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Jyoti, Ghosh R. Printable functionally graded tibial implant for TAR: FE study comparing implant materials, FGM properties, and implant designs. Comput Biol Med 2024; 177:108645. [PMID: 38796883 DOI: 10.1016/j.compbiomed.2024.108645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
Tibial implants with functionally graded material (FGM) for total ankle replacement (TAR) can provide stiffness similar to the host tibia bone. The FGM implants with low stiffness reduce stress shielding but may increase implant-bone micromotion. A trade-off between stress shielding and implant-bone micromotion is required if FGMs are to substitute traditionally used Ti and CoCr metal implants. The FGM properties such as material gradation law and volume fraction index may influence the performance of FGM implants. Along with the FGM properties, the design of FGM implants may also have a role to play. The objective of this study was to examine FGM tibial implants for TAR, by comparing implant materials, FGM properties, and implant designs. For this purpose, finite element analysis (FEA) was conducted on 3D FE models of the intact and the implanted tibia bone. The tibial implants were composed of CoCr and Ti, besides them, the FGM of Ti and HA was developed. The FGM implants were modelled using exponential, power, and sigmoid laws. Additionally, for power and sigmoid laws, different volume fraction indices were taken. The effect of implant design was observed by using keel type and stem type TAR fixation designs. The results indicated that FGM implants are better than traditional metal implants. The power law is most suitable for developing FGM implants because it reduces stress shielding. For both power law and sigmoid law, low values of the volume fraction index are preferrable. Therefore, FGM implant developed using power law with 0.1 vol fraction index is ideal with the lowest stress shielding and marginally increased implant-bone micromotion. FGM implants are more useful for keel type fixation design than stem type design. To conclude, with FGMs the major complication of stress shielding can be solved and the longevity and durability of TAR implants can be enhanced.
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Affiliation(s)
- Jyoti
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Roy HS, Murugesan P, Kulkarni C, Arora M, Nagar GK, Guha R, Chattopadhyay N, Ghosh D. On-demand release of a selective MMP-13 blocker from an enzyme-responsive injectable hydrogel protects cartilage from degenerative progression in osteoarthritis. J Mater Chem B 2024; 12:5325-5338. [PMID: 38669084 DOI: 10.1039/d3tb02871b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
In osteoarthritis (OA), the degradation of cartilage is primarily driven by matrix metalloprotease-13 (MMP-13). Hence, the inhibition of MMP-13 has emerged as an attractive target for OA treatment. Among the various approaches that are being explored for MMP-13 regulation, blocking of the enzyme with specific binding molecules appears to be a more promising strategy for preventing cartilage degeneration. To enhance effectiveness and ensure patient compliance, it is preferable for the binding molecule to exhibit sustained activity when administered directly into the joint. Herein, we present an enzyme-responsive hydrogel that was designed to exhibit on-demand, the sustained release of BI-4394, a potent and highly selective MMP-13 blocker. The stable and compatible hydrogel was prepared using triglycerol monostearate. The efficacy of the hydrogel to prevent cartilage damage was assessed in a rat model of OA induced by anterior cruciate ligament transection (ACLT). The results revealed that in comparison to the rats administrated weekly with intra-articular BI-4394, the hydrogel implanted rats had reduced levels of inflammation and bone erosion. In comparison to untreated control, the cartilage in animals administered with BI-4394/hydrogel exhibited significant levels of collagen-2 and aggrecan along with reduced MMP-13. Overall, this study confirmed the potential of BI-4394 delivery using an enzyme-responsive hydrogel as a promising treatment option to treat the early stages of OA by preventing further cartilage degradation.
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Affiliation(s)
- Himadri Shekhar Roy
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali-140306, Punjab, India.
| | - Preethi Murugesan
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali-140306, Punjab, India.
| | - Chirag Kulkarni
- Division of Endocrinology and Centre for Research in ASTHI, CSIR-Central Drug Research Institute, Lucknow-226031, Uttar Pradesh, India
| | - Malika Arora
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali-140306, Punjab, India.
| | - Geet Kumar Nagar
- Division of Endocrinology and Centre for Research in ASTHI, CSIR-Central Drug Research Institute, Lucknow-226031, Uttar Pradesh, India
| | - Rajdeep Guha
- Division of Laboratory Animal Facility, CSIR-Central Drug Research Institute, Lucknow-226031, Uttar Pradesh, India
| | - Naibedya Chattopadhyay
- Division of Endocrinology and Centre for Research in ASTHI, CSIR-Central Drug Research Institute, Lucknow-226031, Uttar Pradesh, India
| | - Deepa Ghosh
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali-140306, Punjab, India.
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Lappalainen TA, Noponen NA, Kaarela OI, Klemola TM, Ohtonen PP, Leppilahti JI. Postoperative complications after displaced intra-articular calcaneal fracture operations. Foot Ankle Surg 2024; 30:319-324. [PMID: 38262786 DOI: 10.1016/j.fas.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND The objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group. METHODS A total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders's classification and improvement of Böhler's angle were analyzed. RESULTS Early complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler's angle. CONCLUSION Complication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF. LEVEL OF EVIDENCE IV retrospective cohort study at a single institution.
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Affiliation(s)
- Tuula A Lappalainen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland.
| | - Noora A Noponen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Outi I Kaarela
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Tero M Klemola
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Pasi P Ohtonen
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
| | - Juhana I Leppilahti
- Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, 90014 Oulu, Finland
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Nithyaprakash R, Shankar S, Naveenkumar R, Raja AJK, Anand RG, Abbas G, Prakash C, Pramanik A, Basak AK. Effect of Elevated Acetabular Cup on Contact and Failure Analysis in Hip Implants for Different Microseparations and Cup Inclinations Under Routine Gait Activities Using In Silico Approach. Indian J Orthop 2024; 58:705-715. [PMID: 38812869 PMCID: PMC11130114 DOI: 10.1007/s43465-024-01146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/29/2024] [Indexed: 05/31/2024]
Abstract
Objectives The acetabular cup design plays a critical role in reducing contact stress between femur head acetabular cup. Many studies used ellipsoidal and spheroidal geometry in acetabular cup design to effectively reduce contact stress. The present study focuses on elevated acetabular cup rim with round corner design to reduce contact stress with round corner geometry. Methods The cobalt chromium femur head and cup are considered for finite element (FE) model of hip resurfacing. The gait loads of routine activities of humans like normal walking, stair ascending and descending and sitting down and getting up gait activities are applied to the developed 3D FE model. Five microseparations of 0.5, 1, 1.5, 2 and 2.5 mm are considered in the present study. The acetabular cup inclination angle considered for this study are 35°, 45°, 55°, 65° and 75°. The contact stress and von Mises stress plot for each gait activities under these microseparations are analyzed for betterment of longevity of implants. Results Overall elevated cup rim design helped in reducing contact stress to a greater extent than conventional cup with different geometries. Also, the predicted von Mises stress for all the parameters considered in the current study are well within the yield strength of CoCr material. Therefore, elevated cup rim could be used as a better alternative to spline and, ellipsoidal and circular geometries of cup.
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Affiliation(s)
- R. Nithyaprakash
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - S. Shankar
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu India
- Chitkara Centre for Research and Development, Chitkara University, Himachal Pradesh, 174103 India
| | - R. Naveenkumar
- Department of Mechanical Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - A. J. Kirthik Raja
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - R. Gokul Anand
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - G. Abbas
- Department of Mechatronics Engineering, Kongu Engineering College, Erode, Tamil Nadu India
| | - Chander Prakash
- Pro-Vice Chancellor, Research & Development, Chitkara University, Chandigarh, Punjab India
| | - Alokesh Pramanik
- School of Civil and Mechanical Engineering, Curtin University, Bentley, WA Australia
| | - Animesh Kumar Basak
- Adelaide Microscopy, The University of Adelaide, Adelaide, SA 5005 Australia
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Minku, Mukherjee K, Ghosh R. Assessment of bone ingrowth around beaded coated tibial implant for total ankle replacement using mechanoregulatory algorithm. Comput Biol Med 2024; 175:108551. [PMID: 38703546 DOI: 10.1016/j.compbiomed.2024.108551] [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: 12/14/2023] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
The long-term performance of porous coated tibial implants for total ankle replacement (TAR) primarily depends on the extent of bone ingrowth at the bone-implant interface. Although attempts were made for primary fixation for immediate post-operative stability, no investigation was conducted on secondary fixation. The aim of this study is to assess bone ingrowth around the porous beaded coated tibial implant for TAR using a mechanoregulatory algorithm. A realistic macroscale finite element (FE) model of the implanted tibia was developed based on computer tomography (CT) data to assess implant-bone micromotions and coupled with microscale FE models of the implant-bone interface to predict bone ingrowth around tibial implant for TAR. The macroscale FE model was subjected to three near physiological loading conditions to evaluate the site-specific implant-bone micromotion, which were then incorporated into the corresponding microscale model to mimic the near physiological loading conditions. Results of the study demonstrated that the implant experienced tangential micromotion ranged from 0 to 71 μm with a mean of 3.871 μm. Tissue differentiation results revealed that bone ingrowth across the implant ranged from 44 to 96 %, with a mean of around 70 %. The average Young's modulus of the inter-bead tissue layer varied from 1444 to 4180 MPa around the different regions of the implant. The analysis postulates that when peak micromotion touches 30 μm around different regions of the implant, it leads to pronounced fibrous tissues on the implant surface. The highest amount of bone ingrowth was observed in the central regions, and poor bone ingrowth was seen in the anterior parts of the implant, which indicate improper osseointegration around this region. This macro-micro mechanical FE framework can be extended to improve the implant design to enhance the bone ingrowth and in future to develop porous lattice-structured implants to predict and enhance osseointegration around the implant.
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Affiliation(s)
- Minku
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India
| | - Kaushik Mukherjee
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, Hauz Khas, New Delhi, 110016, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Xu J, Zhou K, Gu H, Zhang Y, Wu L, Bian C, Huang Z, Chen G, Cheng X, Yin X. Exosome miR-4738-3p-mediated regulation of COL1A2 through the NF-κB and inflammation signaling pathway alleviates osteoarthritis low-grade inflammation symptoms. BIOMOLECULES & BIOMEDICINE 2024; 24:520-536. [PMID: 38059912 PMCID: PMC11088901 DOI: 10.17305/bb.2023.9921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 12/08/2023]
Abstract
This study aimed to elucidate the roles of microRNA (miR)-4738-3p and the collagen type I alpha 2 chain (COL1A2) gene in the pathogenesis of osteoarthritis (OA) through bioinformatics analysis and cellular assays. The GSE55235 dataset was analyzed using the weighted gene co-expression network analysis (WGCNA) method to identify gene modules associated with OA. Key overlapping genes were identified from these modules and the GSE55235-differential expressed genes (DEGs). The expression levels of selected genes were determined in C28/I2 cells using the quantitative real-time polymerase chain reaction (qRT-PCR). The interaction between miR-4738-3p and COL1A2 was examined in the context of interleukin 1 beta (IL-1β) induction. Exosome characterization was achieved through transmission electron microscopy (TEM), western blotting (WB), and other analyses. The study also investigated the functional relevance of miR-4738-3p in OA pathology through various molecular and cellular assays. Our findings revealed that the green module exhibited a strong correlation with the OA phenotype in the GSE55235 dataset, with COL1A2 emerging as a hub gene and miR-4738-3p as its key downstream target. IL-1β induction suggested that COL1A2 is involved in inflammation and apoptosis, while miR-4738-3p appeared to play an antagonistic role. The analysis of exosomes underscored the significance of miR-4738-3p in cellular communication, with an enhanced level of exo-miR-4738-3p antagonizing IL-1β-induced inflammation and promoting cell survival. Conversely, a reduction in exo-miR-4738-3p led to increased cell damage. This study established a clear regulatory relationship between miR-4738-3p and COL1A2, with the nuclear factor kappa B (NF-κB) signaling pathway playing a central role in this regulation. The miR-4738-3p significantly influences the OA-associated inflammation, primarily through modulation of COL1A2 and the NF-κB pathway. Therefore, targeting miR-4738-3p offers a potential therapeutic approach for OA, with exosome miR-4738-3p presenting a promising strategy.
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Affiliation(s)
- Jun Xu
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Kaifeng Zhou
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Huijie Gu
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Yiming Zhang
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Liang Wu
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Chong Bian
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Zhongyue Huang
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Guangnan Chen
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiangyang Cheng
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
| | - Xiaofan Yin
- Department of Orthopaedics, Minhang Hospital, Fudan University, Shanghai, China
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Jafari A, Khalatbary AR, Taghiloo S, Mirzaie MS, Nazar E, Poorhassan M, Akbari E, Asadzadeh M, Raoofi A, Nasiry D. Exosomes derived from human placental mesenchymal stem cells in combination with hyperbaric oxygen synergically alleviates spinal cord ischemia-reperfusion injury. Regen Ther 2023; 24:407-416. [PMID: 37727798 PMCID: PMC10506088 DOI: 10.1016/j.reth.2023.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
Spinal cord ischemia-reperfusion injury (IR) is a terrible non-traumatic injury that occurs after abdominal aortic occlusion and causes serious damage to neurological function. Several treatment strategies have been suggested for IR, but they were not unable to effectively improve these conditions. Herein we investigated whether exosomes derived from human placental mesenchymal stem cells (hpMSCs-Exos) in combination with hyperbaric oxygen (HBO) could alleviate injury and promote recovery in IR rats. Eighty male Sprague-Dawley rats were randomly allocated into five equal groups. In addition to the control group that only underwent laparotomy, IR animals were planned into four groups as follows: IR group; IR-Exos group; IR-HBO group; and IR-Exos + HBO group. Neurological function evaluated before, 6 h, 12 h, 24 h, and 48 h after injury. After the last neurological evaluation, tissue samples were obtained for stereological, biochemical, and molecular assessments. Our results indicated that the neurological function scores (MDI), the numerical density of neurons, the levels of antioxidative factors (GSH, SOD, and CAT), and anti-inflammatory cytokine (IL-10) were considerably greater in treatment groups than in the IR group, and these changes were more obvious in the IR-Exos + HBO ones. This is while the numerical density of glial cells, the levels of an oxidative factor (MDA) and inflammatory cytokines (IL-1β, TNF-α, and IL-18), as well as the expression of an apoptotic protein (caspase-3) were meaningfully decreased in treatment groups, especially IR-Exos + HBO group, compared to the IR group. Generally, it was found that co-administration of hpMSCs-Exos and HBO has synergistic neuroprotective effects in the rats undergoing IR.
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Affiliation(s)
- Aref Jafari
- Department of Pharmacology, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Reza Khalatbary
- Cellular and Molecular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeid Taghiloo
- Department of Immunology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohamad Sedigh Mirzaie
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eisa Nazar
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahnaz Poorhassan
- Department of Artificial Intelligence, Smart University of Medical Sciences, Tehran, Iran
| | - Esmaeil Akbari
- Department of Physiology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdiyeh Asadzadeh
- Department of Anatomical Sciences, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Raoofi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Davood Nasiry
- Department of Paramedicine, Amol School of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
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Sneed D, Wong C. Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes. PM R 2023; 15:1493-1506. [PMID: 36929699 DOI: 10.1002/pmrj.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.
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Affiliation(s)
- Dustin Sneed
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carmen Wong
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Didvar F, Ghaffari F, Shamsalinia A. Evaluating and Ranking the Factors Affecting the Acute Pain Management in Older Adults with Dementia after Hip Fracture Surgery: Second-Order Confirmatory Factor Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:751-757. [PMID: 38205413 PMCID: PMC10775869 DOI: 10.4103/ijnmr.ijnmr_386_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 01/12/2024]
Abstract
Background Even though nurses take various measures to decrease acute pain after surgery in older adults with dementia, it is unclear why most of them suffer from severe pain. This study aimed to evaluate the factors affecting acute pain management in older adults with dementia after hip fracture surgery. Materials and Methods This cross-sectional study used single-stage cluster and convenience sampling to select 330 nurses working in hospitals located in Western Mazandaran, Iran, in 2020. The demographic characteristic questionnaire and the Obstacles to Postoperative Pain Management in Dementia Scale (OPOPMDS) were used to collect data. Results The study results confirmed the modified model. The second-order Confirmatory Factor Analysis (CFA) indicated that the Critical Ratio (CR) for all three factors was more than 1.96, and the significance level was considered 0.05. Based on the values of standard coefficients, older people-related (β = 0.86, p < 0.001), system-related (β = 0.70, p < 0.001), and healthcare provider-related (β = 0.61, p < 0.001) factors had the highest impacts on the OPOPMD. Conclusions The study results suggested that older adult-related factors had the most significant impact on the OPOPMD.
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Jyoti, Ghosh R. The role of the depth of resection of the distal tibia on biomechanical performance of the tibial component for TAR: A finite element analysis with three implant designs. Med Eng Phys 2023; 119:104034. [PMID: 37634911 DOI: 10.1016/j.medengphy.2023.104034] [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: 04/28/2023] [Revised: 07/14/2023] [Accepted: 08/06/2023] [Indexed: 08/29/2023]
Abstract
The depth of resection of the tibia bone in total ankle replacement (TAR) may influence implant-bone micromotion and stress shielding. High implant-bone micromotion and stress-shielding lead to aseptic loosening of the tibial component for TAR. The aim was to improve the outcomes of the different designs of TAR (STAR, Mobility, and Salto) with the variation of the depth of resection of the distal tibia bone. Finite element (FE) models of the implanted tibia with the depth of resection varying from 6 mm to 16 mm and of the intact tibia was prepared. The value of micromotion increased as the depth of resection increased. The micromotion increased in the proximal anterior-posterior portion of the pegs for STAR, the posterior part of the stem for Mobility, and the proximal lateral portion of the keel for Salto with the increase in the depth of resection. Whereas, the stresses (von Mises) decreased in some regions and increased in some regions depending upon the implant design. But overall stresses decreased in the tibia bone. Furthermore, the mean stress shielding increased in all the designs as the depth of resection increased. This in silico study indicated that the depth of resection should be given more importance during TAR surgery. The ideal depth of resection should be minimum i.e., 6 mm based on this FE study.
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Affiliation(s)
- Jyoti
- School of Mechanical & Materials Engineering, Biomechanics Research Laboratory, Indian Institute of Technology Mandi, Kamand, Mandi, Himachal Pradesh 175075, India
| | - Rajesh Ghosh
- School of Mechanical & Materials Engineering, Biomechanics Research Laboratory, Indian Institute of Technology Mandi, Kamand, Mandi, Himachal Pradesh 175075, India.
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Hayes DS, Cush C, El Koussaify J, Manzar S, Klena JC, Grandizio LC. Defining Nonunion for Metacarpal Fractures: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:677-681. [PMID: 37790820 PMCID: PMC10543803 DOI: 10.1016/j.jhsg.2023.04.014] [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: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Our purpose was to assess how nonunion of the metacarpals has been defined in prior investigations with respect to both clinical and radiographic criteria. We hypothesized that the definitions of nonunion would be highly variable. Methods A systematic review was conducted using MEDLINE and Embase databases for clinical articles related to the treatment of metacarpal fractures (surgical and nonsurgical) from 2010 to 2021. Included articles were searched to assess how nonunion was defined based on clinical and radiographic criteria. We assessed the treatment type, method of union assessment, time to union, and incidence of union as well as article factors such as the following: date of publication, level of evidence, and publishing journal. Results A total of 641 articles were identified, of which 102 were included for a definition of nonunion and 97 were included for the assessment of clinical management and outcomes. Of the included articles, 62% contained level IV evidence. A definition of nonunion was provided in 47% of the articles. Radiographic criteria alone, clinical criteria alone, or a combination of the 2 was used in 22%, 6%, and 19% of the cases, respectively, to define nonunion. The most common definition of nonunion was presence of fracture-site tenderness (with no time defined) in 20 articles (20%), followed by lack of radiographic healing at 6 months (15%). In the 97 included articles, the total number of fracture cases was 4,435 and nonunion was reported in 0.45%. Cases with nonunion were reported in a total of six articles that used a variety of treatment modalities. Conclusions The definition of metacarpal nonunion remains highly variable and lacks standardization with respect to clinical and radiographic criteria. Clinical relevance Standardizing the definition of nonunion for metacarpal fractures would allow for more accurate assessments of the incidence of this complication and may aid in improving diagnostic and management strategies.
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Affiliation(s)
- Daniel S. Hayes
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
| | - Coleman Cush
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
| | - Jad El Koussaify
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
| | - Shahid Manzar
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
| | - Joel C. Klena
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
| | - Louis C. Grandizio
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Geisinger Musculoskeletal Institute, Danville, PA
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12
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Shen J, Nemani VM, Leveque JC, Sethi R. Personalized Medicine in Orthopaedic Surgery: The Case of Spine Surgery. J Am Acad Orthop Surg 2023; 31:901-907. [PMID: 37040614 DOI: 10.5435/jaaos-d-22-00789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/01/2023] [Indexed: 04/13/2023] Open
Abstract
Personalized medicine has made a tremendous impact on patient care. Although initially, it revolutionized pharmaceutical development and targeted therapies in oncology, it has also made an important impact in orthopaedic surgery. The field of spine surgery highlights the effect of personalized medicine because the improved understanding of spinal pathologies and technological innovations has made personalized medicine a key component of patient care. There is evidence for several of these advancements to support their usage in improving patient care. Proper understanding of normative spinal alignment and surgical planning software has enabled surgeons to predict postoperative alignment accurately. Furthermore, 3D printing technologies have demonstrated the ability to improve pedicle screw placement accuracy compared with free-hand techniques. Patient-specific, precontoured rods have shown improved biomechanical properties, which reduces the risk of postoperative rod fractures. Moreover, approaches such as multidisciplinary evaluations tailored to specific patient needs have demonstrated the ability to decrease complications. Personalized medicine has shown the ability to improve care in all phases of surgical management, and several of these approaches are now readily available to orthopaedic surgeons.
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Affiliation(s)
- Jesse Shen
- From the Department of Orthopedic Surgery, Université de Montréal (Shen), the Virginia Mason Medical Center (Nemani, Leveque, and Sethi), University of Washington (Sethi)
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13
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Liang W, Zhou C, Zhang H, Bai J, Jiang B, Jiang C, Ming W, Zhang H, Long H, Huang X, Zhao J. Recent advances in 3D printing of biodegradable metals for orthopaedic applications. J Biol Eng 2023; 17:56. [PMID: 37644461 PMCID: PMC10466721 DOI: 10.1186/s13036-023-00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
The use of biodegradable polymers for treating bone-related diseases has become a focal point in the field of biomedicine. Recent advancements in material technology have expanded the range of materials suitable for orthopaedic implants. Three-dimensional (3D) printing technology has become prevalent in healthcare, and while organ printing is still in its early stages and faces ethical and technical hurdles, 3D printing is capable of creating 3D structures that are supportive and controllable. The technique has shown promise in fields such as tissue engineering and regenerative medicine, and new innovations in cell and bio-printing and printing materials have expanded its possibilities. In clinical settings, 3D printing of biodegradable metals is mainly used in orthopedics and stomatology. 3D-printed patient-specific osteotomy instruments, orthopedic implants, and dental implants have been approved by the US FDA for clinical use. Metals are often used to provide support for hard tissue and prevent complications. Currently, 70-80% of clinically used implants are made from niobium, tantalum, nitinol, titanium alloys, cobalt-chromium alloys, and stainless steels. However, there has been increasing interest in biodegradable metals such as magnesium, calcium, zinc, and iron, with numerous recent findings. The advantages of 3D printing, such as low manufacturing costs, complex geometry capabilities, and short fabrication periods, have led to widespread adoption in academia and industry. 3D printing of metals with controllable structures represents a cutting-edge technology for developing metallic implants for biomedical applications. This review explores existing biomaterials used in 3D printing-based orthopedics as well as biodegradable metals and their applications in developing metallic medical implants and devices. The challenges and future directions of this technology are also discussed.
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Grants
- (LGF22H060023 to WQL) Public Technology Applied Research Projects of Zhejiang Province
- (2022KY433 to WQL, 2023KY1303 to HGL) Medical and Health Research Project of Zhejiang Province
- (2022KY433 to WQL, 2023KY1303 to HGL) Medical and Health Research Project of Zhejiang Province
- (2021FSYYZY45 to WQL) Research Fund Projects of The Affiliated Hospital of Zhejiang Chinese Medicine University
- (2022C31034 to CZ, 2023C31019 to HJZ) Science and Technology Project of Zhoushan
- (2022C31034 to CZ, 2023C31019 to HJZ) Science and Technology Project of Zhoushan
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
- (2022ZB380 to JYZ, 2023016295 to WYM, 2023007231 to CYJ ) Traditional Chinese Medicine Science and Technology Projects of Zhejiang Province
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Affiliation(s)
- Wenqing Liang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, 316000 China
| | - Hongwei Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Juqin Bai
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Bo Jiang
- Rehabilitation Department, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Zhoushan, 316000 China
| | - Chanyi Jiang
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Zhoushan, 316000 Zhejiang Province P.R. China
| | - Wenyi Ming
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Hengjian Zhang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Hengguo Long
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Xiaogang Huang
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
| | - Jiayi Zhao
- Department of Orthopaedics, Zhoushan Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, 355 Xinqiao Road, Dinghai District, Zhoushan, 316000 Zhejiang Province China
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14
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Iliopoulos E, Makiev K, Georgoulas P, Vordos N, Ververidis A, Tilkeridis K. The use of 3D printing technology in limb reconstruction. Inspirations and challenges. Trauma Case Rep 2023; 46:100848. [PMID: 37228849 PMCID: PMC10203763 DOI: 10.1016/j.tcr.2023.100848] [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] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
The management of septic non-unions with associated bone necrosis is challenging, especially when the resulting bone defect after the debridement is extensile. Different techniques have been described in the literature for the treatment of these demanding cases, with the most prominent being free vascularized Fibular graft and bone transport with distraction osteogenesis principles. Recently, 3D printing technology has been increasingly utilized in many complex orthopaedic pathologies. However, the application of those advancements regarding septic non-unions with residual bone defect has not been previously studied. This study presents a novel 3D printing technique for the management of an infected critical bone deficit of the tibia. Queries, challenges and future perspectives concerning the recruiting of 3D printing technology in limb reconstruction are also being discussed. Clinical Evidence Level: IV.
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Affiliation(s)
- Efthymios Iliopoulos
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Makiev
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Paraskevas Georgoulas
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Nick Vordos
- Biophysics Laboratory, Physics Department, International Hellenic University, Kavala, Greece
| | - Athanasios Ververidis
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
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15
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Ge Z, Li W, Zhao R, Xiong W, Wang D, Tang Y, Fang Q, Deng X, Zhang Z, Zhou Y, Chen X, Li Y, Lu Y, Wang C, Wang G. Programmable DNA Hydrogel Provides Suitable Microenvironment for Enhancing TSPCS Therapy in Healing of Tendinopathy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2207231. [PMID: 37066733 DOI: 10.1002/smll.202207231] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/17/2023] [Indexed: 06/19/2023]
Abstract
Tendon stem/progenitor cells (TSPCs) therapy is a promising strategy for enhancing cell matrix and collagen synthesis, and regulating the metabolism of the tendon microenvironment during tendon injury repair. Nevertheless, the barren microenvironment and gliding shear of tendon cause insufficient nutrition supply, damage, and aggregation of injected TSPCs around tendon tissues, which severely hinders their clinical application in tendinopathy. In this study, a TSPCs delivery system is developed by encapsulating TSPCs within a DNA hydrogel (TSPCs-Gel) as the DNA hydrogel offers an excellent artificial extracellular matrix (ECM) microenvironment by providing nutrition for proliferation and protection against shear forces. This delivery method restricts TSPCs to the tendons, significantly extending their retention time. It is also found that TSPCs-Gel injections can promote the healing of rat tendinopathy in vivo, where cross-sectional area and load to failure of injured tendons in rats are significantly improved compared to the free TSPCs treatment group at 8 weeks. Furthermore, the potential healing mechanism of TSPCs-Gel is investigated by RNA-sequencing to identify a series of potential gene and signaling pathway targets for further clinical treatment strategies. These findings suggest the potential pathways of using DNA hydrogels as artificial ECMs to promote cell proliferation and protect TSPCs in TSPC therapy.
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Affiliation(s)
- Zilu Ge
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Li
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Renliang Zhao
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Xiong
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Dong Wang
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yunfeng Tang
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qian Fang
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiangtian Deng
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhen Zhang
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yaojia Zhou
- Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoting Chen
- Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yue Li
- Core Facility of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yanrong Lu
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chengshi Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guanglin Wang
- Trauma Medical Center, Department of Orthopaedic surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
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16
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Mullins RA, Espinel Ruperéz J, Bleedorn J, Hoey S, Hetzel S, Ortega C, Kraus KH, Guevar J. Accuracy of pin placement in the canine thoracolumbar spine using a free-hand probing technique versus 3D-printed patient-specific drill guides: An ex-vivo study. Vet Surg 2023; 52:648-660. [PMID: 37071824 DOI: 10.1111/vsu.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To compare pin placement accuracy, intraoperative technique deviations, and duration of pin placement for pins placed by free-hand probing (FHP) or 3D-printed drill guide (3DPG) technique. SAMPLE POPULATION Four greyhound cadavers. METHODS Computed tomography (CT) examinations from T6-sacrum were obtained for determination of optimal pin placement and 3DPG creation. Two 3.2/2.4-mm positive profile pins were inserted per vertebra, one left and one right from T7-L7 (FHP [n = 56]; 3DPG [n = 56]) by one surgeon and removed for repeat CT. Duration of pin placement and intraoperative deviations (unanticipated deviations from planned technique) were recorded. Pin tracts were graded by two blinded observers using modified Zdichavsky classification. Descriptive statistics were used. RESULTS A total of 54/56 pins placed with 3DPGs were assigned grade I (optimal placement) compared with 49/56 pins using the FHP technique. A total of 2/56 pins placed with 3DPGs and 3/56 pins using the FHP technique were assigned grade IIa (partial medial violation). A total of 4/56 pins placed using the FHP technique were assigned grade IIIa (partial lateral violation). No pins were assigned grade IIb (full medial violation). Intraoperative technique deviations occurred with 6/56 pins placed using the FHP technique and no pins with 3DPGs. Overall, pins were placed faster (mean ± SD 2.6 [1.3] vs. 4.5 [1.8] min) with 3DPGs. CONCLUSIONS Both techniques were accurate for placement of spinal fixation pins. The 3DPG technique may decrease intraoperative deviations and duration of pin placement. CLINICAL RELEVANCE Both techniques allow accurate pin placement in the canine thoracolumbar spine. The FHP technique requires specific training and has learning curve, whereas 3DPG technique requires specific software and 3D printers.
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Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Jorge Espinel Ruperéz
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Jason Bleedorn
- Department of Veterinary Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Seamus Hoey
- Equine Clinical Studies, Diagnostic Imaging and Anaesthesia, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Scott Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Cristina Ortega
- Section of Small Animal Clinical Studies, University College Dublin, Dublin, Ireland
| | - Karl H Kraus
- Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Iowa, USA
| | - Julien Guevar
- Division of Surgery, Department of Clinical Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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17
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Alshaikh NA. COVID-19 associated coagulopathy: A bibliometric investigation. Heliyon 2023; 9:e16507. [PMID: 37274678 PMCID: PMC10211255 DOI: 10.1016/j.heliyon.2023.e16507] [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: 01/10/2023] [Revised: 05/01/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023] Open
Abstract
Infection with SARS-CoV-2 initiates an immune-hemostatic response. While both systems are intimately connected and necessary for an efficient immune response to contain the infection, excessive coagulation activation might exceed the valuable benefits by causing thrombotic consequences and excessive inflammation. This biological response is new to clinicians and researchers, and accordingly, tremendous studies have been conducted on coagulopathy and its relationship to COVID-19 disease during this pandemic. Therefore, it takes a research insight from a bibliometric perspective to determine research hotspots and trends of COVID-19 associated coagulopathy (C19-CA). The analysis relies on the Scopus database for bibliographic content and Visualization of Similarities viewer software to map bibliometric data of C19-CA. Our study finds the most eminent authors, journals, institutions, funding organizations, and countries that publish in the C19-CA. Additionally; this research employs bibliometric analysis of co-authorship, co-citations, bibliographic coupling, and co-occurrence of keywords. A total of 2242 studies were retrieved, and the number of annual publications of C19-CA showed remarkable growth. The top-publishing authors on C19-CA are Smadja, D.M., Diehl, J.L., and Gendron, N (France). The total number of articles published in English in these three years was 1241, with the original article accounting for 99.8% and conference papers accounting for 0.2%. Huazhong University of Science and Technology (China) is the top-productive institution, with the US being the top-publishing country. Journal of Thrombosis and Thrombolysis received the highest number of original articles. The research results were mainly published in the fields of Medicine, Biochemistry, Genetics, and Molecular Biology, Immunology and Microbiology. Yuanyuan Li, who is (China), is the top-collaborating author. China and its authors have the highest number of citations. Keywords' co-occurrence analyses of the authors and all keywords revealed the following themes in C19-CA; abnormal coagulation parameters, pulmonary coagulopathy, venous and arterial thrombotic disorders, distinct features of coagulopathy, inflammation, and thrombosis in COVID-19, and anticoagulants and thrombolytic therapies. By combining bibliometric analysis with VOSviewer software, we identified C19-CA's leaders, collaborating institutions, and research hotspots, as well as give references for future research paths.
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Affiliation(s)
- Nahla A Alshaikh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
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18
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Shokouhi G, Iranmehr A, Ghoilpour P, Fattahi MR, Mousavi ST, Bitaraf MA, Sarpoolaki MK. Indirect Spinal Canal Decompression Using Ligamentotaxis Compared With Direct Posterior Canal Decompression in Thoracolumbar Burst Fractures: A Prospective Randomized Study. Med J Islam Repub Iran 2023; 37:59. [PMID: 37457417 PMCID: PMC10349365 DOI: 10.47176/mjiri.37.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Indexed: 07/18/2023] Open
Abstract
Background There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements. Methods A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance. Results Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040). Conclusion Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.
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Affiliation(s)
- Ghaffar Shokouhi
- Department of Neurosurgery, Tabriz University of Medical Sciences,
Tabriz, Iran
| | - Arad Iranmehr
- Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC),
Tehran University of Medical Sciences, Tehran, Iran
| | - Peyman Ghoilpour
- Department of Neurosurgery, Tabriz University of Medical Sciences,
Tabriz, Iran
| | | | - Seyed Taher Mousavi
- Department of Neurosurgery, Tabriz University of Medical Sciences,
Tabriz, Iran
| | - Mohammad Ali Bitaraf
- Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC),
Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kazem Sarpoolaki
- Neurological Surgery Department, Imam Khomeini Hospital Complex (IKHC),
Tehran University of Medical Sciences, Tehran, Iran
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19
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Lu C, Ma L, Wang X, Yao Q, Zhang C, Du Y, Li W, Jian F. Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis. J Neurol Surg A Cent Eur Neurosurg 2023; 84:188-197. [PMID: 36070792 DOI: 10.1055/a-1938-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND There is a lack of attention to screw placement techniques for surgical treatment of scoliosis in children and adolescents. This meta-analysis aims to compare the accuracy and safety of pedicle screw placement between the 3D-printed navigation template technique and the freehand technique during corrective surgery for scoliosis in children and adolescents. METHODS A comprehensive search was conducted for relevant articles up to December 2021 in databases including PubMed, Embase, MEDLINE, Cochrane, and Web of Science. The systematic meta-analysis compared the efficacy of pedicle screw placement between the two techniques, including accuracy of pedicle screw placement, complication rate, operation time, blood loss, mean placement time per screw, and mean times for fluoroscopy. RESULTS The seven articles analyzed in this study involved 229 patients altogether. A total of 2,805 pedicle screws were placed by the two methods. Our results revealed that the 3D-printed guide template technique was more accurate than the freehand technique in pedicle screw placement (odds ratio [OR] =2.96; 95% confidence interval [CI]: 2.24-3.91; p < 0.000) with a lower complication rate (OR = 0.21; 95% CI: 0.06-0.78; p = 0.02). The operation time (mean difference [MD] = -34.37; 95% CI: -67.47 to -1.28; p = 0.04) and mean placement time per screw (MD = -3.11; 95% CI: -6.13 to -0.09; p = 0.04) and mean times for fluoroscopy (MD = -6.60; 95% CI: -8.66 to -4.55; p < 0.000) significantly decreased among patients in the 3D-printed navigation template group compared with those in the freehand technique group. In addition, the two techniques had no significant statistical difference in blood loss. CONCLUSIONS Compared with the traditional freehand technique, the 3D-printed guide template is a promising technique with higher accuracy and safety in screw placement for surgical treatment of scoliosis in children and adolescents, and is worth popularizing and validating through more prospective clinical studies.
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Affiliation(s)
- Chunli Lu
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Longbing Ma
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Xinyu Wang
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Qingyu Yao
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Can Zhang
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Yueqi Du
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Wei Li
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Fengzeng Jian
- Division of Spine, Department of Neurosurgery, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China.,Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China.,Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Capital Medical University, Xuanwu Hospital, Beijing, China
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20
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Cutler CB, King P, Khan M, Olowofela B, Lucke-Wold B. Innovation in Neurosurgery: Lessons Learned, Obstacles, and Potential Funding Sources. NEURONS AND NEUROLOGICAL DISORDERS 2022; 1:003. [PMID: 36848305 PMCID: PMC9956204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Innovation is central to neurosurgery and has dramatically increased over the last twenty years. Although the specialty innovates as a whole, only 3-4.7% of practicing neurosurgeons hold patents. Various roadblocks to innovation impede this process such as lack of understanding, increasing regulatory complexity, and lack of funding. Newly emerging technologies allow us to understand how to innovate and how to learn from other medical specialties. By further understanding the process of innovation, and the funding that supports it, Neurosurgery can continue to hold innovation as one of its's central tenets.
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Affiliation(s)
| | - Patrick King
- Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | - Majid Khan
- University of Nevada, Reno School of Medicine, Reno, NV, USA
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Fu J, Cai X, Ouyang H, Gong C, Huang Y. Efficacy of electroacupuncture in assisting postoperative healing of distal radius fractures: study protocol for a randomized controlled trial. J Orthop Surg Res 2022; 17:517. [PMID: 36456969 PMCID: PMC9713955 DOI: 10.1186/s13018-022-03415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Manual reduction and surgical treatment are common methods for distal radius fractures (DRFs). The existing literature suggests that postoperative combined rehabilitation treatment and medication are effective for the healing of DRFs. However, the side effects of these treatments remain to be solved. Previous studies have shown that electroacupuncture (EA) can effectively relieve wrist swelling and improve the joint function in patients with DRFs, but more evidence is needed to prove the effectiveness of EA. This trial aims to explore the efficiency and feasibility of combined EA treatment in postoperative treatment of DRFs compared with routine treatment. METHODS This is a parallel randomized controlled trial. A total of 222 patients diagnosed with moderate DRFs will be recruited and randomly assigned to an EA group or a routine treatment group at a ratio of 1:1. Routine treatment group will receive medication and rehabilitation. Yangxi (LI 5), Yangchi (TE 4), Yanggu (SI 5), Hegu (LI 4), and Taiyuan (LU 9) will be selected in the EA group for intervention three times a week on the basis of routine treatment. Both groups will receive 8 weeks of treatment and 4 weeks of follow-up. The primary outcome will be ulnar positive variance. The secondary outcomes will include radiographic healing rate, bone strength, hemorheological indices, serum biochemical indicators and inflammatory factors, grip strength, wrist swelling score, patient-rated wrist evaluation, disabilities of arm, shoulder and hand, and visual analogue scale. Outcomes will be evaluated at baseline, postoperative 3rd day, 2nd, 4th, 6th, 8th, and 12th weeks. DISCUSSION The results of this study will help establish a more optimized scheme to treat patients with DRFs. Trial registration Chinese Clinical Trial Registry ChiCTR2200062857. Registered on 21 August 2022, www.chictr.org.cn/com/25/showproj.aspx?proj=175567 .
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Affiliation(s)
- Jiani Fu
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Xiaowen Cai
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Huailiang Ouyang
- grid.417404.20000 0004 1771 3058Department of Traditional Chinese Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Chunzhu Gong
- grid.470230.2Department of Orthopedics, Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), Shenzhen, China
| | - Yong Huang
- grid.284723.80000 0000 8877 7471School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
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22
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Saeidi M, Barnes SC, Berthaume MA, Holthof SR, Milandri GS, Bull AMJ, Jeffers J. Low-cost locally manufacturable unilateral imperial external fixator for low- and middle-income countries. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:1004976. [PMID: 36530549 PMCID: PMC9753939 DOI: 10.3389/fmedt.2022.1004976] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/07/2022] [Indexed: 03/19/2024] Open
Abstract
Treating open fractures in long bones can be challenging and if not performed properly can lead to poor outcomes such as mal/non-union, deformity, and amputation. One of the most common methods of treating these fracture types is temporary external fixation followed by definitive fixation. The shortage of high-quality affordable external fixators is a long-recognised need, particularly in Low- and Middle-Income Countries (LMICs). This research aimed to develop a low-cost device that can be manufactured locally to international standards. This can provide surge capacity for conflict zones or in response to unpredictable incidents and situations. The fixator presented here and developed by us, the Imperial external fixator, was tested on femur and tibia specimens under 100 cycles of 100 N compression-tension and the results were compared with those of the Stryker Hoffmann 3 frame. The Imperial device was stiffer than the Stryker Hoffmann 3 with a lower median interfragmentary motion (of 0.94 vs. 1.48 mm). The low-cost, easy to use, relatively lightweight, and easy to manufacture (since minimum skillset and basic workshop equipment and materials are needed) device can address a critical shortage and need in LMICs particularly in conflict-affected regions with unpredictable demand and supply. The device is currently being piloted in three countries for road traffic accidents, gunshot wounds and other conflict trauma-including blast cohorts.
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Affiliation(s)
- Mehdi Saeidi
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Spencer C. Barnes
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | | | - Sander R. Holthof
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | | | - Anthony M. J. Bull
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Jonathan Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
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23
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Kurapaty SS, Hsu WK. Sex-Based Difference in Bone Healing: A Review of Recent Pre-clinical Literature. Curr Rev Musculoskelet Med 2022; 15:651-658. [PMID: 36378466 PMCID: PMC9789279 DOI: 10.1007/s12178-022-09803-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Recent literature has sought to understand differences in fusion failure, specifically considering how patient sex may play a role. Overall, there exists inconclusive data regarding any sex-based differences in bone healing. RECENT FINDINGS In vitro studies examining the roles of sex hormones, 5-LO, IGF-1, VEGF, osteoclasts, and OPCs seem to show sexually dimorphic actions. Additionally, donor characteristics and stem cell environment seem to also determine osteogenic potential. Building on this biomolecular basis, in vivo work investigates the aforementioned elements. Broadly, males tend to have a more robust healing compared to females. Taking these findings together, differences in sex hormones levels, their timing and action, and composition of the inflammatory milieu underlie variations in bone healing by sex. Clinically, a robust understanding of bone healing mechanics can inform care of the transgender patient. Transgender patients undergoing hormone therapy present a clinically nuanced scenario for which limited long-term data exist. Such advances would help inform treatment for sports-related injury due to hormonal changes in biomechanics and treatment of transgender youth. While recent advances provide more clarity, conclusive answers remain elusive.
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Affiliation(s)
- Steven S. Kurapaty
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 6061 USA ,Simpson Querrey Institute, Center for Regenerative Nanomedicine, Northwestern University, Chicago, IL USA
| | - Wellington K. Hsu
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL 6061 USA ,Simpson Querrey Institute, Center for Regenerative Nanomedicine, Northwestern University, Chicago, IL USA
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24
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Singh R, Singh R, Baby B, Suri A. Effect of the Segmentation Threshold on Computed Tomography-Based Reconstruction of Skull Bones with Reference Optical Three-Dimensional Scanning. World Neurosurg 2022; 166:e34-e43. [PMID: 35718274 DOI: 10.1016/j.wneu.2022.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND A variety of applications related to neurosurgical procedures, education, and training require accurate reconstruction of the involved structures from the medical images such as computed tomography (CT). This study evaluates the quality of CT-based reconstruction of dry skull bones for advanced neurosurgical applications. The accuracy and precision of these models were examined with reference optical scanning. METHODS Three consecutive CT and optical scans of different skull bones were acquired and used to develop three-dimensional models. The accuracy of three-dimensional models was examined by manual inspection of the defined anatomical landmarks of the skull. Reproducibility was examined by deviation analysis of the models developed from repeated CT and optical scans. RESULTS Precision was excellent in both the techniques with less than 0.1 mm deviation error. On the interscan evaluation of the CT versus optical scan model, deviations of more than 0.1 mm were observed in 16 out of 21 instances. CT reconstruction using standard segmentation algorithms results in missing bone portions while using the default bone segmentation threshold. The segmentation threshold was varied to construct missing bone regions, and its effect on the iso-surface generation was evaluated. The threshold variation led to increased mean deviations of surfaces up to 0.6 mm. CONCLUSIONS The study reveals that bone structure, complexity, and segmentation threshold lead to CT reconstruction variability. The trade-off between the desirable model and accepted mean deviation should be considered as per traits of the desired application.
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Affiliation(s)
- Ramandeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajdeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India; Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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25
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Aili A, Ma Y, Sui J, Dai J, Zhu X, Muheremu A. Application of 3D printed models in the surgical treatment of spinal deformity. Am J Transl Res 2022; 14:6341-6348. [PMID: 36247257 PMCID: PMC9556452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 07/25/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To test if preoperative planning with 3 dimensional (3D)-printed spine models can increase the effectiveness and safety of spinal deformity surgery. METHODS A total of 53 patients who were treated in our center for spinal deformities from January 2010 to January 2018 were included in the current study. They were divided into two groups based on whether 3D-printed models were used in the surgical planning. A total of 28 patients who were treated with 3D-printed models were assigned to the experimental group, and 25 patients who were treated with conventional methods were assigned to the control group. Duration of surgery, intraoperative hemorrhage, incidence of surgery related complications, Oswestry disability index (ODI), visual analogue scale (VAS), and Cobb's angle were compared between the two groups before and after surgery. RESULTS There were significant differences in the duration of surgery, intraoperative hemorrhage and intraoperative x-ray exposure between the two groups (P<0.01). Cobb's angle was smaller in the experimental group than in the control group when measured three days and a year after surgery (P<0.01). Although there was no significant difference between the experimental and control groups (P>0.05), Oswestry disability index and VAS pain scores were lower a month and a year after the surgery than before the surgery (P<0.01). CONCLUSION Surgical planning using 3D-printed spine models can decrease the operation time, intraoperative hemorrhage, and x-ray exposure, and help achieve satisfactory structural restoration in patients with severe spinal deformity.
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Affiliation(s)
- Abudunaibi Aili
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Yuan Ma
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jiangtao Sui
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Jie Dai
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Xu Zhu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
- Xinjiang Institute of Spine SurgeryUrumqi 86830001, Xinjiang, China
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical UniversityUrumqi 86830001, Xinjiang, China
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Veronese N, Cooper C, Bruyère O, Al-Daghri NM, Branco J, Cavalier E, Cheleschi S, da Silva Rosa MC, Conaghan PG, Dennison EM, de Wit M, Fioravanti A, Fuggle NR, Haugen IK, Herrero-Beaumont G, Honvo G, Laslop A, Matijevic R, Migliore A, Mobasheri A, Pelletier JP, Prieto Yerro MC, Radermecker RP, Rannou F, Rizzoli R, Reginster JY. Multimodal Multidisciplinary Management of Patients with Moderate to Severe Pain in Knee Osteoarthritis: A Need to Meet Patient Expectations. Drugs 2022; 82:1347-1355. [PMID: 36112341 PMCID: PMC9512723 DOI: 10.1007/s40265-022-01773-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/17/2022]
Abstract
Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.
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Affiliation(s)
- Nicola Veronese
- Geriatrics Section, Department of Internal Medicine and Geriatrics, University of Palermo, via del Vespro, 141, 90127, Palermo, Italy.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Jaime Branco
- Department of Rheumatology, CHRC, NOVA Medical School, CHLO, EPE, Hospital Egas Moniz, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Bât B35, 4000, Liège, Belgium
| | - Sara Cheleschi
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Maarten de Wit
- Chair EULAR Study Group for Collaborative Research, Amsterdam, The Netherlands
| | - Antonella Fioravanti
- Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Nicholas R Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gabriel Herrero-Beaumont
- Head of Rheumatology Department, Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, 28040, Madrid, Spain
| | - Germain Honvo
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - Andrea Laslop
- Scientific Office, Austrian Medicines and Medical Devices Agency, Federal Office for Safety in Health Care, Vienna, Austria
| | - Radmila Matijevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinic for Orthopedic Surgery, Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Alberto Migliore
- Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Ali Mobasheri
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, LT-08406, Vilnius, Lithuania
- Departments of Orthopedics, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
- Departments of Rheumatology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
- Departments of Clinical Immunology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, FI-90014, Oulu, Finland
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM) and Arthritis Division, University of Montreal Hospital Centre (CHUM), Montreal, Canada
| | | | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM U1124, Paris, France
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
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Wang SK, Wang P, Li XY, Kong C, Niu JY, Lu SB. Incidence and risk factors for early and late reoperation following lumbar fusion surgery. J Orthop Surg Res 2022; 17:385. [PMID: 35962390 PMCID: PMC9373505 DOI: 10.1186/s13018-022-03273-4] [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: 05/20/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE The aim of our study was to determine the rates and indications of reoperations following primary lumbar fusion, as well as the independent risk factors for early and late reoperation. METHODS We retrospectively reviewed patients who underwent lumbar fusion surgery between January 2017 and March 2020. All patients were followed up for more than 2 years. Characteristics, laboratory tests, primary diagnosis and surgery-related variables were compared among the early reoperation (< 3 months), the late reoperation (> 3 months) and the non-reoperation groups. Multivariable logistic regression analysis was used to identify independent risk factors for early and late reoperations. RESULTS Of 821 patients included in our studies, 34 patients underwent early reoperation, and 36 patients underwent late reoperation. The cumulative reoperation rate was about 4.1% (95% CI 3.8-4.5%) at 3 months, 6.2% (95% CI 5.9-6.5%) at 1 year and 8.2% (95% CI 8.0-8.5%) at 3 years. Multivariable analysis indicated that osteoporosis (odds ratio [OR] 3.6, 95% CI 1.2-10.5, p = 0.02) and diabetes (OR 2.1, 95% CI 1.1-4.5, p = 0.04) were independently associated with early reoperation and multilevel fusion (OR 2.4, 95% CI 1.1-5.4, p = 0.03) was independently associated with late reoperation. CONCLUSIONS The most common reasons for early reoperation and late operation were surgical site infection and adjacent segment diseases, respectively. Osteoporosis and diabetes were independent risk factors for early reoperation, and multilevel fusion was independent risk factor for late reoperation. Surgeons should pay more attention to these patients, and future studies should consider the effects of follow-up periods on results.
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Affiliation(s)
- Shuai-Kang Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Peng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China
| | - Jia-Yin Niu
- Capital Med Univ, Ctr Heart, Beijing Chaoyang Hosp, Beijing, 100020, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, 10053, China.
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28
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Bongers JJ, Wilkinson N, Kurihara M, Bridges JP, Baltzer W, Worth AJ. Accuracy of Lumbosacral Pedicle Screw Placement in Dogs: A Novel 3D Printed Patient-Specific Drill Guide versus Freehand Technique in Novice and Expert Surgeons. Vet Comp Orthop Traumatol 2022; 35:381-389. [PMID: 35815627 DOI: 10.1055/s-0042-1750433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of pedicle screw placement at the canine lumbosacral junction using a novel unilateral three-dimensional printed patient-specific guide (3D-PSG) versus a freehand drilling technique. Additionally, accuracy of screw placement between a novice and an experienced surgeon was determined. STUDY DESIGN Preoperative computed tomography images from 20 lumbosacral cadaveric specimens were used to design a novel unilateral 3D-PSG for the L7 and sacral vertebrae which was printed in acryl-nitrile butadiene styrene plastic. A novice and an expert surgeon each placed 3.5mm cortical screws in 10 cadavers; on the left using the unilateral 3D-PSG and by the freehand (anatomic landmark) technique on the right. RESULTS Sixty screws were placed using the unilateral 3D-PSG and 60 using the freehand technique. There was no statistical difference in accuracy for the comparison between methods performed by the expert (p = 0.679) and novice (p = 0.761) surgeon, nor between an expert and novice surgeon overall (p = 0.923). Unexpectedly, the use of a unilateral 3D-PSG increased variability for the expert surgeon in our study (p = 0.0314). CONCLUSION Using a novel unilateral 3D-PSG did not improve the accuracy of screw placement for lumbosacral stabilization by a novice surgeon compared with an expert surgeon in lumbar spine surgery. This may reflect a suboptimal PSG design.
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Affiliation(s)
- Jos J Bongers
- School of Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Nathan Wilkinson
- Axia 3D Design, (currently Nexus Engineering & Design Ltd), Napier, New Zealand
| | - Manabu Kurihara
- Cummings School of Veterinary Medicine at Tufts University, Crafton, United States
| | - Janis P Bridges
- Massey University School of Veterinary Science, Palmerston North, New Zealand
| | - Wendy Baltzer
- University of Sydney, School of Veterinary Science, Sydney, New South Wales, Australia
| | - Andrew J Worth
- Massey University School of Veterinary Science, Palmerston North, New Zealand
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29
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Huang X, Jia Q, Li H, Kerem E, Peng C, Kong W, Tusunniyazi M, Hamiti Y, Feng D, Zhao Y. Evaluation of sparing the pronator quadratus for volar plating of distal radius fractures: a retrospective clinical study. BMC Musculoskelet Disord 2022; 23:625. [PMID: 35773689 PMCID: PMC9245216 DOI: 10.1186/s12891-022-05576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails. AIM The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures. METHODS Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated. RESULTS All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant. CONCLUSION The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.
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Affiliation(s)
- Xiaoxia Huang
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qiyu Jia
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huaqiang Li
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Erxat Kerem
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cong Peng
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Weiqi Kong
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaitiaili Tusunniyazi
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yimurang Hamiti
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Dongwei Feng
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yan Zhao
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Estimation of Tibiofemoral Joint Contact Forces Using Foot Loads during Continuous Passive Motions. SENSORS 2022; 22:s22134947. [PMID: 35808441 PMCID: PMC9269803 DOI: 10.3390/s22134947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
Continuous passive motion (CPM) machines are commonly used after various knee surgeries, but information on tibiofemoral forces (TFFs) during CPM cycles is limited. This study aimed to explore the changing trend of TFFs during CPM cycles under various ranges of motion (ROM) and body weights (BW) by establishing a two-dimensional mathematical model. TFFs were estimated by using joint angles, foot load, and leg−foot weight. Eleven healthy male participants were tested with ROM ranging from 0° to 120°. The values of the peak TFFs during knee flexion were higher than those during knee extension, varying nonlinearly with ROM. BW had a significant main effect on the peak TFFs and tibiofemoral shear forces, while ROM had a limited effect on the peak TFFs. No significant interaction effects were observed between BW and ROM for each peak TFF, whereas a strong linear correlation existed between the peak tibiofemoral compressive forces (TFCFs) and the peak resultant TFFs (R2 = 0.971, p < 0.01). The proposed method showed promise in serving as an input for optimizing rehabilitation devices.
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Ochi H, Kobayashi H, Baba T, Nakajima R, Kurita Y, Kato S, Sasaki K, Nozawa M, Kim SG, Sakamoto Y, Homma Y, Kaneko K, Ishijima M. Acetabular cartilage abnormalities in elderly patients with femoral neck fractures. SICOT J 2022; 8:24. [PMID: 35699460 PMCID: PMC9196023 DOI: 10.1051/sicotj/2022022] [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: 03/23/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Both hemiarthroplasty (HA) and total hip arthroplasty (THA) are widely accepted surgical procedures for hip replacement following displaced femoral neck fractures. However, in cases involving an intact joint line before surgery, the choice between HA and THA remains debatable. This study investigated the prevalence of acetabular cartilage and labral abnormalities in elderly patients with femoral neck fractures. METHODS Thirty-seven patients underwent hip arthroplasty for femoral neck fractures between April 2020 and February 2021. After excluding 4 patients, 33 patients (6 men and 27 women; mean age = 82.2 [range = 67-98] years) with fractures in 12 left and 21 right hips were included. After femoral head removal during arthroplasty, the acetabulum was macroscopically examined for the presence of cartilage and labral lesions. Acetabular cartilage abnormalities were classified as either overall degeneration or partial damage according to the cartilage damage classification system. RESULTS Acetabular cartilage abnormalities, including overall degeneration or partial damage, were found in all hips (100%). Out of the 33 hips, overall degeneration, partial damage, and labral abnormalities were detected in 32 (96.9%), 16 (48.4%), and 9 (27.2%) hips, respectively. DISCUSSION In this study, most elderly patients with femoral neck fractures exhibited acetabular cartilage and labral abnormalities, which were already present at the time of surgery. Therefore, surgeons should carefully examine these abnormalities as they may impact postoperative outcomes such as pain and function.
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Affiliation(s)
- Hironori Ochi
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, San-ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo 130-0012, Japan
| | - Tomonori Baba
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Riko Nakajima
- Department of Orthopaedic Surgery, San-ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo 130-0012, Japan
| | - Yasuha Kurita
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Suguru Kato
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kyoko Sasaki
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masahiko Nozawa
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Sung-Gon Kim
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yuko Sakamoto
- Department of Orthopaedic Surgery, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Clinical applications and prospects of 3D printing guide templates in orthopaedics. J Orthop Translat 2022; 34:22-41. [PMID: 35615638 PMCID: PMC9117878 DOI: 10.1016/j.jot.2022.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 12/05/2022] Open
Abstract
Background With increasing requirements for medical effects, and huge differences among individuals, traditional surgical instruments are difficult to meet the patients' growing medical demands. 3D printing is increasingly mature, which connects to medical services critically as well. The patient specific surgical guide plate provides the condition for precision medicine in orthopaedics. Methods In this paper, a systematic review of the orthopedic guide template is presented, where the history of 3D-printing-guided technology, the process of guides, and basic clinical applications of orthopedic guide templates are described. Finally, the limitations of the template and possible future directions are discussed. Results The technology of 3D printing surgical templates is increasingly mature, standard, and intelligent. With the help of guide templates, the surgeon can easily determine the direction and depth of the screw path, and choose the angle and range of osteotomy, increasing the precision, safety, and reliability of the procedure in various types of surgeries. It simplifies the difficult surgical steps and accelerates the growth of young and mid-career physicians. But some problems such as cost, materials, and equipment limit its development. Conclusions In different fields of orthopedics, the use of guide templates can significantly improve surgical accuracy, shorten the surgical time, and reduce intraoperative bleeding and radiation. With the development of 3D printing, the guide template will be standardized and simplified from design to production and use. 3D printing guides will be further sublimated in the application of orthopedics and better serve the patients. The translational potential of this paper Precision, intelligence, and individuation are the future development direction of orthopedics. It is more and more popular as the price of printers falls and materials are developed. In addition, the technology of meta-universe, digital twin, and artificial intelligence have made revolutionary effects on template guides. We aim to summarize recent developments and applications of 3D printing guide templates for engineers and surgeons to develop more accurate and efficient templates.
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Xue Z, Tu W, Gao J, Dong Z, Yuan J, Lang J. Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60 years of age with intertrochanteric fractures. Eur J Trauma Emerg Surg 2022; 48:4197-4203. [PMID: 35445814 DOI: 10.1007/s00068-022-01969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the incidence and risk factors of preoperative DVT in elderly patients with intertrochanteric fracture of the femur and determine the optimal preoperative time. METHODS Electronic medical records of 358 patients over 60 years of age with intertrochanteric fractures from May 1, 2016, to May 1, 2019, were retrospectively analyzed. The preoperative group was divided into DVT and non-DVT. Univariate analysis was used for preliminary comparison, and multivariate logistic regression analysis was used to identify independent risk factors associated with DVT development. ROC curve was drawn to analyze the specificity and sensitivity of risk factors for DVT diagnosis. The diagnostic value of the model was analyzed by the ROC curve of multivariable combined diagnosis. RESULTS A total of 358 patients who met the criteria were enrolled. The total prevalence of DVT before surgery was 8.38%. Multivariate logistic regression analysis showed that smoking status, preoperative time, albumin (ALB), D-dimer level, diabetes mellitus, and hypertension were independent risk factors for preoperative DVT. Preoperative time has the best sensitivity and specificity for diagnosing the occurrence of preoperative DVT. The ROC curve analysis model of multivariable combined diagnosis has a better diagnostic value. CONCLUSIONS In this study, elderly patients with intertrochanteric femur fracture had a higher incidence of deep vein thrombosis before surgery. Early identification of DVT-related risk factors may contribute to individualized risk assessment and preventing adverse outcomes in patients with intertrochanteric fractures.
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Affiliation(s)
- ZhiQiang Xue
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - WangJie Tu
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JianQing Gao
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - ZeTao Dong
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JianDong Yuan
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China
| | - JunZhe Lang
- Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China.
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Abbaszadeh F, Jorjani M, Joghataei MT, Mehrabi S. Astaxanthin Modulates Autophagy, Apoptosis, and Neuronal Oxidative Stress in a Rat Model of Compression Spinal Cord Injury. Neurochem Res 2022; 47:2043-2051. [DOI: 10.1007/s11064-022-03593-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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dos Santos PK, Sigoli E, Bragança LJ, Cornachione AS. The Musculoskeletal Involvement After Mild to Moderate COVID-19 Infection. Front Physiol 2022; 13:813924. [PMID: 35492595 PMCID: PMC9040683 DOI: 10.3389/fphys.2022.813924] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, has been drastically affecting the daily lives of millions of people. COVID-19 is described as a multiorgan disease that affects not only the respiratory tract of infected individuals, but it has considerable effects on the musculoskeletal system, causing excessive fatigue, myalgia, arthralgia, muscle weakness and skeletal muscle damage. These symptoms can persist for months, decreasing the quality of life of numerous individuals. Curiously, most studies in the scientific literature focus on patients who were hospitalized due to SARS-CoV-2 infection and little is known about the mechanism of action of COVID-19 on skeletal muscles, especially of individuals who had the mild to moderate forms of the disease (non-hospitalized patients). In this review, we focus on the current knowledge about the musculoskeletal system in COVID-19, highlighting the lack of researches investigating the mild to moderate cases of infection and pointing out why it is essential to care for these patients. Also, we will comment about the need of more experimental data to assess the musculoskeletal manifestations on COVID-19-positive individuals.
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Affiliation(s)
- Patty K. dos Santos
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | | | | | - Anabelle S. Cornachione
- Muscle Physiology and Biophysics Laboratory, Department of Physiological Sciences, Federal University of São Carlos (UFSCar), São Carlos, Brazil
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Cui L, Zhao S, Tian H, Guo W, Dong X. Curative efficacy of surgical procedures for older patients with femoral neck fracture: a network meta-analysis and systematic review. J Orthop Surg Res 2022; 17:127. [PMID: 35236384 PMCID: PMC8889721 DOI: 10.1186/s13018-022-02914-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Femoral neck fractures have a higher incidence in older people with poor prognosis, inducing serious social problems. Common treatment methods include total hip arthroplasty, bipolar hemiarthroplasty, double-screw fixation, multiple-screw fixation, and dynamic hip system. METHODS We searched through four electronic databases, including PubMed, Web of Science, Cochrane Library, and Embase databases, for articles regarding femoral neck fractures, bone screw, and hip prosthesis published up to February 11, 2020. All included articles were used for quality evaluation and data extraction. Extracted data were expressed as odds ratios or weighted mean differences, with 95% confidence intervals. We conducted a network meta-analysis for Harris hip score, complications, 1-year mortality rate, reoperation rate, intraoperative blood loss, and duration of operation using STATA version 16.0 software. RESULTS Twenty-two randomized controlled trials and nine cohort studies included in this study involved 3861 patients. Total hip arthroplasty significantly improved the postoperative function of patients with femoral neck fractures. The surface under the cumulative ranking curve value of the Harris hip score for more than 1 year after total hip arthroplasty was 98.2. CONCLUSIONS This meta-analysis indicated no significant difference in mortality among different treatment groups. Total hip arthroplasty can provide satisfactory outcomes in hip joint function, and double-screw fixation results in the lowest intraoperative risk. In general, total hip arthroplasty results in a lower incidence of adverse events and is especially recommended for patients with femoral neck fractures. This article has been retrospectively registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) on November 27, 2020. Registration number: INPLASY2020110123.
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Affiliation(s)
- Lanxin Cui
- College of Mathematics, Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Shishun Zhao
- College of Mathematics, Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Heng Tian
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Xiaoming Dong
- Orthopaedic Medical Center, The Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China.
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Rompen IF, van de Wall BJM, van Heijl M, Bünter I, Diwersi N, Tillmann F, Migliorini F, Link BC, Knobe M, Babst R, Beeres FJP. Low profile dual plating for mid-shaft clavicle fractures: a meta-analysis and systematic review of observational studies. Eur J Trauma Emerg Surg 2022; 48:3063-3071. [PMID: 35237845 DOI: 10.1007/s00068-021-01845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Low profile dual plate fixation using two mini fragment plates (< 2.7 mm thickness) is a relatively new technique and alternative to single plating for treating midshaft clavicle fractures. To date, no meta-analysis has been performed comparing these two techniques. Therefore, a systematic review and meta-analysis of observational studies and randomized clinical trials was performed comparing single plating to low profile dual plating for midshaft clavicle fractures. METHODS PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate and re-intervention rate. Secondary outcomes include healing, operation duration and functional scores. RESULTS Low profile dual plating has favourable outcomes regarding overall complication rate (8.1% vs. 22.5%, OR 0.3, 95% CI 0.2-0.7, I2 = 16%, p = 0.007) and re-intervention rate (6.1% vs. 16.1%, OR 0.3, 95% CI 0.1-0.9, I2 = 25%, p = 0.02). The largest contributing factor behind these differences was the high incidence of implant related complaints in the single plating group (4.7% vs. 11.6%, OR 0.4, 95% CI 0.2-0.9, I2 = 0%, p = 0.02). The use of low profile dual plating does not have a detrimental effect on healing with union being attained in 99% compared to 97.4% in the single plating group (OR 1.8, 95% CI 0.3-10.7, I = 0%, p = 0.5). Data on operating time and functional results is limited. CONCLUSION This meta-analysis shows that dual plating low profile plates for midshaft clavicle fractures is a safe procedure attaining the same union rates seen in patients treated with single plating. In addition, it seems to have a lower overall complication and re-intervention rate, mostly driven by the lower incidence of implant related complaints. Low profile dual plating, however, is a fairly new technique and should be further explored in respect to more differentiated endpoints to test whether these first findings are valid. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ingmar Florin Rompen
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Bryan Joost Marinus van de Wall
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Mark van Heijl
- Department of Surgery, Hand and Wrist Unit, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Isabelle Bünter
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Nadine Diwersi
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Franz Tillmann
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Filippo Migliorini
- Department of Orthopaedics, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Björn-Christian Link
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Reto Babst
- Department of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002, Lucerne, Switzerland
| | - Frank Joseph Paulus Beeres
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
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Grävare Silbernagel K, Malliaras P, de Vos RJ, Hanlon S, Molenaar M, Alfredson H, van den Akker-Scheek I, Antflick J, van Ark M, Färnqvist K, Haleem Z, Kaux JF, Kirwan P, Kumar B, Lewis T, Mallows A, Masci L, Morrissey D, Murphy M, Newsham-West R, Norris R, O'Neill S, Peers K, Sancho I, Seymore K, Vallance P, van der Vlist A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 2022; 52:613-641. [PMID: 34797533 PMCID: PMC8891092 DOI: 10.1007/s40279-021-01588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION CRD42020156763.
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Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Mitchel Molenaar
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jarrod Antflick
- Department of Bioengineering, School of Engineering, Imperial College, London, UK
| | - Mathijs van Ark
- Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | | | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Arsenal Football Club, London, UK
| | - Jean-Francois Kaux
- Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhavesh Kumar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Trevor Lewis
- Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Myles Murphy
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Richard Newsham-West
- School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Norris
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Seth O'Neill
- School of Allied Health, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Kayla Seymore
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Patrick Vallance
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Arco van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
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Manzano W, Lenchik L, Chaudhari AS, Yao L, Gupta S, Boutin RD. Sarcopenia in rheumatic disorders: what the radiologist and rheumatologist should know. Skeletal Radiol 2022; 51:513-524. [PMID: 34268590 DOI: 10.1007/s00256-021-03863-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
Sarcopenia is defined as the loss of muscle mass, strength, and function. Increasing evidence shows that sarcopenia is common in patients with rheumatic disorders. Although sarcopenia can be diagnosed using bioelectrical impedance analysis or DXA, increasingly it is diagnosed using CT, MRI, and ultrasound. In rheumatic patients, CT and MRI allow "opportunistic" measurement of body composition, including surrogate markers of sarcopenia, from studies obtained during routine patient care. Recognition of sarcopenia is important in rheumatic patients because sarcopenia can be associated with disease progression and poor outcomes. This article reviews how opportunistic evaluation of sarcopenia in rheumatic patients can be accomplished and potentially contribute to improved patient care.
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Affiliation(s)
- Wilfred Manzano
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA.
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Akshay S Chaudhari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
| | - Lawrence Yao
- Department of Radiology, National Institute of Health, Bethesda, MD, 20892, USA
| | - Sarthak Gupta
- Department of Medicine, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, MD, 20892, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, 94305-5105, USA
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Ipsilateral femoral neck and shaft fractures: case series from a single Level-I trauma centre and review of literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:803-809. [PMID: 35119486 DOI: 10.1007/s00590-021-03199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Uncommon but increasingly diagnosed, ipsilateral femoral neck and shaft fracture represents a complex injury pattern with challenging management. The conundrum involves optimal diagnostic modality, timing of surgery, sequence of fixation, and the choice of implant. METHODOLOGY A retrospective review was conducted at a Level-I trauma centre to assess the outcome of concomitant femoral neck and shaft fractures managed with various implants and attempt to provide solutions to the aforementioned queries. The time between injury and definitive surgery, choice of implant, sequence of fixation, time to fracture union, and complications were documented and analyzed. RESULTS A total of 46 patients were included in the study wherein associated neck fracture was identified preoperatively in 93.5% of patients. In patients with isolated limb fractures, the mean time to surgery was 16.7 ± 5 h whereas patients with polytrauma witnessed an average delay of 4.6 days before fracture fixation. 72% of patients were managed by dual implants and in the remaining both the fractures were addressed using a single implant with no union time difference amongst implants. The mean time to the union for neck fracture was 21.7 weeks and 24.2 weeks for shaft femur fracture. 21.7% patients developed delayed union of fracture shaft femur and infection complicated 11% shaft fractures. CONCLUSION Although, 6% neck fractures were missed in the series, we advocate that careful pre/intra/post-operative fluoroscopic evaluation of the femoral neck along with a low threshold for a pre-operative CT scan remains the optimal diagnostic modality while avoiding universal employment of computed tomography (CT). With fracture union being unaffected by implant choice, authors suggest that anatomical fixation of the femoral neck is of paramount importance followed by restoration of the length, alignment and rotation of the femoral shaft, and the implant selection primarily depends on surgeon's experience and the pattern of injury.
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[Effectiveness of structural bone graft in total hip arthroplasty for Hartofilakidis type Ⅱ developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:196-202. [PMID: 35172405 PMCID: PMC8863526 DOI: 10.7507/1002-1892.202109098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the effectiveness of acetabulum reconstruction with autologous femoral head structural bone graft in total hip arthroplasty (THA) for Hartofilakidis type Ⅱ developmental dysplasia of the hip (DDH). METHODS A clinical data of 24 patients (27 hips) with Hartofilakidis type Ⅱ DDH, who underwent acetabulum reconstruction with autologous femoral head structural bone graft in primary THA between October 2012 and October 2020, was retrospectively analyzed. There were 3 males and 21 females, with an average age of 40 years (range, 20-58 years). The body mass index was 19.5-35.0 kg/m² with an average of 25.0 kg/m². There were 21 cases of unilateral hip and 3 cases of bilateral hips. The hip Harris score was 51.1±10.0. The leg length discrepancy of unilateral hip patients was (19.90±6.24) mm. The intraoperative blood loss, wound healing, and complications were recorded. The postoperative bone union, coverage rates of acetabular prosthesis and bone graft, and aseptic loosening of the prosthesis were evaluated based on X-ray films, and the improvement of hip function was observed by Harris score. RESULTS The intraoperative blood loss was 50-1000 mL (median, 350 mL). All incisions healed by first intention, and no fracture, hematoma, infection, or other complications occurred. Sciatic nerve injury occurred in 1 case (1 hip) and deep venous thrombosis occurred in 1 case (1 hip). All patients were followed up 15-103 months (median, 40.5 months). At last follow-up, Harris score was 92.6±4.1 and the difference was significant when compared with preoperative value ( t=-28.043, P=0.000). No hip prosthesis needed revision. X-ray films showed that the coverage rate of acetabular prosthesis was 91%-100% (mean, 97.8%), and the coverage rate of bone graft was 13%-46% (mean, 23.8%). The healing time of bone graft was 3-6 months (mean, 4.7 months). At last follow-up, all bone grafts completely healed without any signs of collapse. There was no graft resorption, ectopic ossification or osteolysis, or obvious aseptic loosening of the acetabular and femoral prostheses. The leg length discrepancy of unilateral hip patients was (2.86±2.18) mm, and the difference was significant when compared with preoperative value ( t=17.028, P=0.000). CONCLUSION For Hartofilakidis type Ⅱ DDH patients, if the lateral acetabular prosthesis not covered by the host bone exceeds 5 mm in primary THA, autologous femoral head can be used for structural bone grafting, and the short- and mid-term effectiveness are favorable.
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Comparison of Therapeutic Outcomes of Transabdominal Pararectus Approach and Modified Stoppa Approach in Treating Pelvic and Acetabular Fractures. Indian J Orthop 2022; 56:829-836. [PMID: 35542317 PMCID: PMC9043044 DOI: 10.1007/s43465-021-00585-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pelvic and acetabular fractures are common orthopedic diseases, and this research was to investigate the therapeutic effects of pararectus and Stoppa approaches in treating complex pelvic acetabular fractures. METHODS The clinical information of patients with pelvic and acetabular fractures treated surgically in Lu'an Hospital of Chinese medicine, China from January 2016 to April 2020 was analyzed. There were 30 cases each in the transabdominal pararectus approach and modified Stoppa approach groups. The operation time, incision length, blood loss, and postoperative complications of both groups were recorded according to the Merle d'Aubigné-Postel hip score. The recovery of hip function was evaluated 6 months after surgery, and the clinical and therapeutic efficacies of the two groups were compared. RESULTS The patients were followed up for 6-7 months (average, 6.5 months). The average operation time, incision length, and blood loss in the pararectus and Stoppa approach groups were 180 ± 41.105 min, 8.667 ± 1.373 cm, 259.667 ± 382 mL and 202.667 ± 32.793 min, 11.600 ± 1.958 cm, and 353.667 ± 590 mL, respectively. The satisfactory rate of fracture reduction, excellent and good rate of hip function score, and incidence of complications were 28/30, 27/30, 1/30 and 25/30, 25/30, 3/30, respectively. There were significant differences in operation time, incision length, and blood loss between the two groups (p < 0.05). However, there was no significant difference in the excellent and good rate of hip function score, fracture reduction satisfaction, and complication rate between both groups (p > 0.05). CONCLUSIONS The pararectus approach can reveal the better anatomical structure of the pelvis and acetabulum, such as the corona mortis and quadrilateral plate, for conducive fracture reduction and fixation. It can also effectively shorten the length of the incision, reduce operative blood loss, and shorten the operation time. It is a better choice for the clinical treatment of complex pelvic and acetabular fractures.
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Ali Kazem T, Zeylabi F, Filayih Hassan A, Paridar P, Pezeshki SP, Pezeshki SMS. Diabetes mellitus and COVID-19: review of a lethal interaction from the cellular and molecular level to the bedside. Expert Rev Endocrinol Metab 2022; 17:1-19. [PMID: 34781797 DOI: 10.1080/17446651.2022.2002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION While the main mode of transmission of coronavirus disease 2019 (COVID-19) is close contact with other individuals, the presence of chronic underlying diseases such as Diabetes Mellitus (DM) increases the chance of hospitalization and mortality rate due to infection. AREAS COVERED To investigate the effects of COVID-19 infection in DM patients, we reviewed literature from Google Scholar search engine and PubMed database from '2013 to 2020' using the terms "COVID-19; SARS-CoV-2; Diabetes mellitus; obesity; Angiotensin-converting enzyme 2; ACE2; Insulin and Metformin. Evidence suggests that COVID-19 exacerbates the course of diabetes. Presence of pro-inflammatory conditions, increased expression of receptors, and more difficult control of glucose levels in diabetics COVID-19 patients are some of the problems that diabetic patients may face. Also, psychological problems caused by the COVID-19 epidemic in diabetic patients is one of the most important problems in these patients, which is less covered. EXPERT OPINION DM is a strong and independent risk factor with a poor prognosis, which increases the risk of COVID-19 infection, the need for emergency services, the rate of hospitalization in the intensive care unit and also increases the mortality rate of COVID-19 patients.
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Affiliation(s)
| | - Fatemeh Zeylabi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Pouria Paridar
- Islamic Azad University, North-Tehran Branch, Tehran, Iran
| | - Seyedeh Pardis Pezeshki
- Department of Clinical Biochemistry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed Mohammad Sadegh Pezeshki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Cao J, Zhang X, Liu H, Yao Z, Bai Y, Guo D, Feng L. 3D printed templates improve the accuracy and safety of pedicle screw placement in the treatment of pediatric congenital scoliosis. BMC Musculoskelet Disord 2021; 22:1014. [PMID: 34863150 PMCID: PMC8645104 DOI: 10.1186/s12891-021-04892-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
Background Three-dimensional (3-D) printed guidance templates are being increasingly used in spine surgery. The purpose of this study was to determine if 3D printed navigation templates can improve the accuracy of pedicle screw placement and decrease the complication rate compared to freehand screw placement in the treatment of children with congenital scoliosis. Methods The records of pediatric patients with congenital scoliosis treated at our hospital from January 2017 to January 2019 were retrospectively reviewed. Patients were divided into those where a 3D printed guidance templated was used and those in which the freehand method was used for pedicle screw placement. The accuracy rate of pedicle screw placement, surgical outcomes, and complications were compared between groups. Results A total of 67 children with congenital scoliosis were included (43 males and 24 females; mean age of 4.13 ± 2.66 years; range, 2–15 years). There were 34 children in the template-assisted group and 33 in the freehand group. The excellent accuracy rate of pedicle screw placement was significantly higher in the template-assisted group (96.10% vs. 88.64%, P = 0.007). The main Cobb angle and kyphosis angle were similar between the 2 groups preoperatively and postoperatively (all, P > 0.05), and in both groups both angles were significantly decreased after surgery as compared to the preoperative values (all, P < 0.001). The degree of change of the Cobb angle of the main curve and kyphosis angle were not significantly different between the 2 groups. There were no postoperative complications in the template group and 4 in the freehand group (0% vs. 12.12%; P = 0.009). All 4 patients with complications required revision surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04892-4.
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Affiliation(s)
- Jun Cao
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Xuejun Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China.
| | - Haonan Liu
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Ziming Yao
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Yunsong Bai
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Dong Guo
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Lei Feng
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, #56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
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Optimizing Lumbar Pedicle Screw Trajectory Utilizing a 3D Printed Drill Guide to Ensure Placement of Pedicle Screws Into Higher Density Bone May Improve Pedicle Screw Pullout Resistance. World Neurosurg 2021; 158:e459-e464. [PMID: 34763101 DOI: 10.1016/j.wneu.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lower preoperative Hounsfield Unit (HU) values of vertebral body are associated with pedicle screw (PS) loosening after implantation with traditional trans-pedicular trajectory. However, the relationship between trajectory HU value and PS fixation quality remains unknown. This study aimed to investigate if 3D printed guider directed accurate implantation of pedicle screw could increase the anti-pulling properties of screws. METHODS 3D models of cadaveric spines were reconstructed by using CT image and PS trajectories were designed for both sides of vertebra. The designed trajectories were divided into high HU group and low HU group. PS implantation with 3D printed screw guide can be in complementary shape with target vertebra. Throughout 3D finite element analysis and biomechanical tests, the pull-out strength of screws in high or low trajectory HU groups were compared. RESULTS The HU value was 132± 13(mean ± standard deviation) in low HU group and 189± 17 in high HU group. The distance between planned trajectories and actual trajectories was 1.69 ±0.4 mm. Biomechanical tests showed that in high trajectory HU group the pull-out strength of screws was 750.41± 80.65 N, and compared to 655.83 ±74.31 N in low trajectory HU group, the difference was statistically significant. When simulated with finite element method, the pull-out strength of low HU trajectory pedicle screws was lower than that of high HU trajectory. CONCLUSION Pre-operative computer-assisted trajectory design combining 3D printed screw guide may direct more accurate implantation with optimal implantation trajectory, and may provide a new way to improve pedicle screw fixation.
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Gatti A, Tarantino U, Gasparini M, Cateni M, Piccirilli E, Greggi C, Gasbarra E. Locking screw augmentation in hypertrophic nonunion of tibia: a novel surgical technique. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021434. [PMID: 34747391 PMCID: PMC10523058 DOI: 10.23750/abm.v92is1.11993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Nonunion is a common complication in long bone diaphyseal fracture. Hypertrophic nonunion is commonly caused by mechanical instability due to high strain at the fracture site whereas atrophic nonunion is mainly caused by biological impairment. Multiple surgical techniques have been reported to treat hypertrophic nonunion of long bones but there is no consensus about what is the best choice. We present our surgical option in hypertrophic nonunion of lower limb. METHODS We performed a locking cortical screw augmentation technique in fractures previously fixed with plate and screws in order to increase plate stability and to enhance fracture healing process. RESULTS Radiographic evaluations carried out three months after surgery showed that the fracture line is radiographically filled by bone callus. No pain, no limp, no signs of infection or implant failure were reported. CONCLUSIONS Locking cortical screw augmentation could represent a valid technique to reduce micromovements and to increase the stability at the fracture site with the possibility of early weight bearing and good clinical outcome.
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Affiliation(s)
- Andrea Gatti
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy; .
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy; .
| | - Monica Gasparini
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy.
| | - Marco Cateni
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy.
| | - Eleonora Piccirilli
- 1Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy.
| | - Chiara Greggi
- a:1:{s:5:"en_US";s:30:"University of Rome Tor Vergata";}.
| | - Elena Gasbarra
- Department of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Orthopedics and Traumatology, Policlinico Tor Vergata (PTV) Foundation, Rome, Italy.
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Pertusa C, Tarín JJ, Cano A, García-Pérez MÁ, Mifsut D. Serum microRNAs in osteoporotic fracture and osteoarthritis: a genetic and functional study. Sci Rep 2021; 11:19372. [PMID: 34588560 PMCID: PMC8481273 DOI: 10.1038/s41598-021-98789-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/13/2021] [Indexed: 02/08/2023] Open
Abstract
The rising incidence of bone pathologies such as osteoporosis and osteoarthritis is negatively affecting the functional status of millions of patients worldwide. The genetic component of these multifactorial pathologies is far from being fully understood, but in recent years several epigenetic mechanisms involved in the pathophysiology of these bone diseases have been identified. The aim of the present study was to compare the serum expression of four miRNAs in women with hip fragility fracture (OF group), osteoarthritis requiring hip replacement (OA group) and control women (Ctrl group). Serum expression of miR-497-5p, miR-155-5p, miR-423-5p and miR-365-3p was determined in a sample of 23 OA women, 25 OF women and 52 Ctrl women. Data shown that women with bone pathologies have higher expression of miR-497 and miR-423 and lower expression of miR-155 and miR-365 than control subjects. Most importantly, miR-497 was identified as an excellent discriminator between OA group and control group (AUC: 0.89, p < 0.000) and acceptable in distinguishing from the OF group (AUC: 0.76, p = 0.002). Our data suggest that circulating miR-497 may represent a significant biomarker of OA, a promising finding that could contribute towards future early-stage diagnosis of this disease. Further studies are required to establish the role of miR-155, miR-423 and miR-365 in bone pathologies.
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Affiliation(s)
- Clara Pertusa
- grid.429003.cResearch Unit, INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Juan J. Tarín
- grid.5338.d0000 0001 2173 938XDepartment of Cellular Biology, Functional Biology and Physical Anthropology, University of Valencia, 46100 Burjassot, Spain
| | - Antonio Cano
- grid.5338.d0000 0001 2173 938XDepartment of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Miguel Ángel García-Pérez
- grid.429003.cResearch Unit, INCLIVA Health Research Institute, 46010 Valencia, Spain ,grid.5338.d0000 0001 2173 938XDepartment of Genetics, University of Valencia, 46100 Burjassot, Spain
| | - Damián Mifsut
- Orthopedic Surgery and Traumatology, Clinic Hospital, INCLIVA Institute of Health Research, 46010 Valencia, Spain
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Vakharia VN, Smith L, Tahir Z, Sparks R, Ourselin S, Tucker S, Thompson D. Occipitocervical instrumented fixation utilising patient-specific C2 3D-printed spinal screw trajectory guides in complex paediatric skeletal dysplasia. Childs Nerv Syst 2021; 37:2643-2650. [PMID: 34148128 DOI: 10.1007/s00381-021-05260-2] [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: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Instability of the craniocervical junction in paediatric patients with skeletal dysplasia poses a unique set of challenges including anatomical abnormalities, poor bone quality, skeletal immaturity and associated general anaesthetic risks. Instrumented fixation provides optimal stabilisation and fusion rates. The small vertebrae make the placement of C2 pedicle screws technically demanding with low margins of error between the spinal canal and the vertebral artery. METHODS We describe a novel clinical strategy utilising 3D-printed spinal screw trajectory guides (3D-SSTG) for individually planned C2 pedicle and laminar screws. The technique is based on a pre-operative CT scan and does not require intraoperative CT imaging. This reduces the radiation burden to the patient and forgoes the associated time and cost. The time for model generation and sterilisation was < 24 h. RESULTS We describe two patients (3 and 6 years old) requiring occipitocervical instrumented fixation for cervical myelopathy secondary to Morquio syndrome with 3D-SSTGs. In the second case, bilateral laminar screw trajectories were also incorporated into the same guide due to the presence of high-riding vertebral arteries. Registration of the postoperative CT to the pre-operative imaging revealed that screws were optimally placed and accurately followed the predefined trajectory. CONCLUSION To our knowledge, we present the first clinical report of 3D-printed spinal screw trajectory guides at the craniocervical junction in paediatric patients with skeletal dysplasia. The novel combination of multiple trajectories within the same guide provides the intraoperative flexibility of potential bailout options. Future studies will better define the potential of this technology to optimise personalised non-standard screw trajectories.
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Affiliation(s)
- Vejay N Vakharia
- Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK. .,Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Luke Smith
- Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rachel Sparks
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, St Thomas' Hospital, King's College London, London, UK
| | - Stewart Tucker
- Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dominic Thompson
- Department of Neurosurgery, Great Ormond Street Hospital, UCL Great Ormond Street Institute of Child Health, London, UK
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Species variations in tenocytes' response to inflammation require careful selection of animal models for tendon research. Sci Rep 2021; 11:12451. [PMID: 34127759 PMCID: PMC8203623 DOI: 10.1038/s41598-021-91914-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/24/2021] [Indexed: 01/23/2023] Open
Abstract
For research on tendon injury, many different animal models are utilized; however, the extent to which these species simulate the clinical condition and disease pathophysiology has not yet been critically evaluated. Considering the importance of inflammation in tendon disease, this study compared the cellular and molecular features of inflammation in tenocytes of humans and four common model species (mouse, rat, sheep, and horse). While mouse and rat tenocytes most closely equalled human tenocytes’ low proliferation capacity and the negligible effect of inflammation on proliferation, the wound closure speed of humans was best approximated by rats and horses. The overall gene expression of human tenocytes was most similar to mice under healthy, to horses under transient and to sheep under constant inflammatory conditions. Humans were best matched by mice and horses in their tendon marker and collagen expression, by horses in extracellular matrix remodelling genes, and by rats in inflammatory mediators. As no single animal model perfectly replicates the clinical condition and sufficiently emulates human tenocytes, fit-for-purpose selection of the model species for each specific research question and combination of data from multiple species will be essential to optimize translational predictive validity.
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Xu G, Wang D, Chen J, Hong Q, Zhuang H. Spiral CT measurement for atlantoaxial pedicle screw trajectory and its clinical application. Am J Transl Res 2021; 13:2555-2562. [PMID: 34017414 PMCID: PMC8129255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to focus on the atlantoaxial pedicle screw placement and evaluate the effects of anatomical data and degree of surgical exposure of the atlantoaxial pedicle screw trajectory determined using spiral CT on the reference sites for pedicle screw insertion and various parameters in clinical application. METHOD The data of CT scan of cervical spine from individuals treated in our hospital were selected. Various anatomical parameters of the atlantoaxial pedicle screw trajectory were measured through multiplanar reconstruction (MPR) technology. Anatomical data and degree of surgical exposure of the atlantoaxial pedicle screw trajectory were obtained through spiral CT. Vernier calipers with least count of 0.01 mm was selected and the least count of the protractor was 0.2°. Prism 8.0 was adopted for graphical data analysis. The anatomical data of atlas of the local population were established. The measurement technique for pedicle screw trajectory and the method for pedicle screw insertion were mastered. RESULTS The results indicated that the intraoperative blood loss was between 30-280 ml with no case of excessive blood loss. Follow-up studies 10-18 months after the operations indicated stability of upper cervical spine without adverse conditions. The width of the pedicle screw was 13-24 mm, and the maximal inclination angle of the horizontal for the insertion was 17-21°. CONCLUSION The atlantoaxial pedicle screw placement was an effective surgical treatment for stabilizing the upper cervical spine. The measurement data of the atlantoaxial pedicle screw path was obtained through spiral CT and the surgical placement of pedicle screw was guided through individual data. Postoperative CT scan was adopted to evaluate the accuracy of pedicle screw placement, record the occurrence of secondary injuries, improve the stability of clinical applications, and reduce the risks for patients.
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Affiliation(s)
- Gengtian Xu
- Department of Orthopedics, Jieyang People's Hospital Jieyang 522000, Guangdong Province, China
| | - Dechun Wang
- Department of Orthopedics, Jieyang People's Hospital Jieyang 522000, Guangdong Province, China
| | - Jiyu Chen
- Department of Orthopedics, Jieyang People's Hospital Jieyang 522000, Guangdong Province, China
| | - Quan Hong
- Department of Orthopedics, Jieyang People's Hospital Jieyang 522000, Guangdong Province, China
| | - Huaiming Zhuang
- Department of Orthopedics, Jieyang People's Hospital Jieyang 522000, Guangdong Province, China
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