The principal features essential for the success of an orthopaedic implant are its shape, dimensional accuracy, and adequate mechanical properties. Unlike other manufactured products, chemical stability and toxicity are of increased importance due to the need for biocompatibility over an implants life which could span several years. Thus, the combination of mechanical and biological properties determines the clinical usefulness of biomaterials in orthopaedic and musculoskeletal trauma surgery. Materials commonly used for these applications include stainless steel, cobalt-chromium and titanium alloys, ceramics, polyethylene, and poly(methyl methacrylate) (PMMA) bone cement. This study reviews the properties of commonly used materials and the advantages and disadvantages of each, with special emphasis on the sensitivity, toxicity, irritancy, and possible mutagenic and teratogenic capabilities. In addition, the production and final finishing processes of implants are discussed. Finally, potential directions for future implant development are discussed, with an emphasis on developing advanced personalised implants, according to a patient’s stature and physical requirements.

The aim of this study was to establish a simple and safe method of anaesthesia for intravital microcirculatory observations in small laboratory animals. The usefulness of isoflurane inhalation anaesthesia has been investigated in different strains of mice commonly used in experimental medicine. These were the hairless (hr/hr, n = 12), the BALB/c ( n = 12) and the nude mouse (nu/nu, n = 3). Anaesthesia was maintained by mask inhalation of isoflurane vaporized at concentrations of up to 4% in the induction phase, at 1.5% during acute surgical procedures and at 0.8-1.3% during prolonged experimental observations. Isoflurane was vapoured in a N₂O/O₂ mixture and saturated with 32-36% F_iO₂. During observations the body temperature was kept constant at 37°C. The tail artery was cannulated for monitoring of mean arterial blood pressure (MAP) and heart rate (HR). To maintain the body fluid balance, isotonic saline was administered at a constant rate of 0.2 ml/h. Arterial blood samples were drawn for blood-gas analysis at the end of the experiments. All animals survived the anaesthesia protocol lasting between 3 and 6.5 h. During isoflurane inhalation, no breathing complications or changes in systemic circulatory parameters were observed. Mean values of MAP and HR were 79± 3 mmHg and 486± 13 min^-1, respectively, over the entire observation period. A moderate acidosis was recorded in animals under isoflurane anaesthesia, with alterations of arterial blood pH, p_aO₂ and pCO₂ values (7.29± 0.06, 130± 19 mmHg and 35.6± 4.7 mmHg, respectively). In conclusion, inhalation anaesthesia with isoflurane is useful for experimental studies in the mouse due to (1) the simplicity of administration of the anaesthetic, (2) the rapid induction of anaesthesia, (3) easy control of the depth of anaesthesia, (4) the low percentage of complications, and (5) stable MAP and HR during observations lasting several hours. The proposed technique is especially suitable for observations of the microcirculation under intravital fluorescence microscopy.

The widespread adoption of metal implants in orthopaedics and dentistry has revolutionized medical treatments, but concerns remain regarding their biocompatibility, toxicity, and immunogenicity. This study conducts a comprehensive literature review of traditional biomaterials used in orthopaedic surgery and traumatology, with a particular focus on their historical development and biological interactions. Research articles were gathered from PubMed and Web of Science databases using keyword combinations such as “toxicity, irritation, allergy, biomaterials, corrosion, implants, orthopaedic surgery, biocompatible materials, steel, alloys, material properties, applications, implantology, and surface modification”. An initial pool of 400 articles was screened by independent reviewers based on predefined inclusion and exclusion criteria, resulting in 160 relevant articles covering research from 1950 to 2025. This paper explores the electrochemical processes of metals like iron, titanium, aluminium, cobalt, molybdenum, nickel, and chromium post-implantation, which cause ion release and wear debris formation. These metal ions interact with biological molecules, triggering localized irritation, inflammatory responses, and immune-mediated hypersensitivity. Unlike existing reviews, this paper highlights how metal–protein interactions can form antigenic complexes, contributing to delayed hypersensitivity and complications such as peri-implant osteolysis and implant failure. While titanium is traditionally considered bioinert, emerging evidence suggests that under certain conditions, even inert metals can induce adverse biological effects. Furthermore, this review emphasizes the role of oxidative stress, illustrating how metal ion release and systemic toxicity contribute to long-term health risks. It also uncovers the underappreciated genotoxic and cytotoxic effects of metal ions on cellular metabolism, shedding light on potential long-term repercussions. By integrating a rigorous methodological approach with an in-depth exploration of metal-induced biological responses, this paper offers a more nuanced perspective on the complex interplay between metal implants and human biology, advancing the discourse on implant safety and material innovation.

The peripheral lymphatic system reacts to penetrating microorganisms and self-antigens released from tissues and cells damaged by trauma or intracellular pathogens. The response of regional lymph nodes to tissue trauma has not been thoroughly studied. We investigated the changes in lower limb lymphatics and nodes after fractures and soft tissue injuries. This type of injury is frequently complicated by limb edema. Posttraumatic edema of lower limbs is characterized by long-lasting swelling of the limb, erythema, and increased skin temperature at the site of injury. This suggests that a local inflammatory process is proceeding, even though the process of bone or soft tissue healing is considered to be completed. Twenty-one patients with closed lower limb bone fractures and soft tissues injuries were studied by means of isotope lymphography. Dilated lymphatics of the entire limb were found in all patients, and 62% of them showed enlarged inguinal lymph nodes. Venous thrombosis was found in 24% of cases. There was no correlation between the degree of lymphatic dilatation, lymph node enlargement, and bone fracture or soft tissue injury or venous thrombosis. Surgical intervention was not an independent factor for lymph node enlargement. This study has shown that although the fracture or injured tissues are clinically healed, local inflammatory reaction at the site of injury persists and cytokine signals are sent to the regional lymph nodes.

Introduction Approximately 10–15% of all fractures of long bones heal with delay, prolonged immobilization and repetitive operative interventions. Despite intense investigations, the pathomechanism of impaired healing of skeletal tissue remains unclear. An important role in the pathomechanism of mal-union of close fractures plays subclinically proceeding infections. Aim The question arises whether colonization and proliferation of bacteria in the fracture gap could be related to the mutation of genes for factors regulating local antimicrobial response, such as pathogen recognizing receptors (PRR), cytokines and chemokines. Methods We carried out studies in patients with delayed long bone fractures estimating the frequency of mutation of genes crucial for pathogen recognition (TLR2, TLR4 and CD14), and elimination (CRP, IL-6, IL-1ra), as well as wound healing (TGF-β). The molecular milieu regulating healing process (IGF-1, COLL1a, TGF-β, BMP-2, and PDGF) was validated by Western blot analysis of the gap tissue. Results Microbiological investigations showed the presence of viable bacterial strains in 34 out of 108 gaps in patients with non-healing fractures (31.5%) and in 20 out of 122 patients with uneventful healing (16.4%) (P < 0.05). The occurrence of mutated TLR4 1/W but not 2/W gene was significantly higher (P < 0.05) in the non-healing infected than sterile group. In the non-healing infected group 1/W mutated gene frequency was also higher than in healing infected. In the TGF-β codon 10 a significantly higher frequency of mutated homozygote T and heterozygote C/T in the non-healing infected versus non-healing sterile subgroup was observed (P < 0.05). Similar difference was observed in the non-healing infected versus healing infected subgroup (P < 0.05). The CRP (G1059C), IL1ra (genotype 2/2), IL-6 (G176C), CD14 (G-159T), TLR2 (G2259A) and TLR4/2 (Thr399Ile) polymorphisms did not play evident role in the delay of fracture healing. Conclusions Individuals bearing the mutant TLR 4 gene 1/W (Asp299Gly) and TGF-β gene codon 10 mutant T and T/C allele may predispose to impaired pathogen recognition and elimination, leading to prolonged pathogen existence in the fracture gaps and healing delays.