Femoral Shaft Research Articles

Femoral shaft fractures in preschool children: external fixation and elastic intramedullary nail treatments in clinical practice.

Surgical intervention in preschoolers with femoral shaft fractures has increased due to the evolving lifestyle. This study aimed to analyze and compare the efficacy of elastic intramedullary nailing and external fixation in treating femoral shaft fractures in children aged 2-5. Ninety-nine pediatric patients were categorized into the external fixator (EF) and the elastic intramedullary nail (ESIN) group based on surgical techniques. Data on follow-up, intraoperative parameters, postoperative complications, fracture features, and demographics were gathered and compared. The mean duration of follow-up was 32 months, ranging from 25 to 48 months. All fractures had healed completely and no instances of nonunion were observed. At the latest follow-up, within the EF group, there were instances of malunion, delayed union, and refracture, each occurring once. One case in every group exhibited a leg length difference above 2 cm. The external fixation group had a shorter operation duration (P = 0.04), fewer intraoperative fluoroscopy times (P < 0.01), earlier partial weight-bearing time (P < 0.01), and full weight-bearing time (P < 0.01), while a greater complication rate (29.8 vs. 14.3%, P = 0.07) compared with the ESIN group. The incidence of pin tract infection in the EF group was 21.1% (12/57) compared with 2.4% (1/42) in the ESIN group (P = 0.07). Eighty percent of the patients' families expressed concern about the residual scar after removing the EF. The ESIN group encounters fewer complications and positive aesthetic effects, making it a preferable treatment option in this specific patient population and fracture pattern. Level of evidence: Class III, retrospective comparative study.

Bone tissue condition in early dates of restoration after thermic exposure

BACKGROUND: Thermoablation is a promising method for treating bone tumors. It is important to select the optimal mode (dose/time) of high-temperature exposure to fully realize the potential of this method.AIM: to study in vivo the reaction of rabbits’ bone tissue (BT) in the dynamics of early (3-7 days) recovery after local intraoperative hyperthermic ablation in the temperature range in the bone marrow canal of 55-60℃.METHODS: The study involved 6 mongrel rabbits aged 15 weeks, weighing 3-4 kg. The animals were derived from the experiment on the 3rd and 7th days after local thermoablation of the femoral diaphysis. Histological assay of BT included overall examination (HE staining), assessment of the area of immature BT (Mallory staining), optical density and area of osteoblasts and osteocytes (Einarson staining). Statistical data processing was performed in the R programming language.RESULTS: HE staining showed no signs of pathological changes after high-temperature exposure of BT. Mallory staining revealed no negative effects of local thermoablation on the intercellular bone matrix. Morphometric analysis showed an overshoot in the area of osteoblasts by the 7th day against the background of reduced synthetic activity starting from the 3rd day of the experiment. By the 3rd day, there is also a decrease in the area and optical density of osteocytes in the diaphyses of bones subjected to thermoablation. However, by the 7th day, the area of mature bone cells doesn`t differ from the corresponding value in the contralateral limb.CONCLUSION: Local intraoperative thermoablation of rabbit femoral diaphyses at an intramedullary temperature of 55-60℃ significantly reduces the optical density of osteoblasts and osteocytes in the dynamics of early (3-7 days) recovery after extreme exposure, which suggests a violation of metabolic processes and intracellular organelles (nucleus, ribosomes) of bone cells. At the same time, signs of remodeling of the damaged area were noted, presumably through the mechanism of osteoconduction of endosteal and periosteal cells from metaphyses that were not subjected to direct hyperthermia. The results obtained may be useful in thermoablation of BT tumors with the condition of higher sensitivity of malignant cells to heating.

Histological assessments for anabolic effects in teriparatide/abaloparatide administered rodent models.

Parathyroid hormone (PTH) is thought to induce remodeling-based bone formation by promoting osteoclastic activity, a process known as cellular coupling. Our research has shown that the frequency of PTH administration affects trabecular number and thickness. High-frequency PTH administration induced remodeling-based bone formation, while less frequent administration induced both remodeling-based and modeling-based bone formation. Additionally, we found that specific bone sites influence whether remodeling-based or modeling-based bone formation is more likely to occur. Additionally, while PTH significantly increases trabecular bone, it also causes cortical porosis. Our research on the femoral diaphysis showed that PTH administration resulted in the invasion of blood vessels and osteoclasts into the cortical bone. Abaloparatide acts similarly to teriparatide through the parathyroid hormone receptor type 1 (PTH1R) but may have a wider anabolic window due to its lesser impact on bone resorption. Our mouse studies with abaloparatide showed similar results to those seen in human patients, with increased preosteoblastic cell populations and wider anabolic windows when compared with teriparatide. Abaloparatide-induced bone formation cannot be explained solely by remodeling-based bone formation, indicating the need for further research into modeling-based bone formation.

Closed Reduction Followed by Percutaneous Fixation of Acute Femoral Neck Fractures in Young Adults: A Retrospective Cohort Study

OBJECTIVES: To evaluate the surgical outcomes of femoral neck fractures (FNF) in young adults treated with a closed reduction technique because it pertains to reduction quality, rates of union, and risk factors for complication. METHODS: Design: Retrospective cohort study with radiograph and electronic medical record review. Setting: Level 1 Swiss Trauma Center. Patient Selection Criteria: Between 2012 and 2021, young adults with isolated FNF (AO/OTA 31-B1) treated with percutaneous internal fixation were selected. Exclusion criteria were open reduction technique, age older than 65 years or younger than 16 years, pathologic fractures, and associated femoral head or shaft fractures. Outcome Measures and Comparisons: Primary outcome was quality of reduction, as assessed by 3 experienced trauma surgeons' evaluation of intraoperative and/or first postoperative radiographs using the overall impression, the Garden alignment index, and Lowell criteria. In addition, clinical outcomes, conversion to arthroplasty, and complications after closed reduction and fixation of femoral neck fractures were reviewed. RESULTS: A total of 54 patients with a median interquartile range age of 57.5 (48–60) years were included. Among them, 22 (41%) were women and 32 (59%) were men. The closed reduction technique demonstrated satisfactory reduction results in up to 87% of cases. Major complications occurred in 19%, with 17% requiring conversion to total hip arthroplasty. Unacceptable or borderline acceptable reduction quality correlated significantly with the need for later conversion (P = 0.03). CONCLUSIONS: The study supported the use of the closed reduction technique for acute FNF in patients younger than 65 years, achieving satisfactory reduction results in up to 87% of cases with comparable complication rates to treatment of young femoral neck fractures with open reduction. Furthermore, it underscored the significance of the surgeon's overall impression of reduction quality, alongside the established reduction criteria, the Garden alignment index, and Lowell criteria, in evaluating the quality of the reduction. In addition, risk of conversion to total hip arthroplasty was associated with worse closed reduction quality. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

A Derotational Corrective Osteotomy in a Torsional Malaligned Femoral Shaft Fracture Around a Prior Stuck Intramedullary Nail

Background: Femoral torsional malunion following trauma fixed with intramedullary (IM) nailing can necessitate femoral derotational osteotomy based on the symptomatic limitations of the patient. There is a paucity of studies discussing the utility and methods of femoral derotational osteotomy following post-traumatic femoral torsional malunion fixed with IM nailing that is not removable. Methods: We report a surgical technique in a patient treated with a femoral derotational osteotomy who sustained significant rotational deformity after a femoral shaft fracture initially treated with antegrade IM nailing. A standard inferior patellar approach was performed. The distal interlocking screws of the nail were removed, and a trephine was placed up through the distal femoral canal around the nail to free the nail from the surrounding bone to allow for mobility of the distal femur following osteotomy. Parallel K-wires were placed above and below the cut level for rotational control. A dynamic compression plate was then placed in compression mode on the lateral aspect of the femur, and the distal interlocking screws were placed to lock the IM nail. Conclusions: We recommend this technique only be used in cases where the nail is centric in the intramedullary canal and in line with the trochlea to be able to pass the trephine through the knee. We believe this technique to be an effective surgical option to treat post-traumatic torsional deformities of the femur where hardware cannot be removed.

Rotatory malunion following antegrade intramedullary femoral nailing for femoral shaft fractures: incidence and risk factors.

Retrospective study. Level I academic Trauma Center. Adult patients with femoral shaft fractures in which a bilateral computed-tomography (CT) scan of both femurs was performed, with a two years minimal follow-up. Criteria related to the patient and the fracture were studied. We fixed the following angles, i.e. 10° and 15°, as references for calculating the RM.

To evaluate the outcome of intramedullary nailing in femoral shaft fractures in children.

Objective: To determine the frequency of outcome of intramedullary nailing in femoral shaft fractures in children. Study Design: Case series study. Setting: Department of Orthopedics, ATH, Abbotabad. Period: 27th February 2020 to 26th August 2020. Methods: We included 85 patients with femoral shaft fractures, and age 5 to 10 years of both genders, meeting the criteria and consent was taken. Each patient was followed fortnightly for assessment 2 of outcome (excellent/satisfactory/poor) after 3months post-operative. Results: In our study age ranges from 5 to 10 years with mean age of 7.14 ± 0.90 years. Majority of the patients 60 (70.59%) were between 5 to 7 years of age. We had 64 (75.29%) males and 21 (24.71%) were females. Mean weight was 24.35 ± 4.66 kg. Mean duration of symptoms was 6.48 ± 2.45 days. In this study, the excellent outcome was seen in 70 (82.35%) patients, satisfactory in 10 (11.77%) and poor outcome in 05 (5.88%) patients. Conclusion: This study concluded that intramedullary nail is simple, effective, minimally invasive procedure for treating femoral shaft fractures in children with excellent outcome.

Amorphous Calcium Carbonate Enhances Fracture Healing in a Rat Fracture Model

Background: Delayed and failed fracture repair and bone healing remain significant public health issues. Dietary supplements serve as a safe, inexpensive, and non-surgical means to aid in different stages of fracture repair. Studies have shown that amorphous calcium carbonate (ACC) is absorbed 2 to 4.6 times more than crystalline calcium carbonate in humans. Objectives: In the present study, we assessed the efficacy of ACC on femoral fracture healing in a male Wistar rat model. Methods: Eighty male Wistar rats were randomly divided into five groups (n = six per group): sham, fracture + water, fracture + 0.5× (206 mg/kg) ACC, fracture + 1× ACC (412 mg/kg), and fracture + 1.5× (618 mg/kg) ACC, where ACC refers to the equivalent supplemental dose of ACC for humans. A 21-gauge needle was placed in the left femoral shaft, and we then waited for three weeks. After three weeks, the sham group of rats was left without fractures, while the remaining animals had their left mid-femur fractured with an impactor, followed by treatment with different doses of oral ACC for three weeks. Weight-bearing capacity, microcomputed tomography, and serum biomarkers were evaluated weekly. After three weeks, the rats were sacrificed, and their femur bones were isolated to conduct an evaluation of biomechanical strength and histological analysis. Results: Weight-bearing tests showed that treatment with ACC at all the tested doses led to a significant increase in weight-bearing capacity compared to the controls. In addition, microcomputed tomography and histological studies revealed that ACC treatment improved callus formation dose-dependently. Moreover, biomechanical strength was improved in a dose-dependent fashion in ACC-treated rats compared to the controls. In addition, supplementation with ACC significantly lowered bone formation and resorption marker levels two–three weeks post-fracture induction, indicating accelerated fracture recovery. Conclusions: Our preliminary data demonstrate that ACC supplementation improves fracture healing, with ACC-supplemented rats healing in a shorter time than control rats.

Comminuted Transverse Femoral Shaft Fractures Are at Risk for Nonunion.

The purpose of this study was to investigate the effect of the main fragment fracture type (oblique or transverse) on the union rate of femoral shaft fractures. Patients who underwent surgical treatment with an antegrade intramedullary nail for femoral shaft fracture (Arbeitsgemeinschaft für Osteosynthesefragen / Orthopaedic Trauma Association; AO/OTA type 32 type B or C) between January 2009 and March 2021 were included in this study. Patients with oblique fractures of the two main fragments on radiographs immediately after surgery were classified into the oblique fracture group. Patients with at least one of the two main fractures being transverse fractures were classified into the transverse fracture group. We investigated age, sex, height, weight, body mass index (BMI), AO/OTA classification, time from fracture to surgery, intramedullary nail length and diameter, number of interlocking screws, and bone union rate. A total of 55 fractures were included. The mean age was 34.4 ± 16.7 (range, 16-77) years. There were 41 fractures classified into the oblique fracture group and 14 fractures classified into the transverse fracture group. There was a significantly higher proportion of men in the transverse fracture group. Patients in the transverse fracture group were significantly younger and taller. Only 1 of 41 (2.4%) patients in the oblique group experienced nonunion, while 3 of 14 (21.4%) patients in the transverse group experienced nonunion (p = 0.030). Comminuted femoral shaft fractures with transverse fracture components are more prone to nonunion.

Femoral shaft fracture with a third fragment treated with an intramedullary nail: Is the displacement of the third fragment predictive of nonunion?

Femoral shaft fractures with third fragments are difficult to reduce anatomically, affecting bone healing chances. The goal of this study is to determine the impact of the third fragment's radiological characteristics assessed on post-operative radiographs, as well as other factors, on the healing of type 32B femur shaft fractures treated with intramedullary nail. We conducted a retrospective study of 93 patients treated for femoral shaft fractures type 32 B. On post-operative X-rays, two radiologic parameters were evaluated: the third fragment size and the mean third fragment displacement. Patients had radiologic follow-up at 2, 4, 6, 9, and 12-months and were separated into 3 groups based on their fracture healing time: within 6months (group 1), between 6 and 12months (group 2), or nonunion after 12months (group 3). Among the 93 patients, 72 (77.4%) showed fracture healing at 6months, 13 (14%) at 12months, and 8 (8.6%) demonstrated nonunion at 12months. The mean third fragment displacement was notably different between groups (p < 0.001) and was considerably greater in group 3 than in groups 1 and 2. The influence of third fragment displacement on outcomes under 6months was determined by ROC analysis, using a cut-off value of 14mm. Displacement under 14mm predicted healing within 6months with a sensitivity of 90.3% and a specificity of 61.9%. The statistical analysis demonstrated that the odds of experiencing non-union or delayed healing were approximately 15 times higher for patients with a third fragment displacement of 14mm or greater. The third fragment displacement is the most important factor influencing healing within twelve months in femur shaft fractures type 32B managed with an intramedullary nail. Inversely, the third fragment size had no effect on the healing of the fractures in our series.

Double plating and iliac crest bone graft can safely fix femoral shaft nonunion

Introduction Femoral shaft nonunion can be extremely vexing and result in significant morbidity. We aimed to evaluate the outcomes of patients with nonunion of the femoral shaft fracture undergoing double plating and bone grafts from the iliac crest and femoral canal. Methods This retrospective study included 44 patients with femoral shaft nonunion between March 2020 to March 2022. Patients underwent dual plating, bone grafting from the iliac crest, and the utilization of the femoral canal. Age, sex, body mass index (BMI), the two surgical interventions interval, union time after the second surgery, hip range of motion (ROM), limb length discrepancy (LLD), infections, and deep vein thrombosis (DVT) were evaluated. Results Patients comprised 21 males (47.7%) and 23 females (52.3%), with a mean age of 42.3 ± 15.2 years. The mean BMI was 26.7 ± 3.77 kg/m2. The mean duration between the two surgical interventions for the patients was 17.07 ± 6.6 months. The patients were followed for ≥ 12 months. All patients achieved successful union and fracture healing, with an average time of 5 months. The mean hip flexion and extension were 112.84 ± 7.7˚ and 14.8 ± 5.2˚ degrees, respectively. Thirteen patients showed LLD after the first surgery, with a mean LLD of 7.15 ± 5.04 millimeters. LLDs were successfully rectified in all patients following the surgical intervention. No patients experienced postoperative infections or DVT. Conclusion According to our findings, the utilization of double-plate fixation in combination with iliac crest and femoral canal bone graft has proven to be a secure, productive, and straightforward surgical alternative for the management of femoral nonunion.

Optimizing the Electrical Microenvironment Provided by 3D Micropillar Topography on a Piezoelectric BaTiO3 Substrate to Enhance Osseointegration.

The electrical properties of bone implant scaffolds are a pivotal factor in regulating cellular behavior and promoting osteogenesis. The previous study shows that built-in electric fields established between electropositive nanofilms and electronegative bone defect walls are beneficial for promoting bone defect healing. Considering that the physiological electrical microenvironment is spatially distributed in 3D, it is imperative to establish a 3D spatial charged microenvironment on bone scaffolds to optimize the efficacy of osseointegration. Nevertheless, this still poses a formidable challenge. Here, a bone repair strategy that utilizes micro-scale 3D topography is developed on a piezoelectric BaTiO3 (BTO) substrate to provide 3D spatial electrical stimulation. The BTO micropillar arrays, especially with a height of 50 µm and positive-charge distribution (50 µm positive), promote the spreading, cytoskeletal reorganization, focal adhesion maturation, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). They enhanced the clustering of mechanosensing integrin α5 in BMSCs. The biomimetic 3D spatial electrical microenvironment accelerated bone repair and osseointegration in a rat femoral diaphysis defect repair model. The study thus reveals that implants with a 3D spatial electrical microenvironment can significantly enhance osseointegration, thereby providing a new strategy to optimize the performance of electroactive biomaterials for tissue regenerative therapies.

Sex and stature estimations from dry femurs of Northeastern Thais: Using a logistic and linear regression approach

BackgroundSex determination and stature estimation from skeletal remains are still crucial components in creating biological profiles in forensic anthropology. The femur is particularly valuable due to its high sexual dimorphism and correlation with stature. This study aimed to develop sex estimation models and stature reconstruction equations using femoral measurements in a Northeastern Thai population. Materials and methodThe 400 dry femora were measured for its six parameters including femur maximum length (FL), femoral shaft length (FSL), femur epicondylar breadth (FEB), femur maximum head diameter (FHD), femur midshaft circumference (FMC) and femur weight (FW). Then all parameters were analyzed by using logistic regression for sex estimation and linear regression for stature reconstruction. ResultsResults showed significant sexual dimorphism across all measured parameters, with FHD being the best predictor of sex (correction rate, 88.5 %). The optimized multivariate model achieved the highest accuracy (91.0 %). For stature estimation, sex-specific equations demonstrated superior accuracy compared to combined-sex models. The FL and FSL showed the strongest correlations with stature. ConclusionThis study demonstrated the importance of population-specific standards in forensic anthropology of the femur's reliability as a valuable tool for both sex determination and stature estimation. These results contribute significantly to forensic practice in Thailand, enhancing the accuracy of biological profile reconstruction in medicolegal investigations.

Comparative Study of Exchange Nailing and Augmentative Plating for Treating Aseptic Nonunion of Femoral Shafts Post Intramedullary Nailing: A Single-Blind, Multicentric Randomized Clinical Trial.

Background: Aseptic nonunion of femoral shafts after intramedullary nailing (IMN) can be a challenging condition that may lead to long-term disability and the need for multiple surgical procedures. This study compared the clinical and radiological outcomes between exchange nailing and augmentative plating with bone grafting. Methods: In this multicenter, prospective, single-blind, randomized controlled trial, patients with aseptic nonunion of the femoral shaft after IMN were randomly assigned to receive exchange nailing or augmentative plating. The primary outcomes measured were the time to bone union and union rate 12 months after revision surgery. The secondary outcomes included operative time, blood loss, hospitalization duration, pain level using the visual analog scale (VAS), knee range of motion (ROM), and complication rates. Results: The augmentative plating group had a significantly shorter mean time to union (5.39 ± 1.29 months) compared with the exchange nailing group (7.38 ± 1.97 months; p < 0.001). The union rates at 12 months were 100% in the augmentative plating group and 89.65% in the exchange nail group. Augmentative plating resulted in a shorter operation time (99.46 ± 11.08 min vs. 106.45 ± 12.22 min; p = 0.025) and reduced blood loss (514.79 ± 45.87 mL vs. 547.72 ± 54.35 mL; p = 0.016). Significant pain reduction was observed in the augmentative plating group, with preoperative VAS scores decreasing from 6.04 ± 2.28 to 2.64 ± 1.50, compared with a decrease from 5.66 ± 2.21 to 3.66 ± 2.19 in the exchange nailing group (p = 0.047). Knee ROM improved significantly in the augmentative plating group (p = 0.0176). The complication rate was lower in the augmentative plating group (3.57%) than in the exchange nail group (17.24%). Conclusions: Augmentative plating with autologous bone grafting is superior to exchange nailing for treating aseptic nonunion of femoral shafts. It is associated with faster healing, higher union rates, better clinical and functional outcomes, and fewer complications. We recommend this technique as the preferred treatment option for such complex cases.

Evaluation of the Tobacco Heating System (THS) During Closed Lower Limb Fracture Healing in Trauma Smokers’ Patients

BACKGROUND: Since 1976, it's been recognized that increased cigarette consumption correlates with decreased bone density, hindering fracture healing and leading to prolonged hospitalization. Although prior research has shown the relatively less harmful effects of electronic nicotine delivery systems (ENDS) on bone cells in lab settings and animal models, clinical evidence regarding their impact on fracture healing remains scarce. This study aims to investigate whether switching to a tobacco heating system (THS) post-orthopedic surgery improves outcomes for smoking patients during tibia or femur fracture healing over a 6-month period. METHODS: The study is a prospective, open-label, non-parallel, single-center trial involving 150 patients from a Level 1 Trauma center, Germany, diagnosed and treated for closed tibia, closed femur shaft, or closed distal femur fractures (according to AO/OTA: 41A2-41C3, 42A-C, 43A-C, 32A-C, 33A2-3, 33B-C). Participants will be categorized into three groups based on smoking behavior: smokers (no intervention), THS (participants switching from cigarettes to THS), and ex-smokers (participants abstaining from cigarettes or ENDS during the study). Clinical, radiological, and laboratory data will be collected during preoperative and postoperative assessments at 6, 12, 18, and 24 weeks. The primary outcome will be the serum concentration of N-terminal propeptide procollagen type 1, a bone formation marker. Secondary outcomes include bone metabolism, healing, immunological, blood count, and clinical parameters. Approval for the study protocol and consent declarations was obtained from the ethics committee of the medical faculty of Eberhard Karls University (724/2022BO1). DISCUSSION: The study results will provide evidence that switching to THS previous orthopedic intervention improves clinical outcomes during closed tibia or femur fracture healing in smokers’ patients due to reduced bone resorption rate consequent to the diminished activity of cigarette smoke-activated osteoclast.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries.

Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.

Comparing the performance of a femoral shaft fracture fixation using implants with biodegradable and non-biodegradable materials.

Orthopedic injuries, such as femur shaft fractures, often require surgical intervention to promote healing and functional recovery. Metal plate implants are widely used due to their mechanical strength and biocompatibility. Biodegradable metal plate implants, including those made from magnesium, zinc, and iron alloys, offer distinct advantages over non-biodegradable materials like stainless steel, titanium, and cobalt alloys. Biodegradable implants gradually replace native bone tissue, reducing the need for additional surgeries and improving patient recovery. However, non-biodegradable implants remain popular due to their stability, corrosion resistance, and biocompatibility. This study focuses on designing an implant plate for treating transverse femoral shaft fractures during the walking cycle. &#xD;The primary objective is to conduct a comprehensive finite element analysis (FEA) of a fractured femur's stabilization using various biodegradable and nonbiodegradable materials. The study assesses the efficacy of different implant materials, discusses implant design, and identifies the optimal materials for femoral stabilization. Results indicate that magnesium alloy is superior among biodegradable materials, while titanium alloy is preferred among non-biodegradable options. The findings suggest that magnesium alloy is the recommended material for bone implants due to its advantages over non-degradable alternatives.&#xD.

Dynamic parallel traction theoretical model for the application and validation in femoral neck fractures - a finite element analysis

Study objectiveThis study aims to validate the application effects of a novel theoretical model of dynamic parallel traction in the treatment of femoral neck fractures through three-dimensional finite element analysis. By simulating the femoral neck fracture model, we explore the promotional effect of dynamic parallel traction on fracture healing. MethodA digital 3D femur model was constructed using high-resolution computed tomography data of the lower limbs of a 70-year-old elderly subject. An axial compression of 500N was applied at different traction angles (0°, 10°, 20°, 30°, 40°, 50°). The equivalent stress distribution and deformation of the femur geometric model were calculated at each angle under the six α angles. Statistical analysis was performed using One-Way ANOVA. ResultsAt the parallel angle (α = 0°), the maximum stress on the entire femur occurred at the trochanteric fossa, with a value of 7.945 MPa (α = 0°). The maximum deformation was at the fovea capitis, with a value of 104.13 mm (α = 0°). As the traction angle gradually increased (α = 10°, α = 20°, α = 30°, α = 40°, α = 50°), the maximum stress shifted gradually to the medial cortex of the femoral shaft, with values of 11.236 MPa (α = 10°), 15.196 MPa (α = 20°), 19.263 MPa (α = 30°), 23.149 MPa (α = 40°), and 26.311 MPa (α = 50°). The maximum deformation remained at the fovea capitis but increased to 131.87 mm (α = 10°), 181.96 mm (α = 20°), 228.2 mm (α = 30°), 271.15 mm (α = 40°), and 307.41 mm (α = 50°). One-Way ANOVA revealed that traction angle significantly influenced the stress distribution (F = 4.419, p = 0.0022) and deformation magnitude (F = 4.023, p = 0.0040) at the proximal femur, indicating that traction angle is a critical factor affecting stress distribution and deformation. ConclusionWith the increase of the traction angle, the mechanical properties of the proximal femur decrease, indicating an increased risk of non-union and complications. Additionally, the study proves the effectiveness of the “dynamic parallel traction” theory.

Ipsilateral Femoral Neck and Shaft Fractures: Complex Injuries With High Rates of Femoral Shaft Nonunion.

To investigate nonunion rates and risk factors in patients with ipsilateral femoral neck and shaft fractures. Retrospective review. Two Level I trauma centers. Two hundred seven patients treated for ipsilateral femoral neck (AO/OTA 31-B) and shaft (AO/OTA 32A-C) fractures from 2013 to 2022. Patients with less than 6 months of follow-up were excluded. The primary outcome of this study was femoral shaft nonunion. Risk factors for nonunion were evaluated, including smoking, open fracture, delay to full weight-bearing, blood transfusions, and AO/OTA classification. Two hundred twenty-seven patients were initially identified, but only 154 patients had sufficient follow-up and were included in final analysis. The mean age was 38.9 years (SD = 15.3), and injury severity score was 19.5 (9.7). One hundred ten patients (71%) were male and 69 (45%) required intensive care unit care. Thirty-eight patients (25%) experienced an open fracture, and 44 fractures (29%) were AO/OTA Type C. Thirty patients (20%) underwent initial external fixation, and 88 patients (57%) received a perioperative transfusion. Thirty-four patients (22%) developed a femoral shaft nonunion, and 5 (3%) experienced a surgical site infection. Nonunion was associated with perioperative blood transfusion, AO/OTA Type C fracture, postoperative non-weight-bearing, and delay to full weight-bearing ≥12 weeks. Multivariable regression identified perioperative blood transfusion ≥3 (risk ratio [RR] = 1.91; CI, 1.12-2.72; P = 0.02) and AO/OTA Type C fracture (RR = 2.45; CI, 1.50-3.34; P = 0.001) as independent risk factors. Ipsilateral femoral neck and shaft fractures remain difficult injuries to treat. Much attention is given to diagnosis and treatment of the femoral neck component. These results suggest that successful treatment of the femoral shaft component presents its own challenges with high nonunion rates. Prognostic Level III.

Semiautomated Three-Dimensional Landmark Placement on Knee Models Is a Reliable Method to Describe Bone Shape and Alignment

PurposeThe purpose of this study was to assess the inter- and intra-rater reliability of 21 anatomical landmarks initially placed with an AI-algorithm and then manually verified with human input. Methods30 knee CT scans of participants from the Multicenter Osteoarthritis Study (MOST) ages 45-55 years were included. Approximately one-half experienced progression of patellofemoral osteoarthritis, defined as an increased cartilage score in the patellofemoral compartment on MRI over 2 years. The algorithm automatically placed 19 anatomic landmarks on the femur, tibia, and patella. An additional 2 landmarks were added manually. Two landmark reviewers separately reviewed all 30 scans and verified all landmarks. After 2 weeks, one reviewer repeated the process for the same dataset. The mean Euclidean distance of manual landmark displacement, mean absolute disagreement between and within raters, and intraclass correlation coefficients for inter- and intra-rater reliability were calculated. ResultsAll landmarks had excellent inter-rater reliability. The tibial and femoral shaft centers had ICCs of 1, indicating their positions did not differ. Seventeen landmarks had ICCs between 0.90-0.99 and the tibial tuberosity had an ICC of 0.87. Intra-rater reliability scores were 1 for 16 landmarks and between 0.90-0.99 for the remaining five. ConclusionThere was excellent agreement on the locations of all 21 landmarks evaluated in this study. Clinical RelevanceThe potential role of artificial intelligence in medical imaging and orthopedic research is a growing area of interest. The excellent reliability demonstrated across multiple landmarks in our study reveals the potential for semi-automated 3D methods to enhance precision of anatomical measurements of the knee over 2D methods.