This case report describes the management of a clinically suspected vertical root fracture (VRF) using intentional reimplantation combined with radicectomy and documents the 36-month outcome with cone-beam computed tomography (CBCT). A 63-year-old man presented with spontaneous pain and intense pain on mastication associated with tooth 46. Clinical examination showed grade II mobility, positive percussion and buccal palpation, and an isolated 10-mm periodontal defect with bleeding and suppuration on the buccal aspect of the mesial root. Periapical radiography showed mesial-root underfilling and a radiolucency extending from the middle third towards the apex. Because preoperative CBCT was not obtained, VRF remained a clinical suspicion until direct visualization after extraction confirmed a fracture confined to the mesial root. Following atraumatic extraction, the fractured mesial root was resected at its cervical third; the apical 3 mm of the distal root were resected, ultrasonically retro-prepared, and sealed with Bio-C Repair. The tooth was replanted after an exact extraoral time of 11 minutes and stabilized with an X-shaped suture. At 2, 18, and 36 months, symptoms had resolved and periodontal, mobility, percussion, palpation, occlusal, and functional findings were favourable. CBCT at 36 months demonstrated complete periapical bone fill consistent with healing and no evidence of ankylosis or root resorption. Intentional reimplantation combined with radicectomy may be considered a tooth-preserving option in carefully selected multi-rooted teeth; this single case does not establish predictable effectiveness.

A 9-year-old boy initially presented with a closed metaphyseal transverse fracture of the distal right femur following a fall from a trampoline. Due to the adequate trauma and lack of initial radiological indications for an underlying pathological bone lesion, the fracture was primarily treated with antegrade elastic stable intramedullary nailing (ESIN). Postoperatively, the patient developed persistent pain, progressive soft tissue swelling and highly atypical callus formation accompanied by osteolytic lesions. Following referral to our pediatric trauma center, the radiological diagnostics of the surrounding region raised the suspicion of a telangiectatic osteosarcoma, further complicated by iatrogenic tumor cell seeding along the intramedullary path of the ESIN in the sense of a skip lesion. The diagnosis was confirmed by reference histopathology. Following neoadjuvant chemotherapy according to the EURAMOS/COSS protocol, the iatrogenic tumor cell dissemination necessitated a total femoral en bloc resection and reconstruction using a modular total endoprosthesis.

Inclusion body myopathy associated with Paget disease of bone (PDB) and/or frontotemporal dementia (IBMPFD) is characterized by adult-onset proximal and distal muscle weakness (clinically resembling a limb-girdle muscular dystrophy syndrome), early-onset PDB, and premature frontotemporal dementia (FTD). Muscle weakness progresses to involve other limb and respiratory muscles. PDB involves focal areas of increased bone turnover that typically lead to spine and/or hip pain and localized enlargement and deformity of the long bones; pathologic fractures occur on occasion. Early stages of FTD are characterized by dysnomia, dyscalculia, comprehension deficits, and paraphasic errors, with minimal impairment of episodic memory; later stages are characterized by inability to speak, auditory comprehension deficits for even one-step commands, alexia, and agraphia. Mean age at diagnosis for muscle disease and PDB is 42 years; for FTD, 56 years. Dilated cardiomyopathy, amyotrophic lateral sclerosis, and Parkinson disease are now known to be part of the spectrum of findings associated with IBMPFD.

Background and Objectives: Fragility fractures of the sacrum are increasingly recognized in elderly osteoporotic patients and can cause persistent pain, immobility, and progressive pelvic ring instability. We previously described a modified S1 corridor targeting the higher-density cranial-ventral S1 vertebral body for safe percutaneous implant placement. This study reports the clinical outcomes of osteoporotic and pathologic sacral fractures treated through this corridor and presents an exploratory comparison of two 3D-printed titanium sacroiliac fusion implants: the triangular iFuse™ Implant System and the threaded iFuse TORQ™ (SI-BONE, Inc., Santa Clara, CA, USA). Materials and Methods: This retrospective single-center study analyzed 58 patients with fragility or pathologic sacral fractures (FFP IIIb-V; OF 2-5) treated via the modified S1 corridor between January 2021 and March 2026. Of these, 27 patients received triangular iFuse™ implants, and 31 patients received threaded iFuse TORQ™ implants. The primary outcome was procedural safety (implant revision, neurological injury, cortical breach). Secondary outcomes included the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for pain, operative time, and need for additional fixation. Group comparisons used non-parametric tests; multivariable linear regression adjusted for age, fracture severity (OF classification), and additional fixation. Results: At a mean follow-up of 17.8 ± 9.1 months (iFuse) and 4.1 ± 2.1 months (TORQ), no implant revisions, clinically significant cortical breaches, or neurological injuries were observed in either group. Patient-reported outcome data were available for 48 of 58 patients (20 iFuse, 28 TORQ). Patients in the iFuse™ group were older (80.9 ± 8.5 vs. 76.0 ± 9.8 years; p = 0.050), and OF classification differed between groups, with a higher proportion of OF 4 fractures in the TORQ™ group (p = 0.003). After adjustment for age, OF classification, and additional fixation, TORQ™ implantation was associated with a 15.6-point lower postoperative ODI (p < 0.001), a 13.5-point greater ODI improvement (p < 0.001), a 0.94-point lower postoperative VAS (p = 0.006), and a 1.36-point greater VAS reduction (p < 0.001). Findings remained significant in a sensitivity analysis restricted to patients without additional fixation. Conclusions: Sacroiliac fusion via a modified density-oriented S1 corridor was safe for both large implant types, with no revisions in the analyzed cohort. In this retrospective, non-randomized cohort, threaded iFuse TORQ™ implants were associated with better patient-reported outcomes after adjustment for baseline imbalances. Because the groups were not randomized and follow-up duration differed substantially, these comparative findings are hypothesis-generating and require confirmation in prospective, controlled studies.

Lymphomas are a heterogeneous group of aggressive lymphoid malignancies characterized by frequent extranodal involvement. Musculoskeletal manifestations, although uncommon, represent a clinically significant and under-recognized presentation that often mimics primary bone tumors, soft tissue sarcomas, and infectious conditions, leading to diagnostic delays and inappropriate initial management. This narrative review synthesizes current evidence on the clinical presentation, imaging characteristics, pathology, and biological basis of musculoskeletal T-cell lymphomas, with particular emphasis on implications for orthopedic practice. A structured literature search was conducted across major databases from 2000 to the present, and evidence was integrated across clinical, radiologic, pathologic, and therapeutic domains. Musculoskeletal involvement most commonly presents with localized bone pain, soft tissue masses, or pathological fractures, with imaging features such as diffuse marrow infiltration, soft tissue extension, and relatively preserved cortical bone serving as important diagnostic clues. Definitive diagnosis relies on tissue biopsy with comprehensive immunophenotypic and molecular characterization. Emerging insights into the tumor microenvironment highlight its role in disease progression and therapeutic response, offering potential avenues for targeted treatment strategies. Management is subtype-specific and centers on systemic therapy, with selective roles for radiotherapy and orthopedic intervention in cases of structural compromise. Early recognition through integrated clinical, imaging, and pathological assessment, combined with multidisciplinary collaboration, is essential to optimize outcomes in this rare but challenging disease entity.

Vertebral compression fractures (VCFs) represent the most prevalent osteoporotic fracture and constitute a growing cause of morbidity, mortality, and healthcare utilization worldwide. Although often considered benign, VCFs are associated with chronic pain, progressive spinal deformity, functional impairment, decreased pulmonary capacity, and increased short- and long-term mortality, especially in older adults. Despite their high prevalence, key challenges persist regarding appropriate diagnostic evaluation, optimal treatment selection, and integration of osteoporosis management following fracture. This narrative review consolidates current evidence on the epidemiology, pathophysiology, diagnostic evaluation, management strategies, and public health implications of VCFs, with a focus on emerging spine-focused care models. VCFs predominantly result from compromised vertebral strength secondary to osteoporosis-related deterioration of trabecular microarchitecture, although traumatic and pathologic etiologies should also be considered. Diagnosis involves careful clinical assessment combined with imaging, with magnetic resonance imaging serving as a key modality for distinguishing acute fractures from chronic deformities or malignancy. Despite advances in diagnostic techniques, VCFs remain underrecognized and undertreated, contributing to avoidable disability and recurrent fractures. This narrative review synthesizes contemporary evidence, highlighting practical considerations for clinical decisionmaking in VCF care. Particular emphasis is placed on differentiating acute symptomatic fractures from chronic deformities or pathologic collapse, identifying patients most likely to benefit from vertebral augmentation, and defining surgical indications in the setting of neurologic compromise, instability, or progressive deformity. Conservative management, incorporating analgesia, early mobilization, and rehabilitation, remains the first-line approach for most stable fractures. Vertebroplasty and balloon kyphoplasty may provide short-term pain relief in carefully selected patients with persistent symptoms. However, the long-term benefits of augmentation and optimal patient selection criteria remain under investigation. Treatment options range from conservative measures-including analgesia, bracing, mobilization, rehabilitation, and osteoporosis-directed pharmacotherapy-to minimally invasive vertebral augmentation procedures such as vertebroplasty and balloon kyphoplasty. Vertebral augmentation may provide short-term improvements in pain and function in appropriately selected patients, although its long-term benefits and optimal indications remain under investigation. Surgical decompression and stabilization are reserved for patients with neurological compromise, instability, or progressive deformity. From a public health perspective, deficiencies in osteoporosis screening, delayed diagnosis, and disparities in treatment access continue to affect diverse socioeconomic and racial groups. Emerging innovations, including fracture liaison services, risk stratification tools such as FRAX, and artificial intelligence-based predictive models, may enhance early detection and personalized care. VCFs represent sentinel manifestations of systemic skeletal fragility that warrant evaluation of underlying osteoporosis and implementation of secondary fracture prevention. Pharmacologic therapies, including antiresorptive and anabolic agents, play a key role in reducing recurrent fracture risk, although treatment selection should be individualized. Multidisciplinary, patient-centered strategies focused on early diagnosis, prevention, equitable care delivery, and standardized management are essential to address the growing global burden of VCFs. A structured, patient-centered approach to diagnosis, treatment selection, and post-fracture care may enhance outcomes and reduce the long-term burden associated with VCFs.

Myxoid liposarcoma (MLPS) is the second most common histological subtype of liposarcoma and typically affects the deep soft tissues of the lower extremities. Although local recurrence rates are relatively low, delayed recurrence and metastatic disease may occur years after initial treatment. Pathologic fractures associated with extensive femoral involvement are uncommon and represent a major reconstructive challenge. We present the case of a 62-year-old female with a history of right proximal femoral MLPS treated with radiotherapy 12 years earlier who presented with progressive right hip pain and inability to bear weight following minor trauma. Imaging studies demonstrated a basicervical pathologic fracture associated with extensive osteolytic involvement of the proximal and diaphyseal femur. Due to severe functional deterioration and extensive bone destruction, the patient underwent en bloc femoral resection, followed by reconstruction with a modular total femoral tumor prosthesis as part of a limb salvage procedure. Histopathological evaluation using hematoxylin and eosin staining demonstrated recurrent undifferentiated MLPS with medullary cavity infiltration. Immunohistochemical and cytogenetic studies were unavailable because of institutional resource limitations. At six months of follow-up, the patient remained ambulatory with cane assistance, demonstrated satisfactory pain control, stable implant positioning, and no evidence of mechanical failure. This case highlights the feasibility of limb salvage surgery with total femoral reconstruction in selected patients with recurrent MLPS presenting with pathologic fracture and extensive femoral involvement. Multidisciplinary management and individualized surgical planning remain essential to optimize oncologic and functional outcomes.

Sharp bone fragments can cause damage to major blood vessels or internal organs during the subacute or chronic phases, even if such bone fracture itself does not immediately affect hemodynamics or the patient's condition. Herein, we report a fatal case of delayed aortic rupture in which the anatomically significant relationship between a posterior 8th rib fracture and descending aortic injury was initially overlooked. The patient initially appeared hemodynamically stable under conservative management for fall-related injuries; however, he suddenly collapsed on hospitalization day 10 and subsequently died. Autopsy revealed a full-thickness perforation of the descending thoracic aorta due to the sharp edge of the fractured rib. Retrospective review of premortem computed tomography demonstrated that the rib fracture fragment was extremely close to the aortic wall; however, this finding did not receive sufficient clinical attention. Histologically, the aorta exhibited partially organized adventitial injury, providing objective evidence of repeated premortem contact between the rib fragment and the aortic wall. These findings strongly support delayed traumatic aortic rupture secondary to rib fracture, rather than spontaneous vascular disease. Posterior left lower rib fractures can precipitate delayed and fatal aortic injury. Following initial screening for life-threatening conditions, rib fractures are often managed conservatively, with only pain control and respiratory support. However, posterior left lower rib fractures may warrant consideration for surgical intervention, both for emergent and even prophylactic purposes. This case provides unique pathological and clinical insights into a rare but lethal complication of blunt thoracic trauma, expanding current understanding of delayed aortic injury due to posterior rib fractures.

Background and Objectives: Unicameral bone cyst (UBC) is a benign cystic lesion originating from the metaphysis, often extending toward the diaphysis as the individual grows. It is more common in boys aged 5-15 years, typically affecting long bones like the humerus and femur. UBC is usually asymptomatic and found incidentally on imaging, with pathological fractures being a common complication. Treatment options include conservative observation, percutaneous injection, and surgery. This study aims to compare the diagnostic, treatment, and follow-up processes of UBC cases across multiple centers in our country. Materials and Methods: This study reviewed 180 UBC cases in patients aged 0-20 from seven clinical centers in our country. Patient demographics, symptoms, diagnostic methods, treatment approaches, and follow-up data were collected. Radiological and histopathological diagnostic accuracy, treatment methods (conservative, percutaneous injection, surgical), and recovery were analyzed using Musculoskeletal Tumor Society (MSTS) scores and Capanna criteria. Results: Among 180 patients, 50% had pain. Most diagnoses were made through radiographic imaging, with 96.1% diagnostic accuracy. The humerus (44.7%) and femur (30.7%) were the most commonly affected bones. Pathological fractures were found in 35% of cases. Treatment included conservative (19%), percutaneous injection (31.8%), and surgery (49.2%). The average follow-up period was 81 months, with early complications being skin issues and late complications primarily limb shortening. Conclusions: The study highlights the effectiveness of different treatment approaches for UBC, showing that surgical treatment offers the best clinical outcomes, while percutaneous injection is a less invasive option. Treatment should be tailored to individual patient needs.