1
|
Kaliya-Perumal AK, Celik C, Carney TJ, Harris MP, Ingham PW. Genetic regulation of injury-induced heterotopic ossification in adult zebrafish. Dis Model Mech 2024; 17:dmm050724. [PMID: 38736327 DOI: 10.1242/dmm.050724] [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: 01/31/2024] [Accepted: 04/05/2024] [Indexed: 05/14/2024] Open
Abstract
Heterotopic ossification is the inappropriate formation of bone in soft tissues of the body. It can manifest spontaneously in rare genetic conditions or as a response to injury, known as acquired heterotopic ossification. There are several experimental models for studying acquired heterotopic ossification from different sources of damage. However, their tenuous mechanistic relevance to the human condition, invasive and laborious nature and/or lack of amenability to chemical and genetic screens, limit their utility. To address these limitations, we developed a simple zebrafish injury model that manifests heterotopic ossification with high penetrance in response to clinically emulating injuries, as observed in human myositis ossificans traumatica. Using this model, we defined the transcriptional response to trauma, identifying differentially regulated genes. Mutant analyses revealed that an increase in the activity of the potassium channel Kcnk5b potentiates injury response, whereas loss of function of the interleukin 11 receptor paralogue (Il11ra) resulted in a drastically reduced ossification response. Based on these findings, we postulate that enhanced ionic signalling, specifically through Kcnk5b, regulates the intensity of the skeletogenic injury response, which, in part, requires immune response regulated by Il11ra.
Collapse
Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
| | - Cenk Celik
- Department of Genetics, Evolution and Environment, Genetics Institute, University College London, London WC1E 6BT, UK
| | - Tom J Carney
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
- Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology and Research (A*STAR), 61 Biopolis Drive, Proteos 138673, Singapore
| | - Matthew P Harris
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
- Department of Orthopedic Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Philip W Ingham
- Lee Kong Chian School of Medicine, Nanyang Technological University, 59 Nanyang Drive 636921, Singapore
- Department of Life Sciences, University of Bath, Bath BA2 7AY, UK
| |
Collapse
|
2
|
Observational prospective unblinded case-control study to evaluate the effect of the Gamma3® distal targeting system for long nails on radiation exposure and time for distal screw placement. Injury 2023; 54:677-682. [PMID: 36517283 DOI: 10.1016/j.injury.2022.11.046] [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: 07/07/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine if the DTS decreases radiation exposure (primary outcome measure), fluoroscopy time (secondary outcome measure), and time to distal screw placement (secondary outcome measure) compared to the freehand "perfect circles" method when used for locking of cephalomedullary nails in the treatment of femur fractures METHODS: Fifty-eight patients with hip or femoral shaft fractures that were treated with a long cephalomedullary nail were enrolled in this study. Cohorts were determined based on the method of distal interlocking screw placement into either the "Perfect Circles" or "Distal Targeting" cohort. Time from cephalad screw placement to placement of final distal interlocking screw (seconds), radiation exposure (mGy), and fluoroscopy time (seconds) were compared between groups. Hospital quality measures were compared between cohorts. RESULTS Use of the DTS resulted in 77% (4.3x) lower radiation exposure (p < 0.001), 64% (2.7x) lower fluoroscopy time (p < 0.001), and 60% (1.7x) lower intraoperative time from end of cephalad screw placement to end of distal interlocking screw placement (p < 0.001) compared to the freehand "perfect circles" method. There was no difference in 30-day or 90-day complication rates between cohorts. CONCLUSION The Stryker Gamma3® Distal Targeting System is a safe, effective and efficient alternative to the freehand "perfect circles" method.
Collapse
|
3
|
Gani MH, Liang K, Muzafar K, Dev B, Bhat KA, Ghani A. Outcomes after primary intramedullary nail fixation of open tibial and femoral fractures in low resource settings. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03329-5. [PMID: 35829964 DOI: 10.1007/s00590-022-03329-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Open fractures are unique in the urgency they impart to the injury and the therapeutic challenge they pose. Non-union and infection are among the major concerns. Open tibial and femoral shaft fractures are among the commonest orthopaedic urgencies. Primary intramedullary (IM) nailing requires a skillset and knowledge of the principles of open fracture management and also a well-equipped operating room with the necessary implants and instruments. In a low resource setting, one or more of these prerequisites may not be met, and the outcome may thus be affected similarly. The objective of this study was to study these outcomes. METHODS We prospectively studied primary IM nailing of open 1, 2 and 3A tibial and femoral fractures done in our hospital, in a simple non-modular operating room without an image intensifier. RESULTS There were 106 fractures in 104 patients: 93 tibial and 13 femoral. The mean time from injury to surgical debridement was 19.6 h. Mean duration of antibiotics therapy was 4.3 days, and the mean duration of hospital stay was 4.1 days. All patients were followed up to union. Mean time to radiographic union was 6.1 months for the tibia and 5.7 months for the femur. Non-union was seen in 4 tibial and 1 femoral fractures. There were 3 superficial infections but no deep infection. CONCLUSION The outcomes were comparable to, and in some cases better than, those found in existing literature. We conclude that primary IM nailing in open long bone fractures can be performed in austere environments with good success, in expert hands if the principles are adhered to.
Collapse
Affiliation(s)
| | - Kaifeng Liang
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Khalid Muzafar
- Department of Orthopaedics, Government Medical College, Doda, Jammu & Kashmir, India
| | - Bias Dev
- Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu & Kashmir, India
| | | | - Abdul Ghani
- Department of Orthopaedics, Government Medical College Jammu, Jammu, Jammu & Kashmir, India
| |
Collapse
|
4
|
Extracorporeal measurement of femoral nail length in the treatment of trochanteric hip fractures: the "box" technique. OTA Int 2021; 4:e151. [PMID: 34765901 PMCID: PMC8575418 DOI: 10.1097/oi9.0000000000000151] [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: 11/27/2020] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Intramedullary nails, long and short, are widely used for fixation of trochanteric femur fractures. In theory, long nails may be able to protect the entire length of the femur from a future periprosthetic fracture, providing that the nail spans the length of the entire femoral canal. The described technique for long nail insertion calls for the use of an intramedullary guidewire and depth gauge for premeasurement of the length of the canal, as well as the use of a reamer. However, compared with short nails, this technique may add cost, operating time, and blood loss. We describe a safe technique for long nail measurement that reliably spans the length of the femur while potentially reducing surgical cost, time, and blood loss. We also describe 21 cases in which the technique was applied.
Collapse
|
5
|
Maleki M, Tehrani AF, Aray A, Ranjbar M. Intramedullary nail holes laser indicator, a non-invasive technique for interlocking of intramedullary nails. Sci Rep 2021; 11:21166. [PMID: 34707138 PMCID: PMC8551185 DOI: 10.1038/s41598-021-00382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/12/2021] [Indexed: 11/09/2022] Open
Abstract
Interlocking of intramedullary nails is a challenging procedure in orthopedic trauma surgery. Numerous methods have been described to facilitate this process. But they are exposed patient and surgical team to X-rays or involves trial and error. An accurate and non-invasive method has been provided to easily interlocking intramedullary nails. By transferring a safe visible light inside the nail, a drilling position appears which use to drilling bone toward the nail hole. The wavelength of this light was obtained from ex-vivo spectroscopy on biological tissues which has optimal transmission, reflectance, and absorption properties. Moreover, animal and human experiments were performed to evaluate performance of the proposed system. Ex-vivo performance experiments were performed successfully on two groups of cow and sheep samples. Output parameters were procedure time and drilling quality which there were significant differences between the two groups in procedure time (P < 0.05). But no significant differences were observed in drilling quality (P > 0.05). Moreover, an In-vivo performance experiment was performed successfully on a middle-aged man. To compare the provided method, targeting-arm, and free-hand techniques, two human experiments were performed on a middle-aged and a young man. The results indicate the advantage of the proposed technique in the procedure time (P < 0.05), while the drilling quality is equal to the free-hand technique (P = 0.05). Intramedullary nail holes laser indicator is a safe and accurate method that reduced surgical time and simplifies the process. This new technology makes it easier to interlocking the intramedullary nail which can have good clinical applications.
Collapse
Affiliation(s)
- Mohammadreza Maleki
- Department of Mechanical Engineering, Isfahan University of Technology, 84156-83111, Isfahan, Iran.
| | - Alireza Fadaei Tehrani
- Department of Mechanical Engineering, Isfahan University of Technology, 84156-83111, Isfahan, Iran
| | - Ayda Aray
- Department of Physics, Isfahan University of Technology, 84156-83111, Isfahan, Iran
| | - Mehdi Ranjbar
- Department of Physics, Isfahan University of Technology, 84156-83111, Isfahan, Iran
| |
Collapse
|
6
|
Focus on interlocking intramedullary nailing without fluoroscopy in resource-limited settings: strategies, outcomes, and outlook. INTERNATIONAL ORTHOPAEDICS 2021; 46:115-124. [PMID: 34491387 DOI: 10.1007/s00264-021-05208-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Closed static interlocking nailing with c-arm guidance is the standard procedure for the treatment of closed diaphyseal fractures. In low-income settings, it is still very difficult to carry out such procedures because of few or absent image intensifiers (c-arm) despite the necessity. Authors provide a review of the literature on interlocking intramedullary nailing without fluoroscopy in resource-limited settings, followed by strategies, outcomes, and outlook. MATERIALS AND METHOD A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was performed with the help of a biomedical information specialist. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. RESULTS We identified 15 series of interlocking intramedullary nailing without fluoroscopy in resource-limited settings. All papers focused on the care for long bones (humerus, femur, tibia). All studies discussed the quality of the nailing operative procedure. The entry point was described in five series; the nail insertion in the proximal and distal medullary canal was good in all studies. The distal locking was missed between 0 and 27%. DISCUSSION Intraoperative strategies depend on the type of bone affected, the opening of the fracture site, the fracture line, and the availability of a functional orthopaedic table. Three techniques to insert the nail in the proximal and distal fracture fragment with reduction of the fracture site are described. Insertion of distal screws is possible by using ancillary devices. Outcomes are comparable to those of the series using c-arm guidance. In low-income countries, it can been proposed as an alternative to the gold standard in resources constraints settings. In high-income setting this technique can help to reduce exposure of X-ray. CONCLUSION There is a need to improve equipment in low-income countries hospitals to make trauma surgery with c-arm a gold standard with a minimal exposure to radiation.
Collapse
|
7
|
Mustafa Diab M, Wu HH, Eliezer E, Haonga B, Morshed S, Shearer DW. The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study. Injury 2018; 49:323-327. [PMID: 29162265 DOI: 10.1016/j.injury.2017.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 10/31/2017] [Accepted: 11/15/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In many low and middle-income countries (LMICs) SIGN nail is commonly used for antegrade femoral intramedullary (IM) nailing, using a start site either at the tip of the greater trochanter or piriformis fossa. While a correct start site is considered an essential technical step; few studies have evaluated the impact of using an erroneous start site. This is particularly relevant in settings with limited access to fluoroscopy to aid in creating a nail entry point. The purpose of this study was to evaluate the impact of antegrade SIGN IM nailing start site on radiographic alignment and health-related quality of life. METHODS In this prospective cohort study, adult patients with proximal femur fractures (OTA 32, subtrochanteric zone) treated with antegrade IM SIGN nail at Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania were enrolled. Start site was determined on the immediate postoperative X-ray and was graded on a continuous scale based on distance of the IM nail center from the greater trochanteric tip. The primary outcome measurement was coronal alignment on the post-operative x-ray. The secondary outcomes were reoperation rates, RUST scores and EQ5D scores at one year follow-up. RESULTS Seventy-nine patients were enrolled. 50 of them (63.3%) had complete data at 1year and were included in the final data analysis. Of the fifty patients, nine (18%) had IM nails placed laterally, 26 (52%) medially and 15 (30%) directly over the tip of the greater trochanter. Compared to a start site at the tip or medial to the greater trochanter, a lateral start site was 9 times more likely to result in a varus malalignment (95% CI: 1.42-57.70, p=0.021). CONCLUSIONS Lateral start site was associated with varus malalignment. Although lateral start site was not significantly associated with reoperation, varus deformity was associated with higher reoperation rates. Surgeons should consider avoiding a start site lateral to the tip of the greater trochanter or allow the nail to rotate to avoid malalignment when using the SIGN nail for proximal femur fractures.
Collapse
Affiliation(s)
- Mohamed Mustafa Diab
- Institute for Global Orthopedics and Traumatology, University of California San Francisco, San Francisco, CA, United States; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States.
| | - Hao-Hua Wu
- Institute for Global Orthopedics and Traumatology, University of California San Francisco, San Francisco, CA, United States
| | - Edmund Eliezer
- Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania
| | - Billy Haonga
- Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania
| | - Saam Morshed
- Institute for Global Orthopedics and Traumatology, University of California San Francisco, San Francisco, CA, United States
| | - David W Shearer
- Institute for Global Orthopedics and Traumatology, University of California San Francisco, San Francisco, CA, United States
| |
Collapse
|
8
|
Apóstol-González SA. Subtrochanteric fractures of the femur. Treatment with locking intramedullary nailing. An experience without C-Arc. The guide-wire stopping method for verify distal locking is described. Injury 2017; 48:2563-2568. [PMID: 28867643 DOI: 10.1016/j.injury.2017.08.055] [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: 05/25/2017] [Revised: 07/26/2017] [Accepted: 08/22/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the results of treatment of subtrochanteric fracture with interlocked intramedullary nail and describe a technical for accurate and secure verification of distal locking position when we do surgery without arc-C. METHODS A case series where was reviewed the results in 49 patients with subtrochanteric fracture and treated locking intramedullary nailing. The AO and Russell-Taylor Classification were used. The statistic procedure was done with SPSS program. The traumatic hip scale of Sander et al. was used for final evaluation. Technical for doing distal locking is detailed. RESULTS This series evaluated 49 patients: 35 male and 14 female patients. The mean age was 36 years old (range: 18-86 years). Traffic accidents and gunshot wounds were injury forms most frequent. There were not transoperative complications. The surgical time was between 90 and 120min (mean: 108min). The mean follow-up was 24 months (range: 18-36 months). According to Sanders score, it was reported 22 excellent results, 20 good results and 7 regular results. All distal locking procedures were successfully performed. CONCLUSION Although this series consists in a few numbers of patients, we recommend the placement of interlocked intramedullary nail (Closs-MB Bioimpianti® and Orthosintese®) in subtrochanteric fractures. This device allows placement of distal locking through the insertion frame with safety and precision, even in surgery rooms without arc-C. The guide-wire stopping method allows the verification of distal locking in an objective, accurate, safe and reproducible way.
Collapse
Affiliation(s)
- Saúl A Apóstol-González
- IEQ Clinica, Floor 3rd Office 3-4, 110 Street, Los Mangos Neighborhood, Valencia 2001, Venezuela; Valle de San Diego Medical Center, Floor 1st, Office: 18, Don Julio Centeno Avenue, El Morro 2 Neighborhood, San Diego District, Carabobo State, Venezuela.
| |
Collapse
|
9
|
Panzica M, Suero EM, Westphal R, Citak M, Liodakis E, Hawi N, Petri M, Krettek C, Stuebig T. Robotic distal locking of intramedullary nailing: Technical description and cadaveric testing. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/31/2017] [Accepted: 04/02/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Martin Panzica
- Trauma Department; Hannover Medical School; Hannover Germany
| | | | - Ralf Westphal
- Institute for Robotics and Process Control; Braunschweig University of Technology; Germany
| | - Musa Citak
- Trauma Department; Hannover Medical School; Hannover Germany
| | | | - Nael Hawi
- Trauma Department; Hannover Medical School; Hannover Germany
| | - Max Petri
- Trauma Department; Hannover Medical School; Hannover Germany
| | | | - Timo Stuebig
- Trauma Department; Hannover Medical School; Hannover Germany
| |
Collapse
|
10
|
Ehlinger M, Dillman G, Czekaj J, Adam P, Taglang G, Brinkert D, Schenck B, Di Marco A, Bonnomet F. Distal targeting device for long Gamma nail(®). Monocentric observational study. Orthop Traumatol Surg Res 2013; 99:799-804. [PMID: 24095597 DOI: 10.1016/j.otsr.2013.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/06/2013] [Accepted: 06/27/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nail distal locking screws make it possible to control length and rotation but include an increased risk of radiation exposure. A distal targeting device was recently developed for long Gamma(®) nails (Stryker(®)). The aim of this practical observational study was to evaluate the reliability of this system. Our hypothesis was that the targeting device would be systematically used without conversion or complications. MATERIALS AND METHODS All of the long Gamma(®) nails implanted between November 2011 and October 2012 were recorded: 91 nails (59W/32M, mean age 73.5years old) for 68 traumatic fractures, 14 preventive nailings and nine pathological fractures. A junior surgeon performed the procedure in 45 cases and a senior in 46 cases. The number of times the device was used, the difficulties and complications encountered, the duration of fluoroscopy and the dose of radiation were noted. Risk factors were looked for. RESULTS The targeting device was used 79 times (the surgeon chose not to use it 11 times, and it was not available in one case). There was a measurement error in one case, therefore 78 nails could be evaluated. Three wrong positions of the distal locking screw occurred. No statistically significant risk factors were identified. Distal locking screw corresponded to 18% of the entire procedure at a radiation dose of 7.44% (this was higher with titanium nails and pathological fractures). Total fluoroscopy time was longer with junior than with senior surgeons but the dose and duration for distal locking were not different. DISCUSSION The hypothesis was not confirmed. The device was not systematically used and the risk of complications was not null. No risk factors were identified. The distal locking screw is a difficult step but the use of the targeting device can limit the dose of radiation. This device is effective and allows young surgeons to perform distal locking without increasing the dose of radiation compared to senior surgeons. LEVEL OF EVIDENCE Level IV, cohort study, observational prospective follow-up.
Collapse
Affiliation(s)
- M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | | | | | | | | | | | | | | | | |
Collapse
|