We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a ...We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.展开更多
The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design m...The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design mechanical equivalent porous structures for artificial femoral heads.Firstly,supported by Micro and clinical CT scans of 21 bone specimens,the anisotropic mechanical parameters of human cancellous bone in the femoral head were characterized using clinical CT values(Hounsfield unit).After that,the equivalent porous structure of cancellous bone was designed based on the gyroid surface,the influence of its degree of anisotropy and volume fraction on the macroscopic mechanical parameters was investigated by finite element analysis.Furthermore,a mapping relationship between CT values and the porous structure was established by jointly solving the mechanical parameters of the porous structure and human cancellous bone,allowing the design of personalized gradient porous structures based on clinical CT images.Finally,to verify the mechanical equivalence,implant press-in tests were conducted on 3D-printed artificial femoral heads and human femoral heads,the influence of the porous structure’s cell size in bone-implant interaction problems was also explored.Results showed that the minimum deviations of press-in stiffness(<15%)and peak load(<5%)both occurred when the cell size was 20%to 30%of the implant diameter.In conclusion,the designed porous structure can replicate the human cancellous bone-implant interaction at a high level,indicating its effectiveness in optimizing the mechanical performance of 3D-printed artificial femoral head.展开更多
Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content i...Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.展开更多
BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of periphe...BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.展开更多
Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested...Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested via implantation into sheep carotid arteries(CAs).This is because,unlike humans,acute occlusion of one or both sheep CAs is not associated with morbidity or mortality and thus provides safer experimental testing,with reduced ethical constraints,animal numbers and costs.However,to date there has been no evidence regarding sheep tolerance of femoral artery(FA)occlusion.Methods:In this study,seven sheep underwent CA graft surgery,with digital subtrac-tion angiography(DSA)of the CAs performed every 2 months via femoral access,for a total of 8 months.Four months into the study,the left FA of two sheep became inac-cessible due to a suspected FA occlusion.Thus,femoral angiography was performed,followed by FA dissection,FA histology and retrospective analysis of both veterinar-ian animal monitoring and pain scores.Results:FA angiography and histology confirmed complete left FA occlusion in two sheep.Retrospective animal monitoring demonstrated sheep with occluded FAs did not display increased pain scores or deleterious effects on their gait or wellbeing.Conclusion:Our data shows that sheep tolerate FA occlusion with no symptoms,similar to their cerebral circulation,making them an appropriate model for assessing small diameter femoral graft interposition studies and testing other cardiovascular interventions.展开更多
BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following prima...BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.展开更多
BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigat...BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigate the correlations among anxiety,depression,sense of coherence(SOC),and post-traumatic growth(PTG)in patients who underwent intertrochanteric femoral fracture surgery to improve clinical management strategies and outcomes.METHODS This study carefully selected 211 patients who received surgical treatment for intertrochanteric femoral fractures and were admitted to Dongying People’s Hospital from March 2022 to March 2024.Anxiety and depression in these patients were assessed with the anxiety and depression subscales of the Hospital Anxiety and Depression Scale(HADS),respectively.SOC was evaluated using the 13-item SOC scale(SOC-13),which encompasses three key dimensions:Comprehensibility,manageability,and meaningfulness.PTG was assessed with the Chinese version of PTG Inventory(CPTGI),covering five distinct dimensions:Personal strength,appreciation of life,relating to others,new possibilities,and spiritual change.The Pearson correlation coefficient was used to meticulously analyze the associations among HADS-Anxiety,HADS-Depression,SOC-13,and CPTGI.Further,univariate and multivariate analyses were conducted to identify factors that affect PTG in patients who underwent intertrochanteric femoral fracture surgery.RESULTS The collected data demonstrated that 67.30%and 60.66%of the 211 patients experienced anxiety and depression,respectively,with overall anxiety levels ranging from mild to moderate and depression levels being mild.The mean SOC-13 score was 55.73±8.81 points,indicating a generally low SOC level.The average CPTGI score was 54.93±9.92 points,demonstrating a relatively low PTG level.Notably,both HADS-Anxiety and HADS-Depression scores were significantly negatively correlated with CPTGI,whereas SOC-13 scores were significantly positively correlated with CPTGI.Univariate and multivariate analyses identified the presence of comorbidities[odds ratio(OR)=2.747,P=0.003],monthly household income(OR=3.292,P<0.001),and exercise habits(OR=4.651,P<0.001)as independent predictors of PTG in patients.CONCLUSION The results of this study indicate a significant negative correlation of anxiety and depression with PTG in patients after intertrochanteric femoral fracture surgery,whereas a significant positive association exists between SOC and PTG.This study helps more comprehensively understand the psychological status and recovery processes of such patients,thereby potentially providing valuable information for clinical practice and psychological interventions.展开更多
Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential inf...Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.展开更多
Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed t...Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed the cell biology characters of ONFH osteonecrosis area bone tissue in single cell scale and thus identified a novel ONFH treatment approach based on M2 macrophages-derived exosomes(M2-Exos).We further show that M2-Exos are highly effective in the treatment of ONFH by modulating the phenotypes communication between neutrophil and endothelium including neutrophil extracellular traps formation and endothelial phenotype transition.Additionally,we identified that M2-Exos’therapeutic effect is attributed to the high content of miR-93-5p and constructed miR-93-5p overexpression model in vitro and in vivo based on lentivirus and adenoassociated virus respectively.Then we found miR-93-5p can not only reduce neutrophil extracellular traps formation but also improve angiogenic ability of endothelial cells.These results provided a new theoretical basis for the clinical application of ONFH therapeutic exosomes.展开更多
Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the g...Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the growth plate toward the metaphysis of the femoral neck.This condition can result in hip pain,abnormal gait,and even avascular necrosis of the femoral head,significantly impacting the quality of life in adolescents.Currently,the exact etiology of SCFE remains unclear;however,evidence suggests that risk factors include endocrine disorders,metabolic conditions,and genetic diseases.Endocrine disorders encompass hypothyroidism,growth hormone abnormalities,hypogonadism,and obesity-related hormonal imbalances.Metabolic conditions involve obesity,vitamin D deficiency or rickets,and renal osteodystrophy.Genetic diseases include mutations in the COL2A1 gene,aromatase deficiency,and Prader-Willi syndrome.This review summarizes various medical conditions associated with SCFE and elucidates potential molecular mechanisms from abnormal chondrocyte function in the growth plate,hormonal imbalances and inflammatory/metabolic factors in SCFE based on relevant literature,aim to provide evidence for the prevention and treatment of SCFE.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid tre...BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.展开更多
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.展开更多
The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated ...The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated that GC exacerbates the oxidative stress(OS)microenvironment via promoting nicotinamide adenine dinucleotide phosphate oxidase 4(NOX4)expression in human,rat,and mesenchymal stem cells(MSCs)samples,thus generating excessive reactive oxygen species(ROS),leading to increased apoptosis and unbalanced osteolipogenic differentiation.Furthermore,computational docking results revealed that AMY could bind specifically to the predicted binding sites of NOX4.Additionally,AMY ameliorated the OS microenvironment of MSCs via decreasing NOX4 expression and inhibiting NOX4/ROS/p38MAPK signaling,thereby reversing the GC-induced apoptosis and imbalanced osteolipogenic differentiation,and ultimately alleviating GANFH.In summary,we demonstrated for the first time that AMY attenuated apoptosis and maintained osteolipogenic differentiation balance in MSCs via specifically targeting NOX4,inhibiting NOX4/ROS/p38MAPK signaling,thereby treating GANFH.展开更多
Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patien...Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.展开更多
BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established stand...BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.展开更多
BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a ...BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a periprosthetic infection.We discovered partial paralysis of the quadriceps muscle in this patient.We investigated the femoral nerve anatomy,particularly the nerve entry points,to better understand this phenomenon.AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.METHODS Eight cadaveric hemipelves were investigated.The branches of the femoral nerve were dissected and traced distally.The GRA was performed by the direct anterior approach.Axial stress to the lower extremity was applied,and the relative movement of the femur was recorded.The femoral nerve and its entry points were assessed.RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction,a 1.8 cm shift in the dorsal direction,and a 2.3 cm shift in the lateral direction.A 36.5°external shift was observed.This caused stress to the lateral division of the femoral nerve.We observed migration of the femoral nerve entry point at the following locations:(1)Vastus medialis(5.3 mm);(2)The medial part of the vastus intermedius(5.4 mm);(3)The lateral part of the vastus intermedius(16.3 mm);(4)Rectus femoris(23.1 mm);(5)Tensor vastus intermedius(30.8 mm);and(6)Vastus lateralis(28.8 mm).CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve.Stress occurred at the lateral nerve division leading to poor functional results.展开更多
BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with ...BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.展开更多
This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a litera...This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a literature analysis,we found that elderly patients with femoral fractures face various psychological issues such as anxiety,depression,sleep disorders,and social isolation.The application of systematic nursing interventions in clinical practice,including cognitivebehavioral therapy,mindfulness therapy,family therapy,art therapy,interpersonal therapy,emotion-focused therapy,and relaxation training,has yielded significant results.Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures.Therefore,promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.展开更多
Osteonecrosis of the femoral head(ONFH)is a common complication of glucocorticoid(GC)therapy.Recent advances demonstrate that sympathetic nerves regulate bone homeostasis,and GCs lower the sympathetic tone.Here,we sho...Osteonecrosis of the femoral head(ONFH)is a common complication of glucocorticoid(GC)therapy.Recent advances demonstrate that sympathetic nerves regulate bone homeostasis,and GCs lower the sympathetic tone.Here,we show that the dramatically decreased sympathetic tone is closely associated with the pathogenesis of GC-induced ONFH.GCs activate the glucocorticoid receptor(GR)but hinder the activation of the mineralocorticoid receptor(MR)on neurons in the hypothalamic paraventricular nucleus(PVN).This disrupts the balance of corticosteroid receptors(GR/MR)and subsequently reduces the sympathetic outflow in the PVN.Vascular endothelial cells rapidly react to inhibition of sympathetic tone by provoking endothelial apoptosis in adult male mice treated with methylprednisolone(MPS)daily for 3 days,and we find substantially reduced H-type vessels in the femoral heads of MPS-treated ONFH mice.Importantly,treatment with a GR inhibitor(RU486)in the PVN promotes the activation of MR and rebalances the ratio of GR and MR,thus effectively boosting sympathetic outflow,as shown by an increase in tyrosine hydroxylase expression in both the PVN and the sympathetic postganglionic neurons and an increase in norepinephrine levels in both the serum and bone marrow of the femoral head of MPS-treated mice.Rebalancing the corticosteroid receptors mitigates GC-induced endothelial impairment and ONFH and promotes angiogenesis coupled with osteogenesis in the femoral head,while these effects are abolished by chemical sympathectomy with 6-OHDA or adrenergic receptor-β2(Adrb2)knockout.Furthermore,activating Adrb2 signaling in vivo is sufficient to rescue the GC-induced ONFH phenotype.Mechanistically,norepinephrine increases the expression of the key glycolytic gene 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3(PFKFB3)via Adrb2-cyclic AMP response element-binding protein(CREB)signaling.Endothelial-specific overexpression of PFKFB3 attenuates endothelial impairment and prevents severe osteonecrosis in MPS-treated Adrb2 knockout mice.Thus,GC inhibits sympathetic tone via the hypothalamic descending pathway,which,in turn,acts as a mediator of GC-induced ONFH.展开更多
文摘We report a unique case of bilateral femoral stem fractures in a patient with Dorr A femoral morphology,underscoring the need for a critical reassessment of implant selection strategies.The initial failure involved a cemented revision stem placed using the cement-within-cement technique combined with an extended trochanteric osteotomy(ETO).A second revision was subsequently performed using a cortical window osteotomy and a distally fixed uncemented stem,which resulted in successful recovery.A similar approach was used to treat a subsequent contralateral stem fracture,also with favorable outcomes.This case emphasizes three key considerations:First,that standard-length cemented stems may lead to oversizing and increased stress concentration in Dorr A femurs with narrow canals;second,that ETO may compromise femoral integrity and contribute to implant failure;and third,that cortical window osteotomy enables safer implant removal and reimplantation.Based on these findings,we advocate for an individualized approach to implant selection that may include cemented short stems,uncemented short stems,or modular solutions depending on femoral anatomy and patient-specific factors,and we encourage further investigation into optimal fixation strategies for patients with Dorr A femoral morphology.
基金supported by the National Key R&D Program of China(Grant No.2021YFC2501700).
文摘The current artificial bone is unable to accurately replicate the inhomogeneity and anisotropy of human cancellous bone.To address this issue,we proposed a personalized approach based on clinical CT images to design mechanical equivalent porous structures for artificial femoral heads.Firstly,supported by Micro and clinical CT scans of 21 bone specimens,the anisotropic mechanical parameters of human cancellous bone in the femoral head were characterized using clinical CT values(Hounsfield unit).After that,the equivalent porous structure of cancellous bone was designed based on the gyroid surface,the influence of its degree of anisotropy and volume fraction on the macroscopic mechanical parameters was investigated by finite element analysis.Furthermore,a mapping relationship between CT values and the porous structure was established by jointly solving the mechanical parameters of the porous structure and human cancellous bone,allowing the design of personalized gradient porous structures based on clinical CT images.Finally,to verify the mechanical equivalence,implant press-in tests were conducted on 3D-printed artificial femoral heads and human femoral heads,the influence of the porous structure’s cell size in bone-implant interaction problems was also explored.Results showed that the minimum deviations of press-in stiffness(<15%)and peak load(<5%)both occurred when the cell size was 20%to 30%of the implant diameter.In conclusion,the designed porous structure can replicate the human cancellous bone-implant interaction at a high level,indicating its effectiveness in optimizing the mechanical performance of 3D-printed artificial femoral head.
基金iVascular,S.L.U.,Camíde Can Ubach,11–Nave 3,08620 Sant Vicençdels Horts,Barcelona,Spain。
文摘Background:The efficacy of balloon angioplasty for treating peripheral artery disease is influenced by various factors,some of them not yet totally understood.This study aimed to evaluate the role of elastin content in vascular responses 28 days postangioplasty using uncoated and paclitaxel-coated balloons with the same platform in femoral arteries of a healthy porcine model.Methods:Eight animals underwent balloon angioplasty on the external and internal branches of femoral arteries.Histopathologic evaluation was conducted at follow-up to assess the elastin content,vascular damage,morphological features,and neointimal formation.Results:The elastin content was significantly higher in the external than in the internal femoral artery(p=0.0014).After balloon angioplasty,it was inversely correlated with vascular injury score(ρ=−0.4510,p=0.0096),neointimal inflammation(ρ=−0.3352,p=0.0607),transmural(ρ=−0.4474,p=0.0103)and circumferential(ρ=−0.4591,p=0.0082)smooth muscle cell loss,presence of proteoglycans(ρ=−0.5172,p=0.0024),fibrin deposition(ρ=−0.3496,p=0.0499),and adventitial fibrosis(ρ=−0.6229,p=0.0002).Neointimal formation inhibition with paclitaxel was evident only in arteries with disruption of the internal elastic lamina,with a significant smaller neointimal area in arteries treated with paclitaxel-coated balloons compared to uncoated balloons(median[Q1–Q3]:10.25[7.49–15.64]vs.24.44[18.96–30.52],p=0.0434).Conclusions:Elastin content varies between branches of the femoral artery and significantly influences the integrity of the internal elastic lamina,the vessel's adaptive response,and paclitaxel efficacy after balloon angioplasty.
文摘BACKGROUND With rising angiography costs and risks,we explored whether a 5-minute femoral ultrasound can predict patients that actually require angiography.AIM To detect associations between atherosclerosis of peripheral arteries and coronary stenosis in patients with coronary heart disease(CHD).METHODS The study included a total of 218 patients(63±10.9 years of age;54%male)with CHD subjected to coronary angiography and routine diagnostic assessment,including ultrasound imaging to assess the extent of peripheral atherosclerotic lesions.Receiver operating characteristic analysis and binomial logistic regression were used to detect the associations.RESULTS We demonstrated for the first time that the presence of atherosclerotic plaque with≥70%stenosis in femoral arteries was associated with significant coronary stenosis,with 93%sensitivity and 90%specificity,and thus can be used as an additional diagnostic marker for coronary stenosis.The data indicated associations between femoral artery atherosclerosis and atherosclerotic lesions of coronary arteries,with a high correlation coefficient r=0.8(P<0.05).The presence of an atherosclerotic plaque in the femoral arteries with≥30% or≥70%stenosis was associated with a 30-or 70-fold higher odds ratio of coronary stenosis,respectively.CONCLUSION For resource-limited clinics,our findings suggest skipping carotids-femoral ultrasound alone may suffice to rule out severe CHD.Ultrasound imaging femoral artery atherosclerosis provides a simplified approach for patient stratification.
基金funded by R.D.H.,P.B.,A.S.W. and Z.W,Heart Foundation Vanguard Grant#107321funded by contributions from The Baird Institute for applied Heart and Lung Research.
文摘Objective:Sheep are commonly used as large animal pre-clinical models for inves-tigating cardiovascular therapies,interventions,anatomy and physiology.Further,novel small diameter vascular grafts are frequently tested via implantation into sheep carotid arteries(CAs).This is because,unlike humans,acute occlusion of one or both sheep CAs is not associated with morbidity or mortality and thus provides safer experimental testing,with reduced ethical constraints,animal numbers and costs.However,to date there has been no evidence regarding sheep tolerance of femoral artery(FA)occlusion.Methods:In this study,seven sheep underwent CA graft surgery,with digital subtrac-tion angiography(DSA)of the CAs performed every 2 months via femoral access,for a total of 8 months.Four months into the study,the left FA of two sheep became inac-cessible due to a suspected FA occlusion.Thus,femoral angiography was performed,followed by FA dissection,FA histology and retrospective analysis of both veterinar-ian animal monitoring and pain scores.Results:FA angiography and histology confirmed complete left FA occlusion in two sheep.Retrospective animal monitoring demonstrated sheep with occluded FAs did not display increased pain scores or deleterious effects on their gait or wellbeing.Conclusion:Our data shows that sheep tolerate FA occlusion with no symptoms,similar to their cerebral circulation,making them an appropriate model for assessing small diameter femoral graft interposition studies and testing other cardiovascular interventions.
文摘BACKGROUND Certain implant combinations change leg length and offset in primary total hip arthroplasty(THA).Poor restoration of leg biomechanics is a frequently cited reason for patient dissatisfaction following primary THA.A pure high-offset stem should provide direct lateralization without affecting femoral length when compared to a standard stem.However,clinical experience with preoperative planning software based on computed tomography-based three-dimensionalmodels reveals that using pure high-offset stems in THA may cause a difference between expected(no change in femoral length)and actual(small increase)in postoperative femoral length.AIM To elucidate the causes of these femoral length discrepancies using preoperative planning software.METHODS Preoperative templating for 43 robotic-assisted THAs,optimizing acetabular size and orientation,center of rotation,stem size and offset,and prosthetic head diameter were obtained.The preoperative planning software was used to calculate differences between preoperative and postoperative femoral length for standard and pure high-offset stems,unique to each patient.RESULTS Whilst the increase in femoral length between standard and high-offset stems was not significant(P=0.93),35 femurs(81.4%)experienced a 1-mm increase,and 3(7.0%)experienced a 2-mm increase in femoral length while using high-offset stem compared to the standard stem.The incidence of femoral length increase was lower for patients with shorter femurs(18/22;81.8%)compared to patients with longer femurs(20/21;95.2%).CONCLUSION When pure high-offset stems were used in preoperative planning software,we demonstrated an unexpected increase in leg length between 1-2-mm in 88.4%of patients.This unexpected increase in femoral length is due to a function of the preoperative planning software’s planned stem alignment with the anatomical axis,and not an inherent fault in the stem design.With expanding accessibility of robotic-assisted THA platforms,all potential sources of postoperative leg length discrepancy should be identified during preoperative templating and necessary alterations to the surgical plan should be made to accommodate this unexpected difference when using a pure high-offset stem.
文摘BACKGROUND Postoperative anxiety,depression,irritability,and even fear in patients with intertrochanteric femoral fractures may hinder recovery,compromise treatment efficacy,and impede rehabilitation.AIM To investigate the correlations among anxiety,depression,sense of coherence(SOC),and post-traumatic growth(PTG)in patients who underwent intertrochanteric femoral fracture surgery to improve clinical management strategies and outcomes.METHODS This study carefully selected 211 patients who received surgical treatment for intertrochanteric femoral fractures and were admitted to Dongying People’s Hospital from March 2022 to March 2024.Anxiety and depression in these patients were assessed with the anxiety and depression subscales of the Hospital Anxiety and Depression Scale(HADS),respectively.SOC was evaluated using the 13-item SOC scale(SOC-13),which encompasses three key dimensions:Comprehensibility,manageability,and meaningfulness.PTG was assessed with the Chinese version of PTG Inventory(CPTGI),covering five distinct dimensions:Personal strength,appreciation of life,relating to others,new possibilities,and spiritual change.The Pearson correlation coefficient was used to meticulously analyze the associations among HADS-Anxiety,HADS-Depression,SOC-13,and CPTGI.Further,univariate and multivariate analyses were conducted to identify factors that affect PTG in patients who underwent intertrochanteric femoral fracture surgery.RESULTS The collected data demonstrated that 67.30%and 60.66%of the 211 patients experienced anxiety and depression,respectively,with overall anxiety levels ranging from mild to moderate and depression levels being mild.The mean SOC-13 score was 55.73±8.81 points,indicating a generally low SOC level.The average CPTGI score was 54.93±9.92 points,demonstrating a relatively low PTG level.Notably,both HADS-Anxiety and HADS-Depression scores were significantly negatively correlated with CPTGI,whereas SOC-13 scores were significantly positively correlated with CPTGI.Univariate and multivariate analyses identified the presence of comorbidities[odds ratio(OR)=2.747,P=0.003],monthly household income(OR=3.292,P<0.001),and exercise habits(OR=4.651,P<0.001)as independent predictors of PTG in patients.CONCLUSION The results of this study indicate a significant negative correlation of anxiety and depression with PTG in patients after intertrochanteric femoral fracture surgery,whereas a significant positive association exists between SOC and PTG.This study helps more comprehensively understand the psychological status and recovery processes of such patients,thereby potentially providing valuable information for clinical practice and psychological interventions.
基金supported by the National Natural Science Foundation of China(82422045).
文摘Background:The risk of internal fixation failure remains relatively high in stable femoral neck fracture(FNF)(Garden I or II).Preoperative sagittal displacement of the femoral head has been proposed as a potential influencing factor.This study aimed to evaluate the impact of sagittal displacement on the outcomes of cannulated screw internal fixation(CSIF)in patients with stable FNF(Garden I or II)by reconstructing the axial sagittal oblique plane of the fracture using preoperative computed tomography(CT)imaging.Methods:This study included 167 patients with FNF who underwent CSIF.The sagittal tilt angle of the femoral head(STAFH)was evaluated using three-dimensional CT(3D-CT).The distribution of preoperative STAFH was analyzed,and its independent association with treatment failure was assessed.Treatment failure was defined as the need for revision surgery within 2 years postoperatively due to avascular necrosis,nonunion,or internal fixation failure.Results:Among the 167 patients,9(5.4%)exhibited anterior tilt(AT)of the femoral head,158(94.60%)presented with posterior tilt(PT).A total of 50 patients(29.9%)demonstrated excessive sagittal displacement(AT≥10°or PT≥20°).In the failure group,80.0%of patients had excessive sagittal displacement compared to 28.1%in the healed group.Excessive sagittal displacement was significantly associated with an increased risk of surgical failure(odds ratio:11.953,95%CI:3.656-39.083,p<0.05).Conclusions:In patients with Garden I or II FNF,greater preoperative sagittal displacement of the femoral head was correlated with a higher likelihood of CSIF failure.AT≥10°or PT≥20°were identified as independent predictors of CSIF failure in FNF patients.Nevertheless,these findings still require confirmation through prospective,multi-center clinical trials with large sample sizes.
基金the support of the National Natural Science Foundation of China (Grant No.82272503)Natural Science Foundation of Zhejiang Province (Grant No. LQN25H060006)
文摘Exosomes have shown good potential in ischemic injury disease treatments.However,evidence about their effect and molecular mechanisms in osteonecrosis of femoral head(ONFH)treatment is still limited.Here,we revealed the cell biology characters of ONFH osteonecrosis area bone tissue in single cell scale and thus identified a novel ONFH treatment approach based on M2 macrophages-derived exosomes(M2-Exos).We further show that M2-Exos are highly effective in the treatment of ONFH by modulating the phenotypes communication between neutrophil and endothelium including neutrophil extracellular traps formation and endothelial phenotype transition.Additionally,we identified that M2-Exos’therapeutic effect is attributed to the high content of miR-93-5p and constructed miR-93-5p overexpression model in vitro and in vivo based on lentivirus and adenoassociated virus respectively.Then we found miR-93-5p can not only reduce neutrophil extracellular traps formation but also improve angiogenic ability of endothelial cells.These results provided a new theoretical basis for the clinical application of ONFH therapeutic exosomes.
基金Supported by the Science Project of Hunan Provincial Healthy Commission,No.20230844.
文摘Slipped capital femoral epiphysis(SCFE)is a hip disorder that predominantly affects adolescents.The primary pathological change involves the displacement of the femoral head epiphysis from its normal position at the growth plate toward the metaphysis of the femoral neck.This condition can result in hip pain,abnormal gait,and even avascular necrosis of the femoral head,significantly impacting the quality of life in adolescents.Currently,the exact etiology of SCFE remains unclear;however,evidence suggests that risk factors include endocrine disorders,metabolic conditions,and genetic diseases.Endocrine disorders encompass hypothyroidism,growth hormone abnormalities,hypogonadism,and obesity-related hormonal imbalances.Metabolic conditions involve obesity,vitamin D deficiency or rickets,and renal osteodystrophy.Genetic diseases include mutations in the COL2A1 gene,aromatase deficiency,and Prader-Willi syndrome.This review summarizes various medical conditions associated with SCFE and elucidates potential molecular mechanisms from abnormal chondrocyte function in the growth plate,hormonal imbalances and inflammatory/metabolic factors in SCFE based on relevant literature,aim to provide evidence for the prevention and treatment of SCFE.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
文摘BACKGROUND Unstable intertrochanteric fractures in elderly patients require effective surgical management,with both cementless bipolar hemiarthroplasty(CBHA)and proximal femoral nail anti-rotation(PFNA)being valid treatment options to reduce morbidity and mortality.AIM To evaluate and compare the outcomes of CBHA and PFNA in treatment of unstable intertrochanteric fractures.METHODS A comprehensive search was conducted to identify relevant studies discussing the outcomes of using both CBH and PFNA in treatment of unstable intertrochanteric fractures.Studies published up to January 1,2025 were searched across multiple databases,including PubMed,EMBASE,Scopus,Web of Science,Cochrane Library,and Google Scholar.Full texts of the selected articles were retrieved,reviewed,and independently assessed by the investigators.Discrepancies were resolved by consensus,with any remaining disagreements being arbitrated by a third author.RESULTS This meta-analysis included three studies,all of which were retrospective,involving a total of 240 patients.The follow-up period for participants was at least 12 months.CBHA was associated with significantly higher blood loss compared to PFNA[mean differences(MD):129.14,95%CI(52.51,205.77),P=0.001],though heterogeneity was high(I²=97%).Operative time showed no significant difference initially[MD:6.10,95%CI(-13.34,25.54),P=0.54],but after excluding one study,BHA had longer operative times[MD:21.51,95%CI(18.60,24.41),P<0.00001].Hospital stay and Harris scores showed no significant differences between groups.CBHA facilitated faster progression to weight-bearing[MD:-11.92,95%CI(-22.46,-1.39),P=0.03]and a lower incidence of prosthetic loosening[risk ratio:0.21,95%CI(0.05,0.92),P=0.04].Refracture and thrombus formation rates were comparable between the two groups.CONCLUSION CBHA offers shorter weight-bearing duration and reduced prosthetic loosening but incurs greater blood loss and longer operative times compared to PFNA.Both techniques show comparable functional recovery,hospital stay,refracture,and thrombus risks.Clinical choice should prioritize early mobilization or surgical minimalism,guided by patient needs.Further prospective studies are warranted.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
基金supported by the Natural Science Foundation of China(81873325)the State Administration of Traditional Chinese Medicine of Zhejiang Province(2021ZZ014).
文摘The study aimed to explore the efficacy and potential mechanisms of a naturally aromatic cyanogenic compound amygdalin(AMY)in treating glucocorticoid(GC)-associated necrosis of the femoral head(GANFH).We demonstrated that GC exacerbates the oxidative stress(OS)microenvironment via promoting nicotinamide adenine dinucleotide phosphate oxidase 4(NOX4)expression in human,rat,and mesenchymal stem cells(MSCs)samples,thus generating excessive reactive oxygen species(ROS),leading to increased apoptosis and unbalanced osteolipogenic differentiation.Furthermore,computational docking results revealed that AMY could bind specifically to the predicted binding sites of NOX4.Additionally,AMY ameliorated the OS microenvironment of MSCs via decreasing NOX4 expression and inhibiting NOX4/ROS/p38MAPK signaling,thereby reversing the GC-induced apoptosis and imbalanced osteolipogenic differentiation,and ultimately alleviating GANFH.In summary,we demonstrated for the first time that AMY attenuated apoptosis and maintained osteolipogenic differentiation balance in MSCs via specifically targeting NOX4,inhibiting NOX4/ROS/p38MAPK signaling,thereby treating GANFH.
文摘Purpose:To evaluate the effects of healthcare failure mode and effect analysis(FMEA)on the prevention of deep venous thrombosis(DVT)in elderly patients undergoing femoral fracture surgery.Methods:Eighty elderly patients undergoing femoral fracture surgery who did not apply FMEA in Suzhou BenQ Medical Center from June 1,2022 to May 31,2023 were selected as the control group.According to the equal group experiment method,80 elderly patients who were managed using FMEA from June 1,2023 to May 31,2024 were selected as the FMEA group.The control group received traditional nursing management,while the FMEA group applied FMEA to analyze failure causes,calculate Risk Priority Numbers(RPNs),identify failure modes with higher RPNs,analyze the influencing factors,develop improvement measures,and optimize processes.The RPN values and the incidence of DVT,as well as nursing satisfaction scores,were compared in the two groups.Results:Compared with the control group,the total RPN values of the FEMA group decreased significantly,with a reduction rate of 87.0%.Besides,the incidence of DVT was 1.3%in the FMEA group,lower than 10.0%in the control group(8/80).What’s more,the patients in the FMEA group were more satisfied with the nursing service compared with the patients in the control group.Conclusion:The application of the FMEA in elderly patients undergoing femoral fracture surgery has demonstrated its potential to prevent the incidence of DVT,lower RPN values,and improve nursing satisfaction.
基金Supported by the Peak Discipline of Traditional Chinese Medicine(Orthopedics and Traumatology Integrated Traditional Chinese and Western Medicine),No.YC-2023-0601.
文摘BACKGROUND This article presents a rare case of a complex hip fracture involving the ipsilateral femoral neck,trochanter,and femoral head,that was accompanied by hip dislocation.Currently,there is no established standard treatment method for this specific type of fracture.Therefore,it is crucial to comprehensively consider factors such as patient age,fracture type,and degree of displacement to achieve a successful outcome.CASE SUMMARY A 38-year-old man sustained a comminuted fracture of his right hip as a result of a car accident.The injuries included a fracture of the femoral head,a fracture of the femoral neck,an intertrochanteric fracture of the femur,and a posterior dislocation of the hip on the same side.We opted for a treatment approach combining the use of a proximal femoral locking plate,cannulated screws,and Kirschner wires.Following the surgery,we developed an individualized rehabil-itation program to restore patient limb function.CONCLUSION For this complex fracture,we selected appropriate internal fixation and for-mulated individualized rehabilitation,which ultimately achieved good results.
文摘BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a periprosthetic infection.We discovered partial paralysis of the quadriceps muscle in this patient.We investigated the femoral nerve anatomy,particularly the nerve entry points,to better understand this phenomenon.AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.METHODS Eight cadaveric hemipelves were investigated.The branches of the femoral nerve were dissected and traced distally.The GRA was performed by the direct anterior approach.Axial stress to the lower extremity was applied,and the relative movement of the femur was recorded.The femoral nerve and its entry points were assessed.RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction,a 1.8 cm shift in the dorsal direction,and a 2.3 cm shift in the lateral direction.A 36.5°external shift was observed.This caused stress to the lateral division of the femoral nerve.We observed migration of the femoral nerve entry point at the following locations:(1)Vastus medialis(5.3 mm);(2)The medial part of the vastus intermedius(5.4 mm);(3)The lateral part of the vastus intermedius(16.3 mm);(4)Rectus femoris(23.1 mm);(5)Tensor vastus intermedius(30.8 mm);and(6)Vastus lateralis(28.8 mm).CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve.Stress occurred at the lateral nerve division leading to poor functional results.
基金This study was reviewed and approved by the Ethics Committee of the HUB-Hospital Erasme.
文摘BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.
文摘This review aims to gain a deeper understanding of the psychological state of elderly patients with femoral fractures and provide more theoretical and practical support for clinical treatment and care.Through a literature analysis,we found that elderly patients with femoral fractures face various psychological issues such as anxiety,depression,sleep disorders,and social isolation.The application of systematic nursing interventions in clinical practice,including cognitivebehavioral therapy,mindfulness therapy,family therapy,art therapy,interpersonal therapy,emotion-focused therapy,and relaxation training,has yielded significant results.Systematic psychological interventions can improve the psychological state and quality of life of elderly patients with femoral fractures.Therefore,promoting the application and practice of systematic psychological interventions in the clinical care of elderly patients with fractures will provide more effective psychological services to a wider group of patients with fractures in the future.
基金supported by the National Natural Science Foundation of China (82472439,82270935,81974337,82102627)the Hubei Provincial Natural Science Foundation of China (2021CFB095)+1 种基金the Wuhan Knowledge Innovation Project (2022020801020468)the Project of Scientific Research Plan of Wuhan Municipal Health Commission (WX21Q19)。
文摘Osteonecrosis of the femoral head(ONFH)is a common complication of glucocorticoid(GC)therapy.Recent advances demonstrate that sympathetic nerves regulate bone homeostasis,and GCs lower the sympathetic tone.Here,we show that the dramatically decreased sympathetic tone is closely associated with the pathogenesis of GC-induced ONFH.GCs activate the glucocorticoid receptor(GR)but hinder the activation of the mineralocorticoid receptor(MR)on neurons in the hypothalamic paraventricular nucleus(PVN).This disrupts the balance of corticosteroid receptors(GR/MR)and subsequently reduces the sympathetic outflow in the PVN.Vascular endothelial cells rapidly react to inhibition of sympathetic tone by provoking endothelial apoptosis in adult male mice treated with methylprednisolone(MPS)daily for 3 days,and we find substantially reduced H-type vessels in the femoral heads of MPS-treated ONFH mice.Importantly,treatment with a GR inhibitor(RU486)in the PVN promotes the activation of MR and rebalances the ratio of GR and MR,thus effectively boosting sympathetic outflow,as shown by an increase in tyrosine hydroxylase expression in both the PVN and the sympathetic postganglionic neurons and an increase in norepinephrine levels in both the serum and bone marrow of the femoral head of MPS-treated mice.Rebalancing the corticosteroid receptors mitigates GC-induced endothelial impairment and ONFH and promotes angiogenesis coupled with osteogenesis in the femoral head,while these effects are abolished by chemical sympathectomy with 6-OHDA or adrenergic receptor-β2(Adrb2)knockout.Furthermore,activating Adrb2 signaling in vivo is sufficient to rescue the GC-induced ONFH phenotype.Mechanistically,norepinephrine increases the expression of the key glycolytic gene 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3(PFKFB3)via Adrb2-cyclic AMP response element-binding protein(CREB)signaling.Endothelial-specific overexpression of PFKFB3 attenuates endothelial impairment and prevents severe osteonecrosis in MPS-treated Adrb2 knockout mice.Thus,GC inhibits sympathetic tone via the hypothalamic descending pathway,which,in turn,acts as a mediator of GC-induced ONFH.
