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EFORT Open Reviews May 2024Long bone non-unions represent a serious clinical and socioeconomical problem due to the prolonged episodes, frequent sequelae, and variable treatment effectiveness.... (Review)
Review
Long bone non-unions represent a serious clinical and socioeconomical problem due to the prolonged episodes, frequent sequelae, and variable treatment effectiveness. Bone grafts, classically involving the autologous iliac crest graft as the 'gold standard' bone graft, enhance bone regeneration and fracture healing incorporating osteoconductive and/or osteoinductive/osteogenic capacity to the non-union under treatment. Structural alternatives to autologous bone grafts include allografts and bone substitutes, expanding the available stock but loosing biological properties associated with cells in the graft. Biological alternatives to autologous bone grafts include bone marrow concentration from iliac crest aspiration, bone marrow aspiration from reaming of the diaphyseal medullary canal in the long bones, and isolated, expanded mesenchymal stem cells under investigation. When the combination with natural and synthetic bone substitutes allows for larger volumes of structural grafts, the enhancement of the biological regenerative properties through the incorporation of cells and their secretoma permits to foresee new bone grafting solutions and techniques.
PubMed: 38726992
DOI: 10.1530/EOR-24-0032 -
Indian Journal of Orthopaedics May 2024Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the... (Review)
Review
BACKGROUND
Elastic stable intramedullary nailing (ESIN) and plates are currently the main internal fixation for treating Pediatric Diaphyseal Femur Fractures (PDFF), and the optimal choice of internal fixation is controversial. The purpose of this meta-analysis is to compare the surgical outcomes and complications of the two fixation methods.
MATERIALS AND METHODS
MEDLINE, Embase, and the Cochrane Library were systematically searched for studies published up to March, 2023, that compared ESIN and plate fixation techniques for treating PDFF. Pooled analysis identified differences in surgical outcomes between ESIN and plate, mainly regarding surgical outcomes and postoperative complications, such as time at surgery, fracture healing time, blood loss and related complications.
RESULTS
We included 10 studies with 775 patients with PDFF in our review. Of these, 428 and 347 were treated with ESIN and Plate, respectively. In terms of postoperative complications, ESIN led to a shorter surgery time [MD = - 28.93, 95% CI (- 52.88 to - 4.98), < 0.05], less blood loss [MD = - 66.94, 95% CI (- 87.79 to - 46.10), < 0.001] and more fracture healing time [MD = 2.65, 95% CI (1.22-4.07), < 0.001]. In terms of postoperative complications, ESIN led to fewer fections (RR = 0.77, 95% CI 0.37, 1.60, = 0.48), fewer angulation deformities (RR = 0.80, 95% CI 0.35, 1.83, = 0.60) and more prominent implants (RR = 3.36, 95% CI 1.88, 6.01, < 0.001), more delayed unions (RR = 4.06, 95% CI 0.71, 23.06, = 0.11).
CONCLUSIONS
ESIN and Plate have similar rates of complications besides a prominent implant rate, while ESIN has a shorter period of operation and less intraoperative bleeding. Although both options are suitable, the results of this study support the use of ESIN rather than plates in the treatment of PDFF in terms of complication rates. In clinical applications, surgeons should choose the appropriate treatment method according to the actual situation.
PubMed: 38694693
DOI: 10.1007/s43465-024-01125-3 -
Frontiers in Pediatrics 2024Elastic stable intramedullary nail (ESIN) is a commonly used method for treating diaphyseal fractures of the tibia, but its application in Distal Tibial Diaphyseal...
OBJECTIVE
Elastic stable intramedullary nail (ESIN) is a commonly used method for treating diaphyseal fractures of the tibia, but its application in Distal Tibial Diaphyseal Metaphyseal Junction (DTDMJ) fractures has been a subject of controversy. This study aims to evaluate the clinical efficacy of the Elastic stable intramedullary nail-Kirschner wire (E-K) technique in treating pediatric DTDMJ fractures, providing better clinical decision-making for clinicians in diagnosing and treating such fractures.
METHODS
We conducted a retrospective analysis of patients aged 3-9 years who received treatment at our hospital from January 2019-January 2021 for distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. Based on their surgical procedures, they were categorized into the Elastic Stable Intramedullary Nail-Kirschner wire group (E-K) and the ESIN group. Demographic data, surgical duration, clinical outcomes, complications, and imaging data were recorded.
RESULTS
The study included a total of 57 patients, with 24 cases in the E-K group and 33 cases in the ESIN group. There were 30 males and 27 females. The average age was (6.25 ± 1.59) years in the E-K group and (6.27 ± 1.48) years in the ESIN group. There were no significant differences between the two groups in terms of gender, age, weight, time from injury to surgery, follow-up time, side of injury, associated injuries, nail site infection, deep infection, and nail removal time ( > 0.05). Neither group experienced nonunion or refracture. The E-K group exhibited significantly lower coronal and sagittal plane angular values at the final follow-up compared to the ESIN group ( < 0.001). In the E-K group, the final follow-up coronal plane angle was 2.67 (1.09)°, while in the ESIN group, it was 6.55 (2.05)°. The final follow-up sagittal plane angle was 3.12 (1.54)° in the E-K group and 7.58 (1.48)° in the ESIN group. Both groups showed good alignment in the initial postoperative x-rays, with no statistically significant differences. However, during clinical healing, the ESIN group exhibited significant displacement, whereas the E-K group had minimal displacement, demonstrating a significant statistical difference ( < 0.001). There was a statistically significant difference in the AOFAS joint function assessment between the two groups ( = 0.027).
CONCLUSION
The E-K technique is a viable option for treating DTDMJ fractures in pediatric patients, with well-established clinical efficacy. Its advantages include a straightforward surgical procedure, safety, and a low incidence of severe complications.
PubMed: 38690522
DOI: 10.3389/fped.2024.1333652 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Apr 2024Bone infarction has a low incidence in clinical practice and mostly occurs in the metaphysis and diaphysis.Few studies report the advanced imaging technique for bone...
Bone infarction has a low incidence in clinical practice and mostly occurs in the metaphysis and diaphysis.Few studies report the advanced imaging technique for bone infarction.Here we reported the fast field echo resembling a CT using restricted echo-spacing and calcium-suppressed spectral CT imaging for a case of multifocal bone infarcts in both lower extremities,aiming to provide diagnostic experience for clinical practice.
Topics: Humans; Male; Calcium; Infarction; Lower Extremity; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Adult
PubMed: 38686729
DOI: 10.3881/j.issn.1000-503X.15724 -
Cureus Mar 2024Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on...
Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India. This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively. There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study. An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.
PubMed: 38686267
DOI: 10.7759/cureus.57235 -
Journal of Orthopaedic Case Reports Apr 2024Ewing's sarcoma is the second most common primary malignant bone tumor in children and adolescents, after osteosarcoma. It is a rare tumor, with the axial skeleton being...
INTRODUCTION
Ewing's sarcoma is the second most common primary malignant bone tumor in children and adolescents, after osteosarcoma. It is a rare tumor, with the axial skeleton being the preferred site of development, followed by the long bones. Diagnosis is evoked by imaging and confirmed by histology. Treatment is based on intensive chemotherapy with local surgical treatment in operable forms, and in some cases, radiotherapy. There are only a few sporadic cases in the literature describing distal fibular localization.
CASE REPORT
We report the case of a 7-year-old child who presented with pain on the lateral aspect of the left ankle without local inflammatory signs. Radiological findings revealed a metaphyseal-diaphyseal osteolytic tissue process of the left fibula, and histology concluded that it was Ewing's sarcoma. We proceeded with neoadjuvant polychemotherapy followed by segmental resection of the distal fibula with an anteroexternal tibial rod, plus tibiotalar, and talocalcaneal arthrodesis without recourse to radiotherapy.
CONCLUSION
The management of Ewing's sarcoma is constantly evolving. Its distal fibular location in a growing limb makes it even more difficult. It must be personalized, multidisciplinary, and carried out in specialized centers.
PubMed: 38681924
DOI: 10.13107/jocr.2024.v14.i04.4350 -
Veterinary Medicine and Science May 2024Genetic selection applied to broilers results in fast growth and an increase in meat yield. However, this situation causes welfare problems in broilers.
BACKGROUND
Genetic selection applied to broilers results in fast growth and an increase in meat yield. However, this situation causes welfare problems in broilers.
OBJECTIVES
The aim of this study is to determine the weekly changes in the tibia characteristics in broilers raised on their own commercial diets.
METHODS
In the study, 168 (84 female and 84 male) slow-growing (Hubbard-Isa Red JA) and 168 (84 female and 84 male) fast-growing (Ross-308) day-old broiler chicks were used. Six broilers from each genotype and sex group were weighed weekly and slaughtered to determine the tibia properties during the 10-week fattening period.
RESULTS
Fast-growing broilers had higher tibia weight and longer length, diaphysis diameter and medullary canal diameter than those of slow-growing broilers at the same age. In fast-growing genotypes, the cortical index was low only in the 2nd week, and Robusticity and Seedor indices were observed to be better throughout the whole fattening. The ash content of the total tibia in the fast-growing broilers was higher in all of the examined weeks except the 4th week and the 9th week of fattening than that in the slow-growing broilers. Although the amount of ash per unit body weight in the 1st week of fattening was higher in fast-growing broilers, this situation reversed after the 4th week. The level of all minerals examined in total tibia weight is high in fast-growing broilers, and they differed according to the fattening period.
CONCLUSIONS
When comparing tibia characteristics of two different genotypes fed their own commercial diets, the tibia structure was found to be stronger in fast-growing broilers compared to other genotypes at the same age, but slow-growing broilers were more prominent in terms of body weight. It was observed that the mineral density was higher in male broilers, except in the 1st week.
Topics: Animals; Chickens; Female; Male; Tibia; Animal Feed; Diet; Animal Husbandry; Sex Factors
PubMed: 38678574
DOI: 10.1002/vms3.1455 -
Bioengineering (Basel, Switzerland) Apr 2024The literature suggests that the yield strain of cortical bone is invariant to its stiffness (elastic modulus) and strength (yield stress). However, data about...
The literature suggests that the yield strain of cortical bone is invariant to its stiffness (elastic modulus) and strength (yield stress). However, data about intra-individual variations, e.g., the influence of different collagen/mineral organisations observed in bone aspects withstanding different habitual loads, are lacking. The hypothesis that the yield strain of human cortical bone tissue, retrieved from femoral diaphyseal quadrants subjected to different habitual loads, is invariant was tested. Four flat dumbbell-shaped specimens were machined from each quadrant of the proximal femoral diaphysis of five adult donors for a total of 80 specimens. Two extensometers attached to the narrow specimen region were used to measure deformation during monotonic tensile testing. The elastic modulus (linear part of the stress-strain curve) and yield strain/stress at a 0.2% offset were obtained. Elastic modulus and yield stress values were, respectively, in the range of 12.2-20.5 GPa and 75.9-136.6 MPa and exhibited a positive linear correlation. All yield strain values were in the narrow range of 0.77-0.87%, regardless of the stiffness and strength of the tissue and the anatomical quadrant. In summary, the results corroborate the hypothesis that tensile yield strain in cortical bone is invariant, irrespective also of the anatomical quadrant. The mean yield strain value found in this study is similar to what was reported by inter-species and evolution studies but slightly higher than previous reports in humans, possibly because of the younger age of our subjects. Further investigations are needed to elucidate a possible dependence of yield strain on age.
PubMed: 38671816
DOI: 10.3390/bioengineering11040395 -
Veterinary Sciences Mar 2024This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO)...
This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens ( = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time.
PubMed: 38668413
DOI: 10.3390/vetsci11040145 -
Journal of Functional Biomaterials Apr 2024In orthopaedics, erythropoietin (EPO) is applied in the preoperative management of anaemic patients, but also as a stimulating factor to assist bone regeneration due to...
In orthopaedics, erythropoietin (EPO) is applied in the preoperative management of anaemic patients, but also as a stimulating factor to assist bone regeneration due to its angiogenic and osteoinductive potential. Since orthopaedists mainly rely on their clinical experience to assess bone healing, additional and more objective methods such as studying the dynamics of bone markers are needed. Therefore, the aim of this study was to investigate the plasma activity of bone-specific alkaline phosphatase (BALP), the N-terminal propeptide of type I collagen (PINP), the C-terminal telopeptide of type I collagen (CTX), and deoxypyridinoline (DPD) during the first 2 months of healing of comminuted fractures in cats, either non-stimulated or locally stimulated with recombinant human erythropoietin (rhEPO). The study included twelve cats of mixed breeds, aged 7.2 ± 4 months, weighing 2.11 ± 1.1 kg, with comminuted diaphyseal fractures of the femur. Surgical treatment with plate osteosynthesis was performed in all animals. The cats were randomly divided into two groups-a control ( = 6) and an EPO group ( = 6). The locally applied EPO leads to the increased activity of bone formation markers (BALP and PINP) during the second week after the osteosynthesis, preceding the peaks in the control group by two weeks. The studied bone resorption markers (DPD, CTX) varied insignificantly during the studied period. In conclusion, erythropoietin could serve as a promoter of bone healing in comminuted fractures in cats.
PubMed: 38667563
DOI: 10.3390/jfb15040106