Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B. We tested Amphotericin in PMMA cement mechanically, its elution properties in vitro and present two cases of fungal PJI treated with Amphotericin B powder in Copal cement in vivo. Sterile Amphotericin B is not available as a pure substance but only as powder for infusions. PMMA mixed with such pharmaceutical Amphotericin B formulations colored the cement orange. Compression strength was slightly decreased, bending and impact strength significantly decreased whereas bending modulus was increased. Drug elution was high within the first 24 h and decreased over time until day 5. Amphotericin B in combination with Copal was successfully used in two cases with Candida ssp. infections. No negative side effects, especially no nephrotoxic effects, were observed. Sterile Amphotericin B powder for preparing an infusion solution contains only small amounts of pure drug. In vivo polymicrobial Candida-infections with bacterial co-infection were successfully treated using the combination of Copal cements with added Amphotericin B without systemic nephrotoxic impact. The addition of Amphotericin B to PMMA cement affects the cement’s properties in vitro whereas in vivo the combination with Copal is clinically successful in treating complex cases of fungal PJI. Level IV.

• Tumor-transmitted osteomalacia is a rare FGF 23 transmitted phosphaturic disease. • Delay of diagnosis is common due to small and clinically silent underlying tumors. • The most sensitive imaging modality is ⁶⁸Ga-DOTA-TOC-PET/CT-scan. • Complete resection of the tumor mass cures this paraneoplastic disease.

Background: Limb-lengthening surgeries via nail distraction osteogenesis (DO) have become more popular lately. This provides an opportunity to study human bone that has grown longer. Case details: We present a case of a 22-year-old male who underwent internal upper and lower leg lengthening by 12 cm and 6 cm, respectively, under full weight bearing. He requested bilateral femoral shortening by 4 cm using a shortening nail, 24 months after the index surgery. The regenerated bones were harvested and analyzed. Results: Good bone quality and well-organized structure were observed in the regenerated bones compared with the native human adult bony architecture. Conclusions: This case demonstrates that bilateral bone regeneration during DO with a nail can result in a bone morphology that is comparable to that of native adult human bony macro- and micro-anatomy. This supports the effectiveness and potential of this surgical approach for limb lengthening and shortening procedures, although more investigations are necessary in this regard.

Implant-associated infections, including periprosthetic joint infections (PJI) and fracture-related infections (FRI), are severe complications following orthopedic surgery. Conventional tissue cultures often yield false-negative results, especially after antibiotic initiation or in chronic biofilm-associated infections. Sonication of explanted implants enhances bacterial recovery, but heterogeneous protocols limit comparability. This scoping review maps sonication protocols currently reported in the literature. A comprehensive literature search across three databases (PubMed, Embase, and Scopus) was performed. Clinical studies that reported on sonication protocols used in the microbiological workup of PJIs and FRIs published from 2007 to October 2025 were eligible for inclusion. Eligible studies were screened for the following information: container size and material and fluids, sonication device and settings, pre- and post-sonication handling, culture conditions, reporting format, and/or diagnostic thresholds. Data were extracted and synthesized descriptively. After duplicate removal, 312 records were screened, and 146 studies were included. Reporting was incomplete for several key parameters. Container material was not specified in 43.2% of studies, container type in 30.8%, and fluid type in 31.0%. Among reported protocols, hard plastic containers (54.8%) and Ringer’s lactate or saline (40.4%) were most frequently used, with fluid volumes ranging from 50 to 800 mL. Sonication frequency was reported in 50.7% of studies, most commonly 40 kHz (28.8%). Sonication time was not reported in 34.2%, with reported durations ranging from 1 to 10 min and most frequent duration as 5 min (30.1%). Vortexing and centrifugation were applied in 55.5% and 45.9% of studies, respectively. CFU thresholds varied widely, ranging from any growth to ≥50 CFU/mL or per plate. Time-to-culture and storage conditions were rarely reported. Sonication protocols vary greatly across almost all parameters, with detailed descriptions often lacking, and certain variables rarely reported. Standardizing these protocols is essential to ensure reproducibility and to establish clinically reliable diagnostic cut-offs. IMPORTANCE: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) are serious complications associated with substantial morbidity, repeated surgeries, and a high healthcare burden. Accurate and early pathogen detection is critical for guiding targeted antimicrobial therapy and improving treatment outcomes. Sonication of explanted implants has emerged as a valuable diagnostic tool by disrupting biofilms and enhancing bacterial recovery, particularly in antibiotic-exposed patients. However, sonication protocols vary widely across studies, including differences in containers, fluids, ultrasound settings, processing steps, and colony-forming unit thresholds, with inconsistent reporting further compounding the issue. This variability directly affects diagnostic performance, complicates the distinction between true infection and contamination, and limits inter-laboratory comparability. By systematically mapping this heterogeneity across 146 studies, this scoping review provides a foundation for developing standardized protocols and consensus definitions to improve diagnostic reliability and patient care.