Background: Pelvic fractures are among the most complex and life-threatening injuries encountered in trauma and orthopedic surgery, often resulting from high-energy trauma and leading to severe complications. This review synthesizes recent advancements in pelvic trauma care, with a focus on comparing damage control orthopedics (DCO) and early total care (ETC) strategies, operative versus nonoperative management, and outcomes of minimally invasive versus traditional ORIF techniques. Results: Our comparative analysis highlights that DCO remains the preferred approach for hemodynamically unstable patients, prioritizing rapid stabilization and reducing mortality from hemorrhage. In contrast, ETC has demonstrated superior functional recovery outcomes in stable polytrauma patients, with a 30–40% reduction in pulmonary complications and shorter ICU stays when performed within 24–48 h post-injury. Additionally, percutaneous fixation reduces soft tissue trauma and infection risk but increases the likelihood of malunion, while ORIF provides superior anatomical restoration with a higher risk of postoperative infections. Hybrid approaches, integrating percutaneous techniques with limited open reduction, show promise in minimizing operative time and complications while achieving stable fixation. Conclusions: These findings reinforce the importance of tailoring surgical strategies to patient physiology and injury patterns. DCO and ETC have distinct but complementary roles, and emerging hybrid techniques offer a middle ground that balances stability with reduced morbidity. A precision medicine approach, integrating AI-driven predictive modeling and real-world clinical data, is essential for optimizing outcomes and developing evidence-based treatment protocols. Large-scale, multicenter trials are needed to validate these approaches and establish standardized guidelines for pelvic fracture management.

Background: Periprosthetic joint infection (PJI) remains one of the most severe complications after total joint arthroplasty, causing significant morbidity and healthcare burden. Despite advances in surgical techniques, diagnostics, and antimicrobial therapy, infection rates have not declined substantially, emphasizing the need for comprehensive preventive and therapeutic strategies. Methods: This narrative review synthesizes evidence from peer-reviewed clinical studies, consensus statements, and major international guidelines addressing periprosthetic joint infection in hip, knee, and shoulder arthroplasty. Results: Recent evidence highlights advances in diagnostic biomarkers, molecular testing, and standardized consensus criteria that have improved early detection. Surgical strategies such as DAIR, one-stage, and two-stage revisions—combined with biofilm-active antimicrobial therapy—remain the mainstay of management. Preventive measures focusing on perioperative optimization, infection control, and antibiotic stewardship are the most effective means to reduce infection risk. Conclusions: Future progress relies on precision-based prevention, novel biofilm-targeted therapies, and multidisciplinary collaboration to achieve durable, infection-free outcomes following joint arthroplasty.

Background/Objectives: Bone marrow adipose tissue (BMAT) has been described as an important biomechanic and lipotoxic factor with negative impacts on skeletal and hematopoietic system regeneration. BMAT undergoes metabolic and cellular adaptations with age and disease, being a source of potential biomarkers. However, there is no evidence on the lipid profile and cellularity at different skeletal locations in osteoarthritis patients undergoing primary hip arthroplasty. Methods: Acetabular and femoral bone marrow (BM) and gluteofemoral subcutaneous adipose tissue (gfSAT) were obtained from matched patients undergoing hip replacement surgery. BM, BMAT, and gfSAT were explored at the levels of total lipids, fatty acids, and cells by using thin-layerand gas chromatography, ex vivo cellular assays, and flow cytometry. Results: BMAT content was significantly higher in femoral than in acetabular BM. Total lipid analyses revealed significantly lower triglyceride content in femoral than in acetabular BMAT and gfSAT. Frequencies of saturated palmitic, myristic, and stearic acids were higher in femoral than in acetabular BMAT and gfSAT. The content of CD45⁺CD34⁺ cells within femoral BMAT was higher than in acetabular BMAT or gfSAT. This was associated with a higher incidence of total clonogenic hematopoietic progenitors and late erythroid colonies CFU-E in femoral BMAT when compared to acetabular BMAT, similar to their BM counterparts. Conclusions: Collectively, our results indicate that the lipid profiles of hip bone and femoral BMAT impose significantly different microenvironments and distributions of cells with hematopoietic potential. These findings might bring forth new inputs for defining BMAT biology and setting novel directions in OA disease investigations.

Background: The purpose of this study was to collect all available randomized controlled trials (RCT) on the treatment of open tibial fractures with an external fixator (EF) and intramedullary nailing (IMN) for meta-analysis to provide reliable evidence-based data for clinical decision-making. Material and methods: The systematic review was undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and AMSTAR (Assessing the Methodological Quality of Systematic Review). An electronic search of PubMed, Cochrane Library, and Web of Science was performed until 1 March 2023 to identify RCTs which compared either IMN or EF to fix the open tibial fracture. Outcome measures were: postoperative superficial and deep infection, time to union, delayed union, malunion, nonunion and hardware failure. In addition, pain and health-related quality of life were evaluated after 3 and 12 months of follow-up. Results: Sixteen publications comprising 1011 patients were included in the meta-analysis. The pooled results suggested that the IMN technique had a lower postoperative superficial infection and malunion rate (RR = 3.56, 95%CI = 2.56–4.95 and RR = 1.96, 95%CI = 1.12–3.44, respectively), but higher hardware failure occurrence in contrast to EF (RR = 0.30; 95%CI = 0.13–0.69). No significant differences were found in the union time, delayed union or nonunion rate, and postoperative deep infection rate between the treatments. Lower levels of pain were found in the EF group (RR = 0.05, 95%CI = 0.02–0.17, p < 0.001). A difference in quality of life favoring IMN after 3 months was found (RR = −0.04, 95%CI = −0.05–0.03, p < 0.001), however, no statistical difference was found after 12 months (RR = 0.03, 95%CI = −0.05–0.11, p = 0.44). Conclusions: Meta-analysis presented reduced incidence rates of superficial infection, malunion, and health-related quality of life 3 months after treatment in IMN. However, EF led to a significant reduction in pain and incidence rate of hardware failure. Postoperative deep infection, delayed union, nonunion and health-related quality of life 12 months following therapy were similar between groups. More high-quality RCTs should be conducted to provide reliable evidence-based data for clinical decision-making.

Postamputation pain (PAP), including residual limb pain (RLP) and phantom limb pain (PLP), remains a significant and debilitating complication after limb loss. Despite advances in pharmacological management, many patients experience inadequate pain relief, underscoring the need for alternative therapeutic strategies. Objective: This narrative review critically synthesizes current interventional therapies for PAP, focusing on mechanisms, clinical efficacy and practical application. Methods: A literature search was conducted in PubMed, EMBASE, Scopus and Web of Science databases for studies published between 2015 and 2025. Relevant articles on peripheral nerve interventions as well as different neuromodulation techniques were included. Results: Peripheral interventions (such as alcohol neurolysis, radiofrequency ablation (RFA) and cryoneurolysis (CNL)) and neuromodulation techniques (including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation and cauda equina stimulation (CES)) demonstrate promising outcomes for PAP. Peripheral nerve stimulation (PNS) shows favorable safety and efficacy profiles and may help prevent the chronification of pain. Conclusions: Contemporary interventional therapies represent valuable options in the multidisciplinary management of PAP. Nevertheless, further research is required to standardize clinical algorithms, optimize therapeutic decision-making and improve long-term outcomes and quality of life for individuals with PAP.

Bilateral asymmetrical hip dislocations are rare, occurring in only 0.01–0.02% of all joint dislocations, typically following high-energy trauma. We present a 22-year-old male involved in a high-speed motor vehicle collision, sustaining a right posterior hip dislocation with an associated posterior wall acetabular fracture and a left obturator-type anterior dislocation. He underwent successful closed reduction within two hours post-injury, but due to persistent instability of the posterior acetabular wall fracture, open reduction and internal fixation (ORIF) via a Kocher–Langenbeck approach was performed. A structured rehabilitation protocol facilitated full functional recovery at six months, with no evidence of avascular necrosis (AVN) or post-traumatic osteoarthritis. A literature review of relevant studies highlights the importance of early reduction (<6 h) to reduce AVN risk, timely surgical stabilization for acetabular fractures, and individualized rehabilitation strategies. While our case supports established treatment guidelines, long-term outcomes and optimal rehabilitation protocols remain areas for further research. Expedited diagnosis, early intervention, and evidence-based management are essential in achieving favorable outcomes for these complex injuries.