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Amroodi MN, Maghsoudloo M, Amiri S, Mokhtari K, Mohseni P, Pourmarjani A, Jamali B, Khosroshahi EM, Asadi S, Tabrizian P, Entezari M, Hashemi M, Wan R. Unraveling the molecular and immunological landscape: Exploring signaling pathways in osteoporosis. Biomed Pharmacother 2024; 177:116954. [PMID: 38906027 DOI: 10.1016/j.biopha.2024.116954] [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: 04/19/2024] [Revised: 06/05/2024] [Accepted: 06/15/2024] [Indexed: 06/23/2024] Open
Abstract
Osteoporosis, characterized by compromised bone density and microarchitecture, represents a significant global health challenge, particularly in aging populations. This comprehensive review delves into the intricate signaling pathways implicated in the pathogenesis of osteoporosis, providing valuable insights into the pivotal role of signal transduction in maintaining bone homeostasis. The exploration encompasses cellular signaling pathways such as Wnt, Notch, JAK/STAT, NF-κB, and TGF-β, all of which play crucial roles in bone remodeling. The dysregulation of these pathways is a contributing factor to osteoporosis, necessitating a profound understanding of their complexities to unveil the molecular mechanisms underlying bone loss. The review highlights the pathological significance of disrupted signaling in osteoporosis, emphasizing how these deviations impact the functionality of osteoblasts and osteoclasts, ultimately resulting in heightened bone resorption and compromised bone formation. A nuanced analysis of the intricate crosstalk between these pathways is provided to underscore their relevance in the pathophysiology of osteoporosis. Furthermore, the study addresses some of the most crucial long non-coding RNAs (lncRNAs) associated with osteoporosis, adding an additional layer of academic depth to the exploration of immune system involvement in various types of osteoporosis. Finally, we propose that SKP1 can serve as a potential biomarker in osteoporosis.
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Affiliation(s)
- Morteza Nakhaei Amroodi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, department of orthopedic, school of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mazaher Maghsoudloo
- Key Laboratory of Epigenetics and Oncology, the Research Center for Preclinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Shayan Amiri
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, department of orthopedic, school of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khatere Mokhtari
- Department of Cellular and Molecular Biology and Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Parnaz Mohseni
- Department of Pediatrics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Azadeh Pourmarjani
- Department of Pediatrics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Behdokht Jamali
- Department of microbiology and genetics, kherad Institute of higher education, Busheher, lran
| | - Elaheh Mohandesi Khosroshahi
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Saba Asadi
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Pouria Tabrizian
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, department of orthopedic, school of medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Maliheh Entezari
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Mehrdad Hashemi
- Farhikhtegan Medical Convergence Sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Genetics, Faculty of Advanced Science and Technology Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Runlan Wan
- Department of Oncology, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, China; Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, (Collaborative Innovation Center for Prevention of Cardiovascular Diseases), Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, China.
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Pankratz C, Dehner C, Gebhard F, Schuetze K. [Augmentation techniques for the treatment of osteoporosis-associated fractures of the extremities]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:253-262. [PMID: 38351179 DOI: 10.1007/s00113-024-01414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/26/2024]
Abstract
The current demographic development is leading to an increasing number of cases of osteoporosis-related fractures. Affected individuals are typically part of a vulnerable, predominantly geriatric patient group with limited physical resources. Additionally, the pathophysiological characteristics of osteoporotic bones with reduced bone quality and quantity, pose a significant challenge to the osteosynthesis techniques used. Achieving rapid postoperative mobilization and stable weight-bearing osteosynthesis to prevent postoperative medical complications are the main goals of the surgical management. In recent years augmentation techniques have gained in importance in the treatment of osteoporosis-related fractures by significantly enhancing the stability of osteosyntheses and reducing mechanical complication rates. The main options available are polymethyl methacrylate (PMMA) augmentation and various bioresorbable bone substitute materials with different properties. Implant augmentations can be applied at various locations in the extremity bones and standardized procedures are now available, such as for the proximal humerus and femur. When used correctly, low complication rates and promising clinical outcomes are observed. This article aims to provide an overview of available techniques and applications based on the current literature. Guidelines and substantial scientific evidence are still limited.
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Affiliation(s)
- Carlos Pankratz
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Christoph Dehner
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Florian Gebhard
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - Konrad Schuetze
- Klinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
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Chen H, Liu Y, Lu Y, Zhang A, Yang W, Han Q, Wang J. Bamboo-Inspired Porous Scaffolds for Advanced Orthopedic Implants: Design, Mechanical Properties, and Fluid Characteristics. ACS Biomater Sci Eng 2024; 10:1173-1189. [PMID: 38232356 DOI: 10.1021/acsbiomaterials.3c01690] [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: 01/19/2024]
Abstract
In orthopedic implant development, incorporating a porous structure into implants can reduce the elastic modulus to prevent stress shielding but may compromise yield strength, risking prosthesis fracture. Bamboo's natural structure, with its exceptional strength-to-weight ratio, serves as inspiration. This study explores biomimicry using bamboo-inspired porous scaffolds (BISs) resembling cortical bone, assessing their mechanical properties and fluid characteristics. The BIS consists of two 2D units controlled by structural parameters α and β. The mechanical properties, failure mechanisms, energy absorption, and predictive performance are investigated. BIS exhibits mechanical properties equivalent to those of natural bone. Specifically, α at 4/3 and β at 2/3 yield superior mechanical properties, and the destruction mechanism occurs layer by layer. Besides, the Gibson-Ashby models with different parameters are established to predict mechanical properties. Fluid dynamics analysis reveals two high-flow channels in BISs, enhancing nutrient delivery through high-flow channels and promoting cell adhesion and proliferation in low-flow regions. For wall shear stress below 30 mPa (ideal for cell growth), α at 4/3 achieves the highest percentage (99.04%), and β at 2/3 achieves 98.46%. Permeability in all structural parameters surpasses that of human bone. Enhanced performance of orthopedic implants through a bionic approach that enables the creation of pore structures suitable for implants.
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Affiliation(s)
- Hao Chen
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Yang Liu
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Yue Lu
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, Jilin Province 130022, China
| | - Aobo Zhang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Wenbo Yang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Qing Han
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
| | - Jincheng Wang
- Department of Orthopedics, Second Hospital of Jilin University, Changchun, Jilin Province 130000, China
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Progress of Wnt Signaling Pathway in Osteoporosis. Biomolecules 2023; 13:biom13030483. [PMID: 36979418 PMCID: PMC10046187 DOI: 10.3390/biom13030483] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Osteoporosis, one of the serious health diseases, involves bone mass loss, bone density diminishing, and degeneration of bone microstructure, which is accompanied by a tendency toward bone fragility and a predisposition to fracture. More than 200 million people worldwide suffer from osteoporosis, and the cost of treating osteoporotic fractures is expected to reach at least $25 billion by 2025. The generation and development of osteoporosis are regulated by genetic factors and regulatory factors such as TGF-β, BMP, and FGF through multiple pathways, including the Wnt signaling pathway, the Notch signaling pathway, and the MAPK signaling pathway. Among them, the Wnt signaling pathway is one of the most important pathways. It is not only involved in bone development and metabolism but also in the differentiation and proliferation of chondrocytes, mesenchymal stem cells, osteoclasts, and osteoblasts. Dkk-1 and SOST are Wnt inhibitory proteins that can inhibit the activation of the canonical Wnt signaling pathway and block the proliferation and differentiation of osteoblasts. Therefore, they may serve as potential targets for the treatment of osteoporosis. In this review, we analyzed the mechanisms of Wnt proteins, β-catenin, and signaling molecules in the process of signal transduction and summarized the relationship between the Wnt signaling pathway and bone-related cells. We hope to attract attention to the role of the Wnt signaling pathway in osteoporosis and offer new perspectives and approaches to making a diagnosis and giving treatment for osteoporosis.
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Gueorguiev B, Lenz M. [Cement augmentation and bone graft substitutes-Materials and biomechanics]. Unfallchirurg 2022; 125:430-435. [PMID: 35486124 DOI: 10.1007/s00113-022-01182-z] [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: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Materials with different characteristics are used for cement augmentation and as bone graft substitutes. OBJECTIVE Cement augmentation and bone graft substitutes are the subject of current research. The evaluation of new knowledge allows its specific application. MATERIAL AND METHODS Selective literature search and outline of experimental research results on cement augmentation and bone graft substitutes. RESULTS Augmentation and bone graft substitutes are essential components of current trauma surgical procedures. Despite intensive research all materials have specific disadvantages. Cement augmentation of implants enhances not only the anchorage but also influences the failure mode. CONCLUSION Cement augmentation has large potential especially in osteoporotic bone. In load-bearing regions acrylic-based cements remain the standard of choice. Ceramic cements are preferred in non-load-bearing areas. Their combination with resorbable metals offers still largely unexplored potential. Virtual biomechanics can help improve the targeted application of cement augmentation.
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Affiliation(s)
- Boyko Gueorguiev
- AO Forschungsinstitut Davos, Clavadelerstraße 8, 7270, Davos, Schweiz.
| | - Mark Lenz
- AO Forschungsinstitut Davos, Clavadelerstraße 8, 7270, Davos, Schweiz.,Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, 07747, Jena, Deutschland
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Chen X, Hu Y, Geng Z, Su J. The "Three in One" Bone Repair Strategy for Osteoporotic Fractures. Front Endocrinol (Lausanne) 2022; 13:910602. [PMID: 35757437 PMCID: PMC9218483 DOI: 10.3389/fendo.2022.910602] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 12/17/2022] Open
Abstract
In aging society, osteoporotic fractures have become one major social problem threatening the health of the elderly population in China. Compared with conventional fractures, low bone mass, bone defect and retarded healing issues of osteoporotic fractures lead to great difficulties in treatment and rehabilitation. Addressing major concerns in clinical settings, we proposed the "three in one" bone repair strategy focusing on anti-osteoporosis therapies, appropriate bone grafting and fracture healing accelerating. We summarize misconceptions and repair strategies for osteoporotic fracture management, expecting improvement of prognosis and clinical outcomes for osteoporotic fractures, to further improve therapeutic effect and living quality of patients.
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Affiliation(s)
- Xiao Chen
- Department of Traumatic Orthopedics, First Affiliated Hospital of Navy Medical University, Shanghai, China
| | - Yan Hu
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Zhen Geng
- Institute of Translational Medicine, Shanghai University, Shanghai, China
| | - Jiacan Su
- Department of Traumatic Orthopedics, First Affiliated Hospital of Navy Medical University, Shanghai, China
- Institute of Translational Medicine, Shanghai University, Shanghai, China
- *Correspondence: Jiacan Su,
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Augat P, Simpson H. Enhancement of Fracture Healing. Injury 2021; 52 Suppl 2:S1-S2. [PMID: 34099104 DOI: 10.1016/j.injury.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany & Paracelsus Medical University Salzburg, Austria.
| | - Hamish Simpson
- Department of Trauma and Orthopaedics, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, EH16 4SA, UK
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Van Lieshout EMM, Den Hartog D. Effect of platelet-rich plasma on fracture healing. Injury 2021; 52 Suppl 2:S58-S66. [PMID: 33431160 DOI: 10.1016/j.injury.2020.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/02/2023]
Abstract
Bone has the ability to completely regenerate under normal healing conditions. Although fractures generally heal uneventfully, healing problems such as delayed union or nonunion still occur in approximately 10% of patients. Optimal healing potential involves an interplay of biomechanical and biological factors. Orthopedic implants are commonly used for providing the necessary biomechanical support. In situations where the biological factors that are needed for fracture healing are deemed inadequate, additional biological enhancement is needed. With platelets being packed with granules that contain growth factors and other proteins that have osteoinductive capacity, local application of platelet concentrates, also called platelet-rich plasma (PRP) seems an attractive biological to enhance fracture healing. This review shows an overview of the use PRP and its effect in enhancing fracture healing. PRP is extracted from the patient's own blood, supporting that its use is considered safe. Although PRP showed effective in some studies, other studies showed controversial results. Conflicts in the literature may be explained by the absence of consensus about the preparation of PRP, differences in platelet counts, low number of patients, and absence of a standard application technique. More studies addressing these issues are needed in order to determine the true effect of PRP on fracture healing.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Ke X, Qiu J, Wang X, Yang X, Shen J, Ye S, Yang G, Xu S, Bi Q, Gou Z, Jia X, Zhang L. Modification of pore-wall in direct ink writing wollastonite scaffolds favorable for tuning biodegradation and mechanical stability and enhancing osteogenic capability. FASEB J 2020; 34:5673-5687. [PMID: 32115776 DOI: 10.1096/fj.201903044r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/31/2020] [Accepted: 02/14/2020] [Indexed: 11/11/2022]
Abstract
Surface chemistry and mechanical stability determine the osteogenic capability of bone implants. The development of high-strength bioactive scaffolds for in-situ repair of large bone defects is challenging because of the lack of satisfying biomaterials. In this study, highly bioactive Ca-silicate (CSi) bioceramic scaffolds were fabricated by additive manufacturing and then modified for pore-wall reinforcement. Pure CSi scaffolds were fabricated using a direct ink writing technique, and the pore-wall was modified with 0%, 6%, or 10% Mg-doped CSi slurry (CSi, CSi-Mg6, or CSi-Mg10) through electrostatic interaction. Modified CSi@CSi-Mg6 and CSi@CSi-Mg10 scaffolds with over 60% porosity demonstrated an appreciable compressive strength beyond 20 MPa, which was ~2-fold higher than that of pure CSi scaffolds. CSi-Mg6 and CSi-Mg10 coating layers were specifically favorable for retarding bio-dissolution and mechanical decay of scaffolds in vitro. In-vivo investigation of critical-size femoral bone defects repair revealed that CSi@CSi-Mg6 and CSi@CSi-Mg10 scaffolds displayed limited biodegradation, accelerated new bone ingrowth (4-12 weeks), and elicited a suitable mechanical response. In contrast, CSi scaffolds exhibited fast biodegradation and retarded new bone regeneration after 8 weeks. Thus, tailoring of the chemical composition of pore-wall struts of CSi scaffolds is beneficial for enhancing the biomechanical properties and bone repair efficacy.
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Affiliation(s)
- Xiurong Ke
- Department of Orthopaedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China
| | - Jiandi Qiu
- Department of Orthopaedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China
| | - Xijuan Wang
- Key Laboratory of Molecular Biology in Medical Sciences, School of Medicine, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Xianyan Yang
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, China
| | - Jianhua Shen
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, China
| | - Shuo Ye
- Department of Orthopaedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China
| | - Guojing Yang
- Department of Orthopaedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China
| | - Sanzhong Xu
- Department of Orthopaedic Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Qing Bi
- Department of Orthopedic Surgery, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Zhongru Gou
- Bio-nanomaterials and Regenerative Medicine Research Division, Zhejiang-California International Nanosystem Institute, Zhejiang University, Hangzhou, China
| | - Xiaofeng Jia
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lei Zhang
- Department of Orthopaedic Surgery, The Third Hospital Affiliated to Wenzhou Medical University, Rui'an, China
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Obregon-Miano F, Fathi A, Rathsam C, Sandoval I, Deheghani F, Spahr A. Injectable porcine bone demineralized and digested extracellular matrix-PEGDA hydrogel blend for bone regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:21. [PMID: 31989310 DOI: 10.1007/s10856-019-6354-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/27/2019] [Indexed: 06/10/2023]
Abstract
Extracellular matrix (ECM) has a major role in the structural support and cellular processes of organs and tissues. Proteins extracted from the ECM have been used to fabricate different scaffolds for tissue engineering applications. The aims of the present study were to extract, characterize and fabricate a new class of hydrogel with proteins isolated from pig bone ECM and combine them with a synthetic polymer so it could be used to promote bone regeneration. Porcine bone demineralized and digested extracellular matrix (pddECM) containing collagen type I was produced, optimized and sterilized with high pressurized CO2 method. The pddECM was further blended with 20% w/v polyethylene glycol diacrylate (PEGDA) to create an injectable semi interpenetrating polymer network (SIPN) scaffold with enhanced physicochemical properties. The blend tackled the shortfall of natural polymers, such as lack of structural stability and fast degradation, preserving its structure in more than 90% after 30 days of incubation; thus, increasing the material endurance in a simulated physiological environment. The manufactured injectable hydrogel showed high cytocompatibility with hOb and SaOs-2 cells, promoting osteogenic proliferation within 21 days of culture. The hydrogel had a high compression modulus of 520 kPa, low swelling (5.3 mg/mg) and millimetric volume expansion (19.5%), all of which are favorable characteristics for bone regeneration applications.
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Affiliation(s)
- Fabian Obregon-Miano
- Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2010, Australia.
- Dental School, Faculty of Medicine and Health, Bioengineering Unit, Westmead Hospital, Centre for Oral Health, Westmead, The University of Sydney, Sydney, NSW, 2145, Australia.
| | - Ali Fathi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Catherine Rathsam
- Institute for Dental Research IDR, Westmead Hospital, The University of Sydney, Sydney, NSW, 2145, Australia
| | - Isbel Sandoval
- Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2010, Australia
| | - Fariba Deheghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Axel Spahr
- Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2010, Australia
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11
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Hoffmeyer P, Miozzari H, Holzer N. Non-hip/non-vertebral fractures - How to treat best? Best Pract Res Clin Rheumatol 2019; 33:236-263. [PMID: 31547981 DOI: 10.1016/j.berh.2019.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Fractures of the extremities in the elderly constitute more than two-thirds of all fragility fractures befalling frail, osteoporotic and sarcopenic patients. Although treatment controversies abound, consensus exists. Upper extremity fractures hinder activities of daily living and are debilitating. Open fractures or displaced fractures will need surgical intervention. Wrist fractures treated operatively allow early use of the hand. Most pelvic fractures are treated conservatively. In the lower extremities, fractures of the long bones, tibia and femur need surgical intervention. Non-displaced fractures around the foot may be treated with immobilisation and avoidance of full weight-bearing. As a rule, fractures take four months for consolidation. Individually tailored solutions are needed for frail patients with comorbidities. Maintaining joint mobility and muscle strength preserves mobility and autonomy. Caring for extremities trauma is team work, involving family and health care providers. Prevention efforts are mandatory.
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Affiliation(s)
- Pierre Hoffmeyer
- Swiss Foundation for Innovation and Training in Surgery, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Hermes Miozzari
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
| | - Nicolas Holzer
- Department of Orthopaedics, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1205, Switzerland.
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12
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Lourenço AH, Torres AL, Vasconcelos DP, Ribeiro-Machado C, Barbosa JN, Barbosa MA, Barrias CC, Ribeiro CC. Osteogenic, anti-osteoclastogenic and immunomodulatory properties of a strontium-releasing hybrid scaffold for bone repair. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1289-1303. [PMID: 30889663 DOI: 10.1016/j.msec.2019.02.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 01/08/2023]
Abstract
Strontium (Sr) is known to stimulate osteogenesis, while inhibiting osteoclastogenesis, thus encouraging research on its application as a therapeutic agent for bone repair/regeneration. It has been suggested that it may possess immunomodulatory properties, which might act synergistically in bone repair/regeneration processes. To further explore this hypothesis we have designed a Sr-hybrid system composed of an in situ forming Sr-crosslinked RGD-alginate hydrogel reinforced with Sr-doped hydroxyapatite (HAp) microspheres and studied its in vitro osteoinductive behaviour and in vivo inflammatory response. The Sr-hybrid scaffold acts as a dual Sr2+ delivery system, showing a cumulative Sr2+ release of ca. 0.3 mM after 15 days. In vitro studies using Sr2+concentrations within this range (0 to 3 mM Sr2+) confirmed its ability to induce osteogenic differentiation of mesenchymal stem/stromal cells (MSC), as well as to reduce osteoclastogenesis and osteoclasts (OC) functionality. In comparison with a similar Sr-free system, the Sr-hybrid system stimulated osteogenic differentiation of MSC, while inhibiting the formation of OC. Implantation in an in vivo model of inflammation, revealed an increase in F4/80+/CD206+ cells, highlighting its ability to modulate the inflammatory response as a pro-resolution mediator, through M2 macrophage polarization. Therefore, the Sr-hybrid system is potentially an appealing biomaterial for future clinical applications.
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Affiliation(s)
- Ana Henriques Lourenço
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; Faculdade de Engenharia, Universidade do Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal
| | - Ana Luísa Torres
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - Daniela P Vasconcelos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - Cláudia Ribeiro-Machado
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal
| | - Judite N Barbosa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - Mário A Barbosa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - Cristina C Barrias
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira n. 228, 4050-313 Porto, Portugal
| | - Cristina C Ribeiro
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200 - 135 Porto, Portugal; ISEP - Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015, Porto, Portugal.
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Segredo-Morales E, Reyes R, Arnau MR, Delgado A, Évora C. In situ gel-forming system for dual BMP-2 and 17β-estradiol controlled release for bone regeneration in osteoporotic rats. Drug Deliv Transl Res 2018; 8:1103-1113. [DOI: 10.1007/s13346-018-0574-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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He QF, Sun H, Shu LY, Zhu Y, Xie XT, Zhan Y, Luo CF. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018; 7:468-475. [PMID: 30123496 PMCID: PMC6076359 DOI: 10.1302/2046-3758.77.bjr-2017-0332.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Researchers continue to seek easier ways to evaluate the quality of bone and screen for osteoporosis and osteopenia. Until recently, radiographic images of various parts of the body, except the distal femur, have been reappraised in the light of dual-energy X-ray absorptiometry (DXA) findings. The incidence of osteoporotic fractures around the knee joint in the elderly continues to increase. The aim of this study was to propose two new radiographic parameters of the distal femur for the assessment of bone quality. METHODS Anteroposterior radiographs of the knee and bone mineral density (BMD) and T-scores from DXA scans of 361 healthy patients were prospectively analyzed. The mean cortical bone thickness (CBTavg) and the distal femoral cortex index (DFCI) were the two parameters that were proposed and measured. Intra- and interobserver reliabilities were assessed. Correlations between the BMD and T-score and these parameters were investigated and their value in the diagnosis of osteoporosis and osteopenia was evaluated. RESULTS The DFCI, as a ratio, had higher reliability than the CBTavg. Both showed significant correlation with BMD and T-score. When compared with DFCI, CBTavg showed better correlation and was better for predicting osteoporosis and osteopenia. CONCLUSION The CBTavg and DFCI are simple and reliable screening tools for the prediction of osteoporosis and osteopenia. The CBTavg is more accurate but the DFCI is easier to use in clinical practice.Cite this article: Q-F. He, H. Sun, L-Y. Shu, Y. Zhu, X-T. Xie, Y. Zhan, C-F. Luo. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018;7:468-475. DOI: 10.1302/2046-3758.77.BJR-2017-0332.R1.
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Affiliation(s)
- Q-F. He
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - H. Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - L-Y. Shu
- Emergency Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Y. Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - X-T. Xie
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Y. Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - C-F. Luo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Huang K, Wu G, Zou J, Peng S. Combination therapy with BMP-2 and psoralen enhances fracture healing in ovariectomized mice. Exp Ther Med 2018; 16:1655-1662. [PMID: 30186384 PMCID: PMC6122261 DOI: 10.3892/etm.2018.6353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023] Open
Abstract
The advantages of combining local delivery of bone morphogenetic protein (BMP)-2 with systemic or local anti-osteoporosis treatments have also been studied for enhancing osteoporotic fracture healing. The aim of the present study was to evaluate the effect of combination therapy with BMP-2 and psoralen on fracture repair in ovariectomized mice. At 6 weeks after bilateral ovariectomy, mice (n=30) underwent unilateral transverse osteotomy on the femur and were divided into 3 groups. In the model group (n=10), animals were implanted with an absorbable collagen sponge (ACS) alone and administered physiological saline intragastrically (i.g.). In the recombinant human (rh)BMP-2 group (n=10), animals were implanted with an ACS loaded with 2.5 µg rhBMP-2 and administered physiological saline i.g. In the psoralen + rhBMP-2 group (n=10) animals were implanted with an ACS loaded with 2.5 µg rhBMP-2 and administered psoralen i.g. The mice were euthanized after 21 days and their fractured femurs were assessed by micro computed tomography, histological analysis and biomechanical testing. Furthermore, the serum of the animals was analyzed. Psoralen + rhBMP-2 exerted more beneficial effects on callus consolidation and biomechanical strength. In addition, increased bone-specific alkaline phosphatase levels and decreased C-terminal telopeptide of type-1 collagen were observed in the Psoralen + rhBMP-2 group. However, no difference in estrogen levels was detected between the groups. In conclusion, the present study demonstrated that in ovariectomized mice, combination of locally delivered BMP-2 and systemically administered psoralen improved bone healing compared with BMP-2 alone.
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Affiliation(s)
- Kui Huang
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China.,Department of Acupuncture-Moxibustion and Orthopaedics-Traumatology, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Guofeng Wu
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Ji Zou
- Department of Acupuncture-Moxibustion and Orthopaedics-Traumatology, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Songming Peng
- Department of Orthopaedics, The First Affiliated Hospital of Yangtze University, Jingzhou, Hubei 434000, P.R. China
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17
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Liu DB, Sui C, Wu TT, Wu LZ, Zhu YY, Ren ZH. Association of Bone Morphogenetic Protein (BMP)/Smad Signaling Pathway with Fracture Healing and Osteogenic Ability in Senile Osteoporotic Fracture in Humans and Rats. Med Sci Monit 2018; 24:4363-4371. [PMID: 29938690 PMCID: PMC6050999 DOI: 10.12659/msm.905958] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the effect of the BMP/Smad signaling pathway on fracture healing and osteogenic ability in senile osteoporotic fracture on humans and rats. Material/Methods Sixty-two patients and well-matched normal controls were enrolled for clinical observation. A rat model of senile osteoporotic fracture was established. Serum BMP2 and Smad4 levels, as well as alkaline phosphatase (ALP) activity, were detected by ELISA. Fracture healing was observed by X-ray radiography and bone formation was analyzed by micro-CT. Results Serum BMP2 and Smad4 levels in patients with senile osteoporotic fracture were significantly lower than those in normal controls (all P<0.01). BMP2 was highly positively correlated with Smad4 in patients with senile osteoporotic fracture (r=0.738). Compared with patients with low serum BMP2 and Smad4 levels, visual analog scale scores decreased, bone mineral density (BMD) increased, and duration of fracture healing was shortened in patients with high levels (all P<0.05). Compared with the Model group, serum BMP2 and Smad4 levels increased, fracture healing was improved, BMD, trabecular bone volume (TBV), tissue volume (TV), bone volume fraction (BV/TV), mean trabecular thickness (Tb. Th), and mean number of trabecular bone (Tb. N) were increased, and ALP activity increased in the BMP2 overexpression group (all P<0.05), while each index in the NC group showed no statistical difference relative to rats in the Model group (all P>0.05). Conclusions BMP2 overexpression can promote fracture healing and osteogenic ability in senile osteoporotic fractures through activating the BMP/Smad signaling pathway.
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Affiliation(s)
- De-Bao Liu
- Department of Orthopedics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Cong Sui
- Department of Orthopedics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Ting-Ting Wu
- Department of Anatomy, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lian-Zhong Wu
- Department of Anatomy, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - You-Yu Zhu
- Department of Anatomy, Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Zhen-Hua Ren
- Department of Anatomy, Anhui Medical University, Hefei, Anhui, China (mainland).,Cell Therapy Center, Xuanwu Hospital, Capital Medical University, Beijing, China (mainland)
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Segredo-Morales E, García-García P, Évora C, Delgado A. BMP delivery systems for bone regeneration: Healthy vs osteoporotic population. Review. J Drug Deliv Sci Technol 2017. [DOI: 10.1016/j.jddst.2017.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gracitelli MEC, Malavolta EA, Assunção JH, Ferreira Neto AA, Silva JS, Hernandez AJ. Locking intramedullary nails versus locking plates for the treatment of proximal humerus fractures. Expert Rev Med Devices 2017; 14:733-739. [PMID: 28792243 DOI: 10.1080/17434440.2017.1364624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Proximal humerus fractures (PHF) are common fractures and are the third most common type of fractures among older adults. The most commonly used implants include the locking plate and the locking intramedullary nail. Areas covered: The aim of this study is to perform a literature review of biomechanical and clinical studies that compare the locking plate and intramedullary nail for PHF osteosynthesis. Expert commentary: Twelve clinical studies and seven biomechanical studies were identified that met this criterion. The findings of this review showed that intramedullary nailing and locking plate fixation yielded similar functional results, but with contrasting complication rates. The biomechanical studies showed controversial results, with most of the studies demonstrating better biomechanical properties for the intramedullary nail. Different types of intramedullary nail for PHF have different characteristics, with curvilinear nails presenting a higher risk of complications.
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Affiliation(s)
- Mauro E C Gracitelli
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Eduardo A Malavolta
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Jorge H Assunção
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Arnaldo A Ferreira Neto
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Jorge S Silva
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
| | - Arnaldo José Hernandez
- a Department of Orthopedics and Traumatology, School of Medicine , University of São Paulo , Sao Paulo , Brazil
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Xu M, Xiang F, Li C, Xiaohereti S, Sheng J. [Surgical techniques and effectiveness of volar locking plates for senile delayed distal radius fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:785-789. [PMID: 29845802 DOI: 10.7507/1002-1892.201702039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the surgical technique and effectiveness of volar locking plates for senile delayed distal radius fractures. Methods Between October 2014 and September 2015, 25 cases of delayed distal radius fractures were treated by volar locking plates. There were 3 males and 22 females with an average age of 73 years (range, 65-87 years). Injury was caused by tumble in 19 cases and by traffic accident in 6 cases. All the cases had closed fracture. According to the AO classification, 10 cases were rated as type A2, 7 cases as type A3, 3 cases as type B3, and 5 cases as type C1. The manual reduction and plaster immobilization were performed in 18 cases first, but reduction failed; no treatment was given in 7 cases before surgery. The time from injury to surgery was from 33 to 126 days (mean, 61 days). Preoperatively, the volar tilting angle was (-16.0±3.1)°; the ulnar inclining angle was (10.8±7.0)°; the radial shortening was (11.2±3.6) mm; the wrist range of motion was (41.0±7.5)° in flexion and was (42.0±6.3)° in extension; and the grip strength was 33.0%±3.1% of normal side. Results All incisions healed primarily, and no postoperative complication occurred. The patients were followed up 1-1.5 years (mean, 1.3 years). The X-ray films showed that fracture union was achieved in all the patients, with the mean healing time of 9.2 weeks (range, 8-12 weeks); the displacement of the articular surface was less than 1 mm. At last follow-up, the volar tilting angle was (13.1±3.2)°; the ulnar inclining angle was (21.9±4.6)°; the radial shortening was (2.0±1.1) mm; the wrist range of motion was (52.0±11.7)° in flexion and was (65.0±4.8)° in extension; and the grip strength was 84.0%±4.2% of normal side; all showed significant difference when compared with preoperative ones ( P<0.05). According to the Gartland and Werley score, the results were excellent in 15 cases, good in 6 cases, fair in 2 cases, and poor in 2 cases at last follow-up; the excellent and good rate was 84%. Conclusion By the good design of the volar locking plate and the command of surgical techniques, good effectiveness can be achieved in the treatment of senile delayed distal radius fracture.
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Affiliation(s)
- Mingjian Xu
- Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Fuzhou Xiang
- Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Chunxiao Li
- Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Sulaiti Xiaohereti
- Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233, P.R.China
| | - Jiagen Sheng
- Department of Orthopedics, Sixth Affiliated Hospital of Shanghai Jiao Tong University, Shanghai, 200233,
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Abstract
Xenogeneic bone graft materials are an alternative to autologous bone grafting. Among such implants, coralline-derived bone grafts substitutes have a long track record as safe, biocompatible and osteoconductive graft materials. In this review, we present the available literature surrounding their use with special focus on the commercially available graft materials. Corals thanks to their chemical and structural characteristics similar to those of the human cancellous bone have shown great potential but clinical data presented to date is ambiguous with both positive and negative outcomes reported. Correct formulation and design of the graft to ensure adequate osteo-activity and resorption appear intrinsic to a successful outcome.
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Affiliation(s)
- Ippokratis Pountos
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, United Kingdom.
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Abstract
This manuscript will provide an overview of how the age and osteoporosis related changes in mechanical properties of bone affect the stability of osteosynthesis constructs, both from a mechanical as well as from a clinical perspective. The manuscript will also address some of the principles of fracture fixation for osteoporotic fractures and discuss applications of osteoporotic fracture fixation at sites typically affected by fragility fractures, namely the distal radius, the proximal humerus, the femur and the spine. The primary aim of operative treatment in elderly individuals is the avoidance of immobilization of the patient. In selected cases conservative treatment might be required. Generally, choice of treatment should be individualized and based on the evaluation of patient-specific, fracture-specific and surgeon-specific aspects. The orthopaedic surgeon plays an essential role in enabling functional recovery by providing good surgery but a multidisciplinary approach is essential in order to support the patient to regain his/her quality of life after fragility fracture. Overall, the therapy of fractures in osteoporotic bone in the elderly requires a multidisciplinary therapeutic acute care concept including treatment of co-morbidities and correct choice of timing, and technique of the operative intervention.
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Affiliation(s)
- Christian von Rüden
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical UniversitySalzburg, Austria
| | - Peter Augat
- Institute of Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical UniversitySalzburg, Austria.
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23
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Alt V, Cheung WH, Chow SKH, Thormann U, Cheung ENM, Lips KS, Schnettler R, Leung KS. Bone formation and degradation behavior of nanocrystalline hydroxyapatite with or without collagen-type 1 in osteoporotic bone defects - an experimental study in osteoporotic goats. Injury 2016; 47 Suppl 2:S58-65. [PMID: 27338229 DOI: 10.1016/s0020-1383(16)47010-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The intention of the current work is to assess new bone formation and degradation behavior of nanocrystalline hydroxyapatite with (HA/col-1) or without collagen-type I (HA) in osteoporotic metaphyseal bone defects in goats. After ovariectomy and special low-calcium diet for three months, 3 drill hole defects in the vertebrae of L3, L4, L5, 4 drill hole defects in the right and left iliac crest and 1 drill hole defect at the distal femur were created in three Chinese mountain goats with a total of 24 defects. The defects were either filled with one of the biomaterials or left empty (empty defect control group). After 42 days, the animals were euthanized and the samples were assessed for new bone formation using high-resolution peripheral quantitative computed tomography (HR-pQCT) and histomorphometry with 2 regions of interest. Detail histology, enzymehistochemistry and immunohistochemistry as well as connexin-43 in situ hybridization and transmission electron microscopy were carried out for evaluation of degradation behavior of the materials and cellular responses of the surrounding tissue in respect to the implants. HR-pQCT showed the highest BV/TV ratio (p = 0.008) and smallest trabecular spacing (p = 0.005) for HA compared to the other groups in the region of interest at the interface with 1mm distance to the initially created defect. The HA/col-1 yielded the highest connectivity density (Conn.D) (p = 0.034) and the highest number of trabeculae (Tb.N) (p = 0.002) compared to the HA and the control group. Histomorphometric analysis for the core region of the initially created defect revealed a statistically higher new bone formation in the HA (p = 0.001) and HA/col-1 group (p = 0.001) compared to the empty defect group including all defect sites. This result was confirmed for site specific analysis with significant higher new bone formation for the HA group for vertebral defects compared to the empty defect group (p = 0.029). For the interface region, no statistically significant differences were found between the three groups (p = 0.08). Histology revealed a good biocompatibility without inflammatory reaction for the HA- and HA/col-1 implants with a higher fragmentation of the HA-implant compared to the HA/col-1 biomaterial and formation of new bone in the region between the biomaterial fragments by osteoblasts. Fragmentation was shown by transmission electron microscopy to be caused by multinuclear osteoclast-like cells with degradation of the implant via intracellular incorporation of degraded implant material particles. In conclusion, both nanoparticulate HA with and without collagen type-1 showed better new bone formation compared to untreated drill hole defects in metaphyseal regions of this osteoporotic Chinese mountain goat model with good biocompatibility.
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Affiliation(s)
- Volker Alt
- Department of Trauma Surgery, University Hospital of Giessen-Marburg GmbH, Campus Giessen, 35385Giessen, Germany; Laboratory of Experimental Trauma Surgery Giessen, Justus-Liebig-University Giessen, 35394Giessen, Germany.
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon K H Chow
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ulrich Thormann
- Laboratory of Experimental Trauma Surgery Giessen, Justus-Liebig-University Giessen, 35394Giessen, Germany
| | - Edmond N M Cheung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Katrin S Lips
- Laboratory of Experimental Trauma Surgery Giessen, Justus-Liebig-University Giessen, 35394Giessen, Germany
| | - Reinhard Schnettler
- Department of Trauma Surgery, University Hospital of Giessen-Marburg GmbH, Campus Giessen, 35385Giessen, Germany; Laboratory of Experimental Trauma Surgery Giessen, Justus-Liebig-University Giessen, 35394Giessen, Germany
| | - Kwok-Sui Leung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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Konstantinidis L, Helwig P, Hirschmüller A, Langenmair E, Südkamp NP, Augat P. When is the stability of a fracture fixation limited by osteoporotic bone? Injury 2016; 47 Suppl 2:S27-32. [PMID: 27338223 DOI: 10.1016/s0020-1383(16)47005-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is concerned with the search for threshold values for bone quality beyond which the risk of fixation failure increased. For trochanteric fractures we recognized a BMD lower than 250mg/cm(3) as an additional risk for cut out. For medial femoral neck fractures since joint replacement surgery is available and produces excellent functional results, we see no indication for further differentiation or analysis of bone quality in relation to fracture fixation. In the area of osteoporotic vertebral body fractures, there are many experimental studies that try to identify BMD limits of screw fixation in the cancellous bone on the basis of QCT analysis. However, these values have not yet been introduced for application in clinical practice. In case of indication for surgical fixation, we favor minimally invasive, bisegmental, fourfold dorsal instrumentation with screw-augmentation for a T-value less than -2.0 SD (DXA analysis, total hip or total lumbar spine). For proximal humerus fractures, BMD value of 95mg/cm(3) could be seen as a threshold value below which the risk of failure rises markedly. In relation to osteoporotic distal radius fractures, based on our clinical experience and scientific analyses there are virtually no restrictions as far as bone quality is concerned on the application of palmar locking implants in the surgical management of distal radius fractures. Optimization of preoperative diagnostics might help to revise the treatment algorithm to take bone density into account, thus reducing the risk of failure and, at the same time, acquiring additional data for future reference.
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Affiliation(s)
- Lukas Konstantinidis
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106Freiburg, Germany
| | - Peter Helwig
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106Freiburg, Germany
| | - Anja Hirschmüller
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106Freiburg, Germany
| | - Elia Langenmair
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106Freiburg, Germany
| | - Norbert P Südkamp
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Freiburg, Hugstetterstr. 55, 79106Freiburg, Germany
| | - Peter Augat
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau & Paracelsus Medical University, Salzburg, Prof. Kuentscher Str. 8, 82418Murnau, Germany.
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