Immediate implant placement following tooth extraction often leads to peri-implant defects that require guided bone regeneration (GBR) to achieve complete bone fill and stable osseointegration. Conventional GBR techniques typically rely on primary flap closure, coronal advancement, and additional soft-tissue grafting, which increase surgical complexity and patient morbidity. The S-Technique was introduced to enable simultaneous hard and soft-tissue regeneration under open-healing conditions while preserving the mucogingival junction. A patient presented with a grossly decayed, painful, vertically fractured, nonrestorable maxillary right second premolar (tooth 15). After atraumatic extraction and immediate implant placement, a peri-implant gap defect with limited soft-tissue availability was noted. GBR was performed using particulate xenograft and a resorbable collagen membrane. A dense polytetrafluoroethylene membrane was then placed according to the S-technique protocol, allowing secondary epithelialization without primary closure. Healing progressed uneventfully. At 4 months, clinical assessment showed complete coverage of the peri-implant site, an adequate band of keratinized mucosa, improved soft-tissue contour, a favorable emergence profile, and stable peri-implant architecture. Prosthetic rehabilitation resulted in satisfactory esthetic and functional outcomes with maintained bone support. This case demonstrates the S-Technique as a minimally invasive dual-layer membrane approach for simultaneous hard and soft-tissue regeneration around immediate implants. By eliminating the need for primary closure and autogenous soft-tissue grafting, it offers a predictable alternative for managing peri-implant defects in sites with limited soft-tissue availability, while promoting keratinized mucosa formation and stable peri-implant tissue integration.

Calcaneal insufficiency fractures are uncommon and often overlooked because their early symptoms resemble more prevalent causes of heel pain. A 68-year-old postmenopausal woman presented with two months of progressive bilateral heel pain and swelling without trauma. Radiographs revealed nondisplaced bilateral calcaneal fractures characterized by subtle vertical lucencies and mild cortical discontinuity. Dual-energy X-ray absorptiometry confirmed severe osteoporosis, and laboratory evaluation excluded secondary metabolic bone disease. The initial symptoms mimicked plantar fasciitis and Achilles tendinopathy, contributing to diagnostic delay. Conservative management, including protected weight bearing, romosozumab, calcium, and vitamin D supplementation, resulted in steady improvement, with pain-free ambulation achieved within three months. Follow-up radiographs demonstrated complete resolution of the fracture line and restoration of normal trabecular architecture. Persistent atraumatic heel pain in elderly patients should prompt evaluation for calcaneal insufficiency fractures, and early imaging combined with bone mineral density assessment is essential for timely diagnosis and optimal management.

The purpose of this technical note is to describe a simple and atraumatic loop-passing technique that facilitates tibial anterolateral ligament (ALL) graft passage in Sonnery-Cottet combined anterior cruciate ligament and ALL reconstruction. In the Sonnery-Cottet technique, 2 converging tibial tunnels are created for the ALL, requiring a passing loop to shuttle the graft between tunnels. Conventionally, a needle-mounted braided suture is advanced blindly through subcutaneous tissue, which can be unreliable in patients with thick subcutaneous tissue and may increase the risk of cortical breach or extraosseous passage. We describe a knot-pusher-assisted loop-passing technique using a 0 silk suture. A knot pusher loaded with the silk suture is introduced through 1 tibial tunnel and positioned at the tunnel convergence zone. The silk loop is retrieved from the second tunnel using a probe, creating a continuous loop for graft passage. This technique provides a simple, reliable, and atraumatic method for tibial ALL graft passage in Sonnery-Cottet combined anterior cruciate ligament and ALL reconstruction.

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.

Wet wound adhesion and atraumatic peeling limit the clinical application of conventional hydrogels in trauma surgical wound. To overcome this, a biomineralized wet-adhesive hydrogel (QxAyCz) was successfully fabricated through electrostatic interactions and in-situ mineralization utilizing quaternized chitosan (QCS), sodium alginate (SA), phytic acid (PA), and calcium sources derived from chicken eggshells (CE). The electrostatic interactions between cationic QCS and negatively charged tissue surfaces, combined with multiple hydrogen bonds formed by polysaccharides and the polar groups of PA, facilitates the in-situ formation of nano calcium phytate, which enhances robust calcium coordination interactions. This results in a unique triple synergistic adhesion system that includes electrostatic interactions, hydrogen bonding, and dynamic coordination bonds, thereby achieving reliable wet adhesion and rapid hemostasis on bleeding moist wounds. Furthermore, the QxAyCz enables sustained and steady Ca[2+] release, activating the physiological blood coagulation cascade and optimizing hemostatic efficiency, while also serving as biomineral stitching crosslinks to enhance the internal network cohesion and mechanical toughness of the QxAyCz. Notably, the QxAyCz realizes residue-free, and tear-free peeling after hemostasis and wound sealing are completed. In summary, this CE-biomineralized QxAyCz integrates superior wet adhesion, efficient hemostatic performance, and atraumatic removable properties, presenting a promising candidate for clinical moist wound hemostasis.

Spontaneous (atraumatic) splenic rupture is a rare but potentially life-threatening clinical condition. Most reported cases of spontaneous splenic rupture are associated with splenomegaly due to infectious, neoplastic, or inflammatory diseases. Spontaneous rupture in the absence of these conditions is extremely rare. There is often an underlying trauma history. Factor XIII deficiency, a rare autosomal recessive bleeding disorder, is associated with abnormal fibrin stabilization despite normal routine coagulation parameters. Therefore, it can also lead to defects in wound healing. For the same reason, spontaneous splenic rupture has rarely been reported in patients with Factor XIII deficiency. We report a 32-year-old male with congenital Factor XIII deficiency who presented to the emergency room with hypovolemic shock following sudden-onset abdominal pain. The case was complicated by spontaneous splenic rupture and severe intra-abdominal bleeding. Contrast-enhanced abdominal computed tomography revealed a large perisplenic hematoma. Despite intensive blood transfusion and replacement therapy with fresh frozen plasma and cryoprecipitate, the patient required surgical intervention, and a splenectomy was performed. Histopathological examination revealed no underlying splenic pathology. Spontaneous splenic rupture is extremely rare in patients with factor XIII deficiency, but it should be considered in the differential diagnosis in this patient group presenting with an acute abdomen. Suspicion, early recognition, and supportive care with appropriate blood products and factors, along with prompt surgical intervention, are crucial to prevent mortality.

Secondary mechanical trauma caused by the manual peeling or passive detachment of conventional adhesive dressings represents a key clinical challenge for fragile wound treatment. Herein, a thermally actuated Janus hydrogel was fabricated via sequential casting and one-step photopolymerization, leveraging macroscopic viscosity contrast and nanofiller kinetic locking. It comprised a poly(N-isopropylacrylamide) (PNIPAM)/LAPONITE® top layer (P-layer) and a GelMA-NBNAGA/LAPONITE®-polydopamine (lD) bottom layer (GN-layer), where GelMA-NBNAGA refers to gelatin modified with maleic anhydride (MA) and N'-(2-nitrobenzyl)-N-acryloyl glycinamide (NBNAGA). By adjusting the thickness of the P-layer (x), the mass ratio of l and D (y), and the concentration of lD (z), hydrogel dressings with optimized adhesion and mechanical properties were prepared and denominated as Px/GN-lyDz. Hydrophobic NB groups can serve as a versatile drug-delivery platform that accommodates diverse therapeutic agents for applications ranging from the rapid release of relatively hydrophilic molecules (salicylic acid) to the sustained release of highly lipophilic molecules (resveratrol or menthol). Most importantly, under mild thermal stimulation (∼45 °C warm water), the rapid shrinking of the P-layer is efficiently transduced to drive the autonomous self-peeling of the entire hydrogel dressing. In vitro and in vivo evaluation confirmed the paradigm of active detachment from the tissue surface without any external pulling force, indicating promising applications for next-generation smart dermatological care.

Diabetic muscle infarction (DMI) is an uncommon and frequently underrecognized microvascular complication of longstanding diabetes mellitus characterized by spontaneous ischemic necrosis of skeletal muscle. Polycythemia vera (PV) associated with JAK2 exon 12 mutations represents a rare subtype of myeloproliferative neoplasm that typically presents with isolated erythrocytosis and suppressed serum erythropoietin levels. The coexistence of these two uncommon disorders is exceptionally rare and may create significant diagnostic challenges because painful limb swelling can mimic thrombotic, infectious, inflammatory, or neoplastic conditions. We report the case of a 52-year-old man with poorly controlled type 2 diabetes mellitus who presented with a 3-week history of progressive atraumatic pain and swelling of the left thigh. Doppler ultrasonography excluded deep vein thrombosis and abscess formation, while magnetic resonance imaging demonstrated diffuse muscle edema, short tau inversion recovery (STIR) hyperintensity, and characteristic findings consistent with DMI. Laboratory investigations revealed marked erythrocytosis (hemoglobin 19.9 g/dL), thrombocytosis, and suppressed serum erythropoietin levels. Bone marrow examination demonstrated hypercellularity with erythroid predominance, and molecular testing identified a JAK2 exon 12 mutation, fulfilling contemporary diagnostic criteria for polycythemia vera. Conservative management of DMI together with therapeutic phlebotomy for PV resulted in progressive clinical improvement. This case highlights the importance of maintaining a broad differential diagnosis when evaluating painful limb swelling in patients with diabetes mellitus and persistent erythrocytosis. Recognition of coexisting disorders through careful integration of clinical assessment, imaging, and hematological investigation allows timely diagnosis, avoids unnecessary invasive procedures, and facilitates appropriate disease-specific management.

Atraumatic spontaneous splenic rupture (ASR) is a rare, potentially fatal condition accounting for fewer than 0.5% of all splenic ruptures, with reported mortality of up to 20% when diagnosis is delayed. We report a 63-year-old male with decompensated chronic liver disease and portal hypertension who presented with acute epigastric pain, progressive abdominal distension, and absolute constipation without antecedent trauma. Abdominal ultrasonography identified splenomegaly with a 5 × 6 cm anechoic intraparenchymal collection with subcapsular and perisplenic extension and moderate hemoperitoneum. Noncontrast computed tomography confirmed parenchymal laceration classified as AAST Grade III/WSES Class II. Contrast-enhanced CT was deferred because of concurrent renal impairment. The patient remained hemodynamically stable and was successfully managed with conservative nonoperative management. This case highlights the importance of suspecting ASR in patients with hepatic disease and congestive splenomegaly without trauma, the utility of prognostic scoring in guiding management, and the role of contrast-enhanced ultrasound as a nephroprotective imaging alternative when iodinated contrast is contraindicated.

Spontaneous intramuscular haematoma of the triceps muscle has the potential to pose significant diagnostic and management challenges. We report the case of a 42-year-old man presenting with acute non-traumatic right upper limb pain and a palpable posteromedial mass. He was receiving antiplatelet therapy for a previous transient ischemic attack. Examination revealed a tender mass on his triceps region with mild ulnar sensory deficit. Imaging demonstrated a well-defined cystic lesion; however, malignancy could not be excluded. Ultrasound-guided aspiration subsequently confirmed a haemorrhagic collection consistent with a haematoma. The patient was managed conservatively with planned radiological follow-up. This case highlights the importance of considering spontaneous haematoma in patients presenting with atraumatic soft tissue masses, particularly those on antithrombotic therapy. Careful imaging, histological evaluation when indicated, and appropriate follow-up are critical to exclude malignancy and guide management.