Bone Fracture Research Articles

Computed tomography-guided drainage of a canine intracerebral abscess.

An approximately 7-week-old female American Bulldog was presented for head injury and seizures. The dog was obtunded with absent left-sided postural reactions, absent left palpebral reflex, delayed vestibulo-ocular reflex bilaterally, and calvarial hyperesthesia. CT revealed a fragmented, depressed fracture of the right frontal bone, with an associated abscess and evidence of raised intracranial pressure. The dog initially declined on medical management. Following a CT-guided drainage procedure, the dog improved and remained clinically well twenty months later. This is the first report of minimally-invasive sequential CT allowing successful drainage and culture of a canine intracerebral abscess.

The ultimate microbial composition for correcting Th17/Treg cell imbalance and lipid metabolism disorders in osteoporosis.

Osteoporosis is a systemic bone disease characterised by decreased bone mass and a deteriorated bone microstructure, leading to increased bone fragility and fracture risk. Disorders of the intestinal microbiota may be key inducers of osteoporosis. Furthermore, such disorders may contribute to osteoporosis by influencing immune function and lipid metabolism. Therefore, in this review, we aimed to summarise the molecular mechanisms through which the intestinal microbiota affect the onset and development of osteoporosis by regulating Th17/Treg imbalance and lipid metabolism disorders. We also discussed the regulatory mechanisms underlying the effect of intestinal microbiota-related modulators on Th17/Treg imbalance and lipid metabolism disorders in osteoporosis, to explore new molecular targets for its treatment and provide a theoretical basis for clinical management.

The pentose phosphate pathway controls oxidative protein folding and prevents ferroptosis in chondrocytes

Bone lengthening and fracture repair depend on the anabolic properties of chondrocytes that function in an avascular milieu. The limited supply of oxygen and nutrients calls into question how biosynthesis and redox homeostasis are guaranteed. Here we show that glucose metabolism by the pentose phosphate pathway (PPP) is essential for endochondral ossification. Loss of glucose-6-phosphate dehydrogenase in chondrocytes does not affect cell proliferation because reversal of the non-oxidative PPP produces ribose-5-phosphate. However, the decreased NADPH production reduces glutathione recycling, resulting in decreased protection against the reactive oxygen species (ROS) produced during oxidative protein folding. The disturbed proteostasis activates the unfolded protein response and protein degradation. Moreover, the oxidative stress induces ferroptosis, which, together with altered matrix properties, results in a chondrodysplasia phenotype. Collectively, these data show that in hypoxia, the PPP is crucial to produce reducing power that confines ROS generated by oxidative protein folding and thereby controls proteostasis and prevents ferroptosis.

Heat-inactivated Lactobacillus casei strain GKC1 Mitigates osteoporosis development in vivo via enhanced osteogenesis.

Osteoporosis, a significant bone disease predominantly affecting elderly and postmenopausal women, leads to increased bone fragility and fracture risk, presenting a major public health concern with substantial socioeconomic implications. This study investigated the therapeutic potential of Lactobacillus strains, known for their immunomodulatory properties, in an ovariectomy-induced osteoporosis mouse model. Among three tested strains Lactobacillus casei GKC1, Lactobacillus rhamnosus GKLC1, and Lactobacillus johnsonii GKJ2, GKC1 demonstrated superior efficacy in promoting osteogenesis-related gene expression, including alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP2) and runt-related transcription factor 2 (RUNX2). In ovariectomized mice (n=8/group), both live and heat-inactivated GKC1 (57mg/kg) and fermented GKC1 (1000mg/kg) were administered orally for 28 days, with alendronate (2.5mg/kg) serving as a positive control. The treatment significantly improved bone mineral density and femoral microstructure parameters compared to the ovariectomized control group. For the first time, heat-inactivated GKC1 exhibited superior anti-inflammatory effects through reduction of IL-17A and enhanced bone microstructural integrity, suggesting its potential as a safe and effective therapeutic agent for postmenopausal osteoporosis management. These findings provide compelling evidence for the development of postbiotic-based interventions in osteoporosis treatment, offering a promising alternative to conventional therapeutics.

Adult hypophosphatasia presenting with recurrent acute joint pain.

Hypophosphatasia (HPP) is a genetic disorder due to pathological variants in ALPL, the gene encoding tissue-nonspecific alkaline phosphatase (ALP). HPP is typically associated with bone-related symptoms, such as bone deformity, fractures and bone pain in children, but can appear in adults with symptoms resembling arthritis. A 22-year-old male experienced repeated and severe sudden attacks of joint pain in the elbows and knees. Magnetic resonance imaging and joint ultrasonography showed joint effusions indicating chronic inflammation. Blood biochemical tests revealed a remarkably low serum ALP level, and repeated examination confirmed a sustained low ALP level; urine phosphoethanolamine, plasma inorganic pyrophosphate and plasma pyridoxal-5'-phosphate levels were elevated, raising concern for HPP. While the patient had no history of premature loss of primary teeth, fragility fractures, muscle weakness or abnormalities in growth, genetic testing revealed a likely pathogenic and a pathogenic heterozygous variant in the ALPL gene, i.e., c.979T>C (p.Phe327Leu) and c.1559del (p.Leu520Argfs), confirming HPP. Additional genetic testing of his parents showed a heterozygous c.1559del variant in his father and a heterozygous c.979T>C variant in his mother. A diagnosis of adult HPP due to compound heterozygous mutations was therefore confirmed. Enzyme replacement therapy with asfotase alfa was then introduced; no attacks of arthralgia occurred in the 1-year period since then. This case highlights the possibility of HPP in adults who present clinically with repeated joint symptoms and low serum ALP levels but without bone-related symptoms. A diagnosis of adult HPP without bone-related symptoms can be challenging. A reduction in tissue-nonspecific ALP activity leads to an accumulation of pyrophosphate in the joints, which can cause arthralgia. Some cases of adult HPP have arthralgia as the only presenting symptom. At one-year follow-up, enzyme replacement therapy with asfotase alfa might lead to a reduction in arthralgia attacks due to HPP.

An evaluation of osseous regeneration capability of novel autogenous tooth graft along with orthobiologics for long bone segmental defects.

Extracted tooth, is predominantly considered a medical waste but tooth and bone evince similitude in biochemical composition, so tooth may be considered as bone graft material. We selected twenty-four adult rabbits with age and body weight ranges of 1-3 years and 2-4kg respectively, regardless of sex and breed. These rabbits were allocated into four groups i.e., J, K, L, and M. Autogenous tooth graft was acquired from the individual's incisor. In group J (control), tooth graft alone was used at the mid shaft radius fractured site. For group K, tooth and bone marrow aspirate (BMA) were applied. In group L, tooth-platelet rich plasma (PRP) was administered while for group M, tooth-decellularized fish scale (DFS) was engrafted at the location. The research was conducted for 4 months and parameter evaluation was done on 0, 1st, 7th, 15th, 30th, 45th, 60th, 75th, 90th, 105th and 120th days. The therapeutic regimens were extensively appraised in terms of physiological vitals, hematology, serology, bone biomarkers, mechanical assessment, radiography and histomorphometric parameters. We noticed appropriate osteointegration of autologous tooth with the fractured site, good healing and bone remodeling in all groups with superior to lower trends in Tooth-BMA, Tooth-PRP, Tooth-DFS, and Tooth-solo groups respectively. Though usage of aforementioned regimens in-vivo needs further trials but overall, we may suggest that autogenous tooth is not only a novel and viable graft in solo but its healing capacity, osteointegration and firm callus formation can be augmented with appropriate orthobiologic materials and in future may be useful for bone defect treatments, not only in animals but humans as well.

Cissus quadrangularis: A comprehensive review as an emerging biomaterial for periodontal regeneration

Cissus quadrangularis (CQ) is known for its use as a folk medicine for pharmacological properties such as antimicrobial, antiulcer, anti-inflammatory, antitumor, antihemorrhagic, antiallergic, antidiabetic, and antioxidant properties. It is known for its significant role in fracture healing and bone regeneration. To date, it is safe without any adverse effects when used within normal limits. It contains phytoconstituents such as carbohydrates, phytosterols, flavonoids, triterpenoids, glycosides, tannins, saponins, proteins, Vitamin C, alkaloids, and calcium. The alveolar bone is the tooth-supporting apparatus comprising the alveolar bone proper, cortical bone, crestal alveolar bone, and trabecular bone. Periodontal disease is a polymicrobial host immune-mediated inflammatory disease that destroys supporting structures of the teeth. Periodontal regeneration regenerates the lost periodontal structures. It can be using bone grafts. Periodontal tissue engineering is surging in regenerative medicine. It is a triad that includes cells, scaffolds, and growth factors that help to form newly aligned functional periodontal structures. Plant medicine is an alternative medicine that overcomes the side effects of modern medicine. Plant extracts can be used as bioactive scaffolds for regeneration. CQ can differentiate human-derived mesenchymal stem cells into osteoblast and regenerate bone. This review elaborates on the use of CQ as a bioactive compound for periodontal regeneration.

Поражение костей у взрослых пациентов с болезнью Гоше I типа: распространенность, клинические особенности, костно-суставные осложнения и проблемы инвалидизации

BACKGROUND. Although highly effective enzyme replacement therapy (ERT) for Gaucher disease (GD) is accessible and affordable, orthopedic issues in patients appear often to be the main factor leading to their disability. Bone lesions are essentially observed in 100 % of GD patients. The nature and severity of bone and joint changes, however, are reported to be extremely heterogeneous, whereas their incidence and clinical features have until now remained underresearched. AIM. To assess the incidence and clinical value of bone and joint lesions which complicate the course of GD type 1 with bone involvement. MATERIALS & METHODS. This trial enrolled 267 GD type 1 patients aged 17–85 years (median 38 years), who were followed-up at the National Research Center for Hematology from 2004 to 2024. There were 109 men and 158 women. The analysis focused on the following MRI findings: bone marrow infiltration (BMI), Barnett-Nordin cortical index (BNI), bone deformity, osteolytic and osteonecrotic lesions, as well as orthopedic pathologies progressing to disability. RESULTS. BMI was identified in 213/267 (79.8 %) patients. Erlenmeyer flask-like femoral expansion was observed in 95 % patients (n = 254). The mean BNI was 42.9 % (the normal BNI in adult population exceeds 45 %). Low BNI values were associated with osteolytic lesions, disability, and BMI. No significant association of decreased BNI was seen with osteonecroses. The incidence of osteolytic lesions was 11.2 % (n = 30). New osteolytic lesions were reported neither in ERT nor in substrate reduction therapy recipients. Medullary osteonecrosis was detected in 206/267 (77.15 %) patients, and epiphyseal osteonecrosis was identified in 74/267 (27.72 %) patients. Along with osteonecroses, in contrast to osteolytic manifestations, new lesions (n = 8) were reported to occur under long-term (> 5 years) ERT. The rate of bone fractures was 6.7 % (n = 18). In 18 patients, 64 fractures were observed at various locations. Disability associated with bone and joint complications of GD occurred in 58/267 (21.72 %) patients. After reconstructive surgery, including total articular replacement arthroplasties, 37 patients achieved complete functional recovery. CONCLUSION. Bone changes are essentially observed in all adult patients with GD type 1. However, clinical severity and disability of patients depend on secondary bone and joint complications, among them arthroses resulting from epiphyseal osteonecrosis, pathologic fractures, bone and joint infections. These complications developing on effective ERT were identified in 67/267 patients, which accounted for 25 %.

Synthetic nanointerfacial bioengineering of Ti implants: on-demand regulation of implant-bone interactions for enhancing osseointegration.

Titanium and its alloys are the most commonly used biometals for developing orthopedic implants to treat various forms of bone fractures and defects, but their clinical performance is still challenged by the unfavorable mechanical and biological interactions at the implant-tissue interface, which substantially impede bone healing at the defects and reduce the quality of regenerated bones. Moreover, the impaired osteogenesis capacity of patients under certain pathological conditions such as diabetes and osteoporosis may further impair the osseointegration of Ti-based implants and increase the risk of treatment failure. To address these issues, various modification strategies have been developed to regulate the implant-bone interactions for improving bone growth and remodeling in situ. In this review, we provide a comprehensive analysis on the state-of-the-art synthetic nanointerfacial bioengineering strategies for designing Ti-based biofunctional orthopedic implants, with special emphasis on the contributions to (1) promotion of new bone formation and binding at the implant-bone interface, (2) bacterial elimination for preventing peri-implant infection and (3) overcoming osseointegration resistance induced by degenerative bone diseases. Furthermore, a perspective is included to discuss the challenges and potential opportunities for the interfacial engineering of Ti implants in a translational perspective. Overall, it is envisioned that the insights in this review may guide future research in the area of biometallic orthopedic implants for improving bone repair with enhanced efficacy and safety.

Associations Between Bone Mineral Density and WOMAC Scores in Healthy Individuals: Insights from the Qatar Biobank

BackgroundBone mineral density (BMD) is an indicator of bone health that predicts future bone fractures. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is used to assess the severity of symptoms related to pain, stiffness, and function in diseased hip and knee joints. Here we assessed whether BMD measured at specific sites predicts WOMAC scores in healthy individuals whilst controlling for sociodemographic variables. MethodologyBMD, sociodemographic, and WOMAC data were collected from 1764 healthy adult individuals attending the Qatar Biobank (QBB). Multiple linear regression was used to examine associations between sociodemographic factors, total body BMD and BMD related to specific skeletal sites (including femoral (femoral neck and trochanter), trunk, pelvis and total spine), and the three WOMAC subscales (pain, stiffness, and physical function). ResultsAfter controlling for sociodemographic variables, total body and specific BMD measures did not predict pain. However, BMD measures significantly contributed to predicting stiffness after controlling for sociodemographic variables (R2 = 0.065, ΔF(7, 1724) = 3.34, p = 0.002), with a higher total body BMD associated with increased stiffness and a higher trunk BMD associated with decreased stiffness. Total body BMD measures also significantly contributed to predicting compromised physical function (R2 = 0.091, ΔF(7, 1724) = 3.762, p < 0.001) after controlling for sociodemographic variables, with a higher total body BMD associated with an increase in compromised physical function. ConclusionTotal body BMD seems to be a more important predictor of stiffness and physical function than specific skeletal sites BMD measures. Monitoring BMD may have important implications for osteoarthritis patients.

Evaluation of bone healing in trabeculae structure of mandibular corpus and angulus fracture patients with fractal dimension analysis.

Fractures of the mandibular corpus and angulus are affected by different forces result from different strength of the muscles that influenced them. Therefore, it is presumed that there is a different in healing rate. Fractal dimension radiologic analysis assesses the trabecular pattern, due to it can be used to observe the healing process of bone fractures. The study aimed to compare the healing process of mandibular corpus and angulus fractures with fractal dimension analysis (FD) of trabecular patterns on panoramic radiographs through ImageJ software as consideration to determine mastication loading time. This retrospective cross-sectional study observed medical records and panoramic radiographs of patients with a diagnosis of corpus and or mandibular angulus fractures undergoing open reduction (ORIF) 1 plate treatment combined with maxillomandibular fixation (MMF) at Hospital in 2017-2023. Observations were carried out on postoperative 1st day, 2nd week, 8-13th week and >13th week respectively. Twenty-five subjects who met the inclusion requirements were involved in the study. The results of Two-Way ANOVA statistical test and Fisher's LSD post-hoc showed that the FD values of corpus fracture were significantly greater than that of mandibular angulus with p 0.000 (H1), 0.003 (H2), 0.03 (H3), 0.000 (H4) respectively. In both groups of mandibular corpus and angulus fractures, there was a significant effect of time with p=0.00 in each group. The longer the observation time, the more trabeculae patterns were formed in the healing process of corpus and angulus fractures. Post ORIF observation of corpus fracture shows a greater trabecula formation value which indicates faster healing when compared to mandibular angulus fracture.

Impact of Weather and Holidays on Orthopedic Emergency Room Crowding, Fractures, and Polytraumas in a Third-Level Referral Trauma Center in Europe.

Background: Orthopedic trauma is a significant component of emergency department workloads worldwide. The relationship between weather conditions and injury rates is controversial in modern literature. Even less has been written to investigate bank holidays' influence on contusions, dislocations, fractures, and even polytrauma. Our study aimed to assess whether meteorological factors and national holidays could vary the workloads in the orthopedic ER of a European third-level trauma center. Materials and Methods: Our study consisted of a review of all the patients who underwent orthopedic evaluations in our institution's orthopedic emergency room between 2019 and 2023. Days were divided depending on weather (cloudy or sunny vs. rainy or stormy), day type (regular working days vs. national public holidays vs. Saturdays and Sundays), and presence or absence of COVID-19 restrictions. We also recorded the temperatures of each day. Cases were subdivided into three groups: cases without significant injuries (Group A), cases with isolated bone fractures, major tears or articular dislocations (Group B1), and polytrauma (Group B2). Results: Higher temperatures were associated with a significant increase in overall ER visits, isolated injuries, and polytrauma. Sunny or cloudy days had a significantly higher number of patients with all injury types compared to rainy or stormy days. Weekends saw a significant decrease in overall admissions and isolated injuries but a higher rate of polytrauma compared to weekdays. National holidays had a significantly lower number of admissions for all injury types compared to weekdays. Restrictions due to the pandemic significantly reduced overall ER visits. Conclusion: Temperatures, meteorological factors, and national holidays could vary the workloads in the orthopedic ER of a European third-level trauma center.

VGG-16, VGG-16 With Random Forest, Resnet50 with SVM, EfficientNetB0 with XGBoost-Enhancing Bone Fracture Classification in X-Ray Using Deep Learning Models

VGG-16, VGG-16 With Random Forest, Resnet50 with SVM, EfficientNetB0 with XGBoost-Enhancing Bone Fracture Classification in X-Ray Using Deep Learning Models

β-Caryophyllene and Statins in Bone Fracture Healing - A Narrative Review.

Bone fractures are a leading cause of morbidity and healthcare expenditure globally. The complex healing process involves inflammation, cartilage formation, mineralization, and bone remodeling. Current treatments like immobilization, surgery, and bone grafting, though effective, pose significant challenges, such as prolonged recovery and high costs. Emerging therapies such as biological agents, pharmacological treatments, and physical stimulation techniques are also associated with high costs, side effects, and practical applicability limitations. There is a critical need for alternative therapies that are cost-effective, safe, and easy to use. Recent studies suggest the potential of β-caryophyllene (BCP) and statins in promoting bone healing. BCP, a naturally occurring anti-inflammatory and antioxidant compound found in essential oils, enhances osteoblast activity and inhibits osteoclastogenesis. Statins, known for their cholesterol-lowering effects, also promote bone formation and reduce bone resorption through multiple biochemical pathways. Both BCP and statins have shown promising results in preclinical studies, enhancing bone density and promoting fracture healing. This review explores the individual and potential synergistic effects of BCP and statins on bone fracture healing. It highlights the complementary mechanisms of these agents: BCP's anti-inflammatory and osteogenic properties and statins' ability to inhibit osteoclast activity and promote angiogenesis. Combining BCP and statins could offer a multifaceted approach to enhance fracture healing, reduce complications, and improve patient outcomes. While individual effects are supported preclinically, further studies investigating synergies, formulations, and clinical translation are needed to develop this promising novel therapeutic approach for improving fracture repair outcomes.

A Retrospective Study on Correlation of Facial Fractures and Type of Trauma in Patients Admitted in Department of Maxillofacial Surgery of Stomatology National and Specialized Hospital, Kabul, Afghanistan.

Facial bone fractures represent a significant clinical challenge due to their prevalence and the complexity of treatment required. Understanding the demographic patterns, causes, and treatment outcomes of these injuries is crucial for improving patient care and developing targeted prevention strategies. This study aims to analyze the demographic characteristics, etiological factors, anatomical distribution, and treatment modalities of patients presenting with facial bone fractures at Stomatology National and Specialized Hospital in Kabul, Afghanistan, during 2022. A retrospective analysis was conducted on 463 patients with facial bone fractures treated at the hospital. Data collected included patient demographics, causes of trauma, fracture location, and treatment methods. Statistical analysis was performed to identify patterns and correlations. The study included 463 patients (378 males and 85 females), aged between 3 and 88 years, with a mean age of 26.34 years. The primary causes of trauma were road traffic accidents (RTAs) (29.6%), interpersonal violence (26.1%), and falls (23.3%). The mandible was the most commonly fractured bone (74.1%), with the parasymphysis being the predominant site of injury. Treatment predominantly involved closed reduction (54.9%), with a significant portion of patients undergoing open reduction and internal fixation (ORIF) (45.1%). The findings highlight RTAs, interpersonal violence, and falls as the leading causes of facial bone fractures. The mandible is the most frequently affected bone. Closed reduction remains the most common treatment modality. These insights underline the need for enhanced preventive measures, including stricter enforcement of traffic regulations and targeted interventions to address interpersonal violence and fall prevention.

Traumatic internal carotid artery aneurysm distant from facial bone fractures treated with a flow diverter stent: A case report.

Traumatic intracranial aneurysms (TICAs) can be fatal if ruptured. We report a case of a TICA, distant from facial bone fractures, successfully treated with flow diverter (FD) before rupture. A 20-year-old woman was admitted following a car accident. Initial contrast-enhanced computed tomography revealed traumatic subarachnoid hemorrhage, a 5-mm internal carotid artery aneurysm, LeFort type I + II, and mandibular fracture. On Day 8, she developed oculomotor palsy, and digital subtraction angiography revealed the aneurysm had increased to 12 mm. She started dual antiplatelet therapy (DAPT) following facial fracture repair. On Day 17, FD was placed, resulting in contrast agent stagnation within the aneurysm. Three months postinjury, her neurological symptoms improved. Screening for cerebrovascular injury is crucial several days following severe head trauma, even without skull base fractures. Unruptured TICA can be safely treated with FD following DAPT administration.

Characterization of LIPUS Parameters Suitable for Hip Bone Fracture.

To investigate the effects of ultrasound treatment on the healing of hip bone fractures using frequencies of 0.5 MHz and 1.5 MHz with constant intensity (30 mW/cm2) at the fractured site. For the ex vivo experiments, acoustic attenuations of 0.5 MHz and 1.5 MHz ultrasound were measured and compared using different thicknesses of human cadaver and porcine tissues in a hydrophone system. For the in vivo experiments, 20 hip-fractured rabbits were divided into four groups, namely: control, 1.5 MHz with unchangeable intensity (positive control), 0.5 MHz with changeable intensity, and 1.5 MHz with changeable intensity. For the 0.5 and 1.5 MHz groups with changeable intensity, a constant intensity of 30 mW/cm2 at the fracture site was achieved using a compensation method for power transmission with reference to the acoustic attenuation. The effective intensity measured using a hydrophone was substantially reduced to 6.16 mW/cm2 from 30 mW/cm2 in the positive control device after propagating soft tissues with a thickness of 5.0 cm, with an attenuation of approximately 6.0 dB. Meanwhile, for the 0.5 and 1.5 MHz groups, the ultrasound intensity was consistently controlled at 30 mW/cm2 after passing through tissues with different thicknesses using the compensation method. In the in vivo study using a newly established hip fracture rabbit model, the best results in bone histomorphometry, mechanical properties, and histological evaluation were consistently found in the 0.5 MHz group, while the 1.5 MHz group exhibited relatively better bone healing than the positive control group. The results suggest a LIPUS frequency of 0.5 MHz together with the consistent intensity of 30 mW/cm2 at the fracture site for more effective treatment of hip bone fractures.

A finite element analysis to assess tibial bone fracture in malleolar regions following total ankle replacement: Influences of implant designs and implant-bone interfacial conditions.

Tibial bone fractures in the malleolar regions are a major concern during the early postoperative period of total ankle replacement (TAR), affecting patient outcomes such as stability and recovery. Design, placement, and anatomic misalignment of implant components can contribute to malleolar fractures. The aim of this study is to understand the influence of implant design features, including keel, peg, stem, and bar type design, and bone-implant interfacial conditions on malleolar fracture following TAR. Three-dimensional finite element (FE) models were generated for the intact and implanted tibia bone using computer tomography (CT) scan data. In the present study, both bonded (fully osseointegration) and debonded (non-osseointegration) implant-bone interface conditions were considered. The proximal part of the tibia was fixed. Finite element models of the intact and implanted tibia were solved for three distinct loading situations that correspond to three ankle positions throughout the gait cycle (GC). The influences of implant design and implant-bone interface conditions on malleolar fracture were examined by evaluating stress distribution in tibia bone post-implantation. Finite element (FE) analysis revealed that for the medial region, the tibia bone stress elevated to 10 MPa for the medial keel type design, indicating a possible fracture along the medial region. The risk of a medial malleolar fracture is highest for the medial keel type implant design compared to other designs. The bars, central keel, and stem type TAR implant designs also elevate stress on both the medial and lateral regions of the tibia bone. In the case of fully osseointegrated implant-bone interface conditions, the stress is slightly higher than in the case of non-osseointegrated implant-bone interfacial conditions. The study highlights the potential influence of specific implant designs on malleolar fracture. The current findings are crucial for designing new implants to mitigate tibial bone fracture risks and improve TAR outcomes.

Topology optimization and biomechanical evaluation of bone plates for tibial bone fractures considering bone healing

ABSTRACT Implant designs highly influence their biomechanical performances when fixed with load-bearing long bone fractures. In this research work, the topology optimisation technique was used to obtain different shapes and designs of the bone plates according to three different loadings, e.g. lateral bending (LB), axial compression (AC), and physiological loads (PL), and solid volume fractions Vf of 30% and 70%. Bi-phasic mechano-regulation algorithm was used to investigate the callus healing for a given bone plate design, and stresses in screws and bone plates were monitored. To further validate the bone plate designs, fatigue analyses using Fe-safe and three-point bending tests were performed using additively manufactured plates. Topology-optimised bone plate PL with Vf 70% showed the maximum bending stiffness (peak load of 138 N and bending stiffness of 29 N/mm) among the optimised bone plates, with the best callus healing normalised stiffness of 0.6 and 0.7 in iterations 21 and 42, respectively. Thus, the bone plates produced using actual loading conditions (PL) outperformed other loading conditions during the biomechanical evaluation of fractured bones.

Vitamin D Levels During Fracture Healing in Children

To evaluate vitamin D levels in children treated with fractures during the healing period. A four-year prospective study, including healthy children treated with diaphyseal fracture of femur or forearm bones. Vitamin D levels were examined four times: at the time of the injury and then one, three, and five months after the injury, together with P1NP, ALP, GGT, and parathormone. In the beginning, patients were blindly divided into two groups, one supplemented with vitamin D3 for the entire follow-up period, the other non-supplemented. Altogether, 107 children underwent examination at the time of their injuries. Of these, 63 were included in the study and examined for the entire follow-up period – 36 supplemented, 27 non-supplemented. At the time of injury, 42 % had a deficit of vitamin D, 36.5 % had insufficiency, only 21.5 % had normal levels. In the children supplemented with cholecalciferol, vitamin D levels increased statistically significantly during the follow-up period (already after 1 month), in contrast with non-supplemented patients, where they did not. When we divided patients according to the initial vitamin D levels (deficit/insufficiency/normal levels) or fracture type (femur/forearm), we also observed significantly better results in supplemented groups. We observed a high prevalence of vitamin D deficit or insufficiency in healthy children at the time of their injuries. Patients supplemented with vitamin D3 had normal levels already after one month and this persisted throughout the follow-up period, in contrast with non-supplemented patients. Therefore, we recommend vitamin D testing and administration for children treated for fractures.