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Guillermo Droppelmann Research Center on Medicine, Exercise, Sport and Health, MEDS Clinic, Santiago, RM, Chile
Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Murcia, Spain
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA

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Constanza Rodríguez Facultad de Medicina, Universidad Finis Terrae, Santiago, RM, Chile

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Carlos Jorquera Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago, RM, Chile

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Felipe Feijoo School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile

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Purpose

  • The integration of artificial intelligence (AI) in radiology has revolutionized diagnostics, optimizing precision and decision-making. Specifically in musculoskeletal imaging, AI tools can improve accuracy for upper extremity pathologies. This study aimed to assess the diagnostic performance of AI models in detecting musculoskeletal pathologies of the upper extremity using different imaging modalities.

Methods

  • A meta-analysis was conducted, involving searches on MEDLINE/PubMed, SCOPUS, Cochrane Library, Lilacs, and SciELO. The quality of the studies was assessed using the QUADAS-2 tool. Diagnostic accuracy measures including sensitivity, specificity, diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR, NLR), area under the curve (AUC), and summary receiver operating characteristic were pooled using a random-effects model. Heterogeneity and subgroup analyses were also included. All statistical analyses and plots were performed using the R software package.

Results

  • Thirteen models from ten articles were analyzed. The sensitivity and specificity of the AI models to detect musculoskeletal conditions in the upper extremity were 0.926 (95% CI: 0.900; 0.945) and 0.908 (95% CI: 0.810; 0.958). The PLR, NLR, lnDOR, and the AUC estimates were found to be 19.18 (95% CI: 8.90; 29.34), 0.11 (95% CI: 0.18; 0.46), 4.62 (95% CI: 4.02; 5.22) with a (P < 0.001), and 95%, respectively.

Conclusion

  • The AI models exhibited strong univariate and bivariate performance in detecting both positive and negative cases within the analyzed dataset of musculoskeletal pathologies in the upper extremity.

Open access
Matías Sepulveda Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile
AO Foundation, LEGEC Expert Group, Davos, Switzerland

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Gabriel Orellana Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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Francisco Sanchez Clínica Puerto Varas, Puerto Varas, Chile
Clínica Puerto Montt, Puerto Montt, Chile

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Estefania Birrer Universidad Austral de Chile, Valdivia, Chile
Hospital Base de Valdivia, Valdivia, Chile

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  • Brachymetatarsia involves a reduction in length of one or more metatarsals.

  • The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola.

  • In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia.

  • A possible association with genetic disorders needs to be investigated during clinical evaluation.

  • Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.

Open access
Andrew Kailin Zhou Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
West Hertfordshire Hospitals NHS Trust, London, United Kingdom

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Eric Jou Kellogg College, University of Oxford, Oxford, United Kingdom

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Victor Lu Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom

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James Zhang Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, United Kingdom

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Shirom Chabra Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom

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Matija Krkovic Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom

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  • Compared to other techniques, poller screws with intramedullary nailing are technically simple, practical, and reproducible for the fixation of metaphyseal fractures.

  • In addition, poller screws do not require special instruments or hardware and are minimally invasive. This review takes a historical perspective to evaluate poller screws holistically.

  • A non-systematic search on PubMed was performed using ‘Poller screw’ or ‘Blocking screw’ to find early use of poller blocking screws. Relevant references from these primary studies were then followed up.

  • In 1999, Krettek et al. first coined the term poller screws after the small metal bollards that block and direct traffic.

  • Poller screws were introduced as an adjunct to aid the union of metaphyseal long bone fractures during intramedullary nailing.

  • However, as more evidence was published, the true effectiveness of poller screws was not appreciated, leading to split opinions.

  • Through our research, we have built upon our understanding of poller screws, and we present a novel classification of poller screws over the years while exploring our novel technique and what we believe to be the fourth generation of poller screws.

  • Currently, there is a paucity of research focussing on poller screws.

  • However, studying the original evidence regarding poller screws through the most recent articles has demonstrated a confusion of research in this field. Therefore, we suggest a more organised approach to classify the use of poller screws.

Open access
Hongfu Jin Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Shide Jiang Department of Orthopaedics, The Central Hospital of Yongzhou, Yongzhou, Hunan, China

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Volotovski Pavel Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus

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Djandan Tadum Arthur Vithran Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Wenfeng Xiao Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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Yusheng Li Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China

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  • Reverse total shoulder arthroplasty (rTSA) has been demonstrated to be an effective intervention for various shoulder disorders. The number of rTSA-related studies performed has increased annually over the past three decades.

  • The Journal of Shoulder and Elbow Surgery had the highest number of publications and citations in the rTSA-related research domain and is therefore considered to be the most influential journal in this field.

  • The USA published the most publications and established a high degree of cooperation with many countries worldwide. The University of Florida, the Hospital for Special Surgery, and Rush University, Mayo Clinic were representative and active institutions in this field.

  • It is anticipated that advancements in prosthesis design, specifically with regards to lateralized design concepts, expanding indications for rTSA, a trend toward younger patient populations, and the management of postoperative complications will emerge as research hotspots in the following years.

  • The most valuable publications, influential journals, major researchers, and leading countries were analyzed. The findings of our study will help researchers gain insights into current research hotspots and frontiers and shape their research focus in the field of rTSA.

Open access
Laura Walthert Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland

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Michael Ris Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland

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Kevin Moerenhout Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland

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Sébastien Déglise Department of Vascular Surgery, CHUV, Lausanne, Switzerland

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Pietro Giovanni Di Summa Department of Plastic and Hand Surgery, CHUV, Lausanne, Switzerland

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Sylvain Steinmetz Department of Orthopaedic and Traumatology, CHUV, Lausanne, Switzerland

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  • Major amputations of the lower extremity may be required after trauma and a variety of underlying diseases such as peripheral vascular disease, diabetes, and malignancies.

  • The goal of any major amputation is an optimal functional result with a maximum limb length in combination with optimal wound healing. The preservation of the knee joint is essential for successful rehabilitation, and this is best achieved by the Burgess below-knee amputation (BKA).

  • Whenever a BKA is not possible, the Gritti–Stokes amputation is our first choice.

  • This technique mainly consists of a through-knee amputation with the creation of a pedicled patella flap consisting of the patella, patellar ligament, and overlying soft tissue. After osteotomy of the distal femur and resection of the articular surface of the patella, the anterior flap is rotated in order to cover the femur defect while performing a patellofemoral arthrodesis.

  • The aim of this paper is to describe our surgical technique and experience with GSA and to point out the important steps of this procedure.

  • In conclusion, GSA is an excellent surgical option for patients requiring major lower limb amputations where BKA cannot be considered. Particular attention must be paid to careful preoperative evaluation and optimization of comorbidities. A meticulous surgical technique is warranted, including atraumatic tissue handling and an optimal patellofemoral arthrodesis technique.

Open access
Victor Housset Clinique de l'épaule, Clinique Maussins-Nollet, Paris, France

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Sean Wei Loong Ho Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore

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Alexandre Lädermann Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System), Meyrin, Switzerland
Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

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Sean Kean Ann Phua Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore

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Si Jian Hui Department of Orthopaedic Surgery, National University Health System, Singapore

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Geoffroy Nourissat Clinique de l'épaule, Clinique Maussins-Nollet, Paris, France

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Purpose

  • A variety of instabilities are grouped under multidirectional instability (MDI) of the shoulder. This makes understanding its diagnostic process, presentation and treatment difficult due to lack of evidence-based consensus. This review aims to propose a novel classification for subtypes of MDI.

Methods

  • A systematic search was performed on PubMed Medline and Embase. A combination of the following 'MeSH' and 'non-MesH' search terms were used: () Glenohumeral joint[tiab] OR Glenohumeral[tiab] OR Shoulder[tiab] OR Shoulder joint[tiab] OR Shoulder[MeSH] OR Shoulder joint[MeSH], () Multidirectional[tiab], () Instability[tiab] OR Joint instability[MeSH]. Sixty-eight publications which met our criteria were included.

Results

  • There was a high degree of heterogeneity in the definition of MDI. Thirty-one studies (46%) included a trauma etiology in the definition, while 23 studies (34%) did not. Twenty-five studies (37%) excluded patients with labral or bony injuries. Only 15 (22%) studies defined MDI as a global instability (instability in all directions), while 28 (41%) studies considered MDI to be instability in two directions, of which one had to include the inferior direction. Six (9%) studies included the presence of global ligamentous laxity as part of the definition. To improve scientific accuracy, the authors propose a novel AB classification which considers traumatic etiology and the presence of hyperlaxity when subdividing MDI.

Conclusion

  • MDI is defined as symptomatic instability of the shoulder joint in two or more directions. A comprehensive classification system that considers predisposing trauma and the presence of hyperlaxity can provide a more precise assessment of the various existing subtypes of MDI.

Level of Evidence

  • III

Open access
Tarik Ait-Si-Selmi Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Jean-Pierre Vidalain Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Sonia Ramos-Pascual ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Thomas Kuratle ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Mo Saffarini ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Edouard Dejour ReSurg SA, Rue Saint Jean 22, Nyon, Switzerland

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Michel P Bonnin Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, 55 Avenue Jean Mermoz, Lyon, France
Artro Institute, 8, rue du Pont de Thé, Annecy Le Vieux, France

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Purpose

  • to systematically review comparative studies reporting revision rates, clinical outcomes, or radiographic outcomes of total hip arthroplasty (THA) using collared versus collarless conventional-length uncemented hydroxyapatite (HA)-coated stems.

Methods

  • In adherence with PRISMA guidelines, a literature search was performed on Medline, Embase, and Scopus. Comparative clinical studies were eligible if they reported outcomes of collared versus collarless uncemented HA-coated stems for primary THA. Two reviewers screened titles, abstracts, and full-texts to determine eligibility; then performed data extraction; and assessed the quality of studies according to Joanna Briggs Institute (JBI) checklist.

Results

  • The search returned 972 records, 486 were duplicates, and 479 were excluded after title/abstract/full-text screening. Three further studies were included from the references of eligible studies and from discussions with subject matter experts, resulting in 11 included studies. The JBI checklist indicated six studies scored ≥7 points and four studies ≥4 points. Pooled data revealed collared stems had significantly lower revision rates (OR = 0.45; 95% CI = 0.31–0.64) and subsidence (MD = −1 mm; 95% CI = −1.6–-0.3), but no significant difference in intraoperative complication rates (OR = 0.94; 95% CI = 0.67–1.32) in the short term to mid-term. Unpooled data indicated that collared stems provide equivalent survival, equivalent or better outcomes, and equivalent or lower complication rates.

Conclusion

  • In comparative studies, collared stems have lower revision rates than collarless stems, as well as equivalent or better clinical and radiographic outcomes. Differences could be due to a protective effect that the collar offers against subsidence, particularly in undersized or misaligned stems. Further studies are warranted to confirm long-term results and better understand differences between registry data and clinical studies.

Open access
Diogo Lino Moura Spine Unit, Department of Orthopedics, Coimbra University Hospital, Coimbra, Portugal, Coimbra, Portugal
Anatomy Institute and Orthopedics Department, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

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Purpose

  • The aim of the study was to assess the role of kyphoplasty and expandable intravertebral implants in the treatment of traumatic vertebral compression fractures.

Design

  • This is a systematic review.

Methods

  • A bibliographic search was carried out in the PubMed/MEDLINE database according to PRISMA guidelines regarding kyphoplasty and expandable intravertebral implants in the treatment of traumatic thoracolumbar vertebral fractures.

Results

  • A total of 611 records were screened. In total, 51 studies were obtained referring to traumatic vertebral fractures treated with kyphoplasty; however, of these, only studies addressing traumatic burst fractures were selected, resulting in 12 studies: 10 about kyphoplasty and 2 regarding armed kyphoplasty. In all studies, there was a statistically significant improvement in clinical and functional parameters, restoration of vertebral height and decreasing of vertebral and segmental kyphosis. Overall, there was only a residual loss of height and a slight increase in kyphosis throughout the follow-up period, while complications consisted essentially of cement leakage, all with no clinical repercussions.

Conclusion

  • After the discussion, where we address the concepts of direct and indirect reduction, the association of kyphoplasty with pedicle fixation, the potential advantages of expandable intravertebral implants, as well as the vertebral body type of filling in kyphoplasty, it is concluded that kyphoplasty demonstrates favorable outcomes as a method of posterior percutaneous transpedicular access for reconstruction of the anterior column in burst fractures. It allows for the reconstruction of the vertebral body closer to its original anatomy, carried out in a minimally invasive and safe way, which provides a clinical-functional and imaging improvement maintained at the medium–long term.

Open access
Ahmed Mabrouk Mid Yorkshire Teaching Hospitals, Yorkshire, United Kingdom
Institut du mouvement et de l’appareil locomoteur, Marseille, France

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Jae-Sung An Institut du mouvement et de l’appareil locomoteur, Marseille, France

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Kristian Kley Orthoprofis Hannover, Hannover, Germany

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Komal Tapasvi The Orthopaedic Speciality Clinic, Pune, India

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Sachin Tapasvi The Orthopaedic Speciality Clinic, Pune, India

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Matthieu Ollivier Institut du mouvement et de l’appareil locomoteur, Marseille, France

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  • Varus knees with associated cartilage pathologies are not uncommon scenarios that present to orthopaedic surgeons.

  • There is no agreement on the ideal management of varus knees with concomitant cartilage pathology.

  • Through a literature review, the authors tried to answer three main questions:

  • On October 2022, OVID MEDLINE, EMBASE, and COCHRANE databases were searched. Clinical studies reporting on clinical, radiologic, or macroscopic cartilage regeneration following either isolated knee osteotomy or concomitant osteotomy and a cartilage procedure were reviewed.

  • Despite controversies, the literature demonstrated favourable outcomes of combined knee osteotomy and a cartilage procedure in patients with substantial deformity and cartilage defects.

  • Isolated high tibial osteotomy may induce cartilage regeneration in several scenarios and severities of concomitant malalignment and cartilage defects.

  • There are recommendations that knee osteotomy should be added to a cartilage procedure when an extra-articular deformity of > 5° is detected.

  • Some studies report good outcomes for combining a knee osteotomy with cartilage grafting, but they lack a control group of isolated osteotomy.

  • There is still scarce of evidence on the influence of osteotomies on cartilage regeneration and the outcomes of concomitant osteotomy and different cartilage procedures vs isolated osteotomies.

  • With advanced statistical evaluation (artificial intelligence, machine learning) of big datasets, more answers and better results will be delivered.

Open access
Mattia Loppini Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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Francesco Manlio Gambaro Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy

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Marco di Maio Università degli Studi di Trieste, Piazzale Europa 1, Trieste, Italy

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Guido Grappiolo IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, Italy

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  • The number of primary total hip arthroplasties (THAs) and revisions is expected to steadily grow in the future. The femoral revision surgery can be technically demanding whether severe bone defects need to be addressed.

  • The femoral revision aims to obtain a proper primary stability of the stem with a more proximal fixation as possible. Several authors previously proposed classification systems to describe the morphology of the bony femoral defect and to drive accordingly the surgeon in the revision procedure.

  • The previous classifications mainly considered cortical and medullary bone at the level of the defect of poor quality by definition. Therefore, the surgical strategies aimed to achieve a distal fixation bypassing the defect or to fill the defect with bone impaction grafting or structured bone grafts up to the replacement of the proximal femur with megaprosthesis.

  • The consensus on a comprehensive and reliable classification system and management algorithm is still lacking. A new classification system should be developed taking into account the bone quality. The rationale of a new classification is that ‘functional’ residual bone stock could be present at the level of the defect. Therefore, it can be used to achieve a primary (mechanical) and secondary (biological) stability of the implants with a femoral fixation more proximal as possible.

Open access