BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may comprom...BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.展开更多
Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 20...Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.展开更多
Microcracks are common in compact bone,but their continued propagation can lead to macroscopic fractures.These microcracks cannot be visualized radiographically,necessitating alternative noninvasive methods to identif...Microcracks are common in compact bone,but their continued propagation can lead to macroscopic fractures.These microcracks cannot be visualized radiographically,necessitating alternative noninvasive methods to identify excessive microcracking and prevent fractures.In this study,terahertz time-domain spectroscopy(THz-TDS)was used to examine bone interiors near cracks resulting from loading in bovine tibia samples.Various loading configurations,such as impact,quasi-static loading,and fatigue loading,known to induce different types of micro-scale damage,were applied.The values of refractive index and absorption coefficient of the bone samples were then determined from the THz-TDS spectra acquired before loading and after fracture.The study revealed that different loading configurations led to varying terahertz optical coefficients associated with various types of bone fractures.Specifically,the refractive index notably increased under fatigue loading but remained relatively stable during quasi-static bending.The absorption coefficient of bone decreased only under fatigue loading.Furthermore,samples were subjected to axial and radial impacts without sustaining damage.Results indicated that in the undamaged state,the change in refractive index was smaller compared to after impact failure,while the change in absorption coefficient remained consistent after failure.Under radial impact loading,changes in refractive index and absorption coefficient were significantly more pronounced than under axial loading.Prior to loading,the measured value of refractive index was 2.72±0.11,and the absorption coefficient was 6.33±0.09 mm^(−1)at 0.5 THz.展开更多
Bone resorption by osteoclasts is a critical step in bone remodeling,a process important for maintaining bone homeostasis and repairing injured bone.We previously identified a bone marrow mesenchymal subpopulation,mar...Bone resorption by osteoclasts is a critical step in bone remodeling,a process important for maintaining bone homeostasis and repairing injured bone.We previously identified a bone marrow mesenchymal subpopulation,marrow adipogenic lineage precursors(MALPs),and showed that its production of RANKL stimulates bone resorption in young mice using Adipoq-Cre.To exclude developmental defects and to investigate the role of MALPs-derived RANKL in adult bone,we generated inducible reporter mice(Adipoq-CreER Tomato)and RANKL deficient mice(Adipoq-CreER RANKLflox/flox,iCKO).Single cell-RNA sequencing data analysis and lineage tracing revealed that Adipoq+cells contain not only MALPs but also some mesenchymal progenitors capable of osteogenic differentiation.In situ hybridization showed that RANKL mRNA is only detected in MALPs,but not in osteogenic cells.RANKL deficiency in MALPs induced at 3 months of age rapidly increased trabecular bone mass in long bones as well as vertebrae due to diminished bone resorption but had no effect on the cortical bone.Ovariectomy(OVX)induced trabecular bone loss at both sites.RANKL depletion either before OVX or at 6 weeks post OVX protected and restored trabecular bone mass.Furthermore,bone healing after drill-hole injury was delayed in iCKO mice.Together,our findings demonstrate that MALPs play a dominant role in controlling trabecular bone resorption and that RANKL from MALPs is essential for trabecular bone turnover in adult bone homeostasis,postmenopausal bone loss,and injury repair.展开更多
Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriat...Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriate human resources, infrastructure and medical care are not readily accessible. The introduction of new devices for fracture stabilization and the development of microsurgical procedures for soft tissue reconstruction have greatly improved the management of open fractures. Patients presenting with open fractures of long bones at Kumi Orthopaedic Center are managed with the help of SIGN nail for fracture stabilization. However, long-term outcomes for patients have not been documented. Objective: The objective of this study was to determine the long term outcomes of the management of open fractures of long bones among patients with a Surgical Implant Generation Network (SIGN) nail at Kumi Orthopaedic Center (KOC). Methods: A retrospective study of 39 patients with open fractures who were managed at KOC between 2010 and 2022. Data on patients’ socio-demographic and clinical characteristics and outcomes (both physical and radiographic) was retrieved from the SIGN surgical online database of patients with over 1 year follow up period. Results: The mean age of patients was 40.3 years. The majority were male 32 (82.1%) and the commonest mechanism of injury was Road Traffic Accidents (RTA) 37 (94.9%). The majority did not have a clear record of having received antibiotics immediately after injury 29 (74.4%). However, most had a record of receiving antibiotics 1 hour before surgery 33 (84.6%). The most affected bone was the tibia 33 (84.6%). The commonest fracture type was Gustilo IIIa 18 (46.2%). On follow up;10 (25.6%) developed an infection (osteomyelitis), 6 (15.4%) did not have a union on x-ray, 4 (10.3%) had a loose screw, 1 had an implant breakage and also 1 patient had a varus deformity. However, there was no amputation recorded. Conclusion: The management of open fractures is still a major challenge in low and middle income countries like Uganda, which is still experiencing relatively high complication rates. Guidelines emphasizing the need for early antibiotic prophylaxis and faster access to surgical treatment are required for better treatment outcomes.展开更多
Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the...Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.展开更多
AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The ...AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included "alcoholic liver diseases", "osteoporosis", or "bone fractures". The prevalence of any fractures or osteoporosis, and bone mineral density(BMD) were extracted and analyzed using risk ratios and standardized mean difference(SMD). A random effects model was applied. RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944(95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849(95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD(SMD in femur-BMD:-0.172, 95%CI:-0.453-0.110; SMD in spine-BMD:-0.169, 95%CI:-0.476-0.138). Sensitivity analyses showed consistent results. CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.展开更多
BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours...BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.展开更多
Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sha...Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sham-Vertebroplasty groups. The result from the RCT study suggested that the observed efficacy of the Vertebroplasty procedure, instead of representing the cement-mediated reduction in pain, may relate to the vertebral bone drilling per se. The aim of this study was to demonstrate the effectiveness of pain relief of vertebral bone drilling at the site of painful osteoporotic vertebral compression fractures in the acute phase. Materials and Methods: Twenty-six patients with painful osteoporotic compression fractures underwent the vertebral bone drilling. We assessed primary outcome measures in the NRS pain score and RDQ score at day 0 and 3 following the drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and RDQ score, and the mean NRS and RDQ score at day 3 were 7.3 ± 1.2, 15.7 ± 4.2, 4.6 ± 1.4, 7.3 ± 2.2, respectively. Among the patients, we detected significant improvements in NRS pain score and RDQ score at day 3 following the drilling compared with day 0 (P < 0.001). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic vertebral compression fractures.展开更多
The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is la...The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is largely unknown.In patients who underwent discontinuation after multiple injections of denosumab,the levels of tartrate-resistant acid phosphatase 5b increased compared to pretreatment levels,indicating a phenomenon known as“overshoot.”The rate of decrease in bone mineral density during the withdrawal period was higher than the rate of decrease associated with aging,suggesting that the physiological bone metabolism had broken down.Overshoot and significant bone loss were also observed in mice receiving continuous administration of anti-RANKL antibody after treatment was interrupted,resembling the original pathology.In mice long out of overshoot,bone resorption recovered,but osteoblast numbers and bone formation remained markedly reduced.The bone marrow exhibited a significant reduction in stem cell(SC)antigen 1-and platelet-derived growth factor receptor alpha-expressing osteoblast progenitors(PαS cells)and alkaline phosphatase-positive early osteoblasts.Just before the overshoot phase,the osteoclast precursor cell population expands and RANKL-bearing extracellular vesicles(EVs)became abundant in the serum,leading to robust osteoclastogenesis after cessation of anti-RANKL treatment.Thus,accelerated bone resorption due to the accumulation of RANKLbearing EVs and long-term suppression of bone formation uncoupled from bone resorption leads to the severe bone loss characteristic of denosumab discontinuation.展开更多
Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft f...Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft fractures who were treated in our hospital between May 2011 and December 2016 were collected and divided into control group (n=40) and observation group (n=40) according to random number table, control group received conventional steel plate internal fixation treatment, and observation group received minimally invasive mippo intramedullary nail internal fixation treatment. Differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors, and pain mediators and so on were compared between two groups of patients before operation and 1 week after treatment.Results: Before operation, differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors and pain mediators were not statistically significant between two groups of patients. After operation, serum bone formation indexes P ICP, BGP, BALP and ALP levels in observation group were higher than those in control group;serum bone resorption indexesβ-CTX and OPG levels were lower than those in control group;serum inflammatory factors IL-1β, IL-6, IL-8 and CRP levels were lower than those in control group;serum pain mediators SP, PGE2 and 5-HT levels were lower than those in control group.Conclusion:Minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures can promote the bone formation, relatively inhibit bone resorption and cause less traumatic reaction.展开更多
Although there have been many reports of small bone and vertebral involvement in sarcoidosis, long bone pathology is rare. We report a case of almost identical bilateral fractures of the proximal femoral diaphysis dur...Although there have been many reports of small bone and vertebral involvement in sarcoidosis, long bone pathology is rare. We report a case of almost identical bilateral fractures of the proximal femoral diaphysis during separated in time through a low-energy mode of injury, and explore the difficulties encountered when seeking radiological and tissue diagnosis.展开更多
Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with compl...Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematom...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>展开更多
The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We...The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.展开更多
Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical...Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical treatment in Mianyang Orthopedic Hospital between June 2010 and October 2015 were enrolled and randomly divided into MIPO group and ORIF group who were treated with minimally invasive plate oateosynthesis and open reduction internal fixation respectively. Before surgery as well as 1 d and 3 d after surgery, serum was collected to determine the contents of stress response molecules and bone metabolism markers.Results:1 d and 3 d after surgery, serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of both groups were higher than those before surgery while bone formation markers BGP, BALP, PINP and OPG contents were lower than those before surgery;serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of MIPO group were lower than those of ORFI group while bone formation markers BGP, BALP, PINP and OPG contents were higher than those of ORFI group.Conclusion: Compared with ORIF, MIPO for middle humeral shaft fractures can reduce stress response degree and improve bone metabolism.展开更多
Bone plates play a vital role in bone fracture healing by providing the necessary mechanical fixation for fracture fragments through modulating biomechanical microenvironment adjacent to the fracture site.Good treatme...Bone plates play a vital role in bone fracture healing by providing the necessary mechanical fixation for fracture fragments through modulating biomechanical microenvironment adjacent to the fracture site.Good treatment effect has been achieved for fixation of bone fracture with conventional bone plates,which are made of stainless steel or titanium alloy.However,several limitations still exist with traditional bone plates including loosening and stress shielding due to significant difference in modulus between metal material and bone tissue that impairs optimal fracture healing.Additionally,due to demographic changes and non-physiological loading,the population suffering from refractory fractures,such as osteoporosis fractures and comminuted fractures,is increasing,which imposes a big challenge to traditional bone plates developed for normal bone fracture repair.Therefore,optimal fracture treatment with adequate fixation implants in terms of materials and design relevant to special conditions is desirable.In this review,the complex physiological process of bone healing is introduced,followed by reviewing the development of implant design and biomaterials for bone plates.Finally,we discuss recent development of hybrid bone plates that contains bioactive elements or factors for fracture healing enhancement as a promising direction.This includes biodegradable Mg-based alloy used for designing bone screw-plates that has been proven to be beneficial for fracture healing,an innovative development that attracts more and more attention.This paper also indicates that the tantalum bone plates with porous structure are also emerging as a new fracture internal fixation implants.The reduction of the stress shielding is verified to be useful to accelerate bone fracture healing.Potential application of biodegradable metals may also avoid a second operation for implant removal.Further developments in biometals and their design for orthopedic bone plates are expected to improve the treatment of bone fracture,especially the refractory fractures.展开更多
Objective： To demonstrate the validity and reliability of volumetric quantitative computed tomography （vQCT） with multi-slice computed tomography （MSCT） and dual energy X-ray absorptiometry （DXA） for hip bone m...Objective： To demonstrate the validity and reliability of volumetric quantitative computed tomography （vQCT） with multi-slice computed tomography （MSCT） and dual energy X-ray absorptiometry （DXA） for hip bone mineral density （BMD） measurements, and to compare the differences between the two techniques in discriminating postmenopausal women with osteoporosis-related vertebral fractures from those without. Methods： Ninety subjects were enrolled and divided into three groups based on the BMD values of the lumbar spine and/or the femoral neck by DXA. Groups 1 and 2 consisted of postmenopausal women with BMD changes 〈-2SD, with and without radiographically confirmed vertebral fracture （n= 11 and 33, respectively）. Group 3 comprised normal controls with BMD changes 〉-ISD （n-46）. Post-MSCT （GE, LightSpeed16） scan reconstructed images of the abdominal-pelvic region, 1.25 mm thick per slice, were processed by OsteoCAD software to calculate the following parameters： volumetric BMD values of trabecular bone （TRAB）, cortical bone （CORT）, and integral bone （INTGL） of the left femoral neck, femoral neck axis length （NAL）, and minimum cross-section area （mCSA）. DXA BMD measurements of the lumbar spine （AP-SPINE） and the left femoral neck （NECK） also were performed for each subject. Results： The values of all seven parameters were significantly lower in subjects of Groups 1 and 2 than in normal postmenopausal women （P〈0.05, respectively）. Comparing Groups 1 and 2, 3D-TRAB and 3D-INTGL were significantly lower in postmenopausal women with vertebral fracture（s） [（109.8±9.61） and （243.3±33.0） mg/cm^3, respectively] than in those without [（148.9±7.47） and （285.4±17.8） mg/cm^3, respectively] （P〈0.05, respectively）, but no significant differences were evident in AP-SPINE or NECK BMD. Conclusion： the femoral neck-derived volumetric BMD parameters using vQCT appeared better than the DXA-derived ones in discriminating osteoporotic postmenopausal women with vertebral fractures from those without, vQCT might be useful to evaluate the effect of osteoporotic vertebral fracture status on changes in bone mass in the femoral neck.展开更多
Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft w...Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.展开更多
Objective: To investigate the efficacy of Jintiange capsule in the treatment of acute bone atrophy due to wrist fractures. Methods: Participants were randomly allocated into two groups, i.e. the treatment group and th...Objective: To investigate the efficacy of Jintiange capsule in the treatment of acute bone atrophy due to wrist fractures. Methods: Participants were randomly allocated into two groups, i.e. the treatment group and the control groups. All patients received functional rehabilitation exercise. Patients in the treatment group received Jintiange capsule orally, while the control group received placebos. At 3 and 6 months after the treatment, Cooney score, hand grip and pinch strength were measured. The visual analogue scale (VAS) was applied, and safety events were recorded. Results: No loss occurred during 6 months of follow-up after treatment. Before the treatment, there was no statistically significant difference between the two groups in Cooney score, hand grip strength, hand pinch strength or VAS score (all P>0.05). At 3 and 6 months after the treatment, the Cooney core, hand grip and pinch strength increased, and the VAS were decreased in all patients. The treatment group showed significantly greater improvement than the control group (P<0.05). In additional, both groups showed few side effects. Conclusions: Jintiange capsule can improve the function of the wrist joint and alleviate the pain of fracture. It is safe and effective for treating acute bone atrophy.展开更多
基金Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine,No.75.
文摘BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
文摘Objective: To investigate the effectiveness of the plate screw internal fixation technique on the clinical outcomes of patients with traumatic fractures of long bones in the lower extremities. Methods: From January 2022 to December 2023, 70 patients with traumatic fractures of long bones in the lower extremities were admitted to the hospital and randomly divided into two groups: the control group and the observation group, each consisting of 35 cases. The control group underwent traditional closed interlocking intramedullary nailing, while the observation group received internal fixation with steel plates and screws. Relevant surgical indicators, treatment effectiveness, and postoperative complication rates were compared between the two groups. Results: The observation group exhibited significantly short surgical duration (80.65 ± 5.01 vs. 88.36 ± 5.26 minutes), fracture healing time (13.27 ± 0.32 vs. 15.52 ± 0.48 weeks), and hospitalization days (10.49 ± 1.13 vs. 16.57 ± 1.15 days) compared to the control group (P = 0.000). The effective treatment rate was significantly higher in the observation group (29/82.86%) than in the control group (21/60.00%), with a significant difference observed (χ2 = 4.480, P = 0.034). Additionally, the complication rate in the observation group (2/5.71%) was significantly lower than that in the control group (8/22.86%), with a correlated difference (χ2 = 4.200, P = 0.040). Conclusion: The plate screw internal fixation technique demonstrates significant clinical efficacy in treating traumatic fractures of long bones in the lower extremities. It improves the healing rate, reduces complications, and represents a safe and effective treatment strategy worthy of widespread use and application.
基金supported by the National Natural Science Foundation of China(Grant Nos.11972247 and 12372080).
文摘Microcracks are common in compact bone,but their continued propagation can lead to macroscopic fractures.These microcracks cannot be visualized radiographically,necessitating alternative noninvasive methods to identify excessive microcracking and prevent fractures.In this study,terahertz time-domain spectroscopy(THz-TDS)was used to examine bone interiors near cracks resulting from loading in bovine tibia samples.Various loading configurations,such as impact,quasi-static loading,and fatigue loading,known to induce different types of micro-scale damage,were applied.The values of refractive index and absorption coefficient of the bone samples were then determined from the THz-TDS spectra acquired before loading and after fracture.The study revealed that different loading configurations led to varying terahertz optical coefficients associated with various types of bone fractures.Specifically,the refractive index notably increased under fatigue loading but remained relatively stable during quasi-static bending.The absorption coefficient of bone decreased only under fatigue loading.Furthermore,samples were subjected to axial and radial impacts without sustaining damage.Results indicated that in the undamaged state,the change in refractive index was smaller compared to after impact failure,while the change in absorption coefficient remained consistent after failure.Under radial impact loading,changes in refractive index and absorption coefficient were significantly more pronounced than under axial loading.Prior to loading,the measured value of refractive index was 2.72±0.11,and the absorption coefficient was 6.33±0.09 mm^(−1)at 0.5 THz.
基金supported by NIH grants NIH/NIA R01AG069401(to L.Q.)NIH/NHLBI U54HL165442(to K.T.)P30AR069619(to Penn Center for Musculoskeletal Disorders).
文摘Bone resorption by osteoclasts is a critical step in bone remodeling,a process important for maintaining bone homeostasis and repairing injured bone.We previously identified a bone marrow mesenchymal subpopulation,marrow adipogenic lineage precursors(MALPs),and showed that its production of RANKL stimulates bone resorption in young mice using Adipoq-Cre.To exclude developmental defects and to investigate the role of MALPs-derived RANKL in adult bone,we generated inducible reporter mice(Adipoq-CreER Tomato)and RANKL deficient mice(Adipoq-CreER RANKLflox/flox,iCKO).Single cell-RNA sequencing data analysis and lineage tracing revealed that Adipoq+cells contain not only MALPs but also some mesenchymal progenitors capable of osteogenic differentiation.In situ hybridization showed that RANKL mRNA is only detected in MALPs,but not in osteogenic cells.RANKL deficiency in MALPs induced at 3 months of age rapidly increased trabecular bone mass in long bones as well as vertebrae due to diminished bone resorption but had no effect on the cortical bone.Ovariectomy(OVX)induced trabecular bone loss at both sites.RANKL depletion either before OVX or at 6 weeks post OVX protected and restored trabecular bone mass.Furthermore,bone healing after drill-hole injury was delayed in iCKO mice.Together,our findings demonstrate that MALPs play a dominant role in controlling trabecular bone resorption and that RANKL from MALPs is essential for trabecular bone turnover in adult bone homeostasis,postmenopausal bone loss,and injury repair.
文摘Background: Open fractures are serious injuries with the potential for severe complications such as infection and non-union. Management of open fractures is challenging especially in areas like Uganda where appropriate human resources, infrastructure and medical care are not readily accessible. The introduction of new devices for fracture stabilization and the development of microsurgical procedures for soft tissue reconstruction have greatly improved the management of open fractures. Patients presenting with open fractures of long bones at Kumi Orthopaedic Center are managed with the help of SIGN nail for fracture stabilization. However, long-term outcomes for patients have not been documented. Objective: The objective of this study was to determine the long term outcomes of the management of open fractures of long bones among patients with a Surgical Implant Generation Network (SIGN) nail at Kumi Orthopaedic Center (KOC). Methods: A retrospective study of 39 patients with open fractures who were managed at KOC between 2010 and 2022. Data on patients’ socio-demographic and clinical characteristics and outcomes (both physical and radiographic) was retrieved from the SIGN surgical online database of patients with over 1 year follow up period. Results: The mean age of patients was 40.3 years. The majority were male 32 (82.1%) and the commonest mechanism of injury was Road Traffic Accidents (RTA) 37 (94.9%). The majority did not have a clear record of having received antibiotics immediately after injury 29 (74.4%). However, most had a record of receiving antibiotics 1 hour before surgery 33 (84.6%). The most affected bone was the tibia 33 (84.6%). The commonest fracture type was Gustilo IIIa 18 (46.2%). On follow up;10 (25.6%) developed an infection (osteomyelitis), 6 (15.4%) did not have a union on x-ray, 4 (10.3%) had a loose screw, 1 had an implant breakage and also 1 patient had a varus deformity. However, there was no amputation recorded. Conclusion: The management of open fractures is still a major challenge in low and middle income countries like Uganda, which is still experiencing relatively high complication rates. Guidelines emphasizing the need for early antibiotic prophylaxis and faster access to surgical treatment are required for better treatment outcomes.
文摘Purpose: Osteoporotic vertebral fractures with no sign of vertebral collapse on initial radiographs, which is so-called occult vertebral fractures (VFs), exist. Occult VFs have a high rate of missed diagnosis, and the treatment of these fractures has rarely been discussed in the literature. We evaluated the effects of vertebral bone drilling for the pain due to occults VFs. Materials and Methods: Eighteen patients with painful osteoporotic occult VFs underwent the vertebral bone drilling. We evaluated the clinical outcome by comparing numerical rating scale (NRS) and activity of daily life (ADL) values between before and after the vertebral bone drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and ADL score, and the mean NRS and ALD score after the bone drilling were 8.4 ± 0.8, 2.2 ± 0.6, 2.4 ± 1.0, 4.6 ± 0.5, respectively. Among the patients, we detected significant improvements in NRS pain score and ADL score after the drilling compared with baseline score (p < 0.0002). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic occult VFs.
文摘AIM: To evaluate the association between alcoholic liver disease(ALD) and bone fractures or osteoporosis. METHODS: Non-randomized studies were identified from databases(Pub Med, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included "alcoholic liver diseases", "osteoporosis", or "bone fractures". The prevalence of any fractures or osteoporosis, and bone mineral density(BMD) were extracted and analyzed using risk ratios and standardized mean difference(SMD). A random effects model was applied. RESULTS: In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944(95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849(95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD(SMD in femur-BMD:-0.172, 95%CI:-0.453-0.110; SMD in spine-BMD:-0.169, 95%CI:-0.476-0.138). Sensitivity analyses showed consistent results. CONCLUSION: Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.
文摘BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.
文摘Purpose: The Investigational Vertebroplasty Efficacy and Safety Trial (INVEST), a randomized blinded controlled study of Vertebroplasty, demonstrated similar improvements in pain between blinded Vertebroplasty and sham-Vertebroplasty groups. The result from the RCT study suggested that the observed efficacy of the Vertebroplasty procedure, instead of representing the cement-mediated reduction in pain, may relate to the vertebral bone drilling per se. The aim of this study was to demonstrate the effectiveness of pain relief of vertebral bone drilling at the site of painful osteoporotic vertebral compression fractures in the acute phase. Materials and Methods: Twenty-six patients with painful osteoporotic compression fractures underwent the vertebral bone drilling. We assessed primary outcome measures in the NRS pain score and RDQ score at day 0 and 3 following the drilling. Comparisons were made by using Wilcoxon signed rank test. Results: The mean baseline NRS and RDQ score, and the mean NRS and RDQ score at day 3 were 7.3 ± 1.2, 15.7 ± 4.2, 4.6 ± 1.4, 7.3 ± 2.2, respectively. Among the patients, we detected significant improvements in NRS pain score and RDQ score at day 3 following the drilling compared with day 0 (P < 0.001). Conclusion: Vertebral bone drilling at the site of painful vertebral compression fractures alleviated the intractable pain due to osteoporotic vertebral compression fractures.
文摘The discontinuation of denosumab[antibody targeting receptor activator of nuclear factor kappa B ligand(RANKL)]therapy may increase the risk of multiple vertebral fractures;however,the underlying pathophysiology is largely unknown.In patients who underwent discontinuation after multiple injections of denosumab,the levels of tartrate-resistant acid phosphatase 5b increased compared to pretreatment levels,indicating a phenomenon known as“overshoot.”The rate of decrease in bone mineral density during the withdrawal period was higher than the rate of decrease associated with aging,suggesting that the physiological bone metabolism had broken down.Overshoot and significant bone loss were also observed in mice receiving continuous administration of anti-RANKL antibody after treatment was interrupted,resembling the original pathology.In mice long out of overshoot,bone resorption recovered,but osteoblast numbers and bone formation remained markedly reduced.The bone marrow exhibited a significant reduction in stem cell(SC)antigen 1-and platelet-derived growth factor receptor alpha-expressing osteoblast progenitors(PαS cells)and alkaline phosphatase-positive early osteoblasts.Just before the overshoot phase,the osteoclast precursor cell population expands and RANKL-bearing extracellular vesicles(EVs)became abundant in the serum,leading to robust osteoclastogenesis after cessation of anti-RANKL treatment.Thus,accelerated bone resorption due to the accumulation of RANKLbearing EVs and long-term suppression of bone formation uncoupled from bone resorption leads to the severe bone loss characteristic of denosumab discontinuation.
文摘Objective:To evaluate the bone metabolism balance and traumatic reaction of minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures. Methods:80 patients with femoral shaft fractures who were treated in our hospital between May 2011 and December 2016 were collected and divided into control group (n=40) and observation group (n=40) according to random number table, control group received conventional steel plate internal fixation treatment, and observation group received minimally invasive mippo intramedullary nail internal fixation treatment. Differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors, and pain mediators and so on were compared between two groups of patients before operation and 1 week after treatment.Results: Before operation, differences in serum levels of bone formation indexes, bone resorption indexes, inflammatory factors and pain mediators were not statistically significant between two groups of patients. After operation, serum bone formation indexes P ICP, BGP, BALP and ALP levels in observation group were higher than those in control group;serum bone resorption indexesβ-CTX and OPG levels were lower than those in control group;serum inflammatory factors IL-1β, IL-6, IL-8 and CRP levels were lower than those in control group;serum pain mediators SP, PGE2 and 5-HT levels were lower than those in control group.Conclusion:Minimally invasive mippo intramedullary nail internal fixation treatment of femoral shaft fractures can promote the bone formation, relatively inhibit bone resorption and cause less traumatic reaction.
文摘Although there have been many reports of small bone and vertebral involvement in sarcoidosis, long bone pathology is rare. We report a case of almost identical bilateral fractures of the proximal femoral diaphysis during separated in time through a low-energy mode of injury, and explore the difficulties encountered when seeking radiological and tissue diagnosis.
文摘Multiple segmental fractures of the lower limbs, common in developing countries, are the prerogative of Road Traffic Accidents (RTA) involving two-wheeled vehicles. Their management is difficult, associated with complications, and is most often based on a two-stage strategy: Damage Control Orthopaedics, followed by delayed internal osteosynthesis. The aim is to allow early functional rehabilitation and rapid recovery of patients. We report the case of a 39-year-old man, bike rider, after his RTA, presented with segmental homolateral fractures of the femur and two bones of the left leg. Short-term evolution was marked by the appearance of significant lymphedema and bone infarctions of the lower left limb necessitating a transfemoral amputation. Through this observation, the authors highlight the problems related to the complexity of the management of multiple segmental fractures of the lower limb by emphasizing two post-traumatic complications rarely described but to be feared: chronic lymphedema and bone infarction.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> An open fracture is an injury in which the fracture site and/or hematoma communicates with the external environment. It is associated with significant morbidity and disability and is a challenge to the surgical team. The lower extremities are the most often exposed to traumatic injuries compared to other anatomical parts of the body. Patterns of open fractures differ with different mechanisms of injury and the segment of the long bone affected. The correct and timely management of open fractures is beneficial to the patients and lead</span><span style="font-family:Verdana;">s</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> to a more favorable outcome. This study aimed at describing the pattern of open fractures of long bones of the lower limb treated in 3 major hospitals of the south west region, Cameroon. </span><b><span style="font-family:Verdana;">Methodology: </span></b><span style="font-family:Verdana;">This was a hospital-based retrospective review of files of patients with open fractures of long bones of the lower limb managed at the surgical units of three secondary health facilities in the South-West region of Cameroon from the 1</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of January 2015 to the 31</span><sup><span style="font-family:Verdana;">st</span></sup><span style="font-family:Verdana;"> of December 2019. The socio-demographic characteristics, clinical presentation, treatment modalities, and outcomes were recorded. The data was stored and analyzed using Epi info version 7.0 and SPSS version 23.0 respectively. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">A total of 195 files of patients aged 8 to 80 years were studied. The main age group affected was between 20</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">-</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">40 </span><span style="font-family:Verdana;">years. There were 147 (75.4%) males and 48 (24.6%) females giving a sex-ratio</span><span style="font-family:Verdana;"> of 3.1:1. The most common cause was road traffic crashes 142 (72.8%). In 98 cases (50.3%)</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the left side was more involved. The tibia was the most common long bone affected in 75 (38.5%) cases. Comminuted fracture was the most common fracture pattern encountered in 126 cases (64.6%). A total of 76 (39%) fractures were graded Gustilo-Anderson IIIA. External fixator was used in 112 cases (57.1%) and internal fixator in 86 cases (42.9%). We recorded 127 (65.1%) cases of wound infection and 143 (73.3%) cases of limb shortening as the most common complications. Other complications include</span><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">20 cases (17.1%) of mal-union, 27 cases (22.5%) of delayed union, 18 cases (15.1%) of non-union and 50 cases (38.5%) chronic osteomyelitis. We recorded a mortality of 2.1%. Gustilo IIIB and IIIC were associated to chronic osteomyelitis (P</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.02). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Open fractures of long bones of the lower limb affect the active age group of the population and road traffic crashes</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">are the most common causes. It tends to affect the left side and the tibia being the most fractured long bone. A reasonable proportion of these fractures subsequently get infected. Comminuted fracture is the common fracture pattern.</span>
文摘The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.
文摘Objective:To study the effects of MIPO and ORIF on stress degree and bone metabolism activity in patients with middle humeral shaft fractures.Methods: Patients with middle humeral shaft fractures who received surgical treatment in Mianyang Orthopedic Hospital between June 2010 and October 2015 were enrolled and randomly divided into MIPO group and ORIF group who were treated with minimally invasive plate oateosynthesis and open reduction internal fixation respectively. Before surgery as well as 1 d and 3 d after surgery, serum was collected to determine the contents of stress response molecules and bone metabolism markers.Results:1 d and 3 d after surgery, serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of both groups were higher than those before surgery while bone formation markers BGP, BALP, PINP and OPG contents were lower than those before surgery;serum stress molecules PGE2, CRP, NE and E as well as bone resorption markers TRACP-5B,β-CTX, RANK and RANKL contents of MIPO group were lower than those of ORFI group while bone formation markers BGP, BALP, PINP and OPG contents were higher than those of ORFI group.Conclusion: Compared with ORIF, MIPO for middle humeral shaft fractures can reduce stress response degree and improve bone metabolism.
基金supported by the National Key R&D Program of China(Grant No.2016YFC1102000)the National Natural Science Foundation of China(Grant Nos.81672139 and 81702129)+3 种基金the China Postdoctoral Science Foundation(No.171479)Doctor Initial Foundation of Liaoning Province(No.20170520017)Affiliated Zhongshan Hospital of Dalian University(No.DLDXZSYYDK201701)by a grant from the Research Grants Council of the Hong Kong Special Administrative Region,China(Project No.T13-402/17-N)。
文摘Bone plates play a vital role in bone fracture healing by providing the necessary mechanical fixation for fracture fragments through modulating biomechanical microenvironment adjacent to the fracture site.Good treatment effect has been achieved for fixation of bone fracture with conventional bone plates,which are made of stainless steel or titanium alloy.However,several limitations still exist with traditional bone plates including loosening and stress shielding due to significant difference in modulus between metal material and bone tissue that impairs optimal fracture healing.Additionally,due to demographic changes and non-physiological loading,the population suffering from refractory fractures,such as osteoporosis fractures and comminuted fractures,is increasing,which imposes a big challenge to traditional bone plates developed for normal bone fracture repair.Therefore,optimal fracture treatment with adequate fixation implants in terms of materials and design relevant to special conditions is desirable.In this review,the complex physiological process of bone healing is introduced,followed by reviewing the development of implant design and biomaterials for bone plates.Finally,we discuss recent development of hybrid bone plates that contains bioactive elements or factors for fracture healing enhancement as a promising direction.This includes biodegradable Mg-based alloy used for designing bone screw-plates that has been proven to be beneficial for fracture healing,an innovative development that attracts more and more attention.This paper also indicates that the tantalum bone plates with porous structure are also emerging as a new fracture internal fixation implants.The reduction of the stress shielding is verified to be useful to accelerate bone fracture healing.Potential application of biodegradable metals may also avoid a second operation for implant removal.Further developments in biometals and their design for orthopedic bone plates are expected to improve the treatment of bone fracture,especially the refractory fractures.
文摘Objective： To demonstrate the validity and reliability of volumetric quantitative computed tomography （vQCT） with multi-slice computed tomography （MSCT） and dual energy X-ray absorptiometry （DXA） for hip bone mineral density （BMD） measurements, and to compare the differences between the two techniques in discriminating postmenopausal women with osteoporosis-related vertebral fractures from those without. Methods： Ninety subjects were enrolled and divided into three groups based on the BMD values of the lumbar spine and/or the femoral neck by DXA. Groups 1 and 2 consisted of postmenopausal women with BMD changes 〈-2SD, with and without radiographically confirmed vertebral fracture （n= 11 and 33, respectively）. Group 3 comprised normal controls with BMD changes 〉-ISD （n-46）. Post-MSCT （GE, LightSpeed16） scan reconstructed images of the abdominal-pelvic region, 1.25 mm thick per slice, were processed by OsteoCAD software to calculate the following parameters： volumetric BMD values of trabecular bone （TRAB）, cortical bone （CORT）, and integral bone （INTGL） of the left femoral neck, femoral neck axis length （NAL）, and minimum cross-section area （mCSA）. DXA BMD measurements of the lumbar spine （AP-SPINE） and the left femoral neck （NECK） also were performed for each subject. Results： The values of all seven parameters were significantly lower in subjects of Groups 1 and 2 than in normal postmenopausal women （P〈0.05, respectively）. Comparing Groups 1 and 2, 3D-TRAB and 3D-INTGL were significantly lower in postmenopausal women with vertebral fracture（s） [（109.8±9.61） and （243.3±33.0） mg/cm^3, respectively] than in those without [（148.9±7.47） and （285.4±17.8） mg/cm^3, respectively] （P〈0.05, respectively）, but no significant differences were evident in AP-SPINE or NECK BMD. Conclusion： the femoral neck-derived volumetric BMD parameters using vQCT appeared better than the DXA-derived ones in discriminating osteoporotic postmenopausal women with vertebral fractures from those without, vQCT might be useful to evaluate the effect of osteoporotic vertebral fracture status on changes in bone mass in the femoral neck.
文摘Objective： To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods： Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases （16 sides） with intra-articular calcaneal fractures including 13 males （14 feet） and 2 females （2 feet） ,with average age of 36. 6 years （24-61 years）. All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ （3 type Ⅱa, 3 type Ⅱb and 8 type Ⅱc） and 2 feet of type Illac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results： All patients were followed up for an average of 18.4 months （ranged, 12 to 34 months）. No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society （AOFAS） hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group （86.5±4.4） was better than in joint depression type group （81.2±1.7, P〈0.05）. Radiography showed basic restoration of Bohler＇s angle, Gissane＇s angle and calcaneal shape. Conclusion： The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures, with advantages of simple operation, fewer complications and good clinical results.
基金This study was supported by the Science and Technology Support Project of Hebei Traditional Chinese Medicine Administration (2019210)
文摘Objective: To investigate the efficacy of Jintiange capsule in the treatment of acute bone atrophy due to wrist fractures. Methods: Participants were randomly allocated into two groups, i.e. the treatment group and the control groups. All patients received functional rehabilitation exercise. Patients in the treatment group received Jintiange capsule orally, while the control group received placebos. At 3 and 6 months after the treatment, Cooney score, hand grip and pinch strength were measured. The visual analogue scale (VAS) was applied, and safety events were recorded. Results: No loss occurred during 6 months of follow-up after treatment. Before the treatment, there was no statistically significant difference between the two groups in Cooney score, hand grip strength, hand pinch strength or VAS score (all P>0.05). At 3 and 6 months after the treatment, the Cooney core, hand grip and pinch strength increased, and the VAS were decreased in all patients. The treatment group showed significantly greater improvement than the control group (P<0.05). In additional, both groups showed few side effects. Conclusions: Jintiange capsule can improve the function of the wrist joint and alleviate the pain of fracture. It is safe and effective for treating acute bone atrophy.
