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, in cluding 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.

Objective: Ganglion cysts are benign soft-tissue tumors that are relatively rare in the foot. Although most foot ganglia are asymptomatic, cases of structural compromise and pathological fractures are rare. Patient: A 65-year-old woman presented with right lateral foot pain without direct trauma. Physical examination revealed a soft, non-erythematous mass between the fourth and fifth metatarsals. Imaging demonstrated a scalloping depression at the fourth metatarsal and a pathological fracture of the fifth metatarsal shaft. Results: A surgical excision was performed by tracing the cyst to the fourth metatarsophalangeal joint. The fifth metatarsal was stabilized using a four-hole plate. Bony union was achieved at six weeks with pain resolution. Conclusion: This case highlights the importance of considering the mechanical compression exerted by the cyst and possible osteoporosis as contributing factors. Complete excision with stalk removal combined with fixation is recommended to prevent recurrence and to optimize functional outcomes.

The transoral transmandibular approach is indicated for pathologies affecting C1-3 that require an anterior or combined anteroposterior approach to address. This approach has been described previously for cervical tumors requiring en bloc resection, deformity, and pathologic fractures secondary to rheumatological disease. Here, we to illustrate the transoral transmandibular approach for cervical osteomyelitis. A 29-year-old male presented with neck pain and was found to have osteomyelitis of unclear etiology at C1-4 complicated by pathological fractures at C2-3. He initially underwent a C1-5 posterior spinal fusion and empiric antibiotic therapy but represented 3 months later with pseudoarthrosis. Due to posterior element erosion, the patient underwent an anterior transoral transmandibular approach for C2-4 corpectomies and C1-5 anterior fusion, followed by posterior occiput-C6 fusion. Postoperatively stable neurological exam and improved neck pain. This case demonstrates how the anterior transoral transmandibular approach enables access and robust multilevel anterior column reconstruction for pathologies affecting C1-3.

Fibrous dysplasia (FD) is a rare benign bone disease caused by postzygotic activating mutations in the GNAS gene, leading to replacement of normal bone with fibrous tissue. It may be monostotic or polyostotic, often asymptomatic but sometimes associated with pain, deformity, or fractures. Management is mainly surgical in symptomatic or complicated cases. This retrospective study analyzes a large FD cohort to identify determinants of treatment and outcomes, with a focus on pain and its evolution. The primary aim was to assess factors influencing surgical indication, while the secondary aim was to evaluate predictors of outcome in surgically treated patients, particularly symptom persistence at follow-up. A total of 227 patients were included. Mean age at diagnosis was 35.5 years (range 2-86 years); 79.3% had monostotic and 20.7% polyostotic FD. Pain was the most common presentation (62.6% at diagnosis; 78.4% during disease course), followed by incidental findings (21.6%), fractures (11.5%), and mass (4.4%). Surgery was performed in 51.6% of patients (127 lesions). Surgical patients were younger and had larger lesions and higher Mirels' scores (all p < 0.001), although Mirels' score showed only moderate predictive accuracy for surgery (area under the curve (AUC) 0.71). At a mean follow-up of 4.5 years, persistent pain was present in 24.1% of patients, with no significant difference between surgical and nonsurgical groups. Surgery was not an independent predictor of pain resolution in multivariable analysis. Postoperative complications occurred in 17.3% of procedures, with 7.1% requiring multiple revisions; rates were higher in polyostotic disease (21.3% versus 6.7%, p = 0.004). Our findings suggest that pain alone should not be used as an indication for surgery in FD, as it was not a reliable predictor of outcome in our study. Surgical decisions for pain relief should therefore be made with caution, and patients should be informed about the risk of persistent symptoms. Conservative, multidisciplinary management-including bisphosphonates, monoclonal antibodies, and psychological support-should be considered first-line, as it may improve symptoms and quality of life.