Background: Iliac crest is the most preferred autogenous bone graft harvesting donor site while it has sorts of complications like prolonged pain, hematoma, and fracture. Harvesting cancellous bone from proximal tibia is also increasingly being used because of lower complications and less donor site pain. However, there are lack of studies to compare these two donor sites in detail. Thus, we proposed to investigate the available amount of autogenous bone graft from the proximal tibia. Methods: Fifty-one patients who underwent simultaneous bone graft harvest from the PT and the AIC to fill up the given critical sized bone defects were enrolled in this study. We prospectively collected data including the weight of the harvested bone, donor site pain using the visual analog scale (VAS) score, and complications between the two sites. Results: The mean weight of cancellous bone harvested from the PT was greater than AIC (33.2g vs. 27.4g, p = 0.001). The mean VAS score was significantly lesser in the PT up to 60 days after harvesting (p < 0.001). There was persistent pain up to 90 days in four PT patients and in seven AIC patients. The major complication was reported only in AIC patients (11.8%). Conclusions: Harvesting cancellous bone from the PT is an acceptable alternative to the AIC for autogenous bone grafting owing to availability of more weighted graft bone and less donor site pain.

We report our experience of preoperative plate contouring for periarticular fractures using three-dimensional printing (3DP) technology and describe its benefits. We enrolled 34 patients, including 11 with humerus midshaft fractures, 12 with tibia plateau fractures, 2 with pilon fractures, and 9 with acetabulum fractures. The entire process of plate contouring over the 3DP model was videotaped and retrospectively analyzed. The total time and number of trials for the intraoperative positioning of precontoured plates and any further intraoperative contouring events were prospectively recorded. The mismatch between the planned and postoperative plate positions was evaluated. The average plate contouring time was 9.2 min for humerus shaft, 13.8 min for tibia plateau fractures, 8.8 min for pilon fractures, and 11.6 min for acetabular fractures. Most precontoured plates (88%, 30/34) could sit on the planned position without mismatch. In addition, only one patient with humerus shaft fracture required additional intraoperative contouring. Preoperative patient specific periarticular plate contouring using a 3DP model is a simple and efficient method that may alleviate the surgical challenges involved in plate contouring and positioning.

This narrative review provides an up-to-date overview of atypical femoral fractures (AFFs), emphasizing diagnostic criteria, epidemiology, pathophysiology, risk factors, and evaluation with screening strategies. AFFs are rare but significant complications associated with prolonged bisphosphonate (BP) therapy for osteoporosis. Although the pathogenesis of AFFs has not been fully elucidated, its primary mechanism is thought to involve impaired bone remodeling, leading to unhealed microfractures that progress to stress fractures under repetitive loading. AFFs can occur in various regions of the femur, influenced by femoral geometry and the lower limb axis. Other risk factors include prolonged steroid use, arthroplasty, genetic predispositions, and metabolic bone disorders. The diagnosis of AFFs is based on criteria established by the American Society for Bone and Mineral Research. Key radiographic features include lateral cortical transverse fracture lines and localized cortical thickening, typically with minimal or no comminution on the medial cortex. Dual-energy X-ray absorptiometry for screening tests and magnetic resonance imaging as an advanced imaging modality enable the early detection of incomplete fractures. This multi-modal approach facilitates the prompt identification of prodromal cortical changes, reducing the risk of complete fractures in high-risk populations, particularly patients undergoing prolonged BP therapy.Level of Evidence: V

Background: Unicompartmental knee arthroplasty (UKA) represents a well-recognized treatment option for isolated medial compartment osteoarthritis; however, the debate regarding the superiority of fixed-bearing versus mobile-bearing designs continues. We aimed to evaluate the mid- to long-term outcomes of medial UKA comparing mobile- versus fixed-bearing designs within a single institution over an average 10-year follow-up. Methods: This retrospective study included 81 consecutive patients who underwent primary medial UKA (45 fixed-bearing and 36 mobile-bearing) with a minimum five-year follow-up. Clinical outcomes were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and range of motion (ROM). Radiological measurements included hip-knee-ankle axis angle (HKA) and osteoarthritis progression. Implant survivorship was evaluated using Kaplan–Meier analysis, with failure defined as either conversion to total knee arthroplasty (TKA) or polyethylene (PE) exchange. Results: At a mean follow-up of 10.6 years, WOMAC scores, ROM, and radiological outcomes showed no statistically significant differences between the fixed-bearing and mobile-bearing groups. Significantly higher failure rates were observed in the mobile-bearing group, both when considering conversion only (p = 0.041) and when including conversion or PE exchange (p = 0.009). Survival analysis demonstrated 10-year rates of 97.8% for fixed-bearing and 88.9% for mobile-bearing with TKA conversion defined as failure (p = 0.066). Using combined failure criteria of TKA conversion or PE exchange, 10-year survival rates were 97.8% for fixed-bearing and 83.3% for mobile-bearing (p = 0.015). Conclusions: At a mean 10.6-year follow-up, clinical and radiological outcomes were comparable, but fixed-bearing UKA demonstrated superior survivorship.