Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1-3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH. This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing. Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes. Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia. Level IV.

Hip displacement and dislocation are among the most disabling musculoskeletal sequelae of cerebral palsy (CP) yet reported incidence and risk-factor estimates vary widely across studies. We undertook a systematic review and pooled analysis to quantify cumulative incidence across Gross Motor Function Classification System (GMFCS) strata and identify reproducible clinical and radiographic predictors. A protocol was registered in PROSPERO (CRD420251026860). MEDLINE (PubMed), Embase, CINAHL and CENTRAL were searched from inception to March 30, 2025. Eligible longitudinal studies enrolled ≥30 children with CP aged 2-18 years, provided ≥2 years' follow-up without confounding hip-directed intervention, and reported migration percentage (MP) data or equivalent permitting derivation. Hip displacement and dislocation were harmonized as MP >30 % and >50 %, respectively. Study quality was appraised with ROBINS I. Proportions were stabilized with the Freeman-Tukey double-arcsine transformation and pooled in random-effects (REML) models; odds ratios (ORs) for candidate predictors were combined using inverse-variance random-effects methods. Heterogeneity (I², τ²), prediction intervals, influence diagnostics, Hartung-Knapp sensitivity and Egger tests were performed. Certainty was graded with adapted GRADE. Nineteen studies met inclusion; nine natural-history cohorts (n = 1556; median follow-up 5.1 y) contributed extractable incidence data. The pooled cumulative incidence of hip displacement/dislocation was 38.2 % (95 % CI 31.7-45.1 %; I² = 77 %; prediction interval 6.0 53.8 %). Incidence was 17.1 % in ambulant children (GMFCS I-III) and 71.9 % in non-ambulant children (IV-V), yielding an OR 3.72 (95 % CI 2.56-5.40) for non-ambulant vs ambulant groups. A baseline MP ≥ 30 % quadrupled subsequent risk (OR 4.48, 95 % CI 2.66-7.54; I² = 0 %). Pelvic obliquity ≥10° was associated with increased risk in a single cohort (OR 2.70, 95 % CI 1.34-5.46) and should be regarded as suggestive pending replication. No consistent effects were found for sex, gestational age or CP subtype. Approximately four in ten children with CP, and more than two thirds of those in GMFCS IV-V, develop clinically important hip displacement without targeted intervention. GMFCS IV-V status and an early MP ≥ 30 % are robust, actionable triggers for intensifying hip surveillance to six-monthly radiography; pelvic obliquity ≥10° may further stratify risk but requires confirmation. Uniform MP thresholds, time-to-event analyses and reporting of modifiable exposures are needed in future multicenter cohorts to refine preventive care.

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions.

Background: Adverse local tissue reactions to metal debris are due to a metal-on-metal bearing complication caused by micromotions at modular interfaces that induce corrosion of the protective oxide layer. This process could lead to wear, fretting, and abrasion with the release of metal ions locally and systemically, which may cause adverse local reactions in nearby tissues. The aim of this study is to describe a series of patients with painful local adverse tissue reactions secondary to corrosion at the modular neck–body interface, to document the clinical presentation, diagnostic workup, and surgical findings of our research, and to search for a possible correlation between metallosis and infection. Methods: A retrospective study of patients with adverse local tissue reactions due to metal surface corrosion was performed. Blood samples were collected to identify erythrocyte sedimentation rate, C reactive protein, and procalcitonin, and a magnetic resonance imaging protocol was performed. Results: Serum cobalt and chromium levels of the 43 patients tested were significantly higher on average. However, both erythrocyte sedimentation rate and C-reactive protein were significantly elevated. Magnetic resonance imaging showed adverse reactions to metal debris with large soft tissue masses and surrounding tissue damage. Conclusions: Corrosion in hip prosthesis can lead to the release of metal ions and debris locally and systemically, resulting in local soft tissue changes. A “tumor-like” debridement can reduce this complication.

Recently, total talar prosthesis has been proposed to substitute the talus during the management of complex talar lesions such as talar extrusion, comminuted talar fractures, or avascular necrosis. Herein, we report two cases of talar extrusion treated with total talar replacement after a high-intensity trauma. Both cases subsequently required revision surgery due to degenerative changes of the tibial plafond (arthrodesis in the first case, conversion to a total ankle prosthesis in the latter). We report and analyze the literature concerning total talar replacement to discuss strategies that could help improve prosthesis survival and reduce the incidence of osteoarthritis.

This retrospective study compares the clinical outcomes of the Minimally Invasive Reduction and Osteosynthesis System (MIROS) and intramedullary nailing (IMN) in treating isolated surgical neck fractures of the humerus. A total of 42 patients were included, with 18 treated using MIROS and 24 with IMN. The primary outcomes assessed were the complication rates, functional recovery (DASH score), pain levels (VAS), and radiological healing. The MIROS group exhibited a higher complication rate (22.2% vs. 8.8%), with K-wire migration and superficial infections being the most frequent. Patients treated with MIROS reported lower postoperative pain (VAS 45 ± 25.7) compared to the IMN group (VAS 58.1 ± 12.5). Both groups demonstrated radiological healing within three months, but one MIROS patient required reoperation due to hardware failure. No significant differences were observed in the DASH scores between the groups. Our findings suggest that IMN is a preferable treatment option for younger patients with good bone quality, while MIROS may still be beneficial for elderly patients with significant comorbidities, albeit with a higher risk of complications. Future prospective studies are recommended to confirm these findings.