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Journal of Biomechanics Jun 2024Single and dual integrated screw femoral nails are both commonly used to treat intertrochanteric fractures. This study investigated if using single or dual integrated... (Randomized Controlled Trial)
Randomized Controlled Trial
Single and dual integrated screw femoral nails are both commonly used to treat intertrochanteric fractures. This study investigated if using single or dual integrated screw femoral nails result in different post-operative hip joint loading. In the presence of differences, we investigated potential contributing factors. Patients were randomised for treatment via single screw (Stryker, Gamma3) or dual-integrated screw nail (Smith and Nephew, Intertan). Pre-injury mobility levels were collected at enrolment. Hip radiographs and gait data were collected at six weeks (Gamma: 16; Intertan: 15) and six months (Gamma: 14; Intertan: 13) follow-up. The resultant hip joint reaction forces and abductor muscle forces were estimated using electromyography-assisted neuromusculoskeletal modelling during level walking gait. Our primary analysis focused on the resultant hip joint reaction force and abductor muscle forces. We compared between groups, across stance phase of walking gait, using statistical parametric mapping. At six weeks, the Intertan group showed a short (∼5% of stance phase) but substantial (33 % [0.3 × body weight] greater magnitude) resultant hip joint reaction force when compared to the Gamma group (P = 0.022). Higher gluteus medius forces (P = 0.009) were demonstrated in the Intertan group at six weeks. Harris Hip Scores followed the trend seen for the biomechanical outcomes with superior scores for the Intertan group at six weeks postoperative (P = 0.044). The use of dual-integrated screw femoral nails over single screw devices may allow for hip biomechanics more closely resembling normal hip function at earlier post-operative timepoints, but these appear to resolve by six months postoperative.
Topics: Humans; Hip Fractures; Female; Male; Aged; Biomechanical Phenomena; Aged, 80 and over; Bone Screws; Hip Joint; Gait; Fracture Fixation, Internal; Bone Nails; Muscle, Skeletal; Middle Aged
PubMed: 38795542
DOI: 10.1016/j.jbiomech.2024.112169 -
Sensors (Basel, Switzerland) May 2024Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping... (Review)
Review
Over the past few decades, Information and Communication Technologies (ICT) have revolutionized the fields of nursing and patient healthcare management. This scoping review and the accompanying case studies shed light on the extensive scope and impact of ICT in these critical healthcare domains. The scoping review explores the wide array of ICT tools employed in nursing care and patient healthcare management. These tools encompass electronic health records systems, mobile applications, telemedicine solutions, remote monitoring systems, and more. This article underscores how these technologies have enhanced the efficiency, accuracy, and accessibility of clinical information, contributing to improved patient care. ICT revolution has revitalized nursing care and patient management, improving the quality of care and patient satisfaction. This review and the accompanying case studies emphasize the ongoing potential of ICT in the healthcare sector and call for further research to maximize its benefits.
Topics: Humans; Electronic Health Records; Telemedicine; Delivery of Health Care; Mobile Applications; Nursing Care; Patient Satisfaction
PubMed: 38793983
DOI: 10.3390/s24103129 -
Medicina (Kaunas, Lithuania) Apr 2024: This retrospective cohort study analyzes mechanical complications in hip fracture surgery using the Trochanteric Fixation Nail-Advanced (TFNA) implant. It investigates...
: This retrospective cohort study analyzes mechanical complications in hip fracture surgery using the Trochanteric Fixation Nail-Advanced (TFNA) implant. It investigates the correlation of these complications with demographic, intraoperative, and radiological factors, aiming to identify associated risk factors and suggest improvements in clinical surveillance and treatment strategies. : We enrolled 253 patients diagnosed with pertrochanteric hip fractures treated between 2017 and 2021, with 126 meeting the criteria for a minimum 6-month follow-up. Data on demographics, American Anesthesia Association Classification (ASA), comorbidities, AO/OTA [AO (Arbeitsgemeinschaft für Osteosynthesefragen)/OTA (Orthopedic Trauma Association)] fracture classification, procedural details, and time to failure were collected. Radiographs were evaluated for reduction quality, the tip-apex distance (TAD), progressive varus deviation, and identification of mechanical complications. Statistical analysis was performed using SPSS software. : The predominant AO/OTA fracture classification was 31A2 in 67 cases (52.7%). Reduction quality was deemed good or acceptable in 123 cases (97.6%). The mean time to failure was 4.5 months (range: 2.2-6). The average TAD was 18 mm (range: 1.2-36), with a mean progressive varus deviation of 2.44° (range: 1.30-4.14). A good or acceptable reduction quality was observed in 97.6% of cases. Mechanical complications occurred in 21.4% of patients, with significant associations found with the lateral cortex fracture, use of a TFNA implant with a 130° angle, open reduction, and absence of prior osteoporosis treatment. : The study provides insights into mechanical complications in proximal femur fractures treated with the TFNA nail, emphasizing the need for enhanced clinical and radiographic surveillance, especially in patients without osteoporosis treatment. Our findings support the necessity for further clinical studies comparing these outcomes with other implant designs and underscore the importance of personalized treatment strategies to reduce complication rates.
Topics: Humans; Retrospective Studies; Female; Male; Fracture Fixation, Intramedullary; Aged; Aged, 80 and over; Middle Aged; Postoperative Complications; Hip Fractures; Bone Nails; Cohort Studies; Femoral Fractures; Risk Factors; Proximal Femoral Fractures
PubMed: 38792901
DOI: 10.3390/medicina60050718 -
Journal of Clinical Medicine May 2024: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain... (Review)
Review
: Long bones are commonly affected by musculoskeletal tumors, but they also represent one of the most frequent locations for metastases. The treatment is based on pain management and the prevention or stabilization of pathological fractures by intramedullary nailing. While titanium nails are probably the most used, carbon-fiber-reinforced (CFR) nails have emerged as a new option for oncological patients. The aim of this review is to compare titanium and CFR nails according to current findings. : Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards were followed: a total of 1004 articles were identified and 10 were included. : Traditionally, titanium implants are highly valued for their optimal biomechanical properties and ease of insertion, facilitated by their radiopacity. However, the use of titanium poses challenges in radiotherapy due to interference with radiation dosage and the creation of ferromagnetic artifacts. Conversely, CFR implants have emerged as a recommended option for intramedullary fixation, due to their biomechanical and structural properties and their benefits during radiotherapy and follow-up monitoring X-ray. : CFR nailing represents a promising advancement in the surgical management of oncological patients with long bone metastases. However, further studies are needed to increase surgeons' confidence in their use.
PubMed: 38792483
DOI: 10.3390/jcm13102940 -
An Advanced Human Bone Tissue Culture Model for the Assessment of Implant Osteointegration In Vitro.International Journal of Molecular... May 2024In the field of biomaterials for prosthetic reconstructive surgery, there is the lack of advanced innovative methods to investigate the potentialities of smart...
In the field of biomaterials for prosthetic reconstructive surgery, there is the lack of advanced innovative methods to investigate the potentialities of smart biomaterials before in vivo tests. Despite the complex osteointegration process being difficult to recreate in vitro, this study proposes an advanced in vitro tissue culture model of osteointegration using human bone. Cubic samples of trabecular bone were harvested, as waste material, from hip arthroplasty; inner cylindrical defects were created and assigned to the following groups: (1) empty defects (CTRneg); (2) defects implanted with a cytotoxic copper pin (CTRpos); (3) defects implanted with standard titanium pins (Ti). Tissues were dynamically cultured in mini rotating bioreactors and assessed weekly for viability and sterility. After 8 weeks, immunoenzymatic, microtomographic, histological, and histomorphometric analyses were performed. The model was able to simulate the effects of implantation of the materials, showing a drop in viability in CTR+, while Ti appears to have a trophic effect on bone. MicroCT and a histological analysis supported the results, with signs of matrix and bone deposition at the Ti implant site. Data suggest the reliability of the tested model in recreating the osteointegration process in vitro with the aim of reducing and refining in vivo preclinical models.
Topics: Humans; Osseointegration; Titanium; Tissue Culture Techniques; X-Ray Microtomography; Bone and Bones; Biocompatible Materials; Prostheses and Implants; Cancellous Bone
PubMed: 38791362
DOI: 10.3390/ijms25105322 -
Oxford Medical Case Reports May 2024Dyskeratosis congenita (DKC) is a rare genetic disorder characterized by lacy reticular skin hyperpigmentation, bone marrow failure, nail dystrophy, and oral...
Dyskeratosis congenita (DKC) is a rare genetic disorder characterized by lacy reticular skin hyperpigmentation, bone marrow failure, nail dystrophy, and oral leukoplakia. To the best of our knowledge, only around 200 cases were reported in the medical literature, and in this report, we present another distinctive case from Syria. This case report describes a male patient with generalized reticular pigmentation and abnormal nails since childhood. The patient reported a history of recurrent urethral stenosis and corneal density. Dermoscopic examination revealed pigmented lines arranged in a netlike pattern. Histopathological findings were nonspecific. Hematological values were unremarkable. A contrast CT scan revealed changes in the bladder wall. The final diagnosis of Dyskeratosis Congenita was made based on the clinical criteria. This disorder can present with additional cutaneous manifestations and systemic complications. Treatment are generally prescribed to maintain bone marrow function, based on the fact that it is the major cause of death. Regular monitoring and screening for associated conditions are recommended.
PubMed: 38784779
DOI: 10.1093/omcr/omae049 -
BMC Neurology May 2024Epilepsy, a challenging neurological condition, is often present with comorbidities that significantly impact diagnosis and management. In the Pakistani population,...
BACKGROUND
Epilepsy, a challenging neurological condition, is often present with comorbidities that significantly impact diagnosis and management. In the Pakistani population, where financial limitations and geographical challenges hinder access to advanced diagnostic methods, understanding the genetic underpinnings of epilepsy and its associated conditions becomes crucial.
METHODS
This study investigated four distinct Pakistani families, each presenting with epilepsy and a spectrum of comorbidities, using a combination of whole exome sequencing (WES) and Sanger sequencing. The epileptic patients were prescribed multiple antiseizure medications (ASMs), yet their seizures persist, indicating the challenging nature of ASM-resistant epilepsy.
RESULTS
Identified genetic variants contributed to a diverse range of clinical phenotypes. In the family 1, which presented with epilepsy, developmental delay (DD), sleep disturbance, and aggressive behavior, a homozygous splice site variant, c.1339-6 C > T, in the COL18A1 gene was detected. The family 2 exhibited epilepsy, intellectual disability (ID), DD, and anxiety phenotypes, a homozygous missense variant, c.344T > A (p. Val115Glu), in the UFSP2 gene was identified. In family 3, which displayed epilepsy, ataxia, ID, DD, and speech impediment, a novel homozygous frameshift variant, c.1926_1941del (p. Tyr643MetfsX2), in the ZFYVE26 gene was found. Lastly, family 4 was presented with epilepsy, ID, DD, deafness, drooling, speech impediment, hypotonia, and a weak cry. A homozygous missense variant, c.1208 C > A (p. Ala403Glu), in the ATP13A2 gene was identified.
CONCLUSION
This study highlights the genetic heterogeneity in ASM-resistant epilepsy and comorbidities among Pakistani families, emphasizing the importance of genotype-phenotype correlation and the necessity for expanded genetic testing in complex clinical cases.
Topics: Humans; Pakistan; Epilepsy; Male; Female; Comorbidity; Child; Genetic Heterogeneity; Pedigree; Child, Preschool; Adolescent; Exome Sequencing; Adult; Developmental Disabilities; Young Adult; Intellectual Disability; Phenotype
PubMed: 38783254
DOI: 10.1186/s12883-024-03671-7 -
BMC Musculoskeletal Disorders May 2024Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically,... (Review)
Review
Extending the intermedullary nail will not reduce the potential risk of femoral head varus in PFNA patients biomechanically: a clinical review and corresponding numerical simulation.
Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically, extending the length of the intramedullary nail could optimize fixation stability by lengthening the force arm. However, whether extending the nail length can optimize patient prognosis is unclear. In this study, a review of imaging data from intertrochanteric fracture patients with PFNA fixation was performed, and the length of the intramedullary nail in the femoral trunk and the distance between the lesser trochanter and the distal locking screw were measured. The femoral neck varus status was judged at the 6-month follow-up. The correlation coefficients between nail length and femoral neck varus angle were computed, and linear regression analysis was used to determine whether a change in nail length was an independent risk factor for femoral neck varus. Moreover, the biomechanical effects of different nail lengths on PFNA fixation stability and local stress distribution have also been verified by numerical mechanical simulations. Clinical review revealed that changes in nail length were not significantly correlated with femoral head varus and were also not an independent risk factor for this complication. In addition, only slight biomechanical changes can be observed in the numerical simulation results. Therefore, commonly used intramedullary nails should be able to meet the needs of PFNA-fixed patients, and additional procedures for longer nail insertion may be unnecessary.
Topics: Humans; Bone Nails; Biomechanical Phenomena; Fracture Fixation, Intramedullary; Female; Male; Aged; Hip Fractures; Femur Head; Aged, 80 and over; Risk Factors; Middle Aged; Computer Simulation
PubMed: 38783225
DOI: 10.1186/s12891-024-07334-z -
Cirugia Y Cirujanos 2024The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving...
OBJECTIVES
The aim of the study was to investigate the clinical effect of stainless-steel wire fixation on the early mouth-opening movement of an intracapsular fracture involving the condylar process.
MATERIALS AND METHODS
In this study, patients who underwent mandibular condylar intracapsular fracture surgery in our hospital from 2012 to 2020 were selected as research subjects. A total of 44 patients received steel wire internal fixation treatment, 32 patients received titanium plate-and-nail rigid internal fixation, and 28 patients underwent conservative non-surgical treatment.
RESULTS
For the patients in the stainless-steel wire group, the degree of mouth opening reached normal levels of 3.7 cm approximately 10 days after surgery. The recovery time for the patients in the titanium plate-and-nail rigid internal-fixation group was 21 days, while the patients in the conservative treatment group needed 60 days to recover.
CONCLUSION
The treatment of fixation with a stainless-steel wire for intracapsular condylar fracture reduced the time taken to perform mouth-opening exercises and improved the recovery rate of patients.
Topics: Humans; Fracture Fixation, Internal; Mandibular Fractures; Mandibular Condyle; Stainless Steel; Male; Female; Bone Wires; Adult; Bone Plates; Middle Aged; Titanium; Range of Motion, Articular; Bone Nails; Young Adult; Retrospective Studies
PubMed: 38782385
DOI: 10.24875/CIRU.23000093 -
International Journal of Surgery Case... Jun 2024Knee malalignment can increase the risk of osteoarthritis. Osteotomies can correct limb deformities, but they come with the risk of complications such as cortical hinge...
INTRODUCTION
Knee malalignment can increase the risk of osteoarthritis. Osteotomies can correct limb deformities, but they come with the risk of complications such as cortical hinge fracture, hardware failure, pain syndrome, and infection. Vascular injury is rare, but it can lead to bleeding, limb ischemia, and swelling. If revascularization is delayed for over 12 h, it can result in poor outcomes. The work has been reported in line with the SCARE criteria.
CASE
A 41-year-old female underwent a lateral close-wedge distal femoral osteotomy. Postoperatively, no distal pulse was detected. An emergency vascular surgery consultation revealed popliteal vein penetration and popliteal artery thrombosis, probably during pin penetration. Revascularization was performed, and the patient was discharged without complications. At the three-year follow-up, the patient was in good health and without complications.
DISCUSSION
Knowledge of the femoral artery and vein's proximity to the apex of the wedge is crucial in lateral close wedge distal femoral osteotomy. Despite vascular injury with an oscillating saw, it can happen during guide pin insertion. Although Intraoperative massive bleeding can show vascular injury, lack of it was not a protective factor.
CONCLUSION
During the process of pin insertion, it is important to ensure that the pin's orientation is directly lateral to the medial. This should be checked using the C-Arm by obtaining AP, Lat, and Oblique views. To check for intraoperative bleeding, the tourniquet should be deflated. Once the procedure is complete, it is important to check for any vascular injury by examining distal pulses and limb perfusion carefully, particularly in the recovery room.
PubMed: 38781839
DOI: 10.1016/j.ijscr.2024.109763