Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient’s life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case–control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication.

Sarcomas are a heterogeneous group of malignancies with a high mortality rate. Detection of circulating tumor-derived material, such as circulating RNA in the peripheral blood of patients, has shown to be useful in diagnosis, prediction of prognosis and disease monitoring in several malignancies. This systematic review aims to probe the existing methods for detecting circulating tumor-derived RNAs from patients affected by sarcoma and their possible clinical application. A systematic review of the literature indexed in PubMed was performed. Each article had to analyze circulating RNA in human specimens obtained from liquid biopsies of patients affected by sarcoma. A total of 26 articles were included. We evaluated 1381 patients; 72% were affected by bone sarcoma and 28% by soft tissue sarcoma. By PCR-based methods, all the studies investigated circulating tumor RNA, mostly in the peripheral blood. Nearly half of the authors investigated the tumor expression and/or release of miRNA (42%). Several authors pointed out that circulating tumor-derived RNA has proven to have potential application in a clinical setting for sarcomas. To the best of our knowledge, this is the first review in the literature to attempt to put together data specifically on ctRNA in patients affected by sarcoma.

Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is responsible for an increased risk of fractures. The purpose of our study was to evaluate the orthopedic manifestations and potential pitfalls in the surgical treatments of pathological fractures in a series of patients treated in our institution who were affected by pycnodysostosis. Methods: We retrospectively evaluated clinical and radiographic characteristics of five patients with pycnodysostosis treated for pathological fractures at our hospital in the past 5 years. Results: Two male and three female patients were included in this study. Four patients had a family history of pycnodysostosis. All the patients were of short stature, but only two underwent growth hormone treatment. All the patients experienced fractures, mostly in their lower limbs and occurring as a result of low-energy trauma. Most of the patients experienced either consolidation delay or nonunion. Conclusions: The orthopedic management of fractures in patients with pycnodysostosis poses an ongoing challenge for orthopedic surgeons. The fact that the bone is simultaneously sclerotic and brittle makes any orthopedic surgical treatment challenging and at a high risk of nonunion in any case.

Background: Distal tibial fractures (DTFs) are a major cause of post-traumatic osteoarthritis (PTOA). The risk of conversion to total ankle arthroplasty (TAA) or ankle fusion (AF) after DTFs remains unclear, and the current literature provides heterogeneous and often incomplete data. The aim of this systematic review was to evaluate the incidence of TAA and AF following DTF-related PTOA and to explore potential predictors of conversion, including initial treatment strategy. Methods: A systematic review was conducted according to PRISMA guidelines. The PICO framework was applied during the study design and literature search phase to define the research question and eligibility criteria. Studies reporting adult patients with a history of DTFs who later developed PTOA and underwent TAA or AF were included. Descriptive statistics were performed. Study-level proportions of conversion to TAA, AF, or both were analyzed using random-effects meta-analysis with logit transformation. Results: Eight studies comprising 190,383 fractures met the inclusion criteria. Overall, 31,269 patients underwent TAA or AF, corresponding to a conversion rate of 16.4%. The pooled conversion incidence from the random-effects model was 5.6%, with considerable heterogeneity (I² ≈ 100%). When procedures were analyzed separately, the pooled incidence was 0.25% for TAA and 0.76% for AF. Conclusions: The risk of conversion to TAA or AF after DTFs appears to be relatively low, despite the high prevalence of PTOA. The higher conversion rate observed in surgically treated fractures likely reflects the complexity of the initial fracture rather than the failure of surgical management itself. Level IV, systematic review of retrospective studies.

Background: Radial head arthroplasty is commonly used for unreconstructable radial head fractures, particularly in cases associated with elbow instability. Both loose-fit monobloc and cemented bipolar radial head prostheses are available, but comparative evidence regarding their clinical and radiographic outcomes remains limited. This study aimed to compare mid-term outcomes between these two implant designs. Methods: A retrospective observational study was conducted on 26 patients who underwent radial head arthroplasty for acute radial head fractures between November 2020 and October 2023. Fourteen patients received a loose-fit monobloc radial head prosthesis, while twelve received a cemented bipolar prosthesis. Clinical, functional, and radiographic outcomes were assessed at a minimum follow-up of 24 months. Outcome measures included range of motion, pain, elbow stability, satisfaction, ADL (activities of daily living), IADL (instrumental activities of daily living), SF-12 (12-Item Short Form Health Survey), Oxford Elbow Score, Mayo Elbow Performance Score, DASH (disability of the arm, shoulder and hand score) score, implant loosening, heterotopic ossification, and complications. Results: No statistically significant differences were observed between the two groups in pain, satisfaction, range of motion, elbow stability, functional scores, radiographic loosening, or complication rates. The cemented bipolar group showed slightly better flexion–extension and pronation–supination values, whereas the loose-fit group showed a numerically lower rate of elbow instability; however, these differences were not statistically significant. No cases of aseptic loosening, periprosthetic osteolysis, or undesired implant loosening were observed. The complication rate was 36% in the loose-fit group and 33% in the cemented group. One patient in the loose-fit group required revision surgery due to implant overstuffing. Conclusions: Both loose-fit monobloc and cemented bipolar radial head prostheses provided acceptable mid-term functional scores; however, the relatively high overall complication rate (33–36%) highlights the need for careful implant selection, particularly with loose-fit implants, to avoid overstuffing and postoperative stiffness. Given the small cohort, these findings do not imply therapeutic equivalence.

Introduction: Tibial bone transport using external fixation is widely employed for the reconstruction of large and complex tibial bone defects; however, indications and surgical strategies remain highly heterogeneous. Tibial bone transport using external fixation is a demanding but reliable reconstructive technique, characterized by low failure rates and generally favorable outcomes despite frequent complications. Adequate soft-tissue management, selective docking-site grafting, and early functional rehabilitation were commonly reported. Further prospective studies are needed to standardize treatment strategies and improve clinical decision-making. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines in April 2025, searching PubMed/MEDLINE and the Cochrane Library. Extracted data included patient demographics, comorbidities, indications, defect length, surgical technique, frame type, external fixation time, healing index, complications, failures, and ASAMI bone and functional outcomes. Methodological quality was assessed using the MINORS score and results were synthesized descriptively. Results: A total of 3543 patients from 89 studies were included. Post-traumatic infection or osteomyelitis accounted for 58.5% of indications. The mean defect length was 7.04 cm. Bifocal bone transport was performed in 82.4% of cases, and circular external fixation was used in 79.0%. Early weight-bearing was allowed in approximately 95% of patients. The mean external fixation time was 11.0 months, with a healing index of 54.2 days/cm. The overall failure rate was 25/2748 (0.9%). Most studies were Level III–IV and were of fair-to-good methodological quality. Conclusion: Tibial bone transport using external fixation is a demanding but reliable reconstructive technique, characterized by low failure rates andgenerally favorable outcomes despite frequent complications. Adequate soft-tissue management, selective docking-site grafting, and early functional rehabilitation were commonlyreported. Further prospective studies are needed to standardize treatment strategies and improve clinical decision-making. Level of Evidence: III-IV