Femoral Shaft Research Articles

A Comparative Study Assessing the Efficacy and Outcomes of Sub-Muscular Plating and Elastic Stable Intramedullary Nailing in Paediatric Diaphyseal Femoral Fractures: A Systematic Review

Abstract Background Femoral shaft fractures are among the most common fractures of long bones. Paediatric diaphyseal femur fractures account for 1.4% to 1.7% of all paediatric fractures; the annual rate of children who present with femoral shaft fractures is estimated at 19 per 100,000. The management of paediatric diaphyseal femoral fractures depends primarily on the age of the child although the bone age and size of a child may determine the choice of treatment. The choice of management may also be determined by surgical experience and local trends in practice. Non- operative management plays a role in some cases still though current practice has veered towards operative fixation as it allows early mobilization and shorter hospital stays. Aim of the Work to evaluate efficacy and outcomes of submuscular plating and elastic stable intramedullary nailing in paediatric diaphyseal femoral fractures. Patients and Methods Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. A total of 303 cases were included with mean age 8.3 years. The majority of them were males. Results The current study showed that regarding Outcome; Mean operative time was 74.35 min in nail group vs 111.19 min in plate group. Mean intraoperative blood loss also was 58.1 ml in nail group vs 112.5 ml in plate group. As regarding hospital stay mean period was 4.4 days in nail group vs 5.5 days in plate group. As regarding time to full weight bearing was 10 wk in nail group vs 8.25 wk in plate group. Time to heal of fracture was 2.28 mn in nail group vs 2.35 in plate group. Total number of union in nail group was 161 cases vs 118 in plate. Our results showed that as regards complications; a total of 60 complications were found among included cases in form of infection in 3 with nail vs 4 with plate, malunion in 14 in nail vs 6 in plate group. Heterotopic ossification in 2 cases with plate fixation. Limb length discrepancy in 6 cases with nail vs 5 cases with plate fixation, refracture in 2 cases with plate fixation, pain in 7 cases with nail fixation. External rotation and antecurvatum in 4 cases with nail fixation vs 3 with plate fixation. Conclusion this review provides evidence that both ESIN and SMP are safe, effective, and minimally invasive surgical methods for the treatment of paediatric diaphyseal femoral fractures, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed carefully.

Causes of Failure of Subtrochanteric Fracture Fixation, Systematic Review and Meta-Analysis

Abstract Background Subtrochanteric (ST) femoral fractures is defined as fractures of proximal femoral shaft that is located within 5 cm of the lesser trochanter. Any internal fixation device for trochanteric fractures is subject to significant concentrated bending stresses, leading to implant fatigue and fixation failure. Fixation of sub-trochanteric femoral fracture is considered a critical challenge. Objective To assess causes of failure of sub-trochanteric fracture fixation. Methods This meta-analysis study included 12 papers which included 999 patients, fixation failed in 163 patients. The included studies mentioned approximately 7 causes for fixation failure which included deep infection (in 2 studies), delayed union (in 2 studies), non-union (in 6 studies), screw cut-out (in 3 studies), Poor reduction (in 3 studies), implant breakage (in 4 studies) and varsus deformity /malrotation (in 3 studies). Results This study included 12 studies recruited 999 patients with sub- trochanteric femoral fracture, fixation was failed in 163 patients. The incidence of sub-trochanteric fixation failure was 17% in all included studies 62% of patients with fixation failure were smokers The incidence of fixation failure after intramedullary fixation was lower than after extra-medullary fixation. The incidence of fixation failure after open surgery increases 2.41 times compared with closed surgery. The incidence of fixation failure was higher in patients with post- operative hip varus compared with patients without post-operative hip varus. Conclusion The incidence of sub-trochanteric fixation failure was 17%. The causes for fixation failure included smoking, poor reduction, nonunion, implant breakage, screw cutout, varus deformity, extra-medullary nailing.

Healing sequelae following tooth extraction and dental implant placement in an aged, ovariectomy model.

At present, a lack of consensus exists regarding the clinical impact of osteoporosis on alveolar bone metabolism during implant osseointegration. While limited preclinical and clinical evidence demonstrates a negative influence of osteoporosis on dental extraction socket healing, no preclinical studies offer data on the results of implant placement in 6-mo-old, ovariectomized (OVX) Sprague-Dawley rats. This study aimed to investigate the outcomes of dental tooth extraction socket healing and implant placement in a rodent model of osteoporosis following daily vehicle (VEH) or abaloparatide (ABL) administration. Micro-CT and histologic analysis demonstrated signs of delayed wound healing, consistent with alveolar osteitis in extraction sockets following 42d of healing in both the VEH and ABL groups. In a semiquantitative histological analysis, the OVX-ABL group demonstrated a tendency for improved socket regeneration with a 3-fold greater rate for moderate socket healing when compared to the OVX-VEH group (43% vs 14%), however, this finding was not statistically significant (p=.11). No significant differences were observed between vehicle and test groups in terms of implant outcomes (BMD and bone volume/total volume) at 14- and 21-d post-implant placement. Abaloparatide (ABL) significantly increased BMD of the femoral shaft and intact maxillary alveolar bone sites in OVX animals, demonstrating the therapeutic potential for oral hard tissue regeneration. The present model involving estrogen-deficiency-induced bone loss demonstrated an impaired healing response to dental extraction and implant installation.

The cross-sectional morphology of the proximal femoral diaphysis is defined by the anteversion angle.

Osteoporosis in postmenopausal women is one of the causes of femoral fractures and is prevented by the administration of bisphosphonates. Individual morphologies are considered to increase the risk of atypical fractures associated with long-term administration. To evaluate cortical bone morphology quantitatively, we established a method to measure the distance from the center point of a cross-section to the external and internal borders based on CT images. Using this method, 44 sides of a female femoral skeleton specimen were examined and areas of protrusion and thickening in the medial anterior and lateral posterior regions just below the lesser trochanter were identified. These positions strongly correlated with the anteversion angle, suggesting the involvement of the distribution of the load received from body weight defined by the angle. The finite element method was used to examine the relationships between the positions of these areas with compressive and tensile stress distribution areas in the one-legged standing condition. The medial anterior region and lateral posterior region protruded and thickened in response to compressive and tensile stress, respectively. In addition, a hierarchical relationship was observed between the anteversion angle, tensile stress distribution, protrusion, and thickening in femurs with thinning of cortical bone, indicating that morphogenesis occurs adaptively to loading. The present results demonstrate the usefulness of this method in considering the formation mechanism and function of the femoral diaphysis and suggest that bone remodeling is necessary to maintain adaptability.

Combining Multiple Spectroscopic Techniques to Reveal the Effects of Staphylococcus aureus Infection on Human Bone Tissues.

Osteomyelitis (OM) and periprosthetic joint infections (PJIs) are major public health concerns in Western countries due to increased life expectancy. Infections usually occur due to bacterial spread through fractures, implants, or blood-borne transmission. The pathogens trigger an inflammatory response that hinders bone tissue regeneration. Treatment requires surgical intervention, which involves the precise removal of infected tissue, wound cleansing, and local and systemic antibiotic administration. Staphylococcus aureus (SA) is one of the most common pathogens causing infection-induced OM and PJIs. It forms antimicrobial-resistant biofilms and is frequently found in healthcare settings. In this proof-of-concept, we present an approach based on multiple spectroscopic techniques aimed at investigating the effects of SA infection on bone tissue, as well as identifying specific markers useful to detect early bacterial colonization on the tissue surface. A cross-section of a human femoral diaphysis, with negative-culture results, was divided into three parts, and the cortical and trabecular regions were separated from each other. Two portions of each bone tissue type were infected with SA for one and seven days, respectively. Multiple techniques were used to investigate the impact of the infection on bone tissue, Brillouin-Raman microspectroscopy and attenuated total reflection Fourier transform infrared spectroscopy were employed to assess and develop a new noninvasive diagnostic method to detect SA by targeting the bone of the host. The results indicate that exposure to SA infection significantly alters the bone structure, especially in the case of the trabecular type, even after just one day. Moreover, Raman spectral markers of the tissue damage were identified, indicating that this technique can detect the effect of the pathogens' presence in bone biopsies and pave the way for potential application during surgery, due to its nondestructive and contactless nature.

Nonunion Fractures: Trends in Epidemiology and Treatment of Femur Fractures, 2017-2022.

The incidence of femur fractures has increased in recent years, along with the rate of surgery and subsequent nonunion following these fractures. Nonunion is a significant concern due to the burden it places on both patients and the healthcare system. This study aims to investigate the demographic factors associated with femoral shaft fracture nonunion by comparing two surgical management approaches: open reduction internal fixation (ORIF) with plating versus closed reduction and fixation using intramedullary nailing (IMN). The TriNetX database was queried using current procedural terminology (CPT) codes for surgical repair of femoral shaft fractures (FSFs), including IMN surgery (CPT: 27506) and femur ORIF (CPT: 27507). The subsequent chronological nonunion cases were identified using the 10th revision of the International Classification of Diseases (ICD-10) codes for femoral nonunion (S72.301K, S72.302K). Results were analyzed both descriptively and comparatively to assess differences among patients. Factors considered included age, sex, ethnicity, race, smoking status, and the type of surgical management (ORIF versus nailing) across the six-year study period. From 2017 to 2022, the prevalence of femoral shaft fracture surgeries increased for both IMN and ORIF. The rate of nonunion was 2.1% following IMN and 1.7% following ORIF. The mean age for nonunion was 54 years (SD: 20) following IMN and 63 years (SD: 18) following ORIF. Patients with a positive smoking history had higher rates of nonunion compared to those without. Our study revealed a relatively consistent rate of FSFs and nonunion over the six-year period. However, with a growing population, the absolute number of cases is steadily increasing, underscoring the burden on the healthcare system. This study contributes to the growing body of literature focused on improving patient outcomes and promoting health equity in fracture management practices.

Differences in Femoral Medullary Canal Dimensions in the USA and East Asian Populations

With emerging technologies and improved operative techniques, cementless total hip arthroplasty is becoming more popular and showing better results. The femoral prosthesis and intramedullary nail should precisely fit in the medullary canal to prevent micromotion and loosening. Most of the femoral prosthesis and nail designs are made from the data obtained from Caucasian femur and may not press fit if used in Asian populations. This study compares the femoral medullary canal diameter in American and Oriental populations at different bony levels. A total of 245 dry femora were collected which included 47 from United States, 77 from China, 44 from Japan, 50 from Korea and 27 from Taiwan, and plan radiographs were taken. Radiographs were digitized to measure the medullary canal width at 20% (lesser trochanter; LT), 35% (supra-isthmus; SI), 50% (mid-isthmus; MI), 65% and 80% of the total femur length. The results revealed significant differences in the medullary canal width between the US and East Asian Oriental populations. The medullary canal in the US population was significantly larger at the LT, SI, MI, and 65% but significantly smaller at 80% of the femoral shaft length compared to the East Asian populations. Among the East Asian populations, significant differences were obse4rved between the Chinese and Taiwanese populations as well as the Japanese and Taiwanese populations. The Taiwanese population had the smallest femoral medullary canal size among the east Asian populations. We conclude that there are significant differences in the femoral medullary width between the American and East Asian populations. These results will be useful for surgeons operating on the proximal or distal femur.

Descriptive analysis of road traffic accidents in children aged 0-2 years

Aims: This study aims to investigate road traffic accidents (RTAs) involving infants and toddlers, defined as children from birth to 2 years old, focusing specifically on their epidemiology and outcomes. Methods: A retrospective, single-center, observational, and cross-sectional study was conducted in the Emergency Department of a university-affiliated training and research hospital. Data were collected from July 1, 2019, to January 1, 2024. Results: During the study period, 659 cases involved pediatric RTAs patients (individuals under 17 years old), with 41 cases specifically concerning infants and toddlers. These patients had a mean age of 12.98 ± 5.64 months, and 27 (65.9%) were boys. The median Pediatric Trauma Score for was 9 (range: 5-12) while the median pGCS score was 15 (range: 14-15). Motor vehicle accidents were the leading cause of injuries, accounting for 92.6% of cases, followed by motorcycle accidents (4.8%) and pedestrian-vehicle collisions (2.6%). Hospitalized patients exhibited various injuries, including femur fractures, subdural hematoma, orbital roof fracture, scalp hematomas, and lung contusion. Surgical intervention was required in only one case for a femur shaft fracture. Fortunately, no in-hospital deaths occurred among the study participants. Conclusion: This study underscores the importance of adult supervision to prevent RTAs and emphasizes the critical need for strict enforcement of child passenger safety laws to reduce the incidence of motor vehicle accidents involving infants and toddlers.

Effect of Fibroblast Growth Factor (FGF) 19 and 21 on Hip Geometry and Strength in Post-menopausal Osteoporosis (PMO)

Fibroblast Growth Factor (FGF) receptor signalling is important for skeletal development. The FGF19 subfamily which includes FGF19 and FGF21 are involved in bone metabolism, although their effects on bone mineral density (BMD) and bone strength remain unclear. To further characterise the influence of these two factors on the skeleton, we studied the association between circulating concentrations of FGF19 and 21 with BMD and parameters of hip geometry and strength in post-menopausal osteoporosis (PMO). The study cohort consisted of 374 women aged (mean [SD]) 68.7[12.3] years with PMO. FGF19 and FGF21 were measured in serum by ELISA. BMD was measured at the lumbar spine (LS), total hip (TH) and femoral neck (FN) (n = 277) by dual energy X-ray absorptiometry (DXA) and hip structural analysis (HSA) parameters (n = 263) at the narrow neck of the femur (NN), Intertrochanter (IT) and Femoral shaft (FS) were derived from DXA scans. FGF19 and 21 were not associated with prevalent fractures or BMD when corrected for covariates; age, BMI, smoking habits and alcohol intake. Log-transformed FGF 21 was negatively associated with HSA parameters including Outer Diameter (OD) (p = 0.019), Cross-sectional area (CSA) (p = 0.01), cross-sectional moment of inertia (CSMI) (p = 0.011), Section modulus (Z) (p = 0.002) and cortical thickness (Co Th) (p = 0.026) at the IT only. CSA, CSMI, Z and Co Th were significantly lower (p < 0.05) in women with FGF21 concentrations greater than the median (> 103.5 pg/ml). Our data suggest that FGF 21 may have potentially adverse effects on the skeleton. Further characterisation is needed, particularly as FGF 21 analogues or agonists may be used to treat obesity-related metabolic disorders.

F-type forceps for assisted reduction in femoral shaft fractures surgery

To explore clinical efficacy of F-type forceps for assisted reduction in femoral shaft fracture reduction. Forty-five patients with femoral shaft fracture treated with intramedullary nail and internal fixation from January 2019 to December 2021 were retrospectively analyzed and divided into two groups according to different reduction methods. In observation group, there were 21 patients, included 15 males and 6 females, aged from 27 to 92 years old with an average of (53.38±18.81) years old;9 patients on the left side, 12 patients on the right side;7 patients were type A, 8 patients were type B and 6 patients were type C according to AO fracture classification;the time from injury to operation ranged from 7 to 13 days with an average of (4.62±3.34) days;reduction was assisted by F-shaped forceps. In control group, there were 24 patients, including 17 males and 7 females, aged from 20 to 92 years old with an average of (51.96±20.43) years old;12 patients on the left side, 12 patients on the right side;11 patients were type A, 8 patients were type B and 5 patients were type C according to AO fracture classification;the time from injury to operation ranged from 2 to 13 days with an average of (6.29±3.04) days;traditional reset mode was adopted. Operative time, intraoperative blood loss, intraoperative fluoroscopy times, intraoperative open reduction ratio, clinical healing time of fracture, postoperative complications, hospital stay, hospital cost and Lysholm score of knee joint at 6 and 12 months after surgery were compared between two groups to evaluate clinical effect. All patients were followed up for 12 to 24 months with an average of (16.60±3.45) months. In observation group, operative time, intraoperative blood loss, intraoperative fluoroscopy times, open reduction cases, and clinical healing time of fractures were (58.19±7.93) min, (88.10±44.45) ml, (25.29±5.54) times, 0 case, (4.76±0.77) months, respectively;while in control group was (79.33±22.94) min, (222.92±144.45) ml, (47.46±26.25) times, 5 cases, (7.13±1.80) months, and the difference between two groups were statistically significant (P<0.05). There were no significant difference in postoperative complications, length of stay and hospitalization cost between two groups (P>0.05). At 6 months after surgery, Lysholm score of knee joint in observation group (88.62±4.48) was better than that in control group (79.21±8.91) (F=21.948, P=0.000). There were no significant difference in support use, pain and squat score between two groups (P>0.05). At 12 months after surgery, Lysholm scores of stair climbing and pain in observation group were (9.62±1.20) and (19.76±1.92), which were better than those in control group (7.83±2.04) and (21.88±2.88) (P<0.05). There were no significant difference in scores and total scores of other items between two groups (P>0.05). Compared with traditional reduction method, F-type forceps instrument could shorten operation time, reduce intraoperative blood loss, reduce intraoperative fluoroscopy times, accelerate clinical healing of fracture, and promote earlier functional recovery of knee joint.

Assessing the Accuracy and Reliability of the Fluoroscopic Ruler for Comminuted Femur Fractures: A Cadaveric Study.

Fixation of comminuted femur fractures may result in limb length discrepancy. Intraoperative fluoroscopic measurement of the contra-lateral femur with a ruler is commonly performed to establish a reference for femoral length. No evidence regarding the reliability and accuracy of this technique exists. This study aimed to assess the accuracy and interrater reliability of a fluoroscopic ruler in obtaining correct femoral length in a comminuted femoral shaft fracture model. Approximately 5 cm of bone was removed from the left femoral diaphyses of 8 cadavers. Seven orthopedic surgery residents and 2 attendings measured the length of the intact contralateral femur using a ruler under fluoroscopy. The ruler was then applied to the "fractured" femur with manual traction applied until femoral length matched the measured length of the contralateral femur. The resulting gap in the "fractured" femur was compared with the length of bone that had been resected. Data were analyzed using means, SDs, and intraclass correlation coefficients (ICCs). Fifty-seven measurements were collected. The mean difference between the measured fracture gap and the length of bone removed was 8.0±5.8 mm (range, 0-22 mm). Femoral length was accurate to 5 mm in 40% of cases, 10 mm in 70%, 15 mm in 81%, 20 mm in 98%, and 25 mm in 100%. The overall interrater reliability was poor (ICC, 0.11; 95% CI, 0.001-0.44). Despite poor interrater reliability, the fluoroscopic ruler resulted in a mean leg length discrepancy of 8.0±5.8 mm in this cadaveric study. [Orthopedics. 202x;4x(x):xx-xx.].

Elastic nail versus plate for treatment of single close fracture of femur shaft

This study aims to describe the outcome of pediatric flexible nails versus plates for the treatment of femur fracture. We reviewed the medical records of 28 femur fractures in children treated with flexible nail insertion and 26 children treated with plate fixation from January 2017 to December 2019. The mean age of the children was 8.88 ± 1.86 years. Data were obtained from patient charts. Union of bones was found in all the operated children, 28 (51.9%) of the group flexible nails, while no union was found in 3 (5.6%) of the group plate with screws. Delay union was found in 5 (9.3%) of the plate with screws, while in the group of flexible nails was in 2 (3.7%). Malrotation was found in 2 (3.7%) of the flexible nails and in 1 (1.9%) in the plate and screw. Bursa was found only in the flexible nails with 7 (13%) (p = 0.007). Re-fracture was found only in the group of plates with screws with 5 (9.3%) (p = 0.021). The limbs were shortened only in 1 (1.9%) patient with flexible nails. Superficial infection was high in the group plate with screws group 4 (7.4%). Deep infection was found to be high among 3 (5.6%) of the group plate &amp; screw. We conclude that flexible intramedullary nail fixation of fracture shaft femur in children is a very acceptable way of treatment and is associated with minimal complications.

Ranking the Orthopedic Procedures With the Highest Morbidity and Mortality.

Musculoskeletal conditions currently affect more than one-third of the US population and orthopedic procedures play a pivotal role in managing them. Like any invasive intervention, these carry a wide spectrum of risk, necessitating a comprehensive understanding of the associated morbidity and mortality. This study sought to provide a global perspective of the risks and complications associated with these procedures to establish an easy to understand risk stratification tool for both patients and providers. Current Procedural Terminology codes associated with orthopedic surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2018 to 2020. Each code was associated with its rate of 30-day mortality as well as any adverse event (AAE) and then ranked for descriptive analysis. In total, there were 698,549 patients who underwent orthopedic procedures associated with 94 CPT codes with at least 1 morbidity event and 144 CPT codes with at least 1 AAE. The CPT code associated with the highest mortality was 27590 or above knee amputation. The CPT code associated with the highest rate of AAE was 27507 or open treatment of femoral shaft fracture with plate and screws. This is the first study to compare the rates of morbidity and mortality in all patients with orthopedic procedures. There was a strong bias toward increased risk associated with lower extremity surgery and surgery most often performed in the geriatric population. [Orthopedics. 202x;4x(x):xx-xx.].

Understanding the variability of the proximal femoral canal: A computational modeling study.

Statistical shape modeling (SSM) offers the potential to describe the morphological differences in similar shapes using a compact number of variables. Its application in orthopedics is rapidly growing. In this study, an SSM of the intramedullary canal of the proximal femur was built, with the aim to better understanding the complexity of its shape which may, in turn, enhance the preoperative planning of total hip arthroplasty (THA). This includes the prediction of the prosthetic femoral version (PFV) which is known to be highly variable amongst patients who have undergone THA. The model was built on three dimensional (3D) models of 64 femoral canals which were generated from pelvic computed tomography images including the proximal femur in the field of view. Principal component analysis (PCA) was performed on the mean shape derived from the model and each segmented canal. Five prominent modes of variations representing approximately 84% of the total 3D variations in the population of shapes were found to capture variability in size, proximal torsion, intramedullary femoral anteversion, varus/valgus orientation, and distal femoral shaft twist/torsion, respectively. It was established that the intramedullary femoral canal is highly variable in its size, shape, and orientation between different subjects. PCA-driven SSM is beneficial for identifying patterns and extracting valuable features of the femoral canal.

The effects of endurance trainability phenotype, sex, and interval running training on bone collagen synthesis in adult rats

Bone is influenced by many factors such as genetics and mechanical loading, but the short-term physiological effects of these factors on bone (re)modelling are not well characterised. This study investigated the effects of endurance trainability phenotype, sex, and interval running training (7-week intervention) on bone collagen formation in rats using a deuterium oxide stable isotope tracer method. Bone samples of the femur diaphysis, proximal tibia, mid-shaft tibia, and distal tibia were collected after necropsy from forty-six 9 ± 3-month male and female rats selectively bred for yielding low (LRT) or high (HRT) responses to endurance training. Bone collagen proteins were isolated and hydrolysed, and fractional synthetic rates (FSRs) were determined by the incorporation of deuterium into protein-bound alanine via GC-pyrolysis-IRMS. There was a significant large main effect of phenotype at the femur site (p < 0.001; η2g = 0.473) with HRT rats showing greater bone collagen FSRs than LRT rats. There was a significant large main effect of phenotype (p = 0.008; η2g = 0.178) and a significant large main effect of sex (p = 0.005; η2g = 0.196) at the proximal site of the tibia with HRT rats showing greater bone collagen FSRs than LRT rats, and male rats showing greater bone collagen FSRs compared to female rats. There was a significant large main effect of training at the mid-shaft site of the tibia (p = 0.012; η2g = 0.159), with rats that underwent interval running training having greater bone collagen FSRs than control rats. Similarly, there was a significant large main effect of training at the distal site of the tibia (p = 0.050; η2g = 0.156), with rats in the interval running training group having greater bone collagen FSRs compared to rats in the control group. Collectively, this evidence highlights that bone responses to physiological effects are site-specific, indicating that interval running training has positive effects on bone collagen synthesis at the tibial mid-shaft and distal sites, whilst genetic factors affect bone collagen synthesis at the femur diaphysis (phenotype) and proximal tibia (phenotype and sex) in rats.

Stimulation of fracture mineralization by salt-inducible kinase inhibitors.

Over 6.8 million fractures occur annually in the US, with 10% experiencing delayed- or non-union. Anabolic therapeutics like PTH analogs stimulate fracture repair, and small molecule salt inducible kinase (SIK) inhibitors mimic PTH action. This study tests whether the SIK inhibitor YKL-05-099 accelerates fracture callus osteogenesis. 126 female mice underwent femoral shaft pinning and midshaft fracture, receiving daily injections of PBS, YKL-05-099, or PTH. Callus tissues were analyzed via RT-qPCR, histology, single-cell RNA-seq, and μCT imaging. Biomechanical testing evaluated tissue rigidity. A hydrogel-based delivery system for PTH and siRNAs targeting SIK2/SIK3 was developed and tested. YKL-05-099 and PTH-treated mice showed higher mineralized callus volume fraction and improved structural rigidity. RNA-seq indicated YKL-05-099 increased osteoblast subsets and reduced chondrocyte precursors. Hydrogel-released siRNAs maintained target knockdown, accelerating callus mineralization. YKL-05-099 enhances fracture repair, supporting selective SIK inhibitors' development for clinical use. Hydrogel-based siRNA delivery offers targeted localized treatment at fracture sites.

Bone Marrow Adiposity Alterations in Postmenopausal Women With Type 2 Diabetes Are Site-Specific.

Bone marrow adiposity (BMAT) alterations in patients with type 2 diabetes mellitus (T2DM) may contribute to adverse bone effects. Characterization of BMAT content and composition in patients with well-controlled T2DM. This cross-sectional study included 2 groups of postmenopausal women: one with T2DM and the other without. The proton density fat fraction (PDFF) of the lumbar spine and proximal femur, comprising the femoral head, neck, and diaphysis, was assessed using chemical shift-based water-fat separation imaging (WFI). Magnetic resonance imaging with spectroscopy (1H-MRS) was performed in a subgroup of participants to confirm the PDFF measurements and determine the apparent lipid unsaturation level (aLUL) at the L3 vertebrae and femoral neck. The association of imaging-based PDFFs and aLUL between diabetes groups was investigated by adjusting for confounding factors using a linear mixed model. Among 199 participants, patients with T2DM (n = 29) were significantly heavier (P < .001) and had a higher bone mineral density (BMD) (P < .001 for all sites) than nondiabetic patients (n = 170). When PDFFs were compared after adjusting for age, body mass index (BMI), and BMD, the femoral head WFI-based PDFF was lower in patients with T2DM (mean [standard error] 88.0% [0.7] vs 90.6% [0.3], P < .001). Moreover, the aLUL at the L3 vertebrae was lower in patients with T2DM (n = 16) than in without (n = 97) (mean [standard error] 3.9% [0.1] vs 4.3% [0.1], P = .02). The content and composition of BMAT are modified in postmenopausal women with T2DM and these changes occur at specific sites.

SUCCESSFUL LEFT PELVIC LIMB AMPUTATION IN A WHITE-HEADED MARMOSET (Callithrix geoffroyi) FOLLOWED BY RELEASE INTO THE WILD

Surgical reports involving wild animals are still scarce in the literature, particularly those documenting successful survival through surgery and postoperative handling stress in captivity. This study aims to present a case of Callithrix geoffroyi following total pelvic limb amputation. A young female white-headed marmoset weighing 395 grams, rescued by highway patrol in Guarapari – ES, with anatomical and functional deformities of the pelvic limb, including a multi-fragmented femoral shaft fracture. Given the severity of the fractures and limitations in applicable osteosynthesis techniques, amputation was necessary, considering spinal canal size, animal behavior, and potential for successful release. The white-headed marmoset resumed activity three hours post-surgery and was transferred to the Wildlife Sector at the Veterinary Hospital, housed in a wireframe cage with balanced nutrition, water, and environmental enrichment. Daily monitoring over 10 days assessed behavior, pain, nutrition, and surgical site healing. Upon complete wound recovery, the marmoset was transferred to wildlife management authorities for planned release. During this process, no aggressive behavior was observed from other white-headed marmosets, prompting the opening of the cage and the white-headed marmoset's voluntary movement towards a fruit tree among conspecifics.

Rotationally stable screw anchor (RoSA) vs. Gamma3 Nail (G3N) in pertrochanteric femoral fractures : Afunctional outcome analysis

The pertrochanteric femoral fracture (PFF) represents one of the most common fracture types throughout Germany. To enable early mobilization of patients, the primary surgical goal is load-stable osteosynthesis. Implant failure still represents the largest group of implant-related complications (>80%). The aim of the study was to document and analyze the influence of the implant on the functional outcome and an evaluation of the rotationally stable screw anchor (RoSA) vs. Gamma3 nail. In aretrospective study 43patients with PFF (AO 31A1-A3) were included in the study. The influence of the implant on the functional outcome was assessed by 2standardized questionnaires (SF-36, NMS (New Mobility Score)) and analyzed in aretrospective evaluation. In the study no significant differences in functional outcome scores ≥ 1year after osteosynthesis of the PFF could be shown depending on the implant used. There is an overall tendency for abetter outcome in the G3N group. In the literature the superiority of intramedullary nailing over extramedullary implants is continually discussed. Implant failure is still the most frequent complication. In intramedullary implants, such as the G3N, the primary cause is failure of the head-neck component. For conventional extramedullary implants the biomechanical properties on the femoral shaft also pose a challenge in the case of unstable PFF. The further development of the RoSA to an intramedullary implant could combine the advantages of intramedullary load carriers with the advantages of the blade-screw combination in the head-neck fragment and lead to a reduction in implant-associated complications.

Microscopic characteristics of peri- and postmortem fracture surfaces

This study investigated if microscopic surface features captured with a scanning electron microscope (SEM) effectively discriminate fracture timing. We hypothesized that microscopic fracture characteristics, including delamination, osteon pullout, and microcracks, may vary as bone elasticity decreases, elucidating perimortem and postmortem events more reliably than macroscopic analyses. Thirty-seven unembalmed, defleshed human femoral shafts from males (n=18) and females (n=2) aged 33–81 years were fractured at experimentally simulated postmortem intervals (PMIs) ranging from 1 to 60 warm weather days (250–40,600 ADH). A gravity convection oven was used to approximate tissue decomposition at 37 C and 27 C, and the resulting heat-time unit (accumulated degree hours, or ADH) was used to examine fractures in elastic/wet versus brittle/dry bone. The bones were fractured with a drop test frame using a three-point bending setup, sensors were used to calculate fracture energy, and high-speed photography documented fracture events. The following data were collected to relate fracture appearance to the biomechanical properties of bone: PMI (postmortem interval) length in ADH, temperature, humidity, collagen percentage, water loss, bone mineral density, cortical bone thickness, fracture energy, age, sex, cause of death, and microscopic fracture feature scores. SEM micrographs were collected from the primary tension zones of each fracture surface, and three microscopic fracture characteristics were scored from a region of interest in the center of the tension zone: percentage of delaminated osteons, percent osteon pullout, and number of microcracks. Multiple linear regression showed that microscopic fracture surface features are strong predictors of ADH (adjusted R-squared=0.67 for the 0 – 40,000 ADH samples; adjusted R-squared=0.92 for the 0–16,000 ADH samples). Osteon pullout is the single best predictor of ADH. Additionally, water loss is the primary driver of bone elasticity changes in low ADH samples, while collagen fibers appear to remain intact until later in the postmortem interval (approximately 40,000 ADH in this study). The results of this study indicate microscopic fracture surface analysis detects the biomechanical effects of decreased elasticity more reliably and with greater sensitivity than macroscopic analysis.