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Salamanna F, Tedesco G, Sartori M, Griffoni C, Spinnato P, Romeo P, Ghermandi R, Fini M, Giavaresi G, Gasbarrini A, Barbanti Brodano G. Safety and efficacy of autologous bone marrow clot as a multifunctional bioscaffold for instrumental posterior lumbar fusion: a 1-year follow-up pilot study. Front Endocrinol (Lausanne) 2024; 14:1245344. [PMID: 38260131 PMCID: PMC10801235 DOI: 10.3389/fendo.2023.1245344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Bone marrow aspirate (BMA), when combined with graft substitutes, has long been introduced as a promising alternative to iliac crest bone graft in spinal fusion. However, the use of BMA is limited by the absence of a standardized procedure, a structural texture, and the potential for diffusion away from the implant site. Recently, the potential use of a new formulation of BMA, named BMA clot, has been preclinically described. In this report, we present the results of a prospective pilot clinical study aimed at evaluating the safety and efficacy of autologous vertebral BMA (vBMA) clot as a three-dimensional and multifunctional bioscaffold in instrumented posterior lumbar fusion. Methods Ten consecutive patients with an indication of multilevel (≤5) posterior spinal fusion due to lumbar spine degenerative diseases were included in the study and treated with vBMA. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EuroQoL-5L (EQ-5L) preoperatively and at 3 months and 12 months after spinal fusion. Bone fusion quality was evaluated at the 12-month follow-up using the Brantigan classification on radiography (XR) imaging. Bone density was measured on computed tomography (CT) scans at 6 and 12 months of follow-up visits at the intervertebral arches and intervertebral joint areas and expressed in Hounsfield unit (HU). Results The results indicate a successful posterolateral fusion rate of approximately 100% (considering levels with C, D, and E grades according to the Brantigan classification) at the 12-month follow-up, along with an increase in bone density from 6 to 12 months of follow-up. An improvement in the quality of life and health status following surgery, as assessed by clinical scores (ODI, VAS, and EQ-5L), was also observed as early as 3 months postsurgery. No adverse events related to the vBMA clot were reported. Conclusion This prospective pilot study demonstrates the effectiveness and safety profile of vBMA clot as an advanced bioscaffold capable of achieving posterior lumbar fusion in the treatment of degenerative spine diseases. This lays the groundwork for a larger randomized clinical study.
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Affiliation(s)
- Francesca Salamanna
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Tedesco
- Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Sartori
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Romeo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Giavaresi
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Naredo E, Murillo-González J, Mérida Velasco JR, Olivas Vergara O, Kalish RA, Gómez-Moreno C, García-Carpintero Blas E, Fuensalida-Novo G, Canoso JJ. Examining the Forearm Intersection through Palpation and Ultrasonography. Diagnostics (Basel) 2024; 14:116. [PMID: 38201426 PMCID: PMC10802148 DOI: 10.3390/diagnostics14010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Forearm intersection syndrome causes pain, swelling, and a rub at the dorsal distal forearm where the first extensor compartment muscles intersect with the second compartment tendons. Although primary care settings tend to treat mild cases, high-performance athletes may suffer from severe symptoms that require surgery. This proof-of-concept study aims to help detect the anatomical substrate of forearm intersection syndrome using palpation and ultrasonography when available. METHODS Five individuals were studied using independent palpation and ultrasonography to identify the first dorsal compartment muscles and the second dorsal compartment tendons. The distances between the dorsal (Lister's) tubercle of the radius and the ulnar and radial edges of the first dorsal compartment muscles were measured to determine the location and extent of the muscle-tendon intersection. The palpatory and ultrasonographic measurements were compared using descriptive statistics and the paired t-test. RESULTS The mean distances from the dorsal tubercle of the radius to the ulnar and radial borders of the first dorsal compartment muscles were 4.0 cm (SE 0.42) and 7.7 cm (SE 0.56), respectively, based on palpation. By ultrasonography, the corresponding distances were 3.5 cm (SD 1.05, SE 0.47) and 7.0 cm (SD 1.41, SE 0.63). Both methods showed a similar overlap length. However, ultrasonography revealed a shorter distance between the dorsal tubercle of the radius and the ulnar border of the first compartment than palpation (p = 0.0249). CONCLUSIONS Our findings indicate that a basic knowledge of anatomy should help health professionals diagnose forearm intersection syndrome through palpation and, if available, ultrasonography.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - José Ramón Mérida Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Otto Olivas Vergara
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Diaz, IIS Fundación Jiménez Díaz, Autónoma University, 28049 Madrid, Spain; (E.N.); (O.O.V.)
| | - Robert A. Kalish
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
| | - Cristina Gómez-Moreno
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Eva García-Carpintero Blas
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Gema Fuensalida-Novo
- Department of Nursing, Hospital Universitario Fundación Jiménez Díaz, 28049 Madrid, Spain; (C.G.-M.); (E.G.-C.B.); (G.F.-N.)
| | - Juan J. Canoso
- Division of Rheumatology, Tufts University School of Medicine, Boston, MA 02111, USA; (R.A.K.); (J.J.C.)
- Department of Medicine, Emeritus, ABC Medical Center, Mexico City 01120, Mexico
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53
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Vitharana TN, King E, Moran K. Sensorimotor Dysfunction Following Anterior Cruciate Ligament Reconstruction- an Afferent Perspective: A Scoping Review. Int J Sports Phys Ther 2024; 19:1410-1437. [PMID: 38179582 PMCID: PMC10761632 DOI: 10.26603/001c.90862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/19/2023] [Indexed: 01/06/2024] Open
Abstract
Background Sensorimotor dysfunction is thought to occur following anterior cruciate ligament (ACL) injury which may have implications on future reinjury risk. Dysfunction has been demonstrated within the efferent component of the sensorimotor system. However, no reviews have examined the two main components of the afferent system: the visual and somatosensory systems. Hypothesis/Purpose This study aimed to report differences in function (central processing and local processing) within the (1) somatosensory and (2) visual systems between individuals following anterior cruciate ligament reconstruction (ACLR) and healthy controls (between-subject). The study also aimed to report differences in function within the two systems between the two limbs of an individual following ACLR (within-subject). Study Design Scoping review. Methods A search was conducted in PubMed, SPORTDiscus, CINAHL, Medline and Embase up until September 2021. Level I-IV studies assessing somatosensory and visual systems were included if they compared ACLR limbs to the uninjured contralateral limb (within-subject) or a healthy control limb (between-group). The function of somatosensory and visual systems was assessed across both central processing (processing of information in the central cortex) and local processing (all other assessments outside of central processing of information). Results Seventy studies were identified (52 somatosensory, 18 visual). Studies examining somatosensory central processing demonstrated significant differences; 66% of studies exhibited within-subject differences and 100% of the studies exhibited between-group differences. Studies examining local somatosensory processing had mixed findings; 40% of the 'joint position sense (JPS)' and 'threshold to detect motion (TTDM)' studies showed significant within-subject differences (JPS=0.8°-3.8° and TTDPM=0.2°-1.4°) and 42% demonstrated significant between-group differences (JPS=0.4°-5° and TTDPM=0.3°-2.8°). Eighty-three percent of visual central processing studies demonstrated significant dysfunction between-groups with no studies assessing within-subject differences. Fifty percent of the studies examining local visual processing demonstrated a significant between-group difference. Conclusion Significant differences in central processing exist within somatosensory and visual systems following ACLR. There is mixed evidence regarding local somatosensory and visual processing. Increased compensation by the visual system and local visual processing dysfunction may occur in conjunction with somatosensory dysfunction.
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Affiliation(s)
- Thilina N Vitharana
- Sports Medicine Sports Surgery Clinic
- School of Health and Human Performance Dublin City University
| | - Enda King
- Qatar Orthopaedic and Sports Medicine Hospital
- Department of Life Sciences University of Roehampton
| | - Kieran Moran
- School of Health and Human Performance Dublin City University
- Insight Centre for Data Analytics Dublin City University
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Siddiqui HP, Sennimalai K, Bhatt K, Samrit VD, Duggal R. Effect of adjuvant autologous platelet concentrates on secondary repair of alveolar clefts: A systematic review and meta-analysis. SPECIAL CARE IN DENTISTRY 2024; 44:12-27. [PMID: 36721338 DOI: 10.1111/scd.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the existing evidence on the adjuvant use of autologous platelet concentrates (APCs) with iliac crest bone graft (ICBG) in the reconstruction of the secondary alveolar cleft. METHODS Electronic databases were searched systematically until November 2022. Clinical trials comparing the three-dimensional radiological outcomes of patients who underwent secondary alveolar bone grafting (SABG) with ICBG and APCs to those with ICBG alone and the radiological outcomes assessed 6 months after surgery were included. Two authors performed the study selection and the assessment of the risk of bias. Meta-analysis was performed using the random-effects model to determine the risk ratio (RR) for developing wound dehiscence and the mean difference (MD) with a 95% confidence interval (CI) for the percentage of newly formed bone. RESULTS Nine studies (seven RCT and two CCT) were included with a low to high risk of bias. At the 6-month follow-up, the study group revealed insignificant results regarding the percentage of newly formed bone (MD = 6.49; 95% CI: -0.97, 13.94; p = .09; χ2 = 0.01; I2 = 71%). In addition, the overall risk of developing wound dehiscence was lower in the study group (RR = 0.34; 95% CI: 0.15, 0.78; p = .01; χ2 = 0.67; I2 = 0%). CONCLUSION Currently, there is insufficient evidence to support the adjuvant use of APCs with ICBG on enhanced bone regeneration following secondary alveolar bone grafting. However, combining ICBG and APCs might be beneficial in reducing the risk of developing wound dehiscence.
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Affiliation(s)
- Hamza Parvez Siddiqui
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Karthik Sennimalai
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
- Department of Orthodontics, All India Institute of Medical Sciences, Jammu, J&K, India
| | - Krushna Bhatt
- Division of Oral and Maxillofacial Surgery, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Vilas D Samrit
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Duggal
- Division of Orthodontics and Dentofacial Deformities, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
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Li L, Lu M, Zhao L, Shen Z, He L, Xing J, Wang C. All-Arthroscopic Glenoid Bone Augmentation Using Iliac Crest Autograft Procedure for Recurrent Anterior Shoulder Instability: Button Fixation Is a Feasible and Satisfactory Alternative to Screw Fixation. Arthroscopy 2024; 40:16-31. [PMID: 37355185 DOI: 10.1016/j.arthro.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To investigate the efficacy of all-arthroscopic glenoid bone augmentation surgery using the iliac crest autograft procedure. Furthermore, we sought to compare the clinical and radiographic outcomes of using screw versus button fixation, in patients with recurrent anterior shoulder instability. METHODS Between 2015 and 2019, 134 shoulders with persistent instability were surgically treated with an arthroscopically placed autologous iliac crest bone graft transfer procedure. Preoperative and postoperative clinical follow-up data were evaluated using the range of motion, and the Walch-Duplay, American Shoulder and Elbow Society, and Rowe scores. Radiologic assessment on 3-dimensional computed tomography scans was performed preoperatively, immediately after surgery, as well as postoperatively, at 3 months, 6 months, 1 year, and at the final follow-up stage. Graft positions, healing, and resorption were evaluated from postoperative images. RESULTS This study included 102 patients who underwent arthroscopic iliac crest bone grafting procedure with 2 screws fixation (n = 37; group 1) and 2 button fixation (n = 65; group 2). The mean follow-up period was 37 months. There were no significant differences between groups in terms of clinical scores, shoulder motion range, graft healing, or graft positions on computed tomography scans (P>.05). In group 1, 1 patient showed mechanical irritation and persistent pain around the screw insertion site, being treated through the arthroscopic removal of the screws. The average postoperative bony resorption percentages were 20.3% and 11.2% at 6 months, and 32.4% and 19.3% at 12 months, in group 1 and group 2, respectively. A statistically significant difference was detected between the two groups (P<.05). CONCLUSIONS In the arthroscopic iliac crest bone grafting procedure for the treatment of chronic osseous anterior shoulder instability, excellent functional results were obtained after both button fixation and screw fixation techniques. In addition, less graft resorption and no hardware-related complications were detected with suture button fixation technique. LEVEL OF EVIDENCE Level III, retrospective comparative therapeutic trial.
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Affiliation(s)
- Lingzhi Li
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingfeng Lu
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lilian Zhao
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
| | - Zhaoxiong Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China; 6th Department of Orthopaedics, Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Foshan, China
| | - Lilei He
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Jisi Xing
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
| | - Changbing Wang
- Department of Sports Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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Saghati S, Avci ÇB, Hassani A, Nazifkerdar S, Amini H, Saghebasl S, Mahdipour M, Banimohamad-Shotorbani B, Namjoo AR, Abrbekoh FN, Rahbarghazi R, Nasrabadi HT, Khoshfetrat AB. Phenolated alginate hydrogel induced osteogenic properties of mesenchymal stem cells via Wnt signaling pathway. Int J Biol Macromol 2023; 253:127209. [PMID: 37804896 DOI: 10.1016/j.ijbiomac.2023.127209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Osteogenic properties of phenolated alginate (1.2 %) hydrogel containing collagen (0.5 %)/nano-hydroxyapatite (1 %) were studied on human mesenchymal stem cells in vitro. The phenolation rate and physical properties of the hydrogel were assessed using nuclear magnetic resonance (NMR), Fourier-transform infrared spectroscopy (FTIR), Scanning electron microscope (SEM), swelling ratio, gelation time, mechanical assay, and degradation rate. The viability of encapsulated cells was monitored on days 7, 14, and 21 using an MTT assay. Osteoblast differentiation was studied using western blotting, and real-time PCR. Using PCR array analysis, the role of the Wnt signaling pathway was also investigated. Data showed that the combination of alginate/collagen/nanohydroxyapatite yielded proper mechanical features. The addition of nanohydroxyapatite, and collagen reduced degradation, swelling rate coincided with increased stiffness. Elasticity and pore size were also diminished. NMR and FTIR revealed suitable incorporation of collagen and nanohydroxyapatite in the structure of alginate. Real-time PCR analysis and western blotting indicated the expression of osteoblast-related genes such as Runx2 and osteocalcin. PCR array revealed the induction of numerous genes related to Wnt signaling pathways during the maturation of human stem cells toward osteoblast-like cells. In vivo data indicated that transplantation of phenolated alginate/collagen/nanohydroxyapatite hydrogel led to enhanced de novo bone formation in rats with critical-sized calvarial defects. Phenolated alginate hydrogel can promote the osteogenic capacity of human amniotic membrane mesenchymal stem cells in the presence of nanohydroxyapatite and collagen via engaging the Wnt signaling pathway.
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Affiliation(s)
- Sepideh Saghati
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Tissue Engineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Çığır Biray Avci
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ayla Hassani
- Chemical Engineering Faculty, Sahand University of Technology, Tabriz 51335-1996, Iran; Stem Cell and Tissue Engineering Research Laboratory, Sahand University of Technology, Tabriz 51335-1996, Iran
| | - Sajed Nazifkerdar
- Chemical Engineering Faculty, Sahand University of Technology, Tabriz 51335-1996, Iran; Stem Cell and Tissue Engineering Research Laboratory, Sahand University of Technology, Tabriz 51335-1996, Iran
| | - Hassan Amini
- Department of General and Vascular Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Saghebasl
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Mahdipour
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnaz Banimohamad-Shotorbani
- Department of Tissue Engineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atieh Rezaei Namjoo
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Hamid Tayefi Nasrabadi
- Department of Tissue Engineering, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Baradar Khoshfetrat
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey; Chemical Engineering Faculty, Sahand University of Technology, Tabriz 51335-1996, Iran.
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57
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Liu W, Wang X. Recent Advances of Nanogenerator Technology for Cardiovascular Sensing and Monitoring. NANO ENERGY 2023; 117:108910. [PMID: 39183759 PMCID: PMC11343574 DOI: 10.1016/j.nanoen.2023.108910] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
Cardiovascular sensing and monitoring is a widely used function in cardiovascular devices. Nowadays, achieving desired flexibility, wearability and implantability becomes a major design goal for the advancement of this family of devices. As an emerging technology, nanogenerator (NG) offers an intriguing promise for replacing the battery, an essential obstacle toward tissue-like soft electronics. This article reviews most recent advancements in NG technology for advanced cardiovascular sensing and monitoring. Based on the application targets, the discuss covers implantable NGs on hearts, implantable NGs for blood vessel grafts and patches, and wearable NGs with various sensing functions. The applications of NGs as a power source and as an electromechanical sensing element are both discussed. At the end, current challenges in this direction and future research perspectives are elaborated. This emerging and impactful application direction reviewed in this article is expected to inspire many new research and commercialization opportunities in the field of NG technology.
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Affiliation(s)
- Wenjian Liu
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Xudong Wang
- Department of Materials Science and Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
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Kim S, Glaviano NR, Park J. Exercise-induced fatigue affects knee proprioceptive acuity and quadriceps neuromuscular function more in patients with ACL reconstruction or meniscus surgery than in healthy individuals. Knee Surg Sports Traumatol Arthrosc 2023; 31:5428-5437. [PMID: 37787863 DOI: 10.1007/s00167-023-07596-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To observe how knee proprioceptive acuity and quadriceps neuromuscular function change during and after repeated isokinetic knee-extension exercise in patients with anterior cruciate ligament reconstruction (ACLR) or meniscus surgery. METHODS Patients with ACLR or meniscus surgery and matched controls (n = 19 in each group) performed knee-flexion replication at 15° and 75°, and quadriceps peak torque (PT), central activation ratio (CAR) and rate of torque development (RTD) at baseline and immediately after every five sets of isokinetic knee-extension exercise (times 1-5). RESULTS Compared to the baseline, the ACLR and control groups displayed errors in knee-flexion replication at 75° only at time 5 (115.9-155.6%; p ≤ 0.04, d ≥ 0.97), whereas the meniscus surgery group exhibited errors at all time points (142.5-265.6%; p ≤ 0.0003, d ≥ 1.4). Significant percentage reductions in quadriceps CAR were observed between times 4 and 5 in the ACLR group (-5.8%; p = 0.0002, d = 0.96), but not in the meniscus surgery (-1.4%; n.s.) and control (0.1%; n.s.) groups. Significant percentage reductions in quadriceps RTD were observed between times 4 and 5 in the ACLR (-24.2%; p = 0.007, d = 0.99) and meniscus surgery (-23.0%; p = 0.01, d = 0.85) groups, but not in the control group (-0.2%; n.s.). CONCLUSION Patients with ACLR or meniscus surgery displayed a greater loss in knee proprioceptive acuity and quadriceps neuromuscular function during and after exercise than healthy individuals. Evidence-based interventions to enhance exercise-induced fatigue resistance should be implemented following ACLR or meniscus surgery, aiming to prevent proprioceptive and neuromuscular changes within the knee joint and quadriceps. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sungwan Kim
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea
| | - Neal R Glaviano
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Jihong Park
- Department of Sports Medicine, Kyung Hee University, Yongin, Republic of Korea.
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Kunwor B, Chhetri ST, Thapa N, Regmi S, Basukala S. Surviving the perilous: A case report on an urgent approach to necrotizing fasciitis. Clin Case Rep 2023; 11:e8262. [PMID: 38033680 PMCID: PMC10682240 DOI: 10.1002/ccr3.8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Necrotizing fasciitis is a rare, fatal, and rapidly progressing bacterial infection of fascia and subcutaneous tissues. Skin necrosis, pain, bullae, and erythema are the common manifestations. Early diagnosis and prompt treatment can improve outcome.
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Affiliation(s)
- Bishal Kunwor
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | | | - Niranjan Thapa
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Shiva Regmi
- Nepalese Army Institute of Health SciencesKathmanduNepal
| | - Sunil Basukala
- Department of SurgeryNepalese Army Institute of Health SciencesKathmanduNepal
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Baltas C, Mylonas T, Lamprou D, Koskiniotis AE, Arnaoutoglou C. Dorsal Dislocation of Intermediate Cuneiform With Multiple Cuneiform and Cuboid Fractures Combined With Lisfranc Injury: A Case Report. Cureus 2023; 15:e50689. [PMID: 38229780 PMCID: PMC10791154 DOI: 10.7759/cureus.50689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/18/2024] Open
Abstract
Multiple cuneiform fractures combined with isolated intermediate cuneiform dorsal dislocation and cuboid fracture, with disruption of the Lisfranc ligament, are rare injuries. In this study, we present a polytrauma patient who sustained these injuries, his treatment course, and the follow-up period. The patient was operated on the day of the injury and six months after that the results are very satisfactory.
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Affiliation(s)
- Christos Baltas
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Theodoros Mylonas
- Department of Orthopaedics and Traumatology, General University Hospital Of Larissa, Larissa, GRC
| | - Dimitrios Lamprou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Alexandros E Koskiniotis
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
| | - Christina Arnaoutoglou
- Department of Orthopaedics and Traumatology, General University Hospital of Larissa, Larissa, GRC
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61
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Kotsarinis G, Mauffrey O, Wakefield SM, Giannoudis PV. Neglected pelvic fragility fracture managed with unilateral triangular osteosynthesis. Trauma Case Rep 2023; 48:100932. [PMID: 37753345 PMCID: PMC10518727 DOI: 10.1016/j.tcr.2023.100932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
We report on the treatment of a neglected displaced vertical shear pelvic fracture with functional impairment 6 months after injury in a 74-year-old woman with underlying osteoporosis. She was managed with open reduction and internal fixation and grafting of her left SI joint, while the ipsilateral pubic rami fractures were treated conservatively. She achieved union and pain free weight bearing 6 months postoperatively. Appropriate evaluation of the pathology and selection of the appropriate treatment in this elderly patient cohort is essential for a successful outcome. Experienced surgical team and individualized treatment approach are also vital to optimize the result of treatment.
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Affiliation(s)
- Georgios Kotsarinis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | | | - Sophia M. Wakefield
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter V. Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
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Park S, Jeong YH, Ha BJ, Yoo BS, Kim SH, Lee CK, Yi S, Ha Y, Kim KN, Shin DA. Fusion rate of Escherichia coli-derived recombinant human bone morphogenetic protein-2 compared with local bone autograft in posterior lumbar interbody fusion for degenerative lumbar disorders. Spine J 2023; 23:1877-1885. [PMID: 37516282 DOI: 10.1016/j.spinee.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND CONTEXT The use of recombinant human bone morphogenetic proteins-2 (rhBMP-2) for spinal fusion has been reported to be effective. However, most studies have focused on posterolateral and anterior lumbar interbody fusion, and few have investigated posterior lumbar interbody fusion (PLIF). PURPOSE This study aimed to determine the effectiveness and safety of the delivery of Escherichia coli-derived rhBMP-2 (E.BMP-2) with hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) poloxamer hydrogel composite carriers for PLIF. STUDY DESIGN A retrospective study. PATIENT SAMPLE Patients who underwent 1 to 3 levels of PLIF for lumbar degenerative disc disorders between 2015 and 2020 with a follow-up of ≥1 year were enrolled. In total, 254 patients (357 levels) were included in the analysis. The evaluation was performed at each segment level. In the E.BMP-2 group, 160 patients (221 levels) received autologous local bone with E.BMP-2 (maximum 0.5 mg/level), and in the control group, 94 patients (136 levels) received only local bone graft. OUTCOME MEASURES The primary outcome of this study was to compare the X-ray and CT fusion rates between the two groups. Secondary outcomes included analysis of the patients' clinical outcomes and postoperative complications on CT scans. METHODS Clinical evaluations were performed using a visual analog scale for back pain, the Oswestry Disability Index for disability, and physical and mental component summaries of the Short Form 36-Item Form Health Survey to assess functional effects and quality of life. The fusion was evaluated using radiography and CT. On radiography, solid fusion was defined when the difference between extension and flexion was less than 5°. On CT, solid fusion was defined when the upper and lower vertebral bodies were connected by the trabecular bone (bone bridge formation). In addition, complications such as osteolysis, cage subsidence, and screw loosening were investigated using CT. RESULTS All clinical results for low back pain, disability, and quality of life in both groups were excellent and showed statistically significant improvements compared with baseline (p<.0001). According to the X-ray evaluations, fusion was achieved in 92.31% (204/221) of the patients in the E.BMP-2 group and 82.35% (112/136) of the patients in the control group (p=.0041). According to the CT evaluations, the fusion rates were 93.21% (206/221) and 88.24% (120/136) in the E.BMP-2 and control groups (p=.1048), respectively. Except for screw loosening, which had a significantly higher incidence in the control group (p=.0014), the rates of most postoperative complications were not significantly different between the groups. CONCLUSIONS This study demonstrated that the adjunctive use of a low dose of E.BMP-2 with HA and β-TCP hydrogel can effectively promote bone fusion, making it a promising option for patients with limited autograft availability or compromised bone quality in PLIF.
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Affiliation(s)
- Sangman Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yeong Ha Jeong
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Byeong Jin Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Beom Seok Yoo
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Soo-Heon Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Chang Kyu Lee
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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Ardebol J, Zuk NA, Kiliç AĪ, Pak T, Menendez ME, Denard PJ. Arthroscopic Lysis of Adhesions for Stiffness After Surgical Management of Proximal Humerus Fractures Leads to Satisfactory Outcomes in Most Patients. Arthrosc Sports Med Rehabil 2023; 5:100821. [PMID: 38023446 PMCID: PMC10661499 DOI: 10.1016/j.asmr.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To report patient-reported outcomes (PROs), range of motion (ROM), and satisfaction, in patients who underwent arthroscopic lysis of adhesions for stiffness after open reduction with internal fixation (ORIF) or reverse shoulder arthroplasty (RSA) for fracture. Methods A retrospective review was performed to identify patients with stiffness who underwent arthroscopic lysis of adhesions following ORIF or RSA for proximal humerus fracture at a single institution between 2012 and 2021 with minimum 1-year follow-up. PROs including visual analog scale for pain (VAS), American Shoulder and Elbow Surgeons (ASES), and Subjective Shoulder Value (SSV), as well as active ROM including forward flexion (FF), external rotation (ER), internal rotation (IR), were collected pre- and postoperatively. Attempted nonoperative treatment before arthroscopic lysis of adhesions was documented. Complications and satisfaction were also recorded. Results A total of 21 patients met the study criteria (4 RSA, 17 ORIF), with an average age of 66.7 ± 8 years. The study sample comprised mostly of female patients (90%). The mean time from the index surgery to arthroscopy was 9 months, and mean follow-up post-lysis was 17 months. Patients with ORIF reported significant pain relief (VAS, Δ -3.2) and improvement in range of motion (FF, Δ 36°; ER, Δ 20°; IR Δ 3 spinal levels) and PROs (ASES, Δ 34.7; SSV Δ 44.8) (P < .01) after lysis. Patients with RSA had significant improvement in ASES (Δ 21.8; P = .04), SSV (Δ 8.8; P = .04), and FF (Δ 38; P = .02) but did not have significant improvement in VAS (Δ -2; P = .2), ER (Δ 0°; P = 1.0), and IR (Δ 1 spinal level; P = .2). Satisfaction was 100% in the RSA cohort and 82% in the ORIF cohort. No complications were observed. Conclusions Arthroscopic lysis of adhesions for stiffness after surgical management of proximal humerus fracture leads to satisfactory outcomes in most patients. Post-ORIF, patients may achieve improvement in PROs and global ROM, whereas post-RSA, patients may achieve improvement in PROs and FF but do not necessarily improve in rotational ROM. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | | | - Ali Īhsan Kiliç
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
- Izmir Bakircay University, Izmir, Turkey
| | - Theresa Pak
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
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Yurube T, Han I, Sakai D. Concepts of Regeneration for Spinal Diseases in 2023. Int J Mol Sci 2023; 24:16335. [PMID: 38003526 PMCID: PMC10671128 DOI: 10.3390/ijms242216335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
It is our pleasure to announce the publication of the Special Issue "Regeneration for Spinal Diseases 3.0" in the International Journal of Molecular Sciences (ISSN 1422-0067) [...].
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Affiliation(s)
- Takashi Yurube
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Inbo Han
- Department of Neurosurgery, CHA University School of Medicine, CHA Bundang Medical Center, Seongnam-si 13496, Republic of Korea;
| | - Daisuke Sakai
- Department of Orthopedic Surgery, School of Medicine, Tokai University, 143 Shimokasuya, Isehara 259-1193, Japan;
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Xu Z, Li Y, Huang W, Wang Z, Xu X, Tian S. Preliminary exploration of the biomechanical properties of three novel cervical porous fusion cages using a finite element study. BMC Musculoskelet Disord 2023; 24:876. [PMID: 37950220 PMCID: PMC10636970 DOI: 10.1186/s12891-023-06999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Porous cages are considered a promising alternative to high-density cages because their interconnectivity favours bony ingrowth and appropriate stiffness tuning reduces stress shielding and the risk of cage subsidence. METHODS This study proposes three approaches that combine macroscopic topology optimization and micropore design to establish three new types of porous cages by integrating lattices (gyroid, Schwarz, body-centred cubic) with the optimized cage frame. Using these three porous cages along with traditional high-density cages, four ACDF surgical models were developed to compare the mechanical properties of facet articular cartilage, discs, cortical bone, and cages under specific loads. RESULTS The facet joints in the porous cage groups had lower contact forces than those in the high-density cage group. The intervertebral discs in all models experienced maximum stress at the C5/6 segment. The stress distribution on the cortical bone surface was more uniform in the porous cage groups, leading to increased average stress values. The gyroid, Schwarz, and BCC cage groups showed higher average stress on the C5 cortical bone. The average stress on the surface of porous cages was higher than that on the surface of high-density cages, with the greatest difference observed under the lateral bending condition. The BCC cage demonstrated favourable mechanical stability. CONCLUSION The new porous cervical cages satifies requirements of low rigidity and serve as a favourable biological scaffold for bone ingrowth. This study provides valuable insights for the development of next-generation orthopaedic medical devices.
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Affiliation(s)
- Zhi Xu
- Department of Orthopedic, Zhangjiagang Fifth People's Hospital, Zhangjiagang, 215600, Jiangsu, China.
| | - Yuwan Li
- Department of Orthopedic, Peking University Third Hospital, Beijing, 100191, China
- Department of Orthopedic, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, China
| | - Weijun Huang
- Department of Orthopedic, Shangyu Third Hospital, Shangyu, 312300, Zhejiang, China
| | - Ziru Wang
- Clinical Medical College, Wannan Medical College, Wuhu, 241000, Anhui, China
- Department of Orthopedic, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, Anhui, China
| | - Xing Xu
- Department of Medicine, Zhijin People's Hospital, Zhijin, 552100, Guizhou, China
| | - Shoujin Tian
- Department of Orthopedic, Zhangjiagang First People's Hospital, Zhangjiagang, 215600, Jiangsu, China.
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Cao R, Chen B, Li Q, Qiu P, Liang X, Cao Y. Potential of periosteal cells in bone and cartilage regeneration: a systematic review. Front Bioeng Biotechnol 2023; 11:1292483. [PMID: 38026851 PMCID: PMC10666167 DOI: 10.3389/fbioe.2023.1292483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction: The unavailability of adequate human primary cells presents multiple challenges in terms of bone and cartilage regeneration and disease modeling experiments in vitro. Periosteal cells (PCs), which represent promising skeletal stem cell sources, could be a promising strategy in tissue engineering. The present study aimed to summarize the characteristics of PCs to investigate the efficacy of these cells in bone and cartilage regeneration in different models, paying special attention to the comparison of bone marrow stromal cells (BMSCs). Methods: A comprehensive literature search was conducted in Embase, PubMed/MEDLINE, Web of Science, and Scopus for articles published in English until April 2023. Only original researches in which PCs were employed for bone or cartilage regeneration experiments were included. Results: A total of 9140 references were retrieved. After screening the results, 36 publications were considered to be eligible for inclusion in the present literature review. Overall, PCs demonstrated beneficial bone and cartilage regenerative efficacy compared to the bare scaffold since almost all included studies reported positive results. The 9 studies assessing the differences in bone formation capacity between PCs and BMSCs indicated that PCs exhibited stronger in vivo osteogenic differentiation capabilities compared to BMSCs, while the other study demonstrated stronger chondrogenic potential of BMSCs. Discussion: PCs demonstrated beneficial to bone regenerative efficacy compared to the bare scaffold with a low risk of most studies included. However, the cartilage formation capacity of BMSCs still needs to be investigated due to the limited research available and the certain risk of bias. PCs exhibited higher osteogenic capabilities compared to BMSCs in combination with various scaffolds in vivo with good evidence. Further researches are needed to elucidate the comparative benefits of cartilage regeneration. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023411522, CRD42023411522.
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Affiliation(s)
- Rongkai Cao
- Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Beibei Chen
- Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Qianru Li
- Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Piaopiao Qiu
- Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, China
| | - Xiaojie Liang
- Department of Stomatology, People’s Hospital of Xiangyun Affiliated to Dali University, Dali, China
| | - Yujie Cao
- Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Lai Y, Chuanqing M, Zhiyu C, Chengyong W, Meng L, Jing L, Chen WH. Comparison of two preserved cartilage iliac crest cortical-cancellous bone blocks graft harvesting techniques in children: A prospective, double-blind, randomized clinical trial. J Craniomaxillofac Surg 2023; 51:716-722. [PMID: 37821308 DOI: 10.1016/j.jcms.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. MATERIALS AND METHODS Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. RESULTS Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. CONCLUSION OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China; Stomatological Key Laboratory of Fujian College and University, Fuzhou, China
| | - Mao Chuanqing
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Cai Zhiyu
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wang Chengyong
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lu Meng
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Liu Jing
- Department of Stomatology, Fujian Maternal and Child Health Hospital, No 18 Dao Shan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wei Hui Chen
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China.
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Shabaan AA, Salahuddin A, Aboulmagd I, Ragab R, Salah KA, Rashid A, Ayad HM, El Aty Ahmed WA, Refahee SM. Alveolar cleft reconstruction using bone marrow aspirate concentrate and iliac cancellous bone: A 12-month randomized clinical study. Clin Oral Investig 2023; 27:6667-6675. [PMID: 37794139 PMCID: PMC10630224 DOI: 10.1007/s00784-023-05276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE This study aimed to compare the bone density and volume in patients with alveolar cleft reconstructions utilizing bone marrow aspirate concentrate with iliac graft versus iliac graft alone. MATERIAL AND METHODS Thirty-six patients with unilateral alveolar cleft were randomly allocated into either an intervention group receiving an iliac bone graft mixed with bone marrow concentrate or a control group receiving an iliac bone graft. Cone beam CT was obtained preoperative, 6 and 12 months postoperatively to assess the bone density of the graft and bone volume of the alveolar defect, and then, the bone loss ratio was calculated. RESULTS Bone volume and bone density demonstrated a statistically significant increase in the intervention group at 6 and 12 months. In contrast, the bone loss ratio decreased significantly in the intervention group throughout the follow-up period. CONCLUSION A combination of bone marrow concentrate and iliac cancellous bone in alveolar cleft reconstruction may improve bone densities and volume in addition to decreasing graft loss rate. CLINICAL SIGNIFICANCE Using of bone marrow aspirate concentrate will decrease the amount of the graft needed and decrease the ratio of bone loss at the grafted site by the time. Trial registration ClinicalTrials.org ( NCT04414423 ) 4/6/2020.
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Affiliation(s)
- Alshaimaa Ahmed Shabaan
- Oral & Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, 63511, Egypt
| | - Ahmad Salahuddin
- Biochemistry Department, Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
- Biochemistry Department, Faculty of Pharmacy, Al-Ayen university, Nasiriyah, Iraq
| | - Inass Aboulmagd
- Oral & Maxillofacial Radiology, Faculty of Dentistry, Fayoum University, Fayoum, 63511, Egypt
| | - Reham Ragab
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Khaled Amr Salah
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Cairo University, Cairo, 11111, Egypt
| | - Adel Rashid
- Orthodontics, Faculty of Dentistry, Fayoum University, Fayoum, 63511, Egypt
| | - Haytham Mohamed Ayad
- Oral & Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, 63511, Egypt
| | - Walaa Abd El Aty Ahmed
- Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, 11111, Egypt
| | - Shaimaa Mohsen Refahee
- Oral & Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, 63511, Egypt.
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Kempfert DJ, Chaconas EJ, Daugherty ML, Clark NC. Test-retest reliability of quantitative sensory testing, active joint position sense, and functional hop testing in amateur adult athletes with unilateral anterior cruciate ligament reconstruction. Phys Ther Sport 2023; 64:63-73. [PMID: 37778110 DOI: 10.1016/j.ptsp.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES The somatosensory system fulfils a critical role in functional knee joint stability (FKJS) by providing afferent feedback necessary for neuromuscular control. Individuals with anterior cruciate ligament reconstruction (ACLr) have altered somatosensory function. Somatosensory characteristics are assessed by proprioception and quantitative sensory testing. The purpose of the study was to examine intra-rater and inter-rater reliability of methods used to assess somatosensory characteristics and FKJS in amateur adult athletes with unilateral ACLr. DESIGN Repeated measures. SETTING University. PARTICIPANTS 8 female, 4 male with unilateral autogenous ACLr. MAIN OUTCOME MEASURES Bilateral measurements at 5 lower extremity locations and the anterior forearm: light touch (LT), vibration sense (VS), pressure pain threshold (PPT); knee active joint position sense (AJPS); adapted crossover hop for distance (ACHD). Intraclass correlation coefficients (ICC) determined reliability, defined as: poor (<0.50), moderate (0.50-0.75), good (0.75-0.90). RESULTS ACLr-side intra-rater/inter-rater ICCs ranged: LT, -0.27-0.80/-0.01-0.84; VS, 0.12-0.90/0.25-0.90; PPT, 0.49-0.98/0.86-0.99; AJPS, 0.15-0.79/0.55-0.87; ACHD, 0.98/0.99. Uninjured-side intra-rater/inter-rater ICCs ranged: LT, 0.12-0.66/-0.09-0.64; VS, 0.35-0.89/0.05-0.81; PPT, 0.65-0.99/0.45-0.95; AJPS, 0.07-0.81/0.37-0.99; ACHD, 0.99/0.98. CONCLUSIONS Intra-rater and inter-rater reliability was poor to good for both limbs. Overall, PPT and the ACHD demonstrated the highest ICCs. Some somatosensory assessments can be employed with confidence, while others should be used with caution.
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Affiliation(s)
- David J Kempfert
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Eric J Chaconas
- Doctor of Science Physical Therapy Program, Bellin College, 3201 Eaton Rd, Green Bay, WI, 54311, United States.
| | - Matthew L Daugherty
- College of Rehabilitative Sciences, University of St. Augustine for Health Sciences, St. Augustine, FL, 32086, United States.
| | - Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, C04 3SQ, United Kingdom.
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Lee SW, Farrington J, Tiu T. Dynamic Ultrasonography of Snapping Forearm: Proximal Intersection Syndrome. Am J Phys Med Rehabil 2023; 102:e158-e159. [PMID: 37026823 DOI: 10.1097/phm.0000000000002241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Se Won Lee
- From the Department of Physical Medicine and Rehabilitation, Sunrise Health GME Consortium, HCA Healthcare, Las Vegas, Nevada (SWL, JF); and Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida (TT)
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Wu W, Liu B, Wang H. Caecum Rupture Secondary to Iliac Crest Bone Graft: A Case Report. Cureus 2023; 15:e49545. [PMID: 38156144 PMCID: PMC10753155 DOI: 10.7759/cureus.49545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/30/2023] Open
Abstract
Autogenous bone grafting is a common surgical method in orthopaedics. The anterior iliac crest is a common site for harvesting autologous bone grafts. There are many complications after iliac bone harvesting, and pain and discomfort at the donor site are the most common sequelae. However, intestinal rupture after iliac bone harvesting has not been reported. We report a case of caecum rupture in a 58-year-old male after harvesting bone from his iliac crest. After proper surgical repair, the patient was discharged from the ICU and his bowel function recovered. This serious complication of bone harvesting from the iliac crest prompted investigation of the technique of iliac crest harvesting and donor site reconstruction.
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Affiliation(s)
- Wangsheng Wu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
- Orthopaedics, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Bingsheng Liu
- Orthopaedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
| | - Huajuan Wang
- Anaesthesiology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, CHN
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Morita T, Takigawa T, Ishihara T, Taoka T, Ishimaru T, Kanazawa T, Tada K, Omori T, Yagata Y, Toda K, Nakago K, Ito Y. Minimally invasive surgery technique for unstable pelvic ring fractures with severe vertical shear displacement: A retrospective study. Orthop Traumatol Surg Res 2023; 109:103528. [PMID: 36565742 DOI: 10.1016/j.otsr.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unstable pelvic fractures, especially vertical shear fractures, require surgery for correct reduction, rigid fixation, and improved postoperative outcomes. Herein, we assess the effectiveness of our minimally invasive procedure for the management of unstable pelvic fractures. HYPOTHESIS We hypothesized that this procedure would be useful for the management of unstable pelvic fractures. PATIENTS AND METHODS This study included 28 patients with unstable pelvic fractures (vertical shear injuries; AO types C1-3) treated using minimally invasive surgery for spinopelvic fixation (MIS-SP) between 2014 and 2020 (mean follow-up time, 15 months). The MIS-SP requires four percutaneous pedicle screws and four iliac screw insertions. Subsequently, reduction and fixation are performed. RESULTS The mean preoperative displacement of the posterior pelvic elements in craniocaudal correction was 17.6 (range, 9.0-32.2) mm. The mean length of the craniocaudal reduction was 16.5 (8.1-30.1) mm, with a mean reduction rate of 93.5% (78%-100%). The mean length of the mediolateral reduction was 11.3 (3.9-19.6) mm, with a mean reduction rate of 87.3% (76%-100%). DISCUSSION Our novel reduction and fixation procedure is a powerful, minimally invasive option for the treatment of unstable pelvic ring fractures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Takuya Morita
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan.
| | - Tomoyuki Takigawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takeshi Ishihara
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takuya Taoka
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takahiko Ishimaru
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Tomoko Kanazawa
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Keitaro Tada
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Takao Omori
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yukihisa Yagata
- Department of Orthopedic Surgery, Hyogo Emergency Medical Center, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kazukiyo Toda
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Kie Nakago
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
| | - Yasuo Ito
- Department of Orthopedic Surgery, Kobe Red Cross Hospital, 1-3-1, Wakihamakaigandori, Chuo-ku, Kobe City 651-0073, Hyogo, Japan
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Ball JR, Shelby T, Hernandez F, Mayfield CK, Lieberman JR. Delivery of Growth Factors to Enhance Bone Repair. Bioengineering (Basel) 2023; 10:1252. [PMID: 38002376 PMCID: PMC10669014 DOI: 10.3390/bioengineering10111252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
The management of critical-sized bone defects caused by nonunion, trauma, infection, malignancy, pseudoarthrosis, and osteolysis poses complex reconstruction challenges for orthopedic surgeons. Current treatment modalities, including autograft, allograft, and distraction osteogenesis, are insufficient for the diverse range of pathology encountered in clinical practice, with significant complications associated with each. Therefore, there is significant interest in the development of delivery vehicles for growth factors to aid in bone repair in these settings. This article reviews innovative strategies for the management of critical-sized bone loss, including novel scaffolds designed for controlled release of rhBMP, bioengineered extracellular vesicles for delivery of intracellular signaling molecules, and advances in regional gene therapy for sustained signaling strategies. Improvement in the delivery of growth factors to areas of significant bone loss has the potential to revolutionize current treatment for this complex clinical challenge.
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Affiliation(s)
- Jacob R. Ball
- Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, 1500 San Pablo St., Los Angeles, CA 90033, USA
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Knapp G, Pawelke J, Heiss C, Elmas S, Vinayahalingam V, ElKhassawna T. Traumatic Fracture Treatment: Calcium Phosphate Bone Substitute Case-Control Study in Humerus, Radius, Tibia Fractures-Assessing Efficacy and Recovery Outcomes. Biomedicines 2023; 11:2862. [PMID: 37893234 PMCID: PMC10604612 DOI: 10.3390/biomedicines11102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/18/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
To date, insufficient investigation has been carried out on the biocompatibility of synthetic bioactive bone substitute materials after traumatically induced bone fractures in clinical conditions. This study encompasses the safety, resorption, healing process, and complications of surgical treatment. Our current hypothesis posits that calcium phosphate-based bone substitutes could improve bone healing. In this retrospective case-control study, over 290 patients who underwent surgical treatment for acute fractures were examined. Bone defects were augmented with calcium phosphate-based bone substitute material (CP) in comparison to with empty defect treatment (ED) between 2011 and 2018. A novel scoring system for fracture healing was introduced to assess bone healing in up to six radiological follow-up examinations. Furthermore, demographic data, concomitant diseases, and complications were subjected to analysis. Data analysis disclosed significantly fewer postoperative complications in the CP group relative to the ED group (p < 0.001). The CP group revealed decreased risks of experiencing complications (p < 0.001), arthrosis (p = 0.01), and neurological diseases (p < 0.001). The fracture edge, the fracture gap, and the articular surface were definably enhanced. Osteosynthesis and general bone density demonstrated similarity (p > 0.05). Subgroup analysis focusing on patients aged 64 years and older revealed a diminished complication incidence within the CP group (p = 0.025). Notably, the application of CP bone substitute materials showed discernible benefits in geriatric patients, evident by decreased rates of pseudarthrosis (p = 0.059). Intermediate follow-up evaluations disclosed marked enhancements in fracture gap, edge, and articular surface conditions through the utilization of CP-based substitutes (p < 0.05). In conclusion, calcium phosphate-based bone substitute materials assert their clinical integrity by demonstrating safety in clinical applications. They substantiate an accelerated early osseous healing trajectory while concurrently decreasing the severity of complications within the bone substitute cohort. In vivo advantages were demonstrated for CP bone graft substitutes.
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Affiliation(s)
- Gero Knapp
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Jonas Pawelke
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Christian Heiss
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Sera Elmas
- Department of Trauma, Hand and Reconstructive Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (C.H.); (S.E.)
| | - Vithusha Vinayahalingam
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
| | - Thaqif ElKhassawna
- Experimental Trauma Surgery, Faculty of Medicine, Justus Liebig University of Giessen, 35392 Giessen, Germany; (J.P.); (V.V.); (T.E.)
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Ramella M, Depaoli A, Menozzi GC, Gallone G, Cerasoli T, Rocca G, Trisolino G. Recurrence and Complication Rates of Surgical Treatment for Blount's Disease in Children: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6495. [PMID: 37892633 PMCID: PMC10607610 DOI: 10.3390/jcm12206495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Blount's disease is a growth disorder of the proximal tibia that causes progressive genu varum in children. Surgical treatment is recommended if the deformity worsens, but which intervention is best remains controversial. This study aims to identify factors influencing outcomes and determine the most effective surgical approach. METHODS A systematic review was conducted of studies published before January 2022. RESULTS In total, 63 retrospective studies with CEBM IIIb/IV levels were included (1672 knees in 1234 patients). The most commonly reported treatment was acute correction via osteotomy (47%), followed by hemiepiphysiodesis (22%) and gradual correction (18%). Combined procedures were reported in 13% of cases. The overall recurrence rate was 18%, with a significant difference when comparing the recurrence rates after gradual correction with those after hemiepiphysiodesis (7% and 29%, respectively). Major complications beyond recurrence were observed in 5% of cases. A meta-analysis of the available raw data showed a significantly increased recurrence rate (39%) among treated children who were between 4.5 and 11.25 years of age and were followed for a minimum follow-up of 2.5 years. CONCLUSIONS Overall, poor evidence with which to establish an optimal treatment for Blount's disease was found. This study remarked on the need for early diagnosis, classification, and treatment of infantile tibia vara, since a significant rate of recurrence was found in neglected cases.
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Affiliation(s)
| | | | | | | | | | | | - Giovanni Trisolino
- Unit of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (M.R.); (A.D.)
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Kimmeyer M, Schmalzl J, Rentschler V, Schieffer C, Macken A, Gerhardt C, Lehmann LJ. Correct positioning of the calcar screw leads to superior results in proximal humerus fractures treated with carbon-fibre-reinforced polyetheretherketone plate osteosynthesis with polyaxial locking screws. J Orthop Traumatol 2023; 24:54. [PMID: 37816859 PMCID: PMC10564686 DOI: 10.1186/s10195-023-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/29/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Plate osteosynthesis with implants made of carbon-fibre-reinforced polyetheretherketone (CFR-PEEK) has recently been introduced for the treatment of fractures of the proximal humerus (PHFs). The advantages of the CFR-PEEK plate are considered to be its radiolucency, its favourable modulus of elasticity, and the polyaxial placement of the screws with high variability of the angle. The primary aim of this study is to investigate the influence of calcar screw positioning on the complication and revision rates after CFR-PEEK plating of PHFs. The secondary aim is to assess its influence on functional outcome. MATERIAL AND METHODS Patients were identified retrospectively. Minimum follow-up was 12 months. The cohort was divided into two groups depending on the distance of the calcar screw to the calcar (group I: < 12 mm, group II: ≥ 12 mm). The range of motion (ROM), Subjective Shoulder Value Score (SSV) and Constant-Murley Score (CS) were analysed at follow-up examination. Subjective complaints, complications (e.g. humeral head necrosis, varus dislocation) and the revision rate were evaluated. RESULTS 51 patients (33 female, 18 male) with an average age of 68.6 years were included after a period of 26.6 months (group I: 32 patients, group II: 19 patients). Apart from the gender distribution, no significant differences were seen in the patient characteristics. The outcome scores showed significantly better clinical results in group I: SSV 83.4 vs 71.2, p = 0.007; CS 79.1 vs 67.8, p = 0.013. Complications were seen less frequently in group I (18.8 % vs 47.4 %, p = 0.030). CONCLUSION This study shows that the positioning of the calcar screw is relevant for CFR-PEEK plate osteosynthesis in PHFs with a good reduction of the fracture. Optimal positioning of the calcar screw close to the calcar (< 12 mm) is associated with a lower rate of complications, resulting in significantly superior functional outcomes. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Michael Kimmeyer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany.
- Alps Surgery Institute, Clinque Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France.
| | - Jonas Schmalzl
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Verena Rentschler
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Christian Schieffer
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Arno Macken
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Alps Surgery Institute, Clinque Générale d'Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France
| | - Christian Gerhardt
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology, Hand Surgery and Sports Medicine, ViDia Clinics Karlsruhe, Steinhaeusserstr. 18, 76135, Karlsruhe, Germany
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Tsitlakidis S, Hohenbild F, Saur M, Moghaddam A, Kunisch E, Renkawitz T, Gonzalo de Juan I, Westhauser F. Reduced Sodium Portions Favor Osteogenic Properties and Cytocompatibility of 45S5-Based Bioactive Glass Particles. Biomimetics (Basel) 2023; 8:472. [PMID: 37887603 PMCID: PMC10604502 DOI: 10.3390/biomimetics8060472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/23/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
Besides its favorable biological properties, the release of sodium (Na) from the well-known 45S5-bioactive glass (BG) composition (in mol%: 46.1, SiO2, 24.5 CaO, 24.5 Na2O, 6.0 P2O5) can hamper its cytocompatibility. In this study, particles of Na-reduced variants of 45S5-BG were produced in exchange for CaO and P2O5 via the sol-gel-route resulting in Na contents of 75%, 50%, 25% or 0% of the original composition. The release of ions from the BGs as well as their impact on the cell environment (pH values), viability and osteogenic differentiation (activity of alkaline phosphatase (ALP)), the expression of osteopontin and osteocalcin in human bone-marrow-derived mesenchymal stromal cells in correlation to the Na-content and ion release of the BGs was assessed. The release of Na-ions increased with increasing Na-content in the BGs. With decreasing Na content, the viability of cells incubated with the BGs increased. The Na-reduced BGs showed elevated ALP activity and a pro-osteogenic stimulation with accelerated osteopontin induction and a pronounced upregulation of osteocalcin. In conclusion, the reduction in Na-content enhances the cytocompatibility and improves the osteogenic properties of 45S5-BG, making the Na-reduced variants of 45S5-BG promising candidates for further experimental consideration.
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Affiliation(s)
- Stefanos Tsitlakidis
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
| | - Frederike Hohenbild
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
| | - Merve Saur
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
| | - Arash Moghaddam
- PrivatÄrztliches Zentrum Aschaffenburg, Frohsinnstraße 12, 63739 Aschaffenburg, Germany;
| | - Elke Kunisch
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
| | - Isabel Gonzalo de Juan
- Institut für Materialwissenschaft, Technische Universität Darmstadt, Otto-Berndt-Straße 3, 64287 Darmstadt, Germany
| | - Fabian Westhauser
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (S.T.); (M.S.); (E.K.)
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Ganal İ, Çelen ZE. Midterm Functional Outcomes of Arthroscopically Treated Recalcitrant Osteitis Pubis in Competitive Soccer Players. Orthop J Sports Med 2023; 11:23259671231203677. [PMID: 37900866 PMCID: PMC10605685 DOI: 10.1177/23259671231203677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/10/2023] [Indexed: 10/31/2023] Open
Abstract
Background Outcomes after arthroscopic debridement for isolated osteitis pubis in athletes are unknown, and midterm results following this method have not been established. Purpose/Hypothesis To evaluate the safety and efficiency of arthroscopic treatment for recalcitrant osteitis pubis in competitive soccer players. It was hypothesized that this treatment modality would yield clinical improvement in functional and patient satisfaction scores compared with preoperative values. Study Design Case series; Level of evidence 4. Methods At a single center, 10 consecutive male soccer players (mean age, 23.6 ± 4.4 years; range, 19-32 years) with a mean follow-up period of 72.2 ± 13.4 months (range, 60-97 months) were evaluated. All patients presented with symptomatic osteitis pubis and failed to respond to nonoperative treatment. Arthroscopic pubic symphysiectomy was performed in the supine position, and penile manipulation was performed in all cases to mitigate risks associated with neurovascular structures and the root of the penis. Outcome measurements were time to return to sports, visual analog scale (VAS) for pain, Nirschl Phase Rating Scale (NPRS), Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and patient satisfaction. Preoperative and postoperative radiographs were also assessed. Results The mean time to return to sports was 4.6 ± 1.7 months (range, 3-8 months). The mean VAS pain score decreased from 9.3 ± 0.8 (range, 8-10) to 0.2 ± 0.4 (range, 0-1) (P = .005). The mean NPRS decreased from 6.6 ± 0.5 (range, 6-7) to 0.3 ± 0.5 (range, 0-1) (P = .004). The mean NAHS increased from 35.8 ± 16.7 (range, 14-72) to 98.2 ± 2.7 (range, 93-100) (P = .005). The mean mHHS increased from 47.4 ± 10.6 (range, 27-60) to 98.2 ± 4.5 (range, 86-100) (p = .005). The mean patient satisfaction was 9.7 ± 0.7 (range, 8-10). Scrotal swelling was observed in 4 patients, which was resolved 36 to 48 hours postoperatively. Conclusion Arthroscopic treatment of osteitis pubis may be an option for recalcitrant cases when nonoperative treatment fails. However, further studies are needed to determine whether this technique and the outcomes of this study can be reproduced.
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Affiliation(s)
- İlker Ganal
- Department of Orthopaedics and Traumatology, Yalova Aktif Private Hospital, Yalova, Turkey
| | - Zekeriya Ersin Çelen
- Department of Orthopaedics and Traumatology, Yalova Training and Research Hospital, Yalova, Turkey
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Richter RF, Vater C, Korn M, Ahlfeld T, Rauner M, Pradel W, Stadlinger B, Gelinsky M, Lode A, Korn P. Treatment of critical bone defects using calcium phosphate cement and mesoporous bioactive glass providing spatiotemporal drug delivery. Bioact Mater 2023; 28:402-419. [PMID: 37361564 PMCID: PMC10285454 DOI: 10.1016/j.bioactmat.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Calcium phosphate cements (CPC) are currently widely used bone replacement materials with excellent bioactivity, but have considerable disadvantages like slow degradation. For critical-sized defects, however, an improved degradation is essential to match the tissue regeneration, especially in younger patients who are still growing. We demonstrate that a combination of CPC with mesoporous bioactive glass (MBG) particles led to an enhanced degradation in vitro and in a critical alveolar cleft defect in rats. Additionally, to support new bone formation the MBG was functionalized with hypoxia conditioned medium (HCM) derived from rat bone marrow stromal cells. HCM-functionalized scaffolds showed an improved cell proliferation and the highest formation of new bone volume. This highly flexible material system together with the drug delivery capacity is adaptable to patient specific needs and has great potential for clinical translation.
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Affiliation(s)
- Richard Frank Richter
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Corina Vater
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Margarete Korn
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Tilman Ahlfeld
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Martina Rauner
- Department of Medicine III and Center for Healthy Aging, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Winnie Pradel
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Switzerland
| | - Michael Gelinsky
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Anja Lode
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Paula Korn
- Centre for Translational Bone, Joint and Soft Tissue Research, University Hospital Carl Gustav Carus and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
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Seok HG, Park SG. Dual-Plate Fixation for Proximal Humerus Fractures With Unstable Medial Column in Patients With Osteoporosis. J Orthop Trauma 2023; 37:e387-e393. [PMID: 37296091 DOI: 10.1097/bot.0000000000002645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare radiological and clinical outcomes between lateral locking plate (LLP) and dual-plate fixation (LLP and additional medial buttress plate) for proximal humerus fractures with medial column comminution and varus deformity in patients with osteoporosis. DESIGN Retrospective. SETTING Academic medical center. PATIENTS/PARTICIPANTS Overall, 52 patients were enrolled. Of these, 26 patients underwent dual-plate fixation. The control group (LLP) was matched to the dual-plate group for age, sex, injured side, and fracture type. INTERVENTION Patients in the dual-plate group were treated with LLP and medial buttress plate, whereas patients in the LLP group were treated with only an LLP. MAIN OUTCOME MEASUREMENTS Demographic factors, operative time, and level of hemoglobin of the 2 groups obtained from medical records. Changes in the neck-shaft angle and the development of postoperative complications were recorded. Clinical outcomes were measured based on the visual analog scale; American Shoulder and Elbow Surgeons; Disabilities of the Arm, Shoulder, and Hand; and Constant-Murley scores. RESULTS The operation time and hemoglobin loss did not differ significantly between the groups. Radiographic evaluation showed a significantly lower change in neck-shaft angle in the dual-=plate group than in the LLP group. The dual-plate group also showed better Disabilities of the Arm, Shoulder, and Hand; American Shoulder and Elbow Surgeons; and Constant-Murley scores than the LLP group. CONCLUSION Fixation using additional medial buttress plate with LLP may be considered for treating proximal humerus fractures in patients with an unstable medial column, varus deformity, and osteoporosis. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
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Sebag JA, Clements RC, Togher CJ, Connolly EC. The First Metatarsophalangeal Joint: Updates on Revision Arthrodesis and Malunions. Clin Podiatr Med Surg 2023; 40:569-580. [PMID: 37716737 DOI: 10.1016/j.cpm.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
First metatarsophalangeal joint (MPJ) arthrodesis procedures are a mainstay of forefoot surgery and are associated with high rates of patient satisfaction for addressing a multitude of first ray pathologic conditions. This procedure is often also used as a fallback option for the revision of poor outcomes after other surgical procedures involving the first ray. Despite its successes, there remain instances of complications that can develop after primary first MPJ arthrodesis. This article reviews first MPJ arthrodesis as a procedure for revisional surgery of the first ray, and potential surgical options after failed primary first MPJ arthrodesis.
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Affiliation(s)
- Joshua A Sebag
- Coastal Orthopaedic & Sports Medicine Center, 5158 Southwest Anhinga Avenue, Palm City, FL 34990, USA.
| | | | - Cody J Togher
- Joint Replacement Institute, 3466 Pine Ridge RD, Suite A, Naples, FL 34109, USA
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Kämmerer PW, Al-Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontol 2000 2023; 93:340-357. [PMID: 37650475 DOI: 10.1111/prd.12499] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 09/01/2023]
Abstract
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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83
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Fourman MS, Vaynrub M. Identifying the ideal trajectory for prone trephine iliac crest bone graft harvesting. Spine J 2023; 23:1571-1573. [PMID: 37402430 PMCID: PMC10538411 DOI: 10.1016/j.spinee.2023.06.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/29/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Mitchell S Fourman
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-1011, New York, NY, 10065, USA
| | - Max Vaynrub
- Orthopaedic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, H-1011, New York, NY, 10065, USA.
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84
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LiuFu JF, Lv XM, Yang ZY, Kang YF, Xie S, Shan XF, Cai ZG. The effect of anterior superior iliac spine preservation on donor site morbidity and function after harvesting a vascularized iliac bone flap. Head Neck 2023; 45:2544-2554. [PMID: 37530710 DOI: 10.1002/hed.27478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of anterior superior iliac spine (ASIS) preservation on donor site morbidity and function after harvesting a vascularized iliac bone flap (VIBF). METHODS Patients who underwent jaws reconstruction with VIBF were divided into a maintaining the anterior superior iliac spine (MASIS) group and a not maintaining the anterior superior iliac spine (NMASIS) group. Pain, tenderness, sensory deficit, gait disturbance, and function of the donor site were evaluated before and after the operation. RESULTS Thirty-three patients were included in this study, of which 18 were in the MASIS group. The incidence of sensory deficit in the MASIS group was significantly lower than that in the NMASIS group (50.0% vs. 86.7%, p = 0.010). Pain, tenderness, gait disturbance, and function did not differ statistically between the two groups. CONCLUSION Except for sensory deficit, ASIS preservation has minimal impact on donor site morbidity and function.
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Affiliation(s)
- Jian-Feng LiuFu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Xiao-Ming Lv
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Zong-Yan Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Yi-Fan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Xiao-Feng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterial and Digital Medical Devices, Beijing, China
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85
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Foruria AM. Plate Fixation of Proximal Humerus Fractures: How to Get It Right and Future Directions for Improvement. Curr Rev Musculoskelet Med 2023; 16:457-469. [PMID: 37572239 PMCID: PMC10497484 DOI: 10.1007/s12178-023-09853-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE OF REVIEW Open reduction and internal fixation with locking plates (ORIF-LP) has been used for decades for the surgical management of proximal humerus fractures. Despite good outcomes have been widely published in the literature, unacceptably high rates of complications (up to 40%), many of them yielding poor outcomes and requiring reoperation (up to 25%), have also been reported, especially in elderly patients. Most common complications are related to implant failure, with intra-articular screw penetration as the most frequent and devastating. RECENT FINDINGS Advances in patient selection and surgical technique, and implementation of bone or cement augmentation, have been developed to hopefully decrease complication rates. Mayo-FJD Classification offers prognostic information that can aid in the decision-making process for proximal humeral fractures. Displaced valgus impacted fractures seem to be associated with well over a 10% rate of avascular necrosis after ORIF-LP. A principle-based and stepwise surgical technique combining anatomic reduction and a short screw configuration can provide good outcome in most patients, even the elderly, decreasing implant failures to less than 10%. Acrylic cement augmentation has the potential to further decrease implant failure rate to 1%. Reoperation rates are higher partly due to the need to remove hardware for painful subacromial conflict. However, no studies to date definitively demonstrated the superiority of ORIF-LP compared to non-operative treatment, intramedullary nailing, or reverse shoulder arthroplasty. ORIF-LP can provide good results for the surgical management of displaced proximal humerus fractures even in elderly patients provided adequate patient selection and a principle based and stepwise surgical technique, supplemented with bone graft or acrylic cement when needed. Poor outcomes and high complication and reoperation rates should be expected when these recommendations are not followed.
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Affiliation(s)
- Antonio M Foruria
- Shoulder and Elbow Reconstructive Surgery Unit, Orthopedic Surgery, Autónoma University, Fundación Jiménez Díaz University Hospital, Avenida Reyes Católicos 2, Madrid, Spain.
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86
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Donnelly H, Sprott MR, Poudel A, Campsie P, Childs P, Reid S, Salmerón-Sánchez M, Biggs M, Dalby MJ. Surface-Modified Piezoelectric Copolymer Poly(vinylidene fluoride-trifluoroethylene) Supporting Physiological Extracellular Matrixes to Enhance Mesenchymal Stem Cell Adhesion for Nanoscale Mechanical Stimulation. ACS APPLIED MATERIALS & INTERFACES 2023; 15:50652-50662. [PMID: 37718477 PMCID: PMC10636716 DOI: 10.1021/acsami.3c05128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
There is an unmet clinical need to provide viable bone grafts for clinical use. Autologous bone, one of the most commonly transplanted tissues, is often used but is associated with donor site morbidity. Tissue engineering strategies to differentiate an autologous cell source, such as mesenchymal stromal cells (MSCs), into a potential bone-graft material could help to fulfill clinical demand. However, osteogenesis of MSCs can typically require long culture periods that are impractical in a clinical setting and can lead to significant cost. Investigation into strategies that optimize cell production is essential. Here, we use the piezoelectric copolymer poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE), functionalized with a poly(ethyl acrylate) (PEA) coating that drives fibronectin network formation, to enhance MSC adhesion and to present growth factors in the solid phase. Dynamic electrical cues are then incorporated, via a nanovibrational bioreactor, and the MSC response to electromechanical stimulation is investigated.
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Affiliation(s)
- Hannah Donnelly
- Centre
for the Cellular Microenvironment, University
of Glasgow, Glasgow G12 8QQ, United
Kingdom
| | - Mark R. Sprott
- Centre
for the Cellular Microenvironment, University
of Glasgow, Glasgow G12 8QQ, United
Kingdom
| | - Anup Poudel
- Centre
for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway H91W2TY, Ireland
| | - Paul Campsie
- SUPA
Department of Biomedical Engineering, University
of Strathclyde, Glasgow G1 1QE, United Kingdom
| | - Peter Childs
- SUPA
Department of Biomedical Engineering, University
of Strathclyde, Glasgow G1 1QE, United Kingdom
| | - Stuart Reid
- SUPA
Department of Biomedical Engineering, University
of Strathclyde, Glasgow G1 1QE, United Kingdom
| | - Manuel Salmerón-Sánchez
- Centre
for the Cellular Microenvironment, University
of Glasgow, Glasgow G12 8QQ, United
Kingdom
| | - Manus Biggs
- Centre
for Research in Medical Devices (CÚRAM), National University of Ireland Galway, Galway H91W2TY, Ireland
| | - Matthew J. Dalby
- Centre
for the Cellular Microenvironment, University
of Glasgow, Glasgow G12 8QQ, United
Kingdom
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87
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Otagiri T, Shiga Y, Hozumi T, Matsuura Y, Tajiri I, Takayama N, Alejandra M, Shiko Y, Orita S, Inage K, Eguchi Y, Suzuki T, Suzuki-Narita M, Mukai M, Mukaihata T, Tsuchiya R, Tokeshi S, Okuyama K, Arai T, Toshi N, Furuya T, Maki S, Aoki Y, Ohtori S. Combined effect of DBM, PRP, and bone marrow fluid on bone union in a rat posterolateral fusion model. Sci Rep 2023; 13:15041. [PMID: 37699916 PMCID: PMC10497499 DOI: 10.1038/s41598-023-41844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
Platelet-rich plasma (PRP) promotes bone union through osteoinduction. We investigated whether adding demineralized bone matrix (DBM), derived naturally from biomaterial and with various growth factors, for osteoconductivity and bone marrow fluid for osteogenesis results in different bone unions. Eight-week-old male Sprague-Dawley rats were divided into four groups of five based on transplantation material: sham control (C group); DBM alone (D group); DBM + PRP (DP group); and DBM + PRP + bone marrow fluid (DPB group). After posterolateral fusion at L3-5, postoperative weekly CT imaging determined average number of bone union in facet joints (4 joints × 5 animals = 20 joints) and bone formation. Pathological evaluation and bone strength were assessed using 3-point bending two weeks postoperatively. Facet joint bone union at four weeks postoperatively was 4/20 (20%, DP group) and 8/20 (40%, DPB group) joints. Six weeks postoperatively, it was 7/20 (35%, D group), 12/20 (60%, DP group), and 16/20 (80%, DPB group). Eight weeks postoperatively, it was 13/20 (65%, D group), 17/20 (85%, DP group), and 20/20 (100%, DPB group), suggesting that DPB > DP > D > C. Bone formation and bone strength showed a similar DPB > DP > D > C group trend. Adding PRP and bone marrow fluid to DBM promotes bone union and strength.
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Affiliation(s)
- Takuma Otagiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Takashi Hozumi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ikuko Tajiri
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Takayama
- Department of Regenerative Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Maria Alejandra
- Department of Regenerative Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Shiko
- Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyako Suzuki-Narita
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michiaki Mukai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohito Mukaihata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ryuto Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Soichiro Tokeshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kohei Okuyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takahito Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Noriyasu Toshi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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88
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Shen J, Wei Z, Wang S, Wang X, Lin W, Liu L, Wang G. Treatment of infected bone defects with the induced membrane technique. Bone Joint Res 2023; 12:546-558. [PMID: 37697974 PMCID: PMC10495849 DOI: 10.1302/2046-3758.129.bjr-2022-0439.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
Aims This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes. Methods A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data. Results After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The multivariate analysis with data from 296 patients suggested that older age was associated with higher nonunion risk. Patients with external fixation in the second stage had a significantly higher risk of developing nonunion, increasing the need for additional procedures. The autografts harvested from the femur reamer-irrigator-aspirator increased nonunion, infection recurrence, and additional procedure rates. Conclusion The induced membrane technique is an effective technique for treating infected bone defects. Internal fixation during the second stage might effectively promote bone healing and reduce additional procedures without increasing infection recurrence. Future studies should standardize individual patient data prospectively to facilitate research on the affected patient outcomes.
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Affiliation(s)
- Jie Shen
- Trauma Medical Centre, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhiyuan Wei
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shulin Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiaohua Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wei Lin
- Department of Gynecology, West China Women’s and Children’s Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Orthopaedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Guanglin Wang
- Trauma Medical Centre, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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89
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Berninger MT, Schüttrumpf JP, Barzen S, Domnick C, Eggeling L, Fehske K, Frosch KH, Herbst E, Hoffmann R, Izadpanah K, Kösters C, Neumann-Langen M, Raschke M, Zellner J, Krause M. S2k Guideline for Tibial Plateau Fractures - Classification, Diagnosis, and Treatment. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37673084 DOI: 10.1055/a-2121-6538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Tibial plateau fractures are mostly complex and surgically demanding joint fractures, which require a comprehensive understanding of the fracture morphology, ligamentous and neurovascular injuries, as well as the diagnostic and therapeutic options for an optimal clinical outcome. Therefore, a standardised and structured approach is required. The success of the treatment of tibial plateau fractures relies on the interdisciplinary cooperation between surgical and conservative physicians in an outpatient and inpatient setting, physical therapists, patients and service providers (health insurance companies, statutory accident insurance, pension providers). On behalf of the German Society for Orthopaedics and Trauma Surgery (DGOU), the German Trauma Society (DGU) and the Society for Arthroscopy and Joint Surgery (AGA), under the leadership of the Fracture Committee of the German Knee Society (DKG), a guideline for tibial plateau fractures was created, which was developed in several voting rounds as part of a Delphi process. Based on the current literature, this guideline is intended to make clear recommendations and outline the most important treatment steps in diagnostics, therapy and follow-up treatment. Additionally, 25 statements were revised by the authors in several survey rounds using the Likert scale in order to reach a final consensus.
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Affiliation(s)
- Markus Thomas Berninger
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | | | - Stefan Barzen
- Unfallchirurgie und operative Orthopädie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Christoph Domnick
- Klinik für Unfall- und Handchirurgie, Orthopädie, Euregio Klinik, Nordhorn, Deutschland
| | - Lena Eggeling
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
| | - Kai Fehske
- Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Karl-Heinz Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
| | - Elmar Herbst
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Munster, Deutschland
| | - Reinhard Hoffmann
- Unfallchirurgie und operative Orthopädie, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Kaywan Izadpanah
- Department für Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Clemens Kösters
- Klinik für Orthopädie, Unfall- und Handchirurgie, Maria-Josef-Hospital Greven, Greven, Deutschland
| | - Mirjam Neumann-Langen
- Klinik für Unfallchirurgie, Handchirurgie und Orthopädie, Klinikum Konstanz, Konstanz, Deutschland
| | - Michael Raschke
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Munster, Deutschland
| | - Johannes Zellner
- Orthopädie und Sportmedizin, Sporthopaedicum Regensburg, Regensburg, Deutschland
| | - Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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90
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Haykal S, Hadzimustafic N, Ghazarian D, Musgrave M. Three Ds for diagnosing necrotizing fasciitis by front-line clinicians. J Plast Reconstr Aesthet Surg 2023; 84:37-46. [PMID: 37320950 DOI: 10.1016/j.bjps.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 04/01/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a life-threatening infection and a surgical emergency. Not all clinicians have the experience or resources to detect NF in its early stages. OBJECTIVE To develop a diagnostic algorithm for primary care and emergency physicians to identify patients with possible NF, including an initial approach to triaging such individuals. METHODS Medline was searched to identify studies of validated algorithms for NF diagnosis and/or cohort or case series providing clinical and diagnostic features of NF. Candidate algorithms were validated via application to 3 published cases of initially misdiagnosed NF. We retrospectively reviewed NF cases between 2011 and 2022 at our center to validate our algorithm. RESULTS The search yielded 540 articles; 109 were included following a review of abstracts. No published validated diagnostic algorithm was identified. Using the reported clinical and diagnostic features of NF, we generated an algorithm of the "3Ds" of NF: Disproportionate pain, Dermatological findings, and Disorganized physiology. A larger number of Ds indicated a greater level of suspicion for NF and prioritization for urgent surgical consultation. In 3 published cases of missed NF, the 3Ds algorithm successfully identified all as having possible NF. On reviewing our cases, we identified 56 patients with NF during an 11 year period. 66% of whom had the 3Ds at their initial presentation. DISCUSSION The 3Ds algorithm, a simple and easy-to-remember tool can be easily applied in a primary or emergency care setting, and may improve the early diagnosis of NF. Retrospective analysis of NF cases allows for validation of this algorithm. However, this algorithm requires prospective validation.
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Affiliation(s)
- Siba Haykal
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto General Hospital, Department of Surgery, University of Toronto, Canada.
| | | | - Danny Ghazarian
- Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto, Canada
| | - Melinda Musgrave
- Division of Plastic and Reconstructive Surgery, St. Michael's Hospital, Department of Surgery, University of Toronto, Canada
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91
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Furuhata R, Tanji A, Oki S, Kamata Y. Influence of Proximal Humeral Cortical Bone Thickness on the Radiographic Outcome After Osteosynthesis of Proximal Humeral Fractures: Propensity Matching Score Analysis. Geriatr Orthop Surg Rehabil 2023; 14:21514593231198645. [PMID: 37645438 PMCID: PMC10460996 DOI: 10.1177/21514593231198645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Osteoporosis can affect the surgical outcomes of proximal humeral fractures in older people. Recently, the cortical bone thickness of the proximal humerus on plain radiograph has been proposed to reflect local osteoporosis of the proximal humerus; however, its effect on the surgical outcome of proximal humeral fractures remains unclear. The purpose of this study is to investigate the influence of cortical bone thickness on postoperative radiographic outcomes after osteosynthesis for proximal humeral fractures. Materials and Methods We retrospectively identified 190 patients (≥50 years) who underwent osteosynthesis with an intramedullary nail or plate for proximal humeral fractures. The patients were categorized into 2 groups according to the cut-off value of an average proximal humerus cortical bone thickness of 6 mm on plain radiographs: patients with and without local osteoporosis. After propensity score matching, we compared the incidence of postoperative radiographic complications between the 2 groups. We also performed subgroup analyses of outcomes in a subgroup of patients who underwent intramedullary nailing and those who underwent plate fixation. Results Propensity score matching yielded 60 patients in each group. No significant difference in complication rates was observed between the 2 groups. However, in the intramedullary nailing subgroup, the incidence of reduction loss was significantly higher in patients with local osteoporosis than in those without local osteoporosis (51.7% vs 14.3%, P = .002). Discussion The proximal humeral cortical bone thickness had no significant effect on the overall radiographic outcome; however, reduction loss after intramedullary nailing was susceptible to local osteoporosis of the proximal humerus. Conclusion Our study suggests that plate fixation is advantageous in preventing postoperative reduction loss in patients with lower cortical bone thickness.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery,Ashikaga Red Cross Hospital, Ashikaga-shi, Japan
| | - Atsushi Tanji
- Department of Orthopaedic Surgery,Ashikaga Red Cross Hospital, Ashikaga-shi, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Japan
| | - Yusaku Kamata
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Japan
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92
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El-Sharkasy MH, El-Singergy AA, Mansour AMR, Badawy MA, Khedr A. Union in Lateral Column Lengthening by Plate Fixation Without Bone Graft in Flexible Flatfoot: A Case Series. Indian J Orthop 2023; 57:1283-1289. [PMID: 37525734 PMCID: PMC10387035 DOI: 10.1007/s43465-023-00945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/22/2023] [Indexed: 08/02/2023]
Abstract
Purpose This study's goal was to evaluate the outcomes of lateral column lengthening by plate fixation without bone graft in the management of symptomatic flexible flatfoot. Methods A prospective randomized trial study included 30 feet (27 patients) and was performed from March 2017 to December 2019. Functional and radiological evaluations were done pre-operative and at the final post-operative follow-up. The functional assessment was done using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results The mean follow-up was 16.5 ± 3.027 months. The mean age of patients was 22.6 ± 6.29 years. All cases showed union ranging from 8 to 12 weeks, with a mean of 10 ± 1.88 weeks. The mean AOFAS score improved from 51.6 ± 6.75 to 92.2 ± 6.21. The mean anteroposterior (AP) talo-first metatarsal angle improved from 25.3° ± 8.31° to 3.4° ± 5.10°. The mean anteroposterior (AP) talo-navicular coverage improved from 22.10° ± 4.28° to 2.3° ± 3.46°. The mean Lateral talo-first metatarsal angle improved from 18.6° ± 4.79° to 3.3° ± 3.16°. The calcaneal pitch angle improved from 9.6° ± 4.14° to 15.1° ± 4.43°. The mean lateral talo-calcaneal angle improved from 45.7° ± 3.77° to 37.5° ± 3.47°. Conclusion Using an interposition wedge plate for LCL without bone graft leads to a high union rate, maintains the correction, and avoids possible complications of autografts and allografts.
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Affiliation(s)
- Mohamed Hegazy El-Sharkasy
- Orthopedic Surgery Department, Shoubra General Hospital, Cairo, Egypt
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ali M. Reda Mansour
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
| | | | - Ahmed Khedr
- Orthopedic Surgery Department, Kasr Alainy Hospital, Cairo University, Cairo, Egypt
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93
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Xu K, Yu S, Wang Z, Zhang Z, Zhang Z. Bibliometric and visualized analysis of 3D printing bioink in bone tissue engineering. Front Bioeng Biotechnol 2023; 11:1232427. [PMID: 37545887 PMCID: PMC10400721 DOI: 10.3389/fbioe.2023.1232427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Background: Applying 3D printed bioink to bone tissue engineering is an emerging technology for restoring bone tissue defects. This study aims to evaluate the application of 3D printing bioink in bone tissue engineering from 2010 to 2022 through bibliometric analysis, and to predict the hotspots and developing trends in this field. Methods: We retrieved publications from Web of Science from 2010 to 2022 on 8 January 2023. We examined the retrieved data using the bibliometrix package in R software, and VOSviewer and CiteSpace were used for visualizing the trends and hotspots of research on 3D printing bioink in bone tissue engineering. Results: We identified 682 articles and review articles in this field from 2010 to 2022. The journal Biomaterials ranked first in the number of articles published in this field. In 2016, an article published by Hölzl, K in the Biofabrication journal ranked first in number of citations. China ranked first in number of articles published and in single country publications (SCP), while America surpassed China to rank first in multiple country publications (MCP). In addition, a collaboration network analysis showed tight collaborations among China, America, South Korea, Netherlands, and other countries, with the top 10 major research affiliations mostly from these countries. The top 10 high-frequency words in this field are consistent with the field's research hotspots. The evolution trend of the discipline indicates that most citations come from Physics/Materials/Chemistry journals. Factorial analysis plays an intuitive role in determining research hotspots in this sphere. Keyword burst detection shows that chitosan and endothelial cells are emerging research hotspots in this field. Conclusion: This bibliometric study maps out a fundamental knowledge structure including countries, affiliations, authors, journals and keywords in this field of research from 2010 to 2022. This study fills a gap in the field of bibliometrics and provides a comprehensive perspective with broad prospects for this burgeoning research area.
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Affiliation(s)
- Kaihao Xu
- The VIP Department, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Sanyang Yu
- The VIP Department, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Zhenhua Wang
- Department of Physiology, School of Life Sciences, China Medical University, Shenyang, China
| | - Zhichang Zhang
- Department of Computer, School of Intelligent Medicine, China Medical University, Shenyang, China
| | - Zhongti Zhang
- The VIP Department, School and Hospital of Stomatology, China Medical University, Shenyang, China
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Mostert CQB, Timmer RA, Krijnen P, Meylearts SAG, Schipper IB. Rates and risk factors of complications associated with operative treatment of pelvic fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1973-1980. [PMID: 36059040 PMCID: PMC10276111 DOI: 10.1007/s00590-022-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Post-operative complications following fixation of pelvic fractures can lead to mortality and increased morbidity. Available literature regarding complications is heterogeneous and knowledge on risk factors is limited. This study aims to identify the most common post-operative complications and their possible risk factors following pelvic fracture surgery. METHODS A retrospective cohort study was performed in two level-1 trauma centers in the Netherlands between January 2015 and January 2021. Included patients were all adult patients (≥ 18 years) with an operatively treated pelvic fracture (pelvic ring and/or acetabular fractures). Post-operative complications included surgical site infections (SSI), material-related complications, neurological complications, malunion/non-union and performed reoperations. A forward stepwise multivariable logistic regression analysis was used to identify any risk factors associated with these complications. RESULTS Complications occurred in 55 (24%) of the 233 included patients. SSI's were most common, occurring in 34 (15%) patients. Duration of surgery (odds ratio 1.01 per minute, 95% confidence interval 1.00-1.01) and obesity (odds ratio 1.10 per BMI point, 95% confidence interval 1.29-7.52) were independent risk factors for development of SSI. Less common post-operative complications were material-related complications (8%) and neurological damage (5%). CONCLUSION Limiting operation time by using less invasive and less time-consuming surgical approaches may reduce the risk of SSI. More awareness and post-operative screening for early signs of SSI is mandatory, especially in obese patients. Future research should include large prospective patient cohorts to determine risk factors for other post-operative complications associated with pelvic fracture surgery.
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Affiliation(s)
- C Q B Mostert
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - R A Timmer
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - S A G Meylearts
- Department of Trauma Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Guo Q, Wu Y, Zhang M, Chen F, Wang H, Wu J, Lu X, Ni B. Sagittal Reconstruction of the Atlantoaxial Lateral Mass Complex with an Intra-Articular Cage Fusion Technique for Degenerative Atlantoaxial Instability. World Neurosurg 2023; 175:e129-e133. [PMID: 36921711 DOI: 10.1016/j.wneu.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To evaluate outcomes of sagittal reconstruction of the atlantoaxial lateral mass complex using a modified intra-articular cage fusion technique for treating degenerative atlantoaxial instability. METHODS Data from 15 patients with degenerative atlantoaxial instability were retrospectively reviewed. All patients underwent posterior reduction and intra-articular fusion with a cage filled with local autologous bone. Atlantodental interval values on plain radiography in flexion before and after surgery were recorded. Bone fusion was evaluated on computed tomography reconstruction, and bone fusion time was recorded. Lateral atlantoaxial joint space height before and after surgery was measured on coronal computed tomography reconstruction. Japanese Orthopaedic Association score and visual analog scale score for neck pain before surgery and at final follow-up were compared. RESULTS Mean follow-up time was 40.7 ± 13.4 months. All patients achieved good reduction and solid bone fusion at follow-up. Mean fusion time was 4.4 ± 1.1 months. Atlantodental interval decreased from 8.6 ± 1.5 mm preoperatively to 1.9 ± 0.5 mm at final follow-up (P < 0.05). Lateral atlantoaxial joint space height significantly improved from 1.7 ± 0.5 mm preoperatively to 4.7 ± 0.3 mm at final follow-up (P < 0.05). Japanese Orthopaedic Association score significantly improved from 14.9 ± 1.5 preoperatively to 16.7 ± 0.6 at final follow-up (P < 0.05). Visual analog scale score for neck pain markedly decreased from 4.5 ± 1.8 preoperatively to 0.5 ± 0.6 at final follow-up (P < 0.05). CONCLUSIONS Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique is effective in treatment of degenerative atlantoaxial instability. Satisfactory reconstruction of the sagittal alignment and the height of atlantoaxial complex can be achieved.
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Affiliation(s)
- Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Yaming Wu
- Department of Orthopedics, Kunshan First People's Hospital, Jiangsu University, Kunshan, China
| | - Mei Zhang
- Department of Traditional Chinese Medicine Rehabilitation, Jing'an Zhabei Central Hospital, Shanghai, China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xuhua Lu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
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96
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Jhamnani R, Dhanda MS, Surana A. Study of Functional Outcome and Postoperative Complications Among Proximal Humerus Fracture Patients Treated With Proximal Humerus Internal Locking System (PHILOS) Plating. Cureus 2023; 15:e42411. [PMID: 37637540 PMCID: PMC10447996 DOI: 10.7759/cureus.42411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Proximal humerus fractures comprise nearly 4%-5% of all fracture types and nearly 25% of fracture humerus. These fractures are commonly seen in the elderly population (people aged 60 years or more). The best way to treat elderly people who have three- or four-part fractures of the proximal humerus is debatable, with many in favour of prosthetic humeral head replacements. This study aimed to assess the functional outcome of proximal humerus fractures managed with a proximal humerus locking plate and to investigate the incidence of complications in these patients. Methodology This retrospective study included 32 cases of proximal humerus fractures managed surgically at a tertiary care teaching hospital in Rajasthan between July 2016 to July 2022 with a proximal humerus internal locking system (PHILOS) plate. NEER scoring system was used to categorise the fractures. Functional assessment was done using Constant Murley's shoulder score. Constant Murley shoulder score was graded as failure (0-69 points), unsatisfactory (70-79), satisfactory (80-89), and excellent (90-100). Subjects having metastatic and pathological fractures; associated fractures in the ipsilateral limb; having major nerve injury and cases of open fracture were excluded from this study. Results The mean age was 54.5±6.4 years. Of the total 32 cases of proximal humerus fractures, 12 cases of two-part fractures received an excellent grade, compared to seven cases of three-part fractures. Three two-part fracture cases and two three-part fracture cases all received satisfactory grades. Excellent results (score > 89) were noticed in 62.5% (n = 20) of the instances, satisfactory results (scoring 80-89) in 21.87% (n=7), poor results (score 70-79) in 9.38% (n=3), and failure results (score 70) in 6.25% (n=2). In 65.6% of cases, follow-up showed no complications. Shoulder stiffness and malunion (9.38%) were the most frequent consequences, followed by avascular necrosis (6.25%). Conclusions Based on the findings of this retrospective study, it can be opined that PHILOS plaiting appears to be a secure option for proximal humerus fracture cases. It offers solid fixation, prompt mobilisation, and excellent functional outcomes as observed in this study. Additionally, very few post-operative complication rates again support our conclusion.
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Affiliation(s)
- Rohit Jhamnani
- Orthopaedics, Pacific Medical College and Hospital, Udaipur, IND
| | - Manjeet Singh Dhanda
- Orthopaedics, Shaheed Hassan Khan Mewati (SHKM) Government Medical College, Nuh, IND
| | - Avinash Surana
- Preventive Medicine, Infantry Division, 14 Coprs, Bareilly, IND
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97
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Maccarone MC, Coraci D, Bernini A, Sarandria N, Valente MR, Frigo AC, Dionyssiotis Y, Masiero S. Sarcopenia prevalence and association with nutritional status in cohort of elderly patients affected by musculoskeletal concerns: a real-life analysis. Front Endocrinol (Lausanne) 2023; 14:1194676. [PMID: 37435492 PMCID: PMC10331423 DOI: 10.3389/fendo.2023.1194676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction The progressive loss of skeletal muscle mass, strength, and function that frequently occurs as people get older is referred to as sarcopenia. Elderly musculoskeletal aging, sarcopenia, and obesity are all intimately connected. Our study's aim is to investigate the prevalence of sarcopenia in a real cohort of patients over 65 with musculoskeletal conditions referring to a Rehabilitation Unit. The secondary aim of our study is to investigate associations between sarcopenia and alterations in nutritional status and Body Mass Index (BMI). Finally, quality of life and global health has been investigated in our population. Materials and methods From January 2019 to January 2021, 247 patients over 65 years old with musculoskeletal concerns were enrolled and participated in an observational study. As outcome measures, the Mini Nutritional Assessment (MNA), the 12-Item Short Form Health Survey (SF-12), and the Cumulative Illness Rating Scale Severity Index (CIRS-SI) were used. Additionally, measurements of total skeletal muscle mass (SMM) and appendicular muscle mass (ASMM) using bioelectrical impedance analysis, as well as a hand grip strength test of the non-dominant hand were taken. The Mid Upper Arm Circumference (MUAC) and the Calf Circumference (CC) were measured and recorded as further indications of possible sarcopenia. Results A percentage of 46.1% of subjects with overt sarcopenia was found and 10.1% showed a severe sarcopenia. Patients with severe sarcopenia showed significantly lower values of BMI and MNA. Additionally, sarcopenic patients showed significantly lower values in MNA when compared to non-sarcopenic patients. Considering SF-12, only the physical score revealed slight significant differences. In particular, patients affected by probable or severe sarcopenia presented a lower value than non-sarcopenic patients. Concerning MUAC and CC, severe sarcopenic patients showed significant lower values for both the body parts. Conclusion Our study considers a cohort of real-life elderly subjects with musculoskeletal concerns and shows that these subjects are highly susceptible to sarcopenia. Therefore, rehabilitation for elderly patients with musculoskeletal concerns requires to be customized and multidisciplinary. Future research should further investigate these aspects in order to enable the early identification of sarcopenia and the formulation of customized rehabilitative programs. .
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Affiliation(s)
- Maria Chiara Maccarone
- Physical Medicine and Rehabilitation School, Department of Neuroscience, University of Padova, Padua, Italy
| | - Daniele Coraci
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Padua, Italy
| | - Andrea Bernini
- Physical Medicine and Rehabilitation School, Department of Neuroscience, University of Padova, Padua, Italy
| | - Nicola Sarandria
- Physical Medicine and Rehabilitation School, Department of Neuroscience, University of Padova, Padua, Italy
| | - Marta Rossella Valente
- Physical Medicine and Rehabilitation School, Department of Neuroscience, University of Padova, Padua, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy
| | - Yannis Dionyssiotis
- Spinal Cord Injury Rehabilitation Clinic, University of Patras, Patras, Greece
| | - Stefano Masiero
- Physical Medicine and Rehabilitation School, Department of Neuroscience, University of Padova, Padua, Italy
- Department of Neuroscience, Rehabilitation Unit, University of Padova, Padua, Italy
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98
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Chinnasami H, Dey MK, Devireddy R. Three-Dimensional Scaffolds for Bone Tissue Engineering. Bioengineering (Basel) 2023; 10:759. [PMID: 37508786 PMCID: PMC10376773 DOI: 10.3390/bioengineering10070759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Immobilization using external or internal splints is a standard and effective procedure to treat minor skeletal fractures. In the case of major skeletal defects caused by extreme trauma, infectious diseases or tumors, the surgical implantation of a bone graft from external sources is required for a complete cure. Practical disadvantages, such as the risk of immune rejection and infection at the implant site, are high in xenografts and allografts. Currently, an autograft from the iliac crest of a patient is considered the "gold standard" method for treating large-scale skeletal defects. However, this method is not an ideal solution due to its limited availability and significant reports of morbidity in the harvest site (30%) as well as the implanted site (5-35%). Tissue-engineered bone grafts aim to create a mechanically strong, biologically viable and degradable bone graft by combining a three-dimensional porous scaffold with osteoblast or progenitor cells. The materials used for such tissue-engineered bone grafts can be broadly divided into ceramic materials (calcium phosphates) and biocompatible/bioactive synthetic polymers. This review summarizes the types of materials used to make scaffolds for cryo-preservable tissue-engineered bone grafts as well as the distinct methods adopted to create the scaffolds, including traditional scaffold fabrication methods (solvent-casting, gas-foaming, electrospinning, thermally induced phase separation) and more recent fabrication methods (fused deposition molding, stereolithography, selective laser sintering, Inkjet 3D printing, laser-assisted bioprinting and 3D bioprinting). This is followed by a short summation of the current osteochondrogenic models along with the required scaffold mechanical properties for in vivo applications. We then present a few results of the effects of freezing and thawing on the structural and mechanical integrity of PLLA scaffolds prepared by the thermally induced phase separation method and conclude this review article by summarizing the current regulatory requirements for tissue-engineered products.
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Affiliation(s)
- Harish Chinnasami
- Department of Mechanical Engineering, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Mohan Kumar Dey
- Department of Mechanical Engineering, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Ram Devireddy
- Department of Mechanical Engineering, Louisiana State University, Baton Rouge, LA 70803, USA
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99
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Zhang JA, Lam P, Beretov J, Murrell GAC. Acromion and Distal Clavicle Grafts for Arthroscopic Glenoid Reconstruction. J Clin Med 2023; 12:4035. [PMID: 37373728 DOI: 10.3390/jcm12124035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/28/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND We intended to determine if an acromion or distal clavicle bone graft could restore large glenoid defects using two novel, screw-free graft fixation techniques. METHODS Twenty-four sawbone shoulder models were divided into four groups (n = 6 per group) according to fixation technique and bone graft: (1) modified buckle-down technique with clavicle graft, (2) modified buckle-down technique with acromion graft, (3) cross-link technique with acromion graft, (4) cross-link technique with clavicle graft. Testing was performed sequentially in (1) intact models, (2) after creation of a 30% by-width glenoid defect and (3) after repair. The shoulder joint was translated anteriorly, and glenohumeral contact pressures and load were measured to quantify the biomechanical stability. RESULTS Maximum contact pressures were restored to 42-56% of intact glenoid using acromion and clavicle grafts with novel fixation techniques. Acromion grafts attained higher maximum contact pressures than clavicle grafts in all groups. Peak translational forces increased by 171-368% after all repairs. CONCLUSIONS This controlled laboratory study on sawbone models found that both the acromion and distal clavicle are suitable autologous bone graft options for treating large anterior glenoid defects, having appropriate dimensions and contours for reconstructing the glenoid arc. The modified buckle-down and cross-link techniques are two graft fixation techniques that restore stability to the shoulder joint upon repairing a large glenoid defect and are advantageous in being screw-free and simple to execute.
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Affiliation(s)
- Jeffrey A Zhang
- UNSW Faculty of Medicine, Kensington, Sydney, NSW 2033, Australia
| | - Patrick Lam
- Orthopedic Research Institute, St. George Hospital, Kogarah, Sydney, NSW 2217, Australia
| | - Julia Beretov
- Orthopedic Research Institute, St. George Hospital, Kogarah, Sydney, NSW 2217, Australia
| | - George A C Murrell
- Orthopedic Research Institute, St. George Hospital, Kogarah, Sydney, NSW 2217, Australia
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100
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Ferrie L, Premnath P, Olsen A, Larijani L, Besler BA, Rancourt DE, Duncan NA, Underhill TM, Krawetz RJ. Exogenously delivered iPSCs disrupt the natural repair response of endogenous MPCs after bone injury. Sci Rep 2023; 13:9378. [PMID: 37296277 PMCID: PMC10256810 DOI: 10.1038/s41598-023-36609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 06/07/2023] [Indexed: 06/12/2023] Open
Abstract
Promoting bone healing including fracture non-unions are promising targets for bone tissue engineering due to the limited success of current clinical treatment methods. There has been significant research on the use of stem cells with and without biomaterial scaffolds to treat bone fractures due to their promising regenerative capabilities. However, the relative roles of exogenous vs. endogenous stem cells and their overall contribution to in vivo fracture repair is not well understood. The purpose of this study was to determine the interaction between exogenous and endogenous stem cells during bone healing. This study was conducted using a standardized burr-hole bone injury model in a mesenchymal progenitor cell (MPC) lineage-tracing mouse under normal homeostatic and osteoporotic conditions. Burr-hole injuries were treated with a collagen-I biomaterial loaded with and without labelled induced pluripotent stem cells (iPSCs). Using lineage-tracing, the roles of exogenous and endogenous stem cells during bone healing were examined. It was observed that treatment with iPSCs resulted in muted healing compared to untreated controls in intact mice post-injury. When the cell populations were examined histologically, iPSC-treated burr-hole defects presented with a dramatic reduction in endogenous MPCs and cell proliferation throughout the injury site. However, when the ovaries were removed and an osteoporotic-like phenotype induced in the mice, iPSCs treatment resulted in increased bone formation relative to untreated controls. In the absence of iPSCs, endogenous MPCs demonstrated robust proliferative and osteogenic capacity to undertake repair and this behaviour was disrupted in the presence of iPSCs which instead took on an osteoblast fate but with little proliferation. This study clearly demonstrates that exogenously delivered cell populations can impact the normal function of endogenous stem/progenitor populations during the normal healing cascade. These interactions need to be better understood to inform cell and biomaterial therapies to treat fractures.
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Affiliation(s)
- Leah Ferrie
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Priyatha Premnath
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- College of Engineering and Applied Science, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Alexandra Olsen
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Leila Larijani
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bryce A Besler
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
| | - Derrick E Rancourt
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Neil A Duncan
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada
- Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - T Michael Underhill
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Roman J Krawetz
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- Biomedical Engineering Graduate Program, University of Calgary, Calgary, AB, Canada.
- Department of Cell Biology and Anatomy, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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