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Methods in Molecular Biology (Clifton,... 2021The shortcomings of autografts and allografts in bone defect healing have prompted researchers to develop suitable alternatives. Numerous biomaterials have been...
The shortcomings of autografts and allografts in bone defect healing have prompted researchers to develop suitable alternatives. Numerous biomaterials have been developed as bone graft substitutes each with their own advantages and disadvantages. However, in order to test if these biomaterials provide an adequate replacement of the clinical standard, a clinically representative animal model is needed to test their efficacy. In this chapter, we describe a mouse model that establishes a critical sized defect in the mid-diaphysis of the femur to evaluate the performance of bone graft substitutes. This is achieved by performing a femoral ostectomy and stabilization utilizing a femoral plate and titanium screws. The resulting defect enables the bone regenerative potential of bone graft substitutes to be investigated. Lastly, we provide instruction on assessing the torsional strength of the healed femurs to quantitatively evaluate the degree of healing as a primary outcome measure.
Topics: Animals; Autografts; Biocompatible Materials; Bone Regeneration; Bone Screws; Bone Substitutes; Bone Transplantation; Diaphyses; Disease Models, Animal; Femur; Fracture Healing; Humans; Mice
PubMed: 33197009
DOI: 10.1007/978-1-0716-1028-2_5 -
Journal of Orthopaedic Surgery and... Apr 2020This study was designed to evaluate the clinical outcomes of patients with diaphysis malignant tumors of femur and tibia treated with microwave ablation (MWA) in situ.
BACKGROUND
This study was designed to evaluate the clinical outcomes of patients with diaphysis malignant tumors of femur and tibia treated with microwave ablation (MWA) in situ.
METHODS
Retrospective study of 32 patients with diaphysis malignant bone tumors of femur or tibia have been treated by microwave ablation. Instead of en bloc resection, hyperthermia ablation in situ was carried out followed by strengthen procedure. The patients were followed up for a period ranging from 36 to 180 months.
RESULTS
Twenty-five patients survived over 3 years and all of the patients alive have a satisfactory functional and cosmetic limb. The postoperative survival rate of MWA group was significantly higher than the amputation group in consecutive inclusions.
CONCLUSIONS
MWA is a feasible and effective surgical method for limb salvage operation and it might offer an innovative and distinctive therapeutic alternative for diaphysis malignant bone tumors, which avoiding osteotomy or prosthesis replacement.
LEVEL OF EVIDENCE
Level IV, clinical cohort study.
Topics: Adolescent; Adult; Aged; Amputation, Surgical; Bone Neoplasms; Child; Cohort Studies; Diaphyses; Female; Femoral Neoplasms; Humans; Male; Microwaves; Middle Aged; Radiofrequency Ablation; Radiofrequency Therapy; Retrospective Studies; Tibia; Treatment Outcome; Young Adult
PubMed: 32272956
DOI: 10.1186/s13018-020-01662-1 -
Orthopaedics & Traumatology, Surgery &... Apr 2021This study was conducted to evaluate clinically and radiologically the patients for whom compressive and non-compressive intramedullary nails were applied and to analyse...
OBJECTIVES
This study was conducted to evaluate clinically and radiologically the patients for whom compressive and non-compressive intramedullary nails were applied and to analyse the compression effectiveness in adult femur distal diaphysis fractures.
HYPOTHESIS
The compressive locked nails shortened the union period in the distal diaphysis fractures, and it was found to be an effective method, as the pseudoarthrosis rate was lower.
MATERIAL AND METHODS
A retrospective study was conducted among 59 patients for whom the compressive and non-compressive IMNs were applied to treat femur distal diaphysis fractures. Thirty-one for whom the non-compressive IMN was applied were categorised as group I, and 28 for whom the compressive nail was applied were categorised as group II. Finite element analysis was performed using 1.5mm compression, and a mean stress value of 34.67Mpa.
RESULTS
The mean values of union period were calculated as 13.6±2.4 weeks (range: 11-20 months) and functional score was 79.2, respectively in group I, and they were evaluated as a good grade. In group II, the respective mean values of union period were 11.5±2.6 weeks (range: 10-17 months) and functional score was 86, and they were evaluated as excellent.
CONCLUSION
Radiological and functional scores were determined to be better with interlocking compressive nails and shortened the fracture union period in the follow-up in adult femur distal diaphysis fractures.
LEVEL OF EVIDENCE
III; retrospective cohort study.
Topics: Adult; Bone Nails; Diaphyses; Femoral Fractures; Fracture Fixation, Intramedullary; Fracture Healing; Humans; Retrospective Studies; Treatment Outcome
PubMed: 33333271
DOI: 10.1016/j.otsr.2020.102786 -
Chinese Journal of Cancer May 2012To investigate the clinical characteristics of chondroblastoma with an emphasis on lesions located in the long bone diaphysis, we reviewed the clinical data of 7... (Review)
Review
To investigate the clinical characteristics of chondroblastoma with an emphasis on lesions located in the long bone diaphysis, we reviewed the clinical data of 7 patients with histologically proven chondroblastoma treated in Tianjin Medical University Cancer Hospital and Fudan University Cancer Hospital between January 1995 and May 2009. There were two rare cases of chondroblastoma in the long bone diaphysis. One patient with a lesion in the tibial diaphysis underwent intralesional curettage and bone grafting, and the postoperative bone function was measured as excellent according to the Enneking scoring system. The patient was still alive upon follow-up at 60 months. The other patient with a lesion in the humeral diaphysis underwent resection, and the postoperative bone function was excellent at 48 months, at which there was no evidence of recurrence or metastasis. Thus, except for the distinctive site of the long bone diaphysis, which made diagnosis difficult, the patients' ages, symptoms, X-ray and CT images, treatment, and prognosis were in accordance with typical lesions in the epiphysis and metaphysis. The diagnosis of chondroblastoma in the long bone diaphysis significantly depends on histopathologic characteristics.
Topics: Adolescent; Adult; Bone Neoplasms; Bone Transplantation; Chondroblastoma; Curettage; Diaphyses; Female; Follow-Up Studies; Humans; Humerus; Magnetic Resonance Imaging; Male; Tibia; Tomography, X-Ray Computed; Young Adult
PubMed: 22464651
DOI: 10.5732/cjc.011.10402 -
Scientific Reports Jun 2022To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union,... (Meta-Analysis)
Meta-Analysis
To understand the potential and limitations of the different available surgical techniques used to treat large, long-bone diaphyseal defects by focusing on union, complication, re-intervention, and failure rates, summarizing the pros and cons of each technique. A literature search was performed on PubMed, Web of Science, and Cochrane databases up to March 16th, 2022; Inclusion criteria were clinical studies written in English, of any level of evidence, with more than five patients, describing the treatment of diaphyseal bone defects. The primary outcome was the analysis of results in terms of primary union, complication, reintervention, and failure rate of the four major groups of techniques: bone allograft and autograft, bone transport, vascularized and non-vascularized fibular graft, and endoprosthesis. The statistical analysis was carried out according to Neyeloff et al., and the Mantel-Haenszel method was used to provide pooled rates across the studies. The influence of the various techniques on union rates, complication rates, and reintervention rates was assessed by a z test on the pooled rates with their corresponding 95% CIs. Assessment of risk of bias and quality of evidence was based on Downs and Black's "Checklist for Measuring Quality" and Rob 2.0 tool. Certainty of yielded evidence was evaluated with the GRADE system. Seventy-four articles were included on 1781 patients treated for the reconstruction of diaphyseal bone defects, 1496 cases in the inferior limb, and 285 in the upper limb, with trauma being the main cause of bone defect. The meta-analysis identified different outcomes in terms of results and risks. Primary union, complications, and reinterventions were 75%, 26% and 23% for bone allografts and autografts, 91%, 62% and 19% for the bone transport group, and 78%, 38% and 23% for fibular grafts; mean time to union was between 7.8 and 8.9 months in all these groups. Results varied according to the different aetiologies, endoprosthesis was the best solution for tumour, although with a 22% failure rate, while trauma presented a more composite outcome, with fibular grafts providing a faster time to union (6.9 months), while cancellous and cortical-cancellous grafts caused less complications, reinterventions, and failures. The literature about this topic has overall limited quality. However, important conclusions can be made: Many options are available to treat critical-size defects of the diaphysis, but no one appears to be an optimal solution in terms of a safe, satisfactory, and long-lasting outcome. Regardless of the bone defect cause, bone transport techniques showed a better primary union rate, but bone allograft and autograft had fewer complication, reintervention, and failure rates than the other techniques. The specific lesion aetiology represents a critical aspect influencing potential and limitations and therefore the choice of the most suitable technique to address the challenging large diaphyseal defects.
Topics: Autografts; Bone Transplantation; Diaphyses; Fibula; Humans; Plastic Surgery Procedures
PubMed: 35650218
DOI: 10.1038/s41598-022-12140-5 -
Clinical Orthopaedics and Related... Sep 2020Accurate quantification of bone loss facilitates preoperative planning and standardization for research purposes in patients who undergo revision TKA. The most commonly... (Observational Study)
Observational Study
BACKGROUND
Accurate quantification of bone loss facilitates preoperative planning and standardization for research purposes in patients who undergo revision TKA. The most commonly used classification to rate bone defects in this setting, the Anderson Orthopaedic Research Institute classification, does not quantify diaphyseal bone loss and reliability has not been well studied.
QUESTIONS/PURPOSES
We developed a new classification scheme to rate bone defects in patients undergoing revision TKA and tested (1) the intraobserver and interobserver reliability of this classification for revision TKA based on preoperative radiographs, and (2) whether additional CT images might improve interobserver reliability.
METHODS
This was a preregistered observational study. Interobserver reliability was analyzed using preoperative radiographs of 61 patients who underwent (repeat) revision TKA, and their bone defects were rated by five experienced orthopaedic surgeons. For intraobserver reliability, ratings were repeated at least 2 weeks after the first rating (Timepoints 1 and 2). Directly after the radiographic assessments of Timepoint 2, the observers were provided with CT images of each patient and asked to rate the bone defects for a third time (Timepoint 3), to assess the additional value of CT. Intraobserver and interobserver reliability were tested using Gwet's agreement coefficient 2, which is a measure of agreement between observers in categorical data. Substantial agreement was defined as coefficients between 0.61 to 0.8 and almost perfect agreement as > 0.8.
RESULTS
The intraobserver reliability varied between 0.55 (95% CI 0.40 to 0.71) and 0.87 (95% CI 0.78 to 0.96) in the epiphysis, between 0.69 (95% CI 0.58 to 0.80) and 0.98 (95% CI 0.95 to 1) in the metaphysis, and between 0.95 (95% CI 0.90 to 0.99) and 0.99 (95% CI 0.98 to 1) in the diaphysis. The interobserver reliability varied between 0.48 (95% CI 0.39 to 0.57) and 0.49 (95% CI 0.42 to 0.56) in the epiphysis and between 0.81 (95% CI 0.75 to 0.87) and 0.88 (95% CI 0.83 to 0.93) in the metaphysis, and was 0.96 (95% CI 0.93 to 0.99) in the diaphysis at Timepoint 1. The interobserver reliability at Timepoint 2 was similar to that of Timepoint 1. The addition of CT images did not improve reliability (Timepoint 3).
CONCLUSIONS
The bone defect classification was less reliable in the epiphyseal area compared with the metaphysis and diaphysis. This finding may be explained by prosthetic components obscuring this region or the more severe bone defects in this region. The addition of CT scans did not improve reliability. Further testing of reliability with observers from other institutions is necessary, as well as validity testing, by testing the classification in relation to intraoperative findings.
LEVEL OF EVIDENCE
Level III, diagnostic study.
Topics: Arthroplasty, Replacement, Knee; Bone Diseases; Diaphyses; Epiphyses; Female; Femur; Humans; Male; Middle Aged; Observer Variation; Preoperative Period; Reoperation; Reproducibility of Results; Tibia; Tomography, X-Ray Computed
PubMed: 32023232
DOI: 10.1097/CORR.0000000000001084 -
World Journal of Surgical Oncology Jan 2017Reports showing high recurrence rates for intralesional curettage and bone grafting have made the current treatment principle for fibrous dysplasia controversial. This...
BACKGROUND
Reports showing high recurrence rates for intralesional curettage and bone grafting have made the current treatment principle for fibrous dysplasia controversial. This study aimed to report the postoperative clinical outcomes from three minimally invasive surgical strategies we use for monostotic fibrous dysplasia (MFD).
PATIENTS AND METHODS
Twelve patients with MFD presenting with no pathologic fracture or deformity and treated with one of three surgical strategies-plain open biopsy, plain alpha-tricalcium phosphate (ATP) reconstruction, and prophylactic bridge plating-were included. There were nine men and three women, with median age of 38 years. Mean follow-up was 88 weeks. Five cases involved the proximal femur, two each involved the femoral and tibial diaphyses, and one each involved the distal humerus, radial diaphysis, and proximal tibia. All cases were reviewed for functional and radiological outcomes.
RESULTS
Median time to full activity was 1 day (range 1 to 3) for the plain open biopsy group, while the prophylactic bridge-plating and plain ATP reconstruction groups had longer median recovery times (59 days, range 3 to 143, and 52 days, range 11 to 192, respectively). Musculoskeletal Tumor Society scores at last follow-up were excellent for all the cases (mean 29.6, range 25 to 30). Radiological analysis using Gaski et al.'s criteria showed plain open biopsy resulted in partial resolution of proximal femoral lesions, while ATP reconstruction and prophylactic plating resulted in no change and progression in this lesion site, respectively. For femoral diaphyseal lesions, prophylactic plating resulted in partial resolution, while ATP reconstruction resulted in no change. In the tibial diaphysis, prophylactic plating resulted in partial resolution, while plain open biopsy resulted in no change. For the lesions involving the distal humerus and the proximal tibia, plain open biopsy resulted in partial resolution, while for the radial diaphyseal lesion, ATP reconstruction resulted in no change. Radiological progression was limited in 11 (92%) cases, and none had postoperative complications.
CONCLUSION
Plain open biopsies for asymptomatic lesions; prophylactic bridge plating for symptomatic, large diaphyseal lytic lesions; and plain ATP reconstructions for both small and large nondiaphyseal symptomatic lytic lesions may be acceptable alternatives to curettage-incorporating procedures for MFD.
Topics: Adolescent; Adult; Aged; Bone Transplantation; Child; Female; Fibrous Dysplasia, Monostotic; Follow-Up Studies; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Prognosis; Radiography; Retrospective Studies; Young Adult
PubMed: 28057011
DOI: 10.1186/s12957-016-1068-1 -
Haematologica Dec 2011Molecular and cellular events that resulted in leukemia development are well characterized but initial engraftment and proliferation of leukemic cells in bone marrow and...
BACKGROUND
Molecular and cellular events that resulted in leukemia development are well characterized but initial engraftment and proliferation of leukemic cells in bone marrow and early modifications of the bone marrow microenvironment induced by engrafted leukemic cells remain to be clarified.
DESIGN AND METHODS
After retro-orbital injection of 1,000 leukemic cells expressing Mixed Lineage Leukemia-Eleven Nineteen Leukemia fusion protein in non-conditioned syngenic mice, kinetics of leukemic burden and alterations of femoral hematopoietic populations were followed using an in vivo confocal imaging system and flow cytometry.
RESULTS
Three days after injection, 5% of leukemic cells were found in femurs. Little proliferation of engrafted leukemic cells could then be detected for more than two weeks while the number of femoral leukemic cells remained stable. Twenty days after injection, leukemic cells preferentially proliferated in femoral diaphysis where they formed clusters on the surface of blood vessels and bone. B220(+) lymphoid cells were found near these leukemic cell clusters and this association is correlated with a decreased number of femoral B220(+)IgM(+) cells. Increasing the number of injected leukemic cells or conditioning recipient mice with γ-irradiation resulted in leukemic cell development in diaphysis and knee. Competition experiments indicate that proliferation but not engraftment is a rate-limiting factor of leukemic cells spreading in diaphysis. Finally, 30 days after injection leukemia developed.
CONCLUSIONS
After retro-orbital injection of 1,000 leukemic cells expressing Mixed Lineage Leukemia-Eleven Nineteen Leukemia into syngenic mice, leukemic cell burden preferentially initiates in femoral diaphysis and is preceded by changes of femoral B-lymphoid populations.
Topics: Animals; B-Lymphocytes; DNA-Binding Proteins; Diaphyses; Femoral Neoplasms; Femur; Histone-Lysine N-Methyltransferase; Leukemia, Biphenotypic, Acute; Mice; Myeloid-Lymphoid Leukemia Protein; Oncogene Proteins, Fusion; Transcription Factors; Tumor Burden
PubMed: 21933859
DOI: 10.3324/haematol.2011.045153 -
American Journal of Biological... Apr 2022Long bone variations during growth are susceptible to the combined action of nutritional, hormonal, and genetic factors that may modulate the mechanical forces acting...
OBJECTIVES
Long bone variations during growth are susceptible to the combined action of nutritional, hormonal, and genetic factors that may modulate the mechanical forces acting upon growing individuals as they progressively acquire a mature gait. In this work, we explore diaphyseal length and breadth variations of tibia and fibula during ontogeny (a) to test the presence of changes in relation to early toddling, and (b) to further our understanding of developmental patterns in relation to sex.
MATERIALS AND METHODS
Lengths, breadths, and indices were analyzed on right and left leg bones of 68 subadult individuals (Human Identified Skeletal Collection of the University of Bologna, Italy). Analyses included intersex and age classes (1, 0-1 year; 2, 1.1-3 years; 3, 3.1-6 years) comparisons, linear regressions with age and assessment of correlation among tibial and fibular measurements, as well as principal component analysis.
RESULTS
A significant difference emerged among age class 1 and the others. Age class 1 and 3 differ between them, while age class 2 overlaps with the others. No sex dimorphism was detected. All measurements were strongly correlated with age. Tibial and fibular measurements correlated with each other.
CONCLUSIONS
Our results relate the progressive emergence of toddling attempts in growing individuals at the end of the first year of age. No significant sex differences were found, suggesting that tibial and fibula growth might diverge between sexes in later childhood. We provide quantitative data regarding tibial and fibular linear growth and its timing in a modern documented osteological sample from Italy.
Topics: Humans; Male; Female; Child; Tibia; Fibula; Diaphyses; Leg; Italy
PubMed: 36787708
DOI: 10.1002/ajpa.24440 -
Joint Diseases and Related Surgery Apr 2023This study aims to compare the clinical and radiological results of intramedullary nailing and plating, which are both techniques utilized frequently in the surgical...
OBJECTIVES
This study aims to compare the clinical and radiological results of intramedullary nailing and plating, which are both techniques utilized frequently in the surgical treatment of isolated fractures of the distal third of the ulna diaphysis.
PATIENTS AND METHODS
Between January 2010 and December 2016, a total of 54 patients (34 males, 20 females; mean age: 37.8±7.4 years; range, 22 to 56 years) with isolated fractures of the distal third of the ulna diaphysis were retrospectively analyzed. The patients were divided into those treated with locking plates (Plating group, n=25) and those treated with intramedullary nailing (IMN group, n=29). The operating time and clinical and radiological results were compared between the groups.
RESULTS
The median follow-up time was 93 (range, 84.5 to 99.5) months in the Pg and 86 (range, 80 to 97) months in the IMNg (p=0.179). No significant difference was observed between the groups in respect of age, sex, trauma mechanism, fracture classification, smoking status, and time from trauma to surgery. The median operating time was 46 min in the Pg and 33 min in the IMNg (p<0.001). No significant difference was found in the postoperative length of stay in hospital, reduction quality, infection rates, clinical results, radiological results, and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score between the groups. Implant removal was only needed in the locking plate group (p=0.007).
CONCLUSION
In the surgical treatment of isolated fractures of the distal third of the ulna diaphysis, locked IMN seems to be a good alternative to the plate method with a shorter operating time and less need for implant removal.
Topics: Male; Female; Humans; Adult; Middle Aged; Fracture Fixation, Intramedullary; Diaphyses; Retrospective Studies; Treatment Outcome; Fracture Healing; Bone Nails; Fractures, Bone; Ulna
PubMed: 37462641
DOI: 10.52312/jdrs.2023.992