-
The Journal of Clinical Investigation Jun 2024Osteogenesis imperfecta (OI) type V is the second most common form of OI, distinguished by hyperplastic callus formation and calcification of the interosseous membranes...
Osteogenesis imperfecta (OI) type V is the second most common form of OI, distinguished by hyperplastic callus formation and calcification of the interosseous membranes in addition to bone fragility. It is caused by a recurrent, dominant pathogenic variant (c.-14C>T) in IFITM5. Here, we generated a conditional Rosa26 knock-in mouse model to study the mechanistic consequences of the recurrent mutation. Expression of the mutant Ifitm5 in osteo-chondroprogenitor or chondrogenic cells resulted in low bone mass and growth retardation. Mutant limbs showed impaired endochondral ossification, cartilage overgrowth, and abnormal growth plate architecture. The cartilage phenotype correlates with the pathology reported in OI type V patients. Surprisingly, expression of mutant Ifitm5 in mature osteoblasts caused no obvious skeletal abnormalities. In contrast, earlier expression in osteo-chondroprogenitors was associated with increase in the skeletal progenitor population within the periosteum. Lineage tracing showed that chondrogenic cells expressing the mutant Ifitm5 showed decreased differentiation into osteoblastic cells in diaphyseal bone. Moreover, mutant IFITM5 disrupts early skeletal homeostasis in part by activating ERK signaling and downstream SOX9 protein, and inhibition of these pathways partially rescued the phenotype in mutant animals. These data identify the contribution of a signaling defect altering osteo-chondroprogenitor differentiation as a driver in the pathogenesis of OI type V.
PubMed: 38885336
DOI: 10.1172/JCI170369 -
Frontiers in Surgery 2024The soft-tissue tension is closely associated with postoperative hip dislocation in patients undergoing total hip arthroplasty (THA), especially for those patients with...
BACKGROUND
The soft-tissue tension is closely associated with postoperative hip dislocation in patients undergoing total hip arthroplasty (THA), especially for those patients with neurological disorders and insufficient muscle tension. The aim of this study is to explore the effect of limb lengthening on the incidence of complications following THA in patients with neurological disorders and insufficient muscle tension.
METHODS
This retrospective analysis examines individuals with neurological disorders, such as ischemic stroke and poliomyelitis, who underwent primary total hip arthroplasty (THA) at our medical center between January 2015 and April 2021. Demographic and baseline characteristics (such as age, gender, muscle strength) were obtained from medical records. The limb length, offset and the positional parameters of both acetabular and femoral component were measured on pre- and postoperative plain radiograph. The primary outcome was the occurrence of hip dislocation. The secondary outcome included the incidence of other complications and the hip function (determined by Harris score). The correlation between the occurrence of hip dislocation and limb lengthening was analyzed.
RESULTS
A total of 258 patients were finally analyzed. The hip dislocations were identified in 35 patients (overall incidence = 13.57%). The incidence of early dislocation was lower in patients whose limb-length discrepancy (LLD) was over 20 mm (incidence = 4.1% for LLD >20 mm, 12.2% for LLD 10 mm-20 mm and 17% for LLD <10 mm). The odds ratio (OR) was 0.206 and 95% confidence interval (CI) was 0.058-0.737 (compared between LLD <10 mm and LLD >20 mm). But the no difference was identified regarding on the incidence of late dislocation among patients with different LLD. Moreover, the overall incidence of other complications was elevated in patients with LLD >20 mm (incidence = 17.58% for LLD >20 mm, 11.11% for LLD 10 mm-20 mm and 3.19% for LLD <10 mm; OR = 6.464, 95% CI = 1.768-23.640). And the Harris scores, which reflected the hip function, was gradually decreased with the increasing in LLD. In terms of the relationship between the offset and dislocation rate, it was found that increased offset discrepancy was associated with decreased dislocation incidence (incidence = 4.71% for offset discrepancy >10 mm, 12.5% for offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy <5 mm; OR = 0.238, 95% CI = 0.076-0.742). Furthermore, increased offset discrepancy also bring a reduction in late dislocation. The incidences of late dislocation were 0%, 2.5% and 10.8% for offset discrepancy >10 mm, offset discrepancy 5 mm-10 mm and 17.20% for offset discrepancy respectively. Different from that of LDD, the incidences of other complications were similar among patients with different offset discrepancy. Besides, no influence of offset discrepancy on the hip function was identified in this study.
CONCLUSION
Unfortunately, although increasing in limb length could partially reduce early dislocation postoperatively, it could not affect the incidence of late dislocation in those patients with neurological disorders and insufficient muscle tension. Moreover, over limb lengthening was associated with other postoperative complications and worse hip function. Instead, additional offset could reduce the probability of postoperative dislocation, without increasing the incidence of other complications. Therefore, femoral stem with lower cervico-diaphyseal angle (higher offset) should be recommended to patients with neurological disorders who were in high risk of postoperative dislocation. Isolated increasing in limb length should be avoided.
PubMed: 38881705
DOI: 10.3389/fsurg.2024.1259039 -
Journal of Orthopaedic Surgery and... Jun 2024The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2)...
BACKGROUND
The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2) the influences of the femorotibial angle (FTA) and inclination of the medial compartment of the proximal tibia (MCT) on tibial CBT.
METHODS
The study assessed 60 subjects with varus knee osteoarthritis (OA) (22 males and 38 females; mean age, 74 ± 7 years) and 53 healthy elderly subjects (28 males and 25 females; mean age, 70 ± 6 years). Three-dimensional estimated CBT of the tibial diaphysis was automatically calculated for 2752-11,296 points using high-resolution measurements from CT. The standardized CBT was assessed in 24 regions by combining six heights and four areas. Additionally, the association between the CBT, each FTA, and MCT inclination was investigated.
RESULTS
The OA group showed a thicker CBT in the medial areas than in the lateral areas of the proximal tibia, while the healthy group had a thicker lateral CBT. The medial-to-lateral ratio of the proximal tibia was significantly higher in the OA group than in the healthy group. The proximal-medial CBT correlated with FTA and MCT inclinations in the OA group.
CONCLUSIONS
This study demonstrated that varus osteoarthritic knees showed a different trend of proximal-medial CBT with associations in FTA and MCT inclination from healthy knees, possibly due to medial load concentration.
Topics: Humans; Male; Female; Tibia; Aged; Osteoarthritis, Knee; Cortical Bone; Diaphyses; Aged, 80 and over; Tomography, X-Ray Computed; Lower Extremity; Middle Aged
PubMed: 38879553
DOI: 10.1186/s13018-024-04849-y -
Revista Espanola de Cirugia Ortopedica... Jun 2024The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal...
INTRODUCTION
The association of ipsilateral tibia fractures has a low incidence, being up to 3.2% of total tibia fractures. Currently there is no gold standard regarding the ideal surgical treatment. The objective of this study is to analyze the surgical treatment and the radiographic and functional results, as well as the associated complication rate of ipsilateral bifocal tibia fractures.
MATERIAL AND METHODS
retrospective observational study in our hospital from 2010 to 2022 of 24 patients who underwent bifocal fracture of the ipsilateral tibia. Demographic and surgical data and complications during follow-up were included.
RESULTS
The 24 patients were classified into group 1 when they presented a fracture of the plateau and distal tibia (25%), group 2 with a fracture of the plateau and diaphysis (33%) and group 3 with a fracture of the diaphysis and distal tibia (42%). 3 patients underwent surgery with 1 implant and 21 patients with 2 implants. The average follow-up time in outpatient clinics was 2 and a half years. At one year, 22 patients (92%) had full weight bearing and 2 patients had partial weight bearing (8%) due to the sequelae of the fractures. The average time for consolidation of the diaphysis was 7.75 +/- 2 months, with no significant differences observed between group 2 and group 3 (p=0.06). The average time for consolidation of the metaphysis was 3.50 +/- 1.5 months, with no significant differences observed between group 1 and group 2 (p=0.065). 7 patients (30%) had complications during follow-up Conclusions: Bifocal tibia fractures can be treated using a combination of intramedullary nailing and plate osteosynthesis with good long-term results, obtaining an optimal union rate and low complications. In addition, it facilitates the reduction of the fracture, thus facilitating the patient's recovery and obtaining good long-term functional results.
PubMed: 38878887
DOI: 10.1016/j.recot.2024.06.005 -
Veterinary and Animal Science Sep 2024This study investigated marula seed cake (MSC) as alternative protein source (APS) replacing soyabean meal (SBM) in indigenous chicken diets. Four hundred, 3-week-old...
This study investigated marula seed cake (MSC) as alternative protein source (APS) replacing soyabean meal (SBM) in indigenous chicken diets. Four hundred, 3-week-old Boschveld chicks were randomly allocated to 5 iso-energetic-nitrogenous maize and SBM-based grower diets with 0, 10, 15, 20, and 25 % MSC, each with 5 replicate pens of 16 birds, in a completely randomised design (CRD), for 9 weeks. Results showed that dietary MSC quadratically decreased bird overall feed intake (FI) ( < 0.001) and body weight gain (BWG) ( < 0.01) as it linearly decreased the weights of hot carcass (HCW; < 0.05), spleen ( < 0.05), jejunum ( < 0.05), ileum ( < 0.001), and caecum ( < 0.001). In contrast, MSC increased chicken serum glucose ( < 0.05), cholesterol ( = 0.001) and phosphate ( < 0.05) as it decreased its amylase activity ( < 0.01). Also, it decreased bird meat lightness at 45 min ( < 0.05) and its yellowness at 45 min ( < 0.001) and 24 h ( < 0.001) whilst it increased its redness at 45 min ( < 0.01) and 24 h ( < 0.05) post-slaughter. In addition, MSC decreased chicken bone medial diaphysis ( < 0.05) as it induced no effects ( > 0.05) on overall feed conversion efficiency (FCE) and all other parameters. In conclusion, feeding of ≤ 15 % dietary MSC is nutritionally safe for indigenous chickens whilst detrimental on bird appetite, growth and meat yield, however without significantly affecting their physiology, at higher inclusion levels.
PubMed: 38873090
DOI: 10.1016/j.vas.2024.100364 -
Molecular and Clinical Oncology Jul 2024A high prevalence of proximal femoral metastases persists in patients with cancer, particularly regarding lower extremity fractures. This study offers a detailed...
A high prevalence of proximal femoral metastases persists in patients with cancer, particularly regarding lower extremity fractures. This study offers a detailed analysis of clinical characteristics of patients undergoing surgical treatment for pathological or impending fractures, enhancing treatment strategies for metastatic malignancies. A total of thirty patients who underwent treatment of impending and pathological fractures at Kindai University Hospital (Osakasayama, Japan) were included. The retrospective study comprised parameters including age, sex, fracture site, type of primary malignancy, number of metastases, pre-fracture Eastern Cooperative Oncology Group performance status (ECOG-PS) score, adjuvant therapy, treatment modality, operative time, blood loss, postoperative complications, Musculoskeletal Tumor Society (MSTS) score, outcome and follow-up period. Post-treatment MSTS scores were compared in cases of impending and pathological fractures, and between intramedullary nailing and other surgical procedures. In addition, one-year postoperative survival rates were calculated. Furthermore, operative time, blood loss and survival rates were compared between impending and pathological fractures. The participants' median age was 70.5 years, with disease sites primarily in the subtrochanteric femur, trochanteric femur, femoral diaphysis, femoral neck and other locations. Pathologies included multiple myeloma and unknown primary, lung, breast, kidney, liver, gastric, esophageal and uterine cancers. The median ECOG-PS score pre-fracture was 2. Treatment approaches involved radiotherapy, chemotherapy and a combination of both. Surgical interventions included intramedullary nailing (16 cases), endoprosthesis (1 case), bipolar head replacement (3 cases) and compression hip screw (3 cases), among others. A negative correlation (R=-0.63) existed between MSTS and pre-fracture ECOG-PS scores. The operative time was significantly shorter in impending than in pathological fractures, with impending fractures showing significantly lower blood loss. The treatment algorithm for malignant bone tumors of the lower extremity provided in the present study was efficient, potentially optimizing treatment strategies for such cases, and contributing to improved patient care and outcomes in oncology and orthopedic surgery.
PubMed: 38872948
DOI: 10.3892/mco.2024.2749 -
Acta Biomaterialia Jun 2024To study in vivo the bioactivity of biodegradable magnesium implants and other possible biomaterials, we are proposing a previously unexplored application of PET-CT...
To study in vivo the bioactivity of biodegradable magnesium implants and other possible biomaterials, we are proposing a previously unexplored application of PET-CT imaging, using available tracers to follow soft tissue and bone remodelling and immune response in the presence of orthopaedic implants. Female Wistar rats received either implants (Ti6Al7Nb titanium or WE43 magnesium) or corresponding transcortical sham defects into the diaphyseal area of the femurs. Inflammatory response was followed with [F]FDG and osteogenesis with [F]NaF, over the period of 1.5 months after surgery. An additional pilot study with [Ga]NODAGA-RGD tracer specific to αβ integrin expression was performed to follow the angiogenesis for one month. [F]FDG tracer uptake peaked on day 3 before declining in all groups, with Mg and Ti groups exhibiting overall higher uptake compared to sham. This suggests increased cellular activity and tissue response in the presence of Mg during the initial weeks, with Ti showing a subsequent increase in tracer uptake on day 45, indicating a foreign body reaction. [F]NaF uptake demonstrated the superior osteogenic potential of Mg compared to Ti, with peak uptake on day 7 for all groups. [Ga]NODAGA-RGD pilot study revealed differences in tracer uptake trends between groups, particularly the prolonged expression of αβ integrin in the presence of implants. Based on the observed differences in the uptake trends of radiotracers depending on implant material, we suggest that PET-CT is a suitable modality for long-term in vivo assessment of orthopaedic biomaterial biocompatibility and underlying tissue reactions. STATEMENT OF SIGNIFICANCE: The study explores the novel use of positron emission tomography for the assessment of the influence that biomaterials have on the surrounding tissues. Previous related studies have mostly focused on material-related effects such as implant-associated infections or to follow the osseointegration in prosthetics, but the use of PET to evaluate the materials has not been reported before. The approach tests the feasibility of using repeated PET-CT imaging to follow the tissue response over time, potentially improving the methodology for adopting new biomaterials for clinical use.
PubMed: 38871201
DOI: 10.1016/j.actbio.2024.06.005 -
Bone Jun 2024The effects of gender affirming hormone therapy (GAHT) on bone microarchitecture and fracture risk in adult transgender women is unclear. To investigate the concept that...
The effects of gender affirming hormone therapy (GAHT) on bone microarchitecture and fracture risk in adult transgender women is unclear. To investigate the concept that skeletal integrity and strength in trans women may be improved by treatment with a higher dose of GAHT than commonly prescribed, we treated adult male mice with a sustained, high dose of estradiol. Adult male mice at 16 weeks of age were administered ~1.3 mg estradiol by silastic implant, implanted intraperitoneally, for 12 weeks. Controls included vehicle treated intact females and males. High-dose estradiol treatment in males stimulated the endocortical deposition of bone at the femoral mid-diaphysis, increasing cortical thickness and bone area. This led to higher stiffness, maximum force, and the work required to fracture the bone compared to male controls, while post-yield displacement was unaffected. Assessment of the material properties of the bone showed an increase in both elastic modulus and ultimate stress in the estradiol treated males. Treatment of male mice with high dose estradiol was also anabolic for trabecular bone, markedly increasing trabecular bone volume, number and thickness in the distal metaphysis which was accompanied by an increase in the histomorphometric markers of bone remodelling, mineralizing surface/bone surface, bone formation rate and osteoclast number. In conclusion, a high dose of estradiol is anabolic for cortical and trabecular bone in a male to female transgender mouse model, increasing both stiffness and strength. These findings suggest that increasing the current dose of GAHT administered to trans women, while considering other potential adverse effects, may be beneficial to preserving their bone microstructure and strength.
PubMed: 38866125
DOI: 10.1016/j.bone.2024.117143 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jun 2024This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses...
BACKGROUND
This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits.
METHODS
We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented.
RESULTS
Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients.
CONCLUSION
Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.
Topics: Humans; Male; Female; Humeral Fractures; Retrospective Studies; Adult; Radial Nerve; Middle Aged; Fracture Fixation, Internal; Range of Motion, Articular; Treatment Outcome; Diaphyses; Young Adult
PubMed: 38863290
DOI: 10.14744/tjtes.2024.49500 -
Acta Orthopaedica Jun 2024
Topics: Humans; Denmark; Child; Registries; Radius Fractures; Ulna Fractures; Diaphyses
PubMed: 38856664
DOI: 10.2340/17453674.2024.40814