RESUMEN. Introducción: la osteomielitis esclerosante de Garré es una inflamación ósea crónica, sin signos clínicos activos de infección, que se caracteriza por periostitis hiperplásica y engrosamiento cortical. Suele afectar a huesos largos en pacientes jóvenes, siendo excepcional su localización en el húmero. El objetivo de este trabajo es presentar un caso en húmero y revisar la literatura existente. Caso clínico: niña de 12 años que acude por dolor en el hombro derecho tras una caída. La radiografía reveló una lesión lítica metafisaria con engrosamiento cortical y reacción perióstica. La resonancia magnética (RM) mostró engrosamiento cortical y edema en partes blandas sin abscesos. La biopsia inicial fue sugestiva de condroma, por lo que se realizó exéresis intralesional; el estudio anatomopatológico descartó neoplasia y confirmó osteomielitis aguda. Ante la persistencia del dolor y empeoramiento radiológico, se realizaron perforaciones óseas con hallazgos de inflamación crónica y detección de ADN de Kingella kingae. Siete años después, la paciente presentó una recaída. Se realizó cirugía con ventana ósea, curetaje y relleno con Stimulan. La biopsia confirmó osteomielitis esclerosante de Garré. Siete meses después, se repitió el procedimiento con biovidrio. Los cultivos fueron negativos en ambas ocasiones. Se administró antibioterapia intravenosa y oral, con evolución favorable. Conclusiones: el diagnóstico de la osteomielitis de Garré es difícil por la inespecificidad clínica y la negatividad de los cultivos. Requiere enfoque multidisciplinar, tratamiento quirúrgico y antibiótico y seguimiento a largo plazo, debido al riesgo de recurrencias. Palabras clave: osteomielitis esclerosante de Garré, biopsia, reacción perióstica, húmero. Introduction: Garré's sclerosing osteomyelitis is a chronic inflammatory condition of the bone without overt clinical signs of infection, characterized by hyperplastic periostitis and cortical thickening. It typically affects long bones in young patients, with humeral involvement being exceptionally rare. The aim of this report is to present a humeral case and review the relevant literature. Case report: a 12-year-old girl presented with right shoulder pain following a fall. Initial radiographs revealed a metaphyseal lytic lesion with cortical thinning and periosteal reaction. MRI showed cortical thickening and soft tissue edema without abscess formation. The initial biopsy suggested a chondroma, leading to intralesional excision. Histopathological analysis ruled out neoplasia and confirmed acute osteomyelitis. Due to persistent pain and radiographic worsening, bone drilling was performed, revealing chronic inflammation and detection of Kingella kingae DNA. Seven years later, the patient experienced a relapse. Surgical treatment included a cortical window, curettage, and filling with Stimulans. Biopsy confirmed Garré's sclerosing osteomyelitis. Seven months later, the procedure was repeated with bioactive glass. Cultures were negative on both occasions. Intravenous and oral antibiotic therapy was administered, with a favorable clinical outcome. Conclusions: the diagnosis of Garré's osteomyelitis is challenging due to its nonspecific clinical presentation and negative cultures. Management requires combined surgical and antibiotic treatment, with a risk of recurrence and the need for long-term follow-up.

Background/Objectives: Computer-assisted navigation in total knee arthroplasty (TKA) aims to improve implant positioning and lower-limb alignment. However, its impact on functional outcomes, complications, and implant survival remains uncertain. This study compared radiological and functional outcomes, complications, reoperations, and implant survival between computer-navigated and conventional primary TKA using the same VEGA prosthetic system. Methods: This retrospective observational cohort study included 277 primary TKAs performed for osteoarthritis using the VEGA system between 2019 and 2025: 119 navigated and 158 conventional procedures. Radiological outcomes included postoperative LDFA, MPTA, and HKA alignment. Clinical outcomes included range of motion, Oxford Knee Score (OKS), and Net Promoter Score (NPS). Complications, reoperations, and implant survival were also assessed. Implant survival was analyzed using Kaplan–Meier curves and the log-rank test. Results: The navigated group had a postoperative HKA closer to neutral alignment than the conventional group (177.4° vs. 173.8°, p = 0.0002), and a greater proportion of knees within ±3° of neutral alignment (55.32% vs. 18.75%, p = 0.0003). Excellent postoperative ROM was more frequent after navigation (63.06% vs. 16.46%, p < 0.001). Median OKS was also higher in the navigated group (44 vs. 43, p = 0.031), whereas NPS did not differ significantly. Complication and reoperation rates were similar between groups. Estimated five-year implant survival was 95.88%, with no significant difference between groups (log-rank p = 0.326). Conclusions: Computer-assisted navigation using the VEGA system was associated with more accurate restoration of the mechanical axis and differences in selected functional outcomes. No significant differences were observed in complications, reoperations, or estimated implant survival. The retrospective design, potential confounding by surgeon, and limited follow-up warrant caution when interpreting these findings.

Introducción: La pseudoartrosis séptica humeral es una complicación infrecuente cuyo tratamiento resulta especialmente complejo cuando asocia fracaso de la osteosíntesis, infección crónica y múltiples cirugías previas. Objetivo: Presentamos el caso de un varón de 50 años con antecedente de artrodesis glenohumeral que desarrolló una pseudoartrosis séptica tras una fractura periimplante. Reporte de caso: El tratamiento consistió en un abordaje secuencial en dos tiempos mediante retirada del material de osteosíntesis, desbridamiento radical, fijación externa temporal y antibioterapia dirigida, seguido de reconstrucción definitiva con placa bloqueada una vez controlada la infección. Se consiguió la consolidación ósea sin recurrencia infecciosa durante el seguimiento. Discusión: Con el fin de contextualizar este caso, se realizó una revisión de la literatura que identificó ocho publicaciones sobre el tratamiento secuencial de la pseudoartrosis séptica humeral. La evidencia disponible, aunque limitada, respalda el tratamiento en dos tiempos como una alternativa eficaz en pacientes con infección crónica y elevada complejidad reconstructiva.

Purpose Accurate placement of the guide wire is essential for optimal glenoid component positioning in reverse shoulder arthroplasty. Current navigation systems, while effective, are often costly and complex. The aim of this study was to evaluate the precision of guide pin placement using a new navigation system based on holographic computing through a spatial augmented reality mesh. Methods Five scapulae were reconstructed from patient CT scans to plan optimal glenoid inclination and version. Each was 3D-printed four times. Two surgeons (one in training and a shoulder specialist) inserted guide wires first freehand and then using a mixed reality navigation system. Post-placement CT scans assessed version and inclination angles. Errors were calculated as the difference between planned and obtained angles for both manual and navigated techniques. Results The mean error of the navigated system was 1.85° (SD: 2.08) compared to 10.75° (SD: 8.19) for the manual technique, with statistically significant differences. No significant differences were found between senior and junior surgeons. In the manual technique, errors increased in scapulae with greater deformities for both surgeons (p < 0.05), while the navigated method maintained accuracy regardless of deformity severity. Conclusions Holographic computer-assisted navigation in shoulder arthroplasty matches and improves the accuracy of guide needle positioning regardless of the surgeon's level of experience. Due to its accessibility and simplicity, it represents a promising technique for future surgical navigation.

Diagnostic delay in flexor tendon injuries is common in pediatric patients, and age influences both recovery and postoperative management. We report the case of a three-year-old girl who presented with the inability to flex the distal interphalangeal joint of the left third finger, two months after the digit became entrapped in a chair. Ultrasonography revealed cortical ossification of the middle phalanx compressing the flexor tendon, without clear evidence of discontinuity. Surgical exploration was undertaken due to a strong clinical suspicion of flexor digitorum profundus rupture, revealing an old laceration with fibrotic changes. The proximal tendon stump was reattached to the distal phalanx using a pull-out suture; the bone lesion was left untreated. At six weeks, radiographs demonstrated ossification consolidation, consistent with periosteal injury secondary to a middle phalanx fracture. This case highlights the importance of examination under sedation for pediatric hand injuries. Periosteal injury can result in callus formation, and after tendon repair, postoperative immobilization may need to be prolonged compared with adult patients.

Massive femoral bone loss remains one of the greatest challenges in limb salvage and revision orthopedic surgery. The push-through prosthesis was developed as an alternative to total femoral replacement, allowing preservation of the remaining femoral cortex and its associated muscular attachments; however, clinical evidence regarding its use remains limited. We retrospectively reviewed all patients who underwent femoral reconstruction using a push-through prosthesis at a tertiary referral center between 2006 and 2025. Demographic characteristics, surgical indications, previous procedures, postoperative complications, implant survival, and functional outcomes were analyzed, and the current literature was reviewed. Five patients (mean age, 63.4 years) with massive femoral bone loss following complex reconstructive procedures were included. Surgical indications comprised periprosthetic joint infection (n = 2), complex femoral nonunion (n = 1), mechanical failure of a megaprosthesis (n = 1), and failure of revision total hip arthroplasty (n = 1). At a mean follow-up of more than five years, no cases of aseptic loosening, periprosthetic fracture, prosthetic dislocation, or recurrent infection were observed. No patient required revision surgery, resulting in 100% implant and limb survival. All patients remained ambulatory at final follow-up, although most required walking aids. These findings suggest that the push-through prosthesis is a valuable limb-salvage option for carefully selected patients with massive femoral bone loss when conventional reconstructive techniques are no longer feasible, providing durable implant survival, limb preservation, and satisfactory functional outcomes. However, these findings should be interpreted with caution given the small sample size and the absence of standardized functional outcome measures, highlighting the need for larger multicenter studies.