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.

Objective: To evaluate the relationship between prenatal risk factors and developmental dysplasia of the hip using the Graf grade, and to identify the determinants of a higher Graf grade. Materials and Methods: A retrospective analysis of data from 112 newborns with DDH was conducted. The participants were selected on the basis of a DDH diagnosis using sonography. A total of 181 hips of patients with DDH were considered in our study group (Graf types IIa to IV), and the normal hips of those affected unilaterally were excluded from the analyses (43 participants were affected unilaterally). The risk factors considered included female sex, breech presentation, firstborn status, familiarity, association with other orthopedic abnormalities, and uterine packing, which includes factors such as twin pregnancy, macrosomia, and oligohydramnios. Binary logistic regression was used to analyze the relationship between these variables and the Graf type of DDH at presentation, which was defined using two groups: Graf types IIc–IV, which include unstable or decentered hips, and Graf types IIa and IIb, which encompass stable and centered hips. Results: The analyses revealed a significant protective role of the presence of other lower limb congenital malformations such as clubfoot, which was more closely associated with a stable form of DDH (OR = 0.26, p = 0.017), a significant association between the presence of mechanical risk factors in females with an unstable form of DDH (OR = 5.00, p = 0.042), a borderline significant protective role of breech presentation in females, which was more closely associated with a stable form of DDH (OR = 0.25, p = 0.054), and a borderline significant association between the presence of mechanical risk factors and an unstable form of DDH (OR = 4.28, p = 0.054). Conclusions: Prenatal risk factors may have a complex effect on the Graf grade in DDH. The protective effects of some factors in contrast with the increased risk associated with other factors suggest a possible relationship, with some prenatal risk factors affecting the severity of DDH. These findings may have implications for the early identification and management of DDH.

Background: Distraction osteogenesis (DO) and the Masquelet technique are currently the preferred treatment options for bone defects larger than 5 cm. Methods: Between January 2019 and December 2023, 19 patients were treated with DO for post-traumatic tibial defects at our institution. The results were evaluated using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Results: Patients’ mean age was 32.42 years. The mean defect size was 4.8 cm (range 3.2–8.1 cm), and the mean external fixation time was 21.31 weeks. Bone union was reached on average after 25.9 weeks. The mean follow-up time was 3.7 years. The mean leg length discrepancy at the final follow-up was 0.83 cm. Using the ASAMI system, the functional results were excellent in eight patients, good in eight, and fair in two, with one case of failure; the bone results were excellent in ten patients, good in six, fair in two, and poor in one. Conclusions: DO for the treatment of tibial defects has the potential to yield favourable outcomes, provided that the method is performed correctly. Multicentre prospective studies would allow for more definitive conclusions to be made.

Introduction: Displaced intra-articular calcaneal fractures (DIACFs) are associated with a high incidence of wound complications. Minimally invasive approaches (MIAs) have enabled earlier intervention compared with the extensile lateral approach (ELA). However, the relationship between surgical timing, approach and outcome remains poorly defined. This systematic review evaluated the relationship between surgical timing, approach, and postoperative outcomes in DIACFs. Materials and Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Studies published between January 1990 and April 2026 were searched through PubMed, Embase and Web of Science. Studies reporting the timing to surgery, approach, and postoperative outcomes in operated DIACFs were included. Patients were stratified into three groups according to timing (0–7 days, 8–21 days, and >21 days). Complication rates, radiographic and functional outcomes were analyzed. Results: A total of 25 studies, encompassing 1915 patients, were included. Patients mostly underwent surgery within seven days (60.1%), followed by 8–21 days (37.8%) and >21 days (2.1%). The complication rate was 21.7%, with wound dehiscence (8.9%) and infection (5.2%) being the most prevalent. Dehiscence and necrosis were predominantly associated with the ELA, particularly between days 8–21. Infection rates increased when the delayed sinus tarsi approach was used. No differences were found in radiographic or functional outcomes. Conclusions: Surgical timing does not appear to be an independent outcomes predictor. Complications depend on the interplay of timing, approach, and soft-tissue condition. An individualized treatment, with no rigid temporal thresholds, is probably the best approach.