Infection in orthopaedic and trauma surgery remains a destructive complication with particularly challenging diagnosis and treatment due to bacterial antibiotic resistance and biofilm formation. Along with surgical debridement and systemic antibiotics, an important type of adjuvant therapy is local antibiotic delivery, with the purpose of eliminating bacterial colonization and biofilm development. Calcium sulphate, as a synthetic absorbable biomaterial used for local antibiotic delivery, has experienced an increasing popularity during the last decade, with multiple promoted advantages such as predictable antibiotic elution kinetics, complete and quick biodegradation, good biocompatibility, and limited associated complications. A series of commercially available antibiotic-delivery systems based on calcium sulphate are under investigation and in clinical use, with different presentations, compositions, and application techniques. The current article presents the main available calcium-sulphate-based products and the existing data about the clinical and preclinical research results, stemming from their implementation as local antibiotic carriers for surgical site and implant-associated infections treatment and prevention. Cite this article: EFORT Open Rev 2021;6:297-304. DOI: 10.1302/2058-5241.6.200083

Failure of osteosynthesis implants is an intricate matter with challenging management that calls for efficient investigation and prevention. Using implant retrieval analysis combined with standard radiological examination, we evaluated the main causes for osteosynthesis implant breakdown and the relations among them for a series of cases. Twenty-one patients diagnosed with implant failure were assessed for this work. For metallurgical analysis, microscopy techniques such as scanning electron microscopy (SEM), stereomicroscopy, and optical microscopy were employed. The results showed that material structural deficiencies (nine patients) and faulty surgical techniques (eight patients) were the main causes for failure. An important number of patients presented with material structural deficiencies superimposed on an imperfect osteosynthesis technique (six patients). Consequently, the importance of failure retrieval analysis should not be overlooked, and in combination with other investigational techniques, must provide information for both implant manufacturing and design improvement, as well as osteosynthesis technique optimization.

Soft tissue sarcomas are rare malignant mesenchymal tumors for which accurate diagnosis, prognostic stratification, and therapeutic decision-making remain challenging. Although histopathology and immunohistochemistry are essential diagnostic tools, they frequently fail to capture the molecular complexity underlying tumor aggressiveness and treatment resistance. In this study, we evaluated the utility of RNA-based next-generation sequencing for the molecular characterization of STS and for elucidating transcriptomic mechanisms associated with aggressive tumor behavior. An observational cohort of 24 patients with histologically confirmed soft tissue sarcomas was analyzed, using adipose and skeletal muscle tissue as controls. RNA was extracted from tumor samples, libraries were prepared with a targeted pan-cancer panel, and sequencing was performed on the Illumina platform, followed by bioinformatic analysis using DRAGEN pipelines and DESeq2. RNA-NGS identified a predominance of single-nucleotide polymorphisms and significant differential gene expression, with overexpression of proliferation-related genes (TOP2A, MKI67, BUB1B), extracellular matrix and microenvironment-associated genes (COL11A1, SPP1), and developmental regulators (HOXD13, MELK). Subgroup analysis revealed a distinct transcriptomic profile in leiomyosarcoma, while gene fusion analysis detected clinically relevant alterations. These findings demonstrate that RNA-NGS provides biologically and clinically meaningful insights into the molecular landscape of soft tissue sarcomas and supports its integration into precision medicine-oriented diagnostic workflows.

Hallux valgus is one of the most common forefoot pathologies, with a multifactorial etiology that causes important functional impairment and metatarsalgia. The characteristic deformity originates from a biomechanical imbalance induced by the disruption of first metatarsophalangeal joint alignment and manifests as an abnormal weight transfer on the first ray during walking. Conservative treatment is unable to correct the deformity or stop the evolution of the disease but can distinctly control the symptoms. With time, a myriad of surgical correction techniques have been developed but no definitive surgical treatment algorithm has been generally accepted. Nonetheless, the decision process for choosing the suitable technique must be completed on an individual basis after considering the deformity severity stratification, status of the metatarsophalangeal and tarsometatarsal joints, bone anatomy, and associated comorbidities. In spite of a large variety of surgical options, there are a few main strategies that incorporate these variations: metatarsophalangeal and/or tarsometatarsal joint fusion, metatarsal osteotomies and soft tissue procedures. Nowadays, the surgical management of hallux valgus is dominated by first metatarsal osteotomies performed through open surgery or minimally invasive techniques. Hallux valgus angle has been found to be the single most important parameter for surgical outcome prognostic.