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Kawai MY, Yoshida T, Kato T, Watanabe T, Kashiwagi M, Yamanaka S, Yamamoto H, Nagahiro S, Iwamoto T, Masud K, Aoki K, Ohura K, Nakao K. bmp-2 Gene-Transferred Skeletal Muscles with Needle-Type Electrodes as Efficient and Reliable Biomaterials for Bone Regeneration. MATERIALS (BASEL, SWITZERLAND) 2024; 17:880. [PMID: 38399131 PMCID: PMC10890310 DOI: 10.3390/ma17040880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Bone morphogenetic protein-2 (bmp-2) has a high potential to induce bone tissue formation in skeletal muscles. We developed a bone induction system in skeletal muscles using the bmp-2 gene through in vivo electroporation. Natural bone tissues with skeletal muscles can be considered potential candidates for biomaterials. However, our previous system using plate-type electrodes did not achieve a 100% success rate in inducing bone tissues in skeletal muscles. In this study, we aimed to enhance the efficiency of bone tissue formation in skeletal muscles by using a non-viral bmp-2 gene expression plasmid vector (pCAGGS-bmp-2) and needle-type electrodes. METHODS We injected the bmp-2 gene with pCAGGS-bmp-2 into the skeletal muscles of rats' legs and immediately placed needle-type electrodes there. Skeletal tissues were then observed on the 21st day after gene transfer using soft X-ray and histological analyses. RESULTS The use of needle-type electrodes resulted in a 100% success rate in inducing bone tissues in skeletal muscles. In contrast, the plate-type electrodes only exhibited a 33% success rate. Thus, needle-type electrodes can be more efficient and reliable for transferring the bmp-2 gene to skeletal muscles, making them potential biomaterials for repairing bone defects.
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Affiliation(s)
- Mariko Yamamoto Kawai
- Department of Welfare, Kansai Women’s College, Osaka 582-0026, Japan
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Takeshi Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Tomoki Kato
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Takuma Watanabe
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Marina Kashiwagi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Shigeki Yamanaka
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Hiromitsu Yamamoto
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
| | - Shigeki Nagahiro
- Department of Pediatric Dentistry/Special Needs Dentistry, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (S.N.); (T.I.)
| | - Tsutomu Iwamoto
- Department of Pediatric Dentistry/Special Needs Dentistry, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (S.N.); (T.I.)
| | - Khan Masud
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (K.M.); (K.A.)
| | - Kazuhiro Aoki
- Department of Basic Oral Health Engineering, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (K.M.); (K.A.)
| | - Kiyoshi Ohura
- Department of Nursing, Taisei Gakuin University, Osaka 587-8555, Japan;
- Graduate School, Division of Dental Research, Osaka Dental University, Osaka 573-1121, Japan
| | - Kazumasa Nakao
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; (T.Y.); (T.K.); (T.W.); (M.K.); (S.Y.); (H.Y.); (K.N.)
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Santoshi JA, Reddy L, Agrawal U. Femoral Neck Nonunion Associated With Delayed Union of Ipsilateral Femoral Shaft Fracture. Cureus 2021; 13:e15612. [PMID: 34277230 PMCID: PMC8274465 DOI: 10.7759/cureus.15612] [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: 06/12/2021] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 36-year-old man, who presented to us five months after the initial trauma. He had been treated elsewhere with a cephalomedullary femoral nail. He described severe pain in his right thigh and groin that confined him to a wheelchair. He had shortening of the right lower limb and painful restriction of movements of the right hip. Radiographs demonstrated hypertrophic callus with a gap at the femoral shaft while the neck fracture was in varus malalignment with bone resorption; the neck fracture been fixed using two hip screws that were missing the nail. The patient was managed with removal of the previous hardware, reamed retrograde nailing and Pauwels’ intertrochanteric valgus osteotomy fixed using a 120o double-angled condylar blade plate. Both the fracture sites were not opened. Postoperatively, the femoral shaft showed radiographic evidence of union at three months, while the femoral neck and the intertrochanteric osteotomy site had united at five months. As per the Friedman and Wyman criteria, our patient has a “good” outcome at the four-year follow-up.
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Affiliation(s)
- John A Santoshi
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
| | - Lingaraj Reddy
- Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, IND
| | - Udit Agrawal
- Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
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Wu Y, Song M, Peng G, Xu Y, Li Y, Wei M, Tang H, Lv Q, Wang T, Cai X. Muscle pedicle bone flap transplantation for treating femoral neck fracture in adults: a systematic review. J Orthop Surg Res 2021; 16:304. [PMID: 33964938 PMCID: PMC8106223 DOI: 10.1186/s13018-021-02448-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background This systematic review was conducted to gather available evidence on the effectiveness of muscle pedicle bone flap transplantation in adult patients with femoral neck fractures. Methods Databases such as PubMed, EMBASE, IEEE, Web of Science, and Cochrane library were searched from their dates of inception until March 2021. Two reviewers independently selected the interventional studies on the assessment of the effectiveness of muscle pedicle bone flap transplantation for femoral neck fractures; data extraction and assessment of the methodological quality as per the Institute of Health Economics quality appraisal checklist were also performed by the reviewers. The effectiveness and complication outcomes were assessed by calculating the average rates. Results Overall, 20 studies with 1022 patients were included in this review. Notably, the methodologic quality of the included studies was typically poor. The average effective rates were as follows: good, 73.4%; fair, 15.4%; and poor, 10.9%. Moreover, the average nonunion rate, average avascular necrosis rate, average collapse rate, and the overall reoperation rate were 9.0%, 6.7%, 4.7%, and 7.3%, respectively. Conclusions This systematic review of heterogeneous studies with varying number of patients and varying surgical techniques indicated that muscle pedicle bone flap transplantation provides promising results with low rates of avascular necrosis and nonunion. Nevertheless, further controlled studies are required to ascertain the effectiveness of muscle pedicle bone flap transplantation in treating femoral neck fracture.
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Affiliation(s)
- Yipeng Wu
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Muguo Song
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Guangliang Peng
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Yongqing Xu
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China.
| | - Yang Li
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China.
| | - Mingjie Wei
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Hui Tang
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Qian Lv
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Teng Wang
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
| | - Xingbo Cai
- Institute of Traumatology and Orthopaedics, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, China
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Impaction Bone Grafting and Valgus Osteotomy: A Technical Trick for the Treatment of Femoral Neck Nonunions. J Orthop Trauma 2019; 33:e403-e408. [PMID: 31259803 DOI: 10.1097/bot.0000000000001564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoral neck nonunions in young adults is among the most challenging problems to treat. This is due to their inherent problems, such as neck resorption, increase in fracture gap, sclerosis of fracture margins, and avascular necrosis. Hip salvage in these cases, although challenging, is recommended in the Asian subcontinent where social and religious activities require squatting and sitting cross-legged. Muscle pedicle grafts and other vascularized bone grafting techniques are preferred treatment options, but they are technically demanding and require advanced microsurgical skills. Valgus osteotomy, although successful in certain cases, has a high failure rate in patients with poor bone stock. We present a simple technique of valgus subtrochanteric osteotomy, impaction bone grafting, and stabilization with a sliding hip screw. Here, we describe in detail about the surgical technique and present the clinical outcomes in 44 patients, with a mean follow-up of 3.4 years and a union rate of 95.5%.
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Subramanyam KN, Mundargi AV, Reddy PS, Umerjikar S. Pathological Neck of Femur Fracture with Failed Osteosynthesis in Adolescent: A Report of Two Cases. J Orthop Case Rep 2019; 8:88-91. [PMID: 30915304 PMCID: PMC6424325 DOI: 10.13107/jocr.2250-0685.1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Non-union of the neck of femur fractures in adolescents is a complex problem, especially if there is an underlying pathology such as fibrous dysplasia or unicameral bone cyst. Treatment is challenging and needs careful selection of a combination of strategies. Case Report: We present two such cases with a history of failed osteosynthesis with a sliding hip screw. Our strategy consisted of implant removal, open freshening and cancellous bone grafting of the fracture site, fibular strut grafting, subtrochanteric valgus osteotomy, and fixation with contoured 4.5 dynamic compression plates. Both fractures united uneventfully leaving the patients with good function. Conclusion: A combination of the above strategies is a simple and effective approach to achieve union in non-union of pathological fractures in adolescents despite failed osteosynthesis.
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Affiliation(s)
- Koushik Narayan Subramanyam
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India
| | - Abhishek Vasant Mundargi
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India
| | - Patlolla Siddharth Reddy
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India
| | - Sagar Umerjikar
- Department of Orthopaedics, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, Puttaparthi, Andhra Pradesh, India
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Xing W, Pan Z, Sun L, Sun L, Zhang C, Zhang Z, Feng W, Liu C. Sliding bone graft combined with double locking plate fixation for the treatment of femoral shaft nonunion. J Int Med Res 2019; 47:2034-2044. [PMID: 30890016 PMCID: PMC6567786 DOI: 10.1177/0300060519835334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives The aim of this study was to describe and evaluate a novel method of sliding bone graft combined with double locking plate fixation in treating femoral shaft nonunion. Methods Clinical data from patients with femoral shaft nonunion that was treated with sliding bone grafts combined with double locking plate fixation were retrospectively collected. Data included duration of surgery, blood loss, union rate, time to union and possible complications. Results Twenty-five patients included in the study were followed for a mean duration of 16.6 ± 2.6 months (range, 12–22 months). All of the fractures (100%) achieved bony union. Mean time to union was 6.0 ± 1.0 months (range, 4–8 months). No infections or medullary cavity occlusions were observed. Conclusions Sliding bone graft combined with double locking plate fixation was shown to be a safe, effective, and convenient surgical option for the treatment of nonunion, due to its high union rates with no complications. Further studies with larger sample sizes and longer-term follow-up are warranted.
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Affiliation(s)
- Wenzhao Xing
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Zhenhua Pan
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Lei Sun
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Liang Sun
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Chunpu Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Zhiguo Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Wenling Feng
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
| | - Changcheng Liu
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China
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