Background: The management of diaphyseal and distal tibial defects and non-unions is a significant challenge. Traditional treatments, such as distraction osteogenesis or Masquelet, are characterized by extended treatment times and elevated complication rates. Innovative approaches, such as customized 3D-printed titanium implants, are often required to restore structural integrity and function. This systematic review aimed to analyze the results achieved to date with this technique. Methods: A systematic review of the literature written in English was performed in PubMed, Scopus, and Cochrane to identify all cases of tibial non-unions or defects treated with customized 3D-printed titanium implants, excluding defects from tumor resection. Studies with a minimum of 12 months of follow-up were included. Results: The causes of treatment were infection in 10 patients, non-union in 6 patients, and severe bone loss after trauma in 3 cases. The size of the defect ranged from 3 to 8.5 cm. Osteointegration was 100% in all studies. The mean time to union was 5.3 months. The complication rate was 16%. Conclusions: Good results were reported in most patients. However, the data are insufficient to define the role of customized 3D-printed implants compared to traditional techniques. Further studies comparing them are needed to draw explicit guidelines.

Developmental Dysplasia of the Hip (DDH) is a prevalent pediatric condition affecting 1-3% of newborns worldwide. Early treatment is crucial to prevent long-term complications such as residual dysplasia, avascular necrosis (AVN), and osteoarthritis. Despite the widespread use of the Pavlik harness, the optimal timing of hip orthosis initiation remains a topic of debate. This systematic review and meta-analysis evaluate the impact of age and timing of hip orthosis application on treatment outcomes in infants with DDH. This systematic review was registered on PROSPERO (Registration No. CRD42025638433). A comprehensive literature search was conducted in PubMed, Scopus, and Cochrane Library for studies published between 2000 and 2024. Twenty-two studies meeting inclusion criteria were analyzed, focusing on success rates, healing times, and complications such as AVN and residual dysplasia. Data were pooled for meta-analysis, and statistical analyses were performed using a random-effects model to assess the impact of treatment timing. Infants treated before 3 months of age achieved a pooled success rate of 88.79 % (SE: 0.57 %), with lower complication rates, including AVN (0.89 %, SE: 0.18 %) and residual dysplasia (1.80 %, SE: 0.25 %). In contrast, treatment initiation between 3 and 6 months had a slightly lower success rate of 87.78 % (SE: 0.34 %), but with higher AVN (9.66 %, SE: 0.30 %) and residual dysplasia (20.27 %, SE: 0.40 %) rates. The Pavlik harness and Tübingen hip flexion splint were most effective in early-treated cases, whereas later treatment initiation or severe presentations resulted in less favorable outcomes. Early treatment initiation, particularly before 3 months of age, significantly improves treatment success and reduces long-term complications. These findings emphasize the necessity of early screening and timely intervention to optimize outcomes. Future research should focus on refining treatment protocols for delayed presentations and improving management strategies for severe dysplasia. Level IV.

Introduction: Segmental tibial defects pose significant challenges in orthopedic surgery due to their complexity and high complication rates. This systematic review aimed to evaluate both the effectiveness and outcomes of distraction osteogenesis (D.O.) and the Masquelet technique in treating post-traumatic segmental tibial defects. Materials and Methods: A literature search was performed on PubMed, Scopus, and Cochrane. Relevant retrospective and prospective observational studies with a minimum of 12 months follow-up were included. The primary outcome was bone union rate; the secondary outcomes were the type and rate of complications and the clinical and radiological outcomes. Results: Twenty-seven studies met the inclusion criteria, 18 studies reported data on D.O. and 9 on the Masquelet technique. D.O. demonstrated an overall union rate of 79.4% across 422 patients, and the Masquelet technique demonstrated an overall bone union rate of 85% across 113 patients. For D.O., on average, there was one complication per patient, and with the Masquelet technique, there were 0.5 complications per patient. Conclusions: D.O. and the Masquelet technique are the main treatment options for post-traumatic segmental tibial defects. Although union rates are similar, the Masquelet technique showed fewer complications. Treatment choice should consider patient-specific factors and more comparative studies are needed.

Hip displacement and dislocation are among the most disabling musculoskeletal sequelae of cerebral palsy (CP) yet reported incidence and risk-factor estimates vary widely across studies. We undertook a systematic review and pooled analysis to quantify cumulative incidence across Gross Motor Function Classification System (GMFCS) strata and identify reproducible clinical and radiographic predictors. A protocol was registered in PROSPERO (CRD420251026860). MEDLINE (PubMed), Embase, CINAHL and CENTRAL were searched from inception to March 30, 2025. Eligible longitudinal studies enrolled ≥30 children with CP aged 2-18 years, provided ≥2 years' follow-up without confounding hip-directed intervention, and reported migration percentage (MP) data or equivalent permitting derivation. Hip displacement and dislocation were harmonized as MP >30 % and >50 %, respectively. Study quality was appraised with ROBINS I. Proportions were stabilized with the Freeman-Tukey double-arcsine transformation and pooled in random-effects (REML) models; odds ratios (ORs) for candidate predictors were combined using inverse-variance random-effects methods. Heterogeneity (I², τ²), prediction intervals, influence diagnostics, Hartung-Knapp sensitivity and Egger tests were performed. Certainty was graded with adapted GRADE. Nineteen studies met inclusion; nine natural-history cohorts (n = 1556; median follow-up 5.1 y) contributed extractable incidence data. The pooled cumulative incidence of hip displacement/dislocation was 38.2 % (95 % CI 31.7-45.1 %; I² = 77 %; prediction interval 6.0 53.8 %). Incidence was 17.1 % in ambulant children (GMFCS I-III) and 71.9 % in non-ambulant children (IV-V), yielding an OR 3.72 (95 % CI 2.56-5.40) for non-ambulant vs ambulant groups. A baseline MP ≥ 30 % quadrupled subsequent risk (OR 4.48, 95 % CI 2.66-7.54; I² = 0 %). Pelvic obliquity ≥10° was associated with increased risk in a single cohort (OR 2.70, 95 % CI 1.34-5.46) and should be regarded as suggestive pending replication. No consistent effects were found for sex, gestational age or CP subtype. Approximately four in ten children with CP, and more than two thirds of those in GMFCS IV-V, develop clinically important hip displacement without targeted intervention. GMFCS IV-V status and an early MP ≥ 30 % are robust, actionable triggers for intensifying hip surveillance to six-monthly radiography; pelvic obliquity ≥10° may further stratify risk but requires confirmation. Uniform MP thresholds, time-to-event analyses and reporting of modifiable exposures are needed in future multicenter cohorts to refine preventive care.

Background/Objectives: Flatfoot is a common pediatric foot deformity characterized by a reduced or absent medial longitudinal arch (MLA). The condition can lead to altered gait, pain, and potential long-term morbidity if untreated. Identifying potential risk factors—such as body mass index (BMI), ligamentous or joint instability, shoe choices, and physical activity—is crucial for prevention and management. The objectives are to systematically review and synthesize current evidence on how flatfoot severity correlates with BMI and other risk factors in children and adolescents, and to highlight methodological considerations essential for future research. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five electronic databases from inception to February 2024. Flatfoot severity was measured by various clinical or radiographic indices. Two reviewers independently screened and assessed the risk of bias. Results: Thirty-seven studies met the inclusion criteria. Children with high BMI had increased odds of flatfoot (pooled Odds Ratio = 2.3, 95% Confidence Interval: 1.6–3.1), with one outlier reporting an OR of 9.08. Heterogeneity (I² up to 70%) stemmed from varied diagnostic methods. Other factors, including joint instability, shoe choices, and physical activity, showed mixed associations. Conclusions: Elevated BMI strongly correlates with pediatric flatfoot severity, highlighting the importance of proactive weight management and foot assessments. Future standardized, longitudinal studies are needed to clarify causality and refine interventions.

Background: Contrast therapy (CT) is a non-pharmacological treatment that alternates between cryotherapy and thermotherapy. It helps reduce VAS pain, improve joint ROM, enhance function, alleviate muscle soreness, and manage swelling, while also improving blood circulation. This scoping review summarizes recent studies on its use for musculoskeletal injuries (e.g., exercise-induced muscle damage, ankle sprain), degenerative conditions (e.g., osteoarthritis), and painful disorders (e.g., complex regional pain syndrome), assessing its healing potential compared to other conservative therapies. Methods: PubMed, Scopus, and Cochrane Library were searched to identify relevant publications. Articles were selected using the following inclusion criteria: randomized controlled trials, written in English, published between 2004 and 2024, and addressing the use of CT in the management of musculoskeletal painful conditions. Results: Data from 7 articles and 303 patients with musculoskeletal painful conditions treated with CT were included. There was considerable heterogeneity in terms of treatment protocols, with significant differences in the application method, duration, sequence of individuals in each hot/cold cycle, total treatment time, and the pathologies studied. Nevertheless, all studies showed an improvement in the patients’ initial clinical conditions. Conclusions: This review highlights the lack of guidelines for the clinical use of CT in musculoskeletal painful conditions. The heterogeneity of the studies reviewed (different clinical scores, follow-up periods, data, and samples) makes the results imprecise. In addition, the modest quality of the trials does not allow the authors to draw clear conclusions about the effectiveness of CT compared with other therapies.