The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to in...The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.展开更多
AIM: To investigate the in vivo effects of type Ⅰdiabetes on the mechanical strength of tibial bone in a rodent model.METHODS: The biomechanical effect of diabetes on the structural integrity of the tibia in streptoz...AIM: To investigate the in vivo effects of type Ⅰdiabetes on the mechanical strength of tibial bone in a rodent model.METHODS: The biomechanical effect of diabetes on the structural integrity of the tibia in streptozotocin induced diabetic Wistar rats was analysed. Induction of diabetes was achieved by an intra-peritoneal injection and confirmed by measuring serial blood glucose levels(> 150 mg/d L). After 8 wk the tibiae were harvested and compared to a control group. Biomechanical analysis of harvested tibiae was performed using a threepoint bending technique on a servo hydraulic MTS 858 MiniB ionix frame. Maximum force applied to failure(N), stiffness(N × mm) and energy absorbed(N/mm) were recorded and plotted on load displacement curves. A displacement control loading mode of 1 mm/min was selected to simulate quasi-static loading conditions. Measurements from load-displacement curves were directly compared between groups.RESULTS: Fourteen streptozotocin induced diabetic Wistar rats were compared against nineteen non-diabetic controls. An average increase of 155.2 g in body weight was observed in the control group compared with only 5 g in the diabetic group during the experimental study period. Levels of blood glucose increased to 440.25 mg/d L in the diabetic group compared to 116.62 mg/d L in the control group.The biomechanical results demonstrate a highly significant reduction in the maximum load to failure from 69.5 N to 58 N in diabetic group compared to control(P = 0.011). Energy absorption to fracture was reduced from 28.2 N in the control group to 23.5 N in the diabetic group(P = 0.082). No significant differences were observed between the groups for bending stiffness.CONCLUSION: Streptozotocin-induced diabetes in rodents reduces the maximum force and energy absorption to failure of bone, suggesting a predisposition for fracture risk.展开更多
BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral...BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.展开更多
BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systemati...BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection.展开更多
文摘The number of revision total hip arthroplasties is expected to rise as the indications for arthroplasty will expand due to the aging population. The prevalence of extensive proximal femoral bone loss is expected to increase subsequently. The etiology of bone loss from the proximal femur after total hip arthroplasty is multifactorial. Stress shielding, massive osteolysis, extensive loosening and history of multiple surgeries consist the most common etiologies. Reconstruction of extensive bone loss of the proximal femur during a revision hip arthroplasty is a major challenge for even the most experienced orthopaedic surgeon. The amount of femoral bone loss and the bone quality of the remaining metaphyseal and diaphyseal bone dictate the selection of appropriate reconstructive option. These include the use of impaction allografting, distal press-fit fixation, allograft-prosthesis composites and tumor megaprostheses. This review article is a concise review of the current literature and provides an algorithmic approachfor reconstruction of different types of proximal femoral bone defects.
文摘AIM: To investigate the in vivo effects of type Ⅰdiabetes on the mechanical strength of tibial bone in a rodent model.METHODS: The biomechanical effect of diabetes on the structural integrity of the tibia in streptozotocin induced diabetic Wistar rats was analysed. Induction of diabetes was achieved by an intra-peritoneal injection and confirmed by measuring serial blood glucose levels(> 150 mg/d L). After 8 wk the tibiae were harvested and compared to a control group. Biomechanical analysis of harvested tibiae was performed using a threepoint bending technique on a servo hydraulic MTS 858 MiniB ionix frame. Maximum force applied to failure(N), stiffness(N × mm) and energy absorbed(N/mm) were recorded and plotted on load displacement curves. A displacement control loading mode of 1 mm/min was selected to simulate quasi-static loading conditions. Measurements from load-displacement curves were directly compared between groups.RESULTS: Fourteen streptozotocin induced diabetic Wistar rats were compared against nineteen non-diabetic controls. An average increase of 155.2 g in body weight was observed in the control group compared with only 5 g in the diabetic group during the experimental study period. Levels of blood glucose increased to 440.25 mg/d L in the diabetic group compared to 116.62 mg/d L in the control group.The biomechanical results demonstrate a highly significant reduction in the maximum load to failure from 69.5 N to 58 N in diabetic group compared to control(P = 0.011). Energy absorption to fracture was reduced from 28.2 N in the control group to 23.5 N in the diabetic group(P = 0.082). No significant differences were observed between the groups for bending stiffness.CONCLUSION: Streptozotocin-induced diabetes in rodents reduces the maximum force and energy absorption to failure of bone, suggesting a predisposition for fracture risk.
文摘BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.
文摘BACKGROUND Although the impact of microbial infections on orthopedic clinical outcomes is well recognized,the influence of viral infections on the musculoskeletal system might have been underestimated.AIM To systematically review the available evidence on risk factors and musculoskeletal manifestations following viral infections and to propose a pertinent classification scheme.METHODS We searched MEDLINE,Cochrane Central Register of Controlled Trials(CENTRAL),the Reference Citation Analysis(RCA),and Scopus for completed studies published before January 30,2021,to evaluate risk factors and bone and joint manifestations of viral infection in animal models and patient registries.Quality assessment was performed using SYRCLE's risk of bias tool for animal studies,Moga score for case series,Wylde score for registry studies,and Newcastle-Ottawa Scale for case-control studies.RESULTS Six human and four animal studies were eligible for inclusion in the qualitative synthesis.Hepatitis C virus was implicated in several peri-and post-operative complications in patients without cirrhosis after major orthopedic surgery.Herpes virus may affect the integrity of lumbar discs,whereas Ross River and Chikungunya viruses provoke viral arthritis and bone loss.CONCLUSION Evidence of moderate strength suggested that viruses can cause moderate to severe arthritis and osteitis.Risk factors such as pre-existing rheumatologic disease contributed to higher disease severity and duration of symptoms.Therefore,based on our literature search,the proposed clinical and pathogenetic classification scheme is as follows:(1)Viral infections of bone or joint;(2)Active bone and joint inflammatory diseases secondary to viral infections in other organs or tissues;and(3)Viral infection as a risk factor for post-surgical bacterial infection.
