Background: With the increasing elderly population and prevalence of osteoporosis, geriatric intertrochanteric fragility fractures pose a major challenge to orthopedic practice. These fractures have a significant impact on patient outcomes, with a reported mortality rate of 13.3% within 30 days and 24.5% within one year. Case Presentation: This report presents a rare case of delayed iatrogenic deep femoral artery (DFA) injury due to progressive displacement of the lesser trochanter following intertrochanteric fracture fixation. An 87-year-old female patient developed significant thigh swelling and pain 33 days postoperatively. Imaging confirmed migration of the lesser trochanter fragment, leading to DFA injury and active bleeding. Discussion: Through a comprehensive literature review, we explore the incidence, diagnostic modalities, and management of vascular injuries associated with pertrochanteric fracture fixation. We emphasize the importance of identifying significantly displaced lesser trochanter fragments (>1 cm) preoperatively, as they markedly increase the risk of DFA injury. While debate continues over routine fragment fixation, our case suggests that surgical fixation may be beneficial in selected patients with large displacements to prevent vascular complications. Early CT angiography is highlighted as a crucial non-invasive diagnostic tool for timely detection and intervention in these high-risk cases. Conclusion: This case underscores the need for careful postoperative monitoring and early intervention to optimize patient outcomes. As PFFs become more prevalent, further research is essential to improve geriatric orthopedic care.

Background and Objectives: Tibial tuberosity avulsion fractures are rare injuries in pediatric athletes, with limited data on the potential role of an elevated body mass index (BMI) as a risk factor. Previous studies have primarily focused on age, sex, and sport type, but the association between BMI and these injuries remains underexplored. Tibial tuberosity avulsion fractures are rare injuries predominantly affecting adolescent boys during sports activities involving strong quadriceps contractions. This pilot study aimed to analyze the epidemiological and anthropometric characteristics of patients with these fractures, including the distribution of injury mechanisms and the fracture types, to test whether the prevalence of overweight/obesity among cases exceeded national population benchmarks, and to describe the associated clinical outcomes. Materials and Methods: A retrospective analysis was conducted on medical records and radiographs of patients under the age of 18 treated between 2017 and 2024. The data collected included demographic and anthropometric characteristics, injury mechanisms, fracture classification, treatment methods, complications, and outcomes. The patients were categorized as normal weight (<85th percentile) or overweight/obese (≥85th percentile). The primary outcome was whether the prevalence of overweight/obesity among the cases exceeded national pediatric benchmarks. Formal sample size and power analyses were performed to guide future research. Results: Twenty-one patients met the inclusion criteria, with a mean age of 13.7 years; 95.2% were male. Soccer was the most common injury mechanism (52.4%), followed by athletics and running. The predominant fracture type was Ogden IVb (38.1%). Overweight/obesity was present in 52.4% of the patients, significantly higher than the national benchmarks. An open reduction and internal fixation was performed in 90.5% of the cases, with a mean follow-up of 14.6 months (range: 6–36). Complications occurred in 14.3% overall, all within the overweight/obese group (27.3%). Conclusions: This pilot retrospective study suggests a potential link between an elevated BMI and tibial tuberosity avulsion fractures, with overweight/obesity being significantly more prevalent in affected patients than in the general pediatric population. These exploratory findings warrant confirmation in larger, adequately powered studies, and emphasize the importance of weight management and tailored sports activities as potential preventive strategies. An early diagnosis, timely surgical intervention, and adequate rehabilitation are critical for achieving optimal functional recovery.

Background: Debridement, antibiotics, and implant retention (DAIR) is an established treatment for early periprosthetic joint infection (PJI) following hip arthroplasty; however, reported success rates remain highly variable, particularly in patients with significant comorbidities, fracture-related arthroplasty, or resistant microorganisms. Augmentation of standard DAIR with structured local antimicrobial strategies may improve infection control but remains insufficiently standardized and evaluated. Methods: This retrospective single-center case series evaluated outcomes of a standardized multimodal DAIR-based strategy, the Mursa protocol, in 16 consecutive patients treated for early hip PJI between 2022 and 2025. PJI was diagnosed according to European Bone and Joint Infection Society criteria. The treatment included radical surgical debridement and exchange of mobile components with sequential intraoperative antiseptic microdebridement using povidone–iodine and hypochlorous/hypochlorite solution, followed by postoperative drain-based local antimicrobial irrigation and systemic antibiotic therapy. Treatment success was defined as sustained infection eradication with implant retention, absence of clinical and radiological signs of infection, no requirement for long-term suppressive antibiotics, and no infection-related mortality at a minimum one-year follow-up. Results: The cohort was clinically complex, with a predominance of arthroplasty procedures performed for fracture-related indications (11/16), a high comorbidity burden (median Charlson Comorbidity Index 5), revision arthroplasty in four patients, and a high rate of resistant or polymicrobial infections. At final follow-up, 15 of 16 patients (93.8%) achieved treatment success. One patient required implant removal due to persistent polymicrobial infection. No irrigation-related complications, wound-healing problems, or clinically relevant systemic toxicity were observed. Conclusions: In this high-risk cohort, a structured multimodal DAIR protocol incorporating sequential antiseptic microdebridement and postoperative local antimicrobial irrigation was feasible, safe, and associated with encouraging infection control. However, these findings should be interpreted as hypothesis-generating, and further prospective comparative studies are required to validate the protocol.

Background and Objectives: Simultaneous bilateral scapular fractures are exceptionally rare injuries and are most commonly associated with high-energy trauma, convulsions, or electrical injury. Their occurrence following low-energy trauma is extremely uncommon. This study aimed to conduct a scoping review of the literature on simultaneous bilateral scapular fractures, with emphasis on demographic characteristics, mechanisms of injury, fracture patterns, treatment strategies, and clinical outcomes. To provide clinical context, the findings are illustrated by a case of a 43-year-old previously healthy recreational athlete who sustained simultaneous bilateral scapular fractures after a low-energy fall directly onto the back. Materials and Methods: A scoping review of the literature was conducted in accordance with PRISMA-ScR guidelines using the PubMed/MEDLINE and Scopus databases. Studies reporting simultaneous bilateral scapular fractures were identified and analyzed with respect to demographic characteristics, mechanisms of injury, fracture patterns, treatment modalities, and outcomes. Results: Thirty-seven studies published between 1946 and 2025 were included, comprising a total of 43 patients. Most cases resulted from high-energy trauma (41.9%), convulsions (25.6%), or electrical injury (16.3%). Low-energy trauma and spontaneous fractures were rare. The scapular body was the most commonly involved anatomical region. Conservative treatment predominated and was generally associated with favorable functional outcomes, while surgical intervention was reserved for displaced or intra-articular fractures. The illustrative case involved bilateral comminuted extra-articular fractures of the scapular bodies and spines without associated injuries and was managed conservatively, resulting in complete fracture healing and full, painless shoulder range of motion. Conclusions: The findings of this scoping review, illustrated by the representative clinical case, indicate that simultaneous bilateral scapular fractures may occur even after low-energy trauma in otherwise healthy individuals. Bilaterality alone should not be interpreted as an independent indication for surgical treatment when fractures are stable and minimally displaced. A high index of clinical suspicion and appropriate radiological evaluation are therefore warranted, particularly in emergency and trauma settings, in order to avoid missed or delayed diagnosis, even in cases with seemingly benign mechanisms of injury.

Background and objective: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities affecting mostly elderly patients. In this study, we aimed to provide detailed characteristics of surgically treated patients with cSDH and evaluate outcomes between the two conventional treatment methods. Materials and methods: Patients with cSDH surgically treated with burr hole craniostomy (BHC) and craniotomy (CO) in tertiary centers in Croatia and Serbia during 2017-2019 were included in the study. Characteristics and outcomes of these patients were prospectively collected. Results: In total, 155 patients (mean age 72.3±13.4) were included in the study. BHC group consisted of 124 (80 %) and CO group of 31 (20 %) patients. 32 (20.6 %) patients presented with bilateral cSDH, head trauma was documented in 92 (59.4 %), and anticoagulant therapy in 37 (23.9 %) individuals. The most common symptom was hemiparesis (n=85, 54.8 %). The two groups did not differ by age. CO group had higher Glasgow Coma Scale (GCS) score at the admission, with a significant decrease at discharge compared to admission (12.6±4.8 vs 14.4±1.7, p