-
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 -
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 -
Clinical Orthopaedics and Related... Mar 2017Bone repair is initiated with a local inflammatory response to injury. The presence of systemic inflammation impairs bone healing and often leads to malunion, although...
BACKGROUND
Bone repair is initiated with a local inflammatory response to injury. The presence of systemic inflammation impairs bone healing and often leads to malunion, although the underlying mechanisms remain poorly defined. Our research objective was to use a mouse model of cortical bone repair to determine the effect of systemic inflammation on cells in the bone healing microenvironment. QUESTION/PURPOSES: (1) Does systemic inflammation, induced by lipopolysaccharide (LPS) administration affect the quantity and quality of regenerating bone in primary bone healing? (2) Does systemic inflammation alter vascularization and the number or activity of inflammatory cells, osteoblasts, and osteoclasts in the bone healing microenvironment?
METHODS
Cortical defects were drilled in the femoral diaphysis of female and male C57BL/6 mice aged 5 to 9 months that were treated with daily systemic injections of LPS or physiologic saline as control for 7 days. Mice were euthanized at 1 week (Control, n = 7; LPS, n = 8), 2 weeks (Control, n = 7; LPS, n = 8), and 6 weeks (Control, n = 9; LPS, n = 8) after surgery. The quantity (bone volume per tissue volume [BV/TV]) and microarchitecture (trabecular separation and thickness, porosity) of bone in the defect were quantified with time using microCT. The presence or activity of vascular endothelial cells (CD34), macrophages (F4/80), osteoblasts (alkaline phosphatase [ALP]), and osteoclasts (tartrate-resistant acid phosphatase [TRAP]) were evaluated using histochemical analyses.
RESULTS
Only one of eight defects was bridged completely 6 weeks after surgery in LPS-injected mouse bones compared with seven of nine defects in the control mouse bones (odds ratio [OR], 0.04; 95% CI, 0.003-0.560; p = 0.007). The decrease in cortical bone in LPS-treated mice was reflected in reduced BV/TV (21% ± 4% vs 39% ± 10%; p < 0.01), increased trabecular separation (240 ± 36 μm vs 171 ± 29 μm; p < 0.01), decreased trabecular thickness (81 ± 18 μm vs 110 ± 22 μm; p = 0.02), and porosity (79% ± 4% vs 60% ± 10%; p < 0.01) at 6 weeks postoperative. Defective healing was accompanied by decreased CD34 (1.1 ± 0.6 vs 3.4 ± 0.9; p < 0.01), ALP (1.9 ± 0.9 vs 6.1 ± 3.2; p = 0.03), and TRAP (3.3 ± 4.7 vs 7.2 ± 4.0; p = 0.01) activity, and increased F4/80 (13 ± 2.6 vs 6.8 ± 1.7; p < 0.01) activity at 2 weeks postoperative.
CONCLUSION
The results indicate that LPS-induced systemic inflammation reduced the amount and impaired the quality of bone regenerated in mouse femurs. The effects were associated with impaired revascularization, decreased bone turnover by osteoblasts and osteoclasts, and by increased catabolic activity by macrophages.
CLINICAL RELEVANCE
Results from this preclinical study support clinical observations of impaired primary bone healing in patients with systemic inflammation. Based on our data, local administration of VEGF in the callus to stimulate revascularization, or transplantation of stem cells to enhance bone turnover represent potentially feasible approaches to improve outcomes in clinical practice.
Topics: Animals; Biomarkers; Bone Density; Bone Remodeling; Cellular Microenvironment; Diaphyses; Disease Models, Animal; Endothelial Cells; Female; Femur; Inflammation; Inflammation Mediators; Lipopolysaccharides; Macrophages; Male; Mice, Inbred C57BL; Neovascularization, Physiologic; Osteoblasts; Osteoclasts; Porosity; Time Factors; Tumor Necrosis Factor-alpha; X-Ray Microtomography
PubMed: 27844403
DOI: 10.1007/s11999-016-5159-7 -
American Journal of Biological... Feb 2024Analyses of external bone shape using geometric morphometrics (GM) and cross-sectional geometry (CSG) are frequently employed to investigate bone structural variation...
OBJECTIVES
Analyses of external bone shape using geometric morphometrics (GM) and cross-sectional geometry (CSG) are frequently employed to investigate bone structural variation and reconstruct activity in the past. However, the association between these methods has not been thoroughly investigated. Here, we analyze whole bone shape and CSG variation of metacarpals 1-5 and test covariation between them.
MATERIALS AND METHODS
We analyzed external metacarpal shape using GM and CSG of the diaphysis at three locations in metacarpals 1-5. The study sample includes three modern human groups: crew from the shipwrecked Mary Rose (n = 35 metacarpals), a Pre-industrial group (n = 50), and a Post-industrial group (n = 31). We tested group differences in metacarpal shape and CSG, as well as correlations between these two aspects of metacarpal bone structure.
RESULTS
GM analysis demonstrated metacarpus external shape variation is predominately related to changes in diaphyseal width and articular surface size. Differences in external shape were found between the non-pollical metacarpals of the Mary Rose and Pre-industrial groups and between the third metacarpals of the Pre- and Post-industrial groups. CSG results suggest the Mary Rose and Post-industrial groups have stronger metacarpals than the Pre-industrial group. Correlating CSG and external shape showed significant relationships between increasing external robusticity and biomechanical strength across non-pollical metacarpals (r: 0.815-0.535; p ≤ 0.05).
DISCUSSION
Differences in metacarpal cortical structure and external shape between human groups suggest differences in the type and frequency of manual activities. Combining these results with studies of entheses and kinematics of the hand will improve reconstructions of manual behavior in the past.
Topics: Humans; Metacarpal Bones; Metacarpus; Hand; Diaphyses; Upper Extremity
PubMed: 37929663
DOI: 10.1002/ajpa.24866 -
Orthopaedics & Traumatology, Surgery &... Oct 2018The indication for operative treatment of displaced midshaft clavicle fractures remains controversial. However, if plate fixation is considered, implant prominence and... (Comparative Study)
Comparative Study Review
Are commercially-available precontoured anatomical clavicle plating systems offering the purported superior optimum fitting to the clavicle? A cadaveric analysis and review of literature.
PURPOSE
The indication for operative treatment of displaced midshaft clavicle fractures remains controversial. However, if plate fixation is considered, implant prominence and skin irritation are the most common causes for re-operation. Low profile implants as well as closely contouring plates to the individual anatomy may reduce these complications. The aim of this study was to compare the fitting accuracy and implant prominence of 3.5mm pelvic reconstruction plates (PRP) with pre-contoured anatomical clavicle plates (PACP) for midshaft clavicle fractures.
METHODS
Three-dimensional data of the largest, median and smallest male and female clavicle of an existing database of 89 cadaveric clavicles were included for analysis. A three-dimensional model of a commercially available PACP was used for digitally positioning of the plate on the segmented clavicles. Three-dimensional printouts of each clavicle were produced and the 3.5mm reconstruction plates were manually bent and positioned by the senior author. Computed tomography scans and three-dimensional reconstructions were then obtained to digitally compare the fitting accuracy and implant prominence.
RESULTS
Pelvic reconstruction plates offered superior fitting accuracy and lower implant prominence compared to PACP. The largest difference in implant prominence was observed in large sized female clavicles and measured 3.6mm.
CONCLUSION
Both, the less costly PRP plates and commercially available PACP for midshaft fractures of the clavicle demonstrated a clinically acceptable fitting accuracy. The manually bent pelvic-reconstruction plates demonstrated reduced implant prominence with superior fitting. Hypothetically this might contribute to a reduced rate of reoperation.
LEVEL OF EVIDENCE
Level IV cadaveric study.
Topics: Bone Plates; Cadaver; Clavicle; Computer Simulation; Diaphyses; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Prosthesis Design; Tomography, X-Ray Computed
PubMed: 29555558
DOI: 10.1016/j.otsr.2018.01.013 -
Comparative Medicine Feb 2011To accommodate functional demands, the composition and organization of the skeleton differ among species. Microcomputed tomography has improved our ability markedly to... (Comparative Study)
Comparative Study
To accommodate functional demands, the composition and organization of the skeleton differ among species. Microcomputed tomography has improved our ability markedly to assess structural parameters of cortical and cancellous bone. The current study describes differences in cortical and cancellous bone structure, bone mineral density, and morphology (geometry) at the proximal femur, proximal femoral diaphysis, lumbar vertebrae, and mandible in mice, rats, rabbits, dogs, and nonhuman primates. This work enhances our understanding of bone gross and microanatomy across lab animal species and likely will enable scientists to select the most appropriate species and relevant bone sites for research involving skeleton. We evaluated the gross and microanatomy of the femora head and neck, lumbar spine, and mandible and parameters of cancellous bone, including trabecular number, thickness, plate separation, and connectivity among species. The skeletal characteristics of rabbits, including a very short femoral neck and small amounts of cancellous bone at the femoral neck, vertebral body, and mandible, seem to make this species the least desirable for preclinical research of human bone physiology; in comparison, nonhuman primates seem the most applicable for extrapolation of data to humans. However, rodent (particularly rat) models are extremely useful for conducting basic research involving the skeleton and represent reliable and affordable alternatives to dogs and nonhuman primates. Radiology and microcomputed tomography allow for reliable evaluation of bone morphology, microarchitecture, and bone mineral density in preclinical and clinical environments.
Topics: Animals; Bone Density; Diaphyses; Dogs; Drug Discovery; Femur; Lumbar Vertebrae; Macaca fascicularis; Mandible; Mice; Rabbits; Rats; X-Ray Microtomography
PubMed: 21819685
DOI: No ID Found -
Medicine Jul 2019Indentation hardness test is a good in vitro method of bone quality assessment. The purpose of this study is to explore the distribution characteristics of bone tissue...
Indentation hardness test is a good in vitro method of bone quality assessment. The purpose of this study is to explore the distribution characteristics of bone tissue microhardness in tibial diaphysis and provide theoretical support for the test site selection of the reference point indentation technique.Three fresh right tibias were obtained from 3 cadaver donors. The tibial diaphysis was evenly divided into 6 sections. Bone specimens with a thickness of 3 mm were cut from each part. After appropriate management, micro-indentation tests were performed in various regions of the specimens to acquire the microhardness values of the tibial diaphysis. Statistical analysis was performed by randomized block design variance analysis to study the distribution characteristics of bone microhardness.72 regions were selected for 360 effective indentations. We found that the bone microhardness is inhomogeneous in tibia diaphysis. Mean hardness value of the anterior, medial, posterior, lateral region of tibia diaphysis was 45.58 ± 4.39 Vickers hardness (HV), 52.33 ± 3.93 HV, 54.00 ± 4.21 HV, 52.89 ± 4.44 HV, respectively. The anterior cortex exhibits lower microhardness value than the other regions (P < .001). Within the same region, microhardness varies significantly with positions in the tibial diaphysis. The variations in indentation hardness are bound to have a significant impact on the comparability of different reference point indentation (RPI) studies.The results of this study indicated the regional microhardness difference in the human tibia diaphysis. The microhardness of different planes in the same region is also inconsistent. Inhomogeneous distribution of indentation microhardness would have considerable influence in the test site selection of RPI technique. The data collected in our study would contribute to the design of highly precise 3D printing implants and bionic bones with gradient elastic modulus.
Topics: Biomechanical Phenomena; Cadaver; Cortical Bone; Diaphyses; Female; Hardness Tests; Humans; Male; Middle Aged; Tibia
PubMed: 31335730
DOI: 10.1097/MD.0000000000016523 -
The Journal of Bone and Joint Surgery.... Jan 2006We investigated the effect of stimulation with a pulsed electromagnetic field on the osseointegration of hydroxyapatite in cortical bone in rabbits. Implants were... (Review)
Review
We investigated the effect of stimulation with a pulsed electromagnetic field on the osseointegration of hydroxyapatite in cortical bone in rabbits. Implants were inserted into femoral cortical bone and were stimulated for six hours per day for three weeks. Electromagnetic stimulation improved osseointegration of hydroxyapatite compared with animals which did not receive this treatment in terms of direct contact with the bone, the maturity of the bone and mechanical fixation. The highest values of maximum push-out force (F(max)) and ultimate shear strength (sigma(u)) were observed in the treated group and differed significantly from those of the control group at three weeks (F(max); p < 0.0001; sigma(u), p < 0.0005).
Topics: Animals; Biomechanical Phenomena; Diaphyses; Durapatite; Electromagnetic Fields; Femur; Hip Prosthesis; Joint Prosthesis; Male; Materials Testing; Osseointegration; Rabbits; Shear Strength
PubMed: 16365135
DOI: 10.1302/0301-620X.88B1.16496 -
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 -
Orthopaedics & Traumatology, Surgery &... Jun 2018The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment...
INTRODUCTION
The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy.
HYPOTHESIS
Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis.
MATERIAL AND METHODS
Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used.
RESULTS
The average age was 63years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases.
DISCUSSION
Solitary and metachronous bone metastases have a longer survival. Disease-free interval>2years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life.
RETROSPECTIVE STUDY
Level of evidence: IV.
Topics: Aged; Arthroplasty, Replacement, Elbow; Bone Cements; Bone Neoplasms; Bone Plates; Carcinoma, Renal Cell; Diaphyses; Epiphyses; Female; Fracture Fixation, Intramedullary; Fractures, Spontaneous; Humans; Humerus; Kidney Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Prostheses and Implants; Prosthesis Failure; Retrospective Studies; Treatment Outcome
PubMed: 29654934
DOI: 10.1016/j.otsr.2018.03.009