The treatment for hip fractures consists of a wide variety of orthopedic implants ranging from prosthesis to intramedullary nails. The purpose of this study is to determine the correlation between blood-count-derived biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR) and the systemic immune-inflammation index (SII) and the level of aggression sustained by elderly patients during these surgical procedures. A total of 129 patients aged over 70 and diagnosed with acute hip fractures who underwent surgical treatment between November 2021 and February 2023 were included in our observational retrospective cohort study. Two groups were formed depending on the anatomic location of the fracture for statistical comparison: group 1 with extracapsular fractures, who received a closed reduction internal fixation (CRIF) with a gamma nail (GN) as treatment, and group 2 with intracapsular fractures, who received a bipolar hemiarthroplasty (BHA) as treatment. The length of hospital stay (LHS), duration of surgery, preoperative days, pre- and postoperative red blood count (RBC) and hemoglobin (HGB) levels and postoperative NLR, PLR and SII were significantly different between the two groups (p < 0.05). Furthermore, the multivariate analysis indicated that the postoperative NLR (p = 0.029), PLR (p = 0.009), SII (p = 0.001) and duration of surgery (p < 0.0001) were independently related to the invasiveness of the procedures. The ROC curve analysis demonstrated that a postoperative SII > 1564.74 is a more reliable predictor of surgical trauma in terms of specificity (58.1%) and sensitivity (56.7%). Postoperative SII as a biomarker appears to be closely correlated with surgical trauma sustained by an older population with hip fractures.

Background: Treatment of pelvic injuries poses serious problems for surgeons due to the difficulties of the associated injuries. The objective of this research is to create a clinical workflow that integrates three-dimensional technologies in preoperative planning and performing surgery for the reduction and stabilization of associated acetabular fractures. Methods: The research methodology consisted of integrating the stages of virtual preoperative planning, physical preoperative planning, and performing the surgical intervention in a newly developed clinical workflow. The proposed model was validated in practice in a pilot surgical intervention. Results: On a complex pelvic injury case of a patient with an associated both-column acetabular fracture (AO/OTA-62C1g), we presented the results obtained in the six stages of the clinical workflow: acquisition of three-dimensional (3D) images, creation of the virtual model of the pelvis, creation of the physical model of the pelvis, preoperative physical simulation, orthopedic surgery, and imaging validation of the intervention. The life-size 3D model was fabricated based on computed tomography imagistics. To create the virtual model, the images were imported into Invesalius (version 3.1.1, CTI, Brazil), after which they were processed with MeshLab (version 2023.12, ISTI—CNR, Italy) and FreeCAD (version 0.21.2, LGPL, FSF, Boston, MA, USA). The physical model was printed in 21 h and 37 min using Ultimaker Cura software (version 5.7.2), on an Ultimaker 2+ printing machine through a Fused Deposition Modeling process. Using the physical model, osteosynthesis plate dimensions and fixation screw trajectories were tested to reduce the risk of neurovascular injury, after which they were adjusted and resterilized, which enhanced preoperative decision-making. Conclusions: The life-size physical model improved anatomical appreciation and preoperative planning, enabling accurate surgical simulation. The tools created demonstrated remarkable accuracy and cost-effectiveness that support the advancement and efficiency of clinical practice.

This study investigates the efficacy of an integrated rehabilitation program that combines vestibular and knee-focused therapies to improve proprioceptive function, balance, and motor control in patients suffering from both Benign Paroxysmal Positional Vertigo (BPPV) and knee joint conditions. The study involved 59 participants diagnosed with both vestibular dysfunction and knee impairments, who were enrolled in a comprehensive rehabilitation program. Vestibular interventions included specific maneuvers such as the Epley maneuver and Brandt-Daroff exercises, aimed at repositioning otoliths and reducing vertigo symptoms, while balance retraining exercises were implemented to enhance stability and prevent falls. Additionally, TECAR therapy was used for its deep tissue heating and regenerative benefits, and specific proprioceptive exercises targeting the knee joint were conducted to improve joint position sense and reduce the risk of falls. The intervention resulted in significant improvements in proprioceptive accuracy, as evidenced by enhanced joint position sense measurements and increased scores on the Dynamic Gait Index (DGI). These findings suggest that the dual-targeted rehabilitation approach not only addresses the individual impairments associated with vestibular dysfunction and knee pathology but also effectively improves overall functional outcomes by tackling the complex interplay between these conditions. The study further highlights the importance of a multidisciplinary approach in rehabilitation, where addressing vestibular and musculoskeletal dysfunctions simultaneously can lead to better patient outcomes. The integrated rehabilitation strategy presented in this study offers a comprehensive approach to managing complex clinical cases, ultimately contributing to improved quality of life and functional independence in patients affected by concurrent vestibular and knee joint issues.

Background: The open Latarjet procedure is widely used for the treatment of recurrent anterior shoulder instability associated with bipolar bone defects. Preoperative imaging parameters may be associated with short-term functional outcomes following the open Latarjet procedure for recurrent anterior shoulder instability. Materials and Methods: This retrospective study included 16 patients treated with the modified open Latarjet procedure. Preoperative CT or MRI measurements included glenoid bone loss, Hill–Sachs interval (HSI), glenoid track (GT), HSI/GT ratio and glenoid index. At 6 months, patients were evaluated using the auto-Rowe and auto-Walch–Duplay scores, range of motion, recovery time, residual symptoms, and return to activity. Results: The median Rowe and Walch–Duplay scores were 95 (90–95) and 75 (70–90), respectively. Fifteen patients resumed physical activity, including seven who returned to their previous level. No procedure-related complications were reported. Among the imaging parameters analysed, a higher HSI/GT ratio was associated with lower Walch–Duplay (p = 0.007, q = 0.043) and Rowe scores (p = 0.014, q = 0.043). Higher glenoid bone loss was associated with a lower Rowe score (p = 0.015, q = 0.043), while a higher glenoid index was associated with a lower Walch–Duplay score (p = 0.017, q = 0.043). Glenoid track showed a positive nominal association with the Walch–Duplay score (p = 0.036), which did not remain significant after FDR adjustment (q = 0.072). Discussion: Preoperative assessment of bipolar bone loss, particularly the HSI/GT ratio, may provide complementary information for surgical planning and for exploring associations with short-term functional outcomes. The formula proposed by Boden may help determine whether the coracoid graft is sufficient to convert an off-track lesion into an on-track lesion. In patients with larger Hill–Sachs defects, additional remplissage or humeral head bone grafting may be considered, although these techniques carry risks of external rotation restriction and graft resorption or osteonecrosis, respectively. Conclusions: The open Latarjet procedure is a widely used surgical option for anterior shoulder instability. These exploratory findings require validation in larger cohorts with longer follow-up.

Background: Massive post-traumatic segmental bone defects exceeding 5 cm—particularly those resulting from Gustilo–Anderson type IIIB open fractures—present a formidable reconstructive challenge. Autologous bone graft, though biologically superior, is restricted in this context by limited harvest volume and donor-site morbidity. Nonvascularized structural bone allografts provide unrestricted graft volume and immediate mechanical support, but data on their performance in severely compromised post-traumatic environments remain sparse. Methods: This retrospective case series evaluated three patients with massive distal femoral bone loss following high-energy trauma. All were managed with a staged protocol: radical debridement and temporary joint-spanning external fixation at index surgery, followed by definitive reconstruction with a matched nonvascularized structural allograft and retrograde intramedullary nailing once the host bed was aseptic and soft-tissue coverage was established. Results: Limb salvage was achieved in all three patients at a mean follow-up of 18 months. Two patients attained stable biological integration and restored anatomical alignment; one of these progressed to full unassisted weight-bearing by four months postoperatively. The third patient developed symptomatic pseudarthrosis at the distal host–graft junction. The proximally integrated allograft had preserved sufficient femoral bone stock to serve as anchorage for a segmental total knee arthroplasty performed two years after the index reconstruction, ultimately preventing amputation. Conclusions: Nonvascularized structural allografts combined with rigid intramedullary nailing constitute a reproducible limb salvage strategy for massive femoral defects. The allograft functions not only as a vehicle for primary biological union, but as a structural reserve—maintaining femoral axis and bone stock that remains available for secondary arthroplasty reconstruction should union fail.