Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1–46 months) with a mean follow-up of 37 months (range: 0.5–516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension–flexion arc was 2.1° to 127.8° (range: −10–140°). The mean Bauman’s angle was 72.4° (range: 66–79°), the mean shaft–condylar angle was 43.8° (range: 25–59°), the mean humeral length was 21.9 cm (range: 15.5–25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus–19° valgus). According to Flynn’s criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate.

Bisphosphonates have recently been used as a first-line treatment for osteoporosis. However, prolonged bisphosphonate use may be associated with insufficiency and atypical femoral fractures. In this case report, we present a patient with simultaneous bilateral insufficiency femoral fractures after using alendronate for 11 years, which were treated surgically. Our patient also had a history of a previous right femoral atypical fracture eight years before the latest ones, while on 3-year alendronate treatment. To our knowledge, it is the first patient reported with three atypical - insufficiency fractures covering all the anatomical areas of the proximal half of the femur after long-term bisphosphonate treatment.

Purpose: To evaluate the efficacy of injected leukocyte‐poor platelet‐rich plasma (LP‐PRP) during arthroscopic rotator cuff repair, primarily in reducing failure rates and, secondarily, in improving shoulder function and clinical outcome. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. Medline/PubMed, Scopus, Web of Science, and Cochrane databases were searched up to August 31, 2025, for comparative studies investigating the injectable LP‐PRP during arthroscopic rotator cuff repair. Inclusion criteria were Level I or II studies reporting clinical and radiological outcomes with more than 6‐month follow‐up. Data were extracted on failure incidence and patient‐reported outcome measures. Quantitative synthesis was performed using inverse variance weighting, and heterogeneity was assessed with the I ² statistic. Results: Five randomized controlled trials (n = 470 patients; 235 LP‐PRP, 235 control) were included. No difference was found in mean age ( P = .760) and gender distribution ( P = >.99) between the 2 study groups. Repair failure occurred in 34/213 (15.9%) in the LP‐PRP group versus 63/217 (29.0%) in controls (odds ratio 2.16; 95% confidence interval 1.34‐3.48; P = .001; relative risk 0.55; 95% confidence interval 0.38‐0.79). The LP‐PRP group showed greater improvements in Constant score at 6 months (31.6 vs 28.4; P = .001), 12 months (46.9 vs 44.2; P = .001), and 24 months (45.7 vs 42.8; P = .003), Single Assessment Numeric Evaluation at 12 months (42 vs 38.7; P = .036), University of California‐Los Angeles at 6, 12, and 24 months ( P < .001 for all), and visual analog scale at 3 months (5.9 vs 4.6; P = .001) and 24 months (5.2 vs 4.9; P = .012); nevertheless, none of these improvements reached the minimal clinically important difference. Complication rates were comparable between groups (9.4% vs 7.7%; P = .508). Conclusions: Injection of LP‐PRP during rotator cuff repair appears to be a safe procedure that may increase the healing rate. However, it has not been associated with improvements in patient‐reported outcome measures sufficient to reach the minimal clinically important difference. Level of Evidence: Level II, systematic review of Level I and II randomized controlled trials.