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Post-Stroke Environmental Enrichment Improves Neurogenesis and Cognitive Function and Reduces the Generation of Aberrant Neurons in the Mouse Hippocampus. Cells 2023; 12:cells12040652. [PMID: 36831319 PMCID: PMC9954243 DOI: 10.3390/cells12040652] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/22/2023] Open
Abstract
Ischemic lesions stimulate adult neurogenesis in the dentate gyrus, however, this is not associated with better cognitive function. Furthermore, increased neurogenesis is associated with the formation of aberrant neurons. In a previous study, we showed that a running task after a stroke not only increases neurogenesis but also the number of aberrant neurons without improving general performance. Here, we determined whether stimulation in an enriched environment after a lesion could increase neurogenesis and cognitive function without enhancing the number of aberrant neurons. After an ischemic stroke induced by MCAO, animals were transferred to an enriched environment containing a running wheel, tunnels and nest materials. A GFP-retroviral vector was delivered on day 3 post-stroke and a modified water maze test was performed 6 weeks after the lesion. We found that the enriched environment significantly increased the number of new neurons compared with the unstimulated stroke group but not the number of aberrant cells after a lesion. Increased neurogenesis after environmental enrichment was associated with improved cognitive function. Our study showed that early placement in an enriched environment after a stroke lesion markedly increased neurogenesis and flexible learning but not the formation of aberrant neurons, indicating that rehabilitative training, as a combination of running wheel training and enriched environment housing, improved functional and structural outcomes after a stroke.
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van Trikt CH, Donders JCE, Klinger CE, Wellman DS, Helfet DL, Kloen P. Operative treatment of nonunions in the elderly: Clinical and radiographic outcomes in patients at minimum 75 years of age. BMC Geriatr 2022; 22:985. [PMID: 36539691 PMCID: PMC9764700 DOI: 10.1186/s12877-022-03670-8] [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: 03/29/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Limited information exists on nonunion treatment in the elderly. This retrospective study evaluates whether results of operative treatment of nonunion of the humerus or femur in patients aged ≥ 75 years are comparable to those in younger patients. METHODS We identified patients age ≥ 75 years with a nonunion of humerus or femur treated with open reduction and internal fixation. The Non-Union Scoring System was calculated. Complications, clinical outcome, and radiographic findings were assessed. Primary endpoint was nonunion healing. A literature review compared time to healing of humeral and femoral nonunion in younger populations. RESULTS We identified 45 patients treated for a nonunion of humerus or femur with > 12 months follow-up. Median age was 79 years (range 75-96). Median time to presentation was 12 months (range 4-127) after injury, median number of prior surgeries was 1 (range 0-4). Union rate was 100%, with median time to union 6 months (range 2-42). Six patients underwent revision for persistent nonunion and healed without further complications. CONCLUSIONS Using a protocol of debridement, alignment, compression, stable fixation, bone grafting and early motion, patients aged 75 years or older can reliably achieve healing when faced with a nonunion of the humerus or femur. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Clinton H. van Trikt
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Johanna C. E. Donders
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Craig E. Klinger
- grid.5386.8000000041936877XOrthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY USA
| | - David S. Wellman
- grid.260917.b0000 0001 0728 151XOrthopaedic Trauma Service, Westchester Medical Center, New York Medical College, Valhalla, NY USA
| | - David L. Helfet
- grid.5386.8000000041936877XOrthopaedic Trauma Service, Hospital for Special Surgery and New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY USA
| | - Peter Kloen
- grid.509540.d0000 0004 6880 3010Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Pica G, Liuzza F, Ronga M, Meccariello L, Mauro DD, Smakaj A, De Cruto E, Rollo G. Interprosthetic and interimplant femoral fractures: is bone strut allograft augmentation with ORIF a validity alternative solution in elderly? Orthop Rev (Pavia) 2022; 14:38558. [PMID: 36267217 PMCID: PMC9568417 DOI: 10.52965/001c.38558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Nowadays orthopedic surgeons have a new challenge to treat the interimplants fractures. Although fixation strategies exist for periprosthetic hip and knee fractures, there is no standard of care regarding the more complex interprosthetic and interimplants fractures. OBJECTIVE The aim of our study is targeting the focus on the bone strut grafting to avoid the metal hardware failure and to achieve the bone healing in these injuries. METHODS A prospective case note review of all interprosthetic or interimplants femoral fractures admitted to our trauma center. There were 11 patients (2 males and 9 females) with a mean age over 85 years old. We treated all the patients by ORIF and medial graft strut allograft to reduce the main complication leading to re-operations and morbidity or mortality is the nonunion or delayed union. The criteria to evaluate the patients during the follow-up were: the survival and complication after the surgery; the objective quality of life measured by Activities of Daily Living Score (ADL). The bone healing was measured by X-rays control as the alignment was measured by radiographic UNION SCORE, and postoperative complications. RESULTS All the patients reduced their ADL. In the most of cases we had a good x-rays reduction. We had not: No nonunion or Not delayed union. All patients died within 2 years from the surgery but not due by surgical complications. CONCLUSIONS According us, the purpose of this surgery is to limit comorbidities and early mortality not to improve optimal restoration of lower limb function.
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Affiliation(s)
- Giuseppe Pica
- Department of Orthopaedics and Traumatology, AORN San Pio, Benevento, Italy
| | - Francesco Liuzza
- Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Mario Ronga
- Orthopedics and Trauma Operative Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, University Hospital G. Martino, Messina, Italy
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio, Benevento, Italy
| | - Domenico De Mauro
- Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Amarildo Smakaj
- Department of Orthopaedics and Traumatology, A. Gemelli University Hospital, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Enio De Cruto
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
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Guo Y, Chen C, Zhang S, Ren L, Zhao Y, Guo W. Mediation of mechanically adapted TiCu/TiCuN/CFR-PEEK implants in vascular regeneration to promote bone repair in vitro and in vivo. J Orthop Translat 2022; 33:107-119. [PMID: 35330944 PMCID: PMC8907983 DOI: 10.1016/j.jot.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background/Objective TiCu/TiCuN is a multilayer composite coating comprising TiN and Cu, which provides excellent wear resistance and antibacterial properties. However, its applicability as a functional coating has not been widely realised, and several aspects pertaining to its properties must still be explored. Methods This study uses arc ion-plating technology to apply a TiCu/TiCuN coating on the surface of carbon fibre-reinforced (CFR) polyetheretherketone (PEEK) material.The safety and osteogenic activity of TiCu/TiCuN-coated CFR-PEEK materials were explored through cell experiments and animal experiments, and the molecules behind them were verified. Results The new material exhibits improved mechanical compatibility (mechanical strength and elastic modulus) and superior light transmittance (elimination of metal artifacts and ray refraction during radiology and radiotherapy). The proposed implant delivers excellent biocompatibility for mesenchymal stem cells and human umbilical vein endothelial cells (HUVECs), and it exhibits excellent osteogenic activity both in vitro and in vivo. Additionally, it was determined that the applied TiCu/TiCuN coating aids in upregulating the expression of angiogenesis-related signals (i.e., cluster-of-differentiation 31, α-smooth muscle actin, vascular endothelial growth factor receptor, and hypoxia-inducible factor-1α) to promote neovascularisation, which is significant for characterising the mechanism of the coating in promoting bone regeneration. Conclusion The current results reveal that the TiCu/TiCuN-coated CFR-PEEK implants may emerge as an advanced generation of orthopaedic implants. Translational potential statement The results of this study indicate that TiCu/TiCuN coating-modified CFR-PEEK materials can promote bone repair through angiogenesis and have broad clinical translation prospects.
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Mondanelli N, Troiano E, Facchini A, Cesari M, Colasanti GB, Bottai V, Muratori F, Caffarelli C, Gonnelli S, Giannotti S. Combined Surgical and Medical Treatment for Vancouver B1 and C Periprosthetic Femoral Fractures: A Proposal of a Therapeutic Algorithm While Retaining the Original Stable Stem. Geriatr Orthop Surg Rehabil 2021; 12:21514593211067072. [PMID: 34992896 PMCID: PMC8725223 DOI: 10.1177/21514593211067072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/30/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is lack of consensus regarding best operative fixation strategy for periprosthetic femoral fractures (PFFs) around a stable stem. Evidence exists that some patterns of fracture around a stable stem are better treated with revision surgery than with standard fixation. Anyway, a more aggressive surgical procedure together with medical treatment could allow for stem retention, and reduced risk of nonunion/hardware failure, even in these cases. SIGNIFICANCE This paper is placed in a broader context of lack of studies on the matter, and its aim is to shed some light on the management of PFFs around a stable stem, when peculiar mechanical and biological aspects are present. RESULTS Based on our casuistry in the treatment of nonunions after PFF successfully treated with original stem retention, and on review of Literature about risk factors for fixation failure, an algorithm is proposed that can guide in choosing the ideal surgical technique even for first-time PFFs with a stable stem, without resorting to revision. Mechanical (major and minor) and biological (local and systemic) factors that may influence fracture healing, leading to nonunion and hardware failure, and subsequent need for re-operation, are considered. The proposed surgical technique consists of rigid fixation with absolute stability (using a plate and structural allograft) plus local biological support (structural allograft and autologous bone marrow concentrate over a platelet-rich plasma-based scaffold) at fracture site. Systemic anabolic treatment (Teriparatide) is also administered in the post-operative period. CONCLUSION Mechanical factors are not the only issues to be considered when choosing the surgical approach to PFFs over a stable stem. Systemic and local biological conditions should be taken into account, as well. A therapeutic algorithm is proposed, given the prosthetic stem to be stable, considering mechanical and biological criteria.
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Affiliation(s)
- Nicola Mondanelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Elisa Troiano
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Andrea Facchini
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Martina Cesari
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | | | - Vanna Bottai
- Second Clinic of Orthopedic and
Traumatology, University of Pisa, Pisa, Italy
| | - Francesco Muratori
- Section of Orthopedic Oncology and
Reconstructive Surgery, Azienda Ospedaliero-Universitaria
Careggi, Firenze, Italy
| | - Carla Caffarelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Gonnelli
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Internal Medicine, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Stefano Giannotti
- Department of Medicine Surgery and
Neurosciences, University of Siena, Siena, Italy
- Section of Orthopedics, Azienda Ospedaliero-Universitaria
Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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Meyers KN, Achor TS, Prasarn ML, Ahn J, Khalsa K, Wellman DS, Lorich DG, Helfet DL. The effects of locking inserts and overtorque on the mechanical properties of a large fragment locking compression plate. J Exp Orthop 2021; 8:106. [PMID: 34817734 PMCID: PMC8613322 DOI: 10.1186/s40634-021-00424-0] [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: 05/10/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The study was to determine the effect of locking hole inserts and their insertion torque on the fatigue life of a large fragment Locking Compression Plate (LCP) under bending forces. METHODS Fatigue strength of the LCP was examined using cyclic three-point bend testing at 80% yield strength of the construct. Locking hole inserts were used in 2, 4, and 6-hole of a 12-hole plate to simulate three different working lengths. Within each working length, plates were tested without locking inserts serving as the control group. In the experimental groups, inserts were tightened to manufacturer recommendations (4 Nm) and using overtorque (8 Nm). RESULTS Significantly fewer cycles to failure were observed in control groups versus the locking hole insert groups for all working lengths (2-hole: 4 Nm p = 0.003, 8 Nm p = 0.003; 4-hole: 4 Nm p = 0.02, 8 Nm p < 0.001; 6-hole: 4 Nm p = 0.004, 8 Nm p < 0.001). There was a statistically significant increase in fatigue strength when using overtorque in the 4-hole (p = 0.04) and 6-hole (p = 0.01) defect groups. This was not shown in the 2-hole defect group (p = 0.99). CONCLUSIONS By placing locking inserts in the empty locking regions of Combi holes along the working length, the number of cycles to failure was increased. Tightening inserts to twice the recommended insertion torque further increased cycles to failure in longer working length models. A longer fatigue life has the potential to decease the incidence of plate failure especially in the setting of delayed union due to poor intrinsic healing capacity, fractures in the geriatric population, osteoporosis and periprosthetic fractures.
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Affiliation(s)
- Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Timothy S Achor
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Mark L Prasarn
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jaimo Ahn
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Kevin Khalsa
- Orethopaedic Trauma Service, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - David S Wellman
- Orethopaedic Trauma Service, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Dean G Lorich
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - David L Helfet
- Orthopaedic Trauma Service, Hospital for Special Surgery, New York Presbyterian Hospital, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement. Vet Comp Orthop Traumatol 2020; 33:370-376. [PMID: 32356296 DOI: 10.1055/s-0040-1709486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. MATERIALS AND METHODS Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. RESULTS Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. CONCLUSIONS While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.
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Abstract
Periprosthetic fractures (PPFs) present unique challenges to orthopaedic surgeons in terms of limited cortical fixation options, poor bone quality, cement mantles, and stress risers introduced from the prosthesis. Various fixation strategies have been used in PPFs including the use of intramedullary nails, locked plates, unicortical locking screws, cerclage wires and cables, double-plating techniques, and allograft struts. Here, we will review the biomechanics of various fixation strategies used in PPFs.
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