Diaphyseal Region Research Articles

Heterogeneity in mechanical properties of cortical bone for the selection and design of anatomic site-specific nanoparticle reinforced bone tissue engineering scaffold

Bone tissue has the potential to self-heal and renew, but large-scale bone abnormalities caused by infection, trauma, or any malignancy shall require intervention from external sources. To mimic the host tissue i.e., bone mechanical properties, the scaffolds for bone tissue engineering are designed. However, the host tissue mechanical properties are anatomic site-specific as per the location where a scaffold has to be implanted to facilitate tissue regeneration. This is because of the heterogeneous and hierarchical structure of bone that consists of mineral nano-particles, water, collagenous protein, etc. which makes bone a more complex material. Fabricating nano-scaffolds becomes a challenging task that can resemble the bone properties in form of biological, chemical, or mechanical. As a result, it is required to examine the change in mechanical properties of a bone throughout the site to build efficient nano-scaffolds for tissue engineering/bone regeneration. The mechanical characteristics of cortical bone were investigated at three diaphysis regions of the femoral cortical bone under tension and compression stress. The obtained mechanical properties have been compared statistically using a t-test at p < 0.05 and found a statistical difference in the mechanical properties for different diaphysis locations. The findings of this research may be helpful for the researchers working on the design of nanoparticle-based composite biomaterials to mimic the anatomic site-specific mechanical properties of bone for tissue engineering applications.

Study of outcomes of suprapatellar approach for tibia intramedullary nailing in patients coming to rural medical college, Loni

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibia shaft fractures are most common lower limb long bone fractures. In approximately 80% of patients, tibia fracture occurs in diaphysis region. The procedure of intramedullary interlocking nailing is done by positioning the injured extremity at minimum of 90 degree of flexion in the knee joint to achieve optimal exposure of correct entry point. The tension of quadriceps tendon causes a typical apex anterior angulation of proximal fragment. Supra patellar nailing is done with knee in semi extended position, reducing the anterior angulation. The aim of this study is to study outcomes of supra patellar access of intramedullary nailing for tibia fractures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It is a descriptive longitudinal study which was carried out from October 2019 to September 2021 in Dr. Balasaheb Vikhe Patil rural medical college, Loni, Ahmednagar. In this study 60 case of closed shaft tibia fractures were treated by supra-patellar nailing technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study we selected, 60 patients with tibia fracture admitting in our institute. All patients underwent operative procedure in the form of intramedullary interlocking tibia nail which was done with suprapatellar approach. Out of all the 60 patients treated with suprapatellar approach, excellent results with good range of movements with excellent lower extremity functional scale score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Supra-patellar approach was found to provide excellent outcome for proximal 1/3&lt;sup&gt;rd&lt;/sup&gt; of tibia fracture.&lt;/p&gt;

Stemless anatomic total shoulder arthroplasty: surgical technique and review of the literature

Stemless anatomic total shoulder arthroplasty (aTSA) is a promising option for the treatment of degenerative disease in patients. This novel technique avoids the stem-related complications associated with the traditional stemmed aTSA. Stemless aTSA offers additional benefits such as decreased operative time, preservation of bone stock, improved radiographic outcomes, and easier revision. Moreover, loading of the metaphyseal region rather than the diaphysial region with traditional stemmed implants can decrease stress shielding. When compared to stemmed-implants, stemless aTSA has demonstrated similar outcomes and complication rates. The purpose of this article is to analyze published outcomes and complications following the utilization of stemless aTSA. Additionally,key aspects of the surgical technique that may promote optimal results in stemless aTSA implantation are presented.

A Novel Nanostructured Surface on Titanium Implants Increases Osseointegration in a Sheep Model.

A nanostructured titanium surface that promotes antimicrobial activity and osseointegration would provide the opportunity to create medical implants that can prevent orthopaedic infection and improve bone integration. Although nanostructured surfaces can exhibit antimicrobial activity, it is not known whether these surfaces are safe and conducive to osseointegration. Using a sheep animal model, we sought to determine whether the bony integration of medical-grade, titanium, porous-coated implants with a unique nanostructured surface modification (alkaline heat treatment [AHT]) previously shown to kill bacteria was better than that for a clinically accepted control surface of porous-coated titanium covered with hydroxyapatite (PCHA) after 12 weeks in vivo. The null hypothesis was that there would be no difference between implants with respect to the primary outcomes: interfacial shear strength and percent intersection surface (the percentage of implant surface with bone contact, as defined by a micro-CT protocol), and the secondary outcomes: stiffness, peak load, energy to failure, and micro-CT (bone volume/total volume [BV/TV], trabecular thickness [Tb.Th], and trabecular number [Tb.N]) and histomorphometric (bone-implant contact [BIC]) parameters. Implants of each material (alkaline heat-treated and hydroxyapatite-coated titanium) were surgically inserted into femoral and tibial metaphyseal cancellous bone (16 per implant type; interference fit) and in tibial cortices at three diaphyseal locations (24 per implant type; line-to-line fit) in eight skeletally mature sheep. At 12 weeks postoperatively, bones were excised to assess osseointegration of AHT and PCHA implants via biomechanical push-through tests, micro-CT, and histomorphometry. Bone composition and remodeling patterns in adult sheep are similar to that of humans, and this model enables comparison of implants with ex vivo outcomes that are not permissible with humans. Comparisons of primary and secondary outcomes were undertaken with linear mixed-effects models that were developed for the cortical and cancellous groups separately and that included a random effect of animals, covariates to adjust for preoperative bodyweight, and implant location (left/right limb, femoral/tibial cancellous, cortical diaphyseal region, and medial/lateral cortex) as appropriate. Significance was set at an alpha of 0.05. The estimated marginal mean interfacial shear strength for cancellous bone, adjusted for covariates, was 1.6 MPa greater for AHT implants (9.3 MPa) than for PCHA implants (7.7 MPa) (95% CI 0.5 to 2.8; p = 0.006). Similarly, the estimated marginal mean interfacial shear strength for cortical bone, adjusted for covariates, was 6.6 MPa greater for AHT implants (25.5 MPa) than for PCHA implants (18.9 MPa) (95% CI 5.0 to 8.1; p < 0.001). No difference in the implant-bone percent intersection surface was detected for cancellous sites (cancellous AHT 55.1% and PCHA 58.7%; adjusted difference of estimated marginal mean -3.6% [95% CI -8.1% to 0.9%]; p = 0.11). In cortical bone, the estimated marginal mean percent intersection surface at the medial site, adjusted for covariates, was 11.8% higher for AHT implants (58.1%) than for PCHA (46.2% [95% CI 7.1% to 16.6%]; p < 0.001) and was not different at the lateral site (AHT 75.8% and PCHA 74.9%; adjusted difference of estimated marginal mean 0.9% [95% CI -3.8% to 5.7%]; p = 0.70). These data suggest there is stronger integration of bone on the AHT surface than on the PCHA surface at 12 weeks postimplantation in this sheep model. Given that the AHT implants formed a more robust interface with cortical and cancellous bone than the PCHA implants, a clinical noninferiority study using hip stems with identical geometries can now be performed to compare the same surfaces used in this study. The results of this preclinical study provide an ethical baseline to proceed with such a clinical study given the potential of the alkaline heat-treated surface to reduce periprosthetic joint infection and enhance implant osseointegration.

Medium Activity Prevents Periprosthetic Bone Mass Loss in the Medial Metaphyseal Region of the Tibia after Posterior-Stabilized TKA: A 5-Year Follow-up Study of 110 Knees.

ObjectiveThe bone mass around the prosthesis plays an important role in the stability of the prosthesis. This study aimed to assess the effect of postoperative activity on bone mineral density (BMD) in the proximal tibia 5 years after total knee arthroplasty (TKA). To provide a scientific guidance for postoperative functional exercise.Methods110 patients underwent unilateral primary TKA were divided into three groups based on the University of California Los Angeles (UCLA) activity scale: low activity group (LA group, UCLA = 4, 5); medium activity group (MA group, UCLA = 6, 7); and high activity group (HA group, UCLA = 8, 9). The primary observation was a comparison of the BMD and BMD change percentage (ΔBMD (%)) in the periprosthetic tibia among the LA, MA and HA groups at 1 year, 3 years and 5 years. The secondary observations were radiographic evaluation (prosthetic stability, periprosthetic fractures, aseptic loosening and periprosthetic joint infection) and clinical evaluation (Knee Society Score (KSS), visual analogue score scores and range of motion (ROM)). A one‐way ANOVA was used to compare the clinical scores and BMD among the three groups.ResultsThe BMD of medial region decreased by 10.80%, 12.64%, 13.61% at 1, 3, and 5 years respectively; these were 5.72%, 6.26%, 7.83% in lateral region and 1.42%, 1.78%, 3.28% in diaphyseal region. For medial metaphyseal region, the BMD of the MA group was significantly greater than that of the LA and HA groups at 1 and 3 years (108.9 ± 5.2 vs. 106.1 ± 6.69 vs. 105.4 ± 5.2 and 108.5 ± 6.0 vs. 101.2 ± 6.76 vs. 103.0 ± 6.8, P < 0.01 and P < 0.001), and the BMD changes (ΔBMD (%)) in the MA group were significantly smaller than those in the LA and HA groups (8.75 ± 5.36 vs. 11.92 ± 5.49 vs. 12.70 ± 5.21 and 9.11 ± 5.11 vs. 16.04 ± 4.79 vs. 14.82 ± 4.26, P < 0.01 and P < 0.001).Regarding secondary observations, all of the prostheses were assessed as stable, without periprosthetic fractures, aseptic loosening and periprosthetic joint infection. Regarding KSS scores, there was no significant difference among the three groups. However, the VAS and ROM of the HA group were better than those of the MA and LA groups (1.65 ± 0.79 vs. 2.63 ± 0.77 vs. 3.00 ± 1.17, p < 0.001, and 111.90 ± 9.17 vs. 110.20 ± 6.78 vs. 102.90 ± 8.48, P < 0.001).ConclusionMedium activity prevented periprosthetic bone loss in the medial metaphyseal region of the tibia after posterior‐stabilized TKA, and moderate‐intensity exercise is recommended for patients after TKA to reduce periprosthetic bone loss.

Comparative Osteogenesis and Degradation Behavior of Magnesium Implant in Epiphysis and Diaphysis of the Long Bone in the Rat Model.

Magnesium (Mg), as a biodegradable material, is a promising candidate for orthopedic surgery. Long-bone fractures usually occur in cancellous-bone-rich epiphysis at each end or the cortical-rich diaphysis in the center, with different bone healing processes. Little is known about the differences in results between the two regions when applying Mg implants. Therefore, this study aimed to compare the biodegradation and osteogenesis of Mg implants in a rat model’s epiphysis and diaphysis of the long bone. Twelve male Sprague Dawley rats underwent Mg rod implantation in the distal femoral epiphyses and tibial diaphyses. Every three weeks for up to twelve weeks, degradation behavior, gas evolution, and new bone formation were measured by micro CT. Histomorphology was analyzed by Hematoxylin and Eosin, Villanueva bone staining, and TRAP staining for osteoclastogenesis evaluations. Micro-CT analysis showed statistically significant higher new bone formation in the epiphysis group than in the diaphysis group, which correlated with a lower gas volume. Histological analysis showed higher osseointegration of Mg implants in the epiphyseal region than in the diaphyseal region. The magnesium implant’s osteoclastogenesis-inhibiting properties were shown in the surrounding areas in both the cortical bone of the diaphysis and the cancellous bone of the epiphysis. Our findings show the differences in the magnesium implant’s osteogenesis and biodegradation in the epiphysis and the diaphysis. These dissimilarities indicate a better response of the epiphyseal region to the Mg implants, a promising biomaterial for orthopedic surgery applications.

Biomimetic design of implants for long bone critical-sized defects

This computational study addresses new biomimetic load-bearing implants designed to treat long bone critical-sized defects in a proximal diaphysis region. The design encompasses two strategies: a Haversian bone-mimicking approach for cortical bone and lattices based on triply periodic minimal surfaces (TPMS) for trabecular bone. Compression tests are modeled computationally via a non-linear finite element analysis with Ti6Al4V alloy as a base material. Nine topologies resembling cortical bone are generated as hollow cylinders with different channel arrangements simulating Haversian (longitudinal) and Volkmann (transverse) canals to achieve properties like those of a human cortical bone (Strategy I). Then, the selected optimal structure from Strategy I is merged with the trabecular bone part represented by four types of TPMS-based lattices (Diamond, Primitive, Split-P, and Gyroid) with the same relative density to imitate the whole bone structure. The Strategy I resulted in finding a hollow cylinder including Haversian and Volkmann canals, optimized in canals number, shape, and orientation to achieve mechanical behavior close to human cortical bone. The surface area and volume created by such canals have the maximum values among all studied combinations of transverse and longitudinal channels. Strategy II reveals the effect of interior design on the load-bearing capacity of the whole component. Between four types of selected TPMS, Diamond-based lattice and Split-P have more uniform stress distribution, resulting in a superior load-bearing efficiency than Gyroid and Primitive-based design showing less uniformity. This work offers a new design of the bone-mimicking implant, with cortical and trabecular bone components, to repair long bone critical-sized defects.

A structural reassessment of the Late Pleistocene femur from Maludong, southwestern China

AbstractObjectiveThe Late Pleistocene partial right femur from Maludong in southwestern China has been attributed characteristics of early Homo, especially from the Early Pleistocene, putatively representing a late surviving archaic population in the region. Assessment of additional traits is warranted given newly described postcrania from the Late Pleistocene of southwestern China and characterized by relatively modern features.Materials and methodsWe used micro computed tomography (μCT) to extract and evaluate cross‐sectional diaphyseal structure. New predictions of Maludong femoral length were generated from a regression analysis of Holocene modern humans. Robusticity and shape at multiple, standard diaphyseal regions of interest (ROI) were compared to those of Pleistocene and Holocene humans from East Asia and beyond.ResultsStandardized torsional rigidities at mid‐proximal and subtrochanteric Maludong ROIs fell within ranges of variation exhibited by multiple comparative groups, and closest to medians of Early and Middle Upper Paleolithic modern humans (E/MUP). For Ix/Iy diaphyseal ratios, Maludong was higher than comparative groups at both ROIs, falling closest to the upper end of the E/MUP range. For Imax/Imin shape ratios, Maludong fell well above group medians at the mid‐proximal ROI and nearest E/MUP and Middle Pleistocene group medians at the subtrochanteric ROI.Discussion and conclusionsIn diaphyseal robusticity and rigidity ratios, Maludong fits within variation exhibited by other Late Pleistocene modern humans. While we did not re‐analyze external features described as archaic‐like, internal structure of the Maludong femur contradicts this characterization and instead supports expanding intrapopulation variability expressed by Late Pleistocene modern humans in East Asia.

Absence of P2Y2 Receptor Does Not Prevent Bone Destruction in a Murine Model of Muscle Paralysis-Induced Bone Loss.

Increased incidence of bone fractures in the elderly is associated with gradual sarcopenia. Similar deterioration of bone quality is seen with prolonged bed rest, spinal cord injuries or in astronauts exposed to microgravity and, preceded by loss of muscle mass. Signaling mechanisms involving uridine-5′-triphosphate (UTP) regulate bone homeostasis via P2Y2 receptors on osteoblasts and osteoclasts, whilst dictating the bone cells’ response to mechanical loading. We hypothesized that muscle paralysis-induced loss of bone quality would be prevented in P2Y2 receptor knockout (KO) mice. Female mice injected with botulinum toxin (BTX) in the hind limb developed muscle paralysis and femoral DXA analysis showed reduction in bone mineral density (<10%), bone mineral content (<16%) and bone area (<6%) in wildtype (WT) compared to KO littermates (with <13%, <21%, <9% respectively). The femoral metaphyseal strength was reduced equally in both WT and KO (<37%) and <11% in diaphysis region of KO, compared to the saline injected controls. Tibial micro-CT showed reduced cortical thickness (12% in WT vs. 9% in KO), trabecular bone volume (38% in both WT and KO), trabecular thickness (22% in WT vs. 27% in KO) and increased SMI (26% in WT vs. 19% in KO) after BTX. Tibial histomorphometry showed reduced formation in KO (16%) but unchanged resorption in both WT and KO. Furthermore, analyses of DXA and bone strength after regaining the muscle function showed partial bone recovery in the KO but no difference in the bone recovery in WT mice. Primary osteoblasts from KO mice displayed increased viability and alkaline phosphatase activity but, impaired bone nodule formation. Significantly more TRAP-positive osteoclasts were generated from KO mice but displayed reduced resorptive function. Our data showed that hind limb paralysis with a single dose of BTX caused profound bone loss after 3 weeks, and an incomplete reversal of bone loss by week 19. Our findings indicate no role of the P2Y2 receptor in the bone loss after a period of skeletal unloading in mice or, in the bone recovery after restoration of muscle function.

What we would like to do vs what we can truly Achieve as Surgeons. Treatment of the Humeral Ewing Sarcoma for the Young Pediatric Patient

Ewing Sarcoma (ES) is mainly diagnosed during the second decade of life. It often compromises the appendicular skeleton but also can affect other bones. A surgical procedure is necessary despite its good response to chemotherapeutics and radiotherapy. When planning limb-sparing procedures for the young patient, the main challenges are bone size, growth remaining, and physical demands. Several techniques have been proposed. However, there is no gold standard procedure because many factors must be considered, and each case should be individualized. Also, the resources available change from one medical center to another and every surgeon has to deal with a different reality. This article presents one case of a 5-year-old male patient diagnosed with ES in the diaphyseal region of the humerus. It reviews the possible surgical options for humeral reconstruction in young children with ES and discusses the challenges that surgeons might have overcome.

Bilateral atypical femoral fracture related to bisphosphonate therapy

Introduction. Although bisphosphonates represent the most commonly prescribed antiresorptive therapy for the treatment of osteoporosis and fracture prevention, paradoxically, their continuous use in some patients can lead to an atypical femoral fracture. This type of fracture is characterized by specific features regarding clinical presentation, mechanism of injury and radiological manifestations. The objective of this article was to present a case of a bilateral femoral fracture associated with bisphosphonate usage. Case outline. A 70-year-old female patient was admitted to the emergency department with a severe, throbbing pain in both thighs after a ground-level fall. Radiographs of both femurs verified bilateral complete fracture localized in the diaphyseal region. Prior to hospitalization, she had continuously been taking ibandronate for three years. The patient underwent percutaneous osteosynthesis with intramedullary nailing with interlocking screws of both femurs. Six weeks after the surgical treatment, radiographic findings indicated the presence of early signs of healing on both femurs. At the four-month follow-up, the complete union of the bone fragments was achieved and she managed to walk without any pain and walking aids. Conclusion. Physicians still face doubts regarding optimal duration of bisphosphonate therapy. Although atypical femoral fracture represents a rare adverse event related to bisphosphonate use, all patients receiving this antiresorptive treatment who are complaining of new-onset unexplained pain in the thighs for more than two weeks should be completely diagnostically evaluated in term of atypical femoral fracture. Patients with confirmed atypical femoral fracture should undergo surgical treatment.

Differences between two sequential uncemented stem sizes in total hip arthroplasty: A comparative biomechanical study and potential clinical implications.

Early failure of uncemented femoral stems associated with incorrect sizing is a known postoperative complication. Surgeons are often faced with the question of whether an uncemented stem of adequate stability or a larger-sized stem should be implanted, especially when the proximal femoral cancellous bone is adequate. The biomechanical effect of sub-optimal stem sizing in the femur remains unclear. This study investigated the mechanical behaviour of two sequential sized uncemented stems of the same type. Six laboratory models of synthetic non-osteoporotic femora were randomly divided into two groups and implanted with either a nominal or oversized uncemented hydroxyapatite-coated nonporous titanium collarless stem. Stiffness, uniaxial strain, and pattern of strain distribution were measured under an anatomical one-legged stance. Oversized stems demonstrated a higher overall stiffness compared to nominal; however, this was not statistically significant. The nominal stem showed a higher strain in the neck and the proximal medial diaphyseal region. The oversized stem showed higher strains in the distal region around the implant tip. Opting to use a larger stem may potentially increase primary stability, thus allowing safer early mobility. However, higher stiffness may lead to stress shielding, bone loss, and thigh pain in the long term. In addition, strains in the diaphysis and the tip of the stem may predispose to periprosthetic fractures, especially in osteoporotic bones, making this a relatable aspect for users and biomechanical loading. Given the wide range of complex factors that need to be considered when choosing stem size in uncemented THA surgery, this study's results should be interpreted cautiously.

From Blood to Bone-The Osteogenic Activity of L-PRF Membranes on the Ex Vivo Embryonic Chick Femur Development Model.

(1) Background: To evaluate the effects of the direct and indirect contact of leukocyte and platelet-rich fibrin (L-PRF) on bone development, in an ex vivo embryonic chick femur model. (2) Methods: Both sections of L-PRF membranes (red and yellow portions) were evaluated with scanning electron microscopy and histochemical staining. The in vivo angiogenic activity was evaluated using a chorioallantoic membrane model. The osteogenic activity was assessed with an organotypic culture of embryonic chick femora through direct and indirect contact, and assessment was conducted by microtomographic and histological analysis. Descriptive statistics, One-Way ANOVA and Tukey’s multiple comparisons tests were performed for datasets that presented a normal distribution, and Kruskal-Wallis tests were performed for non-parametric datasets. A significance level of 0.05 was considered. (3) Results: The L-PRF induced angiogenesis reflected by a higher number and a larger and more complex gauge in the vessels that invaded the membrane. The physical presence of the membrane over the bone (direct contact) unleashes the full potential of the L-PRF effects on bone growth enhancement. The greatest increase in mineral content was observed in the diaphysis region. (4) Conclusion: The L-PRF direct contact group presented higher values on mineral content for bone volume, bone surface and bone mineral density than the indirect contact and control groups.

Runx2 is required for hypertrophic chondrocyte mediated degradation of cartilage matrix during endochondral ossification

The RUNX2 transcription factor is a key regulator for the development of cartilage and bone. Global or resting chondrocyte-specific deletion of the Runx2 gene results in failure of chondrocyte hypertrophy, endochondral ossification, and perinatal lethality. The terminally mature hypertrophic chondrocyte regulates critical steps of endochondral ossification. Importantly, expression of the Runx2 gene starts in the resting chondrocyte and increases progressively, reaching the maximum level in hypertrophic chondrocytes. However, the RUNX2 role after chondrocyte hypertrophy remains unknown. To answer this question, we deleted the Runx2 gene specifically in hypertrophic chondrocytes using the Col10-Cre line. Mice lacking the Runx2 gene in hypertrophic chondrocytes (Runx2HC/HC) survive but exhibit limb dwarfism. Interestingly, the length of the hypertrophic chondrocyte zone is doubled in the growth plate of Runx2HC/HC mice. Expression of pro-apoptotic Bax decreased significantly while anti-apoptotic Bcl2 remains unchanged leading to a four-fold increase in the Bcl2/Bax ratio in mutant mice. In line with this, a significant reduction in apoptosis of Runx2HC/HC hypertrophic chondrocyte is noted. A large amount of cartilage matrix is present in the long bones that extend toward the diaphyseal region of Runx2HC/HC mice. This is not due to enhanced synthesis of the cartilage matrix as the expression of both collagen type 2 and aggrecan were comparable among Runx2HC/HC and WT littermates. Our qPCR analysis demonstrates the increased amount of cartilage matrix is due to impaired expression of cartilage degrading enzymes such as metalloproteinase and aggrecanase as well as tissue inhibitor of metalloproteinases. Moreover, a significant decrease of TRAP positive chondroclasts was noted along the cartilage islands in Runx2HC/HC mice. Consistently, qPCR data showed an 81% reduction in the Rankl/Opg ratio in Runx2HC/HC littermates, which is inhibitory for chondroclast differentiation. Finally, we assess if increase cartilage matrix in Runx2HC/HC mice serves as a template for bone and mineral deposition using micro-CT and Von Kossa. The mutant mice exhibit a significant increase in trabecular bone mass compared to littermates. In summary, our findings have uncovered a novel role of Runx2 in apoptosis of hypertrophic chondrocytes and degradation of cartilage matrix during endochondral ossification.

Three-dimensional morphological study of the proximal femur in Crowe type IV developmental dysplasia of the hip

BackgroundWhen performing femoral reconstruction in patients with Crowe type IV developmental dysplasia of the hip (DDH), anatomical deformity presents many technical challenges to orthopedic surgeons. The false acetabulum is suggested to influence load transmission and femoral development. The aim of this study was to describe the morphological features of dysplastic femurs in Crowe type IV DDH and further evaluate the potential effect of the false acetabulum on morphological features and medullary canal of Crowe type IV femurs.MethodsWe analyzed preoperative computed tomography scans from 45 patients with 51 hips (25 hips without false acetabulum in the IVa group and 26 hips with false acetabulum in the IVb group) who were diagnosed with Crowe type IV DDH and 30 normal hips in our hospital between January 2009 and January 2019. Three-dimensional reconstruction was performed using Mimics software, and the coronal femoral plane was determined to evaluate the following parameters: dislocation height, dislocation ratio, height of the femoral head (FH), height of the greater trochanter (GT), GT–FH height discrepancy, height of the isthmus, neck-shaft angle, femoral offset and anteversion of the femoral neck. The mediolateral (ML) width, anterolateral (AP) width and diameter of medullary canal of the proximal femur were measured on the axial sections. Further, canal flare index (CFI), metaphyseal-CFI and diaphyseal-CFI were also calculated.ResultsCompared with the normal femurs, the Crowe type IV DDH femurs had a higher femoral head, larger GT–FH height discrepancy, larger femoral neck anteversion, higher isthmus position and smaller femoral offset. Dislocation height and dislocation rate were significantly larger in the IVa DDH group (65.34 ± 9.83 mm vs. 52.24 ± 11.42 mm). Further, the IVb femurs had a significantly lower isthmus position, larger neck-shaft angle and smaller femoral neck anteversion than IVa femurs. The ML, AP canal widths and the diameter of medullary canal in both DDH groups were significantly smaller than the normal group. Dimensional parameters of IVa femurs were also narrower than IVb femurs in most sections, but with no difference at the level of isthmus. According to the CFIs, the variation of proximal medullary canal in IVb femurs was mainly located in the diaphyseal region, while that in IVa femurs was located in the whole proximal femur.ConclusionsHigh dislocated femurs are associated with more anteverted femoral neck, smaller femoral offset and narrower medullary canal. Without stimulation of the false acetabulum, IVa DDH femurs were associated with higher dislocation and notably narrower medullary canal, whose variation of medullary canal was located in the whole proximal femur.

Biomechanical Evaluation on the Bilateral Asymmetry of Complete Humeral Diaphysis in Chinese Archaeological Populations

Diaphyseal cross-sectional geometry (CSG) is an effective indicator of humeral bilateral asymmetry. However, previous studies primarily focused on CSG properties from limited locations to represent the overall bilateral biomechanical performance of humeral diaphysis. In this study, the complete humeral diaphyses of 40 pairs of humeri from three Chinese archaeological populations were scanned using high-resolution micro-CT, and their biomechanical asymmetries were quantified by morphometric mapping. Patterns of humeral asymmetry were compared between sub-groups defined by sex and population, and the representativeness of torsional rigidity asymmetry at the 35% and 50% cross-sections (J35 and J50 asymmetry) was testified. Inter-group differences were observed on the mean morphometric maps, but were not statistically significant. Analogous distribution patterns of highly asymmetrical regions, which correspond to major muscle attachments, were observed across nearly all the sexes and populations. The diaphyseal regions with high variability of bilateral asymmetry tended to present a low asymmetrical level. The J35 and J50 asymmetry were related to the overall humeral asymmetry, but the correlation was moderate and they could not reflect localized asymmetrical features across the diaphysis. This study suggests that the overall asymmetry pattern of humeral diaphysis is more complicated than previously revealed by individual sections.

High-energy extracorporeal shockwave therapy in humeral delayed and non-unions.

Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5mm (p = 0.002). The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.

A Computational Method for Histological Bone Research using Convolutional Neural Networks

Histological bone research, which involves measuring the characteristics of a bone (in this paper, we consider exclusively the boundary perimeter (bone perimeter, B.Pm), cross-sectional area (bone area, B.Ar), width (cortical width, Ct.Wi)), has been greatly enhanced by advanced medical imaging like the computed tomography (CT) scans, which has made it possible to get cross-sectional images (or slices) of different areas of a bone. The long bone, which is the major focus of our research, is divided into three parts according to its structure: diaphysis, metaphysis, epiphysis. Efficiently measuring the bone metrics mentioned above relies on being able to differentiate these areas from one another, since the different regions require unique approaches. For example, the diaphyseal region consists completely of the cortical bone and therefore obtaining the bone metrics is not perplexing. On the other hand, when it comes to the area of the metaphysis, and especially epiphysis, it becomes more difficult to distinguish the cortical bone from the spongy bone, and so the task of extracting the bone metrics is hampered. In this paper, we propose a fully automated solution for histological research of diaphysis. For this we designed and trained a convolutional neural network-based model to classify the cross-sectional images. Furthermore, we created computational methods to extract the bone measurements and applied them to bones classified as "diaphysis".

The Embryonic Chick Femur Organotypic Model as a Tool to Analyze the Angiotensin II Axis on Bone Tissue

Activation of renin–angiotensin system (RAS) plays a role in bone deterioration associated with bone metabolic disorders, via increased Angiotensin II (AngII) targeting Angiotensin II type 1 receptor/Angiotensin II type 2 receptor (AT1R/AT2R). Despite the wide data availability, the RAS role remains controversial. This study analyzes the feasibility of using the embryonic chick femur organotypic model to address AngII/AT1R/AT2R axis in bone, which is an application not yet considered. Embryonic day-11 femurs were cultured ex vivo for 11 days in three settings: basal conditions, exposure to AngII, and modulation of AngII effects by prior receptor blockade, i.e., AT1R, AT2R, and AT1R + AT2R. Tissue response was evaluated by combining µCT and histological analysis. Basal-cultured femurs expressed components of RAS, namely ACE, AT1R, AT2R, and MasR (qPCR analysis). Bone formation occurred in the diaphyseal region in all conditions. In basal-cultured femurs, AT1R blocking increased Bone Surface/Bone Volume (BS/BV), whereas Bone Volume/Tissue Volume (BV/TV) decreased with AT2R or AT1R + AT2R blockade. Exposure to AngII greatly decreased BV/TV compared to basal conditions. Receptor blockade prior to AngII addition prevented this effect, i.e., AT1R blockade induced BV/TV, whereas blocking AT2R caused lower BV/TV increase but greater BS/BV; AT1R + AT2R blockade also improved BV/TV. Concluding, the embryonic chick femur model was sensitive to three relevant RAS research setups, proving its usefulness to address AngII/AT1R/AT2R axis in bone both in basal and activated conditions.

Differences in Steady-State Erythropoiesis in Different Mouse Bones and Postnatal Spleen.

Adult erythropoiesis is a highly controlled sequential differentiation of hematopoietic stem cells (HSCs) to mature red blood cells in the bone marrow (BM). The bones which contain BM are diverse in their structure, embryonic origin, and mode of ossification. This has created substantial heterogeneity in HSCs function in BM of different bones, however, it is not known if this heterogeneity influences erythropoiesis in different bones and different regions of the same bone. In this study, we examined steady state BM erythroid progenitors and precursors from different bones – the femur, tibia, pelvis, sternum, vertebrae, radius, humerus, frontal, parietal bone, and compared all to the femur. Trabecular and cortical regions of the femur were also compared for differences in erythropoiesis. In addition, mouse spleen was studied to determine at which age erythropoietic support by the spleen was lost postnatally. We report that total erythroid cells, and erythroid precursors in the femur are comparable to tibia, pelvis, humerus and sternum, but are significantly reduced in the vertebrae, radius, frontal, and parietal bones. Erythroid progenitors and multipotential progenitor numbers are comparable in all the bones except for reduced number in the parietal bone. In the femur, the epiphysis and metaphysis have significantly reduced number of erythroid precursors and progenitors, multipotential progenitors and myeloid progenitors compared to the diaphysis region. These results show that analysis of erythroid precursors from diaphysis region of the femur is representative of tibia, pelvis, humerus and sternum and have significant implications on the interpretation of the steady-state erythropoiesis finding from adult BM. Postnatal spleen supports erythroid precursors until 6 weeks of age which coincides with reduced number of red pulp macrophages. The residual erythroid progenitor support reaches the adult level by 3 months of age. In conclusion, our findings provide insights to the differences in erythropoiesis between different bones, between trabecular and cortical regions of the femur, and developmental changes in postnatal spleen erythropoiesis.