. A newly proposed form of cell death, known as cuproptosis, is distinct from necroptosis, apoptosis, autophagy, ferroptosis, and pyroptosis due to its cause: an excessive accumulation of intracellular copper. In the TCA cycle, copper binds to lipoylated proteins, which induces their aggregation, proteotoxic stress, the loss of Fe-S cluster proteins, and ultimately results in cell death. This process highlights the intricate relationship between metal homeostasis and cellular metabolism illustrating excess copper can induce cellular toxicity through biochemical mechanisms. Ever since cuproptosis was introduced, increasing research has highlighted its crucial involvement in the occurrence, development and management of many orthopedic disorders. The skeletal system presents unique features that make it particularly relevant for cuproptosis research: (i) bone tissue undergoes continuous remodeling with high metabolic demands, making it highly sensitive to mitochondrial dysfunction; (ii) osteoblasts, osteoclasts, and chondrocytes rely heavily on TCA cycle activity for energy production and differentiation; (iii) copper-containing biomaterials have been widely used in orthopedics for their dual osteogenic and antimicrobial properties, yet their mechanisms remained unclear until the discovery of cuproptosis; and (iv) the hypoxic microenvironment in bone marrow and inflammatory joints creates conditions favorable for copper accumulation and lipoylated protein aggregation. These distinctive characteristics position orthopedic diseases as an ideal model system for investigating cuproptosis pathophysiology and its therapeutic applications. In the review, we summarize copper homeostasis, copper ions' role in the major cells of bone metabolism, and the interconnections of cuproptosis in osteosarcoma, osteoarthritis, rheumatoid arthritis, osteoporosis, osteomyelitis, spinal disorders, implant infections, and wound repair. We hope to provide novel diagnostic and therapeutic ideas for these diseases by modulating copper homeostasis and targeting cuproptosis.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"597482"},"PeriodicalIF":2.0,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148033798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Role of <i>Cissus quadrangularis</i> in Osteoporosis Management.","authors":"Nicola Manocchio, Andrea Sorbino, Antonio Devito, Luca Gallelli, Daniele Romanello, Sara Rotunno, Calogero Foti, Alberto Migliore","doi":"10.2147/ORR.S609378","DOIUrl":"10.2147/ORR.S609378","url":null,"abstract":"<p><p><i>Cissus quadrangularis</i> (CQ) is a Vitaceae-derived medicinal plant rich in flavonoids, phytosterols, triterpenoids, vitamins, and bone-relevant minerals, conferring combined antioxidant, anti-inflammatory, phytoestrogenic, and osteoanabolic properties that modulate key pathways involved in bone remodeling. This narrative review aims to synthesize preclinical and clinical evidence on CQ as a potential adjunct in osteoporosis management. Preclinical studies demonstrate that CQ enhances osteoblast differentiation, collagen and matrix deposition, and mineralization, while inhibiting osteoclastogenesis and inflammatory osteoclastogenic cytokines, leading to improved bone microarchitecture, bone mineral density, and callus formation in fracture and estrogen-deficiency models. CQ phytobioactives have also been successfully integrated into advanced biomaterials, exosome-like vesicles, and self‑emulsifying drug delivery systems, improving bioavailability, osseointegration, and regenerative performance in critical-sized defects and implant models. Clinical data, although limited and heterogeneous, consistently indicate that CQ accelerates fracture healing, reduces bone pain, and increases functional recovery in maxillofacial and mandibular fractures, with favorable effects on serum calcium, alkaline phosphatase, and osteopontin expression and without major safety concerns based on available short-term data. In postmenopausal osteopenia, randomized trials show that 24‑week oral CQ stabilizes bone turnover markers and delays bone loss, albeit without short‑term gains in bone mineral density. CQ thus emerges as a multi-target, generally well-tolerated candidate for integrative osteoporosis care, particularly for early bone loss (i.e., osteopenia), fracture healing, and osteoprotection during antiresorptive drug holidays (i.e., temporary suspension of bisphosphonate therapy, particularly in the context of dental procedures). However, the absence of standardized formulations, small sample sizes, short follow-ups, and lack of head‑to‑head comparisons with standard anti‑osteoporotic therapies currently available underscore the need for long-term, multicenter randomized controlled studies using bioavailable, well-characterized CQ preparations.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"609378"},"PeriodicalIF":2.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13196723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148016860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Meniscal Extrusion: A Narrative Review of Etiology, Diagnosis, and Therapeutic Strategies.","authors":"Zhuocheng Luo, Ming Li","doi":"10.2147/ORR.S584193","DOIUrl":"10.2147/ORR.S584193","url":null,"abstract":"<p><strong>Objective: </strong>To comprehensively review recent developments in the etiology, imaging diagnosis, and treatment strategies for medial meniscal extrusion, highlighting biomechanical considerations and individualized therapeutic approaches.</p><p><strong>Methods: </strong>We performed a narrative review of English-language clinical, imaging, and biomechanical studies by searching PubMed, Web of Science, and Embase from database inception to June 30, 2024, using terms related to meniscal extrusion, meniscal root tears, meniscotibial ligament injury, osteoarthritis, and corrective osteotomy, and we also screened reference lists of relevant reviews. Studies were included if they explicitly evaluated medial meniscal extrusion and reported quantitative extrusion assessment and/or its determinants, diagnostic performance, or treatment-related changes; we excluded studies not focused on medial extrusion, non-original articles without analyzable data, and reports lacking quantifiable extrusion outcomes.</p><p><strong>Results: </strong>Eighty-five studies were included for qualitative synthesis. Current evidence indicates that medial meniscal extrusion most commonly arises from posterior root tears and degenerative tears that disrupt hoop tension, and is further amplified by meniscotibial ligament insufficiency, varus malalignment, increased body mass index, osteophytes, and subchondral insufficiency fracture, forming a self-reinforcing pathway of extrusion, compartment overload, cartilage loss, and subchondral bone changes. MRI remains the reference standard for static assessment, whereas ultrasound and weight-bearing protocols better capture load-dependent displacement; however, measurement planes, anatomical landmarks, and thresholds vary, limiting cross-study comparability. Across treatment studies, reported strategies ranged from structured nonoperative care to root repair, meniscal centralization, and high tibial osteotomy. In appropriately selected knees, studies evaluating combined biomechanical correction and meniscal stabilization more consistently reported measurable reductions in extrusion than isolated procedures, although outcome definitions and follow-up durations were heterogeneous.</p><p><strong>Conclusion: </strong>Medial meniscal extrusion is best understood as a mechano-structural failure state rather than an isolated imaging sign. Standardized measurement strategies and prospective comparative studies are needed to define actionable thresholds and refine patient-specific treatment pathways.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"584193"},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13165474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupotomy Ameliorates Articular Cartilage Fibrosis in a Rabbit Model of Knee Osteoarthritis via the TGF-β1/Smad Pathway.","authors":"Longfei Xing, Wenting Zhu, Xilin Chen, Rui Che, Jiangong Wu, Yan Guo, Chuxi Liang","doi":"10.2147/ORR.S597057","DOIUrl":"10.2147/ORR.S597057","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate whether acupotomy can regulate the activity of factors related to the TGF-β1/Smad pathway, thereby reducing the degree of cartilage fibrosis in knee osteoarthritis (KOA) and alleviating cartilage degradation.</p><p><strong>Methods: </strong>A modified Videman's long-term knee joint immobilization method in the extended position was used to establish the KOA model. Behavioral Lequesne MG scoring was performed before and after the acupotomy intervention. Masson staining was used to observe the morphology and structure of the cartilage using light microscopy and scanning electron microscopy (SEM). Western blotting and real-time quantitative polymerase chain reaction (RT-PCR) were used to detect the protein levels and mRNA expression of Smad3, Smad7, TGF-β1, collagen type I (Col-I), collagen type II (Col-II), and collagen type III (Col-III) in the cartilage tissue of acupotomy-treated KOA rabbits.</p><p><strong>Results: </strong>The modified Lequesne MG score was significantly higher in the KOA group than that in the control group. Histologically, the cartilage in the KOA group exhibited fissures, matrix dissolution, reduced Col-II content, and obvious fibrosis. TGF-β1 and Smad3 in the TGF-β1/SMAD pathway were significantly upregulated, and Smad7 was down-regulated. Acupotomy treatment reduced the protein and mRNA expression levels of Col-I and Col-III, attenuated the loss of Col-II in cartilage extracellular matrix, and effectively delayed cartilage degeneration in KOA rabbits. This process may be achieved by regulating the factors related to the TGF-β1/SMAD pathway.</p><p><strong>Conclusion: </strong>In the KOA rabbit model, acupotomy alleviated the degree of fibrosis by regulating factors related to the TGF-β1/Smad pathway, thereby delaying cartilage degeneration.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"597057"},"PeriodicalIF":2.0,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13159952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Modified Transforaminal Lumbar Interbody Fusion in Three-Planar Correction for Severe Adult Spinal Deformity: Radiographic and Clinical Outcomes.","authors":"Truc Tam Vu, Thai Duc Hoang, Hanh The Nguyen","doi":"10.2147/ORR.S595645","DOIUrl":"10.2147/ORR.S595645","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformity (ASD) significantly impacts quality of life in geriatric populations due to severe sagittal imbalance, degenerative scoliosis, and associated neurological compression that usually requires surgery when conservative treatment fails.</p><p><strong>Objective: </strong>To evaluate the clinical and radiological outcome of a modified transforaminal lumbar interbody fusion (TLIF) technique in the three-planar correction of severe adult spinal deformity (ASD).</p><p><strong>Methods: </strong>This was a single-center case series study. We recruited 72 ASD patients (mean age 64.5 years) with at least one of the following criteria met (SRS-Schwab sagittal modifier ++; Cobb angle >30°; Coronal vertical axis >3cm) operated between January 2020 and May 2025. The surgical protocol involved four modifications: (1) bilateral facetectomy and posterior column resection; (2) a concave-side approach to the disc space; (3) anterior positioning of the PEEK cage; and (4) supplemental bone grafting posterior to the cage. Clinical and radiological outcomes were evaluated at a mean follow-up of 2.3 years.</p><p><strong>Results: </strong>Significant improvements were observed in SRS-22 (2.6 to 3.7) and NCOS (43 to 74.5) scores (p < 0.05). After surgery, both PI-LL mismatch and the Cobb angle have been markedly improved (35° down to 17° and 21.5° down to 5°, respectively). The fusion rate was 90% at 1 year. Univariate analysis identified osteoporosis (OR = 13.4, p<0.05), \"pear-shaped\" disc morphology (OR = 14, p<0.05), and PI > 65° (OR = 13.7, p<0.05) as significant risk factors for unchanged sagittal modifier after surgery. Early complications included infection (2.7%) and pneumonia (2.7%) whereas the main mid-term adverse event was PJK (15%).</p><p><strong>Conclusion: </strong>Modified TLIF is associated with improvement of mid-term radiographic and clinical outcomes and an acceptable complication rate. Additional research involving larger cohorts and extended follow-up, preferably with a control group, is required to reach more definitive conclusions.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"595645"},"PeriodicalIF":2.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13138273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brace Dose in Scoliosis: Measurement, Monitoring, and Clinical Decision-Making-A Narrative Review.","authors":"Saied Besharaty, Shahab Sheikhalishahi, Hesameddin Jafarinasab","doi":"10.2147/ORR.S608929","DOIUrl":"10.2147/ORR.S608929","url":null,"abstract":"<p><p>Adolescent idiopathic scoliosis bracing is best conceptualized as a dose-dependent therapy in which clinical benefit depends on the delivered, rather than prescribed, corrective exposure. This narrative review synthesizes post-2015 evidence to present a clinically oriented framework for \"precision bracing\" that links brace prescription to objectively measured delivered dose and subsequent clinical response. We summarize evidence that bracing reduces progression risk in skeletally immature patients, while highlighting the efficacy-effectiveness gap driven by incomplete adherence. We review objective adherence monitoring technologies, focusing on temperature-based data loggers and emerging force or pressure sensing approaches, and explain how objective dosing data refine outcome interpretation by distinguishing undertreatment from true treatment failure. We conceptualize brace dose as a multidimensional construct that includes quantity (objectively measured wear time), pattern (regularity), and correction-related indicators (including in-brace and early out-of-brace radiographic metrics and, when available, interface force surrogates). We synthesize key effect modifiers, including skeletal maturity, curve magnitude and phenotype, early radiographic response, and contextual determinants of achieved wear time. We translate this evidence into a practical clinical framework for risk stratification, brace schedule selection, objective monitoring, early reassessment, and escalation when delivered dose is inadequate or response is unacceptable We conclude by outlining research priorities for standardized reporting of delivered dose, pragmatic trials embedded in routine care, and core outcome sets that integrate radiographic and patient-reported outcomes.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"608929"},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13136906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Titanium versus Biodegradable Implants for Fracture Fixation: A Retrospective Comparative Study.","authors":"Wajid Ullah, Aierbanjiang Shali, Alimujiang Abulaiti, Cheng Erlin, Aihemaitijiang Yusufu","doi":"10.2147/ORR.S585068","DOIUrl":"10.2147/ORR.S585068","url":null,"abstract":"<p><strong>Background: </strong>Titanium alloy implants are widely used in fracture fixation due to their excellent mechanical stability, but they often require secondary surgeries for removal. In contrast, biodegradable implants eliminate the need for removal, yet concerns regarding their mechanical strength in load-bearing bones remain. This study evaluates the clinical trade-off between mechanical rigidity and the burden of secondary surgery by comparing titanium versus biodegradable implants in limb and pelvic fractures.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 73 patients treated between November 2021 and August 2024. Patients were divided into the titanium group (n = 40, primarily diaphyseal fractures) and the biodegradable group (n = 33, primarily metaphyseal/peri-articular fractures). Outcomes including implant palpability and reoperation rates were assessed. A stratified analysis compared outcomes in weight-bearing versus non-weight-bearing fractures.</p><p><strong>Results: </strong>The mean age of patients was 42.6 ± 16.03 years. Titanium implants were associated with significantly higher rates of plate palpability (18/40, 45.0% vs 3/33, 9.1%; OR 8.18, 95% CI 2.14-31.3; <i>P</i> = 0.001) and secondary surgery (14/40, 35.0% vs 3/33, 9.1%; OR 5.38, 95% CI 1.39-20.8; <i>P</i> = 0.012) compared to biodegradable implants. Elective removal due to discomfort occurred in 17.5% (7/40) of titanium patients but was eliminated (0%) in the biodegradable group (<i>P</i> = 0.014). In the weight-bearing subgroup, biodegradable implants significantly reduced palpability (11.1% vs 53.3%, OR 9.14) without increasing complication-driven reoperations. However, three cases (9.1%) of refracture occurred in the biodegradable group compared to zero in the titanium group (<i>P</i> = 0.088).</p><p><strong>Conclusion: </strong>In this cohort, biodegradable implants were associated with a reduction in implant palpability and elective removal surgery for metaphyseal and peri-articular fractures. However, due to lower mechanical strength, titanium remains the preferred choice for diaphyseal fractures requiring high mechanical stability. These findings are limited by the retrospective design and heterogeneity of fracture sites.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"585068"},"PeriodicalIF":2.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brucella Infection of the Sternoclavicular Joint with Innovative Localized Drug Delivery: A Case Report and Review of the Literature.","authors":"Xianshuai Kou, Xiao Pan, Yi Zhang, Binfeng He, Zaichun You, Guifu Ma","doi":"10.2147/ORR.S567349","DOIUrl":"10.2147/ORR.S567349","url":null,"abstract":"<p><strong>Background: </strong>Brucellosis is typically associated with complications involving the osteoarticular, cardiovascular, and central nervous systems. However, septic arthritis of the sternoclavicular joint (SCJ) represents an isolated and exceptionally rare clinical entity. We report a case of Brucella-induced SCJ abscess successfully managed via the localized implantation of doxycycline-loaded calcium sulfate. This targeted drug delivery system offers a robust therapeutic strategy for controlling focal infections in atypical anatomical locations.</p><p><strong>Case presentation: </strong>A 47-year-old woman presented with intermittent fever and a progressively enlarging clavicular mass. Physical examination revealed distinct, tender swelling over the right SCJ. The patient's symptoms were refractory to prior antimicrobial therapy with cefuroxime sodium. Computed tomography (CT) demonstrated localized soft tissue swelling and osteolytic destruction at the SCJ. Magnetic resonance imaging (MRI) further characterized the pathology, revealing cortical erosion, marrow edema, and abscess formation. Serological testing confirmed the diagnosis by demonstrating a Brucella antibody titer of 1:400. The patient underwent surgical intervention. Intraoperative exploration exposed significant yellowish-white purulent exudate covering the joint surface. Following extensive debridement, doxycycline-loaded calcium sulfate beads were implanted into the residual cavity, and a drainage catheter was placed. Postoperatively, she received intravenous cephalosporins for two weeks, followed by oral doxycycline and rifampin. At the three-month follow-up, inflammatory markers-including ESR, CRP, and IL-6-had normalized. Long-term monitoring confirmed complete recovery without recurrence.</p><p><strong>Conclusion: </strong>Managing infections at atypical sites often necessitates the adaptation of standard therapeutic protocols. This case illustrates that novel modalities, specifically localized antibiotic delivery systems using calcium sulfate, can effectively treat complex infections where systemic therapy alone may be insufficient. By ensuring sustained local antibiotic release, this strategy expands the therapeutic armamentarium available for clinicians addressing rare, site-specific presentations of pathogens such as Brucella.</p>","PeriodicalId":19608,"journal":{"name":"Orthopedic Research and Reviews","volume":"18 ","pages":"567349"},"PeriodicalIF":2.0,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13023395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}