Elisa Georgiana Popescu

Background: Polytrauma patients with long-bone fractures often require intensive monitoring because the clinical course is influenced by injury burden, hemorrhage, systemic inflammation, and operative timing. This study evaluated early clinical, physiologic, operative, and laboratory factors associated with prolonged intensive care in polytrauma patients with operatively treated long-bone fractures.

Background: The timing of definitive fixation in polytrauma patients with long bone fractures must balance the benefits of early skeletal stabilization against the risks of operative stress in physiologically unstable patients. This study evaluated whether definitive fixation performed more than 24 hours after injury was associated with early orthopedic procedural events and broader adverse orthopedic outcomes. Methods: We performed a secondary retrospective cohort analysis of 115 adult polytrauma patients with operatively treated long bone fractures. Early definitive fixation was defined as fixation within 24 hours (≤24 hours) after injury, and delayed fixation was defined as fixation more than 24 hours after injury. The primary endpoint was an early orthopedic procedural event, defined as deep surgical site infection within 90 days, reoperation by six months, or bone graft/biologic augmentation by six months. Secondary endpoints included a broader adverse orthopedic course, delayed union at 24 weeks, clinical union at 24 weeks, and nonunion at nine months. Continuous variables were compared using Welch's t-test. Categorical variables were compared using Pearson's chi-square test when expected cell counts were adequate and Fisher's exact test when expected cell counts were low. Logistic regression was used for exploratory adjusted analyses. Results: Definitive fixation was performed within 24 hours in 33 patients (28.7%) and after 24 hours in 82 patients (71.3%). The primary procedural endpoint occurred in 20/115 patients (17.4%) and did not differ significantly between groups (4/33 patients (12.1%) vs. 16/82 patients (19.5%); chi-square = 0.895; p = 0.344). The broader adverse orthopedic course was more frequent after fixation beyond 24 hours (40/82 patients (48.8%) vs. 7/33 patients (21.2%); chi-square value = 7.400; p = 0.007). Delayed union at 24 weeks was also more frequent in the delayed fixation group (34/82 patients (41.5%) vs. 5/33 patients (15.2%); chi-square value = 7.269; p = 0.007). In adjusted analysis, fixation after 24 hours remained associated with the broader adverse orthopedic course (adjusted odds ratio = 3.00; 95% confidence interval = 1.09-8.25; z value = 2.124; p = 0.034), but not with the primary procedural endpoint. Conclusions: In this secondary cohort analysis, definitive fixation beyond 24 hours was not independently associated with early orthopedic procedural events, but it was associated with a broader adverse orthopedic course driven mainly by delayed union. These findings support a cautious interpretation of fixation timing as both a potentially modifiable treatment factor and a marker of underlying physiologic and injury-pattern complexity.

Background: Dual mobility (DM) total hip arthroplasty (THA) was introduced to reduce postoperative instability, one of the most frequent causes of revision after hip replacement. Its use has progressively expanded beyond revision surgery to selected high-risk primary cases; however, comparative data integrating both clinical and radiographic outcomes from real-world tertiary centers remain limited. Methods: A retrospective comparative study was conducted including 78 patients who underwent THA with a DM acetabular component between January 2019 and December 2024, and 78 matched controls who received conventional fixed-bearing THA during the same period. Matching criteria were age, sex, and procedure type (primary versus revision). Clinical outcomes were assessed using the Harris Hip Score (HHS) and visual analogue scale (VAS) for pain. Radiographic evaluation focused on component positioning, radiolucent lines, and signs of loosening. Complications and revision rates were compared between groups. Results: The mean age was 71 ± 9 years, and 62% of patients were female. Mean follow-up was 38 months. HHS improved from 54 ± 10 preoperatively to 89 ± 8 postoperatively in the DM group (p < 0.001), with similar final functional outcomes in the conventional THA group (90 ± 9, p = 0.48), and comparable improvement between groups (p = 0.62). Radiographic parameters demonstrated stable fixation and appropriate component positioning in both groups, with no significant intergroup differences. The dislocation rate was numerically lower in the DM group (1.3% vs. 5.1%), although this difference did not reach statistical significance (p = 0.37). No cases of intraprosthetic dislocation occurred. Overall implant survival free from revision at five years was 96.5% for DM and 94.7% for conventional THA (p = 0.47). Conclusions: DM THA achieved excellent clinical and radiographic outcomes, with a numerically lower dislocation rate than conventional THA. Mid-term implant survivorship was comparable between groups, supporting DM as a reliable option for improving stability in appropriately selected patients.

Background: The optimal management of comminuted proximal humerus fractures in the elderly remains controversial. Although hemiarthroplasty is widely used for complex fracture patterns, its functional superiority over reconstruction is not consistently demonstrated. The aim of this study was to compare early functional outcomes following open reduction and internal fixation (ORIF) versus hemiarthroplasty in elderly patients with three- and four-part proximal humerus fractures. Methods: This retrospective single-center study included elderly patients with comminuted proximal humerus fractures treated between 2020 and 2024 by either ORIF or hemiarthroplasty. Functional outcomes were assessed at 6 months using the Constant–Murley and DASH scores. Secondary outcomes included complication rates, range of motion, and early reintervention. Results: At 6 months, the ORIF group showed a mean Constant–Murley score of 62.1 ± 9.4 compared with 58.0 ± 10.2 in the hemiarthroplasty group. DASH scores were 34.2 ± 10.8 for ORIF and 38.5 ± 11.3 for hemiarthroplasty. Pain levels were similarly low in both groups (VAS 2.6 ± 1.1 vs. 2.9 ± 1.2). Complication rates were comparable, with fixation-related issues occurring in 17% of ORIF cases and tuberosity-related complications in 11% of hemiarthroplasty cases. Conclusions: Hemiarthroplasty should not be regarded as the default treatment strategy for comminuted proximal humerus fractures in elderly patients. When stable anatomic reduction is achievable, ORIF can yield comparable early functional results, emphasizing that patient selection and tuberosity management remain more important than the choice of implant.

The optimal surgical approach for total hip arthroplasty (THA) remains a subject of ongoing debate. Posterior, direct lateral, and direct anterior techniqu

Microbial electrosynthesis (MES) has emerged as a promising bio-electrochemical technology for sustainable CO₂ conversion into valuable organic compounds since it uses living electroactive microbes to directly convert CO₂ into value-added products. This review synthesizes advancements in MES from 2010 to 2025, focusing on the electrode materials, microbial communities, reactor engineering, performance trends, techno-economic evaluations, and future challenges, especially on the results reported between 2020 and 2025, thus highlighting that MES technology is now a technology to be reckoned with in the spectrum of biofuel technology production. While the current productivity and scalability of microbial electrochemical systems (MESs) remain limited compared to conventional CO₂ conversion technologies, MES offers distinct advantages, including process simplicity, as it operates under ambient conditions without the need for high pressures or temperatures; modularity, allowing reactors to be stacked or scaled incrementally to match varying throughput requirements; and seamless integration with circular economy strategies, enabling the direct valorization of waste streams, wastewater, or renewable electricity into valuable multi-carbon products. These features position MES as a promising platform for sustainable and adaptable CO₂ utilization, particularly in decentralized or resource-constrained settings. Recent innovations in electrode materials, such as conductive polymers and metal–organic frameworks, have enhanced electron transfer efficiency and microbial attachment, leading to improved MES performance. The development of diverse microbial consortia has expanded the range of products achievable through MES, with studies highlighting the importance of microbial interactions and metabolic pathways in product formation. Advancements in reactor design, including continuous-flow systems and membrane-less configurations, have addressed scalability issues, enhancing mass transfer and system stability. Performance metrics, such as the current densities and product yields, have improved due to exceptionally high product selectivity and surface-area-normalized production compared to abiotic systems, demonstrating the potential of MES for industrial applications. Techno-economic analyses indicate that while MES offers promising economic prospects, challenges related to cost-effective electrode materials and system integration remain. Future research should focus on optimizing microbial communities, developing advanced electrode materials, and designing scalable reactors to overcome the existing limitations. Addressing these challenges will be crucial for the commercialization of MES as a viable technology for sustainable chemical production. Microbial electrosynthesis (MES) offers a novel route to biofuels by directly converting CO₂ and renewable electricity into energy carriers, bypassing the costly biomass feedstocks required in conventional pathways. With advances in electrode materials, reactor engineering, and microbial performance, MES could achieve cost-competitive, carbon-neutral fuels, positioning it as a critical complement to future biofuel technologies.

Microbial electrosynthesis (MES) has emerged as a promising bio-electrochemical technology for sustainable CO₂ conversion into valuable organic compounds. This review synthesizes ad-vancements in MES from 2010 to 2025, focusing on electrode materials, microbial communities, reactor engineering, performance trends, techno-economic evaluations, and future challenges, especially on the results reported between 2020 and 2025. Recent innovations in electrode mate-rials, such as conductive polymers and metal–organic frameworks, have enhanced electron transfer efficiency and microbial attachment, leading to improved MES performance. The de-velopment of diverse microbial consortia has expanded the range of products achievable through MES, with studies highlighting the importance of microbial interactions and metabolic pathways in product formation. Advancements in reactor design, including continuous-flow systems and membrane-less configurations, have addressed scalability issues, enhancing mass transfer and system stability. Performance metrics, such as current densities and product yields, have signifi-cantly improved, demonstrating the potential of MES for industrial applications. Techno-economic analyses indicate that while MES offers promising economic prospects, challenges related to cost-effective electrode materials and system integration remain. Future research should focus on optimizing microbial communities, developing advanced electrode materials, and designing scalable reactors to overcome existing limitations. Addressing these challenges will be crucial for the commercialization of MES as a viable technology for sustainable chemical production.