Diabetic foot osteomyelitis (DFO) is a severe complication of diabetes mellitus and a leading cause of non-traumatic lower extremity amputation. Treatment remains clinically challenging with high recurrence rates despite standard antibiotic therapy and surgical debridement. This narrative review synthesizes current evidence on novel operative and nonoperative therapies for DFO, focusing on emerging biomaterials, local antibiotic delivery systems, innovative surgical techniques, and adjunctive topical agents. Studies examining bioabsorbable and nonabsorbable antibiotic carriers, such as calcium sulfate beads, collagen sponges, and bioactive glass, demonstrate promising infection resolution rates and a potential to reduce the surgical burden, though most are limited by small cohorts and observational designs. Similarly, alternative surgical approaches (i.e., cancelloplasty, conservative bone excision, and tibial cortex distraction) have shown early success in limb preservation. Nonoperative strategies, including adjunct antimicrobials, antimicrobial peptides, and topical oxygen, offer additional options, particularly for patients unfit for surgery. While initial outcomes are encouraging, the supporting evidence is heterogeneous and primarily limited to case series and small, noncomparative trials. Overall, these novel therapies show potential as adjuncts to established DFO management, but further prospective research is indicated to define their long-term efficacy, safety, and role in clinical practice.

Chitosan is a resorbable cationic polysaccharide known for its biodegradability and electrostatic and self-aggregation properties. Chitosan has been shown to influence Schwann cell proliferation, reduce scarring, support axon growth, and provide superior peripheral nerve regenerative outcomes compared to nerve injuries without chitosan. This article reviews preclinical studies to collectively determine whether the presence of chitosan enhances neuroregenerative outcomes following nerve injury as compared to settings without chitosan. The most consistent outcome measure reported across studies was functional analysis, followed by histomorphometry. Most animal studies showed no significant differences in functional recovery, electrophysiology metrics, and histomorphometry parameters between chitosan-based conduit repairs, reconstruction using autografts, or direct nerve repairs. A subset of studies reported superior outcomes with chitosan conduits for nerve reconstruction, while others indicated inferior results compared to conventional repair. The two human studies focused on digital nerve repair with sensory gaps ≤ 26 mm and demonstrated significantly improved 2-point discrimination at 6 months and equivalent function by 12 months with chitosan conduits compared to standard direct repair. The introduction of chitosan into nerve repair and reconstructions provides a potentially beneficial biological augmentation to the nerve microenvironment that enhances cellular, electrophysiological, and functional outcomes. However, heterogeneous approaches to functional, electrodiagnostic, and histological assessments in addition to varying control groups create a significant deficiency in understanding the true utility of chitosan-based devices within the field of nerve regeneration. Further needs for standardization in the study and comparison of biomaterials for effective clinical translation is needed. Nonetheless, this study highlights papers that are effective in achieving a strong propensity towards the utility of chitosan within biomaterial development for nerve reconstruction.

Background: Pilon fractures are complex, often involving severe comminution and soft tissue compromise. Risk factors for infection after ankle fracture definitive fixation have been associated with open and/or comminuted fractures and poorly managed diabetes. However, infection risk following pilon fractures have not been well studied, and the effect of infection on other postoperative outcomes have not been widely discussed. This study aims to identify risk factors for developing infection following pilon fracture and assess the effect of infection on postoperative outcomes. Methods: This study was a retrospective review of patients who presented with a pilon fracture and underwent surgical fixation between January 1, 2013, and June 1, 2023. Only patients with at least 6-month follow-up were included. Demographic data and clinical data were collected. A 2:1 propensity score matching was completed to identify infection and no-infection cohorts. Results: There were 146 patients included in this study. Following propensity score matching, 2 cohorts were identified, including 24 patients with no infection and 14 patients with infection, following pilon fracture. Gustilo-Anderson classification and AO-Orthopaedic Trauma Association (AO-OTA) Classification did not differ significantly between groups ( P > .05). Perioperative characteristics were similar between the 2 cohorts. Mean time to partial weightbearing in weeks was 12.51 (SD 7.6) for the no-infection cohort and 29.61 (SD 28.3) for infection cohort ( P = .0198). Mean time to full weightbearing in weeks was 21.06 (SD 9.7) for the no-infection cohort and 35.90 (SD 31.7) for the infection cohort ( P = .142). In the infection cohort 50.0% (n = 7) of patients experienced nonunion compared with 4.2% (n = 1) in the no-infection cohort ( P < .01). Conclusion: Although fracture severity classification was not significantly different between groups, infection significantly negatively affected time to partial weightbearing, time to full weightbearing, and nonunion rates.

To help guide acetabular component positioning in total hip arthroplasty (THA), computer-assisted devices like robotics, navigation, and mixed-reality (MR) have been incorporated into the operating room with variable results. This study aimed to identify the effect of using MR technology on operative time. This was a retrospective review of patients over the age of 18 years, who underwent primary THA for end-stage osteoarthritis from January 1, 2021, to August 20, 2024, at a single institution with 2 surgeons who incorporated MR into their surgical workflow. Patients that underwent THA with one of these 2 surgeons without HipInsight (Surgical Planning Associates, Inc., Boston, MA) were also included as controls. Demographic data, surgical approach, and operative time were evaluated. There were 411 patients included in this study with 165 patients who underwent surgery with MR and 246 patients who underwent surgery with standard manual instrumentation. The mean operative time in minutes was 89.6 (standard deviation = 12.6) for patients undergoing THA without MR and 89.2 (standard deviation = 13.1) for patients undergoing THA with MR (P > .05). A MR navigation system for THA did not appear to prolong operative times when utilized. Further studies are needed to determine its effect on long-term outcomes.

Introduction: Displaced scaphoid fractures warrant surgical fixation to mitigate the risk of nonunion or malunion. We hypothesized that two-screw fixation would result in higher rates of union at shorter times. Methods: We retrospectively reviewed data of patients who presented with scaphoid fractures and underwent surgical fixation between 1 January 2013 and 30 November 2024. Patients were propensity score matched using demographics and Herbert classification as covariates. Results: After propensity score matching, 92 patients were identified, 47 receiving one screw and 45 receiving two screws. At 6 months after surgery, wrist extension was significantly greater in the one-screw cohort than in the two-screw cohort (71.0°, standard deviation (SD) 10.7° vs. 56.2°, SD 20.5°, p = 0.03); all other range of motion variables were similar between the cohorts at this timepoint. Visual analogue scale scores postoperatively significantly improved compared with preoperatively for both cohorts ( p < 0.001 for both). Patients in the one-screw cohort showed significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function scores after surgery as compared with before surgery. The PROMIS PI scores in the two-screw cohort also showed significant differences after and before surgery. Rates of nonunion, time to union and hardware complications did not show statistically significant differences between the one- and two-screw cohorts. Conclusion: In this study, we reject our hypothesis as two screws were similar to one-screw fixation for rates of healing and outcomes. Level of evidence: III, case-control study