Exostoses Research Articles

Mid-Term Outcomes of a Rectangular Stem Design with Metadiaphyseal Fixation and a 135° Neck-Shaft Angle in Reverse Total Shoulder Arthroplasty.

Background/Objectives: Classical reverse shoulder arthroplasty (RSA) with a high neck-shaft angle (NSA) of 155° has shown satisfactory outcomes. However, newer RSA designs aim to improve results by modifying the stem design. This study evaluates the 5-year outcomes of a stem design featuring a rectangular metadiaphyseal fixation and a 135° NSA. Methods: This prospective bicentric case series included and longitudinally followed up patients that were treated for cuff arthropathy, massive irreparable rotator cuff tears, or eccentric osteoarthritis using a non-cemented rectangular metadiaphyseal fixation stem with a 135° NSA (Univers Revers, Arthrex, Naples, FL, USA). Subjective and objective functional outcome scores (Constant-Murley Score (CS), Shoulder Pain and Disability Index (SPADI), and Subjective Shoulder Value (SSV)), range of motion (ROM), radiographic outcome, adverse events, complications, and quality of life were investigated. Results: This study enrolled 132 patients (59% female, mean age 75 years, SD 6). At the 5-year follow-up, subjective and objective outcomes significantly improved compared to baseline: CS (32.9 to 71.7, p < 0.001), SPADI (38.7 to 86.2, p < 0.001), and SSV (43.0 to 84.1, p < 0.001). ROM improved in flexion (80° to 142.4°, p < 0.001), abduction (71.5° to 130.2°, p < 0.001), internal rotation (p < 0.001), internal rotation at 90° abduction (12.7° to 45.0°, p < 0.001), and abduction strength (0.8 kg to 5.2 kg, p < 0.001). External rotation remained unchanged (32.1° to 32.0°, p = 0.125), but external rotation at 90° abduction improved (20.9° to 52.7°, p < 0.001). No signs of implant migration, subsidence, shift, tilt, alignment loss, or wear were observed, but scapular bone spur formation (11%), scapular notching grade 1 (10%), bone resorption (10%), and partial humeral radiolucent lines (1%) were reported. Conclusions: Rectangular stems with metadiaphyseal fixation and a 135° neck-shaft angle in RSA consistently improve shoulder function, showing no aseptic loosening and minimal radiological changes at 5 years.

Characteristics and multi-omics analysis of spontaneous spondyloarthritis in non-human primates: Case report.

Spondyloarthritis is a prevalent and persistent condition that significantly impacts the quality of life. Its intricate pathological mechanisms have led to a scarcity of animal models capable of replicating the disease progression in humans, making it a prominent area of research interest in the field. To delve into the pathological and physiological traits of spontaneous non-human primate spondyloarthritis, this study meticulously examined the disease features of this natural disease model through an array of techniques including X-ray imaging, MRI imaging, blood biochemistry, markers of bone metabolism, transcriptomics, proteomics, and metabolomics. X-ray imaging results revealed that crab-eating monkeys (Macaca fascicularis) with spontaneous spondyloarthritis developed bone spurs in the spine and experienced bone destruction in peripheral joints. MRI imaging further confirmed inflammatory changes in the spine and facet joints of these monkeys, along with inflammation and bone destruction in peripheral joints. Blood biochemistry analysis showed abnormalities in liver function and kidney function indicators in crab-eating monkeys with spontaneous spondyloarthritis. Analysis of bone metabolism-related markers showed a decrease in bone formation (BGP) and bone resorption (β-CTx). A thorough correlation analysis was conducted on the transcriptome and proteome expression data, revealing a significant positive correlation between the two datasets. A total of eight genes and proteins with high expression levels were identified as common to both the transcriptome and proteome. Subsequent Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed on these co-expressed genes and proteins, indicating a predominant enrichment in the IL-17 signaling pathway, with S100A8 and S100A9 identified as the core proteins. Further analysis using clinical data in conjunction with proteome data through Weighted Gene Co-expression Network Analysis (WGCNA) demonstrated a significant positive correlation between the high expression of S100A8 and S100A9 and the clinical phenotypes of spinal abnormalities, thereby corroborating the close association of S100A8 and S100A9 with the phenotype of spondyloarthritis. Human clinical studies have already established a link between S100A8 and S100A9 and autoimmune-related arthritic diseases, suggesting that the spontaneous spondyloarthritis observed in crab-eating macaques may be related to autoimmune diseases. It is hypothesized that S100A8 and S100A9 could serve as potential predictive biomarkers for spondyloarthritis in non-human primates.

Optimizing knee osteoarthritis severity prediction on MRI images using deep stacking ensemble technique.

Knee osteoarthritis (KOA) represents a well-documented degenerative arthropathy prevalent among the elderly population. KOA is a persistent condition, also referred to as progressive joint Disease, stemming from the continual deterioration of cartilage. Predominantly afflicting individuals aged 45 and above, this ailment is commonly labeled as a "wear and tear" joint disorder, targeting joints such as the knee, hand, hips, and spine. Osteoarthritis symptoms typically increase gradually, contributing to the deterioration of articular cartilage. Prominent indicators encompass pain, stiffness, tenderness, swelling, and the development of bone spurs. Diagnosis typically involves the utilization of Radiographic X-ray images, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT) Scan by medical professionals and experts. However, this conventional approach is time-consuming, and also sometimes tedious for medical professionals. In order to address the limitation of time and expedite the diagnostic process, deep learning algorithms have been implemented in the medical field. In the present investigation, four pre-trained models, specifically CNN, AlexNet, ResNet34 and ResNet-50, were utilized to predict the severity of KOA. Further, a Deep stack ensemble technique was employed to achieve optimal performance resulting to the accuracy of 99.71%.

Comparative study of the histology and Micro-CT scan of the goldfish hood

The hood (also known as head growth or wen) is a distinctive feature of goldfish characterized by skin tissue proliferation. The classification of goldfish hood types and the study of the underlying skeletal structure still have substantial gaps in research. This study aimed to investigate the structural differences in goldfish hood tissues using histological and Micro-CT comparisons, based on traditional Chinese classifications. Histological observations revealed two distinct types: the one-piece type (Crown Pearlscale), characterized by a uniformly thickened epidermis, and the fused type (Oranda, Red Cap Oranda, and Ranchu), which showed irregular epidermal extensions into the dermis. Micro-CT scans further demonstrated that hooded goldfish exhibited skull protrusions, bone spurs, and widening of the cranial region. These findings indicate that fibroblast activity, tissue edema, and bone structural changes may be key drivers of hood formation in these goldfish varieties.

Controversies of the Plantar Fasciitis

Plantar fasciitis commonly reflects a repetitive strain injury of foot’s plantar fascia structure cause by overuse standing or weight bearing activities. Plantar fascia not really a tendon ; it’s sheet of connective tissue (fascia) from bone at back foot to bone at in front, and more like a ligament. This tissue spanning the arch of the foot and stretch from the heel to toes. The pain is caused by chronic irritation of the arch of the foot due to excessive strain of the plantar fascia as the bow’s string and location of the pain is closely to the heel. Pain hits when get up after a period of sitting or rest. Morning pain is a signature symptom of plantar fasciitis. In fact, the plantar fasciitis found so little inflammation and shows collagen degeneration-disorganization, so better to use a more generic suffix – like ‘opathy’ (diseased) or osis (condition) become fasciosis. And degeneration in plantar fascia is similar to the chronic necrosis of tendinosis (dying tissue). Inflammation and necrosis are not the same medical situation, and understanding the differences is essensial for adequate treatment. Bone spurs on the heel or calcaneal spurs get the blame often for plantar fasciitis because it seems so obvious and simple known after x-ray examination. Heel spurs merely a modest calcification of the plantar fascia. The spurs is brittle and thin so that are not as much of painful mechanical problem. Statistically about 10-20% of the population has this spurs and thats lots of people have painless spurs. But the spurs are probably more painful at plantar fasciitis symptoms when other factors are present. In the other hand, examining the foot with ultrasound might turn up some other obvious cause of plantar foot pain, for example thickening of fascia. The evidence shows a connection between fascia thickening, flat feet and plantar fasciitis, but cannot confirmed that thickened plantar fascia is the caused. Treating plantar fasciitis with all available modalities is more rationale consideration because plantar fasciitis has more variable origin and condition, so that is why respond after treatment might be different in each other cases, especially in a chronic plantar fasciitis or stubborn overuse injury.

A HOPE IN THE MANAGEMENT OF CERVICAL MYELOPATHY THROUGH PANCHAKARMA

Cervical myelopathy involves spinal cord compression at the cervical level of the spinal column, resulting in spasticity, hyperreflexia, pathologic reflexes, digit/hand clumsiness, and gait disturbance1 . The spontaneous course of myelopathy is characterised either by long periods of stable disability followed by episodes of deterioration or a linear progressive course. The presentation of cervical myelopathy varies by the severity of the spinal cord compression as well as its location. Without treatment, patients may progress toward significant paralysis and loss of function. Any space-occupying lesion within the cervical spine with the potential to compress the spinal cord can cause cervical myelopathy. Cervical myelopathy is predominantly due to pressure on the anterior spinal cord with ischemia as a result of deformation of the cord by anterior herniated discs, spondylitis bone spurs, an ossified posterior longitudinal ligament or spinal stenosis. In Ayurveda, it can be correlated with kaphavruta vyana vata as both signs and symptoms are similar. Objectives--By consideringg cervical myelopathy as Kaphavritta vyana vata, the present study has attempted to evaluate the efficiency of Ayurvedic formulation in the conservative management of cervical myelopathy. Method-A case of cervical myelopathy, Initially the patient was treated with Dashamoola kaya seka followed by Shastika Shalipinda sweda, followed by Madhutailika basti2 and Anuvasana basti with Murchita tila taila as per Kala Basti schedule, followed by Shamana aushadhi. Result-Patient was observed for symptomatic improvement based on the questionnaire over graded signs &amp; symptoms, also observed for clinical examination before &amp; after treatment. Conclusion: The study has shown that conservative management of cervical myelopathy can be managed effectively through the Ayurvedic principle and improve quality of life.

Management of Atypical M-Shaped Zygomatic Arch Fractures.

M-shaped zygomatic arch fractures can usually be treated effectively through closed reduction. It consists of 2 fracture segments: the anterior zygomatic segment and the posterior temporal bone segment. In clinical practice, atypical M-shaped fractures are often encountered, in which the anterior and posterior fracture segments are discontinuous and separated. Closed reduction usually cannot achieve the desired anatomic reduction effect for this type of fracture. The preoperative design showed that the anatomic reduction of the posterior zygomatic arch fracture segment was hindered due to bone spurs in the most concave area of the anterior zygomatic bone fracture segment. Open reduction and fixation were performed to achieve anatomic reduction and restore facial symmetry. The fracture sites were exposed through a hemicoronal incision. After the bone spurs are removed, the posterior bone segment can be anatomically reduced. Absorbable plates were used for fixation. The patient's facial appearance was restored after the surgery. The postoperative computed tomography scan showed a good alignment of the fracture. The authors believe that for patients with high requirements for facial symmetry, the presence of atypical M-shaped fractures can indicate open reduction and fixation.

Clinical Study of a Four-Step Program for the Treatment of Plantar Fasciitis with Bone Spurs.

The most common causes of plantar and heel pain are plantar fasciitis and calcaneal spurs, and they often co-exist. Surgery is a recognized treatment for refractory plantar fasciitis. However, few studies have proposed treatment options for patients with metatarsophalangeal fasciitis with bone spurs. Accordingly, this study's purpose was to propose a four-step surgical regimen, and to improve the surgical outcome of plantar fasciitis with osteophytes and to establish a procedure for surgical treatment. Retrospective analysis of 45 patients suffering from plantar fasciitis with bone spurs from 2020 to 2023. All patients underwent a four-step procedure, including plantar fascia release, calcaneal spur grinding, inflammatory tissue removal, and calcaneal burr decompression. The imaging parameters and functional scores were recorded before and after the operation. The objective evaluation included the measurement of calcaneal spur length on radiographs. Clinical evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS), the Visual Analog Scale (VAS), and the Foot and Ankle Outcome Scale (FAOS). Measurement data that conformed to normal distribution were expressed as (x2 ± s), and pre-and postoperative AOFAS, FAOS, and VAS scores were compared using repeated-measures ANOVA, and preoperative and postoperative spur lengths were compared using paired t-tests. The 45 patients were followed up for 3 to 30 months, (17.72 ± 8.53) months, at final follow-up, the patient's AOFAS score improved from preoperative (74.93 ± 5.56) to (94.78 ± 3.98), FAOS score increased from preoperative (76.42 ± 3.37) to (96.16 ± 2.74), the VAS score decreased from (3.18 ± 0.54) to (1.07 ± 1.20) (p < 0.05), the length of spur decreased from (0.72 ± 1.81) cm to (0.23 ± 1.19) cm, and there were significant differences before and after operation (p < 0.05). The four-step surgical regimen is an appropriate and effective surgical procedure to treat plantar fasciitis with bone spurs.

Percutaneous Transforaminal Endoscopic Lumbar Foraminotomy in Stable Degenerative Lumbar Isthmic Spondylolisthesis with Radicular Leg Pain: A Retrospective Study.

Endoscopic surgery is a minimally invasive option for effectively addressing lumbar degenerative diseases. This study aimed to describe the specific technology of percutaneous transforaminal endoscopic lumbar foraminotomy (PTELF) as a therapeutic intervention for managing radicular leg pain (RLP) resulting from stable degenerative lumbar isthmic spondylolisthesis (DLIS) and to present the associated clinical results. From March 2022 and April 2023, 25 patients were diagnosed with single-level stable DLIS with RLP and underwent PTELF. Clinical assessments utilized the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. All endoscopic surgery videos were reviewed to interpret the pathology associated with DLIS. The mean age of the cohort was 65.3 ± 11.0 years. The mean preoperative ODI score, VAS score for low back, and VAS score of the leg were 64.1 ± 8.2, 7.0 ± 0.7, and 7.3 ± 0.8, respectively. These scores significantly improved to 16.3 ± 10.4, 2.0 ± 0.6, and 1.7 ± 1.0 at the final follow-up, respectively (P<0.01). The modified MacNab criteria indicated "good" or "excellent" outcomes in 92.0% of cases. Analysis of 23 surgical videos revealed 15 patients with disc herniation, nine with lower vertebral endplate involvement, consistent presence of uneven bone spurs (at the proximal lamina stump and around the foramen), and accumulated scars. Two patients experienced postoperative dysesthesia, and one encountered a recurrence of RLP. PTELF emerges as a potentially safe and effective procedure for alleviating RLP in patients with stable DLIS. However, additional evidence and extended follow-up periods are imperative to evaluate the feasibility and potential risks associated with PTELF.

Magnetic resonance imaging assessment of the patterns and distributions of spinal disc degeneration in patients residing in Lagos State

Background: Degenerative disc disease is a condition in which intervertebral discs losses its structure thereby resulting in loss of cushioning, fragmentation and herniation most times related to ageing. Structural defects and failure are common causes of degenerative disc disease. In some cases, the spine loses flexibility and bone spurs may pinch a nerve root, causing pain or weakness. The aim of this study was to assess the prevalence and distribution of disc degeneration over the spines in patients residing in Lagos state using magnetic resonance imaging. Materials and methods: This was a cross-sectional prospective study conducted among 163 patients presented for spinal magnetic resonance imaging (MRI) scan due to disc degeneration in some selected radio-diagnostic centres in Lagos State, Nigeria. The spine structural appearance, intervertebral disc structural appearance, signal intensity, pathologies, gender, age, height, weight and BMI of the patients will be recorded. Both descriptive (mean, percentage, charts and frequency) and inferential statistics (Chi-square) statistics were used for statistical analysis with p-value set at 0.05. Results: Out of 163, 96(58.9%) were female while males were 67(41.1%). The age of the study population ranges from 20 years to 90 years with a mean age of 57.17 ± 12.35. Grade V was highest 64 (39.3%) followed by 32 (25.8%) grade IV and least 10 (6.1%) were grade II. The study found the most common affected on L4/L5 disc with 35 (21.5%) adults demonstrating disc degeneration, while 17 (10.4%) adults demonstrated no disc degeneration. There is no statistically significant association between gender and pattern of disc degeneration (χ2 = 5.943, p =0.203). Conclusion: The majority of the patients had the grade V patterns of degenerated discs based Pffirman grading system. The most affected disc was the L4/L5 disc followed by the L3/L4 disc. There were negative correlations but not statistically significant between weight and BMI respectively and patterns of the disc degeneration diseases. There exist positive correlations but not statistically significant between age and height respectively, and patterns of the disc degeneration diseases. There is no statistically significant association between gender and pattern of disc degeneration.

Mathematical model of osteophyte development with the first attempt to identify a biomechanical parameter

The paper presents research on identifying a biomechanical parameter from a theoretical model of changes during osteoarthritis. In vitro experiments were carried out on quasi-3D chondrocyte cultures seeded on corn-starch hydrogel materials and subjected to mechanical stress on a designed and constructed stand. The results were adapted to a mathematical model and calculated on a simplified two-dimensional specimen. Numerical simulations have been performed to illustrate the growth of bone spurs. The observed changes of variables which determine osteophytes are qualitative and more correlated to the real-life observations.

Physiotherapy Intervention for Cervical Radiculopathy: A Case Report

Introduction: The objective of this study is to determine the efficacy of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm of physiotherapy on pain and quality of life in cervical radiculopathy. Cervical Radiculopathy is characterised by compression of the nerves by either arthritic bone spurs or herniated disc material. Usually, this impingement causes motor dysfunction in the upper extremities and neck, as well as sensory impairments, numbness, or discomfort extending to the arms. Pathologies affecting the nerve roots might result in cervical radiculopathy. Case Report: This case report focuses on a 31-year-old female patient who has been diagnosed with cervical radiculopathy. She had tingling and numbness in her hands, particularly in right arm shows (median nerve distribution). Patient was recruited on the basis of special test: Spurling Test, Distraction Test, and Upper Limb Tension Test. After 2 week of intervention significant improvement was shown by using- Numeric pain Rating scale for pain, Neck Disability Index for Disability, and SF_12 for quality of life, patient reported less symptomatic and symptoms reduction during work and exercise. This case report demonstrates an effective, evidence based approach to physical therapy treatment for patients in cervical radiculopathy.

Cuboid Cobbles Hinder Elite Youth Football Player.

We describe an elite youth football player who developed lateral foot pain of previously unknown origin. A thorough patient history and physical examination as well as an in-depth presentation of radiographic findings on Computed tomography (CT) and Magnetic Resonance Imaging (MRI) scan were described. Through this combination, the puzzle was resolved and a rare peroneus longus tendinopathy due to bony spurs in the cuboid groove was diagnosed. A peroneus longus exploration, release and reduction of the cuboidal bone spurs was performed and intensive rehabilitation phase followed. The patient successfully returned to performance and set a career in professional football.

Carveol alleviates osteoarthritis progression by acting on synovial macrophage polarization transformation: An in vitro and in vivo study

Osteoarthritis (OA) is a heterogeneous disease that affects the entire joint. Its pathogenesis involves hypertrophy and hyperplasia of synovial cells and polarization infiltration of macrophages, in which macrophages, as a potential target, can delay the progression of the disease by improving the immune microenvironment in OA. To investigate the role and regulatory mechanism of Carveol in cartilage and synovial macrophage reprogramming and crosstalk during the development of OA. RAW264.7 mouse macrophage cell line was mainly used to stimulate macrophages to polarization towards M1 and M2 by LPS, IL4+IL13, respectively. Different concentrations of Carveol were given to intervene, and macrophage culture medium was collected to intervene mouse C57BL6J chondrocytes. ROS assay kit, western blotting, cellular immunofluorescence, scanning microscope and section histology were used to evaluate the effect of Carveol on anti-M1-polarization, M2-polarization promotion and cartilage protection. The mouse destabilization of medial meniscus (DMM) model was observed by micro-CT scan and histology. We found that CA could inhibit the increase of macrophage inflammation level under the intervention of LPS and promote the production of M2 anti-inflammatory substances under the intervention of IL-4+IL13. In addition, Carveol activated NRF2/HO-1/NQO1 pathway and enhanced ROS clearance in chondrocytes under the intervention of macrophage culture medium. The phosphorylation of I-κBα is inhibited, which further reduces the phosphorylation of P65 downstream of nuclear factor-κB (NF-κB) signaling pathway. In addition, Carveol inhibits mitogen activated protein kinase (MAPK) signaling molecules P-JNK, P-ERK and P–P38, and inhibits the production of inflammatory mediators. In vivo, Carveol can reduce osteophytes and bone spurs induced by DMM, reduce hypertrophy of synovial cells, reduce infiltration of macrophages, inhibit subchondral bone destruction, and reduce articular cartilage erosion. Our study suggests that synovial macrophages are potential targets for OA treatment, and Carveol is an effective candidate for OA treatment.

A Clinical Study of Ballitarwadi Gutika in the Management of Manyastambha (Cervical Spondylosis)

Manyastambha symptoms and signs are associated to cervical spondylosis. The disease not only negatively impacts a person's health but also greatly impairs quality of life and daily activities. Neck arthritis, also known as cervical spondylosis, can result from disc and ligament problems, as well as bone spurs. This disease primarily affects persons during their productive years of life, with a male-to-female ratio of 3:1 and an incidence of 0.1-1% in the general population. Without regard to sex, religion, or other factors, a total of 45 individuals with the defining signs and symptoms of Manyastambha were chosen for this research trial (Cervical spondylosis). In the current study Ballitarwadi Gutika in the dose of 500mg thrice in a day with Anupana of like warm water for 45 days. Results showed that pain was reduced by 79.33%, stiffness 57.47% and parasthesia 48.44% which were statistically significant. Statistically very significant results were also found in swelling (64.13%), vertigo (52.38%) and neck muscle strength (52.27%). Restricted neck movements like flexion, extension, rotation and lateral flexion were improved by 50.22%, 51.78%, 51.71% and 52.70% respectively. And overall, 57.25% result was observed during the study.

Prediction of Osteoarthritis in the Knee by KOA Diagnosis Using Artificial Intelligence Based Techniques

Knee Osteoarthritis is the most common form of knee arthritis. A healthy knee's articular cartilage, a smooth, slick tissue, allows for simple bending and straightening. The ends of the leg bones that make up your knee are covered, safeguarded, and cushioned by this material. Two c-shaped segments of meniscal cartilage between your bones serve as "shock absorbers" to cushion your knee joint. Osteoarthritis develops gradually. The cartilage becomes rough and ragged as it ages. It hurts to move the bones along this exposed area. The most prevalent signs and symptoms of knee osteoarthritis are pain and stiffness. After being inactive for a while or in the morning, symptoms typically worsen. The earlier you begin treatment, the better, as osteoarthritis gets worse with time. Your doctor may prescribe additional tests after reviewing your symptoms and medical history, such as X-rays, which can reveal bone and cartilage damage as well as the existence of bone spurs, and magnetic resonance imaging (MRI) scans. So, the KOA diagnosis will be based on two modalities: X-rays and MRIs. Depending upon the patient’s opinion about their knee problems, the doctor will decide whether to take X-rays or MRIs for KOA diagnosis. &#x0D; To avoid such severe knee issues, researchers used many various techniques for KOA diagnosis in the existing system in order to treat it at an early stage of knee problems. In order to do that, we conducted a survey of research articles based on the KOA diagnosis published in the years 2021 and 2022 for this work. From the conducted survey, the methodologies which are AI-based techniques used for KOA diagnosis are discussed and their performance metrics are compared. The current review paper's goal is to do research on the various KOA diagnosis approaches employed in the years 2021 and 2022. As a result of this study, the methodologies which are AI-based techniques used for KOA diagnosis achieves good efficiency in predicting the osteoarthritis in the knee.

A rare case report of mandibular spur on inferior border of the mandible – “Note the point”

Bone spurs are projections that are seen along the borders of bone. These pathologies are usually located within joints and are referred to as osteophytes. Due to the increased frequency or incidence within the joints, osteophytes are named after the location of occurrence, such as extraspinal osteophytes. Due to the lack of a definition or classification of bone spurs in scientific literature and the paucity of cases reported in the jaws, the the current article reports a case of the bone spur along the inferior border of the mandible.

Use of patient-specific guides and 3D model in scapula osteotomy for symptomatic malunion

BackgroundScapular osteotomy for malunion can lead to resolution of pain and functional improvement in scapula fracture sequelae. Understanding three-dimensional bone morphology and analysing post-traumatic deformity is the main step of planning and the key to success of the procedure. 3D models and patient-specific guides are a growing technology to enhance accuracy of planning and to assist during surgery.Case presentationWe report the case of a 50 years old male, complaining of pain and limited function after a malunited scapular body fracture. Clinical assessment showed a severe impairment of shoulder function with active and passive forward flexion limited to 80°, absent external rotation, and internal rotation limited to the buttock. X-rays and CT scan showed an excessive lateral border offset of 53 mm and complete displacement of the glenoid segment anteriorly and medially to the scapular body, with impingement between the lateral most prominent scapular bone spur and humeral shaft. Glenopolar angle was 19°, scapular body angulation on the sagittal plane was 12°. Corrective osteotomy was planned on a virtual interactive rendering and on 3D printed models. Patient-specific guides were developed to perform a body-spine osteotomy with removal of a bone wedge, and a glenoid-spine osteotomy; a patient-specific wedge spacer was used to hold the reduction during plate fixation. Follow-up up to 12 months after surgery demonstrated improvement in scapula anatomy, shoulder girdle function, and patient-reported outcomes.ConclusionsFor the first time in scapula malunion surgery, patient-specific osteotomy guides were succesfully used during surgery to perform osteotomies and to assist in reduction maneuvers.

Novel Formulation Approaches used for the Management of Osteoarthritis: A Recent Review.

Osteoarthritis (OA) causes economic, social, and health difficulties in patients. Approximately 10% to 15% of all persons above the age of 60 have some degree of OA. OA is more common in women than in males. Diagnosed OA prevalence varies widely among EU member states, from 2.8% in Romania to 18.3% in Hungary. Osteoarthritis (OA) is a slow-progressing, non-inflammatory disorder. This disorder ultimately destroys articular cartilage and other joint components. The main symptoms are stiffness, pain, loss of flexibility, swelling, and bone spurs. Many modifiable and non-modifiable risk factors have been associated with osteoarthritis (OA), including obesity and lack of exercise, genetic susceptibility, bone density, work-related damage, and trauma. Hydrogels, micro and nano-sized particles, and novel topical gels are the most common examples. Hydrogels are cross-linked polymers with 3-D architecture that can hold water and expand like living tissue. The micro-carriers and nano-based drug delivery systems provide several advantages and may demonstrate prolonged release, controlled release, and higher joint half-life. OA-induced male Lewis rats were injected with celecoxib-loaded PEA microspheres to assess in vivo biocompatibility and degradation. According to the findings of this research, PEA microspheres loaded with celecoxib may be employed as safe delivery of drugs with self-regulating behavior for pain treatment related to knee osteoarthritis. The concept of novel drug delivery systems has shown tangible benefits as a new avenue for precise, safe, high-quality drug delivery for OA treatment. Currently, herbal drugs are also used in osteoarthritis treatment due to their potency and fewer side effects than synthetic drugs. The herbosynthetic approach is a new concept for the delivery of both herbal and synthetic drugs together to exploit their individual beneficial effects while reducing undesirable side effects.

Does Posterior Cord Compression From the Ligamentum Flavum Influence Clinical Outcomes After Anterior Cervical Discectomy and Fusion?

Retrospective cohort study. To clarify whether outcomes of anterior cervical discectomy and fusion (ACDF) differ according to the presence of posterior cord compression from the ligamentum flavum (CCLF). Although ACDF effectively addresses anterior cord compression from disc material and bone spurs, it cannot address posterior compression. Whether ACDF could result in favorable outcomes when CCLF is present remains unclear. A total of 195 consecutive patients who underwent ACDF and were followed up for >2 years were included. CCLF was graded based on magnetic resonance imaging findings. Patients with CCLF grade 2 were classified as such, whereas patients with CCLF grades 0 to 1 were classified as the no-CCLF group. Patient characteristics, cervical sagittal parameters, neck pain visual analog scale, arm pain visual analog scale, and Japanese Orthopedic Association (JOA) score were assessed. Categorical variables were analyzed using a χ 2 test, whereas continuous variables were analyzed using the Student t test. Multivariable logistic regression analysis was performed to elucidate factors associated with JOA recovery rates of >50%. One hundred sixty-seven patients (85.6%) were included in the no-CCLF group, whereas the remaining 28 patients (14.4%) were included in the CCLF group. Among patients in the CCLF group, 14 patients (50.0%) achieved clinical improvement. JOA score significantly improved in the no-CCLF group after the operation ( P < 0.001), whereas improvement was not appreciated in the CCLF group ( P = 0.642). JOA scores at 3 months ( P = 0.037) and 2 years ( P = 0.001) postoperatively were significantly higher in the no-CCLF group. Furthermore, the JOA recovery rate at 2 years after surgery was significantly higher in the no-CCLF group ( P = 0.042). Logistic regression demonstrated that CCLF was significantly associated with a JOA recovery rate of >50% at 2 years after surgery (odds ratio: 2.719; 95% CI: 1.12, 6.60). ACDF performed for patients with CCLF grade 2 showed inferior JOA score improvement compared with those with CCLF grade 0 or 1. ACDF cannot remove posterior compressive structures, which limits its utility when ligamentum flavum significantly contributes to cord compression.