Background: Complex acetabular fractures involving the quadrilateral plate (QLP) present significant surgical challenges due to poor bone quality, the inherent thinness of the QLP, and the proximity of significant neurovascular structures. While modern anatomical plates exist, their high cost and limited accessibility remain barriers. This study evaluates a novel, cost-effective surgical technique using a locked titanium calcaneus plate combined with a suprapectineal reconstruction plate for medial buttressing. Methods: A total of 60 patients treated for acetabular fractures between 2016 and 2025 were reviewed. Ten patients specifically underwent medial buttressing for QLP fractures. Among these, five patients received a locked titanium calcaneus plate fixed to a suprapectineal reconstruction plate. Clinical and demographic data, fracture classifications (Letournel and Judet), and postoperative reduction quality (measured via CT scans) were analyzed. Reduction was categorized as anatomical (< 2 mm) or non-anatomical (≥ 2 mm). Results: The mean age was 39.5 ± 16.1 years. Posterior wall fractures were the most common elementary pattern (60.6%), while anterior column with posterior hemitransverse fractures predominated the complex group (37%). Postoperative CT scans showed anatomical reduction in 83.3% of the total cohort. The mean follow-up was 11.5 months. The surgical approach was predominantly Kocher-Langenbeck (60%), followed by the modified Stoppa (30%) and ilioinguinal (10%) approaches. Conclusion: Combining a locked titanium calcaneus plate with a suprapectineal reconstruction plate is a viable and effective alternative for stabilizing complex QLP fractures. This technique provides stable medial support using widely available implants, making it a good option in clinical settings where patient-specific or modern anatomical plates are unavailable.

Background and Objectives: Acetabular fracture surgery is associated with substantial perioperative blood loss and prolonged operative time. Routine preoperative pelvic computed tomography (CT) carries information about body composition that is not currently exploited for risk stratification. We tested whether (i) CT-defined pelvic sarcopenia is associated with lower preoperative haemoglobin and (ii) preoperative subcutaneous fat cross-sectional area (CSA) is independently associated with operative time, after adjustment for surgical approach, age, fracture complexity and sarcopenia status. Materials and Methods: In this single-centre retrospective cohort study, 48 adults (37 men, 11 women; mean age 40.2 ± 16.5 years) who underwent open reduction and internal fixation (ORIF) for unilateral acetabular fractures between 2016 and 2024 were included. Pelvic muscle and subcutaneous fat CSAs were measured on the contralateral side of preoperative CT images using ImageJ. Sarcopenia was defined as an internal, cohort-relative classification based on the sex-specific bottom tertile of psoas CSA. Normality was assessed by Shapiro–Wilk testing; Pearson or Spearman correlation was used accordingly, and the 36 pairwise correlations were controlled with the Benjamini–Hochberg false-discovery-rate procedure. The multivariable model used ordinary least squares regression with heteroscedasticity-consistent (HC3) standard errors and a median quantile-regression robustness check. Results: Sarcopenic patients (n = 17) had significantly lower preoperative haemoglobin (12.63 ± 1.24 vs. 14.00 ± 1.53 g/dL; p = 0.002; Cohen’s d = 0.96). The absolute perioperative haemoglobin drop was numerically smaller in the sarcopenic group (ΔHb 1.64 ± 0.91 vs. 2.46 ± 1.87 g/dL) but did not reach statistical significance (p = 0.079); estimated blood loss (p = 0.258) and transfusion requirement (p = 0.567) did not differ between groups. Pelvic muscle CSAs correlated positively with preoperative haemoglobin (all q < 0.05 after Benjamini–Hochberg correction). In the multivariable model (F[6, 41] = 3.71, p = 0.005; adjusted R² = 0.26; all variance inflation factors 1.06–1.26), subcutaneous fat CSA (B = +0.25 min/cm², p = 0.004) and the modified Stoppa approach (vs. Kocher–Langenbeck; +65 min, p = 0.001) were independently associated with operative time. Conclusions: In this exploratory retrospective cohort, routine preoperative pelvic CT contained two body-composition signals that may warrant prospective evaluation: pelvic sarcopenia, which was associated with lower baseline haemoglobin, and subcutaneous adiposity, which was associated with longer operative time in the primary regression model. Both signals require confirmation—the sarcopenia–bleeding relationship was not statistically significant, and the subcutaneous fat association was attenuated under robust inference. These findings are hypothesis-generating; prospective multicentre validation with height-normalised sarcopenia thresholds and body mass index is required before clinical implementation.

Background: Clubfoot (CF) is one of the most common musculoskeletal deformities in newborns, with an incidence of 1–2 per 1,000 live births. While the Ponseti method is the gold standard for initial management and achieves over 90% initial correction rates, relapse remains a significant challenge, particularly in severe cases or in instances of poor compliance with orthotic use. Recurrent CF may require surgical intervention when conservative measures fail. Posteromedial release (PMR) is a well-established surgical technique designed to correct all components of the deformity in a single stage. Methods: This retrospective study included 16 patients (20 feet) with relapsed idiopathic CF who were treated with PMR after unsuccessful conservative or previous surgical treatment. All surgeries were performed by the same surgeon using Turco’s posteromedial approach. Clinical evaluation was conducted using the Pirani Score (PS) before and after surgery. Radiographic parameters including anteroposterior talocalcaneal angle (ATCA), lateral talocalcaneal angle (LTCA), and anteroposterior talo-first metatarsal angle (ATMA) were measured preoperatively and at final follow-up. Results: The mean patient age was 4.5 years, with a mean follow-up of 2.7 years. The mean PS improved significantly from 4.13 to 0.89 (p = 0.001). Radiological outcomes also showed significant improvement: ATCA increased from 21° to 23° (p = 0.047), LTCA from 20° to 30° (p = 0.002), and ATMA decreased from 45° to 11° (p = 0.001). In addition to PMR, the surgical procedures performed on the patients were as follows: cuboid decancellation, medial column lengthening, lateral cuneiform transfer of the tibialis anterior tendon, split tibialis posterior tendon transfer to the proneus brevis tendon, and multiple metatarsal osteotomies. Conclusions: PMR is a safe and effective surgical option for the treatment of relapsed congenital clubfoot when conservative methods fail. It allows for satisfactory mid-term correction both clinically and radiologically, with low complication rates and durable outcomes.

Osteopoikilosis is a rare, benign sclerosing bone dysplasia characterized by multiple, symmetric, well-defined sclerotic lesions primarily located in the epiphyseal and metaphyseal regions of long bones, pelvis, and hands. Although usually asymptomatic and incidentally discovered, its radiographic appearance may mimic osteoblastic metastases, leading to diagnostic confusion. Accurate recognition of imaging features is essential to avoid unnecessary invasive procedures and to provide appropriate patient reassurance.

Background and Objectives: Acetabular fracture surgery is associated with substantial perioperative blood loss and prolonged operative time. Routine preoperative pelvic computed tomography (CT) carries information about body composition that is not currently exploited for risk stratification. We tested whether (i) CT-defined pelvic sarcopenia is associated with lower preoperative haemoglobin and a greater perioperative haemoglobin drop, and (ii) preoperative subcutaneous fat cross-sectional area (CSA) independently predicts operative time, after adjustment for surgical approach, age, fracture complexity and sarcopenia status. Materials and Methods: In this single-centre retrospective cohort study, 48 adults (37 men, 11 women; mean age 40.2 ± 16.5 years) who underwent open reduction and internal fixation (ORIF) for unilateral acetabular fractures between 2016 and 2024 were included. Pelvic muscle and subcutaneous fat CSAs were measured on the contralateral side of preoperative CT images using ImageJ. Sarcopenia was defined a priori as a sex-specific bottom tertile of psoas CSA. Group comparisons used Welch's t-test or Mann–Whitney U; correlations used Pearson's r; the multivariable model used ordinary least squares regression. A sensitivity power analysis was performed for all primary tests. Results: Sarcopenic patients (n = 17) had significantly lower preoperative haemoglobin (12.63 ± 1.24 vs. 14.00 ± 1.53 g/dL; mean difference −1.37 g/dL, 95% CI −2.20 to −0.55; p = 0.002; Cohen's d = 0.96) and a greater perioperative haemoglobin drop (ΔHb 1.64 ± 0.91 vs. 2.46 ± 1.87 g/dL; p = 0.046; d = 0.52) compared with non-sarcopenic patients (n = 31). Psoas, iliacus, gluteus medius–minimus and total muscle CSAs all correlated positively with preoperative haemoglobin (r = 0.42 to 0.49; all p ≤ 0.003). In the multivariable model (overall F[6, 41] = 3.71, p = 0.005; adjusted R² = 0.26), subcutaneous fat CSA (B = +0.25 min/cm², 95% CI +0.09 to +0.41, p = 0.004) and the modified Stoppa approach (vs. Kocher–Langenbeck; +65 min, p = 0.001) independently predicted operative time, while age, fracture complexity and sarcopenia did not. Conclusions: Routine preoperative pelvic CT in acetabular fracture patients can be repurposed as a one-stop opportunistic screen for two clinically actionable phenotypes: pelvic sarcopenia, which flags lower haematopoietic reserve and a greater perioperative haemoglobin drop, and elevated subcutaneous adiposity, which independently predicts longer operative time. Both findings can be obtained at zero marginal cost or radiation burden and could inform preoperative blood-product preparation, prehabilitation triage, and operating-room scheduling.